Cancer Strategy

Steve Brine Excerpts

Thursday 22nd February 2018 Commons Chamber

[Thangam Debbonaire (Bristol West) (Lab)]

It is a great honour to follow the hon. Member for Dumfries and Galloway (Mr Jack), who spoke so passionately and knowledgeably for better understanding, treatment and diagnosis of blood cancer.

Like everyone in the House, I could speak about many aspects of cancer, including my own experience. I could speak about the very moving speech made by Baroness Jowell in the other place—a very special moment in Parliament’s history, and one I will always be glad to have been there for, although I am very sad that she had to be there. I could speak about how horrible chemotherapy is and about how deeply a girl can feel the loss of her eyelashes, for example. I could speak about my support for health labelling for alcohol, as so few people are aware of the connections between alcohol and breast, bowel and other cancers.

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

indicated assent.

[Thangam Debbonaire]

The Minister is nodding vigorously from a sedentary position, and I hope that means he will support better labelling.

I could speak about how important healthy habits are generally for reducing cancer, and again I ask the Minister to do more to urge people to take up those healthy habits from an early age. I could speak about how all women should learn how to check their breasts properly, because so many have told me that they do not how to do that. I could talk about what I learned last week in CERN, of all places, where the Large Hadron Collider is, about the contribution that that scientific institute has made to improving diagnoses of cancer. I could mention, for instance, the development of the MRI—the magnetic resonance imaging—machine. I spoke to scientists there who, I am glad to say, are doing what they can to reduce the very frightening knocking that happens when a person is inside the machine. However, today, I am going to speak about the patient experience of a very specific group—children and young people with cancer and their families.

I say to those children and young people, their parents, their brothers and sisters, their clinicians and the charities supporting them, who may be listening, that this speech is for you. I pay tribute in particular to CLIC Sargent and the Teenage Cancer Trust and thank them and all the other charities, too numerous to mention, that help children and young people with cancer every day. I want to give a very personal thanks to my sister-in-law Emilie, whose volunteering, fundraising and work for CLIC Sargent is an inspiration to so many and whose personal knowledge has taught me so much.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for opening this debate on behalf of the hon. Member for Basildon and Billericay (Mr Baron), and I pay tribute to his excellent work over many years as chair of the all-party group on cancer. I am delighted to support this debate, and as someone who has always taken a key interest in cancer strategy, I wish to highlight three issues. Pancreatic cancer has been well covered by my hon. Friend the Member for Scunthorpe (Nic Dakin), so I will refer to it only briefly. I also want to mention transformation funding and make a plea to the Minister, and I will say something about advance radiotherapy—a hobbyhorse of mine.

As hon. Members may be aware, I have recently recovered from a reoccurrence of lymphatic cancer, so I have first-hand knowledge of the importance of getting the cancer strategy right, not least in terms of early diagnosis and appropriate treatment. Delivering the recommendations set out in the cancer strategy is crucial to improving care and support for thousands of people affected by cancer. I do not seek to make a party political point about the nature of that policy, but essentially it requires resources, a plan, a strategy and commitment.

Sadly, pancreatic cancer has taken friends of mine, and it is particularly nasty. It has the worst five-year survival rate of the 20 most common cancers at less than 7% across the UK—a figure that has hardly changed over the past 40 years. In most other types of cancer, survivability has gone up. For pancreatic cancer, however, it has remained fairly flat. We urgently need investment and action, because pancreatic cancer is set, on current trajectory, to become the fourth biggest cancer killer by 2026. Currently, 80% of pancreatic cancer patients are diagnosed at the stage where the disease is advanced. Surgery is the only potential curative treatment, but sadly it is not an option when the disease is at an advanced stage. As far as I am aware, pancreas transplants are not an option. Early diagnosis is therefore absolutely key to improving the appalling survival rates and ensuring that patients are able to live longer following diagnosis.

I looked up the figures for my own area. Between 2010 and 2014, pancreatic cancer took the lives of 188 people in the Easington, Durham dales and Sedgefield clinical commissioning group area. It is clear that much more work is needed to deliver the kind of change we must see for the people affected, and their families, so we can achieve the improvements in survival rates that are so desperately needed.

Not long ago, I had the pleasure of visiting a local National Citizen Service group of young volunteers in my constituency—I think many Members have taken similar opportunities. The House might be interested to note that one group of young people were raising money for a chemotherapy ward because of their personal and family experiences. They thought that the facilities available were inadequate. This was because the ward, although filled with excellent and committed staff, was grappling with an increase in demand and a lack of funds. These young people raised enough money to buy an assortment of things, including floor fans to keep the patients cool. It is an indictment that, when we are putting additional money into the recovery fund and encouraging people to get through the treatment and to go on, we are relying on charitable donations.

At the Britain against Cancer conference 2016, the chief executive of NHS England announced £200 million of funding for treating cancer, along with improving early diagnosis and funding stratified pathways. The money was intended to support the roll-out of the recovery package. However, since this transformation funding was announced, there have been significant delays in its reaching cancer alliances, with only nine of 16 alliances having received funding. At the Britain against Cancer conference in December 2017, the Secretary of State for Health said that the release of funding to cancer alliances would be delayed in areas that were unable to demonstrate an improvement in their 62-day waiting time standard. That was an additional requirement that had not been included as part of the original criteria set during the bidding process.

Every person diagnosed with cancer—it does not matter where they live—should be able to rely on timely diagnosis and treatment when they are told they have cancer. However, as the final report from the all-party group on cancer’s inquiry concluded, the delayed release of funding to the cancer alliances has had a significant impact on their ability to make progress. I hope the Minister is paying attention, because I want to ask him a question.

[Steve Brine]

He is.

[Grahame Morris]

I am very glad to hear it, because this is a serious point. The Department of Health and Social Care must decouple the release of transformation funding to cancer alliances from progress against the 62-day waiting time standard. I hope the Minister will address that point in his remarks. [Interruption.] I look forward with anticipation to his remarks.

It would not be a contribution on health from me if I did not mention advanced radiotherapy. I have raised regularly its benefits and advocated further investment in its research. Investment and research, given the cost, should be evidence-based, but there are some really quite exciting areas: in particular, proton beam therapy—I visited University College Hospital in London for part of my treatment and saw the installation of the proton beam therapy bunker and equipment there; stereotactic ablative body radiotherapy; adaptive radiotherapy based on advanced imaging—a kind of magnetic resonance linear accelerator; combinations of radiotherapy and novel drugs; biomarkers with selections for altered radiotherapy strategies so that radiotherapy can precisely target the cancer cells; and molecular radiotherapy. It is necessary that we evaluate the use of these new radiotherapy techniques and compare them with conventional radiotherapy and some surgical techniques, as radiotherapy is sometimes more effective than surgery and pharmaceutical products. I am advocating that they be used not instead of, but alongside other treatments and following considerable evaluation. This could result in better outcomes and reduced treatment costs.

Finally, I would like to thank all my colleagues on the all-party group on cancer, the cancer charities that continue to do excellent work and all those in our national health service working in cancer prevention and treatment.

--- Later in debate ---

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

I should like to thank my friend the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), for her remarks. I congratulate the members of the all-party parliamentary group on cancer on securing the debate, in particular the hon. Members for Scunthorpe (Nic Dakin) and for East Kilbride (Dr Cameron)—I shall leave it at that in describing the hon. Lady’s constituency, lest I make a total fool of myself. As the cancer Minister—Members will know that that is the job I always wanted to do—I thank them for the constant work they do on the all-party group and on the Britain Against Cancer conference. Linked to that, I want to extend my appreciation to the Members on both sides of the House who chair the all-party parliamentary groups on different kinds of cancer for the work they do. Some of them are here today. As has been mentioned, I was a co-chair alongside the shadow Minister and the previous Member for Mid Dorset and North Poole and we were quite a team. We were often referred to as Steve and the girls—I found my inner girl. We chaired the group together for five years and I was so proud to do that. We met some amazing people and I think we did some good.

With the shadow Minister, I was also vice-chair of the all-party parliamentary group on ovarian cancer—she still chairs that group—so I know how important it is that Parliament allocates time for this subject, both upstairs in the APPGs and here in the Chamber. Looking at how many people are in the Public Gallery and around the Chamber, this is about quality more than quantity. I say to those watching today who may say, “This is a debate on the cancer strategy. This is so important. Why isn’t the House as full as it is for PMQs?”—this is not all about what goes on in here. This is about what goes on in government, what goes on upstairs in the APPGs and Select Committees and, for so many Members, what goes on within ourselves. I did not know the shadow Minister’s motivation for chairing the APPG. I have never said my motivation—I will one day—but I realise now why she was so passionate.

The hon. Member for East Kilbride pretty much summed things up in the first line of the first speech of this debate when she said that we are all “on the same side” when it comes to cancer—what a brilliant way of putting it. The hon. Member for Coventry North East (Colleen Fletcher) talked about her husband, who lives with cancer. Macmillan has been brilliant with some of its communications, and we have all seen the television adverts saying that a mum with cancer is still a mum. There are so many people who are living with and beyond cancer—they call it “survivorship” in America—and we should always remember that.

Let me start by reassuring the House, if I need to, that cancer is a huge priority for me, for the Secretary of State and for this Government. As several Members have said, cancer survival rates have never been higher, and the latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS cancer treatment compared with three years prior. Our aim is to save 30,000 more lives by 2020 through the cancer strategy that we are debating.

However, I know more than anybody that there is still so much more to do and so much potential, which is why we accepted all 96 recommendations in the cancer strategy. We have backed that commitment with over £600 million of additional funding up to 2021. We are now just two years into the implementation of the strategy, and the fantastic NHS cancer doctors and nurses supporting us to achieve our vision have made tremendous progress in many areas. I echo what many Members have said in their support.

The shadow Minister and others asked whether I will report back on how we are doing on all this. In October, NHS England published its “two years on” report on the day that I gave evidence to the all-party parliamentary group on cancer’s inquiry, which led to its report and to this debate. That was our latest progress report, and I hope that we will be doing something again later this year. NHS England’s national cancer director, Cally Palmer, who is based at the Royal Marsden Hospital and is an incredible lady with whom I enjoy working, is leading the implementation of the strategy. She agrees with me that there are many areas where we agree with the APPG’s report. We do not shy away from scrutiny, which is exactly why we are here. However, progress in many areas was not given sufficient prominence in the APPG’s analysis of progress. We said that at the inquiry. It is important that I put that on the record.

The measure of the strategy’s success will of course be about significant improvements in early diagnosis, which I will come on to, and obviously treatment and research. However, I am increasingly aware in this job that we need to make cancer services even better beyond 2020 and that there needs to be a greater focus on a fourth pillar—the “fourth Beatle”, if you like—which is prevention. Of course, we want to be the best in the world at delivering positive outcomes for patients after a diagnosis, but we have to understand the position. Earlier this week, I responded to a Westminster Hall debate attended by Members from Oxfordshire. There has been a 120% increase in the number of people presenting with cancer in Oxfordshire alone in recent years.

The number of people presenting with cancer continues to rise. We can do very well on the first three pillars, and we are, but prevention is where we will really move the dial. That is why my whole mission as the Minister for primary care and public health, a role created by this Health Secretary, has been to put in place a comprehensive system of measures to reduce the risk of cancer, as well as to treat cancer when it occurs.

