Batten Disease

Caroline Johnson Excerpts

Monday 22nd July 2019 Commons Chamber

[Seema Kennedy]

I thank the hon. Lady for her question. She has spoken to me and spoken in this House about Nicole and Jessica Rich. I agree that it is a highly effective treatment, but NICE sets the guidelines because it is made up of the independent experts and they are the ones responsible for the number of QALYs. However, as I have already said, it is constantly reviewing its guidelines in the light of the best available evidence. I have already reassured the House that I will make sure that I make contact with NHS England so that it is driving forward the process with BioMarin.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I have looked after a number of children with Batten disease in my career, and no one should underestimate the horrific nature of this condition with which a child develops apparently normally and then gets the horrific diagnosis that they will suffer neurodegeneration. I completely respect the importance of NICE being independent, and in general I do not get involved in these debates, but I believe I should do so in this one, because I actually think that NICE has this wrong. This drug does not make a little bit of difference—it does not have the effect of making someone die a couple of weeks later; it makes a phenomenal difference to the quality of life for these children. Yes, the trials have been short so far, but over a reasonable period it makes a massive difference, and I think we should do everything we can. I have heard the Minister say that she will ask the chief executive of NHS England to get BioMarin back round the table. How long will she give him to achieve that, and if he does not succeed, what will she herself do to ensure that these children get these drugs as soon as possible?

[Seema Kennedy]

I pay tribute to my hon. Friend for all the work she has done as a clinician. I can only say again—I know this is very disappointing for the House—that we have to rely on the NICE process to be independent. I hear what the House is saying about some people having doubts about the process, but, again, it is under review. NICE is internationally respected, and it has been going for 20 years. Yes, these are exceptionally difficult cases, but this is why, as custodians of NHS funds, we have to be very careful, because every pound we spend on one drug is a pound we cannot spend on another. I hear what my hon. Friend says about this being a life-changing drug, and I hope that BioMarin, NHSE and NICE will, and we would urge them to, carry on with their negotiations.

Children’s Palliative Care

Caroline Johnson Excerpts

Monday 1st July 2019 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

The subject of tonight’s debate is not an easy one to talk about, but it is very important. This evening, I am going to talk about the 49,000 children throughout the UK who have life-limiting conditions.

As a consultant paediatrician, I have looked after quite a number of these children over the years. I have been the person who has made that diagnosis, who has given that devastating news to families, who has looked after these families during various different points of the journey and, indeed, who has been there in those final minutes and hours. Through that time, I have watched as some of these families have just about managed, but others have really struggled to cope at all and have gone from crisis to crisis. For me as a paediatrician, the opportunity to be a politician gives me the chance to stand here and advocate for those families and for those children and to use this platform—this House—as a vehicle for change, and to make these treatments and the care that these children receive much better.

Children’s palliative care is not, as it is often misrepresented to be, only about the care that someone receives at the very end of their life: it is about improving the quality of their life while they are living with that life-limiting condition from the point of diagnosis. I shall take as an example a child with Batten disease. A child with Batten disease may present as apparently healthy, but they have a gene that will ultimately cause neuro-degeneration. So they will lose the skills that they had—the walking, the talking. Their skills will go backwards, until they become increasingly dependent on their families. Often, they die of chest infection.

The care for those families involves helping the child, the family and the siblings to understand the diagnosis and prognosis, providing support such as physiotherapy to keep the child mobile for as long as possible, providing home adaptions to train their parents in how to use things such as Mic-Key buttons, to provide tube-feeds and to use wheelchairs and hoists in the care of their children, and helping them with medical things such as seizure management, giving medication and speech therapy, as well as with how to navigate the benefits system, applications for a blue badge, education and when to move from mainstream into more specialist provision.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this matter to the House. There will not be a single elected representative who is not aware of someone who has been through this. Is she aware that the money that each children’s hospice has to spend each year to meet the needs of seriously ill children and their families has grown to an average of £3,681, which is a 4.5% increase between 2016-17 and 2018-19, faster than the rate of inflation, yet the funding has been cut or frozen for each of the last three years, leaving children’s hospices struggling to make ends meet? Does she share that concern, which we all have?

[Dr Johnson]

I thank the hon. Gentleman for his intervention. I do indeed share his concern and will come to some of those figures in a moment.

To return to the care that is provided during the palliative care process, finally, the care will indeed be about end of life care and bereavement counselling. Children’s hospices throughout the United Kingdom provide some of this fantastic care. They have specialist medical, nursing and other professional staff and volunteers, and I pay tribute to them, as I know other Members do, for their dedication and the fantastic work they do.

[Tim Loughton (East Worthing and Shoreham) (Con)]

My hon. Friend is a great ambassador on this very important subject. I pay tribute to the Chestnut Tree House hospice, which does such a fantastic job in West Sussex. Does she acknowledge that, because of medical technological advances, many of these children will live for much longer than was anticipated many years ago, and for many of them this is about not care in a hospice but outreach care outside the hospice? It is therefore important that we have good support packages for the parents, including respite and care over a longer term, and that we are more imaginative in the way we build houses, so that children with life-limiting conditions can live in houses—perhaps new social house build—that reflect the increasing physical demands that they will have, so they can stay in their homes to be cared for appropriately?

[Dr Johnson]

I thank my hon. Friend for his intervention. He is indeed right. The demand for children’s hospice care is rising because there has been an increase in the number of children with life-limiting conditions and because those children are living longer and therefore require care for a longer period. The cost of providing that care is also increasing at a rate faster than inflation and faster than the money that the sector receives, which means that in some areas the money received has fallen in real terms.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

The hon. Lady and I work together closely on this issue as co-chairs of the all-party parliamentary group for children who need palliative care, and we hosted an incredibly moving discussion during Children’s Hospice Week at which we heard really powerful stories from parents who had recently lost children. I am sure she appreciates my concern that the hospice care that children receive is often needed not just at the end of their lives but throughout their lives in order to give them the best life possible in the time that they have, and that it is not funded on a sustainable footing. Children’s hospices must not be left to rely on the ability of local areas to fundraise for them. They must be put on a sustainable financial footing to give the children and their families the support that they need.

[Dr Johnson]

The hon. Lady is right. In fact, NHS and local authority funding represents just 21% nationally of the money that children’s hospices need. The rest is raised by charities, but for some hospices in less affluent areas, raising the additional money that is required can be very challenging.

I welcome the fact that the Government have made their end of life care choice commitment, which is really clear about the care support choices that children should have. In our roles as co-chairs of the all-party parliamentary group for children who need palliative care, the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and I carried out an inquiry last year to find out the extent to which this commitment was being met. We found that Ministers were at risk of failing to meet that commitment because of funding, as described, and because the quality of palliative care that children and families can receive is variable, depending on the area in which the child lives.

[David Linden (Glasgow East) (SNP)]

I am grateful to the hon. Lady for giving way, and I pay tribute to her expertise on this issue. Does she recognise that north of the border, in Scotland, the Scottish Government have recognised the need for parity of funding between adult care and children’s care, and that that is not the case in England? Will she join me in calling on the UK Government to look at the model in Scotland to see what a difference we have made and what has been delivered by, for example, CHAS—Children’s Hospices Across Scotland?

[Dr Johnson]

I thank the hon. Gentleman for that intervention. I am not familiar with the details of how hospices are funded in Scotland, but one of our report’s recommendations was that the grant for children’s hospices should be increased to £25 million. That is something that I repeat this evening.

On 27 December last year, we received a late Christmas present when Simon Stevens, the chief executive of NHS England, announced that £7 million of funding over the next five years would be available to children’s hospices each year in addition to the £11 million children’s hospice grant, if the clinical commissioning groups could provide match funding. I understand the benefits of match funding because it increases the engagement of the CCGs locally, but where CCGs are not providing the funding, it can lead to services not being provided properly in that area. Also, later, when the long-term plan was produced, the detail showed that this funding was not only for children’s hospices but for other palliative care services. This was recognised as useful for providing services for children in areas currently not covered by a hospice, but it could equally mean that the money might be diluted into other causes and not reach the children who need it.

Two weeks ago, as the hon. Member for Newcastle upon Tyne North said, we joined our secretariat, the excellent charity Together for Short Lives, which does much work in advocating for these children and their families, and we met parents and representatives from several hospice charities to discuss these issues further. One real concern to us at that time was that one of the charities, Acorns, which receives the most Government funding, was struggling to raise charitable donations in its area to cover costs and was consulting on closing one of its children’s hospices, in Walsall, meaning that families would have to travel much further for the care and support they needed. I know that that is something that no one in this House would want to see happen. Indeed, I have raised the issue with my hon. Friend the Minister for Care and my right hon. Friend the Prime Minister, both privately and in the House. I ask the Minister to raise the children’s hospice grant to £25 million a year and to ring-fence that money. It is a small amount within the NHS budget as a whole, but it would make a huge difference to children receiving hospice care and their families.

[Catherine McKinnell]

The hon. Lady is being generous with her time and is making an excellent speech. While she rightly makes the case for children’s hospices, does she agree that they are not the only vital care support that children and their families need? They also need care at home, which is often provided by charities such as the Rainbow Trust. It is a hugely important service, but CCGs and local authorities are too often not commissioning it, and one can only assume that that is due to funding restraints. Does she agree that local authorities and CCGs should be incentivised and supported to fund and make such services available?

[Dr Johnson]

I thank the hon. Lady for her intervention.

Turning to those who do not receive valuable hospice care, as a doctor I have seen too many families in crisis, struggling to cope with patchy provision or the lack of hospice or home care or respite. As children’s hospices are frequently set up by charities, their locations across the country have not been planned, so some families find themselves too far away from services to be able to use them. I want NHS England to review the provision of services to ensure that care is no longer patchy and no longer dependent on where a child lives. The hospices that I have spoken to have asked me to make the Minister and NHS England aware of how the funding cake is split. Hospices—both the well funded and the less well funded—feel that funding should be disbursed more fairly based on clinical need, so an examination of that situation would be helpful.

Another area on which I would be grateful for the Minister’s response is respite care or short breaks. For most people, an evening out requires a quick call to a friend or relative. If Mr Johnson and I want to go out for dinner, I just need to ask someone to come to our house for a few hours. I do not need to spend weeks planning to take the children away for several nights or a week at a time. I can pop out for a curry for two hours. For families whose children have many complex medical and physical needs, things are much more difficult. Short break provision is often patchy and inflexible. I might want a babysitter so that I can attend my brother’s wedding, but for someone whose child has complex needs, if the weekend on which respite care is available is not the same weekend, that may not be much help. Sadly, having got all the plans in place, respite care is all too often cancelled at short notice. In my time as a doctor, I have seen families pitch up at the hospital with their child, who has remained in an acute hospital bed for the weekend simply because, where else can they go?

I would like an army of help for families, not a patchwork system. I want each family to have the guarantee of short breaks and the opportunity to access trained care assistants who can be booked to come to the family home, like any other family can have if they want to go out for a meal or attend a sibling’s school play—Mr Speaker, you mentioned that your daughter Jemima was in a play recently, and I am sure that it went extremely well. Children with complex needs may have siblings, and the parents will want to be able to attend their plays. The Government should provide such a service through the NHS, and there should be a set amount of guaranteed free home respite care time per year, perhaps with additional subsidised capacity above that amount.

