Public Health

Steve Brine Excerpts

Wednesday 30th December 2020 Commons Chamber

[Steve Brine (Winchester) (Con)]

As usual, my right hon. Friend is making a very thoughtful speech. As the Health Secretary said this evening, the vast majority of the big rise in infections yesterday were of the new variant, which logically suggests that the old variant is almost disappearing from the community. We could do with understanding that distinction each day when new data on infections is published.

[Mr Harper]

My hon. Friend makes a good point, because that will help us to understand the extent to which the new variant is spreading across the country; I know that the Government are concerned about that. I suspect, although I do not know—perhaps the Minister could confirm this at the end of the debate—that that was behind the move of significant portions of the country into tier 4.

Given that most of the country is in tier 4 and most of England is now effectively in lockdown, it seems to me that the only measure in terms of closure that remains to the Government is to close schools and colleges—we saw a hint of that this afternoon in what the Secretary of State for Education said. There are not many other measures left to the Government, so if that does not work, they will need to think again.

Finally, let me elaborate on what I said to the Secretary of State earlier about the vaccine roll-out. As the Government have made clear and as I think the Secretary of State said in an interview with Andrew Marr, the areas that have been moved into tier 4, which includes 78% of the country and I suspect by next week will probably include the rest, will basically stay there until we have rolled out the vaccine; the Opposition spokesman, the hon. Member for Nottingham North (Alex Norris), referred to that as well. It therefore has to be job No. 1, not just for the Department of Health and Social Care but for the whole Government, to get the vaccine rolled out as fast as possible.

In my question to the Secretary of State, I said that that meant that the Government need to get to 2 million doses a week. If they do that, we can vaccinate everybody over 65 by the third week of February, which will take nearly 90% of the risks of death and hospitalisation out of the equation. At that point, we should be able to remove restrictions, at least in law, and allow the country to open up again. The Secretary of State appeared to agree—he said that he agreed.

The Government need to put their shoulder to that objective. This has got to be the central task, and the reason for that is the significant cost to businesses. I know that there will be many businesses in my constituency—non-essential retail, personal care services—that will be devastated by the fact that, as of midnight tonight, they are going to have to close. I have had drawn to my attention the devastation in hospitality businesses in tier 2 areas that were preparing for a really busy evening tomorrow, but that, with just 24 hours’ notice, are now going to have to close. They are going to have a huge amount of stock and product that they have bought, which in effect will have to be thrown away. They are not going to get compensated for that, and that economic loss is going to be devastating for many businesses.

Those are the things that I think the Government need to weigh in the balance, and I look forward to listening to the Minister when she winds up the debate in a couple of hours’ time.

--- Later in debate ---

[Helen Whately]

I do not think that now is the moment for me to hold a remote debate on that with the deputy chief medical officer, and my right hon. Friend also asks me to see into the future regarding the roll-out of the vaccine. I can say, however, that we are following the prioritisation as set out by Joint Committee on Vaccination and Immunisation. That is first and foremost to vaccinate those who are at greatest risk of losing their lives to covid, and that is why we are starting with residents in care homes, which have been so hard hit by the pandemic, as well as care home workers. The next priority category is those who are over 80 and broader health and social care workers, and it then moves down the ages. Our approach follows the JCVI prioritisation to put the vaccine to that crucial and important effect of saving people’s lives from this cruel disease.

The hon. Member for Nottingham North (Alex Norris) asked about the publication of JCVI advice on the use of the vaccine. I can tell him that it has already been published and is available on gov.uk.

[Steve Brine]

I want to get clarity on the point made by my right hon. Friend the Member for Forest of Dean (Mr Harper). If the reason for the restrictions on our constituents’ lives is to prevent people from getting infected, getting very sick and being hospitalised, and thereby to protect the NHS, once we have vaccinated the people who could get very sick and use the NHS, we will no longer have the problem of protecting the NHS, so we should be able to lift the restrictions. Even if the Minister cannot clarify that that is the Government’s position, does it not seem like the logical consequence, or am I just completely daft?

[Helen Whately]

I am being counselled not to respond to my hon. Friend’s description of himself. I do not think I should be drawn into speculation on the roll-out and what we face ahead of us. He will have heard the good news from the Secretary of State earlier that we have an additional vaccine that we can use and that the NHS is ready and poised to roll out at great pace. We are determined to do so. That is so important, as it means that we have hope as we go through this very difficult time.