As my hon. Friend the Member for Chippenham (Michelle Donelan) and the shadow Minister mentioned, one of my first acts as Minister was to launch the tobacco control plan. Why was I so keen to get it out there? Because we promised we would, but also because tobacco is the biggest preventable killer in our country today. The previous Labour Government and this Government have done well with the legislative framework. It is now about supporting local areas to continue bringing down the number of people who smoke from what are already record lows and to ensure that people do not start smoking in the first place.

Last year, we also launched a cross-Government air quality plan, which has been in the news and in the House this week. That plan is important, too, because it will significantly reduce the carcinogens in the air we breathe, which we know has a big impact on the development of disease. Furthermore, in 2016 we published our child obesity strategy, which was just the start of a conversation about how we will reduce child obesity over the next decade. Our overarching focus in all that work is to ensure that our children are supported to live healthy, active and happy lives, so that they grow into healthy, active adults who are less likely to develop cancer. We have always said that the child obesity strategy is constantly under review—it is part one—and we will go further, if needed, to build on that.

As has been mentioned a few times in this debate, perhaps the biggest game changer in preventing cancer is the world-leading work on genomics happening in our country. The chief medical officer’s 2016 annual report, “Generation Genome,” which was published the year before I was appointed, set out the huge potential for genomics in helping us to understand the inherited and acquired genomic causes of cancer and in shaping future research and future personalised cancer treatment, which is so important—it is something we should talk more about, as we should the whole prevention agenda.

Many subjects have been raised today and I am grateful to you, Madame Deputy Speaker, and to Members for giving me time to respond to them. As I suspect she would like me to do, I will give a couple of minutes to the hon. Member for East Kilbride, who opened the debate.

As I have already said, the workforce is key to our strategy. We have already committed to investing in and expanding our diagnostic workforce to improve survival rates by diagnosing cancer earlier. The first ever cancer workforce plan, which Health Education England published in December, set out how we will expand our workforce, how we will continue to invest in the skills of the staff we have, and how we will use their time and expertise where it is most needed.

HEE has already committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers, which we know are in short supply, by 2021. The plan further commits to the expansion of capacity and skills, including 200 additional clinical endoscopists and 300 reporting radiographers by 2021. HEE will also expand the number of clinical nurse specialists, as the shadow Minister rightly mentioned, and develop common and consistent CNS competences, with a clear route into training, to ensure that every cancer patient has access to a CNS or other support worker by 2021—that subject was constantly raised when I chaired the all-party group. HEE will follow the plan later this year with a longer-term strategy looking at the workforce needs beyond 2021.

The hon. Member for East Kilbride and others, including the hon. Member for Easington (Grahame Morris), talked about the link between the 62-day standard and the performance and phasing in of transformation funding. Cancer alliances, as the House knows, are an important mechanism for improving performance on the 62-day standard from urgent referral through to treatment. They bring together clinicians from primary and secondary care, as is right—one NHS. They ensure collective responsibility for the cancer services they provide, and they provide the necessary leadership for the transformation of services. So £76 million of funding has already been allocated to the cancer alliances.

It is imperative that the alliances have the operational rigour and readiness to achieve the transformation that we need. After all, our constituents’ money is being allocated. So it is only right and proper, as the Secretary of State made clear in the question and answer session at Britain against Cancer, that the alliances demonstrate their preparedness for this funding. That is not to say that the 62-day standard is a requirement, but it does give a basis on which NHS England and NHS Improvement, along with other senior clinical advisers, can assess an alliance’s readiness to transform services. Transforming services is what we want to do.

[Grahame Morris]

What happens when cancer alliances do not achieve the 62-day target? It seems completely perverse that individuals suffering from cancer in those areas are penalised by lack of funds from the transformation fund. Is the Minister saying that those cancer alliances can still apply for that funding and measures will be put in place to ensure that they do reach that target?

[Steve Brine]

Yes, this is not hard and fast. I noted that NHS England has written to me as a constituency MP and to all other MPs today with details of the cancer alliances that they have in their individual areas. I bang on about this every time, as the shadow Minister knows, but I implore Members to engage with their local cancer alliances. I suspect that the people in this debate do that, but I would hazard a guess that many other Members do not. Members should know who the cancer alliances are in their areas and should have a relationship with them.

Let me now discuss CPES, which the hon. Member for Strangford (Jim Shannon) mentioned, as did the hon. Member for Lincoln (Karen Lee). On her speech, let me just say, wow. I said to my officials before this debate that there is always one speech in these debates—the shadow Minister was that person a few weeks ago—who leaves not a dry eye in the House, and today it was the hon. Member for Lincoln. I know she is not in her place now and I do not blame her for that. I think the whole House wanted to run over to give her a hug—many Labour Members did, and bless them for doing that. I think that the House, in its own way, gave her a collective hug, and I say well done to her for an amazing speech.

We totally recognise how important CPES is in our continued drive to improve cancer treatment and care, and to monitor that progress. I have always been clear that I want any future survey to continue to deliver the high-quality data that CPES does. I can tell the House that CPES will continue in its current form in 2018-19. We will engage with the cancer community to ensure that any decisions about future delivery and the model to be adopted, should the commissioning arrangements be revised, are informed by all parties and ultimately protect the integrity of the survey and quality of the data. I saw Dame Fiona Caldicott last week in Oxford and discussed the subject with her. Obviously, her work as the patient data guardian led to the challenge we now have—it was necessary work, but it certainly left us with a challenge. Cally Palmer, the national cancer director, and I will meet all the major cancer charities next week at my second roundtable, and this is on the agenda and we will be discussing it with them. I hope Members know that CPES remains very much at the top of my agenda.

Let me touch on early diagnosis, because everybody else has and because it is one of the most important shows in town. In every conversation I have ever had about how we can beat cancer, I have been told, “Early diagnosis”. Historically, our cancer survival rates have lagged behind the best-performing countries in Europe and around the world. The primary reason for that is, without question, late diagnosis. Sir Harpal Kumar will stand down as chief executive officer at Cancer Research UK shortly, but I had the privilege of having lunch with him a few weeks ago, when I asked him what we should think about in terms of the next cancer strategy. He said, “The rock upon which you build your church is early diagnosis.” I will not forget that, which is why one of the key priorities of the strategy is to diagnose cancer earlier, when the disease is more treatable.

How are we doing that? As part of our drive to ensure early diagnosis, we are also introducing the new 28-day faster diagnostic standard from GP referral to diagnosis or the all-clear. I have often said, and I repeat now, that 28 days is not a target; it is a maximum. I well know that when people have a cancer worry, 28 minutes seems like a lifetime, let alone 28 days. However, the 28-day standard is really important. It will be introduced from April 2020. Five pilot sites have started testing the new clinical pathways to ensure that patients find out within 28 days whether they have cancer or the all-clear.

Today, Public Health England, for which I have ministerial responsibility, has launched its 14th “Be Clear on Cancer” campaign, which focuses on breast cancer in women aged over 70, something monitored by my hon. Friend the Member for North Warwickshire (Craig Tracey)—my excellent successor chair of the all-party group on breast cancer—mentioned. That campaign will run until the end of March. It focuses on age-related risk, encouraging older women to be breast aware, and particularly to be aware of non-lump symptoms, which, understandably, have lower levels of awareness.

The other point I want to make on early diagnosis is that we know that the hardest cancers to detect are those where early symptoms can be vague and often symptomatic of less serious illnesses. Patients often see their GP multiple times before that all-important referral. That is why we are piloting 10 multidisciplinary diagnostic centres as part of wave 2 of what we call the ACE— accelerate, co-ordinate and evaluate—programme. Patients presenting to their GP with vague symptoms can be referred to an ACE centre for multiple tests, one after the other, and receive a diagnosis or the all-clear on the same day. The initial findings are incredibly exciting; I do not get easily excited, but I am excited about this. I had the pleasure of visiting one of the ACE pilots at the Churchill Hospital in Oxford last Tuesday, during recess, and I have to say that the enthusiasm and feedback I got from clinicians and patients about the potential of the ACE centres were really quite incredible. I look forward to seeing the analysis on that work in the coming months.

The shadow Minister talked about emergency room presentations, which are something I was quite shocked by as a Back Bencher when I went to all-party group meetings. It is true that emergency room presentations for cancer are horrible, but that is why the 28-day standard and the ACE centres are so important. When I talk to GPs, they tell me that they will refer and that there will then be a wait. Patients who are, understandably, worried and terrified may then present themselves at an A&E, at which point they may be diagnosed with a primary cancer. That then hits the stats around emergency room presentations for cancer. It does not mean that those people have been carried in; they have often walked in. That all explains why we need to grip early diagnosis better than ever.

My hon. Friend the Member for Bosworth (David Tredinnick) talked about Baroness Jowell’s speech in the other place last month. The Secretary of State was there to listen to the speech, and it was incredibly powerful. Baroness Jowell met the Secretary of State and the Prime Minister this morning. Investment in brain cancer research has been limited by a pretty low volume of research proposals focused on the topic in recent years, and we have been working with charities, academics and the pharmaceutical industry to address that over the last 12 months.

To accelerate our efforts in brain tumour research, the Secretary of State has today announced, alongside Cancer Research UK and Brain Tumour Research, a package to boost research and investment into this most harrowing form of cancer. We have announced £20 million through the National Institute for Health Research over the next five years, with the aim of doubling this amount once new high-quality research proposals become available. CRUK has confirmed it will provide £25 million of its money over five years in major research centres and programmes dedicated to brain tumours. Today’s announcement is incredibly positive.

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

I have listened patiently and, unfortunately, I was not here at the beginning. However, my constituent has a very rare form of cancer. He has had to self-fund his treatment in Germany and Southampton, but he has run out of money. The treatment meant he did not die within the weeks he was given and is now living. However, he needs top-up therapy, and his individual funding request has been refused. Without his treatment, he will not live. Could the Minister look into this case?

[Steve Brine]

Obviously, I will not comment on the case. I was going to suggest that the hon. Lady gets the clinicians to make an IFR, but she can by all means bring the case to me.

My hon. Friend the Member for North Warwickshire talked about breast density. The UK National Screening Committee commissioned a Warwick University study to investigate the link between breast density and breast cancer. Once complete, if the review suggests that there should be changes to the national breast screening programme, the UK National Screening Committee, which we work with, will consider that under its modification programme. I am in touch with Breast Density Matters, which is a small charity—small but perfectly formed.

The hon. Member for Coventry North East and others talked about blood cancer. We had a very good Westminster Hall debate last month led by my hon. Friend the Member for Crawley (Henry Smith). As has been said, many patients with blood cancer diagnosis will sadly never be cured; they will be on the regime of watch and wait, often over many years, to see whether the cancer has progressed to a point where treatment needs to begin. That can take a huge psychological toll, which Members have mentioned, on the patient and their families.

By 2020, every patient will receive a holistic needs assessment as part of the recovery package, which is excellent. For the blood cancer patient, their recovery plan will be personalised to take account of the unique characteristics of blood cancer and will include their mental health needs. That is why the Secretary of State announced the additional £1.3 billion last July to expand the mental health workforce. My hon. Friend the Member for Dumfries and Galloway (Mr Jack) made that point very well in his speech—I say this as I am passed a note. I love the notes from the Whips.

[David Tredinnick]

Will the Minister give way?

[Steve Brine]

No, I will not, because I want to finish.

My hon. Friend the Member for Dumfries and Galloway touched on the cancer dashboard, including, yes, rarer cancers. NHS England and Public Health England are currently considering next steps on how we can expand the dashboard. They know that I am frustrated about its being limited to the top four, and I want to see us expand it and do better, and they have had a very clear direction from me on that.

