Coronavirus Response

John Howell Excerpts

Monday 20th July 2020 Commons Chamber

[Matt Hancock]

The hon. Lady makes an important point, but the No. 1 cause of people not self-isolating is if they have coronavirus without symptoms and do not get a test. That is where we need the most effort. However, I hear the point that she is making, and I will take it away.

[John Howell (Henley) (Con)]

Is my right hon. Friend aware that co-trimoxazole is receiving tests against covid in Bangladesh and that the increasingly good results from there and India will be published very shortly? When are we likely to see it in use here?

[Matt Hancock]

I will immediately look into the proposal; I would be surprised if my scientists were not already across the trial. If there is a positive signal from that trial, we will make sure that we will absolutely bring it forward.

Draft NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020

John Howell Excerpts

Wednesday 8th July 2020 General Committees

[The Minister for Care (Helen Whately)]

I beg to move,

That the Committee has considered the draft NHS Counter Fraud Authority (Establishment, Constitution, and Staff and Other Transfer Provisions) (Amendment) Order 2020.

It is a pleasure to serve under your chairmanship, Mr Mundell. Like any organisation, the NHS is not immune to fraud. As hon. Members are aware, the Government have backed the NHS with the biggest cash boost in its history: an extra £34 billion by 2023-24. That money will make a difference to many people. Yet, fraudulent activity in the NHS means that the money intended for patient care sometimes ends up in the pockets of those who did not legitimately earn it, meaning fewer resources available to be spent on frontline health services such as patient care, health care facilities, doctors, nurses and other staff. It is taxpayers’ money, and we have a duty to spend it appropriately. An effective counter-fraud organisation that is able to operate independently is crucial—a body that can act without external interference or influence and perform functions that cannot be undertaken at a local level, such as serious and complex investigations that cross borders and cases of alleged bribery and corruption on a national level.

As a result, the NHS Counter Fraud Service was set up in 1998 as part of the Department of Health. Since then, the function has evolved, and in autumn 2017 the NHS Counter Fraud Authority was launched as an independent special health authority. The National Health Service Act 2006 means it is limited to a maximum lifespan of three years, and so is due to be abolished on 31 October 2020. To prevent that, a statutory instrument was laid on 11 June 2020 to extend the abolition date of the NHSCFA by three years, to 30 October 2023.

I want to take this opportunity to highlight the important work of the NHSCFA and set out why we need to extend its lifespan for a further three years. The NHSCFA is a national centre of excellence. It has built strong relationships with organisations across the health and law enforcement sectors so that we can take the fight to those who seek to deprive the NHS of resources for patient care. Fraud is a hidden crime; to fight it, we have to find it. The NHSCFA is continually developing its intelligence and investigation capabilities, and is breaking new ground in how it detects and prevents fraud. It has also set important national standards for the counter-fraud work of NHS providers and commissioners. It also applies to independent healthcare providers and NHS organisations. Its work is clearly bearing fruit.

The NHSCFA’s latest strategic intelligence assessment shows an overall estimated reduction in losses from fraud of £60 million between 2017-18 and 2018-19. It also showed a £27.6 million reduction specifically on dental contractor fraud, thanks to a relentless focus by the NHSCFA over recent years, along with an £85 million annual reduction in fraud losses from false entitlement claims for help with healthcare since 2017.

It is clear that that approach is working. To change direction now would be a mistake. The concerted approach by the NHSCFA to improve fraud awareness and drive up fraud reporting across the NHS is bearing fruit, so we need it now more than ever, especially when we are in the middle of the greatest threat to public health that we have seen in generations.

As part of the Government’s response to coronavirus, the Chancellor has repeatedly said that the NHS will get the funding it needs. An initial £5 billion coronavirus fund was established at the Budget in April 2020. That was then increased to a £14.5 billion emergency response fund, of which £6.6 billion was earmarked to support our health services. We are continuing to work with the NHS and Her Majesty’s Treasury to ensure the NHS gets the funding and resources it needs.