It was very good to hear so many hon. Members recognise and thank not only NHS staff but those working in social care. Care home workers in particular were mentioned by my hon. Friend the Member for Thurrock, as were the social care workforce more widely. The hon. Member for Twickenham (Munira Wilson) mentioned the mental health of the NHS and social care workforce—something about which I care a great deal. I assure her and others who are concerned about this matter that we have put in place extra mental health support for frontline NHS and social care workers, including specialist helplines that are available 24/7 so that there is always someone they can call.

In conclusion, as we go about our lives under these restrictions, we must remember the pressure the pandemic puts on that workforce. I once again thank the public for all playing their part and for the sacrifices they are making for themselves, but especially for others. The end is in sight, but we have a way to go and we must take the steps necessary to suppress the virus here and now.

Question put and agreed to.

Resolved,

That the Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020 (S.I., 2020, No. 1518), dated 11 December 2020, a copy of which was laid before this House on 11 December, be approved.

Public Health

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1533), dated 14 December 2020, a copy of which was laid before this House on 14 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020 (S.I., 2020, No. 1572), dated 17 December 2020, a copy of which was laid before this House on 17 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers and Obligations of Undertakings) (England) (Amendment) Regulations 2020 (S.I., 2020, No. 1611), dated 20 December 2020, a copy of which were laid before this House on 21 December, be approved.—(Rebecca Harris.)

Resolved,

That the Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 3) Regulations 2020 (S.I., 2020, No. 1646), dated 24 December 2020, a copy of which were laid before this House on 29 December, be approved.—(Rebecca Harris.)

Covid-19

Steve Brine Excerpts

Monday 14th December 2020 Commons Chamber

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

I would like to start with a tribute to Dame Barbara Windsor. She holds a special place in the affections of the nation from her earliest days with the Joan Littlewood Theatre Workshop to being landlady of the Vic. Barbara Windsor asked us to make a stand against dementia, and we will. Our thoughts are with Dame Barbara’s friends and family.

It is now nine months since the first British patient contracted covid-19—nine months that have tested our national character, our national health service and our national leaders; and nine months of terrible grief for tens of thousands of families who face a Christmas with an empty chair at the family dining table. Torn apart with anguish and united in pain, those families were robbed of their chance to say goodbye and robbed of the last hug or kiss, and they are still unable to sleep at night.

Rates of depression doubled during the first wave, but referrals to mental health services dropped. Couple that with nine months of economic turmoil exacerbated by the Brexit shambles, with millions facing the dole or losing their homes and businesses, and people need assurances that their wellbeing will be protected. There are still 3 million freelancers and small business owners excluded from Government support and facing utter ruin, which takes a terrible toll on their mental wellbeing. Some of the 3 million excluded have even, tragically, taken their own lives. It is not too late for Ministers to do the right thing and support the 3 million excluded.

What a year it has been. When the British people were called upon to stand together against a common enemy and to rise to greatness, they were not found wanting. I am thinking of the people who queued down the street to volunteer to deliver food and medicine; people who donated to food banks and looked in on neighbours; and people such as Captain Sir Thomas Moore, who raised not just money, but our spirits and our sense of ambition. I am thinking of those who spearheaded the #WhatAboutWeddings campaign, supporting people whose wedding day plans were derailed and people in the wedding industry whose businesses disappeared. I am thinking of people in the Beauty Backed campaign, supporting workers—mostly women—in the multi-million pound beauty sector whose salons were closed and who could not work to feed their families.

I am thinking of our refuse collectors, delivery drivers, shop workers, shelf stackers, cleaners and others who kept the country running. I am thinking of workers in the social care sector—low paid and so often stigmatised—working at the sharp end of the pandemic in our care homes. These unsung heroes deserve real recognition. Perhaps next time we discuss low pay and minimum wage, we will remember how much we owe all these workers who make Britain tick. I want to give a special mention to Britain’s postal workers, who have played a special role in supporting our communities—not only delivering the post come rain or shine, but looking in on the vulnerable, raising the cheer of isolated and lonely people and being a friendly face amid uncertainty and fear. Britain’s posties, we salute you.

