Health Redress
Baroness Blackwood of North Oxford Excerpts(7 years, 2 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
On 13 July 2016 the Government announced their response to the January 2016 consultation on reform of the current ex-gratia payment schemes for individuals infected with HIV and/or hepatitis C following treatment with NHS-supplied blood or blood products before September 1991.
The Government recognise the suffering experienced by people as a result of this tragedy and the Prime Minister apologised on behalf of the Government in March 2015. Since 1988, successive Governments have set up five schemes to provide financial and other support to those affected. The Government committed further funding of up to an additional £125 million over the existing baseline budget. This additional money more than doubles the Department of Health’s annual spend on the scheme over the spending review period to April 2021. This is significantly more than any previous Government have provided for those affected by this tragedy.
On account of this increased allocation, July’s consultation response set out a package of support measures for those infected and affected by the infected blood tragedy. For the first time, almost 2,500 beneficiaries with chronic hepatitis C infection were eligible to receive an annual payment of £3,500 per year. Those with advanced hepatitis C and HIV received an uplift in their annual payment to £15,500, and we introduced a new £10,000 payment to bereaved partners and spouses.
Since July, the Government have also worked on the detail of the measures proposed for 2017-18 for scheme beneficiaries infected in England such as the new special appeals mechanism for those with chronic hepatitis C infection and reformed discretionary support scheme. The special appeals mechanism, which is now called special category mechanism (SCM) will be a significant new element of the infected blood reforms. Therefore, today the Government announce the launch of a new consultation on the details of the new SCM and our proposals for ensuring the scheme remains within its budget as a result of the new SCM. We invite beneficiaries and other interested parties to comment on our proposals.
The consultation published today and attached will run until 17 April 2017. This is a six-week consultation to ensure that all those who wish to respond have time to do so. There are four elements of reform on which the Government would welcome views.
The addition of a new condition to qualify for the higher financial support given to those infected with hepatitis C who have developed advanced liver disease.
The new special category mechanism (with appeal) (SCM) to identify hepatitis C stage one beneficiaries whose infection has a substantial and long term adverse impact on their ability to carry out normal daily activities, offering those who are successful the higher annual payment.
Proposals to keep the scheme within budget in light of the increased annual payment for successful SCM applicants while preserving discretionary fund.
The type of support the reformed discretionary scheme would offer that is fair to all groups of beneficiaries.
The Government understand that there has been uncertainty about how the SCM and reformed discretionary support will be implemented during 2017. The outcome of the consultation will be crucial to informing our final decisions about these elements. Informed by the consultation responses, the Government will implement the decisions as soon as possible in 2017-18. The Government do not anticipate that there will be any reduction in current spending as a result of the consultation proposals. No one who currently receives an annual payment will be worse off than they are now as a result of the proposed changes to the annual payments.
This consultation does not affect any of the reform elements introduced in the financial year of 2016-17.
Finally, the Government have heard beneficiaries’ feedback regarding our plans for a new scheme administrator. As a result, we announce today that the NHS Business Services Authority will become the new single scheme administrator during 2017. While this transition takes place, annual and discretionary payments and services will continue to be made by the current schemes to ensure a smooth transition to the new scheme administrator with minimum impact on the important financial and non-financial ex-gratia services infected blood beneficiaries will receive this Parliament.
Consultation Document can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-03-06/HCWS520/.
Regulation of Herbal Medicines and Practitioners
Baroness Blackwood of North Oxford Excerpts(7 years, 2 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The issues around the regulation of herbal medicines and practitioners are longstanding and complex. To understand and fully consider all the relevant issues, the coalition Government commissioned an independent working group, led by Professor David Walker, to provide advice on options for the assurance of herbal medicines and practitioners. This report was published in March 2015.
I thank Professor Walker for his report, as well as my hon. Friend the Member for Bosworth (David Tredinnick) and other members of the herbal medicines and practitioners working group whose work informed the report. I would also like to thank those individuals and organisations who contributed to the report by providing information and advice to Professor Walker.
This statement sets out the appropriate level of assurance for herbal medicines supplied by herbal practitioners based on available information and advice, including that provided by Professor Walker’s report. Any system of assurance needs to be proportionate and appropriate to the risks presented to public safety, and enforceable and effective.
Professor Walker recommended: more research into the level of assurance required to ensure public protection (recommendation 6); and that the sector considers seeking accreditation of its voluntary registers by the Professional Standards Authority (recommendation 5).
The Government support these recommendations and encourage the sector to take them forward. Delivery of recommendations 5 and 6 by the sector supports the development of standards for education, training and conduct, and would allow for collaboration on the collection of safety data and the establishment of an academic infrastructure to develop training and research into herbal medicines.
The report, whilst recognising the value of the current system for regulating the supply of herbal medicines, explored the scope for further changes to enhance public protection and access, and made recommendations for more work to: identify known potent or toxic herbs (recommendation 1); and consider if learning can be applied from a review of food lists (recommendation 2).
In response to recommendation 1, the Government are proposing a review to identify potentially potent or toxic herbal ingredients. This is with a view to restricting the use of potent or toxic ingredients through existing mechanisms such as the Human Medicines Regulations 2012. This would link to a scheduled review of toxic ingredients in Schedule 20 of the Medicines Regulations 2012 enabling a targeted approach to be taken with a clear focus on protecting the public. Scoping work will commence in 2017 with a view to commencing any detailed scientific assessment work as soon as practicable thereafter.
While they accept the intention of recommendation 2, the Government believe that existing food lists have little relevance when considering substances used by herbal practitioners, which can be significantly more potent. Case law requires that the classification of a medicinal product must proceed on a case-by-case basis, a point which is made in the body of Professor Walker’s report. The suggestion that food lists (which relate to the safety and availability of products under food law) could be used to classify medicinal products conflicts with this.
Rather than reviewing food lists, which are not applicable to herbal remedies, the Government believe that more benefit will be gained by working with the sector to increase understanding of existing regulatory controls. To deliver this, the Medicines and Healthcare Products Regulatory Agency and the Department of Health will produce a joint communications and engagement plan setting out proposed work with the sector in 2017.
The report also recognises the impact of the EU’s herbal directive on access to some herbal medicinal products by recommending consideration of: a system to allow small scale assembly of products off-site on a named patient basis (recommendation 3); and inviting a review by the European Commission on the operation of the herbal directive (recommendation 4).
In due course, the United Kingdom will be leaving the European Union. The outcome of the exit negotiations will determine what arrangements apply in relation to EU legislation in future once the UK has left the EU.
The Government do not accept recommendation 3. The UK already operates a permissive regime for herbal practitioners which allows them to make up preparations on their own premises for named patients following one to one consultations. Those that are permitted to dispense (pharmacists, other registered medical professionals), and the premises they use, are heavily regulated for safety reasons.
The Human Medicines Regulations 2012 permit herbal medicinal products to be manufactured or assembled by people other than registered nurses, midwives, doctors and dentists provided that preparations are made up on premises they occupy and from which the public can be excluded, that preparations are made up on a named patient basis, and that these preparations do not contain specifically prohibited substances as listed in domestic legislation.
Practitioners therefore may make up preparations on their own premises for individual patients but they may not import or sell any mass-produced products which do not hold a traditional herbal registration or marketing authorisation. Allowing people with no qualifications to put together medicines and carry this out on unregulated premises conflicts with everything else the MHRA does and could cause confusion to the public.
The Government note recommendation 4. The Government are open to further consideration of the case for statutory regulation once there is further evidence to understand the risk and confirm what level of assurance is appropriate and proportionate. This evidence would be obtained from experience of voluntary registration accredited by the Professional Standards Authority and further research undertaken by the sector.
One reason for wishing to consider the evidence is because the range of products has changed following amended regulations in 2011. This has revised the risks presented. Another change is that the development and delivery of the process for independent accreditation of voluntary registers provides an alternative option for the assurance of herbal practitioners.
Consideration of the evidence will support the public, employers and commissioners to make an informed choice about an individual practitioner as they will have demonstrated their commitment to upholding standards relevant to their practice.
[HCWS505]
Oral Answers to Questions
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Craig Williams (Cardiff North) (Con)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The Government recognise the value of surrogacy in helping people who cannot have children to create a family. Surrogacy legislation is now more than 30 years old. In view of changes across society, it is time for an independent review of the legislation, so we have asked the Law Commission to include a project about surrogacy in its proposed work programme for 2017 to 2019.
Craig Williams
The Minister will be aware of the work of my constituent Nicola and Surrogacy UK, to which I pay tribute. I very much welcome the Minister’s answer, but will she say something specifically about the remedial order to address the situation for single parents, for which my constituent Nicola is waiting?
Nicola Blackwood
My hon. Friend has raised this difficult case with me before, and my sympathies go to his constituent. He is right that the High Court has judged that the current provisions for parental orders are discriminatory. The Government are obliged to act within a reasonable timescale, so we will be introducing a remedial order this spring. I am pressing for that to happen by May, but I am in the hands of the business managers. I shall keep the House and my hon. Friend updated.
