HIV Treatment

Baroness Blackwood of North Oxford Excerpts

Wednesday 29th March 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on securing this important debate, and all Members who have contributed to what has been a highly informed discussion. I welcome the opportunity to discuss the findings from the recent and interesting report “The HIV puzzle”, which was produced by the all-party parliamentary group on HIV and AIDS. I pay tribute to my hon. Friend for his work on HIV innovation, and to all the members of the APPG for the work they do to champion HIV within Parliament.

Preventing the spread of HIV and supporting those who already have the disease remains a Government priority. As colleagues present will have heard me say before, and as the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), also said, when we look back at the HIV epidemic in this country we can be proud of our achievements so far. In particular, we have made considerable progress in recent years towards meeting the UN 90-90-90 ambitions to eliminate HIV-related mortality and transmission by 2020. We have already met two of the ambitions, with 96% of people diagnosed with HIV receiving antiretroviral treatments and 95% of those treated virally suppressed. We have made significant progress on the third goal—to reduce undiagnosed HIV so that diagnosis is over 90%. The proportion of undiagnosed cases was 13% in 2015, which means we have seen a fall of almost half, from 25%, in just five years. However, that is still too high and we need to redouble our efforts to ensure that those who are positive receive a timely diagnosis.

The right hon. Member for Exeter (Mr Bradshaw) was right that we must have robust monitoring to ensure that we understand what is happening. He identified some particularly encouraging reports from London; there were some encouraging reports during 2016 from London clinics, particularly Dean Street. Those trends are welcome. Public Health England is actively investigating the trends, and whether the reduction has also been seen in other parts of the country and in other risk groups. It will report on that when the 2016 HIV data are published later this year, and I shall be happy to notify him if he would find that helpful.

Many Members today have reported concerns about how public health funding in the future might affect the provision of HIV prevention and support services. In line with recommendation 6 in the report, we have decided, in relation to this aspect and wider public health funding, to retain the ring fence on the public health grant for a further year, until 2019, as we move towards the implementation of local business rates retention. This is a step on the way to a more locally owned system, but that will help to smooth the transition by providing certainty for the next two financial years. It means that grant conditions will continue to apply and Public Health England will have a clear assurance role in relation to grant spend. I recognise that local authority funding remains tight and that councils have tough decisions to make to ensure that vital public services remain sustainable. Returns from local authorities have identified that more than £82 million was spent on sexual health.

[Dr Poulter]

I thank my hon. Friend the Minister for the constructive approach that she is taking in replying to this debate, as indeed she does in all debates on health matters. Does she recognise that there are areas with very high demographic change, that some of them have high rates of people living with HIV and that the funding formula is beginning to be out of date and needs to be reviewed? There are some parts of the country that need more money than that funding formula makes available for public health purposes.

[Nicola Blackwood]

I am going to come to what we are going to do in the future. The current situation will remain in place for one year, but we have identified the public health spend. A significant proportion of the funding will be allocated to HIV testing and prevention activities. We also recognise that there are reasonable concerns about the practicalities as we move towards business rates retention, and how it will work in practice, in particular in relation to health. The fact is that the only way we are going to get the scale right is if we continue to engage closely with Members. One thing we are looking at is how we manage the move towards mandation and how we look at transparency and accountability in public health spending. We will be doing that in a very consultative way—

[Thangam Debbonaire]

I am sorry to interrupt the Minister. I think she mentioned a minute ago something about protecting public health funding for two years until the change to business rates. I am so sorry, but I missed that point. Could she clarify it? Does she mean that this is a new announcement of new protections?

[Nicola Blackwood]

The public health ring fence will remain in place until 2019.

We also recognise, as recommendation 1 makes clear, that HIV support services are an important part of the overall care that people diagnosed with HIV receive to support their health and wellbeing. I have heard hon. Members’ concerns today about such services being decommissioned because of budget pressures. We are increasing our focus on supporting and improving place-based commissioning, and will work to provide the right opportunities for all commissioners and providers involved in a care pathway to work together to secure the right service response for the needs of the local population, taking into account each partner’s responsibilities.

In line with a number of the recommendations, we also need to ensure that we make the most effective and efficient use of the resources available. We are already seeing some really effective examples of that in the Public Health England HIV innovation fund, which supports voluntary sector-led projects across the country that are focusing, as my hon. Friend the Member for Finchley and Golders Green knows only too well, on HIV prevention and testing. That includes the OutREACH project in Cumbria, which is using community pharmacists to provide HIV testing in a rural area with very high rates of late HIV diagnosis, and the MESMAC project in Yorkshire, which is providing HIV awareness training and testing at a hostel housing migrants who are claiming refugee status in the UK. We are also encouraging innovations such as home testing. Our aim this year is to see 50,000 tests for HIV carried out at home. They are already starting to make a difference. The introduction of compulsory relationships and sexuality education will, as my hon. Friend says, have an important role to play in prevention.

I was very sorry to hear the comments made by the hon. Member for Hove (Peter Kyle) about the Sussex Beacon. I am sure that, given his account of the clear local need and the quality of the service, he is holding local commissioners to account for their decision making. I am afraid that my recollection is that I had responded to him on that matter, and not an arm’s-length body. I am very sorry if there has been confusion, but I am happy to continue the discussion following this debate, so that we can clear it up and ensure that we make progress on it. I would not like him to think that we do not take it very seriously indeed.

As we all know, delivering high-quality HIV services is about not just funding, but getting the commissioning right. As the report highlights, a lot of work still needs to be done to ensure that the commissioning landscape for the services supports effective collaboration and co-operation, so that we can continue to see improvements in these and other outcomes. That is exactly why Public Health England commissioned a sexual health commissioning survey, which very much supports the findings of both the Health Committee and APPG reports.

I recognise that commissioning sexual health and HIV services is complex, given the range of services and the different population needs that are covered under the broad umbrella of sexual and reproductive health and HIV. We are very alive to and are working to address the risk of fragmentation damaging the progress that we have made, so I am particularly pleased to announce that, shortly, Public Health England will launch an action plan to support commissioners and ensure that they can provide the sexual health and HIV services that their populations need.

