Lymphoedema Services

Steve Brine Excerpts

Tuesday 27th March 2018 Westminster Hall

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

I congratulate the new hon. Member for Gower (Tonia Antoniazzi)—I knew the last one—on securing her first debate in Westminster Hall, as she said, which is on a very important issue.

Lymphoedema Awareness Week took place earlier this month, so today’s debate is timely. We heard much from the hon. Lady on the impact of the condition, which she set out very well, although Members should watch themselves looking at people’s legs and feet in supermarkets. I am sure therein lies a problem for me in Winchester, but I take her point. She set out very well the difference that high-quality care and support can make. We can all agree that we want that for people affected by lymphoedema. I hope the debate will encourage service providers across England to consider the improvements that they might make.

It is estimated that between 75,000 and 220,000 people in England are affected by lymphoedema. The condition is caused by abnormal accumulation of lymph fluid in body tissue, which can be the result of a congenital defect, of damage to the lymphatic system or of removal of lymph nodes by surgery, radiation, infection or injury. Obviously, cancer plays a role in that, which I will come to. Regardless of the cause, it is important that the NHS responds appropriately in diagnosing and managing the condition, and that it provides appropriate support and advice to those affected. A lot has changed since we had the last debate.

[Mr Marcus Jones (Nuneaton) (Con)]

Will the Minister say more about consistency of services for lymphoedema across the country, and acknowledge the role of our hospices? In my constituency, the Mary Ann Evans Hospice, of which I am a patron, has a lymphoedema care service, which is very valuable to local people.

[Steve Brine]

In my response I will touch on services across England. My hon. Friend is right to mention the hospice movement. Many people working in hospices become experts in this field by virtue of their day-to-day work. I am very happy to endorse what he said, and I thank everyone working in the hospice movement who is helping patients affected by lymphoedema.

In Scotland, Wales and Northern Ireland, certain national lymphoedema initiatives have been developed—we have heard about the initiatives in Wales. Health is a devolved matter, and devolution is important. The devolution settlement from the last Government stands, and allows the four nations of our United Kingdom to develop the services that they believe meet the needs of their resident populations and the respective size of them. In England, responsibility for determining the overall strategic national approach to improving clinical outcomes for healthcare services lies with NHS England, and the provision of lymphoedema care is the responsibility of local NHS commissioners.

Although lymphoedema has no cure, interventions such as decongestive lymphatic therapy, skincare, exercise advice and weight management can ease symptoms and improve quality of life for those affected. The hon. Lady was absolutely right to raise the issue of weight management—there is a lot of discussion in this place about the obesity challenge that we face. This condition is a not-often-talked-about consequence of the obesity challenge, and I am grateful she raised it. People with lymphoedema can usually be treated through routine access to primary or secondary care services with access to dedicated lymphoedema clinics. I have experience in my family of attending such clinics.

To support clinicians in the diagnosis, treatment and support of patients with lymphoedema, an international consensus document on the condition was produced in 2006, which is endorsed by the British Lymphology Society and the Lymphoedema Support Network. Additionally, the Royal College of General Practitioners offers an e-learning course on lymphoedema—the hon. Lady said that that was one of her concerns. That often supplements GPs’ existing understanding of the condition, which is covered in the GP curriculum, and I am pleased to say that it is identified as a key area of knowledge that we expect of them in their qualifying exams.

We heard from the hon. Lady about calls for a national lymphoedema service in England. Hon. Members may be aware that, in 2015, the British Lymphology Society submitted a proposal for a nationally commissioned specialised lymphoedema service to the Prescribed Specialised Services Advisory Group—we like our titles and acronyms in health—which is an expert committee appointed by the Department to consider these very matters.

Four factors should be considered when determining which prescribed specialised services should be directly commissioned by NHS England, the first of which is the number of individuals needing the service. The second factor is the cost of providing the service—after all, it is a publicly funded health service. The third consideration is the number of persons able to provide the service—the workforce—and the fourth is the cost to clinical commissioning groups in England for providing the service.

Taking account of those four factors, the advisory group concluded that lymphoedema services were not suitable for national commissioning. As the patient population was high in England, there were numerous providers and the burden to commissioners was low. However, we keep that under constant review, which links to my next point about Wales. We recognise that there can be opportunities to learn from our partners in the devolved Administrations while taking high-quality clinical advice from our advisers, such as I just mentioned.

We are aware of the recent evaluation of the lymphoedema service in Wales, which was published in the British Journal of Nursing, and we agree that the results appear to be very positive in addressing the challenges faced in Wales. We also note the caution applied to some of the figures but, as I say, we keep it under constant review, and the hon. Lady’s debate is helpful in that regard.

In my experience as a Health Minister, NHS commissioners are always keen to hear about services that have demonstrated savings and improved care in other parts of the country and the United Kingdom. For example, the Healthy London Partnership, a collaboration including London’s NHS, councils and Public Health England, for which I have responsibility, has drawn on the work of the Welsh lymphoedema service for its own service. We watch that closely. NHS England is also aware of the evaluation of the Welsh service and—the hon. Lady asked about this—is in touch with the national clinical lead for lymphoedema in Wales, who is one of her constituents. That relationship is ongoing and bearing fruit.

The hon. Lady mentioned cancer, for which I am the Minister responsible. Lymphoedema resulting from cancer treatment, which, sadly, has touched my life, is common. About one in five people have lymphoedema of the arm after breast cancer treatment that affects the lymph nodes, which are so difficult. Much of the lymphoedema service improvement in England has developed as a result of national initiatives to improve cancer services and, sadly, the high number of breast cancer incidents. There is growing recognition of the need to support cancer survivors after they fall off the cliff edge when their treatment ends. Lymphoedema services are a key part of that, and I have seen them when out and about doing my job.

Over the years, the Government have driven forward the cancer survivorship agenda, which I am passionate about and committed to, first through the national cancer survivorship initiative, and then through the living with and beyond cancer programme, for which I am responsible. Central to that work has been embedding in mainstream NHS commissioning a recovery package, which is a combination of interventions that, when delivered together, can greatly improve outcomes and the co-ordination of care beyond the cancer pathway, which is what we are looking at, including through better and earlier identification of the consequences of treatment for conditions such as lymphoedema.

Members will be aware that our world-class cancer strategy for England, which has another two years left to run, was published in July 2015 by the independent cancer taskforce. It recommended that NHS England should accelerate the commissioning of services for cancer survivors, including the development of a minimum service specification to be commissioned locally for all patients, based on the recovery package I just mentioned. That specification was published in April 2016 and includes provision of lymphoedema care. It was followed by £200 million of funding to support the implementation of the recovery package and other areas of the strategy, which I am sure I will talk about again in debates in this place. Those services should be provided on the basis of need, not of whether someone has had cancer.

Finally, let me highlight the research that is being undertaken. We invest more than £1 billion a year in health research through the National Institute for Health Research. The NIHR is currently supporting three important lymphoedema studies: an analysis of genes and their functions in primary lymphoedema; an investigation of the pathophysiology of breast cancer-related lymphoedema of the arm, which I mentioned; and a feasibility trial of early decongestive lymphoedema treatment for women newly presenting with breast cancer-related upper limb lymphoedema, which is very important.

As well as thanking you, Mr Gray, for sitting through what I hope has been as interesting a debate for you as it has been for us, let me thank the hon. Lady again for using her first Westminster Hall debate to raise this important issue and highlight the many challenges that people with lymphoedema face. I am confident that, by continuing to build our expertise, increasing the research I listed and ensuring that our commissioners and clinicians have the training, tools and guidance to deliver high-quality lymphoedema care, we can ensure that patients receive the treatment and support they need and deserve. As ever, I am grateful to Members. We keep everything under constant review, because ultimately we have a publicly funded health service that is there for patients. As the Minister with responsibility for primary care, I have responsibility not only for cancer but for prevention, and I am interested in anything that can help us to reduce people’s suffering and the cost to that publicly funded health service.

Question put and agreed to.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 20th March 2018 Commons Chamber

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

Children’s oral health is better than it has ever been, and 72% of five-year-olds in England are now decay free. Of course, that means that 28% are not, which is why our Starting Well programme aims to increase access for young children in 13 high-need areas. NHS England is also looking at making similar approaches available in the areas of greatest genuine local need.

[Tracy Brabin]

In Kirklees, 29% of under-five-year-olds have experience of tooth decay. Nationally, among five to nine-year-olds, tooth decay is the most common cause of hospital admission. Does the Minister agree that the system of penalising dentists for not hitting targets and not paying them when they exceed targets has led to a situation where there are virtually no NHS dentists available for my young constituents? What steps will he take to make more places available?

