Musculoskeletal Services: Greenwich
Baroness Blackwood of North Oxford Excerpts(7 years, 3 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is a great pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Eltham (Clive Efford) on securing this debate. I know that the subject is extremely important to him and his constituents. He has very eloquently raised the different concerns, which is no less than I would expect of him from our shared days on home affairs matters. I would warn him, however, that I doubt whether I will be able to answer every single one of his questions in detail. I will endeavour to get through the best I can and then reply with further detail in writing.
First, I would like to pay tribute to the many staff who work exceptionally hard every day for our NHS and deliver high-quality care for patients. As the daughter of an NHS doctor and nurse, who are now retired, I have seen at first hand how much personal sacrifice that involves from both NHS workers and their families, who often have to spend a lot of time apart from their dedicated NHS family members. It is a sacrifice that I am sure all of us here today would like to honour, especially during this busy time.
It is important to say at the outset—I know the hon. Gentleman is aware of this—that procurement of local health services by means of competitive tendering is a matter for the local NHS. Greenwich clinical commissioning group, which is the deciding body in this case, is a clinically-led independent statutory organisation. We believe it is right that local NHS systems are best placed to understand the health needs of their local populations and to use that knowledge to commission services for local people, to ensure the best clinical outcomes for all patients at the highest quality and best value to the taxpayer.
I know the hon. Gentleman knows that musculoskeletal services are currently provided to about 9,500 Greenwich patients by the four NHS trusts and one private provider, but despite the hard work of local health workers, the latest data show that Greenwich CCG’s referral rate to treatment trauma and orthopaedics performance is only 80.8%, against a target of 92%. It also shows a high number of out-patient appointments—more than 50% higher than the national average—with many seeing a consultant surgeon and then not having surgery. That paints a clear picture of too many patients waiting for too long. Even when they do get an appointment, they do not always see the right health professional, which means another wait for physio or other interventions.
As someone who has a chronic, complex illness and was misdiagnosed for more than a decade, I understand how dispiriting it is to wait in pain only to endure the disappointment of inappropriate or unnecessary appointments or tests and to end up on a new waiting list still in pain, just more frustrated. I know that because I lived it. We have to do better to get the right care to the right patients in the first place.
Taking such steps not only improves patient care and their experience of the NHS, but cuts out wasted appointments and tests, and frees up hugely valuable consultant and technician time, saving money that can be spent on appropriate care instead. That is why the CCG identified the musculoskeletal hub model, which has been successfully implemented using a range of different kinds of providers, private and public—I am agnostic on that point—across the country. It concluded that it would secure better value for money from that more streamlined service model, especially at the point of referral.
Given the hon. Gentleman’s description, I think he knows this, but I will say it anyway: the hub model means identifying one healthcare provider to act as a single point of access for all Greenwich musculoskeletal patients. That healthcare provider then offers patients who need an in-patient operation a choice of where the operation takes place. It is also able to triage patients more effectively into physio and other non-surgical treatments sooner, which means that surgery can often be prevented because it is possible to intervene quicker, which is better for patients.
The hon. Gentleman expressed concern in his parliamentary questions about the procurement process. However, I am sure he welcomes the fact that there was some consultation prior to procurement. He questioned the information that has come to me, and I will double-check it, but I have been told that the draft specification was shared with the CCG patient reference group and the pensioners forum for their comments prior to finalisation. When the musculoskeletal service was put out to tender in April 2016 in an open procurement process, the prospective bidders were required to put forward a programme budget within the range of £14 million to £14.8 million a year.
Clive Efford
Lewisham and Greenwich NHS Trust made about 50 requests for information about the scope of the contract it was being asked to bid for during that process, and it received very few responses from Greenwich CCG. It is very difficult to say that there was adequate information or consultation about the impact of the service, because very little information came from the CCG.
Nicola Blackwood
I am sure more information could have been made available, but there certainly were attempts to engage with patients to ensure the contract was shaped to meet patient need.
In the end, two bids were received. They were anonymised and evaluated by a panel that included clinicians. According to the information I have received, the CCG had at least four GP members in attendance at the governing body meeting of 29 June, as well as three other voting members. The musculoskeletal specialist was from another area, specifically so that the panel could benefit from his experience without risk of conflict. Following the evaluation section of the meeting, all members with a conflict of interest were asked to leave the room, as the hon. Gentleman said. Those members’ votes were transferred to other governing body members, in line with the CCG’s constitution. I am not sure where the hon. Gentleman’s information about the numbers in the meeting comes from. According to the information I have received—which I will check—the remaining members of the CCG governing body then voted, and the meeting was quorate, in line with the actual numbers in the room. They voted on the still anonymised bids. Following that process, the five-year contract was awarded to Circle Health. The bid was assessed by NHS England to be according to the NHS standard procurement process, which is obviously legal.
As the hon. Gentleman said, under the proposed model, Circle will triage all patients registered with a Greenwich GP who require physiotherapy or planned orthopaedic surgery to ensure they receive the most appropriate medical professional support the first time to avoid inappropriate patient experiences. The aim is to reduce the number of first out-patient appointments, because many have been found clinically unnecessary. Further, if the trust experiences fewer unnecessary out-patient appointments, surgeons will have more time to carry out elective surgery, which will reduce waiting times for those who really need it. Over the lifetime of the contract, the CCG expects the average waiting time at Lewisham and Greenwich NHS Trust to reduce from 7.8 weeks to below 7 weeks.
As I said, regardless of the details of the procurement, which we will check, ensuring that patients are better served with the right care at the right time must be something that colleagues from across the House support. I heard the hon. Gentleman’s concerns about the impact on existing services and his view that the assessment should have been carried out further. At any rate, I am pleased it is being carried out now. As I understand it, Greenwich CCG discussed the procurement with Greenwich Council’s healthier communities and adult social care scrutiny panel—which is very snappily named —at a meeting on 3 November. The panel accepted that the process had been correct, but due to the level of public concern it requested that the CCG and the trust co-commission an independent assessment of the likely impact on orthopaedic activity at Lewisham and Greenwich NHS Trust and also that the outcome of that assessment be shared with the HCASC prior to the CCG’s signing the contract. That is what is happening, and it is clearly the right thing to do.
The main concern raised by the HCASC is that the trust may see a reduction in elective orthopaedic activity, as the hon. Gentleman said, which would affect trauma services. The impact assessment will review the likelihood of a range of impacts—from a minus 40% shift in elective orthopaedic surgery to a plus 40% shift—and the resulting effect on local trauma services, emergency department services and other interdependent services at Queen Elizabeth hospital, as well as the risk to the clinical and financial viability of the trust. It will also consider the potential impact, should there be such a shift in orthopaedic surgery, on sustaining undergraduate and postgraduate training, capacity plans and backlogs, interdependent clinical services, the delivery of the national constitution standards for referral to treatment, and the implications on future recruitment of orthopaedic clinicians and support staff. Those are the parameters that were requested by the trust and others, so I think we can be confident that it will achieve its purpose.
The impact assessment is due to be presented to the Greenwich CCG board on 22 February. The report will be shared with the healthier communities and adult social care scrutiny panel the following day and published on the CCG website. The outcome of the assessment remains to be seen, but I am sure the hon. Gentleman agrees that it is essential that the CCG proceeds with what has clearly become a highly politicised decision with the best interests of patients as its core priority. As I said, the data show that we need to work to improve care for musculoskeletal patients in Greenwich, to ensure that all patients are getting the right care at the right time.
Question put and agreed to.
Children’s Wellbeing and Mental Health: Schools
Baroness Blackwood of North Oxford Excerpts(7 years, 4 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is a pleasure to serve under your chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb), his colleagues and the Children’s Society for initiating this debate. As ever, I pay tribute to his continuing personal commitment to improving mental health services, not only as my predecessor but also through chairing the commission on children and young people’s mental health for the Education Policy Institute. That work has been extremely valuable to us.
The right hon. Gentleman is quite right to say that today’s debate is both timely and hugely important. As many colleagues have demonstrated in their comments, we know the distress that mental health problems cause to individuals and those who care for them. Some 10% of children have a diagnosable disorder—700,000 in the UK—and they are twice as likely to leave school with no qualifications, four times more likely to become drug dependent and 20 times more likely to end up in prison. He could not have put it better. There is a compelling moral, as well as social and economic, case for change. We know that if we can get our children and young people the help and support they need early on, when problems first arise, we can make sure that the problems do not become entrenched. That is why the Prime Minister was clear in her determination to improve mental health services and tackle the burning injustice of those with mental ill health having a shorter life expectancy.
As has been discussed, the measures announced by the Prime Minister particularly tackle children and young people’s mental wellbeing and build on the substantial work already in train to implement “Future in mind”. We will continue that work, so that we can go further and faster in intervening earlier more often. In driving those reforms forward, one of the challenges we still face—the right hon. Member for North Norfolk identified this when he was a Minister—is the “fog” when trying to identify and pinpoint the best treatment and support for those with mental health problems. We need to base policies on the most robust evidence possible, so that we can be sure that we are providing the care that people need at the right time and in the right way.
That is why the Department for Education is conducting a large-scale school survey on the activities and approaches used in schools to support children and young people’s mental health in order to find out what works best, and why the Prime Minister requested that the Care Quality Commission undertake an in-depth thematic review—the first of its kind. That is also why we are carrying out a prevalence survey on children and young people’s mental health—the first since 2004, which was before YouTube, Twitter or Snapchat. The survey will look at issues such as cyber-bullying and the impact of social media for the first time, and it is on course to report in 2018. It will fill an important gap in our understanding.
As the right hon. Member for North Norfolk knows, I believe very strongly that transparency in mental health services has lagged behind that in acute services. At a national level, data on children and young people’s mental health services were included in the new mental health services data set for the first time in January. It is still early days, but as collection improves, new metrics to monitor delivery are becoming available. We know from experience in acute services that that does improve accountability, standards and safety for patients. I will respond in detail to the comments of the shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley) about her letter—I do not have time to do that properly right now—but we are looking at how we can drive accountability, eradicate all shadow of confusion from clinical commissioning groups about how they should be reporting, and make sure that we get that data set exactly right. As recommended by the taskforce, we will publish a 10-year research strategy to ensure that the evidence-gathering is sustained. A new policy research unit for mental health will be established in 2017 to make sure that the research continues to become a reality.
While all the evidence-gathering is going on, we cannot stand still. That is why we will press ahead with the implementation of “Future in mind”. As the right hon. Member for North Norfolk said, some areas are performing well and improving, some need to get the message about why this is important, and others are coming from such a low base that they are still working on capacity building, so we are not seeing evidence of improvement yet, but we are clear that we are ambitious not only to deliver “Future in mind” but to go further upstream and intervene earlier to prevent problems. The evidence base that we are building will come together to support the publication of the Green Paper, with increasing focus on preventive activity across all delivery partners. The Prime Minister committed initially to a new focus on schools, colleges and local NHS services working more closely together to provide dedicated children and young people’s mental health services. We are supporting schools and the NHS to develop work by evaluating models and approaches and exploring the impact that closer working can have. We will initially support that by funding the provision of mental health first aid training for teachers in secondary schools—we know that that works. That is our start. I am going to do the training in the next few weeks, to see exactly why it works.
