Tobacco Control Plan

Steve Brine Excerpts

Thursday 19th July 2018 Commons Chamber

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

I beg to move,

That this House considered the Tobacco Control Plan.

Last year—how time flies!—in response to a question from my shadow on the Opposition Front Bench, the hon. Member for Washington and Sunderland West (Mrs Hodgson), I confirmed my intention to publish a tobacco control plan for England. I published it and then we debated its lofty ambitions in this House. Today, on its first birthday, I hope that we can reaffirm the importance of the plan and welcome the progress that has been made, while recognising—as I always do at the Dispatch Box—there is much more to do.

Last year we announced an ambition to reduce the prevalence of adult smokers from 15.5% to 12%, of pregnant smokers from 10.7% to 6%, and of 15-year-old smokers from 8% to 3%. We also pledged to reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. Furthermore, we set out a long-term goal of a smoke-free generation, reducing adult prevalence to below 5%. We were very clear, however, that now—then or now—is not the time for more legislation. I am still of that view because there is quite enough for us to do in this House.

The UK has some of the toughest tobacco control laws in the world, and we are consistently considered by independent experts to have the best tobacco control measures in the whole of Europe. The plan recognised that smoking in certain groups is stubbornly high, although masked by the overall declines in prevalence. To achieve our ambitions, we need to recognise that smoking is increasingly focused on particular groups in society, and in particular areas. We need to shift the emphasis from action at the national level—hence no need for more legislation—to focused local action in support of smokers.

Pregnant smokers are one critical group. People with mental illness are also much more likely to smoke: a little more than 40% of people with serious mental health conditions smoke, which is more than twice the national average. I repeat: smoking among those with mental health conditions is more than twice the national average. We need to work across the system, as we are, to ensure that everyone is making their full contribution to deliver for those groups.

Earlier this year I was fortunate enough to visit the Maudsley Hospital, which has done an awful lot of very good and fruitful work in this area. I place on record my thanks to the team at the Maudsley for their dedication and hard work. It was good to meet them—staff and patients—and to thank them in person.

When I talk about working across the system to ensure that everyone is making their full contribution, that is what we are doing. Last month we published the tobacco control delivery plan, which sets out detailed commitments made by various organisations in central Government and the arm’s length bodies to help deliver on our 66 recommendations. We will be tracking delivery of those commitments, and adding to them, as we move through the lifetime of the plan.

Let me touch on the work that is under way. The Prison Service is making the whole prison estate in England smoke free—no ifs, and definitely no butts. Do you see what I did there, Madam Deputy Speaker? This is a huge achievement, and I would like to pay tribute to the hard work that has made it possible. Her Majesty’s Revenue and Customs has supported the UK Government’s ratification of the protocol on illicit tobacco under the World Health Organisation’s framework convention on tobacco control. This new treaty aims to eliminate all forms of illicit trade in tobacco products throughout the supply chain. The protocol has now been ratified by the necessary 40 countries and is in force.

[Sir Kevin Barron (Rother Valley) (Lab)]

When the Health Committee looked at the issue of smoking in public places and took evidence from different institutions, the Prison Service felt at the time that it would be impossible for it ever to get to a situation in which it was smoke free. We should all look back and thank it for what it has done, which it told us years ago was impossible.

[Steve Brine]

I agree with the right hon. Gentleman. Those of us who have secure estates in our constituencies and go in and visit them regularly will be aware of just how much of a challenge this is, given how ingrained smoking is within the cohort. That relates to the point I made about specific groups. I think that the Prison Service deserves great credit. Suffice it to say that it has a lot of pressures on it, and in some ways it probably felt that this was the least of its worries and the last thing it could deal with, but it is actually very important. That is why I say we are working well across the Government, and the Prison Service is really pulling out the stops in its area. I thank him for that intervention.

To finish on the protocol, HMRC will continue to lead on it on behalf of the Government, working with my officials at the Department of Health and Social Care. Through the protocol, we are sharing our expertise as a leading tobacco control nation; this is not just about what we are doing domestically. We are funding the FCTC secretariat with £15 million over the spending review period to support tobacco control in 15 low and middle-income countries. I am very proud of that work, and I am pleased to say that we are already having an impact. Georgia introduced smoke-free legislation and a ban on advertising on 1 May. It seems strange to talk about banning advertising as a new measure, given how long a ban has been in place in our country, but it shows that other parts of the world have a long way to go to catch up. I am very proud that we are using our experience and our evidence-based experience to help countries such as Georgia to do so. I want to place on the record my congratulations to Georgia.

Domestically, Her Majesty’s Treasury continues to maintain high duty rates for tobacco products to make tobacco less affordable, which is absolutely right. Public Health England, for which I am responsible, and NHS England are working on a joint action plan to reduce smoking in pregnancy. A key part of this is helping midwives to identify women who smoke and help them to quit and to support the implementation of National Institute for Health and Care Excellence guidance on reducing smoking during pregnancy and immediately following childbirth.

PHE has been encouraging the use of e-cigarettes to help people quit. As part of this, the most recent Stoptober campaign for the first time highlighted the role of e-cigarettes in quitting. The best evidence suggests that e-cigarettes are helping thousands of people to quit and that they are particularly effective in the context of a smoking cessation clinic. PHE’s data website, “Local tobacco control profiles for England”—another snappy title I dreamed up—is helping local commissioners and service planners to identify where they are succeeding, where they face the greatest challenges and how they compare with their neighbours and the rest of England.

[Alex Cunningham (Stockton North) (Lab)]

I very much welcome the Minister’s comments in The Guardian newspaper this morning about the activities of one tobacco manufacturer that has been contacting or at least trying to ingratiate itself with NHS staff by helping them to quit smoking. Will he write to all trusts and clinical commissioning groups telling them that they should have nothing at all to do with this initiative?

[Steve Brine]

I already have and NHS England already has: we have already done so. We think that Philip Morris International’s move is totally inappropriate and totally contrary to the protocol. I do not think I could have been clearer either in the press or at the Dispatch Box today, and I thank the hon. Gentleman for giving me the chance to say so again.

All our local activity has the overall goal of helping people to quit smoking and stopping others starting in the first place, so how are we doing? Here is the score card. Publications by the Office for National Statistics and NHS Digital earlier this month show that we are making progress. Since 2011, the number of adult smokers has dropped by a fifth to the lowest level since records began, and we are fully on track to achieve our 2022 ambition for adults. Among 15-year-old smokers, there is good progress, and figures published last year showed that the prevalence of smoking has reduced by a further percentage point from 8% to 7% since the publication of the plan. The number of e-cigarette users in that group is also falling. Latest figures from the ONS annual population survey reveal that smoking rates among 18 to 25-year-olds are falling faster than in any other age group. Considering that that age is when most smokers start smoking, I am particularly pleased with that.

We are also making progress on inequality. Although routine and manual workers continue to have higher smoking rates compared with the rest of the population, the gap has narrowed slightly, from 26.5% at the publication of the plan to 25.7% as reported by the ONS earlier this month. Those are achievements to celebrate. Nevertheless, I must be honest with the House and say that progress on tackling smoking in pregnancy is disappointing, and in truth the figures have barely moved in the past year.

What shall we do in year 2 of the plan? First and foremost, I am determined to redouble our efforts to support pregnant smokers to quit. That will be best for them and for their babies, and we need people to understand that. Secondly, we will use the opportunity of the Government’s investment in the NHS, which the Prime Minister announced last month, to embed prevention and cessation more firmly into the culture of the NHS. Last month, the Royal College of Physicians, which has a proud record of groundbreaking reports on tobacco, published “Hiding in Plain Sight: Treating tobacco dependence in the NHS”. That weighty report calculated that the cost of current smokers needing in-patient care is £890 million a year. It points out that smokers are 36% more likely to be admitted to hospital at some point than non-smokers, and it makes the powerful argument that smoking cessation repays the cost from year 1. I welcome that report, and I will be making that case loud and clear as we engage with NHS England on the content of the 10-year plan that the Prime Minister has asked it to produce.

Thirdly, we will continue to engage with local authorities —they are now top-tier public health authorities up and down the land in England—on promoting smoking cessation as the best evidence-based means of quitting smoking. Encouraging the NHS to do more on cessation is emphatically not about removing responsibilities from local authorities. This is about creating a whole-system approach in which addicted smokers can access the support they need to quit. Public Health England will continue to provide local councils up and down the land with facts and advice on tackling smoking—for example, it will work with sustainability and transformation partnerships, which should be leading that whole-system approach in the constituencies of all English Members.

Fourthly, as I have mentioned, we will continue to raise tobacco duty to make tobacco less affordable, while also taking action to tackle the illicit trade in tobacco. Fifthly, we will maintain a careful watch on so-called novel tobacco products. The Government are keen to use the opportunity of newer products, such as e-cigarettes, to help smokers to quit, without undermining the key message that the best thing someone can do for their health is quit completely. As I said in the Science and Technology Committee’s inquiry into this subject, we will continue to keep the harms of products such as heated tobacco products under review and continue to hold the industry to account. We have been explicit that the promotion of tobacco products is unlawful, as my recent letter to Philip Morris International makes abundantly clear—that letter was written before the one I mentioned in response to the hon. Member for Stockton North (Alex Cunningham).

Last but not least, we will continue to make the case for tobacco control internationally, building on our reputation as a leading tobacco control nation with credibility in that space. We have such credibility because our consistent work in this area goes back to the coalition Government, the previous Labour Government and the Conservative Government before them, and such consistency means that we are highly credible around the world. More than 7 million people a year across the globe die from smoking-related disease, and the UK Government can help make a dent in that toll by sharing knowledge and skills.

[Bob Blackman (Harrow East) (Con)]

I pay tribute to the Minister’s brilliant work both since he became a Health Minister and before then. Will he comment on some of the scientific issues raised about addiction to nicotine, compared with the very harmful by-products that are a part of cigarettes, cigars and other tobacco products? Will he comment on whether it is nicotine or the by-products that are harming people’s health and causing the most damage?

[Steve Brine]

I think cigarettes cause the most damage, because of the tobacco and the nicotine. The carcinogenic properties of the former are lethal. That link was proven with the lung cancer study that started the ball rolling. I pay tribute to my hon. Friend as the chair of the all-party group for the work he has done in this area. There are a lot of things that we know and there are a lot of things that we still do not know. Some people say that I do not go far enough to promote e-cigarettes and novel products, and some people say that maybe we go too far—I mentioned Stoptober. That generally suggests to me that we are in the right place. What I would say—I think that I said it earlier—is that an awful lot of research is still needed on e-cigarettes. One Member once told me that we should make e-cigarettes free on prescription to all pregnant women. The reason I did not say, “Yes, I think that’s a good idea” is that I still think there are risks to that product. I still think that the best thing people can do is to stop chuffing on anything, whether traditional cigarettes or so-called novel products. I thank him for his intervention, and I look forward to hearing what he has to say during the debate.

[Alex Cunningham]

I thank the Minister for giving way a second time. I join the tributes to both the Minister and the chair of the all-party group. There has been tremendous cross-party work on this issue—that has always been the case. The Minister mentions the role local authorities have to play. We all know the pressure they have been under in recent times. I wonder whether he could see a mechanism that would provide and ring-fence the funds to enable local authorities to fulfil their role. Currently, they are struggling to do so.

[Steve Brine]

I thank the hon. Gentleman for that intervention. On providing support to help smokers quit, as I said, we have moved from the national context of legislative work to local application. The challenge is that adult smoking rates vary considerably across the country—for example, they are 8% in Wokingham and 23% in Kingston upon Hull—so it is right that local councils have the flexibility to spend that money. There is some £16 billion in the ring-fenced public health grant during the spending review period, so there is a lot of money in the system. But am I happy with patchy services in areas where smoking rates are too high? No, I am not. That is why I have said that the Government have not made a decision on full business rate retention. I would be concerned about the impact that that might have. I would want all sorts of reassurances from local councils if I were to make that change. Do I think it right that local authorities can design services for their local area? Yes, I do.

The new Secretary of State and I have already discussed prevention, which is one of the three main pillars he wants to focus on. I have told him that the new investment of £20 billion that we are putting into the NHS is fantastic. Bluntly, we could have the money on the side of the bus three or four times over, but unless we get serious about prevention, in this space as much as any other, the NHS will continue to be under enormous pressure. Local authorities are a key partner for us.

I would also say, not least because the chair of the all-party group on community pharmacy is sitting behind the hon. Gentleman, that community pharmacists and pharmacies have a key role to play. They are an NHS centre on street corners up and down our land. Some of them provide really good work. The healthy living pharmacies I have seen help people to access the services they need. They provide a little bit of mentoring and support, using their experience to say, “Yes, you can beat this,” and signposting them to services, whether through the public sector or the third sector.

There is an awful lot that we can still do. That is why the 10-year plan will have prevention embedded at its heart, as the five year forward view said it would—and it did, but I do not think that it lived up enough to the ambition on that. Perhaps people would expect the Minister responsible for prevention to say that, but I am nothing if not consistent.

Tobacco remains the single biggest avoidable killer in our country today, causing a third of preventable cancers. It contributes to around half of health inequalities between rich and poor in our society and is a potent symbol of the burning injustices that the Prime Minister spoke about, which I think affect the life chances of poorer people up and down our land. The tobacco control plan represents the Government’s continuing commitment to tackling this epidemic. It was never presented as a panacea and it is still not a panacea, but it is a cracking good start.

Over the past year, we have seen some impressive progress, but I am absolutely not complacent. In World cup terms, I would suggest that we have made it through to the knockout stages, but nothing more. I hope to be able to demonstrate further progress in a year’s time, and no doubt we will discuss that again in the House. I look forward to hearing hon. Members’ contributions, and I am happy to introduce this important debate.

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

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

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

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

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

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

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

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

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

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

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

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

[Steve Brine]

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

[Mrs Hodgson]

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

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

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

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

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

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

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

--- Later in debate ---

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson), who has done excellent work already in her shadowing role. I know that she was also at the forefront of this debate before shadowing these matters. Equally, I pay tribute once again to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), who set a precedent for future public health Ministers when, at his first outing at the Dispatch Box, he agreed to publish the long-awaited tobacco control plan. We should remember that it had been delayed for a year before it was published last year at the behest of my hon. Friend, probably much to the consternation of his officials.

I also want to pay tribute to the Minister’s predecessors, particularly the former Member for Battersea, Jane Ellison, who did a brilliant job of advancing many of the controls on tobacco that we now have in such a way as to ensure that they were delivered. I remember taking on the first debate on this subject in Westminster Hall, at which many of my colleagues were present. I think it was in September 2013, and it was the first debate after we came back from the summer recess. It took place at 9.30 in the morning, and I feared that I would have an hour and a half to fill by explaining why we should have standardised packaging for tobacco products. I have to say that both major parties were opposed to that idea at the time, but we were able to convince them otherwise and we changed the policy. That measure has now been enacted, which demonstrates the power that we on the Back Benches can have to change policy in a good way.

I must gently chide the Government, however, for taking over our Back-Bench debate. This means that we cannot pass the resolution that we wanted to pass today to encourage the Government not only to adopt smoking cessation policies but to resource them properly, to ensure that the plan is delivered. We understand that we are now having this general debate, however.

I declare my interest as chair of the all-party parliamentary group on smoking and health. We could go through the history of the progress that has been made, and the speeches from the Front Benches have shown us where we are today. I want to take us back to 1974, when I was sitting my A-levels. My late parents were both very heavy smokers. In those days, half the men in this country smoked, as did more than 40% of the women. It is hard to imagine, but in many ways it was considered healthy to smoke; it was somehow considered to be good for our lungs. Sadly, both my parents died five years later of cancer, so for me this is not only a health issue but a personal one. I do not want to see other people going through what my family had to go through as a result of using tobacco products in the way that they are intended to be used.

Smoking rates have dropped remarkably. As has been mentioned, the number of adult smokers has dropped from 7.7 million in 2011 to 6.1 million in 2017. The difficulty with figures, however, is that, as the population increases, we have to go harder and further to reduce the number of people smoking. Smoking-related diseases are the leading cause of preventable death, with 80,000 people a year dying as a result of tobacco products. In Harrow, part of which I have the honour of representing, we still have 14,000 smokers, which is difficult to understand given the encouragement to quit and all the health issues, and the cost to public services is estimated to be £37.9 million a year in just one London borough, out of 32, that has about 250,000 adults. It is clear that we need further action.

The good news is that the UK is one of the leading countries in the implementation of tobacco control policies. We are recognised as a leader in the implementation of the World Health Organisation’s framework convention on tobacco control, and I want to remind the House of article 5.3, which states:

“In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”

The guidelines on implementing article 5.3 have been agreed by the UK and advise Governments not to enter into any partnerships, whether they be non-binding or non-enforceable, or agreements with the tobacco industry, not to accept voluntary contributions from the tobacco industry, not to accept tobacco-industry-drafted legislation or policy or voluntary codes for legally enforceable measures, not to participate in corporate social responsibility or related schemes funded by the tobacco industry, and not to permit tobacco industry representation on Government tobacco control bodies.

Former MP Paul Burstow, my predecessor as chair of the all-party parliamentary group on smoking and health, is now the chair of the Tavistock and Portman NHS Foundation Trust and co-chair of the Mental Health and Smoking Partnership. He wrote to the Minister about the letter sent by Philip Morris International, and I am pleased that the Minister has taken up the issue straight away. The company, which manufactures Marlboro cigarettes, wrote to say that it is

“keen to work with NHS Trusts and Foundations to see if we can support the NHS in helping its employees to stop smoking”.

I do not usually promote this publication, but an article in The Guardian today quotes me, Paul Burstow and the Minister making it clear that we do not want any interference from Philip Morris and that that company should not avoid its responsibilities under the code. I am delighted that the Minister has completely rejected the position of Philip Morris, which also states that it has

“written to the heads of all the NHS Foundations and Trusts in England, all Clinical Commissioning Groups, Simon Stevens, and the Secretary of State for Health and Social Care”

about the issue.

Most local authorities in England have signed up to the local government declaration on tobacco control, which is a public statement of the councils’ commitment to reduce the harm caused by tobacco. The declaration commits signatories to

“protect our tobacco control work from the commercial and vested interests of the tobacco industry by not accepting any partnerships”

and so on. However, local government officers have reported continuing efforts by the tobacco industry to engage with local authorities over tobacco control issues including, but not limited to, the illicit trade. We must be clear that the industry’s involvement is not required and not welcome.

