Diabetes Technologies

Martyn Day Excerpts

Wednesday 23rd November 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship today, Mrs Gillan. I thank the hon. Member for St Ives (Derek Thomas) for bringing forward this interesting debate on diabetes technologies. I thank him for his explanation of the position, and would like to publicly agree with him that we need to accelerate access and that we could do better. I am also grateful to him for informing us of flash glucose monitoring—FGM. It is a new technology that I must admit I am not familiar with, and I would have guessed completely wrong, based on its initials, as to what we were discussing.

There can be little doubt that diabetes is the fastest growing health threat of our time and a critical public health matter. It is estimated that more than one in 16 people across the UK has diabetes—be that diagnosed or undiagnosed—and it is worth remembering that around 80% of diabetes complications are preventable, or can at least be significantly delayed through early detection, good care and access to appropriate self-management tools and resources, of which access to diabetes technologies is a fundamental part. With that challenge of the increasing numbers of people with diabetes, access to the technology to help those living with the disease becomes yet ever more important. We can learn much from the different approaches to this issue throughout these isles, and we have heard examples today that are both good and bad. The right hon. Member for Knowsley (Mr Howarth) informed us of the problems faced by many young people and their experiences at schools. That is a very good example of how we could do better.

Much of the debate centres around the two main technologies: insulin pumps and continuous glucose monitors. It is, unfortunately, fair to say that at present the challenges facing sufferers in Scotland in obtaining them are greater than for those in England and Wales. However, much progress is being made and the Scottish Government are committed to ensuring that people living with diabetes have access to the best possible care.

Since 2010, the Scottish Government have set and met targets to increase insulin pump therapy. In Scotland, we have already made good progress in its provision, and by the end of the current Parliament some 6,000 adults—more than 20% of the type 1 diabetes population across Scotland—will have access to insulin pump therapy; currently, the figure is around 9.5%. In 2010, the diabetes action plan called for NHS boards in Scotland to introduce plans to make insulin pump therapy available for patients who would most benefit from it. That was followed, in 2011, by the target that 25% of under-18s with type 1 diabetes should be on insulin pump therapy; that was met by December 2014, and the figure had reached 31.2% by the end of 2015. Good though this progress is, we must still do better.

This form of insulin delivery has made a big difference to those who have received it; however, it is worth remembering that is not always appropriate for everyone. To be successful, insulin pump therapy requires intensive work by the patient in association with the local diabetes team, and requires self-management and monitoring.

Continuous glucose monitoring devices can be extremely useful in helping sufferers to manage and monitor their glucose levels. The Scottish Intercollegiate Guidelines Network—SIGN—guidance recommends that CGM should not be used routinely for people with diabetes; however, it may be considered for women with type 1 and type 2 diabetes, as it may be beneficial during pregnancy. As a result of that, provision through the NHS in Scotland is limited. Earlier this month, Shona Robison, the Cabinet Secretary responsible for health, wellbeing and sport in Scotland, confirmed that a national approach is being developed, stating:

“Work is currently on-going to develop a national approach for the use of Continuous Glucose Monitoring (CGM) devices in Scotland, as we recognise the speed of development of this technology.”

Best practice on provision of CGMs and insulin pumps will continue to evolve with developments in technology. Innovative new approaches to healthcare may prove key to improving the treatment of conditions such as diabetes. The Scottish Government, in partnership with Scottish Enterprise, has funded a £500,000 competition to develop a new technology to help with the management of type l diabetes. To supplement existing education programmes, competition entrants have been asked to develop a mobile health product, which could be an app, a new interface or a new device, to assist people in dealing with their condition. The competition is a good example of working with partners across private, public and third sector organisations to develop a new and innovative solution. At its launch, Dr Lena Wilson, chief executive of Scottish Enterprise, said:

“The economy grows faster when companies embed innovation in all they do. Scotland operates in an increasingly competitive global market so developing and maintaining competitive advantage is imperative. The work underway with NHS Scotland on solutions to the challenges Type 1 diabetic patients face offers an opportunity for more of our SMEs to embrace innovation.”

Of course, the potential benefits of that are not just with the businesses that take part. Managing diabetes accounts for about 10% of the annual NHS Scotland budget —almost £1 billion a year. When 80% of NHS spending on diabetes goes on treating avoidable complications, potentially significant savings can be made through better self-management and use of technologies—and that is before we consider quality of life for the actual sufferers who benefit.

In conclusion, we can do much to improve diabetes education and care for both type l and type 2 diabetics, and diabetes technologies have a key role to play in that process. The challenge is to find effective ways to overcome barriers to implementation, and to facilitate greater access for those who would benefit. I am thankful for the opportunity to take part in today’s consensual and informative debate.

Self Care Week

Martyn Day Excerpts

Tuesday 22nd November 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Walker. May I start by thanking the right hon. Member for Rother Valley (Sir Kevin Barron) for bringing this timely debate, and also for his clear and detailed explanation of his position?

For my part, I supported Self Care Week last week by treating the latest winter cold I have picked up with a couple of lozenges and a few hot toddies. My hon. Friend the Member for Rutherglen and Hamilton West (Margaret Ferrier) has set me a challenge to get through the debate without coughing; I have to confess I have failed already. However, I will repeat the dosage later on tonight.

We have heard that self-care is the act of looking after one’s own physical or mental health, and that that extends to treating common illnesses with over-the-counter drugs and managing long-term conditions. We know that 80% of all care in the UK is actually self-care, and most people feel comfortable managing everyday minor ailments themselves, particularly when they feel confident that they have been successfully treated before using over-the-counter medicines.

Self-care is a fundamental part of healthcare—and Self Care Week provides an opportunity for us to encourage people to engage in self-care in a wide variety of areas—but it is important for us to get the balance right between managing conditions that are self-treatable and knowing when to get professional medical help. The right hon. Member for Rother Valley stated some examples in which it was clearly inappropriate to go to accident and emergency, and it is getting that balance right that we have to promote.

Self-care need not be as lonely as the term suggests. Often, conditions that can be self-managed are done so with support, be that from health professionals, organised support groups or advice from community pharmacies; people are not out there on their own with self-care. There are many good examples of such support across my constituency, covering a range of conditions and ailments. Eczema Outreach Scotland, which is based in Linlithgow, is a support charity for families affected by eczema. While it does not provide medical advice, it helps affected families in many ways, from practical advice to emotional support. As we know, one of the most common conditions experienced is joint pain, and the central arthritis self-help group, which meets in Grangemouth, organises outings, hydrotherapy and exercise sessions to assist sufferers.