As we know, the Prime Minister also launched a refreshed programme of activity on peer support in schools and online to help young people, through providing access to well-trained mentors, as well as comprehensive support structures to help identify issues and prevent them from escalating.
Nicola Blackwood
Absolutely. We are also looking at increasing support for schools by finding the evidence of what is proven to work in their approaches to mental wellbeing. That will be achieved by a programme of randomised control trials of promising preventive programmes across the country. As the hon. Lady also mentioned, the refreshed suicide strategy has a particular focus on self-harm, which is causing so many problems in schools.
To make the measures work and to see the progress that we so desperately need, we have to work closely with colleagues across Government. As colleagues have said, schools and colleges have an important role to play in supporting children and young people’s mental health. That role is not only laid out in statutory safeguarding guidance but is one of the four areas of Ofsted judgment in the new common inspection framework.
Colleagues are right: if we are to expect schools to play this role, we must give them the right training and resources. In 22 pilot areas, which include 255 schools across the country, NHS England has been trialling a single point of contact in schools. That programme has tested improvements in joint working between school settings and specialist mental health services—particularly improvements in local knowledge and identification of mental health issues—and it aims to develop and maintain effective local referral routes to specialist services to ensure that children and young people have timely access to specialist support where required. It is also testing the idea of a lead contact in schools and specialist mental health services and examining how different areas choose to put that into practice. The work is being independently evaluated by Ecorys, and the final report will be available in the spring. The question is whether that system is more effective than having an individual counsellor in every school. We are looking at that.
Other support available includes Government-funded PSHE Association guidance, and lesson plans on how to teach mental health across all four key stages. A range of training on how to recognise specific mental health issues is available to all professionals who work with young people through the MindEd website; our analytics have shown that teachers are the largest single group of registered users on the MindEd tool. As the shadow Minister said, mental health and wellbeing is an evolving and vital area of education, and we need to make sure that it is fit for children growing up in modern Britain, so the DFE is looking again at the case for further action on PSHE and sex education provision, with particular regard to improving quality and accessibility. I am sure that it will keep the House updated on that.
The right hon. Member for North Norfolk is absolutely right that school counselling can turn around a child’s whole life trajectory, so schools are encouraged to provide counselling services, and the DFE has produced guidance on good school-based counselling as part of a whole-school approach to wellbeing. It has also published advice on behaviour and mental health, which provides teachers with information, and with tools to help them identify pupils who need help and to give effective early support in understanding when a referral to a specialist mental health service may be necessary. An advisory group, including sector experts and young people, looked at what good peer support for mental health and wellbeing looks like and considered how to encourage good practice in schools, community groups and online. There is much greater recognition that the earlier we pick up these things, the better it is for young people and their mental health.
The “Children and Young People’s Mental Health: Time to Deliver” report from the right hon. Member for North Norfolk found that we are making progress in many areas of the country, but not nearly enough to be complacent. I agree completely with that. We are restless in our ambition not only to drive delivery of “Future in mind” in all areas, but to go further and deliver upstream interventions to prevent problems, rather than waiting until the need for treatment. I hope that I have convinced the right hon. Gentleman that this is an area to which we are fully committed, and that we will continue to drive forward with his agenda.
Question put and agreed to.
Resolved,
That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.
Oral Answers to Questions
Baroness Blackwood of North Oxford Excerpts(7 years, 4 months ago)
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David Tredinnick (Bosworth) (Con)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
Evidence-based medicine is about using high-quality research to guide clinical practice and to achieve optimal results for all patients. The National Institute for Health and Care Excellence plays an important role in supporting evidence-based medicine by translating research into authoritative guidance for healthcare professionals on best practice.
David Tredinnick
Is the Minister aware that the author of “Evidence-based Medicine” in 1992, Professor David Sackett, said that it is
“about integrating individual clinical experience and the best external evidence, not just internal evidence”?
Is she further aware that in respect of the interpretation of evidence-based medicine, I have reported the so-called Good Thinking Society to the Charity Commission for the abuse of its charitable status through its use of legal threats to force the Department and health providers to change the law on healthcare?
Nicola Blackwood
NICE obviously considers complementary and alternative medicines when developing its guidance, where there is evidence, and it has been able to recommend some therapies, such as acupuncture for tension headaches and a range of complementary medicines for multiple sclerosis. We expect healthcare professionals to take that guidance into account when designing local services, but they must use their best understanding when treating the individual patients in front of them.
Keith Vaz (Leicester East) (Lab)
The evidence is very clear that eating more sugar increases the risk of diabetes. Apart from introducing the sugar tax, what further evidence-based research can be used by the Government to reduce the risk of diabetes?
Nicola Blackwood
The right hon. Gentleman is a great proponent of tackling the risk of diabetes. He knows that the Government take tackling and preventing diabetes extremely seriously. That is why we have introduced the world’s first national diabetes prevention programme, which we have piloted and are rolling out across the country. It includes not only education programmes but testing, and we are making sure that we use the evidence from the programme to bring about improvement and that we are rolling it out effectively.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
We are all in favour of evidence-based medicine. We are also in favour of decent resources for the national health service but, in the case of Huddersfield and Calderdale hospitals, what we want is good, high-quality management, rather than GPs being promoted to a managerial position that they cannot handle.
Nicola Blackwood
The hon. Gentleman is a great advocate of evidence-based medicine and I am pleased to hear about his support for it. He will be pleased that the national leadership programme is one of the evidence-based programmes that we are rolling out to improve the leadership of the NHS across the country.
Kevin Hollinrake (Thirsk and Malton) (Con)
Chris Green (Bolton West) (Con)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
The UK is already a global leader in the fight against AMR. This Government’s leadership has secured a UN declaration on AMR and a commitment from the G20 to drive the development of new antimicrobials. We will continue to deliver international programmes to tackle AMR, including the Fleming fund and the Global AMR innovation fund, which represent more than £300 million of investment over the next five years.
Kevin Hollinrake
One of the 10 key recommendations of the O’Neill review was to improve the data and surveillance underlying antimicrobial resistance. What plans does the Minister have to routinely test all NHS patients for antibiotic resistance?
Nicola Blackwood
My hon. Friend is absolutely right that it is essential that we improve diagnostics if we are to tackle this national threat. A routine part of the clinical management of patients showing symptoms of infections is to take a blood sample. When an infection is identified, those samples are indeed tested for resistance. Part of our AMR strategy is to improve diagnostics and to fund innovation in this area.
Mrs Villiers
Will the Government commit themselves to ensuring that their strategy will include discouraging the use of intensive farming, given its overuse of antibiotics which contributes to antimicrobial-resistant problems?
Nicola Blackwood
I agree that we must focus on that as well, but we are currently focusing on reducing the need for antibiotics by minimising disease risk in animals through good animal husbandry and on-farm biosecurity. At present, antibiotics provide the only effective means of treatment for a number of animal diseases, and are therefore essential to ensuring the health and welfare of animals. However, we are also working on the matter in an international context with the World Organisation for Animal Health, and we will continue to drive forward the agenda.
Chris Green
What measures are the Government introducing to support the uptake of point-of-care C-reactive protein testing throughout the United Kingdom, given that it is a proven and cost-effective means of reducing levels of inappropriate antibiotic prescribing in primary care?
Nicola Blackwood
As my hon. Friend says, we must focus on innovation and better diagnostic tests, particularly bedside tests. The Government are actively reviewing evidence of the benefits of CRP tests. Pilot studies in the United Kingdom are contributing to that, and will be evaluated so that we can see how best to build on what can be shown to be working well.
Jim Shannon (Strangford) (DUP)
Nicola Blackwood
I am grateful for that immediate promotion from the hon. Gentleman.
We have made considerable progress in establishing the building blocks of our domestic AMR strategy, including better data, guidance for primary care, and a strengthening of the framework for antimicrobial stewardship, which involves introducing incentives for the NHS to improve the prescribing of antibiotics. That has led, in the last quarter, to the first reduction in such prescribing, which I think we can take as an encouraging sign.
Thangam Debbonaire (Bristol West) (Lab)
One of the 10 recommendations of the O’Neill review on antimicrobial resistance was for a massive global public awareness campaign. Given that 700,000 people die each year as a result of AMR, and given the review’s estimate that that figure will rise to 10 million a year by 2050, what assurances can the Minister give that she is behind that awareness campaign?
Nicola Blackwood
The hon. Lady is right to identify the scale of the challenge, which is why we have put AMR on our national risk register, and she is also right to point out that no one country can tackle AMR alone. The United Kingdom has played a global leadership role. We co-sponsored the World Health Organisation’s 2015 global health plan and created the £265 million Fleming fund so that we could specifically help poor countries to tackle drug resistance, and we will continue to play that global leadership role.
Daniel Zeichner (Cambridge) (Lab)
The O’Neill report was published some six months ago and included recommendations for national Governments. What practical progress have the Government made so far?
Nicola Blackwood
On 19 September we published our comprehensive response to the report, which describes a range of actions that we will take on each of Lord O’Neill’s recommendations. The most practical progress that I can report is the fact that the prescribing of antibiotics has fallen for the first time since records began. I think that we can all be proud of that progress.
Gavin Newlands (Paisley and Renfrewshire North) (SNP)
Margaret Greenwood (Wirral West) (Lab)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is too early to speculate on the renewal of this contract, but it will ultimately be for NHS England to determine the selection criteria for the future procurement of services provided by it. My focus right now is on raising the quality of the existing contract, and I have been clear that the standard of Capita’s work under the contract has not been acceptable and it must improve. I continue to meet regularly with Capita and NHS England as they work to improve the performance of the service.
Margaret Greenwood
I thank the Minister for that response. Several GP practices in my constituency have reported serious delays in the transfer of medical records. In some cases the records have gone missing altogether, with serious implications for patient safety. I would like a clear response from the Minister about the assurances she can give to my constituents that the Government—not just NHS England, but the Government—take seriously the safe delivery of their confidential medical records.
Nicola Blackwood
I take this issue extremely seriously, which is why I am personally meeting NHS England and Capita fortnightly and ensuring that detailed rectification plans are in place for each service delivery programme. The improvements should happen between January and April next year. I shall be happy to write to the hon. Lady in more detail if she would like to be able to reassure her GPs, optometrists and dentists on those issues.
Several hon. Members rose—
Kate Green (Stretford and Urmston) (Lab)
Will the Minister advise GP practices in my constituency, who have been massively inconvenienced by the chaos of the Capita contract, that full compensation will be available for the inconvenience they have been put through?