Karin Smyth (Bristol South) (Lab)
Andrew Rosindell (Romford) (Con)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The challenges facing our health system are significant, so we do need to improve the uptake of those innovative technologies that can improve efficiency and patient outcomes to help to meet that challenge, while also providing a pool for investment for innovators. By capitalising on advances in genomics, data, digital health and informatics, the accelerated access review will improve access to cost-effective new products.
Andrew Rosindell
I know that the Minister will agree with me when I say that it is vital that we endeavour to ensure that the NHS gets better value for money for the drugs bill so that we can afford to get more of the latest innovative products to patients more quickly, but does she also agree that much more work needs to be done alongside the accelerated access review and the forthcoming life sciences strategy to achieve that objective?
Nicola Blackwood
I completely agree with my hon. Friend. Medicines are the second highest area of spending in the NHS after staff, and it is vital that the NHS gets best value from that investment. That is why I am pleased that the House supported our recent Bill on the cost of medicines and medicine supplies, which will enable us to tackle unjustified price rises for unbranded generic medicines. We are also working closely with NHS England to promote the use of the new wave of biosimilar medicines and to ensure cost-effective prescribing behaviour.
Nic Dakin (Scunthorpe) (Lab)
When will the Government publish their response to the accelerated access review, and will that include a consideration of how to improve patient access to molecular diagnostics?
Andrea Jenkyns (Morley and Outwood) (Con)
Nicola Blackwood
The National Institute for Health and Care Excellence and NHS England are working together to better manage access to new drugs and medical technologies for rare diseases. We are also working on the UK strategy for rare diseases and its implementation. It has 51 commitments to be implemented by 2020 to improve the lives of constituents such as my hon. Friend’s.
Greg Mulholland (Leeds North West) (LD)
A simple but life-saving use of medical apparatus is tube feeding. Will the Minister join me in welcoming the fact that this is Feeding Tube Awareness Week, which is raising awareness of this important issue and giving support to all the thousands of families in which children or other family members are tube fed?
Nicola Blackwood
I thank the hon. Gentleman for drawing our attention to this issue. Sometimes the simplest solutions are the most effective. We want to make sure that such innovations are driven across the NHS more effectively, which is exactly what our academic health service networks are there for.
Pauline Latham (Mid Derbyshire) (Con)
Nicola Blackwood
AMR is a global issue. We are world leaders in this, and we are working proactively with international partners to identify new and innovative approaches to the treatment of a range of challenging resistant infections, including malaria.
Siobhain McDonagh (Mitcham and Morden) (Lab)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
We are absolutely determined that we will improve access to cost-effective, innovative medicines, including breast cancer drugs. That is exactly why we introduced the cancer drugs fund.
Siobhain McDonagh
The Minister will know that “cost-effective” is not an easy thing to define. Many women will not get access to the breast cancer drugs they need unless there is a review of how NICE assesses cost-effectiveness. Will she support an independent review of those processes, and will she say something about off-patent cancer drugs?
Nicola Blackwood
The hon. Lady and I have debated this in the House before. It is worth looking at our record. The cancer drugs fund has helped 95,000 people to access cancer drugs, to the tune of £1.2 billion, and NICE has approved three breast cancer drugs, while there are others that it has not yet approved. It is important that politicians do not intervene in this debate, as these are very difficult decisions that will always be challenging in the situation where the NHS has a finite budget.
Mr Speaker
If the hon. Member for Brecon and Radnorshire (Chris Davies) were standing because he has a cancer-related question, I would call him, but if he is not, I will not. He is, so I will.
Chris Davies (Brecon and Radnorshire) (Con)
Nicola Blackwood
We have continual discussions with the Welsh Government to make sure that these issues are kept under review. I shall definitely write to my hon. Friend about this. I shall also be happy to meet him if he would like to discuss it in further detail.
Jo Churchill (Bury St Edmunds) (Con)
Does the Minister agree that not one subject that we have discussed today would not be improved by the better transfer of patient data? How is the Department working towards linking social care with the acute sector, with GPs, with mental health services, with innovation and with cancer drugs in order to understand where we can best target patient outcomes and spend our resources?
Nicola Blackwood
My hon. Friend has a leading role with her private Member’s Bill so she is well aware that we are working very hard to improve the connection of patient data, particularly through the role of the national data guardian and her 10 safeguarding rules, which will make sure that we not only protect patient data more effectively but are able to share it in an effective way that improves patient care.
Mr Speaker
Time is against us, but I would like to make a little further progress with Back Benchers’ questions. I call Michelle Donelan.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I pay tribute to the work of the charity the hon. Gentleman mentioned, which does very important work, and have sympathy for the case he mentioned. The UK’s rare diseases strategy has 51 recommendations, which are driving changes through the NHS and improving the life chances of patients with rare diseases. Our genomics work is also bringing life-changing improvements to patients with rare diseases by diagnosing them faster and improving their chances of receiving treatment quicker.
Mark Menzies (Fylde) (Con)
Dr Tania Mathias (Twickenham) (Con)
My constituent, Nicola Johnson, has had primary breast cancer. The secondary was discovered at 10 months. Will the Minister meet me and Nicola, because she falls within the six-month to 12-month period? She is eligible for neither pertuzumab nor trastuzumab emtansine.
Nicola Blackwood
I shall be very happy to meet my hon. Friend about that very difficult case.
Ms Margaret Ritchie (South Down) (SDLP)
What further efforts have been made to increase the level of nurses’ pay, many of whom have high levels of training, expertise and qualifications?
Alcohol Harm
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Bill Esterson
I am pleased that the hon. Lady reminded me of that piece of evidence. Perhaps we should tour the country as a double act, because this is turning into one: she can remind me of all the bits I forget.
The hon. Lady is right about how important this is. It is not just about individual tolerance; tolerance changes as women get older and as they have more children. In families in which, sadly, more than one child is affected by exposure to alcohol during pregnancy, it is invariably younger children who are damaged most.
We all know about the dangers of smoking—now, nobody would dream of saying anything other than, “Don’t smoke during pregnancy”—but we have not got to that point with alcohol. FASD was first diagnosed in 1973. It has been known about since then, so why has so little been done about it in this country? Much more has been done in other countries; they have approached FASD far more effectively. We had good progress from the chief medical officer, but we need so much more.
What do we need to do? We need to have a prevalence study to understand the situation in this country fully, including why women are still drinking during pregnancy. Some of it is about awareness, but there are some other findings from Sweden that I will draw to people’s attention. In a Swedish study, women mentioned societal factors such as peer pressure, not wanting others to suspect that they were pregnant, and insufficient education, as some thought that drinking small amounts during pregnancy was harmless, and we have just heard about the problems that causes. Personal factors were also important, for example not wanting to miss the enjoyment of alcohol. Those were reasons that women in Sweden gave to explain why they felt that abstinence from alcohol during pregnancy was so difficult for them. We must understand those factors in order to do something about them.
That is why it is so long overdue for the Government to go so much further than they have already. We need a prevalence study to understand whether the 35,000 figure that I have cited is correct, and to understand why women are drinking during pregnancy to the extent that they are. Then we can start to make progress in reducing the incidence of problems and providing the support that is needed, because the cost to those children who are affected by alcohol and their families is catastrophic, and it is hugely expensive for us as a society and economy. The situation cannot be allowed to continue.
I urge the Minister to act. I think this is the first time that she has been involved in a debate on this particular issue—
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
indicated assent.
Bill Esterson
This is a chance for the Minister to start on the right footing and to really make some progress.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate my hon. Friend the Member for Congleton (Fiona Bruce), the hon. Member for Sefton Central (Bill Esterson) and the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) on securing this hugely important and deeply moving debate on tackling alcohol harm. I pay tribute to each of them for the work that they have done in leading their APPGs, raising awareness, holding the Government to account and developing policy. We have heard incredibly eloquent testimony from several Members about the harms that alcohol misuse can cause to individuals themselves, but just as much to their friends, family and children. We have also heard about the cost to wider society, and in particular to vital public services such as the NHS.
The majority of people who consume alcohol do so at low-risk levels and as a pleasurable part of their social lives. Pubs and restaurants play an important part in our communities, both as venues for gatherings and, as employers and businesses, as significant contributors to local economies. We should not forget that, but as we have heard, there are very serious harms associated with alcohol misuse that we must not forget either. I would like to take this opportunity to discuss those harms while noting that some progress has been made. I will outline some of the steps that the Government are taking to ensure that consumers have the information that they need to make good choices about their drinking, to equip frontline professionals with the training they need to intervene effectively and to invest in evidence-based services to help people cut back. Of course, that must all be underpinned by the right data and the expertise and advice of Public Health England.
My hon. Friend the Member for Congleton, who gave an outstanding opening speech, rightly pointed to the recent PHE evidence review, which tells us that alcohol is now the leading risk factor for ill health, early mortality and disability among 15 to 49-year-olds in England. It causes 169,000 years of working life to be lost, which is more than the 10 most common types of cancer combined. It is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, several cancers and depression. As many colleagues have said, alcohol-related deaths have increased—particularly deaths due to liver disease, which rose by 400% between 1970 and 2008. That is in contrast with the trends in much of western Europe. More than 10 million people drink at levels that increase the risks to their health, and there are more than 1 million alcohol-related hospital admissions annually, half of which occur in the most deprived communities. It is important for us to face up to that as a nation.