Obviously, self-care for mental health is just as important as for physical conditions. In Bathgate, there is the West Lothian bipolar self-help group, which helps people affected by that common condition to share advice and insights on getting back into work and staying fit. Another example is the West Lothian health and social care partnership, which brings together NHS Lothian and West Lothian Council. It runs the superb “Eatright West Lothian” scheme, which aims to promote good nutrition and healthy eating, which can assist with many different conditions.

It is worth noting that the Self Care Forum recommended the following top tip:

“Involve the local pharmacists and community nurses in giving the same advice and support for self care; and work with the local pharmacists to ensure that their triage of common problems is similar to that in the practice.”

That is not quite the way I would have worded it, but I agree wholeheartedly; it is very good advice. Community pharmacists can only give out certain medicines and products, although the benefits of that can be massive, as it can cut the workload of GPs and other NHS staff across the country. The Scottish Pharmacy Board stated that, in 2015-16, more than one in 10 GP consultations and one in 20 A&E attendances could have been managed by community pharmacists utilising the minor ailment service.

Some 1,200 pharmacies throughout Scotland provide a range of services on behalf of the NHS. As well as dispensing prescriptions, they offer four new NHS pharmaceutical care services which have been gradually introduced since 2006—the minor ailment service, the public health service, the acute medication service and the chronic medication service. Those new services involve pharmacists in the community more in the provision of direct, patient-centred care, with every community pharmacy in Scotland having patients registered for the minor ailments service by 31 March 2015.

The minor ailment service allows people to get advice and free treatment on issues such as, but not exclusive to, acne, headaches, athlete’s foot, head lice, backache, indigestion, cold sores, mouth ulcers, constipation, nasal congestion, cough pain, diarrhoea, period pain, earache, thrush, allergies, sore throat, threadworms, hay fever, warts and verrucae; in fact, pretty much everything that is covered with self-care. Nearly 18% of the population of Scotland are registered for the minor ailment service—a total of 913,483 people. More than 2.1 million items have been dispensed under it, accounting for some 2.2% of all items dispensed by community pharmacies in Scotland.

In Scotland, we recognise just how important community pharmacies are. The Scottish National party Scottish Government are helping to explore new ways for community pharmacies and other primary care services to aid self-care within our communities. The SNP Scottish Government are committed to supporting and developing local GP and primary care services, and have just announced a three-year, £85 million primary care fund to help to develop new ways of delivering healthcare in the community, which will involve pharmacists delivering aspects of patient care.

In conclusion, I welcome the recent words that we have heard from the UK Government that they want to copy the Scottish Government’s approach to community pharmacies and the minor ailment service. I thoroughly recommend that model to everyone, because we have found it to be very good and effective to date. I also welcome the opportunity to take part in today’s interesting and good-natured debate, which I hope will help to promote self-care further to the wider public audience.

Health Service Medical Supplies (Costs) Bill (Third sitting)

Martyn Day Excerpts

Committee Debate: 3rd sitting: House of Commons
Tuesday 15th November 2016 Public Bill Committees

[Dr Whitford]

My colleague will speak to that amendment.

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

It is a pleasure to serve under your chairmanship today, Mr Pritchard. I am somewhat reassured by many of the Minister’s comments, and I thank him for his explanations. Much of this stuff is technical, and I hope he sees amendment 48 in a similar light. I think it would improve and strengthen the measure.

The clause does not currently set out a mechanism for the disclosure of information to devolved Administrations or bodies. For example, how will the information be disclosed, and by what means? Will it be only the Secretary of State who can disclose? In short, will the devolved Administrations be able to get the information when they want and need it, so that it ties in with the figures and statistics they are seeing and they can see patterns? It is about flexibility.

The amendment is fairly straightforward and we think it would help to strengthen and improve the Bill. I hope that the Minister agrees. We would like him to clarify whether the Government intend to leave disclosure to the discretion of the Secretary of State, on an ad hoc basis. Otherwise, what would the terms of disclosure be?

[Rob Marris (Wolverhampton South West) (Lab)]

To tease out the amendment a little more, proposed new section 264B(1)(h) relates to the provision of information to

“any person who provides services to any person falling within any of paragraphs (a) to (g)”.

Is the hon. Gentleman concerned that under his amendment there might be disclosure to other private providers; or is that covered because only paragraphs (a) to (g) are specified?

[Martyn Day]

I thank the hon. Gentleman for his intervention, and I hope that I can clarify my clarification. It is about timing—when the information is disclosed, not to whom it is disclosed. The Bill covers that and we are quite comfortable with that.

I was saying that we think our amendment would strengthen the clause. I am reminded that on Second Reading the Secretary of State referred to fact that there would be amendments—we are grateful to see many of them today—

“to reflect the agreement between the Government and the devolved Administrations, so that information from wholesalers and manufacturers can be collected by the Government for the whole of the UK and shared with the devolved Administrations.”——[Official Report, 24 October 2016; Vol. 626, c. 80.]

We think our amendment would enable him to get his wish and provide a mechanism in the Bill.

We feel strongly about the matter and want to push it to a vote if we do not receive the necessary assurances from the Minister. I hope that he can provide them.

--- Later in debate ---

[The Chair]

If the SNP Front-Bench spokespersons want to press the amendment to a vote, that will happen later, but it would be helpful to the flow of the proceedings if they confirmed now whether they intended to do so.

[Martyn Day]

We are satisfied with the Minister’s answer.

[The Chair]

I am grateful to the hon. Gentleman.

Amendment 1 agreed to.

Amendments made: 2, in clause 6, page 4, line 5, leave out from “any” to “to” in line 6 and insert “UK producer”.

This amendment is linked to amendments 1, 3 to 16 and 19 to 35. It allows regulations to require the provision of information by a person who manufactures, distributes or supplies Welsh health service products, Scottish health service products or Northern Ireland health service products.

