Cancer Strategy for England

Ben Spencer Excerpts

Thursday 31st October 2024 Westminster Hall

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank the hon. Member for Wokingham (Clive Jones) for securing this important debate on what is clearly a difficult subject, given how much cancer affects people: as several hon. Members have said, it affects all of us, not just those who are directly affected. I listened carefully to the powerful speeches that he and the hon. Member for Cheltenham (Max Wilkinson) made about the direct impact that they have experienced.

I pay tribute to all the people who work in our NHS, the charity sector, the research sector and all parts of our community that are active in prevention and in supporting, treating and helping people through the journey with cancer. My speech cannot cover every cancer in the limited time I have, but I will focus on the major cancers, so to speak, in terms of prevalence and mortality rates. That is not to diminish the importance of the range of cancers: it is critical that we focus on rare cancers as well as the major ones.

I thank the hon. Member for Wokingham again for his speech and for sharing his personal experience. He did not mention the fact that he has raised more than £800,000 for cancer charities in his work following his diagnosis. It is important that we pay tribute to him for bringing forward this debate.

I was deeply concerned by the story told by the hon. Member for Thornbury and Yate (Claire Young) about the impact on her constituent of the cessation of their treatment as a result of financial measures. I hope that the Minister can meet her or take up the case; I would be interested to hear how that decision was taken. I hope that the family and the individual affected are doing okay with their treatment. My right hon. Friend the Member for Herne Bay and Sandwich (Sir Roger Gale) made important points, to which I will return later, about childhood and teenage cancer.

I was pleased that the hon. Member for Woking (Mr Forster), my constituency neighbour, raised the impact on his constituents in terms of seeking direct cancer care. As he knows, both of our constituencies are served by Ashford for broader cancer support. I would welcome the chance to meet him to discuss how we can help our constituents, particularly with journey times to access cancer care locally.

It is important to focus on data, so I will refer to data from the NHS and from Cancer Research UK. I have a series of questions for the Minister; I know that a lot may not be in his portfolio, but if he cannot answer today I will be grateful for a written response.

Fundamentally, the things that the state can do about cancer strategies break down into prevention, diagnosis, care and treatment, and research. All the major cancers have modifiable risk factors. Of the 44,000 bowel cancer cases a year, 54% are deemed to be preventable, with 11% linked to obesity, 28% linked to diet and fibre, 13% linked to processed meat and 5% linked to physical activity. Breast cancer is the most common cancer in the UK: of the 56,800 cases a year, about 8% are believed to be linked to or caused by obesity. Lung cancer is the third most common cancer: of the approximately 50,000 cases a year, about 80% are preventable and 72% are linked directly to smoking.

Overall, tobacco is the largest preventable cause of cancer. Some 50,000 cancer cases per year are attributable to smoking. In the last Parliament, we introduced the Tobacco and Vapes Bill because we recognised the importance of reducing smoking. Can the Minister tell me when his Government plan to reintroduce that Bill, so that we can start to see its health benefits? Obesity is the UK’s second biggest cause of cancer, after smoking. It is believed to cause about one in 20 cases: 20,000 cases of cancer per year are attributable to obesity. We brought forward an obesity strategy. Will the Minister review it and bring forward an obesity strategy in this Parliament?

On screening and treatment, while cancer outcomes continue to improve in comparison with the OECD, it is worth looking at the data in the Darzi report. One of the most interesting slides shows that over the past 14 years, we have improved relative to the gradient of cancer outcomes, but we started at a very low point. There are lots of questions to be asked about why we started at such a low point back in 2004. The NHS is still recovering from the disruption to cancer care caused by the covid pandemic, but thanks to the hard work of NHS staff, waits of more than 62 days declined between September 2022 and August 2024. Obviously there is still more work to be done.

Community diagnostic centres and surgical hubs made a difference. They were backed by a £2.3 billion investment, the largest cash investment in MRI and CT scanning in the history of the NHS; those scans, tests and checks are now being delivered in 170 CDC sites. As the independent Health Foundation recently pointed out, surgical hubs have helped to build capacity and reduce waiting lists over the past few years. Although it was not mentioned in Lord Darzi’s report on NHS performance, I welcome the Government’s intention to expand surgical hubs. Will the Minister provide more details on how many new surgical hubs will be established? What plans have the Government to expand the CDC network further?

