NICE Appraisals: Rare Diseases Treatments

Debate between Sharon Hodgson and Steve Brine

Thursday 21st March 2019 Commons Chamber

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

It is a real pleasure to take part in this very important debate. I start by thanking my hon. Friends the Members for Blaydon (Liz Twist) and for North Tyneside (Mary Glindon). We are part of the north-east massive, so I am very pleased to be joining them in this debate today. I thank them for their very passionate and heartfelt contributions. I should also mention, as part of the north-east massive—it goes without saying—my hon. Friend the Member for South Shields (Mrs Lewell-Buck). I thank all other hon. Members who spoke for their excellent contributions. They know who they are and I do not need to name them. They were all fantastic.

Throughout the debate we have heard of the heartbreak experienced by patients and their families when they are unable to access life-saving drugs on the NHS. We have heard of their determination to continue fighting to access those drugs, whether by writing to their MP or even by protesting in Parliament square. I was happy to join my hon. Friend the Member for Bristol East (Kerry McCarthy) there just two weeks ago for the Cystic Fibrosis Trust rally, where people were calling, “Orkambi now!”—they were so loud that we could hear them over the crowds chanting, “No Brexit!” or whatever the shout was at the time.

We must hear patients’ voices in this debate, as it is they and their families who are affected the most by the appraisal process, which is not fit for purpose. The Minister has heard about the real-life experiences of patients throughout this debate, and I am sure that he will continue to listen to them afterwards. I know that he is also in regular communication with patients. In my role as shadow Public Health Minister, I regularly meet patient groups and campaigners, so I know just how important access to these life-saving drugs is to them.

As a constituency MP, I recently met young Riley and his mum Michelle. Riley has phenylketonuria—PKU—and needs Kuvan. He is now 11 and at secondary school. He just wants to blend in with his mates and to be able to go on those first excursions out to the Metrocentre, and perhaps to get something unhealthy to eat from a takeaway, but obviously he cannot do any of that. I asked him about his life and how he felt not having access to Kuvan. He said that it was not fair and that it made him mad. Well, I agree with Riley.

It can take years to get the right diagnosis for a rare disease, so once patients get the diagnosis they are excited and feel that there has been a breakthrough, because they think that they will finally get the treatment they need and deserve. Instead, as we have heard today, they are back at the beginning of the fight, because the life-saving drugs that do exist are not available to them on the NHS. It is one hurdle after another for patients with rare diseases. That is why the Opposition strongly believe that patients should have fast access to the most effective new drugs and treatments. I am therefore pleased to support the motion.

As we have heard, a rare disease is generally considered to be one that affects fewer than five people in 10,000. According to the 2013 UK strategy for rare diseases, it is estimated that in the UK more than 3 million people will suffer from a rare disease at some point in their life. All those patients must have access to the drugs and treatments that they need. However, they are being failed by the NICE appraisal process, which is just not fit for purpose when it comes to assessing the suitability of drugs and treatments for rare diseases.

Patients with rare diseases are squeezed in the middle of two appraisal routes: the highly specialised technology evaluation programme and the single technology appraisal route. The HST evaluation programme is selected for most non-cancer rare disease medicines and is designed for evaluating medicines of that nature, with small patient populations. However, the HST evaluation programme currently lacks the capacity or capability to effectively appraise all new licensed orphan medicines. Since the HST evaluation programme was established in 2013, it has published guidance on eight medicines, which is much fewer than the 45 orphan medicines for non-cancer indications that have been licensed in the same period.

The STA route is designed to appraise treatments for more common conditions and those with existing treatments. This route is poorly suited to considering rare disease medicines, which tend to have small patient populations, a limited evidence base and benefits beyond direct health benefits—something the appraisal process just does not take into account. Some rare diseases are not rare enough for the STA route, and only a handful of medicines are being approved by the HST route. Yes, it is complicated, but it is clear that neither route is working for patients with rare diseases, so patients are missing out on crucial medicines.

Kuvan was licensed in 2008 to treat PKU patients, but it is still not available to patients in England. Orkambi was appraised by NICE in 2016 through STA, but was recommended for use. Three years later, as we have heard, people with cystic fibrosis still have no access to it. That has caused physical and psychological harm to patients and their families. Every day without the drugs that they need makes their condition worse. We must have an appraisal process that captures rare diseases effectively.

