HIV Treatment

Sharon Hodgson Excerpts

Wednesday 29th March 2017 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Main. I thank the hon. Member for Finchley and Golders Green (Mike Freer) for his excellent chairmanship of the all-party parliamentary group on HIV and AIDS, for securing this important debate and for his comprehensive opening speech. It was a tour de force.

I also thank the other hon. Members who have contributed to the debate. I thank the hon. Members for Strangford (Jim Shannon) and for Linlithgow and East Falkirk (Martyn Day), my right hon. Friend the Member for Exeter (Mr Bradshaw) and my hon. Friends the Members for Hove (Peter Kyle) and for Bristol West (Thangam Debbonaire) for their excellent and knowledgeable speeches and interventions. They will all have given the Minister much to think about.

We have come a long way since the height of the HIV/AIDS epidemic of the 1980s, but that does not mean that we should be complacent in our approach to the disease now. Across the UK, an estimated 101,200 people were living with HIV by the end of 2015; 87% of them had a diagnosis, and 96% of those diagnosed were accessing treatment. Although they are a minority of people in the wider population, they are a significant minority that we cannot let down when it comes to their care and treatment.

The number of people receiving HIV care in 2015 in England was just over 81,000. That is a 73% increase in the number of people accessing HIV care since 2006. In part, that is welcome, as it means that more people are accessing care that can improve their lives, but it also provides us with reasons to ensure the future quality of care provided, and that is the crux of why we are here today to debate this issue.

As the APPG highlighted, it is understood that since the passing and implementation of the Health and Social Care Act 2012, there have been growing complications with the commissioning and provision of HIV services across the healthcare system. In the rest of my contribution, I will touch on the Health and Social Care Act’s impact on HIV services, but I will also expand into other areas, such as the cuts to public health budgets and the worrying trend of decommissioning of HIV services, and finally I will touch on issues regarding PrEP.

Since the passing of the Health and Social Care Act, there has been a significant fragmentation of our NHS and wider health services. During the passage of the Act, Opposition Members felt that it was an unnecessary top-down reorganisation. The case of HIV services proves exactly how that fragmentation is causing consequences for the future of vital services. The creation of CCGs and the devolution of public health to local authorities have fragmented HIV services across various bodies, with no coherent commissioning and oversight. Currently, services are failing to maintain the standard that patients expect. That is down to commissioning responsibility not being clearly defined under the Health and Social Care Act. Although the coalition Government argued that the Act would ensure the streamlining of services, the opposite has clearly been the case for HIV services.

I therefore want to push the Minister on what she is doing to look into the APPG’s recommendations, especially about joint commissioning for support services by NHS England and CCGs, along with co-commissioning of HIV and sexual health services by local authorities and NHS England. Another issue that the Minister must look at—I raise this repeatedly with her—is public health funding. The cuts to services further exacerbate the problems that HIV services face because of commissioning responsibilities being unclear, which is pushing services to walk away from their responsibilities.

I know that the Minister will reference the funding going into regular HIV testing and the promotion of safe sex, along with the HIV innovation fund, but the impact on funding cannot be ignored. Last week, the National AIDS Trust published a report showing that in England, there has been a 28% decrease in the expenditure between 2015-16 and 2016-17. That is on top of the cuts to HIV support services, or decommissioning of said services, in Lambeth, Southwark, Oxfordshire, Portsmouth and Bexley. Although public health budgets are only one part of the funding streams for HIV support, treatment and care, they are nevertheless an important part of the pathway, as cuts to sexual health services more broadly are detrimental to HIV care. The £200 million in-year cut and 3.9% cut year on year will only have a negative impact on the future of all sexual health services, including those for HIV. The Minister must seriously address that false economy, or risk seeing a public health crisis that could easily have been avoided.

[Thangam Debbonaire]

I thank my hon. Friend for the excellent speech that she is making. I want to add my support for what she has just said, and perhaps go a bit further. Does she agree that the Minister needs to address the fact that the failure to address preventive services will only store up costs and problems further down the line, and that when there are cuts to public health grants, those services need to be ring-fenced or protected in some other way so that we are not storing up problems for the future?

[Mrs Hodgson]

I thank my hon. Friend for that helpful intervention. I agree with her absolutely. The whole point of preventive services—HIV and sexual health services are preventive—is to save money, and lives, further down the line. We regularly debate preventive measures for other health issues with the Minister in this Chamber.

There is still a question mark over the future of HIV services, not only because of the cuts that we are seeing now, but because the future of public health budgets after 2018 is not guaranteed. There are also issues with the devolution to local authorities of business rates, which will be used to fund public health spending. The Government have still not published details of how they aim to ensure that public health will continue to be prioritised when that comes into effect. I hope that the Minister will be able to offer clarity today.

PrEP is a highly effective way of protecting someone who does not have HIV from contracting it. As the UK PROUD study showed, it was 86% effective in preventing HIV transmission and, if taken correctly, it has closer to a 100% success rate. That is why it is important that this drug treatment is supported as much as possible. While the announcement on the feasibility study is welcome, questions remain that the Minister must answer. Nearly four months since the trial was announced, we are still none the wiser as to when it will begin, other than that it will begin early in the 2017-18 financial year. I welcome that in her letter to the APPG yesterday the Minister said that the trial would begin in the summer, but I hope she will offer further clarity on when we will know more. There remains an issue with the drug Truvada, which is used in PrEP. For the trial to reach the 10,000 people that it plans to, a generic version of Truvada will need to be used. I am interested to know what conversations the Minister has had with Gilead, and how co-operative it has been to ensure the success of the trial.

Finally, I want to ask the Minister about the concerns that many PROUD participants will run out of their supply of PrEP this week, and that between 350 and 4,000 individuals at the highest risk of HIV will run out of supplies. That is a matter of urgency, and the Minister must address it as a matter of priority. We cannot allow the people who take this drug treatment to be put at risk. Therefore, I hope the Minister will go away today and look at the matter immediately.

These issues are highly important to many people who live with HIV or within those communities where infection rates are more common than in others, as we heard from my hon. Friends the Members for Hove and for Bristol West. I was shocked and surprised to hear that there is four times the normal rate of those people in the community of my hon. Friend the Member for Hove. I am well aware why he is here today to speak for his constituents.

The Government’s mismanaged approach to the NHS’s structures and to wider health services is seeing services fall through the gaps and people’s lives affected, which is exacerbated by short-sighted cuts. It is important that we recognise the work that has already gone into addressing HIV in our society, but accept that we still have a long way to go. We cannot squander these opportunities, as we could see yet another public health crisis due to complacency and failure to step up and address this issue. I hope the Minister has listened carefully to all the contributions to the debate and the seriousness of it, and will go away and do the right thing by the tens of thousands of people living with HIV or at those risk of contracting it, and support them. They should not be let down.

Rare Diseases Strategy

Sharon Hodgson Excerpts

Tuesday 28th March 2017 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Pritchard.

I welcome this important debate and I thank the hon. Member for Bath (Ben Howlett) for securing it and for his excellent introduction to it, although I am sorry that I missed the start of his speech because it started four minutes early before my hon. Friends and I were in our places.

I also thank other hon. Members for their contributions this afternoon, including the hon. Member for South Down (Ms Ritchie), my hon. Friend the Member for Cambridge (Daniel Zeichner) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), the spokesman for the Scottish National party, who all made excellent and insightful speeches.

As others have said, here in the UK one in 17 people will be affected by a rare disease at some point in their life, which equates to approximately 3.5 million people in the UK. It cannot go unsaid that those 3.5 million people have a wide range of symptoms, which vary from condition to condition, some of which we have heard about this afternoon. It is clear that there are common experiences that people with these conditions all share. As Rare Disease UK has estimated that it takes on average four years for a patient to receive a diagnosis, it is clear that there are many missed opportunities to help those people living with rare diseases. Each and every person who suffers from a rare disease deserves the necessary support to live a fulfilling life.