There is clearly more work to be done to improve cancer waiting times and outcomes. The major conditions strategy developed under the last Government was designed to provide more impetus for improving cancer outcomes, alongside those for other major conditions. Developing the strategy involved significant consultation and engagement with cancer charities and professional bodies. Since the election, the Government have decided to scrap the strategy. Can the Minister explain why he made that decision?

Given the time that cancer charities and organisations have put in, can the Minister explain how their contributions will be used to develop the 10-year plan for the NHS? Can he explain why, in the NHS consultation that is now being run, there are no cancer-specific questions? We heard earlier that eight people in 10 want a cancer strategy. Will he respond if similar results emerge from the consultation?

The Government scrapped the children and young people cancer taskforce, and we have yet to hear an alternative approach to improve of outcomes in that area. Will the Minister provide clarity on the Government’s plans on children’s cancers and the reasons why they discontinued the children and young people cancer taskforce?

Research is most relevant to some of the rarer cancers that are often not talked about. We very much welcome the protection of Government investment in R&D, with £20 billion allocated to 2025-26 and core research spending protected. That includes a £2 billion uplift for the National Institute for Health and Care Research. I should mention that my doctoral research fellowship was funded by the NIHR, although it was mental health research rather than cancer research. It is great that we support that fantastic institution.

I am pleased that the Government have kept the current rate of research and development tax relief. However, the Minister will know that a lot of support and research is provided by or directly commissioned from charities, which are a critical part of the cancer care and treatment infrastructure. My understanding is that in yesterday’s Budget, public services were protected from the rise in employers’ national insurance contributions. Can the Minister explain what the impact of national insurance employer contributions will be on charities that provide care and treatment in this area? What conversations has he had with those charities, and what concerns have they raised with him?

In the Darzi report and elsewhere, there is rightly a focus on the diagnostic pathway and on the time it takes to diagnose and treat someone following a query as to whether someone has cancer. When does the Minister expect the huge £22 billion injection in the NHS to produce outcomes? Or does he agree with the comments in Lord Darzi’s report that the NHS does not necessarily need more money for outcomes? It has had a lot of money from the former Conservative Government over the past few years. Does the Minister think that reform is the best way to ensure improvement?

[Mr Clive Betts (in the Chair)]

I call the Minister. It would be helpful if he could finish by 4.28 pm to allow the mover of the motion a couple of minutes to respond.

Oral Answers to Questions

Ben Spencer Excerpts

Tuesday 15th October 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

The Prime Minister has repeatedly stressed the importance of preventing people from taking up smoking, as one of his priorities to improve the nation’s health, reduce waiting lists and lessen demand on the NHS, and we agree. The Government like to talk about the record of their first 100 days in office but, according to data from Action on Smoking and Health, 280 children under the age of 16 take up smoking in England each day. That is 28,000 children in England during the Secretary of State’s first 100 days. Why has he not yet reintroduced our Tobacco and Vapes Bill? How many children need to take up smoking before he makes this a priority?

[Wes Streeting]

Perhaps the shadow Minister would like to give us the figures for the entire 14 years that his party was in government. By the way, just to set the record straight, not only did I propose the measures in that Bill during an interview with The Times earlier last year, but if it was such a priority for the Opposition, why did they leave the Bill unfinished? Why had it only had its Second Reading? And why did we go into the general election with that Bill unpassed? I will tell him why: because his party was divided on the issue, and the then Prime Minister was too weak to stand up to his own right-wingers who are now calling the shots in his party. The smoking Bill will be back, it will be stronger and, unlike the previous Government, we will deliver it.

Mental Health Support

Ben Spencer Excerpts

Thursday 10th October 2024 Westminster Hall

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I start by declaring that I am a former consultant psychiatrist and that a family member is a consultant psychiatrist.