Nicola Blackwood
At the moment, NHS England and Capita are focusing very hard on improving service delivery, which I think must be the top priority, but we are also looking into exactly what inconvenience and costs GPs have suffered, along with dentists and optometrists, and that will be considered and discussed with GPs.
Rob Marris (Wolverhampton South West) (Lab)
Natalie McGarry (Glasgow East) (Ind)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
In developing the childhood obesity plan, we considered the latest research and evidence on promotions and advertising, including Public Health England’s evidence package “Sugar reduction: the evidence for action”. We have made no secret of the fact that we considered a range of policies before finally settling on those set out in the childhood obesity plan. The plan includes the soft drinks industry levy and taking 20% of sugar out of certain products. We concluded that our plan is the right approach to secure the future health of our children.
Natalie McGarry
I associate myself with the Secretary of State’s words of sympathy for the people of Berlin, and I also add my thoughts for the people of Aleppo, Yemen, Gaza, Mosul and all the forgotten conflicts of the world.
Public health experts have dismissed the Government’s obesity strategy as a weak approach and a wasted opportunity. The Government say that they are committed to evidence-based policy making, but they have failed to acknowledge that relying on voluntary food action without tackling cost and availability is inherently flawed. Will the Minister commit the Government to getting a grip and bringing forward a ban or restrictions on advertising and price-cutting promotions on junk food?
Nicola Blackwood
I am happy to reassure the hon. Lady that current restrictions on advertising in the UK are already among the toughest in the world. For example, there is a total ban on the advertising of less healthy food during children’s television programmes. Those have been shown to be very effective. However, we also welcome action that has been taken by forward-thinking retailers on promotions elsewhere. In particular, Sainsbury’s has committed to removing multi-buy promotions across its full range of branded and own-brand soft drinks, confectionery, biscuits and crisps, removing more than 50% of its multi-buy promotions from its grocery business while lowering regular prices for products. It should be congratulated on leading the way.
Mr Alan Mak (Havant) (Con)
Advertising agencies and industry bodies can play a key role in ensuring that adverts are appropriate. Will the Minister continue working with the industry to tackle child obesity?
Margaret Ferrier (Rutherglen and Hamilton West) (SNP)
Certain supermarkets persist in placing less healthy foods on promotion near the entrances to their stores, where they are unavoidable. Does the Minister agree that it is not just at checkouts that healthy options should be promoted, and that retailers should exercise more responsibility?
Nicola Blackwood
I absolutely agree that putting healthier options near checkouts and helping people to make healthier choices are part of retailers’ responsibilities. What has been notable in my discussions with retailers is that the penny is starting to drop that this is the direction of travel and what the public want, and I think we are going to start seeing a real sea change in the way retailers are advertising.
Several hon. Members rose—
Philip Davies (Shipley) (Con)
May I urge the Minister not to go down this ridiculous nanny-state route—which one would not expect from a Conservative Government—of setting up an unhealthy food police to go round telling people what they should be eating and what they should not be eating? No food eaten as part of a balanced diet is in itself particularly unhealthy. If the Government are so concerned about families that are just about managing, why on earth would they even contemplate increasing costs for working families?
Nicola Blackwood
My hon. Friend flatters me by saying he thinks I am a nanny—it is really quite a disturbing thought. However, what we have here is an obesity plan that balances the need to cut the sugar in young people’s diets, as a way to make sure they get a healthy diet, and individual choice, which we know is absolutely a Conservative ideal.
Chris Green (Bolton West) (Con)
Fiona Bruce (Congleton) (Con)
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I pay tribute to my hon. Friend for her dogged campaigning on this issue, on which she is a true champion. I have not had a chance to read the report in detail, but I have seen a number of its recommendations and we are taking action on some of them, including the publication of the chief medical officer’s low risk guidelines and Public Health England’s One You campaign, which runs over Christmas and the new year. We are embedding alcohol measures into the NHS health check and we have introduced a national CQUIN—Commissioning for Quality and Innovation—because evidence shows that intervention by a health professional is the most effective way of disrupting problem drinking.
John Mann (Bassetlaw) (Lab)
Adam Afriyie (Windsor) (Con)
Despite some of the obvious challenges in the healthcare service, this is a wonderful time of year when hundreds of thousands of people choose to quit smoking by putting down their cancer stick and picking up an electronic vaping device. Does the Minister share my concern, however, that we must be very cautious in any implementation of the EU tobacco products directive so that it does not act as a barrier to people quitting smoking and taking up vaping?
Nicola Blackwood
The Government are very clear that vaping is significantly less harmful than continuing to smoke. Under the current regulatory regime, huge numbers of smokers are successfully using these innovative products as an effective quitting tool. We have already committed to reviewing the TPD and we will fully explore the opportunities that Brexit may provide, but until exit negotiations are concluded we remain a full member of the EU.
Mr David Hanson (Delyn) (Lab)
Nicola Blackwood
I absolutely cannot confirm that. The tendering process has not even begun. Therefore, we are not considering any form of company, private or otherwise.
Dr Sarah Wollaston (Totnes) (Con)
The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report’s recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?
Dr Rupa Huq (Ealing Central and Acton) (Lab)
TB rates are currently higher in bits of Ealing than in Rwanda. Could the Government better the bilateral innovation fund to which they have committed with China and go for the O’Neill report recommendation to work towards a truly global fund, in conjunction with other nations, to fight antimicrobial resistance?
Nicola Blackwood
As I have already answered, we are a world leader on AMR. We have not only the bilateral fund with China but the £265 million Fleming fund, through which we will deliver bilateral national action plans with a number of developing nations. We are committed to going further than that through the global action plan with the UN.
Tom Pursglove (Corby) (Con)
A fortnight ago, I visited the pharmacy at the Corby urgent care centre to thank the dedicated staff for all that they do all year round, and to have a flu jab as part of the ongoing campaign. Does the Minister agree that exactly that sort of proactive working is crucial in trying to tackle winter pressures?
North-east London STP
Baroness Blackwood of North Oxford Excerpts(7 years, 4 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate the hon. Member for Ilford South (Mike Gapes) on securing this important debate. He is rightly known as a fierce defender of his local NHS services, and his constituents should be proud of his record.
As both a patient with a chronic and complex illness and a daughter of a cardiologist and a nurse, I know from both sides exactly how much heart and soul our NHS workforce put into their day jobs. It is easy in debates such as this about structures and processes to lose sight of that, so I wish to begin by paying tribute to all of those who work at Barking, Havering, and Redbridge University Hospitals NHS Trust in the constituencies of the hon. Gentleman and the hon. Member for Walthamstow (Stella Creasy) for their dedication, determination and commitment to providing first-class services to all those in their care. We should just take a moment to note that.
The NHS’s own plans for the future, set out in the five-year forward view, recognise three great challenges facing the NHS: health and well-being; care and quality; and finance and efficiency. The five-year forward view also recognised that challenges facing different areas of the country will inevitably be buried. The problems facing Ilford will, by definition, not be the same as those facing Ipswich, and a single national plan would not be effective or appropriate. That is why NHS England’s 2015 planning guidance called for local commissioners to come together with their providers across entire health economies to develop a collective strategy for addressing those challenges in their own areas. In much the same way, in fact, Labour’s 2015 general election manifesto on health, “A Better Plan for NHS Health and Care”, said that to reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides. The hon. Gentleman mentioned the King’s Fund, which has been clear that we need to strengthen parts of the STP process. It will be of interest to him that Chris Ham, the chief executive, has also been clear that STPs are the only chance the NHS has to improve health and care services. We have to drive this through and we have to get it right.
All local STPs are now published and, as the hon. Gentleman said, local areas should be having conversations with local people and stakeholders including Members of Parliament to discuss and shape the proposals, understanding what matters to them and explaining how services might be improved. These conversations will inevitably gain pace over coming months and we should all want and encourage as many people as possible to get involved. Where relevant, areas should build on existing engagement through health and wellbeing boards and other existing local arrangements. They should also look for innovative ways to reach beyond those existing relationships and into local communities.
There are 44 STP areas, as the hon. Gentleman will know. They cover the whole of England, bringing together multiple commissioners and providers in a unique exercise in collaboration. That is why this is quite a challenge.
Stella Creasy
It is good to hear the Minister say that she wants to see local people involved in these plans. Will she therefore commit not just to a conversation but a consultation with teeth to give people confidence that the very difficult decisions that we all know have to be made about changing the NHS can be done with their consent, and not simply given to them as a fait accompli?
Nicola Blackwood
Perhaps if the hon. Lady lets me continue with my speech, she will hear a little more about how the process will go forward.
The geographies have been determined not by central bodies, but by what local areas have decided makes the most sense to them. In the case of the constituency of the hon. Member for Ilford South, that has involved five providers, seven CCGs and eight local authorities covering the whole of north-east London. Each area has also identified a senior leader, who has agreed to chair and lead the STP process on behalf of their peers. In north-east London it is Jane Milligan, the chief officer of Tower Hamlets CCG, who is co-ordinating the development of the plan.
I was concerned to hear what the hon. Gentleman said about local authorities not feeling as involved as they should. It is important to emphasise that local authorities must play a role in developing these plans. Reflecting the social care needs of an area, which councils are obviously best placed to represent, will be key to the success of the NHS in the coming years, so they must be closely involved.
The plans offer the NHS an opportunity to think strategically and open up the public discussion about how we will meet the challenges facing the NHS in terms of demand and rising costs. It is inevitable that debate will become heated; it is simply a reflection of how important local NHS services are for us all. By planning across multiple organisations—both commissioners and providers—STP footprints can seek to address in an holistic way the health needs of an area and all the people within it in a way that we have never had the opportunity to have before.
We all know that the NHS faces tough choices about how we will design future services to meet rising demand, rising costs, and more chronic and complex illnesses. Choices have often previously been postponed again and again because they were too hard and because the discussions are too uncomfortable. I do not think anyone in the Chamber would think it is fair or safe for our local populations for us to keep putting them off in this way.
In north-east London, as elsewhere, that has meant having an honest conversation about the best way forward for services that are unsustainable as well as how to integrate services to give patients a clearer route through the system. All those conversations will help ensure that patients maintain access to high-quality care.
As I understand it, the north-east London October STP draft looks at these challenges in a number of different ways. The hon. Gentleman has described some of them. It also proposes embracing integrated services, from urgent and emergency care to mental health care and support as well as public health, which is important to me as the Minister for Public Health. The STP is also exploring how to improve patient outcomes through community-based care and preventive measures, which must be important if we are to manage demand. For example, the proposals include utilising initiatives to provide adequate housing in the area, and using new models of care to give health education. It also highlights three enablers for change for the area—workforce, digital enablement and infrastructure—and investigates how to improve its position with each.