That is why it was welcome that in 2013 the coalition Government published their UK-wide strategy for rare diseases, which was seen as heralding a new era in the treatment and care of rare disease patients across all four home nations. The 51 recommendations are all to be welcomed, as they each take us a step further in addressing concerns about the care and treatment of rare diseases, and the strategy’s aim is to make sure that no one gets left behind just because they have a rare disease. It is an aim that Labour welcomes wholeheartedly.

Most of my contribution to this debate will focus on the issues with the implementation of the strategy, but I will take a moment to mention some of the positives. It is welcome to see that the National Institute for Health Research has launched the Rare Diseases Translational Research Collaboration—I will use the acronym, RD-TRC, as it is much easier to say—which aims to empower patients to engage and become involved with research and research funding decisions. To date, the NIHR has invested £4 million in the RD-TRC, and the programme is expected to continue for another five years, with a £5 million investment.

Work has also been done by Public Health England on data recording, to bolster diagnosis and early intervention, and we have also seen Health Education England collaborate with the National School of Healthcare Science to produce two educational videos for healthcare professionals, in order to raise awareness of the problems faced by families who have a child with an undiagnosed condition and the importance of considering whether it is a rare disease. All this work is to be welcomed and should not go unnoticed.

Yet the sticking point in all of this, and the reason why we are here today to debate this issue, is that the Government are digging their heels in and not getting on with drafting an implementation plan, while the other home nations’ Health Departments are making significant strides. That betrays not only those patients living in England who wish this strategy to be properly implemented but the strategy itself, which stated that all four home nations must see the vision behind the strategy become a reality by 2020. It also undermines all the excellent work that I mentioned previously to implement the recommendations.

The strategy was published in 2013 and we are now just three years from the date set for the vision to be realised. However, the all-party group that the hon. Member for Bath so ably chairs has discovered that the Department of Health does not intend to publish an implementation plan, believing that it should be published by the NHS. Yet the NHS has said that it does not intend to do this either, as it does not have responsibility for other arm’s length bodies of the Department of Health. I want to ask the Minister why. I want to know why we are seeing patients and their families caught in this dispute between the NHS and the Department of Health. This situation cannot continue; there are people suffering right now who need this strategy to be implemented correctly.

I have briefly mentioned the report by the all-party group on rare, genetic and undiagnosed conditions on the lack of an implementation plan, but I know that it covers other issues as well, and I will take a moment to touch on some of them. One of the main issues raised was the lack of communication between organisations responsible for implementing the various aspects of the plan, and the failure to provide patients, families, doctors, industry experts and patient organisations with updates on progress of the strategy. That is deeply worrying, as it is important that people are made aware of the issues that affect them so personally. Therefore, it is not surprising that the all-party group heard from more than 300 patients that widespread disillusionment and disappointment had become the common feeling about the strategy, despite the optimism felt when it was published five years ago. The sting in the tail is that there are implementation plans for the strategy across the UK, with the exception of here in England. I share the frustration of the many others who are affected by the Government’s complacency. The Department’s rationale for not providing updates on progress is that patient organisations can disseminate information to patients and families, but it sadly fails to grasp that those organisations and charities are often very small and do not have the resources to pull together updates and send them out.

Also, issues that have not been worked on since the strategy was published have been identified, including prevention and identification of rare diseases, improving care pathways and failing to implement structures that would facilitate collaboration between the four home nations. In his response, I would be grateful if the Minister could provide us with an update on those points and tell us what his Department plans to do to see the recommendations through.

The strategy is now five years old, and although there has been work to see it realised, it has not gone far enough. The failure here is that the Department of Health in England is not fulfilling its duty to draft an implementation plan to realise the visionary goals in the strategy, which undermines the work already under way and hinders any future work. The Minister must set that right, and I hope he plans to do so today. He has the power to rectify the situation and he cannot be complacent when it comes to supporting people living with rare diseases.

We are not talking about a handful of people; many of our own constituents are being failed by the Government, and all they ask for is that the Department of Health do what Departments in the other home nations are doing and provide an implementation plan to enable the strategy to be fully realised and make the impact it was intended to have. I once more thank the hon. Member for Bath. I hope that the debate will make the Minister think again about the Government’s opposition to taking responsibility for a plan, and that he will honour the whole vision of the strategy, instead of cherry-picking from it.

[Mark Pritchard (in the Chair)]

If the Minister does not use all the time allocated—10 minutes is a guide, but clearly there is more time on the clock—it will allow me to call the hon. Member for Bath for a brief winding up, but that is entirely in the Minister’s gift.

Draft Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) (amendment) Regulations 2017

Sharon Hodgson Excerpts

Monday 27th March 2017 General Committees

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Alan. The Opposition are pleased that the Government have finally brought these regulations before us, especially with the end-date for the mandation of health visitor reviews being so close—it will be in five days’ time, to be exact. I welcome a lot of what the Minister said.

The regulations are welcome as they continue the mandation of health visitor reviews, which are an important part of an early intervention strategy. We will therefore not seek to divide the Committee. However, I have concerns about health visiting and what the regulations will do that I wish to raise with the Minister and on which I seek reassurance.

This year marks 155 years since the start of health visiting, which has had a range of different guises over the years, in 1862. It is important that we protect this long and proud career and give it the support it deserves. It is therefore concerning to see in the provision relating to regulation 5B of the principal regulations a potential watering down of who can do universal health visitor reviews, allowing other qualified health professionals to conduct reviews instead of health visitors. That is concerning when there is anecdotal evidence that health visitors are being told to delegate to other professionals, but are doing so only because they are so overstretched and busy with their huge workloads. That does not mean other health professionals cannot be complementary to the reviews, but the core reviews must be done by health visitors, because they are the specialists and it is their job to do it after being trained to undertake that role.

A health visitor’s role should not be diminished. I hope the Minister agrees and will assure me that she will closely monitor that issue, as I certainly will, to ensure that health visiting is not a diminished profession and that we do not see a reduction in the quality of health visitor reviews. I look forward to her response.

O’Neill Review

Sharon Hodgson Excerpts

Tuesday 7th March 2017 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on bringing this important debate to the House. He gave an eloquent and knowledgeable speech clearly setting out the issue and the matters to be discussed following the O’Neill review. I thank him for that.

An estimated 50,000 deaths occur every year due to untreatable infections, rising to 700,000 globally. That is why it is only right that we do all we can to address antibiotic resistance. It is believed that the number of deaths will rise to 10 million a year by 2050 if no significant action is taken. As we have heard from a number of Members, deaths from drug-resistant infections could exceed deaths from cancer.

This is an incredibly timely debate. Only a couple of weeks ago, the World Health Organisation published a list of 12 bacteria for which new antibiotics are now needed. Some strains of bacteria have built-in abilities to find new ways to fight off treatments that can then be passed on to other bacteria via genetic material to make them drug-resistant too. I find it a bit scary to consider what we are up against. This is a battle that we have to win.

I also thank other hon. Members who have spoken in this debate. My hon. Friend the Member for Bristol East (Kerry McCarthy) gave a very knowledgeable speech about the use of antibiotics in farming; other hon. Members touched on the subject as well. I really think we need to get a firm grip on it internationally, with the UK leading the way. Ten other Members spoke in this very active debate: my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), my hon. Friend the Member for Ealing, Southall (Mr Sharma), the hon. Members for Erewash (Maggie Throup), for Bosworth (David Tredinnick), for Glasgow North (Patrick Grady), for Sleaford and North Hykeham (Dr Johnson), for Mole Valley (Sir Paul Beresford), for Strangford (Jim Shannon) and for Stafford (Jeremy Lefroy), and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who speaks for the Scottish National party. Their speeches were all thoughtful and knowledgeable, albeit brief because of time constraints.