The hon. Member for Bristol West (Thangam Debbonaire), as always, spoke brilliantly. What a brilliant advertisement for her all-party group and its inquiry. If there is anything that I can do to help—I do not know about the cost of cancer report, but if she sends it to me, I would love to see it—she knows that she only needs to ask.

The hon. Members for Scunthorpe and for Easington talked about pancreatic cancer. NHS services for pancreatic cancer have significantly improved in recent years, with clearer diagnostic pathways, decision making by specialist multi-disciplinary teams and the centralisation of pancreatic surgery with specialised teams. On 7 February, the National Institute for Health and Care Excellence published the final guidance on the diagnosis and management of pancreatic cancer in adults. This will ensure quicker, I think, and more accurate diagnosis referred to specialist MDTs and better access to psychological support. The hon. Member for Scunthorpe mentioned tumour profiling tests. NICE has made a decision on that. I will get it to write to me with an explanation of that decision, as he has asked, and I will share that with him.

Let me conclude by paying tribute to the staff who do so much, the patient groups and the charities that are working so hard as part of team cancer—we are all on the same team when it comes to cancer—to implement the cancer strategy and to save lives. We are on track to deliver, we think, but we need to make more progress, especially on early diagnosis and looking further forward on the subject of prevention, as I have said. I thank all Members for speaking today. The fight goes on.

NHS Charges

Steve Brine Excerpts

Wednesday 21st February 2018 Written Statements

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

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

Regulations will shortly be laid before Parliament to increase certain national health service charges in England from 1 April 2018.

In the 2015 spending review, the Government committed to support the five year forward view with £10 billion investment in real terms by 2020-21 to fund frontline NHS services. Alongside this, the Government expect the NHS to deliver £22 billion of efficiency savings to secure the best value from NHS resources and primary care must play its part.

This year, therefore, we have increased the prescription charge by 20p from £8.60 to £8.80 for each medicine or appliance dispensed. To ensure that those with the greatest need, and who are not already exempt from the charge, are protected we have frozen the cost of the prescription prepayment certificates (PPC) for another year. The three-month PPC remains at £29.10 and the cost of the annual PPC will stay at £104. Taken together, this means prescription charge income is expected to rise broadly in line with inflation.

Charges for wigs and fabric supports will also be increased in line with inflation.

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

NHS Staff: Oxfordshire

Steve Brine Excerpts

Tuesday 20th February 2018 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Evans. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing the debate. We have met a number of times and I have responded to a number of her written questions, so I know that she is working hard on this subject.

It is always great to hear Members speak personally about their experiences—maybe none more so that my hon. Friend the Member for Banbury (Victoria Prentis)—and how passionately they speak about the national health service. Members from the county of Oxfordshire have spoken well; I do not know how they play in private, but in public they seem like a very good team. That may not be the case in Hampshire; maybe there are too many of us on the Front Bench. We are only a two-party state in Hampshire; perhaps that is why.

The debate is not only important but timely. I had the pleasure of visiting the Churchill Hospital, which is part of the Oxford University Hospitals NHS Foundation Trust, last Tuesday during our half-term recess. I saw the superb and innovative cancer care provided by the dedicated staff—I obviously echo all the praise for the staff—and had the opportunity to discuss workforce issues for a little time with the chief executive, Dr Bruno Holthof, who is a very nice man, and his senior team. I therefore hope I can provide some well-informed replies to the hon. Member for Oxford West and Abingdon and Members from across the county. The NHS in Oxford is working hard to ensure it has the doctors and nurses to continue to provide excellent care to Members’ constituents.

We met in Maggie’s Oxford cancer centre. As Members will know, I am the cancer Minister—it is the thing that gets me out of bed in the morning—and I was blown away by Maggie’s cancer centre. I know there are a lot of them across the country, but this was in a beautiful building, was brilliantly designed and had incredible, passionate staff. I met a number of patients who described Maggie’s as a haven for them while they are going through their cancer treatment. It was great, as always, to talk to patients.

My hon. Friend the Member for Banbury spoke about the recent story in The Times—the front-page splash on changes to patient cancer treatment plans at the Churchill—which a number of hon. Members mentioned and which I suppose was the spur for the debate, although it seems to have broadened out into everything, covering about four different Government Departments. I, too, was obviously concerned when I saw the story. I called the chief executive of the trust, and he was very clear that, although it would have been a great story, there was only one small problem: it was not true.

The leaked emails—whoever leaked them can examine their own conscience and motives—set out hypothetical challenges and invited suggestions from clinical staff, ahead of a meeting taking place this month. There has been no change to formal policy on chemotherapy treatment at the trust, and any such decision would be a matter requiring clearance at board level anyway. As we discussed, the chief executive’s first consideration was, rightly, the obvious and needless worry caused to cancer patients across Oxford and the wider area. I am pleased, although obviously disappointed it was necessary, that he quickly put in place plans to communicate to his patients that there were absolutely no changes, as the hon. Member for Oxford East (Anneliese Dodds) said, to chemotherapy treatment.

The trust continues to meet two of the three main cancer waiting time standards and is working hard to meet the third. We discussed that last week, too, and the trust should be very proud of it. I was able to congratulate some of the team personally last week. The trust is considering how best to deliver chemotherapy services going forward, and I am confident that it will do that in the correct way, through the correct channels, and of course in compliance with NICE guidance.

When I was on site at the Churchill, I was able to pop in to the ACE wave 2 pilot. ACE stands for accelerate, co-ordinate and evaluate—I know that my right hon. Friend the Member for Wantage (Mr Vaizey) enjoys these acronyms. I met Fergus Gleeson, Sara Bainbridge, Shelley Hayles, a local GP in Oxford who leads on cancer, and Julie-Ann Phillips, who is the navigator—a great title—and seems to make it all happen there. I, as a cancer Minister, and we as a Government are very excited about ACE. It is about taking patients with suspected cancer from the GP and into the accelerated diagnostic centre and getting them a diagnosis or clearance quickly. I met patients and saw how much it means to them.

I asked patients about stories on the front pages of national newspapers, which of course are trying to sell national newspapers. I noted, in relation to the story, which was gleefully run by the BBC that morning once it had read The Times, that by the end of the day the coverage had slightly changed as it realised that it had been reporting fake news all day. I asked patients what they thought about seeing that sort of thing on the front page of The Times while they were receiving world-class cancer treatment in Oxford, and I will not repeat the exact words that they used, but they were very clear about how disappointed they were to see that, and that they did not feel that it represented the professionalism that constituents of hon. Members across this Chamber see. I think that hon. Members can get a sense of what I thought about that story, and I do not take The Times anyway.

Let me start with the global picture, and then I will localise. The dedicated men and women who work in our NHS are of course its greatest asset. The Government have backed the NHS. We have made significant investments in frontline services and are now taking bold steps to plan for future generations. We do, however, recognise the workforce challenges that the NHS faces in its 70th year. That is why the entire system embarked on a national conversation, with the publication by Health Education England in December of “Facing the Facts, Shaping the Future: A draft health and care workforce strategy for England to 2027”, which is designed to stimulate debates such as the one that we are having today. I know that HEE will read the record of this debate.

The strategy sets out the current workforce supply and retention, and the challenges that we face, but also the significant achievements made from work already under way. It is the first step towards a proper plan that stretches beyond any electoral cycle—we must get away from working in that way—and secures the supply of staff for future generations in our health service. The strategy posed a number of questions that will inform a comprehensive strategy for the workforce over the next decade, to be published in July this year. We need to think innovatively about how we can make the NHS workforce fit for the future, and as always in debates about our NHS, we have heard a number of excellent suggestions today. I encourage hon. Members to engage with the consultation, and from what I have heard today, I do not doubt that they will.

We have heard a lot today about recruitment. Of course, that is not the only way to ensure that the NHS has the workforce that it needs to deliver the safe and high-quality care in which I, the Secretary of State and all hon. Members are so interested. We need to ensure that our excellent doctors and nurses want, and are supported, to stay in the national health service, and we have a clear plan to ensure that the NHS remains a rewarding and attractive place to work.

Let me list a few of the things that the plan covers. It includes arrangements for more flexible working—we know that many health professionals are married to other health professionals, and quality of life matters as much as quality of pay—and a system of staff banks for flexible workers across the NHS, increasing opportunities for staff to work on NHS terms and to reduce agency costs for employers. Something else that we discussed last week is a scheme to offer the right of first refusal to NHS employees on any affordable housing built on NHS land, to increase NHS workers’ access to affordable housing, with an ambition of benefiting up to 3,000 families. When I got lost while trying to find Maggie’s cancer centre on the Churchill site, I noticed that there is a lot of surplus NHS land on that site, and I know that it is looking at that. In addition, since September 2014, more than 2,700 nurses have successfully completed the nursing return to practice programme and are ready for employment.

Let me localise to the recruitment and retention of NHS staff in Oxford, which I also discussed last week. It is important to note from the outset that although there are workforce challenges, Oxford University Hospitals NHS Foundation Trust has 388 more hospital doctors and 591 more nurses than it did eight years ago. It is also successfully seeing 11,500 more patients—a 120% increase—with suspected cancers than it was in 2010. One of the key challenges that we discussed is that Oxford, much like London, is a very expensive area to live and work in, as hon. Members have mentioned, and unemployment is very low. Those conditions present a recruitment challenge that other, less affluent areas do not have.

The hon. Member for Oxford West and Abingdon mentioned continuous professional development, and I promised to mention that. It is a matter for employers; any agreements, such as for protected study time, would need to be negotiated between employer and employees. However, it is always in the best interests of employers to encourage and support the learning and development of their employees. HEE provides national funding to support development of the NHS workforce and invests up to £300 million every year in supporting NHS employees to achieve registered qualifications, and that will continue.

We are increasing the number of nurse training places by 25%. That means 5,000 additional nurse training places every year from September 2018. It is one of the biggest increases in NHS history, and I was glad that the hon. Lady welcomed that in her opening remarks. She also mentioned Brexit, as my right hon. Friend the Member for Wantage did. The Secretary of State and the Prime Minister could not have been clearer: the Government hugely value the contribution of EU staff working in our NHS and understand the need to give them certainty. The Secretary of State has made it clear that after Brexit, we will have an immigration system that means that the NHS is able to get the staff that it needs, not just from the EU but from all over the world.

The hon. Lady asked about career progression; I think that she was referring to scale points earned in the NHS and whether they would transfer. I will get back to her on that; I will get a note to her and copy it to other hon Members in the debate, as I know they will be interested.

Pretty much everyone mentioned the idea of pay weighting for Oxford, as with London, given the proximity of the county. There are a number of mechanisms in the NHS funding and pay system to compensate for higher costs in particular areas. It is open to the independent NHS Pay Review Body to make recommendations on the future geographical coverage and value of such supplements. Additionally, there is flexibility for local NHS employers to award recruitment and retention premiums where recruitment is difficult at standard rates of pay, so when they are having their team get-together—

[Anneliese Dodds]

Will the Minister give way?

--- Later in debate ---

[Steve Brine]

I will not, because I need to give a minute to the hon. Member for Oxford West and Abingdon, who introduced the debate.

Pretty much everyone asked about the public sector pay cap. I am glad that everyone recognises and welcomes the fact that we have said that that will be lifted. The shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), and the hon. Lady leading the debate asked about the timetable. I cannot give an exclusive in this Westminster Hall debate today, but I can say that talks between NHS Employers and the trade unions continue, and I know from my hon. Friend the Minister for Health that they are constructive.