Listening to this debate has been a mixed experience. It has been great to hear the wealth of talent and expertise that we have in the House, but at times it has been harrowing to hear people speak about their personal experiences or those of their constituents. That is a reminder to us all of just how substantial the impact of mental illness can be on people—our families and friends. The tone in which this very sensitive debate has been conducted is fantastic.

I thank the hon. Member for Ashford (Sojan Joseph) for bringing forward this debate, for the wealth of experience—22 years—that he brings to this place, and for a very balanced speech in which he acknowledged the catchment investments under the previous Government and raised the importance of waiting lists. When I was first elected, I brought up targets for mental health in a private Member’s Bill, which did not end up going anywhere, on waiting times for getting an in-patient bed when one is requested for somebody with a mental disorder. Of course, we all want improvements in mental health care and treatment, and there need to be improvements in mental health care and treatment. I am sure there will be no disagreement across the House about that.

The hon. Member for Ashford was absolutely spot on to mention housing, work and benefits. It is a testament to his experiences in psychiatric nursing that he went on to mention the surrounding holistic care. One of the challenges of debates on improving mental health services is that we must acknowledge that that involves many other areas of public policy, public provision and cultural factors, and try to broaden that as much as possible.

[Dr Evans]

The former Member for Doncaster, who is now sadly not in this House, was a significant champion for men’s and boys’ health—suicide in particular, which has been mentioned here, is such a problem. My hon. Friend stated the case for mental health being a pan-Government policy area—does he believe that strengthens the argument for having a Minister for men and boys to go across Government and think about all these issues, especially as suicide is the leading cause of death for young men under the age of 45?

[Dr Spencer]

My hon. Friend is absolutely right to point out that, sadly, suicide is the No.1 cause of death among young men. My understanding, although the stats change all the time, is that below the age of 45, suicide is the No.1 cause of death among both men and women. It is absolutely right that we look at sex-specific approaches to intervention. Factors affecting health in men will be different from factors affecting health in women.

I want to go back to the social elements of mental health care, which the hon. Member for Ashford mentioned, and a smoke-free society and banning tobacco. Certainly when I was practising, 50% of tobacco was consumed by people with a severe mental illness. That raises a whole host of concerns and issues about what is happening with tobacco consumption and people with a mental disorder.

My hon. Friend the Member for Hinckley and Bosworth (Dr Evans) was absolutely right, given his experience, about something he has mentioned many times in the House: the importance of delineating mental wellbeing and mental illness. I tend to think about it in this way: we all have mental health, but we need to separate mental wellbeing from mental illness. The two are different and need different approaches, as was echoed by my right hon. Friend the Member for Salisbury (John Glen) and the new hon. Member for Stroud (Dr Opher), who gave rise to a very fertile discussion on his views on the area. The hon. Member for Leicester South (Shockat Adam), who is no longer in his place, rightly pointed out inequalities in detention and outcomes for those from minority ethnic backgrounds. That is a very important issue.

That brings me on to our record in Government over the past 14 years; there are a few things I want to pick out. One is that we set parity of esteem in law through the Health and Social Care Act 2012, which was a big step forward. We still need parity of esteem in outcomes, but nevertheless that was a very important step. We expanded access to psychological therapies and I am particularly pleased by the expansion of individual placement and support, which has been shown to help people get into work, particularly those with a chronic and enduring mental illness. We have seen more people take up maternity care, and we also invested in the mental health estate.

In fact, in my own constituency, we have a new mental health hospital. The Abraham Cowley Unit is being rebuilt, which will provide world-class care for people living in my patch. Perhaps most important of all, given the conversation that we have had today, is the decrease in in-patient and out-patient suicide that we have seen over the years. Of course, I recognise that there are a variety of factors driving that but we should be pleased that things are moving in the right direction on suicides, although there is more to be done.

Today is World Mental Health day and it is a very broad topic, but in my time I would like to focus specifically on one area that, as it certainly was in my former career, is often neglected—psychosis. It particularly affects people suffering from schizophrenia or bipolar affective disorder. It can be a very disabling illness and has been responsible for quite a degree of disability and health concern in the UK. Often debates such as these, and debates in the media, do not focus on psychosis and I think a big part of that comes from the stigma attached to it. People who work in the sector, and those with expertise here, will know that it is an area of great need both in terms of community mental health teams and in-patient settings. The hon. Member for Stroud was absolutely right and I am glad he pointed this out: the 10 to 15 years of life lost following a diagnosis of psychosis is something that we have to fix.