Of course, we praise the 1.4 million of us who work for our national health service. So many NHS workers risked their lives to fight the pandemic, and so many have tragically died. Many more are left with the trauma of dealing with mass casualties. The latest absence figures from the NHS show that just under half a million days were lost to mental ill health in just one month alone. With infections continuing to rise throughout the country and the Christmas easing of restrictions imminent, how will the Government ensure that the NHS has capacity to cope in January? Staff are already burned out and exhausted by the virus. What plans do the Government have to support our NHS to deliver the care that patients need throughout January and prevent the NHS from becoming so overwhelmed that the vaccination programme is affected?

Staff across our health service are struggling, and they know that the adversity is not over yet. I want to take this opportunity to praise workers across the NHS: our ambulance drivers, nurses, student nurses, doctors, health visitors, mental health professionals, midwives, pharmacists, porters, receptionists, radiographers, physiotherapists, admin staff and healthcare assistants. Not only that, but I want to praise the cleaners, the kitchen staff, the gardeners, the dispatch drivers, the record keepers, the chaplains, the volunteers and so many others.

When I turn up for my shifts at St George’s Tooting as an A&E doctor, I know that I am part of an NHS family in which every part relies on the others—a complex web of care and compassion. We as a country rely on them, so let us do more than offer them applause. Let us rebalance the system of wages and rewards in this country so that the most valuable people, such as care workers and nurses, are valued above shareholders and stockbrokers. I have mentioned our national character and our national health service. Both rose to the challenge admirably, but what about our national leadership? Her Majesty’s official Opposition have maintained a consistent position: we will support the Government in tackling this pandemic, but we reserve our right to scrutinise decisions and ask questions on behalf of the people. That is our proper constitutional role.

We will be demanding a full public inquiry into the Government’s response to covid-19, and one particular area that will require forensic dissection is ministerial decision making on procurement. On 18 March 2020, the Cabinet Office issued guidance on public procurement of personal protective equipment and other equipment to tackle the pandemic. That guidance noted that public bodies were permitted

“to procure goods, services and works with extreme urgency.”

By 31 July 2020, more than 8,600 contracts had been awarded, with a value of £18 billion.

Of course we recognise that there was a need for speed, but the National Audit Office reported that there is

“a high-priority lane to assess and process potential PPE leads from government officials, ministers’ offices, MPs and members of the House of Lords”.

Many suppliers with connections to the Government and Ministers obtained lucrative contracts. One such supplier was PestFix, a vermin control company valued at just over £19,000, which was given a contract worth £108 million for PPE that had not been properly tested. The House has heard of the case of Mr Gabriel González Andersson, who was awarded more than £20 million as a middleman between the UK Government and a PPE business founded as the pandemic took hold by Michael Saiger, a Florida-based jewellery designer. And the NAO showed that Stroud Conservative councillor Steve Dechan, who ran a small, loss-making firm, signed a £156 million deal to import PPE from China.

Those are just a few instances of a procurement scandal that will only grow as more of the truth emerges. The Prime Minister says over and again that any Government would have done the same. He is wrong. He must not judge others by his own standards. This is a Government who have stretched the procurement rules to breaking point, overseen a bonanza for chancers, spivs and Del Boys, and wasted millions on the cronies and chums of Government insiders. Doctors and nurses were sent to the frontline without working PPE while profiteers lined their pockets. The truth will come out. The public will get the answers they demand, and the guilty men and women—the hard-faced men who have done well out of the pandemic—will be called to justice.

Now, we face the first Christmas alongside covid-19. Ministers must do more to explain the science behind their current plans for the tier system and their plans to relax the rules during Christmas. The PM says we must be “jolly careful”, but are his Government? Is the Minister aware of the advice of Professor Andrew Hayward, director of the University College London Institute of Epidemiology and Health Care and a member of the Scientific Advisory Group for Emergencies, who told the BBC that allowing people to meet up over Christmas amounted to

“throwing fuel on the Covid fire”

and that it would

“definitely lead to increased transmission”

and was

“likely to lead to a third wave of infection, with hospitals being overrun, and more unnecessary deaths”?

Is the Minister confident that the Government have done everything possible to avoid a third wave in the new year?

With today’s announcement that London will be moved into tier 3 just a week before rules are relaxed, is the Minister confident that the Government can effectively communicate these three rule changes to the public in the next week? What assurance can she offer the millions living in London and the south-east of England who will be under the tier 3 rules on Wednesday that the measures taken will actually halt the spread of the virus and keep them and their families safe over Christmas?