So many other points were raised. They included the future of the Horton. I am told that the decision has been considered by the Independent Reconfiguration Panel and the Secretary of State will consider its advice and recommendations in the next few days. I have a funny feeling that when we have a vote tonight, my hon. Friend the Member for Banbury will seek out the Secretary of State.

My hon. Friend the Member for Henley (John Howell) left us hanging as to what he is transmitting via the internet with his GP. [Laughter.] Perhaps that is the wrong expression, but his point about primary care at scale and truly integrated services that can take pressure off the NHS was so well made and is exactly what we mean: sustainability and transformation partnerships are about one NHS and bringing NHS services together.

If I have not covered any of the points, I will write to hon. Members. The pressures on the health system are significant. I have talked about the sheer increase in the number of people coming forward needing cancer treatment in the area of the hon. Member for Oxford West and Abingdon, and that is true across the NHS. The demands are intense, but the workforce are responding brilliantly. We understand that there is a workforce challenge. That is why we launched the workforce consultation, with which I know hon. Members will want to engage. We look forward to the responses to the consultation exercise, so that collectively we can ensure that the NHS remains the best health system in the world, and the envy of the world, as it celebrates its birthday in June.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 6th February 2018 Commons Chamber

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

12. What plans he has to expand the services provided by pharmacies to assist GPs.

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

It is good to be back.

As I have repeatedly said at the Dispatch Box, pharmacies are a vital frontline service for our NHS, with over 1.2 million health-related visits every day. Community pharmacies have again stepped up during this winter period, and I thank them for their hard work. They have vaccinated more than 1 million people against seasonal flu since October. The Government are committed to ensuring that pharmacies and pharmacists are further embedded in the wider health service.

[Mrs Latham]

I thank the Minister for that answer. Will he come to Derby to meet a constituent who has pharmacies that are working very hard to keep patients out of hospital, therefore saving the NHS money through their innovative ideas?

[Steve Brine]

Yes, I will do that. I think we have a provisional date in the diary in early March. We continue to promote the Pharmacy First scheme. Next month, we will launch the £2 million Stay Well pharmacy campaign to continue to promote the idea of community pharmacy as the first port of call for many minor health concerns. I am out and about visiting pharmacies—I was at one last week—and I will be very pleased to come to see my hon. Friend.

[Tony Lloyd (Rochdale) (Lab)]

21. The Minister will be aware that a disproportionate number of GPs are currently heading towards retirement. Therefore, support for primary care services is vital. What practical steps can be taken to increase the use of pharmacies and to seek alternatives to GP services more generally?

[Steve Brine]

As the hon. Gentleman knows, there are a record number of training places. We know that one of the main reasons why GPs leave general practice is retirement, which is why we have put in place comprehensive measures to ensure that we meet our commitment to deliver an extra 5,000 GPs in the NHS by 2020. GP career plus, the GP retention scheme and the national GP induction and refresher scheme will all help get to valuable experienced GPs back into our NHS, doing the valuable work our constituents so benefit from.

[Huw Merriman (Bexhill and Battle) (Con)]

14. 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 recognise the acute shortages in general practice, which is why we remain, as I said in my previous answer, committed to delivering the additional doctors in general practice by 2020. Millions of patients have already benefited from being able to access evening and weekend GP appointments. We expect everyone in England to have access to this by March 2019.

[Huw Merriman]

I am fortunate to work very closely with the GPs in my constituency. It would be appear that, for a variety of reasons, younger GPs are not as likely to buy into the partnership model as their predecessors. Does the Minister agree that we need a mixed model of both private partnership contractor and direct NHS state provision if we are to get GPs to the places where the public need them?

[Steve Brine]

My hon. Friend works very closely with the GPs and commissioning groups in his constituency and they value him greatly as a local MP. We back the partnership model. As the Secretary of State said last month at the Royal College of General Practitioners, we believe in its many benefits as the cornerstone of primary care. That is why we are embarking on a new piece of work to explore other models with the British Medical Association and the RCGP, which have kindly agreed to work with us on this, and to look at the partnership model in the context of primary care at scale.

[Several hon. Members rose—]

--- Later in debate ---

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

NHS figures continue to show an alarming decline in the number of family doctors working across the north-east, which is why I am supporting the University of Sunderland bid to establish a new medical school. Does the Minister accept that prioritising training places in areas of greatest need is the best long-term solution to the crisis facing general practice?

[Steve Brine]

There are record numbers in training, and I take note of the hon. Lady’s bid for the training school. One reason the Department and my brief have placed such importance on recruiting new GPs into the NHS in England and on making sure that people can stay working in the NHS in England is that we see general practice, rightly, as the cornerstone of the health service.

[Anna Soubry (Broxtowe) (Con)]

T1. If he will make a statement on his departmental responsibilities. And you wear it well, Mr Speaker.

--- Later in debate ---

[Craig Tracey (North Warwickshire) (Con)]

T7. I have had concerns highlighted to me over the national cancer patient experience survey in the light of the introduction of a new national opt-out model. Can the Minister confirm that the survey will continue to deliver the same high-quality data annually and can he tell me when a final decision on its format is likely to be made?

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

I have listened carefully to cancer charities, clinicians and patients on the importance of the cancer patient experience survey. I have been clear that, whatever form the CPES takes as a result of the changes to how confidential data is shared, we want the survey to continue with a methodology as close to that of the current survey as possible.

[Nick Smith (Blaenau Gwent) (Lab)]

T2. Last week at PMQs, the Prime Minister made an inaccurate statement about the emergency health services in Wales. The chair of the UK Statistics Authority concluded that the Prime Minister’s comparison was not valid. Comparisons on the performance of our NHS are important, so will Government Ministers check their partisan figures in future?

[Paul Scully (Sutton and Cheam) (Con)]

In Sutton, we have hugely exciting plans for a London cancer hub, working with the Royal Marsden Hospital and the Institute of Cancer Research, on a single campus to provide a global centre for cancer innovation that will in turn provide a huge boost for our local economy, including 13,000 new jobs. Will the Minister join me in Sutton to see the opportunity at first hand? Will he also tell us how such a project can help to deliver on our Government’s life sciences strategy?

[Steve Brine]

I am keen to visit my hon. Friend in Sutton, so let us fix a date as soon as we can. Cancer survival rates are at an all-time high, but I like the idea of a one-stop shop, and the hub that he talks about could be very exciting.

[Joan Ryan (Enfield North) (Lab)]

T3. The delivery of sustainability and transformation plans is too dependent on the NHS estates strategy, as discussed in the Naylor review, and there is great concern that our NHS assets will be sold off quickly, cheaply and without transparency to make up for Government underfunding. Will the Minister agree to pause the process to accommodate the urgent need for parliamentary scrutiny?

--- Later in debate ---

[Steve Brine]

I thank my hon. Friend for his work in this job on this subject. The Secretary of State was in the other place to listen to Baroness Jowell’s speech, and I read it and watched it back. It was a moving and brave piece of work. We take this matter seriously. My colleague Lord O’Shaughnessy has the report, which we are going through line by line, and he and I will jointly chair a roundtable on the subject in the next few weeks.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Will the Secretary of State give an assurance that any accountable care organisations that he establishes will not be able to use commercial confidentiality excuses to evade scrutiny under freedom of information legislation?

--- Later in debate ---

[Tim Loughton]

Lipoedema affects 10% of women in this country, many without a diagnosis, so why are an increasing number of my constituents saying they cannot get any therapeutic interventions funded by the CCG? Will the Minister meet a delegation of those people and other hon. Members similarly affected?

[Steve Brine]

Yes, of course I will meet my short-tied hon. Friend with the delegation he requests.

[Several hon. Members rose—]

Neuroblastoma

Steve Brine Excerpts

Tuesday 23rd January 2018 Commons Chamber

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

I congratulate my hon. Friend and parliamentary office neighbour, the Member for Spelthorne (Kwasi Kwarteng), on securing this debate on such an important issue.

It is a privilege to be cancer Minister—I hear some of the worst and some of the best. We know that cancer is a disease that will affect most of us, either directly or indirectly, at some point. I suspect it will affect everybody in the House tonight. That is particularly true, and somewhat inevitable, as the population ages, but it is especially heartbreaking, is it not, when cancer afflicts children and teenagers, as it has his constituent Alfie? I have young children myself, and I cannot help but think about that.

Neuroblastoma is an uncommon cancer—there are about 95 cases in the whole of the UK each year—but it has one of the lowest survival rates of all the childhood cancers, and that is why raising awareness of it is vital and why I thank my hon. Friend for bringing it to the attention of the House. As he says, it is always a privilege to speak here and to raise issues on behalf of constituents.

I will come in a minute to how we are prioritising investment, which is so important, in research and improving access to drugs for cancer, particularly those that are less survivable. First I would like to pay tribute to the Bradley Lowery Foundation—my hon. Friend mentioned Bradley—which is providing fantastic support to Alfie’s family, for which I thank it. As a football fan myself—okay, I am a Spurs fan—I saw several times how Bradley’s smile lit up many football grounds, including his own in Sunderland, before he sadly lost his own battle against neuroblastoma, as my hon. Friend said. His legacy is the tremendous awareness of this rare cancer that he raised in his short life. He encouraged a huge amount of fundraising for treatment and research that will help so many children. I often think, whether we live for 100 years or 100 minutes, we all in some way change the world we are born into, and that is certainly true of Bradley’s life.

In England, we want something that is very difficult but quite simple to convey: we want to have access to the best cancer services in the world, especially for children and young people who have to face this disease so early in their lives. That is why the Government—this Prime Minister, the previous Prime Minister, the Secretary of State and I—have prioritised cancer services. Since 2010, we have seen year-on-year increases in the number of people surviving. At the end of last year, this country had its best survival figures ever, which is of course something to be pleased about, but just one person who is battling cancer will not feel like that.

We know that there is a huge amount more to be done. NHS England is leading the health and care system in implementing every one of the 96 cancer strategy’s recommendations with the aim of achieving our ambition to save a further 30,000 lives a year by 2020—although if we can do more, we should. NHS England has committed some £600 million to support the delivery of the strategy. No one will hear me speak about cancer without mentioning early diagnosis, which is the most crucial factor that we know of in successfully treating neuroblastoma or any other cancer.

In 2016, some £200 million was made available to the new cancer alliances, challenging them to encourage innovative ways in which to diagnose cancer earlier and to improve the care for those living with cancer. That is so important. Members will have seen the television campaign by Cancer Research UK, which includes the words “A mum with cancer is still a mum.” Many people are battling cancer, but they are still living their lives. It is always important to say that. The funds are also intended to ensure that all cancer patients receive the care that is right for them, and we are rolling out one-stop shops throughout the country. We have invested some £130 million in upgrading and replacing radiotherapy equipment, to ensure that patients have the best and latest equipment regardless of where they live.

Cancer services for children and young people, including the treatment of neuroblastoma, are specially commissioned by NHS England. Neuroblastoma is often treated with radiotherapy. In 2013, a £23 million fund was used to improve access to intensity modulated radiotherapy, a precise form of radiotherapy that can be directed more accurately at cancers and allows a higher dose of radio- therapy to be given with, hopefully, fewer side effects. That is particularly important to very young children, who may have weaker immune systems and who are less resilient to more invasive treatments.

[Jim Shannon]

I thank the Minister for his endeavours. It is always a pleasure to listen to his response to any constituency issue. In England, responsibility clearly lies with him, but is there any possibility of discussions with the regional Governments with a view to joint working, whatever their role might be? I think of young Oscar Knox in Northern Ireland, and that is really my reason for making the suggestion.