I will touch on two key points: raising public awareness, and supporting research and innovation to combat antibiotic resistance. It is generally accepted that antibiotic resistance is a natural process—bacteria naturally evolve to become resistant to certain drugs used to fight them off—but it has been exacerbated by humans. As Dr Hsu of the Singapore Infectious Diseases Initiative has said, the causes come down to

“a single axiom—abuse and overuse of antimicrobial drugs.”

Concerns have also been raised that the development of new antibiotic drugs has dried up, contributing to the situation. According to the World Health Organisation, we are left in a precarious position. The WHO’s director general, Dr Margaret Chan, describes antimicrobial resistance as

“a crisis that must be managed with the utmost urgency.”

That urgency applies here in the UK, too. In 2014, the chief medical officer, Dame Sally Davies, said that

“we could be taken back to a 19th century environment where everyday infections kill us as a result of routine operations.”

We could be taken even further back: as the hon. Member for Thirsk and Malton said, this could be the new black death. That is not as melodramatic a statement as people may first think. Antimicrobial resistance is a really serious problem that we need to address here and now, so that those predictions do not come true.

I do not always do this, as I am sure you have noticed, Mr Hollobone, but I must give credit to David Cameron’s coalition Government, who were global leaders when they announced Lord O’Neill’s review into antimicrobial resistance. The review’s 10 recommendations show just how complex and multifaceted the issue is and how wide-scale the actions needed to address it are. The review’s final report was published in May 2016 and the Government responded at the end of last year, so now is a good time to ask the Government for an update.

One of the review’s key recommendations was to introduce a large-scale global awareness campaign to reduce the demand from patients to be prescribed antibiotics when they are diagnosed with an illness. I am a firm believer in public awareness campaigns relating to health issues, especially cancer. My hon. Friends and I fully support such a campaign for antimicrobial resistance and we want to see the Government working hard to achieve it. The review’s recommendation was for an international awareness campaign, but what does the Minister plan to do here in the UK to complement that international work? That is a pertinent question because a 2015 Wellcome Trust study found that people in the UK did not fully understand antibiotic resistance and how it affects their health. They did not understand that antibiotic resistance is to do with the bacteria in people’s bodies, rather than a lack of antibiotics or the cost of them; it is not just a case of doctors being awkward. I would therefore be grateful if the Minister told us what relatable public awareness campaigns she is planning to ensure that people understand more about the problem and about what they can do personally.

I have already mentioned the problems with combating antibiotic resistance caused by the drying up of innovative developments in drug technologies. The O’Neill review identifies that the low commercial return on research and development for antibiotics makes them less attractive to pharmaceutical companies and reduces the chance of new drugs being developed. To reverse that situation, it recommends considering market entry rewards to encourage companies to develop new or improved drugs, especially in areas of urgent need. I hope the Minister will explore that issue further in her reply.

Public and private funding is being made available to help to combat these issues. On 20 December, the Minister referred to

“international programmes to tackle AMR, including the Fleming fund and the Global AMR innovation fund, which represent more than £300 million of investment over the next five years.”—[Official Report, 20 December 2016; Vol. 618, c. 1294.]

There is also the incredible work of the Longitude Prize, which is in the middle of its competition to develop

“a cheap, accurate, rapid and easy-to-use point of care test kit for bacterial infections”

to help to address antibiotic resistance. That is important work and we support it.

In summary, we cannot afford to get antimicrobial resistance wrong. Millions of lives depend on our tackling it. It is not far away; it is happening right here, right now, and it affects us all, so it is important that we do all we can to address this growing problem, both in the UK and internationally.

[Mr Philip Hollobone (in the Chair)]

If the Minister will be kind enough to finish just after 4.30 pm, that will give Mr Hollinrake time to sum up the debate.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 7th February 2017 Commons Chamber

[David Mowat]

More information was published on cancer by clinical commissioning groups since the back end of last year than at any time in the history of the NHS. [Interruption.] The hon. Gentleman is right to say that prostate is grouped with neurological cancers in general, and that is the type of surgeon being employed. But the fact is that the Government have been incredibly transparent in terms of information published on cancers.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Last Saturday was World Cancer Day. The theme was unity, and I am still wearing my unity band with pride. We must do all we can to beat cancer, yet the Government are coming to their three-year anniversary of not meeting the 62-day wait target. Treatment quickly after diagnosis is crucial for tackling all cancers. Will the Minister outline what he is doing to ensure that that target is once again met so that patients receive timely treatment?

[David Mowat]

The volume has increased greatly, and there are something like 2,000 more people being diagnosed every day. The hon. Lady is right: of the eight cancer standards against which we judge ourselves, we meet seven, and the 62-day one has not been met. We need to do more to achieve that, and the cancer strategy set out a pathway for doing so. We have particularly invested in the early diagnosis component; we have invested £200 million in early diagnosis and getting a 31-day all-clear or referral for treatment. That is the pathway to meeting the 62-day target. She is right to raise this, because it is an important indicator and we need to do better.

Breast Cancer Drugs

Sharon Hodgson Excerpts

Thursday 26th January 2017 Commons Chamber

[Iain Stewart]

I agree with the hon. Lady. I have not had any personal discussions with Roche; I can only refer to and take at face value the briefing note that it sent me early this morning, which seemed to represent a genuine wish to negotiate with NICE and get the drug down to an acceptable price. I hope the debate is joined in that spirit.

Perhaps it is appropriate to mention now something I was going to bring up later in my speech: one area that needs to be examined is the pharmaceutical price regulation scheme, which is a five-year voluntary contract between the pharmaceutical companies and NICE. If I understand how it is intended to work, the pharmaceutical companies will underwrite any overspend for a particular drug. For various reasons that does not seem to be working in practice. I urge my hon. Friend the Minister to look at that point, which has been made by some in the industry.

In the case of my constituent, Mrs Mears, when her current medication ceases to be effective, Kadcyla is the only option. Although she has responded well to the current treatment, there is every likelihood, and her consultant agrees, that she will respond in a similarly positive way to Kadcyla. There is every chance that she would enjoy the benefits of that drug for a time well in excess of the expected nine months. I would therefore argue that a blanket ban on the drug would be inappropriate. At the very least, there should be some flexibility in the system to make the drug available to people such as my constituent, for whom there is a very high probability that it would have more than the expected benefit. She has responded so well to her existing drug, and if her life could be extended considerably by Kadcyla, that would allow more research to be done on the efficacy of her existing medication, which would be an important body of evidence to add to the appraisal process.

The hon. Member for Mitcham and Morden rightly said that the prescription of drugs should be based solely on clinical need and no other factor, but when I met Mrs Mears, she made one point to me that I could not really answer. Through her life, she worked professionally in the criminal justice system and has done a lot of work saving the public purse money by innovating programmes to reduce youth offending. That value cannot be calculated, but she made the point to me, “At the one point in my life that I need something back from this country, it is being denied to me.” I really could not give an answer to that. I hope that something can be done to make the drug available.

The NICE decision is provisional. I contributed to the consultation and I hope that when NICE meets next—in, I think, early March—it will review the decision.

