Prostate Cancer

Steve Brine Excerpts

Wednesday 6th February 2019 Commons Chamber

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

It is always a pleasure to see you in the Chair, Madam Deputy Speaker. Here we are again and for once we are not in a rush. It will be dark outside before we finish. I congratulate my hon. Friend the Member for North Dorset (Simon Hoare) on securing today’s important debate. He entertained us and educated us, and he set out his stall very well.

Let us start with a positive: cancer survival in this country has never been better. Survival rates are at their best ever, having improved every year since 2010. That is a hard-fought success, and we should celebrate it. Among men, prostate cancer is the most common cancer in the UK and the second most common cause of cancer deaths. However, prostate cancer survival has tripled in the past 40 years, with 85% of men surviving for five or more years.

It is worth stating at the outset—some people who are watching may not be familiar with this subject—that the prostate is found only in men. It produces some of the fluid in semen and is found below the bladder. It is about the size of a walnut and surrounds the urethra, the tube that carries urine from the bladder. The causes of prostate cancer are not that well known. The strongest risk factor is age, but about 5% to 10% of prostate cancer is thought to be due to family history. Black men, whether of black African or black Caribbean origin, are more likely to develop prostate cancer than white men. One in four will get the disease, as opposed to one in eight of all men. Asian and oriental men have the lowest chance of developing prostate cancer, which is interesting—we should always look at this sort of data when looking at prevention. I will come on to that point.

The way that prostate cancer develops is not fully understood. It is not a single disease, but a spectrum of diseases ranging from slow-growing tumours that may not cause any symptoms and may not shorten life at all to very aggressive tumours that can kill. We should remember that. As I said, the strongest risk factor is age, but younger people get it, too. I have a school friend who has recently contracted and beaten—I will come on to the use of language in a moment—prostate cancer. He may even be watching today’s debate; he may be mowing the lawn, who knows? We wish him well.

My hon. Friend raised some very good points in his speech, and I should be able to touch on them all. This is a timely debate for all the reasons he set out, but also because it was World Cancer Day on Monday. It was great to see Cancer Research UK light up the Palace of Westminster in pink and blue.

My hon. Friend’s point about language was very interesting. He may have seen a poll by Macmillan that came out last month. It showed how many people with cancer are fed up with the language of war. We often say “cancer stricken” or “victim”. We often call a person’s cancer diagnosis a “war” or a “battle”. We say that they “lost their battle” or “lost their fight” when they pass away. It is no surprise that articles in the media and posts on social networks were found to be the worst offenders. My advice is to be real and honest. Macmillan has launched the “Right there with you” campaign to highlight the challenges posed by a cancer diagnosis and the support that is available. As we all know, Macmillan does fantastic work, including in this House. I urge people to take a look at its campaign.

My hon. Friend also touched on the all-party group on male cancers, formed by my hon. Friend the Member for Lewes (Maria Caulfield) who is a former nurse. It had one of its first gatherings this week. Orchid, the male cancer charity, will provide the secretariat for the group. It is not that well known as a charity, but it is growing fast. I met the charity at Britain against Cancer a couple of years ago, and it is now part of my cancer roundtable work here in the House every quarter. I pay tribute to its works and to the all-party group. I had a good conversation in the Lobby with my hon. Friend last night. We are going to do an awful lot together. The group is very important. If it did not exist, it would need to be invented, and I congratulate her on inventing it.

My hon. Friend the Member for North Dorset raised early diagnosis, so let us deal with that. The biggest weapon we have in successfully treating cancer is early diagnosis. I have said many times, as did the former chair of the all-party group on cancer, that it is the magic key or magic bullet. That is true, but there are many cancers where early diagnosis is all but impossible. We do not see presentation of symptoms until it is very late and then it becomes incredibly difficult. They will be a big challenge for the cancer ambition that I will come on to talk about in a moment.

As my hon. Friend and others said, we men are notorious for not visiting the doctor at the first sign of a concerning symptom. I think that that is changing, but anything that can raise awareness of prostate cancer, where early diagnosis is indeed the magic key, is to be welcomed. I pay tribute to public figures such as Stephen Fry and Bill Turnbull from “BBC News” for speaking out so honestly about their own prostate cancer diagnosis. They provided an invaluable public service in raising the profile and awareness of the disease, giving some men the vital nudge they need to see their GP if they think something is not right. For some men, it can be a quick burst of symptoms that come on very quickly. They can go to a doctor, are seen and treated and have surgery in a very short space of time. For others, it can be a very slow burn.

I hope that the work that Stephen Fry, Bill Turnbull and others have done will have an impact similar to 10 years ago when the TV personality Jade Goody, following her cervical cancer diagnosis from which tragically she died, spoke out about how vital it was for women to attend their smear tests. We had an excellent debate in Westminster Hall last week on Natasha’s Army—there is that word again. Natasha was a 31-year-old mother from Newton Abbott who died of cervical cancer, leaving four young children just before Christmas. Natasha’s Army are her friends and family who campaign on awareness and smear tests. That is so important. The work Jade Goody did led to a huge uptake in screening, enabling the NHS to detect and treat more cancers early. I hope that, as more people talk about prostate cancer, something similar can happen.

[Nick Smith]

I join the Minister in congratulating people like Stephen Fry and the grassroots movements on doing such a good job in talking about the importance of early diagnosis. The hon. Member for North Dorset talked about the important PSA test. The Minister may not have the figures available, but if he does could he let us know the proportion of men over 50 who have had the test? That would be an interesting indicator as to what is going on.

[Steve Brine]

I do not have that figure with me today, but I will write to Members attending the debate and I will tweet it @BrineMinister—but enough of the advert.

Early diagnosis and the NHS long-term plan is where I want to turn next. Straight after the Christmas recess, we launched the NHS long-term plan, which is a seismic piece of work. I would be the first to say, along with many other people working clinically in the field, that we cannot rely solely on the celebrity cases that I mentioned to improve early diagnosis. The long-term plan included a comprehensive package of measures that will be rolled out across the country, with the aim of securing the Prime Minister’s promise, which my hon. Friend the Member for North Dorset spoke about, from party conference back in the autumn: that three quarters of all cancers will be detected at an early stage—stage 1 and stage 2, when they are most beatable—by 2028. The plan will provide new investment in state-of-the-art technology to transform the process of diagnosis and boost research and innovation, with the aim of ensuring that 55,000 more people are surviving cancer for five years in England every year from 2028.

That ambition refers to all cancers, including prostate. When we came out with that ambition, a number of people, in the breast cancer community, for instance, said, “But what about us? We are already above 75%”, and some said, in relation to the rarer and less survivable cancers, “What about us?” It is very important for me to restate at the Dispatch Box that this ambition does refer to all cancers—not just those that afflict men or women, old or young, or that are easily treatable or more difficult and less survivable. We are clear that to achieve the five-year survival ambition, we have to improve outcomes for all cancers, and we will.

As I said, early diagnosis is key. Early diagnosis of prostate cancer is challenging, in truth, because the symptoms are similar to those of an enlarged prostate and very often, there can be no symptoms at all. As has been said, the most common method of identifying an increased risk of localised prostate cancer is the prostate specific antigen test. However, that is not perfect. The House will have seen press reports a year or so ago stating that a raised PSA level is not necessarily a sign of prostate cancer, and that a low PSA level is not necessarily a sign of it not being there either. That is not entirely helpful, but we must always remember in these debates—and I am not a doctor, as is clear—that medicine is not an exact science. I thought that story was a good example of that.

A raised PSA level can indicate prostate cancer, but in some cases it can miss indicating a cancer. It can also suggest a cancer when there is not one, or identify slow-growing tumours that may never cause any symptoms for a man or shorten his natural lifespan. This can all be very difficult in primary care. My hon. Friend talked about GPs, and there is a clue in the name. I sometimes get a lot of flak for saying this, but general practitioners are so called for a reason—they are general practitioners—and we should remember the devilish job that general practitioners have, given the huge variety in what comes through their door.

The prostate cancer risk management programme—the PCRMP; we love our acronyms in the health service—was established so that men considering a PSA test are given information about the benefits, limitations, which I have touched on, and associated risks. It supports GPs in giving and discussing information with their male patients. A pack of materials is available for primary care to help men to make an informed choice about the PSA test, which includes a leaflet that they can take away to discuss with partners. There is also an evidence booklet and summary sheet for GPs. These are all widely available online.

As I said, there are pros and cons of having a PSA test, but it is so important that men arm themselves with as much information as they can and speak to their GP or practice nurse, including when they go for their NHS health checks—I will be going for one of those at the end of this month. I know that it is hard to believe that I am old enough to be called for one, but they phoned me yesterday, so I have been booked in.

As has been said, men over 50 have the right to be given a PSA test free on the NHS once they have discussed the advantages and disadvantages with their GP. The PCRMP makes that very clear to GPs, and, having discussed the pros and cons, no one over 50 should be told “No”, as we have heard today. I will find those figures—I agree that they will be very interesting.

[Simon Hoare]

I am very grateful that the Minister is setting this out in his customary detail. In a circumstance in which all those conversations have taken place, if the patient says, “Thank you doctor, I hear what you say, but I am entitled to have this test, and I want to have this test done,” will the Minister confirm that GPs are obliged to make the referral, rather than saying, “Well, I’ve heard what you said, but I am your doctor and I am not going to let you have it done”?

[Steve Brine]

We do not often use the term, “No decision about me, without me” any more, but I always remember the former Health Secretary—now Lord Lansley—using that a lot, and that is still very true. A patient over that age has every right to request a PSA test, and certainly even more so if they believe that they have symptoms. I would be very concerned about a GP refusing it—I think it would be extremely unlikely for one to do so in such instances—but any patient has the right of travel. Every patient has the right to change GP if they are not satisfied with the relationship that they have. If my hon. Friend did know of an instance of that, I would be very interested to hear about it—as, I suspect, would the Royal College of General Practitioners —but I would be very surprised.

I want to touch on screening, which we talk about a lot at the moment, and I will come on to why. Because of the limitations of the PSA test, there is currently no national screening programme for prostate cancer. In 2016, Prostate Cancer UK, which has been rightly lauded this afternoon, began work to help to develop tests that could form part of a national screening programme. This would potentially involve better blood tests, which are currently in development, combined with more advanced scanning. It is hoping to make that happen in the next five years—nothing happens quickly in this space unfortunately—and I am sure that we all welcome their efforts.

Members will be aware—I have spoken about this quite a lot in the House recently; we have had a number of cancer debates since Christmas—that Sir Mike Richards is leading a review for the Secretary of State of our current screening programmes. As part of that—I met Sir Mike last month—we will consider how we can make screening smarter, targeting those most at risk. We expect that Sir Mike’s work will have positive implications for future programmes. He is an incredibly experienced and respected figure in this space, and I hope that his work will enable us to roll screening out faster when the evidence base is there to support it. I am very hopeful and ambitious about that work, as I know Sir Mike is.

Let us talk about public awareness campaigns, which my hon. Friend mentioned in opening the debate. The Government have to do all that they can to raise awareness of prostate cancer and target high-risk groups, while recognising that there are limitations on how much the public will listen to public health messages from Ministers at the Dispatch Box—I know that it is hard to believe that people do not take this all to heart, but they do not, so we work with our partners.

In 2014, along with Public Health England, we worked on the phenomenally successful “Be Clear on Cancer” campaign, which has had a number of iterations, on prostate cancer in black men. The campaign messaging included:

“1 in 4 black men will get prostate cancer”,

which was one of its tag lines. It urged black men over 45 who were concerned about their risk of prostate cancer to visit their GPs. The campaign evaluation showed that it had stimulated new conversations about prostate cancer among families and the black community. Public Health England has made all the materials developed for the campaign available online, so that groups and other organisations can use them locally if they wish. They are very striking and powerful, and we believe that they were very successful.

We also welcome the work that Prostate Cancer UK is doing with the Football Association to raise awareness through their “relegate prostate cancer” campaign. It is fronted by high-profile celebrity football figures, including the England football manager, Gareth Southgate, and includes the slogan:

“One man dies every 45 minutes of prostate cancer”.

Anyone who can stay awake for “Match of the Day” on a Saturday night—thank goodness for the repeat on a Sunday morning—will see very many people, including the pundits and the managers interviewed afterwards, wearing the badge that I am wearing today. Members will be very familiar with that badge, which demonstrates the widespread support that Prostate Cancer UK has in continuing to raise awareness of this disease.