Amendment 3, in clause 6, page 4, line 19, at end insert—

“(d) the determination of the payments to be made to any persons who provide primary medical services under Part 4 of the National Health Service (Wales) Act 2006;

(e) the determination of the remuneration to be paid to any persons who provide pharmaceutical services under Part 7 of that Act;

(f) the consideration by the Welsh Ministers of whether—

(i) adequate supplies of Welsh health service products are available, and

(ii) the terms on which those products are available represent value for money;

(g) the determination of the payments to be made to any persons who provide primary medical services under section 2C(1) of the National Health Service (Scotland) Act 1978 (“the 1978 Act”);

(h) the determination of the remuneration to be paid to any persons who provide pharmaceutical care services under section 2CA(1) of the 1978 Act;

(i) the consideration by the Scottish Ministers of whether—

(i) adequate supplies of Scottish health service products are available, and

(ii) the terms on which those products are available represent value for money;

(j) the determination of the remuneration to be paid to any persons who provide primary medical services or pharmaceutical services under Part 2 or 6 of the Health and Personal Social Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I. 14));

(k) the consideration by a Northern Ireland department of whether—

(i) adequate supplies of Northern Ireland health service products are available, and

(ii) the terms on which those products are available represent value for money;

(l) the exercise by the Secretary of State of any powers under sections 260 to 264 and 265;

(m) the operation of a voluntary scheme.”.

This amendment is linked to amendments 1, 2, 4 to 16 and 19 to 35. It sets out the purposes for which a person may be required to record and provide information to the Secretary of State by virtue of regulations under section 264A(1) of the National Health Service Act 2006.

Amendment 4, in clause 6, page 4, leave out lines 20 to 29.

This amendment is linked to amendments 1 to 3, 5 to 16 and 19 to 35. It removes subsections (3) and (4) of section 264A of the National Health Service Act 2006 because the provision made by those subsections now appears in amendment 3.

Amendment 5, in clause 6, page 4, line 30, leave out

“an English producer or other”

and insert “a”.

This amendment is linked to amendments 1 to 4, 6 to 16 and 19 to 35. It is a consequential amendment. A reference to an English producer is no longer needed as an English producer will fall within the definition of “UK producer” inserted by amendment 1.

Amendment 6, in clause 6, page 4, line 33, leave out from “for” to end of line 35 and insert “UK health service products”.

This amendment is linked to amendments 1 to 5, 7 to 16 and 19 to 35. It is a consequential amendment. A reference to English health service products is no longer needed as those products will fall within the definition of “UK health service products” inserted by amendment 14.

Amendment 7, in clause 6, page 4, line 38, leave out “the” and insert “UK health service”.

This amendment is linked to amendments 1 to 6, 8 to 16 and 19 to 35. It is a consequential amendment.

Amendment 8, in clause 6, page 4, line 41, leave out “the” and insert “UK health service”.

This amendment is linked to amendments 1 to 7, 9 to 16 and 19 to 35. It is a consequential amendment.

Amendment 9, in clause 6, page 4, line 43, leave out second “the” and insert “UK health service”.

This amendment is linked to amendments 1 to 8, 10 to 16 and 19 to 35. It is a consequential amendment.

Amendment 10, in clause 6, page 5, line 1, leave out from “whether” to “health” in line 2 and insert

“they are UK health service products and, if so, which of the following they are—

(i) English health service products;

(ii) Welsh health service products;

(iii) Scottish health service products;

(iv) Northern Ireland”.

This amendment is linked to amendments 1 to 9, 11 to 16 and 19 to 35. It is a consequential amendment. It enables regulations to require a UK producer to provide information about products for verifying whether they are Welsh, Scottish or Northern Ireland health service products.

Amendment 11, in clause 6, page 5, line 14, at end insert—

“(8A) “Excepted person” means any of the following—

(a) a person who provides primary medical services under Part 4 of the National Health Service (Wales) Act 2006;

(b) a person who provides pharmaceutical services under Part 7 of that Act;

(c) a person who provides primary medical services under section 2C(1) of the 1978 Act;

(d) a person who provides pharmaceutical care services under section 2CA(1) of the 1978 Act;

(e) a person who provides primary medical services or pharmaceutical services under Part 2 or 6 of the Health and Personal Social Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I. 14)).”.

This amendment is linked to amendments 1 to 10, 12 to 16 and 19 to 35. It lists the persons who are excepted from being a “UK producer” for the purposes of the definition inserted by amendment 1.

Amendment 12, in clause 6, page 5, line 15, at end insert—

“( ) “Northern Ireland health service products” means any medicinal products used to any extent for the purposes of health care provided by virtue of the Health and Social Care (Reform) Act (Northern Ireland) 2009 and any other medical supplies, or other related products, required for the purposes of health care provided by virtue of that Act.”.

This amendment is linked to amendments 1 to 11, 13 to 16 and 19 to 35. It provides a definition of “Northern Ireland health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 13, in clause 6, page 5, line 15, at end insert—

“( ) “Scottish health service products” means any medicinal products used to any extent for the purposes of the health service within the meaning of the 1978 Act and any other medical supplies, or other related products, required for the purposes of that health service.”.

This amendment is linked to amendments 1 to 12, 14 to 16 and 19 to 35. It provides a definition of “Scottish health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 14, in clause 6, page 5, leave out lines 16 to 26 and insert—

“( ) “UK health service products” means any English health service products, Welsh health service products, Scottish health service products or Northern Ireland health service products.”.

This amendment is linked to amendments 1 to 13, 15, 16 and 19 to 35. It provides a definition of “UK health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 15, in clause 6, page 5, line 26, at end insert—

“( ) “Welsh health service products” means any medicinal products used to any extent for the purposes of the health service continued under section 1(1) of the National Health Service (Wales) Act 2006 and any other medical supplies, or other related products, required for the purposes of that health service.”

This amendment is linked to amendments 1 to 14, 16 and 19 to 35. It provides a definition of “Welsh health service products” for the purposes of section 264A of the National Health Service Act 2006.

Amendment 16, in clause 6, page 5, line 26, at end insert—

“( ) Until the coming into force of the repeal of section 27 of the 1978 Act by schedule 3 to the Smoking, Health and Social Care (Scotland) Act 2005 the references in subsections (2)(h) and (8A)(d) to pharmaceutical care services under section 2CA(1) of the 1978 Act are to be read as references to pharmaceutical services under section 27(1) of that Act.”.

This amendment is linked to amendments 1 to 15 and 19 to 35. It makes transitional provision in relation to references to pharmaceutical care services under section 2CA(1) of the National Health Service (Scotland) Act 1978.

Amendment 17, in clause 6, page 5, line 35, at end insert—

“(fa) the Common Services Agency for the Scottish Health Service constituted under section 10 of the 1978 Act;”.

This amendment adds the Common Services Agency for the Scottish Health Service to the persons listed in section 264B(1) of the National Health Service Act 2006. This means that information provided by virtue of section 264A of that Act may be disclosed to that Agency.