I share the view of the hon. Gentleman and the hon. Lady that the public, key stakeholders and elected representatives should be closely involved in the development of STPs. With the plans now published, preparation for STP implementation must begin in the new year. Now is the time for STP leaders to reach out actively and engage patients and the wider public, and I expect nothing less. That means having frank, engaging and iterative conversations across areas, as well as some potentially difficult conversations about what the NHS could and should look like. Simon Stevens and Jim Mackey—the heads of NHS England and NHS Improvement—have written an open letter to STP leaders making that expectation absolutely clear. The letter reiterated that now is the time for local engagement to help develop the proposals and for those involved to make it clear that these plans must have a real benefit to patients.
I should also be clear that, nationally, all reconfigurations must meet the four tests mandated by the Government to NHS England in 2010, which require all local reconfiguration plans to demonstrate support from GP commissioners, strong public and patient engagement, clarity on the clinical evidence base, and support for patient choice. We would not expect any proposal to move forward that has not met all four tests. Patients must be at the heart of the NHS, and no plan can be successful unless they are fully engaged.
I close by saying that the hon. Gentleman has raised some very serious questions around details of his local STP plan and the quality of public consultation. I will ask the Minister responsible for community health—the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat)—to meet him and the hon. Lady to discuss the details to ensure that they are properly ironed out and that the public consultation and discussion are of the highest possible quality.
Question put and agreed to.
Public Health Grants
Baroness Blackwood of North Oxford Excerpts(7 years, 4 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
Today we are publishing the ring-fenced public health grant allocations to local authorities in England for 2017-18.
We are committed to supporting improvements in public health and are making available £3.3 billion to local authorities for this purpose in 2017-18. Over the five years from 2016-17 to 2020-21 we will be investing over £16 billion to support local authorities’ public health responsibilities, which include sexual health, tackling obesity, supporting physical activity, prevention, treatment from drugs, alcohol misuse, stop smoking services and other interventions. This is in addition to what the NHS spends on preventative interventions such as immunisation and screening.
We are expecting the 10 local authorities in Manchester to fund their public health activities from April 2017 through retained business rates as part of a wider pilot of business rate retention. Those 10 local authorities will not receive a central Government grant to fund their public health activities.
Full details of the public health grants to local authorities can be found on www.gov.uk. This information will be communicated to local authorities.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-12-15/HCWS363/.
[HCWS363]
Draft Consumer Rights (Enforcement and Amendments) Order 2016
Baroness Blackwood of North Oxford Excerpts(7 years, 5 months ago)
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The Chair
I know that the Minister is unwell, so I will allow her, if she so wishes, to move the motion from a sedentary position.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I beg to move,
That the Committee has considered the draft Consumer Rights (Enforcement and Amendments) Order 2016.
Thank you, Mr Davies. It is a pleasure to serve under your chairmanship, and I am very grateful for the Committee’s indulgence.
The Consumer Rights Act 2015, which came into force last year, simplifies UK consumer law, empowers consumers, improves consumer choice and drives competition. It provides clear rights for consumers when buying goods, services and digital content, and clear remedies so that consumers know what they are entitled to when things go wrong, and action can be taken where needed. It also provides enforcers such as trading standards offices with a set of updated powers to aid them in investigating potential breaches of law while ensuring that businesses have the relevant rights of appeal.
The order makes a number of small but essential amendments in relation to schedule 5 to the 2015 Act. It adds a number of pieces of legislation to the list in schedule 5 so that enforcers such as trading standards can access the updated investigatory powers in the schedule. The order will ensure that a comprehensive range of powers is available to enforce the Tobacco and Related Products Regulations 2016, which harmonise trading rules on how tobacco products are manufactured, produced and presented, and the Standardised Packaging of Tobacco Products Regulations 2015, which require cigarettes and roll-your-own tobacco to be packaged in a standard colour with a standard typeface.
The order also makes consequential amendments to two pieces of legislation to make them refer to the investigatory and enforcement powers contained in schedule 5. The legislation that the order affects is the London Local Authorities Act 2007, which tackles rogue traders by requiring mail-forwarding businesses in London to register with their local authority, and the Weights and Measures (Northern Ireland) Order 1981, which regulates the quantity of goods and measuring equipment used by traders.
The Government consider that the order provides for the application of the most modern suite of enforcement powers to those pieces of legislation. Importantly, it will allow trading standards offices to play their full part in enforcing new tobacco legislation introduced by the Government. In turn, it will continue to drive down smoking rates in this country. I therefore commend the order to the Committee.
Nicola Blackwood
I thank the shadow Minister for her support and the spirit of bipartisanship in this festive season. The Government share her view that reducing variation in smoking, especially among vulnerable groups, is a top priority. That is exactly why we are working hard on the tobacco control plan to ensure that it is the best possible plan and that it delivers on its aims. I would be happy to update the House as soon as that is possible.
Consumers and businesses benefit from the Consumer Rights Act 2015 in all sectors. The Act was introduced to strengthen, simplify and modernise the law and to consolidate enforcement powers. It is right that the powers are applied to the specified legislation without further delay to provide legal certainty for enforcement authorities. Through that, we can see the benefits of the tobacco legislation that we have delivered and that has made us one of the leading countries in the world on tobacco enforcement. I commend the order to the Committee.
Question put and agreed to.
Variant CJD and Surgery
Baroness Blackwood of North Oxford Excerpts(7 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this important debate on variant CJD and surgery. It is clearly an area on which he has a great deal of knowledge. I recognise that prion disease is the causative agent of transmissible spongiform encephalopathies such as variant CJD. It remains in many ways obscure and there are many aspects of these rare diseases that we are still in the early stages of researching. However, one thing I am confident about is that the UK system for ascertaining CJD case numbers has been for the past 20 years reliable and accurate. Our national CJD research and surveillance unit, which is based in Edinburgh and funded by the Department and the Scottish Government, leads pan-European work and has leadership from expert clinicians and scientists who, in 1996 following BSE, were the first to identify variant CJD as a separate form of the condition.
The Department recognises the potential seriousness of secondary—person-to-person—transmissions of vCJD and has since the late 1990s introduced a series of measures to reduce the risk of such spread, whether by blood transmission or by surgery. We are reassured that there have to date been no cases attributable to surgical transmission and only three cases of clinical disease attributable to blood transfusions, all of which occurred in or before 1999. However, our risk assessment models, which we use in our impact assessments of potential risk reduction measures, continue to take into account the potential for secondary—person-to-person—transmissions by both routes, in people with all genotypes and over potentially very long incubation periods, which my hon. Friend mentioned. This is why the scientific advice we have is that the surgical instrument measures in place are sufficient irrespective of the genotype.
My hon. Friend was right to mention the recent case. It was always anticipated on the basis of a wide body of published scientific work that, following the BSE epidemic, further cases of vCJD, including MV cases, might arise from time to time. We have seen that with similar diseases, such as kuru in Papua New Guinea, and studies suggest MV cases could be seen in small numbers for more than 30 years after exposure. Having reviewed the information about the case of vCJD in a patient with MV genotype, the Advisory Committee on Dangerous Pathogens has advised that no changes in the current risk reduction measures are needed at present. It advises that the measures in place are sufficient, irrespective of genotype, although of course the matter will remain under review.
It is important to stress that modern surgical equipment in the UK is very safe and that robust guidance is in place for the NHS on procedures and practices to reduce the risk of contamination of any kind, including the use of single-use instruments where possible and of decontamination practices. Where it is not possible to use single-use instruments in higher-risk procedures, there are processes in place to track the use of specialist equipment. As my hon. Friend will know far better than I do, there is a potential risk of vCJD transmission via dental surgery, and this has been recognised by the UK’s chief dental officers. In 2007, they issued letters to all dentists to advise that endodontic root canal reamers and files should be used as single-patient or single-use instruments.
Sir Paul Beresford
I am a little worried that the Minister appears to accept that surgical procedures are as good as they can be, given that the Department is inviting research to find a RelyOn equivalent, to improve the situation. The Department must therefore see a flaw in what we have at present.
Nicola Blackwood
My hon. Friend anticipates my next words as only an experienced Member of Parliament can do. I think it is right to say that there has so far been no evidence of any secondary, person-to-person, vCJD transmissions via surgery or dentistry. Nevertheless, we are maintaining and updating our precautionary approach. Surgical instruments guidance has recently been refreshed to support health organisations in delivering the required standard of decontamination of surgical instruments and to build on existing good practice to ensure that high standards of infection prevention and control are developed and maintained. My hon. Friend mentioned a number of these points.
The major change in this latest revision takes account of recent changes to the Advisory Committee on Dangerous Pathogens transmissible spongiform encephalopathy subgroup’s general principles of decontamination. This establishes a move towards in-situ testing for residual proteins on instruments. Residual protein is important because of the potential risk of the transmission of prions, though vCJD has not been shown to have been transmitted person-to-person in this way. The guidance provides information on how sterile services departments can mitigate the patient safety risk from residual protein with the objective of reductions in protein contamination levels through the optimisation of decontamination processes.
The ambition is that all healthcare providers engaged in the management and decontamination of surgical instruments used in acute care will have implemented this guidance by 1 July 2018. However, providers whose instruments are likely to come into contact with higher-risk tissues—for example, neurological tissue—are expected to give the guidance higher priority and to move to in-situ protein detection methodologies by 1 July 2017.
The chief medical officer has also recently written to NICE supporting the need to update its guidance on patient safety and the reduction of risk of transmission of CJD via interventional procedures, to ensure that it is fit for purpose, appropriately targeted, and can command the confidence of those who use it. We would expect this to take account of available evidence, including decontamination methods that are safe and effective against human prions; the epidemiology of CJD, including data on the prevalence of vCJD infectivity in the UK population from the appendix prevalence studies; and the availability and performance of single-use instruments in high-risk specialties. We would also expect the guidance review to be considered in the context of the latest research on prevalence, particularly for those born after 1996, who are currently considered unlikely to have been exposed to the BSE agent.
My hon. Friend is right, however, to say that adopting the precautionary principle alone is not sufficient. That is why successive UK Governments have been supportive of the development of new measures that might help in vCJD risk reduction. The Department of Health has provided over £70 million for CJD-related research in the last 15 years. That research has focused on infectivity, pathogenesis and transmission risk; decontamination of surgical instruments and the development of more sensitive methods to detect residual proteins to improve instrument cleaning; test development, treatment and diagnosis; and surveillance, screening, epidemiology and case finding.
Sir Paul Beresford
I accept everything that my hon. Friend says. However, a test solution is on the market and waiting to come through. The prion unit test has reached the point at which it just needs a final run to ensure that it does come through. I hope that I can count on the Minister to back me in persuading the MRC to support that last round of testing. If we could test blood, we would not have to import blood products from overseas. We could separate out the one in 2,000 or whatever the figure is and cut down on the costs of instrument storage.
