Covid-19: Access to Cancer Diagnosis and Treatment

Jo Churchill Excerpts

Wednesday 2nd December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms McVey. I have been given nine minutes to answer an enormous number of questions, so I will canter through in the hope that I answer some of them. We are a group that meets and discusses these things on a fairly regular basis. Indeed, I am back here this afternoon for a lung cancer debate, so this is an ongoing conversation, which I appreciate is vital. It is right that we recognise, as several hon. Members have, that the NHS has stood up during the pandemic, which was a blow to its very belly. We have put much effort into retaining services, not only for cancer, but for stroke patients and others, so that they can go to our NHS in their time of need.

I thank the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate and for all the work he does as chair of the APPG. He has such a formidable set of musketeers supporting him on what is one of the most focused APPGs. We are due to meet in January, but I will try to fit in a short meeting this side of the recess.

I have never said we were world beating—I came to this place because we were not; we had challenges before. Up to March last year, there were 2.4 million patients, which is 1.4 million more than in 2010. We were on a trajectory and covid hit us hard, and I would be the first to say that it has presented major challenges for the entire healthcare system.

The significant impact of shutting down services resulted in a sharp reduction in the number of people being referred urgently with suspected cancer and from screening programmes. That is a statement of fact. I am not going to stand here and say that it did not happen, but I am also not going to say that Herculean efforts have not been made since then.

I am really pleased that the cancer services recovery plan has had input from many cancer charities, including Macmillan, which has been mentioned, as well as many Royal Colleges, including those of General Practitioners, of Pathologists, of Radiologists and of Surgeons. It is vital that the right people make the recovery plan, which is being led by Professor Peter Johnson and Cally Palmer. It is in their hands together—a coalition—and I hope the recovery plan very much leads the way on a route to addressing the backlog and making sure that we take opportunities.

I think we all agree on some of the challenges, including those on data, referral systems and the lack of optimal radiotherapy machines in Westmorland. Again, that is a statement of fact and we need to address how we improve that situation so that every single person has appropriate access to treatments. As treatments advance or are shorter—more oral chemotherapy can be given at home, for example—there is a chance to redesign services to make them better and deliver more for patients. Every single day, I think of those patients. The hon. Member for Easington (Grahame Morris) made a comment about the loss of individuals. Every single day, that is what motivates me.

I thank my hon. Friend the Member for Warrington South (Andy Carter) for his comments about how hard the workforce are working. Whether it is a cancer nurse specialist, a radiotherapist, a radiographer or a surgeon, they are putting their back into this effort, because it could be a member of their family. They are a tremendously committed workforce, to whom I extend enormous thanks—but we need to get more of them. How do we convince a young nurse that his or her route is to become a cancer nurse, even though all the other specialists are also asking for them? We should also be working on that as a coalition, saying, “This is a fantastic area.”

We want to eradicate breast cancer by 2050. The survival rate for testicular cancer is now at a 98%. Pancreatic cancer is a dreadful disease, but we are now seeing not a two-week death sentence, but a couple of years. There are advances all the time and we must optimise that. Each and every person deserves to see that power, particularly on today of all days, when a vaccine has been approved and we know how brilliant this country’s life sciences industry is. We can beat this disease, but it takes time. I am absolutely committed to the patient-centred approach. One in four patients presented at A&E before this crisis—they presented too late. We know what the golden thread is.

There have been some positive announcements. I was encouraged to hear that we will pilot the Grail blood test, which can detect cancer from saliva. I am also pleased that in November’s spending review there was a further £325 million of investment in diagnostic equipment. The allocation of that will be determined in the next few weeks. I cannot give hon. Members any promises, and they would not expect me to say what will be allocated, but I understand the lobbying and the importance of not necessarily having shiny, sparkly front doors to walk through but getting the kit on the ground that can help save people’s lives. We know that no one single thing gives people the best chance of survival—it is the golden thread of swift referrals and screening that gives us early diagnosis—so we need those faecal immuno- chemical tests and to roll out the lung cancer pilots, and we are doing that. We need to ensure that we drive up those workforce numbers. We also need shorter waiting times for optimal treatment that will ultimately turn the tide on this disease.

Our strategy for maintaining services concentrates on stepping up hubs for cancer surgery and optimising independent use, which we have done as a Government. We stood up; we did not shy away from it. There have been no arguments about us using the private sector during the pandemic, have there?

[Grahame Morris]

rose—

[Jo Churchill]

I am really sorry but I have only got two minutes.

The NHS will accelerate the roll-out of rapid diagnostic centres. As I said in this Chamber yesterday, in March we had 17 of them and we now have 45—we have stood up 28 of them in the course of the pandemic. Most importantly, they will support early diagnosis, which we know is key. I am pleased that we are concentrating on recovering and maintaining cancer services. Through the newly formed cancer recovery taskforce, led by Professor Peter Johnson, we can drive that commitment forward with everybody.

The workforce have adapted, flexed and cared for individuals in the most challenging of circumstances. Every death concentrates my mind. My first text yesterday was from a friend who told of the passing of someone who had lost her fight against breast cancer after seven years. The disease does not go away. I am sure my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) would be here if she were not going through treatment and, as she would tell us, it sucks. The cancer workforce are a special part of the NHS family and I want us to ensure that they know how special they are so that people come forward to join them.

We know that referral rates have been variable across different cancer types. Arguably, some cancers have really challenged us, and particularly those that need endoscopies and colonoscopies. We are still not there because of the treatment. Lung cancer referrals were poor before we went into the pandemic. What would someone think if they had a persistent cough? They might get a covid test. Actually, if that test is negative, we need to ensure that they are referred by 111 to the system for a lung cancer test.

I have a lot more that I would like to tell hon. Members, but I dare say that we will be back here imminently. On that note, I will hand over to the hon. Member for Westmorland and Lonsdale.

Covid-19: Lung Cancer Pathway

Jo Churchill Excerpts

Wednesday 2nd December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the hon. Member for Halton (Derek Twigg) on securing the debate and sharing patients’ stories, showing not only the huge care delivered by the NHS workforce but the challenges for patients, as they struggle to get a diagnosis and navigate the system. In the patient’s story that the hon. Gentleman articulated, there was already spread: not only was the disease at stage 4 but was metastatic, so affected different sites in the body.

All these things pose a challenge, and the hon. Gentleman very articulately laid out the challenges of late diagnosis and how we can improve. The UK Lung Cancer Coalition report articulated how we must not lose the progress that we have seen over the past 10 to 15 years, but must absolutely focus on the aim to extend survival up to 2025. I hope I can reassure him that the initial measures that we took at the beginning of the pandemic, because we did not know what we were dealing with, have not been the focus since June, when we began to refocus and double our efforts on trying to ensure that cancer patients can have full access to services.

There are still some challenges. I have had conversations with thoracic surgeons. There are particular challenges with the trajectory of this disease, because of where it is on the body and some of the aerosol-generating procedures that are needed in diagnosis and so on. I can say to the hon. Member frankly and honestly that we are aware of those issues and we are working hard to get back not just to where we were, but, as I think Professor Peake said, to a normal that is better than what we had at the start.

I also pay tribute to the constituent of my hon. Friend the Member for Bury North (James Daly), Andrew Jenkinson, and add my condolences for the sad loss of his wife. I congratulate him on his energy in campaigning. It is often the biggest tribute someone can give to a person they love, to try to drive forward and make things better for others.

[James Daly]

I thank the Minister for those kind comments, which will mean a lot to Mr Jenkinson. His petition is titled:

“Ensure access to treatment and screening for all cancer patients during Covid-19”.

We know there have been challenges and the pandemic has thrown up things we never dreamt we would be dealing with. Will my hon. Friend offer some assurance that the issues that Mr Jenkinson highlights in his petition are being addressed and that there are positive signs going forward?

[Jo Churchill]

I will indeed come to that, and hopefully give him and others the reassurance that we are focusing hard on making sure that we not only deliver, but learn from the pandemic. That was highlighted in the Lung Cancer Coalition report as well. Where we can make improvements to speeding up delivery of diagnoses or treatment, we need to make sure that we do so.

Lung cancer is one of the country’s most invidious cancers and it is important that it is diagnosed as early as possible, for treatment to be successful. As the hon. Member for Halton highlighted, it is one of the worst cancers for being diagnosed too late, largely at stage 4, and it has often spread. The challenge then is that treatment options are reduced because of the grade of the cancer.

When someone does present, it is vital that they are referred swiftly for further diagnostics, remembering that we are in a pandemic with a disease that attacks the respiratory system as much as anything. I have stood here talking about teenage cancers and diagnostics and treatments already this week. Not all cancers are the same; they all need a bespoke approach. It is important to remember that.

I spoke to a thoracic surgeon at the cancer hub during the summer. He explained to me in some detail the challenges, but also the opportunities now before us. I thank the cancer workforce for all that they have done through the pandemic and their continued effort to restore services. It has been a herculean effort and they have really flexed the service, joining together in cancer hubs and ensuring that areas are covid-secure for patients. Part of the challenge is to encourage patients to come forward for tests. If someone has a persistent cough, or signs of other cancers, they need to do something about it.

