E-cigarettes

Sharon Hodgson Excerpts

Thursday 31st October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Henry. I apologise if I sound a bit croaky; I have a cold that is going round. Hopefully I will get rid of it soon, given what is to come over the next few weeks.

I thank the right hon. Member for North Norfolk (Norman Lamb) for introducing this debate, and for his characteristically well-informed speech. It is sad to think that it could very well be his last speech in what has been an illustrious career as an MP. I am sure that it will not be his last speech as a campaigner or activist. I also congratulate him on his work chairing the Science and Technology Committee, and on the excellent report that we are considering.

I thank all the other right hon. and hon. Members who have spoken, including the hon. Member for Ayr, Carrick and Cumnock (Bill Grant), and my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), who I have enjoyed working with for many years. He has also had an illustrious career, and was an excellent Chair of the Health Committee for a number of years; he will be sorely missed in this place. There were also speeches by the hon. Member for Dartford (Gareth Johnson) and by the hon. Lady who has just spoken; I did not catch the name of her constituency.

[Sir Henry Bellingham (in the Chair)]

Brecon and Radnorshire—by-election win.

[Mrs Hodgson]

Excellent. Thank you.

As we have heard, there is still some uncertainty about the use of e-cigarettes. They entered the UK market only 12 years ago, and because this technology is still so young, we do not know for certain what its long-term impacts on health will be. What we do know is that e-cigarettes are around 95% less harmful than conventional cigarettes, and because of that, an estimated 2.9 million people in the UK are using them to stop smoking. Each year, tens of thousands of people successfully use e-cigarettes to quit. A randomised controlled trial, published in the New England Journal of Medicine earlier this year, found e-cigarettes used in a stop smoking service to be nearly twice as effective as licensed nicotine replacement therapies, such as patches and gum.

The importance of e-cigarettes as a smoking cessation tool should therefore not be dismissed. However, that must come with the caveat—I think everyone has made this point—that using an e-cigarette is not completely risk-free. There has been a recent outbreak of serious lung injury in the US linked to vaping, although that has not been replicated in the UK. Currently, 3.6 million people vape in the UK, yet the number of cases of severe respiratory pathology associated with vaping is low and diverse, with reports over a long period.

I agree with ASH’s recommendation that e-cigarette users should buy vaping products, including e-liquid, only from mainstream suppliers that sell regulated products, because using black market products may carry lethal risks. They should report any adverse effects from e-cigarettes to the Medicines and Healthcare Products Regulatory Agency using the yellow card scheme. If they experience serious adverse effects that they think are due to vaping, they should immediately stop vaping and get advice from their doctor.

Has the Minister considered launching an e-cigarette safety education programme that will ensure that e-cigarette users know the risks, and what to do if anything goes wrong and they manifest any such symptoms? That may lessen the possibility of manifesting the same patterns that we have seen in the US of lung injuries linked to e-cigarettes.

The Committee’s recommendation 4 says that NHS England should issue e-cigarette guidance to all NHS mental health trusts, and the default should be to allow e-cigarette use by patients. As we have heard, people with mental health issues smoke significantly more than the rest of the population, and could therefore benefit significantly from using e-cigarettes to stop smoking. Encouraging and allowing patients in mental health units who are smokers to switch to e-cigarettes as a means of smoking cessation would allow them to engage with their treatment sessions in the facilities without the interruption of smoking breaks.

A third of the 50 NHS trusts that responded to the Committee’s survey ban the use of e-cigarettes. The Government have agreed to issue guidance to NHS trusts about e-cigarettes. Will the Minister please tell us when she anticipates that it will be published? I know that she might have to rush it out in the next couple of days, but she might have a magic wand and be able to do that. Doing so could allow patients in mental health units to engage more fully with their treatment, which could improve outcomes.

As the Committee has found, e-cigarettes have a role to play in our society and in the Government’s commitment to achieving a smoke-free generation. However, we must ensure that advice on the safety of e-cigarettes, both short and long term, is updated regularly and publicly, so that users have the most relevant and up-to-date information available to them. The Government must also consider the role that e-cigarettes play in mental health services and improving patient outcomes across the NHS.

Every contact counts, especially when it comes to smoking cessation, and none should be missed. However, due to the Government’s public health budget cuts since 2013, which I know the Minister is not personally responsible for, smoking cessation services have suffered, leaving the most vulnerable smokers behind, without any support to quit smoking. That must change. Again, I ask the Government to reverse those public health budget cuts, so that local authorities can provide the smoking cessation services that their local communities need and deserve. I look forward to the Minister’s response.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 29th October 2019 Commons Chamber

[Matt Hancock]

I wholeheartedly agree with my right hon. Friend, who is absolutely spot on about this, but there is more that we need to do in ensuring that the health inequalities of people who are homosexual or LGBT are reduced across the board. We have a whole plan to make that happen. She played an important part in government, and I will rest at nothing to ensure that we address these problems, but we should not engage in the sort of scaremongering that we have heard from the Opposition.

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

I hear what the Secretary of State has said, but data from the British Association for Sexual Health and HIV have shown that nine gay and bisexual men in Greater Manchester were diagnosed with HIV while waiting to access the PrEP trial. This is likely to be just the tip of the iceberg in terms of the number of people who have acquired HIV because they could not access the trial. He will agree that this is totally unacceptable and goes against the Government’s own commitment to eradicate HIV by 2030, so does he think that PrEP should be routinely commissioned before the trial ends in September 2020 and will he commit now to that happening?

[Matt Hancock]

We are switching to routine commissioning from April. It is a deep frustration of mine that some local authorities are not putting in place the necessary measures. I will look into Manchester in particular; I did not know about that example. I personally set the goal of our being HIV-free by 2030. I am delighted that, with the support of my right hon. Friend the Member for Portsmouth North (Penny Mordaunt) when she was the Minister for Equalities, we have made the progress that we have. I have absolutely no doubt that there is further road to travel and that we should all come together in support of equalities in health provision, especially in this area. I look forward to working with the hon. Lady and all those who are on the side of trying to make this change happen.