As its first priority, Public Health England will look for ways in which to reduce the fragmentation of commissioning and address the barriers that stop effective collaboration and co-operation between commissioners. That will include encouraging the development of a model of lead integrated commissioning in each locality, including developing models for out-of-area tariffs and other issues that can slow down contracts and increase costs. PHE will also identify system leaders across the country to lead local sexual health, reproductive health and HIV commissioning in an agreed locality and form a national network of commissioning leads to promote the effective national development of commissioning.

To test out how that might work in practice, PHE will pilot local delivery models working with local authorities and CCGs to help to build on effective models of commissioning. We will announce the names of the pilot sites shortly—the work is still in the early stages of implementation—but I take this opportunity to urge any areas that are interested in working with us to get in touch with PHE and to take part in developing the work as it takes shape.

[Mr Bradshaw]

I warmly welcome what the Minister has just announced. When the pilots are up and running and have delivered results, if it is necessary to revisit some of the structural and commissioning changes that were made under the Health and Social Care Act and which caused the problems in the first place, would she be open to doing so? On the ring fence, if she is going to delay its removal by a year, she might as well have a proper review of that, given the concerns out there about the impact of removing it on public health funding and spending in general.

[Nicola Blackwood]

I think the right hon. Gentleman slightly misunderstood me on the ring fence. We have kept it because we believe that transparency and accountability measures need to be put in place, so that when local authorities move to business rates retention, their decisions can be made in an appropriately accountable way that can be scrutinised properly. We do not feel as though we have that yet, so we have moved the date back a bit. We want to do that effectively and to have proper consultation on the mandate. On his other point, I think it is a bit early in the process to start discussing that.

Given the time, let me move on to service specifications. During the debate we have heard examples of contracts for sexual health services becoming divorced from the provision of HIV services. A key recommendation from the APPG report was to create a joint service specification for sexual health and HIV services. We recognise that the existing service specification for sexual health needs strengthening, which is why it is now being updated. PHE has committed to building on existing commissioning guidance to provide more focused advice and examples of locally designed systems to support the commissioning of HIV and sexual health services.

NHS England is responsible for the service specification for HIV treatment and care, and we think that that remains a sensible division. However, the development of a new integrated service specification for sexual health services will allow us the opportunity to join up our advice to produce a more integrated offer.

I want to recognise the continuing priority of PrEP, which many colleagues mentioned, and the trial that was announced last year by PHE and NHS England. Up to £10 million has been set aside to fund the trial, which is anticipated to include at least 10,000 participants over the next three years. We expect the trial to be under way this summer. It has the potential to change the lives of thousands of people who are at risk of contracting HIV.

[Jim Shannon]

I asked about where the older generation featured in things, as did the right hon. Member for Exeter (Mr Bradshaw), but the Minister has not touched on that yet. If she is not able to do so now, perhaps she can come back to us in writing.

[Nicola Blackwood]

The whole point of developing a much more systematic process and having a commissioning programme that does not allow the fragmentation of services, but instead is much more integrated, is that it will take into account more ageing people living with HIV. We believe that that will deal with the issue.

The hon. Gentleman also asked how we will tackle the issue of undiagnosed people living with HIV in the community. We believe that the strategy of increasing education and introducing compulsory sex and relationships education will be part of that, as will improving our performance, testing and early diagnosis. The work being done through the innovation fund is a key plank of that. Having clear specifications in commissioning guidelines so that we have coherent services for all who seek them is the strategy. We think that is a coherent response.

[Mike Freer]

Could the Minister write to hon. Members to clarify what will happen to those who are currently on the PROUD trial? What will happen while there is a gap between the drug stopping and the new trial starting? That would be appreciated.

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[Nicola Blackwood]

I shall be happy to provide that very important clarification.

We should not underestimate our progress on testing and diagnosing HIV. That is down to the campaigning and the very hard work of many people in this Chamber, and by the many campaign groups out in the community that are the bedrock of the service in this country and provide world-class services for people who live in the UK with HIV. However, as today’s debate shows, our way forward is not free of challenges, and we must continue to reflect on how we can best deal with and meet those challenges. I hope that the commitments I have announced today go some way towards reassuring Members that the Government take these issues very seriously. However, the Government cannot do it alone. I am sure that we can continue to rely on the wisdom and support of all those in this room and the incredible work of voluntary organisations, so that we can finally achieve our goal, which we have all been working towards for so many years: a world free from HIV/AIDS.

Draft Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) (amendment) Regulations 2017

Baroness Blackwood of North Oxford Excerpts

Monday 27th March 2017 General Committees

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

I beg to move,

That the Committee has considered the draft Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) (Amendment) Regulations 2017.

It is a pleasure to serve under your chairmanship, Sir Alan. I am delighted to be here to speak about these important regulations, which will continue to ensure the provision of five mandatory health and development assessments and reviews as set out in the healthy child programme.

The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) and Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) (Amendment) Regulations 2015 transferred responsibility for commissioning public health services for children aged nought to five from NHS England to local authorities, allowing local public health services to be shaped to meet local needs. That includes responsibility for delivering the healthy child programme.

The healthy child programme is the main universal health service for improving the health and wellbeing of children, providing families with health and development assessments and reviews, health promotion, screening and immunisation. It is supplemented by advice on health, wellbeing and parenting. The five reviews are offered by health visitors to pregnant women, new mothers and children from birth to age five and include the antenatal visit, new-born review, six to eight-week check, one-year review and two to two-and-a-half-year review. They are required to be provided by all local authorities in England.

Health visitors play a crucial role in ensuring that children have the best possible start in life and lead the delivery of the elements of the healthy child programme that relate to children aged nought to five. Health visitors provide valuable advice and support to families and are trained to identify health and wellbeing concerns. Through the health visitor programme, we have supported the profession more than ever before to transform the service.

In April 2015, when the health visitor programme was transferred, there was an increase of just under 50% in the number of full-time equivalent health visitors in the workplace since May 2010. Health Education England is ensuring sustainable development of the health visitor workforce, and more than 800 health visitor student training places are being commissioned. Along with service transformation, that means that more families now have access to the support they need in those precious early years.