I spoke in the debates yesterday and this morning, and I know only too well the devastation that Mr Jenkinson must be feeling. The particular concern with lung cancer is the overlap with covid-19 symptoms. That was highlighted in the Lung Cancer Coalition report and by a plethora of clinicians. To that end, we have updated 111 protocols. If somebody has received a negative covid test but has a persistent cough, it may indicate lung cancer and they are directed to appropriate clinical care. One challenge has been a sustained fall in people coming forward for lung checks, with the number of people seeking checks at only 76% of pre-pandemic levels. This is about ensuring that we encourage people to come forward, driving forward campaigns such as the Greater Manchester Cancer Alliance and the Northern Cancer Alliance’s campaign “Do It For Yourself”. Ensuring that people are aware of the signs and symptoms is really important, and has an impact on the number of lung cancers diagnosed and treatments started. I cannot stress enough that if individuals do not come forward, we cannot get them into the optimal pathway, which has shown real improvements in how we can help people through their cancer journey.

I was pleased with the £150 million of capital funding issued to regions in October to invest in diagnostic equipment such as MRI and CT scanners. Again, that was very much called for. I know that instant referral to a CT scan is an objective of the report, but getting the equipment so that we can start to deliver quicker routes is part of the issue. The further £325 million for new diagnostic equipment in the spending review, once we know exactly how it is going to be allocated, will, I hope, result in more delivery of diagnostics into cancer care. It is vital that we use that money to maximise equipment in as many places as possible so that individuals can be treated as rapidly as possible.

We know that access to earlier diagnostic screening improves clinical outcomes and that the late stage is really one of the challenges. That is why I am really pleased to see the hugely successful pilots of the targeted lung health check programme rolled out. Those pilots offered places such as supermarket car parks and lorries where people could easily access a check, particularly in areas of high prevalence or high inequalities, making it as simple as possible for somebody to get a check. There were dramatic improvements in those attending and huge upturns in the number of people diagnosed. The pilots were paused due to covid-19, but I am really keen that we turbo-charge them now that we have them back on track, so that they operate more broadly as soon as is safely possible. The programme will be rolled out to 23 clinical commissioning groups, focused on areas with some of the highest rates of mortality from lung cancer.

Because I am short of time, I will not repeat what the hon. Member for Halton said, but we know that we have regional variation, and we need to target more effectively for lung cancer where we have those problems. It is important that we do that geographically in the light of the need to minimise trips to the hospital, particularly for people who may be more vulnerable to covid-19. Radiotherapy services have made use of fewer fraction protocols as evidence has emerged.

The focus on recovery has been on embedding the use of hypofractionated treatment. In addition, the NHS is supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for non-small cell lung cancer and oligometastatic indications, starting with the treatment of non-small cell lung cancer. In some cases, that is an alternative to surgery. Again, I think the report picked up on that. The challenge is that if someone gets covid-19 at the same time as they are having the surgery, it dramatically increases the mortality rate.

It was right to react at speed. Where clinicians say, “We need to be doing it this way,” we have tried to give the direction so that they can. Individuals can safely go to their GPs. If people have worrying symptoms that could be cancer, GPs are open for business and ready to help patients. It is about ensuring that the “Help us help you” campaign from earlier in the year delivers and gets more people coming through the door so that we can treat them quicker.

[Derek Twigg]

Will the Minister give way?

[Jo Churchill]

Yes, of course. Are we allowed the extra minute or two, Ms Fovargue?

[Yvonne Fovargue (in the Chair)]

I do not think so, no.

[Derek Twigg]

Just on the issue of GPs, it is important that they see these types of patients face to face.

[Jo Churchill]

Indeed, and GPs stand willing and ready to see those patients and give them care. Ensuring that they can refer quickly has been part of this drive.

The cancer recovery taskforce, led by Professor Peter Johnson and involving cancer charities, clinicians and other expert stakeholders, is also driving to meet some of the objectives to which the hon. Gentleman alluded: ensuring that we get people into treatment as quickly as possible, that systems and pathways are clear and understandable for the patient and that we do see that capacity rise.

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

Cancer in Teenagers and Young Adults

Jo Churchill Excerpts

Tuesday 1st December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the hon. Member for Strangford (Jim Shannon). I congratulate him on securing the debate and on the sensitive way in which he always approaches these subjects.

Someone once said to me, “You don’t choose it. It chooses you.” That is the challenge with cancer. People have very little control over when or if they have to make that journey. However, it is a matter of making sure that we have the services in place and can have early diagnosis, and that we never take our foot off the pedal in getting the right workforce and making the pathways simple. People are understandably discombobulated when they are told; it is a tsunami of emotions. I would gently say that in the case of someone’s child, the wave is even higher. I could not imagine the pain of being told that.

On that point, I thank the hon. Member for Strangford for talking about Alex. I thank my hon. Friend the Member for Wakefield (Imran Ahmad Khan) for his tribute to Daniel and to Ellis Price. I thank the hon. Member for North East Fife (Wendy Chamberlain) for giving us a little hope and showing us that Toby’s Magical Journey was a way those parents, through the most appalling circumstances, could turn their love of their child into something incredibly productive that is now helping parents who are going through the same thing.

As many hon. Members have said, the issue is a cross-party one. I was so pleased that the title of the debate was about raising awareness, because that is something that we can do in this place no matter what divides us about our other politics. We can raise awareness, and the issue of health is very much one that joins us, although the delivery of it is separate in the devolved nations that we belong to.

I thank those who have made contributions and want to add my good wishes to the hon. Member for East Dunbartonshire (Amy Callaghan). When I noticed that she had become the chair of the all-party parliamentary group on children, teenagers and young adults with cancer, I looked forward to perhaps being able to discuss things with her. As hon. Members have said, the ability to bring personal experience to this place—in the sphere of health, business or anything else—gives debates a power that is sometimes otherwise lacking. In these covid-tinged times, debates in this place have changed, but our ability to do things together—to raise awareness and make sure that people’s voices are heard—is still very much in our control.

We have discussed the fact that cancer is no respecter of anyone. I have two young friends who have been through the challenge of teenage cancer—and it is challenging. One was just a teenager and the other was just exiting that period of life, which, as everyone has said, is one with an awful lot going on, emotionally and in a person’s maturity. We have not talked about ensuring we get the transition right, but speaking to people from the Teenage Cancer Trust or young people who have had cancer, we know that ensuring we get them in the right place in the system is important, so that as they move into adulthood they are not on a ward with very young children and vice-versa.

We have talked about the challenges posed by covid-19. In phase one of the pandemic we stopped services, but as soon as we could push the recovery button, we did. I have focused, along with those leading the drive in the NHS—Cally Palmer and Peter Johnson—to ensure we do not do that again. It is important that people can access other treatments. As the hon. Member for Nottingham North (Alex Norris) said, if covid-19 overwhelms the system, all the other areas we so passionately debate will become secondary and access to those services will become more difficult. We should all be aware, however, of the ambition to be tough on this disease.

We will get into calmer waters. When we do, we need that long-term plan and personalised care interventions, including a holistic needs assessment, health and wellbeing information and support, and end-of-treatment summaries. We need to identify and address the more psychological, psycho-social and emotional needs from diagnosis onwards, and to inform GPs about what is happening to a patient and their ongoing needs. A patient’s journey in hospital is often quite short, so those other medical professionals need help and assistance to access the information they need in their training.

As several hon. Members pointed out, childhood cancer is thankfully rare. That offers professional challenges in ensuring the diagnosis is as early as we would like. We heard from my hon. Friend the Member for Wakefield about the short window between Ellis’s exhibiting symptoms and being in hospital. We often find that in young children; it feels as if the change happens in a week or so. That is a challenge for the profession, but one it is up for. It is incumbent on me to outline to everyone that, thankfully, these cases are rare, but that makes it challenging for doctors when they are looking at a set of symptoms.

In the light of phase one, we have set up the cancer recovery taskforce, which includes children and young people’s cancer charities, to ensure that their voice is heard. It is important that, as we are recovering, we ensure that individuals from across the cancer family have their voice heard, because no two journeys and no two individuals’ needs are the same. That is a challenge. We are focusing on early diagnosis, workforce, treatment pathways, data and support. We are addressing system recovery, urgent referrals and screening, and ensuring the right communication is in place.

I know personally—like all of us—of the devastation this disease causes and the pain it brings to individuals and their families, but the impact on a young person is particularly heartbreaking. We know that cancer is rare among teenagers and young adults, who account for less than 1% of all diagnoses. Approximately 2,200 cancers are currently diagnosed for patients between 15 and 24. However, today’s debate has provided an important opportunity to raise awareness and shine a light on young people’s specific needs, experiences and recovery from cancer.

One of the positives of covid is that many more cancer treatments have become more patient-friendly and less impactful on the individual; that relates to the point made by my hon. Friend the Member for Wakefield about the treatment not being worse than the disease. Therefore, as treatments progress and with genomic testing coming along, it is important to make sure that we target the disease and not the healthy part of the body, so that we get the most positive outcomes for individuals that we can.

[Jim Shannon]

In my speech, I referred to clinical trials and the need for young people to be part of them. That will improve the data and the end results. Perhaps the Minister is about to come to that point and I apologise if she is, but has she any thoughts on how we can do that?

[Jo Churchill]

I thank the hon. Gentleman; if he will give me a second, I will come to that. Like him, I believe that research is the way to unlocking some the problems.

Awareness of teenage cancers in schools is important. Education from an early age on the causes and symptoms of cancer has been mentioned. I was pleased to see that this year’s curriculum for religious, sex and health education means that children are being taught about some of the signs and symptoms of cancer. In particular, that includes skin cancer, the link between smoking and lung cancer and ensuring that people keep a healthy weight. All these things help young people to become more aware of themselves, their bodies and their health outcomes. I hope that will encourage someone to pick up the phone and take steps towards discussing their health if they are worried about it.