Medicines to treat rare diseases are often found to be cost-ineffective, which is why they are not approved for routine commissioning. However, establishing value for money is not straightforward, especially when population groups are small. It does not sit comfortably with me—or, I am sure, with any of us—that cost-effectiveness is prioritised above clinical need, or, as we have heard, the lives of children. Manufacturers want to make a reasonable return on their investment, although some of the figures are huge, but I do not think that that should be a priority. Manufacturers must not hold NICE or NHS England to ransom for their own financial gain.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Or the Government.

[Mrs Hodgson]

Exactly.

Behind profit forecasts are thousands of people and families who need access to life-saving drugs, and they simply cannot wait any longer. We must not put businesses before patients. Because of the NICE appraisal process, patients and their families are being left in an awful limbo. The processes can be long-winded, confusing and difficult to navigate. Some medicines can undergo multiple assessments while others are not assessed at all, and that creates an unpredictable and unattractive system. As a result, patients are left in the dark about when, or if, they will have access to innovative treatments for their conditions.

When a drug is being appraised, patients live in hope that this time it will be approved for use by NICE—as in Maryam’s case, which was described so powerfully by my hon. Friend the Member for West Ham (Lyn Brown)—but they are almost always left to feel disappointed and helpless. Patients and their families must be involved in the processes, and the processes must be transparent.

The wait for access to drugs is excruciating, especially when the drug is available in nearby countries, or even—as we have heard—in Scotland. Spinraza is available to patients in Scotland, but not to those in England. My hon. Friend the Member for West Ham spoke passionately on behalf of her constituents and their seven-month-old baby Maryam. This sounds blunt, but she is dying, because she has been denied access to medication that could extend and enhance her life.

The pain and anguish that the parents of a critically ill child must feel when they are told that there is medicine available that will help but it is not available for their child are unimaginable. Knowing that if your child lived a few hundred miles away, in Scotland or perhaps somewhere in Europe, the drug would be available is heartbreaking and infuriating. Patients in England should not be left behind. We should be working to find ways to get these medicines to the patients who need them, on the NHS.

I hope that the Minister will consider the motion seriously, for the sake of patients with rare diseases and their families. They cannot be left behind any longer: they must have access to these life-saving drugs now.

Draft Nutrition (Amendment etc.) (EU Exit) Regulations 2019

Debate between Sharon Hodgson and Steve Brine

Thursday 28th February 2019 General Committees

[Steve Brine]

Maybe it is set in stone. Members can work out what I mean by that.

The hon. Lady asked lots of different questions. About the impact on business, we appreciate that there may be an additional administrative burden on companies that would have to submit claims to the UK and the EU if they wish to make the claim in both areas, but our intention is that procedures for submitting claims in the UK will closely follow those already in place for the EU. We have been in that family for some 40 plus years.

Leaving the European Union is a complex process, to put it mildly. It is not just about trade deals, reciprocal healthcare and citizens’ rights. It is about complex supply chains at every level of business, and there is a complex supply chain around nutrition regulation. It would be an act of foolishness on our part to diverge too far and we do not intend to do that. We estimate that the application paperwork should take only 30 minutes to complete, and rightly so.

In terms of future divergence with the EU, we will make sure that we continue to review the situation to make sure we stick to regulatory alignment with the EU, as deemed appropriate by the Government and ultimately by this House, which holds the Government to account. I am content, as is the Government, that the SI maintains regulatory standards and nutrition policy in a no-deal scenario, and therefore an impact assessment is not required. I have already said that businesses will have to spend a short time on administration.

We completed an equalities impact assessment. We found that the measures set out in the instrument do not have an impact on any of the protected characteristics as defined in the Equality Act 2010.

The hon. Lady asked why the consultation period was just 10 days. To be factual, it was not. It was 11 days—[Laughter.] That is #factualnews. A consultation’s duration is generally determined by the proposals it contains, and in this case we are proposing to mirror the existing regulatory regime as closely as possible, ensuring minimal disruption to business. With that in mind, we consider the consultation period to be entirely appropriate and in line with Cabinet Office consultation principles.

We received 31 responses to the consultation—a case of quality over quantity. We are pleased that they included responses from a broad spectrum of groups, including manufacturers, trade bodies, members of public and one local authority. The response was supportive of the proposals to mirror the existing regulatory framework, as I have already said. We are working with the Department for Business, Energy and Industrial Strategy’s business insight group—now there is a catchy title—to sight the industry on proposed guidance and to obtain its feedback.

