The National Health Service

Steve Brine Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

The hon. Gentleman makes an important point that capital investment needs to be strategic, and the new health infrastructure plan, which I was discussing at the Health and Social Care Committee yesterday, is intended to put in place that long-term plan for capital investment, and we are building 40 new hospitals over the next decade. It may be fair to say that I got some flak from Labour Members for proposing 10 years’ worth of new hospitals, because they said that only the first part of the health infrastructure plan—the so-called HIP 1—should be announced. I do not think that that is true, however, because we need a long-term approach to capital investment, with 40 new hospitals over the next decade.

[Steve Brine (Winchester) (Ind)]

I thank the Secretary of State for his vote of confidence in the NHS in Winchester. He has always been willing to listen. After a difficult Care Quality Commission report last year, we managed to secure investment to transform the A&E department, which the Minister for Care, the hon. Member for Gosport (Caroline Dinenage), visited recently. We are working with the sustainability and transformation partnership across Hampshire to reimagine what a district general hospital looks like. I encourage the Secretary of State to come down to Winchester—an hour on the train from Waterloo—to see where a new district general hospital is emerging to deliver long-term safe and sustainable services.

[Matt Hancock]

I would love to. I pay tribute to the hon. Gentleman’s work not only on the prevention agenda and public health in government, but on ensuring that the long-term plan approach to capital investment, with a new hospital in Winchester over the next decade, will give the time to ensure that that investment brings the whole health system together in Winchester and really delivers for the people. With him as the local representative, I have absolutely no doubt that that is what will happen.

Health Visitors (England)

Steve Brine Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Tim Loughton]

Again, the hon. Gentleman makes a good point, which was on page 5 of my notes. This issue affects everybody across society, often better-off, more affluent families who might be better at hiding it or less inclined to come forward to seek help. The charity that I chair has units in Liverpool, Newcastle, London and so on, and we see that middle-class parents who have serious attachment dysfunction problems with their children are less likely to come forward. Those, ironically, may be harder-to-reach people. Health visitors are the early warning system and are able to signpost some of those people to services. They can also point out, “I think you have a problem,” and it will be taken on trust.

I appreciate the good points that have been made, but I will make some progress. The cost of failing to intervene early is enormous—financially and, more importantly, socially. The impact of not intervening early can disadvantage a child through early years, school years, adolescence and often into adulthood. In some cases, it can be life-defining.

One of the great achievements of the coalition Government was to pledge a massive increase in health visitors. In opposition, the then shadow Health Minister, Andrew Lansley, championed the recruitment of no fewer than 4,300 new health visitors, based on the successful model of the Dutch Kraamzorg system—I was involved in research into that—where post-natal care is provided to a new mother and her baby an initial eight to 10 days immediately after birth.

Four years ago, the Government’s health visitor implementation plan and the “Call to action” scheme were the pride of the nation. The policy was built on sound evidence that the health visiting profession had the power to drive health improvements and provide a universal service designed to give every child that best possible start in life, as we all want to see. Impressively, for a Government target, it was achieved—just about—in the lifetime of the 2010 to 2015 Parliament.

Depressingly, since then, the numbers have started to drop dramatically. In June 2015, there were 10,042 full- time equivalent health visitors in England. A year later, that had fallen to 9,491 and the latest figures show a 31% drop from the peak. According to the Institute of Health Visiting,

“one in four health visitors do not have enough time to provide postnatal mental health assessment to families at six to eight weeks, as recommended by the government.”

In response to a survey that the institute put out,

“three quarters of respondents said they are unable to carry out government recommended maternal mental health checks three to four months after birth.”

That is a crucial stage at which to pick up mental health problems with the parents, which may already be impacting or will impact on the infant. It is not only about looking after the baby, but the family unit and particularly the prime carer.

To a large extent, the reason for that has been the transfer of responsibility for health visitors from the health service to local government, as part of its enhanced public health responsibilities. I am not challenging the wisdom of doing that, but it has come at the time of the greatest squeeze on local government spending recently. The architecture of the delivery of health and wellbeing services for babies and young children, I think, has been fragmented in a disorienting manner between local councils, Clinical Commissioning groups and NHS England, with insufficiently qualified scrutiny of how it works. There is an issue around the quality of informed local authority oversight over many of these public health roles.

[Steve Brine (Winchester) (Ind)]

I congratulate my hon. Friend on securing this debate. He has been consistently right in this area. My research ahead of this debate presented a worrying picture from GPs in Winchester, who report a distant relationship with health visitors. That is not their fault; it is because health visitors are so thinly spread. Does he agree that as well as providing more health visitors, it would be smart to address where they sit in the system and, maybe, to co-locate teams around the emerging primary care networks?

[Tim Loughton]

First, I pay tribute to the real acknowledgment of the importance of this area by my hon. Friend when he was public health Minister. He was always prepared to take our sometimes annoying approaches to prioritising the issue. He may be right. I am not too concerned with processes and structures; I am concerned with getting the professional face to face with the parent and baby. We need to be smarter about where we can make that engagement happen and ensure it is not through lack of workforce that we are unable to do it.

[Steve Brine]

rose—

[Tim Loughton]

If my hon. Friend wants to intervene again, he may, but it will eat into his own speech time.

[Steve Brine]

The issue is important because the primary care networks and the GPs who rightly run them are responsible for the outcomes of the patients they manage within those lists. If they had ownership of those health visitors, because they were commissioned within that structure, they would have every incentive to close the distant relationship that I mentioned.

[Tim Loughton]

My hon. Friend may well be right. One of my constituents is a health visitor. According to her, the current status of health is not serving families well, based, as it is, on universally delivered process outcomes, which risk, to use a phrase she quoted to me, “ticking the box but missing the point”. That plays to the point my hon. Friend is making.

To illustrate the most successful ways of dealing with vulnerable families, I will use children’s centres as an example, although I will not get into a whole argument about them. The most successful ones that I have seen are those where hot-desking occurs between a district nurse, a health visitor, a social worker, a school nurse and others, who are all signposting. The health visitor may get over the threshold and say, “I am a bit worried that there is a mental health problem there. When I go back and see the community mental health nurse at the children’s centre, I might suggest she has a word.” That is the way it must happen. These are interlinking problems and it is not just down to one professional to treat them.

On the local authority, public health budgets have seen a significant reduction from 2015. The recent 1% increase for 2021 is welcome, but there is a long distance to go to replace some of the past reductions. Some areas have suffered disproportionately. I want to flag Suffolk, where, I gather, the council has been considering plans to slash the health visiting workforce by 25% to save £1 million. I think that is a false economy and short-sighted.

The decline in the number of health visitors since 2015 has been due to qualified nurses retiring or moving to other roles within the health service and too few trainees entering the profession. Alongside workforce cuts by local authority commissioners, the health visiting profession is also facing recruitment and retention problems, falling staff morale and poor progression opportunities. Health visitors have also raised safeguarding concerns as their caseloads increase to meet increasing need and cover shortages.

In a 2017 survey by the Institute of Health Visiting, health visitors reported that children are put at risk due to cuts in the workforce and growing caseloads, finding that 21% of health visitors are working with caseloads of over 500 children, as the hon. Member for Lincoln (Karen Lee) pointed out.

Health Infrastructure Plan

Steve Brine Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

As the hon. Lady will recall, many years ago, when I had more hair and it was not so grey, I sat on Westminster City Council, and St Mary’s was an issue back then that we discussed on various occasions. She is right to highlight it, but I would have expected her to very much welcome the inclusion of Imperial and St Mary’s in the announcement of seed funding to develop their proposals and get the investment they need.

[Steve Brine (Winchester) (Ind)]

We are rather pleased in Winchester at today’s announcement and with our place within it. My constituents do not care about the political knockabout in this House. They love their hospital and are really pleased that it is going to be invested in. Will the Minister confirm how the seed funding process will work in the immediate term—we are in wave 2, but we are keen to get cracking so that we are ready—and will he also confirm that this is a huge vote of confidence in the Royal Hampshire County Hospital in Winchester, not just from the Government, but from the NHS as well?

[Edward Argar]

I know that, since my hon. Friend was first elected to this House, he has made health and the NHS his No. 1 priority. He served with distinction as a Minister in the Department and continues to champion his constituents’ interests in this respect. On the seed funding, we have made the announcement and are keen to get the money to those trusts as swiftly as possible so they can work with us to develop their plans. I agree entirely that its inclusion in this list is a vote of confidence from us and the NHS in the work his local hospital is doing.

NHS Pensions

Steve Brine Excerpts

Wednesday 26th June 2019 Westminster Hall

[Steve Brine (Winchester) (Con)]

I add my congratulations to my good friend, my hon. Friend the Member for Poole (Sir Robert Syms), on securing the debate, kicking things off and so clearly setting out the challenge that we face. In recent weeks, we have worked as a tag team between Winchester and Poole— earlier this month I raised the issue in the Chamber during an urgent question on the NHS people plan, which is a logical place for the subject to sit, and he, obviously, is leading the debate today—and that is entirely appropriate given that we are relatively near constituency neighbours and that many of our constituents work in Winchester, Bournemouth, Poole and Southampton NHS trusts and do shared work across those trusts.

I must say that the debate should be responded to by a Minister from Her Majesty’s Treasury. That is no criticism of the excellent hospitals and workforce Minister, who until very recently I was honoured to call a ministerial colleague in the Department of Health and Social Care. This is the first debate being responded to by a Minister from the Department of Health and Social Care that I have spoken in since I left office. However, seeing as we have a Health and Social Care Minister here, I will focus my remarks on patient care, which my hon. Friend the Member for Poole has discussed.

Over the past few weeks, I have spoken on a number of occasions to the chief executive of Hampshire Hospitals NHS Trust, Alex Whitfield, and I have spoken either through her or directly to numerous consultants and senior clinicians about this challenge. I am aware how serious it is, both for the individuals adversely affected—as we heard from my hon. Friend the Member for Cheltenham (Alex Chalk) and the hon. Member for Newport West (Ruth Jones)—and for patient care and wellbeing, because the NHS is about its people if it is anything.