Although we have seen the nation coming together to celebrate the heroic work of NHS staff, coronavirus unfortunately presents a heightened risk of fraud, where criminals may seek to exploit the situation. Never before has a counter-fraud response to this investment been so important. “Protect the NHS” is not just about protecting staff. It is also about the money that taxpayers contribute to this invaluable national resource.

The NHSCFA has played a key role during this period and has produced and shared coronavirus threat assessments with partners, and coronavirus counter-fraud guidance specifically for the NHS. This includes guidance outlining the unique risks during the coronavirus response and specific guidance outlining types of mandate fraud, and how to identify, prevent and respond to them.

As technology evolves, the risks to the NHS will also evolve, especially the risks from fraud, so we will need organisations such as the NHSCFA to co-ordinate the response at a national level. If we made the decision to abolish the NHSCFA today, that would expose the NHS to significant financial risks. It would mean that there would be no ability to record and assess accurately the nature and scale of fraud, and inform the response to it, both within the NHS and across the wider health sector. That would result in serious and complex fraud investigations being transferred elsewhere—for example to other NHS bodies, the police or the Department of Health and Social Care.

[John Howell (Henley) (Con)]

I thank the Minister for giving way and for the examples that she has just set out. However, could she give us an overall picture of where the fraud is arising? Is it arising from within the NHS, from organisations with which the NHS has a relationship or from the man in the street?

[Helen Whately]

I thank my hon. Friend for his intervention. The fraud we see comes from a range of the categories he has just mentioned, sometimes including members of the public and users of the NHS, but sometimes also organisations with which the NHS has contractual relationships.

Let me come back to the point I was making about the downsides there would be if we did not decide to continue the NHSCFA today. If we were to do that, it would undermine NHS funding—much-needed resources that are critical for patient care. I therefore urge hon. Members to keep this vital organisation in place and allow it to keep doing its important work, providing confidence and even certainty for many people. I commend the draft order to the Committee.

Coronavirus

John Howell Excerpts

Wednesday 17th June 2020 Commons Chamber

[Matt Hancock]

I accept responsibility for everything that happens across the health and social care piece. It is incredibly important to work with care homes, as we have, and to fund care homes, as we have, to put in place infection control. Of course, being in hospital is also not a safe place for people who do not need to be in hospital. The infection control procedures are now there in care homes, with the funding, and that has been the case since the start—since well before the date the hon. Lady mentioned. Although the challenge in care homes has been very significant, we have thankfully seen in this country a lower proportion of overall fatalities from this disease in our care homes than in those across the rest of Europe. That is a good thing, but that is not to say that there have not been significant challenges.

[John Howell (Henley) (Con)]

What further examination of the potential use of co-trimoxazole has taken place, and when will we know the results?

[Matt Hancock]

Co-trimoxazole is another the prospect that we are looking at, but I am afraid that, as with my answer to my right hon. Friend the Member for Wokingham (John Redwood), the timing has to be driven by the science. If we get success, when a result in which the clinicians have scientific confidence can be met, we will stick with the clinical trial methodology that leads to concrete results. Too many other places around the world have pulled clinical trials early because of promising results that have turned out not to be well founded.

Alcohol Harm

John Howell Excerpts

Tuesday 17th March 2020 Westminster Hall

[Fiona Bruce]

The hon. Gentleman has expressed far more eloquently than I have exactly the issue that many will face. It is particularly interesting that the 55 to 64 age group is one of the most at risk, with its excess drinking described by charities working in the field as a “national health disaster”. There is an opportunity here to gently—I am aware there is a lot of other stress—help people understand the implications of drinking to those levels.

In the Green Paper published in July 2019, the Government said

“the harm caused by problem drinking is rising.

Over 10 million people are drinking at levels above the official guidelines and putting themselves at extra risk.”

Tragically, exactly the same thing was stated by Public Health England in the third line of its 2016 evidence-based review, “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies”:

“there are currently over 10 million people drinking at levels which increase their risk of health harm”.

It goes on to talk about

“1 million hospital admissions relating to alcohol each year”.

Interestingly enough, half of those occur in the lowest three socioeconomic areas.

“More working years of life are lost in England as a result of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.”