Infants are deliberately not mentioned in the SI, because the issue does not apply on exit day. Our current policy intention is to make domestic legislation that is consistent with regulation 609/2013. That includes requirements for foods for special medical purposes developed to satisfy the nutritional needs of infants and for infant and follow-on formula, which are important. The Department will issue further advice on that once the EU exit position is clarified, which clearly is yet to happen.

I was asked whether the UK will continue to be a member of EFSA after we leave the EU. I have said no. The nature of our future relationship with EFSA will be subject to negotiation with the EU, and that is not just in terms of the withdrawal agreement. The SI provides for the appropriate expert committee—I appreciate that the acronym is not ideal—to assume EFSA’s functions in a no-deal scenario, which will guarantee certainty.

The hon. Member for Glasgow South West asked what will happen in relation to products banned in the EU after exit day. As I said in my opening remarks, products that EFSA approves after exit day will be for it to approve for the remaining member states. In terms of the relationship between our new committee and EFSA, we have a long tradition of close scientific collaboration with EFSA in this country. We value it greatly and very much hope and intend that to continue in the future. If EFSA makes a decision on a product, it would be most unlikely that our new committee, whatever it is called, would not take notice of that. We want to continue close regulatory alignment in this policy area so that the public have confidence and so that, returning to my first point, businesses do not face an undue burden in getting products covered in both areas.

Public Health England is in the process of recruiting specialist members for the UKNHCC, including the chair. The recruitment was open and transparent: it was advertised on gov.uk from 8 November to new year’s eve; high-calibre applications were received and the shortlisted candidates were interviewed last week. The committee is ready to come into effect if required. I do not have the names here, but I know that recommendations for appointments to the committee have been shared with the devolved Administrations. They have confirmed that they are content with the calibre and experience of the recommended individuals. Appointment letters will be issued shortly; once accepted, they will be published. I have already said I will publish that to members of the Committee.

Finally, guidance is being developed and tested with industry to ensure that it is fit for purpose, is closely aligned and clearly communicates to business any changes in the process that would occur in a no-deal scenario. That guidance will be published shortly—certainly before exit day, which we still hope will be 29 March.

[Mrs Hodgson]

On a point of clarity on the lack of mention of infants, I heard what the Minister said, but there is a lack of clarity on whether there will be a gap between the situation in the EU and the regulations here. Will that gap exist? Will there still be a difference? I know he is sort of saying that he cannot say what the position will be at the moment, but will he seek to ensure that there is no gap?

[Steve Brine]

Not only will I seek to ensure that there is no gap, but I will very much take that as feedback from Her Majesty’s Opposition on the regulations and ensure that it is fed through to the new committee as it is formed. I understand the concerns expressed by the hon. Lady and the Scottish National party spokesman in that regard.

Question put.

Oral Answers to Questions

Debate between Sharon Hodgson and Steve Brine

Tuesday 27th November 2018 Commons Chamber

[Steve Brine]

The hon. Gentleman will remember, of course, that £1 billion extra was put into mental health in the Budget last month, but I would absolutely be interested to hear from him. There are very good things going on up and down the country in local authorities with the ring-fenced £16 billion that we have given them. We are very interested to hear about where there are good examples of things going on, and the long-term future discussions around them will take in the spending review, as I have said.

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

The Secretary of State claims that prevention is one of his top three priorities, yet this year alone the Government have slashed public health budgets by £96 million. That includes cuts to smoking cessation services, sexual health services, obesity and addiction services and many more. This affects the most vulnerable in our society, so will the Minister do the right thing today and cut the rhetoric, commit to reversing these damaging cuts to public health, and put funding in the long-term plan?

[Steve Brine]

The hon. Lady—my shadow Minister—knows that I have a great deal of respect for her. She mentioned smoking; smoking rates in England are at their lowest ever levels. We hear spending commitment after spending commitment from the Labour Government; it is like the arsonist turning up at the scene of a fire. I will take very seriously, as I am sure will the Treasury, her bid towards the spending review discussions, but yes, prevention is better than cure and it will be at the heart of the long-term plan.