I know that NHS resources are finite and that there are many competing demands on its budget. The debate on the overall size of the NHS budget must be a matter for another time, but cases such as this illustrate the need to use what resources we have as efficiently as possible. Just before I met Mrs Mears the other week, I happened to see a story in the media that really made my blood boil. I do not pretend to be an expert on the prescription system, but I simply put this on the table. The story reported that the NHS wastes about £80 million per annum by prescribing simple painkillers such as paracetamol, which can be bought in a supermarket for 20p or 30p a packet. Those prescriptions go through the usual prescription system and cost £80 million a year. Surely there is a way of getting around that, perhaps by giving GP practices a stock of basic painkillers. I am not asking for people who get free prescriptions to start paying but, surely, there is a way for doctors to issue them when it is appropriate to do so, and stop this merry-go-round of paperwork that costs many millions of pounds.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

The hon. Gentleman is making a very valuable point. Does he agree that one way around this issue would be to have prescribing pharmacists who could give out medications such as those basic painkillers, without the need for the patient even to see their GP, which would also free up valuable GP time?

[Iain Stewart]

That sounds an eminently sensible suggestion. As I say, I do not pretend to be an expert on the system, but, surely, something like that could be done. Then the money saved could be added to the cancer drugs fund and make more drugs such as Kadcyla available to people who need them.

I will end my comments, as I know there are many Members who want to contribute. Please let us try to do everything we can in this House to encourage NICE and Roche to look at the overall system and to look in particular at this drug. It means so much to my constituent and to many others up and down the country. I hope that this debate has that effect. I conclude where I started, by congratulating the hon. Member for Mitcham and Morden on securing it.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I thank my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) for securing this debate, following the very sad news that her friend Samantha Heath, who had been receiving this life-extending treatment, had heard from NICE that it was being taken away from her. I am pleased that she was able to secure this important debate through the Backbench Business Committee.

I also thank all colleagues who have attended the debate and made excellent speeches, sharing with us their experiences and thoughts, including the hon. Members for Milton Keynes South (Iain Stewart), for Portsmouth South (Mrs Drummond), for Louth and Horncastle (Victoria Atkins) and for Wycombe (Mr Baker), my hon. Friends the Members for Torfaen (Nick Thomas-Symonds) and for Wythenshawe and Sale East (Mike Kane) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the SNP. I am sure that the Minister has been given lots to think about, and I look forward to her response shortly. I also thank Breast Cancer Now for its work campaigning on this matter, along with Breast Cancer Care for its continued dedication and its support and advocacy for individuals with secondary breast cancer.

In my contribution, I will first briefly establish the documented and perceived benefits of Kadcyla, and then, building on that, discuss the broader issues around the provision of off-patent drugs, before moving on to present the problems with determining the funding of a drug based principally on its cost-effectiveness as judged by NICE.

Kadcyla’s continued funding through the cancer drugs fund in 2015 was a great success for patients and patient advocates. At the time, the value of the drug was recognised and the concession was made that, despite its high cost, its positive impact was worth the funding it needed. Yet just over a year later, the alterations to the cancer drugs fund have prevented the future funding of this drug, along with, potentially, that of a number of other secondary breast cancer drugs such as palbociclib and Perjeta—I hope that I pronounced those correctly—as it moves towards becoming a funding mechanism for under-researched but innovative drugs with cost and value as a principal driver, and away from its original principle, which was to finance drugs that were too expensive to be recommended by NICE but proved effective in treating cancer patients.

We can all agree that patients have benefited significantly since the introduction of the cancer drugs fund, but the progress that has been made in recent years in improving access to cancer drugs is now at risk. That is unsurprising, given the cash-strapped state of the national health service—we have discussed that in the House recently in the past few weeks—which faces pressures to provide these costly drugs that are developed by large pharmaceutical companies, and is forced to consider costs rather than clinical need. I hope that the Minister will tell us whether those concerns have been assessed, and how she plans to address them. We have heard a number of good suggestions today about how funding may be redirected.

[Mary Glindon (North Tyneside) (Lab)]

Is not the situation made all the more poignant by the fact that since 2001, the incidence of breast cancer has been rising by 9% every year?

[Mrs Hodgson]

That is a very good point. It may be that more and more people are coming forward and being diagnosed, but, as my hon. Friend says, this will clearly become more of an issue, not less of an issue, in the years to come.

As we have heard today, it is estimated that Kadcyla benefits 1,200 women every year in England alone, and that on average it can increase the length of a woman’s life by six months, although reports suggest that in the case of some women that can stretch into years. Even if it is measured in months, however, the extra time is surely priceless to the women and families involved. I speak from personal experience, as I lost my mother-in-law to secondary breast cancer 20 years ago this year, when my children were very small. I know that she fought for every extra week and day in the end, and that she would have given anything for an extra six months to spend with her grandchildren. We all wanted that little bit longer for her. For all those 1,200 women, that extra time is time with their families. It means seeing their children reach perhaps one more milestone: starting school or university, getting married, or even giving them a grandchild. What is the cost of such moments, such memories, which are so precious and which help families so much with what, ultimately and inevitably, will follow?

[Iain Stewart]

The hon. Lady has made a powerful point. In the case of the most aggressive cancers, the period between diagnosis and death can be very short. As she says, any extension of life enabling women to celebrate family events, or anything else, is incredibly important, and we should not lose sight of that.

[Mrs Hodgson]

I agree. What price can be put on those precious months?

[Thangam Debbonaire (Bristol West) (Lab)]

I have some investment in this. My own experience of breast cancer treatment over the last two years has left me passionate about the issue of prevention and early diagnosis. Will my hon. Friend join me in not just thanking the breast cancer charities—as she has already done—but calling on all Members to spread the word among all the women they know that they must learn how to examine their breasts? I learnt how to do it from a comic sketch in a television programme: that is how I diagnosed my lump. I want everyone to learn how to do it, and also to learn what they can do to help prevent breast cancer, because, although there is no magic prevention method, there are ways of reducing the risk.

--- Later in debate ---

[Mrs Hodgson]

Although we have not so far touched on prevention or early diagnosis, they are vital issues. We have discussed them in the House on many occasions, but they can never be discussed too often, and I am grateful to my hon. Friend for raising them. Let me add that I am happy every day to see her back in this place, and doing so well.

What also stands out with Kadcyla is the reduced side effects, as we have heard, as opposed to alternative breast cancer treatments, the side effects of which can include the inducement of osteoporosis and an increased risk of blood clots. As some colleagues will, sadly, know first-hand or through experiences of family and friends or constituents, the side effects of some cancer treatments can be truly awful, and in some cases are daunting enough to prevent the acceptance of further treatment entirely. It is a common perception that women make the decision to end their treatment much earlier than planned, despite it prolonging their life sometimes. That is because they feel the suffering they are enduring as a result of the treatment is not worth the additional life it is providing to them, because it is all about the quality of that life.

Research conducted by Genentech in the United States on the side effects of Kadcyla found that less than 5% of women taking the treatment suffered any hair loss. Through my work as co-chair of the all-party group on breast cancer, I know that hair loss can be a highly traumatic experience for women undergoing cancer treatment and is one of the most discussed side effects of cancer treatment in general. Given that in this debate we are discussing the treatment of secondary breast cancer, which is ultimately a terminal disease, the best outcome we can offer through treatment is both the extension of life and the preservation of the quality of life enjoyed pre-diagnosis. Therefore, because Kadcyla causes fewer side effects, it represents a treatment that can effectively achieve not only an extension of life, but the preservation of some of that quality of life enjoyed by these women pre-diagnosis. So I look forward to hearing from the Minister about what she is doing to ensure women will benefit from this vital treatment in the future.

I will now move on to how we can better support off-patent drugs, especially for breast cancer. Drug patents typically last for 20 years—although sometimes only 10 years—and at the end of that patent there is very little incentive for the drugs to be licensed for use in another indication. These drugs are still clinically effective in many cases and can be a low-cost effective treatment, but currently the NHS has no method for making them routinely available.

