Covid-19 Response

Philippa Whitford Excerpts

Wednesday 22nd April 2020 Commons Chamber

[Matt Hancock]

We are ramping up our testing capacity and our capacity for contact tracing in a matter of weeks. We will have it ready to ensure that we can use that capacity as and when the incidence of transmission comes down. It is not tied to the specific decision that we are required by law to take in just over two weeks’ time. The effectiveness of test, track and trace to keep the reproductive rate of the virus down is determined by the incidence in the community, and our goal is to get to a point where we can test, track and trace everybody who needs it.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Like all MPs, I pay tribute to health and care staff across the UK. Particularly in view of the key role of care workers and in recognition of their contribution, will the Secretary of State undertake to ensure that they are paid at least the real living wage, as has been the case for some years in Scotland?

Like everyone, I welcome the stabilisation of covid cases, but does the Secretary of State accept that the testing and contact tracing must be in place before any easing of the lockdown, to avoid resurgence and a second peak? Will he achieve 100,000 tests a day by next week? If not, when? How accurate are the tests? A 25% false negative rate has been reported.

I know the Secretary of State is a fan of phone apps, so I am glad to hear him recognise the need to increase public health staff both to conduct and co-ordinate contact tracing. Will he reverse the 20% cut in public health funding in England since 2015, to ensure that those staff can be recruited now?

Finally, when I raised the issue of asymptomatic spread on 11 March, the Secretary of State claimed that it was rare, but actually it accounts for about 50%. How is he taking that into account in his covid strategy?

[Matt Hancock]

The hon. Lady asks a number of questions. First, on the living wage, all health and social care staff in the UK are paid the living wage, because that is the law. I am very proud that we introduced the living wage, which has led to a significant rise in pay, especially for people in social care who were on the minimum wage previously. She asks about asymptomatic transmission. The scientific evidence shows that asymptomatic transmissions occurs, which is one of the very significant challenges that this virus presents. She also asked about test, track and trace. I absolutely agree that that is a critical part of keeping the spread of this virus low. The lower the number of new cases is, the more effective test, track and trace is. We are therefore building now the capacity for the very large-scale contract tracing necessary to go alongside the large-scale testing—the 100,000 tests at the end of this month that I mentioned in my statement—and the technology that can help us to do that.

Covid-19

Philippa Whitford Excerpts

Monday 16th March 2020 Commons Chamber

[Matt Hancock]

The measures on shielding are specifically for those who have significant health conditions and will be contacted by the NHS. They are not for the generality of over-70s who are healthy, for whom the guidance is the same as that for people of working age, except that we strongly advise, as opposed to advising. That is for their own protection, because the over-70s, and especially the over-80s, are at significantly higher risk of mortality—of dying from this virus.

The other points made by my hon. Friend are welcome. He made a very important point about rent, which featured in the discussions that we had earlier today. I have been talking about it to those at the Treasury and to the Secretary of State for Work and Pensions. Many banks have already taken action on mortgages.

My hon. Friend’s point about the availability of drugs is, of course, critical. We have a very comprehensive drug supply chain system that we understand well, thanks to the planning that we have done over the last couple of years. Thus far we have not seen shortages beyond those that already existed before the virus, such as the one that we debated in the autumn in the context of HRT, but of course we keep the position under constant review.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Secretary of State will be aware of the concern about why the UK Government’s approach was such an outlier until now, including the talk about herd immunity, when it is not clear that any immunity from this virus is long-term. The UK is now facing an exponential rise, and I therefore welcome what the UK Government have said about decreasing all non-essential contact, as I think that it is critical to slow down and limit the spread of the virus.

The briefing from the Prime Minister talked about not providing emergency services for large gatherings, but can the Secretary of State clarify whether the Government are advising against or forbidding mass gatherings? I welcome the talk about increasing testing capability, but the briefing talked about only testing those in hospital and key workers. In Scotland, surveillance testing in practices that monitor disease in the community is continuing. Will that also be the case here in England?

Following the confusion over the weekend and, indeed, the comments that he has just made about healthy people over 70, will the Secretary of State clarify what exactly is the advice for people over 70 who live in their own homes or in care homes? Are they meant to be staying at home, or are they simply meant to be decreasing contact? In particular, is the Secretary of State discussing with social care providers lengthening the time of each visit so that there is time for the careworker to take precautions? He says that the healthy should go to work, but what if they work in a club? What provision is being made for socially vulnerable people such as the homeless or those who have no recourse to public funds, such as refugees or asylum seekers? We on these Benches welcomed the measures in the Budget, but when will the devolved Governments know exactly how much funding they will have to mitigate the economic impact of this in the three devolved nations? Finally, what further changes will be carried out in the Houses of Parliament to ensure that core services continue without increasing the risk to, in particular, older Members of both Houses?

[Matt Hancock]

We do not support mass gatherings. We have advised against unnecessary social contact, so it goes without saying that we do not support mass gatherings.

The hon. Lady asked about surveillance testing. Across the UK, we have one of the biggest coronavirus surveillance operations in the world. Of course it happens in Scotland, but it happens throughout the UK. She also asked about Parliament. I understand, Mr Speaker, that you have been having discussions today about how Parliament will operate, but I think the whole House will be sure, in our collective decision, that although Parliament may have to operate differently, it must remain open.

Coronavirus

Philippa Whitford Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

I want to make two comments in response to my right hon. Friend. First, I want slightly to correct the point about the deputy chief medical officer, who said that in the next couple of weeks we may see the numbers starting to rise fast to their peak. We do not expect numbers to peak in the next fortnight. We expect them to continue to rise after that. The peak would be in a matter of a couple of months, rather than a couple of weeks. This is a marathon, not a sprint. Secondly, the World Health Organisation declaring this afternoon that the virus is globally now regarded as a pandemic indicates that the WHO thinks it will spread right across the world, and that will have a significant impact on the way in which countries around the world will now take forward their plans. Of course, the expectation that this may well happen was all within the plan that we set out. We will be discussing that at the Cobra meeting tomorrow.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I echo the good wishes to the hon. Member for Mid Bedfordshire (Ms Dorries).

I welcome the declaration to keep Parliament open, but surely we should be looking at core functions, at who comes into the House and at what we do in the House. I have to say that I was a bit disappointed to have several hundred of us jammed into the voting Lobbies on Tuesday. That is just not a good idea. There are ways of working that would still allow Parliament to stay open.

With cases having increased by 13 times outside China in just two weeks, the virus has of course been declared a pandemic by the WHO, which describes its concerned at “levels of inaction”. It calls for quicker and wider testing so that milder cases are diagnosed quickly, isolated and the spread reduced. We have seen the speed of change in northern Italy over a matter of a couple of weeks, so should we not be thinking about the delay phase? Containment and delay are a continuum; it is not a switch between one and the other.

We see large leisure events still continuing. They are not critical, so should we not be decreasing them? Do we know yet whether children are spreaders? We know they do not catch the virus, but do they spread it? That would be central to any decision about closing schools, and obviously closing schools would have an impact on NHS and social care staff.

I welcome the announcement in the Budget of funding to support people on sick pay, but will the Secretary of State clarify whether this will be provided to people who do not have sick pay in their contract? That is exactly who we were concerned about when we raised this point.

How quickly will all three devolved Governments hear about the extra funding that they are going to get, since it is urgent for them to take action as well? There has been talk about bringing doctors back from retirement. Is there a discussion with the General Medical Council about relicensing doctors, and about providing Crown indemnity for doctors who may have retired within the last year or two? The UK is already outside the European Centre for Disease Prevention and Control, so will the Government now at least rethink leaving the pandemic early warning and response system?

[Matt Hancock]

The hon. Lady asked some important questions about how Parliament will function. Matters of how we work are of course for Parliament—for the Leader of the House, the Speaker and the Commission, all guided by the science. They are in constant contact with Public Health England to get the very best advice. As for when we are voting, this disease passes in very, very large part from people who have symptoms, and we may not have symptoms. What really matters is making sure that as soon as people have symptoms potentially of coronavirus, they get in contact with 111 or Public Health England.

The hon. Lady asked for more testing. We are absolutely ramping up the testing capabilities. We have been commended on the approach we are taking by international bodies; she mentioned the WHO. She asked about children. One of the good pieces of news about the virus is that it does appear to have a much, much less significant impact on children. On the GMC and indemnity, absolutely —both those issues will be addressed in the Bill, and we are working very closely with the GMC.

The hon. Lady asked about collaboration and work with the European Union. We still remain within the European Union data transfer capabilities. Most of this data is being transferred—frankly, it is being published. We are being as transparent as possible. This week, we brought out a new website in order to be as transparent as possible about all the cases in the UK. Most European nations are taking exactly that approach.

Health Inequalities

Philippa Whitford Excerpts

Wednesday 4th March 2020 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Obviously I welcome what the Minister has said, but she talked about starting to take action and, given that we have had Conservative-led Governments for the last decade, I find it a bit surprising to hear talk of starting to take action now.

Health is much wider than the NHS. This is a confusion that many people make. Health is about everything else. In his acclaimed review “Fair Society, Healthy Lives”, Michael Marmot defined the social determinants of health: the conditions in which people are born, grow, live, work and age. He explained that the variation was driven by inequity in power, money and resource. The review set out how public expenditure could act on the social determinants to reduce health inequalities. The problem is that, although it was welcomed by the coalition Government—there was even a public health White Paper—no action was really taken. In contrast, in 2016, we saw essentially the repeal of the Child Poverty Act 2010, including the reduction targets to get more children out of poverty. In the 2020 Marmot review, therefore, we see not success over the past 10 years, but things going in the wrong direction.