[Steve Brine (Winchester) (Con)]

I have expressed my concerns in the House before about the Christmas policy. There is a lot of care going into looking at the data for the review of the tiers, and yet weeks ago, the Government announced a five-day relaxation starting on 23 December. What is the position of the official Opposition in respect of the Christmas firebreak? Do they now oppose that, are they still supportive of it, or are they abstaining?

--- Later in debate ---

[Adam Holloway (Gravesham) (Con)]

First, I thank the care home staff and NHS staff in my constituency, particularly the medical staff at Darent Valley Hospital and Medway Maritime Hospital, who I know have their work cut out for them at the moment.

I would like to again bang the drum for the hospitality industry. If we believe that the main drivers of infection are hospital and care home settings, schools and households mixing within family homes, should we not be doing everything we can to avoid such household mixing? Regrettably, I firmly believe that many people in this country, unable to go into bars and restaurants, are mixing in unsuitable conditions in other people’s homes. We have seen since the end of the first lockdown the extraordinary and incredibly expensive efforts of the hospitality industry to make preparations to minimise the risks to their staff and customers and to stay afloat as businesses. When I look at establishments owned by friends of mine such as the Iron Pier brewery in Northfleet, the Griffin Inn in Fletching or TJ’s pub in Gravesend, I see that the driving principle of customer service for them since the first lockdown is the safety of their customers and their staff.

We have seen no evidence at all to confirm that people are more at risk in pubs than in private homes or more at risk congregating in well-run hospitality establishments. If we are knowingly going to crash the businesses and the life’s work of so many entrepreneurs in the hospitality industry, which we will be doing by knowingly restricting their ability to trade in the run-up to Christmas, when trading this month might actually save many of them, it would be nice if we could at least provide some evidence to support that.

[Steve Brine]

Does my hon. Friend share the concern of many Members in this House about so-called wet pubs? The Bakers Arm in Winchester contacted me this morning to say they are finding it difficult to take seeing the bustling high street all around them and people sitting outside coffee shops drinking cappuccinos, yet people cannot buy anything from their businesses. They are literally going under. Does he have that same problem in his constituency?

[Adam Holloway]

I completely agree with my hon. Friend. I said the other day that the last time I went into the Compass Ale House in Gravesend, it was literally like putting myself under the control of a manager saying, “Sanitise your hands. Do this. Do that. Sit down. Don’t do that. Why have you taken your mask off?”

I am absolutely not suggesting that pubs open as normal—in fact to the contrary, and that is the point. They are ready to operate safely in the new normal that they have arranged at such huge cost. I suggest a well-run pub is a safer environment for people to meet their friends than their front rooms, but like everyone in Whitehall and across the country, we have absolutely no idea either way. It is just a hunch.

Covid-19 Vaccine Roll-out

Steve Brine Excerpts

Tuesday 8th December 2020 Commons Chamber

[Matt Hancock]

We have not made such an assessment; we are still in the early days.

[Steve Brine (Winchester) (Con)]

I think I have sat through every single urgent question and statement that the Secretary of State has done, but the fact that it says “Covid-19 Vaccine Roll-out” on the annunciator screen is still hard to believe. The Secretary of State said earlier that we had got there because of international science. We will deliver global health security only through an international effort—put another way, no one is safe until everyone is safe—so I wonder whether he can update us on how we will work with Gavi, the Vaccine Alliance to help the poorest countries in the world, and of course, those nearest to us who are not the poorest countries, but with which we have a lot of inbound and outbound travel? How can we get them on the same page as us quickly?

[Matt Hancock]

The UK has put more money into the international search for a vaccine, and the distribution of a vaccine to the countries that otherwise would not be able to afford it, than any other state of any size, and we should be very proud of that. The way that we have managed the Oxford-AstraZeneca vaccine is to ensure that it is available on a not-for-profit basis, essentially, worldwide. We have taken this approach because, to put it exactly as my hon. Friend did, nobody is safe until everybody is safe. This is a global pandemic and we need to address it globally. That is the only fundamental way to solve this for the long term. In the short term, what we all need to do is keep following the rules.

Childhood Cancers: Research

Steve Brine Excerpts

Monday 7th December 2020 Westminster Hall

[Steve Brine (Winchester) (Con)]

It was the privilege of my life to hold the role of cancer Minister in the previous Government. Through that work, I learned of the battles of DIPG patients and the all-too-tragic outcomes.