As we have heard, the public health burden of alcohol, including its health, social and economic harms, is wide-ranging. There are direct and tangible costs to the health, criminal justice and welfare systems. According to PHE’s evidence review, the economic burden of alcohol is substantial; estimates place its annual cost at between 1.3% and 2.7% of GDP, and the estimated annual cost to the NHS is around £3.5 billion. Harms can also be indirect, including the loss of productivity due to absenteeism or unemployment, and they can be intangible and difficult to cost, such as the poor quality of life or emotional distress caused by living with a heavy drinker.
Much of that burden of disease and deaths is preventable, so it is right that the matter is given our full attention. Of particular interest to the Government is the strong inequalities profile of alcohol harms, which fall disproportionately on more deprived communities. We estimate that if all local authorities had a mortality rate that matched the most affluent areas, about 4,000 alcohol-related deaths would be avoided each year.
Though I note my hon. Friend’s calls for caution, there are some promising trends that give us cause for optimism. People under 18 are drinking less, attitudes are beginning to change and there has been a steady reduction in alcohol-related road traffic accidents. We have also seen real progress in Government working in partnership with industry. The industry removed 1.3 billion units of alcohol from the market through improving consumer choice of lower-alcohol products, and nearly 80% of bottles and cans now display unit content and pregnancy warnings on their labels.
As my hon. Friend the Member for Congleton—and my hon. Friend the Member for Ribble Valley (Mr Evans), who is no longer in his place—rightly said, partnership continues to play an important role in tackling alcohol misuse, and the Government are committed to that principle. In the report produced by the APPG that my hon. Friend the Member for Congleton, recommendation 9 is to educate the public about the harms of alcohol and do a better job in prevention. We are taking a number of actions to try to help people manage their alcohol consumption, because we believe that the most sustainable long-term solution to alcohol misuse is informed and empowered citizens and consumers. To ensure that that is possible, we have a responsibility to provide the most up-to-date and clear information to enable people to make informed choices about their drinking. That includes publishing the low-risk drinking guidelines, as we did last year, which a number of colleagues mentioned. Those guidelines provide the public with the latest information from the four UK chief medical officers about the health risks of different levels and patterns of drinking.
Officials are now working with partners in industry to update the advice provided on packaging and labelling to reflect the latest evidence. That is to ensure, as the hon. Member for Sefton Central mentioned, that awareness is raised and people understand exactly what those low-risk drinking guidelines mean.
Fiona Bruce
The Minister talks about increasing knowledge and awareness, but her Department’s own report says:
“Although playing an important role in increasing knowledge and awareness, there is little evidence to suggest that providing information, education…is sufficient to lead to substantial and lasting reductions in alcohol-related harm.”
I support that action, but, without the type of policies I addressed in my speech, I do not believe we will see the difference we need to make.
Nicola Blackwood
My hon. Friend is right that that is not enough in and of itself, but it was an important step, because we did need to review the latest evidence and provide updated risk guidelines. That is also why we remain committed to high-impact public education campaigns. Last year, PHE launched its “One You” campaign, which she may be aware of, which aims to motivate people to take steps to improve their health through action on the main risk factors, including alcohol consumption. “One You” has been used by more than 1.6 million people so far. It includes a drinks tracker app, which helps drinkers to identify risky behaviour and lower their alcohol consumption. PHE will launch a new “Days Off” app on 7 February to encourage people not to drink alcohol for a number of days a week, which is in line with the CMO’s guidelines. Evidence supports that as an effective way to reduce drinking and a good, effective and manageable way in which to use the guidelines.
Bill Esterson
I am pleased that the Minister is making practical suggestions to address some of the problems that have been raised. I hope that she will take up the shadow Health Secretary’s offer to work together on this. As an initial step, perhaps she could sit down individually with the three of us who initiated the debate to take things further, because we have said a lot today but there is a lot more to the debate that may be of assistance to her.
Nicola Blackwood
The hon. Gentleman put his finger on it when he said that a huge number of issues have been raised. I am trying to get through as many as I can. It is likely that I will not get through every point, so, if I do not, I will try to write. I will certainly try to give as much detail as I can. I think I noted everything down, but, if I did not, I am sure hon. Members will remind me with interventions. If they will let me make a bit of progress, I shall do my best.
In the report produced by my hon. Friend the Member for Congleton, recommendations 3 and 4 were to increase awareness and training for health professionals. A number of colleagues raised that as an important issue for identifying earlier and intervening on those who are misusing alcohol. We recognise that as important. All health professionals have a public health role, and we need to ensure that our frontline workforce are properly trained to tackle such challenges, especially alcohol misuse and drinking in pregnancy. I will come on to the points made by the hon. Member for Sefton Central in a minute.
Kelvin Hopkins
To be specific, will the Minister look carefully at what I suggested in my speech? We should have notices in all medical establishments and all areas where alcohol is consumed or purchased with the wording used in America about birth defects, and we should ensure that all medical professionals know about that problem and tell all women about it.
Nicola Blackwood
I will come in a moment to how we are dealing with the issues of foetal alcohol syndrome and foetal alcohol spectrum disorders, but I want to talk first about training for professionals, if that is okay.
By 2018, about 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems. We think that is important so that future doctors can better advise on the health impact and effects of substance misuse. One of the key areas for that must be primary care. Since April 2015, the standard GP contract has included the delivery of an alcohol risk assessment to all patients registering with a new GP, which offers the opportunity to raise awareness of alcohol as a risk factor. In addition, the inclusion of an alcohol assessment in the NHS health check is a good opportunity for healthcare professionals to offer advice. That check is offered to all adults between 40 and 74 in England.
That large-scale intervention has the potential to make a real difference, because we know that one of every eight people who receive the intervention moderate their behaviour. Put simply, evidence shows that that is one of the most effective interventions available to us. Since we mandated the alcohol assessment and advice component in 2013, more than 10 million people have been offered a check, and nearly 5 million people have taken up the opportunity, which is a take-up rate of about 48%. That is progress, but we want to go further.
Recent research has shown that referrals to alcohol services following an NHS health check are about three times higher than among those receiving standard care. We therefore think that the health check is a good way to prompt an adjustment in behaviour. We will continue to deliver it, although we will be happy to hear recommendations on how we can improve it.
Another thing we are doing to support frontline professionals to identify those who might need more significant intervention is that Public Health England is currently leading a review of the higher-risk drinking advice. That is being undertaken in partnership with the devolved Administrations, and the updated advice will be published once the evidence has been considered.
The hon. Members for Sefton Central and for Luton North (Kelvin Hopkins) gave important speeches on the risks of FAS and FASD. They were concerned about the availability and understanding of the CMO’s guidelines. As I mentioned, we are working with partners in industry to update the advice provided on labels, which should disseminate those guidelines. I will certainly consider the comments made about putting that information on labels, in GP surgeries and in other appropriate locations. One of the other ways in which we are trying to get that information out is through the “One You” campaign and the drinks tracker, which I have just mentioned.
We are also trying to disseminate that information through health professionals in a more targeted way. Health professionals are supposed to discuss it with pregnant women as part of their routine work, but women who are heavy drinkers are much less likely to engage with antenatal care, so identifying them can be challenging. Over the past year, PHE has therefore been undertaking a piece of work to identify those at risk and provide advice. It has piloted in three regions of England a training programme developed in Wales called “Have a Word”, which sounds much like what the hon. Member for Sefton Central proposed. PHE is considering the findings from the pilots with a view to rolling the programme out across England if it is effective. We are particularly looking at the findings on how pregnant women can be targeted. I am happy to share those findings with the hon. Gentleman, as I suspect they will address his concerns on raising awareness and targeting pregnant women.
The hon. Gentleman raised the problem of professionals dismissing foetal alcohol spectrum, which sounds familiar. One problem I have been made aware of is the lack of research in this particular field and the need to increase it. Although the World Health Organisation has started a global prevalence study, which he called for, it recognises that information is lacking in many countries, including the United Kingdom. That creates a number of challenges, because the feasibility of estimating prevalence is difficult given the ethical challenges associated with research in that area.
Public Health England recently published the most comprehensive and up-to-date review of current harms of alcohols and the evidence on the effectiveness of alcohol control policies. We are currently engaged in further work to understand the impact of parental drinking on children; we discovered during the initial work that we did not have sufficient evidence on that, so we are going forward with that work. Public Health England is also developing prevalence figures at local authority level, as well a toolkit to support local authorities to respond to the issue of parental drinking. That is due to be published later next year, and I hope it will be of assistance to the right hon. Member for Birmingham, Hodge Hill in the work of his all-party parliamentary group as well.