[Steve Brine]

We are testing the new prevention-focused dental contract, which the hon. Lady knows about, to improve access and outcomes for NHS dental treatment. We have also made great progress on children’s oral health, as I have said. NHS England in her area is currently finalising arrangements for extra funding to support dentists in offering additional access and places. That funding will be available from 1 April, so she and other Members should stand by their phones.

[Philip Davies (Shipley) (Con)]

The hon. Member for Batley and Spen (Tracy Brabin) is absolutely right about this particular issue. The Government have long acknowledged that there is a shortage of dentists in West Yorkshire, and in the Bradford district in particular, where the shortage is pretty chronic. Will the Minister set out what the Government are doing to ensure that there is an acceptable number of NHS dentists in the Bradford district?

[Steve Brine]

I will not pre-empt what the NHS in Yorkshire and the Humber will say to my hon. Friend or to the hon. Lady, because this is a local decision, but I will say that the 13 Starting Well areas—the programme was a manifesto commitment for us—were selected nationally based on overall need and using a wide range of data including access to NHS dental services.

[Julie Cooper (Burnley) (Lab)]

The Minister seems to be in denial. The British Dental Association reports that almost half of all NHS dentists are not accepting new patients—either adults or children. In several regions right across the country, from Yorkshire to Salisbury, patients are having to rely on the third world dental charity, Dentaid, with its now-famous wheelie bin dental surgeries. Does he think that that is an acceptable state of affairs? Will he outline what action he intends to take to improve access to NHS dentists?

[Steve Brine]

It is interesting that the hon. Lady should raise this; it is one of the things that we might be discussing shortly. According to the GP patient survey for January to March last year, whose results were published later last year, 59% of the adults questioned had tried to get an NHS dental appointment in the past two years, and of those, 95% were successful. Those are not bad figures.

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[Stephen McPartland (Stevenage) (Con)]

13. Whether he has plans to establish a satellite radiotherapy unit in Stevenage.

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

NHS England is working with the East and North Hertfordshire NHS Trust to determine the best way to deliver radiotherapy services to patients in Stevenage. This is part of a system-wide NHS England review of the way in which radiotherapy services are delivered.

[Stephen McPartland]

Hertfordshire has more than 1 million people and no radiotherapy provision. My constituents have to travel more than 80 miles for every treatment, which means thousands of miles during the course of their treatment—there is no public transport. My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and I have run this campaign for a number of years, and we have all the agreements from every part of the NHS. We are meeting the board of the trust on Friday, so will the Minister give them a direction to get on with building the facility?

[Steve Brine]

All trusts have been directed to get on with the review. The NHS England specialised commissioning team is in discussions with my hon. Friend’s local trust as it develops its five-year strategic plan for the cancer pathways. It is working with his local cancer alliance, including radiotherapy services. It is recognised that a more radical approach and a broader review of the radiotherapy options may be required in future. As my hon. Friend says, he and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) have that meeting later this week, and I hope the discussions are productive. I feel sure that my hon. Friend will come back to me if they are not.

[Mr Speaker]

Let us hear from the neighbour. I call Sir Oliver Heald.

[Steve Brine]

Obviously my right hon. and learned Friend is right to speak up for services in his area. The review is not about cutting those services, but about making sure that they are in the right places. We have to be mindful that sometimes the services have to be centralised to be in the right place to deliver the right outcomes for cancer patients.

[Mr Speaker]

I will take the next question on condition that Members are exceptionally brief, as time is constrained.

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[Craig Tracey (North Warwickshire) (Con)]

21. What steps he is taking to increase the capacity and availability of GP services.

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

We of course recognise the shortages in general practice, which is why we remain committed to delivering an additional 5,000 doctors working in general practice by 2020 compared with 2015.

[Royston Smith]

Like many other places throughout the country, Southampton is struggling to recruit and retain GPs. There are many reasons for that, but perhaps one is the practice of discouraging medical students from going into general practice while encouraging them to become specialist consultants. Is my hon. Friend aware of that and of how widespread is it? What is he doing to encourage more people into general practice?

[Steve Brine]

The Secretary of State has already outlined the plans for the new medical schools and the record 3,157 GP training places that were filled. I am aware of the practice that my hon. Friend mentions, and that is why we are working with the profession on a range of measures to boost recruitment into general practice. The existing professionals also have a role to pay, and the superb chair of the Royal College of General Practitioners, Helen Stokes-Lampard, is really leading from the front in that respect.

[Steve Double]

Does the Minister agree that part of the way to address some of the pressures that GPs face is to enhance the role of community pharmacies? Will he update the House on what steps he has taken to support pharmacies and further integrate them with general practice?

[Steve Brine]

We know that there are benefits to be had from the better integration of community pharmacies with sustainability and transformation partnerships. Through the pharmacy integration fund, we are integrating pharmacists into primary care. I hear good reports about how that is going and we will have 2,000 of them in general practice by 2020. Community pharmacies themselves should also be integrated, through STPs, because it is one NHS.

[Craig Tracey]

It is great to see that record numbers of medical students are going into general practice this year, but far too many GPs are choosing to retire and leave the NHS when they are in their 50s because of tax penalties on their pension scheme. Does the Minister agree that we need to address that situation so that experienced GPs are not penalised for staying in the NHS?

[Steve Brine]

Along with concerns about workload and, for example, indemnities, pensions are an issue that older GPs often bring up with me. Ultimately, it is a matter for Her Majesty’s Treasury. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised a similar issue at Prime Minister’s Question Time last week, and the Chancellor was on the Bench to hear it. I am sure he will read the report of these exchanges, too.

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

In Stoke-on-Trent we have some fabulous GPs, not least the wife of the hon. Member for Stafford (Jeremy Lefroy), but too many people present to A&E because their primary carer is not up to dealing with the workload. That means that the A&E is over-logged so fines are levied on the hospital. What is the Secretary of State going to do to make sure that when hospitals pick up the slack from GPs, they are not subsequently fined by clinical commissioning groups for missing targets?

[Steve Brine]

We are going to integrate primary and secondary care properly through the new models of care—for instance, extended access is important in that. The new multidisciplinary teams—for example, I have talked about pharmacists working in primary care—are not only about providing the plaster when the cut happens, but about preventing the cut in the first place. The prevention agenda is very important.

[Chris Bryant (Rhondda) (Lab)]

Do we not need more salaried GPs?

[Steve Brine]

We need more GPs, which is why today’s announcement is very important. I am sure that the hon. Gentleman welcomes them.

[Mr Speaker]

Well, if there are to be more GPs, they will have to be paid.

[Bill Esterson (Sefton Central) (Lab)]

Patients at Hightown GP surgery were promised that their surgery would stay open, but, out of the blue, they were written to and told that the surgery would close on 8 June. The Government are belatedly taking action on the shortage of GPs, but will the Minister intervene to make sure that Hightown surgery is kept open and that a promise is kept to patients?

[Steve Brine]

I will look at Hightown surgery, and if the hon. Gentleman wants to talk to me about it, he is welcome to do so. Of course it is the responsibility of his clinical commissioning group and NHS England in his area to provide primary care services for the patients who are his constituents, but if wants to talk to me further, I am very happy to do so.

[Andrew Lewer (Northampton South) (Con)]

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

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[Mr Ranil Jayawardena (North East Hamp- shire) (Con)]

T5. Although my younger daughter, being at the discerning age of one, is a particularly fussy eater, childhood obesity is becoming one of the most quickly rising and important issues of our time. Does my right hon. Friend recognise that it is something that we really need to tackle, and quickly?

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

We are already delivering an ambitious plan to address childhood obesity, including taxing sugary drinks and helping children to exercise more, but we need to keep a close watch on this. We have taken the first few steps in a long race, and we are always looking to learn from successful initiatives elsewhere. Last week I was in Amsterdam looking at the system-wide approach there, which has led to very impressive reductions in child obesity. We should be listening and we are.

[Ruth George (High Peak) (Lab)]

T2. Head- teachers in my constituency tell me that they are asked by the child and adolescent mental health services to prove that children have tried to commit suicide before CAMHS is prepared to accept a referral. The Minister has just admitted that less than half of children who are referred are treated, and that under the new plans less than two thirds will get treatment. There is so much rationing going on. Will the Secretary of State please commit to improving the amount of ring-fenced funding now?

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[Ronnie Cowan (Inverclyde) (SNP)]

T4. This morning I met the family of Alfie Dingley and members of the End Our Pain campaign. Alfie’s case, along with those of Murray Gray and Billy Caldwell—and many, many more—highlight the case for medical cannabis. Will the Minister liaise with the Home Office to introduce medical cannabis for the thousands of people who would benefit, but who do not want to be branded as criminals?