Let me turn to research, as I come to a conclusion. Research has played a crucial part in the advances that we have made in cancer survival over the past four decades. More than 15 years ago, the Department identified the need for further research into prostate cancer, and we have since worked closely with Cancer Research UK—it was here this morning; I was pleased to pop into its drop-in—Prostate Cancer UK, the Medical Research Council and others, through the National Cancer Research Institute, which is a strategic partnership of the major UK funders of cancer research. NCRI spend specifically on prostate cancer research increased from £17.1 million in 2011-12 to £26.5 million in 2015-16.

[Mary Glindon]

On research, does the Minister think that those who are diagnosed with cancer should be encouraged to take part in clinical trials that aid research and help us to find ways to halt or even cure these horrendous diseases? I think this is underplayed and that we should encourage as many people as possible to help with research by themselves getting involved in trials.

[Steve Brine]

I am happy to agree with the hon. Lady. In her work on brain cancer, the late Baroness Jowell made the point about stimulating new research projects, and that work has been incredibly successful, including subsequent to her death. She also spoke a lot about clinical trials. Anybody diagnosed with a cancer for which there is no significant treatment would want to load the gun with the trial bullet, but there are challenges there. There is only so much that one can do, and there is a toxicity issue with moving from trial to trial that patients do not always fully appreciate, but in consultation with one’s oncologist and physician absolutely it has a critical role to play. Without trials, we would not have any of the treatments we have today, so I thank the hon. Lady for raising that point.

My hon. Friend the Member for North Dorset said that women’s cancers, such as breast cancer and the gynaecological cancers, perhaps get more Government attention. I have to disagree. Last April, the Prime Minister pledged £75 million towards clinical trials for prostate cancer, which will focus on improving early diagnosis and survival rates as well as exploring options for different treatments for men affected by the disease. We expect 40,000 men to be recruited to new research projects with this cash boost. I hope this demonstrates our ongoing commitment to male cancers as well as female cancers.

I am the first guy to hold the post of Public Health Minister in a long time, possibly ever, and it is true that there is a lot of focus on female cancers, but I am determined to raise the bar for men’s health generally, but for male cancers in particular, which is why I was pleased to mention the all-party group earlier.

Alongside the £75 million for research, in 2016-17 the NIHR clinical research network recruited patients to over 90 trials—the hon. Member for North Tyneside (Mary Glindon) raised the point about trials—and other studies on prostate cancer, so there are a lot of trials in this area. The NIHR biomedical research centre at The Royal Marsden here in London and the Institute of Cancer Research also have a five-year £3.1 million prostate cancer research theme.

I started by saying that we do not know everything about prostate cancer. We hope to see these projects deliver more personalised diagnosis, treatment and care of men with prostate cancer through better understanding of the molecular and genetic pathways that determine the non-uniform nature of prostate cancer. The prostate testing for cancer and treatment—ProtecT—trial was the largest publicly funded clinical trial ever to take place in the UK. NIHR funding to date is £40million, which is quite a significant sum.

I agree with what my hon. Friend said about the workforce. The NHS is nothing without the 1.3 million staff on whom patients depend day and night, and for no group is that more true than for cancer patients. We will not achieve our cancer ambitions without an increased cancer workforce, which is why the Secretary of State has commissioned Baroness Dido Harding, working closely with Sir David Behan, who used to lead the Care Quality Commission, to lead a number of programmes to engage with key NHS stakeholders to develop a detailed workforce implementation plan. Baroness Harding and Sir David will present initial recommendations to the Department in March, and these will consider detailed proposals for growing the workforce rapidly alongside the implementation of the NHS long-term plan, including that early diagnosis of cancer target I mentioned.

In connection with that, my hon. Friend mentioned cancer nurse specialists. Health Education England is working to expand the number of cancer nurse specialists and to develop their competencies and routes into training. This will mean every cancer patient having access to a CNS or other support worker by 2021, which I think he will agree is a very good thing.

I have covered today just some of the many initiatives the Government are undertaking in our significant efforts to tackle prostate cancer for many of our constituents, including my friend. I hope I have given the House some information today and a promise of some more. The Government remain totally committed to maintaining and improving cancer survival rates. Prostate cancer is the second-biggest cancer killer among men and is right at the top of our list of priorities.

Finally, I could not close without paying tribute to Prostate Cancer UK, led by Angela Culhane, and the work it does on research and early diagnosis and in supporting men with prostate cancer and reassuring them that they are not alone and that there is often a way out. As cancer Minister, I have been told many times by cancer patients that the cliff edge of an all clear is every bit as bad as the original diagnosis. Owing to our successes, people are living much longer and perfectly normal and full lives after cancer, but we need to support them better, so I pay tribute to the work of Prostate Cancer UK. Its work is invaluable, as is that of all those members of staff who make the NHS what it is. I thank everybody for taking part in today’s debate.

Question put and agreed to.

Orkambi

Steve Brine Excerpts

Monday 4th February 2019 Commons Chamber

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

It is a pleasure to see you in the Chair for the Adjournment debate, Mr Speaker. My hon. Friend the Member for North Herefordshire (Bill Wiggin) and all Members who have contributed to the debate, some of whom I recognise from previous debates, have spoken on behalf of constituents from the heart as usual, regardless of political persuasion, with one voice. That is good to hear. I had a school here this morning, and the students asked me what the biggest misconception about this place is. I said that we get on far more than we do not, even at the moment. If they tune in this evening, they might see that happen. Adjournment debates are always a good example of that, in my experience—and as Public Health Minister, I have significant experience of the Adjournment debate, as does my poor Parliamentary Private Secretary.

Everyone has been speaking without political bias and with one voice, and that voice wants patients to benefit from effective treatments for cystic fibrosis. So do I, and the Government wholeheartedly share that view. We have urged Vertex to accept the fair offer that NHS England has made to the company, which would guarantee immediate access for NHS patients to all Vertex’s cystic fibrosis treatments. I hope that the pleas we have heard from my hon. Friend and other Members once again this evening will go some way to persuade Vertex—I agree that it will be listening intently—to consider NHS England’s fair and best offer.

[Mr Ivan Lewis (Bury South) (Ind)]

rose—

[Ian Austin (Dudley North) (Lab)]

rose—

[Steve Brine]

I will give way once—and that is it—to the hon. Gentleman who rose first.

[Mr Lewis]

I thank the Minister for giving way, and I congratulate the hon. Member for North Herefordshire (Bill Wiggin) on securing this Adjournment debate. We have been debating this in this place for months, and the fact is that our constituents and patients still do not have access to Orkambi. May I say to the Minister that it is time that Ministers themselves took over these negotiations and responsibility for sitting face to face with and eyeballing the company so that our constituents get the justice they deserve? These negotiations between NHS England and the drug company have got us nowhere, despite the efforts of right hon. and hon. Members in this House. Will Ministers now directly get their hands dirty, roll up their sleeves, participate in these negotiations and bring this matter to a conclusion on behalf of our constituents?

[Steve Brine]

Okay, the hon. Gentleman has got his press release with his intervention. Perhaps I should go back on what I said at the start. All he has done is to take away time, on what is a very complex issue, from my trying to set out a response to my hon. Friend’s Adjournment debate.

My hon. Friend has called on the Government to consider making use of the legal provision in UK patent law of Crown use licensing to break, as he rightly puts it, the current “deadlock”. As the hon. Member for Bury South (Mr Lewis) said, in a reasonable part of his intervention, it is a deadlock and it has been going on for some time. I commend my hon. Friend’s efforts in raising this. Indeed, it is right that we consider every possibility. Every effort must be made to ensure that effective medicines are made widely available to cystic fibrosis patients. There is no doubt and no debate about that.

I can assure my hon. Friend that we, too, have considered this option. Indeed, I have received initial advice on Crown use licensing. While the use of these mechanisms is not our preference, we are looking at all options. Crown use licensing is complicated, and it would not represent a quick solution to ensuring patient access to Orkambi. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) mentioned that in her intervention and, sadly, she is right.

The UK is one of a limited number of countries that actively protects the role of intellectual property in medicines development in international forums. We believe, however, that there is a balance to be struck between providing incentives to create and commercialise new medicines and ensuring that they remain affordable to the taxpayer—our constituents.

The 2019 voluntary scheme for branded medicines pricing and access, alongside the statutory scheme for branded medicines, are two mechanisms that are in place for ensuring branded medicines are affordable to the NHS. The 2019 scheme provides for flexible commercial arrangements between companies and NHS England—in other words, the customer in this scenario.

In theory, Crown use licensing could be utilised with respect to Orkambi. However, in the past Crown use has only really been intended or designed to deal with emergencies, where a particular patented product is not available in the UK at all. Crown use has not historically been intended to circumvent commercial agreements or to create a mechanism for the production of medicines at a lower price.

The relevant legislation on Crown use states that compensation would need to be provided to the original patent holder—in this case, Vertex, and that would stick in the throat of many of us—which would need to take into account any loss of profit from not being awarded a contract to supply the patented medicine. Unless an agreement could be reached with Vertex, it would be for a court to decide on an amount in this instance. This would of course need to be paid from the public purse. If a Crown use licence were issued, then there would be a subsequent, critical question about how the medicine would be produced and authorised as the usual licensing requirements would apply, with approval required by the Medicines and Healthcare Products Regulatory Agency.

Vertex has protections in the form of both data and marketing exclusivity for Orkambi, and it will continue to have these for a number of years. As such, unless another manufacturer conducted its own clinical trials, there are no realistic alternatives at this time to produce it and the NHS does not hold such a capacity. Using this route, it could take several—many—years before the drug was available on the market, and it would, in all likelihood, be very expensive for another manufacturer. The total length of time and cost of manufacturing and licensing—plus the compensation to the patent holder and a potential appeals process through the courts, which seems inevitable everywhere we turn these days—could be potentially significant.

We also do not know what impact Crown use would have on the other medicines that Vertex supplies to the NHS or the pipeline of products that it is developing. We should remember—and my hon. Friend reminded us of this in his opening speech—that around 50% of people with CF would benefit from Orkambi; in other words, 50% would not.

Crown use could have the effect of putting patients at a disadvantage, jeopardising access to future medicines and potentially setting a precedent of issuing further licences at very high cost.

[Ian Austin]

Will the Minister give way?

[Steve Brine]

Just because I cannot resist the hon. Gentleman, I will give way to him.

[Ian Austin]

I am grateful to the Minister for giving way. He is setting out all the arguments against Crown use licensing. I agree with the point that he has made in the past—that Vertex needs to show flexibility on this—but I think we all think that the Government also need to show flexibility and to think carefully about whether the NICE guidelines work when evaluating these new, precision medicines. What we would all like to hear from him tonight is what he proposes to do, and what the Government are going to do, to break this deadlock and bring these negotiations to a conclusion.

[Steve Brine]

In response to the hon. Gentleman and to one of the other interventions about compromise and meeting in the middle—there is lots of talk about compromise at the moment—I suggest that the £500 million offer is a pretty good first step from the Government. I suggest that that is a pretty good attempt to meet in the middle. That is our constituents’ money.

[Mr Hepburn]

Will the Minister give way?

[Steve Brine]

I will not.

The hon. Member for Dudley North (Ian Austin) talked about breaking the impasse and breaking the deadlock. I said in response to the point from my hon. Friend about Crown use that I have not closed the door on it tonight. I am not trying to put obstacles in the way. I have been asked a question at the Dispatch Box about the practical realities of making this policy move, and I am setting out for the House’s benefit—on the record for everybody listening and for Members—the practicalities.

My hon. Friend talked about use of similar mechanisms by other countries. It is always interesting to understand what other countries are doing and what they are considering and implementing in their health services—there is much that we can learn from each other. However, I cannot comment on the circumstances that would prompt another country to take these steps; other countries have different health systems, and they do not have NICE. We have said—the hon. Member for Dudley North touched on this in his intervention—that we are looking to review the NICE processes, but we should also remember that NICE is respected around the world. If we did not have NICE, we would probably have to invent NICE—that is the truth for Ministers in this Government, as it would have been for Ministers in the previous Government.

I understand the sense of frustration in this Chamber.

[Mr Hepburn]

Will the Minister give way?

[Steve Brine]

I said I would not.

I think the House gets a minuscule sense of my frustration about the situation. I want this sorted. I have constituents who contact me about this too. I am sure the key question we are all thinking about is, where does this leave us now? I suppose that is the point of the intervention that the hon. Member for Dudley North made. I just want to be clear that we are still taking a very close interest in this matter.