We are also committed to supporting school-age children and young people by promoting their health and wellbeing through school nursing services. There are about 1,100 school nurses in England, supported by other professionals such as community staff nurses, healthcare support workers and nursery nurses. In January 2016, Public Health England published commissioning guidance for school nursing, which makes clear that school nurses should be accessible and responsive to children’s needs.

The 2015 regulations, which place a duty on local authorities to provide the five universal health visitor reviews, contain a sunset clause and will therefore lapse on 31 March 2017. The legal obligation on local authorities to provide health visitor services is also set to lapse on 31 March 2017. The draft regulations will prevent that from happening.

The current regulations also include a provision for a review to be undertaken of their operation. The Department of Health commissioned Public Health England to carry out a review of the operation of the five mandated universal health visitor reviews following the transfer of responsibility to local authorities, as set out in the 2015 regulations. A review was carried out in summer 2016, and Public Health England’s report was published on 1 March 2017. The review found widespread support from local authorities and commissioners for the universal health visitor programme remaining in place in order to secure the delivery of long-term benefits from the healthy child programme, including improved health and wellbeing outcomes for children and their families.

There was also a strong view held by professional representatives of local government and the nursing profession that the services are essential for prevention and early intervention and a general agreement that they deliver a positive return on investment and contribute to other Government priorities such as reducing childhood obesity, reducing smoking in pregnancy and improving maternal mental health. I would like to thank Public Health England for its important work on the review and for helping to inform the regulations.

Local authorities will continue to be funded to deliver the mandated health visitor reviews. Local authorities will receive more than £16 billion between 2015-16 and 2020-21 to spend on public health, which includes children’s services and health visitors. That is in addition to what the NHS will continue to spend on vaccinations, screening and other preventive interventions.

I announced earlier this month that we have decided to retain the ring fence on the public health grant for a further year, until 2019, as we move towards implementing 100% local business rate retention. That is a step on the way to a more locally owned system and will help to smooth the transition by providing some certainty for the next two financial years. It is right that local authorities have appropriate flexibility to deliver against their local priorities, but it is also appropriate that some key requirements are set nationally, such as the five universal health visitor reviews.

By continuing these mandated elements of the healthy child programme, we intend to maintain consistency across all local authorities when ensuring the delivery of these services. The draft regulations will remove the sunset clause from the current regulations, ensuring that local authorities continue to provide these important visits to families. Removing the sunset clause will ensure that the duty on local authorities to provide these services does not lapse on 1 April. I am confident that that sends a clear signal to health visitors, family nurses, local authorities and the public of the Government’s ongoing commitment to universal public health support for pregnant women, children and their families.

The Government are committed to improving our children and young people’s health outcomes so that they become among the best in the world. What happens in pregnancy and the early years impacts on the life throughout its course. Therefore, a healthy start for all children is vital for individuals, families, communities and, ultimately, the nation. I commend the regulations to the House.

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[Nicola Blackwood]

I am grateful for the shadow Minister’s support for the regulations. As she said, they will be essential to ensure the future health of the upcoming generation. I listened to the points she made. She can see in the health visitor numbers, which stand at 4,200, and in the 800 training places that we are committed not only to health visitors and a strong health visitor training force but to the quality of assessment within that force. I hope that she is reassured on that point.

Health visitors support families to give children the best possible start in life. That is exactly why we have taken this strong action to continue to ensure the provision of the five mandatory health and development assessments and reviews so that this service will continue to be provided to all families. I hope that the shadow Minister is reassured.

Question put and agreed to.

Oral Answers to Questions

Baroness Blackwood of North Oxford Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mary Robinson (Cheadle) (Con)]

8. What steps his Department is taking to use digital platforms to encourage people to access help to support their mental health and wellbeing.

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

The Prime Minister herself announced our commitment to developing and expanding digital mental health services, and we have backed that with an investment of more than £65 million. This work includes improving digital technology for the mental healthcare system, developing digital tools and therapies, and improving mental health information and services provided through nhs.uk and 111 platforms.

[Mary Robinson]

The Minister will know that for people with mental health problems, attending accident and emergency or going to see their GP is not always the best point of intervention, so I welcome measures to improve accessibility. Stockport Healthy Minds, which serves my constituency of Cheadle, provides a range of services such as online self-help courses, one-to-one therapy sessions, and group workshops. What is her Department doing to provide projects like Healthy Minds with the support and accessibility they need?

[Nicola Blackwood]

In addition to the funding that we are providing to improve the mental health pathways through nhs.uk and 111, we are providing £500,000 for the development of six digital tools, with a particular focus on children and young people’s mental health. I pay tribute to the work of Healthy Minds in my hon. Friend’s constituency and to her own championing of this issue.

[Mr Speaker]

Order. It is always a pleasure to hear the hon. Member for Hyndburn (Graham Jones), but can I just say to him that it is a good idea to bob consistently, and then one knows of the interest of an hon. Member? On this occasion, he looked at me meaningfully but was not bobbing; I am not psychic. But let us hear the voice of Hyndburn: Graham Jones.

[Mr Speaker]

Order. I was quite tough on the hon. Member for Burnley (Julie Cooper), but the hon. Gentleman took his time—he really did.

[Nicola Blackwood]

The hon. Gentleman misrepresents the situation entirely. Not only are we investing an extra £1 billion year in mental health services and expanding mental health services at a faster rate than anywhere else in Europe, but we have invested £15 million extra in places of safety for those in crisis and are expanding triage services, precisely to address the problem that he raises of those in mental health crisis who come into contact with the criminal justice service.

[Several hon. Members rose—]

[Helen Jones (Warrington North) (Lab)]

While digital platforms can be useful in guiding patients to the right service, does the Minister accept that there are still huge shortages of people who can carry out talking therapies, and long waits for child and adolescent mental health services? When are the Government going to stop talking about improving mental health services and actually ensure that the money is going where it is needed to recruit staff?

