Medical Technology Regulations and the NHS

Martyn Day Excerpts

Tuesday 28th March 2023 Westminster Hall

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

I am grateful to the hon. Member for Gosport (Dame Caroline Dinenage) for securing today’s debate, and for the manner in which she summarised the case. I may disagree with her optimism on the Brexit side, but I think there is a lot here that we can agree on.

This issue is of great concern to all our nations. Medical devices are used in the diagnosis, treatment and management of a wide range of diseases and conditions. Across these islands, it is estimated that one in 25 people has an implanted medical device. The regulation of medical devices is reserved to the UK Parliament and regulator, and the Medicines and Healthcare products Regulatory Agency covers all medicines and medical devices used in the diagnosis and treatment of illnesses. Under the current UK regulations, manufacturers must report any adverse issues involving medical devices to the MHRA.

In the Scottish context, Health Facilities Scotland assists the MHRA in providing technical and operational support to the Scottish Government health and social care directorate, and to NHS Scotland. In February 2018, the independent medicines and medical devices safety review was launched to investigate how the health system responds to concerns about the safety of treatments. The review, chaired by Baroness Cumberlege, focused on vaginal mesh, sodium valproate and hormone pregnancy tests. The review’s report, published in July 2020, made nine recommendations. My colleagues in the Scottish Government have committed to implementing all the recommendations of Baroness Cumberlege’s review, including the appointment of a Scottish patient safety commissioner.

As we have heard, patients, families and campaigners brought to light those horrific medical disasters: the use of the hormone pregnancy test Primodos; the use of the antiepileptic drug sodium valproate in pregnancy; and the use of vaginal mesh. It is clear that the same underlying issues have driven all three disasters. There were four main features: a failure of licensing and regulation in the first place, particularly regarding implantable devices, such as vaginal mesh; a lack of accurate information to enable doctors to discuss the risks of those devices and allow patients to give informed consent; a weak system for doctors or patients to report the adverse events, which would have resulted in action; and, in some cases, a failure of doctors to listen to the affected women who raised concerns.

Health technology, medical devices and equipment are crucial in delivering services in NHS Scotland, and they must meet clinical and information governance requirements to minimize the risk of adverse events. To provide high-quality patient care, medical technology must be procured, managed and maintained appropriately. Although the regulation of medicines and medical devices is currently a reserved matter for the UK Government, the Scottish Government support ongoing reform of the assessment of medical device safety. However, there are concerns that the UK Government intend to compound the Brexit harms in the NHS by removing many European standards and regulations from the statute book with their Retained EU Law (Revocation and Reform) Bill.

The Scottish Government are concerned about the impact of the UK’s departure from the EU on the regulation of medicines and medical devices. The Scottish Government believe that regulatory reform must include the systematic incorporation of patients’ experiences in decision making. There have been shortages of medicines since the UK’s departure from the single market, and they have resulted in price increases and the use of serious shortage protocols. It will come as no surprise that the SNP opposes the Retained EU Law (Reform and Revocation) Bill, which could remove important protections, such as food labelling, animal welfare, and environmental controls. Scotland wants to maintain EU standards for medication safety and controls.

NHS Strikes

Martyn Day Excerpts

Monday 6th February 2023 Commons Chamber

[Will Quince]

I thank the Chair of the Select Committee for his question. He is right that we are committed to the independent PRB process, which is the right way to set public sector pay and has operated successfully for over four decades. We are not changing that process, but we decided to take the step to engage with the unions on our respective evidence so that it can be as informed as possible, and we very much thank the trade unions for working with us in that spirit. We need to wait for discussions with unions to finish across Government, so I hope I can use the word “shortly”; I am mindful that we want to get this done as quickly as possible.

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

What does the Minister think when he looks across the border to Scotland and sees that Unison, Unite and other unions representing the majority of NHS Agenda for Change staff have accepted the 7.5% pay rise offer? There are no planned strikes in Scotland while pay deals are being considered, which clearly illustrates that negotiating with the unions is a better way of ending strikes than picking fights with them. The UK Government are unique among the four Governments of the UK in that they are the only ones who have full financial powers, and therefore the only Government who are not acting with a hand tied behind their back in offering pay uplifts to their NHS staff. Why is it, then, that the UK Government are facing the greatest number of strikes and have failed to settle any pay disputes?