When I first spoke to my local trust about this, the chief executive told me that

“the pension situation is having a significant impact on our people”

in Winchester and Basingstoke, and:

“The NHS scheme is particularly affected by changes to the pension tax system relating to the Annual Allowance and the Life Time Allowance.”

She is not wrong when she says:

“These changes are complicated and for individuals in the NHS defined benefit pension scheme the implications are not at all transparent.”

That point was well made by my hon. Friend the Member for Poole. She says:

“As a result, individuals are receiving unexpected tax bills of tens of thousands of pounds. It particularly impacts on consultant doctors, senior nurses and managers. Individuals are making different decisions as a result of these bills.”

I will pause on that point, about the senior NHS staff on whom this is having an impact.

I was privileged to be part of a Department that, under the previous Secretary of State, who is now the Foreign Secretary, and under the current Secretary of State, has delivered a record funding settlement for the NHS—£20.5 billion a year. I saw that play out in Winchester a few weeks ago, when I opened the new emergency department of the Royal Hampshire County Hospital in the heart of the city. That is excellent news. In my opinion, the challenge for the NHS will not be too little money, as a result of the settlement and the excellent long-term plan, but having the right people, who can spend that money in the right way to deliver the patient care outcomes that we want. If we are losing senior people, we have a senior problem.

As well as speaking to the leadership at my local trust, I wanted to find out more from the horse’s mouth, so I asked members of the local clinical community to come forward with their own stories and, if I may, I shall put a few of them on the record. One consultant set the scene very clearly. He told me that the issue is the annual allowance pension tax taper, which I will come back to, and the inflexibility of the NHS pension, which is landing consultants with huge tax bills for doing extra work on top of their contracted hours. The consultant was clear—and I agree, not least as a former Health Minister—that that extra work keeps the NHS running in the face of ever increasing demand.

I was told that, in certain circumstances, the marginal tax rate on earnings for the extra work is greater than 100%, which means that senior doctors working in my local hospital are in effect having to pay to do extra work. They are some of the most committed individuals in public service in our country, and I have had the privilege of working closely with many of them, but that is taking things a bit too far. It is clearly not a sustainable situation and, now that the huge tax bills are landing on doorsteps, it is causing a huge change in the behaviour of consultants at all levels in my local trust.

Another consultant told me that she has been an NHS doctor for 19 years and has worked as a consultant in my local trust for the last seven. She is employed on a full-time contract, with additional out-of-hours cover. Moreover, she regularly covers additional lists and shifts that require cover, sometimes at very short notice. She could not have been clearer with me that she is happy to provide that cover in the interest of safe patient care, which is of course what this is all about, as everyone has said. However, she has now been hit with a £30,000 tax bill, and she tells me that the only way she can avoid regular large tax charges, which may be for tens of thousands of pounds a year and which of course are in addition to her not insignificant income tax payments, is seriously to reduce the hours that she works for the NHS and not to take on any additional duties. As has been said, that goes to the heart of the issue. The consultant fears, as does her MP, that that is the conclusion that many of her colleagues will be forced to accept.

Let me again give some facts from trust level. Hampshire Hospitals NHS Foundation Trust recently ran a survey on the pension issue and received a healthy 2,500 responses. It is the case that 42% of all the respondents have reduced their work commitment; 20% have avoided promotion; and, critically, when the people were asked who might change working practices in the future, the figure goes up to 80%, including 33% considering early retirement and just over a quarter considering leaving the NHS altogether.

I have no doubt that the changes were introduced in good faith. They are aimed at top rate earners, as my hon. Friend the Member for Poole said, but in practice this has had a damaging effect on key people in the NHS, and if it is not sorted quickly, we will see that escalate further, and it will become harder and harder to retrieve the position. The suggestions put to me for fixing it include removing the annual allowance tapering. When I spoke during the urgent question earlier this month, a number of consultants from across my local trust and Poole and Southampton contacted me. They are pleased that the consultation, which I am sure my hon. Friend the Minister will say more about, is imminent, but what they fear from that is that the 50:50 fudge will just not work. We need wholesale reform, and the taper really does need to be scrapped.

In addition, I ask the Minister whether it is worth considering removal of the annual allowance taper for public sector workers. Of course, that is a decision not for him but for the Treasury and for whoever is inhabiting No. 10 in a few weeks’ time—I may be well placed to influence that, or I may be not at all placed. The point is this. If we want to make the NHS a great place to work, why not provide a tax benefit to working for the public sector—one of the biggest employers in the world? That is food for thought.

Let me finish in the same way as I have tried to make the whole of my contribution this morning—with a real-life example from Hampshire Hospitals NHS Foundation Trust of what we are seeing at trust level. In Winchester, like everywhere else and as I have set out, the Royal Hampshire County Hospital, one of the three hospitals in the trust, relies on many doctors and other senior staff doing additional sessions over and above their timetabled work in order to fill gaps in the medical workforce. Locally, we have seen that especially in radiology, where the additional sessions are used for radiologists to review scans and write the reports about what they see. The reporting of scans is clearly required so that patients can be told what the scan shows and clinical staff can work with patients on the most appropriate treatment.

My good friend from the Scottish National party, the hon. Member for Central Ayrshire (Dr Whitford), whom we will hear from shortly, and I spent many hours in this Chamber when I was the Minister with responsibility for cancer, and I was extremely proud to get the 75% stage 1 or 2 diagnosis ambition into the long-term plan, as announced by my right hon. Friend the Prime Minister. That is critical: early diagnosis is cancer’s magic key, as has been said by me and others many times in this Chamber. If we are to get anywhere near realising that ambition, we have to have a functioning, improved and expanded radiology service. Any reduction in radiology and the diagnosis stage will have an adverse impact and make that ambition unattainable, in my opinion. I am reliably told by my local trust that it has seen the backlog of scans waiting to be reported growing each week over the last few months. That concerns me greatly. It is of course just one department—it is an area that I know a little about—but it is a sobering example and one that we simply cannot ignore.

I shall finish by saying that we must act. I have so much respect for this Minister, but we need the Treasury to take this issue seriously and we need the next Prime Minister to act. If we do not, it will only get worse. We need to grip it, and we need to grip it fast.

[James Gray (in the Chair)]

Despite his late arrival to the debate, I call Mr Paul Sweeney.

--- Later in debate ---

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

I congratulate the hon. Member for Poole (Sir Robert Syms) on securing this important debate, and I underline the fact that I am a shadow Treasury Minister responding on behalf of the Opposition.

We are here today to discuss the impact of changes to allowances on tax relief on pensions specifically in regard to NHS pensions. As people in this Chamber will know, in 2016-17, an estimated £38.6 billion in tax relief was provided on contributions to approved pension schemes; obviously that is the overall figure and does not cover just those who work for the NHS. It is a very substantial amount of relief.

As I am sure Members will also know, the last Labour Government introduced the annual allowance and lifetime allowance back in 2006. The annual allowance was initially set at £215,000 and the lifetime allowance at £1.5 million. Since then, as other Members have discussed, we have seen gradual reductions. Under the coalition Government and the Conservative Government, the lifetime allowance was reduced from £1.8 million to £1.5 million in April 2012, then to £1.25 million in 2014, and to £1 million in April 2016. It has actually floated up a little bit with inflation up to 2019-20, when it will be—as has been mentioned—£1,055,000. There has been a similar trend with the annual allowance, which was reduced from £255,000 to £50,000 in April 2011 and it then went right down to £40,000 in 2014.

Of course, the particular changes that we have focused on today are around the interaction of all of these measures with the taper, which George Osborne introduced in the summer Budget of 2015. From April 2016, the annual allowance would be tapered at a rate of £1 for every £2 of taxable income, including pension benefits and not subtracting employee pension contributions, received over £150,000 in adjusted income, going right down to £10,000 for those with an income of more than £210,000. As has also been mentioned, that final change affects those people whose pay is more than £110,000 a year, excluding pension benefits and employee pension contributions, and who see an increase in their pension benefits of more than £40,000 in a given year.

As my hon. Friend the Member for Newport West (Ruth Jones) said, and the hon. Member for Central Ayrshire (Dr Whitford) underlined, all that obviously amounts to a considerable number of changes in a very short time. So we have seen the tax treatment of pensions for all high-paid workers changing very substantially, indeed in a way that they probably could not have envisaged when they first joined their pension scheme. The hon. Member for Central Ayrshire was right to indicate the parallels between this situation and what has happened to several other groups of taxpayers.

I see that the Minister is kindly scribbling things down at the moment. I hope that he will pass on to his Treasury colleagues that it is simply unacceptable if, at the very least, these taxpayers do not receive adequate information about what their liabilities will be. I was deeply concerned to hear from the hon. Member for Central Ayrshire that, for example, people are not receiving their pension statements. Surely that is the very minimum that is required.

On principle, it is surely necessary for the pension allowance to decline gradually for those people who earn very high incomes. It is fair, and consistent with other core principles of our tax system, that tax charge exemptions should be reduced for people who have very high incomes. However, there is of course the issue about the interaction of that system with other pension schemes, especially the NHS pension scheme, and given the fact that we have a very tight labour market for those in the NHS with substantial expertise. As has been mentioned, about 30% of doctors earn £110,000 or more, and nearly 10% earn more than £150,000. Clearly, this group of staff are the people who have the necessary expertise, as has also been mentioned a number of times.

I am aware of course that official representations have been made on this issue. We have heard what has been stated by the British Medical Association and the British Dental Association, and I think that the polling to which the hon. Member for Winchester (Steve Brine) referred was very interesting in that regard. It was also helpful to hear from my hon. Friend the Member for Glasgow North East (Mr Sweeney) about the impression that he received from his local NHS trust about what is going on.

When we consider this issue, it is very important that we do not just talk about tax treatment; we must also consider how it inter-relates with what is a very complex NHS pension scheme, one that, as I understand it, was not fully consulted on with representative organisations when it was introduced.

As has been mentioned, we now have three different schemes, and my hon. Friend the Member for Newport West indicated how working out how these schemes relate to each other and how that will impact on tax outcomes is very difficult for individuals. As the hon. Member for Poole rightly said, the impact of these changes—related to this combined test of both the threshold and the annual income, plus the taper—makes it very difficult for individuals to work out what their liability is without any kind of professional help. Of course, that professional help is also expensive.