The reason I responded so robustly to the earlier intervention about Ministers getting their hands dirty is that I do not think that is particularly helpful. Ministers are not the customer here; NHS England is the customer, Vertex is the seller and NICE is involved. Ultimately, we have made a very, very generous offer to this company, and I think that it should look again, and look long and hard, at its moral obligations as much as anything else, as somebody mentioned in their intervention.

Of course I recognise the impact that these protracted discussions are having on the daughter of my hon. Friend’s constituent. I heard the lady on the “Today” programme this morning on Radio 4, and it breaks our hearts to hear these stories. Of course we want this sorted. For many of the patients who suffer from this debilitating disease, including constituents of my own, it is extremely disappointing that Vertex rejected the final offer made by NHS England, as well as rejecting the opportunity for NICE to appraise its new medicines.

I have talked about the £500 million over five years; it is the largest ever commitment of this kind in the 70-year history of the NHS—it is not insignificant. It is a huge sum of money and of course NHS England must also fund other drugs for other distressing diseases. My hon. Friend made reference to that. I do not often get asked to come and answer Adjournment debates about spending less on precision drugs for other conditions. There are many, many other drugs that demand our funds. Vertex must re-engage with the NICE appraisal process. We understand the frustration of the CF community. However, it has been made crystal clear to Vertex that its drugs need to be priced responsibly and that any reassessment of Orkambi’s effectiveness must be carried out by NICE’s established process.

The position of Vertex is unreasonable. It is unacceptable to us, to patients and to our constituents. I know that other countries also worry for their patients because of Vertex’s unfair pricing of this drug, so let me put on record once again that Vertex should and must take up the very generous offer that NHS England has made. That offer will improve the lives of eligible cystic fibrosis patients and their families. For all the reasons I have set out, it is far and away the quickest and simplest way to resolve this matter.

Question put and agreed to.

Negotiations for Primary Care Contract for GPs 2019-20

Steve Brine Excerpts

Thursday 31st January 2019 Written Statements

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

I am today updating the House on the outcome of the negotiations on the primary care contract for GPs between the General Practitioners Committee of the British Medical Association and NHS England.

For the first time a new five-year contract has been agreed for general practice across England which includes billions of extra investment for improved access to general practice.

The contract for 2019-20 will deliver the most ambitious reform in general practice in a generation and is the first major step forward in delivering The NHS long term plan. It aims to bring 20,000 extra staff into general practice by 2023-24 including pharmacists and social prescribing link workers. This will free up GPs to spend more time with patients who need them most.

It will establish new primary care networks across the country to ensure the NHS is fit for the future for patients, their families and staff. This is part of a record investment in primary medical and community services, which is set to increase by over £4.5 billion by 2023-24, and rise as a share of the overall NHS budget.

The contract will also protect the general practice workforce against rising indemnity costs by introducing a new and centrally-funded clinical negligence scheme for general practice from April 2019. The Department also intends to establish the arrangements for an existing liabilities scheme in April 2019, subject to satisfactory discussions with the medical defence organisations.

Other key elements of the contract include:

a record £8.9 billion in funding in 2019-20,

a 4% funding increase each year for the next five years,

a review of GP access to address unwarranted variation in patients being able to book an appointment with their GPs,

all patients able to access their records digitally by April 2020 and have the option of web/video consultations by April 2021,

more joined up services as 111 will be able to directly book GP appointments for callers,

greater transparency as GPs earning over £150,000 per annum will need to declare their earnings, and

streamlining of the quality and outcomes framework system with more clinically appropriate indicators to deliver focused improvements in the quality of care.

We understand that NHS England will apply the provision to personal medical services and alternative provider medical services where appropriate.

[HCWS1287]

World Cancer Day

Steve Brine Excerpts

Wednesday 30th January 2019 Westminster Hall

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

As ever, time is short, so I cannot answer everyone’s questions, but that is the nature of Westminster Hall. It is nice to see you in the Chair, Sir Christopher.

It is an honour, as always, as the Cancer Minister, to respond to these debates. As the shadow Minister said, we have been here before many times. The three Front Benchers are consistent and other hon. Members move around us. This time I congratulate my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) on securing the debate and on lighting up Parliament pink next Monday. It will be my wife’s birthday, so she will enjoy that. I look forward to seeing my hon. Friend for the event on the Terrace.

The title of the debate, World Cancer Day, suggests two things to me—the fact that cancer is recognised as important enough to have its own world day, and the fact that it transcends every international border and, tragically, affects everybody, regardless of their standing, their age and the wealth they accumulate. It touches everybody, including those of us here in the Chamber. I offer my condolences to the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) and his family. I hope that tomorrow goes well, and I am sure they will honour his late brother-in-law. I wish the hon. Gentleman well.

The hon. Member for Lincoln (Karen Lee) always speaks with great passion in cancer debates. She is another one of the consistencies in such debates—it is always nice to see her. She talked about the screening review. She was not here on Monday, when we had a very big debate on cervical cancer. There was a Petitions Committee debate initiated by a young lady who died of cervical cancer at the age of 31, leaving four very young children. It was a heartbreaking story, and all her friends were in the Gallery. There was obviously a lot of talk about cervical cancer and the screening age for it. As I said in that debate, Sir Mike Richards is doing a big piece of work for the Department on screening programmes, including for cervical and breast cancer. I am optimistic about what the review will bring, and I know the hon. Lady will take great interest in that report.

The hon. Lady mentioned the national cancer patient experience survey. As she knows, I agree that it is very important, because we need to know what patients are saying. She will therefore be pleased that I decided to give that a permanent opt-out from the new Data Guardian rules, to ensure that that can continue and that the data can be good. She also mentioned technology and Skype interactions, and I know that she will be pleased that technology is one of the three priorities of the new Secretary of State, and that it is at the centre of the long-term plan. She is right to say that words should be followed by action—indeed, that is why the 10-year plan for the NHS has been produced and there will be £20.5 billion a year of extra investment for the NHS in England.

As always, the hon. Member for Central Ayrshire (Dr Whitford) spoke from great experience and raised many good points, which I shall not repeat. She is right to say that smoking is still the biggest preventable killer in our United Kingdom. We must and will do better, and we have a very ambitious tobacco control plan in England. We had an interesting ten-minute rule Bill in the House yesterday on smoking in NHS properties in England, which provoked an interesting debate. The Bill was promoted by the hon. Member for Batley and Spen (Tracy Brabin).

The hon. Member for Central Ayrshire asked about bowel cancer screening at 50. I cannot give a firm commitment on timescales for lowering the age to 50, but the NHS long-term plan makes it clear that we are committed to doing so as soon as practically possible, which is the key phrase—it has to be practically possible. NHS England and Public Health England, for which I am responsible, are working hard on that. They know I am on their case about it, and I hope to be able to confirm a start date very shortly. I am following it incredibly closely and will say more as soon as I can—I know that she will be watching like a hawk.

The hon. Member for High Peak (Ruth George) and my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), talked about the workforce. As I have said many times, the NHS is nothing without the 1.3 million staff who patients depend on day in, day out. With the right workforce in place, we can deliver the long-term plan. In December 2017, Health Education England published the first ever cancer workforce plan, in which we set out our ambitious plans to expand the capacity and skills of the NHS cancer workforce. That was a welcome first step, and the Secretary of State has now commissioned Baroness Dido Harding—she is working closely with Sir David Behan, formerly of the Care Quality Commission—to lead a number of programmes to engage with the key NHS interests and develop a detailed workforce implementation plan. In March they will present initial recommendations to the Department and Secretary of State, who will then consider the detailed proposals to grow the workforce rapidly as we move towards the big spending review.

The sponsor of the debate, my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk, raised many great points. He asked about the health boards that they have north of the border, and about those boards’ collaboration with the 19 cancer alliances that we have in England. My cancer alliance is down in Wessex—I should not think that they have an awful lot of interaction. He raises a good point, and I am always up for more collaboration—the hon. Member for Strangford (Jim Shannon) often raises that subject with me, certainly in the absence of an Executive at Stormont. He knows that the offer is always there. In answer to my hon. Friend’s question on health boards, to be honest, there is not much interaction between them and the cancer alliances at that level, but I would say there is significant collaboration at the clinical level, particularly on research. The original bowel cancer screening trial was based at sites in England and Scotland. Indeed, the chair of the UK National Screening Committee, Professor Bob Steele, is based at the University of Dundee. There was therefore a lot of clinical interaction, but maybe not enough practical interaction. I am happy to explore ways to make that happen.

The hon. Gentleman mentioned research, and I think that our record is clear: we are, and want to remain, a world leader in cancer research. That is made clear in the long-term plan. The National Institute for Health Research spent £137 million on cancer research in 2016-17, and the largest research investment in a disease area was in cancer.

The hon. Member for Rutherglen and Hamilton West (Ged Killen), who is no longer in his place, made the point about the late Baroness Jowell and her work on brain tumours. Her great legacy there is to stimulate the research community to come forward with decent research proposals that we can back. We heard the same in last week’s debate on the treatment of ME: it is not for Ministers in the Department of Health and Social Care to decide what research projects will and will not happen. The projects have to come from the research community, and they have to be good to be backed by the NIHR. That is the same for cancer as it is for every area.

How much of the extra NHS funding will be used to tackle cancer? The funding breakdown for the long-term plan is still being finalised, but the plan has significant ambition for England around the 75% stage 1 to early diagnosis standard. I am very proud of that. We have already put £600 million into the 19 cancer alliances in England, and there will be more. They are very much our delivery mechanism and, as I said, I would be very keen to see any interaction between those two across the border—especially on behalf of those who represent seats close to the border.

Many other points were made—those around PIP and DLA were well made—and I know that CLIC met the Minister for Disabled People, my hon. Friend the Member for Truro and Falmouth (Sarah Newton). She, too, will take notice of all the points made in the debate.

I wish to give my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk 60 seconds to sum up, so I will conclude. We have made great strides in cancer in the past 20 years, and we have the best survival rate ever. On research, diagnostics, treatment and, ultimately, survival rates, however, there is so much more to do. Anyone who knows me or listens to me when I respond to such debates knows that I certainly do not lack ambition in this area, nor is there an ounce of complacency in me.

Cervical Cancer Smear Tests

Steve Brine Excerpts

Monday 28th January 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Roger—I shall refer to you again in a moment. I feel somewhat outnumbered, along with the hon. Member for City of Chester (Christian Matheson) and my hon. Friend the Member for Henley (John Howell), but I am rather used to that, having chaired the all-party parliamentary group on breast cancer for five years with the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson). We were often referred to as “Steve and the girls”.

I completely endorse the point by the hon. Member for Lanark and Hamilton East (Angela Crawley) that this is not a women’s issue. Natasha, whom I will come to in a moment, had four children—two of each. It is very much a boys’ issue for them, as it is across the board. [Interruption.] We may have heard the B-word only once during the debate, but I could have sworn I just heard something from outside. I must be imagining things.

It has been a privilege to be part of this debate. It is only right that I start by expressing my sincerest condolences to the family and friends of Natasha Sale, who tragically passed away in December. I know I speak on behalf of all Members present when I say that our thoughts are with her family and friends. Anybody who has lost a loved one to cancer knows the pain and anguish that the family are experiencing due to Natasha’s loss. As somebody who has fought and lost more than I have won, I am one of those people. In some of the coverage of Natasha’s death, I saw a quote from Amanda Scott, her best friend, who said:

“God only takes the best”.

I thought that was a lovely quote. We have heard that many times before, but I was interested in how that was reported.

As the Minister responsible for public health and cancer, cancer prevention and early diagnosis are vital priorities for me. I am delighted to see Natasha’s army here today. I saw the pictures on the bus on social media this morning, with some interesting hand signals—I must ask them about that. It is very good to see them all here. I hope they know, as Members know, that I will continue wholeheartedly to support the efforts of the NHS and Public Health England, which I hold to account, and of all our excellent cancer charities, which work as part of team cancer to prevent cancer and reduce the number of families who have to go through what Natasha’s family is going through.

There have been so many interesting speeches. Luckily, for once I have time to touch on a number of them, if not all of them. I was very interested in the point made by the hon. Member for Darlington (Jenny Chapman) about the data showing that take-up is better in the north-east than almost anywhere else. I was interested in what she had to say about the reasons behind that. The NHS as a system too infrequently talks to Members of Parliament, who know their areas better than most. I will ask Sir Mike Richards to contact her, perhaps along with the hon. Member for City of Chester, who is obviously still waiting for an introduction. I am very happy to facilitate that. Her other point was about access, which many Members mentioned. I will ensure that her very good point about disabled women is fed into Sir Mike Richards’s review, and I encourage her to raise that with him when she sees him.