[Will Quince]

I remember another Scottish National party Member making a similar comment in a previous urgent question, crowing about how Nicola Sturgeon, the First Minister of Scotland, was directly negotiating with the unions and that they had paused their industrial action, but only a handful of weeks later that industrial action was renewed. Pay is of course a devolved matter for Scotland and for Wales.

I will not make unfunded promises or pledges from this Dispatch Box. I want to have an honest and open dialogue with the unions about what is affordable for the NHS, where we recognise and reward NHS staff—who do the most incredible job day in, day out—with one eye to recruitment and retention, but it also has to be fair to taxpayers; and that is the spirit in which I approach this matter.

Cystic Fibrosis: Living Costs

Martyn Day Excerpts

Thursday 2nd February 2023 Westminster Hall

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

I am grateful to the hon. Member for Strangford (Jim Shannon) for securing this debate on the impact of cystic fibrosis and for covering the issue quite comprehensively. Cystic fibrosis is a chronic condition that affects the lungs and has many other serious side effects. It is one of the UK’s most common life-threatening inherited diseases; about 10,800 people across the UK currently have it.

There can be little doubt as to the profound impact of cystic fibrosis on one’s life. We must recognise that the current cost of living crisis disproportionately affects those with disabilities, including those with cystic fibrosis. This has been well illustrated in today’s debate by a range of Members who gave examples of direct lived experience from their families and constituents, in particular the hon. Members for Ashfield (Lee Anderson) and for Stretford and Urmston (Andrew Western), who both did so excellently.

A report from the University of Bristol put the additional cost of living with cystic fibrosis at £6,500 a year. The dietary requirements alone—good nutrition is vital to support the need for 150% to 200% more energy —represent an alarming cost for many. As the hon. Member for Strangford mentioned, people with cystic fibrosis may have to take as many as 70 enzyme pills to help to digest food: an absolutely staggering number. As well as that, most people with the condition require 20% to 50% more calories a day than people without it, while some may need considerably more.

Some people with cystic fibrosis use a wheelchair to get around and oxygen to help them breathe, with sufferers often having to undergo a rigorous daily regime of treatments to stay healthy. All this comes with costs attached, and often relies on an individual or their family having sufficient income to cover it.

Cystic Fibrosis UK’s report, “The cost of cystic fibrosis”, shows that 87% of people with cystic fibrosis are worried about the cost of living, and that this is a growing concern for many in the community over the coming months. The report also found that one in three people with cystic fibrosis had missed a hospital appointment due to the cost, one in three had run out of food before they had enough money to buy more, and one in three had to prioritise one basic essential over another.

The impact of shielding and lockdowns as a result of the covid-19 pandemic and the rising cost of living have added even further financial burden for many people with cystic fibrosis. Extra life costs for sufferers and their families—spending more on essential goods and services such as heating, insurance, specialist diets, equipment and therapies—mean less money in their pockets, with the result that they are more likely to have a lower standard of living, even when they earn the same as an adult without the condition.

In England, cystic fibrosis is currently not one of the medical conditions that exempts people from paying prescription charges. In contrast, as we have heard already, the Scottish Government have scrapped all prescription charges. It is particularly concerning that 25% of people with cystic fibrosis use their benefits to pay for prescriptions that are essential to live with the condition. Some 44% of people with cystic fibrosis said that they rely on statutory sick pay while sick. I continue to oppose the rules around statutory sick pay, which fall far short of meeting a dignified standard of living and are not flexible enough to meet real needs, as the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) highlighted earlier. Workers need to earn at least £120 per week to be eligible for statutory sick pay, meaning the lowest earners and those working part time are more likely to miss out on income support. As we have heard, many with cystic fibrosis fall into those categories. The UK has one of the lowest sick pay rates in the OECD. The current rate of £99.35 is wholly inadequate, and one in five workers is not eligible for it. Groups most likely to miss out are women and those in insecure work. I have repeatedly called on the UK Government to increase statutory sick pay in line with the real living wage, make it available to everyone by removing the qualified worker and earnings requirements, and extend it to 52 weeks instead of 28.