Nicola Blackwood
That is one reason why the Department has continued in difficult financial times to ring-fence £5.5 million a year for CJD-related research. We are keen to see safe, evidence-based, cost-effective measures to reduce the risk of vCJD. At the moment, however, there is no validated diagnostic blood test that can be used before the onset of CJD symptoms to diagnose whether someone is infected or incubating the disease. We will of course take advice from the ACDP and the Advisory Committee on the Safety of Blood, Tissues and Organs on the use of any potential test in any proposed Department of Health-funded research study or deployment by UK blood services, but there are established systems for applying for research funds. We have put such funds out there, and any applications for those funds must go through the standard processes. To do otherwise would be to undermine the reputation for research excellence that the UK scientific community has fought hard to establish.
To that end, we recently launched an open competition, inviting proposals for research to further inform our risk-management and health-protection measures, including our understanding of vCJD infection in the UK population, the development of a test able to detect pre-clinical levels of infection in blood, and the development of decontamination technologies for reusable medical instruments. I understand that Professor Collinge’s RelyOn is one application that is currently going though that process, so it would be inappropriate for me to intervene.
I assure the House that the Department recognises the fatal consequences of all forms of clinical CJD and the devastating cost to individual patients, their families and carers, which my hon. Friend described movingly. That is why we set up the vCJD Trust in 2001 in recognition of their wholly exceptional situation and the fact that the Government are their last resort for help. The trust provides a no-fault compensation scheme for vCJD patients and their families, providing payments to be made in respect of 250 cases from a trust fund of £67.5 million. Over £41 million has been paid out by the trust to date.
Jim Shannon
In my intervention on the hon. Member for Mole Valley (Sir Paul Beresford), I asked whether compensation should be increased because of the number of years since the agreement was first made. With great respect and humbleness, I ask the Minister whether the Government would consider that.
Nicola Blackwood
The scheme is considered to be particularly effective. I shall look at it in the light of the hon. Gentleman’s comments, but it seems to be meeting current concerns. It is also important not to overstate the risks of CJD compared with other disease threats we face. The incidence is now low, with only two new cases in the UK since 2012. While every death is an individual tragedy and we must be alert, we need to ensure that finite resources—research funding, policy development or committee activities—are applied proportionately and are appropriately evidence based.
The ACDP continues to provide independent risk assessment advice on prion disease, informing both research priorities and public health measures to mitigate against risks from healthcare interventions, including the surgical, medical and dental procedures issues that were raised today. The ACDP is clear that risk to both patients and the general public is extremely low. Nevertheless, the current robust systems of active surveillance for CJD continue, and our experts maintain a close watch on new evidence, reviewing it as it becomes available. I assure the House that neither the Government nor the NHS has drawn back from our responsibilities to ensure that precautionary and proportionate measures are in place to protect patients from the risk of acquiring infection with prion agents during their healthcare. We have put in place robust research investment to ensure that the situation can only improve.
Question put and agreed to.
Child Cancer
Baroness Blackwood of North Oxford Excerpts(7 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is, as always, a pleasure to serve under your chairmanship, Mr Davies.
I begin by acknowledging and thanking the many thousands of people who have supported the petition in memory of Poppy-Mai Barnard. I extend my deepest sympathies to Poppy-Mai’s family and friends. I also thank my hon. Friend the Member for Bath (Ben Howlett) for the thoughtful way in which he presented the petition. The debate has been moving. I shall do my best to respond to as many comments as possible; if I fail, I shall write in response.
I acknowledge the success of Poppy-Mai’s family in raising more than £100,000 in her name, with the aim of building a sanctuary for children with terminal illnesses and their families to make memories. I know that they would, in the spirit of the petition, want action to ensure that fewer and fewer children have to suffer from cancers, and that they would want to know that the Government are investing in key research and innovation to that end. I hope that there is some comfort to be derived from hearing of the work of the NHS and its partners to benefit children and their families in the future. I thank colleagues on both sides of the House for their moving and highly informed contributions and all who have bravely shared personal stories. They remind us forcefully of why we must fight harder in the battle against childhood cancer. The importance of that cannot be overstated.
At this point, I want particularly to respond to the hon. Member for Alyn and Deeside (Mark Tami), who made some extremely important and pertinent points, in particular about ensuring that there is the right support for families. They must battle on many fronts, not only at the point of diagnosis but in the longer term. As the Minister responsible for mental health I share the hon. Gentleman’s view that we must do better in taking into account the mental health implications of long-term and critical illness. I shall certainly take up his challenge to consider the issue of higher suicide rates among childhood cancer survivors. At the moment we are in the process of refreshing the suicide strategy, targeting vulnerable groups. I shall consider the issues that the hon. Gentleman raised.
We can take heart from the fact that we are making progress in a number of areas. National statistics reveal a general trend of increasing five-year survival for children aged up to 14 diagnosed with cancer in England. In 1990 only 67% of children diagnosed with cancer survived five years; in 2009 that had increased to 80.9% of children. The figure was about 40% in the 1970s, which enables us to understand how far we have come. However, some types of children’s cancers, as we have heard, remain hard to treat, with longer-term physical and psychological consequences. In the past few decades we have improved our understanding of the consequences and have been able to manage them better; but we must and can do better. As the hon. Member for Birmingham, Selly Oak (Steve McCabe) said, we need to speed up the translation of basic research into patient care, and to improve the quality of survivorship.
As my hon. Friend the Member for Bath said, the five-year cancer strategy for England is at the forefront of our efforts. That was produced on behalf of the whole cancer community by the independent cancer taskforce. It is our aim through that strategy to save an extra 30,000 lives of all ages by 2020. The taskforce, as hon. Members would expect, brings together all the major players supporting people with or at risk of cancer. It includes patient groups and voluntary sector organisations, which we know are crucial to the support of cancer patients. I join colleagues in paying tribute to Oliver, the nephew of the hon. Member for Barnsley East (Michael Dugher), and to Be Child Cancer Aware, Anthony Nolan, Cancer Research UK and many other charities that do so much in this area. Without the outstanding work of many medical charities, our work would be less robust and innovative and there would be less hope of bringing about the step change that we need.
The strategy was published in July 2015 and was followed by an implementation plan to take it forward in May 2016. The first annual report was published last month. The Government accepted all 96 recommendations of the strategy, some of which are directly related to children, including a review of children’s and young people’s cancer services to inform actions. The aim is to deliver improvements across the cancer pathway and to improve the quality of care and survival rates—to make exactly the Herculean effort, and with the same co-ordination, called for by my hon. Friend the Member for North Thanet (Sir Roger Gale).
I am relieved that the taskforce found that cancer services for children and adults, and the outcomes in those services, have improved in recent years. The strategy is specifically designed to build on that momentum. Many of the recommendations relate to all cancers and cancer services; but of course some are relevant to, and greatly benefit, children and their families in their experience of care, and improve outcomes.
NHS England is leading the health and care system in delivering the strategy and investment is being targeted to support that. Key elements include: investing up to £300 million a year by 2020 to increase diagnostic capacity to meet a new faster diagnostic target—many people have spoken of the importance of early diagnosis —so that all cancer patients will be given a diagnosis or the all-clear within 28 days of GP referral; investing £130 million to modernise radiotherapy across England, ensuring that over the next two years older Linac radiotherapy equipment being used in hospitals will be upgraded or replaced, so that patients get access to the latest leading-edge technology regardless of where they live; establishing cancer alliances throughout the country to drive clinical leadership; and supporting the national cancer vanguard to test new models of care.
A theme of the strategy is the improvement of information on services and outcomes, including, from 2017-18, exploring approaches to collecting data on the experience of care of children who are cancer patients.
Thangam Debbonaire
On the point about upgrading Linac machines for radiotherapy, one of the key problems that Cancer Research UK raised with me was radiographer and radiologist staffing shortages. Can the Minister add anything to reassure us that when the Linac machines are upgraded there will be sufficient staff?
Nicola Blackwood
There is also work being done on making sure the workforce are in place; and there is an overall strategy with Health Education England to do that. I am happy to write to the hon. Lady to give her details. I am slightly concerned that I have a lot to get through and I am going to bore everyone.
The taskforce has also recommended a new drive to deliver chemotherapy e-prescribing, which makes a significant difference to the experience of families who are supporting children being treated for cancer. Providers are working to implement plans for children by September 2017. Under the strategy, proposals will have been developed by March 2017 to improve the transition of young patients with cancer between children’s and adult services. As the hon. Member for Bristol West (Thangam Debbonaire) has said, transitions continue to pose a problem in some areas, with paediatric services stopping at 16 in some hospitals, but adult services not starting until 18. In addition, pathways between specialist centres and shared care units currently cause great difficulty for patients. The strategy says that there is a need to address that, and I hope that the hon. Lady will be reassured that work is being done on it.
An important recommendation of the strategy is that NHS England, the National Institute for Health Research and cancer research charities should work together to consider how to achieve a significant increase in access to clinical trials for teenagers and young adults with cancer—the shadow Minister, the hon. Member for Burnley (Julie Cooper) spoke about that. A far smaller proportion of teenaged and young adult patients than of younger children take part in clinical trials. There is obviously an opportunity that we need to grasp. The strategy recommends that we explore ways in which clinical trials for children and young adults with cancer could be significantly increased. As the shadow Minister said, NHS England should set an expectation that all centres should aim to recruit at least 50% of their patients for those trials by 2025. That is the target that we are reaching for.
Outside London, only four centres treat more than 100 children with cancer a year, across all types of cancer. The strategy recommends that NHS England, working through the children, teenagers and young adults clinical reference group, should consider whether outcomes could be improved through further reconfiguration of services, as the shadow Minister said. Any review should again be based on patient outcomes, including patient experience, as few centres offer comprehensive specialist services for children at the moment.
Many hon. Members have rightly called for research to be prioritised in that context. It is good that, since 2010-11, we have increased annual investment in cancer research through the National Institute for Health Research, including research into childhood cancers, from £101 million to £142 million. However, we know that a lot more needs to be done if we are to deliver the changes that we want to see. That is why the Government announced the largest ever investment in health research in September— £816 million over five years from April 2017. Some 20 NHS and university partnerships across England have each been awarded funding through the NIHR, and we expect to see significant research activity in childhood cancers within that programme of investment.
The NIHR is also collaborating with three charities—Teenage Cancer Trust, Children with Cancer UK and CLIC Sargent—to identify gaps and unanswered questions in research into young peoples’ cancer and to then prioritise those gaps that patients and clinicians agree are the most important. The initial survey opened just last month, so we expect to see progress on that soon.
A new working group has brought together clinicians, charities and officials to discuss how we can increase the level and impact of research into brain tumours, including those in children. The group first met in October and the Government anticipate that it will complete its tasks by September. I will be co-chairing the next meeting in January with the Department of Health’s chief scientific adviser, Professor Chris Whitty, to make sure that we make the progress needed.
Julie Cooper
Does the Minister agree with the important comments made by brain tumour charities that EU funding is fundamental, and will she commit to ensuring that, should we not have access to EU research funding post-Brexit, the UK Government will make sure that that gap is filled?