I am delighted that, on 1 November 2017, the Minister made a clear statement in this House on the Government’s position, and I am delighted that will continue. I welcome his comments, both in his opening speech and in his letter. What else can he do to make sure that local authorities, the NHS and any other interested parties do not get sucked into this offer from Philip Morris?

On the risks we run, as the hon. Member for Washington and Sunderland West said, one of the problems is that the plan and the targets might not be met. We have to encourage everyone to get to that point. The reality is that smoking rates among young people have started to level out. There is a risk that we will not hit those targets. The target to get smoking rates down to 5% or less by 2022 is good, but I would like to see it at 0%—no one smoking. We could then say that we have achieved what we wished to achieve.

We clearly have to encourage young people not to start smoking. As has been said, more than 350 young people a day take up smoking, and 60% of them go on to smoke for the rest of their life. The huge risk is that those people will fuel the tobacco industry for the future.

There is therefore a case for further control measures, including increased funding for the initiatives, and new legislation. Although it is not appropriate to allow the tobacco manufacturers to make voluntary contributions, if they are offering to give money to the NHS and to local authorities as part of so-called corporate social responsibility, the industry clearly has money to pay for the measures we need to control tobacco and to mitigate the harm it causes, so let us make the tobacco manufacturers pay.

At a time when public sector budgets are under pressure both at national and local level, the tobacco manufacturers, if they have money, should pay an increasing share of the cost of control, as an application of the “polluter pays” principle. That is the clear recommendation of the all-party parliamentary group, and I trust my hon. Friend the Minister will therefore advance that recommendation to the Chancellor.

[Steve Brine]

Consider it advanced. Time will be limited for the wind-ups, so I will address the point about young people. Earlier this week, I held a roundtable in the Department of Health with a number of charities working on drug policy and with reformed drug takers. One gentleman said to me, “The trouble was that I really enjoyed taking drugs. What I didn’t enjoy was the outcome of taking drugs.”

I have heard young people say that they really enjoy smoking but that they do not enjoy the outcome. We should welcome today’s statement by the Secretary of State for Education on the new work that will be done in schools on health and relationships education. Specifically, health education can help young people to understand the health consequences of smoking, even if they might enjoy the process of smoking.

[Bob Blackman]

I thank my hon. Friend for his intervention, and I completely agree that health education is an appropriate way to consider the issue.

There is a model in the United States that we could introduce. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the US Food and Drug Administration the power to regulate the tobacco industry, funded through what is called a user fee on manufacturers. The total amount to be raised is set out in legislation and apportioned to manufacturers on the basis of their share of the US tobacco product market. I ask the Minister to look at that US legislation as a way of introducing such a model.

The major recurring costs of tobacco control, and they are important, are mass media campaigns to discourage uptake and to encourage quitting. An approach such as the one in the US would: raise hundreds of millions of pounds a year from the tobacco industry; help to protect the business of legitimate retailers who obey the tobacco control legislation; help to protect Government tax revenues—at the moment, the excise tax raised £9.9 billion in 2016-17, but the loss on illicit tobacco was estimated to be £2.4 billion; pay for the mass media campaigns to discourage smoking, which we desperately need; and provide a source of revenue to local authorities, which could help to fund local tobacco control measures, including enforcement activity and the provision of support to smokers seeking to quit. Funding for trading standards has fallen substantially in recent years, from £213 million in 2010 to only £124 million in 2016, and the National Audit Office estimates that the number of full-time staff has reduced by 56% in seven years. So there are fewer people to enforce the rules that we want to see enforced. Such an approach could also support regional partnerships working to tackle illicit tobacco. The success of that has been shown in the north-east and north-west, which have concerted multi-agency enforcement activity and effective, evidence-based measures to reduce demand. So it is clear that we can deliver on this.

Polling conducted for ASH—Action on Smoking and Health—asked respondents how strongly they would support measures requiring tobacco manufacturers to pay a levy or licence fee to help encourage people to quit and prevent young people from starting to smoke. The net support for that was 71%, with only 9% opposing. So the Minister should impress on the Chancellor the need for this and the benefit of doing it.

One key issue that I wish to emphasise above all else is the need for mass media campaigns to shock people into realising how desperate smoking is and how damaging it is to health. There is nothing like seeing those sorts of mass campaigns for encouraging people to realise that they are responsible for their health. The analysis of these campaigns has shown that they are very effective but that they have declined in recent years. Public spending on such campaigns in the UK peaked in 2008-09 at £23.38 million, but now that has fallen dramatically, to only £1.5 million in 2016-17. Clearly, we need to encourage local authorities and the Department of Health and Social Care to use the opportunity to shock people so that they understand the damage they are doing. I therefore ask the Minister to look at mass media campaigns and ensure that they are used as part of the strategy.

Finally, let me say that my area now has a large number of people from the European Union who have chosen to come here to live in this country. If we go to many eastern European countries, we see people smoking everywhere; these places do not have the tobacco control that we have in this country. Those people need to be reached to encourage them to give up smoking and ensure they look after their own health. It is those people we have to reach out to fully. I look forward to other contributions from right hon. and hon. Members, and I am sure that the Minister will reply in suitable fashion.

--- Later in debate ---

[Steve Brine]

With the leave of the House, I will also respond to the debate, Mr Deputy Speaker. I am aware that I am standing in the middle of the A14—almost literally—which is tonight’s Adjournment debate, but I will respond to the points that have been raised in this short and small but perfectly formed debate.

The shadow Minister—my good friend, the hon. Member for Washington and Sunderland West (Mrs Hodgson)—rightly mentioned the issue of pregnant women and smoking, to which I referred in my opening remarks. Public Health England and NHS England are working on a joint strategy at the moment, setting out recommendations for how local areas can work together to achieve our ambition on smoking in pregnancy. In a way, I guess that is given a greater impetus in the light of the flatlining figures—I suppose that is the accurate way of putting it. This work is part of the maternity transformation programme, which started in 2016 and which I know she is aware of. Public Health England will look at how its mass media campaign can more effectively reach young people, especially working-class women of reproductive age and their families and friends. I wanted to put that on the record.

The hon. Lady returned to the subject of smoking services. I repeat what I said during the debate: there are varying rates across the country, so it is right that local councils have the flexibility to respond. I will touch on the point that the right hon. Member for Rother Valley (Sir Kevin Barron) mentioned about this being all the responsibility of local authorities. There is a third way, he will pleased to know, as a Blairite—that has finished his career, I apologise. I put on record again that councils will receive £16 billion of the public health funding until the next spending review, when the spending plans will be announced. We expect them to use it wisely.

My hon. Friend the Member for Harrow East (Bob Blackman) talked about the Back-Bench debate and the general debate. I will leave that matter for the usual channels, but the important thing is that we are having the debate, which is very welcome.

The shadow Minister spoke about smoking cessation training and those services. The success of our plan hinges on all manner of professionals offering help that works, which is why effective training on supporting smokers to quit is central to the tobacco control plan—from doctors and nurses in the NHS to physiotherapists in the community, to pharmacists, who I have mentioned, and to the health professionals who need to equip smokers with the capability, opportunity and motivation to quit for good. It often involves very brief advice and there is a lot of online training out there. Twenty minutes or so of online training can teach a professional how to have a short conversation with somebody with a smoking challenge, with proven results. I wanted to put that on record.

My hon. Friend the Member for Harrow East mentioned Philip Morris International and its kind proposal to help NHS trusts, which has been in the newspapers today. I thought I would place on record for the House that what it talked about in its offer to trusts was “operating a scheme that allows employees who do not quit to trial one of our range of smoke-free alternatives”. We have to give them 10 out of 10 for effort, but it is totally inappropriate and that is why we have written to all trusts to make it clear.

I understand my hon. Friend’s Budget 2018 proposal for the Chancellor of the Exchequer on the need for the money in respect of the polluter pays principle. I know that the Chancellor will have heard that. My hon. Friend talked about the need for hard-hitting campaigns. We do have them, of course, and they are an essential part of tobacco control. In England for several years now, we have sought the balance between hope and harm. Every January, we have the Health Harms campaign and in the autumn, we have our more upbeat Stoptober campaign, and 2018 will be no exception.

The hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the SNP, talked about the illicit tobacco trade protocol, and I thank him for putting on record that we indeed ratified the protocol on 27 June to eliminate the illicit trade in protocols. The first meeting of the members of the protocol will be in Geneva from 8 to 10 October.

The hon. Gentleman talked about track and trace. The tobacco products directive contains a commitment for member states to provide the track and trace system by May 2019 for cigarettes and roll-your-own tobacco. The European Union has published draft recommendations on the track and trace proposals, and we voted in favour of implementing the regulations. I would say that the EU measures go beyond the requirements of the framework convention on tobacco control, but many of its benefits arise from the exchange of information between nations, so it seemed sensible to us for the UK to align with the EU after exit in this respect.

Both the hon. Member for Stockton North (Alex Cunningham) and the hon. Member for Linlithgow and East Falkirk talked about smoking and the media. The Government do not interfere in editorial decisions. I think it right that content makers decide what to include in their programmes, provided that they comply with the broadcasting code, and I ask them to take their responsibility seriously. Obviously, as Members have said, they are regulated by Ofcom. Last month, it published a note to broadcasters reminding them of the rules in this area, and advising them on the depiction of branding and health warnings. The last time Ofcom found a breach of the broadcasting code related to smoking was in 2015, so I think that broadcasters take the code seriously.

Many Members mentioned the British Board of film Classification, which I know well and which is a well-managed organisation. Its guidelines were last updated four years ago, in 2014. Consultation on the new guidelines began late last year, and they are expected to be published early in 2019.

There was a lot of talk about e-cigarettes, which were partly dealt with at the beginning of the debate. Public Health England will update its evidence report on e-cigarettes and other novel nicotine delivery systems annually until the end of the current Parliament in 2022, and we will include that in our “quit smoking” campaign messages about the relative—I underline “relative”, if Hansard can underline—safety of e-cigarettes. I enjoyed the comparison that the right hon. Member for Rother Valley made with Ireland: I thank him for that.

The right hon. Gentleman also said that not everything could be done by local authorities. We have not said that it should. I have made it very clear to Public Health England that where we have more work to do is where they should target their help and support, but there is also a new grant to support the tobacco control plan. The Government have launched a competitive scheme whereby organisations can apply to undertake work to support the plan’s ambitions. The grant is £140,000 a year for three years, from 2018-19: a total of £420,000 is available. Applications are currently being assessed, and we will contact the successful applicants in the autumn. I will find out some more details and send them to the all-party group.

The hon. Member for Strangford (Jim Shannon)—as always!—asked whether we would introduce vaping areas in hospitals. Public Health England advises that the smoking of e-cigarettes should not be routinely treated in the same way as smoking tobacco, but it is true that it is for NHS trusts to make their own policies. Some, including the Maudsley, have designated areas both indoors and outdoors.

[Alex Cunningham]

Will the Minister give way?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

It is up to the Minister. He said that he wanted to speak for only one minute.

[Steve Brine]

I will give way.

[Alex Cunningham]

The Minister has 12 minutes left.

--- Later in debate ---

[Alex Cunningham]

Let me tease the Minister on three matters. One, what are we going to do about the “tab houses”? Two, what is his position on cigarette pack inserts? Three, what is he doing to do about the fact that mass media campaign funding has been cut by 90% in the last 10 years? We need that funding in order to be effective.

[Steve Brine]

I will write to the hon. Gentleman about his first two points. As for the mass media point, the hard-hitting campaigns that we conduct through the mass media are incredibly powerful. Last year’s campaign showed a gentleman rolling a cigarette with roll-your-own tobacco made of blood and gore. That was very hard-hitting, and it had an incredibly good response mechanism when we tested it and when we rolled it out. In this year’s campaign, “between hope and harm”, I think the hon. Gentleman will see a good balance of that mass media campaign that he talked about.

I realise that that was more than a minute, Mr Deputy Speaker. There is so much to say about this subject! It is so exciting.

Let me end by reaffirming the Government’s commitment. What everyone has said today has been very kind. Yes, I am committed to this subject, but ultimately we will be judged on our record. We are committed to making further sharp reductions in smoking prevalence, not so that we can meet the ambitions of the plan, although that is all very nice, but so that we can make a difference to people’s lives, because as the right hon. Member for Rother Valley said, if our constituents were dying in these numbers in road accidents we would be calling for crossings.

We want to make the smoke-free generation a reality to help people’s lives and to make a difference. Tobacco control is a key priority for us, and it will be a key priority for the 10-year plan that the Secretary of State and I will be working on with NHS England. I was interested to hear the comments of Simon Stevens at the Select Committee, and I agree with Simon, not for the first time.

I thank all Members who have spoken for their contributions—and it is amazing how far a minute can go, Mr Deputy Speaker.

Question put and agreed to.

Resolved,

That this House has considered the Tobacco Control Plan.

Use of Chamber (Women MPs of the World Conference)

Resolved,

That this House welcomes the events organised to celebrate women’s suffrage and to mark the centenary of the Representation of the People Act 1918; recognises that the Women MPs of the World Conference provides a unique opportunity to gather parliamentarians from across the world to engage in discussions about equal representation and bring about social change; and accordingly resolves that parliamentarians who are delegates participating in the Women MPs of the World Conference should be allowed to hold a debate in the Chamber of this House on a day in November other than a day on which this House is sitting or a day on which the UK Youth Parliament is making use of the Chamber.—(Mims Davies.)

Access to Orkambi

Steve Brine Excerpts

Tuesday 17th July 2018 Commons Chamber

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

I say from the outset that there are 22 people in the Chamber for this Adjournment debate. Normally, it is me, the proposer of the debate and the hon. Member for Strangford (Jim Shannon). I say to the hon. Member for Bury South (Mr Lewis) that it is nice for other people to be here with us. I will say at the start that I will not take any interventions. A lot of Members have come to listen to this debate, and they want to hear the Minister. There are things that I as the Minister need to put on the record, and I am going to put them on the record before we finish at 8.5 pm.

I thank the hon. Gentleman for securing this debate and for giving me the opportunity to speak once more on an important issue that matters to me and my constituents as much as it does to his. May I again place on the record the sterling work undertaken by the Cystic Fibrosis Trust? Its support for cutting-edge research, campaigns to drive up standards of care and support for the CF community is fabulous. We are lucky to have it.

Once more, we have heard hon. Members make compassionate—that is a very good word—pleas urging an immediate resolution in the ongoing discussions between NHS England and Vertex to make Orkambi available on the NHS in England. To the hon. Member for North Down (Lady Hermon), who raised this in an intervention, I say that, absolutely, I will make sure my officials are talking to the permanent secretary—the very hard-working and probably overworked permanent secretary—at Stormont, because we need to make sure we have a joined-up approach. I wholeheartedly agree with everyone’s calls for exactly that: every effort must be made to ensure that precision medicines are made widely available to cystic fibrosis patients.

Many people have raised concerns this evening and in many other places about NICE’s process for the assessment of drugs for rarer diseases. I said this in the last debate in Westminster Hall and I will say it again: it is a key commitment of this Government to ensure that people with comparatively rarer conditions, such as CF, get the same quality, safety and efficacy in medicines as those who have more common conditions. I assure the House that where a company is willing to set a fair price for a drug, NICE’s technology appraisal process has been proven to be suitable for the assessment of drugs for rare diseases.

[James Frith]

Will the Minister give way?

[Steve Brine]

I said I would not give way, and I will not do so.

I thought the hon. Member for Bury South made a good point when he said if NICE did not exist, we would have to invent it. I agree. Indeed, NICE has been able to recommend a number of drugs for patients with rare diseases through its technology appraisal process, including pirfenidone for pulmonary fibrosis and mifamurtide—why they cannot produce easier names, I will never know—for a rare form of bone cancer, to name but two.

I know that it is distressing, to put it mildly, for patients and their families, as well as campaigners, when NICE is not able to recommend a treatment. Unfortunately, there will continue to be occasions when NICE is not able to a recommend one for routine use on the NHS. As we know, NICE has not so far been able to recommend the use of Orkambi for treating CF, because the benefits were not sufficient to justify its considerable cost. At list price, the cost per quality-adjusted life year of Orkambi is many times higher than the upper end of the threshold used by NICE in deciding whether to recommend a treatment. NICE does not stick rigidly to a cost per QALY threshold, and it applies plenty of flexibility in deciding whether to recommend treatments where the decision is a borderline one. However, it must be stressed that the cost per QALY is not an arbitrary measure, but a tool to assess what the impact would be on other NHS patients if the NHS were to spend money on a particular treatment.

I want to talk about the discussions with Vertex. As Members know, NHS England has been in intensive discussions with Vertex to encourage it to lower the cost of Orkambi to a level that would allow NHS England to fund its use without adversely impacting other patients. I and the Under-Secretary of State Health, Lord O’Shaughnessy, who sits in the other place—he leads on this area for us—have been keeping an extremely close eye on these discussion, as I promised the House in the Westminster Hall debate I would do. As Members will remember, we wrote to Vertex in April, urging it to commit to pricing that is responsible and proportionate. I have the personal assurance from NHS England that it is committed to seeking a way forward in these negotiations, and I think it has shown flexibility.

Sadly—I am not ratcheting up the rhetoric or name-calling, as this is just fact—Vertex has been unwilling to price responsibly thus far, which has, as we have heard today, meant that patients have missed out on two years of treatment. Vertex claims that it has made the NHS

“the best offer in the world”—

but it has yet to substantiate that claim. I would challenge Vertex to waive confidentiality—which it can do: I cannot—so that we can all see, in the interests of transparency, the kind of prices it is trying to charge the NHS and, as a result, our constituents.

As mentioned this evening by the hon. Member for Bury South, NHS England wrote to Vertex yesterday to set out a proposed five-year deal with an option to extend, which provides the potential for Vertex to secure revenues from the NHS in the region of £500 million over the next five years. NHS England has made the content of this proposal public, to give patients and taxpayers the opportunity to make a judgment about the fairness of this offer. The proposed deal, if accepted, would guarantee immediate and expanded access, as clinically appropriate, to the two licensed medicines, Orkambi and Kalydeco—as was said earlier, Orkambi is not the only show in town. It would also provide immediate access for Symdeco from the date it is licensed for use in the UK, which is expected in coming weeks.