As ever, it is the personal stories that connect. I wish I could show Members the pictures, but I have the words of Emily, the mum of Atticus—a fantastic name:

“In June 2018 our happy, charming, caring 4 year old son started to exhibit very mild symptoms which gave us cause for concern. Slight issues with balance, difficulty concentrating and mild drooling. Nothing significant but… you know when your child is not ‘right’… Atticus went… for a CT scan and was the referred to Southampton General for an MRI. On 1 July 2018, 2 years ago, my husband and I were guided into a small room to be given the results. I will never forget that moment. The neurologist told us that… he had a likely survival time of 9-12 months. In one breath our whole world came crashing down and we began to grieve—even though Atticus was still with us… On 7 February Atticus fell asleep forever in the bed next to me. I’ll never, ever forget watching my child pass away. It is the most unnatural, unjust and devastating experience any parent can suffer.”

Emily wrote to me again the other day:

“As we face the second Christmas without our beautiful boy, we can take some comfort in the prospect of increased funding and research to help eradicate this terrible cancer. It is all we can hope for.”

I guess the question is whether we—and whether they—have hope. As has been said, a child diagnosed with DIPG today faces the same prognosis as a child diagnosed over 50 years ago. Survivable rates are near zero for this particular cancer.

It is true, as the Government said in their response to this petition, and as the Minister will almost certainly say today, that

“we have invested £1bn per year in health research through the National Institute for Health Research”.

Expenditure in this area is the largest it has ever been. I remember working with the Tessa Jowell Brain Cancer Mission. It was a privilege to work with Tessa and her daughter Jess, who were very forceful ladies and very good at lobbying Ministers, including me. We were able to promise an extra £40 million over five years for brain tumour research as part of the mission’s work. That included funding for childhood cancers.

One key point of their work was to stimulate the research market in this area, to see new research propositions come forward. Tessa understood that acutely. It is never the case that we have enough money for health research. I suggest that we need both investment and strategy. That is why I was struck by this particular recommendation in the campaign that led to this petition, which the hon. Member for Gower (Tonia Antoniazzi) touched on.

The UK does have excellent collaborative research at our medical facilities, but we must assign sufficient funding to DIPG research and implementation of the new treatments. I urge the Government to convene and appoint special UK experts directly to centralise efforts and bring forward that new prioritisation strategy, so that we can stimulate the research market, as Tessa and her campaign urged me to do when I was sitting in the Minister’s position.

The Minister cannot wave a magic wand and make this go away—I have sat in her place enough times to know that. However, we can agree to make this change and to work together to finally face DIPG and start to turn the corner, with the collaborative strategy that I have mentioned. That is the hope—to reiterate that word—that these families want. I do not think that is too much to ask.

HIV Commission

Steve Brine Excerpts

Tuesday 1st December 2020 Commons Chamber

[Steve Brine (Winchester) (Con)]

Through you, Madam Deputy Speaker, I thank Mr Speaker for granting what is a special Adjournment debate on the launch of the HIV Commission, falling as it does on World AIDS Day. I am very grateful.

World AIDS Day is a campaigning moment, a day when we wear a red ribbon and, on this World AIDS Day, when we launch the final report of the HIV Commission. That is very much how I viewed it when I was the Public Health Minister, but actually World AIDS Day is a day of remembrance and reflection.

Terry Higgins, who gave his name to the Terrence Higgins Trust, was one of the first people in the UK to die of an AIDS-related illness. He was only 37 when he died in July 1982, just across the bridge from here, in St Thomas’ Hospital. He was of course followed by many more. Today, we remember not only someone whose name is well known and synonymous with the fight, not only the rock star who made Live Aid what it was, but the dad, the mum, the son, the daughter, the brother, the sister, the partner, who we will never know, but those they left behind certainly did.

We also pay tribute to the HIV activists—many are still with us, and too many are not—who have never given up in their pursuit of better treatment for HIV, a cure one day, an end to new transmissions, improved services and the fight against the dreaded stigma of HIV, which still persists. The best way we can honour all those people is to refocus our efforts and to end new cases of HIV by 2030. Today, it so happens we have a plan to do just that.