I know the Minister understands how important children’s palliative care is to children and families, and I know how hard she has worked and pushed for this issue in her Department. I know she understands the need for the Department to work with NHS England to review this provision and how it is spread across the country, and I hope she will be able to assist with the provision of respite care breaks so that these very vulnerable families find it easier to have short breaks and access to childcare, like any other family and any of us would want. Most importantly, I ask the Government to make sure that NHS England now honours the original announcement by recommitting to protecting the children’s hospice grant for the long term and by increasing it to the £25 million a year that is needed.

[The Minister for Care (Caroline Dinenage)]

I congratulate my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) on securing a debate on this important matter. I particularly thank her for the fantastic work she does both as a medical professional—a paediatrician—and in her role as co-chair of the all-party parliamentary group for children who need palliative care, on which she has been a tenacious, passionate and very effective campaigner.

The APPG produced a report last year on children’s palliative care, to which the Government responded in full, and today we have an opportunity to pay tribute to the incredible work offered by children’s palliative care providers, many of which are hospices, in supporting some of our most poorly children and their families.

Children’s Hospice Week took place last month, and this year’s theme was “moments that matter.” As MPs, we are all very aware of the crucial role played by hospices in supporting and caring for our communities at a time of great need. I first became aware of that many years ago, when my mum was involved in fundraising to build the Naomi House children’s hospice near Winchester. In fact, she embroiled my whole family in a series of embarrassing fundraising activities to further her ends.

Since then, I have been privileged to visit Naomi House and, later, Jacksplace, a facility for young adults collocated on the site, to see for myself the incredible care and support they offer to very poorly children and their parents, both on site and more broadly in the community.

In my role as Minister for Care, I see how crucial palliative and end of life care services are for families in need. We know that many areas across the country are delivering excellent support and palliative care for children, but there is no room for any kind of geographical inconsistency, which is why it is crucial that more is done to challenge and support areas that are not providing it. That is why we have made children’s palliative and end of life care a priority in the NHS long-term plan, particularly in supporting children’s hospices.

NHS England’s hospices programme currently provides £12 million a year for children’s hospices, helping to provide care and support to children with life-limiting conditions and their families. I am delighted to announce, and my hon. Friend and other members of the all-party parliamentary group will be very pleased to hear, that NHS England has committed to increase the funding to £25 million by 2023-24. That will guarantee the additional £13 million for the children’s hospice grant. Clinical commissioning groups had been asked to provide match funding, but NHS England has now taken the decision to guarantee the investment after concerns were raised. As my hon. Friend said, match funding would not necessarily achieve the full investment anticipated.

I care very deeply for the hospice movement, and I hope this funding will provide it with full reassurance of the Government’s commitment to and support for its incredible work.

[Dr Caroline Johnson]

I thank the Minister for this fantastic announcement, and I know the money will make a phenomenal difference to the lives of the poorliest children in this country.

[Caroline Dinenage]

I thank my hon. Friend for that. She must take some of the credit, because it is her work, along with that of her co-chair of the all-party group, that has helped to secure these strong commitments from NHS England, so I wish to pay tribute to them this evening. But there is more. We know that children’s hospices are not evenly spaced throughout the country, so NHS England has also committed to undertake a needs assessment to understand whether additional investment, nationally or from clinical commissioning groups, is required where palliative care is provided by means other than hospices.

[Caroline Dinenage]

The hon. Lady has powerfully put her sentiments on the record, and I absolutely with them. In parallel with the announcements that NHS England has made on the much-welcomed investment, it is working to develop commissioning models specifically for children and young people with palliative care needs, to support CCGs. We know it can be difficult for some commissioners to meet the needs of this vulnerable group, and these models will help them overcome the challenge of delivering services for small and geographically spread groups of patients, whose conditions can fluctuate over the course of their lives. Together for Short Lives is involved in this important work, and I also wish to put on record my thanks to it for its continued support.

My hon. Friend mentioned Acorns hospices, which is currently consulting its staff on the closure of one of its children’s hospices at Walsall. I have been made aware that there is a financial aspect to this consultation, but there are other aspects to it, such as a reduction in the number of bed days used by in-patients. As I say, this is a consultation at this stage and I am hoping that the announcement of this money will help to make a difference to its decision.

In “Our Commitment to you for end of life care”, we set out what everyone should expect from their care at the end of life, and the actions being taking to make high quality and personalisation a reality for all in end of life care. The choice commitment is our strategy for end of life care, which, through the NHS mandate, NHS England is responsible for delivering through its national end of life care programme board, with all key system partners and stakeholders, including Together for Short Lives. This presents the best opportunity to continue to deliver the progress we all want to see and make the choice commitment a reality for both adults and children.

Looking to the future, the NHS long-term plan has set out a range of actions to drive improvement in end of life care and deliver the choice commitment. In addition to the £25 million of investment in children’s hospices announced today, the NHS long-term plan has made a number of commitments that will improve palliative and end of life care for children.

[Dr Caroline Johnson]

Along with the all-party group and Together for Short Lives, we have asked the Minister for three things this evening, and we appear to have received two of them—the extra money and the NHS England review. We will keep pushing for the third—respite care and an army of babysitters—but as Meat Loaf said, “Two out of three ain’t bad”.

[Caroline Dinenage]

As I said at the beginning, my hon. Friend is nothing if not utterly tenacious and passionate in her pursuit of this. I will talk about the short breaks now. She is absolutely right on this; I do not think families are necessarily looking for big long holidays, they just need short breaks, but for those need to be reliable and consistent. People need not to be let down at the last minute. That is the message I am getting loud and clear. Local authorities have a legal duty to commission short breaks, as established by the Breaks for Carers of Disabled Children Regulations 2011. Although the NHS role is not statutory and is a matter for NHS commissioners, the NHS may provide the clinical aspects of care to support such services, if appropriate.

According to the 2018 Together for Short Lives report, 84% of CCGs reported that they commissioned short breaks for children who need palliative care. That is an increase on the support in 2017, when it was 77%, but I recognise that we have much further to go. Parents desperately need short moments of respite and to know that their children will be well cared for at such times. The breaks also need to be reliable, and we will continue to work on that.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 18th June 2019 Commons Chamber

[Seema Kennedy]

A wide range of activity has been undertaken to help people to understand whether they need to pay for their NHS prescriptions, and I remind the House that 84% of NHS prescriptions are available for free. My Department and the DWP are working together to provide further clarity to universal credit, and hopefully we will be adding a universal credit tick box to the prescription form.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

9. What steps he is taking to ensure that people can access Changing Places facilities when they use NHS services.

[The Minister for Care (Caroline Dinenage)]

Last year, I announced £2 million funding for NHS trusts in England to install Changing Places facilities in hospitals; this is now available for trusts to bid for. We estimate that 250,000 people in the UK cannot use standard accessible toilets, and the fund could help to install well over 100 more Changing Places facilities.

[Dr Johnson]

Many of the disabled children who use Changing Places facilities also have a life-limiting or life-threatening condition. I welcome the increase in Changing Places facilities, but in this national Children’s Hospice Week could I ask my hon. Friend to go further in protecting these vulnerable children by increasing the children’s hospice grants to £25 million to give them the financial security they need?

[Caroline Dinenage]

I am really pleased that my hon. Friend has mentioned that it is Children’s Hospice Week. It is a great opportunity to pay tribute to the incredible work that children’s hospices do up and down the country, supporting some of our most poorly children and their families. I thank my hon. Friend for the work that she does on the all-party parliamentary group for children who need palliative care. The short answer to her question is yes; the NHS will match fund CCGs that increase their investment in children’s palliative care, including hospices, by up to £7 million. That is increasing support to a total of £25 million a year by 2023-24.

Healthcare: East Midlands

Caroline Johnson Excerpts

Tuesday 30th April 2019 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. In case hon. Members are not aware, I am a consultant paediatrician and work in the east midlands as a doctor during times that fit around my parliamentary commitments. I have worked in a number of hospitals around the east midlands: in Lincoln County Hospital, Mansfield Community Hospital, King’s Mill Hospital, and in both of the major Nottingham hospitals, Queen’s Medical Centre and Nottingham City Hospital. I have also worked at Doncaster hospital and I am now at Peterborough. I have a fairly wide experience of the different hospitals serving the east midlands population.

I was proud to hear last week that Peterborough has received a “good” rating from the Care Quality Commission. Not just that; the CQC will shortly return because the trust is not happy with “good”—it wants to receive an “outstanding”. It was somewhat displeased that the visitors focused on the areas they thought might be a problem, rather than on the areas we might have been able to showcase. The CQC will return to see the areas that it knew were very good already, to see whether we are entitled to see the “outstanding” mark. I hope that is achieved.

I congratulate the hon. Member for Lincoln (Karen Lee), my constituency neighbour, on achieving this hour-and-a-half debate. I was pleased to hear her welcome the extra money for the NHS, but disappointed to hear that she does not think it is enough, unlike the former Labour Health Secretary. We need to bear it in mind that a 3.4% average real-terms annual increase—£20 billion more—is a lot more money. I was also disappointed to hear about problems; it is easy to identify the problems and much more difficult to identify the solutions. Money is one of the solutions, but this is about much more than money.

I want to highlight some of the really good things going on in the east midlands. The hon. Lady correctly identified morale as one of the issues with the workforce. One of the things that affects workforce morale is people focusing on problems rather than on the areas in which excellent services are being delivered, which is the focus of most of my constituents—me and my family included—who receive excellent service from the hospitals in our area. The problem with low morale in the workforce is that it causes people to leave. When people leave we have more locum staff, which increases costs. Since less money is available, there is less ability to trial new things, so staff leave—and so the cycle continues. We need to reverse that, so I welcome the new routes into nursing, such as nursing apprenticeships, and the hard work we have done to increase the number of nurses who can train.

As a doctor, I am aware of shortages in medical staff, particularly in paediatrics, which is the area I work in. The University of Lincoln is opening a medical school in the hon. Lady’s constituency. That is a really good intervention. Students commonly stay to work in the area in which they trained, and that medical school will enable that to happen. The Government also need to look at remuneration. The remuneration of my junior medical colleagues is significantly lower in real terms than the remuneration I received as a junior doctor at the same grade.

I would be grateful if the Minister looked at issues with retirement. In my constituency, some GPs and other doctors retire earlier than they might wish to, because if they continued to work they would accrue very high pension contributions that they would not benefit from. If they continued to work but withdrew from the pension scheme, they would lose other benefits, such as death in service benefits. The Government should look at that.

In my rural constituency, once I have visited the GP it takes me 15 minutes to drive to a pharmacy in the nearby towns of Grantham or Sleaford with the prescription I have been given. Some patients at my surgery, including me, are entitled to have their prescriptions dispensed to them on site. How frustrating it is, though, for constituents who do not have that entitlement but would if they moved one house further down the street, not because they live in the wrong area but because they moved practice after they moved house. A constituent recently wrote to tell me that if someone moves into the area and then changes their GP, they are not entitled to dispensing services, but if they move GP and then move home, they are entitled to those services. That seems incongruous. GPs at dispensing practices receive a revenue increase, so they have both an incentive to provide an excellent one-stop service to their patients and a financial incentive to work in a rural area that offers such a dispensing service. I should be grateful if the Minister would look at that.