[Ian Austin in the Chair]

I will come to the hon. Member for Warrington North (Helen Jones), who introduced the debate on behalf of the Petitions Committee, because many of the points she raised will come up in my speech. I was pleased that my hon. Friend the Member for Henley talked about the “Be Clear on Cancer” campaign and the new Public Health England campaign that will be rolled out next month. He mentioned the role of GPs in those campaigns. “Be Clear on Cancer” is a public-facing campaign, but elements of it relate to GP education, which I will come to. He often makes very good points in our debates, and I thank him for raising that topic. The hon. Member for Rotherham (Sarah Champion) also mentioned GP understanding, which I will touch on.

The hon. Member for Livingston (Hannah Bardell) made a very personal speech. She said she is awaiting results, and I think I speak for everyone when I say we wish her well. We will be thinking of her, and our fingers are crossed for her. She made a point about the trans community, which I had not heard mentioned in this context. NHS England has published clear guidance for trans men—people who have changed from female to male. Trans men who still have a cervix and have not had a hysterectomy remain entitled to screening. If a trans man is still registered with their GP as a female, they will continue to receive invitations for screening. If they are registered as a male, they remain eligible for screening but will not automatically be invited. The guidance makes clear that trans men need to request screening from their GP. I thank her for raising that point, which is another that I want to feed into Sir Mike’s screening review.

The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) made a brilliant speech, as always. She should be on the stage. The rather unconventional advice surgery she talked about may not catch on, but I enjoyed hearing about it. We constituency MPs all dread somebody saying, “I’m sure I know you from somewhere.” She talked about education, particularly in schools. Public Health England has a range of materials aimed at providing teenagers and their parents with information about things such as the HPV vaccination programme. She will know that the Department for Education is also working on new relationships and sex education guidance. Its consultation closed in November. That guidance, which will include input from Health Education England, will be published in the first half of this year.

I took the Teenage Cancer Trust and CoppaFeel!—a breast cancer charity with possibly the best name of any cancer charity—to see my right hon. Friend the Minister for School Standards at the end of last year. We were very keen to make the point to them that we must improve awareness in schools of health, bodies and particularly cancers, but in a balanced way that educates children about warning signs without frightening the life out of them. I think we have struck that balance, and I think Members will be pleased when they see that guidance rolled out in the first half of 2019.

[Helen Jones]

Will the Minister tell us whether that guidance includes educating young girls about the need to go for smear tests? Some of Natasha’s friends have forcefully made the point to me that if we do that, it may encourage girls to go for smear tests when they reach the age for screening.

[Steve Brine]

I cannot tell the hon. Lady that, but I will find out and write to her and other Members who in the debate. It is not my policy area—obviously I am not the Minister of State for School Standards—but it is a good point and it would seem logical that that is done in consultation with the Department of Health and Social Care and with Health Education England.

To go to the heart of where I want to start, the hon. Member for City of Chester talked about a constituent being refused a smear test. He said that it would be simple for a Minister to change the regulations and said that this was an example of the system not doing what we direct it to do. As the shadow Minster said, the system should already do that. It would not be appropriate to go into individual instances, but it is important to understand that cervical screening is a screening test and not a diagnostic test. It aims to detect abnormalities of the cervix that if left undetected may develop into cancer, so it is preventative. Cervical screening is not appropriate for women with symptoms, but if women of any age, including under-25s, have unusual symptoms or abnormal bleeding, they should consult their GP immediately and they should be treated under the NHS and initially offered a speculum examination in accordance with the National Institute for Health and Care Excellence guidance for primary care. If that is not happening and if that were one of my constituents, I would be taking that up through the procedures that the hon. Gentleman will know about as an experienced constituency MP. I think that is clear.

The hon. Gentleman also touched on the petition. To be clear, the petition is entitled:

“Lower the age for smear tests from 25 to 18 to prevent cervical cancer.”

He is right to raise the point about women requesting that. We do not often hear about “Liberating the NHS: No decision about me, without me” in the House these days, but it is still very much alive. I would encourage him to take that case up, as I would encourage any other Member who runs into that issue to do.

[Liz McInnes (Heywood and Middleton) (Lab)]

Will the Minister address the issue of self-screening kits for HPV in his remarks? I am sure he will go on to talk about them. My interest is at the other end of the spectrum, with women aged over 64, but it is pertinent to young women, aged 18 to 25, as well.

--- Later in debate ---

[Steve Brine]

Indeed. If the hon. Lady is not satisfied with what I say now, then please come back and we will make sure that she gets more information after the debate. Self-testing for HPV is an emerging area of medicine. It is not in the same place as the fecal immunochemical test for bowel cancer, but it is an emerging and exciting area of policy. I echo all the positive words that have been said about Jo’s Trust, Jo herself and Rob Music, who runs that charity.

Members will be aware that the NHS offers cervical screening to all eligible women aged 25 to 49 every three years and to those aged 50 to 64 every five years. The screening is designed to detect abnormalities of the cervix at an early stage so that women can be referred for effective treatment. It is important to remember that the purpose of population screening is to reduce mortality and morbidity from cancer and other conditions—that is why we do it—in people who appear healthy and have no symptoms, by detecting conditions at an earlier, more treatable stage. Hence prevention is better than cure.

The purpose of any screening service is to maximise the chances of healthier outcomes and, by association, minimise risk of harm to the whole population. With this in mind, the UK National Screening Committee considers the evidence on whether population level screening should be offered and makes recommendations to Ministers. It is not Ministers who make this stuff up, and nor should we. Using research evidence such as pilot programmes and economic evaluation, the NSC assesses the evidence for programmes against a set of internationally recognised criteria. It is important that these recommendations are made by experts based on the best available evidence, and not by politicians.

On this basis, in 2012 the UK NSC recommended that women should be invited for their first cervical screening at the age of 25. This recommendation was based on evidence that showed that the majority of women below this age would receive little benefit from being screened and treated, which can lead to unnecessary treatment, as we have heard from hon. Members. It is very rare that cervical cancer occurs in women under 25 —as the shadow Minister said, there are fewer than three cases per 100,000 women. That is no consolation to someone who, like Natasha, is one of those three who pays the ultimate cost. I am only setting out the facts as they are.

Younger women often undergo natural and harmless changes in the cervix—it is part of their physiology—and screening could identify those as cervical abnormalities. In most cases the abnormalities resolve themselves without any need for intervention. The recommendation picked up by the NSC in 2012 concurred with a major review by the Advisory Committee on Cervical Screening undertaken in 2009, so the advice goes quite a long way back. The hon. Member for Warrington North asked me whether the NSC would publish its evidence on the decision to screen from the age of 25. The NSC publishes minutes of all its meetings and the full rationale behind any recommendations. However, I will ask Public Health England and the UK NSC to publish any relevant evidence used by the NSC in reaching its conclusions and on which they based their recommendations that is not already in the public domain, which I hope she will be pleased to hear.

I will talk about HPV primary screening. Every life is precious and we cannot be complacent in continuing to do all we can to prevent cancer—those who know me know that I am not complacent. Therefore, we are modernising the cervical cancer screening programme by introducing the detection of human papillomavirus as the primary test in the NHS cervical screening programme. I can confirm that this will be implemented across England by 2020. Cancer Research UK estimates that, when fully implemented, HPV primary screening could prevent an additional 600 cases of cancer every year. As we have heard, almost all cervical cancers are caused by HPV, which is a very common sexually transmitted infection which is linked to the development of the disease.

In addition to changing the primary test in the cervical screening programme itself, I want to highlight that vaccination against HPV, introduced in 2008 under the previous Government, is now routinely recommended for all girls aged 12 to 13. In England and Wales the first dose is offered in school year 8. The programme aims to prevent cervical cancer related to HPV infection and the best way to do that is to vaccinate girls and young women. We are fortunate to have achieved good uptake of the HPV vaccination in adolescent girls since 2008.

The first cohort of teenage girls to receive the HPV vaccination in year 8—those born in September 1996—will turn 23 this year and become eligible for routine screening in two years’ time. It will be of intense interest to all of us to see what impact the vaccination will have on the number of abnormalities detected through routine cervical screening and we will be monitoring this very carefully. I will be watching it like a hawk, as Members would expect. We have already seen that the vaccine has led to a reduction in HPV infection in young women and we anticipate a fall in the numbers diagnosed with cervical cancer at the age of 23 to 24 this year.

Boys have received a level of protection from the girls’ vaccination programme over the last 10 years and we have had debates in the House about that. I referred to the previous Chair, my right hon. Friend the Member for North Thanet (Sir Roger Gale), because he led a debate in the House about HPV vaccination for boys and there was a lot of debate about it. A lot of people said that the boys get herd immunity and therefore they do not need the vaccination programme. Again, I am led by the evidence and the advice that I am given, but my personal view was that I did not agree with the herd immunity argument. I was pleased that I agreed with the advice and from September 2019, all boys aged 12 and 13 will also be offered the HPV vaccination against HPV-related diseases, such as oral, throat, penile and anal cancer. I know the hon. Member for Rotherham wanted to hear about that. That will help reduce the incidence of HPV infection circulating in the population.

It is worth saying that, although HPV infection is the primary cause of cervical cancer, many other cancers, such as head and neck cancer, will be seen a long way down the line. Without wishing to be indelicate, I am told that the popularity of oral sex means that HPV vaccination will have a big impact on the incidence of oral cancers. As the dental Minister, I often hear from dentists that that is a growing problem, so I am pleased that we are able to make a positive policy response, which has been well received.

As the hon. Members for Warrington North and for Rotherham said, there are plenty of people who disagree with HPV vaccination. Whenever I speak on the subject— I can feel the tweets landing in my inbox as we speak—I open myself up to the responses of those who vehemently disagree. All I can say is that I think they are wrong and that that is what the evidence suggests. This is a free society and they are of course entitled to that opinion, but we base policy decisions on the evidence. That is where we are. What I have said about the HPV vaccination for girls, and now boys, is important, but I reiterate the message that it is still important for women who have been vaccinated to attend their cervical screening appointments when invited. It does not turn people into Wonder Woman.

The hon. Member for Washington and Sunderland West asked me what we are doing about education for young adults on HPV vaccination, and regional variations in uptake, a point that she has raised with me before. NHS England works in close liaison with Public Health England to deliver the HPV vaccination programme for girls, and in future for boys, and closely monitors uptake rates. It sends me regular reports. Local NHS England commissioners have access to those uptake rates in their area and, in due course, so will MPs. They work with providers, schools and healthcare professionals to improve coverage, sharing best practice where relevant. It became clear to me when looking at the information that there are variations, which is a concern. I made my concerns about regional variation in vaccination uptake clear to the NHS and have had meetings with NHS England and Public Health England on a number of occasions—twice in recent months—asking for additional action to increase uptake across England. I want them back in my office on a regular basis to report to me. That somehow seems to stimulate them.

I am pleased that the NHS long-term plan featured involving local co-ordinators to encourage uptake. That came out of those meetings along with various other commitments to improve vaccination rates, not just for HPV but across the vaccination piece. That includes requiring CCGs to ensure that all vaccination programmes are designed to support a narrowing of health inequalities. They know that I remain on their case. If the hon. Member for Washington and Sunderland West would like to continue the conversation on that with me, I should be pleased to hear it.

The review that the Secretary of State has asked Sir Mike Richards to carry out has been mentioned. Cervical cancer affects many women and their families, and screening can help to prevent many people from developing cancer each year. It is obviously important that women take up their screening appointments to help spot abnormalities. However, with uptake only at about 75%, we know that we need to make it easier to book appointments and more convenient for women to attend them—that point about access came up a number of times in the debate.

I met Mike recently and said that I have an app on my phone that tells me when my car is due for a service and lets me book a local appointment at a time that suits me. We do not embrace that kind of no-brainer technology enough in healthcare. We have to embrace modern technology to ensure that screening programmes are fit for the 21st century. The Secretary of State and I feel passionate about that, and it should offer greater ease of access. Doing that will, I am sure, improve uptake rates. That is one key reason why we are considering comprehensively how our current national screening programmes can be improved, particularly in the light of recent issues that could affect public confidence in screening and lower uptake.