Breast Cancer

Debate between Sharon Hodgson and Steve Brine

Thursday 18th October 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Thank you for chairing our session today, Mr McCabe. I add my congratulations to the hon. Member for Lincoln (Karen Lee) on securing the debate and the hon. Member for Crewe and Nantwich (Laura Smith) on leading us off today. Breast cancer sadly affects so many of us so personally. It is always a privilege to respond to any debate in this House, especially on cancer and more especially on breast cancer, and this has been a constructive, small and perfectly formed debate.

It is always a pleasure to follow my shadow Minister and friend, the hon. Member for Washington and Sunderland West (Mrs Hodgson); I think this is the first time that a debate has been led by all three chairs of the same all-party parliamentary group, speaking for their respective parties. It was important to us when we chaired the group that we had the three main parties in the chair. The third chair was then held by the Liberal Democrats—remember them?—[Laughter.] Stop it. When the hon. Member for Central Ayrshire (Dr Whitford) joined the House, it was a real pleasure that she came on board and took that seat.

I will start by saying, “Happy BCAM!” There is much to celebrate, as hon. Members have said, and it is Breast Cancer Awareness Month, or BCAM for short. I pay tribute to all the people who are here, the survivors—survivorship is very important—and to all the people who have gone. Macmillan Cancer Support ran a heartfelt campaign earlier this year on the idea that “A mum with cancer is still a mum”, which was one of the best pieces of advertising I have seen in the health space for a long time. The reason I say, “Happy BCAM!” is that the people who have gone were still mums, daughters and sisters, even while they were going through their challenges. That is very important. Even children who lose their battle with cancer after being on this earth for a matter of days leave an indelible mark, because they were here for a few days. It is important to me that we always remember that, and I always do.

The title of today’s debate on the Order Paper is “Future of breast cancer”. The hon. Member for Washington and Sunderland West said to me once in one of our group meetings, “You will be cancer Minister one day.” If she could predict something else great for me, that would be excellent.

[Mrs Hodgson]

Chancellor.

[Steve Brine]

Oh yes; the hon. Lady has already said Chancellor today. I am not sure about that one.

As the cancer Minister, I want a future where there is no breast cancer. The hon. Member for Strangford (Jim Shannon) mentioned that, and I think all hon. Members who have contributed this afternoon would like to see a future where there was no breast cancer. One day, perhaps—but the statistics show that we are making good progress. That is why I said that there are things to celebrate. We are ensuring that more people than ever survive breast cancer. As has been said, 10-year survival rates have almost doubled, from around 40% to nearly 80%, in the last 40 years.

I hope I do not need to say it, but cancer is a huge priority—the priority—for me. The Prime Minister chose to make it a central point of her party conference speech this month, and there was a reason for that; it is a huge priority for her and for her Government. Survival rates have never been higher, and they have been increasing year on year. Of course the Prime Minister celebrates that, but it is also why she announced a very ambitious package of measures for cancer care and treatment, showing that cancer will be absolutely central to the long-term plan for the NHS, which she has challenged NHS England to write before the end of this year and of which I will say more later. We are committed to investing an extra £20 billion a year in our NHS. The investment will build on the success we have already achieved through the implementation of the cancer strategy for England. I pay tribute to Harpal Kumar and those at Cancer Research UK who put that strategy together. We will build on that legacy and take it forward into the long-term plan.

In opening the debate, the hon. Member for Crewe and Nantwich raised a number of good points. She talked about secondary breast cancer data collection—a number of people did so, but she raised it first. She is right that the robust and timely collection and sharing of data is vital for improvements in breast cancer services. If we do not measure it, we do not know, and if we do not know, we cannot act. The National Cancer Regulation and Analysis Service, or NCRAS, collects data on all cancers diagnosed in England, with the data collection specified by the cancer outcomes and services dataset. That data collection of secondary breast cancers was mandated as part of the COSD for diagnoses from April 2013 onwards.

I remember, with my shadow Minister, taking a delegation to see Prime Minister David Cameron in No. 10 to talk about that exact issue just before Christmas; I remember our photo by the tree. It is good that that happened, but it is evident, comparing the collected data with sources in academic literature, that a large proportion of cases are still not being reported in the COSD. That is of great frustration to me. NCRAS continues to work with NHS trusts to improve the completion of the data, and we have redesigned aspects of the COSD to allow more relevant information on occurrence to be captured, but I do not for one minute shirk the fact that there is more to do in this area, and I assure the House and colleagues that I will constantly redouble my efforts in that regard.