Amendment 18, in clause 6, page 5, line 36, at end insert—

“(ga) the Regional Business Services Organisation established under section 14 of the Health and Social Care (Reform) Act (Northern Ireland) 2009;”.

This amendment adds the Regional Business Services Organisation to the persons listed in section 264B(1) of the National Health Service Act 2006. This means that information provided by virtue of section 264A of that Act may be disclosed to that Organisation.

Amendment 19, in clause 6, page 5, line 40, leave out “English producers or other”.

This amendment is linked to amendments 1 to 16 and 20 to 35. It is a consequential amendment. A reference to English producers is no longer needed as an English producer will fall within the definition of “UK producer” inserted by amendment 1.

Amendment 20, in clause 6, page 5, line 46, at end insert “(subject to subsection (4))”.

This amendment is linked to amendments 1 to 16, 19 and 21 to 35. It flags the provision made by amendment 29.

Amendment 21, in clause 6, page 6, line 4, leave out “or (4)” and insert

“(a) to (c), (l) or (m)”.

This amendment is linked to amendments 1 to 16, 19, 20 and 22 to 35. It is consequential on amendments 3 and 4.

Amendment 22, in clause 6, page 6, line 8, leave out “or (4)” and insert

“(a) to (c), (l) or (m)”.

This amendment is linked to amendments 1 to 16, 19 to 21 and 23 to 35. It is consequential on amendments 3 and 4.

Amendment 23, in clause 6, page 6, line 11, leave out “to (g)”.

This amendment is linked to amendments 1 to 16, 19 to 22 and 24 to 35. It is consequential on amendments 25 and 26.

Amendment 24, in clause 6, page 6, line 12, leave out

“either of the matters specified in section 264A(4)”

and insert

“any of the matters specified in section 264A(2)(d) to (f), (l) or (m)”.

This amendment is linked to amendments 1 to 16, 19 to 23 and 25 to 35. It is consequential on amendments 3 and 4.

Amendment 25, in clause 6, page 6, line 13, at end insert—

“(ca) in relation to a person falling within subsection (1)(f) or (fa), the purpose is that of exercising functions connected with any of the matters specified in section 264A(2)(g) to (i), (l) or (m);”.

This amendment is linked to amendments 1 to 17, 19 to 24 and 26 to 35. It is consequential on amendments 3, 4 and 17.

Amendment 26, in clause 6, page 6, line 13, at end insert—

“(cb) in relation to a person falling within subsection (1)(g) or (ga), the purpose is that of exercising functions connected with any of the matters specified in section 264A(2)(j) to (m);”.

This amendment is linked to amendments 1 to 16, 18 to 25 and 27 to 35. It is consequential on amendments 3, 4 and 18.

Amendment 27, in clause 6, page 6, line 17, leave out “(c)” and insert “(cb)”.

This amendment is linked to amendments 1 to 16, 19 to 26 and 28 to 35. It is mainly consequential on amendments 25 and 26.

Amendment 28, in clause 6, page 6, line 20, leave out “or (4)”.

This amendment is linked to amendments 1 to 16, 19 to 27 and 29 to 35. It is consequential on amendments 3 and 4.

Amendment 29, in clause 6, page 6, line 20, at end insert—

“(4) The Welsh Ministers may disclose any confidential or commercially sensitive information disclosed to them under subsection (1) to any of the following persons—

(a) a Local Health Board or other person appointed under section 88(3)(b) of the National Health Service (Wales) Act 2006 to exercise the functions of a determining authority under Part 7 of that Act;

(b) a National Health Service trust established under section 18 of the National Health Service (Wales) Act 2006;

(c) any person who provides services to the Welsh Ministers or to any person falling within paragraph (a) or (b).

(5) A person to whom any confidential or commercially sensitive information is disclosed under subsection (4) may not—

(a) use the information for any purpose other than the purpose of exercising functions connected with any of the matters specified in section 264A(2)(d) to (f), (l) or (m), or

(b) disclose the information to another person.”.

This amendment is linked to amendments 1 to 16, 19 to 28 and 30 to 35. It allows the Welsh Ministers to disclose information to other persons including Local Health Boards, National Health Service trusts and persons providing services to those persons.

Amendment 30, in clause 6, page 6, line 24, leave out “English producers or other”.—(Mr Dunne.)

This amendment is linked to amendments 1 to 16, 19 to 29 and 31 to 35. It is a consequential amendment. A reference to English producers is no longer needed as an English producer will fall within the definition of “UK producer” inserted by amendment 1.

Question proposed, That the clause, as amended, stand part of the Bill.

NHS Funding

Martyn Day Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

I have enormous respect for my hon. Friend. I respect her passion for the NHS, her knowledge of it and her background in it, so I will always listen carefully to anything she says. I hope she will understand that just as she speaks plainly today, I need to speak plainly back and say that I do not agree with the letter she wrote today, and I am afraid I do think that her calculations are wrong.

The use of the £10 billion figure was not, as she said in her letter, incorrect. The Government have never claimed that there was an extra £10 billion increase in the Department of Health budget. Indeed, the basis of that number has not even come from the Government; it has come from NHS England and its calculations as to what it needs to implement the forward view. As I told the Select Committee, I have always accepted that painful and difficult economies in central budgets will be needed to fund that plan. What NHS England asked for was money to implement the forward view. It asked for £8 billion over five years; in fact, it got £10 billion over six years, or £9 billion over five years—whichever one we take, it is either £1 billion or £2 billion more than the minimum it said it needed.

I think my hon. Friend quoted Simon Stevens as saying that NHS England had not got what it asked for. He was talking not about the request in the forward view, but in terms of the negotiations over the profile of the funding we have with the Treasury. The reason that the funding increases are so small in the second and third year of the Parliament is precisely that we listened to him when he said that he wanted the amount to be front- loaded. That is why we put £6 billion of the £10 billion up front in the first two years of the programme.

I fully accept that what happens in the social care system and in public health have a big impact on the NHS, but on social care we have introduced a precept for local authorities combined with an increase in the better care fund—[Interruption.] This is a precept, which 144 of 152 local authorities are taking advantage of. That means that a great number of them are increasing spending on social care. It will come on top of the deeper, faster integration of the health and social care systems that we know needs to happen.

On public health, I accept that difficult economies need to be made, but it is not just about public spending. This Government have a proud record of banning the display sale of tobacco, introducing standardised packaging for tobacco, introducing a sugary drinks tax and putting more money into school sports. There are lots of things that we can do on public health that make a big difference.