Diabetes: Tailored Prevention Messaging

Sharon Hodgson Excerpts

Thursday 24th October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Buck. In my long tenure as shadow Minister for Public Health, it has been a pleasure to speak in many debates with the hon. Member for Strangford (Jim Shannon), on all sorts of health issues. I congratulate him on securing this debate and on his excellent speech. I know that diabetes is an important issue to him and I thank him for speaking so honestly about his own journey with diabetes. In the past, I have spoken about my own journey, but I do not plan to dwell on that too much today.

I thank other hon. Members for their excellent contributions: my hon. Friend the Member for Heywood and Middleton (Liz McInnes), my right hon. Friend the Member for Leicester East (Keith Vaz) and the SNP spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day). Although there are not many of us in attendance, we have heard some excellent contributions and the debate has been full, detailed and excellent. I also thank charities such as Diabetes UK for the work that they do, both to support people with diabetes and to prevent diabetes.

Like the Secretary of State and, I am sure, the Minister, we all believe that prevention is better than cure. We all say that, and I honestly think that we all believe it. As hon. Members have said, however, the Government repeat that mantra but have cut public health funding to the tune of £700 million since 2013. Those cuts have had a serious impact on the nation’s health, but they have hit those in low-income areas the most, as we have heard. That is particularly concerning, given that children and adults living in deprived areas are substantially more likely to be obese, and obesity is a risk factor for diabetes—particularly type 2 diabetes, as my hon. Friend the Member for Heywood and Middleton made clear.

According to NHS Digital, one quarter of people living with type 2 diabetes in England are from the most deprived fifth of society, compared with 15% from the least deprived. We have had that knowledge for a long time, so it really is time that the Government used the knowledge and took action to tackle both the obesity and the diabetes epidemic, both of which disproportionately affect those in the most deprived areas.

Opposition Members have been clear that there is no silver bullet to fix the issue. However, we support the proposal to introduce a 9 pm watershed on the advertising of food that is high in fat, salt and sugar. We also support a restriction on the sale of energy drinks to under-16s and clearer labelling on food and drink—that would help us all. Those are all policies on which the Government have consulted, but we have yet to see anything from the Government setting out whether they will be implemented. Can the Minister update us on the consultations when she responds?

[Jim Shannon]

I congratulate the hon. Lady on her contribution and her comments. I was sitting here thinking about families and diabetes. In a family of four or five, there may be one diabetic member of the household. I believe that the whole family—mum and dad, brothers and sisters; whoever it may be—need to give consideration to the person with diabetes to ensure that their battle with diabetes is one that the whole family fights together. That is difficult to do, but it is important that families realise that they have a job to do.

[Mrs Hodgson]

I am not sure whether there is a hereditary aspect to it, but I am aware that sometimes there can be a number of people with diabetes in the same family. I am the only one I know of in my family with the condition, but then again I do not know my father’s side. My mam always says that I take after my dad with regard to my size, so perhaps there is a link and I am just not aware of it. The eating habits of members of a family can be very similar. If eating habits have led someone to get diabetes, the condition could have affected others in the same family, so the hon. Gentleman makes a valid point.

The evidence shows that the policies proposed by the Government, if they are fully and quickly implemented, could help us to make real progress towards reducing childhood obesity by 2030. Will the Minister tell us what the delay is? Instead of just window-dressing with the childhood obesity plan chapters 1 and 2 and the former chief medical officer’s special report on childhood obesity, which we had in the past couple of weeks, the Government must now take bold action and implement all the policies in the reports. The time for reports and consultations is over. We all know what needs to be done, and now we need urgent action.

According to NHS England, managing the growing incidence of diabetes in England is set to become one of the major clinical challenges of the 21st century, as we have heard expressed clearly in this debate. Estimates suggest that the number of people with diabetes is expected to rise to 4.2 million by 2030, affecting almost 9% of the population, with all the associated costs.

More than half of all cases of type 2 diabetes could be prevented or delayed. The hon. Member for Strangford and my right hon. Friend the Member for Leicester East both spoke about that in detail. By reducing the number of people who are overweight or obese, we can reduce the number of people who develop type 2 diabetes and live with the life-changing complications that are associated with it. Like the hon. Gentleman, I wish I had known much sooner the irreversible damage that I was doing to myself. I have done a detailed blog post about it, which is available online, if anyone is interested in my thoughts—I will go into them no further in this debate. Steps that the Government take today will benefit people greatly tomorrow, so will the Minister please outline the Government’s plans to prevent further incidence of diabetes?

There is no one-size-fits-all approach to diabetes, which is why targeted messaging and support is so important, alongside societal and environmental changes to tackle obesity, as I have mentioned. Interventions such as NHS health checks, weight management programmes and the NHS diabetes prevention programme should therefore be offered and taken up more often in order to identify risk and to prevent diabetes. Many people who are eligible for the NHS health checks are not invited to them or do not attend.

What will the Government do to encourage people to attend their NHS health check and to ensure that everyone who is eligible is definitely invited for a check? About 1 million people live with undiagnosed type 2 diabetes, and one in three people already have diabetes complications by the time they are diagnosed with type 2 diabetes, so that service could be invaluable in preventing further incidence of diabetes and of the complications that sufferers experience.

Those who have diabetes know that it is possible to put type 2 diabetes into remission through substantial weight loss. As the hon. Member for Strangford mentioned, my hon. Friend the Member for West Bromwich East (Tom Watson) has been incredibly vocal about his very visible journey. He has been an inspiration to many. We need to make sure that when people go into diabetes remission, they continue to get support, access to diabetes monitoring and, where necessary, care, because, as I was told, “You are never cured.” Even if someone with diabetes is in remission through diet, they will still forever be a diabetic—we have broken our bodies, basically.

People who wish to go into remission must have continued support. There is still a need for more research to understand the long-term impact of remission on reducing complications, but for now the future in that regard looks positive. This debate has been excellent, and it has demonstrated that there are clearly steps that the Government can and should take to prevent diabetes. I hope that the Minister will take them on board. I look forward to her response.