Oral Answers to Questions

Debate between Sharon Hodgson and Steve Brine

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

Yes, he will. I am pleased to say that prevention is one of the Secretary of State’s three key priorities. The HPV vaccine is a key prevention measure, while one of the drivers behind the child obesity plan was Cancer Research UK’s very clear advice that being overweight was one of the big risk factors, alongside diabetes, in cancer. Yes, prevention is always better than cure.

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

I welcome the Government’s acceptance of the JCVI’s recommendation to extend the vaccination programme to adolescent boys, but the Minister will know that there are huge regional differences in the take-up of the vaccination among girls. What steps will he take to tackle these regional differences before and during the roll-out to boys?

[Steve Brine]

The shadow Minister is absolutely right to raise this issue, which she also raised with me in the Westminster Hall debate on the same subject introduced by my hon. Friend the Member for North Thanet (Sir Roger Gale), who has done a lot in this area. I have already spoken to Public Health England about this in respect of the girls’ programme, and I will be speaking to it again now that we have announced the boys’ programme, because the equality of doing the dual programme must be matched by the equality of its taking place in her constituency as much as in mine in Hampshire.

Tobacco Control Plan

Debate between Sharon Hodgson and Steve Brine

Thursday 19th July 2018 Commons Chamber

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

It is a pleasure to be here to speak about the tobacco control plan, which celebrated its first anniversary only yesterday, as the Minister said. We are here to discuss the progress of the plan so far in reaching the Government’s goal of a smoke-free generation by 2022. I start by thanking the Government for allowing time for this debate to take place after all the drama and commotion of this week. As the Minister said, my first outing as shadow Minister for public health was in a debate on this issue, and thanks to him, we have the new, updated tobacco control plan that we are debating today. I know that it holds a very special place in both our hearts and, like him, I look forward to the debate.

The Opposition welcomed the plan and its ambitious goals, but we remain concerned about how they will be achieved by 2022. It is true that smoking is now thankfully at an all-time low, but the Government must not be complacent—I know that the Minister is not—and must not quit when it comes to measures that reduce smoking rates.

There are still 7.3 million adult smokers in the UK but, shockingly, smoking is an addiction of childhood, with the vast majority of smokers starting to smoke before the age of 18. Between 2014 and 2016, more than 127,000 children aged between just 11 and 15 started to smoke in the UK. According to a recent study by the Society for Research on Nicotine & Tobacco, this amounts to 350 young people starting smoking each day. That is equivalent to 17 classrooms of secondary school children starting to smoke every day. The Government therefore have a huge challenge on their hands—as we all do in Parliament—to tackle smoking in childhood and to reduce the rate of children smoking to 3% or less.

Between 2013 and 2016, the rate of decline in smoking among young people slowed down and the proportion of 15-year-old regular smokers had fallen from 8% to 7% but, at this rate, we will fail to achieve the ambition for England of 3% by 2022. The Minister mentioned in his opening remarks that we really will need to accelerate our progress when it comes to the number of children taking up smoking. Tackling this issue will be the first step to achieving a generation that is not only smoke-free, but healthier.

Smoking remains the leading cause of preventable premature death, such as from cancer or lung disease, and accounts for around 100,000 deaths each year in the UK. Each of those deaths could have been prevented. In 2015-16, there were approximately 474,000 smoking-related hospital admissions, with smokers also seeing their GPs 35% more often than non-smokers. In 2017, 22% of hospital admissions for respiratory problems were directly attributed to smoking. In 2015-16, smoking-related respiratory diseases cost NHS England £167.4 million in adult secondary care costs. I am sure that the Minister agrees with me that an ounce of prevention is better than a pound of cure.

The National Institute for Health and Care Excellence estimates that every £1 invested in smoking cessation generates £2.37 in benefits. However, according to the King’s Fund, spending on smoking cessation services in 2017-18 was reduced by almost £16 million compared with figures for 2013-14. Furthermore, the Health Foundation has found that next year just £95 million will be spent on smoking and tobacco control services, which is 45% less than in 2014-15. Has the Minister made any assessment of the impact that those cuts will have on local smoking cessation services?