As the mum of four daughters and, like my hon. Friend the Member for Wakefield, as the friend of parents who have been in this situation, raising awareness in a sensitive manner especially when the risks are low is something that we should all work on. Cancer is a frightening subject at any age and I pay tribute to the cancer charities that specifically deal with young people. As many Members have said, they do an amazing job not only to support people but to promote cancer awareness. For example, the charity HeadSmart helps to improve the understanding and awareness of the symptoms of brain cancer. The Teenage Cancer Trust, CLIC Sargent and Teenage and Young Adults with Cancer are also in this space, and the hon. Member for North East Fife pointed out that many local charities, such as Toby’s Magical Journey, do good work right across the country.

There is another debate in the conversation about moving to a cashless society and understanding how charities will probably have to reframe their work. In my constituency only last month, a small team of three raised more than £400,000 in an online auction. Things will have to move in a different direction when traditional collections cannot take place. We saw that with the Royal British Legion’s poppy collection, which was severely impacted. Like the hon. Member for Nottingham North, I am aware that if we are not careful, we will create a two-tier society because many people in all our constituencies still want to use cash. We could probably be smarter, but that is an issue for another day.

On the learning in school guidelines, we will keep an eye on how the research develops and feed that in. I will have further conversations with my colleagues at the Department for Education to understand how we look at the curriculum and what more we can do.

I turn to research. Only by understanding the data can we understand the treatment pathways and cohorts. I want to make a point about those carrying the BRCA gene, who tend to be much more at risk. A young friend with BRCA in their family recently had a double mastectomy. She wrote to me about the support that she had had from a charity and she mentioned raising awareness.

Understanding the data is really important. The National Institute for Health Research is leading a multi-stakeholder strategy with NHS England and NHS Improvement, cancer charities, teenage and young adult cancer patients and clinicians, focused on increasing the participation of teenage and young adult patients in research, as set out in the recommendations of the independent cancer taskforce in 2015 to improve outcomes. I regularly meet Cally Palmer. Our focus last week was on teenage cancers, because it is a challenging area where we know we have to do better. The collection of data is very important, as is the participation in clinical trials.

The NIHR clinical research network has funded specific teenage and young adult research and also nurse posts in its 15 local clinical networks, and has instituted measures to identify all teenage and young adult cancer patients participating in the NIHR portfolio research. It is also taking a lead role in an international initiative to remove artificial age barriers that prevent adolescents and young patients from accessing clinical trials.

There are some challenges around data protection and various other things that make the collection of age data a little problematic, but my offer to the hon. Member for Strangford is to take that away and further discuss with colleagues how we can do it. Although things often seem simple, they sometimes are not, and we have to consider the unintended consequences of collecting vast amounts of data. For example, who do we allow the data to be shared with? We can depersonalise it for research purposes, but very often people want it personalised because they think that perhaps the school should know or whatever. All these things are very sensitive and need handling in the correct way.

The long-term plans states that we will

“actively support children and young people to take part in clinical trials, so that participation among children remains high”

and rises to the 50% that the hon. Gentleman mentioned by 2025. However, it is a challenge. Clinical trials need to be more representative across the board. We often find that they are particularly skewed towards males, but that is for another debate. Pharmacology and treatments act differently across genders and age boundaries, so making sure we have the right participants is important.

More effective consent processes for using data and tissue samples will contribute to improving survival outcomes. We will seek the views of patients aged under 16 to ensure that the NHS continues to offer the very best services for young people, which is where the cancer patient survey is most important. That will be used alongside other data to inform service design and transformation.

It is a given that we all want to do more, but making sure that the ambition for the future of cancer diagnosis and care is foremost is something that I am particularly focused on.

I am pleased that we have delivered on our commitment of September 2019 and that all boys aged 12 and 13 are being offered the vaccination against human papillomavirus-related diseases such as oral, throat and anal cancer. That builds on the success of the girls’ programme, which has already reduced the prevalence of the main cancer-causing types of HPV, 16 and 18, by more than 80%. There is also prevention here, which is very important. Ultimately, that will reduce cervical cancers and other cancers as people go through their lives.

Our aim is to drive more personalised treatments for patients, but particularly children. From last year, we have targeted the use of whole genome sequencing, which will enable more comprehensive and precise diagnosis and access to personalised and less invasive treatment. Cancer treatment is often challenging, and the personal approach reduces medications and interventions that may be harmful to healthy parts of the body.

We also support increased access to clinical trials, making sure we have diverse participation across age, genders and ethnicities. Following from that commitment, we made available treatments targeting neurotrophic tyrosine receptor kinase gene fusion solid tumours earlier this year, following the National Institute for Health and Care Excellence appraisal. Further guidance that has been issued by NHS England and NHS Improvement prioritises the delivery of the long-term plan commitments that support the recovery of services.

The ambitions include improving survival rates and early diagnosis. In March, we had 17 live rapid diagnostic centres. However, since October we now have 45, and I hope the fact that, even during the pandemic, the cancer workforce have stood up a further—I will do my maths very quickly—28 rapid diagnostic centres shows that commitment. Continuing the accelerated roll-out of places where people can be swiftly diagnosed is vital to getting on top of this disease.

I know hon. Members have raised concerns about the impacts on services through the second wave. As I said at the start, we must protect NHS capacity for non-covid services such as cancer. We expect cancer services to be maintained, with the redeployment of staff or blanket decisions to postpone services made only as a last resort and only at the behest of the clinicians involved in the treatment of others in their local area.

I have been meeting regularly with the national cancer director, Cally Palmer, and this week NHS England issued its latest guidance on maintaining cancer recovery throughout the second wave. It is important to continue to advise children and young people and their parents, as several hon. Members have done, to contact their GPs if they are worried about any sign of cancer. It is far better to pick up the phone and ask and to have their worries allayed than to think that maybe they could have rung before.

Referrals in September were running at 102% against referrals last year, but we do have a backlog to make up, and we still have some challenges in some of the pathways, which I know the workforce are addressing as swiftly as they can. We saw 199,801 urgent referrals, which, as I say, was 102% of the normal rate year on year; in April it was at 40%. That gives hon. Members some idea of the differential that we have to drive forward. We intend to ensure that we get education right for professionals and that we maintain a patient-centred approach.

I would like to conclude by wishing all those young people the best for their treatment and a fervent hope that they get to ring the bell. At the end of treatment, in most wards, there is a bell that young people get to toll, which marks out that they have finished what is a pretty gruelling episode of their life. I would like to hear that bell ring out for every family. While I know in reality that that is not possible, with good attention to research, by ensuring that we collect the data appropriately, and with all of us focused on raising awareness, I hope we will hear those bells ring out much more regularly.

NHS Dentistry and Oral Health Inequalities

Jo Churchill Excerpts

Wednesday 25th November 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Bradford South (Judith Cummins) on securing this important debate. I know her long-standing and grounded interest, shared by many across the House, in helping individuals access better health care broadly and in particular for their oral health. She has much support, as my hon. Friend the Member for North Cornwall (Scott Mann) showed.

This is a challenge which, as the hon. Lady neatly articulated, has become much worse under the pandemic. I hope to go into more detail about the fact that dentistry has faced specific challenges while delivering what care it has been able to. There are particular long-standing concerns about access to dental treatment in Yorkshire, including the hon. Lady’s area. She gave credit to my hon. Friend the Member for Winchester (Steve Brine) for the work that he did with her, because flexible commissioning has been operated in that area, and it is agreed that most dentists would prefer to move in that direction. As she said, there are challenges with units of dental activity, and arguably an evolution towards capitation, looking at dentistry in the round, and highlighting prevention would start to address those. The Department, NHS England and NHS Improvement are committed to the growth of access to dental services. There have been a number of actions, and seeing them come to fruition in Yorkshire is helpful in understanding how they might benefit a wider population.

As I said, the pandemic had a significant impact on dentistry. That reduced drastically, as the hon. Lady explained, the number of patients whom dentists can safely see each day. The dental risks were new. At the start of the pandemic we stopped dentistry because of the risk of transmission being much higher, owing to the aerosol-generating procedures used. That applies to extraction, but there is even such a risk in scaling and polishing.

During spring, urgent dental care centres were quite rapidly set up. Up to 635 centres were set up across the country and the remainder of high-street practices were asked to deal with the three As—telephone advice, antibiotics and analgesics. I understand that that was a challenge for patients, but I am sure that the hon. Lady will agree that it was vital to ensure the safety of dentists, dental technicians, nurses and entire teams at the beginning of the pandemic.

[Barry Gardiner]

It is really good to hear the Minister giving a straight response to the questions raised by my hon. Friend the Member for Bradford South (Judith Cummins). She mentioned dental technicians. Is she as concerned as many of us are that because of the lack of work for them now, people are leaving that employment, and the skills base is being lost in such a way that it will be difficult to cope with the expansion of demand once we move from present circumstances beyond the epidemic?

[Jo Churchill]

I believe that the workforce, more broadly, is something we must look at properly in the round.

Aerosol-generating procedures present a high risk, as I said, and under initial guidance issued by Public Health England, infection control required that rooms should be rested for up to an hour, as the hon. Member for Bradford South said, to allow the airborne spray to settle. NHS dental practices were allowed to start offering services from 8 June providing that they had appropriate PPE and infection prevention and control measures in place.