In closing, I thank and congratulate—on behalf of all us who are living with diabetes—Professor Ian Shanks, the inventor of the blood glucose monitor some 40 years ago. I was so pleased to hear the news overnight that he is to be paid a small award. I say “small” because, although it is £2 million, I understand that most of it will be eaten up by the legal costs of a 13-year battle. He might not be a rich man after he has paid all his legal bills, but he will be rich in terms of gratitude for the millions of lives he has saved, and no doubt improved, with his invention.

Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019

Sharon Hodgson Excerpts

Monday 7th October 2019 General Committees

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

I am grateful, Dame Cheryl; I was not sure what order we would speak in. It has been a while since I have done one of these Delegated Legislation Committees; it was probably before the summer recess, when we did quite a few. I am very pleased to serve under your chairmanship, Dame Cheryl, and I thank the Minister for introducing the statutory instrument and providing a summary of it.

As the Minister said, the SI was discussed earlier this year by the hon. Member for Winchester (Steve Brine), and a lot has changed. We have had not just our summer holidays, but a full remake of the Government—we have a totally new Government. Nevertheless, we still have uncertainty about whether the UK will leave the EU in 24 days, with or without a deal, and about the impact that could have. As legislators, we have to get this right, and I deeply regret that once again we find ourselves back in this room debating necessary SIs and having to rush this legislation through in case of a no-deal Brexit, which none of us in the Opposition wants. I know some Members on the Government side do not want it either.

I move on to the legislation before us. As we all agree, the safety of our food is of the utmost importance to our health and wellbeing, and we cannot get it wrong. Food safety must be protected at all costs. I share the Government’s commitment to ensuring that there is no change in the high-level principles underpinning the day-to-day functioning of the food safety legal framework. Ensuring continuity for business and public health bodies is of the utmost importance and in the interest of the public.

The Minister will not be surprised that I have a few questions about the SI. First, why was this missed from the SI in March? She might have touched on that. Has any assessment been made of what would have happened had the UK left the EU in March without a deal and without the SI in place? What exactly will the Minister’s responsibilities be under the SI? Finally, what additional substances can be approved by Ministers if needed, and how will that impact food safety? I see that the SI gives some leeway for Ministers to approve substances that can be added to our food. I would be interested to hear how confident the Minister is that a high standard for food safety will be maintained from day one of Britain’s exit from the EU.

The safety of our food is hugely important, and we cannot get this wrong. With those few brief comments, and not wanting to delay the Committee, I look forward to the Minister’s response.

[The Chair]

We do have one and a half hours for this debate, if people wish to take it. I call the hon. Member for Paisley and Renfrewshire North, who speaks for the Scottish National party.

Community Pharmacies

Sharon Hodgson Excerpts

Wednesday 2nd October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing the debate, and for her excellent opening speech. For their contributions early on this cold Wednesday morning, I also thank my hon. Friend the Member for Heywood and Middleton (Liz McInnes), my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for York Central (Rachael Maskell), the hon. Member for Westmorland and Lonsdale (Tim Farron), my hon. Friends the Members for Scunthorpe (Nic Dakin) and for Great Grimsby (Melanie Onn), and the hon. Member for Motherwell and Wishaw (Marion Fellows), who speaks for the Scottish National party.

It is clear that community pharmacies are valued across all our constituencies. On Friday I will be visiting Davy Pharmacy in Castletown in my constituency. I will hear once again at first hand how my constituents benefit from community pharmacies, and the impact that their services are having.

I welcome the new Minister to her role. I look forward to hearing from her today and to shadowing her in the months to come. I know that health is very important to her, and that it is one of the reasons why she stood to be a Member of Parliament. We previously worked together as officers of the all-party parliamentary group on breast cancer.

I will begin with one of the first things that springs to all our minds when we think about community pharmacies: prescriptions. As my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Secretary of State for Health, announced in Brighton last week, the next Labour Government will introduce free prescriptions for all. We believe that prescription charges are a tax on sickness. When as few as 5% of patients actually pay for their prescriptions and many of them struggle to pay, surely it is time that the charge was scrapped.

The £9 per item prescription charge results in some patients on low incomes reducing their medication or going without, which is dangerous and can impact on a patient’s long-term health. It can even be fatal, as in the heartbreaking case of 19-year-old Holly Warboys, who died of an asthma attack. Holly did not have a full inhaler because she could not afford one. Nobody should have to pay to breathe.

A large proportion of the 5% of people who pay for their prescriptions budget for them by taking advantage of prepayment certificates, to reduce what they have to pay to the equivalent of about one and a half prescriptions per month. When all the costs of administering the fines and prepayment certificates, and the whole kit and caboodle around charging, are taken into account, it seems eminently sensible, fair and cost-effective to extend free prescriptions to all.

Research backs that up. A study from the University of York has shown how beneficial free prescriptions can be as a means of prevention. When patients suffering with Parkinson’s disease, for example, were given free prescriptions, hospital admissions were reduced by 11.4%, patient day care was reduced by 20.4%, and accident and emergency attendances were down by 9%. I am sure that the Minister will see that the policy will improve patient outcomes and save precious NHS resources. I know that she is new to her post, so she might want to make a bold announcement today. Will she match Labour’s commitment to ending this tax on sickness? The subject was definitely on the radar of one of her predecessors on the health team, the hon. Member for Winchester (Steve Brine), as I had conversations with him about it.

As we have heard, filling prescriptions is only the tip of the iceberg of the services that our community pharmacies provide. There is the potential for the expansion and development of a whole range of services. For example, I would like to see an expansion of pharmacists being able to prescribe, especially basic medications, in order to relieve pressure on our GPs. I understand that that service is very successful where it currently happens. Community pharmacists are the most accessible healthcare professionals, and community pharmacies are a genuine hub for the delivery of a diverse range of health and wellbeing services. The Government’s television campaign advises people to ask their pharmacist, because it really is an easy thing to do. That is especially true for traditionally hard-to-reach people who benefit from the barrier-free access to healthcare that community pharmacists provide.