A study conducted by Action on Smoking and Health—ASH—and Cancer Research UK found that in 2017 budgets for stop smoking services were reduced in half of the local authorities in England, following reductions in 59% of authorities in 2016 and 39% in 2015. It is a wonder that there are any smoking cessation services left at all. What that means on the ground is that smokers who want to quit do not have access to the services that they need, and smokers who may need an extra push to seek help to quit are not getting that push.

Given that local smoking cessation services are on their knees, how does the Minister’s Department expect to reach the goal of reducing smoking rates to 12% by 2022? The Government’s own plan acknowledges that

“local stop smoking services continue to offer smokers the best chance of quitting”,

but cuts in local authorities’ funding have led to unacceptable variations in the quality and quantity of services available to the public. In my region of the north-east, the current smoking rate is 16.2%, which is down from 17.2% in 2016. That represents the biggest fall in smoking in England. It means that smoking rates in the north-east have fallen by more than 44% since 2005, when 29% of adults in the region smoked, and that there are about a quarter of a million fewer smokers.

It has to be said that that decline in smoking rates is due to the excellent programme Fresh north-east. I know that the Minister has commended the programme before, and no doubt he will take the opportunity to do so again. Its vision is to make smoking history and to reduce smoking prevalence in the north-east to 5% by 2025.

[Steve Brine]

I am happy to place on record my thanks for the work of Fresh north-east, whose representatives I have met. It is a good example of what I was talking about—local systems working together. It is not just about what local authorities commission and the state provides. Fresh north-east is a coalition consisting of the public sector and the third sector.

[Mrs Hodgson]

That is important, especially when, as the Minister has acknowledged, we are in such straitened times when it comes to local authority budgets. I am sure that Fresh north-east will be very grateful for what he has said.

Sadly, other areas are not as lucky. They do not have a Fresh north-east; if only they did. Stop smoking services are roughly 300% more effective than quitting by going cold turkey, but in some places the specialist services are being decommissioned altogether. For example, in Blackpool, smoking prevalence is 22.5%, while the average for England is 15.5%, yet Blackpool Council recently decommissioned its specialist smoking cessation service, citing a number of factors including public sector budget cuts.

That example leads me to my next point. Between 2012 and 2014, the healthy life expectancy for newborn baby boys in England was the lowest in Blackpool at 55 years. Again, the shortest life expectancy among men was in Blackpool too, at 74.7 years. Interestingly, in 2014, Blackpool had the highest smoking prevalence at 26.9%. Wokingham had the lowest smoking prevalence at 9.8%, but the highest healthy life expectancy of 70.5 years. That is a 15.5 year difference between healthy life expectancies, and while there will be several factors in play in these figures, it is clear that smoking is one of the largest causes of health inequalities in England.

Some 26% of routine and manual workers now smoke, compared with 10% of those in managerial and professional jobs. This has slightly increased rather than decreased the inequality from 2016. Some 28% of adults with no formal qualifications are current smokers compared with only 8% of those with a degree. It is these people—manual workers or those from low socioeconomic backgrounds—who suffer the most when the Government cut spending to public health services. I therefore ask the Minister what steps his Department is taking to ensure that these people are reached by local smoking cessation services. What assessment has the Minister made of the impact that smoking rates have on widening health inequalities, and how does he intend to address them?

Finally, I move on to smoking in pregnancy. The Government’s ambition to reduce smoking in pregnancy to 6% or less by 2022 is laudable. In 2015-16 the rate was 10.6%. However, new data published recently showed that the rate of smoking during pregnancy in 2017-18 had increased slightly, to 10.8%. It is therefore deeply concerning that the Smoking in Pregnancy Challenge Group, which I recently met, has warned that this ambition is unlikely to be met unless urgent action is taken.

In 2010, 19,000 babies were born with a low birth weight because their mothers had smoked during pregnancy. Up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy. In addition, many other children will be three times more likely to take up smoking in later life because they live in smoking households. If we are going to have a smoke-free generation in the future, the Government must take urgent action to ensure that rates of smoking in pregnancy fall. We must not forget that it will be those very babies who will become the smoke-free generation that we all hope to see.

The current target is to reduce smoking in pregnancy to 6% or less by 2022. If that is achieved, it could mean around 30,000 fewer women smoking during pregnancy, leading to between 45 and 73 fewer stillborn babies, 11 to 25 fewer neonatal deaths, seven to 11 fewer sudden infant deaths, 482 to 796 fewer pre-term babies, and 1,455 to 2,407 fewer babies born at a low birth weight. That is something to aim for, but it will only happen if the Government take urgent steps to reduce the number of women smoking during pregnancy.