In response to the hon. Member for York Central (Rachael Maskell) I would say that all NHS dentists can access the portal. Registration is voluntary, and 5,500—equating to about 81% of all NHS dentists—have signed up, and 50 million items of personal protective equipment have been dispensed. Making sure that our frontline services have what they require is vital, but the e-portal is being used, and I urge the remaining dentists to sign up.

There are more than 6,000 NHS practices in England that should now be offering face-to-face care, in other than exceptional circumstances. Guidance to practices has made it clear that during the difficult period they should prioritise care for vulnerable groups and then address the delayed routine check-ups; but that remains a challenge.

I recognise the comments that the hon. Member for Bradford South made about expectant mothers; I have asked my officials to look at that at speed, and I will come back to her on that. I am determined that we mitigate widening oral health inequalities as much as we can during this difficult period because, as we have alluded to, we know we had a problem beforehand.

NHSEI is keeping more than 600 urgent dental centres stood up to provide additional capacity in the system. My hon. Friend the Member for North Cornwall said he has problems too—and we have them across the country—so making sure that we have that universal coverage with UDCs is important. I must put on record my gratitude to dentists, dental nurses, technicians and all the team, because this has been a really difficult period. Dentists and their staff have kept vital care going through the initial peak, both remotely and in frontline urgent dental centres; many also volunteered to be deployed if needed on the frontline of covid services, and their contribution was very much appreciated.

It is important to ensure that NHS dentists are financially supported as businesses. NHSEI has continued to pay dental contracts in full, minus the running costs for downtime in the initial lockdown, whatever the volume of service to be delivered, and NHS dentists holding NHS contracts have welcomed that support. However, I am mindful that that support was for NHS dentists, and there are challenges in the private sector—and many practices are a mixture of both.

The focus now is on increasing dental provision as fast and as safely as possible. Key work has been done to establish ways to reduce room resting times, and that advice has been made available to the profession. I regularly meet with the chief dental officer, the BDA and other stakeholders, because it is vital that we keep looking at how we can get volumes up. That also means updating the existing dental infection prevention and control guidance, but it does not solve the challenge of delivering dental care at volume through the pandemic. It is an important step forward, but part of the problem is the variability in the estate, as the hon. Member for Bradford South alluded to—the different sizes of practices, where they are located, and so on. NHSEI is in discussion with the profession and is taking clinical advice on the expectations for delivery of services to the end of March.

I met the BDA and other dental stakeholders last week to progress conversations further, and I heard those messages. The challenge is to make sure that we can get the optimal amount of care for our constituents and patients while safely ensuring that dental teams can be protected, but we do need to see increased provision. I am keen to understand what further work can be done to solve the challenges in dentistry and how it faces the pandemic, and I have asked officials and NHSEI to look at potential solutions, including testing, increased use of ventilation and the financing thereof.

I understand the constraints under which the profession is operating and how vital services are. We know without doubt that oral health inequalities are likely to have increased over the period of the pandemic and NHSEI is working hard to ensure that caring for vulnerable communities is prioritised. Poor oral health can have a devastating impact on somebody’s quality of life, particularly a child’s, and dental disease is entirely preventable. In the Green Paper published in 2019 we committed to looking at those barriers, to fluoridation and to consulting on rolling out supervised tooth-brushing schemes in more preschool and primary settings. We are working as hard as we can to make sure we hit the consultation dates, but there are challenges.

[Rachael Maskell]

Will the Minister give way?

[Jo Churchill]

I am all but out of time.

Sugar plays a crucial role as well, and dental professions are important in healthcare more broadly: diet, spotting oral cancers, diabetes and so on. NHS England is working on a number of key initiatives to reduce inequalities for children, the elderly and the frail. I know that all dentists seek to put prevention at the heart of what they do, recognising that good oral hygiene and diet are the foundation of a lifetime of good oral health.

Through more flexible commissioning, dentists can be partially remunerated for carrying out initiatives such as outreach to schools, care homes and other settings—the homeless are often very compromised with their teeth as well. I hope that provides some reassurance that we are determined to tackle both the long and short-term issues with dental access and the continuing and very concerning inequalities around health, and I am happy to continue this conversation informally.

Question put and agreed to.

Dental Patient Charge Uplift 2020-21

Jo Churchill Excerpts

Monday 23rd November 2020 Written Statements

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

The National Health Service (Dental Charges) (Amendment) Regulations 2020 (“the Amendment Regulations”) will be laid before Parliament to increase National Health Service dental patient charges in England from 14 December 2020.

This is the fifth and final year of the spending review 2015 commitment to annually uplift dental patient charges by 5% for the duration of the spending review period.

Following a six-month freeze, the dental charge payable for a band 1 course of treatment will rise by £1.10, from £22.70 to £23.80. A band 2 course of treatment will increase by £3.10 from £62.10 to £65.20, and a band 3 course of treatment will increase by £13.50 from £269.30 to £282.80.

Details of the revised charges for 2020-21 can be found in the table below:

Covid-19

Jo Churchill Excerpts

Wednesday 18th November 2020 Commons Chamber

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

I beg to move,

That this House has considered covid-19.

Yesterday, there was an increase of 19,609 cases of coronavirus in the UK, and sadly we recorded 529 deaths. I am sure I speak for everyone when I say that our sympathies and prayers are with each and every family. It is a stark reminder, if we needed one, that we still have a long way to go in beating this disease and seeing our country thrive again.

I know that Members across the House will join me in wishing those who are currently unwell a speedy recovery and thanking all the staff across health and social care and key workers for all they do, but I would also like to mention one or two who do not always get a mention: those working in community health, including our health visitors and our pharmacists, and many of the volunteers who keep many of the shows on the road.

As the Office for National Statistics report on loneliness earlier today showed, these changes are taking a toll on our lives. They are taking a toll on individuals, families and businesses, so the news this week of further successful vaccine trials with Moderna and today’s update from Pfizer have given rise to the very real prospect of an effective vaccine in the near future. While I share that sense of hope with many, we still have some way to go, and we must never lose sight of the challenges that we face at the moment. A vaccine still has to go through a regulatory process, but it is right that the planning of the huge logistical exercise of a vaccine roll-out led by the NHS is now very much under way. Throughout this pandemic we have had to learn, and each week brings further understanding.

As more information continues to emerge on the risks of long covid, for example, we are reminded how this virus can remain a threat. I am sure hon. and right hon. Members will be pleased to hear that the NHS will have a network of 40 long covid clinics in place before the end of this month, bringing together doctors, nurses, therapists and other NHS staff to help those patients suffering from the lasting effects of this virus. That is an example of how our response to the virus has to continue to evolve and strengthen to protect staff, patients and the public, moving with the science as we learn more.

It is hard to overstate how little was known about the virus at the start of the year. We have done many things for the first time, and the learning curve has definitely been a steep one, but looking back, we have come a long way through this difficult year. We have always sought to base decisions on evidence, data and scientific advice, and we have been willing to reflect and adapt as we go. From repatriating individuals from Wuhan in the early days of the pandemic, we have constantly faced and met enormous challenges. In the words of General Sir Nick Carter back in April, distributing personal protective equipment, for example, was

“the single greatest logistical challenge”

in his 40 years of service. However, with others helping, such as the Army, we built those supply chains and responded to demand. In some areas, demand went up by 17,000% for eye protection, for example, and by approximately 4,700% for masks. So far, we have distributed more than 4.9 billion items of personal protective equipment to the frontline, and today we have a four-month stockpile in hand across all nine key lines, with a further 32 billion items of PPE on order. We have regularly delivered to more than 58,000 health and care organisations. I would like to pay tribute to Lord Deighton and his team for their extraordinary efforts in building resilience into the supply chain, to enable us to be as confident as we are today.

I am clear that none of this would have been possible without the incredible collaboration we have seen between industry, social care providers, our NHS, the armed forces and others. Industry and individual businesses stepped up to meet the challenge. At the start of the pandemic, only 1% of PPE was manufactured here in the United Kingdom. By the end of the year, we will be manufacturing 70% of the amount of PPE we expect to use from December to March in all key areas bar gloves. This enormous national effort has put our country on a strong footing today and for years to come. Following the launch of the PPE strategy in September, we are looking at sustainability and initiating a UK production site for gloves.

[Karin Smyth (Bristol South) (Lab)]

I accept that it was an extraordinary time and that extraordinary measures needed to be taken, but as we have heard from the National Audit Office today, tried and tested processes and procedures were not used. Will the Minister say something about that report and why that was the case, why we had 11 ministerial directions by May and whether those lessons have been learnt by her Department and others that fell foul of the procurement procedures?

[Jo Churchill]

The NAO report to which the hon. Member refers highlights that we were acting with “extreme urgency” in a global market where demand exceeded supply. The report states that the situation in responding to the covid-19 pandemic was unprecedented, but that we

“secured unprecedented volumes of essential supplies necessary to protect front-line workers.”

[Karin Smyth]

Will the Minister give way again?

[Jo Churchill]

If the hon. Member will bear with me, I will continue.

The NAO report examined potential conflicts of interests involving Ministers and the awarding of contracts and found none. It states:

“we found that the ministers had properly declared their interests, and we found no evidence of their involvement in procurement decisions or contract management.”

The report recognises that there are robust processes in place for spending public money, to ensure that critical equipment got to where it needed to go as rapidly as possible while ensuring value for money. I welcome the report, because we can all learn.