If Vertex is not willing to accept the deal, it must return to discussions with NICE and go through that process. Let me be clear that I truly hope it does not come to that, but until Vertex adjusts its prices, NICE will not be able to recommend the drug’s use. I repeat that we have put a figure on the table. The ball is in Vertex’s court. It has made a preliminary response today, saying that it is good to see that NHS England is negotiating. NHS England has been negotiating throughout. It is not Ministers who are negotiating on this.

[Mr Ivan Lewis]

rose—

[Steve Brine]

I will break my rule and give way to the hon. Gentleman who secured the debate.

[Mr Lewis]

That is kind of the Minister and I thank him for his serious response to the debate.

We said the last time we met that we did not want Ministers to keep an eye on the issue: we wanted Ministers to be actively engaged in it. The Minister gave us an assurance that his colleague would be actively engaged, not keeping an eye on it. Today, we repeat that we do not want NHS England and the drug company left in a room alone to work this out, otherwise we will be back here in six months’ time. We expect the Secretary of State to be in the room with the chief executive of NHS England and the drug company to bang heads together and come up with a satisfactory conclusion. Will the Minister respond directly to that point and give us an assurance that there will be political involvement and engagement in the negotiations, because we have waited for too long?

[Steve Brine]

When I say “keeping an eye”, I do not mean it like keeping an eye on the football scores on a Saturday afternoon. It is just my turn of phrase. Ministers are keeping very close tabs on this and making sure that NHS England is in no doubt that we want it to come to a conclusion with Vertex. But it takes two to tango, as we are seeing in another negotiation right now. We need Vertex to tango. The ball is in its court, and it is time to return it.

I stand by what I said at the last debate: it is vital that we go through the right process here. There is a process. I do not think for one minute that the Opposition are suggesting that if they were in government, Ministers would be making these decisions like Roman emperors, as that would be totally wrong. It is an important principle that the NHS must ensure that healthcare services get the best value for patients, and that is the approach NHS England is rightly taking.

NHS England has proven that it can strike innovative deals, working with the life sciences sector to make treatments available for patients, while securing fair value for taxpayers—our constituents. That includes hundreds of patients with multiple sclerosis who now benefit from a treatment called cladribine and the use of pertuzumab for breast cancer. It is important for me to be clear with hon. Members that Ministers should not make a decision on behalf of NHS England, which has the clinical expertise and the powers to purchase medicines.

I put it on record again that I urge Vertex to accept the proposal presented by NHS England, or it will only make those living with cystic fibrosis suffer. Yes, of course there are discussions among the new ministerial team. I spoke to the new Secretary of State just this evening in the Lobby. He is taking an incredibly close interest in this issue, less than a week into the job, and I pay tribute to him for that. I ask Vertex to recognise NHS England’s flexible approach. It would represent the largest ever financial commitment of its type in the 70-year history of the NHS. I certainly hope that they can reach a deal. Many, including in my own Winchester constituency, are counting on them.

Question put and agreed to.

Universal Health Coverage

Steve Brine Excerpts

Thursday 5th July 2018 Westminster Hall

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

I am sorry for my musical chairs during the debate, Mr McCabe, but I could not hear everyone from the end of the Chamber—I think it is my age and the heat. I thank the hon. Member for Strangford (Jim Shannon) for, as always, an interesting speech. I congratulate him, especially today—birthday day—on securing the debate in his residence of Westminster Hall. He mentioned that he might still be here in 2050—I would almost hazard a wager with the hon. Gentleman about that one, but I hope we shall all still be here.

Was not 5 July 1948 a pivotal day for our country, with the inauguration of healthcare free at the point of use for all our citizens? Seven decades later, the NHS remains one of our nation’s most loved institutions. The NHS is often described as the closest thing we have to a national religion, and this lunchtime a service in Westminster Abbey proved the point. The NHS is one of our country’s crowning achievements, possibly the crowning achievement—along with the English football team, of course—and it is the envy of people across the globe. When I travel around the world in this job, people are fascinated by and envious of the NHS in equal measure.

As has been said by my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and everyone else who has spoken today, the NHS is of course nothing without its fantastic staff, who show such a level of Christian compassion—some without even knowing it—day in, day out. More than 1.5 million people work each day to provide the best possible care for our constituents.

The questions that the hon. Member for Strangford asked are important. We are the proud owners of an excellent universal healthcare system, albeit one we continually strive to strengthen, as we must—the best friends are prepared to criticise, and the NHS is not above criticism in our struggle to make it better—but he asked what we are doing to share our experiences. I shall certainly be able to cover that point.

The health of UK citizens is not dependent only on action in the UK. Diseases do not respect borders, and we need to act internationally to protect ourselves as well as to help others. Not only is that relevant when an outbreak hits—recently we had an Ebola outbreak, which I have monitored closely—but we must keep working with other nations to strengthen their capacity to prevent, detect and respond to diseases. UHC is critical to that. Threats such as that of antimicrobial resistance, which the hon. Gentleman mentioned in his opening remarks, can be tackled only through global action.

There is much that we can learn from each other. The NHS has evolved a huge amount since the late 1940s, and the next 70 years will require ongoing adaptation and innovation as we deal with the challenges of 1 million more over-70s—the ageing population—and further reap the rewards of scientific advancements, which have been so central to the NHS in its first 70 years. Other countries develop innovative approaches that we may not yet have considered—it is not all about the great empire of Britain, telling the rest of the world how things shall be—and there are plenty of challenges that no one has yet cracked. We should work together, and we do. It is right that we support others who have not yet achieved universal health coverage to do so, including by sharing our experiences.

We are committed to delivering the sustainable development goals, which the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) mentioned, including SDG 3. That is crucial to tackling many other health challenges, including the improvement of maternal, newborn and child health, as he said, and specific diseases such as TB, HIV, malaria and—everyone rightly mentioned this—pneumonia, the single largest infectious cause of death in children worldwide.

Universal health coverage is a goal, not a blueprint. Country needs, plans and perspectives are central to our work, and we have no interest in imposing an NHS model. It is crucial for each country to find its own path to UHC, which may entail greater private sector involvement, if that is what the country wishes, or a national health insurance scheme if that is what the politicians are brave enough to do. That is not our choice, but it is the choice in some parts of the world. We cannot just go with our judgment in trying to help other countries achieve universal health coverage.

Poorer, marginalised populations must achieve better access to good-quality essential services without the risk of financial hardship, as we choose in our NHS. Support for UHC must also involve helping countries to achieve sustainable funding mechanisms for their system, whichever they choose. The countries in greatest need deserve our financial support, but the ultimate goal must remain to transition to domestic funding, so that countries can maintain health systems in the long term.

The UK engages on UHC in a number of international forums. We strongly support the World Health Organisation’s focus on UHC through its new general programme of work, and we provide funding through a number of DFID programmes. We engage on this topic at governing body meetings and our annual UK-WHO strategic dialogue. I have a good, open and direct relationship with the head of the WHO, as part of my responsibility for international health at the Department of Health and Social Care. Underpinning the WHO’s success is a strong and effective organisation, and the UK continues to promote reform of the WHO so that it is the best it can be. As the second largest donor to the WHO, we are in a very strong position in that regard.

We promote UHC as a priority in other forums such as the G20 and the G7; I attended the G7 Health Ministers meeting last year in Milan. We were pleased to see strong commitments on health in the recent Commonwealth Heads of Government meeting, including on eye care, which I am passionate about. We will continue to follow up with the Commonwealth secretariat on the implementation of everything that was agreed in London. The high-level meeting on UHC at the UN General Assembly in 2019 will be an important opportunity to share experiences and to drive greater collective action. I will pass on the hon. Gentleman’s request, which I agree with, for us to use our chairmanship of the Commonwealth to further the UHC agenda that we all believe is so important.

My Department has rightly taken on a global leadership role on patient safety, along with our German and Japanese counterparts, to whom I spoke directly at the G7 Health Ministers meeting last year. Hon. Members will know that patient safety is the central mission of the Secretary of State. It is crucial to universal healthcare—as the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East rightly says, the aim cannot just be universal healthcare but must be good-quality and safe universal healthcare. Providing access but not quality care is not truly delivering on the sustainable development goals. We hosted the first global ministerial summit on patient safety in 2016, bringing together political leaders and experts to galvanise action on this crucial issue. Subsequent summits in Germany and Japan have continued that legacy.

Another key but often overlooked facet of universal health coverage is addressing mental as well as physical health. Again, my Department is taking an international role: we will host the first global ministerial mental health summit in October. The summit will bring together political leaders, experts by experience, policy makers and civil society to share innovative and effective approaches to mental health care, which the Prime Minister has rightly said is one of her main priorities. The Department of Health and Social Care frequently receives ministerial and official delegations from overseas to look at topics as diverse as childhood obesity, on which we lead the world; emergency response, as we often send people around the world; and elderly care.

The international team, which the hon. Member for Strangford mentioned and which I look after, manages the Department’s bilateral and multilateral engagement, working closely with colleagues at DFID and across Government. The team also leads on co-ordinating global health strategy across Government and on the health implications of trade and of the UK leaving the European Union.

The hon. Gentleman asked about our support for low and middle-income countries. The UK has a number of programmes with those countries. They are largely led by DFID, although a number draw on my Department, the NHS and Public Health England, for which I have ministerial responsibility. The UK supports the aim of countries working towards universal health coverage, with priority given to ensuring that poorer, harder to reach populations achieve better access to good-quality essential services without risk of financial hardship.

We apply a health systems strengthening approach to all health investments. That includes addressing global health security issues such as antimicrobial resistance; scaling up nutrition interventions, which are about building up country resilience; improving reproductive, maternal, newborn and child health; and targeting specific diseases such as HIV, TB and neglected tropical diseases. One of the first things I was able to do in that space was to speak at the family planning summit organised by DFID over the road at County Hall, which was backed by Bill and Melinda Gates, about our record in driving down the teenage pregnancy rate in this country. Of course, getting reproductive health right often helps developing countries to make their health systems more robust and sustainable.

The hon. Gentleman mentioned the delicate subject of male circumcisions and HIV. He is right to say that circumcision is practised across many parts of Africa to prevent HIV. The WHO and the UN consider male circumcision to be effective in HIV prevention, where there are heterosexual epidemics and high HIV and low male circumcision prevalence. However, the practice provides only partial protection. The procedure should not be seen as a green light to risky behaviour; it should be one element of a comprehensive HIV protection package. It would be remiss of me not to mention that I get a lot of letters on this subject. A number of campaign groups in this country and around the world make arguments about the human rights elements of the matter, especially when children undergo circumcision surgery, and its impact later in life. It is important to recognise all those facts, but the hon. Gentleman is right to mention it as part of the toolkit used in certain countries, Tanzania being one of the most prevalent.

We provide support directly to countries, work through the WHO and scale up targeted, cost-effective preventive and treatment interventions through global initiatives such as the global health fund, Gavi and the global financing facility. We are the largest donor to Gavi, which provides developing countries with pneumococcal vaccine to protect against the main cause of pneumonia. Between 2010 and 2016, 109 million children received the vaccine; we estimate that saved about 760,000 lives.

The health partnership scheme is another good example of how the UK can use our expertise overseas. Since 2011, we have trained 84,000 health workers across 31 countries. The scheme relies on volunteers from the NHS who help to support the training of staff overseas and benefit themselves through gaining new skills and motivation. Last October, the Minister of State, Department for International Development, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who I work closely with across Government, announced the new £30 million programme with the catchy title “Stronger Health Partnerships for Stronger Health Systems”. It will run for five years from 2019 and will support partnerships between leading UK institutions and those in developing countries.

One of the benefits of being the Minister in these debates is that sometimes I can mention the good things that happen in my constituency. Hampshire Hospitals NHS Foundation Trust, which covers the Royal Hampshire County Hospital in Winchester and the Basingstoke and North Hampshire Hospital, has two very good international links, including with Yei in South Sudan, where a number of medical professionals from that trust have worked on antibiotic resistance studies, looking at the bacteria that can cause pneumonia. In collaboration with the Rotary Club in Winchester and the Brickworks, which is a Winchester-based charity, it has secured funding for textbooks to repopulate a midwifery and lab training institution and funding to build schools for South Sudanese refugees in Uganda, so that refugee children can continue their primary and secondary education. There will be examples in the constituencies of Members throughout the House of health professionals using such expertise as part of their upskilling, but also to help those less fortunate than us.

The UK offers development opportunities for the medical workforce globally. The medical training initiative allows overseas medical specialists to train in the UK for up to two years, to see our system close up, so that they can return to their home country and apply their skills and knowledge to the benefit of their population. Of course, that benefits the NHS by providing extra staff, who we desperately need, and enhances the clinical capacities of health systems in low and middle-income countries. We estimate that just over 3,300 overseas doctors have taken part since 2009. I know the House will be interested in that positive programme.

We are passionate about tackling AMR, and we are committed to doing so. My Department is working across Government with a wide range of stakeholders to refresh our AMR strategy, which rightly gets a lot of attention in the House, with a view to republishing it at the end of 2018. I know that the hon. Member for Strangford will be interested in that. One of the ambitions we set out in response to Lord O’Neill’s independent review of AMR, which was established by George Osborne when he was at the Treasury, was to halve healthcare-associated gram-negative bloodstream infections. We are focusing on E. coli infections this year, but we are also collecting data on Klebsiella and Pseudomona pathogens.

I think there will be a lot of interest among Members in the refreshed AMR strategy. Health Question Time seldom goes by without AMR being mentioned. AMR is important. As the chief medical officer, who is busy in other ways today, has said, it is one of the greatest threats, if not the greatest threat, that our world—not just our healthcare world—faces.

We welcome all new research that contributes to our work to tackle AMR—especially great research such as that produced by Queen’s University Belfast, which the hon. Gentleman mentioned. There are a number of funding opportunities, and high-quality proposals are always welcomed. He rightly mentioned that people from Queen’s were at the House yesterday. He and I met them together—we had our photo taken with them—at an excellent Breast Cancer Now event, which was a great chance to hear about some of the incredible research that is being done on that disease in our United Kingdom.

Great research projects often start with relatively small grants from charities such as Breast Cancer Now, which act as the building block for other researchers to jump on board and get with the plan. That is very important. This is not all about the Government starting research projects; it is about institutions such as Queen’s being world-renowned. The lady I met yesterday was clearly on top of her game. She deserves great credit, and I thank her and all her colleagues at Queen’s for the work they do for our country.

We have strong join-up across Government. My Department, DFID, Public Health England and the Foreign Office in particular take a “one HMG” approach to global health, which was recently praised by the Independent Commission for Aid Impact. That includes regular meetings between Ministers, and a co-ordination group of senior officials meets very regularly to look strategically at our international activity and some of the programmes I mentioned. It includes joint delegations to WHO meetings and daily contact between our officials. It also includes joint working on projects such as the UK public health rapid support team. That is a partnership between the Department of Health and Social Care, Public Health England and the London School of Hygiene and Tropical Medicine that, at countries’ request, deploys people rapidly to some of the poorest parts of the world to investigate significant disease outbreaks and support capacity building. I mentioned examples of times when that has been invaluable, such as during the Ebola crisis.

In concluding, let me return to the incredible achievements of our NHS over the past 70 years, during which time life expectancy has leapt. Its staff work tirelessly to ensure that it remains the best in the world. We are committed to ensuring that it provides universal health coverage in the UK for generations to come, but we do not keep it all to ourselves—we are desperately keen to go on sharing our knowledge to help other countries do the same, so that people around the world can benefit from the incredible privileges we have in this country.

[Steve McCabe (in the Chair)]

Mr Shannon, would you like to make some concluding remarks?

Phenylketonuria: Treatment and Support

Steve Brine Excerpts

Tuesday 26th June 2018 Westminster Hall

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

No pressure, then. I will try to give some hope.

Thank you, Mr Robertson, for chairing our debate. I also thank the hon. Member for Blaydon (Liz Twist) for introducing the debate with such humanity. She speaks so well and passionately on this subject. We also heard from my hon. Friend the Member for East Renfrewshire (Paul Masterton), who mentioned the Irn-Bru issue. The Treasury has a policy on the sugar tax, which is part of our child obesity plan. We published the update on that yesterday. The policy long predates me. This subject has not been raised with me before, but we cannot let the bad be the enemy of the good. Taking sugar out of fizzy drinks is a good thing for society, but the unintended consequences of that need to be addressed, and he is right to raise it.

We also heard from the hon. Gentleman from my own county, the hon. Member for Portsmouth South (Stephen Morgan), from the hon. Members for Dudley North (Ian Austin), for Warrington South (Faisal Rashid), for Hornsey and Wood Green (Catherine West), for Derby North (Chris Williamson), and from my hon. Friend the Member for Waveney (Peter Aldous), who always speaks so passionately, from the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), and, as always, the hon. Member for Strangford (Jim Shannon), all of whom—I think everybody—touched on the subject of Kuvan. Many touched on the dietary aspect and everybody gave personal examples of constituents. I hope to address all of those subjects.

I congratulate the hon. Member for Blaydon and the all-party group on the work that they do. When I was a Back Bencher I was involved in many all-party groups, including the APPG on breast cancer with the hon. Member for Washington and Sunderland (Mrs Hodgson), who speaks for the Opposition. So much of the good work of this place goes on in APPGs. I hope that the public watching inside and outside today can see that.

The House debated PKU and Kuvan in March this year, led by my hon. Friend the Member for Chelmsford (Vicky Ford), who spoke well again today. I was not able to attend that debate in person back in March, so I am grateful to have the opportunity today to hear the issues around PKU and access to treatments. I have learnt a lot today, as I did in my reading ahead of today. The importance of rare diseases, of which PKU is one, is of course recognised by us and by policy makers and healthcare service providers in the UK and internationally, and rightly so. One in 17 of us will suffer from a rare disease at some point in our lives.

With the number of known rare diseases steadily growing as our diagnostic tools improve, the Government remain focused on and dedicated to improving the lives of those living with a rare condition. That was reinforced in the Prime Minister’s words last Monday at the Royal Free. I was fortunate to be there when she set out a vision for the long-term plan for the NHS, underpinned by increased funding for the service. She said the UK had an opportunity,

“to lead the world in the use of data and technology to prevent illness, not just treat it; to diagnose conditions before symptoms occur, and to deliver personalised treatment”,

informed by our own data, including our genetic make-up. I will say more about that in a moment.