HPV Vaccination for Boys

Debate between Sharon Hodgson and Steve Brine

Wednesday 2nd May 2018 Westminster Hall

[Steve Brine]

Those people are nearer to my hon. Friend than he knows, and they will have heard his point.

In his opening remarks, my hon. Friend the Member for North Thanet asked the JCVI to take the long view, and I hope that I can reassure him somewhat on that point. Some examples of what the JCVI is taking into account in its considerations include: the projected future number of HPV cancers resulting from the current incidence of HPV infection; the potential savings as a result of preventing future cancers, which a number of Members have mentioned; the potential savings from preventing genital warts; and, crucially for my hon. Friend’s point, the long-term impact of HPV infection up to 100 years into the future, which will outlive even him.

The JCVI’s interim advice indicated that to vaccinate boys would be

“highly unlikely to be cost-effective in the UK, where uptake in adolescent girls is consistently high”.

It is true that the UK has achieved high uptake for the girls HPV immunisation programme for the past 10 years. In 2016-17, 83.1% of girls completed the current two-dose course, including the daughter of the hon. Member for Washington and Sunderland West. I have two young children—one of each—and of course those of us who are parents want what is best for our children. Somehow arguments about cost-effectiveness do not feel right. Cost-effectiveness is important, however, because it is about how to fairly, consistently and robustly assess which interventions and treatments should be funded in what we must remember is a publicly funded health system. We need to deliver value for money for the taxpayer and deliver the most health benefit possible to all patients. That is our system.

[Mrs Hodgson]

I take on board what the Minister is saying for areas where uptake is high but, as I cited earlier, there are parts of the country where uptake is nowhere near high enough, such as Stockton, where it is 48%. How does that work? How does that argument stand up for those parts of the country?

[Steve Brine]

The hon. Lady makes a very good point. I was hoping to have a note to respond on that specific point about regional inequalities, but I will have to write to her. Perhaps it is something we can discuss offline. That very good point has not been raised with me recently, but I will take it away and follow it up.

My hon. Friend the Member for North Thanet did not mention discrimination and equality, but other Members certainly did. I accept that equality needs consideration in this case, and I confirm that the Department is carrying out an equality analysis. That cannot be completed until we have received the JCVI’s final advice and we know what it is advising and why, but I can confirm that officials will make contact with key organisations such as HPV Action—I met members of it recently at a roundtable I held on cost-effectiveness methodology for immunisation programmes and procurement, and I know that some of them are here today—as they progress the equality analysis to ensure that such views are taken into account. I confirm that the equality analysis will be published, and I will make the House aware when it is.

There have been a number of threats of judicial review related to equality and sex discrimination in relation to HPV vaccination. I do not think it would be appropriate to say more at this stage, but the House will have heard those two commitments.

[Mrs Hodgson]

On the equality point and the herd immunity point, may I raise the issue of men who have sex with men and the fact that their first presentation at a sexual health clinic could be at the age of 32? Again, there is no way for there to be herd immunity or even for us to extend the vaccination, as we have done in the pilot, to men who have sex with men. There will still be huge numbers of people not covered. Does the Minister agree, and what is he going to do about that?

[Steve Brine]

The hon. Lady makes her point, and it is not one that I miss, I assure her. That issue forms part of the ongoing deliberations. She has made that point twice, and it is a good point.

I know there are concerns, to put it mildly. My hon. Friend the Member for North Thanet set out the timeline of how long it is taking the JCVI to finalise its advice. However, the consultation raised some important, complex issues around the cost-effectiveness model, and it would be remiss of the JCVI not to ask for those issues to be addressed before it puts the matter on its agenda and makes its final decision. I appreciate that my hon. Friend and other Members want the advice quickly—believe me, so do I—but I cannot advocate asking the JCVI to cut corners, which would call into question the quality and robustness of its advice and undermine an internationally respected organisation. The JCVI will get its advice on boys to me as soon as it can, and I am certainly expecting it this year. As soon as I have it, we will turn it around as quickly as we can.