Sadly, several years on, we still do not have what is very much needed: a distinct and discrete alcohol strategy—it could be better called an alcohol harm strategy—to address the issue. I recommend the Health Minister to look at the alcohol charter, if she has not seen it, which was produced by some of our all-party parliamentary groups following the 2016 report and makes some suggestions as to what that strategy could contain. They include tackling the increased availability of excessively cheap alcohol, empowering the public to make fully informed decisions about their drinking and providing adequate support for dependent and non-dependent drinkers.

If I had a main call today, it would be to ask that the Government produce an up-to-date alcohol strategy. The last one was produced in 2012 and it is out of date, not only because of statistics—I am afraid I will bore colleagues with some more shortly—but also with reference to our approach to minimum unit pricing, which I will refer to later.

Our relationship with alcohol is complex, and so are its harms. Alcohol is embedded in our culture. Whether we are celebrating, had a tough day or need to reward ourselves, alcohol very often seems to play a role. It has become normalised. It is increasingly difficult to find a birthday card that does not wish an un-beer-lievable or gin-tastic birthday to someone, or makes another reference to alcohol. Although our culture celebrates alcohol—enjoyment in the right proportions is not a bad thing—we are too silent about its harms. All too often, we stigmatise people who are dealing with the consequences of harmful alcohol consumption, or leave them to cope with those consequences alone.

Most of us know a person or family affected by harmful drinking. The statistics are, if I may say, sobering: across the UK, more than 80 people a day die from alcohol-related causes. That figure is far higher in areas of poverty where people struggle to cope. Alcohol is now the leading risk factor for death, ill-health and disability among 15 to 49-year-olds in England, and is associated with around 40% of violent crime. In my local authority of Cheshire East, there were 185 alcohol-related deaths and 8,460 alcohol-related hospital admissions in 2017. The number that sticks out the most, however, is the number of people who do not get help: 88% of dependent drinkers in Cheshire East are not in treatment and do not get the support that they need.

[John Howell (Henley) (Con)]

My hon. Friend said that the effects of drinking alcohol were obvious, but does she accept that for men trying to have a family, for example, the effects can lead to permanent difficulties such as infertility, which is not always obvious?

[Fiona Bruce]

My hon. Friend makes an excellent point. Having engaged on this subject for many years in this place, I thought that there was nothing that I did not know, but I did not know that, so I thank him for drawing people’s attention to it. Similarly, it is of great concern that many people are unaware of the impact of foetal alcohol syndrome, which arises from drinking during pregnancy—we cannot emphasise enough the importance of not doing so.

Public Health England estimates that only one in five dependent drinkers in England gets the right support. That is sad because treatment, when obtained, can be very effective and good value for money. For every £1 spent, there is a societal benefit of £3. It does not stop there, though. Alcohol not only impacts individuals, but wider society and public services, costing NHS England £3.5 billion every year. There is no better time than now to remind ourselves that we should encourage help and the prevention of harm where we can, so that our NHS staff, whom I thank in this time of crisis, can treat those in health difficulties.

Anyone who has been in an A&E on a Friday or Saturday night will not be surprised to hear that alcohol-related incidents account for 25% of A&E work in England. Sir Ian Gilmore, who chairs the Alcohol Health Alliance—I thank them and commend their work informing the public and supporting parliamentarians—said

“While A&E departments used to feel the impact on Saturday nights, it’s now every night of the week”,

and that

“The lack of a strategy is really harming the nation”.

English police spend more than half of their time dealing with alcohol-related casework.

Alcohol’s impact on families is stark: in England, about 200,000 children live with an alcohol-dependent parent. I will speak a little about that, but I will first commend the Government because when my hon. Friend the Member for Winchester (Steve Brine) was Health Minister, he was very conscious of the issue and granted more than £6 million to help the children of alcoholics, following a campaign run by colleagues in the House. He rightly said:

“Alcohol abuse can tear lives apart, not only for the people trapped in the grip of an addiction but for their children, who are often robbed of the support, comfort and structure they need from their parents.