Professor Sir Mike Richards will be leading a review of all three cancer screening programmes, which of course includes cervical screening. His review will report in the summer and will specifically assess the strengths and weaknesses of the individual programmes. It will also address, as I have just outlined, how the latest innovations can be utilised and integrated with research to encourage more people to be screened, and to make it easier for them to do so. That point was raised by many hon. Members, including the hon. Member for Warrington North. I met Sir Mike a couple of weeks ago to discuss the fact that his review clearly needs to set out how we can bring our screening programmes right up to date to make them fit for the people who use them. I await his recommendations with optimism. Mike ran screening programmes in the Department of Health and Social Care before the passing of the Health and Social Care Act 2012. He has great experience and credibility within the system, which is important. We have great optimism about his work.

We must do more to raise awareness not just of the importance of taking up screening, but of how to recognise the potential symptoms of cervical cancer. Breast cancer awareness campaigns have been phenomenally successful in that kind of work. In her petition, Natasha said that she wanted to make a difference to the next generation of young women by raising awareness of the symptoms. I have seen the videos online of her little girls—they are heartbreaking. Natasha certainly raised awareness of the symptoms of what is a terrible disease. I believe she has already made a difference, highlighting how vital it is for women with symptoms to contact their GP as soon as possible. Indeed, it is 10 years since Jade Goody, who also took on the fight to raise awareness, sadly died of the illness. We shall, with the permission of Jade’s family, use the anniversary to help raise awareness of the importance of screening, and of taking up appointments. In the aftermath of Jade’s sad death attendance rates rocketed. Obviously that has waned. We will, in Jade’s and Natasha’s honour, make the most of the 10-year anniversary to save other women.

[Jenny Chapman]

It is encouraging to hear what the Minister says, and his comments about the legacy of Jade Goody and others. It is a tremendous thing that they have left to us, with the campaigns we have benefited from. However, is there not, up to a point, cause for concern in that the examples being used are younger women, which could reinforce the misinformation about the need for younger women to be more concerned about cervical cancer—and therefore for older women to be less concerned? Sometimes I wonder whether the prominence given to the examples in question may create an issue for another group of women.

[Steve Brine]

The hon. Lady makes a good point, and there is always a danger with public awareness campaigns, even down to the models, actors and actresses used in the advertising campaigns, with presentation and positioning. I take the point, and Public Health England, which works on such campaigns for me, will also take the point the hon. Lady raises. I assure her it will be sent a copy of the debate.

A number of hon. Members, including my hon. Friend the Member for Henley, who is no longer in his place, have raised the matter of GPs. Guidance for GPs has been developed and published, specifically aimed at improving the primary care of young women who present with gynaecological symptoms. That guidance, produced by a multidisciplinary group, including professionals, patients and the voluntary sector, and endorsed by the relevant royal colleges, offers clinical practice guidelines for the assessment of young women aged 20-24 who present with abnormal vaginal bleeding. GPs are continually made aware of the symptoms of cervical cancer and the need to refer women under the age of 25 for further investigation. From today’s debate, it sounds as if we have further to go, but we knew that, of course. As part of the delivery of essential medical services under the National Health Service (General Medical Services Contract) Regulations 2004, GP practices must offer consultations and, where appropriate, they must also offer physical examinations for the purposes of identifying the need, if any, for treatment or further investigation and, if needed, referring the patient onwards as soon as possible. The hon. Member for Rotherham made an excellent point about understanding the history of trauma that some women on their lists had had. Obviously it is a subject that she has a lot of experience of in her constituency; I thank her for making that excellent point, and I will ensure it is fed into the Mike Richards review.

I have mentioned the “Be Clear on Cancer” campaign a couple of times, and said that Public Health England will work to raise awareness of this disease through that campaign, which we have run in partnership with Cancer Research UK since 2011. It has covered many different areas and is scheduled to promote the uptake of cervical screening from next month.

While we are still on the awareness point, in the 2016 Budget the Government announced that Jo’s Cervical Cancer Trust, which does so much good work in this area, as has been said, would be a beneficiary of the tampon tax. It received £650,000 in funding to kick-start a campaign to get closer to eradicating cervical cancer. I take part in many of these debates and talk about cancer, as does the shadow Minister. One third of cancers are preventable and two thirds of cancers are just bad luck. With some cancers, we are nowhere near, but this is a cancer we can get rid of. This is a “bad” that we can eradicate. That is why we are so determined to get it over the line.

Jo’s Cervical Cancer Trust ran a campaign on eradication in 2017 and 2018; it was a wide-reaching awareness programme, with a specific focus on groups where there is a higher prevalence of non-attendance of cervical screening: interestingly, that is women from black, Asian and minority ethnic communities, women from disadvantaged backgrounds—a point already made—and women in the 25-to-29 and over-50 brackets. The funding enabled the trust to provide targeted education and information to those groups and to produce a body of evidence on the barriers to screening and how to overcome them.

The trust found that some young people do not attend appointments because they are embarrassed; that finding received a lot of press coverage and came out in Prime Minister’s questions last year. Others do not think the test is important, and yet more do not think they are at risk because they lead healthy lifestyles. One in four do not attend their screening appointment, and that needs to change, so this is important work.

From talking to Rob from Jo’s Cervical Cancer Trust, I know that one thing they found on the roadshows when they were testing this work in 2017 and 2018 was the importance of talking to women’s partners and the role partners can play in reminding, or nagging—whatever word we choose to use—women about taking up their screening appointments. Last week, the trust led their annual cervical cancer awareness week, with an event here in Parliament. The aim is to help as many people as possible to know how they can reduce the risk of the disease, and to promote that among their constituents.

The #SmearForSmear campaign reinforces the message that smear tests prevent 75% of cervical cancers, so while they may not be pleasant, as we have heard, they are important. I was pleased to support them myself, as most of the Health team did, at the event in Parliament last week, and I thank all hon. Members who took part; I know Jo’s Trust found it helpful. As Natasha’s Army says—this is such an important message—we need to support all young women to “lose the fear, take the smear”.

If I may try to draw my remarks to a close, this Government—as did the previous Government, and as will the next Government—recognise that cervical cancer is a devastating disease, and we are committed to providing well-managed screening programmes based on the most up-to-date, peer-reviewed evidence. Cancer is right at the heart of the NHS long-term plan, which was published on 7 January, and I am very proud of that fact. The plan sets out a comprehensive package of measures that will transform cancer diagnosis and treatment across the country over the next 10 years, a decade in which patients can expect to see vast improvements in the prevention, diagnosis and treatment of cancer. The aim is to see 55,000 more people surviving cancer for five years in England each year from 2028. That is quite an ambition, but we will get there.

Cervical screening saves an estimated 5,000 lives a year, and the Government are committed to continuing to do all we can to prevent cancer and ensure early diagnosis, which is often rightly called cancer’s “magic key”, so that more families do not have to go through these personal tragedies, as the Sales have done. We are up for the fight. I thank everyone for taking part.

Appropriate ME Treatment

Steve Brine Excerpts

Thursday 24th January 2019 Commons Chamber

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

The two-minute limit produced an impressive result, showing what can be done in the Chamber, but let me issue a plea to the Backbench Business Committee. I know it is unusual for Ministers to make comments like this, but I reckon that sometimes doing less and doing it better is preferable to trying to squeeze two really important debates into a very short space of time. Perhaps the Committee will listen to my plea.

I thank those who have contributed to the debate, including my hon. Friend the Member for Southend West (Sir David Amess), the hon. Member for West Bromwich West (Mr Bailey), my right hon. Friend the Member for Loughborough (Nicky Morgan), the hon. Member for South Shields (Mrs Lewell-Buck), my hon. Friend the Member for Torbay (Kevin Foster), the hon. Member for Stroud (Dr Drew), my hon. Friend the Member for Stirling (Stephen Kerr), the hon. Member for Luton North (Kelvin Hopkins), the hon. Member for Ealing North (Stephen Pound), who spoke in his usual style, the hon. Member for Lincoln (Karen Lee), the hon. Member for Ceredigion (Ben Lake), the hon. Member for Blaydon (Liz Twist), the hon. Member for Torfaen (Nick Thomas-Symonds), the hon. Member for Heywood and Middleton (Liz McInnes), whom I have heard mention her constituent before, the hon. Member for North Ayrshire and Arran (Patricia Gibson), the hon. Member for Bristol North West (Darren Jones), who I thought gave the best speech—the prize goes to him—and the hon. Member for Bedford (Mohammad Yasin).

I also, of course, thank the hon. Member for Glasgow North West (Carol Monaghan) for introducing the debate. I think I am right in saying that this is the third debate on this subject that she has tabled and been granted in the last 12 months. I applaud her dedication, and her passion for ensuring that awareness of ME is kept very high. I echo the thanks given by the hon. Member for Washington and Sunderland West (Mrs Hodgson) to all the charities that are working in this space, and I welcome the ladies from the Millions Missing campaign who are in the Public Gallery. I thank them for coming to listen to our debate; I am sorry that it has been so rushed.

The Government do not for one minute underestimate ME. As we heard from the hon. Member for Central Ayrshire (Dr Whitford), the truth is that we do not understand the underlying causes, and there is no single diagnostic test to identify it. Although some patients—very few—improve and recover, there is currently no cure. We know that the condition has a devastating impact, and we have heard some stories about that today. It has a complex range of symptoms which cause great difficulties for physicians, including disabling fatigue, a flu-like malaise and neurological problems. We have also heard about the effect on families, friends, carers, schools and housing.

No one mentioned the powerful film “Unrest” today, so let me mention it briefly in passing. It won an award at the Sundance film festival a couple of years ago. That was a powerful presentation, if ever I saw one, of the impact that ME can have on people’s lives. I will not say any more about it, because last time I did so someone accused me of doing a film review instead of responding to the debate—which I think was slightly harsh, but that is what social media does for you. I thought that the hon. Member for Ceredigion, who is still in the Chamber, put it very well: although we give constituents’ stories in this place, we cannot for one minute begin to understand what it must be like to suffer from this condition. Those who have seen the film will know that it literally puts people flat on their backs, sometimes for years.

We have heard a lot about the medical profession today, and I think—the hon. Member for Central Ayrshire touched on this—that the profession has had a bad rap, some of it deserved. As we have heard, the difficulties in diagnosis mean that patients with ME often experience great delays in receiving the treatment and support that they require. Recognising the need for GPs to be aware of the condition, the Royal College of General Practitioners includes it as a vital area of clinical knowledge that GPs should have as part of their qualifying exams, featuring it in the guidance for the applied knowledge test, which is a key part of those exams.

The RCGP has also produced an online course on ME for GPs. It highlights many of the common misconceptions, and considers the challenges for primary care professionals that surround this complex condition. Nevertheless, once they are qualified, clinicians are responsible for ensuring that their own clinical knowledge remains up to date—it is not for Ministers to go on educating GPs; that is one of the jobs of the RCGP—and for their ongoing learning. I made clear in the last debate, and I will make clear again, that that activity should continue, and should take into account new research and developments in guidance such as that produced and updated by the National Institute for Health and Care Excellence.

My hon. Friend the Member for Southend West said that people felt that they had been fobbed off. They should never be fobbed off by the medical profession, and I should be very concerned to hear of any examples of that.

[Mr Bailey]

Will the Minister give way?

[Steve Brine]

No, I will not, because everyone had a chance to speak and wanted the Minister to respond.

As I have said, I think that GPs have had a hard rap this afternoon. Before the debate I spoke to Helen Stokes-Lampard, who chairs the RCGP, because I anticipated that that would happen. I asked her whether she would be willing to come to the House if I were to facilitate a roundtable—perhaps involving the all-party parliamentary group on myalgic encephalomyelitis, which we hope will be reconstituted, but certainly involving the sponsors of today’s debate. She is very willing to do that, and I think it would be a positive development. If the hon. Member for Glasgow North West would like to be part of that, perhaps we can get in touch and make it happen. The door will be open.

The NICE guidance is clear on a number of important points. There is no one form of treatment to suit every patient; that is self-evident. The needs and preferences of patients should absolutely be taken into account. Doctors should explain that no single strategy will be successful for all patients, which is a hallmark of this condition. In common with people receiving any NHS care, ME patients have the absolute right to refuse or withdraw from any part of their treatment; nobody is making this happen. Those with severe symptoms may require access to a wider range of support, managed by a specialist.

NICE guidance supports commissioners to plan, fund and deliver ME services. As we have heard in this debate, and in others secured by the hon. Member for Glasgow North West, the use of CBT and GET in treating ME has long been controversial for patient groups, charities and some clinicians, who are very divided on this condition—understatement of the afternoon, perhaps. That began with the publication of the NICE guidance in 2007, and continued with the PACE trial. However, as Members clearly, from what I have heard this afternoon, know, NICE is updating the ME guidance and will examine the concerns about the PACE trial and whether there are implications for its current recommendations.