[Nicola Blackwood]

We are working extremely hard on increasing staff. We are not only introducing our new mental health workforce strategy, which we will publish shortly, but increasing the number of people who are seeing these services. Four million extra people have seen psychiatry services—talking therapies—and 90% of those patients are being seen within six weeks, which is exceeding our waiting time target.

[Mr John Baron (Basildon and Billericay) (Con)]

9. What assessment he has made of the potential effect of the EU general data protection regulation on the availability of data for research in the health sector.

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

We have engaged fully with the health and research community to ensure a positive and beneficial application of the GDPR in the UK. My hon. Friend is right that data are vital to the delivery of safe and high-quality care, but we need to ensure that there is a trusted system in place, and that people understand that their information is secure and have confidence in its use.

[Mr Baron]

I thank the Minister for that answer, but I have to tell her that when the EU’s general data protection regulation becomes enforceable next year, it will be more difficult to share data. Cancer charities, including Cancer Research UK, are concerned because the progress of life-saving research, especially into rare and children’s cancers, would not have been possible were it not for data-sharing. Will she do what she can to shield the UK from this harmful regulation, given that it disproportionately affects us because of the wealth of our data?

[Nicola Blackwood]

We have been clear that we are going to introduce the data regulation. We are working on exactly how we will do that in a balanced way that encourages data-sharing for the purposes of research in a sustainable NHS. We have set up a sub-group to examine the impact of the GDPR on research. It is hosted by the Wellcome Trust and includes members of the Health Research Authority’s confidentiality advisory group, the NHS Confederation, the Medical Research Council, the Department of Health, and the PHG Foundation. We will ensure that this works in an effective way to address the concerns that my hon. Friend has raised.

[Sir Nicholas Soames (Mid Sussex) (Con)]

10. If his Department will take steps to introduce the enriched culture medium test for group B streptococcus for pregnant women; and if he will make a statement.

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[Rushanara Ali (Bethnal Green and Bow) (Lab)]

15. What recent assessment he has made of the Government’s effectiveness in tackling childhood obesity in the inner cities.

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

Our childhood obesity plan includes a number of measures, such as the soft drinks industry levy, reformulation and school-based interventions, that will help all children, including those in inner-city communities. We will monitor progress carefully, including through the national child measurement programme. We will routinely publish developments on all key measurements for the programme, but it stands to reason that those who are most in need will benefit most from these interventions.

[Rushanara Ali]

I thank the Minister for that answer, but it remains the case that childhood obesity is twice as high in deprived areas as it is in more affluent areas. In Tower Hamlets, 20% of children are obese and a third are overweight. What will the Government do to reduce childhood obesity and when will the plan be published?

[Nicola Blackwood]

The childhood obesity plan has already been published. I think the hon. Lady may be talking about the reformulation targets and the baseline data, which are coming out imminently. The experts in Public Health England are working feverishly to make sure that the data are exactly as they should be. One measure I think she will be particularly keen to see is the investment in schools committed to by the Chancellor in the Budget, including the voluntary healthy rating scheme, which will be published in June.

[Mr David Nuttall (Bury North) (Con)]

What measure is being used to ascertain the success or otherwise of the strategy and when will we know whether it has worked or not?

[Nicola Blackwood]

As I mentioned, we will be publishing the reformulation baselines against which all future success will be measured. They will include measurement across all industry targets. In addition, we will of course have the voluntary healthy rating scheme for primary schools to recognise and encourage their contribution to preventing obesity.

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

T1. If he will make a statement on his departmental responsibilities.

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

We are firmly committed to improving the UK’s air quality and cutting harmful emissions. We have committed £2 billion since 2011 to increase the uptake of ultra-low emission vehicles, support greener transport schemes and set out how we will improve air quality through a new programme of clean air zones. In addition, in the autumn statement we announced a further £290 million to support electric vehicles, low emission buses, taxis and alternative fuels. I regularly meet the Department for Environment, Food and Rural Affairs to see how we can roll out this work.

[Jonathan Ashworth (Leicester South) (Lab)]

The Government have not met the four-hour target for A&E since July 2015. In the NHS mandate, finally published yesterday, the Secretary of State is effectively telling hospitals that they do not need to meet it in 2017 and that it only needs to be met in aggregate across hospitals

“within the course of 2018”.

Is that not the clearest admission that the targets will not be met next year, because in the next 12 months the NHS will be denied the funding it needs and, as a consequence, patients will suffer?

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[Ben Howlett (Bath) (Con)]

T6. Following the publication of the report of the all-party parliamentary group on rare, genetic and undiagnosed conditions on the UK rare diseases strategy, what plans does the Minister have to introduce an implementation plan for NHS England?

[Nicola Blackwood]

Frist, let me pay tribute to my hon. Friend for his leadership of the APPG on rare diseases. I am sure he will join me in feeling proud that the UK is a recognised leader in research, treatment and care for rare diseases in particular. We are at the forefront of the genomics revolution. He is right that the UK strategy for rare diseases needs to be translated into an implementation plan, and that is one of my personal commitments.

[Diana Johnson (Kingston upon Hull North) (Lab)]

T5. Will the Secretary of State explain why my area of Hull, with its in-built health inequalities and poorer health outcomes, is getting just £13 million out of the additional money for social care set out in the Budget, while the local authority area that the Secretary of State represents in Surrey is getting £21 million-worth of additional support?

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[Catherine West (Hornsey and Wood Green) (Lab)]

The Secretary of State will be aware of a recent High Court case concerning a surrogacy issue that has led to legal limbo. Does he agree that the existing legislation has let children down, and that reform is urgently needed?

[Nicola Blackwood]

I can confirm that the High Court has made a judgment, that the current orders for parental orders are discriminatory, and that the Government will act within a reasonable timescale. We intend to lay an order before the summer recess in an attempt to address some of the challenges.

[David Morris (Morecambe and Lunesdale) (Con)]

One of my constituents, Harriet North, has been diagnosed with TRAPS—tumour necrosis factor receptor-associated periodic syndrome. Her consultants say that the drug Anakinra will not only transform her life, but will save her life. Will my hon. Friend meet me to discuss how we can get the best treatment for Harriet, and if it is possible for NHS England to review the decision on this?