On capital, I agree with my hon. Friend about the pressure on the capital budget, but hospitals have a big opportunity to make use of the land they sit on, which they often do not use to its fullest extent, as a way to bridge that difficult gap.

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

With some 80% of trusts in deficit and only 4% meeting accident and emergency targets, I am grateful to the Health Committee for flagging up the dire financial state of the NHS in England, as evidenced by its letter to the Chancellor. We learn from that document that the £10 billion figure is a bit of a fallacy. In Scotland, the SNP Government are committed to investing an additional £2 billion by 2021, but any reduction in new money for the NHS from the UK Government would have an impact on Barnett consequentials. Given that the UK Government have already slashed Scotland’s budget by 10% between 2010 and 2020, they need to be honest and transparent about what that reduction will mean for Scotland’s funding. With the Department of Health having accidentally not adjusted its books for an extra £417 million from national insurance contributions, and having broken its control total by £207 million, will the devolved Governments get any share of that additional £624 million?

[Mr Hunt]

Many people in Scotland will be somewhat surprised by the hon. Gentleman’s comments, because in the last Parliament spending on the NHS in England went up by 4%, whereas in Scotland it fell by 1%. The IFS confirmed that at the time of the independence referendum, saying:

“It seems that historically, at least, Scottish Governments in Holyrood have placed less priority on funding the NHS in Scotland…than governments in Westminster have for England”.

In this Parliament, the hon. Gentleman’s party has already lost a vote on NHS cuts in the Scottish Parliament and been criticised by Audit Scotland for its performance. When the SNP has the courage to increase NHS spending in Scotland by the amount we are increasing it in England, we will listen, but until then it should concentrate on looking after Scottish NHS patients in Scotland.

Young People’s Mental Health

Martyn Day Excerpts

Thursday 27th October 2016 Commons Chamber

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

It is a privilege to take part in the debate. I thank the Backbench Business Committee for selecting it, and extend my praise to the Youth Select Committee for its excellent report on young people’s mental health. It is a genuinely superb summary of the current situation, backed up by sensible recommendations, and it makes a welcome contribution to the wider debate.

The details of the debate have already been clearly outlined by the hon. Member for Dulwich and West Norwood (Helen Hayes). I agree wholeheartedly that it is a debate about resources and the framework for their use. I also agree that the current situation is not acceptable, and that the demand for services is indeed increasing. I thank the hon. Lady for her clear explanation of the position, and for giving some powerful statistics.

The importance of this issue to the young people of the UK nations is illustrated by the fact that it has been repeatedly chosen as a priority campaign by the UK Youth Parliament, and voted for in the British Youth Council poll. The issue has also been the subject of research by the Scottish Youth Parliament, with the report “Our generation’s epidemic”. So we need not wonder what issues are of concern to young people; they have clearly, intelligently and repeatedly told us and it is incumbent upon us as elected politicians to address the concerns highlighted. The fact mentioned already today by several Members, including my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), that more than half of all mental ill-health starts before the age of 14 serves to illustrate the seriousness of this issue.

I am also grateful to the hon. Member for High Peak (Andrew Bingham) for illustrating the risk of the issue going unnoticed and undiagnosed and for highlighting the generation gap technology has developed and the issue of cyber-bullying. I am sure I am not alone in this Chamber in being glad that my youthful teenage years are not preserved for posterity on the internet and in social media.

As well as highlighting an important issue, the Youth Select Committee report shows the importance of young people being engaged in our democratic debate. In Scotland we are already making good progress with this engagement, and our 16 and 17-year-olds had the right to vote in the 2014 Scottish referendum and 2016 Scottish Parliament election. That, however, is an issue that needs revisiting in another debate. I endorse the call of the hon. Member for East Worthing and Shoreham (Tim Loughton) for an annual debate in Government time on the good work of the YSC.

The issue of mental health is widespread. It affects every part of the country and people from all parts of our society. All ages, races, classes and backgrounds are susceptible to this illness.

The hon. Member for West Ham (Lyn Brown) highlighted the disparity between mental and physical health problems and emphasised the scale of the issue. We have heard many examples from across the House showing how young people have been affected and that more needs to be done.

All of us will be aware of local examples, and of groups working to address these issues. One such group which covers my area is the Falkirk and District Association for Mental Health, the subject of early-day motion 125 tabled by my hon. Friend the Member for Falkirk (John Mc Nally). Among the wide range of support the group offers is a befriending service to help combat the isolation experienced by young people suffering from mental health issues. The group also offers a health and wellbeing drop-in, counselling, support groups and other services.

But it is not just specialist mental health groups that help to tackle this illness. For example, the Open Door project, which provides supported accommodation for young people in the West Lothian area, carries out a risk assessment of every young person who approaches it for help. If following the assessment it feels there is an issue it refers them to “moving into health”, psychiatric nurses from the health and homeless team. Some 89 people were assessed in 2012-13, of whom 33 presented with mental health issues. Indeed, the project believes that the number of people presenting with mental health issues is increasing, a theme highlighted by several Members today.

Another example is the Chill Out Zone, or COZ, in Bathgate, a healthy living centre for young people aged between 12 and 20. It is a partnership between Children 1st, West Lothian Council and NHS Lothian. COZ provides a drop-in service that young people can use in their own time to get information, counselling and advice, or if a young person prefers they can make an appointment with a nurse or a counsellor to talk about sensitive physical, emotional, mental and sexual health matters.

I could go on highlighting many other examples, but I think everyone gets the picture. It is not just our young people who are telling us this is an “epidemic”; the evidence of support groups and the impact on other organisations locally demonstrates this for all to see, and highlights the need for action.

Of course in Scotland health and education are devolved to the Scottish Parliament, and many of the devolved issues were covered succinctly by my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow. I am grateful for her professionally informed opinions in today’s debate.

Mental health is a priority for the Scottish Government, as demonstrated by the fact that Scotland has the first dedicated Minister for Mental Health in the UK, and while across England funding for young people’s mental health services has been reduced since 2011 the SNP-led Scottish Government have doubled the number of child and adolescent mental health service psychologists, as part of an additional £150 million to improve mental health services.

The Scottish Government have welcomed the Scottish Youth Parliament’s recent research “Our generation’s epidemic”, which I mentioned earlier. That research was undertaken as part of the Scottish Youth Parliament’s Speak Your Mind campaign on mental health. Maureen Watt, the Minister for Mental Health, met representatives of the Scottish Youth Parliament in September and took note of their recommendations that relate specifically to the Scottish Government. They will be considered as part of the public engagement on the new 10-year mental health strategy for Scotland. The SNP will continue to review the legislation in Scotland to ensure that the interests of children and their need to form and maintain relationships with key adults in their lives are at the heart of any new statutory measures.