When I was first elected, I was terribly worried about East Midlands ambulance service. In the preceding few months, I had attended a number of incidents—just as an individual member of the public who had been driving past—where patients waited an inordinate amount of time for an ambulance. That was completely unacceptable, and one of those patients died, although I suspect that was not related to the time the ambulance took to arrive. That is why my first Prime Minister’s question, my first meeting with the Prime Minister and my first meeting with the Health Secretary were all about East Midlands ambulance service.

I was therefore pleased to go back and visit the ambulance service recently and hear how much has been done. The extra money that has been put in has produced 67 new ambulances, of which 27 are brand-new and additional as opposed to new-for-old replacements. The service’s response time for patients in the most acute need—the most unwell patients—has fallen by more than two minutes, which is a good success; we have to bear in mind the rural geography. I was also interested to hear about the research that is going on. Not all improvements in healthcare are delivered by money; some are delivered by research and improvements in knowledge and treatment. The East Midlands ambulance service has a research and audit department, which is looking at ways that the service can deliver better care to its patients; that is excellent.

A number of hon. Members mentioned the challenges of delivering healthcare in rural areas. Hon. Members may know about the joint work between Bishop Grosseteste University in Lincoln, United Lincolnshire Hospitals NHS Trust, Public Health England, Health Education England and others on launching a national centre in Lincoln to look at how we deliver better care to people in rural areas—that is its main focus. That is another attraction for people to come and work in the beautiful county of Lincolnshire. The centre will look at data, research and technology. I would love to have time to go into all the different things it can do to improve healthcare for my constituents and others, but time is short, so I will move on.

Let me touch on orthopaedic services at Grantham. People rightly are terribly concerned about the number of people who prepare for an operation—they build themselves up, take time off work and put plans in place for the care of those who are dependent on them—that is cancelled. We understand the reasons why that might happen, but ULHT has worked really hard on delivering better care. The fantastic Grantham Hospital—it has saved my husband’s life on two occasions—has a designated ward for orthopaedic surgery, which is only for what it calls “cold” operations. That is part of the “Getting It Right First Time” approach, looking at how we ensure that we get the very best care in orthopaedic surgery.

Trauma services have been moved to Lincoln. People might say, “Oh, that’s a dreadful cut,” but it means there are more people on hand in Lincoln to deliver more operations more effectively and more efficiently; more people get their operations done—fewer are cancelled—and there is a dedicated team of people in Grantham who are knowledgeable in orthopaedics and focused on delivering joint replacements and other non-urgent care. Overall, the service has improved massively. I congratulate ULHT and Grantham Hospital on the improvements they have delivered, and I wish they were being shouted about more publicly.

I also want to mention the A&E at Grantham Hospital. My husband, whom I love very much, has had his life saved twice at Grantham Hospital, so maintaining A&E services there and ensuring that people can access them is extremely important to me and my family, not least because we live very close by. I welcome the fact that the A&E will be reopened on a 24-hour basis soon, but I want soon to be now.

I have run out of time, but I thank the hon. Member for Lincoln for securing the debate and I hope to hear some good answers from the Minister.

Infant First Aid Training for Parents

Caroline Johnson Excerpts

Wednesday 3rd April 2019 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this important debate. She has been a champion of raising awareness to reduce avoidable deaths through working with the UK Sepsis Trust—sepsis is also a major killer of adults and children—and I am delighted that she has now lent her voice to the cause of infant first aid training for parents. As a paediatric consultant, this is an issue close to my heart.

My hon. Friend highlighted the alarmingly high number of cases where something could have been done to prevent a child’s death: 21% according to the Royal College of Paediatrics and Child Health. I should declare my membership of that organisation. Working on a children’s ward for the last 15 years, sadly I have seen far too many of those 21%. However, I have also seen children whose lives were saved by passing members of the public, as was described earlier in the case of Rowena, by doctors or health professionals, or by visiting family members who just happened to spot something and were able to help.

My hon. Friend the Member for Truro and Falmouth powerfully described a case of a child choking. As we approach Easter and then summer, mini-eggs and grapes are particular culprits. Advice should include how to manage a choking child, as well as simple measures to prevent choking. Chopping up grapes into little pieces, sitting down while eating and not running about with things in the mouth are helpful in preventing choking, but it can still happen to anybody, young or old, at any time. We should all know some of the manoeuvres that can help, such as the one my hon. Friend described in the case of the baby choking. The baby should be held face down across the adult’s legs, so that the baby’s head is lower than the adult’s knee, and blows should be applied to the baby’s back, between the shoulder blades.

That sort of information does not take long to learn, but can have a huge impact and can be responsible for saving somebody’s life. The information is already provided to a number of parents. I have delivered infant first aid to parents whose children have been in hospital. Each of the neonatal units that I worked on in the midlands provided first aid training to parents before they left hospital, in part because pre-term babies are more vulnerable when they have just left hospital and in part to provide parents with the confidence to manage very small babies when they go home, as was described by my hon. Friend the Member for Moray (Douglas Ross). Training is also provided routinely to parents who have had a child die in the past, but obviously we want to look at prevention.

The hon. Member for Belfast South (Emma Little Pengelly) talked about contact with health visitors and midwives. Evidence shows that parents are particularly receptive to messages about healthcare and first aid when they have just had their baby or when they are expecting their baby, as my hon. Friend the Member for Moray mentioned. That is a time before life becomes really busy, when one can reflect on the joy that is to come and be well prepared for it.

There are lots of opportunities for first aid training to be provided. There are antenatal classes, where training can be signposted or provided, as well as nurseries. I strongly believe that the practical advice should not just include what to do when things have gone wrong, but how to stop them going wrong in the first place. My hon. Friend the Member for Moray mentioned burns. I remember the case of a child who walked past a lit candle; it caught her dress and she got severe burns to her whole front. In that case her mum knew what to do—drop her to the floor, roll her over and stop the burning—and treated the situation appropriately, but even so the injury was severe and could have been prevented if the candle had not been left on such a low table.

Using seatbelts and car seats are among other simple measures that we know we should to do. One major cause of preventable deaths in children is drowning, so there should be simple advice about making sure that children are not left unsupervised around open water. I have seen this particularly in situations where there has been open water and a group of people, often at a big family event, where everybody is looking after the child but there is not one specific person watching to see that they do not end up in the water. At one of my children’s christenings, I was upstairs in a bedroom on the other side of the house when I saw from the window that a friend’s little boy had gone towards the small pond we had in the garden and that he was on his own. I ran downstairs and was fortunate that he had not gone into the pond by the time I got there. My husband was out with a digger the following day getting rid of the pond. It was not worth the risk, but if people have such ponds they need to be carefully managed. I have certainly seen children drown in those situations.

[Jim Shannon]

One thing that can be neglected in homes is fluids in cupboards. Years ago, when we were younger, fluids were kept in lemonade bottles and similar containers, and children did not realise that. I well remember when my second boy was very young—he was the one who everything seemed to happen to—he managed to get a gulp or two of Brasso. He had the shiniest backside that any child ever had, but that is by the way. It can easily happen that a fluid can be drunk or absorbed by a youngster. We need to take steps in our own homes to ensure that all fluids are under lock and key, wherever they may be.

[Dr Johnson]

I take the hon. Gentleman’s point about fluids. I noticed when I bought some washing detergent last week that the lids now have a clasp that is especially difficult to open, so children cannot consume those little bubbles. No one is ever perfect; I know that if I looked for hazards to my three children in my own home they would be there. So far, thank God, I have been lucky and I hope that will continue, but we can all do things to reduce risk.

I am glad that the Government are committed to ensuring that all early learning staff have first aid training, but it is time that they did the same for parents. Since 2016, all newly qualified level 2 and 3 early years staff must hold a current paediatric first aid or emergency paediatric first aid certificate. The Millie’s Mark quality scheme, which was commended by my hon. Friend the Member for Cheadle (Mary Robinson), was also launched in 2016. It requires childcare providers to train 100% of their staff in paediatric first aid, not just to have one trained person on site at any one time. The 300th nursery gained Millie’s Mark last summer, which was a cause for celebration, and I am proud those nurseries include Dappledown House Nursery and Appletree Corner Daycare in my constituency. My son’s nursery has offered parents first aid training in the last couple of months, so the message is getting out there and that needs to continue.

The efforts to provide safety in schools should now be matched to provide safety in the home. The time and financial investment needed to provide that is small. It costs £30 for two and a half hours of invaluable training on some of the most common causes of avoidable death, including choking, and ways of providing resuscitation. Providing preventive medicine is one of the best investments we can make. As well as avoiding tragedy, it takes pressure off our NHS services, which are facing ever-increasing demand. It is the right thing to do for both our children and our country, and I am glad to lend my support to this cause today.

--- Later in debate ---

[Julie Cooper]

I am grateful to the hon. Gentleman for that important intervention. I shall certainly speak with a loud voice about the subject in my constituency, and I encourage all Members to do the same.

The other point made by the hon. Member for Moray was that access is not easy. In preparation for this debate I checked up on access to training courses for my constituents and found that, even though I represent an urban community, it involves a 60-mile drive or a long train journey on a slow, rickety train line. That presents a massive barrier to my constituents accessing such training. I totally take the point that the hon. Gentleman makes, and I agree with him entirely.

The safety of our children is and always should be paramount, and it is therefore important that, in the event of an obvious health emergency, parents have at least a basic knowledge of first aid so that they can take action before professional help arrives—actions that might save the child’s life. The hon. Member for Truro and Falmouth made a strong point about how it is important that parents are trained to recognise the symptoms of what can be serious diseases, such as sepsis and meningitis. It would be useful if parents were equipped to recognise the symptoms before they decide whether to call 999 or take their child to hospital, because knowing how to spot the symptoms really does save lives.

First aid, as the term suggests, is the first medical attention that a person receives after an accident or during a medical emergency. Despite what many people have been led to believe, first aid does not have to be delivered by medical professionals—we have established that. A person’s chances of surviving a medical emergency are increased dramatically if a member of the community can respond with first aid immediately. What happens in the crucial minutes after someone dials 999 or the NHS’s 111 and before professional help arrives can be the difference between life and death. The British Red Cross reported that close to a quarter of infant deaths could have been prevented had there been a qualified first aider on hand, and who better to be trained than the parent?

[Dr Caroline Johnson]

A few weeks ago I was walking to a parliamentary event across the square, and I came across a man who was unconscious and not very well. When I called 999 for an ambulance, I noticed that the ambulance operators who answer the phone provide detailed and step-by-step advice to callers about what to do. That is a beneficial thing to note.

[Julie Cooper]

That is an important point. I have been on the receiving end of that with a family member, waiting for an ambulance and listening to instructions. Nevertheless, I appreciate that having the confidence to follow those instructions, particularly with a young child, might go a little beyond that.