[Nicola Blackwood]

My hon. Friend has raised this case with the Department and has been making a number of pleas on behalf of his constituent. It is a very difficult case and I would like to pass on my sympathies to his constituent. Obviously, the National Institute for Health and Care Excellence is independent and this drug is not recommended for TRAPS. I do not know the details of the case because it is confidential, but I will be very happy to meet my hon. Friend and his constituent to see if anything can be done.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I do not know if you spotted the rather topical news story about children’s dentistry this morning, Mr Speaker: there were 1,464 hospital admissions for children for teeth extractions across one clinical commissioning area of Birmingham last year, the highest figure since 2010-11. How does the Minister account for this, and what is he going to do about it?

Health Committee

Baroness Blackwood of North Oxford Excerpts

Thursday 16th March 2017 Commons Chamber

[Dr Wollaston]

I would be delighted to meet the hon. Gentleman and share the report, as he suggests, because I agree that we should be sharing best practice throughout the devolved nations and England. On the specific point about the role of the media, the Samaritans has produced really clear guidelines, which I hope all media organisations will look at closely. We should also go beyond broadcast and print media and look at the role of social media and the internet.

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

I welcome the Health Committee’s report on suicide prevention and congratulate my hon. Friend and her Committee on their work on this very important issue. I join her in thanking those with lived experience who bravely contributed to the Committee’s work; the impact of their contribution cannot be overestimated.

Every death by suicide is a tragedy that has a devastating effect on families and communities, which is why the Government are committed to reducing the national suicide rate by 10% by 2020. We want all areas to learn lessons from organisations such as Mersey Care, with its zero suicide ambition. We were particularly grateful that the Committee published an interim report in December, as it allowed us to address many of its recommendations in our update of the national strategy. These included how we are driving local delivery, addressing stigma, improving suicide bereavement services and increasing awareness of the consensus statement for information sharing for people at risk of suicide. However, we do accept that we need to go further on implementing the cross-Government national suicide prevention strategy, which is why we published the updated strategy to strengthen delivery in key areas, including in implementation. It is also why we will continue to provide further updates.

The refreshed strategy now includes better targeting of high-risk groups and, for the first time, addresses self-harm as an issue in its own right, which is one of the most significant issues of suicide risk. We are working with the National Suicide Prevention Strategy Advisory Group, delivery partners across Government, and other agencies and stakeholders to develop an improved implementation framework.

We are already making good progress in ensuring that all local areas have a suicide prevention plan in place by the end of the year. To date, 95% of local areas have a suicide prevention plan in place or in development. We will also work with local areas to assess the quality of those plans, building on guidance on good practice. We have run a series of suicide-prevention planning masterclasses carried out by Public Health England to improve that quality. We have also published guidance to local authorities in January on developing and providing suicide bereavement services as an important plank of the plan.

Furthermore, we have announced that we will publish a Green Paper this year on children and young people’s mental health and develop a national internet strategy, which will explore the impact of the internet and social media on suicide prevention and mental health. That will address some of the issues that my hon. Friend has raised about the media and suicide. Hon. Members will also know that we are committed to all A&Es having core liaison services by 2020. They have rightly raised the fact that the workforce will be essential in delivering that ambition, and we will imminently be publishing our mental health workforce strategy, the performance of which I am sure that the Select Committee will closely scrutinise. We will carefully consider all the recommendations made by the Committee in this report and respond to them in due course.

My hon. Friend has rightly raised the connection between mental health services and suicide prevention. Does she agree that we cannot think about suicide without considering the broader matter of mental health? Will she and the Committee join me in welcoming the wide range of measures set out by the Prime Minister in January, in addition to the five year forward view for mental health, with a focus on earlier intervention and prevention in mental health services, because those improvements will be essential if we are to make the progress on suicide prevention that all of us in this House want to see?

[Dr Wollaston]

I thank my hon. Friend the Minister for her comments and agree with her absolutely about the importance of prevention and early intervention. I look forward to the strategies to which she has referred and to working with her to do all that we can to improve mental health and to reduce the terrible toll from suicide.

Pandemrix Vaccine: Compensation

Baroness Blackwood of North Oxford Excerpts

Wednesday 8th March 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Ryan, on International Women’s Day. I congratulate the hon. Member for Batley and Spen (Tracy Brabin) on securing this, her first Westminster Hall debate, on an important and sensitive topic. She gave a moving account of her constituent Di and her son Sam’s battles with narcolepsy and cataplexy, as did my hon. Friend the Member for York Outer (Julian Sturdy) on behalf of his constituent, Ben Foy. The hon. Lady clearly articulated what she would like to see happen as a result of the debate. I am grateful to her for her opening statement in support of the life-saving effects of vaccinations and her recognition of our world-class immunisation programme. It is important that we remember that as we discuss some of the issues at hand today.

As the hon. Lady has focused the debate on the specific vaccine Pandemrix, it is right that I start by explaining why it came to be used in the UK, although she did outline some of that. Pandemrix was developed for use in a flu pandemic. Flu pandemics pose a challenge for any Government, and they occur when a flu virus emerges and spreads around the world and most people do not have immunity.

Each pandemic is different. The nature of the virus, the population groups most likely to be affected and its impact cannot be known in advance. It is impossible to predict the severity of a new virus strain. Large swathes of the population can become infected over a relatively short period of time if transmission spreads rapidly. The potential impact of pandemic flu makes effective measures to limit the spread and morbidity of virus infection a public health priority. Countermeasures are employed in combination, including vaccination when possible.

As the hon. Lady knows, the most recent flu pandemic was H1N1 swine flu in 2009-10. All Governments have a responsibility to protect public health in such a situation. The decision to commence the swine flu vaccination programme, made by previous Ministers in 2009, was based, as she said, on the expert advice of the Joint Committee on Vaccination and Immunisation. Pandemrix was one of two vaccines used in the UK in that pandemic. Thankfully, the H1N1 strain of swine flu turned out to be relatively mild, but we should not forget that it still caused more than 450 deaths in the UK.