The Youth Select Committee report highlights the importance of ending stigma around mental health, and the SNP is committed to playing its part in ending that stigma. Education Scotland is developing a national resource to support the development and practice of nurturing approaches for primary schools. A whole-school nurturing approach can promote school connectedness, resilience and the development of social and emotional competences, all of which are key aspects of promoting mental wellbeing.

It is completely wrong that people with mental health issues should suffer discrimination and stigma, but sadly too many still do. The Scottish Government, in collaboration with Comic Relief, fund the See Me initiative to help address this, and they do invaluable work, but the truth is that each and every one of us has it within our power to do our bit to end this stigma and to be more understanding of people who have mental health problems.

It has been a pleasure to take part in this well-informed and largely consensual and good-natured debate.

National Arthritis Week

Martyn Day Excerpts

Thursday 20th October 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Betts. I start by thanking the hon. Members for Strangford (Jim Shannon) and for Congleton (Fiona Bruce) for leading today’s interesting and timely debate. It is surprising that it is the first such debate for five years.

We have heard from many speakers how arthritis affects people, including young people and working-age people, and I thank my hon. Friend the Member for Glasgow South West (Chris Stephens) for his excellent example of a person in work and the real troubles that they face. We have heard how it is a fluctuating condition with symptoms that can change on a daily basis, as well as many personal cases and constituents’ experiences that highlight this problem affecting many people. We all know members of our own families who are affected.

[Steven Paterson (Stirling) (SNP)]

I do not come to this debate with any great expertise, but my gran suffered greatly with arthritis, which affected the joints in her hands and legs and basically left her housebound. Does he agree that one of the real benefits of today’s debate—I pay great tribute to those who have secured it—is that we can raise awareness of the condition more widely, and that it is incumbent on all of us to go forward from this debate and do that?

[Martyn Day]

I agree entirely with my hon. Friend.

The scale and significance of this issue has been clearly illustrated by several key statistics that we have heard today. Several speakers have told us how each year, a fifth of the population consult their GP about musculoskeletal problems. There are 30.6 million working days lost each year to arthritis, which account for a fifth of all working days lost. Scottish estimates tell us that 60,000 people have rheumatoid arthritis, and 2,500 people are diagnosed each year. One in five people in Scotland experience chronic pain and one in 20 experience severe, disabling chronic pain, with the back and joints being the most common location for chronic pain. Arthritis Care has estimated that approximately 800,000 to 900,000 people in Scotland alone are living with osteoarthritis.

All those figures highlight the enormity of the issue. However, we must remember that data collection and management is particularly poor for arthritis and musculoskeletal issues and it needs to improve if we are to get a clearer picture of the numbers across Scotland and the rest of the UK. That point was made by my colleague, the hon. Member for Strangford.

On a positive note, Scotland is the only nation in the UK to routinely publish data on chronic pain. That is welcome, as we have one in 20 living with disabling chronic pain that has a serious impact on physical wellbeing and mental health issues. There is no doubt that arthritis and musculoskeletal conditions can be very disabling, and we must take action to raise awareness about the conditions and improve musculoskeletal health —be that by promoting physical activity, tackling obesity or using medicines.

The hon. Member for Heywood and Middleton (Liz McInnes) made a point that we should all echo about carers’ work, which is often overlooked. In my constituency —I am sure this will be the case for most—we have a number of support groups for arthritis sufferers. The central arthritis self-help group in Grangemouth is a good example, with monthly meetings including entertainment and social events, along with talks on health and other subjects. The group also organises outings, hydrotherapy and exercise sessions. As a society, we owe a debt of gratitude to groups such as that for the work they do and to everyone else who is helping sufferers.

There is much that can be done for sufferers. One of the most important things is faster diagnosis of conditions such as inflammatory arthritis, as with earlier treatment, they can be controlled better. In Scotland, there is much focus on tackling obesity, both to prevent and to treat musculoskeletal conditions. We must strive to do more to improve diets and encourage physical activity—in saying that, however, I recognise the point made by the hon. Member for Neath (Christina Rees) about sport-related conditions.

In my area, a good example is Together for Health—often known as T4H—which is a community-based project that works to promote healthy lifestyles in the Armadale and Fauldhouse areas within my constituency and that of my hon. Friend the Member for Livingston (Hannah Bardell). It works in partnership with a range of local organisations, businesses and community groups to promote healthy lifestyles and delivers a variety of activities and events to encourage people to move more and eat better, with the overall aim of reducing childhood obesity.

Key messages of the project include the benefits of a balanced, affordable diet, and encouragement of children and families to be more physically active and spend less time doing sedentary activities. That is not just a Scottish or a UK problem, of course. We have a global ageing population and although the link between arthritis and ageing is well known in our own countries, there are fewer data on how older people in lower and middle-income countries are affected.

What we do know, however, is alarming. The World Health Organisation estimates that 9.6% of men and 18% of women aged over 60 have symptomatic osteoarthritis, and that 25% of those with osteoarthritis cannot perform the major daily activities of life. Taking action internationally is important for the millions of older people who are directly affected, but it also has an impact on the lives of many of those who depend on them. Often older people in developing countries are the main carers of children whose parents have had to leave for work or who have been orphaned due to conflict or illnesses such as HIV.

In conclusion, it is important that we do more locally and internationally to help alleviate these conditions, and we must make preventive measures a greater priority.

Tobacco Control Plan

Martyn Day Excerpts

Thursday 13th October 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Brady. I thank the hon. Member for Stockton North (Alex Cunningham) for bringing forward this interesting debate. I should say that I have never smoked a cigarette in my life, so if I start coughing, as I have been doing throughout the week, that is purely down to a bug that I have picked up.

When the Scottish Parliament brought in its smoking ban in 2006, I thought it was a birthday present, because it was brought in on 26 March, which is my birthday. Since 2007 my party has been in power in Scotland, where we do things a little bit differently. However, there are many parallels on this issue. The latest figures from Scotland show that tobacco use is associated with more than 10,000 deaths and about 128,000 hospital admissions every single year. It costs the NHS in Scotland £400 million to treat smoking-related illness, which highlights the scale of the problem across the UK.