Nicola Blackwood
The shadow Minister has made some important points about the EU, as have a number of colleagues, and I will come on to them before I finish. First, let me complete my remarks on the amount of funding that we have put into research, because it is important that it is seen as a package. Less than two weeks ago, the Government announced a further £112 million of funding to support the skilled personnel and cutting-edge facilities needed to help at the forefront of clinical research—experimental clinical research in particular, including research into child cancers. I visited one of those facilities myself, and they are an important aspect of the research we are supporting. The Chancellor announced £2 billion additional funding per year for research and development by 2020-21 in the autumn statement, including for scientific research at universities and businesses. That is another part of the picture.
The hon. Member for Birmingham, Selly Oak, who is not in his place, spoke of the importance of precision cancer medicines. The Government agree, which is why we have funded the 100,000 genomes project, to diagnose, treat and prevent rare disease and cancer, including childhood cancers. The Government have invested hundreds of millions of pounds in that project to date and it is already making a difference—the first children with rare diseases have received diagnoses through the project at Great Ormond Street Hospital. The project promises to offer a genuine step-change in diagnosis and precision treatment, which is encouraging.
Ben Howlett
The Minister is being very generous with her time. I am pleased about the rare diseases aspect of what she has just mentioned. However, when engagement exercises are being undertaken with charities, it is often the case that the larger cohorts are focused on. Will she give assurances that in those engagement exercises with charities, some of the rarer cancers will also be a focus?
Nicola Blackwood
My hon. Friend is absolutely right. It is important to make sure that all different groups and diseases get the attention that they deserve. That takes me on to the issue of patient cohorts and the importance of collaboration across Europe.
For particularly rare diseases or cancers, it is sometimes necessary to look across borders to make sure that research includes the right numbers of patients. That has been a particular focus of the Department, and I am confident, owing to the work that we have been doing, that international—particularly European—networks and data sharing for research purposes will continue. We need to make sure that initiatives that have facilitated research, such as the paediatric medicines regulations, continue. My noble Friend Lord Prior is leading on that area of policy. I know that he is closely involved in all of those issues, and I am going to ensure that the specific concerns that have been raised today are passed on to him and are not dropped.
I assure the shadow Minister that the Chancellor has guaranteed that the UK will continue to have all of the rights, obligations and benefits that EU membership brings, including EU funding—up until the point that we leave, obviously. The Treasury has also committed to underwrite the payment of awards to UK organisations that make competitive bids to the European Commission —for example, for universities bidding for Horizon 2020. In addition to all of the funding I have spoken of, those moneys are protected.
My hon. Friend the Member for Bath made a couple of points about reviewing the work undertaken by NHS England to ensure that more children receive the treatment that they deserve. We will be working closely with NHS England and all partners to make sure that the strategy we have put in place becomes a reality and that the right performance metrics are in place, although that is a challenging process. Our best measure of success will be the cancer survival statistics. Those are currently provisional, but the Office for National Statistics will hopefully be assessed by the UK Statistics Authority in the future.
We have heard from many hon. Members of some deeply moving cases of young people battling cancer. We have heard of their courage and resilience, and of the fortitude of their parents and siblings.
Wes Streeting
I am grateful to the Minister for giving such a thorough and thoughtful response to the debate. As I mentioned, Kaleigh’s family are campaigning on DIPG. It would mean a lot to them if the Minister or one of her Departmental colleagues met them to talk about their experience and their hopes for how research funding in this area might improve the search for a cure going forward. Is the Minister able to make that commitment?
Nicola Blackwood
I am sure that either I or a Departmental colleague will be delighted to meet the hon. Gentleman and his constituents. It was moving to hear of their campaign.
Holding the Government and the NHS to account in this way could not be more important. I hope that my response has made completely clear not only my personal commitment but the Government’s wholehearted commitment to funding life-changing innovation and research into cancer, to delivering the cancer strategy in a way that transforms cancer care for current and future generations and to improving the long-term quality of life of childhood cancer survivors. That is surely the greatest memorial that we can offer to each and every one of those brave children who, like Poppy-Mai, have lost their battle with cancer. That is our task, and as I look around the Chamber, it is clear to me that each and every Member here will work as hard as they possibly can to make sure that they hold us to it.
Contaminated Blood and Blood Products
Baroness Blackwood of North Oxford Excerpts(7 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) and all the members of the all-party parliamentary group on haemophilia and contaminated blood on helping to secure this debate, and I thank the Backbench Business Committee for providing time for it. It has been a highly informed, very personal and moving debate, but it has also been non-partisan. I thank all Members from across the House for the constructive way in which they have approached the debate.
I would like to begin by formally adding my personal apology to all those who have been affected by these tragic circumstances and the impact that this has had on so many families. I thank all colleagues’ constituents for their bravery in allowing their personal circumstances to be shared in the House today. It brings this debate to exactly where it should be, reminding us all what we are trying to achieve through the process. The importance of that cannot be overstated. I wish I could refer to all the constituents who were mentioned today. I listed them, but that would take most of the debating time that we have today, so I say thank you to all those who allowed their stories to be told. That is exactly why the Government are introducing the reforms we have been debating today to existing support schemes, alongside a commitment within this spending review period of up to £125 million until 2020-21 for those affected, which will more than double the annual spend over the next five years.
At the beginning, however, we should be up front in recognising that nothing can make up for the suffering and loss these families have experienced, and no financial support can change what has happened to them. However, I hope all of those here today will recognise that the support provided is significantly more than any previous Administration have provided, and recognise how seriously the Government take this issue. I would like to join colleagues in paying tribute to the previous Prime Minister and to my predecessor, my hon. Friend the Member for Battersea (Jane Ellison), for all their work on the issue. I reiterate their statement that the aim of this support scheme is that no one will be worse off.
It is, as many colleagues have said, time for our reforms to bring an end to the tortured road that far too many of those affected have been down. It is time for a more comprehensive and accessible scheme that gives those affected their dignity back. However, as I hope is clear from the debate, not all the details are yet resolved. I hope to answer as many questions as I can today, but I am certain that the noble Lord Prior will be listening closely to the debate, and he will be in contact with all those here today to make sure we can resolve details that I cannot get to in the time available.
Let me turn to where we are. The reforms guarantee that all those who are chronically affected will, for the first time, receive a regular annual payment in recognition of what has happened to them. That includes all the 2,400 individuals with hepatitis C stage 1, who previously received no ongoing payment, but who will now expect to receive £3,500 a year.
Increases to existing annual payments have also been announced. These are not designed in themselves to guarantee a reasonable standard of living. The package needs to be considered in the context of the whole range of support that is available for the patient group, including support being exempt for the purposes of tax, and benefits being claimed by beneficiaries of the schemes, as the hon. Member for Glasgow South West (Chris Stephens) rightly mentioned.
I would like to address a couple of the issues raised by the hon. Member for Kingston upon Hull North about finances. We do expect to spend all the budget allocated to the scheme in the year, but the budget for the scheme does come within the Department of Health’s budget, not the Treasury budget, so if there is an underspend in any one year, the money will remain in the Department of Health. If any payments that should be made within that year fall into the next year, we can take that money forward.
I would also like to address the concerns that have been raised about the tendering for the scheme. The shadow Minister is, I am afraid, not quite correct that Capita and Atos have already bid to administer the scheme. The invitation to tender has not yet been issued, so no initial bids have been received so far. We intend to issue the invitation to tender shortly, and I am absolutely sure that, as the tender is being designed, the concerns that have been raised in the debate will be heard, and that the concerns about trust and the history of this situation will be well understood by all those involved in the design.
Diana Johnson
I am grateful to the Minister for clarifying the position around the tender, but could she confirm that the only organisations or businesses that have been invited in for conversations with the Department of Health were the two that have been mentioned by a number of hon. Members today? Is that correct or not?
Nicola Blackwood
I have had no meetings on this issue, because it is obviously not within my departmental brief. I am happy to try to find out about that issue, if the hon. Lady would like.
Nicola Blackwood
I would like to move on to some other issues because we are quite tight for time.
I would like to talk about the budget that has been allocated, because it has been mentioned on a number of occasions. The pressures on the health budget will come as no surprise to anyone here today—we had an animated debate about that just this week. I would like to assure everybody in the House that, even in the context of those pressures, we fought hard to protect the money for this scheme through tough budget negotiations so that we could fulfil commitments that were made and ensure that the concerns of those affected are addressed as far as possible.
In that context, I would like to talk in a little more detail about some of the concerns that have been raised today by colleagues. Colleagues have rightly raised the issue of support for the bereaved and those relying on discretionary payments. That is why we have introduced the one-off payment of £10,000 to bereaved partners or spouses of primary beneficiaries, where infection contributed to the primary beneficiary’s death, and in recognition of their relationship at the time of death.
Nicola Blackwood
I will in one second. I just want to respond to a point made by the hon. Member for Kingston upon Hull North about the certification of death. We understand that death certification may not state a direct contribution, so the policy that is to be published will recognise other ways to show a causal link between infection and death. We would like to make sure that issues around that are not a barrier to support under the scheme.
Jim McMahon
I thank the Minister for giving way on that point, which she has partly answered in her contribution. However, could we just get some clarity on cases where the death certificate is marked “unascertained” and on whether there will be more flexibility around that, providing that the hepatitis can be proven?
Nicola Blackwood
The hon. Gentleman makes an important point. Those are exactly the issues that are being wrestled with at the moment by the Department, and we are trying to resolve them.
We realise that the accessibility of the payment scheme for the bereaved, but also of the discretionary support scheme, will be important, as mentioned by the hon. Member for Glasgow South West and my hon. Friend the Member for Worthing West (Sir Peter Bottomley). I am not able to give the complete details of the discretionary scheme at the moment. In 2017-18, a new, single discretionary scheme will replace the three discretionary support schemes that are currently in place. It will have an increased budget, and it will be transparent and flexible so that it can support the beneficiaries who are most in need. However, until those details are fully worked out, it would not be fair for me to speculate on exactly what they will be. I want to reassure hon. Members, however, that until we are in a position to introduce that new system, the current discretionary payments will stay in place.
I would also like to reassure hon. Members that the policy of paying bereaved partners and spouses £10,000 will be published by the Department of Health, and it will be communicated to all major stakeholders, including the APPG, to ensure that we reach out to those who were bereaved a long time ago and make both these policies as accessible as possible.
We realise that these payments can never make up for the personal loss bereaved partners or spouses have experienced, but we are trying to make sure that the process is as smooth and effective as possible, with as few barriers as possible, so that individuals do not feel as though they are trying to jump through hoops.
Chris Stephens
On the point I made earlier, which was echoed by the hon. Member for Worthing West (Sir Peter Bottomley), will death certificates be dealt with in a very sympathetic fashion, so that someone’s death certificate will not say HIV or hepatitis C, although we will know through their medical records that that was the cause of death? Will the Government look at that?
Nicola Blackwood
The issue of death certificates is one that we are very alive to. It is one that the Department is trying to address, and I hope that we will be consulting closely with the relevant groups to make sure we deal with it in as sympathetic a manner as possible.