The hon. Lady clearly described the consequences and impact that narcolepsy and cataplexy have on Sam’s life. I assure her that I do not underestimate how distressing narcolepsy and cataplexy can be. As someone who lives with a complex chronic illness that causes me to collapse in the street at times, I know how vulnerable that can make both those who live with the condition and their families feel. It is important that anyone who lives with narcolepsy receives the appropriate care and attention to manage their condition.

The hon. Lady set out her understanding that Pandemrix has caused narcolepsy for some individuals, including her constituent, Sam, as did my hon. Friend the Member for York Outer in the case of his constituent, Ben Foy. Causation is currently one of the issues in dispute in the ongoing legal proceedings in which the Department of Health is involved, alongside the claimants and the vaccine manufacturer. Those legal proceedings are much wider than the issue of causation and cover many other areas. Until those proceedings are resolved one way or the other, it is not appropriate for me to comment on that in detail; it is a process that should be allowed to continue without interference from a politician. However, I assure the hon. Lady that I am deeply concerned about this and will keep a close eye on it as Minister.

The hon. Lady wants to ensure that Sam and people like him are adequately compensated for the development of narcolepsy following Pandemrix vaccination, and has set out the changes she would like to see to the vaccine damage payments scheme to address that. It is important to be clear that the VDPS was not designed to be a compensation scheme; there is no assessment of what losses were actually suffered. Someone who wishes to seek compensation needs to pursue a claim against the vaccine’s manufacturer. There are ongoing personal injury claims in this case, and it is important that those proceed without interference as well.

The VDPS was established in 1979 to help ease the burdens of individuals for whom, on very rare occasions, vaccination has caused severe disablement. The extent of that disablement is assessed on the same basis as for the industrial injuries disablement benefit scheme. The VDPS provides a one-off, tax-free lump sum payment of £120,000 for those who are severely disabled as a result of a vaccination against the diseases listed in the 1979 Act and diseases that have been specified since 1979 by various statutory instruments. Those vaccinations are within the childhood vaccination schemes.

The hon. Lady noted that Sam’s mother applied to the VDPS but her claim was rejected. The hon. Lady claims that was because Sam was not severely disabled enough, but my understanding is that, although the DWP agrees that Pandemrix can cause narcolepsy in theory, it did not do so in this particular case; the DWP did not accept causation in this particular case, rather than its not accepting that Sam was severely disabled enough. I have a different understanding from the hon. Lady, so perhaps she would like to write to the DWP for clarification.

I should also clarify that the Department of Health is responsible for policy and legislation for the VDPS, but the DWP is responsible for assessing claims, making payments against successful claims and handling appeals. To qualify for a VDPS payment, a claimant has to meet two legal tests. The first is to establish, on a balance of probabilities, that the disablement was caused by vaccination against a disease covered by the VDPS, and the second is that the resulting disablement is severe—60% or more—assessed on the same basis as for the industrial injuries disablement benefit scheme.

Decisions take into account advice from medical advisers who are fully registered doctors with a licence to practise and who have also undertaken special training in disability assessment. They review each claimant’s medical records and advise the DWP’s decision maker on causation and disablement. It is therefore important that the hon. Lady clarifies what happened in her constituent’s case, as it is for my hon. Friend the Member for York Outer in the case of his constituent.

Each claim is decided upon its own evidence. If a claimant disagrees with the outcome, they have the right to request a reversal of the Secretary of State’s decision. There is then an opportunity to provide further information to support that request, and the case will be reconsidered. They can also challenge the decision to reject the claim through a first-tier tribunal.

The hon. Lady also raised more general questions about how the VDPS operates and has suggested changes that she thinks are needed. I will address as many of those questions as I can in turn; if I do not get to some of them, I will write to her. She suggested that anyone who has had a Pandemrix vaccination should be eligible for a VDPS payment if they have developed narcolepsy following a vaccination. The Vaccine Damage Payments Act is based on diseases, not specific vaccines, so it is not possible to include Pandemrix in that legislation. However, the list of specified diseases covered by the Act already includes pandemic influenza A—swine flu—for which vaccination was administered from 10 October 2009 to 31 August 2010. That was a temporary addition considered appropriate by the Ministers at the time. Pandemrix-related claims are therefore already eligible under the VDPS, so long as other eligibility criteria are also met. I am aware that some individuals received a Pandemrix vaccination outside the timescale covered by the Act, and that that was the subject of a debate in the House; perhaps the hon. Lady would like to look at that, and if she has any further questions for me, I will be very happy to answer them for her and her constituent.

The hon. Lady also made the case that the level of the VDPS payment is not adequate to meet the needs of someone with narcolepsy. As I mentioned earlier, that is because the VDPS is not a compensation scheme and the sum paid is not based on an assessment of losses; it is a one-off, tax-free lump sum payment to help ease the burden. It must be seen in the context of wider help and support for the severely disabled within our benefits system, but payments through the scheme cannot meet all of their needs. There are no plans at the moment to increase the value of the payment, but as I mentioned earlier, it is open to individuals to pursue personal injury claims for compensation, in addition to applying to the VDPS.

The hon. Member for Strangford (Jim Shannon) raised the recent Court of Appeal judgment on how disablement is assessed. I can confirm that the Government will not appeal that decision. DWP medical advisers will now consider future prognosis in addition to the current level of disablement when assessing claims. Previous cases in which causation has been accepted will be reconsidered in accordance with the Court of Appeal judgment where claimants consent to a further investigation of their medical history.

[Jim Shannon]

Will the change at the DWP following the Court of Appeal’s decision start immediately?

[Nicola Blackwood]

It will start as soon as it can be implemented.

I will also follow up on the point that the hon. Member for Batley and Spen made about Xyrem. The scheme for its supply is due to continue until the personal injury claims are settled, at which point it will be reviewed. I hope that reassures her. I will be happy to look into the issue that she raised about a postcode lottery to try to understand how that situation can be eased.