The Scottish Government have implemented and overseen a number of progressive actions on smoking: increasing the age for tobacco sales from 16 to 18 in 2007; the overhaul of tobacco sale and display law, including legislation to ban automatic tobacco vending machines and a ban on the display of tobacco and smoking-related products in shops; the establishment of the first tobacco retail register in the UK in 2011; and the passing of a Bill in December 2015 to ban smoking in cars when children are present. Record investment in NHS smoking cessation services has helped hundreds of thousands of people to attempt to quit smoking.

This year, the Scottish Parliament celebrated the 10th anniversary of the ban on smoking in public and welcomed comments from the World Health Organisation, which praised the Scottish Government’s

“excellent example of global public health leadership”

for implementing its framework convention on tobacco control. In 2013, the Scottish Government published a tobacco control strategy setting out bold new actions that will work towards creating a tobacco-free generation of Scots by 2034. I hear that in the Humber there are more plans in advance of that, although I think our problem may be slightly larger. Key actions in the plan include setting the target date of 2034 for reducing smoking prevalence to 5% and eliminating it in children; a pilot of the schools-based programme ASSIST—“A Stop Smoking in Schools Trial”; and a national marketing campaign on the dangers of second-hand smoke in cars and other enclosed spaces. I echo the comments on the need for a UK-wide national campaign and media advertising.

Although the Scottish Government have long made clear their aspiration for a tobacco-free Scotland, the strategy sets the date by which we hope to realise the ambition. It is not about banning tobacco in Scotland, though if we were to discover it today we would never licence it. I remember as a child listening to the Bob Newhart radio sketches—some may remember them—and he had one about Nutty Walt and the discovery of tobacco. That was only about the crazy tobacco scene and did not even go into the ludicrous health aspects. Nor is the strategy about stigmatising those who wish to smoke. The focus is on doing all we can to encourage children and young people to choose not to smoke.

In September, the Scottish Government welcomed figures that showed that children’s exposure to second-hand smoke in the home reduced from 11% to 6% from 2014 to 2015, which I think sets us in the right direction. Health inequality is a key theme running through the Scottish National Party’s tobacco control strategy, with explicit recognition that current smoking patterns have a hugely disproportionate impact on Scotland’s most deprived communities. That is no different from anywhere else in the UK or, as we have heard from so many speakers, throughout the world.

Scotland has a proud record on tobacco control. We believe the UK Government need to get their finger out and commit to publishing their promised new tobacco control plan for England. I am a great believer that we can learn from each other and pinch good practice whenever we see it, so a good tobacco control plan for England may well help us in Scotland by exposing a few other ideas and strategies that perhaps we have not considered or pushed as firmly.

[Ms Karen Buck in the Chair]

[Alex Cunningham]

The hon. Gentleman has outlined a great catalogue of activities north of the border, in my own homeland. I appreciate that, but what new, big ideas are there north of the border that could contribute to the plan of colleagues in England?

[Martyn Day]

I thank the hon. Gentleman for that question. I have mentioned some of the key points that we are targeting, and stopping children smoking is the key aspect. The title of the strategy we are working on is “Creating a Tobacco-Free Generation”. That is important. The point has been alluded to by other speakers that stopping people smoking is more important than reducing it, although reduction is important for those who smoke because of the impact on deaths and on the health service.

We encourage the UK Government not to keep the House waiting but to fulfil their promise to publish their new plan. If they are stuck for ideas, they are welcome to look at Scotland’s 2013 plan.

European Medicines Agency

Martyn Day Excerpts

Wednesday 12th October 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank the hon. Member for Cambridge (Daniel Zeichner) for initiating this very important debate.

As we know, the European Medicines Agency is a decentralised agency of the European Union, employing about 890 people and located at Canary Wharf in London, which makes it the biggest EU operation in the UK. As we have heard, its staff is multinational; only 7% are from the UK, but all now face the prospect of a painful and uncertain period that almost inevitably will lead to relocation. It is inconceivable to me that an EU institution would not be located within the EU, although that will be decided by the member states at some point after the UK has left. Given that it took seven years to establish the organisation and given the possible further complication of its recent 25-year lease for its headquarters, who knows how long it may take to disentangle?

Of course, it is not just the staff who face the prospect of an expensive move. There are likely to be repercussions for the public purse and implications for medicine regulation. We know that currently more than one third —almost 40%, in fact—of EU drug approvals are outsourced to the Medicines and Healthcare Products Regulatory Agency, which clearly places significant reliance on that business for its income. Consequently, there will be a financial gap for the UK. I would be interested to hear from the Minister how the Government plan to plug that gap.

The complications are not just financial; there may well be implications for how medicines are regulated. We seem to be looking at a hard Brexit. If the UK does not become a member of the European economic area, marketing authorisations will be required from the MHRA for the UK. I am in no doubt that the implications of that will be less efficiency and possibly longer processes for obtaining authorisations in the EU and the UK, resulting—I fear—in innovative drugs taking longer to reach patients. Some industry leaders predict delays in the region of 150 days, based on the examples of Switzerland and Canada.

According to a piece that appeared in the Financial Times, when Sir Michael Rawlins, chair of the MHRA, was asked whether it would be able to take on all the extra work registering new drugs and medical devices that is currently carried out by the EMA, he said: “Certainly not.” Considerable investment and recruitment would be required to re-establish it as a stand-alone national regulator.

The EMA is central to the harmonised approach to medicines regulation. Losing this mechanism would have huge implications for the way in which drugs and medicines are tested and marketed, with concerns already expressed by many in the pharmaceutical industry that leaving the EU will result in the UK losing out on some trials that might otherwise benefit patients, as we will no longer be part of that harmonised procedure. The pharma industry argues that the UK is involved in about 40% of all adult rare disease trials in the EU at present, but that would be undermined by a change of status. Some in the pharma industry argue that that would in itself reduce the importance of this country in the eyes of the global drug companies. Being outside the EU would mean that the UK was not part of the harmonised procedure and so might lose out on some trials that might otherwise benefit patients. Officials at the National Eczema Society say that they have been informed by two US companies that trials of new treatments will not take place in the UK in the event of Brexit.

Across the UK, the pharmaceutical industry will be dealt a hammer blow through the loss of the European Medicines Agency, which is crucial for attracting foreign investment. It is clear that international pharma companies like to be close to their regulators. Until now, the EMA has been an attraction for companies to locate their European headquarters in the UK. The Japanese Government recently published a report detailing consequences if requirements from UK-EU negotiations are not delivered. Many Japanese pharmaceutical companies operate in London because of the EMA’s location in London. The Japanese Government have said that the appeal of London as an environment for the development of pharmaceuticals would be lost, which could lead to a shift in the flow of research and development funds and personnel elsewhere.