[Karin Smyth (Bristol South) (Lab)]

I agree with the hon. Member about the social determinants of health. Does she agree that, going back 10 or 15 years, to before 2010, the Labour Government appreciated those determinants and directed public policy to that end?

[Dr Whitford]

I do. I respect the work that Labour did, and child poverty was falling. Interestingly, the upturn in child poverty we have seen did not happen with the crash in 2008; it happened after the 2012 welfare changes. That is striking. The impact of Government policy has been austerity in every way and in every approach to individuals, families and communities. We have seen slow income growth for the vast majority of people over the last decade. There has been absolute inequality. The majority of the growth that there has been, has been at the top. The national living wage simply is not a living wage. More people are in insecure work—zero-hours contracts, the gig economy—and do not have protections. As the shadow Health Secretary mentioned, in all the discussion about covid-19, we have been trying to highlight that people on low pay and insecure contracts do not get sick pay, yet we will be asking them to stay at home for two weeks and self-isolate. In the meantime, the wealthiest people have actually trebled their wealth. So categorically we have not all been in it together over the last 10 years.

In addition, we have seen a restriction on public expenditure. The regressive welfare cuts of 2012 and 2016 have reduced support for families by 40%: the benefit cap, the benefits freeze, the two-child limit, the five-week wait for universal credit, which puts people in rent arrears and debt, personal independence payments, the bedroom tax. Eighty per cent. or more of these cuts have affected women directly because they tend to be lower paid, to be carers and to rely more on services. In the main, they are responsible for children. The disabled have also been particularly hard hit. We have not seen a cumulative impact assessment of female lone parents who are disabled and have three or more children. Some of them have had their income slashed.

There have been cuts to local government and services. Interestingly, the least deprived areas face 16% of cuts, while the most deprived on average had 31% cut from their local government budget. I have heard Labour Members talk about between 40% and 60% cuts in their local government budgets. There are changes in the pipeline to move £300 million from local authorities in the north to the south. I wonder if that will be reversed now that the Conservative party has won some seats in the north.

[Jamie Stone]

Some years ago, when I was a councillor, I had a harrowing case involving a young female constituent who was clobbered by the bedroom tax. She has multiple sclerosis and she was going to lose a lot of cash. I want to put on the record my thanks to the Scottish Government for the action they took to ameliorate and offset that tax.

[Dr Whitford]

I thank the hon. Member for that recognition. The Scottish Government are spending more than £100 million every year in mitigating some of these cuts—they pay the bedroom tax and they have set up the Scottish welfare crisis fund—but that is money that should be going into devolved areas, not patching up austerity decisions here; it is not the role of the Scottish Parliament just to mitigate.

Public health in England has been cut by £850 million—again, the greatest cuts to the poorest areas—and it is exactly the same with future planned cuts. This has led to cuts in smoking cessation projects. There is no point standing up and talking about the importance of stopping smoking—we all know that. People who have smoked for decades need help to stop and those services are critical. We have also seen cuts to drugs and alcohol projects and to sexual health projects, and all those have an impact on the poorest people.

The Minister, who is no longer in her place, might have listened to Dame Carol at the drugs summit in Glasgow but, sadly, the Minister for Crime and Policing, the hon. Member for North West Hampshire (Kit Malthouse), did not. He came to Glasgow, made his speech and then left before all the expert evidence was given. We also hear of a social care gap across England of over £6 billion. Again, that affects women if they have to give up work to look after elderly relatives or disabled children. This rolling back of the state has affected the social determinants and increased health inequalities. Child poverty has increased, as we have heard, with 4 million children affected, and 1,000 Sure Start centres have been closed. Education funding is down. There is a housing crisis and therefore a rise in homelessness. People with insufficient funds to afford a healthy life are depending on food banks, and deprived communities are simply losing hope.

Poverty is simply the biggest driver of ill health and has the biggest individual impact on life expectancy. The increase in life expectancy in England has stalled for the first time in 120 years—the first time since 1900. The gap between the most and least deprived has widened: the gap is now almost 10 years for women and the life expectancy of some women in areas of the north-east of England has dropped by almost a year.

[Dr Murrison]

I always listen with great respect to what the hon. Member has to say, but given that the SNP has its hands on many of the levers relating to the things she has discussed this afternoon, I am assuming from what she has said that Scotland is in the wonderful position of having narrowed health inequalities. Could she perhaps compare and contrast what has happened in Scotland with what has happened in the rest of the United Kingdom? I rather think that the two are very similar.

[Dr Whitford]

If the right hon. Gentleman waits to hear the rest of my speech, I will highlight some of the differences in child poverty.

We have seen life expectancy for those women falling, but when we look at healthy life expectancy, the gaps are even bigger. Time spent in poor health is increasing, and that of course puts pressure on the NHS and care services. We in this Chamber are always discussing the pressure that the NHS is under. Emergency admissions in areas with low life expectancy are double the numbers in wealthier areas. Women in deprived areas will now spend two decades or more of their life in poor health. Improving the healthy life expectancy by at least five years was actually a policy in the industrial strategy, so that people could be active and engaged in the economy, but what we have seen is an adverse effect both on health and health equality.

We know that someone’s health for most of their life is determined in the early years, even starting when their mother is pregnant. Child poverty is central to this and it is rising. It is defined as children in households with less than 60% of median income. England had child poverty down to 27%, but it is now 31%. Scotland had it down to 21%, and it is now 24%. That is because welfare changes are taking place right across the UK. Poverty is decided in this Chamber; it is not decided anywhere else, and the Scottish Parliament, as we have heard, spends a lot of energy on trying to mitigate it.

As we know, housing costs are a major contributor because of the shortage of housing. This is a rising issue among the poorest: 38% of the poorest will spend 30% or more of their income on rent or housing. That figure was 28% 10 years ago. The Scottish Government have built 87,000 affordable houses, and that is part of why our child poverty level is lower. It is the housing impact. In the 2015 general election, the Conservatives promised 200,000 starter homes. They built precisely zero.

Some 4 million children are growing up in poverty, and that will affect their whole lives. Whenever the issue is raised at the Dispatch Box, we are told that unemployment is down and that people must work their way out of poverty. We are told that that is how we change things, yet two thirds of those children already have a working parent. The problem is that all of this drives ill health.

[Munira Wilson (Twickenham) (LD)]

Does the hon. Lady agree that children living in poverty are more likely to suffer mental health issues? They face a double whammy, as the Children’s Commissioner recently found, in that there is also a postcode lottery in spending on children and young people’s mental health, which varies between about £15 and £200 per person, depending on the area.

[Dr Whitford]

I totally accept that, and actually, children in low-income families have three times the rate of mental health problems. Three-year-olds in a household with an income of less than £10,000 have two and a half times the chronic diseases, and by the time they start school, we find that the poorest children have over a year’s gap in vocabulary. It is important to try to balance that. That is one reason that the Scottish Government are investing in early learning for all children—all three-year-olds and four-year-olds and vulnerable two-year-olds—and also have put in a pupil equity premium that allows the school to have additional funding to try to meet the challenge where they are serving poorer communities.

The problem starts before the child is born. A woman carrying a female child is carrying her grandchildren, because the eggs in a female are formed in the womb. That means that if that mother is badly nourished, she will be affecting health for the next two generations. That needs to be changed, which is why we have invested. We have the best start grant, which goes to the pregnant woman at birth, when the child starts nursery and when the child starts school. There is also food support, because we need to change this right at the start of life.

Health and wellbeing should be an overarching priority for any Government and for all their citizens, regardless of where they live. This requires a “Health in all policies” approach, not saying, “Clean air is DEFRA’s issue.” We need this as a cross-government policy whereby every decision is checked to see whether it will improve the physical, mental and environmental wellbeing of the citizens the Government are responsible for.

[Several hon. Members rose—]

--- Later in debate ---

[Derek Thomas (St Ives) (Con)]

I am glad to be able to speak in this debate. Cornwall and the Isles of Scilly, which I represent, have a real issue with health inequalities, and I was glad recently to ask the Prime Minister to take a look at health inequalities in dental care. That has been touched on already this afternoon in relation to children. As I have said previously in this Chamber, 60% of adults in my constituency and across Cornwall and 40% of children have not seen a dentist in the past year. It is not so much a lack of funding—the funding actually gets returned to NHS England—as a lack of dentists prepared to work in the NHS. I am glad that the Government’s amendment states that they are

“committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.”

[Dr Whitford]

Does the hon. Gentleman agree with me that part of the problem is the dental contract, whereby dentists are not rewarded for the amount of work they do and certainly not rewarded for preventive care?

[Derek Thomas]

I do agree with that. I did not want to get into party politics, but the Labour party gave the 2006 dental contract to dentists, and we have seen the decline in the availability of dental care in Cornwall from that point. I understand that it cannot be reviewed for another couple of years, but I believe there is work that can be done before then to respond to the challenge, and that is what I want to raise today.

Since I last raised this issue in the House, I have been asking my constituents about their experience. I have heard about disabled people who have to consider accessibility—they cannot get in to the dentist’s and therefore cannot get an appointment. Pensioners are unable to afford private treatment, and have been left stranded without provision for years. Some were getting NHS treatment, but then practices stopped offering it, as they are unable to keep up with demand. Pregnant women do not get access to NHS dental care for the entire pregnancy, but are offered it a long time afterwards, even though it is free during a pregnancy. People have ended up travelling further and further, and I heard of constituents travelling to Bristol and London to get the dentist care they need, which cannot be good for us as we try to reduce our carbon footprint. As I have said, there is also a lack of access for children.