One challenge we face is insufficient evidence, which is why we are trying to build the evidence base up so that we can assist medical professionals and local authorities as they try to make decisions; if they do not have the evidence, it is very difficult to make proper policy decisions in this area. I hope that reassures the hon. Member for Sefton Central, and I am happy to come back to him on any of the other points that he made.
We have also put several measures in place to ensure that children are provided with the information and tools they need, including through the Frank drug information and advice service. Family nurse partnerships help parents in vulnerable families to develop their parenting capacity, while tailored and co-ordinated support is offered via the troubled families programme. A lot of that needs to be delivered through local authorities; one of the recommendations in the report by my hon. Friend the Member for Congleton was to promote increased partnership through local communities. We believe it is right that local authorities should lead on that work as they are best placed to understand the different challenges in their areas; what is perhaps a challenge in Birmingham may be slightly differently represented in Bournemouth. However, we must make sure that local authorities are properly held to account when they lead on that, which is why we are keeping a close eye on whether they are delivering on these investments in the first place.
Our data show an increase in local authority spending on alcohol services for adults—from approximately £200 million in 2014-15 to £230 million in 2015-16—which we think demonstrates their understanding of the need for a commitment to invest in those treatment services. Our data also show that 85,000 individuals were treated in 2015, of whom 39% successfully completed treatment. The right hon. Member for Birmingham, Hodge Hill quoted different figures. I have not seen his freedom of information request or the response, so I am not sure why that is, but I am happy to investigate the variation between our figures and to discuss it with him to try to get to the bottom of exactly what is going on.
I am also happy to discuss the issues the right hon. Gentleman and the shadow Health Secretary raised regarding children of alcoholics; both made important and moving speeches about that. I thank the right hon. Gentleman for his leadership on this issue. I know it is not easy to speak out in this place about personal trauma and loss, and I know that we too often feel it will weaken us and expose us to personal attacks. I hope that by his standing up in that way, more people—not only in this building but across the country—will feel that they can be open about their personal experiences of addiction and of being in families with those with addiction, and will be able to seek help.
This is an incredibly important step in tackling addiction and the stigma that still exists around it. I thank both Members for the steps they have taken in progressing what is a very challenging cultural area in the UK, and I hope they will accept my commitment to working with them to trying to progress it as well. I want to put it on the record that we are trying to take steps, through the troubled families programme, to improve the situation for children of alcoholics. The troubled families programme has a responsibility to tackle problem drinking and to commission appropriate prevention and treatment services —including to support the children of those families.
Liam Byrne
I pay tribute to the Minister and welcome her commitment to working together across the aisle, so to speak, to put a new strategy in place. The troubled families programme is very important, not least because there is a lot of money in it. That money is often focused on families in the most chaotic of circumstances, but our evidence shows that many families with alcoholic parents do not look troubled or chaotic to the outside eye—they are often functioning alcoholics. Our definition of what constitutes a troubled family may therefore need to be stretched a little in order to help those children.
Nicola Blackwood
The right hon. Gentleman is obviously an expert on the issue, but understanding how to identify those at risk is not specific to this area of public health; it occurs in other areas and is familiar to me from my mental health brief as well. This will be something that we need to sit down and discuss to understand more accurately.
It may be that we need to look at the troubled families programme to see how that could be addressed in order to work more effectively to target those in need of assistance. The key message today is that children of alcoholics in the United Kingdom should not feel as though they are alone—they should feel as though support is there, and they should know that they will find help when they seek it. I must go on to talk about some of the other issues that were raised; I hope I am not taking too much time.
The NHS remains critical to the prevention of alcohol harms. We must incentivise NHS providers to invest in interventions to reduce risky behaviours and prevent ill health from alcohol consumption. NHS England and Public Health England have worked together to develop a national commissioning for quality and innovation—CQUIN—payments framework, which is an important intervention. For those less familiar with the CQUIN payments framework, it was set up to encourage service providers to continually improve the quality of care provided to patients. CQUIN payments enable commissioners to reward innovation by linking a proportion of service providers’ income to the achievement of national and local quality improvement goals. In this case, it means that every in-patient in community, mental health and acute hospitals will be asked about their alcohol consumption. Where appropriate, they will receive an evidence-based brief intervention or a referral to specialist services, which should improve the treatment of children in the care of alcoholics, as in cases like those raised by the shadow Health Secretary. That is something we should be pleased about.
More than 80% of hospitals offer some form of specialist alcohol service, and investment in similar alcohol care teams in every hospital would potentially provide the NHS with an opportunity to maximise its delivery of identification and brief advice interventions to patients. As I said, that has been identified as one of the most important interventions to change behaviours.
Hon. Members will be aware that the NHS and local authorities have been developing sustainability and transformation plans—STPs. Those are now published on NHS England’s website, and the vast majority include actions to reduce the harms from alcohol, including through investment in brief advice, which was one of the recommendations from my hon. Friend the Member for Congleton, and expanding the approaches for those with more problematic alcohol use. That is an encouraging sign. Underpinning all of our work is the expertise of Public Health England, as we have seen from its report. PHE staff work closely with local authorities and the NHS to try to tackle alcohol harms. Building on its recent review, we must ensure that it gives the right data analysis, so that local authorities know how to effectively target their policies.
One issue raised by a number of colleagues is the call for a review of the licensing legislation to include a health objective, as in Scotland. I have some questions about how effective that would be. Although it is easy to link a criminal justice problem to a specific location, it is much more difficult to link a health challenge to an individual establishment. It is quite hard to prove that buying a drink in an individual establishment has caused someone’s liver disease.
PHE is leading our engagement with the Home Office’s second phase of the local alcohol action areas programme and offering support and advice to participating areas that have identified improving the public health response to alcohol-related harms as a key focus of their approach. Successful applicants were announced by the Under-Secretary of State for the Home Department, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), on 27 January, with 18 of the 33 successful areas looking at how they can improve the health of their residents. That is one way in which this is being done.
The House of Lords Select Committee on the Licensing Act 2003 is looking at that Act and is due to publish its report in March. We will, of course, carefully consider its recommendations. I gave evidence to the Committee, which is looking at health as part of that issue.
Fiona Bruce
On the issue of availability, the Minister’s Department’s own report indicates that reducing the number of hours during which alcohol is available and looking at density—the number of outlets where alcohol is sold—can help to reduce alcohol harm. I hope she will look at that as she proceeds. The local licensing objective could have real teeth if those issues were introduced into it.
Nicola Blackwood
My hon. Friend is passionate about this issue. I understand the argument for introducing the health objective. The problem is proving the risk posed by the individual establishment. However, we will consider the evidence that comes forward.
I will briefly turn to taxation, which was raised by a number of colleagues, including Scottish National party Members. I have to say at the outset that making changes to taxation is a matter for the Chancellor and slightly above my pay grade. We also have to note that the UK currently has the fourth highest duty on spirits compared with other EU member states, and higher strength beer and cider are already taxed more than equivalent lower strength products. We are considering the introduction of minimum unit pricing in England and Wales but are waiting for the outcome of the court case in Scotland. Until we hear the Supreme Court’s decision, which is still unknown—we are supporting the process of that case—we cannot proceed with any policy decision in the United Kingdom. It is a little unfair to berate us for not introducing a policy that cannot yet be enforced in Scotland.
On targeted changes in taxation, I am advised that current legislation on alcohol duties requires that duty on wines and ciders is paid at a flat rate within defined bands of alcoholic strength. I understand that my hon. Friends the Members for Congleton and for Ribble Valley have advice that it is possible to do something else, which I would be pleased to see, although that is a Treasury matter. At the moment, my understanding is that the EU directive sets bands for alcohol products in relation to strength and that while we have some flexibility to set rates within the structure of those bands, we are not able to link a duty absolutely to alcohol strength. Obviously, with our vote just yesterday, there is an opportunity with Brexit to consider these issues more specifically going forward, but that is my understanding of EU legislation as it stands and the advice I have received on this specific point.
Fiona Bruce
The information I have received is that the Government could just split the general rate into two separate brackets, therefore achieving their goal without the need to go through the EU. If the Minister will permit me, I will pass to her the opinion we have received on that.
Nicola Blackwood
My hon. Friend is very kind; I would be happy to see it.
I will close now, as I have cantered through a large number of issues and am sure hon. Members are tired of hearing my voice. I thank colleagues from both sides of the House for taking part. This has been an important debate. There have been very moving speeches, especially from the hon. Members for Sefton Central and for North Ayrshire and Arran (Patricia Gibson), the right hon. Member for Birmingham, Hodge Hill and the shadow Minister. They all illustrated powerfully the devastating impact that addiction and alcohol misuse have on not only people’s own health but, as we heard so eloquently, their families, children and local communities, not to mention the health and social care systems and wider society.
We have to give credit where it is due. We have to thank the many NHS workers, local authority staff, charities such as Childline and Aquarius and volunteers who are making such a difference in this area already. They are saving lives. We must recognise progress where it is being made, especially in the changing attitudes among young people. We must not despair.