Ms Ritchie
Could the Minister comment on the points I made about the inactivity of the Northern Ireland Executive? Would it be possible for further phone calls to be made to the Minister for Health in Northern Ireland to accelerate the process and to enable payments and a scheme to be made available?
Nicola Blackwood
If the hon. Lady will have a little patience, I have an entire section on the devolved nations coming up. Before then, however, I would like to move on and speak a little about the other sections of the scheme. As well as the one-off payment to bereaved partners and spouses, the Government’s response to the consultation makes it clear that partners and spouses will be able to continue to access discretionary schemes on a means-tested basis. However, that is not the end of the story. My officials will continue to work with a reference group of experts on the details of the policy for this new payment for the bereaved and on elements of the wider discretionary payment. As soon as the policy is confirmed, the Department will publish it and give guidance on who is eligible and how to access the payment as easily as possible.
I recognise that, as has been clear from this debate, some do not feel that the new payments that have been announced are sufficient. However, they are based on the consultation response, and a judgment was made to provide support to the widest group of people possible to recognise the pain and suffering of those who have been affected by this tragedy. There are never really any right answers when designing a support scheme in recognition of such awful circumstances. Difficult judgments have to be made in relation to prioritising support. We consulted on the proposals and used the responses gathered to announce reforms that, for the first time, provide annual payments to all infected individuals rather than waiting for more people to get sicker before they receive support.
The hon. Member for Kingston upon Hull North raised issues about other viruses. We have not expanded the scheme to include other viruses, including vCJD. In that case in particular, that is because there is already a vCJD compensation scheme that offers no-fault compensation. It was set up by the Government for vCJD patients and their families in recognition of their wholly exceptional situation. The scheme provides for payments to be made, in respect of 250 cases, from a trust fund of £67.5 million. Over £41 million has been paid out by the trust to date. There are currently no proposals to extend the infected blood system of ex gratia payments to include other viruses or infections that were contracted through routes other than NHS-supplied infected blood. This is based on the advice of the Advisory Committee on the Safety of Blood, Tissues and Organs. For example, hepatitis B was not involved in the schemes when they were set up because the blood donor hepatitis B screening test had been introduced in the 1970s. There are other reasons for not including hepatitis E that I am happy to write to the hon. Lady about in more detail should she wish me to do so.
We now arrive at the devolved nations section that I mentioned to the hon. Member for South Down (Ms Ritchie). Many colleagues have referred to the Scottish Government’s reforms. We are working closely with officials from Northern Ireland in keeping them up to date on our progress with implementation. These beneficiaries, as the hon. Lady said, will be eligible under the Northern Irish scheme to continue to receive support at their current levels. I am happy to ensure that my noble Friend Lord Prior is made aware of her concerns about the potential impact on Northern Irish victims.
The hon. Member for Linlithgow and East Falkirk (Martyn Day) rightly raised the importance of co-ordination between the devolved nations on the support schemes. Given the significance of the points that he raised, and some complexities about the co-ordination of business, it is important that I ask my noble Friend Lord Prior to contact him directly on those points so that these matters can be co-ordinated effectively. I can reassure the hon. Gentleman on one point: the £500 winter fuel payment is now automatically included in the payment that people in England are getting as part of the support scheme. That means that they do not have to apply for it, as was the case previously. I hope that he will accept that that is a degree of progress.
Many colleagues point to the Scottish scheme as a blueprint for what they would like to see introduced in England, but there are some differences, as the hon. Gentleman noted. In England, there are about 2,400 individuals with hepatitis C stage 1 who were not receiving any annual payment. We have introduced a new annual payment for all those individuals so that they can get support now rather than waiting for their health to deteriorate before they are eligible for it. The Scottish Government have made their own judgments. They have chosen to provide a lump sum payment, and there are currently no proposals for annual payments to the hepatitis C stage 1 group.
We have put in place other measures to avoid the sense that, as the hon. Member for Hammersmith (Andy Slaughter) suggested, this support could be grudging, or that, as the hon. Member for Kingston upon Hull North mentioned, people could feel as though they were being treated as beggars. We have specifically put in measures to avoid this. For example, as we announced in response to the public consultation, people should not feel as though they have to jump through hoops to prove that they are worthy of support. We have no intention of introducing individual health assessments to registrants of schemes as a means of making people feel as though they have to prove their eligibility. Another key element is a special categories mechanism, with appeal, for those with hepatitis C stage 1 who consider that the impact of their infection, or the treatment for it, is similar or greater than for those at stage 2, such that they could qualify for stage 2 annual payments. This is a particularly beneficial aspect of the scheme.
Members have raised the issue of those who could clear hepatitis C infection. They will remain entitled to compensation under the scheme. The shadow Minister is right that those who clear the virus during the acute phase are not included in the scheme, but that is because the body fights off the infection before the severe health impacts occur. That has been the judgment of the expert advisory group, which we have been pleased to listen to.
Chris Stephens
Will the Minister deal with the question of tax rules? Has she had any discussions with HMRC on that issue?
Nicola Blackwood
I thought I had already answered that. These schemes are exempt from tax and we are continuing to ensure that the ongoing schemes will be subject to the same tax rules.
Several colleagues raised the issue of a public inquiry. The Prime Minister has been very clear that we do not believe that a public inquiry would provide further information. The things that a public inquiry could achieve, according to media reports, are establishment of the facts, learning from events, preventing a recurrence, catharsis, improving understanding of what happened, and rebuilding confidence and accountability. It is difficult to see what more information could be made available through a public inquiry given that action was taken as soon as possible to introduce testing and safety measures for blood and blood products as these became available, with the introduction of health and heated products, and that the Government have published all documents associated with this event from the period 1970 to 1985, in line with the Freedom of Information Act 2000. However, I am sure that campaigners will continue to make their case.
We have heard a lot about when this year’s payments will be made. I share that concern. When I was appointed as Parliamentary Under-Secretary of State with responsibility for public health and innovation, I made resolving this issue one of my highest priorities. I am not prepared to suffer any further delays. It is not fair that affected patients should suffer the continuing uncertainty that has been raised by colleagues. I have told the Department that it must announce the scheme immediately. I am pleased to announce that letters to all hepatitis C stage 1 sufferers were sent out on 11 November informing them of their new annual payment and asking them to claim this through the existing schemes. The schemes have said that they will be able to make these payments by 22 December. Letters to those at stage 2 and those with HIV have been sent this week, and their additional payments will be made shortly before Christmas. The schemes are also planning to send all letters to bereaved partners and spouses before Christmas with the aim of paying their new lump sums before the end of the financial year, and certainly during March 2017. Details of the payment schedules are now available on the schemes’ website. In addition, as already announced, all new and increased payments will be backdated from April 2016 or the date of joining the schemes, if later.
I believe it is right that the Government’s focus is on considering how best to create and implement a system with the increased budget that is affordable, that redesigns the inconsistencies that we have heard about, and supports those most affected by these tragic events now and into the future. I will continue to listen to the concerns of those affected. I hope that I have responded to those concerns as effectively as I possibly can.
Reducing Health Inequality
Baroness Blackwood of North Oxford Excerpts(7 years, 5 months ago)
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Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
I welcome the opportunity to speak in the Chamber for a second time today, on yet another important topic. This time we are debating health inequalities and I thank the Backbench Business Committee for allowing this debate to take place following the application by the hon. Member for Totnes (Dr Wollaston) and other hon. Members across the House. The hon. Lady made an excellent speech, and we are very grateful to her for that. I also want to thank other hon. Members across the House for their excellent contributions today. I especially want to highlight the excellent speeches by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and my hon. Friends the Members for Stockton North (Alex Cunningham), for Bradford South (Judith Cummins), for Heywood and Middleton (Liz McInnes) and for Hackney South and Shoreditch (Meg Hillier).
I enjoyed the speeches by the hon. Members for Plymouth, Sutton and Devonport (Oliver Colvile)—a fellow member of the all-party parliamentary group on basketball—and for Erewash (Maggie Throup), who made an excellent speech on obesity and childhood obesity. I also enjoyed the speech by the hon. Member for Glasgow Central (Alison Thewliss). As she knows, I agree with most of what she says, especially about breastfeeding. We have had an excellent debate, with excellent contributions all round.
When it comes to addressing health inequalities, there are many conversations about the need for systemic change to reverse the trends. However, I want to look at tangible specifics that the Minister can get to work on in her remit as Minister for public health. I will do that by looking at the current state of health inequality and then the two key areas of smoking and childhood obesity and what more can be done to address those signifiers. I will then move on to the cuts to public health grants, which are exacerbating the situation.
The most recent intervention on health inequality came from the Prime Minister, who used her first speech on the steps of Downing Street to highlight that,
“if you’re born poor, you will die on average 9 years earlier than others.”
We have heard clear examples of that from constituencies around the country. That welcome intervention set the tone of her Government’s serious work to address health inequalities.
It is hard not to agree when the facts speak for themselves. Two indicators from the most recent public health outcomes data show that London and the south-east have the highest life expectancy while the north-east and north-west have the lowest. The same pattern appears when looking at excess weight in adults, which we have also heard about today. Rotherham comes out the highest at 76.2% and Camden is the lowest at 46.5%. Those figures prove what we all know to be true: people living in more deprived parts of the country do not live as long as those in more affluent areas. Contributors to ill health such as smoking, excessive alcohol consumption—which we heard about from the hon. Member for Congleton (Fiona Bruce)—and obesity are more prevalent in deprived areas.
There is a moral argument that it is important for the Government to address such issues, so that we can improve our nation’s health, but there is also an economic argument to be made. If we have an unhealthy population, we will not be as productive. In England, the cost of treating illnesses and diseases arising from health inequalities has been estimated at £5.5 billion a year. As for productivity, ill health among working-age people means a loss to industry of £31 billion to £33 billion each year. Those two arguments must spur the Government into action, but there are many issues to tackle and multiple ways for the Government to address them. Many such issues have been raised in the debate but, as I said, I will examine two key areas that the Minister must get right: smoking cessation and childhood obesity.
My first outing as shadow Public Health Minister was to debate the prevalence of tobacco products in our communities and the need for the Government to bring forward the new tobacco control plan.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
indicated assent.
Mrs Hodgson
The Minister remembers it well. The Government need to set out key actions to work towards a smoke-free society. Smoking is strongly linked to deprivation and has major impacts on the health of those who do smoke, such as being more prone to lung cancer and chronic obstructive pulmonary disease and facing higher mortality rates. If we look at that by region, which I have already established is a factor in health inequality, smoking levels are higher in the north-east at 19.9% compared with the lowest in the south-east at 16.6%. When looking at smoking by socioeconomic status, we find that the smoking rate in professional and managerial jobs is less than half that in routine and manual socioeconomic groups, at 12% and 28% respectively.