[Steve Brine]

Obviously, everybody in the House is aware of this case, and our thoughts are with Alfie and his family. The policing Minister has met Alfie’s family and discussed options that may assist him. No decisions have been made, and any proposal would need to be led by Alfie’s clinicians using sufficient and rigorous evidence.

[Maria Caulfield (Lewes) (Con)]

Despite not hearing it from Opposition Members, I am sure that all Members in this House welcome the five new medical schools announced today. Will the Minister also welcome the extra medical school places in Brighton and Sussex Universities, supporting my constituents, and the launch last week of the new nursing apprenticeship scheme by the University of Brighton, which will enable more nurses to enter the profession?

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[Alan Brown (Kilmarnock and Loudoun) (SNP)]

T7. Over a third of children in the UK are either overweight or obese. The Royal College of Paediatrics and Child Health has warned that a trade deal with the US could lead to an influx of junk food with high fat, sugar and salt content. Will the Health Secretary make sure that health is put above trade going forward?

[Steve Brine]

As I have said, we are concerned about child obesity, which is probably the big public health challenge, not least in the impact that it can have on diabetes, heart disease and cancer. That is why I so welcome Cancer Research UK moving into this space. We have one of the most ambitious plans in the world. We have already said that it is the start of a conversation, not the end, and if we need to go further, we will.

[Helen Whately (Faversham and Mid Kent) (Con)]

May I welcome today’s announcement on a new medical school for Kent? In an area that struggles to attract doctors, this will make a huge difference: it is genuinely a game changer. Will my right hon. Friend congratulate the University of Kent and Canterbury Christ Church University on their successful bid?

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[Stephen Lloyd (Eastbourne) (LD)]

Bowel cancer remains a major killer in the UK. The National Institute for Health and Care Excellence recognises the new FIT—faecal immunochemical test—to be a far more effective bowel screening process, but there remains a lack of clarity about when it is going to be rolled out nationally. Will the Minister provide that clarity today so that people can be saved down the line?

[Steve Brine]

The UK National Screening Committee has recommended that FIT be the primary screening test for bowel cancer, and NHS England remains absolutely committed to implementing it in 2018-19. We expect to make a decision very shortly on when that will be.

[Sir Edward Leigh (Gainsborough) (Con)]

You wanted short, Mr Speaker. I thank the Secretary of State for our new medical school at Lincoln.

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[Judith Cummins (Bradford South) (Lab)]

My local paper, the Bradford Telegraph and Argus, has recently launched its “Stop the Rot” campaign, as children in Bradford have some of the worst dental health outcomes of anywhere in the country. Does the Minister agree that prevention is key to improving children’s dental health? Can he tell us what steps the Government are taking to ensure that prevention is a key element of any new dental contract?

[Steve Brine]

I think that would be the brilliant Bradford Telegraph and Argus. As I said, 75 dental practices are continuing to test the preventive focus clinical approach alongside the new remuneration system, which supports an increased focus on prevention through the dental contract. I know it is taking time, but I want to get it right.

[Mary Robinson (Cheadle) (Con)]

We know that early diagnosis of cancer is crucial for successful treatment outcomes, but for many cancers, such as pancreatic and ovarian cancer, early symptoms can be vague and the chance to diagnose early easily missed. What are the Government doing to ensure that hard-to-detect cancers are diagnosed early?

[Steve Brine]

That is an excellent question. We are testing the new Accelerate, Co-ordinate, Evaluate programme—ACE—which I visited recently at the Churchill Hospital in Oxford. Patients with vague symptoms can be referred for multiple tests and often receive a diagnosis or an all-clear on the same day. I do not get excited very easily, but that promises great excitement.

[Mr Speaker]

It is a delight to see the Minister in a state of high excitement. We hope to see it repeated on innumerable occasions.

[James Frith (Bury North) (Lab)]

Seventy MPs from across the House in yesterday’s Westminster Hall debate all agreed that we need Orkambi on the NHS now. Can the Minister tell me what he will be doing differently for sufferers of cystic fibrosis and when we will hear news of a breakthrough? Sufferers of cystic fibrosis are slowly drowning in their disease without access to Orkambi.

[Steve Brine]

It was a very good debate, and the hon. Gentleman spoke very well in it on behalf of his constituents. We have made a counter-offer to Vertex. I call on Vertex to be reasonable, and I call on Vertex and NHS England to get back round the table and get this sorted.

[Several hon. Members rose—]

[Henry Smith (Crawley) (Con)]

I would like to thank the Under-Secretary of State for Health, the hon. Member for Winchester (Steve Brine), for his response to the all-party parliamentary group on blood cancer report. Will he continue to ensure that cancer alliances and GPs are diagnosing early?

[Steve Brine]

That is an easy one—absolutely, yes.

[John Grogan (Keighley) (Lab)]

With a significant amount of public money at stake, should not NHS trusts that are proposing to set up subsidiary companies publish their full business cases?

NHS Planning in 2018-19

Steve Brine Excerpts

Tuesday 20th March 2018 Written Statements

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

I am today updating the House on the outcome of the General Medical Services (GMS) contract negotiations with the General Practitioners Committee of the British Medical Association and NHS Employers on behalf of NHS England.

The GMS contract for 2018-19 comprises a pay uplift together with a CPI uplift of 3% to expenses totalling £102.9 million, as part of the overall investment of £256 million. The investment includes £60 million which has been allocated to cover increased indemnity costs incurred in the past financial year.

Other key parts of the contract include:

An agreement that will pave the way to general practitioners no longer issuing paper prescriptions, instead using the NHS electronic prescription service.

The roll out of the NHS e-referral service into general practice. NHS England has allocated £10 million to facilitate GPs uptake of the electronic referral service.

An agreement with the GPC to work with DHSC and NHSE to establish the extent and reasons behind locum use and cost.

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

Full details of the agreement can be found at: http://www.nhsemployers.org/GMS201819.

[HCWS565]

General Medical Services Contract Negotiations 2018-19

Steve Brine Excerpts

Tuesday 20th March 2018 Written Statements

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

I am today updating the House on the outcome of the general medical services (GMS) contract negotiations with the General Practitioners Committee of the British Medical Association and NHS Employers on behalf of NHS England.

The GMS contract for 2018-19 comprises of a pay uplift together with a CPI uplift of 3% to expenses totalling £102.9 million, as part of the overall investment of £256 million. The investment includes £60 million which has been allocated to cover increased indemnity costs incurred in the past financial year.



Other key parts of the contract include:

An agreement that will pave the way to general practitioners no longer issuing paper prescriptions, instead using the NHS electronic prescription service.

The roll out of the NHS e-referral service into general practice. NHS England has allocated £10 million to facilitate GPs uptake of the electronic referral service.

An agreement with the GPC to work with DHSC and NHSE to establish the extent and reasons behind locum use and cost.

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

Full details of the agreement can be found at: www.nhsemployers/GMS2Q1819.

[HCWS565]

 Orkambi and Cystic Fibrosis

Steve Brine Excerpts

Monday 19th March 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, and that of Mr Evans, Sir Roger. May I be the final speaker to thank my hon. Friend the Member for Sutton and Cheam (Paul Scully), who has done his job as a member of the Petitions Committee in introducing the debate on the petition today. As the hon. Member for Washington and Sunderland West (Mrs Hodgson) said, the number of Back-Bench MPs who have spoken is 22. My Parliamentary Private Secretary reckons that we have had 60 Members through the Chamber in the past three hours. Of course that is only just over 9% of MPs, but, as we all know, having been to many Westminster Hall debates between us, that is a lot of MPs in one debate. That did not even include the hon. Member for Strangford (Jim Shannon)—I am worried for him. As we know, so many MPs attending the debate suggests a great deal of interest in the subject, and the way everyone spoke was excellent. Perhaps I may mention that the speech of the hon. Member for Motherwell and Wishaw (Marion Fellows) cannot have been an easy one to make, and she delivered it with grace.

With more than 115,000 signatures—my goodness—the petition shows what huge public support there is for tackling this terrible disease. The passionate way in which hon. Members across the board have spoken on behalf of their constituents is testament to that support. I want to make a special mention of the “Bury brothers”, who represent the 202 people in the Bury constituencies who signed the petition: the hon. Members for Bury North (James Frith) and for Bury South (Mr Lewis) both spoke well and in a sensible and balanced way. I can only assume that the hon. Member for Bury South, from what he said, must be a former Health Minister. Am I right?

[Mr Lewis]

indicated assent.

[Steve Brine]

I thank 163 of my own constituents who signed the petition and who have been in touch with me, and one who has been to my constituency surgery. I may be the Health Minister responding to the debate, but I am also a constituency MP and a parent of two young children.