[Steve Brine]

I am glad that the hon. Gentleman is here. He raised the same point last week during the Westminster Hall debate on blood cancers, to which I responded. As he had to leave before I did so, I will repeat what I said then. Obviously, once devolved government returns to Stormont and there is a Health Minister in the Northern Ireland Executive, I shall be happy to meet him or her, and I am sure that the hon. Gentleman would like to be involved in that meeting. We shall then be able to talk about some of the successes that we have had in England and some of the things that I am sure we can learn from Northern Ireland.

An even more precise form of radiotherapy that can be used in neuroblastoma treatment is proton beam therapy. It sounds like something out of the future, and in many ways it is, but the future is coming. In 2012, the Government provided some £250 million for the building of two PBT centres in England, at University College Hospital here in the capital and at the Christie cancer centre in Manchester. I had the privilege of visiting the Christie last year—I happened to be there in the autumn, for some reason—to see its new PBT facilities, which are incredible and which will be providing treatment for patients later this year. As a result, the NHS will no longer need to send young patients to the United States—which has caused great upheaval to patients and their families, has had an impact on patient outcomes and has, of course, involved huge expense to the families and the NHS—for this cutting-edge treatment.

My hon. Friend the Member for Spelthorne spoke about guidance from the National Institute for Health and Clinical Excellence. We want the very best new innovative treatments, such as the promising antibody therapy we have heard about today, to be available on the NHS. NICE is the independent body that provides guidance on whether drugs and other treatments represent a clinically effective and cost-effective use of resources in the NHS—a publicly funded health system. I am advised that NICE is currently considering two antibody-based treatments for neuroblastoma. It is appraising Dinutuximab-beta for use in high-risk neuroblastoma, but the appraisal has been delayed as NICE awaits additional evidence from the drug company. Final guidance on the use of any drug can be issued only after careful consideration of all the available evidence and extensive engagement with stakeholders. That has to be the right approach, however frustrating it is. Another drug used in the treatment of high-risk neuroblastoma is dinutuximab or Unituxin. NICE’S appraisal of this drug, which is in the same family as Dinutuximab-beta but is distinctly different, has also been suspended as demand for the drug in the United States has exceeded expectations and is outstripping the company’s ability to meet global need.

I stress that just because drugs are not routinely available to patients on the NHS that does not preclude their use. Clinicians can make a case on a patient’s behalf for exceptional funding if they believe a particular treatment would deliver the best clinical outcomes. I understand that Alfie’s consultant is looking at doing that. Individual funding requests made by a supporting clinician are always a potential route for access to treatments that are not currently commissioned by the NHS. NHS England is not aware of any IFR in Alfie’s case, but I will be happy to make it so, working with my hon. Friend, following tonight’s debate.

Despite the strides we have made in increasing overall cancer survival rates, we recognise that there are some cancers where progress has been far too slow. That is why our focus for these cancers is on research and innovation, and ensuring that proven innovations, once they are discovered, are adopted swiftly across the health service in England. I am pleased to say that the Government are fully supportive of the Less Survivable Cancers Taskforce, which I launched last summer here in the House, specifically to address the survivability gap between the least and the most survivable cancers. I met the taskforce just before Christmas to discuss how we can work together to raise awareness of the symptoms of cancer and how we can ensure that less survivable cancers have better access to research funding. That is a promising workstream. The taskforce is a cutting-edge group and I look forward to working with it.

Cancer Research UK is also funding research to better understand childhood cancers such as neuroblastoma. In September 2016, the Government announced the largest ever investment in health research infrastructure—£816 million over five years from April 2017 for 20 National Institute for Health Research biomedical research centres in England. That was a big step, and I am sure hon. Members recall the Prime Minister’s announcement. That includes £61.5 million in the biomedical research centre at the Royal Marsden Hospital here in London and the Institute of Cancer Research. The NIHR spent £137 million on cancer research in 2016-17—an increase from just over £100 million in 2010-11. That investment in cancer research is of huge importance and constitutes the largest in a disease area.

[Mary Glindon (North Tyneside) (Lab)]

I am not sure whether this has any bearing on the subject of the debate, but will the accelerated access review help to bring some of these potential new treatments forward more quickly?

[Steve Brine]

The accelerated access review is an important piece of work, and I will be happy to write to the hon. Lady in more detail than I have time to go into now. It is about bringing treatments quickly to the market for patients’ use once they are approved, instead of having to take a rather arduous and tortuous route.

I want to put on record that we want the NHS to be the best in the world at treating childhood cancers and all cancers. We can only imagine the pain that Alfie’s family are going through, and they have our prayers and our support. I hope my hon. Friend the Member for Spelthorne will agree that the Government are working hard, even in difficult economic times, to implement the cancer strategy, to invest in research and to continue the investment in cancer treatment to ensure that we can lead the world in the fight against cancer and make this a reality by making life better for people like Alfie.

Question put and agreed to.

NHS Blood Cancer Care

Steve Brine Excerpts

Wednesday 17th January 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Wilson—I believe it is the first time that we have danced in such a way. I congratulate my hon. Friend the Member for Crawley (Henry Smith) on securing this debate on an issue that I know he feels passionately about, and I commend him for his work chairing the all-party group. We all come to the House with our motivations and experiences, and we all gather more experiences in the House. One reason why this is the job that I always wanted to do in government is because I have fought many types of cancer in many different ways, and lost more than I have won. It is always moving to hear Members speak personally about their experiences and why they have promoted certain issues in their parliamentary career, and I thought my hon. Friend did that brilliantly. Such experiences make us the MPs that we are, and I hope only that the figures for the people watching this Westminster Hall debate match those for people watching daytime television shows instead, because I think they would have a great view of the way that Parliament operates.

Let me start by saying that the Government, and this Minister more than ever, are absolutely committed to transforming cancer services across England, and we take an all-cancer approach to doing so. It is true that cancer survival rates have never been higher, but we want cancer services in England to be the best in the world. We want to ensure that every patient, regardless of the type of cancer that they unfortunately get, has access to the treatment, the services and the support that give them the best possible chance of a successful clinical outcome and a successful recovery back into their lives, which are temporarily paused while they go through treatment.

Shortly after this debate, as my hon. Friend the Member for Crawley advertised very well, the all-party parliamentary group will publish its first report. Having chaired the all-party parliamentary group on breast cancer with the shadow Minister for many years—and for a bit with the hon. Member for Central Ayrshire (Dr Whitford)—and produced all-party parliamentary group reports, I know how much work goes into them and how important they are. My hon. Friend should know that they are noticed by Ministers—they are certainly noticed by this Minister. I have here the copy he kindly shared with me. I think it is an excellent and informed piece of work and I congratulate him and the charities that supported him through the secretariat. I assure him that the Government and NHS England will take careful notice of its findings and recommendations. As I always do when I speak in response to the launch of a report, I will see that he gets a response in writing to the recommendations that he has made, in addition to what I will say in today’s response.

The report highlights that someone is diagnosed with a blood cancer every 14 minutes. Nearly 250,000 people are living with blood cancer in the UK today, and it claims more lives than breast or prostate cancer. It is the third biggest cancer killer in our country, so this debate is as timely as it is important. I am pleased to say that many of the recommendations in this report mirror the strategic priorities set out in the cancer strategy for England, which outlines how we will implement all of the 96 recommendations of the independent cancer taskforce, chaired by Sir Harpal Kumar of Cancer Research UK, who will shortly step down from that role. What a loss that will be. I wish him well. I hope I can therefore assure my hon. Friend and other hon. Members that two years into the implementation of the strategy, we are already making significant progress in implementing the recommendations of the APPG report.

My hon. Friend the Member for Crawley stated where we must start—a point also made by my hon. Friend the Member for Henley (John Howell)—and that is early diagnosis. We all know that this is key for all cancers and it gives the best possible chance of successful treatment. To improve early diagnosis, the Government made £200 million available to cancer alliances in December 2016 to encourage new ways to diagnose cancer earlier, improve the care for those living with it and ensure that each cancer patient gets the right care for them. The APPG report highlights that early diagnosis of blood cancers is difficult—we have heard different contributions as to why that is—as symptoms such as tiredness or back pain, are often misdiagnosed. My hon. Friend the Member for Crawley mentioned that his mother presented with flu-like symptoms, which maybe threw them off the scent a bit in the early days. That is why, for suspected blood cancers, the National Institute for Health and Care Excellence published a revised guideline in 2015, which clearly sets out that GPs should consider a very urgent full blood count within 48 hours to assess for leukaemia, if adults present with suspicious symptoms. I am very sure that there is more that we can do around education in primary care, but I think that was a positive move from NICE.

Further, I must here mention the accelerate, coordinate and evaluate programme—ACE for short. It is a unique early diagnosis initiative, and a programme of 60 projects exploring innovative concepts across England. The programme is testing a new multidisciplinary diagnostic centre approach to diagnosing patients with vague or unclear but concerning symptoms, often characteristic of hard to diagnose cancers such as blood cancers. There are ten pilot MDCs across five areas of the country. They are one-stop shops that can ensure patients rapidly receive a suite of tests, reducing the risk that patients bounce around services receiving multiple different referrals for the same problem, having to start that explanation all over again—I know that is incredibly difficult—and do not get that all-important early diagnosis. We know that early analysis of these schemes is very positive and many patients can receive a diagnosis or the all-clear within just 24 hours. I look forward to seeing further analysis of these pilots when that is available and I very much hope that MDCs can become an important tool in helping us to identify blood cancers earlier. We have the new 28-day faster diagnosis standard coming down the track. I always say that 28 days is not a target, it is an end point. If we can beat it and do it in 28 hours, happy days.

Patient experience when it comes to cancer is clearly so important. The APPG’s report also rightly highlights the importance of that. Improving patient experience is one of the six strategic priorities set out in the cancer strategy, and cancer patients are receiving better and more effective care, we believe. We are committed to ensuring that this improvement continues. In 2016, NHS England surveyed just over 118,000 people through the national cancer patient experience survey, which I am committed to continuing in one form or another, because I know how important it is. Over 70,000 cancer patients took part in the latest survey. I am very grateful to all of them for giving us their feedback to help to improve the experiences of cancer patients in the future. This feedback is vital to inform and shape the way hospital trusts and clinical commissioning groups achieve further improvements for patients. The Cancer Vanguard has also developed an innovative cancer patient feedback system which is now being used by many organisations that provide cancer care in our country. This new system collects real-time patient feedback at key points in the patient care pathway, which we have heard mentioned today, so that it can be fed back and used by those redesigning services to put patient experience at the heart of improvements in service.

Linked to this point about patient experience is access to a cancer nurse specialist. My hon. Friend made the important point in his opening remarks that access to a CNS can make a hugely positive difference to the treatment experience of patients with blood cancer. Health Education England’s first ever cancer workforce plan clearly stated that we will ensure that every patient has access to a CNS or other support worker by 2021, and if we can do it sooner we will. We will do this by developing national competencies and a clear route into training.

I thank my hon. Friend and others for their tributes to Macmillan Cancer Support. I have been to Southampton General Hospital—my neighbour, the hon. Member for Southampton, Itchen (Royston Smith), was here earlier—to visit the acute oncology centre, which is a partnership between the University Hospital Southampton NHS Trust and Macmillan, and a brilliant centre it is too. I met patients undergoing treatment for blood cancers. It was not a planned visit, but it was timely, given this debate. Macmillan—a brilliant charity—is also currently carrying out a specialist audit to understand the current size and location of the specialist cancer nurse workforce. This will enable us in the Department and NHS England to develop a much more comprehensive picture of how many specialist nurses are working in cancer and what further action and investment might be required to ensure timely and good quality patient care and experience in line with the target that I have set out. Once we have this data, I hope in the spring, we will publish an additional chapter to the cancer workforce plan, and consider the actions needed to support and enhance the wider nursing contribution to cancer.