This is about re-teaching people about what they think they know. There is a lot of so-called knowledge out there among people who think they know first aid, but that is often based on what they have seen in the media, which sometimes puts style before substance. In fact, procedures shown for dramatic effect often bear little resemblance to safe first aid. Furthermore, carrying out procedures without proper training might do more harm than good. First aid for babies is also vastly different from first aid for adults and other young children. Such important matters should be regarded as key parenting skills.

All parents, irrespective of their ability to pay, should have access to high-quality first aid training as a priority. Access to first aid training is about more than skills; it is also about building confidence and resilience. The British Red Cross surveyed a group of people it had trained in first aid, and asked whether they felt the training had contributed to their personal wellbeing. Three quarters of the respondents said it had made them more capable and more reliable in an emergency, and half said it had made them more determined and better at finding their way out of difficult situations.

Ahead of this debate, the British Red Cross shared with me the case of Leanne, a young mum from Swindon. When her baby, Maia, was six months old, Leanne took a baby first aid course with the British Red Cross. When Maia was 18 months old, she had a febrile seizure. Using knowledge from her first aid course, Leanne was able to save Maia’s life by instantly recognising the signs, taking steps to cool her down by removing her blanket, and placing her on the floor so that she did not injure herself during the seizure. After the seizure was over, Leanne further reduced Maia’s temperature by stripping her down to her vest, and she placed her in the infant recovery position. Leanne’s quick thinking saved Maia’s life before the paramedics arrived, and Maia is back to her playful, happy self. Leanne was able to do that only because she recognised the signs of a febrile seizure from her baby and child first aid course.

A seizure can be a terrifying and violent event for a parent to witness, especially when they do not understand what is happening. Febrile seizures are not unusual in babies and children between the ages of six months and three years. However, the Red Cross reports that, when questioned, 66% of parents had not been taught to recognise a febrile seizure, and 65% did not even know what one was. The baby and first aid course gave Leanne the knowledge and skills to act, but most importantly it also gave her the confidence. She said:

“I’m grateful that I had attended a baby and child first aid course which meant I knew what to look out for and how to deal with a febrile seizure.”

Because of her first aid knowledge, she felt calm and able to act for her daughter.

We have heard many examples of such events, and we are grateful to the hon. Member for Sleaford and North Hykeham (Dr Johnson) for sharing her expertise. People in the wider public often talk about MPs living in a bubble or ivory tower, but the hon. Lady’s expert and practical knowledge demonstrates yet again that Members of Parliament are in touch and know what is happening out there. As the hon. Member for Henley (John Howell) said, it is right and proper to use our position to spread that knowledge and champion causes such as this.

In 2014, Mumsnet sponsored 20 mums to take part in British Red Cross baby and infant first aid training. All the mums rated the training highly, and one said:

“I really enjoyed the course as every single thing discussed could easily relate to me and my children. All the videos of real-life scenarios really brought it home how easily these things could happen, but now I feel confident and that I could make a real difference to the outcome, and would feel so much more knowledgeable on what to do in an emergency situation.”

As we have heard, there are many different providers of first aid training for parents of infants. I specifically mentioned the British Red Cross, and other hon. Members have mentioned St John Ambulance, which offers first aid courses designed specifically for babies and children. There are also local providers, such as the one championed by the hon. Member for Truro and Falmouth. In addition, the NHS provides an online app to support parents with first aid for their infants. One parent said:

“Although you could read everything on the app and watch the videos for free, I think doing it in a class environment really makes you take it all in. It will also make you feel more confident if you were ever to need to help someone or your own child.”

As the Secretary of State for Health and Social Care often reminds us, technology in the NHS is helpful, but it is not a substitute for services delivered by real people. In terms of first aid provision for parents, such apps can be useful to reinforce training given in a class setting, but they should not be seen as a substitute.

[Dr Caroline Johnson]

The hon. Lady is generous in giving way. Does she agree that both technology and face-to-face contact have their benefits and can be combined? A “sim” dolly is an electronic version of a resuscitation dolly, and when supervised resuscitation is provided to a baby, it provides electronic feedback on whether compressions are deep or fast enough, as that can be measured electronically by the dummy itself.

[Julie Cooper]

I am grateful to the hon. Lady for her expertise in that technology, and such things can be used in combination with a class setting and training to support existing knowledge. I agree that, on specific occasions, such technology has an important role.

In terms of treatment, we lack consistency of provision and access. We have already spoken about distances to, and charges for, courses being a barrier for some parents. Shockingly, research by the Red Cross showed that 95% of parents did not know what to do when shown three examples of life-threatening medical emergencies. Surely it is time to ensure that training is available for every parent in every region. I take the point that we ought not to be prescriptive, but in leaving things to local providers, we must ensure that no one falls through the gaps and no parent is missed.

The Royal College of Paediatrics and Child Health has warned that UK infant mortality levels are among the highest in the developed world. There are many reasons for that, but cuts to local child services, community health projects, and community midwives and health visitors have undoubtedly not helped. It is clearly desirable to ensure that this important provision is adequately funded, but a significant proportion of deaths could be prevented by ensuring that all parents are equipped with important first aid skills.

Of course, a parent first aider is no replacement for a health visitor or paramedic, but they can be the first line of defence when it comes to helping their children live longer and healthier lives. Informed parents can prevent unnecessary trips to the GP and inappropriate hospital admissions, and it is a shame that despite the support that community and parent first aiders provide to the NHS and families, they are barely mentioned in the NHS long-term plan. That is important because if the Secretary of State is serious about making the NHS the best health service in the world, and about having an NHS that promotes health and wellbeing through a focus on prevention, the Government must make first aid in the community a priority. Equipping parents to look after their infants is a good and important step.

Will the Minister take action to ensure that universal first aid training forms part of the antenatal care available to parents? This is about providing families and communities with the skills to step forward in an emergency so that tragedies can be avoided. Learning such skills can be the difference between a life saved and a life lost.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 15th January 2019 Commons Chamber

[Steve Brine]

Of course, health is devolved, but we talk to our opposite numbers all the time, as do our officials. Our north star ambition to halve child obesity by 2030 is right and it is shared and matched by our colleagues in Scotland, and we look to our colleagues in Northern Ireland to do the same. Any advice and support that they want from our world-leading plan is more than on offer.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Does the Minister agree with the campaign being advanced by Jamie Oliver to ensure that doctors in training are given more extensive training in nutrition and its benefits for health?

[Steve Brine]

Yes, I do. I was fortunate enough to visit Southend pier before Christmas to talk to Jamie and Jimmy about this. Nutrition training and the understanding of what is involved in achieving and maintaining a healthy weight varies between medical schools. Some courses have only eight hours over what can be a five or six-year degree. Together with the professional bodies and the universities, we will—as we said in the long-term plan—ensure that nutrition has a greater place in professional education training.

Nursing: Higher Education Investment

Caroline Johnson Excerpts

Wednesday 21st November 2018 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing a debate on this very important subject and the Minister for Health on his new role.

I do not think there is anybody in Westminster Hall today who would doubt the value of nursing or the importance of good nursing and nurse training. I have worked for my entire career as a paediatrician; I am now a consultant paediatrician. Nurses and midwives have had a significant impact on both my career and my personal experiences. When I worked on a neonatal intensive care unit, many nurses influenced my career. However, there was one in particular—a lady called Mary Palfreman, a nurse in Nottingham—who had a profound effect on me, because she is such a fantastic nurse. On a personal level, I was cared for through several of my pregnancies by a midwife called Marie Robinson, who was able to balance treating me as a medic, who had more knowledge of neonates and babies than the average first-time mum, with treating me as a mum. She recognised that I was a bit of both and perhaps needed a slightly different approach from others—even a unique approach. She treated everybody as she found them, and she is a fabulous woman.

None of us, therefore, would doubt the value of a good nurse and the importance of making sure that there are adequate numbers of nurses. Nursing is a great and varied career, which is something we should be selling more. Nurses have the opportunity to nurse in many different fields. As their career progresses, they can go into administrative roles, managerial roles and specialist technical roles in the community or in a hospital, and develop a good and, at the high level, extremely well paid career.

So what should a good training scheme do? Obviously, it should provide high-quality experience, so that students develop the necessary expertise; it should provide the opportunity for continuing personal development; and it should ensure that there is an adequate supply of nurses. We have a change in demographics: the population is getting older, there are more people with complex health needs, and the population is increasing in size. So we need to ensure that the number of new nurses keeps up with both those developments and the natural attrition of nurses as people retire and so on. We also need to ensure—this is very important to me as a Conservative— that anyone who has the desire and the aptitude to train as a nurse can do so and is not limited by how much money they have or where they are from.

Looking at some of the figures, it is evident there has been a drop in the number of people applying to become nurses, but at this stage there are still many more applications for nursing than there are nursing training places. I was not a parliamentarian when the new policy was introduced, but I understand that the aim behind it was to ensure that more places were available so that more people with the desire and the aptitude could train. The figures I have been given show there are 13,000 more nurses on the wards now than there were in 2010.

In January I was a member of the Select Committee on Health when it produced the nursing workforce report that the hon. Member for Stockton South (Dr Williams) mentioned earlier. It showed specific shortages in mental health, learning disability and district nursing. I understand that the previous Minister undertook to give up to £10,000 to people training in that field, to try to address the shortages. Will the Minister tell us how that is working and whether it is increasing applications? Also, the Government had recognised specific challenges for people wishing to go back into nursing or to develop nursing as a career after having children. Is the Minister looking into what support can be offered to those with disabilities and those with children to make sure that they are still able to access nurse training and become the fabulous nurses that they can be?

The issue of part-time jobs has been raised. Most of the nursing students I have worked with in my career have had part-time jobs, usually as a healthcare assistant, often on the same ward that they have worked on as a nurse, so I am not sure the point that was made entirely reflects what I have seen.

Finally, I want to mention alternative routes into nursing. There is more than one route to achieving a goal. There are opportunities for people to work as nursing associates. Some of the healthcare assistants I have worked with have done that, and they really enjoy their training. There is also the opportunity to go into a nurse apprenticeship as an alternative way of training while working. That is not for everybody, because people want different things, but it is another way in which we can increase nurse numbers without having an impact on training. I am aware of the time, but will the Minister update us on—

[Philip Davies (in the Chair)]

Order. The hon. Lady’s time is up.

--- Later in debate ---

[Stephen Hammond]

Inspiration has just reached me. As the hon. Gentleman will know, Health Education England recently published a report on attrition rates on nursing courses—I made the point earlier that the rate of attrition among all people applying for university places has gone down. However, I will write to the hon. Gentleman. The report published by Health Education England describes how attrition rates on those courses have fallen considerably over the past few years, but I will write to him to be absolutely clear. He may then choose to make that letter available.

[Dr Caroline Johnson]

“The nursing workforce” report, which was published by the Select Committee on Health in January, identified that 30% of students due to complete in 2015-16 or 2016-17 did not complete within that period. Significant variability between different training institutions was also identified. Will the Minister commit to looking at why some institutions have such high attrition rates compared with others?

[Stephen Hammond]

That is an extremely important point. There is not necessarily a universal reason why particular institutions have worse attrition rates than others, and that may well be key to retaining people who wish to stay in the profession.