Heating and energy costs are another area where sufferers typically face higher monthly bills than others. As has been mentioned, removing VAT from energy bills would help. I also support the idea of reimbursing additional costs for lifesaving medical equipment powered at home. Perhaps it is time to investigate the possibility of effectively prescribing energy for some conditions.

The SNP will continue to urge the UK Government to use all the reserved powers at their disposal to tackle the cost of living crisis on the scale required. That includes access to borrowing, providing benefits and support to households, and ensuring that those benefits rise in line with the cost of living. Tackling VAT on fuel, taxation on windfall profits and regulation of the energy market are all areas where the power is currently reserved to Westminster. Until the Scottish Parliament has full power over those areas, we require action from this place. I look forward to the Minister’s response.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 24th January 2023 Commons Chamber

[Mr Speaker]

I call the SNP spokesperson.

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

With more than 4,000 fewer specialist doctors from the EU or the European Free Trade Association in the UK than in pre-EU referendum trends, there is clear evidence that shutting off free movement is a totally unnecessary barrier to recruitment for our care and health services. Have the Minister and Secretary of State made representations to the Cabinet to discuss the disastrous effects of Brexit on the UK?

[Helen Whately]

Yet again, an hon. Member from the SNP thinks it is all to do with Brexit, when the facts show that that is simply not the case. As I said a moment ago, 12,000 more staff from EU and EEA countries are working in the NHS in England since the referendum. However, I point the hon. Gentleman yet again towards his own party’s record in government in Scotland and the problem of the NHS in Scotland haemorrhaging staff.

--- Later in debate ---

[Mr Speaker]

I call the Scottish National party spokesperson.

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

When I brought up pension tax rules in November, the Secretary of State agreed that pensions were an important issue and said that he would meet the Chancellor later that day. Can he give an update on the progress that his Cabinet colleagues are making to provide a permanent solution that will help retain NHS staff?

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 1st November 2022 Commons Chamber

[Mr Speaker]

We now come to SNP spokesperson, Martyn Day.

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

The NHS Confederation wrote to the former Chancellor raising its concerns about rising energy costs and the knock-on effects on health and on NHS services. We all know that this winter we will see people making the choice between heating and eating. Both routes will inevitably lead to more illness and worse health outcomes, so what action are Ministers taking, with their colleagues in Cabinet, to avoid this public health catastrophe?

--- Later in debate ---

[Mr Speaker]

Order. I know we are bedding back in, but Front Benchers have to think about Back Benchers. These are their questions as well, so please let us make sure that I can call as many of them as possible.

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

The Scottish Government introduced new national guidelines to make it easier for retiring NHS staff to return to support the NHS, while drawing their pensions. However, there is a substantive issue of pension tax rules pushing senior clinicians to reduce their commitments or retire early. As we know, pension taxation is a wholly reserved matter, so will the Minister address this issue with Cabinet colleagues in order to find a permanent solution that will allow us to help the NHS retain senior staff?

[Steve Barclay]

Pensions are an important issue, and I shall be meeting the Chancellor later today.

Motor Neurone Disease

Martyn Day Excerpts

Thursday 20th October 2022 Commons Chamber

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

I am grateful to the Backbench Business Committee for arranging this very important debate, and to the hon. Members for Northampton South (Andrew Lewer) and for Newport East (Jessica Morden) for securing it. I am grateful, too, for the thorough manner in which this debate was opened.

This vital issue clearly has cross-party support. I find myself in complete agreement with all the points that have been made from both sides of the House. I, too, have been impressed by Doddie Weir, whom I met last year before speaking in a previous debate. I was taken by his positivity and energy, which was truly inspirational and something that inspires so many.