We do not have a huge amount of time left, so I will bring my remarks to a close. I assure the hon. Lady that I have every sympathy for Sam and others affected by narcolepsy; I have a small amount of understanding about quite how distressing that can be. The hon. Lady should not consider the VDPS in isolation as a means of supporting Sam and others like him. It is part of a much wider package of care and support that is available to people with disabilities, including the NHS, social care and the benefits system. It is important not to leave the debate with the impression that vaccines are dangerous. Vaccine safety is of paramount importance, and with modern technology and stringent manufacturing and control processes, vaccines are the safest they have ever been. I hope that, by the end of the debate, hon. Members will know that the Medicines and Healthcare Products Regulatory Agency and the Government’s independent expert advisory Commission on Human Medicines keep the safety of all vaccines under review. Serious side effects are, thankfully, very rare.

While it is important to have a scheme such as the VDPS in place—I am grateful to have had the opportunity to hear the views on it of the hon. Lady and of my hon. Friend the Member for York Outer, who is no longer in his place—it is also important to acknowledge that we have a world-class immunisation programme that is the envy of many other countries that are not able to prevent the diseases we do in the UK. Immunisation is a vital way of protecting individuals and the community as a whole from serious diseases. Uptake for UK immunisation programmes is more than 90% of the target population for most childhood vaccinations. Vaccinations save lives, and I strongly encourage families to take them up when offered. I assure the hon. Lady that I have listened to everything she has said and will consider it going forward as the Pandemrix case continues.

Question put and agreed to.

O’Neill Review

Baroness Blackwood of North Oxford Excerpts

Tuesday 7th March 2017 Westminster Hall

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

I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing this very well attended debate and on his ongoing commitment to highlighting this issue. I pay tribute to the all-party group on antibiotics, my hon. Friend the Member for York Outer (Julian Sturdy) and the right hon. Member for Rother Valley (Sir Kevin Barron) for their leadership. I also commend my right hon. Friend the Member for Tatton (Mr Osborne), who is no longer in his place. He really set the issue squarely on the international agenda during his time as Chancellor.

As many hon. Members have described well today, antimicrobial resistance has the potential to lead to 10 million deaths by 2050—more than are caused by cancer—and a loss to global productivity of £100 trillion. As my hon. Friend the Member for Thirsk and Malton said, the figures are on a scale that is hard to comprehend, but the good news is that the ramifications of AMR are now widely acknowledged, and we can be proud that the UK has played no small part in that. Our chief medical officer, Dame Sally Davies, has led a global campaign to get AMR and the lack of new drugs in the development pipeline high on the global political agenda.

We have used the UK’s antimicrobial resistance strategy and our response to the O’Neill review, which we published last September, to drive change at home and abroad. This has led to the landmark UN declaration on AMR in September, which was adopted by 193 countries. The declaration recognises that AMR is an issue that relates not just to human health, but—as my right hon. Friend the Member for Chipping Barnet (Mrs Villiers) and the hon. Member for Bristol East (Kerry McCarthy) rightly said—to animal health, agriculture and the environment, with a significant social and economic impact. It puts AMR squarely not just on the global development agenda, but on the global security agenda.

As numerous hon. Members have mentioned, a key Government commitment in response to the review was to work with international partners to develop a global system that rewards companies for bringing new, successful products to market and makes them available to all who need them. There are a number of options for addressing the market failure, but the O’Neill review suggests using a system of market entry rewards to incentivise companies to bring new products to market. A number of international organisations, including the Boston Consulting Group, commissioned by the German Government, have looked at the issue more recently and come to similar conclusions, which is helpful in building an international consensus.

The UK supports that approach, particularly options that involve private sector contributions, but although a global solution is needed, different countries have different perspectives. In some countries, lack of access to effective antimicrobials is as great a risk as resistant bugs. The WHO estimates that 30% of people in developing countries do not have access to essential medicines, rising to 50% in sub-Saharan Africa. The UK is working to reach an agreement at the G20 to acknowledge market failure. The G20 has commissioned the OECD to consider potential solutions, and it will consider a range of options. The UK will support alternative systems that can effectively tackle market failure in a cost-effective and sustainable manner that ensures a long-term, sustainable supply of new antibiotics but also provides access to all.

While Lord O’Neill made it clear that interventions to stimulate the antimicrobials market should be administered at global level, he was also clear that at national level we must have better purchasing arrangements that conserve antimicrobials and do not incentivise unnecessary use. That is why the Department of Health is working with industry, through a joint working group with the Association of the British Pharmaceutical Industry and the National Institute for Health and Care Excellence, to consider reimbursement approaches that support these aims and how reimbursement models that de-link revenue from volume can be operationalised. It is essential that such a scheme is workable, so I will report back to Members when I am able to do so.

Colleagues are right that we will not make progress if we do not improve our stewardship and diagnostics, and cut avoidable infections and inappropriate prescribing. One of our ambitions in that regard is to halve the number of healthcare-associated Gram-negative blood stream infections by 2020. Delivery of that ambition is being led by NHS Improvement. Our initial focus is a 10% reduction in E. coli infections by 2017-2018, because there are established interventions to prevent such infections, and we are making some progress in this area.

A second ambition is to halve inappropriate prescribing by 2020. This work is now being led by the chief pharmaceutical officer at NHS England, with support from Public Health England, but the challenge is to identify the proportion of current prescribing that is inappropriate, so that we can safely reduce our use. Our experts are working to set a baseline, so that we can clarify our ask to prescribers. This will build on work that is already under way to reduce unnecessary prescribing.

I can report that there has been some progress in this area. In November 2016, data showed that total consumption of antibiotics by humans in England fell by 4.3% between 2014 and 2015, which is the greatest change that we have seen since the early 2000s. We are making progress, but our experts believe we can go further so we have put incentives in place through the NHS quality premium and commissioning for quality improvement schemes—which is quite a mouthful—to encourage further reduction, and we will maintain that system for a further two years, so that we can embed those changes.

My hon. Friend the Member for Thirsk and Malton also said that over-the-counter antimicrobials were a key area. It is illegal for websites based in the UK to sell antibiotics online without a prescription. Some websites offer online consultations with doctors, but they must abide by the General Medical Council guidance on remote prescribing, and it is extremely important that people exercise caution in how they use online care providers, especially when it comes to seeking medicines or treatments that may not be appropriate for them.