My hon. Friend the Member for Gordon (Colin Clark) spoke of workforce shortages north of the border. It is a familiar tale. We both face a cancer workforce challenge, which is why HEE produced our cancer workforce plan. It is a significant challenge to the NHS and cancer care, but one that we are absolutely determined to meet head-on and to beat.

My hon. Friend the Member for Crawley and other hon. Members made points about living with and living beyond cancer. I take the point made by the shadow Minister about that term. Obviously the cancer strategy is as published, but in time it will be refreshed, and I take on board the point, which she made well. More than ever, thanks to innovations in treatment there can be a full life beyond a cancer diagnosis. The hon. Member for Central Ayrshire reminded us really well about the C-word. It did used to be the big C. It used to be a terror, and still is for many, but so many people now have a full life beyond a cancer diagnosis.

[Dr Whitford]

While we are obviously talking in particular about the chronic types of blood cancer, there are also solid tumours. Indeed, hormone positive breast cancer is actually much more of a chronic disease. It carries the same risk into the future and people may be living with it for decades. We have to get round that curve of seeing cancer as something that is dealt with acutely and then is over. There will be many cancers that we control, and we therefore need to help people to accept them as a chronic disease and not torture themselves with the C-word.

[Steve Brine]

What a good point. I love the term “survivorship”, which we often hear. It is probably an Americanism, but it is one of ours now. It is a great term because it suggests a positive: we have survived and we will continue to survive and to fight. My officials do not like me using the term “to fight cancer”, but I do think that it is a battle, and a constant battle. Macmillan’s brilliantly moving PR campaign at the end of last year talked about life with cancer. There are lots of people living with chronic conditions. When I visit cancer patients, as I did on Friday in Southampton, I always make a point of asking them what they do when they are not in the cancer ward and what they are planning to do when they finish being in the cancer ward, because their lives are more than their cancer, and they are not their cancer.

From the moment that they are diagnosed, patients benefiting from the recovery package, which we have heard mention of, receive personalised care and support. Working with their care teams, patients develop a comprehensive plan that addresses their physical and mental health requirements, which we have also rightly heard mention of, as well as identifying any other support that they may require. We are working to ensure that every patient in England, including those with blood cancer, has access to the recovery package by 2020. I repeat: if we can do it sooner, we will.

Different cancers affect the body in different ways, and treatment and the recovery journey for someone with blood cancer can vary greatly to those for a patient with a solid tumour cancer. That is why every patient will receive a holistic needs assessment as part of their recovery package. For blood cancer patients, their recovery plan will be personalised to take account of the unique characteristics of blood cancer. My hon. Friend the Member for Crawley described the end of treatment as falling off the end of a conveyor belt, which is an expression that I have heard before. In my job I have seen research to the effect that the end of treatment can be more depressing than the moment of diagnosis. That is a really hard thing to say and to accept, but I can well believe, and know from personal experience, that it is true.

That moves us on to psychological support. My hon. Friend makes the point that many patients with a chronic blood cancer diagnosis will sadly never be cured. They will be on a regime of watch and wait, often over many years, to see if the cancer has progressed to a point where treatment needs to begin. That can, understandably, take a huge psychological toll on the patient and their families. That is why the point made by the hon. Member for Central Ayrshire is so true, and why the recovery package rightly takes a holistic approach and considers the patient’s mental health needs. The Prime Minister has made improving access to mental health services a priority for her Government. There has been a fivefold increase in the number of people accessing talking therapies since 2010, but we know there is much more to do, and I will be watching that like a hawk in my job.

We have heard today about the importance of research. If we are to continue to beat cancer and to better our figures, sustained investment in research is vital. The National Institute for Health Research spent £137 million on cancer research in 2016-17. That represents the largest investment in any disease area. It is thanks to advances in research that more than 90% of children diagnosed with the most common form of childhood leukaemia now survive. However, I recognise that progress in improving survival rates, including for some blood cancers, has been slow and that survival rates remain low. We have heard today that treatment of blood cancer is especially dependent on the development of new drugs and on being able to access them—an obvious truism—and that is why our focus is on not only research, but ensuring that proven innovations are adopted swiftly across the NHS in England. NICE’s fast-track appraisal process, or the FTA, which was introduced in April last year will, we hope, do just that. The FTA process will help to ensure that cancer patients have accelerated access to any clearly effective treatment that represents value for money for what is a publicly funded health service.

[Dr Whitford]

Will the Minister explain how that interacts with the budget impact assessment that allows drugs to be delayed by up to three years, even if they have been passed by NICE, if the overall cost of them might be more than £20 million? There are many concerns among groups that that might actually delay innovative drugs, which often tend to be expensive.

--- Later in debate ---

[Phil Wilson (in the Chair)]

Order. Before the Minister responds, can I say that I would like to see if we can get the Member who moved the motion in at the end for a winding-up speech?

[Steve Brine]

I thank the hon. Member for Central Ayrshire for that point. I might have to come back to her on it, so that—as is only fair, and bearing in mind the Chair’s point—I am able to cover some of the other points that Members raised in their speeches.

My hon. Friend the Member for Crawley said that he would be sending a copy of his report to his local CCG, and I would echo his call for MPs from England who are in the debate today to do the same. MP and CCG relationships are very important to implementing the cancer strategy and reports such as this one. I have the mobile numbers of my local CCG lead and CCG chair in my phone, and I did long before I was a Minister. How many other Members, not only in this Chamber, but in the House, have that? It is a key relationship and Members have a role to play.

The hon. Member for Coventry North East (Colleen Fletcher) spoke very well, as always, with her personal testimony. She calls for five-year plans for patients who have had a stem cell transplant. As I said, the recovery package is a personalised care plan for all cancer patients, and if the care team feel that a five-year plan is appropriate, I expect it to be considered and, if appropriate, commissioned.

The hon. Member for Strangford (Jim Shannon), who has left his place, spoke, as always, in an informed contribution full of personal testimony. I will say that cancer survival rates in England have never been higher. If we can help his colleagues in the Northern Ireland Assembly, when that is back on its feet, I would be delighted. If he wants to set up a meeting, I would be delighted to attend.

I need to close because I know, Mr Wilson, that you want to move on to the proposer of the debate. I hope that my hon. Friend will agree that implementation of the strategy is already beginning to transform services and to implement a number of the recommendations in his report, which is an excellent piece of work. Next week I will be meeting Bloodwise, which I know has representatives here today and does excellent work with his all-party group, to discuss further the important issues that Members have raised today. Next month I will be having the second of my big cancer roundtables, which this time will be joined by Cally Palmer, who is NHS England’s national cancer director. That is a great chance for me to bring all the cancer charities together.

I thank my hon. Friend for bringing the report to Westminster Hall today and wish him well with its launch in a few minutes’ time.

Junk Food Advertising and Childhood Obesity

Steve Brine Excerpts

Tuesday 16th January 2018 Westminster Hall

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

Child obesity remains one of the top public health challenges on my desk and for the Government. I congratulate my hon. Friend the Member for Erewash (Maggie Throup) on securing this debate through the offices of the Backbench Business Committee. I also thank the Health Committee for its ongoing inquiry into child obesity. Its Chair is not able to be here today, but she has a great personal interest in this subject. Ministers always say that debates are wide-ranging, useful and interesting, but this one certainly has been—it has been much wider than the title of the debate. We have learned a number of things, not least the shadow Minister’s new year activities. She has learned about the work of the pop band the Editors and advergames in the last week alone, and it sounds like one of her new year’s resolutions is to look into Candy Crush—the things you learn here!

As colleagues who are still here will be aware, the latest figures continue to show that our childhood obesity rates remain too high. About a third of children leaving school are overweight or obese. I and the Government will not accept that. In addition, evidence shows that the deprivation gap in obesity prevalence between children in the most and least deprived areas continues to widen. Again, I definitely will not accept that. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) made that point well. When she first came to office, the Prime Minister spoke on the steps of Downing Street about the burning injustices she sees in this country. This is undoubtedly one of the pillars of burning injustice in Britain today.

The gap continues into adulthood: obese children are much more likely to become obese adults, which increases their risk of developing serious diseases, as we have heard, such as type 2 diabetes, heart disease and, of particular interest to me as the cancer Minister, more than 13 types of cancer—I suspect that is underplaying it—including bowel and breast cancer. The shadow Minister and I share a great interest in that subject, having chaired the all-party group on breast cancer for many years together. Obesity is also a major risk factor for non-alcoholic fatty liver disease, as a number of hon. Members said. I see this as a huge challenge to individuals’ health and wellbeing, and a huge cost to the NHS and the country. Obesity-related ill health is estimated to cost the NHS some £5 billion a year—again, I suspect that that underplays it.

There is no denying that obesity is a complex, far-reaching problem. It will sadly not be solved by one action alone, as pretty much all hon. Members said—my hon. Friend the Member for Erewash said that in opening the debate. Neither will it be solved overnight. It is a tanker to be turned around. We launched our childhood obesity plan in August 2016, informed by the latest evidence and research in the area. It challenges us all—the national Government, local government, businesses, the NHS, schools and families—to play our role in reducing childhood obesity levels. There are many parts of the jigsaw, and many players we need to tackle, including the healthiness of the food we are eating, how much we are eating—portion size—how active we are and the environment we live in. Of course, marketing plays an important part.

As part of the plan, we introduced two key measures to challenge the food and drink industry to improve the healthiness of the food children eat every day, and those policies are already showing positive signs. The soft drinks industry levy, which is set to become law in April, has already seen almost half of the soft drink market reformulate its sugary soft drinks to include less sugar. Companies such as the maker of Lucozade and Ribena —I will be visiting it later this week to see more detail—and Tesco have led the way by removing millions of tonnes of sugar. That is a crucial step forward in improving our children’s health, as the data shows us that sugary soft drinks are the main contributor of sugar in our children’s diets.

[Kerry McCarthy]

This is slightly off-topic, but Lucozade has been named public villain No. 2 after Pringles, in terms of its plastic packaging. The plastic sleeves around the outsides of the bottles mean that they are impossible to recycle. Lucozade and Ribena are particularly bad. Will the Minister mention that too when he is having a go at the company about sugar?

[Ms Nadine Dorries (in the Chair)]

Order. I will allow that, Ms McCarthy, but that is the only off-issue topic.

[Steve Brine]

It is on my list.

We also challenged the food and drink industry, with Public Health England’s sugar reduction programme, to reduce the amount of sugar in the foods our children eat most by 20% by 2020. Some of the biggest players in the industry, including Waitrose, Nestlé and Kellogg’s, which a number of hon. Members mentioned, have already made positive moves towards that target. Data will be available in March this year to give us a better picture of how the whole market has responded—we will be naming names—and to show whether we have met our year one target of a 5% reduction. We remain positive, but we have been clear from the beginning that if sufficient progress has not been achieved, we will consider further action. We rule nothing out.

We further built on the foundations of the childhood obesity plan in August 2017 by announcing the extension of the reformulation programme to include calories. The Government will publish more detail of the evidence for action on calorie reduction, and our ambition and timelines for that, in early 2018.