Bisphosphonates are one such example of an off-patent drug that is not being made universally available to patients, despite evidence showing its effectiveness. It is estimated that, if given to the entire eligible population, this drug could prevent one in 10 breast cancer deaths. It is therefore concerning that research conducted by the UK Breast Cancer Group found that only 24% of breast cancer clinicians were offering bisphosphonates to patients. Solving this issue therefore provides an opportunity to improve breast cancer survival rates, and it is something that I hope the Minister will consider carefully.

I want to finish by discussing the cost-effectiveness of drugs. Currently NICE measures cost-effectiveness using quality-adjusted life years—QALY—and one QALY is equal to one year of life in perfect health. As I am sure colleagues will agree, it is almost impossible to objectively measure someone’s quality of life, and there are questions surrounding the morality of attempting to do so, as raised in NICE’s “Social value judgements” paper on the moral evaluation of drugs.

As is so often the case in these debates, a clear cause of the problem lies with how NICE approves drugs. At the last general election, Labour proposed a top-to-bottom reform of NICE, ensuring that drug acceptance and funding is determined solely by clinical need, not with cost or value considerations. This debate shows there is clearly a need to re-address these issues.

As I have already mentioned, Kadcyla patients tend to experience considerably fewer side effects, and this can potentially have a positive impact on their ability to enjoy a higher quality of life post-diagnosis. Because of practicality and cost implications, it is almost impossible for NICE to comprehensively and effectively measure this exact quality of life. However, what we can say, without a doubt, is that these individuals would suffer a lower quality of life without Kadcyla, and this, I believe, deserves more attention and value in the process of drug approval and funding.

The current funding of drugs is becoming based on the cost-effectiveness of a drug, rather than clinical need, yet, as this debate has shown, it should not be the final deciding factor as it disregards very personal reasons for many people who rely upon drug treatments. Kadcyla has benefited many women during their time living with a terminal disease, and has now been pulled, devastatingly, out of their reach.

It is the Minister who has the levers of power to address the problems in the system which is letting these women down. Members from across this Chamber have eloquently made their case to the Minister. I hope she has listened—I am sure she has—and will give these women and their families some reassurances today.

Accelerated Access Review

Sharon Hodgson Excerpts

Tuesday 13th December 2016 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship, Sir Alan. I thank my hon. Friend the Member for Dudley North (Ian Austin) for securing this important debate. I note that as he said, it is just over a year since he first brought to the House a debate on cystic fibrosis.

I appreciate all hon. Members who have attended and spoken in this debate to show their support for the cause; it is one that we must urgently get right. Members have shared many moving cases involving their constituents whose lives Orkambi could save and would certainly transform. My hon. Friend the Member for Dudley North mentioned Carly Jeavons and Sam and Rob, the parents of Daisy. The hon. Member for Strangford (Jim Shannon) spoke about Evie-May, and my hon. Friend the Member for Bristol East (Kerry McCarthy) mentioned her niece Maisie. My right hon. Friend the Member for Leigh (Andy Burnham) spoke about his office manager Karen Aspinall and her son, as well as Philip and his sister Melissa, who sadly died. Philip believes that Orkambi would have helped his sister and would certainly help him, as he also suffers from cystic fibrosis. Those people believe that their lives would be transformed by Orkambi. I believe that too, and the evidence supports it, as we have heard in detail.

I thank all hon. Members who have spoken in this debate, including the hon. Member for St Ives (Derek Thomas), the hon. Member for Bath (Ben Howlett) and my hon. Friend the Member for Cambridge (Daniel Zeichner), for their excellent contributions, as well as the many others who have made valuable interventions. I also thank the Cystic Fibrosis Trust for its dedicated campaigning on the issue, and the 20,000 people who have been involved in its survey, in the digital debate here in Parliament, and in petitions and e-action. The concerns and the need for action are clear, and it is up to the Minister to give all those people beyond this place the answers that they need.

In my contribution, I will set out why the Opposition want to see the Government do more on innovative drugs, through case studies involving Orkambi. I will touch on issues of access to Orkambi and other drugs for those living with cystic fibrosis and expand into the recommendations of the accelerated access review, which can do much to address many of the issues involving access to new drugs.

Although it is welcome that the prescription drug Kalydeco was given the go-ahead by NHS England last week for two to five-year-olds as part of re-prioritisation, Orkambi remains an issue. There is currently a deadlock in negotiations between the pharmaceutical company Vertex, the Government and NHS England for the drug to be accessible to the 2,700 people who stand to benefit from it. As we have heard in detail today, that is all down to rejection of the drug under NICE’s appraisal system because there is a lack of long-term data. Although it is welcome that NICE recognises the treatment as effective in managing cystic fibrosis, it is clear that we desperately need a new system under which drugs can be better accessed, especially those that show that they can benefit patients. We have also heard about new data that NICE did not take into account and that would have showed 42% effectiveness.

Orkambi has been shown to halve the amount of hospitalisation of cystic fibrosis sufferers, and 96-week data published recently showed that it can help to slow lung function decline by 42%. The data are also backed up by anecdotal evidence from people who have accessed Orkambi through the compassionate use programme and are beginning to report transformations in their health—some are reporting enough improvement to come off the lung transplant list. That information is all positive. It should be made better available for consideration as part of the appraisal process; it should also form part of the negotiations between Vertex, the Government and NHS England. However, when we see a deadlock, all of that information is for naught. Thousands of people are suffering irreversible lung damage that could be stopped if the current impasse between those around the negotiating table was broken. Those who will suffer the most are stuck in the middle.

It is up to the Government to facilitate the end of the deadlock so that people can access Orkambi and see their lives transformed. One way to do that is to begin the job of implementing the recommendations set out in the accelerated access review, which the Opposition welcome. The goal of speeding up access to drugs by cutting four years off the time needed to bring new medicines to patients is something that we should all welcome; we need to see whether it can be achieved. The review has the potential to change the philosophy of the NHS in line with the five-year forward view, but also to help to maintain our global lead in life sciences. The recommendations set out in its final report have the potential to transform how we provide drugs and treatments, ensuring that we see innovation in drugs, diagnostic tools and healthcare developments. However, there still remain issues around thresholds for new drugs, which NICE and NHS England are currently consulting on. I understand that some associations and charities have raised concerns about that, and I hope that the Minister will update us on some of those discussions.

[Mark Durkan (Foyle) (SDLP)]

My hon. Friend is right to be so positive about many aspects of the accelerated access review. However, as she has mentioned, there are concerns that new definitional ruts could be created by some of the terms of the review, which could lead to some patients and some promising drugs being trapped in exactly the sort of deadlock that she has described.

[Mrs Hodgson]

My hon. Friend is right to raise those concerns. We do not want to move into a new system that will create new unintended consequences. Perhaps the Minister will touch on that in his speech.

Although some are calling for interim solutions to help people who are stuck waiting for the accelerated access review’s recommendations to be implemented, it is also important that the Government get on with implementing those changes. The review was announced more than a year ago and was published two months ago now. It is important to remember that the transformation that we all want to see will not happen straight away, but it is still right that we keep up the pressure for the recommendations to be implemented. There are many such recommendations, and I hope that the Minister will be able to update us today on the progress on each of them. There are two in particular that illustrate what can be done to resolve the deadlock around Orkambi—the immediate establishment of an accelerated access partnership and the setting up of a new flexible strategic commercial unit.

The accelerated access partnership is one way in which, through co-ordination and collaboration across the system, we could see drugs brought on to the market more quickly to benefit patients who need access to them. I would be interested to hear from the Minister what progress has been made on its creation, especially in conjunction with the issues surrounding the deadlock on Orkambi.