In some circumstances, if there is a high turnover of GPs in an area, the community pharmacist is the only one providing continuity of care, which builds invaluable trust and the capacity for important health interventions. It is therefore a natural and sensible progression to allow basic prescribing, especially if it is coupled with a sort of triage service that is linked to an ability to make appointments for people with more serious concerns directly with their GP.

As we have heard, community pharmacies have long provided a range of services in addition to the provision of medicines, including minor ailment schemes, smoking cessation services, blood pressure testing, support for asthmatics and diabetics, emergency hormonal contraception and monitored dosage systems. Despite that, community pharmacies are in many ways the NHS’s best kept secret. They are invaluable in a health service that is overwhelmed by increased demand.

There is so much untapped potential in community pharmacies, as well as some excellent examples of best practice across the country that could be rolled out nationwide. For example, when patients phone the Central Gateshead Medical Group with a minor illness such as earache or a sore throat, they may be offered a referral to one of 13 community pharmacists in the Gateshead area for a same-day booked consultation, which creates capacity for GP appointments for patients who need to be seen by a GP. The patient’s referral details are sent to the pharmacy using a secure NHS mail account. Patients are then sent a text message to confirm the details of the appointment with the community pharmacist. Community pharmacists are already doing some great work and they have a huge role to play at the heart of every primary care network. The Government are failing to recognise that if they do not try to roll that out.

I welcome the Government’s commitment to prevention, but they must put their words into action, for example by reversing the terrible cuts to local authority public health budgets and by recognising the importance of community pharmacists in particular and the role that they can play in prevention. As we have heard, thousands of people—millions, actually—visit their community pharmacy every day. Every one of those presents an opportunity for a positive health or wellbeing intervention. In the words of Simon Stevens, “Make every contact count”.

The profession and its representatives, the Pharmaceutical Services Negotiating Committee and the National Pharmacy Association, have offered to deliver more services. The recently negotiated new pharmacy contract begins to recognise what the NHS has been missing for so long. There are many welcome features, including the new community pharmacist consultation service, which will take patient referrals from NHS 111 and will be extended for referrals from other parts of the NHS, such as GPs and A&E. Similarly, the new Medicines reconciliation service will ensure that medicine prescribed in secondary care is appropriately implemented on discharge to the community, which will reduce the number of unnecessary hospital readmissions. Those changes will be not only convenient for patients, but enormously important in relieving pressure on GP surgeries and A&E departments, which is what we all want to do.

That is why we need a shift to service-based remuneration in the context of a five-year agreement. If community pharmacies, with their huge potential, are to remain viable, the remuneration must be adequate. Can the Minister tell us today what the new funding settlement will look like? I hope that, in her response, she will celebrate the work of community pharmacies—I am sure she will—and set out what the Government will do to utilise their potential.

Hernia Mesh in Men

Sharon Hodgson Excerpts

Thursday 5th September 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the hon. Member for Strangford (Jim Shannon) for securing the debate and for his characteristically passionate, thought-provoking and knowledgeable speech. Although, for all the reasons he gave, the debate is not heavily subscribed, it is an extremely important debate about an issue we have not yet addressed in this place. I know that all the men and, indeed, women watching—be they wives, partners, family members or mesh sufferers themselves—will thank him for bringing this issue before the House too. I also thank the hon. Member for Linlithgow and East Falkirk (Martyn Day) for his remarks on behalf of the SNP.

I welcome the Minister to her new role. We were both elected in 2005—I remember seeing her at the induction on my first day—but I think this is the first time we have faced each other speaking from our respective Front Benches in this capacity. I look forward to shadowing her on some of her policy areas and to holding her Government to account on all things public health and patient safety, which tends to be the area I cover. I also look forward to her response to the debate, but first I have some questions of my own for her.

As the hon. Member for Strangford said, we have had a number of debates in this Chamber and the main Chamber about the impact of vaginal mesh on women—including, sadly, as I am sure Members have heard, my own mam. She is a sufferer of vaginal mesh, which I have spoken about at length in other debates. Although this debate is about hernia mesh in men, it is clear, as the hon. Gentleman said, that there are similarities between the two that need to be addressed. First, the devices are made of the same material—usually polypropylene plastic, which is also used for plastic bottles. It is hard to believe that it is being inserted inside people; obviously, we are now hearing about the damage that causes. The other similarities are a lack of data and a lack of information about the risks for patients, both of which cause harm to patients.

As we heard, the majority of hernia mesh operations are successful, and the Royal College of Surgeons states that the implants remain “the most effective way” to treat a hernia. However, that does not mean we should ignore the patients who tell us that the operation caused them extreme pain and discomfort. The surgery might be successful in the sense that it repairs the hernia, but if it causes extreme pain and life-changing symptoms for some patients, it cannot be right to call it successful.

As I have said in debates about vaginal mesh, if a car, a washing machine or a drier failed in such numbers, there would be a full recall and sales would cease immediately, no ifs or buts. Research shows that between 10% and 15% of people who have hernia mesh surgery suffer from chronic pain and complications after the surgery. That is just not acceptable. That is not a tiny number of people—it is not just the odd one—and it is devastating for the lives of every one of them.

According to NHS data, 10% of people who have hernia mesh fitted go back to their clinician at some point after their surgery. Some surgical experts claim that complications occur in as many as 30% of hernia mesh surgeries, and that those can be every bit as harmful as with vaginal mesh. Until today, hernia mesh patients have not had their voices heard, because the extent of the problem is just not measured. What assessment has the Minister made of the number of complications following hernia mesh surgery, and what consideration has she given to establishing a hernia mesh database to audit the number of surgeries and any associated complications?

The lack of data collection means patients cannot adequately be informed about the risks before surgery. I hope that changes as a result of the debate. Hon. Members may have heard of Dai Greene, a world-class hurdler who captained the Great Britain athletics team at the 2012 Olympic games and was subsequently treated with hernia mesh. He says he cannot remember being warned about any associated risks but was told he would be back training after a few weeks. That was not to be the case: Greene lost five years of his career due to complications after the surgery.