I am totally committed to our world-leading vaccination programme. It is an area where this country leads the world. I am as keen as my hon. Friend and other Members present to hear the JCVI’s final advice on HPV vaccination for boys as soon as possible. The JCVI has helped successive generations of Ministers and, as my hon. Friend said, it will help those who come after me—there will be many, and maybe sooner than we think. It has helped Ministers make decisions that are fair and justifiable, and we need to allow it to complete its advice without too many distractions that could slow it down even further, which no one wants.

We have heard an impassioned case for an HPV vaccination programme for boys from, among others, the hon. Member for Washington and Sunderland West, for whom I have so much respect. As my hon. Friend the Member for Worthing West (Sir Peter Bottomley) suggested, I will send a transcript of the debate to the JCVI to ensure that in the unlikely event there are any issues it was not aware of, that can be reflected in its final advice. It is listening to the debate today. For the reasons I gave at the start of my remarks, I cannot give the House an indication of when exactly a decision will be made, or what that decision might be—trust me, I would love to—but I can say that I will prioritise consideration of the JCVI’s final advice as soon as I receive it.

Oral Answers to Questions

Debate between Sharon Hodgson and Steve Brine

Tuesday 19th December 2017 Commons Chamber

[Steve Brine]

Happy Christmas to St Helens as well. I agree that we need to work together. The Healthy Start programme, for which I am responsible, provides a nutritional safety net to hundreds of thousands of pregnant women and families with children under four. There is a slight increase in cases being reported in recent years. In part, that is due to much better diagnosis and detection. Some 1.1 million children get free school meals in England, and the Government are investing £26 million in breakfast clubs. Only last week, Kellogg’s was here with its breakfast club awards—an excellent innovation.

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

That being said, it is disgraceful that under this Government’s watch we have seen a 54% increase in children admitted to hospital with malnutrition. Instead of seeing malnutrition rising, we really should be eradicating it. As the festive period is upon us and it is the season for good will and giving, will the Minister give this House an assurance that he will seriously address this matter to ensure that no child in this country ever experiences malnutrition?

[Steve Brine]

Of course we want no child in our country to experience malnutrition. I mentioned the Healthy Start scheme and the breakfast clubs. Healthy Start is an excellent programme run by Public Health England that encourages a healthy diet among hundreds of thousands of families with children under four. It is exactly that which is helping us to tackle this issue.

Oral Answers to Questions

Debate between Sharon Hodgson and Steve Brine

Tuesday 14th November 2017 Commons Chamber

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

Under this Government we have seen lung disease admissions to A&E rise at double the rate of general admissions. That is even more concerning when the bulk of lung disease admissions happen over the winter months, when A&E departments are already under significant pressure. Will the Minister commit today to introducing a lung disease strategy to ensure that we can reverse these worrying trends and this pressure on people’s lives and on our NHS?

[Steve Brine]

The meeting was in Milan, Mr Speaker, but we do not mention football in relation to Italy or Milan any more. I hear it is a touchy subject. [Interruption.] Very topical.

There is no plan for a new national strategy or taskforce, but we work closely with charities like the British Lung Foundation. We have to remain committed to implementing the NHS outcomes framework for 2016-17. As the Secretary of State said, we are better prepared for winter than we have been before, and the hon. Member for Washington and Sunderland West (Mrs Hodgson) is right to raise that point.

Oral Answers to Questions

Debate between Sharon Hodgson and Steve Brine

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

Yes, absolutely. Local authorities have an obligation to do that, but as I said to the new hon. Member for Ipswich (Sandy Martin), it is important that local plans come forward alongside the new national plan. Local solutions are needed for different areas, and that will be the case in my hon. Friend’s borough just as it is in my area of Hampshire.

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

Last week marked the 10th anniversary of the smoking ban across the UK, but sadly the celebration was dampened by the fact that we have yet to see the Government’s new tobacco control plan, which was promised in December 2015. The previous two Health Ministers I have shadowed repeatedly said that we would see the plan shortly, but they failed to set out an updated strategy for working towards a smoke-free society. I welcome the Minister to his new post—we have worked well together in the past on the all-party parliamentary group on breast cancer—and I am hoping that, although he has not yet given us a date for the plan, he will be able to give us an indication. Is it going to be published before Christmas?

[Steve Brine]

I thank my hon. Friend for her question. I think I can call her that; we have worked closely together in the past. I am new to my ministerial post, but I have been through the plan, and it is I who has to stand up and defend it. I want to be sure that it is right and that I am as happy with it as everyone else in the Government. My intention is that it will be published before the summer recess.