I believe that we also need to improve access to treatments such as clozapine, which is an excellent treatment for schizophrenia. I am pleased to have previously worked with Clozapine Support Group UK in its campaign to try to get more access to clozapine for people for whom it is indicated. We have also seen the reform of the Mental Health Act 1983, which the former Prime Minister Theresa May kicked off with the Wessely review. I was part of the working groups on the Wessely review, particularly looking at helping with the tribunal system, and I was on the pre-legislative scrutiny committee as well. How we look after people detained for treatment in the absence of consent is very important, and I am pleased that this Government have committed to take forward the work on reviewing that Act.

I thank everyone who works in the care and treatment of people with mental illness. As we have heard today, that is a very broad sector; it is not only people who work in the NHS but those who work in the third sector in a variety of organisations and institutions. That is very important work.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

Will the hon. Member give way?

[Dr Spencer]

Very briefly—I have only a couple of minutes left.

[Lee Pitcher]

My cousin died from suicide two years ago. We have talked about a lot of facts and figures today, and we have talked a bit about heart, but I can absolutely tell the hon. Member that a family never recovers from that. My auntie and uncle will never recover from the fact that they lost their child before they themselves went.

All a person can do in that situation is put their energy into something positive, and that is about how to help people going forwards. One of the big things is absolutely those charities that support people, such as the Jackson Hope Foundation. I have gone along and spoken there myself even this last Friday, and I talked about some of my experiences in Parliament really openly and freely. It is a safe place. There are 16 men there talking unbelievably openly about how they feel, and it makes such a difference. I want to ensure that going forwards, whatever we do, learning from those groups feeds into our plans and strategies because it makes all the difference to people.

[Dr Spencer]

I thank the hon. Gentleman for sharing something so personal in his intervention, and for sharing his experience of the impact of suicide. Many Members have shared personal experience in this debate. That is very important.

I am mindful that there will be people in the Gallery or watching at home who may be affected by the topics we are discussing, and I take a moment to point out that there are a variety of services to help people in their recovery, if one can call it that, after a loved one has tragically died from suicide, or to help people who are in crisis, such as local crisis services, the Samaritans or Mind. There is a variety of third sector and charity helplines that can help. Men’s Sheds is one organisation I know of that is very helpful. I am really pleased that the hon. Gentleman raised this issue.

I will finish with a few questions for the Minister. The Government do not have a mental health care and treatment strategy or a psychosis strategy and, following an answer to a written parliamentary question I tabled, I understand that there are no plans for a mental ill health strategy to be brought in. Given today’s debate, I wonder whether the Minister will reconsider that position. What are the Government’s plans on taking forward our suicide prevention strategy, or a specific psychosis or mental ill health strategy—however he wants to cut the cloth?

Secondly, when does he expect the Mental Health Bill to have its First Reading in this place? All Members are going to want to extensively debate and scrutinise that Bill. When does he expect it to come forward? What is his appraisal of the challenges that the Bill needs to answer when it comes to the interaction between the Mental Health Act 1983 and the Mental Capacity Act 2005 and the deprivation of liberty safeguards? What about the MM case on deprivation of liberty in the context of a restricted patient in the community, and the interaction with the Children’s Act 1989 on when children can choose a nominated representative? I realise he may not have the answers to that immediately, but I would be grateful if he could write to me. Community mental health teams are the core of psychiatric teams in the community and our psychiatric care and treatment service. What is his plan to support them?

Finally, what is his appraisal of integrated care systems and their commissioning of mental health services? The hon. Member for Hastings and Rye (Helena Dollimore) mentioned the challenges with her ICS. What is the Minister’s appraisal of that commissioning and how integrated care systems can be held to account to make sure that is being delivered?

[Peter Dowd (in the Chair)]

I want to give the sponsor an opportunity to wind up at the end. I call the Minister.