In the time I have, let me share some of the comments that have been made. Mike left the Royal Navy and had a three-year wait for an NHS dentist. Then he got a dentist, but appointments have been constantly cancelled, so he is not seeing a dentist. He believes that the armed forces covenant should offer dental provision. Fred said that he has been waiting five years to get a dentist in Cornwall, so he is now registered at a London dentist, even though he lives in my constituency 300 miles away.

A gentleman who worked away a lot, but his family was in Cornwall, said that he, sadly, did not visit the dentist for two years so was “removed” from the dentist’s list. He had cracked his tooth, but was not able to see a dentist, despite his wife and children still being registered and able to get an appointment. Another gentleman who had been living in Penzance for eight years had to wait two years to be placed at a dentist’s. He got a dentist, but then found that they kept cancelling, so he had not seen a dentist in three years. There is story after story of this happening.

There is light at the end of the tunnel. A lot of work was done last summer by the former MP Sarah Newton and me and other colleagues in Cornwall, and a plan was put in place. NHS England said that it would engage with the national NHS England dental workforce team to look at a more innovative way to attract dental staff to Cornwall and put forward a plan by the end of the year—that was last year. It also said:

“Work is also under way at a national level to identify solutions to the dental recruitment and retention pressures in NHS dentist services, and to understand and address the constraints of current national NHS dentist contracts”,

which has been referred to. I would like the Minister to look at what has happened to the plan Cornwall was promised at the end of last year and what is happening to the review that is going on across the county.

We are doing work locally, but it needs the commitment of Government and others. There is an irony in that we train a lot of dentists in Truro but they do not seem to stay in Cornwall so this also needs the involvement and commitment of the Peninsula dental school, as well as NHS providers and NHS England, to get a grip of this and to ensure that children and adults, particularly vulnerable adults, are no longer discriminated against and no longer face these health inequalities.

We must come together quickly and creatively to ensure that dental care provision is addressed. As we have heard, if we get it right very early in life then we save ourselves a whole host of problems later on.

Coronavirus

Philippa Whitford Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Matt Hancock]

My right hon. Friend raises an incredibly important point, and the answer to the question is yes. We are putting out further advice and guidance to the health system, to the NHS, to GPs and to hospitals today. That will go out from Keith Willett in the NHS.

On the point about the kit needed to keep health workers safe: yes, we are putting in place the actions to ensure that it is available at the right moment when it is needed. There are some GP surgeries that do not have that equipment yet, but we are putting in place the actions needed to ensure that they have it as and when it is needed. As my right hon. Friend knows, the number of cases right now is relatively small. It is 51, as of 9 o’clock this morning. The protective equipment is there, so that for each of these cases we can get right on to them, but if the virus becomes more widespread, of course more and more NHS settings right across the country are going to need that sort of equipment.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the plan, although I have to say that I would have welcomed receiving the briefing yesterday that the shadow Secretary of State mentioned, which I did not receive. The plan lays out a reasonable worst case scenario, and it is clear about the three time phases. Research is of course ongoing, but this will help to prepare the public for decisions that may have to be made down the line. At the moment, containment is based on self-isolation of cases, contacts and those who have travelled to risk areas, but with the spread elsewhere in the world, it is becoming harder to define risk areas. With regard to north Italy, the chief medical officer talked about those with underlying conditions perhaps interpreting the advice more stringently and not travelling, so will the Government either discuss with insurance companies or even consider legislation to make underlying conditions an acceptable reason to cancel a holiday, so that people can get their money back rather than putting themselves at risk?

I agree with the Secretary of State regarding asymptomatic workers and sick pay, but there are staff who have no sick pay in their contract, and some protection has to be given to them. He referred to the seven-day period for self-certification, but isolation is for 14 days, and we do not want people turning up at their GP surgery halfway through that period. Can that be looked at? One issue that I have come across is an employer telling a member of staff returning from a holiday in Tenerife that they should not come to work for two weeks, but the employer does not wish to pay them for that period. We need to look at that, even if it is not health advice but an employer stipulation expecting people to have no income.

As we move into delay, we see that children are not particularly vulnerable to catching this. However, as with other coronaviruses, they may well spread it. Do we have evidence for how much they contribute to transmission, as that will affect decisions on school closures?

What preparations are being made for the long haul? Previous coronavirus outbreaks have lasted not just for a few months but for over a year, so we could be dealing with this next winter. If we move into mitigation, the situation will reverse and it will be about protecting the vulnerable and early discharge to home care. That might require the changing of staff from hospitals and care homes to work in the community, so are the Government in negotiations on such matters as legal responsibility and liability?

The Secretary of State quite rightly talked about what the public should be doing, but should we not already be thinking about stopping shaking hands and about working from home, if possible, without an economic impact? That would also help the climate emergency. Containment moves into delay without a border, so should we not be thinking about trying to get ahead of the curve?

[Matt Hancock]

We have been briefing colleagues as much as possible. Clearly, the CMOs’ time is incredibly valuable at the moment. We have worked with the Scottish Government on this plan; it was signed off by both the First Minister and the CMO for Scotland. In fact, it has been developed with the Scottish Government, the Welsh Government and the Government of Northern Ireland, so ultimately it is a multi-party plan.

The hon. Lady made the point about seven-day certification. That is indeed the sort of reason why we are holding this area under review and there is work ongoing, including on the points she has raised. She also asked about shaking hands. The medical advice is that the impact of shaking hands is negligible; what really matters is washing hands. Our public health advice will remain clear and based on the science—what matters, more than anything else, is that people wash their hands for 20 seconds or more, using soap and preferably hot water. That is the core of the public health advice.

The hon. Lady mentioned working from home. There is an incredibly important point about timing written into the plan. There are actions that we may need to take in future that it would not be appropriate to take now. We are not advising people to work from home now, but we do not rule out doing so in future if that might be more effective clinically, given the disruption it could cause.

Medicines and Medical Devices Bill

Philippa Whitford Excerpts

2nd reading & 2nd reading: House of Commons & Money resolution & Money resolution: House of Commons & Programme motion & Programme motion: House of Commons & Ways and Means resolution & Ways and Means resolution: House of Commons
Monday 2nd March 2020 Commons Chamber

[Matt Hancock]

Yes, that is right. This Bill empowers us to be able to move faster. Essentially, it empowers the UK to build a life sciences regulatory framework that is the best in the world—of course, working with EU partners, but also with partners from right around the world—and all with the intention of getting the most innovative products, as quickly as possible and as cost-effectively as possible, into the NHS. That is the goal of the entire Bill. It is a benefit of Brexit, but it is also worth doing in its own right.

The measures to strengthen innovation with respect to diagnostic tests again strengthen patient safety, because they strengthen the role of the Medicines and Healthcare Products Regulatory Agency. This includes, for instance, allowing us to legislate to create a comprehensive statutory register of medical devices in the UK. Such a register could be held by the MHRA, and we would make it compulsory to register a device along with information such as who manufactures and supplies it. This would mean that the MHRA could conduct post-market surveillance of devices in the UK, making it easier to trigger device recalls where a safety concern arises.

Indeed, we will enhance patient safety by giving the MHRA a new power to disclose to members of the public any safety concerns about a device. This was not possible while we were part of the EU. Previously, if an NHS trust raised a concern about a device and asked if similar reports had been received elsewhere, too often the MHRA was restricted in sharing that information; nor could it always routinely share information with the Care Quality Commission or other NHS national bodies. This Bill gives us the ability to share vital information about reporting patterns with the NHS family, and where necessary with the public, with enforcement powers that will be proportionate, transparent and suitably safeguarded.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I do not recognise the Secretary of State’s description that it was not possible to inform NHS bodies of concerns about machinery or devices. In my 33 years on the frontline, we received daily information about anything that was considered a danger or a failing, so I do not recognise that.

[Matt Hancock]

In some cases it was possible to share that information but not in all cases, and it will be possible now. I have no doubt that the hon. Member, like others on the frontline, will have received some information, but the MHRA is currently limited in the information that it can share with other NHS bodies. We are removing the limits on that information sharing, which of course needs to be done appropriately, but should not be set in primary legislation.

Our goal is this: we want the UK to be the best place in the world to design and trial the latest medical innovations. This Bill gives us the powers we need to make that happen. It will mean that the NHS has access to the most cutting-edge medicines and medical devices, with enhanced patient safety; it will help our life sciences seize the enormous opportunities of the 2020s, supported by a world-leading regulator; and it will help us pave our way as a self-governing independent nation. I commend the Bill to the House.

--- Later in debate ---

[Chris Green (Bolton West) (Con)]

It is a pleasure to follow the hon. Member for Leicester South (Jonathan Ashworth) and to speak in this important debate. This is an immensely important subject of great national interest. In the context of leaving the European Union, the Bill will allow existing European Union regulations on medicines and medical devices to be transposed into UK law. The Bill is closely linked to the timings of the transition period as we leave the EU—and perhaps to any extension, which we hope to avoid.

I welcome the Bill’s principal thrust, which is to remove unnecessary bureaucracy for the lowest risk clinical trials, to encourage the rapid introduction of new medicines, to ensure patient safety by combating counterfeit medicines, and to extend the UK’s global lead in personalised medicines and artificial intelligence in health. Ultimately, all those concerns link up to what ought to be our principal focus in this debate: better patient outcomes and creating a healthier society.