It is clear that the strategic commercial unit could help to benefit those who wish to see Orkambi offered on the NHS. The unit could work with those involved in this dispute to end the current deadlock through facilitation of the flexibility and transformational change promised by the accelerated access review. That would go some way towards helping to access data on drugs such as Orkambi and getting them out to patients. There is a willingness out there for that flexibility to be brought into the system; for example, the Cystic Fibrosis Trust has offered to use the UK cystic fibrosis registry to help to provide essential data that can help to prove how effective drugs can be and what more needs to be done. We have already heard how substantial that registry is; it includes 99% of sufferers. I understand that the trust’s offer has been welcomed by all sides in the negotiations but is blocked due to the lack of progress in implementing the changes set out in the review. I hope that the Minister will give us some clarity on when the unit will be created and when we can see a culture shift within the system that will allow for flexibility to accept data and information that show how much effect these drugs have on people’s lives.

[Dr Philippa Whitford]

Does the hon. Lady share my concern about drugs for other conditions, such as sofosbuvir for hepatitis C? Even after they get NICE approval, those more expensive drugs are now being rationed at the NHS England stage. At the moment we are fighting to get through NICE, but it needs to be a smooth path all the way through.

[Mrs Hodgson]

The cost of drugs sometimes leads the NHS into the terrible and unfortunate situation in which rationing seems to become the norm. There can also be a postcode lottery, which is another element that we need to look at. The price of drugs really is the crux of the issue.

In conclusion, I hope that the Minister will offer some insight into the progress being made on the recommendations of the accelerated access review. The case of Orkambi can help to drive through these changes and to end this deadlock, which, as we have heard, is causing unnecessary suffering for those living with cystic fibrosis. The review has established a space for change and for patients to access new and innovative drugs and treatments. It is important that there is no stalling or delay in transforming the system, because people’s lives depend on the changes called for by the review. I am sure that the Minister will keep that in mind when he goes back to his officials.

Draft Consumer Rights (Enforcement and Amendments) Order 2016

Sharon Hodgson Excerpts

Monday 12th December 2016 General Committees

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

The order does not change anything that is already on the statute book; it just updates enforcement provisions, following the passing of the Consumer Rights Act 2015. We therefore welcome it and will not divide on it.

Enforcing the regulations and legislation relating to the sale, packaging and marketing of tobacco is incredibly important, especially as we are continuing down the road to becoming a smoke-free society. Currently, one in five adults smokes, and although the number has halved since 1974 we still have a long way to go before we can cheer and pat ourselves on the back for achieving that vision of a healthier society.

Over the years, important work has been done to reduce the prevalence of smoking in our society, including the ban on smoking in public places introduced by the previous Labour Government and some important measures introduced under the coalition Government, such as the standardised packaging of tobacco products, which the hon. Member for Battersea (Jane Ellison) spearheaded so valiantly. I know it is peculiar for a shadow Minister to be bipartisan, but the hon. Lady deserves credit for her work on this matter, especially on the previous tobacco control plan.

That brings me nicely to my last point. I cannot miss the opportunity to remind the Minister that we remain concerned that our work to reduce tobacco consumption in our society could stall if the new tobacco control plan is not introduced sooner, rather than later. I want to use this opportunity to ensure that it is at the forefront of the Minister’s mind—I am sure it is—and that she does not forget it over the Christmas break.

Cancer Strategy

Sharon Hodgson Excerpts

Thursday 8th December 2016 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Like all other hon. Members who have spoken, I welcome this very important debate, which was secured by the hon. Member for Basildon and Billericay (Mr Baron) and others. Although he is, uncharacteristically, not in his place, for very important reasons—we all send him and his wife our very best wishes—I want to place it on the record that this House and, indeed, the whole country owe him a huge debt of gratitude for all that he does on the issue and for his sterling leadership as chair of the all-party parliamentary group on cancer in aiding our work in fighting this terrible disease.

I thank my hon. Friend the Member for Scunthorpe (Nic Dakin), who opened the debate. Like me and several others, he is a chair of an all-party group on cancer; his group is on pancreatic cancer. He works tirelessly on this issue, and he chaired the Britain against cancer conference with aplomb this week. He set the scene today so well, and his knowledge and passion shone through.

I thank all hon. Members who have spoken in the debate: the hon. Member for Crawley (Henry Smith), my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), the hon. Members for Bosworth (David Tredinnick), for Strangford (Jim Shannon) and for Castle Point (Rebecca Harris)—the hon. Lady is also the chair of a cancer all-party group—the hon. Member for Harrow East (Bob Blackman) and my very good friend the hon. Member for Bury St Edmunds (Jo Churchill), who is also vice-chair of the all-party group on breast cancer, of which I am a co-chair. They all made excellent contributions, and each and every one has made some important points about where we need to go next with the cancer strategy.

Much of the debate has focused on the report published by the all-party group on cancer, which looked at the progress made in implementing the cancer strategy one year on from its publication. The report makes many valid points and recommendations, and I look forward to hearing from the Minister on the specifics mentioned in it. The strategy can go a long way towards helping some of the estimated 2.5 million people living with cancer and the people who are diagnosed each year with cancer. The strategy, if implemented in full, could save 30,000 more lives per year by 2020.

That should be paired with the deeply worrying news that broke at the beginning of November that more than 130,000 patients a year have not been receiving cancer treatment on time, because cancer patients did not see a cancer specialist within the required 14 days. In some areas, the problem was so severe that more than 6,000 patients were forced to wait 104 days or more. In addition, our findings show that the Government met their 62-day target only once in the last 20 months. That should drive the Government to do more, and it is clear that we are seeing issues around the transformations already. That should not be knocked, and I am certainly not knocking it, but we must all continue to hold the Government to account where we can.

That is why in my contribution I want to touch on two areas: improvement in preventive measures that can help to reduce the occurrence of cancer, and the significant concerns that have recently been raised regarding the cancer workforce. We can all agree that prevention is key to addressing many health conditions, illnesses and diseases, and cancer is no different. As we have heard from several hon. Members in this debate, four in 10 cancers are preventable, and we should be doing much more to prevent cancers from developing, especially those that could have been prevented by lifestyle changes. Prevention was a central pillar of the cancer strategy, along with the five-year forward view.

The Minister is surely prepared for what I am going to say next, because I have said it to him often enough in my short time as the shadow Minister with responsibility for public health. It remains true, sadly. The false economy of cutting public health funding with no assessment of the ramifications of doing so on various aspects of our lives, or on other parts of the NHS and the wider health service, is seriously worrying. According to data collected by the Association of Directors of Public Health, smoking cessation services are expected to be reduced by 61% in 2016-17, with 5% of services completely decommissioned. For weight management support there will be a 52% reduction, with 12% being decommissioned. That is damning information when smoking and obesity are, as we have heard, two of the biggest preventable causes of cancer. We know that 100,000 people are dying each year from smoking-related diseases, including cancer.

It is right that the cancer strategy strongly recommended the introduction of a new tobacco control plan post haste and an ambitious plan for a smoke-free society by 2035, as has been outlined. We still have not seen the plan, despite being promised repeatedly over the last year that we would. I am sure that the Minister will give us further information on that in his response, and we all look forward to it. I hope that we see that plan sooner rather than later, and that hope has been echoed by several hon. Members from both sides of the House.

A continued delay will never be beneficial for our shared vision of a smoke-free society or for preventing cancer from happening. Another plan we have finally seen, although it has been considerably watered down, is the one for childhood obesity. After smoking, it is understood that obesity is the next biggest preventable cause of cancer. If we allow current trends to continue, there could be more than 670,000 additional cases of cancer by 2035. This completely goes against the vision set out in the cancer strategy. We saw some of the detail of the sugary drinks levy earlier this week, and it will be interesting to see how this develops in the months ahead, but I hope the Minister can outline a little bit more about what else he and his colleagues plan to do on obesity and its links to cancer.