However, as we have heard from today’s debate, stories and statistics, we cannot be satisfied with this. There is much more we can and must do, and I hope I have reassured colleagues today of my personal commitment to ensure we strengthen the information, support and, if necessary, treatment we give people to reduce the harms of alcohol misuse. With a health challenge as culturally entrenched as this, it can sometimes feel as though it is a mountain we will never successfully climb, but I take courage from today’s debate. Great social change requires three things: long-term political will, non-partisan partnership and bravery. I have heard all three of those today. I hope that each Member who has spoken here today will continue to work with me as we fight on to tackle this social injustice.
Breast Cancer Drugs
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
A large number of important and technical points have been raised today, and I will do my best to respond to as many of them as possible, but where I am unable to do so, I hope that colleagues will allow me to write to them. I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing this important debate, and I join Members across the House in paying tribute to the all-party parliamentary group on breast cancer for all its advocacy on behalf of patients and families. The hon. Lady has campaigned tirelessly to improve access to breast cancer drugs on behalf of her constituents, and I share her commitment to ensuring that patients are able to benefit from the latest effective and often cutting-edge cancer drugs and technologies.
Cancer is a truly terrible disease, and as has been made clear by the many moving personal contributions that we have heard today, there are few of us who have not been touched by it. That is why the availability of effective drugs to treat cancer is of such importance to all of us and to so many of our constituents. I particularly want to thank all those who have allowed their personal stories to be shared today, and all who are here in the Public Gallery. These stories remind us powerfully of why we are all here, and their importance cannot be overestimated.
Sir Desmond Swayne
There is an all-party group for almost every disease known to man, with the possible exception of rigor mortis. If patients and campaigners are to have confidence in clinical decision makers, there will have to be profound changes. At the moment, people lobby their MPs, who are uniquely unqualified to make these decisions. May I suggest to my hon. Friend that one of the changes might need to involve a thorough review of the framework and guidance under which the National Institute for Health and Care Excellence operates?
Nicola Blackwood
My right hon. Friend makes an important point. It has been made by a number of colleagues today, and I shall address it later in my speech if he will allow me.
We want the UK to lead the world in fighting cancer. Survival rates in this country have never been higher, but we must go further. Medicines are a vital weapon in the battle against cancer, but we must not forget the bigger picture. More than half of people receiving a cancer diagnosis will now live 10 years or more; 96% of women diagnosed with breast cancer in England will live for a year after their diagnosis; 86% will live for five years; and 81% are predicted to live for at least 10 years. Improving outcomes for all cancers remains a priority for this Government.
Our mandate to the NHS sets out an ambition to make England one of the most successful countries in Europe at preventing premature deaths from all cancers, and we are working to achieve this through the implementation of the most recent England cancer strategy. As the hon. Member for Bristol West (Thangam Debbonaire) said, early diagnosis and prevention are essential to achieving that aim. The new faster diagnosis standard will speed up the diagnosis of all cancers. The new standard aims to ensure that every patient referred for an investigation with a suspicion of cancer is diagnosed or has cancer ruled out within 28 days. It is also important that we support further clinical research, as this can have a considerable impact on cancer survival rates, and that is exactly why the National Institute for Health Research spent £142 million on cancer research in 2015-16. And of course we must not forget the vital research carried out by the cancer charities, supported by the millions of pounds donated by members of the public each year.
The Government fully understand how important it is that people affected by cancer are able to access new and promising drug treatments, and we firmly believe that clinically appropriate drugs that are established as cost-effective should be routinely available to NHS patients. We all know that these decisions, which can be fiendishly complex, are never easy. We also know from long experience in this place that they should not be made by the arbitrary interventions of politicians. They must be clinically led and made on the basis of the best available evidence. They must also be frequently reviewed when new evidence comes forward. That is why it is right for NICE to play that role in providing independent, evidence-based guidance for the NHS on whether significant new drugs represent a clinically effective and cost-effective use of NHS resources.
If a drug is recommended by NICE, the NHS is legally required to fund it, and over the years many thousands of people in England have benefited from the cancer drugs that NICE has recommended. Those include transformative drugs for cancer, such as Herceptin for breast cancer, pembrolizumab for skin cancer and Zytiga for prostate cancer. Unfortunately, although we would all wish it were not the case, there are cancer drugs that NICE is not able to recommend as clinically effective and cost-effective on the basis of the available evidence, which is exactly why the Government established the cancer drugs fund in England. Since October 2010, we have invested more than £1.2 billion in the CDF, which has helped more than 95,000 people in England to access life-extending cancer drugs that would not otherwise have been available to them.
In July 2016, as colleagues will know, NHS England and NICE introduced a new operating model for the CDF that builds on that and ensures that it is placed on a more sustainable footing for the future. The new operating model is designed to achieve three key objectives: to make sure that patients have faster access to the most promising new treatments; to make sure that taxpayers get good value for money on drug expenditure; and to make sure that pharmaceutical companies are willing to price their products responsibly and can access a new fast-track route to NHS funding for the best and most promising drugs.
As part of the transition to the new operating model, NICE is looking at whether drugs that were previously available through the fund should be funded through baseline funding in the future. NICE has recently been able to recommend two of these drugs for breast cancer, Halaven and Afinitor, as well as a further breast cancer drug, Perjeta. These drugs will now be routinely available to patients. NICE was able to recommend each of these products by taking into account patient access schemes, a mechanism by which companies can improve the cost of drugs to the NHS.
As we are discussing today, NICE also reappraised Kadcyla. As the hon. Member for Mitcham and Morden rightly explained, NICE consulted on the draft guidance but was not able to recommend the drug for routine use because it is too expensive for its benefits. As my hon. Friend the Member for Milton Keynes South (Iain Stewart) rightly said, it is important to stress that NICE has not yet issued its final guidance on Kadcyla and will take stakeholders’ responses to the recent consultation fully into account in developing its final recommendations, which allows time for further negotiation between NICE and Roche. That is why today’s debate has been of value.
I fully appreciate that this is an anxious time for women with breast cancer, but I hope that all here today will appreciate that these are difficult decisions and that NICE must be able to make them free from political interference. I assure the House that, regardless of the appraisal’s outcome, NHS England will continue to fund Kadcyla through the CDF for all patients who have already begun treatment.
The hon. Member for Mitcham and Morden and others raised the importance of access to bisphosphonates for breast cancer patients, as well as the general use of off-patent drugs. The use of off-label and off-patent drugs is common in clinical practice, and there is no regulatory barrier to their prescription. NICE often considers off-label and off-patent drugs in guidance and issues advice to clinicians on new off-label uses of drugs.
The hon. Member for Torfaen (Nick Thomas-Symonds) made an important and informed speech on the issue that proved, in just over 10 minutes, exactly why he is the chair of the APPG. He is right that progress needs to be made in this area. The working group is about to review its latest progress in the next month, and I will certainly take up the issues that he raised with my colleague, the noble Lord O’Shaughnessy, who is responsible for this policy area. I will ask him to respond, especially on sharing the working group’s progress and providing an update regarding the publication of the “British National Formulary”, which the hon. Member for Wythenshawe and Sale East (Mike Kane) also mentioned.
The hon. Member for Torfaen would perhaps like to know that the Association of Medical Research Charities is also working with the Department of Health to facilitate and improve take-up of new robust research findings on repurposed drugs, where appropriate for the patient. I suspect he already knows that, however, given the nature of his speech.
For other colleagues who intervened on this point, bisphosphonates are medicines that are primarily used to prevent or treat osteoporosis. As colleagues clearly know, they are also used for a number of other medical conditions, including reducing the risk of primary breast cancer. That is based on the research in The Lancet in 2015, which found that bisphosphonates can be used to help women who are being treated for early breast cancer after the menopause by reducing the risk of the breast cancer spreading to the bone by 28%.
Bisphosphonates are not licensed for the treatment of breast cancer, but because there is good research evidence that supports their use, they can be prescribed to patients for that purpose when prescribers consider that that meets their clinical needs. There are concerns that access to bisphosphonates and their prescription is variable and that there may be some confusion at a local level as to who is responsible for commissioning them for such use, so I am happy to share NHS England’s advice on these points. While NHS England is, of course, responsible for commissioning specialised services, the manual for specialised services makes it clear that the decision to prescribe bisphosphonates for breast cancer rests firmly with the clinician and patient, subject to funding from the relevant clinical commissioning group.
Members may also be aware that NICE is updating its guideline on the diagnosis and management of early and locally advanced breast cancer. The use of bisphosphonates will be considered as part of the update. The revised guidance is due in 2018. Given the concerns about prescription, my officials have spoken to NICE about the timescale for the guideline, and I am pleased to say that NICE is looking at the feasibility of bringing forward the recommendations on the adjuvant use of bisphosphonates. It will of course be important to consider what the implications might be for the timescale for the remainder of the guideline. I am happy to keep the House updated on that decision.