The updated guidance is due, but sadly not until October next year, and until then the existing guidance will remain current. I will look into the request made by the hon. Lady and others for an early statement from NICE, but NICE is an internationally respected independent organisation; if we did not have NICE, we would have to invent it. The time allotted for the development of the new guidance will allow all the evidence to be considered and all the voices to be heard, and I am determined to make sure that happens.

I think every single speaker—I have a list here of who spoke and what they said—mentioned research. As set out in previous debates, the Government invest £1.7 billion a year in health research via the National Institute for Health Research and the MRC through UK Research and Innovation. Together, the NIHR and MRC welcome high-quality applications for research into all aspects of ME, which would absolutely include biomedical research. The MRC has had a cross-board highlight notice on ME open since 2003, updated in 2011, inviting innovative research proposals, alongside a bespoke funding call in that year.

ME research remains an area of very high strategic importance for the MRC. I do not have time to go into all the money granted. Members have said this afternoon, “We must surely fund more research,” but Ministers do not sit in the Department of Health and Social Care and decide on what to do research. One of the great legacies of the late Baroness Jowell was that she understood in brain tumour research that we need to stimulate that research community to come forward with the best research proposals that then can be successful in bidding for funding. The truth is—sometimes it is a hard and inconvenient truth to hear—there have not been good enough research proposals in the ME space, partly because of the stigma—a point raised very well by the hon. Member for Lincoln; she looks delighted that I have mentioned her—and partly because of the division in the medical community. We need people to come forward with good research proposals in this space; that can only be advantageous.

I want to give the hon. Member for Glasgow North West a chance to conclude, but I thank her for raising the issue again on behalf of those affected, including many of my constituents who have contacted me asking if I would be able to attend today’s debate; I was able to say, “Yeah, there’s a fairly good chance that I will pop in.” One of the Whips present on the Treasury Bench, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), asked me to mention her constituent, Rosalind Amor, who has been in touch with her many times on this subject.

The Government fully recognise the strength of feeling on this issue, as we do for all those living with conditions and disorders which research is unable yet to help us fully understand. That is why we remain fully committed to delivering significant investment in our research programmes and infrastructure, but we need people to come forward with quality proposals.

Foetal Alcohol Spectrum Disorder

Steve Brine Excerpts

Thursday 17th January 2019 Commons Chamber

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

Nobody has ever handed over to me that way before, but I like it. I was just saying to the Whip on duty that I should congratulate the hon. Member for Sefton Central (Bill Esterson) not just on getting this debate, but on his consistent record of campaigning in this area over many years. I am sorry that that came about due to bad personal experience, but I hope that his two adoptive daughters are okay and are proudly watching him do his work in the House tonight.

I thank the hon. Gentleman for all his work to raise awareness of the condition through the all-party parliamentary group on foetal alcohol spectrum disorders. I chaired many APPGs when I was on the Back Benches, and I always say—I make no apologies for repeating it—that so much good work in this House goes on in APPGs. There is so much expertise, and they do not get enough awareness in the public or in this House, but they should. The hon. Gentleman has certainly helped with that tonight.

It is true that we do not know enough about the extent of FASD. The recent Bristol screening tool study suggests that between 6% and 17% of people in the general population could be suffering from FASD, but I suspect that that is an underestimation. The study is an important contribution but, even as its authors acknowledge, there are limitations to the data, and its prevalence estimates should be treated with caution. There is no question that the hon. Gentleman is right that more needs to be done to clarify the true prevalence of FASD, and the Department will consider future research in this area—I take the hon. Gentleman’s challenge. We do know that the impact of FASD can be severe, with the lifelong physical, behavioural and/or cognitive disabilities that he mentioned. Unfortunately, there is no cure, but we know that early intervention can help improve a child’s development and help them to lead an improved life. The hon. Gentleman made well the point that FASD does not just affect babies.

Touching on prevention, the hon. Gentleman will know that it is one of the key priorities of the new Secretary of State for Health and Social Care, which is music to my ears as the Minister for Public Health, Primary Care and Prevention. The hon. Gentleman is right that FASD is an entirely preventable condition, so that makes my ears prick. Prevention is vital, and the all-party parliamentary group has made it the fulcrum of its work to raise awareness of the dangers of drinking in pregnancy in order to protect future generations from an entirely preventable condition.

First and foremost, we need to be absolutely clear to women about the facts on alcohol so that they can make well-informed decisions. That applies both before they become pregnant and when they come into contact with the health system—in primary care we call it making every contact count. The UK chief medical officer, Professor Dame Sally Davies, with whom I work closely, published low-risk drinking guidelines in 2016, which provide very clear advice to women not to drink alcohol if they are planning for pregnancy or if they are pregnant. Public Health England, for which I have ministerial responsibility, reinforces that advice through its public health messaging, both global and targeted.

We have been very clear with the alcohol industry that we expect the guidelines to be reflected on the labelling of all alcoholic products, and we have given the industry until September 2019 to ensure that its labelling reflects the updated guidelines. The industry knows that I will be watching it like a hawk.

There is also central advice through NHS.uk and other media platforms such as our Start4Life branding to inform women of the dangers of drinking during pregnancy. Of course, all upper-tier local authorities in England are now public health authorities. As part of their local public health duties, they rightly continue to educate the public about the dangers of alcohol during pregnancy, and it is encouraging to hear about initiatives such as “Be your baby’s hero, keep alcohol to zero,” which is one of my particular favourites. In Blackpool, of all places, areas of high alcohol use in pregnancy are being targeted to stop future cases of FASD. Be your baby’s hero, keep alcohol to zero—I just like saying it.

Once women are pregnant, they generally come into contact with health services frequently, which gives many opportunities for healthcare professionals to give advice on alcohol. As I mentioned at Health and Social Care questions this week, there are many campaigns on diet and nutrition, and health professionals are very aware of the dangers of drinking. Cancer Research UK has been helpful on this issue, and it is very aware of the dangers of drinking alcohol during pregnancy. The key thing is that pregnant women are given consistent messages, delivered in a supportive, non-judgmental way. The same goes for obesity, another area for which I am responsible. Messages about being overweight should be delivered in a supportive way and alongside a call to action, and many primary care professionals find that difficult, which I understand. It is easy for us to say, “Well, they should just mention it,” but it is not quite so easy.

Midwives and health visitors have a central role in providing clear, consistent advice and early identification and support, and they are well equipped to do it supportively. We are reinforcing that role through a number of strategies. Through the maternity transformation programme, the Department is working with NHS England, Public Health England, the Royal Colleges and a range of charities such as Sands, the stillbirth and neonatal death charity. The House will be well aware of Sands, which does such good work to promote safer maternity services. This programme covers a range of initiatives, which include raising awareness of the known risk factors among pregnant women and health professionals, as the hon. Gentleman has asked for. This will ensure that women receive consistent, supportive advice on how to minimise the risk of stillbirth, including the importance of healthy eating and of not smoking—I am responsible for the tobacco control plan—or drinking alcohol during pregnancy.

The National Institute for Health and Care Excellence has updated its guidelines to reflect the CMO’s advice not to drink during pregnancy. The Department will continue to work with the Royal Colleges—I was with the head of the Academy of Medical Royal Colleges last night—and various other regulatory bodies to raise the profile of the CMO’s guidelines and to recommend that they include those guidelines within their training, which the hon. Gentleman has consistently asked for.

[Bill Esterson]

I appreciate the tone and content of the Minister’s response so far. I neglected to ask him about the alcohol strategy. Will he say a few words about his intentions to include action on FASD in that strategy? That would be an extremely important and welcome step for those interested in this subject.

--- Later in debate ---

[Steve Brine]

I do not directly own the alcohol strategy, but obviously I am involved in it. I take the hon. Gentleman’s challenge on board, and maybe we can discuss it further. I know he has stuff he wants to feed into the strategy—he has produced it through the all-party parliamentary group—so perhaps we can discuss it further. I can then discuss it with my ministerial colleagues in the Home Office. It would make absolute sense to do so as part of the strategy, and I suggest linking it to our Green Paper on prevention, which we will be bringing out this year. His question is spot on.

I will now touch on services for affected families. We know that FASD can have a huge impact on the early years development of children and on their life chances, and the hon. Gentleman gave a number of good examples. We also know that early intervention services in this area, as in every area, can help to reduce some of the effects and, therefore, the secondary disabilities that come as a result. The responsibility for commissioning services in this space lies with the clinical commissioning groups in England, working together across all different sectors of the local health economy. We have heard of cases of long waiting times for a diagnosis. My Department will consider how we can improve access to these services and a diagnostic pathway, but we also need to learn from best practice. The Tameside and Glossop Integrated Care NHS Foundation Trust has developed the maternity alcohol management algorithm pathway—why can people not come up with something snappier, like that first one? It has introduced screening and awareness of FASD, enabling what we think is effective early intervention. Just as the long-term plan gives different examples on smoking, with the Canada example on challenging smoking rates among pregnant women, I am interested in the best practice ideas and that trust has a lot to bring in this space. The Surrey and Borders Partnership NHS Foundation Trust has a specialist centre, although sadly it is the only one in England. The trust provides a comprehensive and rapid diagnostic pathway for those with FASD and it has a lot to share from its journey and with its ideas for service delivery, and on the success it has had.

[Bill Esterson]

The Minister mentions Surrey and Borders, and I have had significant interaction with Dr Raja Mukherjee, the specialist who runs that centre. I am glad the Minister acknowledged that it is the only one in the country. May I encourage him to intervene to make sure we have such centres right across the country, as that would make a massive difference?

[Steve Brine]

The hon. Gentleman can certainly encourage me in that regard, and I will look at that in terms of the prevention paper. We would have to be guided by the clinicians and the CCGs on where they would see the greatest need for that provision to be. That is very much the spirit of the long-term plan, but it is not ideal that that centre is the only one. Surrey is near my constituency, but a long way from Sefton.

Finally, I wish to touch on the wider departmental policy engagement in this area. Our deputy chief medical officer, Gina Radford, has held roundtable meetings on the subject, which considered the future development of policy to improve prevention and support. I do not know whether the hon. Gentleman has been involved in that. These meetings were attended by experts in the field and, crucially, FASD service users. I thank NOFAS UK—the National Organisation for Foetal Alcohol Syndrome-UK—which has been helpful in supporting and contributing to these meetings, along with other charities working in this field. We are also providing wider support to children and families affected by alcohol misuse, through the children of alcoholic dependant parents programme, which I am proud of. It was one of the first thing I got to announce in this job. The previous Secretary of State working as one with the current shadow Secretary of State had managed to do this, which shows that cross-party working can happen in this Parliament between the two main parties—and there were no preconditions to it.

[Lyn Brown]

That is a career-limiting comment.

[Steve Brine]

The preconditions did not come from this side; I filled it in nicely. Through that programme, we are investing some £6 million over three years to support a vulnerable group, as part of our new alcohol strategy.

The Government take alcohol concerns, across the board, very seriously and even more so when they relate to pregnancy. We are making progress—I hope—to prevent future FASD cases, and trying to change the landscape on prevention and treatment for those affected. But there is not an ounce of complacency in us—there certainly is not in me. We will continue to work towards improvements in the area. I can promise the hon. Gentleman that and I know, given his consistent work in this space, he will make sure he holds us to that and continues to raise awareness of the dangers of drinking alcohol during pregnancy in this House and outside. I thank him for that.

Question put and agreed to.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 15th January 2019 Commons Chamber

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

13. What recent clinical advice he has sought on the licensing of cannabis oil for medicinal purposes.

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

The Government acted swiftly to change the law to allow cannabis-based products to be prescribed for those patients who might benefit, with advice from the chief medical officer and the Advisory Council on the Misuse of Drugs. NHS England and the CMO have written to clinicians in England highlighting the interim clinical guidance available.

[Ronnie Cowan]

When the Government announced that they were prepared to allow medical cannabis under prescription, the decision was welcomed by many people throughout the United Kingdom who suffer from a range of conditions, but the process that has been adopted has failed to deliver. When will the Government take steps to facilitate GPs to prescribe and pharmacists to provide the appropriate effective forms of medical cannabis?

[Steve Brine]

We commissioned the National Institute for Health and Care Excellence to produce further guidance that should be out by October. Doctors are right to be cautious when the evidence base remains limited and further research in this area is vital. The change to the law will facilitate that. The National Institute for Health Research has called for research proposals to enhance our knowledge in the area and I think that that is absolutely right.