We need to look at NHS pensions, and I hope that it will be possible for the Minister to take that issue away and discuss it with his Treasury colleagues. However, I will just say to those in this Chamber that, as well as talking about the problems for high-paid NHS staff, we of course also need to look at the issues for low-paid NHS staff. The pension situation is quite concerning for them. The annual report on retirement by Scottish Widows indicated that overall one in five young people are saving nothing for their later life, and many of those people who are working in our NHS on low pay have opted out of pension schemes, because they feel that they need the cash now to make sure that they can make ends meet.

A freedom of information inquiry in 2018 found that more than 245,000 workers from across the NHS in England had opted out of the NHS pension scheme in the previous three years. A lot of those were low-paid workers, so that is enormously concerning. Although I agreed with much of what the hon. Member for Winchester said, I do not agree with him that the levels of resource currently being considered by his Government will be adequate in the future.

Let us consider the current situation. We obviously have the cumulative impact of the pay cap over many years. The Government finally saw sense on that, but it took them a long time to do so. There are also groaning waiting lists, extended waits for accident and emergency, and the rationing of NHS services, with many procedures no longer being offered by the NHS. Until we see a change in that situation, it will be difficult for many of us to argue that the NHS is heading in the right direction resource-wise.

I know that the Government have made a commitment to improve funding in the future, but the Opposition continue to believe that that commitment is not sufficient.

[Steve Brine]

My point was that the NHS long-term plan has been significantly funded, with record funding, which, for the record—seeing as the hon. Lady has gone there—is significantly more than was promised by the Opposition. Yes, other resources will be required, around public health for instance, and around the people plan, but perhaps the hon. Lady can tell us what Labour’s fiscal promise is to the NHS, and how it will be paid for.

[Anneliese Dodds]

Absolutely. I am grateful to the—

--- Later in debate ---

[Stephen Hammond]

The hon. Lady is right to make that point; as I said in my remarks about her speech, I recognise the impact on training. There is clearly concern that unless we address this matter, it will have a number of impacts, of which that is one.

The hon. Member for Oxford East (Anneliese Dodds), speaking for the Opposition, rightly opened her remarks by pointing out the scale of the cost of tax release for pensions to the Treasury. She made valid points about doctors’ knowledge about that liability, and about the interaction of core tax principles with particular schemes. I was rather hoping that she would also welcome the long-term plan and the cash settlement, but I suspect that element of unity was probably a step too far.

As my hon. Friend the Member for Poole may have mentioned at the beginning of his speech, we have fewer Members here and a lower number of contributions. However, those contributions, combined with some of the interventions, have meant that we have had a debate of high quality.

Needless to say, I have heard the representations from everyone in the Chamber. It will not surprise anyone that I have received, as has the Department, representations from NHS employers reporting exactly what we have been discussing—that consultants are increasingly no longer willing to work additional sessions. The lost capacity is clearly difficult to replace, especially in some clinical areas where there are already shortages, and it can be expensive, as employers can pay a premium for locums to fill the gap. It is obvious and right that where there is evidence of an impact on the delivery of services, the Government should be prepared to take action.

At the outset, I reiterate that the Secretary of State and I take seriously the concerns of doctors. That is why we have been involved in a number of discussions with the Treasury, which has resulted in the 50:50 flexibility and the consultation. I will come to that in a moment, but, as Members will hear as I develop my remarks, that will not be the end of our conversation with other Departments.

Looking at the case for pension flexibility, it is true that outside public service, employers in some cases have flexibility to adjust benefit packages to allow high-earning employees to target a lower level of pension saving and so reduce the potential for large regular annual allowance tax charges. That flexibility is not currently present in the NHS. The NHS pension scheme does not allow any flexibility over the level of pension growth. Staff who participate in the scheme must pension all regular earnings from their employment. The Government are right to take the view that it is important to ensure that staff have a good level of pension savings, but senior clinicians, particularly consultants and GPs, have a unique degree of flexibility over their workloads and obviously can reduce their commitments. Consultants can reduce the number of additional sessions undertaken, and many GPs are self-employed. That can create incentives for clinicians to seek to control their income and pension growth by limiting or reducing their NHS work to avoid breaching their annual allowance. As a number of Members have discussed, that clearly has an impact on the delivery of patient care.

It is clear that retaining and maximising the contribution of our highly-skilled clinical workforce is crucial to the NHS and the long-term plan for the NHS. While any pension tax regime should seek to achieve the fiscal ambition of distributing pension saving incentives fairly, it has to be recognised that, in combination with the fixed structure of the NHS pension scheme, that could produce—listening to the evidence today and the evidence I have directly received—unintended consequences for service capacity and the delivery of patient care. The Government are prepared to change the rules to give clinicians more flexibility.

Alongside the publication of the “Interim NHS People Plan” earlier this month, my right hon. Friend the Secretary of State announced our intention to consult on new flexibility for clinicians. The consultation will be published in the coming days—I hope very shortly—and will set out proposals for a 50:50-style option, offering 50% pension accrual and halved contributions. Earlier this year, as part of the new five-year GP contract, the BMA and NHS England asked the Government to consider introducing that option. While I recognise that the BMA has not been unequivocal in its support, it has welcomed the proposal as a step in the right direction.

The Government believe that a 50:50 option balances the benefit of flexibility with the fiscal impact to the Exchequer. The 50:50 option will allow clinicians to build up their pensions more slowly and at a lower cost. Clinicians will still need to make their own personal assessment as to whether their financial interests are best served by taking advantage of the 50:50 model or continuing with full-rate accrual, but I have heard—not necessarily in the debate today, but directly from a number of consultants—that the 50:50 option is not flexible enough and that other measures should be considered.

The new pension flexibility should be viewed as a positive development for clinicians. My hon. Friend the Member for Winchester mentioned that he has asked me about the consultation period on the Floor of the House and that he has spoken to consultants about it. The consultation will be an opportunity to listen to a range of views before any final proposition is agreed. I encourage all Members here today to encourage their local clinicians to take part in that consultation. Equally, I encourage anyone from the health system in its widest context to take note of the debate and take part in the consultation. We want not only to hear any suggestion that there is a generic case for tax changes, but to listen carefully to what clinicians say using their own personal examples to provide evidence for any change they seek.

[Steve Brine]

Is the consultation discussing the merits or otherwise of a 50:50 option, or is it genuinely open to discussion about whether that option in itself is a good idea? As I said in my speech, the initial responses I have seen have not broadly welcomed, to put it politely, the idea of 50:50.

[Stephen Hammond]

The consultation is both. I recognise, as I said a few moments ago, that the 50:50 option has not received unequivocal support from the BMA, but to its great credit, it has asked us to consider that. We have come forward with this proposal. The BMA has welcomed it, but has said that it would want to discuss further options for flexibility and other pension matters. We have said that the consultation will look at the merits of the 50:50 option—or question it—but we will rightly open up that consultation to other suggestions. My hon. Friend will have just heard me say that I hope Members will encourage their local clinicians to use the consultation as a way of expressing their concerns about the 50:50, if they have any, and to express their views on other measures they would like to see introduced in terms of pension contributions. I stress that point again in response to his intervention. He will probably be interested in my next set of remarks, which are on flexibility.

Although the 50:50 option provides a new flexibility, we recognise that it does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth and contributions. The financing model for the scheme means that any flexibility that reduces contribution income has an immediate fiscal impact on the Exchequer. The 50:50 option does not set aside the annual and lifetime allowance tax policies, but will give clinicians a new flexibility to manage their pension growth.

Where 50% accrual reduces pension growth by more than they wish, clinicians can use the contribution savings from the 50:50 model to buy additional pension to customise their own pension growth incrementally. Additional pension can be purchased in units of £250. That clearly adds some flexibility to their ability to manage their own contributions. However, some clinicians may continue to experience annual allowance tax changes, even with accrual rates reduced to 50%. For that group, while 50:50 reduces the charge, it does not eliminate it. We recognise that a number of individuals may wish to target a lower level of pensions growth. We will listen carefully to that suggestion through the consultation.

Interim NHS People Plan

Steve Brine Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

I thank the hon. Lady for welcoming the plan. I think she will accept that this is a good interim plan; it is a stepping stone. She asks what we are doing to fill nursing places. I point out yet again that we are increasing applications and ensuring that there are 5,000 extra clinical placements available, which is a 25% increase on last year. Far from being complacent about the number of nursing applicants, we are looking to ensure that more nurses can be trained in this country, beyond the 35,000 who are being trained at the moment.

The hon. Lady asked about doctors. The Royal College of Physicians has made it clear that we need more medical school students. We are committed to increasing the number of undergraduate medical school places for domestic students by 1,500, with the first 630 being taken up last year. By 2020, there will be five new medical schools across England, helping to deliver—[Interruption.] Of course it takes time, but if we do not take that step now, we will never make the end of that journey. That has been a consistent problem for many years. There are still more doctors coming through now, but we need to do more, which is why this plan is being put in place.

The hon. Lady will have heard me say to my right hon. and learned Friend the Father of the House that there are more than 63,000 EU nationals working in the health service. That is more than there were in December 2017, and over 5,000 more than there were in June 2016. She is right to point out that we want those skills in the right clinical areas. I reiterate what I said a moment ago: we wish to make it absolutely clear that the contribution of EU nationals working in the health service is extraordinary and valued and will continue to be so.

The hon. Lady briefly mentioned pensions. She will have noted that we launched a consultation yesterday, setting out some ideas. I am pleased to say that the British Medical Association has welcomed them but asked us to look at other flexibility within the pension rules. I encourage the hon. Lady and all consultants to take part in that consultation.

[Steve Brine (Winchester) (Con)]

The Minister knows from our time together in the Department how much I welcome the interim people plan. It simply is the turnkey without which our long-term plan just cannot work. He is aware of how important retention is, and that is at the heart of the plan. I know he has mentioned this several times already—and consultations are great, and I will encourage my constituents to take part—but may I ask him to look urgently at the changes to the NHS pension scheme in relation to the annual allowance and the lifetime allowance? My trust has contacted me to say that senior consultant doctors and senior nurses are receiving unexpected tax bills of tens of thousands of pounds—up to £50,000—which is starting to have an impact on decisions about their future and the additional sessional work they are prepared to take up. This is impacting on patient care now, so on behalf of my constituents, I urge him—I know he will take this seriously—to look urgently at the NHS pension scheme issue.