Medicines

Ben Spencer Excerpts

Monday 9th September 2024 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

It is not often that one speaks in this place on changes to the law that will have the direct result of saving lives, but once the draft regulations pass, as I hope they will this evening, we expect them to save many peoples’ lives. Today is a very special occasion. I do not say this to disparage people who work in the public health industry, but at its core, public health is not about flash or pizazz; it is about incremental changes that make a real difference to people’s lives, and have an ongoing, cumulative effect. Naloxone reverses the effects of opiate intoxication or overdose. It stops people from dying of accidental or deliberate overdoses of heroin and other opiate drugs, and opiate medications. It is quite literally a life-saving medication. Accordingly, it is one of the World Health Organisation’s essential medications.

Tomorrow is World Suicide Prevention Day, so I am pleased that we are supporting and debating a motion to expand access to and administration of a vital antidote to opiate poisoning. Suicide is the biggest cause of death in men under the age of 50. The stats vary, but while I was looking for the best and most recent data, I read that around three quarters of suicides each year are by men, and that suicide is the biggest killer of under-35s, impacting people from all walks of life. Many people are affected by such deaths. On World Suicide Prevention Day, we remember all those affected by suicide, and the work that we need to do to reduce suicides through public health measures and mental health service provision and treatment.

The use of highly addictive, lethal opiates, perhaps in combination with other substances, is often responsible for death as a consequence of drug misuse. In 2022, opioids were involved in 73% of drug misuse deaths in England, and 82% in Scotland. The last Government worked very hard to make progress on reversing the upward trend in drug poisoning deaths. Our 10-year, cross-departmental drugs strategy, published in 2022, aimed to prevent nearly 1,000 deaths in England by 2025. The naloxone roll-out has been highly effective in reducing drug misuse deaths by treating the effects of opiate overdoses.

There have been several regulatory changes that have expanded access in the last decade. Under the last Government, the Human Medicines Regulations were approved in 2012 to regulate the supply and use of drugs in the UK. That was followed by further amendments in 2015 and 2019, which focused on expanding access to naloxone for emergency use. The last Government then called on Dame Carol Black to lead an independent review of drugs policy. I thank Dame Carol for her work in this space, and indeed everyone working in this area, and those who contributed to our consultation earlier this year.

One of Dame Carol’s key recommendations was that more individuals supporting drug users be able to access and give out naloxone. I am pleased that she welcomed the proposals to expand access to naloxone earlier this year. When we launched a consultation seeking views on improving naloxone access through named services and professionals, as required by the Medicines and Medical Devices Act 2021, there was strong support. There were over 300 responses, of which a third were from organisations and over 200 from individuals and professionals. More than 80% were supportive of improving access through named services and professionals, and of introducing registration with a naloxone supply co-ordinator.

I am pleased that Ministers have followed the direction of the previous Government in legislating to expand access to naloxone to more healthcare professionals and services, as they want and need it. That will build on work across the UK to reduce the scourge of drug-related deaths caused by opioids. On this legislation, the Government will have the support of His Majesty’s loyal Opposition, and I encourage all colleagues from across the House to give it their backing.

Of course, I have a question for the Minister about training, which is critical. During my psychiatric training at medical school, a key thing instilled into my head about the use of naloxone is that it is a wonderful drug for the first 30 minutes, but then it starts to wear off. It has a short half-life—the time that it takes to leave the body—and then the effects of opiate overdose can start to reoccur, especially when we are talking about long-acting opiates, so although it fixes one problem, another problem is coming down the track. The patient must have adequate treatment quickly so that they do not suffer after effects when naloxone wears off. Can the Minister reassure me that for those involved in the administration of naloxone kits and aftercare—she mentioned families, and broader access for homelessness charities—the training component is as secure as possible, so that everything is done to avoid further drug-related deaths?

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

Healthcare Provision: East of England

Ben Spencer Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank you for your comments about self-regulation. In the first Westminster Hall debate of the parliamentary term, especially as it is on healthcare, it is good to start off in the spirit of self-regulation.