Many people would be surprised to hear just what a contribution the life sciences sector makes to the UK economy. It encompasses pharmaceuticals, medical devices and medical technology, and it is worth over £74 billion per annum. The sector also employs close to 250,000 people in the UK. Many of those jobs are often secure, and are highly skilled and highly qualified. We will shortly introduce an immigration Bill. It is right that we focus on the skills and the contribution people can make to the UK. Bringing more people to the UK with PhDs and STEM—science, technology, engineering and maths—qualifications ought to complement and enhance the support of our life sciences sector. The more we hear about technicians, engineers and scientists who want to come to the UK, the more it will be a really positive thing not only for the sector but for immigration to the UK as a whole, and how people perceive it.

[Dr Whitford]

Does the hon. Gentleman recognise that young graduates with a degree or a PhD, technologists and researchers often do not earn more than the threshold the Government have set for a visa?

[Chris Green]

That is a significant concern. The Government have reduced the starting point in the immigration Bill from £30,000 to about £25,000 and I believe the points-based system will have the flexibility we require, but those areas should be judged and reviewed as time goes on. Certainly in these sectors we want highly qualified, highly skilled and highly experienced people to come to the UK.

One big concern in medicine is data. A lot of what we do in medicine falls into the category of big data: the acquisition, transmission, storage and application of that data. This is a really interesting time for technology. The devices themselves are able to generate good quality data. As has been highlighted, it is now so much easier for personal devices to be worn not just for a few hours or a couple of days, but for a long period of time. People are now able to go about their daily lives in a normal way, whether they are exercising or doing something as basic as having a shower. Some devices could not previously cope with people taking exercise or having a shower, but increasingly, devices are able to cope. They can amass a vast amount of data. It is pretty much impossible for a clinician or a GP to judge such a huge wealth of data, so we are increasingly looking at how GPs and hospital consultants can use artificial intelligence and other methods to give them a helping hand in carrying out the assessments. They might end up with tens of thousands of pages of data and a consultant just will not have time to consider it all. Using artificial intelligence could help them to do the assessments and come to conclusions.

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[Chris Green]

That is a vital and well-made point. Data can empower the individual. They can have more detailed access to their own records and their own data. The data generated by someone wearing a device day in, day out, week in, week out can be transmitted to a consultant, who can call a patient more promptly if there is anything a little worrying. If there is a heart murmur or someone feels a bit dizzy, the person can register that concern at that moment. That is useful information for the clinician, who will be able to recognise when someone’s lifestyle has aggravated a condition. There are many ways that the data can be used. I think we are in relatively early days. I am not sure I would include Fitbits and that kind of technology—there is far more interesting and advanced technology—but it is important that people are increasingly engaged.

There is a concern about the embrace of technology, devices and data, and the streamlining of processes in hospitals. The contribution of individuals, GPs and consultants provides an opportunity to consider a more engaged approach to hospital and GP services in a way that could reduce the number of appointments that are necessary. Some hospital trusts have a chief innovation officer on their board. I think there are about 20 across the country, which is a relatively small proportion. It may be worth considering what the Minister can do to promote that. Ideally, we need the early adoption of approved medicines in the system. This is where the register ought to help. If we can have people in hospital trusts leading and championing the adoption of new technologies, providing information and insight, perhaps we can give more confidence to chairmen and boards as a whole. We could then have more trusts adopting technologies. We could therefore support the industry and patients, and get them the medical treatment they need earlier.

[Dr Whitford]

That might well be the case with gadgets, devices or new digital apps, but with new drugs, it is usually the clinicians who are desperate to get their hands on them. Most new drugs, particularly for challenging conditions such as cancer, are expensive and it will be several years before they are passed by NICE in England or the Scottish Medicine Consortium. The delay is not the clinicians not wanting access; it is the cost of introducing them.

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[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Bill is necessary because of Brexit, as the UK is losing the European Medicines Agency—one of the great advantages was working together to have a single licensing system that licensed new drugs right across Europe. As the hon. Member for Bolton West (Chris Green) described, it is about working with other countries to avoid duplication and to speed up getting new drugs from the laboratory to patients who need them.

The problem is that manufacturers will have to apply separately to the UK, which means extra processes and additional costs. It is important, therefore, that whatever system is adopted is as similar to the EU as possible and does not ask for a whole different set of work-up, investigation and paperwork, or that will put manufacturers off launching their drugs in the UK. The same issues apply to veterinary medicines, hence they are in the Bill.

The simple fact is that the EU is a market of 500 million people—a quarter of the world pharmaceutical market. The UK on its own is only 3%, which is why drugs tend to be launched in the US and Europe at the same time. In all my 33 years on the frontline, I saw an acceleration of drugs getting from the bench top to the patient, because of the EU and the European Medicines Agency. This means that there are likely to be delays for patients. Canada and Australia wait another six to 12 months before drugs are launched there, so how will the Government avoid a delay in patient access, particularly for new drugs from outside the UK and for conditions such as cancer, where patients are literally waiting for the drug?

[Chris Green]

I realise that this is a distinct area, but does the hon. Lady share my concern that sometimes the EU as a whole is quite slow at reform—for example, with the clinical trials directive and the clinical trials regulation? The CTD was first devised in 2001. We are now in 2020 and we have not yet updated it. Industry and wider sectors would like the update to happen, but it is taking a very long time.

[Dr Whitford]

I thank the hon. Gentleman for that point. When we are trying to collaborate and get a group of 28 countries—indeed, 31 countries, because the European economic area is involved—to all agree to such enormous changes, with legal ramifications for their drug and device producers, and so on, it takes time, but in the end, I think it will be worth it. Of course, I would have liked it earlier. Having been involved in breast cancer trials, I know that the clinical trials directive was clunky and bureaucratic, but it is being changed.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank my hon. Friend for answering the extremely important points that have been raised. Does she agree that it is also extremely important that those with rare diseases still have access to the clinical trials that can perhaps only take place in the EU, because they need to have so many participants? The UK on its own might struggle to have those clinical trials for rare diseases.

[Dr Whitford]

That is an excellent point, which I will come on to shortly, and I absolutely agree with my hon. Friend.

The Bill puts attractiveness as a place to do trials and supply medicines almost on a par with safety and drug availability. What exactly does that mean? The shadow Health Secretary was right to seek a definition of that phrase. Is it about cutting red tape? If so, I would point out that one man’s red tape is another man’s life and limb. The Association of the British Pharmaceutical Industry says that the industry does not want divergence or lower standards, or standards that change all the time. Alignment with the EMA and the FDA in America keeps costs down, reduces delays and keeps bureaucracy down. The industry here will have to match EU standards for the bulk of its production and will not be keen on doing small-batch production for the UK only if that has a totally different set of standards.

It is important that the new measures on falsified and counterfeit medicines be taken. The unique identifier number, including barcode scanning, is important, as are tamper-proof containers. There is a whole market out there in counterfeit drugs and it endangers patient safety, which is vital in all of this. As part of that, we will have to negotiate data sharing with the EU and the EMA to enable pharmacovigilance on a bigger scale and make it possible to recognise much earlier patterns of side effects and complications.

How will the Government provide the extra funding and support to the MHRA, which is to take on an extensive area of extra work? How will it combine that with delivering quicker assessments and licensing so as to encourage companies to launch their devices or other drugs in the UK? As has been referred to, there is a need to replace the clinical trials directive, which in the original version was indeed very bureaucratic. As a clinical trialist within breast cancer, I found it to be often quite off-putting. The new clinical trials regulations create an EU-wide portal—a single point of digital registration of trials and collaboration on design, recruitment, data, entry and analysis. Unfortunately, UK-only regulations will not replace that when it finally goes live in 2022.

International collaboration is critical to research, and the European research network is the biggest in the world—bigger than China and bigger than the US. As mentioned by my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and the hon. Member for Bolton West, that collaboration is vital for rare diseases, where the number of patients in any one country is low. That is why we have made so much progress in rare diseases, childhood diseases and childhood cancers in the past decade or so—because of funding from the EMA and collaboration on an extensive Europe-wide basis. As regards cancer, my own specialty, half of all UK cancer trials are international, and 28% of Cancer Research UK trials involve at least one other EU state. The BEACON trial for recurrent neuroblastoma involves 10 countries. It was designed in the UK, but the principal investigator is in Spain. Some of the original funding came from the UK, but the drug comes from Switzerland. Ten countries are contributing to trying to find hope for children and families suffering from this horrible disease, for which we are struggling to find a cure. There were 4,800 UK-EU trials between 2014 and 2016. How will the Government maintain that sort of collaboration and involvement?

Part 3 of the Bill relates to medical devices, and I totally agree it is not before time. The EU has also moved to bring in regulations regarding medical devices. It is important to apply similar rules to devices as are applied to drugs. Until now, it has been far too lax. As was mentioned, manufacturers pay for assessments, and I would suggest the same apply to digital health apps. At the moment, the companies that design them assess them themselves. We need instead a neutral and independent system of ensuring that they are safe. Just because something is AI or digital does not mean it will give patients good advice.

Registered clinical trials of devices should report all findings. It is far too common, where there are negative findings or findings of no advantage, that they are not published and that therefore in essence the information is hidden. As we have heard, there should be no tabletop licensing of devices whereby a device is simply migrated from one form to another without being retrialled. This was exactly the problem with vaginal mesh, where in essence the end operation, compared to the original operation in the trials, was unrecognisable. The Cumberlege review should give us food for thought and help us focus on safety and not market expediency. It is also important that there is a system to report complications to the MHRA, like the yellow card system with drugs, so that problems are spotted sooner. Again, across a bigger population that is likely to be quicker.