[Stephen Hammond]

Again, my hon. Friend was absolutely right at the start of his question to point out that this is a key stepping stone to making sure that the long-term plan works. He is also absolutely right to point out that we recognise and have taken extraordinarily seriously the difficulties that a number of clinicians have had with the pension tax changes. He will know from his time in the Department that we have been in continuous discussions with the Treasury about what options may be available. I have set out today that the consultation will propose a new 50:50 option for higher-earning clinicians to halve the rate of pension growth in exchange for halving contributions. I accept that that is only one part of the solution, but it is a step forward. I welcome contributions to the consultation, and I urge him and his consultants to take part.

Tessa Jowell Brain Cancer Mission

Steve Brine Excerpts

Monday 13th May 2019 Commons Chamber

[Matt Hancock]

The cross-party tone of this discussion demonstrates what we can achieve when we work together. This is not just about Baroness Jowell, who did so much and was so brave in how she made her case—in the last few months in particular, but before that as well. It is about the many others who have worked together, including the many who were inspired by her words to work harder on brain cancer.

In truth, the amount of research money going into brain cancer—and therefore the number of clinical trials, which the hon. Member for Leicester South (Jonathan Ashworth) mentioned—was too low. There were so few clinical trials because research overall was too low. That is partly because brain cancer is a very difficult disease to treat. Just because it is difficult, however, does not mean we should not try, so we have increased the amount of research money, and I am determined to see an increase in the number of clinical trials and to make sure that the data from them is properly used and openly disseminated.

The hon. Gentleman asked about the cancer workforce. As I mentioned, of course we will need more people to treat cancer. That is partly what the £33.9 billion extra is all about.

The hon. Gentleman is also right to say that we need more early diagnosis. The truth is that, while the NHS is very good at treating cancer once it has been spotted—indeed, it is one of the best in the world—our cancer survival rates in this country need to improve through early diagnosis. That means giving more support to community services, strengthening primary care and ensuring that we have the diagnostic tools that he mentioned. We have more MRI scanners and more Linux machines for treatment purposes, but of course there is always more that we can do.

[Steve Brine (Winchester) (Con)]

During my time as the cancer Minister, I had the pleasure of meeting Tessa. You will recall, Mr Speaker, a very special debate that we had in the Chamber last April, when Tessa was back in the House of Commons, sitting in the Under-Gallery with her lovely family and listening to the debate.

Obviously I welcome the roll-out of 5-aminolevulinic acid—5-ALA—which allows surgeons to tackle some of the most difficult cases while ensuring that the healthy cells remain untouched. Does the Secretary of State agree that the exciting new frontier in cancer treatment is not only allowing people to survive it—more people are doing that for longer than ever before—but enabling them to live really well after treatment? It is no good surviving cancer if it is a rubbish time afterwards. Is that not the real promise of this?

[Matt Hancock]

My hon. Friend is a former colleague and dependable Minister, and I regret not having mentioned the work that he did in my opening remarks. The hon. Member for Leicester South said that he and my predecessor as Secretary of State had worked together on this issue, but the person who did the hard yards was my hon. Friend, and I pay tribute to him.

My hon. Friend is completely right: it is not just about surviving cancer, but about living well both with and after it. We must make sure that we learn that lesson and put the needs of patients at the heart of the process—not only their medical needs, but their non-medical and social needs. One of the humorous and amusing things that Tessa would talk about was the importance of the shape of the wig and the colour of the headscarf to a person who is going through chemotherapy, and that should be at the heart of treatment.

NICE Appraisals: Rare Diseases Treatments

Steve Brine Excerpts

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.

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

Let me add my congratulations to the hon. Member for Blaydon (Liz Twist) on securing the debate. I was not familiar with the north-east massive, although I am now. I was familiar with the individual component parts of the north-east massive, especially my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), but I have not seen them as a collective before. I must say that they hunt well as a pack.

I know of the work of the hon. Member for Blaydon, who chairs the all-party parliamentary group on phenylketonuria. We have discussed these matters before, in Westminster Hall, and I do not doubt that we will discuss them again.

Other Members have spoken passionately today, on behalf of their constituents, about the importance of access to new medicines. As the hon. Member for Dudley North (Ian Austin) rightly said, Members are doing their job, and I am doing mine: as requested, I have listened very carefully to the debate. I thank my hon. Friend the Member for Reigate (Crispin Blunt), and the hon. Members for Wolverhampton South West (Eleanor Smith), for Bristol East (Kerry McCarthy), for West Ham (Lyn Brown), for Liverpool, West Derby (Stephen Twigg), for Heywood and Middleton (Liz McInnes), for Dudley North, for South Shields (Mrs Lewell-Buck)—part of #massive—for Strangford (Jim Shannon) and for Motherwell and Wishaw (Marion Fellows), who speaks for the Scottish National party.

The hon. Member for Liverpool, West Derby touched on the subject of cannabis, and I will happily write to him about that in more detail if he wants. As he knows, the all-party group report came out yesterday. I have not had a chance to look at it yet; I am aware of it, obviously. The Government changed the law and specialist doctors can now provide cannabis-based medical products where there is clinical benefit. To support doctors in this—because the politicians are ahead of the clinicians on this one—we asked NICE to develop new clinical guidelines and we asked Health Education England to provide additional training, while encouraging more national research to develop the evidence base in this. I have said before and I shall say again that I am very clear that we need to provide more support and encouragement to commissioners in this space because, as I said, politicians are ahead of the clinicians on this one.

Everyone has spoken incredibly passionately and there has been very little politics in the debate, which has been excellent, at the end of this week. It is very good to hear Parliament discussing something else, which of course it does all the time; it is just that that is never reported— I dare say this will not be, either.

The Government share the view of everyone in the House that it is in the interests of all NHS patients that we have the best system in place for making evidence-based decisions on whether new medicines are routinely available. Of course it is easier when one is on the Back Benches to just say the system is hopeless, but we have to work with the system we have, or change it. We inherited the NICE set-up. It was mentioned in the first Labour Queen’s Speech, in ’97. It was created in 1999 in a Delegated Legislation Committee by then Health Minister of State John Denham, who is a good man. He set it up. When he did so, he said it was set up to make independent, evidence-based recommendations for the NHS on whether drugs represent an effective use of NHS resources.

NICE is widely recognised as a world leader in the field of health technology assessments. Its methods and processes have been developed and continuously refined over the last 20 years through periodic review and engagement with stakeholders. Politicians are not in the middle of those decisions, and rightly so; that is how the system was set up by the aforementioned Mr Denham. Maybe the hon. Member for Heywood and Middleton was right to trust her instincts—

[Lyn Brown]

Will the Minister give way?

[Steve Brine]

No, because the hon. Lady has had her say and I am going to have mine in the short time I have. If I have some time—

[Lyn Brown]

It is on behalf of my constituents.

[Steve Brine]

Mr Deputy Speaker, I think the hon. Lady has spoken on behalf of her constituents a lot today, and very well. [Interruption.] I do not think, given the tone of this debate, we need to get unpleasant in here. [Interruption.] I will address the points in my speech and, if the hon. Lady does not like that, I am sorry, but I do not think anybody watching this, least of all the families affected, need to hear that tone.

As a result—

[Lyn Brown]

rose—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Whether the Minister wishes to give way is up to the Minister and we must let him finish his speech.

[Steve Brine]

Indeed, Mr Deputy Speaker; some people just cannot help themselves.

NICE operates two separate programmes for the assessment of new medicines. First, there is a technology appraisal programme through which NICE assesses the vast majority of new medicines. Secondly, as has been said, there is a highly specialised technologies, or HST, programme that is reserved for the evaluation of very high-cost drugs for the treatment of the very small number of patients in England treated in a handful of centres in the NHS. Decisions on whether a medicine should be routed to NICE’s mainstream technology appraisal, or the HST programme are taken through an established topic selection process that includes consideration against published criteria and engagement with a wide range of stakeholders. When NICE recommends a drug for use through either route, NHS organisations are legally required to provide funding so that it is made available to patients.

Today, we have heard concerns that NICE’s technology appraisal programme is not suited to the assessment of medicines for rare diseases, with some calls for individual drugs to be assessed through the HST programme instead. We have also heard calls for a third appraisal route for rare diseases not eligible for the HST programme. I have listened very carefully to all of them and will reflect on them all. There is some sense in a lot of what has been said. Indeed, over the last 20 years, NICE has made positive recommendations in 75% of its appraisals of orphan medicines. By comparison, NICE recommends around 80% of medicines for more common diseases.

I shall give the House two recent examples, because of course we only ever hear about the examples that are stuck or refused. NICE has been able to recommend orphan medicines for neuroblastoma, a cancer of the nerve cells that affects children—this has been widely welcomed—and for primary biliary cirrhosis, a progressive liver disease. Moreover, through its HST programme, NICE has to date been able to recommend a further eight medicines for NHS patients outside of the standard appraisal route. In each case, NICE’s recommendation is subject to a managed access agreement negotiated between the drug company and NHS England.

There will always be cases where NICE is unable to recommend a medicine because the price set by the company does not reflect the benefits that it brings. That is a fact. Hon. Members have of course spoken about the rare diseases of people in their constituencies—they are doing their job—but NICE is an independent body and it should be allowed to develop its guidance free from politicians. The hon. Member for Heywood and Middleton said that that was her initial instinct before she became a politician. That is the foundation of NICE’s reputation as a world leader in its field, and it is in the best interests of patients that it does that.

The hon. Member for Blaydon, in introducing the debate, raised concerns about Kuvan, the treatment for phenylketonuria. NICE has initiated an appraisal of Kuvan, and officials from NICE, NHS England and our Department have been reconsidering the appropriate assessment route in the light of the new available information that the hon. Lady mentioned. Riley is right: we have to make this fair. I am told that a final decision will be taken promptly—I urge that again from the Dispatch Box today—and with the minimum impact on the timescale for NICE’s assessment.