In the debate held just over a month ago, the Minister was pushed on when the new tobacco control plan would be published. Concerns have been raised by various charities, including ASH, Fresh NE and the British Lung Foundation, about how the delay could jeopardise the work already done. Sadly, the Minister evaded my specific question back then, so I will ask her the same thing again: when can we expect the new plan? Will it be this year or next year? The plan will not only go a long way to work towards a smoke-free society, but help to reduce health inequalities in our deprived areas. The Minister can surely understand that and the need to come forth with the plans.
The Minister knows that I also take a keen interest in childhood obesity. She has said repeatedly that the publication of the childhood obesity plan was the start of the conversation. Childhood obesity is the issue on everyone’s lips right now as it is the biggest public health crisis facing the country. I will not repeat the stats we all know about the number of children who start school obese and the number who leave obese—they are shocking. Many organisations and individuals, including Cancer Research UK, the Children’s Food Trust and Jamie Oliver, have made clear their dismay at the 13-page document that was snuck out in the summer and have said that it did not go far enough. Incidentally, it came out on the same day as the A-level results, so it looked like it was being hidden.
Obesity-related illnesses cost the NHS an estimated £5.1 billion a year, and obesity is the single biggest preventable cause of cancer after smoking. It is also connected to other long-term conditions such as arthritis and type 2 diabetes. When obesity is linked with socioeconomic status, we see real concern that the plan we have before us will not go far enough to reverse health inequality. National child measurement data show that obesity among children has risen, and based on current trends there could be around 670,000 additional cases of obesity by 2035, with 60% of boys aged five to 11 in deprived communities being either overweight or obese. There is a real need for the Government to come to terms with the fact that many believe the current plan is a squandered opportunity and a lot more must be done. That is why I hope the Minister will be constructive in her reply to this debate, giving us reassurances that move us on from this being “only the start”. At the end of her speech, the hon. Member for Erewash gave us a list of four or five items that we could start straightaway, which would certainly take us further on.
The Government have stalled or not gone far enough on the plans I have mentioned, but there is also deep concern that the perverse and damaging cuts to public health spending will widen the health inequality gap. The Minister knows the numbers that I have cited to her previously, but I will cite them again, even after my right hon. Friend the Member for Kingston upon Hull West and Hessle has done so. We are greatly concerned about the £200 million cut to local public health spending following last year’s Budget, which was followed by the average real-terms cut of 3.9% each year to 2020-21 in last year’s autumn statement. I want to add some further concerns that go beyond those raised by Labour.
Concerns were identified in a survey by the Association of Directors of Public Health, which found that 75% of its members were worried that cuts to public health funding would threaten work on tackling health inequalities. Those concerns are backed up by further evidence published by the ADPH, which found that local authorities are planning cuts across a wide range of public health services, because of central Government cuts. For example, smoking cessation services saw a 34% reduction in 2015-16, and that will become 61% in 2016-17, with 5% of services being decommissioned. That is seen across the board among local public health services and will be detrimental to reversing health inequalities. For the Government to fail to realise that cutting from this important budget will not help the overall vision on health inequality, set out by the Prime Minister earlier this year, is deeply worrying and shows a distinct lack of joined-up thinking around this issue.
In conclusion, health inequality is a serious issue that we cannot ignore or let the Government get wrong, as the health of our nation is so important, not only in a moral sense, but economically. I know the Minister will fully agree with the Prime Minister’s statement from earlier this year—there is no second-guessing that, as we all do—but we need radical proposals that get to the bottom of this persistent issue, which blights the lives of so many people living in our most deprived communities. We all want to see a healthier population, where nobody’s health is determined by factors outside their control, and we must all work together to get to the point where it is no longer the case that the postcode where somebody is born or lives determines how long they will live or how healthily they will live that life.
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
I congratulate the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), on her characteristically thoughtful opening of this debate. I thank the Backbench Business Committee for agreeing to the debate, which has been not only highly informed, but very wide ranging. I will therefore start by apologising for the fact that I will not be able to comment in detail about all the points raised, but I will reply in writing where I am not able to respond. Colleagues are right to say that the Prime Minister has made this issue a national priority, so it is not surprising that the Government share the commitment of the House to having an effective cross-Government policy that will reduce health inequalities.
We are recognised as world leaders in public health, and that has been achieved by avoiding the temptation to put health inequality in a silo. Marmot, as many have pointed out, is clear that an approach to treating health alone will not tackle what we here know are some of the most entrenched problems of our generation. We have avoided a health-only approach in the past, which is why the Chancellor’s autumn statement yesterday announced important and relevant measures such as raising the national minimum wage, raising the income tax threshold and providing, as the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, rightly observed, an additional £1.4 billion to deliver 40,000 extra affordable homes. That provision is in addition to the Homelessness Reduction Bill.
It is right that we also look to the work of industry and non-governmental actors. I am pleased to say that the food and drink industry has made progress in recent years. Its focus under voluntary arrangements has been on calorie reduction. Billions of calories and tonnes of sugar have been removed from products, and portion sizes have been reduced. Some major confectionary manufacturers are committing to cap single-serve confectionary at 250 calories, which is an important step forward. As my hon. Friend the Member for Erewash (Maggie Throup) mentioned, some retailers have played their part by removing sweets from checkouts, while others have cut the sugar in their own-brand drinks. We welcome that and urge others to follow suit. The challenge to industry to make further substantial progress remains. We should praise those who have had success, but we will continue to challenge those who lag behind.
Colleagues are right to highlight the importance of employment, and it is encouraging to see that some gaps are narrowing. As the Chancellor said yesterday,
“over the past year employment grew fastest in the north-east…pay grew most strongly in the west midlands, and every UK nation and region saw a record number of people in work.”—[Official Report, 23 November 2016; Vol. 617, c. 900.]
But there are still some who are left behind, which is why our health and work Green Paper is specifically focused on driving down the disability work gap for those who wish to work. It is this emphasis on the social, economic and environmental causes of inequalities that convinces me that public health responsibilities as they are traditionally understood do rightly sit in local government, where national action can be reinforced and resources can be specifically targeted at pockets of inequality within local populations.
Let me respond to the concerns raised by my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) about his GP practices. When a GP practice closes, NHS England has a responsibility to make sure that patients still have access to services and are not misplaced. I am pleased to hear that he is making some progress on the matter, but if he finds that he reaches a roadblock, I will be happy to raise his concerns with the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), who has responsibility for community health.
Although, as a number of colleagues have said, councils have had to make savings and are acting in tough financial circumstances, they are still accessing £16 billion over the next five years from their public health grant. They have shown that good results can be achieved while efficiencies are found and the greatest effect is generated. There are a number of examples of outstanding practice to which we should pay tribute today. The HIV innovation fund, for example, which is funded by Public Health England in collaboration with local government, provides funding for services that meet local needs and offers the most at-risk populations free, reliable and convenient alternatives to traditional HIV testing. That is happening at a time when driving up HIV testing is a key public health priority.
As my hon. Friend the Member for Totnes rightly noted, however, we must focus on key determinants such as obesity, smoking, suicide and alcohol. That is the core of the challenge that we face, which is why we are working closely with our partners in the NHS, PHE, local government and schools to deliver the childhood obesity plan. That subject has been raised by many speakers today and I assure the House that the delivery of the plan has started. We have consulted on the soft drinks industry levy and launched a broad sugar reduction programme. Those measures will have a positive impact, particularly on lower income groups, which are disproportionately affected. As many colleagues have mentioned, the measures will have secondary benefits, such as better dental health and diabetes prevention.
As was mentioned by my hon. Friends the Members for Erewash and for Taunton Deane (Rebecca Pow), it is particularly important that we focus on effectively delivering a key plank of that obesity plan: the hour of physical activity every day. One of the ways in which we will make sure that is delivered effectively is by introducing a new healthy rating scheme in primary schools to recognise the way in which they deliver this and to provide encouragement. I believe that we have delivered the right approach to secure the future health of our children, but I am determined that we will implement it quickly and effectively, and I am very happy to enter into discussions about how we make sure that that implementation works.
I entirely agree with hon. Members on both sides of the House that mental health must not be forgotten when we are discussing health inequalities. We have made progress, but parity of esteem must be more than just a phrase; it must be backed by increased funding and effective reform. That is why we are investing an additional £1 billion every year by 2020 to help 1 million more people with mental illness to access high-quality care, including in emergency departments, as well as putting in place a record £1 billion of additional investment in children’s mental health. That money is funding every area in the country. We are working hard to make sure we drive these reforms to the frontline, including, as my hon. Friend the Member for Totnes said, by refreshing the suicide strategy with a particular focus on the alarming figures for suicides among young men and for self-harm.
There can be no complacency about the scale of the challenge, as the figures quoted today forcefully remind us. We know that inequalities can be stubborn to tackle. Variations in smoking rates, particularly in pregnancy, persist, and concerted efforts are required to tackle that. That is exactly why I am prioritising the tobacco control strategy so that we can use our combined efforts to target vulnerable groups, including pregnant women, mental health patients and children, and reduce those differences, not least by supporting local areas to use data effectively to understand how best to target their policies.
Alex Cunningham
Can the Minister offer us a timescale for the tobacco strategy?
Nicola Blackwood
I cannot, because I am not yet satisfied that it is as effective as I want it to be.
In addition, I am pleased with the action we have taken to introduce standardised packaging for cigarettes and other legislative measures. We have also launched the world’s first diabetes prevention programme, as mentioned by the hon. Member for Heywood and Middleton (Liz McInnes), and we had a very good debate just yesterday about how we can improve diabetes care. We also have one of the most effective immunisation programmes in the world. That shows our commitment to take firm action where the evidence guides us, but as I have said, that action must be cross-government, at both a local and a national level.
Our job is to put prevention and population health considerations at the heart of everything we do, as the five year forward view makes clear. Devolution deals are giving local areas more control over many of the social determinants of health, such as economic growth, housing, health and work programmes, and transport. The focus on integrated public health services within devolution promises to remove many of the structural barriers to prevention that we have discussed today, and it makes public health everyone’s business, exactly as the SNP spokesman, the hon. Member for Glasgow Central (Alison Thewliss), said.
However, with devolution, to which the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) referred, and as we move towards business rates retention, transparency will be ever more vital to ensuring that public health outcomes improve. That is happening, but we need to go further, and we need to do more to engage local people and their elected councillors in highlighting the unjustifiable inequalities that persist. Ensuring that transparency translates into accountability is a key priority for me, and I assure the House that I am actively involved in this matter.
Members on both sides of the House are right to launch this challenge today, and I take fully on board their suggestions of how we can collectively reduce health inequalities. However, I hope that I have made it clear that the only way we are going to make progress on this issue is to adopt a whole-Government, whole-society approach. We have to constantly remind ourselves that reducing these inequalities is for not just the NHS or Public Health England, but the whole of Government, as well as local areas, industries and, indeed, all Members of this House. Today I reaffirm my commitment to work together with the widest range of partners, inside and outside Government, to make progress on this agenda. I hope that every Member here will do the same, because we owe our constituents nothing less.