Implants should also have a unique identifier number that can be scanned as a barcode to the patient’s electronic records, to the hospital episode system and to any registers. A register will be data that is just sitting there and which can be interrogated if someone needs to recall patients with certain implants because of a problem. Following the scandal around PIP implants, which did not have medical grade silicon in them, I remember having to wade through the case sheets of patients who had had breast reconstruction. It was not an implant we had ever used in our hospital, but we had to be 100% certain that no patient treated in the plastics unit in Glasgow had had the implants either. It is critical that we avoid such chaos in the future, and if a register has an expert steering committee, it can become a registry, a dynamic beast that can monitor practice and bring knowledge back to medical practitioners, researchers and so on. One of the earliest and biggest examples is the national joint registry.

The Bill includes provisions to extend low-risk drug prescribing to other healthcare professionals. We all recognise the changes in the workforce that have already happened and which are coming in the future. There are processes for assessing competency and certifying that someone—an advanced nurse practitioner, for example—can prescribe in their own right. The Royal College of Surgeons and the Royal College of Physicians have raised the issue of physician associates and surgical care practitioners. They feel that if prescription powers are to be given to such individuals it is critical that they are registered and regulated, but while these new professions are developing they are not registered or regulated. If this is the future of the NHS workforce across the UK, it has to be dealt with—they need to be registered practitioners.

[Jim Shannon (Strangford) (DUP)]

The hon. Member refers to physicians and others and to the shortage of doctors, but is there not also a role for pharmacies to play in diagnosing people early on? Is that not something that should be done as well?

[Dr Whitford]

In Scotland, we have had the community pharmacy system since 2005, which includes that, and the range of protocols for a pharmacist to prescribe against has been increased, but I agree it has further potential. One advantage is that pharmacies are usually open all day Saturday and often have longer hours. For people who are working who have a relatively minor condition, being able to get both advice and treatment from a pharmacist makes a big difference.

[Jim Shannon]

I forgot to mention that I also believe pharmacies could play a role in diagnosing sight loss, glaucoma and other things—small things that can be done in pharmacy. Is that something else that could be addressed?

[Dr Whitford]

In Scotland, we put a lot of effort into sweating the assets, if you like, within the community, so optometrists can carry out that job. They no longer refer through a GP. If they diagnose cataracts, for example, they refer directly, and they provide a lot of out-of-hours care for people with acute eye problems, foreign body inflammation, infection and so on, to the point that very few patients now go to A&E with an acute eye problem. We have all sorts of expertise in our communities, and we should use it, so I agree with the hon. Gentleman.

I welcome the Bill’s reference to internet pharmacy provision, but I think that there should be a step up—a whole step change—in the form of stronger action to control internet pharmacy providers, especially in the context of what are described as prescription-only medicines. The son of a constituent who came to see me was able to obtain large quantities of dihydrocodeine, a fairly addictive painkiller, over the internet simply by filling in an online form, having not seen a GP and without producing a prescription. I asked the constituent to find out what the website was so that I could report the organisation, but the website had gone. That is the problem with the internet: it is ephemeral. Unfortunately, that young man has now become addicted to dihydrocodeine, and is trying to be weaned off it. As in the case of other versions of online harm, we need to deal with people who are hiding in the internet: we cannot allow the supply of counterfeit or addictive medicines to patients without any form of control.

I have some concerns about the Bill. For instance, I agree with the hon. Member for Leicester South (Jonathan Ashworth) about the extensive delegated powers. The Secretary of State said that the same powers had been in place when the United Kingdom was in the European Union, but their purpose in the past was to enact EU directives which had been debated and consulted on in the European Council and the European Parliament. They had been worked out before agreement was reached, and were therefore purely about enacting something that had been hammered out and agreed within Europe. That is not the case here. Almost every clause in the Bill simply hands over a delegated power, but I think some of the major changes that are being introduced in the Bill are significant and should be in primary legislation. Of course regulations will flow from that and will be covered by delegated powers, but for radical changes to made purely in relation to such powers represents a missed opportunity, and they should be limited.

Part 3 provides for the maximum sentences for offences against the Bill to be set at six months. In Scotland, the maximum sentence in a summary case is 12 months. Removing that sentencing power in Scotland with no consultation does not seem right, and a presumption against sentences below 12 months there would make custodial sentences less likely. What kind of prevention and what kind of warning will there be if it is clear to people that imprisonment is never going to happen? The civil penalties presided over by the Secretary of State prevent criminal prosecution if either the maximum or a lower sum is paid in advance. That fetters the operation of the Scottish criminal justice system, because those involved in it would lose the right to prosecute if they felt that the issue was serious enough. The Lord Advocate in Scotland should have been consulted on both issues, and I suggest that that should be corrected as the Bill proceeds.

Part 4 does indeed call for consultation prior to any new regulations, but there is no formal mention of Ministers in the devolved Government, despite their responsibility for healthcare. In other Bills with which I have been involved, it has been normal for the Ministers of the devolved nations to be listed specifically. When legislation is to impinge on such a major devolved competency, it is important for them to take part in discussions. I also think it important to have a structure enabling medical bodies, experts and industry to contribute to the consultations, to ensure that all aspects have been considered.

There is no choice but for the Bill to go ahead because of the legislative gap that will result from our leaving Europe and the European Medicines Agency, particularly at the end of the transition period. We will therefore not force a vote, although I hope that we will be able to strengthen some aspects in Committee. Having to leave the EMA is just one example of what we are losing because of Brexit. Far from cutting red tape, Brexit will increase bureaucracy and costs for the pharmaceutical industry, the NHS and patients—and that is even before the possible impact of a United States trade deal on drug costs.

I am concerned by the threat to walk away from negotiations in June and move towards a no-deal outcome yet again. That would increase the risk to patients. Simply calling it an Australian deal does not cut it, because the Australians do not have a trade deal with the EU. I should like to know whether the Prime Minister or the Secretary of State has somehow solved the problem of supplies of insulin and medical radioisotopes, not just for a couple of months around the transition point but in the long term. The UK does not produce insulin or medical radioisotopes, and any friction at the border—which at present looks inevitable—will increase costs and delay access.

I also find it concerning that despite covid-19, which initiated a Cobra meeting this morning, the UK apparently does not even want to remain in the PANDA—Protocol for the Assessment of Nonviolent Direct Action—early warning and response system of the EU post-transition. Such isolationist policies are dangerous for everyone: for our constituents, and for our patients. We cannot get away from it: Brexit is a loss to healthcare and research, and the Bill cannot stop that. The principle of collaboration is central to the EMA, the European research network and, indeed, the EU itself, and it will be hard to replace that if we are throwing up barriers.

--- Later in debate ---

[Dr Evans]

Absolutely, and I agree with the hon. Gentleman that that is exactly what a GP should be doing. However, when a GP is dealing with hundreds of requests for repeat prescriptions, it is unlikely that they will have time to phone every single one of those patients to say, “Is this what you need? Have you already got it?” That has been the role of clinical pharmacists, particularly in relation to people who have multiple prescriptions for four, five or six medications, at the time of their medication review, which I entirely agree with. A GP will indeed look at a medication review, but when someone asks for a repeat prescription, they usually do it either electronically or by making a simple mark or cross on a piece of paper that they take to the GP surgery. It is unlikely, if the prescription has already been set for six or 12 months, that there would be a review of the prescription each month. That is the whole idea of having an annual review. In the old days, people could be on medications for months, if not years, without ever being checked. The reason for doing that was convenience. If a patient had to come in to see their GP every month to justify why they wanted their medication when their condition, say diabetes, was stable, that system would not be sustainable, given the current pressures on the NHS.

My second point relates to trials and tests. For me, another element that is missing from the Bill is a duty of care. I would like to give an example of a patient who came to see me who had had her genome sequenced. She came in with a report, and she said, “Dr Evans, I have been told I have a 50% chance of having cardiovascular issues and an 80% chance of having Parkinson’s disease. Please can you help me out?” That was very difficult to deal with. First, there is as yet very little we can do to influence Parkinson’s. Secondly, at that point I had had no training on counselling someone who had had genomic testing. The cardiovascular side was easier: we know some remits, and we can make a difference with cholesterol, exercise and lifestyle advice. But this is just the tip of the iceberg, and as the tests become more advanced and more people have them, I would like to see emphasis being put on ensuring that those doing the tests have a duty of care to ensure that there is follow-up and comeback for the person who has the test.

[Dr Whitford]

Does the hon. Gentleman therefore agree that it was completely wrong last year when the NHS in England tried to offer genomic testing for £500 or £600, provided that people were willing to allow the data from their genomic testing to be used in research, without any thought of the outcome that that would generate for general practices right across the country?

[Dr Evans]

The hon. Lady makes a good point. I have no problem with that, provided that those doing the tests are also doing the follow-up and ensuring that the patient who has had the test has had counselling before, during and after it.

[Dr Whitford]

If the hon. Gentleman thinks that genomic testing for completely asymptomatic people without any family history is a benefit, does he then support the idea that it would only be the better-off people who could afford £500 or £600 who would have the test? Would that not widen health inequalities, which we will be debating on Wednesday?