The hon. Members for Strangford, for Bristol East and for Dudley North have all spoken about the issue of Orkambi so many times and so well. It is incredibly frustrating and disappointing to Ministers, just as it is to them and everyone else, that Orkambi is not available to NHS patients in England at the moment. I understand and share that frustration. This is why my right hon. Friend the Secretary of State held a meeting with Vertex, NHS England and NICE a couple of weeks ago. I was at that meeting, at which the parties again discussed how best to reach a conclusion. I am pleased to say that they are meeting again today to continue the discussions and decide on the next steps. Decisions about the availability of drugs in Scotland are of course a devolved matter, and that is up to Scotland. I understand that no decision has been taken on routine funding for NHS patients in Scotland, but the hon. Member for Motherwell and Wishaw asked me to look again at the Scottish system. I will do that and I will ask the Minister responsible for this policy area to do so.

The hon. Member for North Tyneside and others raised the issue of the drug Spinraza for the treatment of spinal muscular atrophy. I understand that NICE’s independent appraisal committee met earlier this month to consider its recommendation on Spinraza following new evidence being put forward by the company. NICE wrote to the company and patient groups last week to say that it was not yet able to provide an update on the outcome of the meeting, but that it would provide an update soon. Again, I encourage that to happen even sooner. I recognise that the protracted process in this instance is hugely frustrating for patients and their families and, whatever our differences across the Dispatch Box, of course I feel the deep hurt that the hon. Ladies who spoke on the subject have laid out. I hope they will appreciate that a final decision has not yet been made and that NICE must be allowed to complete its work free from political interference.

I do not have time to go into a huge amount of detail. I have been asked lots of questions during the debate, but I have little more time than the people who have spoken today. I thank Members for speaking so passionately and I hope that they will welcome the forthcoming review of NICE’s methods and processes over the course of this year for both its technology appraisal and its highly specialised technologies programme, which is at least partly what today’s motion calls for. It would not be appropriate to pre-empt the review by commenting in detail on what it should look at, but I will ensure that it is directed towards the motion before us today and to the transcript of today’s deliberations. I now want to give time to the hon. Member for Blaydon, who introduced the debate, to close it in the time that we have left.

[Liz Twist]

I hope that hon. Members will forgive me if I do not list them all, but I want to respond to the Minister. First of all, Minister, it is not easy for us on the Back Benches to criticise and lobby. It is really difficult for us, because these are our constituents. They are real people who have real conditions. We have tried to be constructive in the debate and said that we have identified issues around the NICE appraisal system that we think need to be addressed urgently. I notice that he mentioned the review and said that our concerns would be drawn to its attention, but will he ensure that there is dialogue and input before the review takes place to ensure that it is not just technical, but addresses the concerns that we have raised?

[Steve Brine]

indicated assent.

[Liz Twist]

I see the Minister nodding, so perhaps that can be recorded in Hansard. He also said that he has heard from us about these issues before, but I can tell him that he will hear from us again—

Exiting the European Union (Food and Agriculture)

Steve Brine Excerpts

Tuesday 19th March 2019 Commons Chamber

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

I beg to move,

That the draft Materials and Articles in Contact with Food (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 5 February, be approved.

[Mr Speaker]

With this, we shall consider the following motions:

That the draft Genetically Modified Food and Feed (Amendment etc.) (EU Exit) Regulations 2019, which were laid before this House on 4 February, be approved.

That the draft Novel Food (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 4 February, be approved.

That the draft Animal Feed (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 5 February 2019, be approved.

[Steve Brine]

The instruments, which all concern food and feed safety, relate to those substances collectively known as “regulated products” and to animal feed hygiene and marketing. They are made under the powers in the European Union (Withdrawal) Act 2018 to carry out necessary amendments to the overarching food regulations so that those can continue to protect public health from risks that may arise in connection with the consumption of food. These are protections that our constituents would expect us to pass.

As the UK leaves the European Union, the Government remain committed to maintaining the high standards of food and feed safety and consumer protection that we enjoy in this country. As some hon. Members are aware, I have recently presented numerous instruments that will help to deliver a functioning body of food and feed law. I say “some hon. Members” because, by and large, they have been taken upstairs—so I like to think that today is a bit like me moving from BBC2 to the primetime slot on BBC1. The instruments will correct deficiencies in the regulations to ensure that the UK is prepared in the event we leave the EU without an agreement.

As with all the previous statutory instruments I have presented, I wish to make it clear that these instruments make no policy changes and that it is not our intention to make any at the present time. Similarly, they are crucial to maintaining the effective controls and standards that protect public health and consumer interests in relation to regulated products used in and on food and animal feed.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

As the Minister knows, in the ceramics industry contact with food is a huge part of the regulations. What assurances can he give to me that I can relay to the industry that should Europe change its own arrangements for contact rates and provisions—in other words, if our regulatory systems diverge—producers in this country that are in line with our regulations could still sell to the EU?

--- Later in debate ---

[Steve Brine]

I shall be able to talk in more detail about the ceramics issue, which I can well imagine is of great interest to the hon. Gentleman. However, the point of the regulations is to port across everything that is currently on the EU’s statute book. We have 100% regulatory alignment at this stage, because we are a member state at present; if we have a withdrawal agreement in place, there will of course be a seamless bridge. The purpose of the instruments is to ensure that that seamless bridge comes about regardless.

If, when we are a third country, we as a nation, and this as a sovereign Parliament, decided to make a change to the regulations, we would have to do so with the consent of Members. All the considerations would be taken into account, including the impact on areas such as the one that the hon. Gentleman represents, and I am pretty sure that he would be a very loud voice in any future debate. I hope that that answers his question.

[David Simpson (Upper Bann) (DUP)]

What consultation has there been with the devolved nations?

[Steve Brine]

I ask the hon. Gentleman to bear with me. I will definitely come on to that, in respect of all the SIs.

As I said to the hon. Member for Stoke-on-Trent Central (Gareth Snell), the purpose of the SIs is to ensure that UK domestic legislation that implements directly applicable EU regulations continues to function effectively after exit day. The proposed amendments are critical to ensuring that there is minimal disruption to novel foods, feed additives and other regulated products collectively if we do not reach a deal with the EU.

The first SI, the Materials and Articles in Contact with Food (Amendment) (EU Exit) Regulations 2019—also known as Food Contact Materials—refers to all items that are intended to come into contact with food, both directly and indirectly. They include processing line machinery, transport containers—not vehicles, but the actual containers of food—kitchen equipment, packaging, cutlery as sold and dishes and utensils as sold, and can be made from a variety of materials including metal, paper, plastic, wood, rubber and, indeed, ceramics.

Let me say for the benefit of Members who do not live and breathe these regulations, in the unlikely event that there are any, that specific examples of food contact materials are tin cans for holding baked beans and plastic bottles for holding water. The regulations will ensure that those materials are robust enough to do the job, but safe enough to do it without transferring anything to the foodstuffs.

The instrument is critical in meeting our priority of maintaining after we leave the European Union the very high standards of food safety and consumer protection that we currently enjoy in this country. It will ensure that provisions in four main pieces of EU food contact materials legislation continue to function effectively in the UK after exit day. The first is European Commission regulation 1935/2004, which sets out the framework for all materials and articles intended to come into contact with food. The regulations then become progressively more specific. The second is regulation 10/2011, on plastic materials and articles intended to come into contact with food. The third is regulation 450/2009, on active and intelligent materials and articles intended to come into contact with food. The fourth is regulation 2023/2006, on good manufacturing practice for materials and articles intended to come into contact with food.

The instrument also makes relevant changes to other specific technical pieces of legislation on individual types of food contact material. It will ensure that regulatory controls for food contact materials continue to function effectively after exit day, that public health continues to be protected, and that high standards of food safety are maintained. Consumers must be protected against potential adverse effects of exposure to some substances used in the manufacture of materials and articles that are in contact with the food that we eat. The instrument will ensure that the effectiveness of the controls that we have is maintained.

This instrument, and the other SIs that we are debating today as part of the fourth and final bundle, will transfer responsibilities incumbent on the European Commission from Ministers in the European Council to Ministers in England, Wales and Scotland and the devolved authority in Northern Ireland. It will also transfer responsibility currently incumbent on the European Food Standards Authority to the relevant food safety authority: the Food Standards Agency, for which I hold ministerial responsibility in England, Wales and Northern Ireland, and Food Standards Scotland north of the border. The change will also ensure a robust system of control to underpin UK businesses’ ability to trade both domestically and internationally.

Let me now say something about the impact of this instrument on industry. The proposed amendments are expected to have a very minimal impact on businesses that produce or use food contact materials or articles. Existing provisions have received very positive feedback from our previous consultations, and there is no evidence that the changes required will be detrimental to industry. I was asked about the devolved Administrations. They have consented to the instrument. We liaise closely at official level with our opposite numbers, and, as with the instruments that we have already debated, throughout this month we have engaged positively with the devolved Administrations throughout the development of these instruments. Let me place on the record again my thanks to them for their positive engagement with me and my team.

[Sarah Newton (Truro and Falmouth) (Con)]

I am pleased by the Minister’s reassurance about the commitment to the extremely high standards of food safety that exist in our country, but will he consider making some improvements as we take on this responsibility in our sovereign Parliament? A number of my constituents are worried about claims that many of the plastic items used to store and protect food are biodegradable or recyclable when that is actually not true. Will the Minister consider improving the current standards in future, so that we can have proper regulation and proper communications about how biodegradable or recyclable plastics really are?

[Steve Brine]

It is good to see my hon. Friend here, but not so good to see her there. She knows what I mean.

Along with the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), I chaired the all-party parliamentary group on breast cancer for many years. There is definitely talk in the lobbying community about plastics and their impact, and, as the hon. Member for Washington and Sunderland West knows, pieces of academic work make claims in that respect. Those claims are certainly not proven, and there is a wide range of scientific debate about them.

I take my hon. Friend’s point about biodegradable plastics, but it is not specifically a matter for me. The instruments deal with food standards and food safety. They do not make any degradations in our food safety, but neither do they make any improvements; they are housekeeping measures.