Early and accurate diagnosis of rare conditions is essential for the best outcome for patients with rare diseases such as PKU. We know that without early treatment the outlook for those born with the condition is very poor, as the Scottish National party spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day), and the Opposition spokesperson, the hon. Member for Washington and Sunderland West, said. With early treatment, however, the outlook can be good, which is why, as a number of speakers have said, screening has such a vital role to play. I have two children, and equally watched the pin heel prick with trepidation—little did I know what it could have found. I had no idea what they were doing—I was in that daze—let alone what it could have found, so I have great compassion for people in that moment.

The current newborn screening programme in the UK is based on the blood spot test—the heel prick test that we have referred to—and screens for nine rare but serious conditions, including PKU. With that early diagnosis, treatment can start straight away. For patients with the condition, that treatment includes a special diet and regular blood tests. We have heard so many incredible examples today.

We have heard how severely limiting a protein-restricted diet is and how difficult it must be for any patient to stick to, but particularly for young children. Those of us with young children can really feel that. Children with PKU, as has been said, cannot eat most of the foods that we all take for granted, such as meats, fish, milk and treats such as chocolate—everything in moderation—and that is just to name a few.

I stand here as a Minister, but also as a constituency MP. I, too, had not heard of PKU until constituents brought the condition to me. I recently met with one of my constituents, Sarah, who was a doctor and, like many people, as we have heard, had to give up her job to look after her children. Her three-year-old daughter, who is a beautiful little girl, lives with the condition. I heard first-hand of much of the daily strain that it puts on her daughter and the family. My constituent, like many carers, cares for the child full time—preparing the meals, calculating ingredients and going to doctor appointments—and has had to give up her career. As the hon. Member for Blaydon said in her introduction, when we say that the condition can be treated by diet it sounds quite easy. However, in an email last night my constituent said to me,

“If she goes off ‘the diet’, she will suffer permanent and irreversible brain damage.”

If my seven-year-old boy goes off diet and drinks a fizzy drink we certainly suffer the consequences, but it usually lasts for only an hour. I have a great understanding from today’s debate about that.

I understand that even in adulthood, as the hon. Member for Dwyfor Meirionnydd said, PKU can cause harrowing symptoms that make any attempt at a normal life and contributing to society very difficult and sometimes impossible. The availability of specially formulated low-protein foods and nutritional supplements through the NHS is therefore vital. Since its development in the ’50s, it has saved the lives of and improved outcomes for many patients.

I cannot deny that PKU is not on the list of medical conditions in England that are exempt from prescription charges. As such, only the usual age-related pre-paid certificate exemptions apply to such patients. That is the current situation, but everything can be challenged and can change. As I said at the start, the power of all-party groups is incredible, and perhaps that is something that the all-party group may wish to look at and campaign on.

An awful lot of information is available. My constituent Sarah is also the editor of the National Society for Phenylketonuria’s magazine. She sent me the summer 2018 edition last night, which I read overnight. It was a really interesting read, and I might touch on a couple of things in it before I close. That magazine and its website contain all sorts of information on foodstuffs, advertisements for foodstuffs, products and recipes—and yes, avocado does keep coming up.

[Catherine West]

Will the Minister give way?

--- Later in debate ---

[Steve Brine]

I will briefly, but then that will be it, because I know hon. Members want to hear from me, as the Minister. We have heard from Back Benchers.

[Catherine West]

As the Minister knows, there have been five applications for an individual funding request. Two of those were allowed and one, which I mentioned earlier in the debate, had to go to the High Court. The judge declared that the decision that had been made was irrational and unlawful. Will the Minister not just speak about the dietary supplements, which we can all find out from Google, but about what he is doing to push these requests? Specifically, what is he doing on behalf of Olivia, aged 11, whose mother is here today, who would like to know whether he will personally support her application for Kuvan?

[Steve Brine]

I was going to come on to talk about Kuvan; obviously, I stopped to listen to the hon. Lady’s intervention. No, I will not personally support an individual request. That would not be appropriate for a Minister at the Dispatch Box. That is not how our system works, but if she wishes to write to me with the specific example then of course I will see that she gets a reply. That should be handled through the right processes. I know that the processes for individual funding request applications are sometimes torturous, and I am sure that we could do them better.

Let us touch on Kuvan, which everybody has raised. It is one treatment option that has been found to lower blood phenylalanine levels in some patients with mild or moderate PKU. We know that the drug is effective in a small number of patients, depending on their genetic make-up, and is more likely to benefit those with milder forms of the condition. If patients respond to treatment, it is likely that they will still need to continue with some form of dietary restrictions—everyone understands that.

As we have heard, Kuvan is not currently routinely commissioned for use in children and adults. That is due to the lack of evidence of its effectiveness on nutritional status and cognitive development at the time the policy was developed in 2015. NHS England does, however, have a commissioning policy for PKU patients with the most urgent clinical need—namely, pregnant women, as we have heard.

[Vicky Ford]

Will the Minister give way?

[Steve Brine]

No, I will not. Although the decision taken by NHS England was not to commission Kuvan routinely, the system has the flexibility to review that decision if new evidence emerges. As the House heard during the debate in March, NHS England received a preliminary policy proposal for the use of Kuvan in the management of PKU for adults and children, because new evidence has now been published to support its use. Kuvan was subsequently referred to the National Institute for Health and Care Excellence for assessment through its topic selection process—the process through which NICE prioritises topics for appraisal in its technology appraisal or highly specialised technology programme.

The NICE process is important. It is independent of Ministers and provides a standardised, governed procedure to ensure that NICE addresses topics that are important to the patient population, carers, professionals and commissioners and, similarly, helps to make the best use of NHS resources. To update the House on progress, Kuvan has progressed through the first stage of the topic selection, and NICE is currently considering whether the drug should proceed to the draft scope creation stage. We are expecting that decision to be taken in the autumn. I will press NICE, along with the relevant Minister in the Department—the Under-Secretary who sits in the other place—to bring that to a conclusion as swiftly as possible.

People have asked today for me to personally get involved in access to Kuvan. NICE’s process is important and sits independently of Ministers. It would be a very strange situation if Ministers were able to sit in the Department of Health and, like a Roman emperor, give a thumbs up or thumbs down. I do not think that any Minister in this Government or previous Governments would want to be in that inappropriate position. As I said, we expect the decision to be taken in the autumn and we will press for that to be brought to a conclusion as soon as possible.

I will give the hon. Member for Blaydon time to wind up the debate, but let me say first that there are other promising treatments on the horizon. NICE is currently considering pegvaliase, an enzyme substitution therapy indicated for adults, through its topic selection process, and recently consulted stakeholders on its suitability for the technology appraisal. I can update the House that a scoping workshop on this topic is scheduled to take place tomorrow, 27 June.

Finally, my hon. Friend the Member for Chelmsford said that there had not been a response on BioMarin. She mentioned that point to me last night, and I am worried to hear it. As I said, Kuvan is currently going through the independent NICE assessment. If the topic goes ahead, there will be many opportunities for BioMarin to engage in commercial discussions, as per NICE’s usual process. BioMarin and NHS England are already in discussions about a number of other drugs, so it has the opportunity to raise the issue. However, it seems to me that NHS England could at least communicate better, because no answer sounds like a bad answer. I will take that away from the debate and ensure that it happens ASAP.

I know you want me to stop, Mr Robertson, and let the hon. Member for Blaydon close the debate, so I will do that.

Childhood Obesity Strategy: Chapter 2

Steve Brine Excerpts

Monday 25th June 2018 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)(Urgent Question)]

To ask the Secretary of State for Health and Social Care to make a statement on the Government’s childhood obesity strategy.

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

Today the Government published the second chapter of our childhood obesity plan. The plan is informed by the latest evidence. It sets a new national ambition to halve childhood obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030.

Childhood obesity is one of the biggest health problems that the country faces. Nearly a quarter of children are overweight or obese before they start school, and the proportion rises to more than a third by the time they leave. The burden is being felt hardest in the most deprived areas, with children growing up in low-income households more likely to be overweight or obese than more affluent children.

Childhood obesity has profound effects, which are compromising children’s physical and mental health both now and in the future. We know that obese children are more likely to experience bullying, stigma and low self-esteem. They are also more likely to become obese adults, and face an increased risk of developing some forms of cancer, type 2 diabetes, and heart and liver disease. Obesity is placing unsustainable costs on the national health service and our UK taxpayers, which are currently estimated to be about £6.1 billion per year. The total costs to society are higher and are estimated to be about £27 billion per year, although some estimates are even higher than that.

The measures that we outline today are intended to address the heavy promotion and advertising of food and drink products that are high in fat, salt and sugar, on television, online and in shops, and to equip parents with the information that they need in order to make healthy, informed decisions about the food that they and their children eat when they are out and about. We are also promoting a new national ambition for all primary schools to adopt an “active mile” initiative, like the Daily Mile. We will be launching a trailblazer programme, working closely with local authorities to show what can be achieved and to find solutions to problems created by barriers at a local level.

Childhood obesity is a complex issue that has been decades in the making, and we recognise that no single action or plan will help us to solve the challenge on its own. Our ambition requires a concerted effort and a united approach by businesses, local authorities, schools, health professionals, and families up and down the country. I look forward to working with them all.

[Jonathan Ashworth]

We have a childhood obesity crisis, and we need action.

Of course, many of the policies announced today seem familiar. That is because they are actually our policies. Supporting the Daily Mile initiative is a Labour policy. Supporting a ban on the sale of energy drinks to under-16s is a Labour policy. Proper food labelling is a Labour policy. A target of halving childhood obesity is a Labour policy. The Minister should not be commending his statement to the House; he should be commending the Labour party manifesto to the House.

But what was not in the Minister’s response? There were no mandatory guidelines on school food standards, and no powers for councils to limit the expansion of takeaway outlets near schools. There was nothing about billboards near schools, there was no extension of the sugar tax to milky drinks, and there was no commitment to increasing the number of health visitors—and what about television advertising? We were told action was coming:

“the Health Secretary, is planning a wave of new legislation...including a 9 pm watershed”

said the Telegraph.

“Barring a last-minute change of heart, advertising for products high in sugar, salt and fat will be banned before the 9 pm watershed”

insisted The Times. But what did the Secretary of State announce yesterday? He is

“calling on industry to recognise the harm that constant adverts for foods high in fat, sugar and salt can cause, and will consult”.

So not even an “intention” to ban advertising of junk food—just a consultation. Surely this former Culture Secretary has not given in yet again to big vested interests?

We would bring forward legislation to ban the advertising of junk food on television. We have a childhood obesity crisis; the Government should be introducing restrictions on the advertising of fudge, not serving more up of it.

The Government talk of the role of local authorities. We agree, so will council public health budget allocations still have to wait until the spending review? Does that not mean new money will not be available for councils until 2020?

The Government have today announced 13 consultations and reviews; that hardly suggests the Government are gripped with a sense of urgency to tackle this crisis. Yet the evidence is clear: we need determined action now. I can assure the Minister that we would co-operate on the timely passage of legislation, so rather than stalling further, will he take us up on our offer? Our children depend on it.

[Steve Brine]

I have been doing this job for just over a year now and I had yet to find the party politics in child obesity, but I have to say that the hon. Gentleman has just managed to land that one correctly, if nothing else. He seems to be suggesting that everything in the plan is a Labour idea and that the last two years have been in some way a wasted opportunity since the 2016 plan. I would suggest that that is not true, and it is not even close, actually. Over half of the products in the scope of the soft drinks industry levy that we brought in under Chancellor Osborne have been reformulated, with many important manufacturers leading the way. Our comprehensive sugar reduction programme has reduced sugar in some products that children eat the most. We have also made a number of significant investments, including doubling the primary PE and sport premium to £320 million a year, transforming children’s physical activity, as well as investing about £100 million this year in the healthy pupils capital fund and £26 million over three years to expand the breakfast clubs, with a focus on the Department for Education’s opportunity areas.

But we were always clear that chapter 1 was the start of the conversation—the clue is in the name—and we are very clear that more needs to be done; that is why I said what I said in my opening remarks. That is why we are introducing the bold new measures outlined in chapter 2. I am sorry that the hon. Gentleman does not like consultations, but what could be described as delay through consultations I would describe as getting it right, and I expect that we will come on to discuss some of these measures in the coming minutes. But we must get these measures right and make sure people cannot duck underneath them.

Finally, the hon. Gentleman spoke about public health. We are spending £16 billion in the ring-fenced public health budget during this spending review. There are many good examples of local councils doing excellent things with that money, and we will probably hear about some of them as well.

[Several hon. Members rose—]

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the second chapter of the childhood obesity plan, which takes us so much further in a number of areas. Can my hon. Friend the Minister set out the timescale for these consultations and confirm that the responses will be considered in a timely manner, treating this with the urgency it deserves?

[Steve Brine]

Yes, and may I thank the Chair of the Select Committee for the work she has done on this? Ever since we came into Parliament together she has been championing this issue—long before it was fashionable, I might add—and she has really led the line with her Select Committee inquiry on it, to which I and other Ministers joining me on the Front Bench today, including the Minister for Digital and the Creative Industries, my hon. Friend the Member for Stourbridge (Margot James), gave evidence. With most, if not all, of the consultations we are not hanging about; they will be getting under way this year.

[Carol Monaghan (Glasgow North West) (SNP)]

This is a ticking time bomb that needs to be dealt with properly. We know that children from deprived backgrounds are twice as likely to suffer from obesity, so I first want to ask the Minister how this ties in with his plans to tackle poverty. The Scottish Government’s ambition to halve obesity in Scotland by 2030 and initiatives such as the Daily Mile are extremely important in addressing this. Those initiatives have received the backing of Jamie Oliver, who has stated that Scotland

“has picked up the baton that Westminster dropped”.

The Scottish Government will support small and medium-sized enterprises that have innovative ideas for junk food alternatives. What support will the UK Government be giving to companies founded to offer alternatives to fatty foods? Does the Minister agree that restricting the powers of the Scottish Parliament to lead the way on legislation on food safety, labelling and health claims could severely restrict Scotland’s ability to lead the way in this area?

[Steve Brine]

I thank the hon. Lady for what I think was her welcome for this. Looking at the letter on the comprehensive strategy to tackle child obesity that was sent to the Prime Minister on 25 April and signed by her leader, the First Minister of Scotland, I have ticked alongside the bullet points and I reckon that 80% or possibly 90% of the things that her leader has asked for are in this plan. She has asked about inequality, for example, and we have the lowest levels of inequality in 30 years. I am not going to get into the devolution arguments, but I will say that we welcome the North Star policy that the Scottish Government have announced, with the support of Jamie Oliver—who, I might add, has been very supportive and helpful throughout this process. We matched that, but the difference is that we have a plan for how we are going to get there.

[David Tredinnick (Bosworth) (Con)]

Is my hon. Friend aware that Hinckley and Bosworth Borough Council is already leading in Leicestershire in the areas of prevention strategy and tackling obesity? Chapter 2 will be widely welcomed. Has he considered talking to supermarkets about healthy shopping strategies?

[Steve Brine]

I cannot say that I have considered that personally, but I know about lots of the technology solutions that supermarkets are bringing in. I am not surprised to hear the news about my hon. Friend’s local council, and yes, this is absolutely about prevention. Last week, the Prime Minister announced a record investment of new money in the NHS, alongside our new long-term plan, of £20.5 billion a year, but that must go hand in hand with prevention. Investment and prevention are always better than cure.

[Keith Vaz (Leicester East) (Lab)]

I also warmly welcome these proposals. These have been asks of the all-party parliamentary group on diabetes and of Diabetes UK for a number of years. There is a clear link between childhood obesity and diabetes, and 4.1 million people in the UK suffer from diabetes. Does the Minister agree that retailers do not have to wait for the consultation? As with the sugar tax, they can start to make the changes now to prevent diabetes in the future.

[Steve Brine]

Yes, and I thank the right hon. Gentleman for his support for this. Diabetes UK has said:

“Diabetes UK welcomes the ambitious range of measures outlined by the government in their commitment to tackling the childhood obesity crisis facing the UK.”

Its brilliant chief executive, Chris Askew, has been very supportive of this plan. This is one of the drivers of the need to tackle this issue, and no, nobody has to wait for this. There have been many examples, and I am happy to name-check Waitrose, which took the lead on not selling energy drinks to children. Its example was followed by all the other mainline supermarkets.

[Mr John Whittingdale (Maldon) (Con)]

I welcome the Government’s multi-pronged approach, but will the Minister bear in mind the fact that, when it comes to calls for banning advertising before 9 o’clock, such a measure would do huge damage to the economics of the commercial broadcasters, just at a time when fewer and fewer young people are watching scheduled television? Instead, they are now watching the on-demand services that are the direct competitors of commercial TV stations.

[Steve Brine]

I take my right hon. Friend’s views very seriously, but we want to protect children from the advertising of products that are high in saturated fat, salt and sugar, and we are going to consult on introducing a 9 pm watershed. He mentions online, catch-up and social media, and that is one of the reasons that this is an important area for us to consult on. We want to ensure that we get this right, and it is not about punishing the industry. The people who work in the industry and in advertising are also parents, members of society and taxpayers. They also have a stake in this and in the reason for it all to succeed.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I am really glad to hear the Minister talk about tackling the health inequalities of obesity among children, because we know that the gap between the least deprived and the most deprived children has become more pronounced over the past eight years. Will he go into a bit more detail about what he is going to ask local authorities to do to close that gap?

[Steve Brine]

I will work with local authorities on a new pathfinders programme, which the hon. Lady may not have had a chance to look at as it was published only this morning. We want to work with them to model solutions and barriers to action through the pathfinders programme. There are already some good examples, some of which are set out in the plan, including in Blackpool and at Derbyshire County Council, which are doing good things. Many local authorities already have a number of substantial levers and powers. We want to model the best so that others, such as Liverpool, can follow.

[Sir Desmond Swayne (New Forest West) (Con)]

Why are the poorest children disproportionately among the fattest? It is not because they watch more adverts, is it?

[Steve Brine]

It could be that, but it is a job of education and about helping their parents make sensible choices, because it is the poorest in society who miss out when we get this wrong. It is about what the Prime Minister described as a “burning injustice” when she was first elected, and I agree with her.