The Government are not complacent about the availability of breast cancer drugs, and we continually look for measures to drive greater access to innovative new technologies. That is why the Government commissioned the independent accelerated access review, as mentioned by the right hon. Member for North Norfolk (Norman Lamb). Its final report in October set out how the UK can accelerate access to innovative cost-effective drugs, devices and diagnostics for NHS patients and create a more attractive environment for innovators and investors. The Government will respond to the review in the spring, but I acknowledge that NICE must continue to evolve to adapt to changes both in the development of new drugs and in the health and care system. Given the time, and if it is all right, I will respond on some of the details in writing to the hon. Member for Mitcham and Morden. We will continue to work with NICE to ensure that its methods remain fit for purpose.
We must remember that improving outcomes for cancer patients is not just about drugs. That is why we accepted all 96 recommendations in the independent cancer taskforce’s “Achieving world-class cancer outcomes” report. The recommendations represent a consensus of the whole cancer community on what is necessary to transform cancer care across the whole cancer patient pathway, from prevention and early diagnosis to living with and beyond cancer, including dealing with side effects, as was mentioned so movingly by the shadow Minister. We are implementing that through a strategy that was published in May and we hope to see great progress as it is delivered. As was made clear in the speeches of so many in the Chamber, breast cancer affects many people in this country today. We continue to invest so much in cancer services so that more people survive cancer and more people live better with cancer. To do that, they need rapid access to more effective treatment, be it surgery, radiotherapy or drugs. That is what I want to see and that is what this Government will deliver.
I am sure that the whole House will join me in congratulating all who have fought and survived breast cancer. We want to stand alongside everyone who is living with a breast cancer diagnosis, battling treatment and living with the sometimes hidden day-to-day impacts of breast cancer. We remember all those who fought valiantly but lost the battle with breast cancer. We have made much progress in improving care, providing drugs and funding research, but there is much more that we can and must do to fight this disease. I hope that each and every Member here will do what they have been doing today and hold the Government to account as we move on and try to do just that.
Stem Cell Transplants
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate the hon. Member for Alyn and Deeside (Mark Tami) on securing this important debate and on his moving contribution. I also thank his co-chair, my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), for his contribution, which was characteristically informed. I join them in thanking the all-party parliamentary group on stem cell transplantation and the Anthony Nolan trust for all their hard work and advocacy in this field on behalf of patients and their families. I particularly want to thank all those who have allowed their personal stories to be shared in the Chamber tonight. They are a powerful reminder of why we are all here. Their importance cannot be overstated.
As the hon. Gentleman said, stem cell transplants promise a life-saving cure for many patients, but the key is finding a suitable matching donor. While many patients are able to find suitably matched family members, for more than 1,000 patients a year, that is not possible and they have to rely on the generosity of others. I am sure that the whole House will want to join the hon. Gentleman in paying tribute to the more than 800 people in the UK this year who donated their stem cells.
I will go on to speak about improving patient care and the importance of research, as my hon. Friend mentioned, but both my colleagues raised commissioning as a particular concern, so I shall start there.
Over the past few months, there have been particular concerns raised regarding the commissioning by the NHS of second stem cell transplants for patients with relapsed disease. I recently had the chance to visit Anthony Nolan’s research labs at the Royal Free, where I was introduced to Emma Paine. Emma is alive today, as the hon. Gentleman said, thanks to a second stem cell transplant. She looks extraordinarily well and she is a powerful advocate for the cause. She spoke to me with extraordinary eloquence about the difficulties of the commissioning process, so I am in no doubt about the importance of the issue.
Decisions regarding prioritising specialised commissioning are always going to be difficult, which is why I believe that they are rightly a clinically led operational matter for NHS England, as the hon. Gentleman anticipated I would say. Knowing that I was coming here tonight, I asked for an update from NHS England. Contrary to some reporting on the issue, NHS England has not withdrawn the provision of second transplants. Second transplants have been, and remain, routinely commissioned for patients where the grafting process has failed, but NHS England has recently reviewed a proposal, alongside all the other priorities that were put forward, to begin routinely commissioning second transplants for patients with relapsed disease, for the first time since it was established in 2013. That would have replaced the current case-by-case provision of those transplants.
To prioritise funding for specialised services, as colleagues will know, NHS England has an established mechanism to evaluate proposals for new areas of investment. This reviews proposals on the basis of their clinical benefit and cost, as colleagues have discussed. The clinical benefit is based on the latest published clinical evidence.
As the hon. Gentleman said, that proposal was not approved. NHS England explained to me that its decision not to recommend routine commissioning of second transplants was based on the associated cost of the treatment, which the hon. Member for Strangford (Jim Shannon) mentioned, and the clinical evidence that suggests that less than one third of patients with relapsed disease survive more than five years after the second transplant. However, as I think colleagues mentioned, there is also evidence to suggest that, in that area, clinical practice is ahead of published evidence. For that reason, work is ongoing to ensure that the evidence base is updated before the decision is next reviewed.
Prioritisation decisions are kept under review in the light of new evidence and NHS England tells me that proposals for second transplants will be reviewed again later this year. Until the completion of any review, as the hon. Member for Alyn and Deeside said, clinicians can continue to apply for funding for second transplants for relapsed disease where NHS England assesses that the patient is clinically exceptional or has a clinically critical need, although I accept what colleagues have said about how difficult that process can be.
I shall certainly put to my colleague, the Minister of State, Department of Health, the point raised by the hon. Member for Alyn and Deeside about the transparency of decision making and the sensitivity in communicating that decision. I shall ask that my hon. Friend take it up with NHS England.
Mark Tami
Does the Minister accept that, for a whole host of illnesses, we fund, probably rightly so, drugs that may cost vast sums for people for whom the prognosis is that their lives might be extended by weeks, whereas we are now discussing not only extending people’s lives for years but potentially enabling them to live a full life over which they could pay back some of the cost of the treatment?
Nicola Blackwood
As a politician, I do not feel I am qualified to make the judgment about the different clinical priorities, which is exactly why that decision is supposed to be made by clinicians. We are, though, hearing that there is a difference between the published evidence that is going forward to the board for decision making and that at the coalface. That is what needs to be rectified before the decision is made. We are working hard to try to ensure that that happens so that patients such as Sasha, Emily and others have the best possible chance.
It is precisely because of the extreme stress and the fear of relapse that the hon. Member for Coventry North East (Colleen Fletcher) identified—the hon. Gentleman agreed with her—that in the meantime we are trying to focus our efforts on improving patient care and driving forward research, so that we can improve the outcomes of first stem cell transplants and explore all possible treatments and therapies for these very hard-to-treat conditions. That is why the Department of Health has not washed its hands of stem cell treatments. We have provided more than £19 million to our delivery partners, NHS Blood and Transplant and Anthony Nolan, since 2010, and a further £2.5 million this year.
Support from the Department is shaped by expert advice from the clinical community and has led to a number of tangible improvements that mean that patients are now significantly more likely to find a matched donor. Better matching of donor and recipient means that the stem cell transplants are much more likely to work the first time, which is a better outcome for the patient anyway. We have also supported the creation of a unified donor registry, which, combined with advances in tissue-typing, means that the time taken to identify a suitable donor has been significantly reduced. As many colleagues have said, patients in need of a stem cell transplant are often very ill and do not have time to waste, so that progress is very important.
Despite significant improvements in the chances of finding a suitable donor, there remains a global shortage of donors for patients from minority groups, which is unacceptable. That is why we are continuing to support the expansion of the cord stem cell bank. Stem cells from umbilical cords tolerate minor mismatches in tissue type, so are disproportionately used to treat patients from minority groups, for whom finding an exactly matched donor may be impossible. We are trying to combine that with the targeted recruitment of adult donors from under-represented communities. The chances of patients from minority groups continue to improve, but we recognise that there is still more to be done and are working closely with charities and hospitals to try to ensure that that happens.
Recent high-profile donor search campaigns, such as Match4Lara, have done a lot to help to raise awareness of the particular challenges that some patients face in finding a donor. Through that and other campaigns, Anthony Nolan has demonstrated the value of using social media to reach young people in all sections of the community. Overall, it is estimated that investment by the Department and the work of delivery partners such as Anthony Nolan means that, compared with 2010, more than 130 additional lives are being saved each year. We are making progress, but there is no complacency, and we recognise that more needs to be done.
Mr Burrowes
I am the first to congratulate the Government on making that investment, and on that commitment and partnership work. Nevertheless, is there not a mismatch? The investment commitment to collections at source is no doubt meant to ensure that there are outcomes in relation to transplantation. Our issue is that it seems that, at the end of the day, when a patient gets to the second transplant, which is sadly part of the complicated life-cycle for them, we seem to be just pulling the rug from under them.
Nicola Blackwood
My hon. Friend will have heard my answer on that. We are trying to address that as we go through the commissioning process by ensuring that the best possible evidence is there and that it is the most up-to-date clinical evidence, so that, through what has to be a robust prioritisation process, the second stem cell transplantation for relapse has the best possible chance. I also think that it is important that we address the other areas of stem cell transplantation to ensure that patients have the most improved outcomes at, for example, first transplant level, so that the research is available to feed through into that prioritisation process, and also so that patients have the best possible experience going through the process.