We all trust that surgery will be safe for patients and will improve their quality of life. Patients trust that they will be informed of any associated risks. With vaginal and hernia mesh, that has not been the case for thousands of patients. How will the Minister address these serious concerns? Patient safety and trust must not be compromised in favour of a cheap or quick procedure. My mam was told, “Oh, it’ll be 15 minutes that will change your life.” My word, it changed her life—but not for the better.

I understand that the independent medicines and medical devices safety review is due to report its findings soon. I attended one of its sessions in Newcastle with my mam. It was very well attended, as I believe they all were. Baroness Cumberlege was there, and she was very attentive and compassionate to all the women in attendance. I look forward to her report. Hernia mesh is not included in the review, but given the parallels between vaginal and hernia mesh, which have been highlighted not just today but consistently— the hon. Member for Strangford cited Victoria Derbyshire, who has also done great work on this issue—the Minister should consider the review’s findings in the light of this debate and treat hernia mesh with the same seriousness as vaginal mesh.

Will the Minister work with NICE and NHS England to ensure that patients are clearly informed in good time before surgery about the risks associated with their treatment so that they can make properly informed decisions, with updates on risks as research develops? This is about patient safety and confidence, which is paramount to our NHS.

In closing, I welcome again the Minister to her role. I appreciate that this week must have been a baptism of fire, trying to get on top of so many issues. I understand that she has had to respond to three debates—as the hon. Gentleman said, she has got a hat-trick. Nevertheless, I hope she will address these concerns today and take away any that she cannot. No doubt, we will revisit this issue for debate at a later date.

--- Later in debate ---

[Ms Dorries]

I thank my hon. Friend for his absolute honesty and openness in bringing forward his own case.

The bowel can come through the opening in the muscle wall, strangulate and develop into peritonitis, with dire consequences. The fact is that the alternative method of repair—just to stitch the muscle wall—is nowhere near as effective, and the same dangers can present. There can be a rupture, and the hernia will present again with the same complications.

[Mrs Hodgson]

The Minister, with her medical knowledge, can give the details on hernia repairs in men that otherwise would have been missing from the debate. The hon. Member for Burton (Andrew Griffiths) speaks from his experience. Although I do not want to be a harbinger of doom, for him it is very early days; often the pain that comes in 10% to 15% of cases appears a few years later, as the hon. Member for Strangford said in his speech. The Minister rightly points out that it is a good operation for what is a life-threatening condition in men, as opposed to stress incontinence in women, but still in 10% to 15% of cases we are talking about real pain. I would like her to elaborate on what we should do about that.

[Ms Dorries]

The hon. Lady is absolutely right. No one should suffer with chronic pain. There is a difference between acute and chronic pain, with acute pain happening immediately post operation and the chronic pain continuing afterwards. In inguinal mesh repair operations, the chronic pain is due to the mesh—like a small piece of net curtain—rubbing up against nerve endings and causing inflammation. For many men, the pain is quickly cured by an injection of local anaesthetic such as lignocaine with a steroid, which reduces the inflammation and takes away the pain completely. For many men who present back in out-patients, their pain is quickly sorted.

I do not want it to sound as though I am trivialising in any way the problems of those who continue to suffer pain. I believe that the Cumberlege report covers mesh as a wider issue, as well as issues related to the use of mesh, so we may gather more information from the report that will inform the debate on inguinal hernia mesh repair.

There are, however, other options. The best practice is shared decision making between the patient and the clinician, with the clinician fully explaining the operation to the patient, what is involved and what the options are. One option for patients who present with a hernia is for the clinician to reduce it in the clinic back in through the muscle wall. At that point, the patient may know how to handle it and manage it by not over-exercising and being careful when they cough. The patient will be registered as having had a hernia reduced and, if they want it operated on, they just ring up and go straight on to the operating list. That is a good option for many men if they think they can carefully and responsibly manage the hernia and come back to hospital only if it gets worse, if it pops again or if they need immediate attention. Whatever happens, they will be registered as having had an inguinal hernia and seen a clinician and therefore in need of treatment should it reoccur.

We are encouraging clinicians to have that conversation with patients. I do not know whether the clinicians treating my hon. Friend the Member for Burton (Andrew Griffiths) did, but clinicians should do so that patients can decide whether they want to go ahead with an operation.

--- Later in debate ---

[Ms Dorries]

I am delighted to hear that.

I am pleased to say that shared decision making is set out in the NHS long-term plan and I hope we will see more of it in other areas. As the hon. Member for Strangford mentioned, it has the full backing of the Royal College of Surgeons and the Royal College of Anaesthetists. I know from my own experiences in the health service that the role of patient voices is critical at every stage along the treatment pathway. Indeed, as we have said, the Government have asked Baroness Cumberlege to lead a review on the theme of patients’ voices. I will say more about that later.

All of us, including Ministers, regulators and clinicians, must listen to patients, such as the constituent mentioned by the hon. Member for Strangford who has had an ongoing problem, when they raise concerns. Only by listening to those patients’ voices and understanding the issues they have after hernia repair can we learn and develop what we need to do to ensure that it does not happen to people in the future. We must strike a fine balance as we steer through innovation, emerging science, clinical advice and the voices of a multitude of patients.

Hernias are relatively common. One in five men will get an inguinal hernia in their lifetime and it is worthwhile briefly outlining why men are mostly affected. Inguinal hernias are a type of groin hernia, which are the most common type of hernia. Some 98% of them are found in men, as the male anatomy is particularly vulnerable in this region. The main reason to operate on a hernia is to reduce the risk of bowel obstruction or necrosis, which is tissue death. Both of these conditions require major emergency surgery, where there is a risk of death.

Hernia surgery is therefore often a necessity. I have been advised by clinicians that when an individual’s condition indicates surgery, mesh repair is the standard operation for adults with inguinal hernias. It is safer than non-mesh repair in the first instance and is less likely to lead to pain post operation. It is also less likely to lead to hernia recurrence. To address the point made by the hon. Member for Strangford, I hope he understands not only that this treatment is the most effective but that the alternative is more likely to result in complications. Mesh is therefore used in approximately 97% of all surgical inguinal hernia repairs in England.