In my last minute, I will finish on this point: NHS England, NHS Improvement and Health Education England are all working with trusts on a range of recruitment, retention and return-to-practice programmes. Some of those have met with some success: NHS Improvement’s retention programme works directly with trusts to support improvements in retention. However, I want to make clear that, as the newest member of the Government and of the Department, I regard the retention of our NHS professionals as a priority, and I am looking forward to making a contribution not only to things like the “Talk Health and Care” platform, through which there has already been positive engagement, but on this matter more generally. Retention is key, and we want to make sure nurses understand that we recognise how important they are. The long-term plan will set out a strategy to ensure a more sustainable future supply of nurses. They work incredibly hard, and it is absolutely right that this Government will commit to ensure that funding is dedicated to the supply—

Motion lapsed (Standing Order No. 10(6)).

Budget Resolutions

Caroline Johnson Excerpts

Tuesday 30th October 2018 Commons Chamber

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

The House of Commons Library tells me that I have listened to Budgets in the House 44 times, so I hope I am an experienced Budget evaluator. I always come to the Chamber to listen to the Budget, and I base my evaluation of its quality on two criteria. The first is the great global issues that we face, which for me are always the fragile planet, the environment, climate change and global warming, and the fact that the planet’s burgeoning population has to be fed, and fed sustainably. We also face the challenge of keeping the peace. Many of us thought that that could be taken for granted, but in the current global circumstances, keeping the peace has become a great concern for us all.

My second criterion for evaluating a Budget is what it will do for my constituents. I believe that I have a sacred duty to come here and represent my constituents, and to make sure that everything that I do—the contribution that my colleagues and I make in the House—adds to the welfare, health and prosperity of my constituents. Those are the twin criteria, and on both I believe that this is an uninspiring little Budget. It is lacking in passion, leadership and values. That is my sincere criticism of the Budget.

Let me go into a little more detail. I have been in the House at times when the country has been in great crisis. At a time of crisis, I have seen people whom one would have thought were pretty ordinary politicians suddenly stepping up to the Dispatch Box and showing the world that they had leadership quality, that they understood what was going on in the wider world, and that they could stand up to do the right thing. I take umbrage at the fact that a Chancellor of the Exchequer could stand in the Chamber yesterday and call the cataclysm of 2009 and the global meltdown of the world economy “Labour’s great recession.” I have to say that it must have been a very powerful Labour party and Labour Government who caused the world recession. What rubbish that the man who is supposed to be our Chancellor of the Exchequer could say such a thing—shame on him!

I saw Gordon Brown and Alistair Darling at that Dispatch Box, calm in the face of a hurricane in the world economy. They stood there and made the right decisions. They bailed out the selfish banks. They did what was necessary to save our country. This bunch over on the Government Benches should not tell us how to rise to our responsibilities. We showed leadership. We showed that we had the values. We worked incessantly to get this country back on track.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

We understand that there was a global banking crisis, but is it not right that the Labour Government did not prepare the country for problems that might occur, given their chronic overspending of money that we just did not have, which left us in a great deal of debt when the recession happened?

[Mr Sheerman]

I hear what the hon. Lady says, but let us be serious. I recommend that she goes away and looks at a rather good book that I have recently read called “Reckless Endangerment: How Outsized Ambition, Greed, and Corruption Led to Economic Armageddon” by Gretchen Morgenson. Read it and learn it, because that was what we came through.

The Chancellor’s remarks yesterday did not really touch on many of the issues that affect my community. The fact is that we have a hospital in danger that suffers due to a private finance initiative scheme. All the Chancellor said was that Labour was responsible for PFI. I have been here long enough to know that the great charm offensive on PFIs was led by John Major. PFIs were the fashion among Members on all Benches. As Chairman of the Education Committee, I saw good PFIs and bad PFIs, but I also saw a lot of smart City types who danced rings around local authorities and local health authorities and gave them a rotten deal. That is the truth of PFIs—there were good ones and bad ones, but a lot of City spivs made a lot of money out of them. Nothing that the Chancellor said yesterday will rescue my local hospital and health trust from that burden.

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

There is much to digest in the Budget, so I shall focus on only a few of the announcements that were made. In line with the theme of today’s debate, I shall start with those on health.

As a children’s doctor, I work on the frontline of the NHS. Throughout my career, I have become increasingly concerned about the number of young people with mental health problems. More than half of those problems start before the child is 14, and 75% have started by the time the child is 18, so early intervention is critical to try to avoid crises further down the line. I therefore welcome the Government’s announcement of £2 billion more for mental health, which will ensure that every school has a dedicated mental health team to tackle what is becoming an epidemic of eating disorders, depression and self-harm among young people. It is a welcome step as part of the Government’s commitment to develop parity of esteem for mental and physical health problems. More work needs to be done to identify the cause of these problems so that they can be tackled earlier.

As my right hon. Friend the Secretary of State for Health and Social Care thinks about how to spend the Government’s £20 billion increase for the NHS, will he consider how much money is given to children with life-threatening and life-limiting disorders? Many of their families struggle from day to day, so extra money to help to fund children’s hospices, as well as the availability of respite care, would be most welcome.

I have spoken in the Chamber previously about the challenges facing ambulance services in rural areas. My beautiful constituency of Sleaford and North Hykeham covers some 433 square miles. Ambulances have to rattle along lots of little tiny winding roads, at speed, to get to patients. Increasing the number of ambulances available to East Midlands ambulance service would help.

Ambulances do not just travel by land. Air ambulances provide an incredible service to our most unwell patients. They are funded entirely by philanthropy, and such services are under constant pressure to fundraise so that they can buy and maintain aircraft and pay for staff. I welcome the Government’s announcement of £10 million of capital funding for air ambulance trusts, which will contribute towards these life-saving services.

For ambulances on the ground, the challenge is not just distance but the road network along which they travel. The additional £28 billion investment in roads will represent the biggest single upgrade of the network since the expansion of the first motorways in the ’60s and ’70s. I will continue to campaign for extra money to complete the Lincoln bypass, and to improve the A46/A17/A1 junction and areas of the A1 and A15, so that roads in Lincolnshire are safer and we can travel more smoothly.

The money for potholes has been mentioned by other right hon. and hon. Members. Potholes are a big problem in Lincolnshire, so I am pleased that extra money will be spent on them, particularly as winter is coming.

I am glad that the Government are investing in our physical infrastructure, but in the 21st century, digital infrastructure is also extremely important. We rely on the internet more and more in our daily lives, so the lack of high-speed broadband in some rural areas can create a real sense of isolation. Whether for the person who cannot download their papers, the small-business owner who cannot submit their taxes online or the studious schoolgirl who cannot complete her homework on the online maths platform, a poor internet connection affects all aspects of work, family life and opportunity for rural constituents. I am therefore delighted that the Government are providing an extra £250 million for high-speed broadband in rural areas. It will be a welcome boost, if it is ensured that the money is directed towards connecting the remaining 5% to 8% who are not yet connected rather than towards getting faster speeds for those who already have a reasonable connection.

A Government’s first responsibility is always the protection of their citizens. As we mark the centenary of the end of the first world war, we remember the sacrifices that were made by many, and also remember the sacrifices made every day by our brave servicemen and women. I participated in the Royal Air Force branch of the Armed Forces Parliamentary Scheme, through which I met many service people at all levels. I heard about their concerns and worries, and about the pressures they were facing. They do an incredible job in the most challenging and, often, the most terrifying of circumstances. It is vital that we provide them with the support that they need, and the Chancellor’s announcement of an extra £1 billion for our armed forces will help to ensure that our armed forces can continue to operate at the very highest level.

Finally, I welcome the Government’s commitment to making work pay. Increasing the work allowance and decreasing the taper rate further for universal credit will help even more people into work. Some 1,000 more jobs are created in the UK every day, and we also have one of the lowest unemployment levels in Europe, which affects young people in particular. Young people in this country have a much better chance of getting a job than those in other parts of Europe, which is something of which we should be proud.

Furthermore, increasing the personal allowance to £12,500, which fulfils our manifesto promise a full year early, allows people who have gone out to work to keep more of what they earn to spend as they wish. The best stability that someone can have is a monthly pay packet, and this Government’s effort will ensure that a record number of people have that stability.

--- Later in debate ---

[Fiona Onasanya (Peterborough) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Sheffield Central (Paul Blomfield) in this important debate.

It is important that we pay attention to the fact that the Prime Minister announced the end of austerity, yet yesterday it was announced that austerity is “coming to an end”. Which is it and when will this be? Austerity was a political choice, not an economic necessity. How will the Government alleviate and redress the devastating impact of austerity? Austerity has not tackled the deficit; rather, the onus of who pays has been shifted to teachers, police and nurses. After eight years of this Government’s hard austerity, too many people are suffering and too many vital public services are in crisis.

Yesterday, we heard not a penny announced for the day-to-day costs of schools, even though school funding has been cut by 8%; not a penny for regular policing, even though 21,000 officers have been cut and violent crime is on the rise; and not a penny for local councils to close the funding gap of £7.8 billion by 2025—and they are facing cuts of £1.3 billion next year, too. The Government are not fixing the fundamentals. Must it always take a tragedy to effect meaningful change?

Take a look at our fire service: rather than fighting fires, it is having to fight for funding. It is beneath contempt not to pay those who work in our fire service properly. Indeed, real wages are lower today than they were in 2010, while CEOs are paid 143 times the wage of the average worker.

The late Audrey Hepburn once said: “As you grow older, you will discover that you have two hands: one for helping yourself, the other for helping others.” When will the Government stop and realise that? Rather than help, the Government have shown again through the Budget that they know the price of everything, yet the value of nothing. Once again, they are saying, “Your price is way too high; you need to cut it, cut it, cut it, cut it.” It is like the emperor’s new clothes: the emperor seeks to describe an elegant, flamboyant gown that he is wearing, but he is actually completely naked.

This Budget does not mark the end of austerity. The NHS has experienced the slowest spending growth in its history. When the Government created the Budget, clearly ignoring the issues caused by their austerity, it seems they had 99 problems but did not consider the state of the NHS to be one if they believed that £20.5 billion was sufficient to repair the damage caused by eight years of under-investment.

According to the Health Foundation, the £20.5 billion promised is simply not enough. The £2 billion that has been announced for mental health is welcome, but it is half what is needed, and let me be clear: this is not new money and these are not new resources. These financial gimmicks fool no one. The Health Secretary has said that it would take a generation to establish parity of esteem under this Government. However, people with severe mental health conditions cannot afford to wait five years for meaningful action from this Government. Too many people, including children, are already waiting months to access the treatment that they need, leading to a devastating mental health crisis.

In my constituency, there has been a real-terms cut of 10.6% in adult social care, almost double the national average, and the Government consider their announcement of £650 million for long-term adult social care services an accomplishment when it is less than half what the King’s Fund estimates is required to meet demand. Nearly 1.5 million elderly people are not getting the care that they need—an increase of 20% in just two years. The sum of £84 million over the next five years to expand children’s social care programmes is pitiful compared with the £3 billion needed by 2025. Services are over- stretched, and the recent trends in the level of funding are unsustainable and unacceptable. The needs of Peterborough —my constituency—have been attended to on the cheap for far too long. As a consequence, cracks are beginning to appear in our services. Our needs have not been properly or adequately assessed, or indeed addressed, and the current settlement is blatantly below par.