I pay tribute to the Cystic Fibrosis Trust, which does a tremendous job on behalf of all our constituents. I know we are not meant to address the Gallery. I will not do so, but if I did I would thank those who have made the trip in the snow and ice, probably not all from SW1, to come to Westminster today. It is a credit to them that they have made time to do that.

I recognise the progress that Vertex has made to date in its mission—I believe it is a mission—to discover ultimately a cure for cystic fibrosis, and recognise the treatments that it brings to the market. I know Vertex understands the importance of the UK market, and NHS England as a customer, to its future and to that mission.

This petition is calling on the British Government—that would be me—

“to call for a resolution to ongoing negotiations between Vertex Pharmaceuticals, NHS England and NICE as a matter of the utmost urgency. It is essential that a fair and sustainable agreement is found.”

I am here today to do exactly that. It is not a difficult call to agree to. The negotiations must remain constructive and be undertaken with the utmost urgency, for all the reasons we have heard—I will not repeat them all—or, as my hon. Friend the Member for Mid Dorset and North Poole (Michael Tomlinson) said, people living with cystic fibrosis will suffer.

It seems to me that the main ask I have heard from pretty much every hon. Member speaking today is, “Get involved.” I am not the Minister directly responsible. That falls to Lord O’Shaughnessy, the Parliamentary Under-Secretary who sits in the other place, but I can say on his behalf and on mine that we are involved, and you can bet your life that we will continue to be involved. I do not think I can be clearer.

[James Frith]

The Minister says, “You can bet your life” that he will continue to be involved. Any further delay is literally betting lives and the ever-diminishing lung capacity of those who go without Orkambi. What will he commit to do differently from today, and when will Orkambi be prescribed by the NHS?

[Steve Brine]

The hon. Gentleman knows that I cannot give the answer to his when question. I will come to the other bits of his question. His point about the reducing lung function is well made, and has been made by almost everybody. The Government wholeheartedly support efforts to ensure that the precision medicines we have heard about are made widely available to CF patients and other patients. It is true that high-cost precision medicines represent a challenge to the NHS, but they are also a tremendous opportunity to deliver high-quality outcomes through highly specialised treatment. I hope I can go some way to ensuring 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, and to doing so in a way that is sustainable for the NHS.

There has been much talk about NICE, which has a difficult job, as the hon. Member for Bury South rightly said, but as we know, England has the second-highest number of cystic fibrosis patients in the world and there is sadly no cure. Current treatments generally target the complications rather than the cause of the disease. Of course, I can appreciate the huge daily burden of treatment for patients and their families, and the uncertainty that they live with. Uncertainty is a huge burden—the hon. Member for Dudley North (Ian Austin) mentioned the mental health burden. It is so important that patient voices are heard during any appraisal process to ensure that that burden is fully understood.

NICE’s technology appraisal programme makes recommendations for the NHS on whether drugs represent an effective use of NHS resources in what we must remember is a publicly funded health system, as many hon. Members have said. There are other parts of the world where, if someone could not afford it or their insurer could not afford it, this would not even be a discussion. That system means that patients can have the confidence that the price paid by the NHS is consistent with the improvement in health outcomes a medicine brings, ensuring fairness as well as the best possible use of funding for patients and the NHS.

Those are very difficult decisions to make, but it is essential that patients are getting the maximum benefit from every pound of our constituents’ money that is spent by the NHS. NICE takes its decision independently of Ministers. The Government rightly have no say in whether a new medicine is recommended for the NHS at the price proposed by the manufacturer. NICE published its final guidance on the use of Orkambi in July 2016 and, as we have heard, did not recommend it for use in treating cystic fibrosis. That, of course, is not the end of the story, and I do not want it to be. I will return to that in a moment—although, ironically in a three-hour debate, time is short for me to give our position.

Since 2013, NHS England has been responsible for securing high-quality outcomes for patients with cystic fibrosis. Six years ago, it agreed to fund Ivacaftor and Kalydeco for cystic fibrosis patients with the relevant genetic mutation. An additional possibility that may further the pool of treatment options for CF in the near future is the double combination therapy branded Symdeko, which has shown positive results and is currently undergoing European Medicines Agency licensing.

More broadly, the number of medicines for cystic fibrosis patients expected within the next three years is promising, with products being developed by a range of manufacturers as well as Vertex. NICE is aware of 31 other technologies by 19 different companies—not Vertex—that are in the pipeline for cystic fibrosis. Clearly, the prices for any new treatment will also be considered by NICE and we must ensure that the arrangements NHS England enters into now do not restrict options for patients to have the best available medicine in the future. The hon. Member for Bury North made that point very competently.

The NHS is in discussions with Vertex about Orkambi. Vertex has approached NHS England with a proposed deal to reduce its prices. While I cannot share the details of this proposal due to their commercially confidential nature—believe you me, I wish I could—I can assure hon. Members that, at the level that Vertex has proposed, the products are still far from cost-effective. Therefore, there is more talking to do.

Last week NHS England made a counter-proposal, which would ensure that the drugs could be used at a price that is cost-effective. I understand that NHS England has agreed to meet with Vertex—I would jolly well hope so, and of course it is not over email—to discuss that counter-proposal further. I have seen the statements made this weekend—I must say I am no fan of Twitter diplomacy in this or any other form of diplomacy. The statements this weekend were not exactly encouraging, but they must not be the end of the story.

While it is not for Ministers to approve, I truly believe this can be a mutually satisfactory arrangement for both parties. I know I speak for my colleague, Lord O’Shaughnessy, when I say that we are both impatient for a breakthrough and are watching the matter like hawks. I get the message loud and clear: the House has said, “Get involved.” The House has that assurance from me.

I thank all hon. Members who have spoken so passionately. They have helped the cause on behalf of their constituents. On Orkambi in particular, I hope above all that hon. Members can see that this is a live issue and that it is work in progress.

NHS Dental Charges

Steve Brine Excerpts

Monday 12th March 2018 Written Statements

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

Regulations have been laid before Parliament to uplift dental charges in England from 1 April 2018.

Dental charges remain an important contribution to the overall cost of dental services. They have existed in some shape or form since 1951, and are one of the NHS services that can be charged for under the 2006 Act.

We have taken the decision to uplift dental charges for those who can afford it, through a 5% increase this year.

This means that the dental charge payable for a band 1 course of treatment will rise by £1 in 2018-19, from £20.60 to £21.60. The dental charge for a band 2 course of treatment will increase by £2.80 in 2018-19, from £56.30 to £59.10. The charge for a band 3 course of treatment will increase by £12.20 in 2018-19, from £244.30 to £256.50.

The uplift announced today continues with the aim of finding an appropriate balance between the costs paid by service users and those met by the NHS through the contributions of taxpayers, If this uplift was not implemented resource savings from other parts of the NHS would need to be generated to make up the shortfall.

Those who qualify for free dental treatment will remain entirely exempt from charges. Those under the age of 18, those under the age of 19 and in full-time education, pregnant women or those who have had a baby in the previous 12 months, and those on qualifying low income benefits will not be impacted by these changes.

Even those not entitled to exemption from dental charges, but who are on low incomes, are eligible to receive full or partial help with dental charges through the NHS Low Income Scheme.

This policy will allow us to continue to protect the most vulnerable through exemptions and the NHS low income scheme. We therefore consider that the proposed uplifts in charges are fair and proportionate and will support NHS front line services.

Details of the revised charges for 2018-19 can be found in the table below;

Branded Health Service Medicines

Steve Brine Excerpts

Monday 12th March 2018 Written Statements

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

My hon. Friend the Parliamentary Under-Secretary of State for Health (Lord O’Shaughnessy) has made the following statement:

This statement is to update the House that regulations were laid before Parliament on 9 March 2018 to revise the statutory scheme to control the cost of branded health service medicines. The changes will come into force on 1 April 2018, and are estimated to result in £33 million of savings in the first year. I have also published a response to the consultation and impact assessment which can be viewed on the Parliament website.



Last year the Government consulted on reforms to the statutory scheme to better align the way the statutory scheme and voluntary 2014 pharmaceutical price regulation scheme work, and move towards a more level playing field between companies in the two schemes.

Reforming the statutory scheme will also enable the Department to put more effective pricing and enforcement controls in place, while increasing the levels of savings of health service medicines covered by the scheme.

Having considered the responses to the consultation, the Government are making regulations for a statutory scheme requiring manufacturers and suppliers that come within the scope of the scheme’s provisions to pay the Department of Health and Social Care 7.8% of their net sales income received from the supply of health service medicines. A record of the maximum prices that may be charged for the supply of those health service medicines will be published by the Department. The operation of the statutory scheme will be supported by the requirement for manufacturers and suppliers to record and keep information and to provide that information in accordance with the regulations. Payments received through the scheme will be passed to the NHS in England, with apportionment to Scotland, Wales and Northern Ireland.