All the expert scientific advice that Ministers have received does not support a ban. It is important to emphasise that internationally no other country has banned the use of mesh to treat hernias. According to the National Institute for Health and Care Excellence, approximately 70,000 surgical inguinal hernia repairs are performed in England each year, at a cost to the NHS of £56 million a year. These mesh repairs are performed by either open surgery or laparoscopic surgery, as my hon. Friend the Member for Burton described.

NICE has developed guidance which recommends laparoscopic surgery as one of the treatment options for the repair of inguinal hernia. The guidance states that it should only be performed by appropriately trained surgeons who regularly carry out the procedure. This evidence was reviewed by NICE in February 2016 and the recommendations have remained in place since then. The Medicines and Healthcare Products Regulatory Agency and others will continue to review the situation as further evidence and analysis emerges, and will take any appropriate action on that basis. That is why this debate and the recounting of the experiences of constituents is important. They have ensured and will continue to ensure the safety of patients who need treatment.

Unfortunately, no type of surgery is without risk, both during and post surgery. The right balance between risks and benefits for individual patients must be achieved, which places patient autonomy and consent at its heart. I stress that I am deeply concerned to hear about instances where these conversations may not have happened, or have not been conducted in a manner that sufficiently informs the patient. Every patient should expect to receive safe and effective care, and to have an opportunity to raise concerns and feel confident that they will be listened to.

I will talk about the pain and suffering experienced by some men after mesh surgery. The vast majority of patients who undergo surgery using mesh to treat hernias go on to live normal, independent lives. While we do not know the exact number of complications, we believe it is low. However, I understand that those who experience the most adverse outcomes are those who suffer chronic pain or long-term discomfort.

I have been advised that 10% to 12% of men experience moderate to severe chronic pain post surgery. While that number is high, it is lower than for those who have non-mesh repair. I have been advised that acute pain is normal during healing, but chronic pain is not normal. As I said, one example of pain management is to treat chronic pain by injecting local anaesthetic and steroid. Long-term discomfort or pain is fortunately rare, but can still occur in one in 20 inguinal hernia repairs. While this number is still concerning, and, I believe, too high, the risk is dependent on the circumstances of each case. For example, there is an increased likelihood of it where patients have small hernias and where the predominant symptom before the operation is pain. Patients present at the clinic with pain and continue to have the pain after the operation. Both these adverse outcomes—the severity and the longevity of pain—remind us that regrettably complications can arise when any person undergoes surgery.

[Mrs Hodgson]

What we are establishing is that there are still many unknowns with regard to the numbers and when the pain occurs. That is what we need to drill down on. The hon. Member for Burton said that his surgery has been totally successful, however many months it is since it took place. However, the problem is not just post-surgery. Often, as we have heard, people are fine for two or three years and then suddenly, “Boom!”—they are hit with whole host of pain and autoimmune reactions. We need to drill down on that when we are looking at the problem. Will the Minister commit to trying to use the data to do that?

[Ms Dorries]

I am hopeful that the Cumberlege report will touch on that area to some degree. I will study the report in some detail, as will officials in the Department, and we will decide where we go from it, but I emphasise that the alternative of not having the mesh repair is more dangerous and has more complications, as we know from the data, than having it.

Decriminalisation of Abortion

Sharon Hodgson Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend reminds us that this is not always an easy process for women to go through. As with any medical procedure, full consent must be given, based on full information. As long as pills can be accessed via the internet rather than via medical professionals, it is clearly more likely that women will not be informed of the risks of taking the pills. Any medication can have risks and consequences, and women need to be fully advised so that they can manage what they are going through.

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

Thank you, Mr Speaker, for granting this urgent question. I thank my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) for and congratulate her on securing this urgent question, and thank her for her tireless campaigning on this issue. I share her disappointment that no Home Office Minister was available to respond to this urgent question; waiting for a call is obviously more important. I thank the British Pregnancy Advisory Service for its excellent work on this issue, and for its new campaign, launched today, called #PunishedForPills.

Following the passage yesterday of the Northern Ireland (Executive Formation) Bill, we find ourselves with a discrepancy across the UK when it comes to abortion. As we have heard, sections 58 and 59 of the Offences Against the Person Act 1861 no longer apply in Northern Ireland, but still apply in England and Wales, which means that if a woman does not seek the permission of two doctors before having an abortion, she could face up to life imprisonment in Britain, but not in Northern Ireland. The same goes for women who access abortion pills online. There are a whole host of reasons why women may do that, including not being able to get an appointment at a clinic, which now happens more and more often; not having childcare; living in a rural area; or being in an abusive relationship. Although women in Northern Ireland will no longer be persecuted for accessing abortion pills, the same cannot be said for women in Britain. I know this issue does not fall under the Minister’s brief, but will she ensure that abortion will be decriminalised, but not deregulated, throughout the UK? That would increase access to and the safety of abortions for women throughout the UK.

No one takes abortion lightly—this is a very sensitive issue—but I am sure that we in the House can all agree that women deserve access to safe and legal health procedures, and that includes abortion. A woman’s right to choose is a human rights matter. We need to seize on the momentum of the great result in the Republic of Ireland and deliver equality of rights for women throughout the UK and equality of resources across the whole NHS. The Government need to make this a landmark year in which women’s reproductive rights are fully respected and realised. That is why I call on the Government to repeal sections 58 and 59 today, to make abortion rights equal throughout the UK.

[Jackie Doyle-Price]

I thank the hon. Lady for the characteristically constructive spirit in which she has engaged with this issue. The nub of the point she makes is that decriminalisation must not be met with deregulation. Whatever we do, we must make sure that in repealing those sections of the 1861 Act—if that is what Parliament chooses to do—the regime that replaces it must not only guarantee the rights of women to take decisions for themselves but protect them and keep them safe. That is my priority in addressing this issue.