[Dr Caroline Johnson]

Does the hon. Lady agree that one of the biggest challenges facing Peterborough hospital, which serves her constituency and in which I work, is the financial burden of the PFI that was used to build the hospital? It is a beautiful hospital, but so much money was spent on it that we are burdened with this PFI. It was a Labour Government who did that and we are now having to pay for it.

[Fiona Onasanya]

I thank the hon. Lady for her intervention. Yes, I know that very well about the PFI, which is why Labour is seeking to end PFIs. [Interruption.] Before she says that we signed it, I would like to talk about now and the fact that PFIs actually came in under John Major. Talking about now, Government are pursuing efficiency to the point of ineffectiveness. I end on this poignant note: investment now is lower in relation to GDP and we are ranked 22nd in the world. The time for warm words is over. Austerity has dire consequences and a little extra just will not cut it.

Paediatric Cancers of the Central Nervous System

Caroline Johnson Excerpts

Monday 22nd October 2018 Commons Chamber

[Chris Elmore]

I thank my hon. Friend for her, as ever, courteous and heartfelt intervention. I know of the trauma she is facing in her family life. Richard and Lorraine are extraordinary people, as are their wider family. I have been impressed by their courage throughout Cian’s illness and, now, his passing.

We must not forget those who are lucky enough to survive such aggressive forms of cancer. Survivors often face a lifetime of other health complications, including mobility issues, cognitive challenges, infertility, growth complications and other conditions that require a high level of medical support. We must ensure that aftercare for those children is world class, and that they are able to lead as full, happy and long a life as possible.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate the hon. Gentleman on securing this Adjournment debate to raise awareness of an important health condition. He described how the tumour affecting his constituent was in the cerebellum and is now discussing the long-term effects for survivors of childhood brain tumours. Both treatment and recovery are determined to some degree by the location of the tumour, which can vary widely. I remember clearly a young patient who had a tumour so close to her brainstem—the part of the brain that controls breathing, which we do not think consciously about—that she had to live in intensive care for many months during her treatment, because at any point she could stop breathing. I remember sitting with her when she was making a cotton wool collage of a winter scene and she simply stopped breathing. When she was awake, one could say, “Breathe,” and she would make a conscious effort to breathe; if she was asleep or distracted, or no one was paying attention, she would have passed away. She needed that constant reminder. That is why it is important to ensure not only that we have research and medical treatment during illness, but that for recovery there is a multi-disciplinary team—physios, speech therapists, occupational therapists and so on—so that children who survive these awful tumours make the fullest possible recovery and can live the fullest possible lives afterward.

[Chris Elmore]

I agree with the hon. Lady entirely. There is clearly a need to look not just at treatment but at what comes next. If we are to improve survival rates, which we must—research is a key part of that—then we need to look at what comes next for these families and for the children who, touch wood, will survive.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

I, too, wish we were not here, but let me congratulate my friend the hon. Member for Ogmore (Chris Elmore) on securing this evening’s debate. I commend him on his support and the incredible tribute he gave to Cian and Cian’s family this evening, and on the way he has handled the debate. For those who know him, in both the Government and the Opposition, it is rather typical of the man.

From what we have heard this evening, it is clear that Cian was a very special little boy who touched many people in his short life. I have seen his “Cian’s Kicking Cancer” campaign online, including the picture of him with his hands out in front of the No. 10 Downing Street door—it is a lovely photo—and I pay tribute to the determination of Cian’s parents to raise awareness of paediatric cancers. The way that they have been supported by their local MP is brilliant.

As the cancer Minister, I all too often hear of the devastation that this terrible disease can bring to people and their families, but nothing is as heartbreaking as when a child is affected. I said last week in the breast cancer debate that a life lived long or a life lived short is still a life lived, and I passionately believe that a life lived, short or long, still leaves an indelible mark on this world and still changes this world forever, even in a small way. From what the hon. Gentleman has told the House this evening, there is no question but that Cian has left his mark and changed the world a little bit. We will do our best to honour that and see whether we can change it a bit more.

Every day, at least 12 children and young people are told that they have cancer. When they are born—I have children myself—we all imagine bright futures for our children and the things that we want them to do, but cancer robs many children of that future and the opportunity to fulfil their potential. As the hon. Gentleman said, it is relatively rare in young children, but that is absolutely no consolation to the parents of a child with cancer. It can even be worse to know that and inevitably leads to questions such as, “Why me? Why my child? They haven’t made any lifestyle choices.” Cancer is indiscriminately cruel, and that is one of those awful truths that we face in life.

It is great that we have so much time for this debate. I know that there has been a bit of knockabout that the business finished early again this evening, but I genuinely believe that there is a reason why that happened, and we are going to make the most of it. I start by reassuring the House and those watching that cancer absolutely is a priority for me—I think most people know that—and for this Government.

I happened to be in the Tea Room before coming into this debate and the Prime Minister popped in after her marathon stint on her statement this afternoon. She asked me what I was working on and I said that I was doing this debate tonight. We spoke about how remarkable the way in which the House comes together in these debates is and how there is a concentrated audience for such debates. I know that the hon. Gentleman has put out on social media networks, as I am sure many others have, the fact that this debate is happening tonight, and I know, many people will be watching, so let us be clear: fighting cancer is absolutely central, as the Prime Minister said in her conference speech, to our long-term plan for the national health service in England—I have to say “in England”, because I am an English Health Minister, and the English cancer Minister. It will build on the progress already achieved in the cancer strategy and will set out how we will achieve our ambition that some 55,000 more people in England will survive cancer for five years each year from 2028.

I am absolutely committed to ensuring that our plan transforms outcomes for children with cancer over the next 10 years. The fantastic work being done by NHS cancer doctors and nurses, as well as the invaluable support that we get from our incredible cancer community, is helping us to achieve our vision of transforming cancer services for children and young people.

As I have said, childhood cancers are mercifully rare, but 1,600 children under 15 are still diagnosed each year in the UK. Central nervous system cancers are estimated to account for 25%, with 400 children diagnosed each year. Brain cancers alone account for more than 100 CNS cancers, making each cancer extremely rare.

It is true that survival for children’s cancer has gone up over the past decade, with five-year survival for children’s CNS cancers at 75%—that is how we measure it, but, of course, if people develop a cancer in their 70s, a five-year survival rate is a more significant achievement than for those who develop a cancer when they are under five. The survival rates have gone up, but there is not an ounce of complacency in me; we will and must keep working hard to go further and faster.

Treatment of CNS cancers varies depending on several factors—age, the tumour growth rate and the location and size of the tumour—but, as the hon. Gentleman said, it will usually involve a combination of surgery, chemotherapy and radiotherapy, depending on the clinical need. To ensure that patients have access to the latest, most cutting-edge technology wherever they live, we have invested heavily—some £130 million—to modernise NHS radiotherapy equipment. Over the past two years, 73 trusts have had their older linear accelerators, as they are known, upgraded or replaced, and that is an important thing that we have done—[Interruption.] Cheltenham is one of them, says my Parliamentary Private Secretary, my hon. Friend the Member for Cheltenham (Alex Chalk)—who says that PPSs do not speak in the House? He sits there diligently day in, day out, so why not?

The hon. Member for Ogmore mentioned proton beam therapy and I want to touch on that. In the past few years, there has been an increase in the use of PBT—for those who do not know, it is an advanced form of radiotherapy—for treating children with CNS tumours. It uses high-energy proton beams to treat the cancer much more precisely. These targeted doses of treatment have less impact on surrounding healthy tissue and fewer side-effects. In childhood cancers, that is critically important—the hon. Gentleman mentioned side-effects of treatment with regard to fertility, for instance.

Until now, PBT for children has been commissioned from overseas. We have sent children to America and to Germany. That is why we have invested £250 million to provide PBT services in England. I am delighted that the first NHS centre, at the Christie in Manchester, is scheduled to begin treating patients this autumn. A second facility is due to open at University College London Hospitals in London in 2020. I had the pleasure of visiting the Christie shortly after delivery of the giant ProBeam proton system, which is a significant engineering feat. The scale and complexity of the technology is truly breath-taking, and I am tremendously excited that we will shortly be providing PBT on the NHS in England, sparing patients the upheaval, discomfort and cost—I will come on to that—of travelling abroad for treatment.

Although survival rates for CNS cancers have been improving, some children will unfortunately suffer relapse, as we heard in Cian’s case, and treatment options can sadly be limited, even for palliative care. That is why NHS England is reviewing whether additional radiotherapy treatments, such as stereotactic radiosurgery and stereotactic radiotherapy—there is a difference—would be suitable for these patients. I am following that work closely, as I am interested in and excited by its potential.

This month, NHS England published the draft national genomic test directory for cancer, setting out how whole-genome sequencing for paediatric brain tumours and other genetic tests are now being considered for CNS cancers. I hope that introducing those tests will support better tumour identification and more targeted treatments for CNS cancers in children, and give hope to many others.

Perhaps the most exciting development in our efforts to treat childhood cancers successfully is the increasing availability of personalised treatments such as CAR-T therapy, about which there is understandably a lot of excitement in the medical community. With the introduction of more personalised and targeted treatments and different treatment options for children with CNS cancers, NHS England is reviewing how best to ensure that children receive the available treatment and from the relevant clinical team, now and in the future. We expect the availability of more personalised treatments to be a real game-changer for childhood cancers. The work is still in its early stages, and it will involve clinicians, service providers and charities as it progresses, but I will of course update the all-party group, which I will come to in a moment, as it develops.

Research, which the hon. Gentleman mentioned, is a crucial part of the fight against brain tumours. In May, we announced £40 million over five years for brain tumour research through the National Institute for Health Research, as part of the late Tessa Jowell’s brain cancer mission, which includes research for children with brain cancer. I only met Baroness Jowell once, unfortunately, but I was left in no doubt about what she wanted me to do—her legendary determination was very much in evidence. I very much enjoyed meeting her and Jess, her daughter, who is carrying on much of the work.

The hon. Gentleman talked about research projects. Baroness Jowell’s mission is about stimulating quality research projects—a point that the late baroness was able to nail as soon as she started to look into it. Although the NIHR spent £137 million on cancer research in 2016-17—the largest ever investment in a disease area—it does not allocate funding for specific disease areas. It does not have a basket for each disease area. Spending has to be driven, therefore, by scientific potential and the number and scale of quality funding applications.

The baroness was very pithy and understood immediately that we needed to stimulate the market in brain tumour research to enable quality research proposals to come forward. After that, the clinical research network, which is recruiting for or setting up more than 700 cancer trials and studies, including studies into childhood cancers and brain tumours, can press forward and do its work. Funding for paediatric cancer research is critical.