[Dr Evans]

I am grateful for the hon. Lady’s point, but I would simply say that the NHS is going that way and will be providing those tests. My simple point is that whoever goes through such a test must have counselling afterwards to tell them what to do with the information. We could put that in law. It does not matter if the testing is done by the NHS or by a private testing facility. If an individual makes the choice to have the test, it must be incumbent on the person doing the test to inform them completely and counsel them throughout the test and of course afterwards when they are given the result. That duty should fall on the NHS, if the NHS has done the test, and on the private provider if the private provider has done it.

--- Later in debate ---

[Liz Twist (Blaydon) (Lab)]

The Bill is, of course, necessary to ensure that, in the absence of the European regulations under which we operate until the end of the implementation period, there are effective ways to regulate medicines and medical devices. Even under the current regulatory arrangements we have seen some patients face real difficulties, so it is vital that we get this right, as others have said.

The Minister will be aware that I and many hon. Members across the House have been working with the National Society for Phenylketonuria, or PKU, through the all-party group, to ensure that people with PKU have access to Kuvan, a drug widely available in many other countries. It feels like that has been a pretty hard slog at times, and we have not got there yet. I pay tribute to the NSPKU and, in particular, to Kate Learoyd and Caroline Graham, who have done such a lot of work to get the all-party group established and keep it very lively.

How much more difficult must it be for those people living with PKU—children and adults—to know that there is a drug that would help many of them, but to find that it is not available, than it is for us to see that situation for our constituents? In introducing the debate, the Secretary of State made a great deal of our new powers to act under these arrangements, and I hope very much that that means that Kuvan will become available very quickly. More broadly, I ask the Minister what this Bill will mean for patients with PKU who are hoping to have that drug made available, and how it will affect new therapies and drugs that are in development to treat PKU. How will they be licensed and made available?

Many rare diseases require a large pool of patients to have effective clinical trials of new treatments, and again I ask the Minister if she can say how she will ensure that UK patients can take part in those trials and benefit from innovative treatments. This will be important to the community of patients with rare diseases, not only those with PKU, and I know that there will be great anxiety about the issue of translating EU regulation into UK law and making sure that issues of access, safety and clinical trials are fully covered and regulated. UK patients with rare diseases must not be disadvantaged by separate licensing and trial arrangements, and I ask the Minister to comment on that.

Secondly, this legislation clearly impacts on the role of the MHRA. At this point, I want to mention the great work of Emma Murphy and Janet Williams, who have worked so hard on the issue of fetal valproate spectrum disorder, to which my hon. Friend the Member for Leicester South (Jonathan Ashworth) referred. They have found that, despite the devastating impact arising from women with epilepsy being prescribed the drug valproate during pregnancy and despite these problems being known about among the medical profession for many years, that drug is still being prescribed, sometimes in unmarked boxes, and is still causing damage to babies whose mothers have taken the drug. I hope that this new system will ensure that the regulations are strengthened to ensure that that cannot happen in any case in the future—the will is there to do it. This is happening even after advice to doctors and pharmacists had already been given as a result of the fetal valproate syndrome campaign, so we need action to resolve that straightaway.

[Dr Whitford]

I totally agree with the hon. Lady about the concerns and, we hope, the opportunity to ensure that any pack of sodium valproate that is dispensed carries the information. Does she share my concerns at the talk of having digital information, as many people are digitally excluded? Having actively to seek information about a drug is perhaps an additional barrier. We should be making this easier, simplifying the leaflets that are in with drugs, perhaps by having more infographics, to allow people with poor English or limited understanding to recognise what they should be doing around their medication.

[Liz Twist]

I thank the hon. Lady for her intervention, and I agree that there is a concern about that. All forms of communication are great, and digital, as an extra, is good, but it must not exclude people who do not have access to computers or the internet. It certainly must not replace those paper warnings on boxes of tablets—we need to strengthen that bit as well.

I would like to see a strengthening of this legislation to make sure that what I have described could never happen again. I would also like to see effective data sharing, so that issues such as this were identified and acted upon quickly. Data sharing with the EU will continue to be important, so I ask the Minister, how will such data be shared with EU countries to ensure that we share those experiences and warnings?

Finally, I am concerned at the use of Henry VIII powers to create pharmacy hubs. There is already a concern that some community pharmacies face challenges from prescription-by-post services, at the same time as we are encouraging people to seek advice from their local pharmacist first. It is really important that local pharmacies are not pushed out of communities as a result of these measures, because they are really valued by the people who use them. Will the Minister tell me how she will ensure that that does not happen as a result of the powers to create pharmacy hubs?

Coronavirus

Philippa Whitford Excerpts

Wednesday 26th February 2020 Commons Chamber

[Matt Hancock]

There has been a roll-out to a wider number of laboratories, and we are working through plans for wider commercial diagnostic testing. We are working with around a dozen private companies, and using private diagnostic testing companies, not least because globally there is a search for a “by the side of the bed” testing capability. At the moment, all testing is done in labs, which means that someone has to take a swab to the lab and get the result. We want testing capabilities that involve a bit of kit by the bedside of the patient, so that tests can be run onsite. There is a global search for that capability, but it does not yet exist. We are putting funding and support into making that happen, and I hope we will soon get to that solution.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Worldwide we are looking at about 80,000 cases of coronavirus. That is 10 times the number that we saw with SARS, which suggests it is a very infectious condition. Will the UK Government liaise with international partners to ensure accurate reporting? It is critical to map the spread of coronavirus, and there will be a danger that some countries under-report because they are afraid of economic impacts. Has any consideration been given to using thermal detection technology at Heathrow, and for that to be spread across more sites? We can no longer think that this only involves people who come from a few countries—people follow different routes, and almost everyone coming in would need to be screened.

As the Secretary of State said, there is only a small window of opportunity when it is possible to prevent or contain the initial spread of coronavirus. As I have previously said, I am concerned about not self-isolating asymptomatic people, particularly when we are aware that the case that spread the condition to others in the UK involved someone who was not significantly symptomatic. We do not know what the prodromal phase of coronavirus is, and people could be spreading the condition without our knowledge. The advice must be clear.

Does the Secretary of State recognise the confusion there is that those returning from certain parts of north Italy must self-isolate, even if asymptomatic, but those coming from China do not need to self-isolate if asymptomatic? That is causing confusion and we may end up behind the curve. If containment is to work, we must be ahead of the curve. Self-isolating does not count as illness, so will the Government send a clear message to employers, so that those who are advised to self-isolate will still be paid or receive sickness cover? Otherwise, there will be people who feel that they must go to work, because they simply cannot afford to have no income for two weeks.

The Secretary of State suggested that he would not go to wider northern Italy, and the Chief Medical Officer suggested that people with health conditions should not go there. Travel insurance kicks in only when the Foreign and Commonwealth Office gives clear guidance. Will that guidance be changed to state that people should not be travelling to wider northern Italy, and other areas, so that people are not disadvantaged by not having travel insurance if they choose not to put themselves, and indeed all of us, at risk of the disease spreading?

[Matt Hancock]

The hon. Lady is right with regard to concerns about under-reporting, especially in some countries. I am afraid I do not recognise some of her clinical observations, and I do not recognise the idea that we should change travel advice between China and Italy. We should base travel advice on expert clinical evidence. I am very happy to ensure that she receives a full briefing from medical experts, so that she can get the clinical points right.

On thermal detection, rather like stopping flights this is against clinical advice. The clinical advice is not to undertake thermal detection, because we get a lot of false positives. Indeed, the only country I know of in Europe that undertook thermal detection at the border was Italy and that is now the scene of the largest outbreak.

Finally, the hon. Lady made a very important point about people in work and self-isolation. Self-isolation on medical advice is considered sickness for employment purposes. That is a very important message for employers and those who can go home and self-isolate as if they were sick, because it is for medical reasons.

Wuhan Coronavirus

Philippa Whitford Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

This is a very important strand of our prepare and mitigate policy to ensure that should things get worse here the NHS is fully prepared. The NHS has the capability now to cope with the very highest level of intensity and isolation with 50 cases, and the capability to expand that to 500 cases without an impact on the wider work of the NHS. If the number of cases gets bigger, we will of course need to take further steps. As my right hon. Friend knows from his time in my shoes, extensive plans are already in place for how they should happen if we reach that eventuality.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, welcome the Secretary of State’s statement, and we support the use of powers to maintain isolation, as they are critical for the health and safety of other people in the country. I would, however, also support their being transparent and proportionate. I also welcome that the four chief medical officers across the UK are working together on this issue.

The Government are advising symptomatic returnees from the high-risk countries, but should that not be all people returning from high-risk countries? We simply do not know what the prodromal part of the incubation period is, nor how infectious someone actually is before they have any symptoms at all. I have to say that I was surprised to see the bus drivers, who were driving those on their way to quarantine, sitting in the front seat in shirt sleeves besides someone in full hazmat gear. That seemed to me to send out a rather strange message.

It is also advised that only those from Hubei province should self-isolate even if asymptomatic, but we see from the cases in France that this is spreading very quickly, and we already have 40,000 cases across 28 countries. Therefore, if anyone is flying and going through airports, there is the risk of spread, from simply being on an aeroplane with someone coming from China.

I welcome the funding for vaccine research and the expansion to 12 test centres across the four nations, but what publicity campaign is planned to educate the public upfront not to go to their GP and not to go to accident and emergency, where they will actually spread it to someone else? I understand that the information is there on the Scottish NHS inform system or 111, but if someone is not looking maybe we need to be proactive about the message.

Finally, the UK is no longer part of the European Centre for Disease Prevention and Control. While we are able to take part in the early warning and reporting system during transition, we are no longer part of the decision making or central procurement of vaccines. How much of that system is the UK still able to be part of at the moment during transition and in the long term? Does that perhaps raise up the agenda some of the areas of co-operation that need to be sought with European Union agencies?