Body Image and Mental Health

Sharon Hodgson Excerpts

Tuesday 23rd July 2019 Commons Chamber

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

I think we can all agree that this has been an eye-opening and interesting debate, and I start by thanking all the hon. Members present for making such excellent, personal and candid speeches. I also want to continue the theme of hoping that the Minister will still be in her position at the end of the day, because, as everyone has said, she really takes on board the cross-party consensus on many such issues, doing so with regard to the matter rather than the politics. On these things, there is always more we agree on than disagree on. Having reinforced her embarrassment, I will now move on.

Today we have heard about the impact that negative body image can have on people’s mental health, and I will particularly address the mental health of children and young people. It is clear that more needs to be done to promote healthy body image, which should start as early as possible.

I pay tribute to the Mental Health Foundation for its comprehensive research and campaigning on this topic. It has found that even children under the age of six have reportedly felt dissatisfied with their bodies, so promoting a healthy body image from an early age is therefore a crucial step. It is obvious from what we have heard today that more needs to be done to ensure that happens.

It is heartbreaking to hear that more than half of children and young people have been bullied because of their appearance, and that one third of teenagers say they have felt shame because of their body image. The Children’s Society has found that children’s happiness with how they look has not improved since the mid-1990s, and young people themselves say that body image is their third biggest area of concern in life, after their education and employment prospects. Why, then, are we failing to address poor body image when it is such a crucial issue?

It is clear that educating young people about their bodies is an important step in improving their body confidence, so do the Government have plans to ensure that schools cover body image concerns as part of the introduction of compulsory relationships and sex education in 2020? More needs to be done to promote healthy body image and good mental health among our young people.

Classroom-based teaching should not only extend to teaching children about their bodies; more needs to be done to ensure that children understand how to use social media safely, understand how to improve their self-esteem and understand their emotions. Can the Minister outline how the Department for Education is tackling these issues in schools? I know the Minister is here representing the Department of Health and Social Care, but the Under-Secretary of State for Education, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), the Children’s Minister, was here a moment ago, and they should be in close contact on this.

Children who are concerned about their body are less likely to take part in physical activity. We can all remember our school days, and I am sure we were all concerned about that. This is concerning when we know the health benefits of physical activity, so promoting positive body image can have benefits for physical health, as well as for mental health.

The mental health consequences of poor body image can be severe. Although having body image concerns is not a mental health problem in itself, having such concerns can be a risk factor for mental health problems. Mental health support should start where children need it, which is in school. Can the Minister tell the House what interim funding has been offered to schools to provide mental health support, given that the Green Paper’s proposed support package will not be rolled out nationally until 2023? Schools really cannot wait another four years for this support because, as we know, they are already struggling with their current budgets.

Where mental health problems develop, early intervention and support from mental health services is crucial. Too many young people who are not able to access the mental health support they need from child and adolescent mental health services are left waiting for treatment on waiting lists for far too long or are turned down for help because their condition is deemed to be not bad enough. The best way to stop our young people developing eating disorders is to make sure they do not have to wait until they have an eating disorder and until they are bad enough to get that help. For children and young people who need support from CAMHS, there needs to be specific support to help them with body image concerns. What are the Government doing to ensure that support is in place?

According to a survey of family doctors, nearly all GPs worry that young people with mental health problems will come to harm because of difficulties in accessing treatment on the NHS, which should absolutely not be the case, and I know the Minister agrees. As was said at Health questions earlier, it is time to ring-fence funding for children’s mental health budgets to ensure that mental health services for children are properly funded.

I have spoken mostly about the impact on children and young people, because it is vital that the causes of poor body image are addressed early to ensure that children and young people think positively about their bodies and therefore go on to think positively about their bodies as adults. People with long-term conditions, such as cancer, and new mums can also have particular body image pressures and concerns, so it is important that as well as mental health services, other health services are there to support people when that is required. In some other cases, the issue is not due to mental health but can become a mental health issue if the matter is not addressed earlier.

According to the Mental Health Foundation, cognitive behavioural therapy—CBT—and other talking therapies can help people who are struggling with body image concerns, but we know that access to talking therapies can be a bit of a postcode lottery. Will the Minister explain how the Government plan to try to end that postcode lottery?

It is worrying to hear about body image concerns among lesbian, gay and bisexual people. One third of adults who identify as lesbian, gay or bisexual have reported experiencing suicidal feelings in relation to their body image. It is therefore important that lesbian, gay and bisexual people have access to support that is tailored to them. Has the Minister taken steps to ensure that lesbian, gay and bisexual people have access to appropriate mental health support?

As we know, trans body image is often linked to a specific condition called body dysmorphia, which means it is not included in the statistics I just mentioned. Trans people face specific challenges in accessing mental health support, so it is vital that the Government ensure that mental health support tailored to trans people is available throughout the country. Will the Minister explain what steps the Government are taking to provide mental health services for trans people in this regard?

We have heard today about the profound impact that social media, celebrity culture and advertising can have on young people and adults and their views of their bodies. Too often, the content shared on social media is having a negative impact on mental health. That is why it is vital that more is done to protect children and young people and vulnerable people online, including from harmful images that can affect their body image. Far too often, social media companies turn a blind eye to harmful content. More really does need to be done to stop such content appearing online. I commend my right hon. Friend the Member for North Durham (Mr Jones) for mentioning Facebook, as well as a former Member of this place and what he might be able to do in that regard.

I am reminded of all those pro-ana websites. I never even used to know what pro-ana meant—I did not realise it was even a thing—but when I see some of those websites and some of those YouTube stars, and the sort of body image that they present as being obtainable and the norm, I think more really should be done to take those images down. I also include in all that the fact that the movie world, Hollywood, TV and Netflix have a responsibility to promote a healthy body image when they cast their shows and movies. I will not name any particular show, movie or artist, but I have in mind a particular example of casting that really does, in my opinion, promote a very wrong body image. That does cause harm. The harms caused online need to be seen and treated as public health concerns, which, as shadow public health Minister, I am passionate about.

Labour is calling for a regulator with teeth that can take serious action against social media companies and for an enforceable duty of care to deal with the harms, hate and fake images that many online companies allow to flourish on their platforms.