Thanks to a reckless gamble with our membership of the EU, the UK now faces the prospect of losing being part of the EMA, which not only will mean patients losing out on pioneering and beneficial medical trials, but will leave a disastrous trail when the inevitable happens and it seeks to have its headquarters in the EU.

Blood Cancers

Martyn Day Excerpts

Thursday 7th July 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Walker. I thank the hon. Members for Strangford (Jim Shannon) and for Crawley (Henry Smith) for securing this informative and timely debate. Although I might have sleepless nights at the thought that one in two people will receive a cancer diagnosis, I thank them both for driving home that point to the wider populace.

There can be little doubt that a cancer diagnosis is a daunting prospect for those affected and their families, which is why it is vital that we support them throughout their journey from detection through to aftercare. Many heartfelt examples and experiences have been detailed in today’s debate, and it is clear that the support that individuals require can vary greatly. One size does not fit all, so we need a system that considers the problems from all angles. I agree wholeheartedly with the hon. Member for Strangford that everyone should be offered tailored support.

I am grateful to the hon. Member for Erewash (Maggie Throup)—I hope I have pronounced it correctly—for her explanation that we should refer to all the diseases as blood cancers. As a layman, I found it helpful. There are 130 of them, all with complex names, and having done some research for this debate, I found the names confusing. It is a good approach. Her argument about the strong need for more clinical research should be taken on board.

I was grateful to hear from the hon. Member for Coventry North East (Colleen Fletcher) about her personal circumstances. I am glad that her husband has had a positive outcome. The regional variations are somewhat disappointing; a lot more can be done. I thank the hon. Member for Crawley for his submission and for securing this debate. He drove home the fact that blood cancers are the third biggest cancer killer, and spoke about the difficulties caused by small sample sizes in providing adequate data for drug assessments. That is an important point.

In Scotland, of course, health issues are devolved, so unlike many hon. Members here today, I see only a tiny number of such cases in my casework, as they go to MSPs instead. Our experience in Scotland is also a little different. The Scottish Government are implementing a £100 million new cancer plan to improve prevention, early diagnosis and treatment, and have reformed how the Scottish Medicines Consortium assesses drugs in order to give patients better access to treatments that can give them longer and better quality lives.

Basically, we have combined our cancer drugs fund with our rare diseases drugs fund and simply called it the new drugs fund. The amount in the fund has been quadrupled, which is a significant factor. That approach will serve as a blueprint for all cancer services in Scotland, improving the prevention, detection, diagnosis, treatment and aftercare of those affected by the disease.

Other initiatives include a £50 million fund over the next five years to improve radiotherapy equipment and support radiotherapy training, ensuring that everyone who would benefit from it has access to advanced radiotherapy, and £9 million over five years to support access to health and social care services during and after treatment, such as link workers to provide support in the most deprived communities. We will also invest £5 million over the next five years in reducing inequalities in screening. There are many such examples, and we can learn from one another’s good practices in the different parts of the United Kingdom.

In Scotland, the Scottish Medicines Consortium considers drugs as NICE does, including worldwide evidence, and works up each drug in detail. The balance for us seems to be slightly more on effectiveness than on cost, although cost obviously remains a factor in all matters. Our impression is that, for NICE, cost would sometimes be a bigger component. Both organisations consider cost-effectiveness; as we all know, there is not an infinite pot of money.

In conclusion, although no system will ever produce a favourable result for every individual, more can always be done and we can always learn lessons from each other’s systems. In that light, I suggest that Ministers consider giving NICE the power to change its decision-making process and consider new medicines more flexibly.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 5th July 2016 Commons Chamber

[Jane Ellison]

As I have said, it was our Prime Minister who commissioned the independent O’Neill review, showing astonishing foresight, and that review is now galvanising the discussion. I was at the World Health Assembly in Geneva in May, and the review was the talk of Geneva. Lord O’Neill presented it to many delegations from around the world and we now need to move forward. As well as working on human health, we are also looking to work with animal health organisations, as we take forward the very important recommendations on prescribing and the use of antibiotics as growth stimulators.

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

3. If he will make an assessment of the potential effect of the UK leaving the EU on the availability of NHS services for (a) EU nationals living, studying and working in the UK and (b) UK citizens abroad.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Before I start, the House will want to mark an important milestone, which is that this year, alongside Arnold Schwarzenegger, Brian May, Camilla Parker Bowles and Meat Loaf, the NHS is 68 years old, and its birthday is, in fact, today. I know that we will all want to wish the NHS and all who work there a very happy birthday.

As long as the UK is subject to EU law, current arrangements remain in place. As we move to a new relationship with Europe, our guiding principle will be to get the best possible deal for British citizens who live and work in, and who visit, EU countries. An EU unit will be set up in the Cabinet Office and will report to the Cabinet, and my Department will feed into its work.

[Martyn Day]

I am aware that nothing will change for the next two years, but what is the Secretary of State’s proposal for reciprocity of access to healthcare within the EU, and does he envisage the £500 NHS immigration health surcharge applying to EU nationals already living in the UK?

[Mr Hunt]

The health surcharge that this Government have instituted for people on long-term visas to come and work and live in the UK is the right thing to do, because it is important that everyone makes a fair contribution to the cost of NHS services. In terms of future arrangements for EU nationals in the UK, that would obviously be subject to the negotiations that now happen, and a very important part of those negotiations will be access to the EU health systems for British citizens currently living in EU countries.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

My hon. Friend raises an important point. NHS England is currently unable to take final decisions on this year’s new treatments, including this particular drug, until the courts have decided whether pre-exposure prophylaxis HIV prevention should compete with other candidate drugs. She makes an important point about timeliness, and that is why I am leading an accelerated access review to speed up the way in which such decisions are taken.

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

T4. In March, the Scottish Government made a commitment to substantially increase the financial support for the victims of contaminated blood. Initially, that will have to be administered through the current system, but the Department of Health appears to be dragging its feet. Will the Secretary of State explain the cause of the hold-up and say how he plans to expedite these payments to people with life-threatening illnesses?

[Jane Ellison]

No one is dragging their feet and we are trying to get this matter sorted out. I have had a number of discussions with the Cabinet Secretary for Health and Sport, Shona Robison, most recently last Thursday. We are working together to facilitate the increased payments, using the current scheme administrator. We want the payments to be made as quickly as possible to people who were infected in Scotland and across the UK. Officials in the Department of Health and officials in Scotland are working closely together to expedite the matter.