After consideration, the Government have amended their approach to the classification of companies in the scope of the scheme, to the exemptions from the payments, and have made a number of minor and technical amendments to ensure the new scheme operates as effectively as possible with the minimum administrative burden to companies.

The regulations will apply to the whole of the UK. Medicines pricing is a reserved area with respect to Wales and Scotland and devolved with respect to Northern Ireland. A legislative consent motion (LCM) was sought from the Northern Ireland Assembly during the passage of the Health Service Medical Supplies (Costs) Act 2017 (“the 2017 Act”). However, the Assembly was dissolved before the motion itself could be passed. With that in mind, the 2017 Act provided for separate commencement in Northern Ireland, on the basis that it was hoped that a restored executive could complete the LCM process before the provisions were commenced. In the light of the ongoing absence of an Executive, however, a point has been reached whereby a decision on whether to commence the provisions cannot be further deferred. The UK Government have therefore decided to proceed with UK-wide implementation. This decision has not been reached lightly. Yet it is clear that not commencing the provision UK-wide would introduce substantial burdens on companies, and further delay would lead to fewer savings being made by health services across the UK. Given those factors, and noting the support the measures commanded from the previous Executive (with a Legislative Consent Motion laid in the Assembly albeit not passed), I assess that now is the right time to move forward with commencement.

I recognise that I made a commitment to the House during passage of the primary legislation that the provisions would not be commenced in Northern Ireland without an LCM in place. However, there has been no Assembly in place to provide an LCM over a period of more than 13 months and, in its absence, there is a clear public interest in seeing these measures proceed, not least because the measures will generate savings of £1.5 million for Northern Ireland in the first year. It is on that basis that I consider we should move forward. When an Executive has been restored I will write to the Northern Ireland Health Minister to confirm that they are content for the commenced 2017 Act to remain in place. I will also continue to consider carefully any further representations from stakeholders in Northern Ireland, while recognising the broad support that these measures have commanded previously.

It is also available online at: http://www.parliament.uk/writtenstatements.

[HCWS538]

Mental Health Services: Children and Young People

Steve Brine Excerpts

Thursday 8th March 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the Care Quality Commission’s review of children and young people’s mental health services.

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

Not enough scripture is quoted in this House, but I cannot match what was just said. However, I can tell the House that the Care Quality Commission published its “Are we listening? Review of Children and Young People’s Mental Health Services” report this morning, and, yes, we are listening. It was the second piece of work commissioned by the Prime Minister in January 2017 to look at this area of services, and the findings include examples of good or innovative practice and of dedicated people—we thank every one of them—working in every part of the system and a number of areas with strong practice ensuring that patients and families are involved in planning care, but there are also concerns around the join-up between children’s services. We thank the CQC and Dr Paul Lelliott for their work.

The Government have already committed to making available an additional £1.4 billion to improve children and young people’s mental health services to deliver on the commitments in “Future in mind” and NHS England’s five year forward view for mental health, and the CQC welcomes that progress in its report. I know that the hon. Lady and others have worries about this, but spend is reaching the front line. By 2020-21, we have committed to ensuring that 70,000 more children and young people each year will have access to high-quality NHS mental healthcare when they need it. However, there is so much more to do. Claire Murdoch, the national mental health director for NHS England, said in response to the report:

“CAMHS services are now improving, but from a starting point of historic underfunding and legacy understaffing, relative to rapidly growing need”

We see those things across the service.

In December, the Department of Health, jointly with the Department for Education, published “Transforming children and young people’s mental health provision”. That Green Paper responds to a number of the problems raised by the CQC in this report, and sets out a range of proposals to strengthen how schools and specialist NHS mental health services work together and to reduce the amount of time that children and young people have to wait to access specialist help. The proposals are backed by an additional £300 million of funding. We have carried out extensive face-to-face consultation on the Green Paper proposals and have received a high volume of responses to our online consultation, and we thank everyone for that. We will respond to this CQC review, alongside the Green Paper consultation, in the summer.

The report calls for the Secretary of State to use the inter-ministerial group on mental health to guarantee greater collaboration across Departments in prioritising mental health. We agree, and that recommendation is already in hand. The IMG has already contributed to the development of the Green Paper and will continue to provide leadership on the issues that the report raises. The CQC also recommends that everyone who works, volunteers or cares for children and young people is trained in mental health awareness. We are already rolling out mental health first aid training to every secondary school and have committed to rolling out mental health awareness training to all primary schools by 2022. The Government and Ministers remain wholly committed to making mental health everyone’s business and building good mental health for our children and young people.

[Barbara Keeley]

The report is the latest piece of recent evidence revealing systematic failures in our mental health services. It follows similar reports of the past few weeks that call into question the Government’s claims to have made mental health a priority equal to physical health. In this report, we see evidence of services actively putting up barriers to treatment, resulting in children and young people having to reach crisis point before being able to get access to the right treatment. Children are suffering because of those high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14 and that 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes more serious? These high thresholds are even prompting GPs to tell children to pretend that their mental health is worse than it is. Will the Minister agree to look into referral criteria as a matter of urgency, so that children and young people get the proper treatment at the right time?

The report links these excessively high eligibility thresholds and reductions in access with funding reductions and not enough capacity for services to respond to local needs, so, whatever the Minister says, clearly not enough money is reaching the frontline. Can the Minister tell us how he plans to address that? The report, like the CQC’s recent report on rehabilitation services, raises concerns about out-of-area placements, which we know are a barrier to recovery. Will he tell the House what action is being taken to increase the number of in-patient beds available locally?

Finally, what will the Minister do to address the clear problems, highlighted in this report and others, associated with the rigid transition at age 18 from child and adolescent to adult mental health services, which is also a barrier to accessing care?

[Steve Brine]

The hon. Lady rightly raises the issue of spend reaching the frontline; I said in my opening remarks that it is doing so, and she asked what evidence there was of that. Last year, there was a 20% increase in clinical commissioning group spend on children and young people’s mental health, rising from £516 million in 2015-16 to £619 million in 2016-17.

On the broader issues raised in the hon. Lady’s response, I said that we have made up to £1.4 billion available over five years to support transformation of these services, and there is the additional £300 million that I mentioned. I want to touch on waiting times, referral routes and workforce. We are the first Government to introduce waiting time standards, and that is relevant to children and young people’s mental health, too. We are meeting, or on track to meet, both targets. We will pilot a four-week waiting time for specialist children and young people’s NHS mental health services, as was outlined in the recent Green Paper. As I say, we are considering responses to that.

On referral routes, our Green Paper proposes senior designated leads and mental health support teams—a new workforce—based on the findings of the Department for Education’s schools link pilot. They aim to improve the join-up with specialist services and to result in more appropriate referrals.

[Barbara Keeley]

indicated dissent.

[Steve Brine]

The hon. Lady shakes her head; I can only tell her the facts. Health Education England’s workforce plan recognises new ways of working as a cornerstone of delivering these improvements. HEE will also work with our partners to continue the expansion of these newly created roles in mental health services, and to consider the creation of new roles, such as that of early intervention workers, who would focus on child wellbeing as part of a psychiatrist-led team.

[Several hon. Members rose—]

[Fiona Bruce (Congleton) (Con)]

I commend the Government for promoting the Emotionally Healthy Schools project, which, in my constituency, is working well and engaging not just children who have challenges, but their families. Does the Minister agree that helping children with their mental health challenges needs to involve, wherever practical, their families, family relationships and inter-parental relationships, as recommended by the Early Intervention Foundation?

[Steve Brine]

As ever, my hon. Friend makes a point about families. I said that we are already rolling out mental health first aid training to every secondary school, which is of course important, and we are also committed to rolling out mental health awareness training to all primary schools by 2022, but to coin a phrase, it takes a village. This is about the state—of course, schools are part of that—but also the third sector, which has an important role to play. It is also absolutely about the love, support and Christian embrace of families.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

This is a very important issue, especially given that half of mental health problems are established by the age of 14. It is therefore particularly shocking that some children are receiving assistance only after attempting suicide. Claire Murdoch, the national mental health director of NHS England, has stated:

“Child and Adolescent Mental Health Services are now improving, but from a starting point of historic under-funding and legacy under-staffing”.

This report is surely an example of the latest reports in recent years demonstrating the impact of this Government’s austerity-driven agenda on public services. By comparison, in Scotland, which had the UK’s first ever dedicated mental health Minister, we have seen staffing for Scotland’s psychology and children and young people’s mental health care services at a record high, with a 79% increase since 2006. Surely as part of the Minister’s response to these findings he will wish to look at the actions being taken in Scotland and learn from them.