I thank the hon. Member for Norwich South (Clive Lewis) for securing the debate, and for his speech, which was a tour de force. It was wide ranging, reflecting on socialist history. From the topics that he covered, and from his history of advocating for his constituents over the years, his deep-seated passion for delivering high-quality health services is clear, particularly as regards the cross-party campaign for a new dental school. He put a very precise question to the Minister, and I look forward to hearing her response. One subject that piqued my interest was the question of the NHS being in service of whom and to what end—particularly with reference to his points about the NHS being the greatest representation of socialism in the modern day. Dare I say it: I believe the NHS exists to serve the people, but the state does not exist to serve the NHS.

I was pleased that my hon. Friend the Member for Broadland and Fakenham (Jerome Mayhew) focused on the importance of productivity and on delivering tangible results to our constituents, as well as to hear about his support for the dental school. He was right to point out that the challenges of the Queen Elizabeth hospital and the rebuild programme, which I will return to.

I enjoyed the speech by the hon. Member for Lowestoft (Jess Asato), who again raised concerns about the James Paget centre and dental care, and the speech from my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson), which covered his campaign for a new GP surgery in Wixams, which he is a very strong advocate for. He also made important comments on the accountability of integrated care systems.

I cannot cover all the speeches made today, but dentistry and delivery were the themes. We are all here because, as re-elected and newly elected Members of Parliament, we are passionate about delivering health services for our constituents. We want success on that both in our constituencies and across the UK.

In some ways, I think it is a bit easier for the Minister to make her speech than it is for me to make mine, and I wish I was on the opposite Benches—although obviously not in the Labour party—to deliver it. I anticipate that she will start by saying that, in some way, the economy is broken or that there are huge financial pressures. She will probably go on to say that the NHS is, in inverted commas, “broken”. I am quite concerned about that language, and particularly about the morale of our NHS workers when such statements are made.

The Minister will then describe her plans. That is where I feel for her, because she will be very pleasant and supportive, and I know she is passionate about the subject—she will recognise that this speech is very similar to the one she gave in a debate on dentistry back in 2022. Unfortunately, she will be evasive about her Government’s plans because she is on a bit of a sticky wicket. The Labour Government have decided that they will review a lot of work that has already been put in to deliver for people in the east of England. Hinchingbrooke hospital is at risk. Queen Elizabeth hospital, James Paget university hospital, Watford general hospital, West Suffolk hospital, Cambridge cancer research hospital and many other projects across the UK are under review, despite all the work that has gone into them over the years. It is on the Minister, because that is how integrated care system accountability works in our system under the Health and Care Act 2022—we are accountable to our constituents, but ICSs are accountable to her—so I ask her to reassure our constituents and the people who have put the work into developing those programmes that they will be delivered as promised by the previous Conservative Government. Will she think again about supporting dental vans to deal, on a temporary basis, with some of the dentistry challenges?

Oral Answers to Questions

Ben Spencer Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

May I congratulate those on the Government Front Bench on their appointments? I should declare that I am a former NHS consultant psychiatrist, my wife is an NHS doctor and I participated in the Wessely Mental Health Act review. While I no longer have a licence to practise, I may gently correct the Minister in that it is possible to provide a prescription without a diagnosis. [Laughter.]

The Opposition are pleased that the Government intend to build on the work of Conservative Governments, kick-started by the former Member for Maidenhead, to reform the Mental Health Act 1983. We will work constructively with them to make such legislation as effective, fair and compassionate as possible. With that in mind, does the Minister intend to make changes to the code of practice to the Mental Health Act now so that non-statutory changes and protections can be enacted while the Bill works its way through Parliament?

[Stephen Kinnock]

I welcome the shadow Minister to his place and congratulate him on his appointment. It is a little bit rich to receive a question like that, given that the Conservatives had 14 years to address the issue; I have been in this position for 16 days. If he looks at the plan that we are bringing forward, he will see that we have more ambition and more boldness in our plans than what we have seen in the last 14 years. We will introduce legislation that will address those extremely important issues for people who have some of the more severe conditions.

To the shadow Minister’s specific point on a code of practice, the first step will be to see the legislative process moving forward. But, of course, we remain open to looking at any solution or reform that will help to address this extremely important issue.