As part of the cancer strategy, a review of the current workforce was called for so that we could fully understand the shortfalls—the areas of investment needed and the gaps in the training of new and existing NHS staff—and meet the ambitious and noble goals set out in the strategy. In my capacity as chair of the all-party group on ovarian cancer and co-chair of the all-party group on breast cancer, I along with colleagues from both sides of the House—some of them are in the Chamber, notably the hon. Member for Bury St Edmunds, who is a vice-chair of the all-party group on breast cancer—raised this at the beginning of the year with Health Education England, which is conducting the review. In our letter, we raised the need for immediate solutions to fill the specialist gaps in our cancer workforce, but also the need for a strategic, longer-term solution to be put in place.

The issue of the cancer workforce is an incredibly important one, especially given that Cancer Research UK warned over two weeks ago that pathology services in the UK were at a tipping point, and that the Royal College of Radiologists warned earlier in the year that 25% of NHS breast screening programmes were understaffed, with 13% of consultant breast radiologist posts left vacant, a figure that has doubled since 2010. That should spur on the Department to push ahead on the workforce issues that have been raised so often with Ministers.

Only this July, organisations such as Macmillan and Cancer Research UK joined with other organisations to call for a set of principles to be taken up by the Government, including a review of the current and future workforce. The Minister should also heed the words of Dr Harpal Kumar, who during an oral evidence session for the inquiry by the all-party group on cancer into progress on the implementation of the review, said that workforce issues remained “significant and severe”.

The ageing population, which means that more and more people could be diagnosed with cancer, and the much welcomed push to improve earlier diagnosis of cancer mean that pressures on the workforce will rise if the right support is not found, especially given the projection that 500,000 Britons will be diagnosed with cancer by 2035. That should remain at the forefront of the Minister’s mind, and in the minds of his officials and those who deal with workforce capacity.

It is clear that investment is failing to keep up with demand. That was raised in the cancer strategy, which called on NHS England to invest to unlock the extra capacity we need to meet the higher levels of cancer testing. The Opposition support the calls made only a few short months ago by the national cancer advisory group for NHS England’s cancer transformation board to prioritise a focus on the cancer workforce in the coming months. I hope the Minister will ensure that that happens, and that when we come back from the Christmas recess, we will start to see the much needed progress that has been called for.

In conclusion, the work that has started on the transformative programme is to be welcomed. It is a large task to undertake, yet the Government will not be allowed to sit back; I know that they and the Minister will not do so. It is up to all of us in this House, along with many people outside this place, to continue to do all we can to hold the Minister and the Government to account on what are such important and personal matters for all of us who have been affected by cancer, be it personally or through family and friends. We must all be critical friends in this drive to fight off cancer once and for all. We all agree that cancer should be at the top of our list of health priorities. It is so destructive, and, very sadly, it will affect us all in some way. We must ensure that we get this right, because we cannot afford to get it wrong.

Reducing Health Inequality

Sharon Hodgson Excerpts

Thursday 24th November 2016 Commons Chamber

[Maggie Throup]

My hon. Friend makes a good point. It is not just Tesco that has done that; so have Waitrose and Morrisons, to name just two—I am sure there are many more. It is really good that major retailers have taken on board the severity of the challenge faced both by us as a nation and globally. Parents need to be role models, as do retailers. Sometimes they are not quite the role models that they should be, but we need every bit of help we can get.

It is not just childhood obesity that is linked to social class and to different levels of deprivation; adult obesity is, as well. The highest prevalence of excess weight for both men and women is found among low socioeconomic groups. If current trends continue, almost half of women from the lowest income quintile are predicted to be obese in 2035.

Obesity is the single biggest preventable cause of cancer after smoking. The Government acknowledge the importance of early cancer diagnosis, and dedicated NHS staff at all levels are committed to delivering that, so surely every preventive measure that can be put in place, must be. As previously noted, as well as cancer, obesity leads to a greater risk of type 2 diabetes and heart disease. Those conditions are all life-changing and life-limiting.

I am sure people now understand that there is a link between obesity and diabetes, but, sadly, I fear that many think they can just take a pill to keep diabetes under control. Sadly, for far too many diabetes sufferers, that is not the case. The consequences are vast, with many diabetes patients needing lower limb amputation and suffering kidney disease, heart disease and sight loss—as I said, it is life-limiting and life-changing. Action needs to be taken now to turn around what I believe has become an obesity epidemic.

Everything I have talked about should prompt a reconsideration and review of the Department of Health’s childhood obesity plan. Although the Government were leading the world in producing the plan for action, when it was published, many, myself included, said that it was quite a let-down. I stand by that view. There simply was not enough detail in that 13-page document. It was aspirational, rather than a focused plan of action; it ignored the recommendations of Public Health England, which were endorsed by the Health Committee; and it did not set firm timescales for turning the tide on childhood obesity.

The plan we have is insufficient for the scale of the task we have to tackle. That does not mean starting all over again, however; it means that we need to do more. We need clear actions and timescales. I acknowledge that there is a fine balance between a nanny state, business co-operation, and parental and personal responsibility, but I am sure it is not impossible to find that common ground. Yes, it is the responsibility of parents to ensure their children eat healthily, are physically active and learn good habits that will last a lifetime, but time and again that has proven insufficient by itself. Parents need more help and the current childhood obesity plan cannot and will not give them what they need.

It would also be a mistake to think the answer lies in burdensome regulation of business, namely the food and drink sector. Demonising that sector is both unhelpful and unfair. As we have discussed, some producers, manufacturers and retailers have already taken great strides in reformulating products and encouraging healthier consumer behaviour. We must commend them and welcome those actions. Evidence suggests that the least affluent households in the UK have higher absolute exposure to junk food advertising than the most affluent households. Interventions such as reducing the promotion of junk food, or the soft drinks industry levy, are likely to have a positive impact on reducing health inequalities by delivering change across the population and consequently delivering disproportionate benefit to the most deprived communities.

Just as the current plan does not help parents, however, it likewise does nothing for business, which would be better served by clear goals for reformulation, advertising and labelling, and timeframes in which those must be achieved. Both publicly and privately, many businesses in the sector note that they would be better served by clearer, more far-reaching Government recommendations that at least gave them a measure of certainty for the future.

We may well be horrified by the national child measurement programme figures and other data we read on an almost daily basis now. Just this week, Cancer Research UK revealed that teenagers drink almost a bathtub full of sugary drinks on average a year—I hope that a visual representation will shock some teenagers into changing their habits rather than suffering the consequences.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

The hon. Lady is making an excellent and thoughtful speech—she will be pleased to hear that there has been nothing in it that I have disagreed with so far. Was she therefore as disappointed as I was at the removal from the childhood obesity plan—we can only guess at why—of targets on halving childhood obesity, as well as measures on advertising and marketing that would have helped with the issues she has been discussing?

[Maggie Throup]

I thank the hon. Lady for that intervention. I will come on to that point when I make some requests of the Minister towards the end of my speech.

We know that childhood obesity levels will not drop tomorrow, but we need to see some signs in the next few years that they are declining. The foundations of an effective strategy are readily available in the form of the Public Health England recommendations and the Health Committee’s report.