[Ellie Reeves (Lewisham West and Penge) (Lab)]

Breastfeeding is a protective factor against childhood obesity. Although initial rates are about 75%, fewer than 45% of mothers continue to breastfeed by six to eight weeks. There is no mention of breastfeeding in the childhood obesity plan. With health visiting services being cut, what are the Government doing to promote this important part of a child’s nourishment?

[Steve Brine]

There is no mention of breastfeeding in the plan, but that does not mean that I and my colleagues do not see it as a very important part of the early years programme. In areas that I represent, as well as, I am sure, in other areas represented by colleagues, local authorities are often actively engaged in making sure that breastfeeding is a very important part of a child’s start in life.

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

It was the drive and passion of Alderman Eric van der Burg, a right-wing politician, that led to results in bringing down child obesity in Amsterdam. What more do we need to do to get local authority leaders here to see that this is actually part of their core business, not a fringe activity?

[Steve Brine]

As my hon. Friend will remember from my speaking to the Health Committee, I have also been to Amsterdam, but unfortunately not for as long as the Committee members were. The whole-systems approach taken by Mayor van der Burg and Amsterdam is very impressive and has resulted in a 13% reduction in child obesity. Local authorities can learn from their attempts to market their cities, areas and regions, and I would suggest that having a good, healthy community and a good, healthy look when people walk out of the airport and do not see massive adverts for unhealthy fast food is an important part of that.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I welcome the Minister’s statement. Will he encourage supermarkets to offer free fruit to kids coming into the store? Nothing has changed my supermarket shop more than my local store doing so; when kids go in, they now ask for their free clementine rather than their chocolate.

[Steve Brine]

That is an easy one to agree with. Tesco has been doing that for years, and my children regularly avail themselves of the opportunity.

[Philip Davies (Shipley) (Con)]

May I urge the Minister not to get into some nanny state, socialist claptrap arms race with the Opposition parties, which will never be satisfied, as we heard earlier from the shadow Secretary of State? May I remind the Minister that he is actually supposed to be a Conservative and urge him to think about this from a Conservative standpoint, which focuses on things like parental responsibility and not seeking to ban anything that moves?

[Steve Brine]

I am very pleased that my hon. Friend made that very helpful contribution. I am a Conservative—I said so in my opening remarks—but at the end of the day this is a publicly funded health service that we all believe in and all love. If we want it to celebrate its 140th birthday, we need to protect it, and that means getting serious about prevention and stopping people coming into the service and getting sick. Everyone in the House—Conservative, Labour and everyone in between—should get behind that.

[Helen Goodman (Bishop Auckland) (Lab)]

As I understand it, a six-year-old will be 18 before the Minister’s proposed ban on the promotion of unhealthy food at supermarket checkouts will come into effect. Surely this is meant to be a crisis, not a long-term plan.

[Steve Brine]

I thought for one fleeting moment that the hon. Lady and I were going to agree. I do not recognise that that six-year-old will have to wait another 12 years for the measure to be consulted on and put in place, so I think the hon. Lady might need to check her math.

[Mr Philip Hollobone (Kettering) (Con)]

I think the Minister said that one quarter of children are obese by the time they go into primary school. The figures are shocking. Surely that must mean that nought to five-year-olds have far too much refined sugar in their diet. Can we please have an emphasis on parental responsibility for those young children?

[Steve Brine]

Yes. I am absolutely clear that there are three parts to this particular puzzle: there is Government, and using the power of Government for things like a sugar tax, which clearly only the Government can do; there is business, and the reformulation we are seeing from many, many businesses is impressive and helpful; and there are parents. Parental responsibility is central to this—we cannot do it without them—but we are going to give them information to help them do it.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister’s Conservative Government introduced a tax on sugary drinks, which worked because, as we know, manufacturers have reformulated their drinks. Why does he not accept that the voluntary approach to high-sugar food is not working? Why does he not introduce regulation to cut sugar in the high-sugar foods marketed at families?

[Steve Brine]

The hon. Lady and I went through this at oral questions just last Tuesday. There is a two-part approach: the stick and the carrot. As a carrot, we have a sugar-reduction programme on fizzy drinks, and my colleagues at Public Health England are doing a calorie-reduction programme—working closely with the industry, and with great success, to reduce calories through changes to recipes and portion sizes, for instance. Yes, sometimes the Government need to wave a stick, but there are also times when they need to encourage and to help along the way. We are going to do both.

[Robert Halfon (Harlow) (Con)]

At a time when families are struggling with the cost of living, I urge my hon. Friend to make sure that these measures do not increase prices, which hit those on the lowest incomes the most.

[Steve Brine]

I have been very aware of that throughout the drawing together of this plan. For instance, we do not propose to ban “children eat free” offers. We are talking about food and drink price promotions, such as two-for-one multi-buy deals in the retail and the out-of-home sector, to prevent needless consumption and to help parents with pester power—with which I am incredibly familiar, as I have a 10-year-old and a seven-year-old.

[Paul Blomfield (Sheffield Central) (Lab)]

The challenge is about both prevention and cure. We need to act now to help the growing numbers of children who are already obese, but in its recent inquiry the Health and Social Care Committee heard that provision of tier-3 and tier-4 services is bare. It concluded:

“Addressing health inequalities must include providing help for those children who are already obese.”

What is the Minister going to do about the commissioning of tier-3 and tier-4 services?

--- Later in debate ---

[Steve Brine]

The hon. Gentleman is absolutely right. This is not just about some future generation; it is about the generation now that is already too big. It is about helping people through a sugar-reduction programme, a calorie-reduction programme and—something we have not yet talked about—the Daily Mile and the activity programme we see in so many schools in my constituency, and I am sure in the hon. Gentleman’s constituency. That will help children in the future, and it will certainly help children now. It is never too late.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I welcome my hon. Friend’s proposals, and I am grateful for his recent visit to Bexley to see our local plans for coping and dealing with childhood obesity. Chapter 2 is a good plan. Does he agree that targeting sedentary lifestyles is a top priority, and that to do so we need parental involvement?

[Steve Brine]

It was a pleasure to visit my right hon. Friend’s constituency to see how Bexley Council is using its power, money and public health grant—the council made it very clear to me that it would like more, and my right hon. Friend is a very good advocate on the council’s behalf—to bring forward a whole community response like the one I saw in Amsterdam. I would like to see much more of that in England.

[Wera Hobhouse (Bath) (LD)]

We have heard that obesity is caused not only by the wrong food but by a lack of exercise. Far too few children walk or cycle to school. Will the Minister engage with all our schools to make sure we have proper, realistic travel plans in place so that many more children walk or cycle to school?

[Steve Brine]

Yes. The Daily Mile happens when children are in school, but getting to school is important. I work with Sustrans, a charity, quite a lot in my constituency, as I am sure many Members do. It works to help children to cycle and scoot to school. That is very important, and the hon. Lady is right to raise it.

[Robert Courts (Witney) (Con)]

rose—

[Robert Courts]

As the father of a two-year-old, I am increasingly concerned about the sedentary lifestyles that children lead. Will the Minister join me in praising Middle Barton, Great Rollright, Queen Emma’s, Clanfield and Stanton Harcourt primary schools in West Oxfordshire, which have signed up to the Daily Mile programme? Will he encourage others to do the same?

[Steve Brine]

My hon. Friend will have enjoyed that contribution; I suspect his office are clipping it as we speak. We have a national ambition for every primary school to adopt an active mile initiative, such as the Daily Mile, as a result of this plan. I visited Western Church of England Primary School in my constituency recently, which has good plans to do that. This week is National School Sport Week. I will be at my sports day on Friday, taking part—as I am sure you will be at some point, Mr Speaker.

--- Later in debate ---

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

On Friday, I met Councillor Hazel Malcolm, Wolverhampton’s cabinet member for public health. We discussed this challenge for the city, where, unfortunately and sadly, the child obesity problem is often worst in the lowest income wards. The Minister has mentioned the Daily Mile a few times during this statement. What can he do to make this more than something there are warm words about and to roll it out in schools so that children get the benefit?

[Steve Brine]

The education team are working very closely on this, and the Minister for School Standards wrote a very good piece in The Sunday Times about it. [Interruption.] Indeed, the children’s Minister, the Under-Secretary of State for Education, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), is right here on the Bench with us. We are encouraging all schools to take part in the initiative and we have a national ambition for it. There is no reason why schools in the right hon. Gentleman’s constituency cannot do it, as is the case for schools in my constituency and those of other Members.

[Rebecca Pow (Taunton Deane) (Con)]

I, too, want to welcome the Daily Mile initiative. We should not be arguing about who was first to introduce it; I know we are competitive, but this is competitive for the schools. Does the Minister agree that any sporting activity in schools should be encouraged? Does he also agree that the social prescribing of sporting activities could also play its part in tackling this obesity crisis?

[Mr Speaker]

Any sport, of course, but particularly tennis, I suggest to the Minister.

[Steve Brine]

Especially tennis, Mr Speaker. I know my hon. Friend is keen on social prescribing, as am I. I recently signed an accord between National Parks England and Public Health England to use the brilliant natural resource of our national parks. They are clearly part of the social prescribing mix that we increasingly see across our country, and I want to see more of it. She is right to raise that.

[Jim Shannon (Strangford) (DUP)]

I, too, thank the Minister for his statement. With 25% of children overweight in Northern Ireland, will he confirm how he intends to work cross-departmentally there in the absence of a working devolved Assembly? We need a strategy that works for all of the United Kingdom of Great Britain and Northern Ireland.

[Steve Brine]

Yes. Some of the measures in this strategy relate to reserved matters, such as the advertising proposals that I have spoken about. I have been speaking to my officials, who are already talking to officials in Stormont and will be helping them to develop their own plans. I know they have been very interested in what we are doing, and I hope they can copy and follow some of this locally.

[Kevin Foster (Torbay) (Con)]

Community sports clubs, such as the Cary Park tennis club in Torquay, play a large role in making children active and encouraging them to participate in activity. Will the Minister confirm that looking at these sorts of groups will be part of the strategy—to get people active, not just to tackle what they are eating?

[Steve Brine]

Yes, that is part of the strategy, in so much as we want local authorities to be involved, and upper tier authorities in England are all now public health authorities in their own right. There is absolutely no reason why sports clubs, which are plentiful in all of our constituencies, should not be a key part of the active lives agenda. Not just children need to do more activity in our country; all of us do.

[Jeremy Lefroy (Stafford) (Con)]

I thank the Minister for the inclusion of both physical exercise and diet in this. Of course physical exercise is vital for mental health as well as physical health. Is the ambition to halve childhood obesity by 2030 ambitious enough, given that this is such an important issue for the future of not only the children, but our health service?

[Steve Brine]

I think it is very ambitious. Our first plan was world-leading and I outlined some of the things it has achieved. I think this plan is ambitious enough at the moment. We say in the plan that it is chapter 2 and that there will be a chapter 3—and no doubt there will be.

[Justin Tomlinson (North Swindon) (Con)]

As 80% of children are not doing the recommended minimum of exercise, we owe it to them to do better than make political gestures. In stark contrast to when the Labour Government devastated school sport, will the Minister commit to making it an absolute priority to work with the Department for Education to unlock school sports facilities for free after school and in the school holidays for sports groups and parents, in order to provide opportunities?

[Steve Brine]

I spoke earlier about the Government’s doubling of the primary PE and sport premium to £320 million per year, which is very important. My hon. Friend is absolutely right to raise the issue. I will of course work with all my colleagues across Government to implement the plan and to do even better than we currently are.

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

Obesity harms the life chances of too many children. Given the Minister’s encouragement earlier, will he join me in praising schools such as Lytchett Matravers Primary School, which has already set up a Daily Mile scheme, and encourage others to follow suit?

[Steve Brine]

Yes.

Childhood Obesity: Plan for Action Chapter 2

Steve Brine Excerpts

Monday 25th June 2018 Written Statements

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

Today, Government have published the second Chapter to the Childhood Obesity Plan. This plan is informed by the latest evidence and sets a new national ambition to halve childhood obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030.

A copy of the plan can be found at: https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action-chapter-2.

[HCWS794]

ME: Treatment and Research

Steve Brine Excerpts

Thursday 21st June 2018 Westminster Hall

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

I shall start where everyone else has started and thank the hon. Member for Glasgow North West (Carol Monaghan), who secured this important debate, very much. She did so along with my right hon. Friend the Member for Loughborough (Nicky Morgan), who has to be in her constituency today to deal with a royal visit—lucky her.

Raising awareness of this debilitating condition is critical, and the hon. Member for Glasgow North West has undertaken significant work in this area over a number of years. Thirteen—lucky for us—Back Benchers spoke in today’s debate. I counted 25 Members present at our peak, which is excellent. I spend a lot of time with the hon. Member for Strangford (Jim Shannon) in Westminster Hall, it must be said, but that is a lot of MPs for a Tuesday afternoon, let alone a Thursday afternoon, so that is excellent.

As we have heard, ME, otherwise known as chronic fatigue syndrome, is an incapacitating condition with a plethora of symptoms, primarily characterised by long-term fatigue, chronic pain and post-exertional symptoms of malaise, to name but a few. There are many more and we have heard some excellent testimony of those from Members on behalf of their constituents.

As so many have said, the underlying causes of the condition, which for brevity I will call ME, are still poorly understood. There is no one diagnostic test to identify it, and although some people can and do improve and recover, there is currently no cure. That is a hard reality to face. Although the severity of symptoms and therefore the impact vary, ME can lead to poor attendance and affect outcomes at school for young people. I have a constituent in exactly that position with whom I am in regular correspondence—I will not name her but she knows who she is and I wish her and her mum well. ME can result in significant or indefinite time off work or job loss in adults; reduction or complete cessation of daily activities, which can lead to isolation and strain within families and the breakdown of marriages; and overall poor quality of life. As my hon. Friend the Member for Stirling (Stephen Kerr) said, it can lead to almost no life for some people and their loved ones.

I am surprised that other than the hon. Member for Bristol East (Kerry McCarthy), nobody mentioned “Unrest”. I know it well. Some constituents came to see me to tell me about the film. It had screenings in Winchester and Chandler’s Ford in my constituency, which were oversubscribed—packed to the gunwales—and there was not a dry eye in the house. I pay great tribute to Jennifer and her partner Omar who made that film. I am sure there were times when it gave Jennifer’s life a great purpose, but I am sure there were times when she wanted to say, “Get that bleeping camera out of my life!” There is a touching moment at the very start of the film when she says that when she was a young girl, she want to eat the world “whole”, because she wanted to see it all and do it all. That went to the heart of her great disappointment that she was so sick.

Jennifer set out very clearly and movingly the sheer ups and downs of this condition. For some, it is almost a constant down. I was struck by watching her at the Princeton University reunion day, during the rather surreal procession through the streets by old boys and girls from Princeton. She so enjoyed seeing old friends that day and looked full of life, but within an hour of it finishing she was absolutely poleaxed on the floor, saying that she felt her eyes were being pushed out of her head from the inside. It was horrible to watch.

It was interesting how the film moved around the different wild and crazy treatments that are out there on the internet. If hon. Members google any condition, they will see lots of wild and crazy treatments, but that is particularly the case with ME. One of the saddest things in it, although it covered it well, was the point that my hon. Friend the Member for Cheltenham (Alex Chalk) raised of the suicides resulting from this condition.

Millions Missing was mentioned by many Members, and I see some people wearing T-shirts in the Public Gallery. The hon. Member for Ealing North (Stephen Pound) is right that it has had some bad PR, but it is getting its act together. Millions Missing is an absolutely brilliant way of encapsulating the problem. A number of Members mentioned the shoes; I was particularly moved by the messages on the shoes. They were outside Richmond House, where the Department of Health used to be, as part of the Millions Missing campaign. The mission was to write what you miss; somebody had written on a pair of ballet shoes, “I miss dancing in these shoes.” That was really moving and a human way of putting it. I might touch on the film again a little later.

[Stephen Pound]

I assure the hon. Gentleman that I was not implying any absence of PR skills on the part of the advocates and the people who suffer from this debilitating disease; I was anthropomorphising the actual disease itself. I stole the words of the hon. Member for Cheltenham (Alex Chalk) when we pitched this debate to the Backbench Business Committee, because he was not in Westminster Hall at the time.

[Steve Brine]

That is so unlike the hon. Gentleman. Good clarification.

The stigma quite rightly has been mentioned by pretty much everyone who have spoken today. We recognise that people with ME have encountered significant stigma, in part due to the unfavourable media representations of the condition that not only go back to the 1980s but have continued in recent times. I have seen a clip of Ricky Gervais in one of his otherwise amusing stage shows, when he says of ME, “Yes, that’s the one where they say I don’t want to go to work today.” Ricky Gervais is a very talented comic, but given that he is quite active on Twitter, perhaps he could retract that and apologise to the ME community today. Perhaps he could put #ME so we can look out for it.

My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) made a very good point about mental health; it is totally wrong and insulting to say it is all in the head, but it also goes against the grain of what we are talking about in modern-day healthcare: the parity between mental and physical health. There must be a parity, and to suggest that that somehow lessens it is wrong. His intervention was timely and good.

The physical impacts of the condition have an impact on mental health, as other hon. Members have said. I am also the Minister with responsibility for cancer, so I speak in lots of debates in Westminster Hall and we talk about the mental health impact of cancer—the hon. Member for Washington and Sunderland West (Mrs Hodgson) knows all about them. A recent example was when we talked about the mental impact of blood cancer. People with ME often report that the legitimacy of their symptoms has been questioned by family, friends, employers, healthcare professionals—yes—and society as a whole. Lest hon. Members did not understand it from my opening remarks, let me clear that Ministers—especially this one—are not among that group of people.

That stigma can and does play a part in the development of the co-morbid symptoms of depression and anxiety, particularly for young people—I will come on to them in a minute—who keenly feel the consequences of the resultant social isolation at that moment of their development. As we have heard, suicide is not unheard of. We know that those who experience stigma often also experience discrimination, which has a profound negative effect on their lives. That is unacceptable, so I welcome the debate as a forum to raise awareness of ME and talking about it. The hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) mentioned that MND is being talked about, and he is absolutely right. He is a very good communicator, and I think this will probably be one of his next Facebook Live sessions.

[Luke Pollard]

indicated assent.

[Steve Brine]

He is nodding. It is important that we raise awareness and educate people, including me, about the condition and its impact on people’s lives.