[Steve Brine]

We always look at the actions being taken in Scotland and in all the devolved Administrations. The hon. Gentleman is right to touch on prevention, which was the first point he made. The proposals in the Green Paper are focused on providing significant support for schools to develop the work they already do on prevention and early intervention. Today’s report talks about the many good things that are going on and, as I said, some of the things we have already taken forward with the Green Paper. While we are kicking this about, let us just remember in these exchanges that this is about the health of young people in England, whom we all represent.

[Jeremy Quin (Horsham) (Con)]

The CQC has recommended that Ofsted should be charged with looking at what schools are doing to support mental health. Will the Minister take that up with his ministerial colleagues in the Department for Education?

[Steve Brine]

I am sure my colleague the Under-Secretary of State for Health, the hon. Member for Thurrock (Jackie Doyle-Price), who is responsible for mental health, will be taking that up as she considers responses to the Green Paper. My hon. Friend the Member for Horsham (Jeremy Quin) is absolutely right to raise that issue and I thank him for doing so.

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

With increasing numbers of university students having mental health problems, what action will the Minister take to ensure better joined-up care, with better communication between home and university GPs and student welfare services?

[Steve Brine]

As a former student union president, I think that is a very good point. One key proposal in the Green Paper is about the new mental health support teams, which will be very important in that. The hon. Lady is right to say that they should work across higher education as well as the earlier forms of education.

[Steve Double (St Austell and Newquay) (Con)]

In the next few weeks, work will begin on the construction of a new mental health residential unit for young people in Cornwall, which is long overdue and much anticipated. It is a clear sign that this Government are investing in young people’s mental health. However, we continue to have a problem with our clinical commissioning group in delivering frontline services, even though the Government are providing more money, so what steps will the Minister take to ensure that CCGs allocate the money provided to those services?

[Steve Brine]

I do not know the specific example that my hon. Friend raises, but he may wish to take it up with the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock. I did say that there was a 20% increase in clinical commissioning spend for children and young people’s mental health between 2015-16 and 2016-17. We have all been frustrated about spend reaching the frontline, and we have made it very clear that we expect it to do so. I am pleased to see progress in the right trajectory.

[Norman Lamb (North Norfolk) (LD)]

These damning findings come three years after we secured £1.25 billion extra over a five-year period. We know that that money has fallen well short of what was committed to three years ago. Will the Minister absolutely commit to make good the shortfall of money getting through to children’s mental health services?

[Steve Brine]

I thank our former ministerial colleague for that. We have not exactly been shy in investing in this area, both when he was a Minister in the Department and now. We have made £1.4 billion available over the five years to support the transformation of services—and the extra £300 million. He says this is a damning report, but we must remember that it is a report we commissioned. We do not hide from these things. The last time I responded to an urgent question from the hon. Member for Worsley and Eccles South (Barbara Keeley) it was on a CQC report on social care. We must not hide from these things and we do not want to bury our heads in the sand. We must recognise and build on the examples of good person-centred care that are taking place in our country at the moment, and that is why we are putting the money behind it. The right hon. Gentleman is right to raise this issue.

[Luke Graham (Ochil and South Perthshire) (Con)]

I welcome the priority and funding that are coming from my hon. Friend. What is he doing to co-ordinate and support the devolved nations in this regard, such as Scotland where adolescent mental health waiting time targets were actually missed? We want to make sure that no British child is left behind, no matter what part of the UK they live in.

[Steve Brine]

That is an excellent point. I will make sure that my colleague, the Under-Secretary of State for Health, is talking, as I know she is, to the devolved Administrations as she considers the responses to the Green Paper, which I am sure include responses from them.

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

The Care Quality Commission’s review found that children were waiting up to 18 months to receive treatment for their mental health conditions. In Lewisham, the Government are cutting the budget for child and adolescent mental health services by 5%. The Green Paper will not help children currently waiting. What will the Government do to address this?

[Steve Brine]

We will put the money in, publish a sensible strategy in a Green Paper, consider the responses and then take it forward, backed by the investment we think we need to deliver the strategy. That will be the same in Lewisham as in Winchester.

[Nigel Huddleston (Mid Worcestershire) (Con)]

I am sure that both sides of the House will welcome the commitment to 21,000 more personnel in mental health service provision by 2021, but can the Minister assure me that this will lead to more children accessing mental health services within the four-week target period?

[Steve Brine]

We talked about testing the four-week target in the Green Paper—it was one of its key pillars—and we hope to pilot the idea to test the impact of our additional investment on reducing waiting times. We will then assess the benefits and challenges and provide information on how the waiting time standard should be adapted to avoid perverse incentives—around thresholds, for instance.

[Conor McGinn (St Helens North) (Lab)]

The Minister’s description of mental health provision will not be recognised by anyone providing or using services. Does he think that cutting the funding for the north west boroughs partnership year on year since 2011 has led to improved services for young people in St Helens?

[Steve Brine]

I do not know about the issue in St Helens. I will look into it, or ask my colleague, the Under-Secretary of State for Health, to do so, and get her to write to the hon. Gentleman.

[Henry Smith (Crawley) (Con)]

I very much welcome the Government’s commitment to mental health workers throughout England’s schools. Will my hon. Friend update the House on its timely roll-out?

[Steve Brine]

As I have said, we will be considering the four-week pilot as part of the Green Paper. We want to see these mental health first-aiders in schools, and as soon as we can give my hon. Friend an exact timetable on the situation Crawley, as well as elsewhere, I am sure that my colleague the Under-Secretary will do so.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Some 75% of mental health problems start before the age of 18, but less than 10% of funding goes to young people. What can the Minister do to prioritise more funding for CAMHS?

[Steve Brine]

As I have said, the overall budget is the money we have promised in the Green Paper, but the hon. Gentleman is absolutely right. The Green Paper has at its heart a focus on prevention and significant support—in early years, through schools and, as the hon. Member for Heywood and Middleton (Liz McInnes) mentioned, through higher education—to prevent issues from snowballing in the first place.

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

With the understaffing of mental health services and the recent Health Select Committee report on the nursing shortage, does the Minister accept that the Government’s decision to remove nursing bursaries, which has particularly affected the number of students training to be mental health nurses, was a mistake?

[Steve Brine]

No, I do not accept that it was a mistake. We need to increase the number of people coming into nursing, and we were turning away far too many who wanted to come into it. The workforce is obviously a huge challenge across the NHS, in primary care—my area—in secondary care and, of course, in mental health, which is why the Secretary of State has said we will create 21,000 new posts by 2021 to support one of the biggest expansions in mental health services in Europe.

[Tony Lloyd (Rochdale) (Lab)]

The Minister will know from his own background that primary care does not always have the necessary expertise in mental health. How will he guarantee that every GP surgery will have the necessary capacity to deliver excellence in mental health services for our young people?

[Steve Brine]

That is a good point—and one that sits at the centre of my portfolio. GPs are generalists. As the Minister for cancer, I know that there is always criticism of their specialism in that, but, by their very nature, GPs cannot be specialists in everything. That is why the mental health support teams, which are at the heart of the proposal in the Green Paper, are a key part of our strategy, and we expect them to work closely with GPs and the Royal College of General Practitioners to upskill GPs, working within the multi-disciplinary teams, to help young people when they need that help.

[Rachael Maskell (York Central) (Lab/Co-op)]

Tomorrow, I am meeting the chief executive of my local mental health trust because we are so desperately worried about the mental health provision for young people in York. We are not only short of staff but short of resources. It takes time to train mental health staff, so what are the Government going to do in the interim to ensure that we have staff in the service?

[Steve Brine]

I hope that when the hon. Lady meets that person in her constituency tomorrow she will recognise the good work that is going on and the number of people who are going over and above to deliver the services to children and people. I should also say that one of her responsibilities as a Member of Parliament, as it is ours as Ministers, is to see to it that the sustainability and transformation partnerships in her area collaborate with all the various organisations in her constituency and that the traditional health and social care services are joined up with schools, police, probation services and mental health services, because ultimately it is one NHS.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Will the Minister listen more carefully to the voice of parents? All my experience as chair of the Westminster Commission on Autism tells me that if parents think there is something wrong with their child—whether it is a mental health challenge or autism—they want early diagnosis and treatment, and they want it at the standard that they have in Sweden.

[Steve Brine]

I am very aware of the hon. Gentleman’s work on the Westminster Commission on Autism—he has a big event coming up in the next few weeks that I hope to go to. I completely agree with him, which is why it was so welcome that the CQC report highlighted Government proposals such as establishing dedicated mental health support teams in schools.