[Chris Bryant (Rhondda) (Lab)]

I want to make a very different point, which is about how well prepared we were for this year and how prepared we would be if all this were to happen again. The truth is that we tend to run the NHS at 90% to 95% capacity, and it takes the requirement of only a tiny smidgen of increased capacity for the whole thing to fall over. I am particularly conscious of that in relation to intensive care. We have had to cancel elective surgery just to keep intensive care going. If we had the same number of beds per head of population as France or Germany, we would not have had to do that. Another affected area is neuro-rehabilitation after brain injuries, which was already struggling and will even more so because covid clearly leads to some neuro-degenerative conditions.

[Jo Churchill]

The hon. Member is an incredible campaigner in the area of neural injuries. When elective procedures are stood down, those are clinical decisions. We have ensured that many can keep going in the second wave, but this must be done on a local level. There is surge capacity in the Nightingale hospitals, with an additional 2,000 beds, and we have the ventilator capacity that was built up during the first wave of the pandemic. I recognise what he says, but I do feel that these decisions have to be made locally by the clinicians who are involved in delivering the care.

[Chris Bryant]

rose—

[Jo Churchill]

I will give way briefly but then I would like to push on.

[Chris Bryant]

I am not having a go at the Minister; I am simply trying to ask a question for the country, in a way. For the future, we will have to have much more capacity in the NHS, won’t we? We will have to nearly double the amount of capacity we have in some areas, particularly in intensive care, in neuro-rehabilitation and, for that matter, in radiotherapy.

[Jo Churchill]

I will come on to the area of cancer, in particular. Strides have been made in different ways of treating virtually, so that fewer people go into the hospital setting, and so on. I take the hon. Gentleman’s point about capacity, but that is why the Government have committed to building 40 new hospitals—because there is a need to ensure that sufficient capacity is available across the country for people.

[Karin Smyth]

Will the Minister give way?

[Jo Churchill]

I am going to push on a little bit and then I will give way again.

This enormous national effort has put our country on a strong footing for today and years to come. We are using the best of British ingenuity to help us to deliver in this area. Progress has also been seen in other areas. As the pandemic unfolded, the UK could not call on a major diagnostic industry. From a standing start of about 2,000 tests a day in March, our capacity is now over half a million tests per day. This matters, because it has often been said in this place that in order to beat the virus we need to draw on different parts of our armoury to help to get us through. Testing works. It helps to deny the virus the connections it needs to spread. Mass testing therefore offers us a chance to achieve that on a much bigger scale. We are making progress in city-wide testing in Liverpool. I thank Joe Anderson for his leadership in helping to deliver not only in testing but in other areas too. We are also rolling out a further localised approach to other areas with the help of directors of public health, among others, who know their local areas. Some 83 local authorities have now signed up to receive regular batches of lateral flow tests, which allow for a result to be seen in 15 minutes.

Further, I know that hon. Members will celebrate Monday’s announcement of two mega-labs coming on stream early next year—very high-throughput laboratories, one in the midlands and one in Scotland, adding a further capacity of some 600,000 tests per day. These are massive gains that we are achieving by embracing cutting-edge technology such as automation and robotics and harnessing the best of British industry and academia, meaning that we will not only be able to process more tests but that they can be processed quicker and at a lower cost. The mega-labs will be another powerful weapon in our defence against this deadly virus in order to get back to a more normal way of life, but more than that, they will form a permanent part of the country’s new diagnostic industry. They can help us to respond in the future and build further resilience.

I am excited at the potential for a new diagnostic industry to help to care and deliver across other disease types, not least cancer. Hon. Members will know that, informed in large part by my own experience, I was an advocate of improved cancer outcomes long before I came to this place or took on this role. Early diagnosis is the key to beating the disease, and with bold steps forward in diagnostics, I would like it to make it my mission—I am sure with many others across the House—that we seize new opportunities in cancer services so that covid-19 is not a derailer but an opportunity for a new phase in smarter, faster diagnostics.

[Tim Farron (Westmorland and Lonsdale) (LD)]

rose—

[Jo Churchill]

I would be happy to hear from the hon. Member, who champions radiotherapy.

[Tim Farron]

I very much appreciate the Minister’s work in this area. She will have seen that leading clinicians think it will take five years for us to catch up with the cancer backlog. Indeed, Cancer Research UK has recognised that there have been 35,000 avoidable deaths from cancer over this period. Only very recently, there was an awful figure in an article in The BMJ saying that there have been 60,000 lost life years as a consequence of cancer during this period. I absolutely acknowledge that progress is being made when it comes to diagnostics; I am less convinced that progress is being made when it comes to treatment. Will she confirm whether her Department is making an urgent bid for spending review funding for smart radiotherapy, for delivery at satellite sites and for digital technology, to ensure that we clear the backlog, save lives and catch up with cancer?

[Jo Churchill]

I thank the hon. Gentleman for his intervention. As he will know, the comprehensive spending review will deliver forth, and bids have been put in across the piece. I am sure he will understand that it is not my place to answer, as those decisions are still being made.

We know that some of these figures relate to specific challenges. For example, endoscopy is still a particular challenge because of the aerosol-generating procedure. That is why I was really pleased that Cally Palmer, Professor Peter Johnson and other stakeholders, including charities, have formed the cancer recovery taskforce. They will be laying out a national plan for how we beat this, and also how we optimise the use of new treatment paths. As the hon. Gentleman knows, we are using fewer radiotherapy treatments, or fractions, so that people do not have to attend so much. There is also oral chemotherapy and many other advances that need building in, to ensure that patients get timely and quick treatment.

As the first wave subsided, the NHS rose to the challenge of restoring cancer services: it kept focus and did some amazing reconfiguration work around cancer hubs and rapid diagnostic centres. I recognise that, as the hon. Gentleman says, there is a way to go, but I am aware of how much each day spent waiting for a diagnosis, for treatment or for an answer suspends time and feels like a year for the individual. We will continue to ensure that cancer services are prioritised and we thank those who work in the cancer workforce for everything they are doing.

In September, slightly over 86% saw a cancer specialist within two weeks of a referral from a GP, and 94.5% had treatment within 31 days of a decision to treat. I would really urge people who are worried about cancer or any other major issue, “Please, don’t leave it. Help us to help you.” It is always challenging, and many people have said to me that they do not want to overload the system, but doctors are keen to help.

A vaccine will perhaps be our most potent weapon, once we know that it is safe and effective. However, we do not yet have a vaccine. I must be very clear on that point. We are not quite there yet—we must ensure that we stick to hands, face, space and ventilate our environments by opening windows for short bursts—but progress on this front is encouraging. Last week, we heard about phase 3 trials from Pfizer and BioNTech, stating that their vaccine was more than 90% effective in preventing covid. Today, further data indicates that the vaccine is now thought to be around 94% efficacious for those who are 65-plus, with good data on many other groups. As I say, we are constantly learning. Earlier this week, preliminary trial data from Moderna suggested that its vaccine had an effectiveness of 94.5%. Additionally, we have had the start of Janssen’s phase 3 trials in the UK this week, and we will hopefully have more phase 3 trials reported in the next few weeks.

This is all very positive, but of course, our regulator will not approve any vaccine until it is proven to be clinically safe and effective, and the way to get there is via trials. On that note, I would like to give a shout-out to my hon. Friend the Member for St Austell and Newquay (Steve Double), who is taking part in the trial, and my hon. Friend the Member for Saffron Walden (Kemi Badenoch), who is also doing so. I know that my hon. Friend the Member for Vale of Clwyd (Dr Davies) and my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) have registered, although I do not know whether they are part of it. I am sure several other Members across the House have also stepped up.

We have already struck commercial deals to secure access 355 million doses of seven vaccines, and the Department is working at pace with the NHS to ensure that we will be ready to roll out any that are proven safe and effective immediately. That will be a massive undertaking, and I thank everyone for their hard work thus far.

Mr Deputy Speaker, you were not in the Chair yesterday, but I somewhat embarrassed myself by perhaps displaying more of the parent in me than the Minister. This country’s journey in beating the pandemic, however, has been a little like watching one’s child grow: it is a huge undertaking, it comes without a manual, we are proud of the successes and, when things are trying, we attempt to learn and move on—but the work is never done. Over the past year, so many parts of our country have risen to meet an incredible set of challenges; challenges they are facing every day. Only by ensuring that we have those different lines of defence, and by pulling together in local, regional, national and international ways will we protect those on the frontline and allow family and business life to resume and get back to a different, albeit more normal way of life.

[Mr Deputy Speaker (Mr Nigel Evans)]

As Members will see from the call list, quite a number of people wish to participate in this debate. We will start all non-Front-Bench contributions at six minutes, although clearly that limit might be reduced later on depending on how many interventions there are.

Oral Answers to Questions

Jo Churchill Excerpts

Tuesday 17th November 2020 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

What steps his Department is taking to ensure adequate supplies of personal protective equipment for (a) health, (b) social care and (c) other frontline services during the covid-19 outbreak.

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

We have a four-month stockpile of all covid-critical PPE in place. Thanks must go to the tremendous contribution from UK manufacturers, including Honeywell in Motherwell in Scotland, which now meet 70% of our PPE needs. We have distributed 4.7 billion items, ensuring health and care providers and others have access to the critical protective equipment that they need to help keep everyone safe.