The hon. Gentleman also talked about international research. I absolutely agree that international collaboration is key for successful research on rare diseases such as CNS and childhood cancers. The Prime Minister has made it very clear that we want to work closely with Europe in science and research and that the UK is committed to establishing a far-reaching science and innovation pact with the EU, facilitating the exchange of ideas and researchers and enabling the UK to continue to participate in key programmes alongside our EU partners. Whatever “take back control” meant—one day I will be told—it did not mean that we are not to work with our EU partners in such areas. I am determined that it will not mean that, as are the Government. The Chancellor has also made it clear that he will guarantee EU structural and investment funding and underwrite payments for competitive EU research awards through the Horizon 2020 underwrite guarantee, which is a very important project.

The hon. Gentleman mentioned the Eliminate Cancer Initiative, which the late Baroness Jowell made sure I was acutely aware of. Its tagline “Making cancer non-lethal for the next generation” is really neat, and we certainly support it. It has huge global potential and reach. As he mentioned, given my international health brief, I travel to talk to Ministers from around the world. I was at the G20 earlier this month. The G20 and G7 have Health Minister meetings, as they should do; I certainly hope they will when we have the chair. I would like to see international research collaboration, specifically on cancer, on one of the G20 or G7 agendas. The hon. Gentleman’s point was well made. I will take it up with my officials so that, as we lobby for the chair of the next meetings, we talk about that. It would be an interesting piece of work that we as fellow Ministers could do. I know that people think that sometimes these international meetings are talking shops, and of course there is an element of that, but actually an awful lot of good stuff goes on and an awful lot of other agencies—the OECD, the World Bank, the EU—are part of those meetings. If Ministers decide that this is part of our agenda, that will make a difference and move the dial.

Several Members have talked about awareness of childhood cancers and I thank the hon. Gentleman for what he said about the all-party group on children, teenagers, and young adults with cancer. I am pleased to see my friend the hon. Member for Bristol West (Thangam Debbonaire) in her place. I welcome the establishment of that all-party group on the specific needs of children and young people with cancer. It is an excellent all-party group—several of its members are or were here. I was delighted to give evidence to its patient experience inquiry earlier this year. She had some of her patient advocates there, who asked great questions as well, and I commend it for an excellent report. I do not have to do this for all-party groups—I do for Select Committees—but I have undertaken that the Department will respond line by line to its report. I will definitely do that. It is not ready yet, but it will happen.

One of the all-party group’s recommendations was on signs and symptoms, which I will come on to, and another was on the cost of travel. The hon. Member for Alyn and Deeside (Mark Tami) mentioned the CLIC Sargent report that highlighted the financial impact of travel on the families of young cancer patients. It is a really good piece of work. I assure hon. Members that the Government are working to review the service specifications for children and young people with cancer. This will help us to consider how some aspects of the patients pathway might be provided more locally to reduce the travel burden for patients and their families. There is the other element: sometimes that cannot be done and people have to travel for treatment. The NHS cannot do everything brilliantly everywhere—clearly, specialisms are sometimes needed. That is why we have the healthcare travel costs scheme, which is part of the NHS low income scheme. It allows for patients’ travel costs to be reimbursed if they are in receipt of a qualifying benefit or are on a low income. The scheme helped some 337,000 applicants to receive financial help with their NHS treatment. I am very interested in the recommendations of the all-party group on that and I assure its members that I am taking great note of them.

[Dr Caroline Johnson]

I am pleased to learn that my hon. Friend takes such an interest in reports from all-party parliamentary groups. Will he undertake to look equally carefully at the report that will be produced tomorrow by the all-party parliamentary group for children who need palliative care, known as Together for Short Lives, which I co-chair with the hon. Member for Newcastle upon Tyne North (Catherine McKinnell)? It looks at how we provide palliative care for children with cancer and other life-limiting and life-threatening conditions.

[Steve Brine]

I will now take an intervention from the hon. Member for Ilford North (Wes Streeting).

Childhood Obesity

Caroline Johnson Excerpts

Tuesday 16th October 2018 Commons Chamber

[Ms Nadine Dorries (Mid Bedfordshire) (Con)]

Let me first declare an interest: I am currently taking part in a television experiment relating to obesity.

The United Kingdom is now the third most obese nation in the world. That is a shocking fact, especially when, as we know, the second biggest preventable cause of cancer is obesity. This is a crisis, and as always when there is a crisis, the innocent victims are the children. The obesity crisis that is hitting the UK is no exception: the victims are the vulnerable, the poor and the children.

I pay tribute to Andy Cook, the director of the Centre for Social Justice. The work of that prestigious organisation does not receive the praise or recognition that it should. A report produced by the CSJ, “Off the Scales”, provides an in-depth analysis of the obesity crisis facing the UK and makes a series of recommendations that complement the Government’s own obesity strategy report of 2016. However, the difference between the two reports is fundamental.

The CSJ report takes a holistic, headline view that is workable and suggests pathways towards the measuring of deliverable outcomes and progress. It highlights the success of implementing a joined-up cross-organisational and cross-departmental strategy to solve a problem that is costing the taxpayer more than £30 billion a year, and, more importantly, costing the lives of a future generation. It highlights some of the weak areas in the Government’s childhood obesity plan, which was published by the Department of Health in August 2016 and aimed to reduce childhood obesity rates in England over the next 10 years. It is a good plan, but it has little chance of making any impactful difference, as there is little in the way of joined-up thinking or leadership, or accountability, on the part of individual Departments.

Let me explain, in the starkest terms possible, why this issue is so important. For the first time ever, one in four children of the next generation will die younger than their parents. Nearly a third of all children aged between two and 15 are overweight or obese, as the Government report itself highlights. Younger generations are becoming more obese at earlier ages, and obesity doubles the risk of dying prematurely, so this is an incredibly serious problem. I am not sure that many parents know that, but they should, and we should be doing more to make sure that they do.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate my hon. Friend on securing this debate on such an important topic. Does she agree that this is a major health crisis affecting young children? Not only will those children die younger than their parents and before they would have expected to, but they will experience more suffering during their life due to the ill health caused by obesity.

[Ms Dorries]

I thank my hon. Friend for that intervention. She is a doctor and knows more than most about the health impacts of obesity, which include diabetes and other illnesses that are costly both to life and the Government.

--- Later in debate ---

[Ms Dorries]

The hon. Gentleman nearly got a speech in there. As I said, I will go on to address funding issues.

The parents on whom this issue impacts the most, and who are most likely to be affected, are those who make the poorest nutritional choices. They do not take The Times, or spend time on the internet reading the news or visiting any other sites where information about the effects of obesity on their children is likely to be repeated. They are also the parents who live in areas of higher deprivation. The fast-food, junk-food giants place more of their outlets in such areas than in areas of affluence, which makes the temptation easier and the consequences more impactful.

What can we as a Government do? I want to praise the headteacher and staff at Shillington Lower School in my constituency. Every morning after assembly, every child joins in with 15 minutes of vigorous exercise. Some are outdoors, running around the field perimeter, while others are in the hall doing boot camp with the cyber coach. That is in addition to their normal PE lessons and physical activities. The school actively encourages walking to school, and I have to say that Shillington Lower School’s efforts are there to be seen, but that is one approach, in one school in one village.

I am doing my little bit by embarking on a tour of schools in my constituency, and I am speaking to public health officers at Central Bedfordshire Council to find out how much more we can do locally in my Mid Bedfordshire constituency. However, this piecemeal approach is part of the problem. We have local council initiatives, as well as individual schools, teachers, parents, elected Mayors, public health officers, social workers and health visitors all doing their own little bit, and while that is all incredibly worth while, no one knows what the other is doing. The approach is taken on the basis of good intentions, but it is far from being an effective plan to deliver any measurable results.

This issue should be a governmental and departmental priority, regardless of Brexit and the noises off. This crisis has nothing to do with Brexit and everything to do with the lives of our children, yet there is no plan that co-ordinates a national strategy to make dealing with this issue a priority, and there is zero leadership from the top—I am very sad to say that. A national crisis requires leadership and a holistic, co-ordinated headline plan. Tackling this problem needs to be one of the Government’s top five priorities, and that needs to include funding.

The Minister is very much doing his bit, in line with the Government’s obesity plan. That is a great achievement, but sadly it is nowhere near enough to tackle the problem. The Minister is a good, conscientious and pragmatic man, and the father of healthy and very beautiful young children. I know that he personally is as worried about this as anyone else, but he is just one Minister in one Department, although I accept that his is the Department that should be leading on this, in accordance with the Government’s aims and objectives in this area. However, if we had some high-level leadership and direction, we could have all the Departments working together towards one strategy and working together as one taskforce to establish our short, medium and long-term goals to reduce the weight of the nation and in particular of our children.

In fact, the Minister is the only person who is accountable for tackling this national crisis. As “Off the Scales” highlights, there is little or no direct accountability among Departments for the childhood obesity plan, other than the Department of Health and Social Care and a small requirement on the Department for Education. What about the Ministry of Housing, Communities and Local Government? What about the Department for Digital, Culture, Media and Sport, given that sport is one of the biggest players in the fight against obesity? What about the Department for Environment, Food and Rural Affairs, the Department for Transport and the Treasury? We know that the Treasury is the place where all good ideas go to die, regardless of which party is in power, and it is not giving this national crisis serious consideration. So many people—from the wonderful staff at Shillington Lower School all the way up to the Department of Health and Social Care—are doing their own thing, but, sadly, none of this can be monitored or measured, because it is all entirely disjointed and unconnected.

The NHS has recently enjoyed a £20 billion cash injection. At present, only 0.2% of the NHS budget is allocated to Public Health England to deal with obesity and to put in place preventive strategies with regard to childhood obesity, yet the Government’s plan places huge responsibility on Public Health England to tackle this issue.

[Dr Caroline Johnson]

Does my hon. Friend agree that money spent on managing obesity is money well spent? In fact, the money that is invested in helping people to be more healthy will be recouped, because there will be less NHS spending on their ill health.

[Ms Dorries]

I think that my hon. Friend has seen my speech; my next point is that we are putting the cart before the horse.

There is a huge responsibility on Public Health England, yet it has only 0.2% of the NHS budget. The Government have reduced the public health budget by £600 million between 2015 and 2018 and increased the NHS budget for acute and hospital care. This complements my hon. Friend’s point, because they are pumping all that money into hospitals and acute care, but putting very little into strategies to prevent people from going into hospital in the first place. This imbalance in the NHS budget demonstrates how little attention and importance are being given to this crisis at the top of the Government by No. 10 and No. 11—particularly No. 11 and the Treasury.

As I said, the cart is being put before the horse. As a nation, we are allowing people to become ill. We are failing to prevent that from happening, but we are providing state-of-the-art hospitals and doctors in our amazing NHS to treat them. We should be placing our focus on preventing obesity, which is the second biggest preventable cause of cancer after smoking, and keeping people out of hospital.

Of all the nations that fund healthcare, we have one of the highest healthcare budgets in the world. We spend more each year on treating obesity and diabetes then we spend on our police, our fire service and our judicial system combined, yet we allocate only 0.2% of the NHS budget to Public Health England. When we cost out Public Health England and take out its accountable costs, we see that only a tiny fraction of that 0.2% is given over to obesity prevention and treatment in real terms. The chasm between treatment and prevention highlights the critical need for the Government to develop their approach to the delivery of public health services further and to ensure that prevention receives the investment it so desperately requires.