I am committed to finding new ways to help families in the midst of these heart-breaking situations.”

I would be interested to hear from the Minister about progress on the pilot schemes in several local authorities, which I expect are now quite well developed, to help children of alcoholic parents or carers, following his initiative.

I have always found Health Ministers to be very concerned about the issue, but one of the systemic problems appears to be that the Home Office leads on alcohol strategy. That has to change. There is a lot of concern among Health Ministers and the Department of Health and Social Care about the issue, but we need them to lead on it.

Children of alcoholic parents or carers experience real difficulties. They are twice as likely to experience difficulties at school, three times more likely to consider suicide, four times more likely to develop alcohol problems of their own, and five times more likely to develop eating disorders. I am pleased by the progress that I have mentioned, but we still have a long way to go on tackling harms.

The Government are rightly excited about the positive impacts of alcohol care teams in hospitals, and I encourage them to go further and ensure that a team is embedded in every hospital when time can be given to that. However, we know from listening to dependent drinkers that help in hospital needs to be complemented by help in communities, if they are truly to be helped.

The loneliness agenda and social prescribing are important initiatives that need to include suitable provision for dependent drinkers. Having attended an Alcoholics Anonymous meeting as a guest, I was really impressed with the care and support that members of that AA group gave one another. It was clearly proving very effective, but we need to do more.

I thank Adrian Crossley, the head of addiction and crime at the Centre for Social Justice, who is doing a lot of work on alcohol treatment. He basically says that we have to assign funding to each local authority in accordance with locally recognised need. I know that this is an unpopular term, but we must ring-fence it so that it really can make a difference.

We must also develop the Government’s promised addiction strategy to ensure that there are wrap-around services to help to stabilise and then promote lasting recovery—particularly the family support that is needed for the 200,000 children in England who are living with an alcohol dependent parents. Those are important initiatives. There is no wrong door to accessing the most appropriate services, but we need to join them up—whether they are local family services, voluntary groups or mental health support.

If I may, Mr Paisley, I will take a little longer than normal to make my speech, because there are not too many colleagues present. I was disappointed in the Chancellor’s view on alcohol duty in the recent Budget. I thank him for providing £2.5 million towards the development of family hubs in local areas. Such hubs are one-stop-shops where people will be able to go—several are up and running in the country now—for joined-up services from local health providers, local authorities and voluntary groups.

People can go to such hubs with any issue that relates to their family life. One of those issues should, and hopefully will, be addiction. Sadly, many families do not come forward for help. They are ashamed of the stigma, are soaked in a culture that celebrates the products that often blight their lives, and carry a burden that is often unrecognised and unsupported. We need more accessible, practical support for families.

We need to remember, too, that the harms from alcohol do not fall evenly across the UK. The burden falls most heavily on poorer communities. The north of England, for example, has significantly higher rates of alcohol-related deaths than London or the south-east. I am delighted that this one nation Conservative Government are committed to reducing inequalities and levelling up across the country, but, as I have mentioned in this House before, we will not be able to do that simply by repairing physical infrastructure such as roads and bridges. We need to create stronger, healthier communities and families, and one of the ways we can do that is by tackling alcohol harm.

The figures I have mentioned demonstrate that alcohol presents a grave public health challenge. Without question, we need a paradigm shift. Tackling alcohol-related harm needs to become a fundamental policy priority. Regulation certainly plays a part in shifting behaviour on a personal level, as we have seen over the past few years with tobacco; I commend parliamentarians who took a lead on that. As we have seen there, the Government can create an environment that enables us to make informed choices and lead healthier, happier lives.

I will now focus on price. Why? Because the 2016 report from Public Health England concluded:

“Policies that reduce the affordability of alcohol are the most effective”

policies in health treatment. Yet, over the past few years since then, and even before then, quite the opposite has occurred. Alcohol duty rates have been cut or frozen in Budget after Budget and as a result, in real terms, beer duty is some 18% lower than in 2012, duty on spirits and cider is 10% lower and duty on wines 2% lower. We all know that the price of something has an impact on whether we will buy it, and alcohol is no exception; as I say, Public Health England said price was the number one factor in determining how much alcohol is bought.