I will now turn to the two issues that have primarily been debated today, research and treatment. On research, the Government invest more than £1.7 billion a year in health research via the National Institute for Health Research and the Medical Research Council through UK Research and Innovation. The NIHR and MRC welcome high-quality applications for research into all aspects of CFS and ME, which would certainly include the biomedical research that the hon. Member for Glasgow North West spoke about in her opening remarks.

Since 2011, the MRC has funded seven projects on CFS/ME totalling £2.62 million, and it is ready to support further applications of the highest scientific quality, which is required to make those scientific breakthroughs. My hon. Friend the Member for North West Norfolk (Sir Henry Bellingham) is no longer in his place, but he spoke about the Norwich Research Park—didn’t he push that a few times?—which sounds very promising. I look forward to hearing more about it, and I feel certain that he will tell me.

The MRC has had an open cross-board highlight notice on ME since 2003. It was updated in 2011 alongside a bespoke funding call in that year. ME research remains an area of high strategic importance for the MRC. Applications that focus on the underpinning mechanisms of ME are encouraged, with priority areas including immune dysregulation—[Interruption.] Sorry, I am distracted by someone shouting about stopping something outside—I think he is saying, “Stop ME!”. The priority areas include pain, improved sub-phenotyping and stratification of ME, and mechanisms of ME in children and young people.

A number of people mentioned the late Baroness Jowell. I was very privileged to meet her. I did so just the once, but I was left in no doubt about her resolve on the issue of brain tumours. Let me say in reference to her and to the research environment that, as my Parliamentary Private Secretary, my hon. Friend the Member for South Suffolk (James Cartlidge), reminded me, that journey started around the time of a Westminster Hall debate. Perhaps that is a good sign.

Our challenge with brain tumour research is the lack of high-quality research proposals that have come forward. The late Baroness Jowell was passionate about stimulating the research community to get that situation changed, and we have latched on to that. That is one of her great legacies. I would hazard a guess that her greatest legacy is yet to be reached, but that is one reason it is important to mention her today.

The NIHR has, since 2011, provided £3.37 million of funding for projects and training on ME. That might not be termed biomedical research, but as with other disorders, given that the cause and mechanisms of the condition are still poorly understood, it is important that we carry out both biomedical research, to further our understanding, and applied health research, to improve the treatment offered to people with ME now and to help to improve their symptoms and quality of life.

The NIHR and the MRC recognise that ME is a debilitating condition and are working with the UK CFS/ME Research Collaborative, which was mentioned towards the end of the debate, and with patient representatives on how best they can support a joined-up approach to encourage high-quality research into this complex disorder. I mentioned that Baroness Jowell is a good example of how to start such research. They hope to be able to update colleagues on those discussions by the end of the year, and I for one will look keenly for that update.

For Members who do not know about that important collaboration, it was set up in 2013 to promote high-quality basic and applied research into ME. The CMRC brings together researchers, major funders and charities, and provides them with a mechanism for working together in a co-ordinated and collaborative way, increasing awareness of ME in the research community—that is so important if we are going to stimulate applications—highlighting priorities for research funding and increasing such funding. Both the NIHR and the MRC sit as observers on the CMRC board.

Everyone who contributed to the debate spoke passionately, but the hon. Member for Ealing North spoke particularly passionately, and I liked his point about humanity. This is a matter of good Christian humanity in many ways.

The Royal College of General Practitioners oversees GP training in England. It provides an online course for GPs and other primary care practitioners that includes an overview of the presentation, diagnosis, assessment and ongoing management of ME. The course highlights common misconceptions about ME and considers the challenges that surround that complex condition for patients, carers and primary care professionals. It is produced as part of the METRIC study, which is funded by the NIHR.

Of course GPs can always know more and learn more, but let me speak up for them for a moment. They are called “general practitioners”. Be a GP for a day—it is incredibly difficult to know everything about everything and to be a master of all. General practice is, though, where most patients with ME are likely to be managed, certainly in the first instance. The condition is identified as a key area of clinical knowledge in the RCGP applied knowledge test content guide. The AKT is a summative assessment of the knowledge base that underpins general practice in England and a key part of GPs’ qualifying exams.

Although I understand hon. Members’ points about raising awareness among medical professionals, and as a result of the debate I will redouble my efforts to do that as part of my role as Minister for primary care, all GPs certainly should be aware of ME, and should maintain their clinical knowledge of it and other conditions, as part of their commitment to continuing professional development. Indeed, I have resolved—I have already sent a note to myself—to send a copy of the report of the debate to Professor Helen Stokes-Lampard, who currently leads the RCGP, and to ask for the college’s latest thinking about this subject.

Before any medical condition can begin to be treated, it must be diagnosed. That goes to the heart of our challenge. As the symptoms of ME often resemble those of many other debilitating illnesses—we heard about Lyme disease—there is no test with which to make an accurate diagnosis. ME, therefore, is not always easy to diagnose, to put it mildly. Diagnosis relies on clinical observation of symptoms by healthcare professionals. We understand that that can be frustrating, to put it mildly, for patients—and, it must be said, for their clinicians.

People with ME should be referred to a specialist service, where care should be based on their needs, on the type, complexity and severity of their symptoms, and on the presence of co-morbidities. That decision should be made jointly by the patient and their healthcare professionals. As the shadow Minister said, referral to specialist ME care should be offered within six months of presentation to people with milder symptoms, within three to four months of presentation to people with moderate symptoms, and immediately to people with severe symptoms. Clinicians are responsible for advising patients about available treatment options.

Of course I am aware that access to services for those with severe ME is a big and ongoing issue. Under the Health and Social Care Act 2012, the configuration of services is a matter for local NHS commissioners, who have to be best placed to deliver services for their area. A number of Members referred to the report of the chief medical officer’s independent working group on ME, which was published in 2002. Following that, a central investment programme of £8.5 million was established to address the service gaps across England—I am responsible for the NHS in England. That included the establishment of 13 centres of expertise across the country, 36 multidisciplinary community teams for adults and 11 specialist teams for children and young people, and facilitation of access to advice on clinical management for patients, families and health professionals.

Linked to that—the Department is, of course, now called the Department of Health and Social Care—the vast majority of people with severe ME and their families will come into contact with social care services at some point. The Care Act 2014 requires a local authority to carry out a needs assessment where an adult or carer appears to have care and support needs. The local authority must then decide whether the person has eligible needs by considering the outcomes they want to achieve, their needs, and how those impact on their overall wellbeing. Where a person is assessed as having eligible care and support needs, those must be met by their local authority.

Let me say some more about children and young people, who were mentioned by a number of Members. There is a powerful moment in “Unrest” where a young lady is celebrating her birthday. She says, “I remember my 16th birthday in this bed, and my 17th birthday, and my 18th birthday”—and she goes on through; I think she was celebrating her 22nd birthday in the film. Although access to services was raised, I know that access to education is also a huge issue for children and young people with ME.

All schools have a legal duty to make arrangements to support pupils with a medical condition in school. Guidance to schools states that they should put in place arrangements that show an understanding of how medical conditions affect a pupil’s ability to learn and give parents and young people confidence in the school’s ability to provide effective support for their condition. Children and young people with ME should have an individual healthcare plan, which should normally be drawn up in partnership with the school, healthcare professionals, parents and the young person, and should be tailored to their needs.

Schools and other services should work together to ensure that children and young people with ME receive an education that is flexible and appropriate. That could mean programmes of study that rely on part-time attendance, in combination with alternative provision or home schooling, which was mentioned. Consideration should also be given to how children and young people are integrated back into school after a period of absence, when they are feeling better and, hopefully, more able physically to cope.

A lot was said about NICE guidelines, which are clearly a sensitive topic and a source of much unhappiness among Members and the wider ME community. According to NICE guidelines, recommended treatments for ME include cognitive behavioural therapy and graded exercise therapy. I know that many patients disagree with those treatments, and we heard powerful testimony about that. The NICE guideline is clear that there is no one form of treatment to suit every patient; that the personal needs and preferences of the patient should be taken into account; that doctors should explain that no single strategy will be successful for all patients; and that, in common with all people receiving NHS care, ME patients have the right to refuse or withdraw from any part of their treatment that they do not agree with or they think is doing them harm.

As we heard, the NICE guideline is being updated—a jolly good job, too. NICE will look at the current evidence base, including the PACE trial, which has been debated at length in the House before. Of course, we welcome NICE’s decision to undertake a full review of ME guidelines. Many of the ME charities we have heard about today are registered to take part in the guideline development process, but NICE is the independent expert body responsible for developing robust, evidence-based guidance for the NHS to design services that are in line with the best available evidence, and no one should hide from the evidence. It would be inappropriate and wrong for Ministers to interfere with the process, but I feel sure that NICE will be listening to the debate and taking a keen interest in it.

[Carol Monaghan]

The Minister has rightly said that any patient has the right to withdraw from medical treatment. However, when the DWP is saying that patients must undertake graded exercise therapy, and when health insurance companies are saying that they must undertake graded exercise therapy, it puts the patient in a very difficult position.

[Steve Brine]

I fully appreciate that point—the hon. Lady put it on the record very well earlier—which takes us on very neatly to welfare benefits.

The hon. Members who requested the debate also flagged the issue of benefits. I know they would like, and are having, an ongoing conversation with the DWP. I am clearly not a DWP Minister—they wanted a Health Minister to respond to the debate, and that is what they have. The DWP obviously recognises that ME is a real and disabling condition. Entitlement to benefits depends on the disabling effects of the condition, which of course must be taken on an individual basis. When assessing claimants, healthcare professionals are expected to be mindful of the fact that many illnesses—including ME—produce symptoms that vary in intensity over time, and they are instructed not to base their opinion solely on the situation observed at the assessment. The DWP assures me that all healthcare professionals are required to read an evidence-based protocol on ME as part of their training, as well as engaging in a programme of continuing medical education that includes modules on the condition.

From what I have heard today, Members clearly feel that that is not happening— certainly not in a consistent way. I will take an action from the debate to send a copy of what has been said to the relevant Minister—I believe it is the Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton)—at the DWP. However, I encourage members of the all-party group to seek more and continuing engagement with the DWP on this issue. I will certainly follow that up with them.

Once again, I thank the hon. Member for Glasgow North West, who opened the debate, and her colleagues who secured the debate through the Backbench Business Committee for raising the issues of ME research and treatment on behalf of those affected—their constituents and mine. I welcome this and all other opportunities to raise awareness within the House. Ultimately, raising awareness is what we can do, and that can lead to action and real change, as we saw within the brain tumour community.

I thank the ME charities—they are very active in my part of the world, in Hampshire—for their continuing work in this area. What has been fascinating today, as always with debates in my portfolio, is that I have not heard one single person mention their party political colours. There really is no politics in ME, and nor should there be. I want to see us come together at our true, cross-party best to focus on the needs of people with ME and see if we can move the research agenda forward in this area.

I think the hon. Member for Glasgow North West said in her opening remarks that professionals should welcome research, because evidence-based treatment is ultimately the basis of their training. I welcome such research. I echo what has been said, and on the email that she read out earlier—clearly, I have not seen it and have only heard her reporting of it; I think she will give it to me afterwards—I hope that that will be the second apology received as a result of my remarks today. I look forward to being copied into that.

As I said earlier, the NIHR and MRC are speaking to the UK CFS/ME Research Collaborative and patient representatives about how they can best support a joined-up approach to high-quality research into this complex disorder. I hope they will update colleagues about those discussions later in the year. I will end with what Jennifer said right at the end of “Unrest”:

“every book I read…said, ‘when you fall ill, either you...find the cure or die trying.’ It always ends in triumph or tragedy. But that’s not my story—at least not yet.”

That is how she put it.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 19th June 2018 Commons Chamber

[Craig Tracey (North Warwickshire) (Con)]

6. What recent assessment he has made of the public health benefits of participation in sport.

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

There is a strong body of evidence on the health benefits of participating in sport— possibly not watching it, if last night is anything to go by. Last year, a review by Sport England brought together evidence to show the association between sport and physical and mental wellbeing.

[Craig Tracey]

As the Minister may be aware, I co-chair the all-party parliamentary group for golf—a sport sometimes labelled, rather unfairly, a good walk spoiled. Does he agree that there are many positive health benefits associated with participation in golf, especially for people with long-term conditions?

[Steve Brine]

I certainly would, as someone who used to work in the golf industry before coming to the House. I was at Wentworth last month for the PGA, and a good example of what my hon. Friend refers to is a social enterprise that I met called Golf in Society led by an inspirational chap called Anthony Blackburn. He founded a project at Lincoln Golf Centre that works with people with dementia and Parkinson’s disease to show that golf is one of the best leisure activities out there, and gives people with those long-term conditions a sense that their life is not over and that they can still play golf, and play it rather well—probably better than me.

[Ruth Smeeth (Stoke-on-Trent North) (Lab)]

In 2016, Stoke-on-Trent was the European city of sport, but it faces some of the highest health inequalities in the country. The Stoke newspaper The Sentinel highlighted the power of exercise in its recent NHS SOS campaign. Will the Minister meet the editor Martin Tideswell and my hon. Friend the Member for Stoke-on-Trent Central (Gareth Snell) to receive details of that incredibly important local campaign?

[Steve Brine]

I am aware of that campaign. Something that we want to see in schools across the country, including in Stoke, is the Golden Mile. I see good examples in schools in my constituency and across the country when I travel. We are interested to learn more about what Stoke has done on this subject.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

7. What steps he is taking to ensure that homeless people are able to access healthcare and dentistry services.

--- Later in debate ---

[Mary Glindon (North Tyneside) (Lab)]

11. What recent discussions his Department has had with representatives of NICE on increasing the capacity of the highly specialised technologies evaluation process.

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

My officials have regular discussions with the National Institute for Health and Care Excellence, of course, but we are clear that there is no fixed capacity in NICE’s HST programme. The number of drugs that it evaluates each year is driven by the pipeline of drugs expected to come to market, and we will refer any suitable drugs to it for evaluation.

[Mary Glindon]

There is a risk that new treatments for life-limiting conditions, such as Duchenne muscular dystrophy and spinal muscular atrophy, might not be approved by NICE, so will the Minister meet me and Muscular Dystrophy UK to discuss ways to facilitate access to treatments, as highlighted by the charity’s FastTrack campaign?

[Steve Brine]

NICE has recommended the drug Translarna for use in the treatment of Duchenne muscular dystrophy; it is now routinely available on the NHS. It is a disease that I grew up with—the friends that I grew up with did not, and I did, and this is a timely reminder of how terrible this disease can be. I would be really pleased, therefore, to meet the hon. Lady and the charity that she mentioned.

[Derek Thomas (St Ives) (Con)]

Is the Minister aware of the recent NICE draft review regarding treatment of abdominal aortic aneurysms? Some 1,500 to 2,000 lives are saved yearly by NHS AAA screening. If the draft recommendations are adopted, a patient is likely to have an aneurysm erupt before treatment and 80% of patients are then likely to die. Will the Minister look carefully at this issue to avoid this unintended consequence?

[Steve Brine]

I am not the all-seeing eye, so all I can say is yes, I will look very carefully at the issue that my hon. Friend raises.

[Paul Masterton (East Renfrewshire) (Con)]

12. What steps he is taking to support community first responder units.

--- Later in debate ---

[Nigel Mills (Amber Valley) (Con)]

16. What steps his Department is taking to support the use of innovative drugs and devices in the NHS.

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

The Government are committed to ensuring that innovative healthcare products reach patients faster than ever before. We have established the Accelerated Access Collaborative to identify transformative innovations and help their route to market, and today we have appointed Lord Darzi as the new chair of the AAC to lead this work.

[Nigel Mills]

I welcome the fact that the Prime Minister in her speech yesterday announced much more funding for personalised medicines and new technologies that will transform care. On that basis, will the Minister update the House on when the groundbreaking CAR-T— chimeric antigen receptor T-cell—therapy might be made available to NHS patients suffering from cancer?

[Steve Brine]

Yes, indeed. As the cancer Minister, I consider CAR-T to be one of the most innovative and exciting treatments ever offered on the NHS. NICE is considering the first of the therapies this year and preparations are well under way. We are working closely with NHS England to make these transformative medicines available to cancer patients.

[Liz Twist (Blaydon) (Lab)]

Patients with PKU—phenylketonuria—are awaiting progress on the approval of a drug called Kuvan. In the meantime, their illness is controlled by diet. Will the Secretary of State and other Members join me in Committee Room 21 after this meeting to hear about the “Diet for a day” challenge, which many Members across the House are taking up next Thursday?

[Steve Brine]

Having just dialled into the Secretary of State’s diary, I know that he is going right after these questions.

[Mr Speaker]

That is very impressive, up-to-the-minute information from the hon. Gentleman.

[Sir Desmond Swayne (New Forest West) (Con)]

Does the Minister have proposals for the reform of the Medicines and Healthcare Products Regulatory Agency? I hope so.

[Steve Brine]

We keep all our arm’s length bodies, including the MHRA, under review to provide best value for taxpayers, and we are working closely with Lord O’Shaughnessy, who is the Minister responsible for this area.

[Mr Speaker]

We have been so brief that we must now include Mr Hollinrake.

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

Thank you, Mr Speaker. Probably the most important recommendation in the new O’Neill review into antimicrobial resistance was the requirement for diagnostics prior to the prescription of antibiotics by 2020. Will the Minister update the House on progress towards that goal, and will he agree to meet me and colleagues, including Lord O’Neill, to discuss the establishment of an antibiotic diagnostics fund?

[Steve Brine]

Yes, the Government’s response to Lord O’Neill’s review in 2016 set out new ambitions building on existing progress, including ensuring that tests on epidemiological data are used to support clinical decision making and delivering high-quality diagnostics in the NHS in support of our other ambitions. My hon. Friend is right to raise this issue, and I am happy to meet him.

[Justin Tomlinson (North Swindon) (Con)]

17. What steps he is taking to reduce rates of childhood obesity.

[Johnny Mercer (Plymouth, Moor View) (Con)]

19. What steps he is taking to reduce rates of childhood obesity.

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

We are delivering the most ambitious childhood obesity plan in the world, and we are already seeing results. We always said that our 2016 plan was the start of the conversation, not the final word. [Interruption.] Yes, it does say that here, but I have also said it everywhere else many, many times.