In 1986, I was one year into secondary school when AIDS touched down. No one can forget seeing the tombstone advert—never mind the iceberg version, which was actually more scary—of the “Don’t Die of Ignorance” campaign, with the raspy, menacing voiceover provided by the wonderful John Hurt. I want to read out the opening words of that TV commercial:

“There is now a danger that has become a threat to us all. It is a deadly disease, and there is no known cure...Anyone can get it, man or woman. So far it has been confined to small groups, but it is spreading”.

Does that sound familiar? Back in 1986, AIDS seemed to be a threat that would overwhelm us—also familiar. Those words of John Hurt that I read out—those adverts —terrified a nation, and they were meant to. I would argue that it was the most successful public health message in our history—until, perhaps,

“Stay at home. Protect the NHS. Save lives.”

Fast forward 30 years and I find myself, much to my surprise, the Public Health Minister with the opportunity to put what has become scientifically possible—ending new cases of HIV by 2030—into policy. When we first proposed the idea to my right hon. Friend the Secretary of State—I am deeply touched that he is here to respond to the debate, today of all days—it was not a tough sell. We had already done so much as a country, meeting the UNAIDS 90-90-90 targets on testing, treatment and early suppression, and the Secretary of State understands that prevention is better than cure more than most. It was terrific to watch him tell the AIDS-free cities global forum in London in January 2019 that this Government would set themselves the ambitious—but we think wholly achievable—goal of today’s commission. Just as Lord Fowler, in 1986, as Secretary of State for Health and Social Security, rejected a moral crusade against a way of life in favour of a practical plan to fight a virus, so we, in creating the HIV Commission, turned the possible into policy and the policy into this practical plan.

I pay tribute to Dame Inga Beale, who chaired the commission with a firm hand and great style, as well as the hon. Member for Ilford North (Wes Streeting) and the eight other commissioners, who put so much into producing what we launched this morning, with the help—wearing a fabulous jacket, if I may say so—of Sir Elton John. I also pay tribute to the three CEOs who made this possible—Ian Green of the Terrence Higgins Trust, Deborah Gold of the National AIDS Trust and Anne Aslett of the Elton John AIDS foundation; thank you so much. I also pay tribute to many, including the chair of the all-party group on HIV and AIDS, the hon. Member for Cardiff South and Penarth (Stephen Doughty), and my hon. Friend the Member for Finchley and Golders Green (Mike Freer) who cannot speak this evening, who have done so much to assist us in this journey.

The prize is clear: England could be the first country to end new cases of HIV, and we can help the world do the same.

[Wes Streeting (Ilford North) (Lab)]

It has been such a privilege being a member of the independent HIV Commission, not least because of the wide range of people we have met and engaged with during our work. That has helped us to put together a concrete action plan that could help us, if we get this right, to end HIV transmissions by 2030. That is such an enormous prize.

I want to join my hon. Friend in thanking everyone who took part in the commission, particularly the chair, Inga Beale, for her wonderful leadership. If I may do so from the Opposition Benches, I want to thank the Secretary of State for Health and Social Care for being in the Chamber this evening to respond to the debate. We have seen great cross-party leadership from him, and from the Leader of the Opposition—the leader of my party. Therein lies the hope that, with joined-up political leadership locally and nationally, we will turn the report into not just a worthy piece of work, but a concrete plan of action that changes people’s lives and changes the course of history.

[Steve Brine]

I bless my hon. Friend for that. It has been a pleasure to work with him on the commission. He has Front-Bench responsibilities himself and it is a big commitment. We had to be sure that that commitment would lead to something proper, something realistic, something deliverable; and I do not think we could have asked for better in the plan that has been produced. The cross-party element is so important. There is no room for an inch of partisanship in the all-party group for HIV and AIDS in this fight because, whatever happens at the 2024 general election, we cannot reset after that election if there should be a change of Administration; we need to keep up the focus and keep working across the House. I give way to the Chair of the all- party group.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

I absolutely commend the hon. Gentleman’s work and leadership on this, not only as a Minister but as a member of the commission. I commend my hon. Friend the Member for Ilford North (Wes Streeting), the Secretary of State, and the Health Ministers in the devolved Administrations as well—including my colleague Vaughan Gething, the Health Minister in Wales—because it is only with leadership on this issue and cross-party working, and cross-UK working, that we will get to that crucial target of zero infections by 2030. Does the hon. Gentleman agree that, as on so many public health issues, this is a global fight as well, and that our continued support as a country for things such as the UN Global Fund is crucial to getting to that 2030 target globally, as well as in this country?