I will keep my remarks brief as the points have been so well made by earlier speakers. As we have heard, MND seems like a rare disease, but it is sadly all too common. It is the most common neurodegenerative disease of midlife, and many younger people are also affected. It is currently a terminal and incurable progressive condition. Progression is rapid, with one third of people dying within a year of diagnosis. It is a truly horrible disease. As people with the condition generally die so quickly, only 5,000 people in the UK live with the disease at any one time. However, MND is not rare. One in every 300 people across all communities develops MND in their lifetime, and about 200,000 of the current UK population will die of MND unless effective treatments are found. It is diagnosed in 200 Scots every year, and in more than 1,500 people across the UK.

There are clear links between research and investment in palliative care standards to improve the quality of life of those with MND while research continues to develop. All NHS boards in Scotland have a named MND clinical nurse specialist, either employed directly by the board or provided by a neighbouring board through service level agreements. I encourage the UK Government to follow the lead of the Scottish Government in providing universal free prescriptions. Free prescriptions are just one small way that we can help improve the quality of life of those who have been diagnosed with MND while research is still ongoing. Prescription charges, as we know, were abolished in Scotland in 2011, while in England the current charge is £9.35 per item.

Most worryingly, MND is on the increase, and we do not yet know why. The only effective drug available to fight it is called riluzole or Rilutek, which can deliver a small improvement in patients’ overall survival, but it is not a cure and does not stop the condition progressing.

Last year, I spoke at length on this issue when opening the Petitions Committee debate in July. The urgency and potential benefit of dedicated research funding has been well made over a sustained period by many Members here and Members who were in that previous debate. That need is more urgent than ever now.

The research for new therapies requires a truly multi-disciplinary and pan-national approach, spanning the entire translational pathway. Establishing a virtual MND translational research institute, which campaigners have consistently called for, will deliver that. There is no doubt that extra MND research funding from the UK Government is needed to support effective patient treatment and medicines, in the hope that a cure for MND can be found soon. That is what the petitioners in the previous debate and the sufferers of this disease need, and I believe that it is possible. Sufferers simply do not have time to wait for action. They need results now—their life expectancy is, sadly, too short.

I was truly delighted, therefore, when the UK Government announced the £50 million funding specifically for research into MND last November. I have praised them on the record for it before and I do so again today. I am also grateful that we had confirmation only last month that that funding is ring-fenced. However, I would particularly like to know what progress has been made in allocating the funding. Just when will the consultation on the MND partnership result in a tangible plan? Progress on that feels too slow for my liking, so if the Minister could address those points I would be grateful.

Vaccine Damage Payment Scheme: Covid-19

Martyn Day Excerpts

Tuesday 6th September 2022 Westminster Hall

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

I thank the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright) for securing today’s important debate on covid vaccines and the vaccine damage payment scheme, and also for the manner in which he presented the case. I think we can all agree that it is vital that those with genuine claims are supported, and that spurious anti-vax conspiracists are not allowed to undermine legitimate claims.

It is clear that it is beyond time for the UK Government to review the compensation scheme. Although the vast majority of vaccinations do not cause serious side effects, in a tiny number of incidents there have been and will be serious side effects. Any medicine, even an over-the-counter medicine, is capable of having seriously detrimental side effects. It is a tragic reality that, although vaccination is the right course of action, and the risk of harm from coronavirus far outweighs the risk of harm from the vaccines, some people will have serious side effects, including disablement and death.

The first payment under the compensation scheme in the UK has been handed out, to a bereaved individual whose partner lost their life as a consequence of the AstraZeneca vaccination. There are serious, valid claims of harm, and they must be respected and listened to. That is also vital to maintaining faith in the UK’s vaccination programme, both now and in the future. As those claiming make clear, making claims is not about being anti-vaccine.