[Matt Hancock]

I am grateful for the broad support expressed by the hon. Lady. I am also very grateful for the work of the devolved authorities in Scotland, Wales and Northern Ireland, and the work of the four CMOs across the UK, who have worked very closely together on what is a public health emergency.

To answer the hon. Lady’s specific questions, all those returning from any of the named countries, which I reiterated in my statement, should, if they are symptomatic, self-isolate. We are taking all measures that are deemed to be effective on the clinical advice. As a clinician herself, I am sure she will recognise the importance of following the epidemiological science wherever possible to make sure we take steps that will be effective and proportionate to the scale of the challenge.

The hon. Lady also asked about the monitoring of those returning on flights. We have enhanced monitoring in place for all those returning, as I said. She also asked about a publicity campaign to get the message across about what people can do—people should wash their hands and follow the advice in the “catch it, bin it, kill it” tissue-use campaign—as well as the important message that the first thing that someone should do is call 111. We have a very significant publicity campaign and I will double-check that that is being co-ordinated with the devolved authorities—I think it is but I will double-check, because that is very important.

Finally, to answer the point about the bus drivers, that decision was again taken on clinical advice to promote the safety of the passengers and balance all the considerations that needed to be taken into account.

Paterson Inquiry

Philippa Whitford Excerpts

Tuesday 4th February 2020 Commons Chamber

[Ms Dorries]

My hon. Friend is right; Rahman has been suspended. He is not practising at the Spire group. However, he is still in a non-patient facing role at the trust, and we are querying that.

My hon. Friend is right to say that this has been harrowing, and many women were affected. I do not think I can give him a guarantee that this would never happen again, because for that to happen we would have to have somebody reviewing every single appointment, operation and case that any doctor undertook. We have a process in place now that was not in place then. The CQC was not inspecting the private sector then, and it was not inspecting the NHS robustly enough. That has now changed. We also have the revalidation system, brought in by the General Medical Council in 2012 after Paterson. It is really important to point out that Paterson is in jail and has been for some time. This inquiry came after Paterson had gone to jail, and the purpose of the inquiry is learning, so that we can look at the recommendations and improve our service to patients in both the NHS and the private sector as a result.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Having been a breast cancer surgeon for 33 years, I find this case heartbreaking, and I can only apologise on behalf of the profession. The hon. Member for Leicester South (Jonathan Ashworth) highlighted that the way in which women were treated after the event and the fact that they had to fight for help and compensation added insult to injury.

As the Minister said, this was not a failure of processes not existing; it was a failure of processes that were not enforced. This scandal went on for 14 years, which highlights a failure to listen to people who raised concerns early on and the fact that there was a power differential between Paterson and people who were raising concerns. It should have been striking that his rate of surgery was so much higher among his private patients than his NHS patients. His practice was not being looked at within NHS quality audits, which might have shown that up. What will the Government do to ensure that all units are taking part in national audits, which faded away over the last decade, and in Getting it Right First Time, so that units cannot just opt out? Will that be rolled out to the independent sector, to ensure that units take part in national audits?

Breast cancer is a multidisciplinary team specialty, but we have to do a 360° appraisal only every five years. To me, that is the most telling and most important part of appraisal, and the Government should look at that part of appraisal being made more frequent and, again, being extended to private hospitals.

The Health Service Safety Investigations Body is currently envisaged as working only in NHS hospitals and for NHS patients treated in independent hospitals. Surely the Government recognise that the Bill legislating for that will need to be amended, to ensure that the HSSIB can investigate across the piece.

Once again, we come back to whistleblowers who have raised concerns, have not been listened to and have been suffering detriment, and an opportunity to stop Paterson many years earlier has been missed. What reforms are the Government planning genuinely to support whistleblowers? I am presenting a private Member’s Bill tomorrow, because we need a root-and-branch reform of how whistleblowers are treated.

[Ms Dorries]

The hon. Lady raises a wide range of issues, which I will try to go through. First, I reassure her that, at the time Paterson was practising, the CQC was not investigating or assessing the private sector; that was introduced in 2015. Whistleblowing was in an entirely different place from where it is now. We now have 500 lanyard-wearing national guardians across the NHS, and we encourage people to raise their concerns with those national guardians, the guardians to listen and the trust to act quickly on the concerns raised. I think it is fair to say, that since 2012, when the CQC introduced revalidation, a number of regulatory processes have been put in place. There was shockingly little at the time that Paterson was practising. The system is now much more robust—and yet, I completely take her point; much more still needs to be done.

We are learning the lessons from Getting it Right First Time. In fact, that is a subject of discussion within the Department. We are looking at how the lessons have been applied and what we can learn.

The hon. Lady is right about revalidation and 365° appraisal every five years. As she will know, the CQC is an independent body. It introduced revalidation and appraisal. Our job is now to ask the CQC to make that system more robust and look at how to improve it, because that is an important part of the equation, ensuring that something like this does not happen again. I say here and now at the Dispatch Box that I would like the CQC, as a matter of urgency, to look at how it can make that system more robust and effective, so that we can quickly identify doctors—not those like the hon. Lady—who are not up to standard, who are outliers and who should not be practising.

We will look at the hon. Lady’s point about the HSSIB. I do not think that there is a role for the HSSIB in the private sector. The private sector is a matter of personal choice. It is our job to ensure that healthcare reaches the same standard across the board, whether it is in the private sector or the NHS. The CQC does that, and that is how we hold the private sector to account. Then it is down to patients to make the choice about where they wish to be treated; that is their independent choice. That is a matter of consent, which is something else we need to look at—how do conversations about consent take place? Does the patient have the capacity to take in the information being given to them? Are they making an informed choice? Do they have enough information about the surgeon they are seeing to make the right choice? Those are the issues we need to focus on.

NHS Funding Bill

Philippa Whitford Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

Let me now say a few words about new clause 5 and inflation. I am conscious that a number of other Members wish to speak, so I will be fairly brief. The new clause is a safeguard to deal with a mistake made in the Bill. Because the amounts are presented in cash rather than real terms, the figures may not end up being as big as they at first appear. While inflation is now relatively stable and within a reasonable range of the Bank of England’s target, I do not think that anybody—particularly at this time—can confidently predict the rate at which it will be running at in two, three or four years’ time.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Is that not the most critical weakness in the Bill? Given that inflation is expected to rise after Brexit, the figures for 2023-24 are just guesswork. There should be a commitment to £20 billion by that year, in real terms.

[Justin Madders]

There are indeed many weaknesses in the Bill, which, given that it is so short, is quite an achievement on the Government’s part. That is the point of the new clause. We cannot say with any certainty what the rate of inflation will be in a few years’ time. It is important for funding that is seen as adequate now—at least by Conservative Members, if by no one else—not to be downgraded further as a result of economic turbulence. We have had no guarantees that a different economic picture will change the Government’s stance. Indeed, when on Second Reading we sought assurances that the NHS would still receive the real-terms increases envisaged in the Bill should inflation run at unforeseen levels in the future, no commitments were forthcoming. When pressed by my hon. Friend the Member for Nottingham South (Lilian Greenwood), the Secretary of State could not give the cast-iron commitments that are needed by those delivering the services. Even if this is an unsatisfactory settlement, they deserve some certainty that the sums involved will not be eroded by spikes in inflation.

As the Secretary of State said on Second Reading,

“The crucial thing in this Bill is the certainty.”—[Official Report, 27 January 2020; Vol. 670, c. 560.]

We are not sure whether he meant certain failure, because we know that the sums set out in the Bill are not enough to keep up with demand, but the new clause seeks to ensure that the NHS is, at least to some extent, insulated against unforeseen economic shocks. It would act as a safety net in the event that inflation ran above 3.3% for more than six months in any 12-month period. It also requires a statement from the Secretary of State about whether any additional funds will be made available to supplement the sums set out in the Bill. That would at least provide some clarity and certainty about whether there will be any real-terms reduction in funding as a result of a sustained rise in inflation.

Let me finally say a little about new clause 11, and the adequacy of the allotment to NHS England. As I have already made clear, the Bill sets NHS expenditure for the next four years at a level that is not sufficient to put the NHS on a sustainable footing or to improve performance. That is why we are seeking to ensure that the impact of unforeseen changes in the costs of pharmaceutical treatments, medical devices and services—possibly as a result of our leaving the European Union, or of the trade deals that we sign—are reviewed by the Government so that adequate funds are available to meet any uplift, and so that there is no negative impact on health outcomes. Much has been said about the possibilities in new trading arrangements, but not enough about the risks, of which this is only one.

--- Later in debate ---

[Jeremy Hunt]

I can be honest with the hon. Gentleman and say that I regret not being able to build lots of hospitals around the country in that period, because funding was short. Now, however, we are in a different situation. It is important that we build these extra hospitals, but there will be some big challenges in ensuring that we do so.

[Dr Whitford]

I thank the right hon. Gentleman for giving way. I welcome his suggestion of a central design team, because the NHS is over 70 years old and we seem repeatedly to reinvent the wheel. Does he recognise that it is not just about building new hospitals, because maintenance has also been allowed to slide? There are leaking roofs and leaking sewers, and patients are still in hospitals that are basically not fit for use. Maintenance is most urgent.