[Nick Smith (Blaenau Gwent) (Lab)]

Phase 1 on the CQC review noted that there were unacceptable variations in quality. How can quality be provided more consistently throughout the country?

[Steve Brine]

That is an excellent point. The NHS is very good at sharing best practice; the challenge comes in implementing it. The report rightly says that there are very good examples of good person-centred care throughout the country. The challenge is to make sure that is rolled out everywhere. I suppose the answer is to focus on the workforce and the investment, and to make sure that we have in place the agreed strategy to take the sector with us and do that.

Childhood Obesity: Bexley

Steve Brine Excerpts

Tuesday 6th March 2018 Westminster Hall

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

Let me start by repeating what was said by my right hon. Friend the Member for Bexleyheath and Crayford (David Evennett): childhood obesity remains one of the top public health challenges, if not the top one, facing this generation. I have said that in this Chamber before, and I welcome any chance to debate this subject. I congratulate my right hon. Friend on securing the debate. I also echo his words about how nice it is to see my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) back in his place. He is my dear friend and I worked closely with him when he was Secretary of State for Northern Ireland. We have said many prayers for him in the last few months. It is great to see him back in his place.

As right hon. and hon. Members will be aware, the latest figures, which I pore over, continue to show us that child obesity rates in England remain way too high. Almost a quarter of children are overweight or obese when they start primary school. Probably more worrying is the fact that that figure rises to around a third by the time they leave primary school.

Evidence shows us that the deprivation gap in obesity prevalence between children in the most and least deprived areas is increasing. My right hon. Friend the Member for Bexleyheath and Crayford gave figures for Bexley, and he was right to, but let me give some national averages. Obesity prevalence among children in reception living in the most deprived areas was 12.7%, compared with just 5.8% among those living in the least deprived areas. In year 6—the final year of primary school—those figures were 26.3% and 11.4% respectively. That gap worries me. It should worry us all. It continues to widen. This is one of the great burning injustices of our times; the Prime Minister has used that phrase, and she is dead right. My view is that we have not just a right to act, but a responsibility to act as a Government with a publicly-funded health system.

Bexley is fairly affluent, but there are areas of significant deprivation, as there are in all of our constituencies. Data for Bexley show higher rates of excess weight in children than the averages for London and for England. Also, obesity prevalence has remained higher than the national average, as my right hon. Friend said, for over five years, so he is right to highlight the issue. The impact for Bexley and the rest of the country was highlighted just last week through new analysis by my good friends and partners at Cancer Research UK suggesting that millennials are on course to be the most overweight generation in history. That should and does worry us greatly.

We know that obese children are much more likely to become obese adults; it is very hard to lose the weight, as my right hon. Friend said. That increases their risk of developing the serious diseases that I speak about as part of my portfolio, including type 2 diabetes. There was a lot of press coverage and an Adjournment debate in the House last week about the sheer number of people picking up type 2 diabetes, which is an entirely preventable condition. It increases your risk of heart disease and some types of cancer, including bowel and breast, two of the most common cancers, which is why CRUK are rightly so active in this space. It is also a major risk factor for non-alcoholic fatty liver disease.

We launched our child obesity plan in August 2016, as my right hon. Friend rightly said. It was a very robust piece of work informed by the latest evidence and research in the area. At the heart of the plan is a simple desire to change the nature of food that children eat and to make it easier for families and parents—who play a key role—to make healthier choices for them and for the country.

The plan is a challenge—and it is meant to be—to us in national Government as well as those in local government, which I will come on to, in businesses, in the NHS, and in schools and families. We all have a role to play in reducing child obesity levels. In developing the plan, my officials and my predecessors have been clear, as I am, that we have considered a number of different policies. We have focused on the ones that are likely to have the biggest impact on preventing child obesity.

As my right hon. Friend will remember, key measures in the plan include the soft drinks industry levy, which was announced by the previous Chancellor; the sugar reduction and wider reformulation programme; and helping children to enjoy an hour of physical activity every day, which is so important.

Since we published the plan, real progress has been made on sugar reduction. The soft drinks industry levy will come into effect in April—it is important to remember that it has not yet come into force, but it is nudging behaviour. Public Health England has formulated a comprehensive sugar reduction programme with the aim of a 20% reduction in sugar in key foods by 2020, including a 5% reduction in year one. We will be judging that shortly to see where progress has been made.

Companies, such as the makers of Lucozade, are important. I visited the headquarters of Ribena, the Suntory brand, in Uxbridge earlier this year. I pay great tribute to its work. I was in the lab testing the new Ribena, which goes live this week.

[David Evennett]

Was it nice?

--- Later in debate ---

[Steve Brine]

It was very nice and very refreshing.

As a company, Ribena has taken a hit in doing that, but it reports great staff satisfaction and a feeling that it is doing the right thing. As the Minister, I have never been afraid to call out businesses that are making poor choices and those that are making the right choices. Ribena is making the right choices.

Kellogg’s also made a good decision about the reformulation of sugar in its cereals, which sit on my children’s breakfast table every morning. Tesco, Waitrose and Nestlé have led the way by removing millions of tonnes of sugar from their products and they deserve credit for that. We expect almost half of all drinks that would otherwise have been in-scope of the soft drinks industry levy to have been reformulated by the time it comes in. That is a crucial step towards improving our children’s health, as data shows that sugary soft drinks are the main contributor of sugar in our children’s diets.

My right hon. Friends might be thinking that we will be victims of our own success, because the industry levy will not produce the revenue so we will not be able to reinvest it. However, someone far cleverer than me, before my time, managed to persuade the Treasury—a clever, neat trick—that we will invest all the revenue we expected to get from the levy, plus what we said we hoped to raise during this Parliament, in giving school-aged children a better and healthier future, including through doubling the primary school PE and sport premium; investing in school breakfast clubs, which are so important; and providing £100 million in 2018-19 for a new healthier pupils capital fund.

As was said by my right hon. Friend the Member for Bexleyheath and Crayford and by the hon. Member for Strangford (Jim Shannon), who is no longer in his place, this work should be done between the Department for Education and the Department of Health and Social Care, and of course it is being. Our original plan was a cross-Government piece of work. Last month, I talked to the new Secretary of State for Education about the plan and introduced him to some of things that I want to do.

It is a joined-up conversation because, as my right hon. Friend said, schools have a huge role to play in teaching children about healthy eating. The national curriculum requires them to teach children about food, nutrition and healthy eating, and how to cook a repertoire of dishes as part of design and technology classes. Things have changed since my day, when a fish finger sandwich was one of my challenges in design and technology and I managed to get it wrong.

It is compulsory for pupils in maintained schools from key stages 1 to 3 to be taught about the principles of a healthy and varied diet and why that is important, and the national curriculum can be used as a benchmark for free schools and academies, which ordinarily sit outside it. Alongside our commitment to continue to provide free school lunches to infant pupils, which means that about 1.4 million more children are eating a healthy lunch, we are investing £26 million in breakfast clubs, using revenue from the soft drinks industry levy.

Our plan is not just about school-aged children. In November, we published a series of example menus and associated guidance to support early years settings, such as nurseries and childminders, to offer food and drink in line with Government dietary recommendations for infants and children from about six months to four years—a key cohort—before they get to primary school.

The guidance includes useful information for early years settings to show how they can meet the early years foundation stage welfare requirement to provide “healthy, balanced and nutritious” meals for children. They are also responsible for educating parents and carers to help them to prepare healthy, balanced meals at home and introduce their child to new foods. There has to be a consistent thread from the education setting to the home setting.

My right hon. Friend was right to mention local authorities, which have a key role to play in creating healthier local environments in our constituencies. They can have a significant impact in local communities through levers such as the planning system, urban design and transport strategies. There are great examples of that, such as the restrictions on new hot food takeaways in Gateshead, which is something that my right hon. Friend might want to look at. I was interested to hear from my right hon. Friend about the borough-wide prevention strategy. As the Minister with responsibility for prevention, I would be interested to hear more and I note his offer to visit him in his constituency.

Other local initiatives include last year’s London-wide great weight debate on child obesity, which several London authorities, including Bexley, took part in. Such events show how communities can make their own contributions. The results of that debate are feeding into the five-year obesity strategy being developed in Bexley, which my right hon. Friend talked about. I welcome that, because it cannot all be about what the national Government do. We have to set the framework and the ambition. Sometimes we can use the taxation system as we have with the industry levy, but local government has a key role to play. I am excited to see the progress being made.

We continue to learn from the latest evidence around the country and around the world, such as the very interesting whole-systems approach in Amsterdam that led to a reduction of 2,500 in the number of overweight and obese children between 2012 and 2015. I am talking to people there and I hope to visit at some point.