Finding a suitable donor is only the start of a long recovery process for patients, as Emma said very clearly to me. The report from the independent Cancer Taskforce, with which hon. Members are familiar, identified a number of ways in which people living with and beyond cancer could and should be better supported. In the case of patients receiving stem cell transplants, NHS England has set out the pathway in its service specifications. It is widely recognised that patients receiving a stem cell transplant often experience severe psychological and emotional stress. The aggressive nature of the treatment and the need for prolonged hospital stays mean that the psychological impact on patients can be particularly severe.
Transplant centres recognise that the long-term management of these effects is an important aspect of the transplantation process. It is important that we stay by those patients for the long term, as has been mentioned. There is also an urgent need to improve the clinical outcomes of stem cell transplants and to track those outcomes so that we have the evidence to present. The planned impact project is an important aspect in addressing the development of the best possible clinical practice. This network, supported by the charities, Anthony Nolan and Leuka, will complement the existing National Institute for Health Research clinical trials network. It aims to recruit 20% of stem transplantation patients into clinical trials. We believe that it is only through further research supported by clinical trials that the survival rates for these transplants can be improved.
During my recent visit to the Anthony Nolan laboratories, I was particularly impressed to see that they are involved in applying the latest genomics technology to improve the matching of donors and recipients. It is a clear example of how we are directly improving care and access through our research and through the 100,000 Genomes Project.
Mark Tami
I thank the Minister for giving way; she is being very generous. She has touched on a key point there, and it is something that I have raised with her before. We are rightly prepared to spend a large sum of money on treatment to give people the transplant they need. As she says, it is a very difficult process for the patient. Afterwards, there is virtually no support for that patient and for their mental health. They may have a lot of questions and a host of issues—a child, for example, may want to know why it has happened to them and why they look different—yet they really have to search for support. The support should be part and parcel of the whole package, rather than something that is applied as some sort of add-on.
Nicola Blackwood
The hon. Gentleman is absolutely right. It is very important that we look at the whole child as well as the psychological impacts of long-term illness—whether it is a cancer or any other kind of long-term illness. He will know that we are developing a Green Paper for children’s mental health, and I do intend, and hope, to be addressing the ways in which we can look at not only the broad spectrum of children’s mental health, but those who have particular challenges that they need to overcome. He has raised the matter with me before. I gave him a commitment that I would follow through on it, and I reassert that commitment tonight.
The way in which we are working on this, which is to build up the research to improve patient care and to ensure that we are allowing the NHS to deliver world-leading therapies based on genetic information, is essential to ensuring that every patient receives the appropriate treatment. That is what colleagues say they want to happen. It also highlights the importance of having the right infrastructure in place throughout the NHS, because if we do not have that, we will not be able to provide the best support.
That is why we announced in September an £816 million investment for biomedical research centres over the next five years. We also specifically support translational research into stem cell transplantation through the stem cell and immunotherapy research unit—one of four NIHR blood and transplant research units, each of which is a partnership between a university and NHSBT. The stem cell unit at University College London is involved in the development of new and potentially transformative forms of treatment involving immuno- therapies. Such therapies are perhaps the most exciting and promising area of cancer therapy and may eventually entirely replace the need for stem cell transplantation. I appreciate, however, that those advances cannot come soon enough for the patients mentioned tonight.
As ground-breaking as our research efforts undoubtedly are and as necessary as they are for the long term, we must always remember that research is not an end in itself. Ultimately, we are all working to deliver better, more targeted patient outcomes that offer hope to the thousands of people living with an incurable condition. In doing so, we must ensure that we are helping to improve the lives of those patients and their families while we work to transform NHS care for generations to come. That is what we are working to deliver. I hope that the hon. Member for Alyn and Deeside and my hon. Friend the Member for Enfield, Southgate will work with me as we try to do that.
Question put and agreed to.
Children’s Mental Health In-patient Services
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I would like to update the House following a point of order on this issue on 12 April 2016 (Col 183) made by my predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), former Minister of State for Community and Social Care, who met the voluntary and community sector organisation that brought this issue to light with the BBC. He was able to have a useful discussion with them on the key problems and potential solutions. He made the commitment to look into this issue and set out how this will be improved in the future.
Deaths in children’s in-patient mental health services are rare events. Every preventable death, especially in young people, is a tragedy and it is important that they are properly recorded so that lessons can be learned and action taken where necessary. There can be particular challenges in the way deaths are registered and classified. There can be a time lag before an inquest concludes on the cause of death and where a young person is concerned; there may be a lack of clarity around intent, so that the cause of death may not be classified as suicide.
Officials have now made a detailed assessment of the available data. I can confirm that there have been 11 deaths of patients under the care of mental health in-patient services, both inside and outside of the premises since January 2013. It is not possible to provide an accurate figure on the number of deaths prior to this time period, due to the commissioning arrangements and data collection methods which were in place at that time. It is with regret that I cannot provide a figure for this earlier time period. However, I am fully committed to making sure that we are able to improve on this in the future.
Following assessment of the data, the right hon. Member for North East Bedfordshire brought into effect increased oversight in this area. As of June 2016, both the Minister with responsibility for mental health and the Secretary of State for Health receive an immediate report of any death in a children’s in-patient mental health setting or on home leave from such services where they occur. We will simultaneously notify the National Confidential Inquiry into Suicide and Homicide if a self-inflicted death has occurred in these circumstances, so that both the figures and clinical lessons can be captured as part of annual reports, which will be made available to Parliament. This will provide insights for national and local organisations to take on board. We have written to providers of children’s mental health in-patient services to remind them of the responsibilities of their reporting duties.
A report by the National Confidential Inquiry into Suicide and Homicide on Suicide in Children and Young People, which was published on 26 May 2016, shows that 60% of those who had died had not been in contact with mental health services at all. This illustrates the urgent need to make sure that children and young people can access mental health services to prevent such tragedies in future. The ambitious transformation programme that has been put in place to ensure that young people receive the support they need is designed to do just that.
We know that we need to improve the system of investigating deaths of mental health patients. The Government and local providers are working hard on the implementation of the Mental Health Taskforce report which will address these issues, and the House will be kept informed. Also, the Secretary of State recently announced a series of measures in response to the Care Quality Commission’s report “Learning, candour and accountability” that will require NHS trusts and foundation trusts to improve their understanding of deaths arising from problems in care and demonstrate the learning and action that follows.
On behalf of both previous and current Ministers, I am grateful to those who have brought this matter to our attention in the House.
[HCWS427]
Employment, Social Policy, Health and Consumer Affairs Council: December 2016
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The Employment, Social Policy, Health and Consumer Affairs Council met on 8 December in Brussels. For the health part of the meeting, the UK was represented by the Deputy Permanent Representative to the EU. The meeting featured one substantive item about the European semester and health, and a number of other items as part of the “any other business” section of the agenda.
On the topic of the European semester, the UK stressed member state competence and the importance of maintaining a narrow focus for the semester. Regarding the involvement of Health Ministers in discussions about the semester, the UK stated that it had no objection to focused discussions, although added that Health Ministers are already engaged through national co-ordination. Discussions about this issue will continue under the Maltese presidency.
Under the AOB part of the agenda, the UK presented on the candidacy of Dr David Nabarro for Director-General of the World Health Organisation (WHO). The UK emphasised Dr Nabarro’s UN experience—including on cholera, food security and sustainable development—and stressed that he has demonstrated a reform-minded approach and is committed to transforming organisational effectiveness. The UK stated that he had the backing of the Prime Minister and chief medical officer.
On antimicrobial resistance (AMR), the UK stressed the importance of keeping up momentum following the recent agreement of a declaration on AMR at the UN General Assembly, and outlined areas where work needed to be focused; including on research and innovation, the development of new products, on implementing national action plans and on benchmarking.
There were also discussions on alcohol, about the production of paediatric medicines, and about follow-up work relating to Council conclusions on pharmaceuticals. The EU Commission provided an update on European reference networks, as well as feedback about the report “State of Health in the EU”, which it has jointly published with the Organisation for Economic Co-operation and Development. There was also an update about the discussions held at the recent conference of the parties to the WHO framework convention on tobacco control.
Finally, there were updates about recent conferences, and Malta provided an overview of priorities for its presidency, commencing on 1 January.
[HCWS425]
Pharmaceutical Price Regulation Scheme
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
On 23 December 2016, the Government published the level of payment due from members of the Pharmaceutical Price Regulation Scheme (PPRS) in 2017 to keep health service spend on branded medicines within the levels agreed under the scheme.
The Department of Health and the Association of the British Pharmaceutical Industry have agreed in principle to amend chapter 6 of the 2014 PPRS in accordance with paragraph 3.4 of the scheme in order that the scheme continues to deliver its agreed objectives of predictability and stability to Government and industry, and to ensure that the cost of branded medicines to the NHS stays within affordable limits. The effect of the changes is that the payment percentage for 2017 is to be set at 4.75% for 2017, and the 2018 PPRS payment percentage will be determined by reference to the existing PPRS payment mechanism, provided that the resulting percentage falls within the lower and upper limits of 2.38% and 7.80%. The Government recognises the additional contribution being made by the pharmaceutical industry in acknowledgement of the financial challenges facing the NHS.