The second SI, the Genetically Modified Food and Feed (Amendment etc.) (EU Exit) Regulations 2019, is also crucial to meeting our objective of ensuring that the current high standards are maintained. It was made under the powers in the European Union (Withdrawal) Act 2018 to make necessary amendments to retained EU genetically modified food and feed law. It will ensure that regulatory controls for GM food and feed continue to function effectively after exit day, and that public and animal health and, crucially public confidence are protected. The EU law governing GM food and feed provides a harmonised regulatory framework, including transparent and time-limited procedures for robust risk assessment and authorisation before these products can be placed on the market, and we believe that those strict controls must be maintained.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

Food safety is a critical element in the fight against antimicrobial resistance and the tackling of superbugs. Will my hon. Friend do all that he can to ensure that the UK remains a world leader in this area after we have left the European Union?

[Steve Brine]

I would have been disappointed if my hon. Friend had not raised the subject of antimicrobial resistance. He is ingenious in managing to get it into every debate. He knows of my commitment in that regard, not just domestically but internationally. This country is rightly respected and looked to for its work in the field, and I thank him for putting that on the record.

[Rebecca Pow (Taunton Deane) (Con)]

We have received assurances from the Secretary of State for Environment, Food and Rural Affairs that in no way will any of our food standards be lowered as we leave the EU. That is very important to all our constituents, not least the people of Taunton Deane. Will the Minister assure me that we will stick to that, and, indeed, that there might be opportunities to raise our standards so that we are effectively a leader in many areas of the food, farming and animal feed sector?

[Steve Brine]

My hon. Friend makes a good point, and it is an interesting one to bring up at this moment. We have been very clear across Government from the Prime Minister down, including the Environment, Food and Rural Affairs Secretary, that we will not lower our standards in pursuit of trade deals as a result of leaving the EU, and that we will use all the tools at our disposal to make sure that standards are protected and we are not therefore left at a competitive advantage. My hon. Friend mentioned the Environment Secretary, who made that point very clearly at the Oxford farming conference, I think earlier this month. That is very much where this House is, and that is very much where I am as Minister responsible for food safety. I hope that is clear.

The law governing GM food and feed provides a harmonised regulatory framework. The authorisation process involves a safety evaluation based on rigorous scrutiny of scientific data by the European Food Safety Authority in line with international guidelines. GM events for use as food and/or feed are authorised by means of individual pieces of legislation. Authorisations are granted for a period of 10 years, which may be renewed if, following assessment of the required renewal data, the previous risk assessment remains valid. The rules also provide for the withdrawal of authorisations in appropriate circumstances.

There are also very clear requirements for the traceability of genetically modified organisms and the labelling of GM food and feed products, and importantly this enables products to be tracked through all stages of the supply chain. So the instrument ensures the continuation of these robust and effective GM food and feed safety labelling controls after we leave the EU.

As was the case with the other SIs, this instrument will make no change to policy beyond the technical amendments necessary, but it assigns powers and responsibilities currently incumbent on EU entities to appropriate UK entities. So I want to be clear that powers to make legislation, and risk management functions currently held by the European Commission to authorise GM food and feed and revoke or modify authorisations, will be assigned to Ministers in England, Wales and Scotland and the devolved authority in Northern Ireland. Those include discretionary powers to set down detailed rules that work for the UK in relation to the UK reference lavatory—laboratory, sorry, not lavatory; that would be strange.

Returning to industry, no changes to the way in which UK food or feed businesses are operated or regulated will arise from this instrument. There will be a continuation of the robust authorisation system I have outlined, the labelling requirements I have touched on, and the controls for GM food and feed that UK industry is familiar with and relies upon. The instrument enables the continued use of GM food and feed authorised in the UK. Again, the devolved Administrations provided their consent for it.

Thirdly, the Novel Food (Amendment) (EU Exit) Regulations 2019 are another instrument to be made under the powers of the European Union (Withdrawal) Act 2018. Novel foods are those that are relatively new or do not have a significant history of consumption in the EU. Those foods must be assessed for safety before they are introduced into the market to ensure that they do not present a risk to public health. This instrument will ensure that the regulation of and controls on novel foods continue to function effectively after exit day and that public health is protected. Anything permitted prior to exit day will be permitted after exit day. The purpose of the instrument—which again makes no policy changes—is to rectify deficiencies in the retained legislation. So foods new to the market are not assumed to be safe; that is where we have decided to place the burden. In the interests of public health the regulations require novel foods to have a pre-market safety assessment to identify whether they pose a risk and how that risk could be managed. The regulations will ensure that the existing levels of public health protection and food safety are maintained.

The EU framework regulation on novel foods is supported by four implementing measures, which provide the detailed rules, data requirements and administrative procedures governing all novel products. This instrument will ensure that provisions in the four main pieces of EU legislation continue to function effectively after we leave. They will correct the following retained EU law: regulation 2015/2283, which is the main framework for regulation on novel foods; regulation 2017/2469, which provides administrative and scientific requirements for the applications; regulation 2017/2468, which provides administrative and scientific requirements concerning traditional foods from third countries, which of course there would be; and regulation 2017/2470, which establishes a Union list of novel foods. Finally, regulation 2018/456 establishes procedural steps for the consultation process to determine the status of novel foods.

I know that food businesses watch these proceedings with interest, and there will be no change in how they are regulated. The instrument will, however, ensure that the robust system of controls that underpins UK businesses’ ability to trade both domestically and internationally continues. Again, we have engaged positively with the devolved Administrations, and we have their consent for this instrument.

Finally, the Animal Feed (Amendment) (EU Exit) Regulations 2019, which concern feed law, are also made under powers in the European Union (Withdrawal) Act 2018. We are making necessary amendments to the overarching food and feed regulations under the powers in the Act, so that we continue to protect the public. The primary purpose of this instrument is to ensure that feed legislation continues to function effectively. The retained EU legislation on animal feed encompasses requirements relating to feed additives, feed hygiene, sampling—when local authorities do sampling, for instance—marketing, and the use of feed, including labelling.

This instrument will fix the inoperabilities in the retained EU legislation and provide a continuation of the legal requirements that already exist in EU law. These proposed amendments are equally crucial to maintain a functioning statute book and to maintain public safety and confidence. The instrument introduces a number of changes, but the purpose of them is to ensure that the animal feed regulations remain operable after EU exit.

Risk assessment responsibilities, currently incumbent on EFSA, will be assigned to the Food Standards Agency and, again, Food Standards Scotland north of the border, and again, we have had consent from the devolved Administrations.

These four statutory instruments are all necessary to ensure that our legislation relating to food and animal feed safety and hygiene continues to work effectively after EU exit day. No policy changes are being made. I hope the House will support the proposed amendments in these four instruments to ensure that continuation, and I commend them to the House.

--- Later in debate ---

[Steve Brine]

We have heard a number of well-made points, to which I am pleased to respond.

My dear friend opposite, the hon. Member for Washington and Sunderland West (Mrs Hodgson), often makes the point that it is late in the day. It is late in the day, but we did not say that all the SIs would be done a year ago. These are complex matters and we have to get them right. Whether they are taken now or next Tuesday is immaterial. The fact is that they will be done, as long as the House agrees to them today. It is important that they are done, because we need to make sure that the law is in the right state, as I set out in my remarks.

The hon. Lady asked about risk assessments, risk management and the loss of EFSA and its scientific expertise. Leaving the EU does not change the FSA’s top priority, which is rightly to ensure that food remains safe. The FSA has strengthened its risk-analysis process in preparation for EU exit. It has had significant extra funding this year of £14 million. That point has been raised by other hon. Members in respect of the FSA’s capabilities.

The FSA will undertake robust risk assessments and provide evidence-based risk management advice and recommendations on future food and feed safety issues. That is nothing new. The UK already produces independent risk assessments that are recognised internationally. The FSA currently undertakes a significant amount of the risk assessment and management work to maintain the high standards we expect.

The point about chlorine-washed chicken came up again, although the hon. Member for Coventry South (Mr Cunningham) is no longer in his place. I have been clear about that point many, many times. Chlorine has not been approved and so cannot be used. Chicken that is washed with chlorine cannot be placed on the UK market. The Prime Minister, the Secretary of State for Environment, Food and Rural Affairs and I have been very clear about that.

The lav—I nearly did it again! I meant to say the laboratory capability. Edit the record. The hon. Member for Washington and Sunderland West made a very good point about having the laboratory capability to assess and validate the methods of detection with the same rigour that we have had at EU level. The bottom line is that the UK is developing alternative approaches to deliver the necessary functions that are currently provided by EFSA, the European Commission and other institutions, including the EU reference laboratory.

We will build on our capacity and capability to carry out those risk assessments and then to manage and control the food and feed safety risks. We already have the network of national reference laboratories in place that help to ensure the safety of our food and feed, and to prevent the entry and spread of infectious diseases in crops, livestock and feed. They are recognised internationally for their scientific expertise, and we are working with them to ensure that they are able to validate new analytical methods and ensure that they can mirror the scientific capability that we have.

The hon. Member for Washington and Sunderland West asked about novel foods. I am touched that she thinks that is the most interesting of the four SIs—it is a low bar, but I take her point. She asked whether the UK will maintain the existing process or conduct our own review and assessment. We will start from the list as it stands on exit day. As I said to other Members, there will be full convergence at exit day. Any applications will then be assessed by our UK risk assessors. To answer her question directly, the UK advisory committee on novel foods is the body that will perform the role. That body existed prior to 2015, when that was transferred as a Commission competence. It will be unfrozen and will again carry out assessments for the novel list.

On materials and articles that are in contact with food, the hon. Lady made a point about recycling. She was referring to the requirements of Commission regulation 10/2011. That will be maintained, as I said in my opening remarks. The FSA works very closely with DEFRA, but the recycling remit lies with the Department and is not in scope of the amendments we are discussing today.

The hon. Member for Stroud (Dr Drew) is no longer in his place, but I will still respond to his point. He spoke about a food strategy to deal with the crossover between the Department of Health and Social Care and DEFRA. That point was also mentioned by my hon. Friend the Member for Camborne and Redruth (George Eustice). I am the sponsor of the FSA as an arm’s length body. It works very closely with DEFRA, the Department of Health and Social Care and Public Health England, for which I am also responsible. We continue to take a co-ordinated approach on food to support consumer choice. Yes, the fourth SI on feed could as easily have been introduced by a DEFRA Minister, but as my hon. Friend knows full well, what we give to animals ends up in the food chain, so it ends up in my brief.