[Justin Tomlinson]

With one in three primary school children leaving either obese or overweight and more than 77% of children not doing the minimum requirement for physical activity, surely the Government’s priority should be getting children active by opening up school facilities after hours and in the holidays, not faffing around with political gestures on television advertising that children have long since stopped watching.

[Steve Brine]

I do not think that it is a binary choice. We recognise that child obesity is caused by many different factors, and that no one policy will work on its own. Yes, this is about tackling advertising, and yes, it is about tackling children’s activity and working with schools; and, as I said recently, we will present new proposals very shortly.

[Johnny Mercer]

As the Minister will know, perhaps the two biggest challenges that we currently face in relation to young people’s health are mental health and child obesity. Will he update the House on the progress of chapter 1 of his childhood obesity plan in reducing the amount of sugar in both food and drink?

[Steve Brine]

Since we published the plan, progress has been made on sugar reduction. The amount of sugar in soft drinks has been reduced by 11% in response to the industry levy, and Public Health England has published a detailed assessment of progress against delivery of the 5% reduction for the first year. Progress is good, but it is not good enough, which is why we have said that we will produce chapter 2 shortly.

[Diana Johnson (Kingston upon Hull North) (Lab)]

The Minister says that progress is not good enough, so why does he not introduce a levy on high-sugar food as well as the one on sugary drinks? Manufacturers would then reformulate the food that they produce.

[Steve Brine]

Because we believe that there should be a mixture of carrot and stick. We believe that the soft drinks industry levy has been successful, but we are also working with the industry on reformulation across the board. I recently visited Suntory, which makes Lucozade and Ribena. If we work with industry, we see transformative results for companies and for the people who buy their products.

[Mr Gregory Campbell (East Londonderry) (DUP)]

A few years ago, I initiated a debate on this issue in Westminster Hall. Since then, no progress has been made on childhood obesity. Would the Minister care to outline what he thinks will happen in the lifetime of this Parliament in terms of achieving the objectives that he has set out?

[Steve Brine]

We assess the plan all the time, and we make progress reports on it, as we did last month with the sugar report. However, when I addressed the Health Committee recently, I could not have made it clearer that we think there has been progress.

This is a world-leading plan. When we talk to other people around the world, they are very keen to hear about what we are doing and very interested, and we are interested in learning from them. If we do not take action, one of our biggest public health challenges will get worse and worse, and that will have implications for the health service and for all our constituents.

[Rosie Cooper (West Lancashire) (Lab)]

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

--- Later in debate ---

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

Survival rates are high, but I am ambitious for more. That is why the Prime Minister recently announced £75 million to support new research into the early diagnosis and treatment of prostate cancer. We will recruit 40,000 patients into more than 60 studies over the next five years, and further to this even more exciting is the rapid pathway that I was discussing yesterday with Cally Palmer, our national cancer director, which we are trialling across three hospital sites in west London as part of its local cancer alliance.

[Hannah Bardell (Livingston) (SNP)]

T2. Given the challenges the Secretary of State and his Government face in recruiting and retaining health and social care staff, will he follow the example of the Scottish Government, who pay their social care assistants and care assistants the real living wage, meaning they earn £1,100 a year more than their counterparts in England?

--- Later in debate ---

[Kirstene Hair (Angus) (Con)]

Can the Minister provide an update on the work being undertaken by the policy research unit on obesity to consider the relationship between the many streams of marketing and obesity, and can he tell us whether the unit is looking specifically at childhood obesity?

[Steve Brine]

The National Institute for Health Research—the policy research unit—is specifically looking at the impact of the marketing of products with a high sugar, fat or salt content on children’s food and drink preferences and consumption. The unit has already published a report on children’s exposure to television advertising, and it will be publishing further findings from other projects later this year.

[Stephen Morgan (Portsmouth South) (Lab)]

T5. The Institute for Fiscal Studies says that there is no such thing as a Brexit dividend, so the Secretary of State will need to put up taxes to fund our NHS. Will he be transparent and promise NHS workers in Portsmouth, to whom he has only just given a pay rise, that the burden will not fall on hard-working families like them—or is he robbing Peter to pay Boris?

--- Later in debate ---

[Vicky Ford (Chelmsford) (Con)]

Stroke is the fourth largest single cause of death in Britain. What action are the Government taking to prevent stroke and to raise awareness? And will the Minister meet me to discuss my GP surgery at Sutherland Lodge?

[Steve Brine]

Two for the price of one. Up to 70% of strokes are preventable if hypertension, atrial fibrillation, diabetes, cholesterol and other lifestyle factors are detected and managed earlier. The current national stroke strategy came to an end last year, so we are working closely with NHS England and the Stroke Association on a new national plan, which I hope to publish this summer.

[Afzal Khan (Manchester, Gorton) (Lab)]

T9. One of the biggest causes of regional health inequalities is the broken social care system, yet yesterday’s announcement postponed social care reforms again until the autumn. There is no end in sight for the overstretched and underfunded social care system, and without reforms to care, the extra money for the NHS will be wasted. Will the Minister bring up the timetable for those reforms before the care system collapses?

--- Later in debate ---

[Sir Roger Gale (North Thanet) (Con)]

Mr Speaker, you will recall recently granting me a Westminster Hall debate on the HPV vaccine for boys. Will the Department update me on progress?

[Steve Brine]

I remember that debate. The matter was on the Joint Committee on Vaccination and Immunisation’s June agenda, and I am awaiting its advice with bated breath. As I said in the debate, I will turn that advice around as soon as I get it and get a decision. I know a lot of people are waiting on that.

[Several hon. Members rose—]

Acquired Brain Injury

Steve Brine Excerpts

Monday 18th June 2018 Commons Chamber

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

I beg to move,

That this House has considered acquired brain injury.

After the last three hours, I think the expression is—and now for something completely different.

For the past hour and a half, some of us English Members have endured watching the match—Tunisia 1: Spurs 2; I mean, England 2. It is a pleasure to be in the House, and we are very grateful to SNP Members for enabling us to watch the match.

I rise to speak to the motion in the name of my right hon. Friend the Prime Minister. I pay tribute to the hon. Member for Rhondda (Chris Bryant) and my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) for their persistence at business questions and elsewhere, and for securing this debate in the House. Brain Injury Awareness Week took place last month, which makes today’s debate especially timely.

Let me first recognise the important work of organisations such as Headway and the United Kingdom Acquired Brain Injury Forum in raising awareness and in providing information and support to those living with acquired brain injury and to their friends, families and carers. I know that some of them are with us this evening, and I thank them for their persistence during the family dispute we have had in the Chamber for the past three hours.

Acquired brain injury—ABI—is an injury that takes place after birth in an otherwise healthy brain. It includes traumatic brain injuries such as those caused by road traffic accidents, falls or assaults, and non-traumatic brain injuries related to illnesses or medical conditions, including meningitis, stroke or brain tumours. While prevalence estimates for ABI are quite hard to make, the number living with it is thought to be over 500,000 and could be as high as 1 million people. The total cost of brain injury in the UK has been estimated by our officials to be at least £1 billion per year.

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

My hon. Friend talks about the cost of brain injuries. My constituent Stuart Tranter asked me to lobby the Government to put more money into brain tumour research, which has been very much the poor relation, and I have been successful. I congratulate the Government on having doubled that money since Tessa Jowell, who used to serve on the Opposition Benches and then went to the House of Lords, died. I am very grateful to the Minister and the Department for putting so much money into that much needed research.

[Steve Brine]

I thank my hon. Friend. This is the first time I have been at the Dispatch Box since Baroness Jowell passed away. As I said during the debate when she was sitting in the Under Gallery with her lovely family, I did not know her well but the one time I met her I was left in no doubt about her determination on this subject. It is great that we are able to do so much. I pass on my condolences to Jess, her daughter, whom I have got to know a little, and her family. The trauma of the immediate is horrible and it goes on for a long time. Our thoughts are with them. I thank my hon. Friend for what she has said. We will do well by Baroness Jowell, especially through the money that we will put into research to try to instigate new research projects, which have traditionally been thin on the ground in this area. We are hoping to stimulate the research market.

ABI can have a devastating impact on our constituents’ lives; even minor head injuries can cause short-term impairment. Those surviving more severe injuries are likely to have complex long-term problems affecting their cognitive and functional ability, personality, close relationships and ability to return to any form of independent life.

[Alex Chalk (Cheltenham) (Con)]

rose—

[Caroline Lucas (Brighton, Pavilion) (Green)]

rose—

[Steve Brine]

Ladies first.

[Caroline Lucas]

Does the Minister share the concern raised with me by my Brighton constituents who travelled up to Westminster to share their stories, about the lack of funding for support for relatives and carers—in particular, the education that family members and carers need about how to look after someone with ABI? It can be incredibly stressful for the person themselves and for family members if people do not know how best to provide care. Funding can make a huge difference.

[Steve Brine]

I thank the hon. Lady for that point, which I shall come to. There are other Ministers on the Bench with me, including from the Department for Work and Pensions, because I wanted them to hear other parts of this debate. The hon. Lady’s point is well made.

[Alex Chalk]

The Minister rightly listed a number of impacts from traumatic brain injury. Does he agree that one of those can be an increasing propensity to commit criminal offences? We are starting to wake up to the fact that a number of people in custody have sustained precisely that injury. That should be a focus for preventive work in future.

[Steve Brine]

I thank my hon. Friend, who has professional experience of the criminal justice system. I shall come to his point in a moment, but I thank him for putting it on the record. Sometimes it is a difficult subject to talk about, but it is very relevant.

[Jim Shannon (Strangford) (DUP)]

This debate is important to me personally; many years ago my brother had a serious brain injury as a result of racing motorbikes. That made an independent, single-minded person into someone who depended very much on others; it took him from being a person with his own business and social connections to being someone who could not co-ordinate more than one thing at a time.

I look forward to some comfort in the Minister’s response, which I know we will get. We need not only help for the person in an institution; they need to be taken home and given a semblance of order in their lives and what quality of life is possible. Does the Minister accept that families need help to take on that job for someone whom they love and want to help?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Before the Minister responds, I should say that I appreciate that many want to make interventions because they do not want to stay until the end of the debate. We have only an hour and 10 minutes. A lot of people wish to make speeches and there will have to be a time limit. Interventions must be short.

[Steve Brine]

I do not know what you mean, Madam Deputy Speaker, but I will certainly be here until 11 pm.

The hon. Member for Strangford (Jim Shannon) makes a good point, which follows on neatly from the point made by the hon. Member for Brighton, Pavilion (Caroline Lucas). It also leads me neatly on to the point I was about to make. The all-party group on ABI is currently conducting a very broad inquiry into the condition—its causes, treatments and societal impact—and I am sure it will consider the wider family. When I say family, I do not just mean the nuclear family but society’s family and even the Church, which can embrace people suffering the life change the hon. Gentleman spoke about so well with regard to his brother. I want the all-party group to know that I will support its inquiry as best I can. They should know that that offer is there.

As a Health Minister, I will obviously focus on the health aspects of ABI, but I just want to highlight some of the other areas—this touches on one or two of the interventions—where its impact is felt and action is under way. On education, many children and young people with ABI are rightly in education and have special educational needs as a result of their injuries. The Government recently provided some £29 million to support local authorities with ongoing implementation of individual education, health and care plans to meet those needs. It is vital to us that health, social care and education services work jointly in developing these care plans. I know my colleagues in the Department for Education share that view.

On offending behaviour—ABI touches on a lot of different Government Departments—there is an increasing body of evidence suggesting that children and young people who survive traumatic brain injury are more likely to develop behavioural problems that can be linked to an increased vulnerability to offend. NHS England’s liaison and diversion service has collaborated with the charity Headway, which I mentioned at the start of my speech, to improve awareness of ABI in vulnerable offenders and the support available—the point raised by my hon. Friend the Member for Cheltenham (Alex Chalk). Further, the Ministry of Justice is piloting approaches to improve screening and support for prisoners with ABI to prevent a cycle of re-offending once they enter the secure estate. The Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), is very kindly on the Government Front Bench to listen to the debate and I am grateful to her. The Minister of State, Ministry of Justice, my hon. Friend the Member for Penrith and The Border (Rory Stewart), who has responsibility for prisons, had hoped to be here but was pulled away. I know he will be taking a close interest in what is said tonight, because this issue will come up again.

Sport is another area for which there is a growing body of evidence and concern about the levels of risk and response to injury. This is why the Government commissioned an independent review of the duty of care that sport has to its participants, which published its findings in April 2017, and we are now working to implement its recommendations, including around awareness and prevention of head injury while playing sport.

On trauma centres, it is vital that those with the most serious brain injuries receive the best care that our NHS —our birthday NHS—can offer. In 2012, 22 regional trauma networks were developed across England. Within those networks, major trauma centres provide specialised care for patients with multiple, complex and serious major trauma injuries, including brain injury. Two years after their introduction, an independent audit of the network, commissioned by NHS England, showed patients had a 30% improved chance of surviving severe injuries and that the networks had saved some 600 lives. There is a positive story there.

A vital part of the treatment pathway for people who have suffered ABI is neuro-rehabilitation that is timely and appropriate to their needs. There is good evidence that access to high quality rehabilitation both improves outcomes for patients and can save money.

[Nic Dakin (Scunthorpe) (Lab)]

The neuro-rehabilitation centre in Goole is an excellent example of such practice. It serves north Lincolnshire and the wider area. I commend that service, and others like it, to the Minister.

[Steve Brine]

I thank the hon. Gentleman for his intervention. I hope to get to his part of the world at some point while doing this job and it may be that I could visit it while I am up there.

The World Health Organisation states that rehabilitation intervention should be aimed at achieving the following five broad objectives: preventing the loss of function; slowing the rate of loss of function; improving or restoring function; compensating for lost function; and maintaining current function. NHS England’s Improving Rehabilitation programme applies those principles, rightly, in a holistic way to encompass both mental and physical health. In 2015, the programme published the “Principles and expectations for good adult rehabilitation” to support commissioners on delivering rehabilitation care locally in our constituencies. This document describes what good rehabilitation looks like and offers a national consensus on the services that we think people should expect.

[Eddie Hughes (Walsall North) (Con)]

It is important that we consider that it is not just trauma with regard to ABI. One of the other causes might be excessive exposure to carbon monoxide, so I was grateful to the support that Headway gave to my private Member’s Bill, which seeks to introduce mandatory carbon monoxide detectors in new-build and social rented houses.

[Steve Brine]

My hon. Friend makes an excellent point. As I said at the start, obviously there are non-traumatic injuries—so, through conditions, and meningitis and stroke were two examples that I gave—but he is absolutely right to point out that issue. I congratulate him on his success with his Bill.

The rehabilitation programme includes 10 principles and expectations that were designed by people who use rehabilitation services—the carers, healthcare professionals, commissioners, strategic clinical networks and national clinical directors. Building on this, in 2016, NHS England published further rehabilitation guidance covering both adults and children. This provides local service planners with a commissioning model, a range of case studies and crucially, an evidence base for the economic benefits of delivering high-quality rehabilitation services.

While the vast majority of rehabilitation care is locally provided, NHS England commissions specialised rehab services for those patients with the most complex levels of need. Teams within trauma units assess and develop a rehabilitation prescription for patients with ABI. Through this, patients can access specialists in rehabilitation medicine, whose expert assessment helps to inform the prescription. The teams manage ongoing patient care, including a key worker to support patients through the pathway and into rehabilitation at a level appropriate to their clinical need, in accordance with their clinician’s advice—be that highly specialised rehabilitation or through a local provider in the local network.

I want to mention the Rehab Matters campaign. As I said, rehabilitation is a key part of the patient’s recovery. I saw at first hand the impact that this can have in helping people to recover from illness or injury when I visited the Hobbs rehabilitation centre in my Winchester constituency earlier this year. The Chartered Society of Physiotherapy launched its Rehab Matters campaign here in the House at the end of October last year. It makes a very powerful case for community rehabilitation, and I think that all commissioners should ensure that levels of provision are meeting local needs and look to places such as the Hobbs centre as a good example of what can be achieved through rehabilitation care. The society produced a film that was made by the Oscar-shortlisted UK director, Chris Jones, called “Rehab Matters”, and I highly recommend it to Members interested in this area.

I am just going to skip over to research, and then close, because we have only an hour and I know that a lot of people want to speak. Let me just highlight the research being undertaken in this important area. We are investing over £1 billion a year in health research through the National Institute for Health Research. The NIHR is funding ABI research from basic science to translational research in civilians, military and sport. For example, we are investing over £100 million, over five years up to 2022, in a biomedical research centre in Cambridge that is developing new approaches to reduce the impact on patients’ health and wellbeing of neurological disorders, stroke and brain injury. We are investing £5 million to co-fund the surgical reconstruction and microbiology centre in partnership with the Ministry of Defence—that has been going since 2011. The centre specialises in research, taking discoveries from the military frontline to improve outcomes for all. We have invested about £16 million in brain injury research since 2014 through the NIHR health technology assessment programme, and we are investing just over £2 million over three years through NIHR’s global health research group on neurotrauma, which aims to advance global neurotrauma care and research to help to save lives, reduce disability from the trauma and improve the quality of life for patients with brain injury.

I fully recognise the devastating impact that acquired brain injuries can have on individuals and their families. The evidence shows that neglecting rehabilitation is a false economy. Rehabilitation equips people to live their lives, fulfil their potential and optimise their contribution to their family, their community and society as a whole. I am honoured to have introduced this debate and, as always in such debates, I look forward to hearing the views and insights from across the House on what further work or support is needed to reduce risk and improve the care available.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Minister.

[Steve Brine]

I had finished, Madam Deputy Speaker. Incredibly, it was timed to perfection.

[Madam Deputy Speaker]

I beg the Minister’s pardon. I have never before heard such a feat of perfect rhetoric. Thank you for being so perfect. [Interruption.]. Yes, it was quite unusual.

--- Later in debate ---

[Steve Brine]

I am back, Mr Speaker. Time is very tight. If I do not answer any specific questions asked, I will write to Members; I always do.

It has been a very interesting and far-reaching debate. We have heard about some of the excellent work being undertaken to improve the care, treatment and support of those with an ABI. We have also heard about so many areas where so much more needs to be done, particularly around variation in care. I am the first to admit that there is a lot more that we need to do. I am clear from the debate that we need to keep our focus on providing rapid and appropriate triage and treatment of head injury, to ensure that patients can access the most appropriate service and level of expertise from the start—especially, as the hon. Member for Rhondda (Chris Bryant) said so well, in our schools. We should be seeing joint working between health, social care and education, with multi-professional assessments of a child or young person’s needs, including all the relevant experts, to get this right earlier and to prevent the cycle of problems that often lead to exclusion, brushes with the criminal justice system and a life scarred more than it already is. Dare I say it, as someone once said, we need to understand a little more and condemn a little less. I still believe in that.