[Mr Speaker]

I call Alistair Carmichael. Where is the fellow? I hope that he is not in Orkney and Shetland because that would be a pity. Never mind, I am sure that we will see him ere long.

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[Andrew Selous (South West Bedfordshire) (Con)]

9. What steps he is taking to reduce obesity.

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

This Government are taking bold, world-leading action on child obesity that meets the scale of the challenge that we face. We have a soft drinks industry levy, a sugar reduction programme already working, measures on banning energy drinks, calorie labelling consulted on, and a consultation on restricting price and location promotions of sugary and fatty foods which I launched on Saturday.

[Andrew Selous]

The introduction of a 9 pm watershed on the marketing of junk food to children is the No. 1 ask of the Obesity Health Alliance, supported by Cancer Research UK, Diabetes UK and many of the royal colleges. When will we see that consultation launched?

[Steve Brine]

I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.

[Jim Shannon (Strangford) (DUP)]

With recent Northern Ireland figures showing that at least 25% of young people and 40% of teens are classed as overweight or obese, will the Minister outline what cross-departmental discussions have taken place on the strategies to improve the health of young people through co-ordination and interaction with parents and the provision of healthy eating schemes?

[Steve Brine]

Of course, health is devolved, but we talk to our opposite numbers all the time, as do our officials. Our north star ambition to halve child obesity by 2030 is right and it is shared and matched by our colleagues in Scotland, and we look to our colleagues in Northern Ireland to do the same. Any advice and support that they want from our world-leading plan is more than on offer.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Does the Minister agree with the campaign being advanced by Jamie Oliver to ensure that doctors in training are given more extensive training in nutrition and its benefits for health?

[Steve Brine]

Yes, I do. I was fortunate enough to visit Southend pier before Christmas to talk to Jamie and Jimmy about this. Nutrition training and the understanding of what is involved in achieving and maintaining a healthy weight varies between medical schools. Some courses have only eight hours over what can be a five or six-year degree. Together with the professional bodies and the universities, we will—as we said in the long-term plan—ensure that nutrition has a greater place in professional education training.

[Mr Speaker]

We are all very impressed by how well connected the Minister is. He is obviously on first-name terms with these illustrious individuals—[Interruption.] Indeed, I am sure they are thrilled to befriend the Minister—no reason to doubt it.

[Alison Thewliss (Glasgow Central) (SNP)]

Scotland’s childhood obesity plan recognises breastfeeding as the best start to life for babies. Will he look at that in his plans and ensure that the support is available to allow women to breastfeed for as long as they wish to?

[Steve Brine]

Yes, we will. We recognise that it gives a good start in life. Working with my colleague the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), I will meet one of the groups in that area to talk about it shortly. I know the hon. Lady chairs the infant feeding all-party group, and I am happy to talk to her about that at any time. We see it as an essential start in life.

[Bim Afolami (Hitchin and Harpenden) (Con)]

10. What the aims are of the new mental health support teams to be placed in schools and colleges; and what steps those teams will take to improve mental health for young people.

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[John Howell (Henley) (Con)]

12. What steps he is taking to improve the diagnosis and treatment for patients with rare diseases and cancer.

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

Our much-mentioned new plan sets out the clear ambition to diagnose three quarters of all cancers at an early stage—up from half today.

[John Howell]

The blood cancer charity Bloodwise launched its “Hear our voice” report in Parliament last week. Will the Minister ensure that NHS England works with the charity to ensure that blood cancer is included in the 75% target?

[Steve Brine]

Yes, I will. I spoke at the launch of Bloodwise’s excellent report at its parliamentary reception last week. I have been clear since the new ambition was announced that the 75% target applies to all cancers, and we will not achieve it unless we focus on harder-to-diagnose cancers, such as blood cancer.

[Daniel Zeichner (Cambridge) (Lab)]

Given that the number of people suffering from rare diseases in any one country is always likely to be small, and given our changing relationship with the European Medicines Agency and the European medicines market, what is the Minister doing to ensure that the future development of orphan drugs in this country is safeguarded?

[Steve Brine]

The hon. Gentleman will know that the draft withdrawal agreement hopefully sets us on a relationship with the EMA, but the UK’s strategy for rare diseases, which was published in 2013, sets out our commitment to improve the diagnosis and treatment of patients with rare diseases and to end the diagnostic odyssey that has been referred to throughout the past few years.

[Mike Wood (Dudley South) (Con)]

14. What steps he is taking to increase support for people with autism and learning disabilities.

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[Norman Lamb (North Norfolk) (LD)]

20. What assessment he has made of the effect of changes to local authority public health budgets in 2019-20 on his Department’s ability to achieve its “Prevention is better than cure” vision.

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

Local authorities will receive £3 billion in 2019-20, ring-fenced exclusively for use on public health, but our ambitions for prevention go far beyond any one pot of money. “Prevention is better than cure” was widely welcomed, and we will build on it with a comprehensive Green Paper later this year.

[Norman Lamb]

The number of people attending sexual health clinics is up 13% over four years, and the number with gonorrhoea and syphilis is up 20% over the last year, yet the Health Foundation says that funding for sexual health is down 25%. Will the Secretary of State and the Minister be making a powerful case, as part of the spending review, for proper investment in public health, and particularly in sexual health, given their commitment to prevention?

[Steve Brine]

Yes, of course. Matters for the spending review are just that, but one thing that the right hon. Gentleman, as a former Health Minister, will have noticed—and probably welcomed—in the long-term plan is that we are going to look at the commissioning of, and therefore the funding flow for, sexual health services as part of the long-term plan.

[Mr Clive Betts (Sheffield South East) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

T9. As we heard earlier, obesity is a major health problem in Britain. Nationally, 1,100 people per 100,000 are admitted to hospital because of obesity-related problems. This is a particular problem in Sittingbourne and Sheppey, where 1,700 people per 100,000 are affected. That is the highest rate in the whole of Kent and Medway. Does the Minister recognise the huge strain that such a statistic puts on the budget of the Swale clinical commissioning group, and, if so, what steps will he take to provide the funds needed to solve the problem?

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

Yes, of course we recognise the economic strain that obesity puts on the NHS, which is why we are taking the action we are, including with our renewed focus on prevention. The measures in the plan include doubling the capacity of the diabetes prevention programme and the further 1,000 children a year we hope to treat for severe complications relating to their obesity. That should help my hon. Friend’s CCG, as well as mine and those of all Members.

[Mohammad Yasin (Bedford) (Lab)]

T3. A senior Bedford GP was told by the East of England Ambulance Service that a patient who required urgent admission would have to wait 10 hours for an ambulance. I am deeply concerned about this response time. Will the Minister urgently investigate why patients are being deliberately downgraded when an ambulance is called from a GP surgery?

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[Tracey Crouch (Chatham and Aylesford) (Con)]

In the event of an out-of-hospital cardiac arrest, access to a defibrillator can make the difference between life and death. Although there are tens of thousands of defibs across the United Kingdom, the majority are not known to the ambulance service, so will the Minister join me in welcoming the British Heart Foundation’s efforts to map the location of all defibs so that ambulance services can direct people to their nearest heart restarter in an emergency and, hopefully, we can save more lives?

[Steve Brine]

Yes, I will. We work closely with partners such as the BHF to harness new technology. Ultimately, this is about using data—big data—to ensure that patients benefit, and that is at the heart of the health service.

[Chris Ruane (Vale of Clwyd) (Lab)]

T10. We have an excellent advocate for those with motor neurone disease in north Wales, one Vincent Ryan. He has drawn my attention to the fact that the social care Green Paper was expected before the new year, but the Health Secretary has now said that it will be published before April, more than two years after it was first announced. Can the Secretary of State confirm that, whenever the Green Paper does arrive, it will address social care provision for adults of working age living with a disability as well as older people?

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[Mrs Pauline Latham (Mid Derbyshire) (Con)]

What advice can the Minister give to elderly and vulnerable people who missed out on the first wave of flu jabs? Are they still available?

[Steve Brine]

Yes, they are still very much available. People should make an appointment through their GP or their wonderful pharmacist.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

While working a night shift in A&E this weekend, I was struck by the fact that I was working alongside so many members of staff from our EU—Italian, Irish and Spanish. I am proud that St George’s Hospital is paying for the visas of those vital staff post Brexit, but can the Secretary of State tell me why the financial burden of retaining them and improving their morale is falling on NHS trusts and not the Government?

Diabetes

Steve Brine Excerpts

Wednesday 9th January 2019 Westminster Hall

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

We were so close.

[Martyn Day]

Yes, but it had to come in, given the requirement to stockpile insulin. Diabetes charities have warned that lives could be put at risk without reliable supplies of insulin, as the UK imports the vast majority of its stocks of the medicines. In response, stockpiles have been increased, which is good. Dan Howarth, the head of care at Diabetes UK, said in September:

“Insulin and other diabetes medication aren’t optional extras for the millions of people in the UK who rely on them. It’s incredibly important that the companies involved in their production and distribution, and those involved in guaranteeing their entry into the UK, work together so that supply continues uninterrupted.”

I would be grateful for reassurances from the Minister that that will indeed happen and about how long our supplies will last should we face the worst-case scenario.

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

It is nice to see you in the Chair, Mr Robertson. I thank all Members for their contributions and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) for securing the debate. He introduced it with his usual flourish, and I know that people watching will have been interested in what he said and the issues that he raised.

We have to keep these issues high on the agenda. They affect a lot of people and we talk about them a lot in Parliament; I cannot think of a Health oral questions that I have been involved in as a Minister when diabetes has not come up. There is a reason for that: because it affects so many of us and our constituents. We must keep raising it.

This is a timely debate. We published the long-term plan for the NHS on Monday. Diabetes features prominently in the plan, which is no accident. We would expect it to, and if it did not, we would have a debate on why not. However, more than that, the plan has a strong focus on prevention and on building a health service for the needs of the 21st century that supports people to manage their own health—not only for diabetes but across the piece—and wellbeing.

We really support that agenda in this Department and with this Secretary of State. That matters for patients—our constituents—with diabetes and others. Chris Askew is a very good man and chief executive of Diabetes UK, and his welcome for the long-term plan and the diabetes sections within it greatly attests to that.

We have heard some excellent contributions. I very much enjoyed listening to the intervention from my right hon. Friend the Member for Wantage (Mr Vaizey) and his suggestion about Brine labelling; my right hon. Friend the Member for Ludlow (Mr Dunne), who gave us insights about his two-year-old daughter; and my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who talked about the food industry and child obesity. We also heard speeches from the right hon. Member for Knowsley (Mr Howarth), who talked about an artificial pancreas, which was very interesting, and from the hon. Member for Workington (Sue Hayman). I should be able to cover all those items. If I do not cover everyone’s points, I will of course write to them, as is my usual practice.

I have to say that I particularly enjoyed the contribution from my hon. Friend the Member for Rochford and Southend East (James Duddridge). It was a very powerful and insightful speech, as it always is from him, and it was delivered from the heart. He made the very good point that we are all different. That is one of the challenges not just for diabetes care, but for healthcare generally. Healthcare is not an exact science. I say that not as a doctor, but as someone who spends a lot of time with doctors.

My hon. Friend also made a point about the complexity of diabetes. In reality, it is a spectrum. We have heard a lot of talk this morning about type 1 diabetes—from the right hon. Member for Knowsley, for instance—and about type 2 diabetes from many others. But increasingly we hear about—it is not a new term—type 1.5 diabetes, otherwise known as LADA, or latent autoimmune diabetes in adults. As I understand it, that is not a clinical definition, but is generally used to describe a slow-onset form of type 1 diabetes that is often mistaken for type 2 diabetes. There are many support services for that condition, and people are increasingly talking to their doctors about it. There is lots of clinical debate around it, but the topic has been around since the 1970s. That goes to the heart of my hon. Friend’s point. Diabetes is a complex condition. There is a spectrum for diabetes, as there is for many other conditions.

I, too, pay tribute to the NHS staff, to the diabetes nurses and the doctors, but also to the support groups. My constituency has the Winchester and Eastleigh diabetes support group, which I spoke to recently. We will all have those groups in our constituencies. As MPs, we are very used to having in front of us people who are far more expert on the subject that they have come to talk to us about than we are—every single one of my constituency surgeries is an example of that—but never is that more true than when we talk to people with diabetes, who have a great and expert knowledge of their condition and the management of it. If they do not, we need to help them to have better, expert knowledge of their condition, because that is as much in our interest as it is in theirs.