The hon. Member for Washington and Sunderland West touched on consultation. She is often rightly concerned about the impact on industry, which was also mentioned by other hon. Members. We carried out a full public consultation on the proposed approach to retained EU law in the food and safety space before we tabled the SIs. It was open for six weeks from 4 September until the middle of October. The approach we outlined proposed making a number of corrections to retained EU law under the powers of the European Union (Withdrawal) Act 2018. The responses we received are all available on the food.gov.uk website. Generally speaking, of the 59 responses received, 82% supported or did not disagree in any way with the approach we proposed.

I said to the hon. Member for Stoke-on-Trent Central (Gareth Snell) that I would come back to ceramics. The ceramics legislation dates from a European directive of 1984. Why it has not been updated before now is a fair question and one that I have asked of officials. I can write to him with more detail without detaining the House. He will be interested to know that work is ongoing at a European level to revise the legislation in this space. The FSA has collaborated closely with the UK industry on the establishment of the new European limits. He may wish to follow that up and check it in his constituency, but I am sure that is the case. Obviously, we are importing the law—the directives and the directions—as they stand. Therefore, anything that was in train on exit, we would not import.

It was interesting to hear the reflections of my hon. Friend the Member for Camborne and Redruth on how the FSA grew out of the BSE crisis. We should also remember, as I have said many times, that EFSA grew out of the FSA. That is the rock on which it built its church, in many ways. The relationship between the FSA and EFSA is incredibly strong, even though the legal position will change. Many of the people there are actually our people. I am therefore confident that as the ceramics legislation changes, we will have a strong voice around the table, even if, legally, we are not around it.

[Gareth Snell]

I thank the Minister for that response. It will be heartening for some of the industries in my city, and I look forward to his letter. The issue that will be of most concern to them, albeit diminished because of his helpful answer, is that significant changes to the food contact regulations could affect the way in which they glaze their products through the use of cadmium or other elements. Whether that changes in the UK has an impact on them, but it also affects them if we lose step with Europe and have two operating standards for exports. I appreciate that that is more of a trade question than a contact question, but the two things are very much linked.

[Steve Brine]

It is a trade question, but ultimately if we want to trade with our biggest trading partner and our neighbours in the EU, we have to maintain those standards. We would not want to do anything to hobble our world famous potteries industry. I know that he agrees with that sentiment.

A lot has been said about GM food and feed. My hon. Friend the Member for Taunton Deane (Rebecca Pow) made that the kernel of her remarks. The laws around genetic modification were very high profile, perhaps due to Prince Charles’s interventions, back when I was at school.

[Valerie Vaz (Walsall South) (Lab)]

Not that long ago.

[Steve Brine]

Quite right. The GM regulations are not about changing the robust controls that we have for GM food and feed; they are about correcting the deficiencies in the authorisations that will exist at the point of EU exit. I want to maintain those robust controls. I am putting in place a UK-centric authorisation process as a result of exit, but the data requirements and the robust scientific studies that are required for application will remain exactly the same. Any assessments made of GM food and feed will be made purely on scientific, evidence-based grounds. There is plenty of evidence to suggest that decisions are not made entirely on those grounds at an EU level at the moment. That is one of the benefits that we will glean from taking back control—I knew I would get it in there somewhere.

My hon. Friend the Member for Taunton Deane (Rebecca Pow) mentioned the Agriculture Bill. These SIs only fix the operability of EU law when it is brought into UK law. It is for the House to discuss and debate any changes required to give effect to policies in the Agriculture Bill, and I know that she will be at the heart of that.

The hon. Members for Edinburgh North and Leith (Deidre Brock) and for Falkirk (John Mc Nally) are absolutely right, and I have said that whenever I have spoken about SIs. There has been a lot of talk of the withdrawal Act containing Henry VIII powers, but Henry VIII was an awful lot more powerful than the Act. It is a piece of housekeeping legislation that allows us to bridge EU regulations over to UK legislation; it does not allow us to make significant changes either way on standards. That is perfectly reasonable. Once this House resumes the role of a sovereign Parliament, it will be able to make those decisions for our country, and the Scottish Parliament will be able to do the same north of the border.

If I may say so respectfully, many of the arguments that the hon. Member for Edinburgh North and Leith made belong back before 2016. The country made a decision to leave the European Union. She argues against a no-deal Brexit, as I do—that is not the Government’s policy. I gently say to her that I keep voting for a safe exit from the European Union; she and her party do not.

My hon. Friend the Member for Camborne and Redruth, whom I am sorry to see on the Back Benches, because he was an excellent farming Minister, is absolutely right that this is about having an operable statute book and transferring functions. I have learned many things about food and feed in the past few months, because we are discussing them in the House of Commons and its Committees. That is very refreshing, and we will be doing so more, because when we introduce changes either way, they will have to be discussed and agreed by this House. He is right that they were previously only discussed by the Committee chaired by my hon. Friend the Member for Stone (Sir William Cash). I am sure he thoroughly enjoyed that, but they are now discussed on the Floor of the House of Commons. That truly is progress.

My hon. Friend’s thoughts on the FSA’s conception and birth were very interesting. He was right to spot—he gave the paragraph references in three of the four SIs—that Ministers must have regard to FSA advice. He was also dead right to say that how operability will function is not a finished piece of work. That is why we have taken these powers in the first instance. Once we are a third country, we will have to refine and change that, and we will discuss it with the House and its various Committees. On the architecture, his advice about looking at the Health and Safety Executive was very interesting. I and the FSA, I am sure, will be very interested to talk to him in more detail about that.

We have spent a long time talking about housekeeping measures that will ensure that we maintain the food and feed standards that our constituents expect. Notwithstanding the difficulties we have deciphering what 17.5 million people meant when they voted leave, I am sure we all agree that they did not mean lower standards in the food that they eat and give to their children. These regulations play a very important part in ensuring that those standards are maintained when we leave the European Union.

Question put and agreed to.

Resolved,

That the draft Materials and Articles in Contact with Food (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 5 February, be approved.

Exiting the European Union (Agriculture)

Resolved,

That the draft Genetically Modified Food and Feed (Amendment etc.) (EU Exit) Regulations 2019, which were laid before this House on 4 February, be approved.—(Steve Brine).

Exiting the European Union (Food)

Resolved,

That the draft Novel Food (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 4 February, be approved.—(Steve Brine).

Exiting the European Union (Agriculture)

Resolved,

That the draft Animal Feed (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 5 February 2019, be approved.—(Steve Brine).

Independent Breast Screening Review Recommendations

Steve Brine Excerpts

Thursday 14th March 2019 Written Statements

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

Following publication of the report from the independent breast screening review on 13 December, and the initial statement that I made at the time, I am pleased to now be able to provide the Government’s substantive response to each of the 15 recommendations made by the review.

As I said at the time, it is essential that we take all necessary actions to learn from any problems identified in the breast screening programme. I can now confirm that the Government have accepted all the recommendations made by the independent review team.

In responding to these recommendations, we have also taken account of the findings from the recent investigation into adult screening programmes conducted by the National Audit Office, which was published on 1 February 2019. In some cases, similar issues were highlighted about where improvements can be made in terms of how our national screening programmes are delivered.

A few recommendations are contingent on forthcoming advice from the UK National Screening Committee on how the upper age limit for breast screening should be defined. In the interim, I can confirm that we will maintain the upper age definition of 70 years and 364 days as set out in the current service specification.

In addition, and in line with the statement made at the time, I can confirm that the AgeX trial will continue as planned. The trial will provide significant new evidence on screening women under 50 and over 70 that is not currently available, providing the evidence needed to make decisions about the age range for breast screening in the future.

Some of the areas highlighted for improvement are being considered by Professor Sir Mike Richards as part of his review into cancer screening that was commissioned by NHS England and which was announced on 15 November 2018. Where possible, improvements to the programme are already being taken forward. Where a more considered response is required, it is appropriate to wait for Professor Richards to report and this is reflected in our response. We look forward to receiving Professor Richards’ recommendations in the summer of 2019.

[HCWS1412]

Draft Food and Feed (Chernobyl and Fukushima Restrictions) (EU Exit) Regulations 2019 Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Steve Brine Excerpts

Thursday 14th March 2019 General Committees

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

I beg to move,

That the Committee has considered the draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019.

[The Chair]

With this it will be convenient to consider the draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019.

[Steve Brine]

It is nice to see you in the Chair, Mr Wilson. These instruments, which concern food and feed law, are made under the powers in the European Union (Withdrawal) Act 2018 to make the necessary amendments to UK regulations. This is the third bundle of such regulations that we have debated in these fun sessions.

The Government’s priority is to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. These statutory instruments correct deficiencies in regulations to ensure that the UK is prepared in the event that it leaves the EU without an agreement. They are limited to necessary technical amendments to ensure the legislation is operative on EU exit day; they make no policy changes.

Leaving the EU with a deal remains the Government’s policy. That is what the public want and expect us to do, and it is most certainly what I as a Minister expect us to do. We are working hard to get to a position where we do that. As the House made clear last night, it does not wish to leave without a withdrawal agreement at the end of March. Regardless, we have to make necessary preparations, and that is what this Committee sitting is about. The primary purpose of these instruments is to ensure that legislation that allows for the protection of the public from radioactive contamination of food resulting from past and any future nuclear accidents is operative on EU exit day. I do not think I have introduced many regulations that we so much hoped would not be needed.

The draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 cover the importation of food from areas affected by historical nuclear accidents at Chernobyl in present-day Ukraine and at Fukushima in Japan. The instrument makes alterations to the legislation governing imports of food from the areas affected by the Chernobyl accident, which, believe it or not, was in 1986, when I was still at school—the shadow Minister was yet to get there. The Chernobyl accident resulted in widespread radioactive contamination, which affected food production in many countries. Thirty-three years after the accident, levels of contamination have fallen, and now only certain products, including wild game, wild mushrooms and berries——

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

rose—

[Steve Brine]

I just want to cover the berries, which are very important; those products and berries, such as blueberries and cranberries, show high levels of contamination. On berries, I give way.