This week, as my right hon. Friend mentioned, to implement part one of the child obesity plan, we launched our ambitious calorie-reduction programme alongside Public Health England. It is ambitious: it challenges all sectors of the food and drink industry to reduce calories in everyday food by 20% by 2024. I absolutely believe the sectors can do that—we have had a brilliant and positive response from them—and yesterday’s announcement, which is in the newspapers today, is very welcome. We are confident that those measures can make an impact.

All the reports and data that we publish on our progress in delivering our world-leading childhood obesity plan will be open to scrutiny and, I hope, to further debates in this place. That will include Public Health England’s assessment of progress on sugar reduction, which I mentioned earlier and which will be published in the spring. The Obesity Policy Research Unit’s evaluation of that research will be published as individual projects are completed. We are deliberately publishing and being measured all the time, and we will use that to decide whether sufficient progress has been made and whether we need to go further.

I thank my right hon. Friends the Members for Bexleyheath and Crayford and for Old Bexley and Sidcup for their contributions, and I look forward to continuing the conversation in coming months.

Question put and agreed to.

Diabetes

Steve Brine Excerpts

Monday 26th February 2018 Commons Chamber

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

I thank the hon. Member for Heywood and Middleton (Liz McInnes), whom I know well and have worked with already on this in my time as a Minister, for giving us the opportunity to debate such an important issue. The turnout for this Adjournment debate suggests that it is of great interest to the House. It is normally just me, the Member introducing the debate, my Parliamentary Private Secretary and the hon. Member for Strangford (Jim Shannon). Tonight’s turnout has been a revelation. In November, I remember the hon. Lady introducing me and leading the event in the Terrace pavilion for the launch of the “Future of Diabetes” report by Diabetes UK, which is the biggest study of its kind. I promised then that I would respond recommendation by recommendation to the report, which I believe I have done. The offer I gave then is the offer I repeat now, which is to work with the all-party group and the charity on each and every one of those recommendations. I hope she knows I am sincere in saying that.

I would like to use this opportunity to pay tribute to Diabetes UK—led by the excellent Chris Askew, whom I have known for many years wearing other hats when he used to lead the breast cancer charity Breakthrough—which continues to work both with us in government and independently to improve the lives of so many people who are at risk of this increasingly common condition.

Diabetes is one of the biggest health challenges facing the country, and the figures are truly sobering. There are currently 3.5 million people in the UK who have been diagnosed with diabetes. If nothing changes, by 2025 more than 5 million people will have the condition. That is a significant public health challenge. Type 1 diabetes affects 400,000 people in the UK and its incidence is increasing by about 4% a year. It is not preventable, so the emphasis is on improving the lives of people with type 1 diabetes and helping them to manage their condition. During half-term recess, I paid a visit to a brilliant charity in your constituency, Mr Speaker, called Medical Detection Dogs. I met a brilliant dog who looks after a lady with diabetes. As if on cue, when I walked into the room to meet her he sat and put his paw on her knee, which was him assessing her levels and indicating that she needed to take action. It was incredible to watch. If Members are not familiar with Medical Detection Dogs, please do look it up.

Type 2 diabetes, as we have heard, is much more common. It is a leading cause of preventable sight loss in people of working age and a major contributor to kidney failure, heart attacks and strokes, among the many other conditions the hon. Lady read out in her cheery list. Diabetic foot disease, including lower limb amputations and foot ulcers, accounts for more days in hospital than all other diabetes complications put together. According to Diabetes UK, 11.9 million people in the UK are at high risk of developing type 2 diabetes, which is largely preventable.

Aside from the human impact on people’s lives, the financial cost of diabetes and its complications is huge. It already costs the NHS in England over £5.5 billion a year and that figure continues to rise. Managing the growing impact of diabetes is one of the major clinical challenges for us in the 21st century. That is why, as the hon. Lady and the right hon. Member for Leicester East (Keith Vaz) who chairs the all-party group so well rightly say, preventing type 2 diabetes and promoting the best possible care for all people with it is a key priority for the Government.

The hon. Lady mentioned the child obesity plan. She was absolutely right to do so. She knows I am passionate about delivering part 1 of the plan. We always said that it was the start of a conversation and that it was called part 1 for a reason. I am absolutely committed to taking further action if necessary, particularly across marketing, reducing portion sizes and price promotions, to help young people and to make healthy choices become the easiest choice of all. I think she knows me well enough to know I mean what I say and I say what I mean. If we need to take further action we will do so and she should watch this space.

[Karin Smyth]

I just inform the House that this morning, Committee D of the British-Irish Parliamentary Assembly, of which I am vice-chair, had a session in Portcullis House on childhood obesity with Members from all parts of the islands. We produced a report recently and are doing further work. If I may be so bold, I will make sure that the Minister has a copy of that report. He will be interested in some of the reflections that we are bringing together from across the Republic of Ireland, Northern Ireland, Scotland and Wales, and they might help to inform that work.

[Steve Brine]

That would be very interesting—if the hon. Lady did that, I would be grateful. We are working hard to improve diabetes services. The Government are strongly committed to taking action to prevent diabetes and to treat it more effectively. The Government’s mandate to NHS England for 2017-18 includes an objective for NHS England to

“lead a step change in the NHS in preventing ill health and supporting people to live healthier lives.”

[Mr Howarth]

The Minister will be aware that an algorithm exists whereby it is possible to create an artificial pancreas, and that the Juvenile Diabetes Research Foundation is heavily involved in research at the University of Cambridge to bring that concept to a workable proposition. Will he give a commitment that the Government will fully support that work so that we can end up with something that will help type 1 diabetics to monitor their condition?

[Steve Brine]

I will not give a commitment at the Dispatch Box, but I know the JDRF well. I have supported it in my constituency through various events, including the Alresford music festival, which I am sure the right hon. Gentleman is familiar with. I will take a look at what he said and if he wants to chat to me offline about that, I would be very happy to do so.

The diabetes prevention programme has been mentioned. Wherever possible, the aim is to prevent type 2 diabetes from developing in those most at risk. I am proud to say that NHS England, Public Health England, for which I am responsible, and Diabetes UK have had some success working on the NHS diabetes prevention programme—the first such programme that we have delivered at scale nationwide. I know that a lot of other countries are looking at what we are doing.

The programme is putting in place support for behavioural change in people who have been identified by their GP, or through the NHS health check, as being at high risk of developing diabetes. Individuals can then get tailored, personalised help to reduce their risk of developing the condition, including bespoke exercise programmes and education on healthy eating and lifestyle. It is incredibly positive.

I am aware of the time, so I will move on to treatment and care programmes. After successfully securing significant new investment in diabetes through the spending review, NHS England has developed a diabetes treatment and care programme, which is aimed at reducing variation and improving outcomes for people living with diabetes. As part of that, NHS England will invest £42 million in proposals from individual CCGs, collaborations and sustainability and transformation partnerships to improve the treatment and care of people with diabetes.

[Christine Jardine]

rose—

[Steve Brine]

I will not take another intervention, because I will conclude in just a second. The spending review made provision for significant transformation funding through to 2020-21, and I expect that to be spent in line with the priorities set out in NHS England’s mandate, including for diabetes.

We have talked about the childhood obesity programme and the national diabetes prevention programme. I am responsible for other public health initiatives, such as Change4Life and the One You programme. People like me with young children will see the Change4Life branding coming through in book bags for them. It has been an incredibly successful campaign. The programmes are crucial in both encouraging a healthy lifestyle and promoting exercise among young people, as are such things as the Golden Mile, which is almost universal in primary schools across England. The benefits of such programmes should be acknowledged in reducing not only the incidence of diabetes, but other debilitating and life-threatening conditions such as cancer and heart disease, in which I also have a great interest.

[Rachael Maskell]

Will the Minister give way?

[Steve Brine]

Yes, but then I might not be able to conclude.

[Rachael Maskell]

Very quickly on the issue of exercise, children are now reduced to just one hour of PE. Will the Minister speak to his colleagues in the Department for Education about increasing that?

[Steve Brine]

I am not responsible for the Department for Education, but the hon. Lady is absolutely right to say that I talk to it. I was in the Department with the Secretary of State and a Minister just last week talking about what further action we need to take on school food standards and the Golden Mile, because I want children to be more active. It is not just about what happens in school, though: the exercise through the Golden Mile in schools should be mirrored in out-of-school activity. There is so much more that we can and should be doing to help to prevent diabetes.

In conclusion, diabetes is emblematic of many challenges that the health and care system and my desk face. Prevention is critical, as is working in partnership with people in a way that tailors support and intervention. I, this Government and this Prime Minister are committed to improving outcomes not only for the millions of people in this country who are living with diabetes, but for the many more who are at real risk of developing the condition. We need to help both.

Question put and agreed to.