Alcohol has become dramatically more affordable in the past 30 years. The affordability of beer in the off-trade has more than tripled in real terms since 1987 and off-trade wine and spirits are 163% more affordable. One of the most targeted approaches to addressing the price of the cheapest alcohol is minimum unit pricing. I urge the Minister to look at it again.

Minimum unit pricing, as the name suggests, sets a price below which alcohol cannot be sold. In Scotland, which introduced minimum unit pricing two years ago, it is currently 50p. That means that a pint of beer containing two units of alcohol—for the record, as many here will know, the chief medical officer’s suggestion for sensible and moderate drinking is 14 units a week—cannot be sold for less than a pound.

Minimum unit pricing would have hardly any effect on pubs and restaurants, where the vast majority of alcohol is sold at more than 50p per unit. Instead, it is highly targeted at the cheapest products that cause the most harm, such as white cider and super-strength cheap lager. If the Minister cares to look, I introduced the Alcohol (Minimum Pricing) (England) Bill in 2018, so there is one oven ready if the Government would like to take it up.

One reason the Government did not take it up was that they said they wanted more evidence that MUP would work. I remember the Chancellor saying that we would await the outcome in Scotland. As I say, two years since Scotland implemented MUP, the evidence is very encouraging. Consumption fell by 3.6% in Scotland in the year after MUP was implemented. During the same period, it rose by 3.2% in England and Wales. The important thing is that the fall in consumption appears to have occurred particularly among those consuming the most alcohol, who are most at risk, and it seems to have been in the high-strength, dangerous drinks of the sort that I mentioned that consumption has fallen.

Wales has decided to follow Scotland’s lead and is implementing MUP this month. Following the evidence, these are the statistics. Again, I apologise to colleagues for more statistics. In England, a 50p MUP is predicted to save 525 lives and prevent over 22,000 hospital admissions and 36,000 crimes annually when at full effect. The evidence is clear, we need to act without delay and implement MUP in England. It was interesting that the 2012 alcohol strategy referred to this very positively. I refer the Minister to the foreword by the then Prime Minister:

“We are not rejecting MUP, merely delaying it until we have conclusive evidence it will be effective”.

Will the Ministers look again at MUP and the evidence following Scotland?

The duty escalator which was in place between 2008 and 2012 increased alcohol duty by 2% every year. The result was that alcohol-related deaths fell while it was in place. They have started to rise again since it has been abolished. Last week, the Chancellor announced in this year’s Budget alcohol duty will be frozen across the board. In real terms, this means a cut. It will lower the price of alcohol. All decisions present trade-offs.

While I appreciate the desire to support our local industry of pubs and brewers, I want to reflect on the impact of this decision on health. Research from the University of Sheffield—I am sure the Minister’s staff will look at the report, because it is commendable—has shown that changes in alcohol duty since 2012 have led to nearly 2,000 additional deaths and 61,000 hospital admissions in England. There was an enormous human cost, but also a strain on public services by adding an estimated £317 million to NHS England’s bill. It is estimated the duty changes could have cost England’s businesses as much as £58 million in lost working days since 2012.

Increasing alcohol duty also raises urgently needed revenue. Considering the impact of the current cuts alongside all changes to duty policies since 2012, in this year, 2019-20, the Government are losing out on nearly £1.3 billion in forgone revenue. That is enough money to pay the salaries of more than 40,000 nurses. By 2024-25, the cumulative costs of these cuts will be £13 billion.

While the budget focused on supporting pubs, I do not believe that cutting duty will be that helpful for them. Ending the alcohol duty escalator after 2012 and the subsequent duty cuts and freezes have not made a measurable difference to the rate of pub closures. This reflects the experiences of those working in the pub trade. Nearly 90% of publicans in the north-east said that duty cuts have not had a positive effect on their business. Less than 5% felt that alcohol taxes were the main cause of pub closures, while a majority thought that cheap alcohol from supermarkets and off-licences was to blame.