[Mr Dhesi]

Sadly, my intervention does not relate to berries. Will the Minister confirm that standards and safeguards will not be watered down as a result of these statutory instruments? We enjoy very high standards and safeguards for permitted levels of radioactive contamination. Can he reassure us that that will continue to be the case post Brexit?

[Steve Brine]

I can absolutely assure the hon. Gentleman that that is the case. The draft regulations are an import from EU regulations. The European Union (Withdrawal) Act 2018, which I referred to, is a housekeeping piece of legislation, not a changing piece of legislation. If we wished to make changes either way—to strengthen or to weaken such regulations—they would come through the House and be examined by it. I am sure the hon. Gentleman and the good people of Slough would rightly take an interest and have something to say about them—as, indeed, would I.

[Ruth George (High Peak) (Lab)]

My constituency hosts children coming over from Chernobyl and Ukraine. Children as young as three are already getting cancers, so although levels of radioactivity in foodstuffs may have declined, we are still seeing a much larger prevalence of cancers in that area, particularly among children. Does the Minister agree that it is important not only to encourage such exchanges, so that children can come and eat uncontaminated food and breathe fresh air in this country, but to ensure we keep our country protected from such levels of radioactivity?

[Steve Brine]

The hon. Lady has put that point very well; I could not disagree with a syllable of that.

This instrument also makes alterations to similar European legislation, regulation 2016/6, which imposes special conditions on the imports of food from areas of Japan that were affected by the Fukushima accident, which was in 2011. In this case, eight years after the accident, higher levels of radioactive contamination are limited to only certain areas of Japan, and affected products include—believe it or not—wild mushrooms again, and other wild vegetables. Wild game may also show high levels of contamination, but those products are not eligible for import into the UK under food safety measures that are not related to these regulations.

As the regulations relate to specific contamination incidents, as radioactivity naturally decays, and since natural and human activities remove contamination from the environment, it is right that the regulations are regularly reviewed to ensure that controls are fit for purpose. The legislation relating to the Chernobyl accident has an expiry date of 31 March 2020—next year—while the legislation relating to the Fukushima accident must be reviewed before 30 June 2019. That is what is stated in the regulations that we are importing.

I raise this point because I want to be clear with the Committee that we will be bringing over those review dates into UK legislation. It is the same point that I made when I responded to the hon. Member for Slough about standards: we are not going to drop the ball in any way on their being reviewed. It is important for those two communities and those two countries that we do that as well as that we ensure that we review the safety risk in this country.

The second statutory instrument in this bundle, the Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019, ensures that regulation 2016/52, the legislation covering the application of maximum permitted levels of radioactivity in food and feed following a nuclear emergency, continues to function effectively after exit. The first statutory instrument is about Chernobyl and Fukushima; the second looks ahead to what we hope will never happen—possible future incidents.

EU law in this area establishes maximum permitted levels of radioactive contamination in food and feed that would come into effect following a nuclear accident or any other case of radiological emergency, which could be an accident involving a medical use, a domestic power incident or, indeed, an aggressive act that led to some form of nuclear accident—although that would not be an accident. The regulation therefore acts as a framework that can be enacted promptly to apply emergency levels of radioactive contamination in food and feed to protect consumers.

If those levels were exceeded, it would have a detrimental effect on human health from the consumption of food contaminated by radioactivity. Applying the levels would assist the response to a radiological incident. Currently, the European Commission holds a range of powers under European legislation that enable it to respond in the event of such an accident or another radiological emergency. Those powers allow the Commission to put in place measures in the form of emergency implementation regulations that apply the maximum permitted levels set out in regulation 2016/52, and so prevent potentially contaminated food from getting on to the marketplace.

Let me emphasise again that there are no changes to policy in these instruments beyond making the minimal changes necessary to rectify the deficiencies in what will be retained EU legislation. I am confident in saying that consumers in the UK will benefit from high standards of food and feed safety. We are committed, as I said to the hon. Member for Slough, to maintaining those.

The instruments will transfer responsibilities from the European Commission to Ministers in England, Wales, Scotland and the devolved authority in Northern Ireland. In addition, the instruments will change references regarding import into the European Union import into the European Union to references regarding import into the United Kingdom—perfectly logical.

To be clear, the draft instruments will not introduce any changes in how food businesses are regulated or run, unlike previous SIs we have discussed in this sequence, nor will they introduce any extra burdens. The instruments provide continuity for businesses, protect consumer interests and ensure that enforcement of the regulations continue in the same way. They will ensure a robust system of control, which will underpin UK businesses’ ability to trade domestically and internationally.

It should be noted that the draft regulations will apply only following a nuclear accident or other radiological emergency, as I have mentioned. They are not intended for routine activities, which are governed through regimes such as those under the domestic Ionising Radiation Regulations 2017 or the Environmental Permitting (England and Wales) Regulations 2016, which the Health and Safety Executive owns.

It is important to note that the devolved Administrations have provided consent for the draft instruments. We have engaged positively with the DAs throughout the development of the regulations, and the engagement is warmly welcomed—as before, I place that on the record.

The regulations therefore constitute a necessary measure to ensure that our food legislation relating to food and feed safety and radiological protection continue to operate effectively after EU exit day. That is the case both for the historical Chornobyl and Fukushima regime and for the future. I urge hon. Members to support both sets of regulations.

--- Later in debate ---

[Steve Brine]

Let me start by saying that the hon. Member for Poplar and Limehouse always speaks so well. As a former firefighter, he put his comments very well, and they do not require me to add to them.

The shadow Minister, the hon. Member for Washington and Sunderland West, is right that this is an important week for the country. It is the most important week since the last most important week. The House expressed its will last night that it did not want to leave with no withdrawal agreement at the end of March or thereafter, but the House expressing its will is not enough to change the law of the land, which is why the Government said yesterday that they will bring forward measures to do that if necessary. That is why today’s motion is very clear that we will seek a short extension to deal with the necessary EU exit legislation if the House supports a withdrawal agreement before 20 March, with the Council being the next day. If it does not, there will be an extension—for how long?—on or before 20 March.

The point is that it is easy to put a tweet out or to write a headline about what did or did not happen in this place last night, but the bottom line remains unchanged: there are only two ways to stop us leaving without a withdrawal agreement. One is to revoke article 50, which I do not see any remote majority for in the House. The other is to agree a deal. Yes, we have not agreed a deal in January or this week, but just because we have not does not mean that we can’t or shouldn’t. Whether or not we agree one before 20 March, we still at some point have to agree a deal with our friends and closest trading partners in the EU. That is my position and the position of the Government. I think that is pretty clear.

I acknowledge the hon. Lady’s work in this space. I am very fortunate to be surrounded by very clever people who work tirelessly in the FSA and my Department to provide me with all this information. I know it is hard to believe that I do not have all that buried up here in my head, but the hon. Lady has to wade through it pretty much on her own, with a small amount of staff. I know that there is a lot of it, and I acknowledge that work, because the work that the Opposition do and are meant to do never gets noticed in this place. It is an important part of our constitution.

The hon. Lady’s question about levels staying the same is a good one. My point is that just because we are changing our constitutional arrangements does not mean that the science changes—the science is still the science. She asked whether the maximum permitted levels are set appropriately. They are for now. They are recommended and reviewed by the group of experts formed under article 31 of the Euratom treaty and independent scientific advisers to the European Commission. The UK radiological experts in the FSA, Food Standards Scotland and Public Health England agree that the current maximum permitted levels are within safe limits and are appropriate to provide public health protection. When the regulation was presented for consideration by the European Council, EU member states unanimously agreed that the levels were appropriate to deal with these issues. The levels will be kept under review by UK radiological experts in the FSA, FSS and PHE, as indeed they should be.

I made a point about reviewing the regulations, specifically with regards to Japan and Fukushima, because obviously that date is coming up. This is a routine annual review. I said that it will be carried over, and it jolly well should be. The European Commission started the review in January 2019, and the UK has been represented at those sessions by the FSA, in conjunction with the devolved Administrations and FSS. They are already reviewing the data and the measures in place and will continue to engage with the Commission’s review until exit day. The FSA will then assess future measures implemented by the EU and advise Ministers on appropriate controls for the UK. Any SI made would be subject to the usual parliamentary scrutiny. Until then, the current instrument, as ported over into UK law, will apply.

I reiterate the point I made last week, which I also made to the Lords EU Energy and Environment Sub-Committee last week. Just because we are leaving certain structures, that does not mean that relationships will change. The European Food Standards Authority grew out of the Food Standards Agency; it came from us, not the other way around. Those relationships are incredibly strong, and they are to our benefit, as well as the EU’s.

On Euratom, the UK equivalent and who the domestic risk manager will be, Ministers will ultimately manage the risk on advice from the FSA, and FSS north of the border. Their advice to us is always, and will always be, publicly available. We will have continuing dialogue with the Euratom authorities for the reasons I set out, including the historical reasons.

The hon. Member for Washington and Sunderland West asked how we can justify the cost to businesses. This is a similar point to one we have previously covered. The law in this area is not changing, so we consider the costs to this area to be minimal, if anything at all, as businesses are already very familiar with how the law operates. As I said earlier this week, a business starting from scratch would take longer to familiarise itself with the law, but I am not unduly concerned about that.

Finally, the hon. Member for Lanark and Hamilton East, who speaks for the Scottish National party, asked about funding. An extra £14 million last year and £16 million this year has been given to the FSA for its EU exit preparations. About 140 staff—give or take, as things move around—have been recruited, including to its expert bodies. The FSA received a £2 million grant for 2018-19 and for 2019-20 to support food activities related to EU exit pressures within local government and within the port authorities, which is important. I have rightly been asked that question quite a lot throughout this process. Their lordships are interested in this particular point, not least because some of them set up the FSA, and one is its former chairman. I believe—I ask the FSA this question and it is not shy in giving me an answer—and can assure Members that the FSA is appropriately resourced to be the lead agency in this matter. Without further ado, I rest, Mr Wilson.

Question put and agreed to.

Resolved,

That the Committee has considered the draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019.

Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Resolved,

That the Committee has considered the draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019.—(Steve Brine.)