[Richard Thomson]

According to Treasury figures, the UK Government have spent £15 billion to date on PPE contracts, and the majority to date have been awarded without open tendering, often to those with connections to the governing party or to companies with no PPE experience at all. Does the Minister consider it is acceptable that, instead of that resource being used to protect frontline healthcare staff, so much of it has been squandered on millions of items that are absolutely unusable because they do not meet NHS standards, and how does she propose to restore this Government’s reputation for competence, probity and openness in the tendering process?

[Jo Churchill]

The global pandemic presented us with unprecedented challenges in securing the volumes of PPE required. We moved swiftly in order to make sure that we kept people safe. We procured goods and services, and worked with extreme urgency in accordance with procurement rules and Cabinet Office guidance. All offers were prioritised based on volume price, clinical acceptability and lead time. I am happy to reiterate: we have four months’ supply.

[Martyn Day]

The UK Government removed the zero VAT rating for PPE on 1 November, increasing costs by 20%. Social care and other frontline services are already having to pay higher prices and to buy larger quantities of materials, so why are this Government making it even more expensive to protect key workers during what is the second wave of covid?

[Jo Churchill]

I would like to thank the hon. Gentleman. In the main, many of our frontline operators are getting it free—social care, general practice, dentistry, optometry and so on. The relief was designed specifically to relieve the burden of VAT on sectors particularly affected by coronavirus while supply did not match demand. Now the Government are able to supply covid-related PPE across all sectors, the burden of VAT will still not fall on frontline providers for all covid-related PPE and demand will be met. Most businesses that make taxable supplies can recover the VAT that they incur on purchases of PPE as business expenses. They will therefore be able to reclaim all VAT after the 31st. But I reiterate: for the majority of frontline healthcare, it is free.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

The price of an FFP2 mask bought by the Government increased by 1,400% in just six weeks to the end of May and gowns by 350%. I welcome all efforts by the Government to procure PPE, but I have concerns that we may not be getting a fair price. One company, PPE Medpro Ltd, was given Government contracts worth over £190 million. PPE Medpro Ltd had no previous experience and coincidentally was only set up on 12 May 2020. Reports have suggested that the company has substantial links to Conservative party donors, so can the Secretary of State or the Minister categorically assure the country that no Conservative party donors are profiteering from the pandemic?

[Jo Churchill]

Our plan on PPE has to be to stabilise the system and build resilience. That was outlined in the PPE strategy published on 28 September. [Interruption.] Children! Thank you.

[Mr Speaker]

Minister Churchill, I think that is down to me; you carry on.

[Jo Churchill]

I am sorry, Mr Speaker, but it is that old habit from being a mother of four.

We procure goods and services, as I have said, with extreme urgency in accordance with procurement rules and Cabinet Office guidance. We are confident of our supply, with four months’ worth of covid-critical PPE, over 70% of it now manufactured in the UK, providing UK businesses with jobs and ensuring that all health and care providers have access to critical protective equipment needed to keep patients and staff safe.

[Philip Dunne (Ludlow) (Con)]

What progress his Department has made on building new hospitals.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

What recent assessment he has made of the effect of the covid-19 outbreak on (a) access to routine dental services and (b) early diagnoses of mouth cancers.

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

This Mouth Cancer Action Month is a timely reminder that everybody should seek advice if they are worried. Early in the first wave, dental services were suspended, but rapidly, over 600 urgent dental centres were set up to deliver care. Since June, dentists have continued to prioritise urgent treatment and vulnerable groups and to provide routine care across the dental network. They have worked hard to restore dental activities, while keeping patients and staff safe, owing to some aerosol-generating procedures that mean we have to take particular care in the dental sector.

[Rosie Cooper [V]]

I recognise the Minister’s comments that people are trying to get back to work in dentistry, but the reality is that there is massively reduced dental capacity; routine dental work is not going ahead as easily as people might imagine. Dentistry also plays a vital role in identifying mouth cancers. Following on from a previous question, I wonder what help the Minister can give dental surgeries to improve their capacity. Currently, they have to have an hour’s gap between patients. I understand that ventilation systems are available, which can help, but unfortunately they are very expensive. What help can Ministers give to enable dentists’ surgeries to purchase that equipment? Can grants be made available? This is a really urgent question.

[Jo Churchill]

I recognise the hon. Lady’s concern in this area. I assure her that I am working closely with NHS Improvement and the chief dental officer. I have held several meetings over the past week alone, and tomorrow I am meeting the chair of the British Dental Association. Some areas of challenge that she articulates, such as fallow time and so on, are things that we are actively working on at pace, as well as looking at specific testing solutions for dentistry. We are also looking at the issue of ventilation. I am happy to report when further work has been achieved.

[Mrs Sheryll Murray (South East Cornwall) (Con)]

What steps his Department is taking to support the development of covid-19 vaccines.

--- Later in debate ---

[Ms Angela Eagle (Wallasey) (Lab)]

What recent plans he has made for the distribution of covid-19 vaccines.

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

On top of the positive news this week of two vaccines, a covid vaccine will be deployed only once it has met robust standards on safety, effectiveness and quality through clinical trials and been approved for use by the Medicines and Healthcare Products Regulatory Agency or an appropriate regulatory body. The Government have asked the NHS to be ready to deploy any safe, effective vaccine as soon as it is available. Distribution arrangements must be flexible and include the make-up of the workforce needed to rapidly deliver a vaccination programme, training requirements, consumables and any supporting infrastructure. The key point, though, is that the Government have been clear they will do everything they need to do to roll out a successful vaccine.

[Ms Eagle]

Does the Minister agree that it is going to be a mammoth logistical effort, not only to do a vaccination-style thing as we do every year with flu, but to include everybody? Also, it looks as though, in order for the vaccine to be effective, people might have to have two injections rather than one, which doubles the number. Can she give any view at this stage, given the logistical efforts that are going in, of how long it will take us to safely vaccinate everybody in the country?

[Jo Churchill]

First, I would like to place on record my enormous thanks to Liverpool and its local leadership for how it has helped us with repatriating from Wuhan and with the mass testing. I am sure that Liverpool will once again step to the fore with any help we might need with deploying the vaccine. We will deploy it as fast as possible, but there is a process. We have to know that it is safe, through the regulatory framework. We then have to know that as it arrives from the manufacturers, we can distribute it at pace. We are aiming to do that, and every sinew is being strained to ensure that we can deliver as swiftly as possible. The entire population wants to get on with living a normal, or more normal, life.

[Sir David Amess (Southend West) (Con)]

What steps his Department is taking to protect care home residents during the covid-19 outbreak.

Breast Cancer Diagnosis and Services: Covid-19

Jo Churchill Excerpts

Thursday 12th November 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I have an awful lot to cover and less than 10 minutes to respond, if I am going to give my hon. Friend the Member for North Warwickshire (Craig Tracey) time to sum up. I congratulate him on securing the debate and on the important work he does running the APPG on breast cancer with his co-chair. I know that he has been a fundraiser for breast cancer and that, like me, he came to this place with tackling this issue as one of his key ambitions. We will get there.

As my hon. Friend the Member for Winchester (Steve Brine) said, everyone with breast cancer is a mum, a sister, a daughter or a friend. Some 3% of them are now fathers, sons and brothers. I am grateful for the contributions to the debate. A debate such as this allows us to park much of the politics but talk about what is really important here: the patients, and the outcomes for them.

Early diagnosis is key, and hon. Members have outlined the challenge that covid has brought. I thank my hon. Friend the Member for Crewe and Nantwich (Dr Mullan), and indeed the hon. Member for Ellesmere Port and Neston (Justin Madders), for outlining just how challenging covid-19 has been for the NHS and how it has responded to an unprecedented event in an unprecedented way. I reassure all hon. Members that in the second wave, we have made sure, as we have heard from many hon. Members, that cancer services are prioritised and remain.

I pay my own tribute to my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who has written to me because she would have liked to be here today and who is currently in treatment, as well as to my hon. Friend the Member for Norwich North (Chloe Smith), who is currently having treatment, the former Member for Dewsbury, who has been mentioned, and the former Member for Eddisbury, who is having her own challenge living with cancer. It is around us all. I well remember the emotional tsunami that diagnosis brings. As my hon. Friend the Member for Chatham and Aylesford said in her letter, because she is always the same with language, “Cancer sucks”. I could not agree more. I wish them all the best on their journey, as I do every patient through their treatment.

I am really aware of how covid-19 has upended our lives, but clinical decisions had to be made in March. We were dealing with the unknown and we had to protect people and highlight priorities. For those who have had their cancer treatment or surgery changed or delayed, I understand the uncertainty and anxiety they have had on top of that diagnosis of cancer. For patients and their families, this is a really tough time. We must have a laser focus on early diagnosis, as was laid out in the manifesto, and we must not veer from that. I do not want covid-19 to be the derailer; I want us to seize some opportunities that have come about.

Although it makes it no less bearable for those affected, the decision to pause some patients’ treatment in the first wave was taken on clinical advice that factored in the risk to the most vulnerable. As soon as it was possible, however, the NHS was charged with restoring cancer services as quickly as possible, and it has risen to that challenge. I meet with Cally Palmer, who was mentioned earlier, and Professor Peter Johnson often—at points weekly—to make sure that we are doing everything we can.

Across the country, there are 21 cancer alliances and their cancer hubs. My hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) outlined the amazing work done at the Royal Marsden to bring hospitals across the capital together to optimise safe theatre space to deliver treatments and so on. We have asked for that approach to happen across the country to ensure that we optimise treatment. I hear my hon. Friends the Members for Wakefield (Imran Ahmad Khan) and for High Peak (Robert Largan), but it cannot always be on the doorstep at this time; we have to have a bit of flex. I will happily meet my hon. Friend the Member for High Peak to talk about his particular concerns.