Anti-vaxxers have attempted, however, to abuse the scheme and undermine the delivery of compensation. At one point, it was claimed that the compensation scheme was for anyone who was not made fully aware of the health risks of the vaccine. Such actions are designed to overwhelm the system, making it harder for people with legitimate claims to be heard, which ultimately undermines faith in the system. They promote the unfounded claim that the extremely unlikely consequences of the vaccine were hidden. Similar actions were seen in America, where there were many spurious claims for compensation, including on the basis of having a sore arm after vaccination. That was the only symptom that I had, and it was similar for many of my friends; it was a regularly experienced side effect, as we know.

We must support those with valid claims, while ensuring that anti-vaxxers do not hijack the scheme for their propaganda purposes. As I stated earlier, it is beyond time for the UK Government to review the compensation scheme.

[Sir Jeremy Wright]

I understand exactly the point that the hon. Gentleman is making. Would he agree that the best gift that we could give to the anti-vaxxers would be to allow them to say that people injured by the vaccine will receive no compensation and no help from the Government?

[Martyn Day]

I absolutely agree. MPs have warned since 2015, before I was in Parliament, that the system is out of date and in need of review. Payment levels under the scheme were set in 2010, and have not been reviewed since. Lawyers specialising in vaccine injury cases have criticised the 60% disablement criterion as out of date and as not reflecting the reality of some consequences of covid and the covid vaccinations.

In the aftermath of the coronavirus pandemic and the largest mass vaccination programme in the history of the United Kingdom, it is well beyond time that the vaccination compensation scheme is reviewed. This is made even more necessary in the face of the spiralling cost of living crisis, with those who have been disabled or bereaved by vaccine injury facing higher costs and lower incomes. In conclusion, the SNP calls on the UK Government to deliver an uplift to the compensation quantity and to ensure that no legitimate cases are being denied rightful compensation.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 19th July 2022 Commons Chamber

[Mr Speaker]

We now come to the Scottish National party spokesperson, Martyn Day.

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

Vaccination remains one of the most important ways to protect ourselves and others against covid-19, so I welcome the Secretary of State’s announcement that he has accepted the independent advice from the Joint Committee on Vaccination and Immunisation on the autumn covid-19 booster programme, but what additional steps does the Minister feel need to be taken to encourage vaccine uptake among those with a hesitancy for the additional boosters?

[Maggie Throup]

The hon. Gentleman is right and, as I said to the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), we know that there is more work to be done and we cannot rest on our laurels. We know that covid-19 vaccinations are our best line of defence and that the more people who come forward and take up their first jab, the more people are protected. That evergreen offer is still there, so if anyone has not had their first jab or has not come forward for their second or their booster, I encourage them to come forward now. It is never too late.

--- Later in debate ---

[Mr Speaker]

I call SNP spokesperson, Martyn Day.

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

While the Tories flogged off PPE contracts to party donors and friends of Ministers through their unlawful VIP PPE lane, the Scottish Government’s processes ensured value for money, as we have heard; their PPE costs were less than a third of the UK Government’s. Will the UK Government follow Scotland’s example in future, and refuse to engage in cronyism and corruption?

[Maria Caulfield]

I outlined in my answer to the hon. Member for East Renfrewshire (Kirsten Oswald) that around half a billion-worth of pounds of procurement in Scotland did not go through the usual channels. All offers that were identified, regardless of route, underwent rigorous financial, commercial, legal and policy assessment, led by officials, and the final decision on whether to enter a contract sat with the appropriate accounting officer at the Department.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 14th June 2022 Commons Chamber

[Mr Speaker]

We now come to the Scottish National party spokesperson, Martyn Day.

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

The lack of evidence on the quality, safety and efficiency of cannabis-based products for medical use is the main barrier to their being prescribed by NHS clinicians, which is why the SNP continues to support the development of clinical trials. Without proper funding, the UK Government are holding back potential successful health outcomes, so what steps are they taking to increase the priority of medicinal cannabis in research funding?

[Maria Caulfield]

I met the responsible Scottish Minister in April to discuss this issue. There is not a lack of funding. The National Institute for Health and Care Research has funding available but we are not seeing bids, so this is a plea to the clinicians, researchers and groups for those to come forward. The NHRA is also happy to meet any groups considering undertaking clinical research to ensure that it is the type of research that will provide the evidence they need to licence these products.