Many Members talked about the need to ensure that patients have access to the necessary specialists and services that are relevant to their rehabilitation needs and to work harder than ever to iron out inconsistencies in what is available. I mentioned in my opening remarks the regional trauma networks, which have been very successful. A number of Members spoke about those, including my hon. Friend the Member for Chippenham (Michelle Donelan). The hon. Member for Barrow and Furness (John Woodcock), as usual, spoke from the heart and gave us a very personal insight into what happens when you are unlucky on a ladder and the fall-out across family and children. I think he has recovered incredibly well.

A number of Members, including my hon. Friend the Member for Cheltenham (Alex Chalk), talked about identifying and supporting individuals in whom a previous brain injury may be informing impulsive risk-taking activity leading to crime. I also take away the clear message that we must maintain our research commitment. The hon. Member for Washington and Sunderland West (Mrs Hodgson) said that a review of neuro-rehabilitation is required. The audit that we published at the end of 2016 recommends that all providers reflect on the capacity that they have. The national clinical audit of specialist rehabilitation will address that in the next stages of the audit, which are due to complete later this year.

The hon. Lady also talked about discussions with the DWP. We have discussions all the time. Many comments were made today about the DWP, so I am grateful that the Minister for Disabled People, Health and Work was on the Treasury Bench to hear those. Through the personal support package for people on employment and support allowance, the DWP is working to improve the support that it offers to those with long-term conditions such as brain injury, including peer support and training for disability employment advisers. However, it sounds like there is a lot of work to be done, and I know that my hon. Friend is keen to see that done.

[Chris Bryant]

We have had to go at a bit of a gallop this evening. I wonder whether the Minister could use his best offices to ensure that we have another debate fairly soon.

[Steve Brine]

I may have been called “perfect” by Madam Deputy Speaker, the right hon. Member for Epping Forest (Dame Eleanor Laing)—Mr Speaker, you do not want to know—but all I can say is that there are many things at my disposal, but scheduling debates in this House is not one of them. There are many ways in which the hon. Gentleman can bring forward debates in this House, and knowing him as I do, I have a funny feeling that he will be doing it some more. Whichever Minister responds to such a debate, I welcome that, because there are a lot of issues and we need to look at them. He talked about an invisible epidemic, and he may well be right. It has been a pleasure to listen to this debate, short as it has been, and an honour to respond to it.

Question put and agreed to.

Resolved,

That this House has considered acquired brain injury.

Hepatitis C

Steve Brine Excerpts

Tuesday 12th June 2018 Westminster Hall

[Sir David Amess]

My hon. Friend was a Health Minister and has real expertise in this area. I shall use the expression “joined-up government”. He is absolutely right that we need Departments to work together. That is why it was so good that we visited the prison.

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

I may be able to help my hon. Friend here. As he knows, the drug strategy board is a cross-government committee. It met yesterday, chaired by the Home Secretary, and its members include the Justice Secretary, Health Ministers, Home Office Ministers, Housing, Communities and Local Government Ministers and representatives from the Department for Work and Pensions, as well as senior police officers, representatives from the National Crime Agency and a representative of the police and crime commissioners. That board takes that cross-government look, and hepatitis C is certainly an issue I would like to see it look at.

[Sir David Amess]

That is excellent news. I thank my hon. Friend for that positive response to looking at this issue.

The testing and treatments initiatives in place will lead to a decline in the prevalence of the disease. However, prevention will come from identifying and educating at-risk groups. To do that, we need the help of substance misuse services, sexual health clinics and peer programmes that can educate those most vulnerable sections of society on the transmission of the virus. I am advised that these services are at risk of closure without sufficient increases in their funding. Perhaps the Minister will have some news on that when he replies.

Harm reduction is another paramount mode of prevention. If we can reduce the harm to at-risk groups, we can combat one way in which the disease is transmitted. That can be achieved by providing clean and sterilised injecting equipment. Our report also emphasises the treatment-as-prevention approach towards tackling newer infections. That approach has been successful in treating drug users and other users engaging in riskier behaviours to prevent the spread of hepatitis C.

As I said earlier, between 40% and 50% of people living with hepatitis C in England are undiagnosed, which is shocking. It is therefore vital that we continue to increase testing and diagnosis levels. It is generally believed that the vast majority of those who have been diagnosed and put in touch with support services have now been treated, which I welcome. The challenge is therefore to locate those people who remain undiagnosed. That is a tricky one; it will be a real challenge.

--- Later in debate ---

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

It is genuinely a pleasure to serve under your chairmanship, Mr Streeter, and to be back in Westminster Hall on such a quiet day in Westminster. The hon. Member for Ealing, Southall (Mr Sharma) is sadly not in his place today, but I thank my hon. Friend the Member for Southend West (Sir David Amess) for securing and leading this debate. Although he said that he was not the best person to introduce the debate, he could have fooled us because he did it very well.

Hepatitis C is a significant health issue in our country, and for too long it has been overshadowed by other public health concerns that, despite the superstars involved, have had higher public profiles. I pay tribute to the Hepatitis C Trust and the wonderful Charles Gore, whom I have got to know in this job. He is a colossus in this area, and has become a friend. I also thank the Hepatitis C Coalition—this issue has been central to both those organisations.

My hon. Friend mentioned lots of local services for Southend residents, and a lot is going on in his constituency. Few MPs champion their constituency more than he does, so for his press release I will mention that screening and onward referral services are provided by the Southend Treatment and Recovery Service, known as STARS. For primary care, GP practices refer people to the specialist treatment services in my hon. Friend’s much-loved Southend Hospital. Local drug and alcohol treatment services in Southend hold outreach screening sessions for hepatitis, and all positive cases are referred for onward treatment. Big local successes that I noted in my papers included last year’s hepatitis C roadshow, which took place in my hon. Friend’s area, and there is the hepatitis C operational delivery network educational event 2018—he can see me after class for more details if he would like.

It is always good to see the hon. Member for Strangford (Jim Shannon) in his place, speaking so knowledgably and passionately about this issue, as well as the hon. Member for Central Ayrshire (Dr Whitford), and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter).

The World Health Organisation has set ambitious targets to reduce the burden of chronic hepatitis C over the coming years, with a pledge to eliminate it as a major public health threat by 2030. The UK Government are committed to meeting and beating that target, as has rightly been said.

A few years ago, hepatitis C-related mortality was predicted to increase in our country, but through the measures that we have in place and the hard work and dedication of so many unsung heroes in the field, 9,440 treatments were delivered nationally against a target of 10,000 in 2016-17; the number of deaths fell for the first time in more than a decade, and that has been sustained for another year; and between 2014 and 2016, there was a 3% fall in deaths from hepatitis C-related end-stage liver disease. That is good news.

However, hepatitis C continues to make a significant contribution to current rates of end-stage liver disease. I welcomed the recommendations to tackle that in the report, “Eliminating Hepatitis C in England”, which was published in March by the all-party parliamentary group on liver health, of which my hon. Friend the Member for Southend West is co-chair. I often produce a recommendation-by-recommendation response to Select Committee reports in my area, but when I checked with my officials during the debate, I found that I did not do it for that report—I was not asked to by the group—but I offer to do so. In fact, I will go further than that—I will go crazy and do it. The group will get that from me as a written response to its report.

This is a timely debate, because NHS England recently launched its procurement exercise for the new generation of hepatitis C antivirals. If that exercise delivers successfully, the ambition is to eliminate hepatitis C as a public health threat earlier than the WHO goal of 2030, and to get to 2025.

[Dr Poulter]

Given the experience that we had with NHS England on HIV PrEP medication and its argument that that was a public health responsibility, which I believe was wrong and which was legally found wanting, will the Minister ensure that he holds its feet to the fire on hepatitis C so it recognises that although it is a public health issue, it has a responsibility for the effective procurement of antivirals and for making them available to all people with hepatitis C?

[Steve Brine]

Point taken; feet will be held to said fire. I do not think that NHS England is found wanting in this area, and I will go on to say why, but I take my hon. Friend’s point and will follow it through, because I want this to work.

The new industry deal may allow for longer contract terms that cover a number of years, but whether a long-term deal can be reached and what its duration is will be contingent on the quality and value of the bids submitted by industry. I expect the outcome of that in the autumn.

On local delivery networks, NHS England has established 22 operational delivery networks across our country to ensure national access to the antiviral therapy. I will touch on the issue of the cap in a minute. Those clinically led operational networks are given a share of the national annual treatment run rates based on estimated local need.

That local operational delivery network model ensures better equity of access. Many patients with chronic hepatitis C infections come from marginalised groups that do not engage well with healthcare, as has already been said. Through the development of networks, it has been possible to deliver outreach and engagement with patients outside traditional healthcare settings, such as offering testing through drug and alcohol services and community pharmacies.

As hon. Members know, I have a great soft spot for community pharmacies, and I think that they can and do play an important role in this space. In April, I hopped along to Portmans Pharmacy, which is just up the road in Pimlico, to see the pharmacy testing pilot of the London joint working group on substance use and hepatitis C that is going on there. I saw the testing and the referral to treatment that takes place in pharmacies that offer needle and syringe programmes across six boroughs in London.

Portmans Pharmacy has provided a needle and syringe programme and the supervised consumption of methadone for a number of years. Those points of contact with people who inject, or previously injected—a key distinction—drugs provide an ideal opportunity for us to make every contact count and to test for hepatitis C, as we think that about half of people who inject drugs in London have the virus.

The approach of Portmans Pharmacy and the London joint working group is innovative. It aims to provide quick and easy access to testing and a clear pathway into assessment and treatment in specialist care, which is obviously critical. I pay great tribute to the work that the group has done. It has rightly received a lot of coverage and a lot of plaudits. I am anxious and impatient—as my officials know, I am impatient about everything—to see the peer-reviewed results of that work and where we can scale it out more.

The hon. Member for Central Ayrshire mentioned treatment in respect of the cap. It is different north of the border, but NHS England offers treatment as per the NICE recommendations. The drugs that she mentioned are expensive, which limits the number of people who can be treated each year, but treatment has been prioritised for those most severely affected. The NHS then provides treatment to others who are less severely affected. So far, 25,000 people in England have been treated with the new drugs and a further 13,000 will be treated this year. The NHS procurement exercise should allow for even larger numbers to be treated each year. Of course, nothing is perfect in life. Resources in a publicly funded health system are finite, which is why we have to target them at the most challenged group. That is one of the reasons why making every contact count through primary care and pre-primary care, as I call community pharmacies, is so important.

[Dr Whitford]

Does the Minister accept, though, that the people who are likely to continue to spread the condition are those who are less ill? The old concoctions tend not to be so effective or well tolerated. That is a big difference from the new antivirals, which are very effective and very well tolerated. It strikes me that in England, we may be letting more people become more ill before they qualify for the better drug.

[Steve Brine]

Of course, the hon. Lady states a fact not an opinion, and I accept that, which is why I speak of the importance of primary care and of making every contact count. The people who Portmans Pharmacy interacts with are not all sick. People who have a hepatitis C infection or a drug-use issue have other issues—they get flu too—so they interact with that pharmacy, and the pharmacy makes every contact count by grabbing people earlier. That is one reason why I am so passionate about the way that that underused network can help us to reach the ambitious targets that we have set.

Everyone has rightly talked about prevention—in many ways, I am the Minister with responsibility for prevention and it is the thing that I am most passionate about in our health service. As well as testing and treating those already infected, an essential part of tackling hepatitis C must be the prevention of infection in the first place, or the prevention of reinfection of those successfully treated, which would not be a smart use of public resources.

NHS England and Public Health England, which I have direct ministerial responsibility for, are actively engaged in programmes at a local level to prevent the spread of infection. As people who inject drugs or share needles are at the greatest risk of acquiring hepatitis C, prevention services, particularly those provided by drug treatment centres, are key components of hepatitis C control strategies. Clearly, the key to breaking the cycle of hepatitis C is to prevent infection happening in the first place.

[Dr Poulter]

The fundamental issue is that there is no greater evidence of fragmentation—I speak from my own clinical experience—and failure of joined-up working than the fact that local authorities commission substance misuse services but that the NHS commissions mental health services for the same patients and secondary care services for hepatitis C patients. People are falling through the gaps. Many people who have hepatitis C do not present to GPs, and are not even routinely on their lists, so the issue has to be looked at in a much more effective way if we are to make a difference.

[Steve Brine]

I hear my hon. Friend’s experience of the frontline and I would not disagree that in some areas there is unhelpful fragmentation. If I remember rightly back to those happy early days of the election of my hon. Friend and I to this place, we sat on the Health and Social Care Bill Committee. That piece of legislation, controversial as it was, enacted the decision to pass that responsibility to local authorities and, of course, all local authorities are now, in effect, public health bodies. All of them—well, top-tier authorities in England—have directors of public health.

Just because there are challenges and fragmentation, that is not a reason to redraw the system. I do not think there is any desire within the system for a top-down or bottom-up reorganisation—I suspect that, as a doctor, my hon. Friend would agree with that—but there is a challenge to the system to come up with a much better whole-system approach, to make sure that people do not fall between those cracks.

My hon. Friend and I could debate at length—I am sure we will—whether those cracks can ever be filled, and whether there will ever be Polyfilla that is big enough or strong enough to fill those holes, but I do not think that it is a reason to break open the system.

[Dr Poulter]

rose—

[Steve Brine]

I give way to my hon. Friend for the last time.

[Dr Poulter]

This fragmentation of commissioning is a really important point and it comes up in so many debates in Westminster Hall and, indeed, in the main Chamber. I urge my hon. Friend and indeed the rest of the health team—we have got to put right the things that we got wrong. If we want to get this issue right, and get it right for people with hepatitis C, and for people with mental health conditions who are not getting access to services because of this fragmentation, then we have to revisit it.

I urge my hon. Friend to go and spend some time out on the frontline with some professionals and to get them to talk to him candidly—not on a ministerial visit. He should get them to talk to him candidly about these problems, because we have to recognise that this situation needs to change for the benefit of the people we care about, who are the patients.

[Steve Brine]

I will not prolong this discussion, Mr Streeter, but I take my hon. Friend’s point and I think it is a subject that will receive further airing, to put it mildly.

[Dr Whitford]

Will the Minister give way one last time?

[Steve Brine]

One last time and then I must conclude, because I want to touch on prisons.

[Dr Whitford]

Obviously, this debate has emphasised the importance of diagnosing people and getting people to undergo testing. However, does the Minister see that it is much easier to encourage people to undergo a test when they can be promised that they will get effective, tolerable treatment that will be successful, as opposed to their perhaps being left languishing on what is now relatively old-fashioned treatment that is full of side effects?

[Steve Brine]

Yes, of course, and that is why I have talked about the local networks, and about early detection and prevention. What the hon. Lady says is self-evident.

The Hepatitis C Trust, which has rightly received many plaudits today, has played an important role for us in recent years in piloting pretty innovative ways of increasing testing rates, through mobile testing vans—for example, in the constituency of my hon. Friend the Member for Southend West—and the pharmacy-based testing work that I mentioned, as well as the introduction of peer educators in prisons, which a number of people have mentioned today. My hon. Friend mentioned his visit to Wandsworth Prison, which he was right to say is a very good example of peer educators working.

The subject of prisons is one the House knows is of great interest to me. Given the number of people who, sadly, actively inject drugs across the criminal justice system and the custodial system today, it is obviously likely that a significant proportion of those in the infected but undiagnosed population will have spent some period at Her Majesty’s pleasure.

As part of the health services commissioned for those in detained settings, an opt-out testing programme for blood-borne viruses, including hepatitis C, in adult prisoners was fully implemented across the English secure estate last year, 2017-18. Because of the expected higher rates of prevalence, opt-out testing for blood-borne viruses is offered in 100% of the prison estate in England, as part of the healthcare reception process, although, it has to be said, with differential success and outcomes. We are currently addressing that through a range of initiatives that have been put in place to improve the delivery of testing and the provision of successful treatment in prisons. So, in some areas the whole-system changes are being piloted.

My shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), made the very good point that we’ve started, so we must finish. Absolutely; as I said earlier, it would be a very inefficient use of public resources to start treatment inside the secure estate. That is why, when we talk about through-the-gate treatment, that treatment must include health treatment. That is something—I cannot believe that my hon. Friend the Member for Bracknell (Dr Lee) is getting a second mention in this debate; I see that he is on his feet in the main Chamber—that I look forward to talking to the new Minister with responsibility for prison healthcare about, whenever he or she takes up that lucky role in future hours or days.

Let me take the opportunity once again to congratulate the all-party parliamentary group on liver health. It is not the first time that I have said this and it will not be the last: so much good work in this place goes on in all-party parliamentary groups, including so much informed debate. As a Minister—I am sure that others in the Chamber who have been Ministers would concur—I think that those groups are incredibly valuable to us and to the work that we do.

That is why I spend so much time listening to all-party parliamentary groups, helping them, including helping them to launch their reports, and then writing back with line-by-line responses to their reports, because their work is so vital to us. It is critical on a public health issue such as this, which, as I said at the start, is often overlooked and sometimes brushed under the carpet as being a little bit, “We don’t want to discuss this.” That is because, exactly as the hon. Member for Central Ayrshire said, there may even—God forbid—be an unspoken feeling that, “Well, with their behaviour they had it coming.” She is very brave to say it and I have no qualms in repeating it, but I think that feeling does exist.

The measures that I have spoken about today are not a panacea; the target is an incredibly challenging one for us. However, the Government, Lord O’Shaughnessy—who speaks for us in the other place on this subject and shares an office with me—and I are all passionate about this issue. We passionately believe that it is something that we can and will beat. We are taking it seriously, and we are in a good position to push forward and significantly reduce the burden of hepatitis C, in line with our commitment on it.

This debate shows us that improvement in hepatitis C testing and delivery of treatment are best delivered where there have been whole-system improvements. The Government, together with the wider health and social care system, have got to take all the opportunities available to us to address this key, but sometimes overlooked, public health challenge.