There are a couple of points to touch on. My right hon. Friend the Member for South Holland and The Deepings, in introducing the debate, and my hon. Friend the Member for South West Bedfordshire touched on the food and drink industry and healthier eating. It is important that we build on the world-leading action set out in both chapters of our childhood obesity plan. We have already seen real success. More than half of all drinks in the scope of the soft drinks industry levy are being reformulated. That is equivalent to removing some 45 million kg of sugar every year, as a result of the so-called sugar tax. And some products in the sugar reduction programme are exceeding their first-year targets. For example, a 6% reduction is being achieved for yoghurts.

We will consider further use of the tax system to promote healthy food—the challenge that my hon. Friend put to me. He mentioned sugary milky drinks. The Treasury was very clear, when former Chancellor of the Exchequer George Osborne launched the sugar tax, that in 2020—next year—we would review the sugar levy and whether to extend it to milky drinks. As the Minister, I for one will certainly be welcoming that.

As part of chapter 2, we have already held consultations on ending the sale of energy drinks to children and on calorie labelling in restaurants. We are reviewing the feedback and will formally respond in due course. We will very shortly be launching consultations on restricting promotions of fatty and sugary products by location and price, and we will be consulting on further restrictions, including a 9 pm watershed, at the earliest opportunity, with the aim of limiting children’s exposure to sugary and fatty food advertising and driving further reformulation. What I will say, in answer to the challenge that I have been given on those products, is that not everyone agrees that we should do this. Let us be honest: there are people in our party who do not. I challenge them to look at the challenge that we have in our country with obesity and what it is costing our country and our health service. If we believe in a publicly funded health service, we believe in a public health system that challenges these kinds of condition, so I say to my hon. Friends: keep raising the issue in the House. Next Tuesday they will have an opportunity to do so.

Alongside that, we are committed to exploring what can be done on food labelling when we leave the European Union. My hon. Friend the Member for Ochil and South Perthshire (Luke Graham), who is no longer in his place, raised traffic light labelling. We cannot do that as a member state, but we will soon be free. Some companies have decided to take it on themselves. Kellogg’s, the cereal manufacturer, which has been mentioned this morning, announced just before Christmas that it intends to do that. I welcome that and give credit to Kellogg’s for doing it.

Wherever possible, the aim is of course to prevent type 2 diabetes from developing in the first place, which is emphasised in the NHS long-term plan. I am very pleased that NHS England and Public Health England, for which I have responsibility, and Diabetes UK, working hand in glove, have had great success in working on what is the first diabetes prevention programme to be delivered at scale nationwide anywhere in the world.

[Andrew Selous]

Will the Minister give way?

[Steve Brine]

Very briefly—be quick.

[Andrew Selous]

I, too, am very pleased that Kellogg’s has brought in traffic light labelling, but does the Minister agree that, with Kellogg’s Frosties at 37 grams of sugar per 100 grams, there is much more to do as far as Kellogg’s is concerned?

[Steve Brine]

Not only do I agree with my hon. Friend, but the company would agree with him. It is very aware of how much pressure that I and the Government are putting on it to change its products. I would say that it is top of my Christmas card list. Many other manufacturers have not yet made it on to my list, and I ask them to step up and raise their game to the level of the best. I am sure that they can.

In 2018-19, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographical coverage. That is a great achievement, and the figures are good. As set out in the long-term plan, NHS England intends to double the capacity of the programme up to 200,000 people per annum by 2023-24. As my right hon. Friend the Member for South Holland and The Deepings said, it is a modest number in context, but it is also a big number. This is still the largest diabetes prevention programme of its kind. He asked whether we keep these things under constant review and whether we have the ambition to go further. You bet we do, and I think we need to.

There has been much talk this morning about technology. We are also developing an online, self-management support tool called HeLP, comprising a structured education course that has content focused on maintaining a healthy lifestyle for people with type 2 diabetes. That includes content on weight management and alcohol reduction—that can of course help with many health challenges—and cognitive behavioural therapy related to diabetes-related distress. NHSE hopes, once the tool has been developed, to roll it out in the summer of this year.

[Sir John Hayes]

In my opening remarks, I called for a new system for appraising technology and ensuring that it is allocated according to need and consistently across the country. On education, it does seem to me that there is a littered landscape. We have Public Health England, the NHS and local authorities. That littered landscape could easily lead to complication, confusion and even, possibly, contradiction, so will the Minister look at that, too?

[Steve Brine]

Of course I will look at it. I talk to Public Health England regularly about all these matters, and I take my right hon. Friend’s challenge on board. In the time that we have, I cannot respond in any more detail, but I totally take his challenge on board.

There are public health campaigns such as One You, the behavioural change campaign aimed at people in the 40-to-60 age bracket—sadly, that now includes me—and designed to motivate people to take steps to improve their health through action on the main risk factors, such as smoking, inactivity, obesity and alcohol, which will help to reduce the risk of developing type 2 diabetes.

I would like to say so much more, but as ever in the House of Commons there is no time to do so. What I will say is this. We have great ambition in the long-term plan. The long-term plan is a living document, a document that we will build on—we have ambitions to go even further—but I hope that the Government and I, as the Public Health Minister, have shown our commitment to improving outcomes for people with diabetes and living with it through treatment, but also to helping to prevent people from developing it in the first place. Our constituents demand that from us, and our health service, if we believe in it as a publicly funded, free at the point of use health service, which we do, needs us to deliver on that, and we will.

Cancer Workforce and Early Diagnosis

Steve Brine Excerpts

Tuesday 8th January 2019 Westminster Hall

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

That was very decisive of you, Mr Howarth. It is quite cold in here, but the ministerial radiator next to me is doing very nicely. Note to the Box: must get radiator for shadow Minister.

It is a pleasure to serve under your chairmanship, Mr Howarth. I wish everybody a happy new year. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing the debate. It is good to see him again. He has impeccable timing; I am not sure if he knew that the plan would be published when he applied for the debate. If he could let me know how he managed that, I would be very grateful.

The hon. Gentleman and everybody else talked about cancer survival rates. The truth is that they have never been higher and have increased year on year over the last decade or so. The reason for that is not only the investment and policy decisions by the last Government and this Government but, as the shadow Minister said, the hard work of NHS staff up and down our country. They work tirelessly, going over and above to give cancer patients the care and compassion that they need. I place on the record my thanks to them, which was perhaps not said enough in the Chamber yesterday. We are not in the slightest bit complacent, though. At the end of the day, one death from cancer still devastates somebody’s life and their family’s life. We know that we need to do so much more to ensure that we deliver the world-class cancer outcomes in England that all of us want and expect for our constituents.

In introducing the debate, the hon. Gentleman set the tone when he talked about the workforce. He said that the workforce are, in a way, the rock on which to build the church. I will start with that. Where we cannot prevent cancer, which I will come on to, we must ensure that we have the right staff with the appropriate skills and expertise to ensure that patients receive the best care. The NHS is nothing without its 1.3 million staff. It is the biggest employer of trained staff in the world. In 2017, Health Education England published the first ever cancer workforce plan, in which we set out ambitious plans to expand the capacity and skills of the NHS cancer workforce, committing to invest in 200 clinical endoscopists in addition to the 200 already committed to, as well as an extra 300 reporting radiographers, by 2021. However, we know that we need to go much further and do more than that. The Prime Minister set out our new ambitions on cancer in her party conference speech, and we also set out our early diagnosis targets in the long-term plan and our survival targets. As the Secretary of State set out yesterday, the long-term plan is the next step in our mission to make the NHS the world-class employer that delivers the cancer survival rates that we want.

To deliver on those commitments, we have asked Baroness Dido Harding, chair of NHS Improvement, to chair a rapid programme of work for the Secretary of State. She will engage with staff, employers, professional organisations, trade unions, charities in this space, think-tanks, Members and all-party parliamentary groups to build a workforce implementation plan that matches the ambition set out in the long-term plan. She will provide interim recommendations to the Secretary of State by the end of March on how supply, reform, culture and leadership challenges can be met, and then final recommendations later in the year, around the time of the spending review, as part of the broader implementation plan that will be developed at all levels to make the long-term plan a reality.

The hon. Gentleman and others asked about the work of HEE and Baroness Harding. The announcement of the long-term plan superseded HEE’s plans to publish a longer-term cancer workforce plan. HEE will now work with NHS England and Baroness Harding’s NHS Improvement under the plan, led by the baroness, to understand the longer workforce implications for the development of the plan. As I said, recommendations will be made in March, with a full implementation plan published later in the year. I did not say, “Soon.” I cannot give the House an exclusive this morning.

The hon. Gentleman also talked about Sir Mike Richards’s screening review. That will make initial recommendations by Easter this year and be finalised in the summer to, as it says in the plan,

“further improve the delivery of the screening programmes, increase uptake—

I know that the shadow Minister is concerned about that; I am too—

“and learn the lessons from the recent issues around breast and cervical screening, and modernise and expand diagnostic capacity.”

[Theresa Villiers (Chipping Barnet) (Con)]

Will the Minister give way?

[Steve Brine]

I will, but it will mean that other Members will not get a response.

[Theresa Villiers]

Does the Minister agree that a crucial part of success in early diagnosis is for both the NHS and local authorities, with their public health budgets, to have specific strategies to engage with minority ethnic communities to raise awareness of cancer symptoms, and to encourage them to take part in screening programmes? That is an essential part of an effective strategy to improve cancer treatment in this country.

[Steve Brine]

Yes. That is why the House gave all upper-tier local authorities the power to be effective public health authorities with ring-fenced public health budgets—£16 billion during this spending review period. Decisions will obviously be made about that going forward. One reason why we did that was our belief that, for example, my right hon. Friend’s borough will have different priorities and demographics from mine in Hampshire.

It is a statement of fact that I will clearly not be able to respond to every Member’s points in the short time that we have left. I will respond to everybody in writing, as I always assiduously do. I will try to take a few themes in the minutes that I have.

The hon. Members for Easington (Grahame Morris) and for Westmorland and Lonsdale (Tim Farron) touched on radiotherapy. I very much enjoyed our meeting, and I thank them again for their work. I will send the hon. Member for Easington a note with more detail on his point on tariffs, because I know that he and the hon. Member for Westmorland and Lonsdale are concerned about it.

The hon. Gentlemen also talked about the manifesto response. We await the publication of the new radiotherapy specification before we respond. It is an excellent piece of work that will address many of the recommendations made, and we expect it to be published very shortly. I am afraid to say that the long-term plan makes no commitment to a one-off investment. However, it commits to improving access to safer and more precise medicines, including advanced radiotherapy. That document is not the final word. It is a living document that I will work on while listening to all-party parliamentary groups such as their own.

The hon. Member for Westmorland and Lonsdale also talked about the radiotherapy review. There was a phenomenal response to NHS England’s consultation, not surprisingly—a lot of those were from the west country of England. The NHS will plough through that. I am putting great pressure on it to publish its report in response to that, which I am hoping, and am told, will be in early 2019.

The hon. Member for Central Ayrshire (Dr Whitford), otherwise known as the Member for the Irish sea a body of water, talked about prevention and smoking and child obesity and humour. I loved her reference to “poo in the post”. There is a great charity that talks about men’s bits called It’s in the Bag, which is good at promoting awareness of testicular cancer. She is right to talk about prevention. I am the Minister for Public Health and Primary Care, looking at prevention. The Secretary of State has made prevention one of his top three priorities, and she knows that it is key for me.

Smoking is still the biggest preventable killer in our country today, as I said in the House last night in the statutory instrument debate. We have published a world-leading plan on child obesity. We will consult very shortly. I try to be honest with the House at all times, and I hoped to get it out before Christmas, but there is an awful lot else going on and there is only so much I can get out the door at one time. However, I will get the 9 pm watershed consultation out the door. It is damned important that we do that. We said that we will, so we will.

The hon. Lady is absolutely right that prevention is better than cure, which is why the child obesity plan and Cancer Research UK’s work in that space has been very helpful.

[Mr George Howarth (in the Chair)]

I remind the Minister that he ought to leave a little bit of time for the mover of the motion to speak.

--- Later in debate ---

[Steve Brine]

Okay. I will have to close. There is a lot of ambition in the long-term plan, which some people have very kindly said I may have had something to do with. That may be so. However, that ambition is matched by finances, and finances need to be matched by people. We understand that, but it is also about the much wider, holistic approach to prevention, and about staff being part of that. We get that. I hope I have given some reassurances around the work that will be done on that. I will write to Members on the rest of the points raised. I thank everybody for their—as usual—incredible and passionate contributions.