--- Later in debate ---

[Mr Speaker]

I call the SNP spokesperson, Martyn Day.

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

The Government have noted that Sir Robert Francis will give evidence on his work on the infected blood inquiry on 11 and 12 July, and said that they will act after hearing his evidence. What discussions has the Secretary of State had with Cabinet colleagues on the potential impact on victims’ mental health of the lengthy waiting times for compensation in relation to contaminated blood?

[Sajid Javid]

The hon. Gentleman raises a very important issue. The House is well aware of the Government’s work to bring justice to those who have been affected by contaminated blood, and we will continue to take that seriously.

Malnutrition and the NHS

Martyn Day Excerpts

Monday 25th April 2022 Commons Chamber

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

Mr Deputy Speaker, you have no idea how pleased I am to be making this speech now, mainly because I originally thought it would be at 12.55 am. Having made the shortest speech of my political career earlier today, I now have the opportunity to perhaps make my longest. But I think I can do it in a normal measure and we can all get away home. I thank Mr Speaker for granting the debate and the Minister for attending.

Malnutrition is a word that often conjures up images of undernourished children in developing or war-torn countries; not surprising really, when we consider it is linked to 45% of deaths among under-fives worldwide. That the UK Government have reduced nutrition-specific international aid by 70% is certainly concerning. However, that is not the focus of what I will be discussing today. It is equally concerning that in the UK, the fifth-richest country in the world, malnutrition has tripled since 2010. However, although they are undoubtedly related, neither will I specifically be discussing food insecurity, nor the exponential rise in food poverty, which has been widely argued in this place to be a political choice. Instead, I want to take this opportunity to highlight the direct impact that malnutrition has on our NHS and to ask the Minister to consider some of the ways that the Government could potentially mitigate those negative impacts.

I am pleased to have secured this Adjournment debate for two main reasons. First, it is an opportunity to draw attention to the most recent survey of malnutrition and nutritional care in adults, which was carried out by the British Association of Parenteral and Enteral Nutrition, otherwise known as BAPEN. It is relevant to point out that 83% of the individuals who took part in this survey were living in England. BAPEN hopes to include all four UK nations in future surveys, but I am referring to this one as I understand it is the most recently published. Using the malnutrition universal screening tool, the survey demonstrated that 40% of the participants were at medium or high risk of malnutrition, and that disease-related malnutrition at that time affected 1.3 million people over the age of 65. I will refer to further findings of the survey throughout this speech.

The second reason that I am happy to be able to raise the issue of malnutrition and the NHS specifically concerns the Advisory Committee on Borderline Substances, which, for ease of reference, I will refer to as “the committee”. That scientific advisory committee is responsible for reviewing applications for substances that are specifically formulated by manufacturers to manage medical conditions. Malnutrition is one of these medical conditions and the substances that the committee reviews may be nutritional or dermatological products.

The committee plays a pivotal role in the NHS, as it is also responsible for advising the Secretary of State for Health and Social Care on the prescribing of borderline substances in NHS primary care. The committee’s advice covers two main areas: borderline substances policy; and the clinical and cost-effectiveness of borderline products.

Before I talk more about those areas, I will give a bit of background about malnutrition and its many implications for the NHS. Being malnourished does not simply mean being underweight; it can also affect overweight people and take many forms. For example, if someone does not consume enough energy and nutrients, perhaps because of social, economic or age-related factors, they become undernourished and consequently suffer from undernutrition. Undernutrition can affect all ages; it is indeed a “cradle to grave” scenario that the NHS was set up to provide healthcare for.

Then there is disease-related malnutrition, whereby a disease creates specific nutritional needs that result in an insufficient intake of energy and nutrients. Examples of disease-related malnutrition include some types of cancer or cardiovascular disease. There is also micronutrient-related malnutrition, which can be either a deficiency or an excess of important vitamins and minerals.