The Government heeded Labour’s call and announced a regulator in the online harms White Paper, which is great, so it is now imperative for a regulator to be put in place as soon as possible. Will the Minister let the House know when that regulator might be expected? The process might take many months, and meanwhile children, young people and vulnerable adults are left at risk of severe online harms. The Government need to move faster and to go further, and perhaps we might see that under the new Administration—who knows—but it is clear from this debate that more needs to be done to tackle harmful content and body stigma, and to provide appropriate mental health support for everyone who needs it. Following this debate, as we have all said, I hope that the Minister will still be in her job and able to tackle this.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Seema Kennedy]

As I said to the hon. Gentleman and other hon. Members in the Westminster Hall debate on the drug, a deal is the preferred option. However, the attitude taken by Vertex, which has been called an outlier in this situation, means that my right hon. Friend the Health Secretary has instructed NHS England to look at other options.

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

Over the past three years, all of us in this House have heard the numerous calls for Orkambi to be made available to cystic fibrosis patients. The Minister could go down in history if she takes the all-important step this week, while still in her job—I hope she will still be in the job tomorrow—of announcing an alternative route to access cystic fibrosis drugs, such as a Crown use licence or clinical trials. Today, before we break for recess, will she commit to that so that families can have Orkambi now?

[Seema Kennedy]

The National Institute for Health and Care Excellence process is important, because it is an independent expert review and the way in which we allocate resources sensibly. The Crown use licence is not a quick or easy solution, and it is open to legal challenge, which might delay things even more. Vertex has been offered the biggest settlement in NHS history, and I urge the company to accept it. However—I have said this on numerous occasions from this Dispatch Box and in Westminster Hall—the Secretary of State has urged and asked NHS England to look at other options, such as the ones to which the shadow Minister has referred.

Batten Disease

Sharon Hodgson Excerpts

Monday 22nd July 2019 Commons Chamber

[Seema Kennedy]

I thank my hon. Friend for his questions. I will attempt to answer all of them.

In terms of governance, no, NICE is not above accountability. Ministers set the framework for NICE, which is a non-departmental body. The reason it was established was to have fairness—so that there was no postcode lottery on access to various drugs. It is important that medical experts and scientists make these decisions rather than politicians. Regular governance meetings are held between the Department and NICE. There is a framework agreement. Where the Secretary of State considers that NICE is failing, or has failed, to discharge its functions or to do so properly, he can direct NICE to discharge functions. If NICE were to fail to comply with the Secretary of State’s direction in those circumstances, he could discharge such functions himself. There is therefore a strong and robust governance system with regard to NICE.

It is not always very helpful to use other jurisdictions as a comparison because we do not know the exact price that has been agreed. In addition, different systems have different healthcare populations and do not necessarily have the equivalent of our national health service.

Turning to access to Brineura, I pay tribute to my hon. Friend and to Max’s family. I know from the very moving testimony by him and by other hon. Members such as the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and from speaking to my constituent Melanie on numerous occasions that this is an absolutely dreadful disease. That is why we want the NICE process to be able to bring drugs to market as quickly as possible. Drug companies find this drug difficult to develop—that it is very expensive. It is not necessarily a drug that will be paid for by having millions of sufferers globally, and therefore a different system needs to be in place. That is why the bar for QALY is so much higher.

My hon. Friend’s suggestion on arbitration is very interesting, and I will take it away. On NHS England and the negative procedure, yes, in theory we could do that, but it is unlikely if NICE does not recommend a process. Overall, where a drugs company and NICE are unable to come to an agreement—we see this with other medication as well—Ministers urge the company to carry on negotiating to have a fair price, because every pound spent on one drug is a pound that we cannot spend on a drug for another sick person.

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

Thank you, Mr Speaker, for granting this urgent question. I thank and congratulate the hon. Member for North East Somerset (Mr Rees-Mogg) for securing it following his Adjournment debate last week. I do not doubt that he would have preferred the Minister to have come before the House voluntarily, rather than being forced to come here today for his urgent question.

Time and again, we come to this place to talk about a drug and its benefits to patients, only to be told that no matter how good it is, people cannot access it on the NHS. Among all the politics, there are people, including children like Max, who are suffering. No parent wants to hear a critical diagnosis for their child who has not yet really experienced childhood, let alone reached adulthood.

As we have heard, Brineura, a drug made available by BioMarin, could stop the progression of Batten disease. An assessment by NICE has found that Brineura could provide 30 extra years of good-quality life to patients. But, as has become expected when we discuss drugs for rare diseases in this place, Brineura is not available for patients on the NHS. NICE confirmed earlier this year that it was unable to recommend the use of Brineura on the NHS because of cost-effectiveness. The drug costs over £500,000 per person for each year’s treatment. BioMarin has another drug for rare diseases—Kuvan, for patients with phenylketonuria, or PKU. PKU patients do not have access to Kuvan, because it is also deemed not to be cost-effective. Does the Minister agree that the NICE appraisal process is just not fit for purpose when it comes to assessing the suitability of drugs and treatments for rare diseases?

Access to Brineura would help to give patients and families their child back, and it would allow them to enjoy time with their child and treasure special moments with them. As time ticks on without access to the drug, parents will witness their child’s condition deteriorate. No parent wants to see that, so we really need an appraisal process that captures rare diseases effectively.

Will the Minister step in and personally urge BioMarin, NHS England and NICE to meet and come to an agreement? Families do not want just warm words from the Minister; they want and need access to medicines now. I hope that this urgent question will result in real change in how we address rare diseases.

[Seema Kennedy]

In answer to my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), I urged BioMarin to get back around the table with NHSE and NICE and come to a fair and reasonable price. NICE has already approved drugs for 75% of rare diseases through its technology appraisal programme, including drugs for idiopathic pulmonary fibrosis and neuroblastoma. NICE’s process and review methods are constantly reviewed, and they are internationally respected. NICE knows that it has to keep up to date with developments in science, medicine and healthcare. There is a periodic review going on at the moment, and that includes extensive engagement with stakeholders.