The Department has published a document setting out further details entitled “Pharmaceutical Price Regulation Scheme (PPRS) 2014: revised payment percentages at December 2016”.
Pharmaceutical Price Regulation Scheme (PPRS) can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-01-20/HCWS426/.
[HCWS426]
NHS Fertility Services
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe), my right hon. Friend the Member for Wantage (Mr Vaizey) and the right hon. Member for Carshalton and Wallington (Tom Brake), who is not in his place, on securing this important debate. I am grateful for the opportunity to discuss NHS fertility services. This has been a moving debate and, on behalf of the Government, I recognise at the outset that infertility is a serious condition, affecting a growing number of people: women and men and same-sex couples. I personally thank all of those who have allowed their stories to be shared today. They remind us powerfully of the distress that infertility causes. The value of their being shared in the debate cannot be overstated.
It is important to remember that those stories are not isolated cases. As hon. Members are well aware, fertility problems are estimated to affect one in seven heterosexual couples and, for couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring in the following year is 25% or less. We should keep those figures in our minds.
As my right hon. Friend said, infertility can and does have a powerful and lasting impact on the quality of life of those affected. Research has shown that there can often be psychological effects, as powerfully described in the debate, for both men and women suffering from fertility problems. It can cause stress and it puts pressure on relationships, primarily between the couple themselves but also on relationships with family and friends. It is therefore important that the NHS provides access to fertility services for those who need clinical help to start a family.
The availability of NHS fertility treatment is and always has been a matter for local determination. As my right hon. Friend said, these are not easy decisions to make, but we expect them to be made fairly. Decisions on the level of service provision are underpinned by clinical insight and knowledge of local healthcare need. That has been the case since the introduction of the purchaser-provider split in the 1990s, and today that determination is, as we all know, made by CCGs, which are clinician-led and have a statutory responsibility to commission healthcare services that meet the needs of their whole population, reducing inequalities and improving care quality.
While provision of services will, by necessity, vary—for example, the health needs and priorities of the population of Birmingham will not be the same as that of Bournemouth—it is right that those difficult prioritisation decisions are led by clinicians who know their patients and local areas best rather than being made centrally. The Government have made it clear that blanket restrictions on any healthcare treatment—including fertility services—are unacceptable. Where a service is not routinely commissioned, clinicians can still make individual funding requests for their patients when a clinical case can be made and if treatment is likely to provide significant benefit. It is the role of NHS England to ensure that CCGs are not breaching their statutory responsibility to provide services that meet the needs of their local population and to take action if such breaches do take place.
Steve McCabe
I recognise what the Minister says about this being an issue for local determination. However, does she agree that it does not make sense to use moralistic criteria to ration the provision of services, which—as in the example I cited in Birmingham—is then put to a public poll that produces an inconclusive result on a very low turnout? Surely that is not the kind of local determination we want. Is that not something that NHS England should act on?
Nicola Blackwood
The hon. Gentleman gave a very good opening speech in which he raised some points that I will comment on. The quality of commissioning of fertility services is one of those points, and having regard for guidance already in place to guide local commissioners in commissioning fertility services is a point on which I am about to comment. He has anticipated my speech as only a seasoned politician can.
NICE first introduced its fertility guidelines in 2004. As with all clinical service guidelines, they have never been mandatory. Successive Administrations have supported the principle of locally determined implementation of key recommendations of the guidelines, because decisions about local services should be made as close to patients as possible by those best placed to work with patients and the public in their area to understand their needs. However, it is sadly the case that implementation has been variable over the years, particularly with the provision of three IVF cycles for qualifying couples, as we have heard. As the hon. Member for Birmingham, Selly Oak and the shadow Minister rightly said, the 2016 Fertility Fairness survey showed that just 16% of CCGs provided the recommended three cycles of IVF, with 22% providing two, 60% providing one and 2% providing no IVF funding at all.
I understand that commissioners in some areas are undertaking their own evidence reviews, as the hon. Member for Birmingham, Selly Oak said, to determine whether their CCG should offer IVF. I take this opportunity to say that that is unnecessary. NICE was established for the specific purpose of reviewing the available clinical and scientific evidence of a treatment’s effectiveness and, working with a wide range of stakeholders, to make recommendations based on that evidence about services that should be available to all within the NHS. NICE guidelines for fertility services are robust and fit for purpose, and there is no need for them to be second-guessed by commissioners.
The hon. Gentleman also raised NICE guidelines for same-sex couples. NICE guidelines seek to offer heterosexual and same-sex couples the same access to investigation and treatment for fertility problems, the criterion for which is a failure to conceive over a set period of time. NICE sets that criterion to ensure that NHS funding is available for donor sperm for female same-sex couples, or surrogacy arrangements for male same-sex couples, on the basis that they are medically sub-fertile, not that their childlessness is owing to the absence of gametes from the opposite sex—sperm or eggs.
Access to NHS-funded investigations is commissioned in female same-sex couples who fail to conceive after six cycles of artificial insemination within a 12-month period. NICE recognises that same-sex couples could be disadvantaged, because they may have to pay for artificial insemination before they can be considered for NICE assessment and possible treatment. NICE considers six cycles to be equivalent to the 12-month period of unprotected intercourse required of heterosexual couples before they are offered investigation for fertility problems. Same-sex couples are offered access to professional consultation and advice in reproductive medicine before they embark on attempts to conceive, to ensure that they are informed about appropriate and safe self-funding attempts. I can tell the hon. Member for Birmingham, Selly Oak that NICE is due to review its fertility guidelines this year, and he may wish to write to NICE’s guidelines review team to offer his views on the issue. The Department of Health will certainly be doing so.
On the implementation of NICE guidelines, I commend CCGs, such as Camden, Oldham and others that have been mentioned, that have implemented the NICE fertility guidelines in full and continue to offer three IVF cycles to qualifying couples. That shows it is entirely possible for CCGs to implement NICE’s IVF provision recommendations. It was disheartening to learn from the Fertility Fairness survey that access to IVF treatment on the NHS has been reduced in so many places, and it is deeply disappointing that some CCGs have stopped routinely commissioning it. I strongly encourage all CCGs to implement the NICE fertility guidelines in full, as some CCGs are successfully doing.
Justin Madders
The Minister has correctly identified that some CCGs are not providing any treatment at all. Does she think that blanket policy should be dealt with?
Nicola Blackwood
I am about to go on to work that we are doing to assist CCGs with better commissioning, including giving them advice on pricing, which the shadow Minister mentioned. Perhaps he will allow me to do that; I think it will be enlightening for him.
Work is under way to assist CCGs in better commissioning fertility services for their local community. It is right that we do that. My right hon. Friend the Member for Wantage was correct—the cost of IVF is falling, but not all CCGs are benefiting from that. We know that the prices that fertility clinics charge CCGs for an IVF cycle vary, and that some CCGs are not contracting in the most effective way.
The Fertility Fairness survey reported that the price being charged by service providers for an IVF cycle varied across the country, from around £2,000 at the bottom end to more than £6,000 at the top, although it is not clear what all of those treatment cycles involve. The Department of Health, NHS England and professional and stakeholder groups are working together to develop benchmark pricing for fertility services to ensure that CCGs get the best value for their money. That is obviously the first step to be taken before NHS England’s longer term work towards developing a national tariff, which my right hon. Friend called for.
In addition to that initiative, the national fertility regulator—the Human Fertilisation and Embryology Authority—is developing commissioning guidance that aims to improve the quality of commissioning, for example by encouraging greater use of single embryo transfers where appropriate for a patient. That does not reduce the chance of a woman having a baby but significantly reduces the incidence of multiple births, with their attendant risks and complications for mothers and their babies. NHS England has agreed to disseminate and promote that guidance to all CCGs in England.
Those approaches are intended to raise the level of knowledge and expertise within CCGs to ensure that they are able to commission services appropriately in what is a specialist area, exactly as my hon. Friend the Member for South West Bedfordshire (Andrew Selous)—who is no longer in his seat—called for. It would also be helpful for CCGs to pool their resources and expertise and collaborate more with each other to get a better deal for their patients. That has happened in the north of England, where members of two commissioning collaboratives are able to offer three IVF cycles to qualifying couples.
As I hope has been clear, it is the Government’s view that infertility is a serious medical condition. Those suffering from infertility who meet the criteria in the NICE fertility guidelines for NHS-funded treatment should be able to seek that treatment. We do not agree that clinical infertility should not be part of a comprehensive national health service. Reflecting on the strength of feeling expressed today, I will be writing to NHS England to ask that it communicates clearly to CCGs the expectation that NICE fertility guidelines should be followed by all.
The Department of Health, NHS England and professional and stakeholder groups will redouble efforts to develop the benchmark pricing for fertility services, which, as I have said, is a precursor to NHS England introducing a national tariff. NICE will continue with its review of fertility guidelines this year. I hope that series of actions demonstrates just how seriously the Government take this situation, and leaves all those watching the debate confident of our commitment to finding practical solutions to this serious problem.