Being malnourished can lead to: poor growth and/or development in children; weaker immune systems and increased risk of infection, and indeed reinfection; muscle and bone weakness, or becoming more frail and likely to fall; poor wound healing; and slower recovery times. It is because of those common effects that, compared with the average well-nourished person, those who are malnourished are twice as likely to visit their GP, have three times the number of hospital admissions and, on average, stay in hospital for three days longer.

Malnutrition affects more than one in 20 people in the UK, which is a similar prevalence rate to well-known, treatable illnesses such as asthma. However, the rate increases to one in 10 people over the age of 65. It is also more prevalent in those with existing illnesses. Outside those two groups, malnutrition is disproportionately concentrated in lower-income regions and households, and undernutrition is more common in children from less well-off backgrounds.

Hon. Members can see how this mounts up to be a significant cost to the NHS that equates to around 15% of the total UK healthcare budget. That is quite a staggering figure. Additionally, those who are malnourished divert scarce healthcare resources unnecessarily, which brings me to the committee’s advice on the cost-effectiveness of borderline products.

Across the UK, the cost of malnutrition to the health service is currently estimated to be a staggering £23.5 billion. As the population ages, the costs of failing to put in place proper systems for the diagnosis and treatment of malnutrition are likely to rise. The cost of treating a malnourished patient is two to three times more than treating a non-malnourished patient. It has been calculated that treating a non-malnourished patient amounts to £2,155, whereas treating a malnourished patient comes to £7,408. That is reported to be driven largely by poorer outcomes leading to increased healthcare needs.

Reducing the prevalence of malnutrition would therefore be a significant way to get the best from our NHS in monetary terms and relieve pressure on the healthcare system and NHS staff. Most importantly, in human terms, it would improve patient outcomes. That point leads me on to the committee’s advice on borderline substances policy.

On 1 April 2016, the United Nations General Assembly proclaimed 2016 to 2025 as the United Nations decade of action on nutrition. It stated:

“The Decade is an unprecedented opportunity for addressing all forms of malnutrition.”

Led by the World Health Organisation and the United Nations Food and Agriculture Organisation, the United Nations decade of action on nutrition calls for policy action across six key areas:

“creating sustainable, resilient food systems for healthy diets; providing social protection and nutrition-related education for all; aligning health systems to nutrition needs, and providing universal coverage of essential nutrition interventions; ensuring that trade and investment policies improve nutrition; building safe and supportive environments for nutrition at all ages; and strengthening and promoting nutrition governance and accountability, everywhere.”

We are now just three years away from the end of the decade of action on nutrition, yet the most recent survey of malnutrition and nutritional care in adults found that

“disease-related malnutrition continues to be prevalent.”

Indeed, although the findings were similar to those of BAPEN’s survey the previous year, the prevalence of disease-related malnutrition was found to be higher than in surveys carried out in the years before the decade of action on nutrition was declared. That suggests that instead of seizing the opportunity to address all forms of malnutrition, as the UN advocates, the UK has either avoided tackling the problem or failed in its efforts. It also raises the question of the role of the committee’s advice on borderline substances policy in addressing malnutrition.

Last year, the UK Government published an open consultation that outlined proposed changes to the committee’s policy on oral nutritional supplements, which are a key part of management strategies in the treatment and prevention of malnutrition—incidentally, it would be helpful if the Minister could clarify when the response to the consultation will be published. The changes proposed in the consultation have a considerable potential impact on clinical practice, but not necessarily a positive one.

In reference to the consultation, the British Specialist Nutrition Association concluded that oral nutritional supplements

“are a clinically and cost-effective way of managing disease-related malnutrition. As clinical experts in nutrition, dietitians should maintain their autonomy in being able to make the best decisions for their patients. The new ACBS consultation on ONS is at risk of limiting dietitian autonomy, impacting patient safety and care, and limiting the ability of industry to innovate.”

That point leads me on to some available ways to tackle malnutrition. I hope that the Minister will agree and will recognise them as opportunities to address malnutrition across the UK in the spirit of co-operation that is intended.