It is time for the Treasury to think forwards, not backwards, by reversing the reduction in councils’ public health budgets and providing local councils with the funding they need to tackle this problem head on. Local councils should be the major player in this strategy, yet they have seen their funding for public health services cut. They know their own demographics. They know the problems in their area, and they know how to deal with them. Local councils have already engaged as much as they can with this issue, and they are saving the lives of the next generation.

I cannot say it often enough or strongly enough: one in four children will die younger than their parents. If we lined up 50 parents and told them that figure, they would be shocked. Parents needs to know that information.

How much of the new £20 billion that the Government are allocating to the NHS will be made available to Public Health England and, in turn, towards funding the Government’s childhood obesity plan of 2016? As much as people scream and shout that the NHS is being starved of funding, the truth is that the recently announced £20 billion, along with savings from the £20 billion Nicholson challenge, amounts to a £40 billion uplift to treat people who are taken to hospital with illnesses induced by obesity.

Given that Public Health England has been given responsibility for decreasing the proportion of children leaving primary school overweight over a 10-year period, why is so little of the NHS budget allocated for preventive medicine? What uplift was PHE given to address this childhood obesity crisis? How is it supposed to achieve the aims and objectives set out in the 2016 plan? Does the Minister not believe that there should be a cross-departmental strategy, devised by Ministers, to set out in detail what each Department will do to achieve pre-determined goals? If that is not the case, we should engage in a national information and media drive to warn parents of the dangers of obesity. Allowing a child to become obese is almost as dangerous as putting cigarettes in their mouth.

I understand why the Department of Health and Social Care introduced a policy to cap the calories in various types of junk food, but it will not work—people will buy two. The voluntary sugar reduction targets in the 2016 plan have not been met by the main producers and providers of these foods.

Is it not time to introduce a mandatory approach? I am aware that the money raised by the sugar levy—I probably should have mentioned this earlier—is to be allocated to implementing some of the aims and objectives set out in the 2016 plan, and the Government’s approach is a welcome step, but where and to whom will that money go? Will it be allocated to local councils? Is it enough?

As we have seen with food producers that are not meeting the requirement to reduce sugar in food, will the same happen with the sugar levy? Will it actually make a difference? Will it give us the funding that we need to tackle this crisis? I would say not, because we are basing our plans on something subjective and unknown. We do not know how much the levy will raise. We do not know whether producers will reduce sugar in drinks and food. We do not know to what degree the sugar levy will work. As this is such a crisis, should we not be looking at more quantifiable measures?

Where will the money go? Is it not time to consider the recommendations of the Centre for Social Justice and develop a frontline approach? I cannot think of any Government policy on which all Departments work together and on which there is a non-political taskforce above the Departments run by an independent body to pull together policies from each Department to tackle an issue—that goes entirely against our culture—but that is what we need. Should we not work with companies that load food with sugar and set them mandatory goals, not voluntary goals, to reduce the amount of sugar over a period of time? Should we not introduce financial penalties? We have seen producers of products such as breakfast cereals do just that, but the problem is that it is not happening fast enough, it is not consistent and it is not equitable, because only some producers are doing it.

Only by adopting a long-term approach that is nationally led and locally driven, with the councils involved and heading it, that is overseen by an independent body outside the influence of party politics and that is championed by committed political, cross-party leaders will an effective childhood obesity plan ever be delivered. I do not want to chuck a bucket of cold fizzy drink over the Minister’s 2016 plan, because it is a great initiative and I hope it will make some difference, but I hope he understands my concern that the money just is not there to tackle this problem head on now. I go back to the substantive point in what I have just said: 0.2% of the NHS budget going to Public Health England, despite the sugar levy and the taxes we are going to raise, is just not saying, “We are committed to doing this,” and the money has to go to local councils.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Let me start by reiterating what my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), my good friend, has said: childhood obesity is one of the top public health challenges for this generation, if not the top one. I thank her for mentioning my two beautiful children—we are not sure where they get it from, although undoubtedly it is Mrs Brine. They are watching us right now, so for once I shall be useful to Mrs Brine and say, “Surely it must be time for bed after you’ve seen daddy.”

As Members will be aware, figures released only last week in the national child measurement study continue to show that our child obesity rates remain far too high. About a fifth of children are overweight or obese when they start primary school, and that rises to about a third by the time they leave. What is worse, as we have heard, is that the burden of obesity does not fall evenly across our society. The number of severely obese children living in the most deprived areas is more than four times that of those living in the least deprived areas—this is one of the burning injustices of our age. The effects of obesity have a profound impact on a child’s opportunities in life—on both their physical and mental health. We know that obese children are more likely to be bullied and have low self-esteem as a result. They are also more likely to become obese adults, which will give them a higher chance of developing certain types of cancer, type 2 diabetes, and heart and fatty liver disease.

So the Government are determined that we will lead the way in tackling childhood obesity. We have already heard from my hon. Friend about our 2016 childhood obesity plan, part 1—there was a clue in the title—and I agree with her that it is a good plan. It introduced bold, world-leading measures, such as the sugary drinks levy. I was in Argentina at the G20 earlier this month, giving a presentation about the work we are doing in this area. Many other countries around the world look to what is happening in England and are copying it. Since bringing in the levy, we have seen the equivalent of a staggering 45 million kg of sugar taken out of soft drinks through reformulation. As a result, hundreds of millions of pounds have been poured into improving opportunities for physical activity for children. My hon. Friend asked where the money was going—that is where it is going. It is going into the sport premium in schools. The Treasury has kindly agreed to double that sum. I will expand on the point about where it is being spent. She mentioned one example, but I have others.

We also challenged manufacturers to reduce the sugar content in some of the foods children eat most, and they responded. Tesco, Lucozade Ribena Suntory, Kellogg's, whose people I met this afternoon, Waitrose and Nestlé are just some of the companies that deserve credit and deserve a mention, as they are dramatically lowering levels of sugar in their products.

[Dr Johnson]

Will the Minister give way?

[Steve Brine]

Very briefly, because we do not have long.

[Dr Johnson]

I have a quick question: are these manufacturers of food and drinks products removing the sugar and making the products less sweet, or are they replacing the sugar with artificial sweeteners?

[Steve Brine]

They are doing both. As the representatives from Kellogg’s were at pains to say to me today, it is about healthy eating and quality taste. I passionately believe that that is true.

We were always clear that our 2016 plan was just the start of the conversation, and we are clear that more needs to be done. We always said that we reserve the right to do more, which is why in June this year we published chapter 2 of the child obesity plan. My hon. Friend the Member for Mid Bedfordshire asked whether there is a cross-departmental strategy; yes, chapter 2 is very much a cross-departmental strategy. It sets a bold ambition—what we like to think of as a north star—to halve child obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030. As with our initial plan, the new policies were informed by the latest research and emerging evidence, including from many debates in Parliament and various reports from key stakeholders. Those stakeholders include the Health and Social Care Committee and, yes, the Centre for Social Justice. In fact, the latter’s “Off the Scales” report is on my coffee table in the Department. It was the Centre for Social Justice that told me all about Amsterdam and it is because of it and its good work that I went to Amsterdam to see the work being done there.

Key measures in the next chapter include looking to address the heavy promotion and advertising of food and drink products high in fat, salt and sugar on television, online and in shops. Alongside that, we want to equip parents with the information that they need to make healthy and informed decisions about the food that they and their children eat when they are out and about.

My hon. Friend mentioned Brexit. Of course, there is never a debate in which we do not mention it, but there is a Brexit connection for this debate. One thing that campaigners call for is traffic-light labelling on the front of products. We are unable to do that while we are an EU member state, but once we are no longer, we will have new freedoms in that regard. I do not know whether that is what was meant by taking back control, but I put that on the record for the House.

I was pleased to hear of the efforts of Shillington Lower School in my hon. Friend’s constituency. Staff there are obviously doing all the right things to encourage children to take part in physical activity. I have seen great examples in my own constituency, most recently at Western Primary School, and I am sure that many other Members have seen good examples, too. Yes, it is about recognising that we need foods to be reformulated, but it is also very much about the importance of physical activity in tackling obesity. Yesterday, I opened a major physical activity and health conference across the way at the Queen Elizabeth II centre. It is going on all week and will consider the benefits of physical activity and health. As part of chapter 2, we are promoting a new national ambition for all primary schools to adopt the initiative of an active mile—or healthy mile; people call it different things.

I agree with my hon. Friend that achieving our ambition to reduce child obesity will require a concerted effort from many others, including families, schools and local authorities, which she mentioned. At the recent Local Government Association conference, I announced the trailblazer programme, which will work closely with local authorities to show what can be achieved and find solutions to barriers at a local level to address child obesity. I took great inspiration from what has been done in the city of Amsterdam. My hon. Friend is absolutely right that local authorities know their local areas best. By sharing ideas with each other—some very good things are going on—they can achieve the full potential of the powers and levers that they have. Many local authorities already have great powers and levers to change their areas. For instance, they have powers over junk-food advertising in the areas around schools. We want to see those powers used better.

As part of the second chapter, we have already launched the consultation on banning the sale of energy drinks to children—the message is clear: we do not think that they are appropriate for children—and the consultation on calorie labelling for food and drink served outside the home, or in the out-of-home setting, as they say. Later this year, we will launch consultations on restricting the promotion of fatty and sugary products by location and by price, and we will consult on further advertising restrictions, including a 9 pm watershed on high fat, salt and sugar products. Currently, products deemed HFSS are banned from being promoted only during programmes predominantly aimed at children. We will consult on taking that through to a 9 pm watershed. That work is with the Department for Digital, Culture, Media and Sport, the sugary drinks levy—the sugar tax—work is with Her Majesty’s Treasury, and the trailblazer programme work is with the Ministry of Housing, Communities and Local Government, so I gently reject the idea that this is not a cross-Government strategy. These consultations are genuine and are open to everybody, and we welcome full and considered responses from across society and industry.

So far as the future is concerned, we continue to learn from the latest evidence; my hon. Friend mentioned evidence. The Policy Research Unit informs us all the time of new approaches from across the UK. We welcome the action taking place in Scotland, which is consulting on its own obesity plan at the moment. It is good to see that many of our ambitions align. As I said, I often talk to partners in other countries about work going on internationally—I have mentioned Amsterdam a couple of times—and about where we can learn from them and, possibly, where they can learn from us..

My hon. Friend is also right to mention the additional £20.5 billion a year for the NHS that will support the new long-term plan. I cannot pre-empt what the NHS will put into the plan—the Prime Minister set NHS England the challenge of writing it—but we have been clear from the outset, and the new Secretary of State has been clear, that prevention should be a key part.

Our ambition is bold but simple. We have a lot to gain by reducing obesity, and we have an awful lot to lose. We believe that the hard, evidence-based actions that we propose will encourage healthier choices and will make those choices more readily available and identifiable to parents. Taken together, we are confident that those actions will have a real impact on child obesity. We will continue to monitor progress and emerging evidence. As we have always said, this is not the end of the conversation. We watch things like a hawk.

Finally, I reiterate my thanks to my hon. Friend for securing the debate, and to you, Madam Deputy Speaker, for facilitating it.

Question put and agreed to.