[Jeremy Hunt]

I agree with the hon. Lady. Maintenance is a big issue in many hospitals. A number of hospitals are still essentially prefab buildings that should have been torn down a long time ago, and there are others where maintenance can solve the problem. I think we have to attack all of that, and I welcome the fact that there is a real commitment from the Government to do so.

Finally, I want to talk about new clause 4, which relates to whether the Government are giving enough to the NHS to meet the current waiting time targets for elective care, A&E, cancer and so on. I welcome the Opposition’s focus on this matter, because the public absolutely expect us to get back to meeting those targets. It was an important step forward for the NHS that we did bring down waiting times, and I have often credited the previous Labour Government for that happening, as I hope the Labour party will credit this Government for the focus on safety and quality in the wake of Mid Staffs. However, as we focus on safety and quality, I would not want to lose the achievements that were made on waiting times, because it is fundamental to all patients that they do not have to wait too long for care. Indeed, waiting times themselves can be a matter of patient safety.

--- Later in debate ---

[Patrick Grady]

There we go. We have now had as many Welsh and Scottish Members contributing from the Floor, as Members from elsewhere in the United Kingdom. These points were raised back in the day, on the Procedure Committee, even if it was not the hon. Gentleman who gave that evidence.

This morning, the Prime Minister turned up at the Science Museum in London to launch a conference that is taking place in Glasgow. That probably tells us all we need to know about the Government’s concept of how the United Kingdom works. Four days after the UK leaves the European Union, and the Tory Government choose to display their love for the precious Union on these islands by creating two classes of Member in the House of Commons—those who can amend legislation and those who cannot. Well, as the Chair of the Health Committee asked us to say, “Thank you.” Thank you so much, because the polls are showing that support for independence in Scotland has reached 52% and growing, and that support will not go away. Constituents in Scotland will be watching today’s proceedings, wanting to know why their Members of Parliament are not allowed to vote on amendments that could increase health spending, not just here in England but throughout the United Kingdom.

Labour’s new clause 5 rightly calls for the Government to analyse the effect of inflation on the figures set out in the Bill.

[Dr Whitford]

Does my hon. Friend agree that, as I mentioned earlier, the fact that inflation could make these cash rises meaningless makes it very difficult for the Scottish Government to predict what Barnett consequentials they can count on in 2023 and 2024, so it should be committed to in real terms, not just cash terms?

[Patrick Grady]

Yes; my hon. Friend is absolutely right, and we would be very happy to support new clause 5 if the procedures of the House allowed us to. It is absolutely crucial to what the Bill is trying to achieve.

We know it is a showpiece Bill anyway, but the Government are getting a showpiece English Parliament out of it as well. Of course, the terms of the money resolution are so restrictive that amendments intended to amend the figures in the Bill are completely out of order. The Labour party tried that—that point was raised by more than one Opposition Member at Second Reading, and I am not sure that Ministers could answer it.

Labour’s amendment 3 prevents capital funding from being transferred to revenue streams. That is hugely important as well, because any increases in the revenue funding—the figures on the face of the Bill—have to come from new money. Otherwise, the whole thing is pointless: it is just shuffling things around. It is new money that would give rise to Barnett consequentials, and that is where our interest comes in.

New clause 4, on performance targets, makes exactly the same point, and we support that as well. That is also relevant to us.

[Dr Whitford]

It is often cast up here that the Government in Scotland are not spending all the Barnett consequentials on health, but they do. The problem is that although the Government here keep talking about the rise they are giving to the NHS, there are cuts to public health and social care, and there have been cuts to education and training. In Scotland, we still take the whole responsibility of a health Department seriously.

[Patrick Grady]

My hon. Friend is absolutely right on that. The Scottish National party has always pledged—we have done this throughout our time in government—that any Barnett consequentials that arise from health spending in England get passed to the NHS in Scotland. Any time the figures set out in this Bill increase, those Barnett consequentials would be expected to fall to the Scottish block grant, so it is well within the interests of Members from Scotland, Wales and Northern Ireland to seek to amend this Bill. Our own unselectable suggestions that appear on the amendment paper require analysis of what would happen if health spending per capita in England and Wales was raised to the level in Scotland. That was part of our manifesto commitment; by raising health spending in England, we would also raise spending across the United Kingdom. But here and now, on the Floor of the House of Commons, in the UK Parliament, that idea cannot be tested, voted on or even, technically, discussed.

[Dr Whitford]

Does my hon. Friend agree that “per capita” is a much more informative way of describing spending, because demand is increasingly rapidly, with an ageing population that is not ageing healthily, and just talking about the headline numbers does not show whether the amount provided for each person is sufficient to provide their services?

[Patrick Grady]

I thank my hon. Friend for that. The contributions she is making demonstrate precisely why Members from Scotland should have been allowed to participate fully in this stage of the Bill and the whole process.

If the official Opposition choose to press any of their amendments this afternoon, we will seek to express our views, on behalf of our constituents, by walking through the Lobby. We will walk past the signs that say, “England only” and if the Tellers from the Government Whips team choose not to count us, that will be their decision. Of course they will also have to discount any of their own colleagues from Scotland and Wales who deliberately or accidentally end up in the Lobby; perhaps that is also an argument for getting rid of this ridiculous voting Lobby system, but I appreciate that that is for another day.

The Government could have avoided this situation, by allowing proper time for a Report stage, where Members from Scotland and elsewhere could move amendments. They could have committed the Bill upstairs to a Public Bill Committee, but they chose to convene an English Parliament here in the Chamber of the House of Commons, which is supposed to represent the whole of the UK.

--- Later in debate ---

New clause 9 would go further than the Opposition amendment, which looks to measure inputs and money, and would require the Government to do something broader and ultimately more meaningful to the British people, whichever quarter of the United Kingdom they come from.

[Dr Whitford]

We have discussed today, and on many other occasions, the issues relating to child and adolescent mental health and the pressure that young people are under right across the UK, and training for teachers to support them in schools was mentioned. In Scotland, we are putting 350 counsellors into schools. Does the hon. Lady recognise that putting that level of investment into education, where these young people are, would reduce the pressure on CAMHS, and that any assessment would need to include that? If children end up in CAMHS who do not need to be there and who could have been helped earlier, that is also a failure.

[Anne Marie Morris]

The hon. Lady makes an apposite and correct point. We cannot talk about mental health just within the health and care bucket, so to speak. What do we do to help young mums? What do we do in the school environment for youngsters, who are increasingly put under huge pressure, with cases of stress and depression growing daily? What are we doing in the workplace? Historically, mental health has been something that we do not talk about; indeed, people almost dare not to for fear of being demoted and losing their job. There are many aspects of mental health that need to be taken into account if we are truly to deliver parity of esteem. I would like to think that the Government, and perhaps the Minister when he responds to the debate, would acknowledge the breadth of the need to work together across Government Departments so that we look properly at the outcomes and at the different pieces that affect those outcomes, which go well beyond the Minister’s particular brief.

--- Later in debate ---

[Anne Marie Morris]

My hon. Friend makes an excellent point. Just like physical health checks, which are very much part of the standard GP system, mental health checks should equally be a part of the standard checks that take place when people present at surgeries. I entirely agree.

[Dr Whitford]

Does the hon. Member recognise that we all know what we should be doing to look after our physical health—there is a handful of five key points—but that most of us have no idea what we should be doing to look after our mental health? As well as talking about primary care in schools and workplaces and public campaigns, we should all be being taught how to develop our own resilience and how to look after our own mental health better.

[Anne Marie Morris]

That is one of the best points that I have heard in this debate, and it is extremely well made. However, it is a real challenge trying to help individuals to accept even that they might be vulnerable to mental health problems, because it has been such a taboo—let alone the second stage of learning what we can do to try, as the hon. Lady says, to make ourselves resilient. I am pleased that we are having mindfulness classes across the House, not just for MPs but for our researchers. That is not the total solution, but it is at least a step in the right direction. However, her point is about something much bigger than just an intervention—it relates to a big piece missing from this whole agenda. We spend a lot of time talking about illness and not enough time talking about wellness.

[Dr Whitford]

Is it not particular to mental health that when we use the phrase “mental health” we actually mean illness? We all have mental health, sometimes good and sometimes bad. If we changed the language, it might be easier for people to talk about.

[Anne Marie Morris]

The hon. Lady is absolutely right. The challenge, as she recognises, is how we change the language in a way that is accepted and becomes the norm. Part of this is having a much greater focus, as I hope the Secretary of State and his team ultimately will, on wellness, because that is absolutely as important as dealing with the illness when it happens.

We need to remember that in terms of stages of intervention, the whole lifecycle is not just about birth, education and the workplace; it is also about the elderly and veterans, for whom there is often not as much done to identify need and provide support. An older person in a rural area will often have the need but because they are simply out of scope—under the radar—they will, for a very long time, suffer in silence to a point beyond which they cannot be helped. The challenge of mental wellness/illness for older people needs to be a specific focus.

For all that we say, and rightly, about the importance of ensuring that our veterans are properly diagnosed and properly supported, I am certainly conscious of veterans in my constituency who are struggling to get help and support, or even an initial diagnosis. Sometimes the support they need is so complex that they can only get it in London. For somebody who does not have good mental health, the journey from Devon right the way up to London is something they simply cannot conceive of and make a reality.

I am extremely grateful to the Minister for sitting and listening to my thoughts, and for understanding my approach in terms of looking at this in a much more holistic way and seeing how we might measure and report on it so that we can demonstrate to people that we are making progress on parity of esteem. We should look at inputs as well as outputs. I look forward with a great deal of interest to his reply on the points that have been made, particularly on outputs in mental health.