In conclusion, when the Minister responds, I would like to hear a firm commitment to the soft drinks levy; clear goals for product reformulation and timeframes within which those should be achieved; action on junk food advertising during family viewing; and action on supermarket and point-of-sale promotions—for example, we do not want to go to buy a newspaper and be offered a large bar of chocolate. I would also like to hear what accountability will be put in place to ensure that schools provide the exercise outlined in the plan. Such measures would ensure that we had a strategy, rather than just a vision, and enable us to start tackling the obesity challenge in our society today.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I welcome the opportunity to speak in the Chamber for a second time today, on yet another important topic. This time we are debating health inequalities and I thank the Backbench Business Committee for allowing this debate to take place following the application by the hon. Member for Totnes (Dr Wollaston) and other hon. Members across the House. The hon. Lady made an excellent speech, and we are very grateful to her for that. I also want to thank other hon. Members across the House for their excellent contributions today. I especially want to highlight the excellent speeches by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and my hon. Friends the Members for Stockton North (Alex Cunningham), for Bradford South (Judith Cummins), for Heywood and Middleton (Liz McInnes) and for Hackney South and Shoreditch (Meg Hillier).

I enjoyed the speeches by the hon. Members for Plymouth, Sutton and Devonport (Oliver Colvile)—a fellow member of the all-party parliamentary group on basketball—and for Erewash (Maggie Throup), who made an excellent speech on obesity and childhood obesity. I also enjoyed the speech by the hon. Member for Glasgow Central (Alison Thewliss). As she knows, I agree with most of what she says, especially about breastfeeding. We have had an excellent debate, with excellent contributions all round.

When it comes to addressing health inequalities, there are many conversations about the need for systemic change to reverse the trends. However, I want to look at tangible specifics that the Minister can get to work on in her remit as Minister for public health. I will do that by looking at the current state of health inequality and then the two key areas of smoking and childhood obesity and what more can be done to address those signifiers. I will then move on to the cuts to public health grants, which are exacerbating the situation.

The most recent intervention on health inequality came from the Prime Minister, who used her first speech on the steps of Downing Street to highlight that,

“if you’re born poor, you will die on average 9 years earlier than others.”

We have heard clear examples of that from constituencies around the country. That welcome intervention set the tone of her Government’s serious work to address health inequalities.

It is hard not to agree when the facts speak for themselves. Two indicators from the most recent public health outcomes data show that London and the south-east have the highest life expectancy while the north-east and north-west have the lowest. The same pattern appears when looking at excess weight in adults, which we have also heard about today. Rotherham comes out the highest at 76.2% and Camden is the lowest at 46.5%. Those figures prove what we all know to be true: people living in more deprived parts of the country do not live as long as those in more affluent areas. Contributors to ill health such as smoking, excessive alcohol consumption—which we heard about from the hon. Member for Congleton (Fiona Bruce)—and obesity are more prevalent in deprived areas.

There is a moral argument that it is important for the Government to address such issues, so that we can improve our nation’s health, but there is also an economic argument to be made. If we have an unhealthy population, we will not be as productive. In England, the cost of treating illnesses and diseases arising from health inequalities has been estimated at £5.5 billion a year. As for productivity, ill health among working-age people means a loss to industry of £31 billion to £33 billion each year. Those two arguments must spur the Government into action, but there are many issues to tackle and multiple ways for the Government to address them. Many such issues have been raised in the debate but, as I said, I will examine two key areas that the Minister must get right: smoking cessation and childhood obesity.

My first outing as shadow Public Health Minister was to debate the prevalence of tobacco products in our communities and the need for the Government to bring forward the new tobacco control plan.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

indicated assent.

[Mrs Hodgson]

The Minister remembers it well. The Government need to set out key actions to work towards a smoke-free society. Smoking is strongly linked to deprivation and has major impacts on the health of those who do smoke, such as being more prone to lung cancer and chronic obstructive pulmonary disease and facing higher mortality rates. If we look at that by region, which I have already established is a factor in health inequality, smoking levels are higher in the north-east at 19.9% compared with the lowest in the south-east at 16.6%. When looking at smoking by socioeconomic status, we find that the smoking rate in professional and managerial jobs is less than half that in routine and manual socioeconomic groups, at 12% and 28% respectively.

In the debate held just over a month ago, the Minister was pushed on when the new tobacco control plan would be published. Concerns have been raised by various charities, including ASH, Fresh NE and the British Lung Foundation, about how the delay could jeopardise the work already done. Sadly, the Minister evaded my specific question back then, so I will ask her the same thing again: when can we expect the new plan? Will it be this year or next year? The plan will not only go a long way to work towards a smoke-free society, but help to reduce health inequalities in our deprived areas. The Minister can surely understand that and the need to come forth with the plans.

The Minister knows that I also take a keen interest in childhood obesity. She has said repeatedly that the publication of the childhood obesity plan was the start of the conversation. Childhood obesity is the issue on everyone’s lips right now as it is the biggest public health crisis facing the country. I will not repeat the stats we all know about the number of children who start school obese and the number who leave obese—they are shocking. Many organisations and individuals, including Cancer Research UK, the Children’s Food Trust and Jamie Oliver, have made clear their dismay at the 13-page document that was snuck out in the summer and have said that it did not go far enough. Incidentally, it came out on the same day as the A-level results, so it looked like it was being hidden.

Obesity-related illnesses cost the NHS an estimated £5.1 billion a year, and obesity is the single biggest preventable cause of cancer after smoking. It is also connected to other long-term conditions such as arthritis and type 2 diabetes. When obesity is linked with socioeconomic status, we see real concern that the plan we have before us will not go far enough to reverse health inequality. National child measurement data show that obesity among children has risen, and based on current trends there could be around 670,000 additional cases of obesity by 2035, with 60% of boys aged five to 11 in deprived communities being either overweight or obese. There is a real need for the Government to come to terms with the fact that many believe the current plan is a squandered opportunity and a lot more must be done. That is why I hope the Minister will be constructive in her reply to this debate, giving us reassurances that move us on from this being “only the start”. At the end of her speech, the hon. Member for Erewash gave us a list of four or five items that we could start straightaway, which would certainly take us further on.

The Government have stalled or not gone far enough on the plans I have mentioned, but there is also deep concern that the perverse and damaging cuts to public health spending will widen the health inequality gap. The Minister knows the numbers that I have cited to her previously, but I will cite them again, even after my right hon. Friend the Member for Kingston upon Hull West and Hessle has done so. We are greatly concerned about the £200 million cut to local public health spending following last year’s Budget, which was followed by the average real-terms cut of 3.9% each year to 2020-21 in last year’s autumn statement. I want to add some further concerns that go beyond those raised by Labour.

Concerns were identified in a survey by the Association of Directors of Public Health, which found that 75% of its members were worried that cuts to public health funding would threaten work on tackling health inequalities. Those concerns are backed up by further evidence published by the ADPH, which found that local authorities are planning cuts across a wide range of public health services, because of central Government cuts. For example, smoking cessation services saw a 34% reduction in 2015-16, and that will become 61% in 2016-17, with 5% of services being decommissioned. That is seen across the board among local public health services and will be detrimental to reversing health inequalities. For the Government to fail to realise that cutting from this important budget will not help the overall vision on health inequality, set out by the Prime Minister earlier this year, is deeply worrying and shows a distinct lack of joined-up thinking around this issue.

In conclusion, health inequality is a serious issue that we cannot ignore or let the Government get wrong, as the health of our nation is so important, not only in a moral sense, but economically. I know the Minister will fully agree with the Prime Minister’s statement from earlier this year—there is no second-guessing that, as we all do—but we need radical proposals that get to the bottom of this persistent issue, which blights the lives of so many people living in our most deprived communities. We all want to see a healthier population, where nobody’s health is determined by factors outside their control, and we must all work together to get to the point where it is no longer the case that the postcode where somebody is born or lives determines how long they will live or how healthily they will live that life.