I join my hon. Friend the Member for North Warwickshire and other hon. Members in recognising the tremendous efforts of the cancer workforce. In forming those cancer hubs and the rapid diagnostic centres, people have moved mountains to care for the patients they look after every day. Ultimately, they are the ones on the frontline to ensure that breast cancer services are there when we need them, and our thanks go to them.

The latest official data for September, which was published only this morning, shows that urgent two-week GP referrals across the entire spectrum of cancers are 2% higher than last year and they continue to rise for all cancers. In breast cancer, we have seen a month-on-month rise of more than 15% from August to September, but we still have work to do; I am not going to stand here and say that we do not. There is still a way to go to meet current demand and improve on that rise for those who are waiting for treatment.

More than 86% of people saw a cancer specialist in September within two weeks of their referral from a GP, and nearly 95% of patients received treatment within 31 days of a decision to treat. I know precisely how long every day feels when people have had a diagnosis. I have had tumours in both breasts and other primary sites. The wait is anxious. It is terrifying. Your mind asks, “Who will pick the children up?”, and, as my hon. Friend the Member for Winchester said, a million other unanswerable questions every single day.

There have been some bright spots and some innovative treatments that have moved the profile of the disease further forward. I personally—this is an ambition of Breast Cancer Now—want to see the eradication of breast cancer by 2050. We must work to that, because it is possible. As we have a 98% ability to treat testicular cancer, we can do better. Breast cancer should not claim the lives of over 11,000 women a year. I want to see it put back in its box.

Breast cancer treatments are advancing. This year has been no exception, with advances in radiotherapy and chemotherapy. We have seen oral chemotherapies that are easier to deliver and better for the patient. We have seen the publication of the FAST trial, which looks at five-fraction radiotherapy to treat early breast cancer. I thank the hon. Member for Easington (Grahame Morris), who is no longer in his place, and the other members of the APPG on breast cancer who came to see me. That treatment enables individuals to be treated quicker with fewer hospital visits. When we are fighting covid-19 and we are trying to keep people out of hospitals, it is better to minimise visits. All radiotherapy providers in England are adopting this approach. Yes, we have challenges with the workforce, but radiotherapy did remarkably well at keeping itself going through the pandemic.

I will try to cover as many of the different issues as I can, but I barely have any time left. They will drag me out of here with my nails pulling on the carpet. Clinical nurse specialists are important, valued and flipping marvellous—we all need one. Some 350 extra clinical cancer nurse specialists were allocated in the long-term plan, but we need to work together. I am working with Andrew Strauss and my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire).

Cancer nurse specialists need to come from the existing workforce. They must be encouraged to do further training. We need to ensure that it is seen as a career path that really does have that purpose. Boy, oh boy, when one needs a cancer nurse specialist— they save the oncologist and one can phone them to ask about one’s niggles—they do amazing things. I want to see everyone come together, including the charities, to encourage nurses to come forward and help the community.

I met with the secondary breast cancer women before the pandemic. The situation is variable, and that is not good enough. The journey of a woman who has a cancer nurse specialist by her side is not an easier journey, but it is one where they feel supported. They have someone there. My cancer nurse specialist helped me to get some of the psychological counselling that colleagues have spoken of. I was angry and ticked off that I had that disease again. We need to encourage people to sign up to do that additional training. The money is there.

Data needs to be better. I could go on about data, screening and clinical trials, but I am aware that I have such little time. The majority of clinical trials are open for registration. I am urging local decisions to be made to get people reinstated and on to clinical trials. We have opened up screening with open invitations to try to get more women through. We know we have an issue with women not attending their appointments. We need to make people feel safe when they go to have their screening test in a hospital. Unless they feel safe, they will not go. We must work together to say, “It is open, but you have to go. Our NHS is a really precious resource. If you have an invitation, take it up and go to see the professionals who are there to help you.”

I wish I could say more, but I want to give my hon. Friend the Member for North Warwickshire a second or two to sum up. I thank everyone working on the frontline. Advances are happening; there is more to do. I am happy to work with my hon. Friend on an audit. We need to get better data. It is collected, but not in a good enough format. I want to see us do better in all those areas.

Covid-19

Jo Churchill Excerpts

Wednesday 11th November 2020 Commons Chamber

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

I would like to thank everybody who has contributed to the debate and to the tone of it. I add my personal thanks to all those who are working on the frontline and in public services. This has been an incredibly difficult year for those individuals, and there is arguably still much work to be done.

I would also like to add my thanks to the armed forces. We heard powerful speeches earlier this afternoon on everything that our armed forces have done, but they have also contributed enormously to our ability to tackle the pandemic so far through the distribution of PPE, rolling out mobile testing centres, building Nightingale hospitals and being involved in the important planning for the roll-out of a vaccine when one is fully approved.

I would like to thank all those who brought to this place today stories of personal loss—in particular, the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy), who told us of the sad loss of her family member this week, and my hon. Friend the Member for Beaconsfield (Joy Morrissey), who told us so poignantly about Jamie.

From many of the contributions, it is clear that hopes for a vaccine are running high following the encouraging news of the phase 3 trial results from Pfizer and BioNTech on Monday, and I share that sense of optimism. Science, academia, life sciences and private and public institutions have worked together. As my hon. Friend the Member for Wakefield (Imran Ahmad Khan) said, we would not be here without such endeavours of the private sector working with us. It is a promising development, and the UK is ahead of the game in securing an order for 40 million doses.

I would like to thank the head of the vaccine taskforce. The hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey) said that she is “impressive” and on top of her brief. I could not have put it better than my hon. Friends the Members for Gloucester (Richard Graham) and for Warrington South (Andy Carter). It is under her leadership that this is one of many vaccine candidates that we have secured.

There are six in total, two at phase 3. We have placed orders for a further 300 million doses from the five other candidates, which are yet to report. That also includes the Oxford AstraZeneca vaccine; my hon. Friend the Member for South Cambridgeshire (Anthony Browne) highlighted the endeavours of AstraZeneca in Cambridge.

I share the sense of optimism, but I also want to associate myself with the words of caution that many Members have expressed, including my right hon. Friend the Member for North Somerset (Dr Fox). It is worth reiterating that the MRHA will not approve a vaccine unless it is clinically safe. There are still many unknowns. Until a vaccine is rolled out, we will not know how long its effects will last or its impact on reducing transmissions, and there are no guarantees.

The hon. Member for Nottingham East (Nadia Whittome) articulated the importance of making sure that people have accurate information to ensure that they take up vaccines. I assure her that the Government are working hard to ensure that people feel confident in the vaccine roll-out. We are working with the Department for Digital, Culture, Media and Sport, cross-Government and with technology companies to ensure that we limit misinformation and promote positive messages to get as much uptake of vaccination as we can. If this or any other vaccine is approved, we will be ready with a large-scale vaccination programme, which is being worked on at the moment.

I thank my hon. Friends the Members for Don Valley (Nick Fletcher), for Stourbridge (Suzanne Webb) and for North East Derbyshire (Lee Rowley) and my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) for their optimism in outlining the progress that we have made so far and how hard people have worked.

One point in particular that I would like to pick up on is PPE. When the pandemic started, we produced 1% of our PPE needs in the UK. By December, we will be providing 70% of the amount that we expect to use at the rates anticipated in December for all items except gloves. That is enormous progress. It is an industry that has been built from scratch, and it has been replicated through testing and diagnostics across the country. I would like to thank everyone involved.

But it has been tough, and nowhere has it been tougher—we have heard about how difficult it is—than for families with members of their family in care homes. We heard about that from my hon. Friends the Members for Beaconsfield, for Hastings and Rye (Sally-Ann Hart) and for West Bromwich West (Shaun Bailey), and my right hon. Friend the Member for Clwyd West (Mr Jones). I pay tribute to the Minister for Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), who has to perform an incredibly difficult balancing act. It is a terribly hard time for families and residents, but also for care home staff. Their first duty is to keep their residents safe.

Last Thursday, guidance was published to enable care home providers, families and local professionals to find the right balance between the benefits of visiting and the risk of transmission. Care home visits will be allowed to develop further via trials to allow more visits supported by testing. Care homes, like GPs, can access free PPE via the portal until March, so if people are not signed up, I would encourage them to do so.

On testing, the House should also be encouraged by the pilots, and I thank those hon. Members who were grateful for the roll-out of testing. I also thank all those hospitals, such as Warrington, who have run pilots for us. We cannot learn without developing these systems. We have the pilots in Stoke-on-Trent and Liverpool in whole-town and city testing,  and we are now in a position to roll out twice-weekly testing for all NHS staff, something that I am grateful the hon. Member for Tooting (Dr Allin-Khan) mentioned. It is essential for the safety of patients and staff alike.

I will move on to international restrictions because, despite the positive developments, the national restrictions for England, which this House voted for last week, are as important as ever. Although I hear the calls of colleagues, we must remember that we are here to protect lives. However, I fully take on board that we are also here to protect livelihoods. I have heard those contributions on how the measures have impacted on businesses, and I recognise the strength of feeling on that.

[Bob Seely]

Will the Minister give way?

[Jo Churchill]

I have only two minutes left. I would be happy to take the matter up with my hon. Friend afterwards.