Before I end, I want to address alcohol labelling. If we want to create an environment in which people are supported to make informed choices to live healthier, happier lives, we need to make sure they have all the information they need. At the moment, people do not get it. We have more information on a pint of milk than when buying alcohol. It is no surprise that only one in five people know that the chief medical officers commend us not to drink more than 14 units a week, but the public wants to know this information. Research from the Alcohol Health Alliance found that more than 70% of people support warnings that exceeding the drinking guidelines can harm one’s health. I put down an EDM on this last June. It is interesting that it garnered support from 20 colleagues. It stated that two and a half years after the chief medical officer’s guidelines of 14 units per week for low-risk drinking were published:

“a survey of 320 products found that two-thirds of alcohol labels still displayed the old guidelines; … that the pregnancy logo and number of units are not legally required to be shown on labels”.

We believe they should be and there is a lack of information generally on alcohol labels compared with other food and drink labels. Will the Government look again at labelling and make the information on alcohol products mandatory? The public want to know more. It is not just that alcohol increases health risks and that therefore information on alcohol content is wanted, but that they are actually interested in the calorific content. I was involved in a joint event with the all-party parliamentary group on obesity some years ago. It was remarkable. Evidence was given that when people drink with a meal and are perhaps not as thoughtful about what they are eating, the overall increase in calorific consumption can be 400 in that meal alone. It is time to look again at alcohol harm. Alcohol containers should, like any other food and drink container, have to display ingredients, nutrients and calories. They should display the CMO’s guidelines and warnings that exceeding this amount could damage one’s health. We can no longer ignore the harm caused to our society, communities, constituents, families and friends by alcohol.

--- Later in debate ---

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Mr Paisley, and to follow my two colleagues, my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for East Lothian (Kenny MacAskill), who have done us a great service by looking at the underlying causes of alcohol consumption and its role in society. Those very important factors need to be taken into account.

I totally agree with the hon. Member for East Lothian that education on its own will not solve the problem. A much bigger attack on the whole way we drink, and the reasons why, is required. My hon. Friend the Member for Congleton raised a number of those, particularly pointing out people’s need for alcohol when they are lonely, and we should look at that in more detail. Public Health England states that between the ages of 15 and 49, alcohol is the leading risk factor for ill health. It also pointed out that working years of life lost would be saved as a result if this situation were to end.

I raise two issues in particular—one about drink-driving and another relating to pregnancy. I absolutely support the coronavirus strategy. In 2014, there were 240 fatalities as a result of alcohol. That has to be set against the number of fatalities at the moment from the coronavirus. Getting some perspective on this is essential to tackling the disease. I would certainly like to see a lower limit for drink-driving. There has been some success in curbing drink-driving, but I do not think it has been enough. It still accounts for a large amount of hospital admissions and difficulties in that area.

There is an important point relating to pregnancy. There is a tremendous amount of advice for a woman who is looking to become pregnant or is pregnant, but pregnancy does not arise from just one person, it arises from a couple, and there needs to be equal concentration on the result of drinking alcohol for the man as well as the woman.

We know that drinking during pregnancy can lead to lifelong physical, behavioural and cognitive disabilities for the child. My hon. Friend the Member for Congleton mentioned foetal alcohol syndrome as a sign that a woman has drunk too much during pregnancy. Of course, binge drinking is the great no-no. A long list of difficulties occur as a result, but I will not go into them into them all here; a number of speakers have already gone into that.

However, the important question is when to advise a woman to stop drinking altogether, since that is the advice of the medical establishment in this area. There is a very good indication that she should stop when she intends to get pregnant, rather than when she is pregnant. There can be a fairly long period between someone intending to get pregnant and knowing that they are pregnant, which reinforces the value of that.

I mentioned that the role of the man needs to be taken into account, and I repeat that the ability of a man to stay off alcohol when wanting to create a family is essential. I pointed out that a long-term risk is that alcohol increases the risk of infertility. There are issues here that we need to take into account. We need to provide much wider advice to reinforce that. The short-term risks of alcohol fall on men, but the long-term risks of alcohol fall on women. Understanding that is a helpful way of approaching this for the future.