After leaving the EU, the Prime Minister asked some former Ministers to identify how the UK could take advantage of its new-found regulatory freedoms, so the Taskforce on Innovation, Growth and Regulatory Reform was convened. The taskforce reported its recommendations to the Prime Minister on 16 June last year. In relation to nutraceuticals and the consumer health sector, it stated:

“Our traditional silos of regulatory classification (food/medicine/diagnostic/device) are being challenged by the pace of bioscience and technological convergence of biological and digital platforms…science is starting to point the way to a new sector of nutritional products with increasingly explicable and/or verifiable medicinal benefits, which needs to be reflected in our regulatory framework.”

The taskforce report included a headline proposal:

“Create a new regulatory framework for the fast-growing category of novel health enhancing foods and supplements”.

However, that proposal was rejected. I recently received a written parliamentary answer confirming that

“the United Kingdom already has in place the legislation and processes required for the regulation of such products. As such, there are no current plans to implement a new regulatory framework.”

Given the lack of progress on tackling the prevalence rate of malnutrition across the UK, I urge the Minister to revisit the proposal. I am mindful that it would also address one of the key areas that the United Nations decade of action on nutrition calls for:

“ensuring that trade and investment policies improve nutrition.”

Across the UK, one of the basic problems with malnutrition is that it is an underdiagnosed and therefore undertreated condition. For example, the one in 10 of over-65s who are at risk of, or suffering from, malnutrition in Scotland equates to about 103,000 people, but just a fraction of them are identified and offered support or products to treat their condition, and the same clearly applies throughout the rest of these islands.

Screening patients for malnutrition is not currently standard practice across the NHS. If a screening programme were introduced for people being admitted to hospital, patients on wards and those in a social care setting, it would allow for intervention to limit malnutrition in the most vulnerable patients. That simple measure would constitute a policy aligning with several of the key actions called for by the United Nations decade of action on nutrition. Identifying the problem at the earliest opportunity would allow treatment to reduce malnutrition and its associated problems.

Given the UK’s increasingly ageing population, I am sure the Minister will agree that it is important for more resources to be devoted to preventive care, which would reduce pressure on the healthcare system. Reducing malnutrition by improving diets, promoting campaigns to spot the signs of malnutrition and testing through GPs and in care homes could also play an important role in a preventive care model.

Another available way of addressing malnutrition is provided by the health and social care reforms that are currently taking place across the UK. Improving links in the healthcare system between hospital and community or social care is vital. What better opportunity could there be to showcase joined-up healthcare by not only better diagnosing malnutrition, but prescribing products that treat it and then monitoring a patient’s progress in their home, community or social care setting?

I have already mentioned that undernutrition is more common in children from less well-off backgrounds, and the World Health Organisation expands on that eloquently:

“Poverty amplifies the risk of, and risks from, malnutrition. People who are poor are more likely to be affected by different forms of malnutrition. Also, malnutrition increases health care costs, reduces productivity, and slows economic growth, which can perpetuate a cycle of poverty and ill-health.”

This resonates with the regional inequality that the UK Government’s levelling-up agenda aims to address by

“giving everyone the opportunity to flourish. It means people everywhere living longer and more fulfilling lives and benefitting from sustained rises in living standards and well-being.”

Malnutrition does not give anyone the opportunity to flourish and live longer; in fact, the opposite is true. Should it not therefore be a key target for the agenda of the Office of Health Improvement and Disparities to tackle inequalities in health and care?

Concerns have been raised with me about the impact of delays by the committee on patient choice in respect of malnutrition treatment products and additional costs to the NHS. However, I was recently advised that the Department of Health and Social Care had

“made no assessment of the potential impact of application processing delays by the Advisory Committee on Borderline Substances…on patient choice for malnutrition products and additional costs to the National Health Service.”

The British Specialist Nutrition Association has noted that

“Unlike most prescribed drugs, palatability and choice of ONS”

—oral nutritional supplement—

“products are critical in meeting different patient preferences and supporting patient compliance and, as such, dietitians require access to a wide range of different product styles, flavours and volumes.”

May I finally urge the Minister to prioritise the treatment of malnutrition and effective management strategies that include better support and facilitation of the medical nutrition sector?