I cannot speak for the Chancellor, but I know he will have heard the contributions by hon. and right hon. Friends, particularly my right hon. Friend the Member for North Somerset, to ask him to listen to those who pay themselves through dividends. However, we have had an unprecedented package of support, including some £200 billion since March and the furlough scheme, which has protected the jobs of some 9 million people. I am married to a small business owner. Some 99% of all businesses in this country are SMEs and 95% of them are micros. This is hard, and nobody is denying that.

On data, I thank my hon. Friend the Member for Sevenoaks (Laura Trott), because it is important. I note the comments of my hon. Friend the Member for Isle of Wight (Bob Seely), but the scientific picture last week was bleak and the consequences, as we have seen, come in the 10 days after, with rising numbers of admissions and, tragically, deaths. The R rate was above 1 in every single region of the country. The virus is growing more quickly in older populations, and the number of cases in the over-60s in England doubled between 14 October and 4 November. That is why it was imperative to take action. As we deliver the vaccination, it will be the JVCI that determines how we roll it out and the risk stratification on which we do it.

We must persevere. I understand the weariness of people, but I close by echoing the words of many—I am sure all of us—and pay tribute to the NHS and care staff, who I know are exhausted. They will be so important in helping us get through this winter and, we hope, in delivering a safe and effective vaccine. I pay special tribute not only to the general practice community pharmacies and community health teams, but all workers on the frontline. There are some unsung heroes of the pandemic, and I want them to know how much we value them. It is through incredible contributions that we will see this through to a brighter day.

Question put and agreed to.

Resolved,

That this House has considered covid-19.

Obesity: Covid-19

Jo Churchill Excerpts

Tuesday 10th November 2020 Westminster Hall

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

What a pleasure it is to serve under your chairmanship, Mr Davies. My first very pleasant duty is to thank the hon. Member for Strangford (Jim Shannon) for securing this debate. It has been an hour and a half of people coming together. We know that we have a problem and we have tried to come up with solutions. As has come out from across the Chamber, we know it has taken us some time to get here, and we know that it will take more than one individual silver bullet to get to the place that we want to be. Although one is often pleased to be at the top of a list, being at the top of the list or second to Malta on the obesity statistics is nothing to be proud about. As many hon. Members have outlined, the concomitant of that results in links to poor outcomes from covid-19, whether it is the links to heart disease, diabetes, cancer or any one in a plethora of things. It is really about an individual’s ability to have a good quality of life for as long as possible, because we know that obesity affects it quite dramatically.

I thank all hon. Members for their considered and thoughtful contributions in what has become very much a theme of the moment. Much of the work that has been done—the House of Lords report and the national food strategy—has led to this debate and highlights much of the work that needs to be done. The obesity strategy is the pathway of the marathon that is needed to help change those behaviours, and to help drive us in a direction where we see results and—as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) said—see them for a long time, because we want this work to produce results.

We have known for decades that living with obesity reduces life expectancy and increases the chances of disease, as I have said. The life of the hon. Member for Strangford, from being 17 stone and consuming Coke and Chinese food, has obviously now been totally turned around. However, as he said—indeed, it is the one thing that I want everyone to keep in mind—losing weight is not easy. It can be depicted in a Sunday magazine as something that can be achieved in four weeks, but actually it is incredibly hard. It is really, really hard to sustain weight loss. Given the way that we talk about this issue, I was really grateful that the hon. Member for Bath (Wera Hobhouse) and others spoke about the tone in which we talk about it, because it is really important.

Over the past few months, evidence has consistently shown that people who contract covid-19 who are overweight are—as my hon. Friend the Member for Vale of Clwyd (Dr Davies) spoke about, both from the perspective of a doctor and as vice-chair of the all-party parliamentary group on obesity—will have poorer outcomes. We know that those outcomes get substantially poorer with age and with weight. We know that the one thing we cannot do in life is change our age, but we can modify our weight. Weight is the one modifiable factor that we have.

We have also heard from many hon. Members that the problem is more prevalent in black, Asian and minority ethnic populations and in those living in deprived areas, which was articulated by my hon. Friend the Member for Stoke-on-Trent Central (Jo Gideon). People in those populations and in those areas are at greater risk of experiencing poorer health outcomes, not only from covid-19 but right across the health spectrum. And they have an elevated risk of being overweight or suffering from obesity.

Across all Departments, we are actively tackling obesity, because many different factors are involved and we need to make sure that we target them. Covid-19 has provided a laser focus on obesity, so it is crucial to support people in achieving a healthier weight, and to help families, because we know that there is also a common link between mothers and fathers who are overweight and their children’s weight; the likelihood is that their children will also be overweight, or obese.

So, in July we published the new strategy, “Tackling obesity: empowering adults and children to live healthier lives”, which sets out the overarching campaign to reduce obesity, including taking measures to get the nation fitter and healthier. I will look at some of those messages. This process is about building blocks and not about hectoring. As we all know, it is about helping people and having holistic policies. We know the statistics and we have heard them several times, so I will not repeat them. But it is right that our policy focuses on improving diet and reducing obesity.

Since we published the first chapter of the plan in 2016, we have seen important steps forward, and we have spoken to other nations. Just recently, I spoke to Joe FitzPatrick about calorie labelling on alcohol. I have also reached out to the other devolved nations, because, as has been said, it is important that we have such conversations.

We have also looked internationally. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) mentioned Amsterdam and the good work being done there, but I also had a very insightful conversation with Dr Jebb on Singapore, because it has done a great deal of work on how best to incentivise people on the journey to weight loss.

The soft drinks industry levy has been a huge success; the latest statistics show that the sugar content of soft drinks has dropped by 44%, which is a remarkable reduction. We know that sugar content in breakfast cereals, yoghurt and fromage frais has also dropped. However, we also know that calories have gone up in out-of-home desserts. So, we have a really mixed picture and that it is likely that further measures will be needed.

During the pandemic, we have seen people snacking more, with more snacks being purchased, as well as a reduction in levels of physical activity. The cessation of weight management and obesity services, as the NHS focused on covid-19, has not helped the situation, but we very much welcome local authorities’ efforts in adapting weight management, so that we have much greater results; there are many more remote and digital options available to us now.

I will now move on to consider the tangible things. First, the current advertising restrictions for products that are high in fat, salt or sugar are not protecting children. We are seeing significant levels of such advertising on TV and online, and we know that children are now viewing much more of their content online. The advertised diet in the UK does not reflect the healthy diet that so many hon. Members have spoken about. We have set out in the strategy that we want to ban those adverts on television before 9 pm, but we want to go further. This is a very auspicious day for the hon. Member for Strangford—it is almost as if he knew—as we launch the six-week consultation restricting advertising online. We have made it six weeks because we want it to be short and pithy and we want to get to a result, which is what so many hon. Members are keen for us to do.

We are taking decisive action on promotions. We spend more money on buy one, get one free promotions in this country than any other European country. We know they influence preferences and we want to shift the balance to help shoppers. As a further strand, we will legislate to stop the promotion of high fat, salt and sugar products by volume and prominent location— removing them from the gondola end. Those restrictions will apply online and in store and we will publish that result very shortly.

Food eaten out of the home—on-the-go food—which was mentioned by several Members, forms a growing part of people’s diet. That is part of the bigger narrative and bigger conversation about children’s learning to prepare food, eating as a family and all those other things that, if we had had more time, we would probably have discussed at more length. We are introducing legislation to require large out-of-home sector businesses with 250 or more employees to calorie label the food they sell. We will also encourage voluntary calorie labelling by smaller businesses, and we will look at the scope.

Many people mentioned weight management services, and the hon. Member for Strangford asked how we can evaluate them. We can see success through the child measurement programme, but we are very much aware that our bariatric referrals are much lower than across Europe, as is people’s ability to access weight loss programmes. There is some brilliant work going on in pockets and in some of the more deprived areas across the country, and there are great cook schemes. There is a brilliant weight loss project in Sheffield, and I met the people who run it. There is also a “dads and lads” project, helping dads and lads to cook, because it is not always a woman who needs to prepare the meal—says a mother of four, married to a man who does not cook very often. I will leave that there.

Our progress in work includes the NHS 12-week weight loss plan app, as we advertised in the summer, helping people with different levels of intervention to live better with obesity and hypertension and to get the support they need. We have accelerated the expansion of the NHS diabetes prevention programme and we hope to start to target some of the loss of limbs that my hon. Friend the Member for South West Bedfordshire spoke about. That programme has already helped half a million people. The better health campaign aims to reach millions of people who need to lose weight and encourage them in that behaviour change. The app also provides direction to weight loss programmes at discounted prices from Slimming World and WW, formerly known as Weight Watchers.

I am aware that I have not had time to canter through everything. To respond to the hon. Member for Bath, we are very aware that we ensure that messages are attenuated in the right way for those people who are struggling with eating disorders. They are a serious disease, and we work hard to ensure that the language and policy efforts do not have an adverse effect; we do impact assessments and put those on gov.uk. I also talk to my colleague the Minister for Patient Safety, Mental Health and Suicide Prevention, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who holds the portfolio for mental health, so we are very much attuned to ensuring that these policies are aligned. However, we know we have to do more. It is not our intention that anyone should be harmed in our raising awareness of obesity, but we do need to tackle this matter and we need to tackle it full-on.

My hon. Friends the Members for Stoke-on-Trent Central and for Vale of Clwyd spoke about levelling up. I am going to stop, although I have plenty more that I wish to say. It is a combined national effort—I could not have put it better—and I think we are all united in knowing that we must work hard to meet it.