Our plan also includes school-based interventions, which a couple of hon. Members mentioned, including the expansion of healthy breakfast clubs for schools in more deprived areas, with £10 million per year of funding coming from the soft drinks industry levy. That is on top of the doubling of the school sport premium, which is flowing into schools as we speak, and represents a £320 million annual investment in the health of our children. The hon. Member for Bristol East (Kerry McCarthy) asked whether that cash will continue to flow as companies take action. I will come back to that point, but the Treasury has guaranteed a level of funding over the next three years, regardless of what comes in from the levy. If she wants me to write to her to put that in more detail, I am happy to do so—I have found the note I meant to read out, but we have covered it anyway. Such actions will ensure that we are tackling the healthiness of the food offer available to all families. The evidence shows that that is absolutely the right thing to do.

On marketing restrictions, another part of the jigsaw is how these foods are marketed, in particular to children, which is of course the central tenet of today’s debate. I thank the Centre for Social Justice and Cancer Research UK—I met both last week—and the Obesity Health Alliance for their recent reports highlighting the marketing of products high in fat, sugar and salt, or HFSS, to children. All are welcome updates that add to the debate.

This month marks 10 years since the first round of regulations to limit children’s exposure to marketing of products high in fat, salt and sugar, when we banned advertising of HFSS products in children’s television programming. We monitor that closely, including in my own home. At the weekend I tried to explain the premise of this debate to my children and, last night, when I phoned home, they told me that while watching a well-known commercial television channel they saw a slush drink mixed with sweets. Such products are being monitored closely in the Minister’s household as well as by my officials. When I get home, I will ask my children to show me that.

Recently, we welcomed the Committee of Advertising Practice strengthening the non-broadcast regulations to ban marketing of HFSS products in children’s media, including in print, cinema, online and on social media. That point was made strongly by my hon. Friend the Member for Angus (Kirstene Hair) in her excellent speech.

The restrictions that the UK has in place, therefore, are among the toughest in the world, but I want to ensure that in the fast-paced world of marketing—many people spoke about how quickly that world is moving—it stays that way. We heard lots of “go further” calls, including by the hon. Member for Bristol East, and that is why we have invested £5 million to establish a policy research unit on obesity that will consider all the latest evidence on marketing and obesity, including in the advertising space. That is also why we are updating something called the nutrient profile model, which does not sound exciting but is important. It is the tool that helps advertisers determine which food and drink products are HFSS and, as a result, cannot be advertised to children. The purpose is to ensure that the model reflects the latest dietary advice. Public Health England expects to consult on that in early 2018.

[Dr Poulter]

In that context, what measures are in place or is the Minister considering putting in place regarding online advertising to children?

[Steve Brine]

I will come on to that—if I do not, I will write to my hon. Friend—so I ask him to bear with me.

My hon. Friend the Member for Erewash, who opened the debate, said that the Department should have the lead on advertising. I am not sure that my friends in the Department for Digital, Culture, Media and Sport will agree, but I understand her point. I have noted that the Department for Digital, Culture, Media and Sport, the Ministry of Housing, Communities and Local Government, the Department of Health and Social Care, the Department for Education and the Department for Environment, Food and Rural Affairs have all been touched on in the debate. I reassure the House that tackling the challenge is a cross-Government concern. The childhood obesity plan that was published is a cross-Government plan, and all Departments have a rightful role to play, which continues to be the case as that plan is delivered.

The hon. Member for Westminster Hall, otherwise known as the hon. Member for Strangford (Jim Shannon), spoke well as always. I know he had to leave—he let the Chair and me know that. He spoke about food management and touched specifically on diabetes. He actually said, “If only I had known the damage being done”—I have heard that so many times. On Friday, I visited a brilliant organisation called LifeLab at Southampton General Hospital, which is partly funded by Southampton University. LifeLab empowers children through scientific inquiry to understand the impact on their bodies of their behaviour, the food that they eat and the drinks that they drink. A new spin-off called Early LifeLab goes into primary schools, while secondary schoolchildren from Southampton, across the south of England and further afield come into LifeLab to understand. So in answer to, “If only I had known,” that is what LifeLab does. I am very interested in looking at evaluations of LifeLab as it goes forward and in how that work might be built into a wider public policy roll-out.

My hon. Friend the Member for South West Bedfordshire made an excellent speech, as he always does. He rightly said that the poor are the most negatively affected, and we have touched on that point. I thank him for his Thailand, Popeye and spinach example. He also mentioned local authorities and planning. Local authorities have a range of powers to create healthier environments in their area through local plans and individual planning decisions. The national planning policy framework makes it clear that health objectives should be taken into account. The DHCLG is in the process of updating the framework to see if other aspects can be strengthened.

I thank my hon. Friend for making that point, and for the offer of a weekend together among the spring tulips in Amsterdam, which is very appealing on a cold January morning in Westminster. He also mentioned the Centre for Social Justice which, as I said, I met last week. I am very interested in its work. He touched on Making Every Contact Count and GPs. He is absolutely right about that and we could do much better. It is a subject that I am sure will come up over dinner later this week when I go to the annual dinner at the Royal College of General Practitioners.

My hon. Friend was intervened on by our colleague, my hon. Friend the Member for St Ives (Derek Thomas), on the daily mile. At every single school that I go into, whether as a local MP or as a Minister, I ask if the daily mile is being done. That has been a brilliant import from north of the border and it is excellent. I hope that every Member who goes into a school talks about the importance of the daily mile and encourages them to do it.

Many other points were made. My hon. Friend the Member for South West Bedfordshire talked about colour coding and the traffic-light system. Our colour-coded, front-of-pack labelling scheme is voluntary at the moment. It covers about two thirds of the market. We will consider other available labelling options as part of our withdrawal from the European Union—he has my guarantee on that.

The hon. Member for Reading East (Matt Rodda) spoke about the imbalance of information. His point was well made, I thought, about manufacturers and industry providing more information than the NHS does in his constituency. I would say that the Government have a strong voice in this debate, and rightly so, which is why we are seeing good progress on delivery of the plan, but we are also investing in the highly successful Change4Life programme, which I am responsible for through Public Health England. It informs families about healthier eating. Can we do more? We can, without doubt, in the public health and prevention space.

The hon. Member for Bristol East mentioned the “eatwell plate” in reference to the public sector. To respond, we have in place robust standards for public sector procurement, the Government buying standards for food and catering services. DEFRA is the lead Department and comes into the story here. It continues to drive compliance across other Departments and among NHS hospitals, which are required to meet the standards through the NHS standard contract. The hon. Lady makes a good point. She also raised the issue of academies, and I understand that the Department for Education will shortly begin a campaign to get them all signed up. I thank her for making that point.

In conclusion, from day one we have been consistently clear that the childhood obesity plan marked the start of the conversation—it has never been the final word. We continue to learn from the latest evidence. We are confident that the measures we are taking will lead to a reduction in childhood obesity over 10 years, but we take nothing for granted and will keep everything under review. I thank all Members for their contributions and look forward to further ones.

Misuse of Xanax

Steve Brine Excerpts

Monday 15th January 2018 Commons Chamber

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

I congratulate the hon. Member for Enfield, Southgate (Bambos Charalambous) on securing this important debate on the misuse of Xanax. His telling of Zoe’s story was an example of how we should bring some of our constituency casework to the Floor of the House, and I thought he did it very well. He has raised awareness of an issue that I do not think has previously been discussed in the House of Commons, so well done to him for that.

Last July, the Government published an ambitious new drug strategy. As the Home Secretary compellingly set out in her foreword, the harms caused by drug misuse are far-reaching and affect lives at almost every level. This includes crime committed to fuel drug dependence; the organised criminality, violence and exploitation that go hand in hand with production and supply; and, of course, the irreparable damage and loss to the families and individuals whose lives it destroys. As somebody who has young children, listening to Zoe’s story filled me with horror about what could be to come, with the parent’s sense of panic that we all know.

Concerns about the misuse of Xanax and its potential for harm have been very clearly expressed by the hon. Gentleman. I want to set out some of the facts. Xanax is an anti-anxiety drug in the benzodiazepine family, as he rightly said. It is similar to, but—I am told—20 times stronger than Valium, and it has a quicker, shorter-acting effect. It is not licensed for use in the UK and it is not prescribable on the national health service, but doctors can prescribe it privately and, as he said, it can of course be obtained from internet pharmacies or bought illicitly online.

In the United States Xanax is widely used to treat anxiety disorders, panic disorders and anxiety caused by depression. Its increased use in the UK is related in part to its use being associated with or written about by some celebrities—the hon. Gentleman and the hon. Member for Leeds North West (Alex Sobel) both mentioned Future and “Dr.K”. Rappers have great power and bring great pleasure to many, but they have a great responsibility in the position they hold. However, the hon. Member for Enfield, Southgate also rightly mentioned a rapper with whose work I am sure you are familiar, Madam Deputy Speaker: Lil Pump, who took that responsibility seriously and tweeted just after new year that he will not be taking Xanax in 2018. The cockpit of the nation, the House of Commons, might possibly have less impact on the behaviour of young people than what Lil Pump says on his Twitter feed.

There is a serious risk of harm from the misuse of Xanax. Its long-term use can lead to dependence and severe withdrawal symptoms if use is stopped suddenly. There have been reports in the UK of recreational misuse of Xanax among young people. The hon. Gentleman said that people have been bringing such reports to him since he secured the debate. They include accounts of hospitalisation of young people, particularly where they have combined use of the drug with drinking large amounts of alcohol. Young people’s substance misuse services have reported an increase in misuse of Xanax among the young people accessing their support services. There was a story in The Guardian about activity in Sussex on new year’s eve.

Prescription-only medicines such as Xanax are, by their very nature, potent and should be prescribed—and indeed “unprescribed”—only by a doctor or appropriate healthcare professional. Prescribers can assess an individual’s condition and medical history, consider possible risks associated with taking a particular medicine, and monitor recovery.

The regulation of human medicines in our country is the responsibility of the Medicines and Healthcare Regulatory Agency, for which I have ministerial responsibility in this House. The MHRA has identified an issue relating to the large-scale diversion of benzodiazepines and other hypnotics from the regulated supply chain to the criminal market. The latest information, which I obtained before coming to the House tonight, is that around 130 million tablets have been so diverted since January 2014. There is evidence of extensive criminality involving a number of businesses. The MHRA is working with regulatory and law enforcement colleagues, including the Home Office, the General Pharmaceutical Council and the Care Quality Commission, to identify how that has occurred, to prosecute those involved in criminal activity—rightly so—and to implement preventive measures.

Given the potential for harm presented by the misuse of prescription drugs, including Xanax, the MHRA is taking a range of measures to tackle the illegal online sale and supply of medicines, including public awareness campaigns to deter people from buying medicines from unregulated sources. In addition, the CQC will continue to monitor how controlled drugs are managed within health and care services as part of its inspection processes, taking account of the latest guidelines from the National Institute for Health and Care Excellence.

The hon. Gentleman talked about education. Patterns of drug use in the UK and beyond change over time, particularly amongst young people, where fashions move fast. Public Health England continually updates Frank, the Government’s very successful drug information and advisory website, to reflect new and emerging patterns of drug use, but I think PHE would admit that it is constantly chasing the next fad. That work has included revising the benzodiazepine pages to raise awareness of the dangers of Xanax misuse, and the pages on Xanax are the top-visited and top read news story on the home page right now, which tells its own story. The Frank service remains a key element in providing accurate factual advice on the risks and effects of a range of drugs and alcohol, as well as broader advice around substance abuse, including signposting to relevant local services for young people.