Regulatory agencies, such as the Medicines and Healthcare Products Regulatory Agency and the Care Quality Commission, are monitoring the safety and efficacy of prescription medicines and those selling them. Following an internal review of all 43 online services that are registered, the CQC has brought forward a programme of inspections, prioritising those services that it considers might pose a risk to patients. It will obviously report soon on that work.

My right hon. Friend the Member for Chipping Barnet and the hon. Member for Bristol East were absolutely right that the Department of Health needs to work closely with the Veterinary Medicines Directorate to reduce the use of antimicrobials in livestock and in fish farmed for food. Between 2014 and 2015, we saw a drop of 10% in sales of antibiotic for food-producing animals, but we know that we need to go further. So we are now in the process of setting sector-specific targets, as my right hon. Friend the Member for Chipping Barnet said, to ensure that we achieve our ambition of 50 milligrams per kilogram weight of animal by 2018.

My hon. Friend the Member for Erewash (Maggie Throup) was also right to highlight the need for better diagnostics if we are to achieve our stewardship ambitions. O’Neill was clear that that was necessary for better clinical decision making in both animal and human health. There is great potential to make better use of the diagnostic tests that are already available in a range of settings, including for self-care and monitoring in pharmacies and other high-street services. So NHS England has a programme in place not only to improve the use of the diagnostic tests that we already have but to identify the priority needs for new tests, so that we can work with researchers and industry to support the development and uptake of those tests. NHS England is also working with NICE to identify how its programmes could support more rapid uptake of effective diagnostic tests. If my hon. Friend would like us to, we will write to her with the details of that work.

In the end, this challenge is a global one that requires global leadership, as my right hon. Friend the Member for Tatton has said. The UN declaration was the start of a longer process to make sure that all countries develop and implement a national action plan, and it is essential that the follow-up process, which was agreed in the declaration, is put in place as soon as possible, to ensure that no time is lost in getting to where we want to be before we go back to the UN General Assembly in 2018. Within that timeframe, we will continue to support other countries to tackle antimicrobial resistance, including providing help to build capability and capacity to develop good surveillance systems in low and middle-income countries, through our £265 million Fleming fund and our £1 billion Ross fund, exactly as the hon. Member for Glasgow North (Patrick Grady) has said.

Lord O’Neill also recommended the establishment of a global innovation fund of $2 billion by 2020. The UK co-hosted a side event at the UN in September 2016 that brought together a package of pledges from Governments around the world to tackle AMR, totalling more than £675 million, which is a really considerable start in achieving that recommendation.

All of this work means that we now have unprecedented levels of global collaboration in research in the UK, co-ordinated by the AMR Funders Forum and supported by the Medical Research Council. We are now working hard to promote research and innovation in AMR globally, which includes making a further £50 million commitment towards setting up a global AMR innovation fund, to increase global investment in AMR and support the development of new drugs and diagnostics.

In closing, I thank all Members—

[David Tredinnick]

On that note, will the Minister give way?

[Nicola Blackwood]

I will close now but follow up later.

I thank all Members who have attended today. The high turnout and the quality of debate speaks to the fact that AMR is more than a domestic health challenge and more than a global development challenge. It is truly a global security challenge, of a scale that requires long-term political leadership to drive through the international change, the up-front investment to break the cycle of market failure in drugs development and the urgent action needed to improve diagnostics and cut inappropriate prescribing, and to ensure that patients complete their courses of medicines in an appropriate way.

We can be proud of the genuinely leading role that the UK has already taken, both domestically and on the international stage, but my commitment to all Members here today is that we shall not miss a step in driving forward on research and development, on stewardship and on international co-operation. As a science superpower with an integrated healthcare system, we are uniquely well placed to meet this challenge and we are determined to do so.

[Mr Philip Hollobone (in the Chair)]

Before I ask Kevin Hollinrake to sum up, I detect that there may be some Members in the Chamber who are here for the debate on social care in Liverpool. We have a half-hour debate on student loans before we get to that debate; everything has been held up by the Divisions in the main Chamber. I am just trying to be helpful to Members who might here for another debate.

Health Redress

Baroness Blackwood of North Oxford Excerpts

Monday 6th March 2017 Written Statements

[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

Tuesday 28th February 2017 Written Statements

[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

Tuesday 7th February 2017 Commons Chamber

[Craig Williams (Cardiff North) (Con)]

5. What plans the Government have to bring forward new legislative proposals on surrogacy.

[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)]

6. What plans he has to ensure that the implementation of recommendations in Sir Robert Naylor’s review on the NHS estate is compatible with local sustainability and transformation plans.

--- Later in debate ---

[Andrew Rosindell (Romford) (Con)]

9. What plans the Government have to increase access for patients to innovative drugs and medical devices.

[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?

[Nicola Blackwood]

We are working hard on that exact point.

[Andrea Jenkyns (Morley and Outwood) (Con)]

20. As the Health Secretary is aware, my constituent Abi Longfellow is suffering with a rare kidney condition—dense deposit disease. What plans do the Government have to increase access to specialist drugs for those such as Abi with ultra-rare diseases?

[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)]

17. Now that four failures have been recorded of the main drug used to protect UK patients from malaria, and scientists are warning for the first time that resistance may be increasing, will the Minister outline what further steps are being taken to tackle antimicrobial resistance in the coming years?

[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)]

11. What assessment he has made of how the accelerated access review will improve access to breast cancer drugs.

[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)]

18. I am delighted to do so, Mr Speaker—thank you very much. Given that there is no general hospital in my constituency and a large number of my constituents have to travel many miles for cancer treatment, what discussions has my hon. Friend had with the Welsh Government to persuade them to fund mobile cancer treatments?

[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.

--- Later in debate ---

[Mr Speaker]

We got the thrust of it.

[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)]

T6. People in Lancashire will be pleased that the emergency department in Chorley has reopened, providing access for people 12 hours a day. Will my hon. Friend welcome that good news and thank everyone involved?

--- Later in debate ---

[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

Thursday 2nd February 2017 Westminster Hall

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.