As part of the Government’s updated drug strategy, Public Health England is supporting programmes that have a positive impact on young people and adults, giving them the confidence, resilience and risk-management skills to resist drug use in the first place, which must be our aim if we are to prevent constituents such as Zoe, whom the hon. Gentleman represents, from being in the situation she was put in.

The Government’s drug strategy makes it clear that we are committed to reducing both the number of young people using drugs and under-age drinking. A recent report published by NHS Digital found that in 2016 24% of pupils—11 to 15-year-olds—reported that they had taken drugs. That is compared with 15% in 2014. There has been progress, but there is clearly a long, long way to go.

That is why drug education is a statutory part of the new national curriculum for science at key stage 2 and key stage 3, and rightly so. Pupils should be taught about the effects of recreational drugs, including substance misuse, on their behaviour, their health and their life chances. Provision in this area can be further strengthened through personal, social and health and economic education, and I know that it is.

Launched in April 2013, ADEPIS, the Alcohol and Drug Education and Prevention Information Service—we do like our acronyms in the health service—is a drug and alcohol information and advice service for teachers and practitioners, providing accurate and up-to-date evidence-based information and resources for alcohol and drug education and prevention in schools. This service is delivered by Mentor UK.

Since the 2010 strategy was published, we have made progress. Drug use in England and Wales is lower than it was a decade ago. In 2016-17, 8.5% of adults had used a drug in the last year, compared with 10.1 % of adults in 2006-07. More adults are leaving treatment successfully than in 2009-10, and the average waiting time to access treatment is just two days.

Obviously, funding decisions on drug and alcohol treatment budgets for adults and young people have been devolved to local authorities through the Health and Social Care Act 2012. We think local authorities are best placed to understand the support and treatment needs of their specific populations. Of course I recognise that there are concerns about funding and that there are pressures on local authority budgets, and authorities need to make difficult choices about how they spend their resources. This is why we are extending the ring-fenced public health grant until at least April 2019 and retaining the specific condition to improve drug and alcohol treatment uptake and outcomes as part of that.

While the intention remains to give local authorities more control over the money they raise, such as business rates, we are actively considering the options for 2019 onwards with my colleagues in the Department for Housing, Communities and Local Government. We remain committed to protecting and improving the outcomes from core services such as those dealing with substance misuse, and we will involve the key stakeholders I work with in discussions about how we achieve that

While we have made strong progress in tackling the misuse of drugs, we are not complacent, and we know there is a huge amount more to do. There are new fashions being invented all the time. There are fundamental challenges, such as drug-related deaths, which we need to tackle, as well as newer issues, such as the misuse of Xanax, which the hon. Gentleman has raised so successfully in the House this evening. We will tackle those challenges with the full range of partners, who are essential to making the strategy a success and enabling us to maintain and build on what we have already achieved. I thank the hon. Gentleman for bringing the issue to the House this evening and especially for the way he has done so.

Question put and agreed to.

NHS Winter Crisis

Steve Brine Excerpts

Wednesday 10th January 2018 Commons Chamber

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

Happy new year to you, Madam Deputy Speaker.

We have had a good debate this afternoon with some well-informed—as the hon. Member for Bristol South (Karin Smyth) put it—contributions from both sides.

The NHS is a service that we are all immensely proud of; we can agree on that. Even during the challenging winter period it continues to deliver overwhelmingly safe and effective care to thousands of our constituents, and we should never lose sight of that. We have heard examples of that today, including from my right hon. Friend the Member for Meriden (Dame Caroline Spelman), who spoke with her usual calm about the triage model she saw working well in her area when she had to go to hospital over the holiday period. My hon. Friend the Member for Stafford (Jeremy Lefroy) was among many Members who visited the NHS over the recess period and he spoke, as well he might, and as well as he usually does, about the safe care he saw being delivered.

As my right hon. Friend the Secretary of State, and before him the Prime Minister, said earlier, we have done more preparation for winter this year than ever before, planning earlier to make sure the NHS is better prepared. More than that, we have put in the money, in the form of an additional £337 million for winter pressures and an additional £1 billion for the social care system this year. As the Public Health Minister, I am proud of our flu vaccination programme, already the most comprehensive in Europe, which has been extended even further. This was planning ahead.

We have also allocated £100 million of capital funding to help hospitals set up GP streaming systems at their A&Es, reaching 91% coverage by the end of November. This, too, was planning ahead; they did not just appear overnight. And for the first time ever, people were able to access GPs nationally for urgent appointments from 8 am to 8 pm seven days a week over the holiday period.

Of course, there were additional pressures this year: very cold spells in December, a sharp uptick in flu and respiratory conditions, and higher hospitalisations from confirmed cases of flu than in the peak of winter last year.

[Paul Farrelly]

There are also questions about NHS leadership. As the Minister is aware, Staffordshire is under great pressure. The Secretary of State received reports about the closure, with lack of consultation, of community hospitals in our area on 18 October, which slated two local CCGs. Yet a week later the NHS appointed the chief operating officer of those two CCGs to oversee four more in Staffordshire. Will the Minister ask his right hon. Friend the Secretary of State to explain that decision?

[Steve Brine]

The sustainability and transformation partnerships have been established across England—I am sure that the hon. Gentleman will have engaged with the one in his area—and they take local decisions about how services are organised in local areas. I implore him to engage with his STP; indeed, I know that he is already doing so. If he wishes to talk to me about this, he can of course do so.

Let me respond to some more of our contributors. The hon. Member for Bristol South always speaks sensibly. She spoke about the public representation and involvement in STPs. I agree that we could do more in that area, and as the Minister responsible for STPs, I want to see that we do so. Her point was well made. The hon. Member for Crewe and Nantwich (Laura Smith) spoke about her constituent, Elle, who lost her battle with cystic fibrosis. She speaks up for her constituents well, and very emotionally, and if she continues to do that, she will do extremely well in this House.

The hon. Member for Stockton South (Dr Williams) is a new Member, and I already have a lot of respect for him. In his typically sensible contribution, he made some sensible suggestions for improvement in the NHS. He went on to talk about how we could do better on prevention, and he was absolutely spot on. We all agree that prevention is part of our one NHS. He said that this was not all about money, and I agree. Money is a key part of this, however, and that is why we spend 9.9% of our GDP on healthcare, which is above the EU average.

The hon. Member for Leicester West (Liz Kendall) said that this is not what happens every year, but the NHS is under great pressure at this time every year. A headline from The Guardian newspaper on 27 October 2001 stated “NHS faces another winter of crisis”. The NHS is often under pressure at this time of year, and the important thing is how we prepare for that. As I have said, we are better prepared than ever. It is a shame that the hon. Lady is not listening to my response. [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I hesitate to interrupt the Minister, but I do not understand why there is so much noise on the Opposition Benches. I would not be surprised if Members were heckling the Minister, but they are simply making a noise, so the Minister cannot be heard. He is answering the questions that he has been asked this afternoon, and those who asked the questions ought to want to hear the answers.

[Steve Brine]

Thank you, Madam Deputy Speaker. The Members appear to be heckling themselves.

The hon. Member for Wirral West (Margaret Greenwood) said that the NHS was a political organisation. I totally disagree. The NHS is an organisation run by hard-working people who are public servants. They go to work every day to do a job for our constituents, and the NHS is not a political organisation. The Labour party is a political organisation, and it is politicising the NHS—

[Margaret Greenwood]

Will the Minister give way?

[Steve Brine]

I will not give way; the hon. Lady has had her say.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) spoke about leadership, and he was absolutely right. He knows the Luton and Dunstable University Hospital NHS Foundation Trust, which has been ably led by Dame Pauline Philip. She has achieved 98.6% of patients meeting the four-hour target. That is the kind of leadership that can be achieved, which is why Dame Pauline was brought in to NHS England to help with our national response to winter pressures.

My hon. Friend the Member for South West Wiltshire (Dr Murrison) said that this was all about outcomes and that, on cancer, we do not do well. We have had the best cancer outcomes ever in our country, but I agree that our ambition for the long term needs to be even better and that we need to aim higher. His point on a royal commission is noted.

My hon. Friend the Member for Henley (John Howell) spoke about the out-of-hospital care work that Henley’s hospital is doing. I thank him very much for his invitation. My ministerial colleagues also heard what he had to say, and it was good to hear about the cross-party working that is going on in Oxfordshire. My hon. Friend the Member for Southport (Damien Moore), a new Member of the House, talked about joined-up care and continuous improvement. He reminded us that without a strong economy there is no strong NHS. This is not the Government’s money; it is the public’s money. We need to spend it well, and I think we are doing so.

My hon. Friend the Member for North Dorset (Simon Hoare) spoke about community pharmacies, a subject close to my heart. They play a key part, and better integration of them within the NHS is part of the prevention and primary care agenda. I completely agree with the points that he made. My hon. Friend the Member for Taunton Deane (Rebecca Pow) spoke about the A&E hub at Musgrove Park Hospital. That sounds very interesting indeed, and the new Minister of State, Department of Health and Social Care, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), was also interested to hear what she had to say. We would like to come and see it, and we will take her up on her invitation.

Finally, I welcome back my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) and congratulate her on the birth of Clifford. She spoke very well, as always, about the integration of health and social care, saying that it can only make sense and will only serve to make the preparations for next winter better.

I hope to end this debate on a note on which both sides of the House can agree. We are all truly thankful for the extraordinary dedication of NHS staff in caring for their patients—our constituents—during this extremely challenging time. As ever, they are doing a brilliant job.

Question put and agreed to.

Resolved,

That this House expresses concern at the effect on patient care of the closure of 14,000 hospital beds since 2010; records its alarm at there being vacancies for 100,000 posts across the NHS; regrets the decision of the Government to reduce social care funding since 2010; notes that hospital trusts have been compelled by NHS England to delay elective operations because of the Government’s failure to allocate adequate to the NHS; condemns the privatisation of community health services; and calls on the Government to increase cash limits for the current year to enable hospitals to resume a full service to the public, including rescheduling elective operations, and to report to the House by Oral Statement and written report before 1 February 2018 on what steps it is taking to comply with this resolution.

[Jonathan Ashworth]

On a point of order, Madam Deputy Speaker. Can you confirm that the effect of the Government refusing to defend their position in the Lobby this afternoon is that the motion that stands in the name of the Leader of the Opposition has been endorsed by the whole House and that we should therefore expect the Secretary of State to come to the House before the end of the month to make an oral statement to explain to our constituents when their cancelled operations will be rescheduled?

Public Health Grants: Local Authorities

Steve Brine Excerpts

Thursday 21st December 2017 Written Statements

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

Today I am publishing the public health allocations to local authorities in England for 2018-19 along with indicative allocations for 2019-20.

Through the public health grant and the pilot of 100% retained business rate funding for local authorities in Greater Manchester, we are investing £3.215 billion for public health in 2018-19. We will be investing over £16 billion for public health over the five years of the 2015 Spending Review until 2020, in addition to what the NHS spends on preventative interventions such as immunisation and screening.

The indicative allocation for 2019-20 will help local authorities to develop and extend their planning, including initiatives better delivered across more than one year. The grant in both 2018-19 and 2019-20 continue to be subject to conditions, including a ring-fence requiring local authorities to use the grant exclusively for public health activity.

Full details of the public health grants to local authorities can be found on gov.uk.

This information will be communicated to local authorities in a Local Authority Circular.

Public health allocations 2018-19,

Public health indicative allocations 2019-20.

The above allocations can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-12-21/HCWS387/.

[HCWS387]