[Steve Brine]

I most certainly would. As a Health Minister I travelled around the world to G7 and G20 meetings. The NHS and what we do within it, as the Health Secretary has said many times, is so well respected around the world that we often set the tone and the lead. Yes, this is a plan for England, but I hope it will work across the devolved nations of the UK. I hope that we will set the standard around the world, as we have in so many areas of public health policy, so that others will then follow. I take the hon. Gentleman’s point exactly.

[Jim Shannon (Strangford) (DUP)]

First, I congratulate the hon. Gentleman on securing the debate. I just want to add my support for the HIV Commission project. I spoke to him beforehand. It is important that we put on record the hard work that has been done by so many people, including by those in my constituency. The Elim Church’s missions have helped to address HIV in Swaziland. Over the years I have known them and what they have done, they have been instrumental—it is a wonderful thing—in assisting the Swazi Government to reduce the number of adults who have HIV from 50% to 27%. A programme of education and medical support has helped. Does he agree that what they have done in Swaziland could enable us, through the House of Commons, to deliver that to the rest of the world as well?

[Steve Brine]

Yes. The faith element is very important. We have done very well on driving down the numbers, but we have to do even better, and it will get harder as we get closer to the goal. Reverend Steve Chalke, a Baptist minister and the founder of the Oasis Charitable Trust, was one of our commissioners. He provided a very important element and the hon. Gentleman’s point is very valid.

Why do I say that this is scientifically possible? A HIV diagnosis is a notification of a serious condition, but these days, thank goodness, it is not the death sentence it once was and many understand it to be. An end is therefore in sight. Treatment has come such a long way. People on the right treatment have their viral load suppressed, meaning that they cannot pass on HIV. That, frankly, was a game changer. Overwhelmingly, people in England and the UK now know their HIV status. Of the 106,000 people with HIV in our country today, 94% know they are HIV positive, 98% are on treatment, and nearly all are virally suppressed and therefore cannot pass it on.

In addition, we have a wonder drug, PrEP— pre-exposure prophylaxis—which is taken by people who are HIV negative. It stops transmission during sexual intercourse. The PrEP impact trial data comes out in the new year, but we know already that it is a massive success—I hope I am proved right in that assertion. The Secretary of State made the drug readily available, free on the NHS—that was important. That took a little longer than it might have done but, legal challenges notwithstanding, let us not dwell on old ground. Let us ensure that all communities that can benefit from it know about its virtues and its availability.

If we are to get the benefits of PrEP to all who need it, HIV testing is needed in GP surgeries, pharmacies—I refer the House to my entry in the Register of Members’ Financial Interests—termination clinics, gender clinics and much more besides. Then, PrEP prescribing powers need to be given to each of those bodies. Again, it can be done—we need the will to do it. I commend the PrEP Protects campaign, focusing on black African women and men. If we can get take-up in other communities as there has been with gay and bisexual men, we will be changing lives and saving money. So thank you to the Terrence Higgins Trust, the National AIDS Trust, I Want PrEP Now, who lobbied me heavily as a Minister, and PrEPster for their amazing campaigns on the issue.

[Alison Thewliss (Glasgow Central) (SNP)]

I thank the hon. Gentleman very much for giving way. Does he commend the efforts of community groups who are going out and selling that message to their own communities? Those who work for Waverley Care in Glasgow and the Hwupenyu Health and Wellbeing Project are making sure that the message gets out into the community.

[Steve Brine]

Absolutely. The big society groups have been so important to the work of the commission. We have heard from many of them and I know they are very important north of the border, so I thank the hon. Lady for putting them on the record.

With the cavalry—the science—in place and the policy agreed, we needed a practical plan. For 18 months, the commission met, listened, learned and deliberated. Its recommendations are clear and I will close with a few of them. The first benchmark is to get new instances and the number of people undiagnosed down by 80% by 2025. Most of those will be in communities we already work with to reduce HIV transmissions, but the last 20% most likely will not. They will be hard to find, but the rewards will be great.

Secondly, we want Ministers to report to Parliament annually on the 2025 target and the 2030 goal. This will focus minds and track progress. To make these kinds of advances, we need the promised HIV action plan in very short order.

Thirdly, HIV testing—this is the crucial bit—must become normalised in the system. No longer should 250,000 people go to a sexual health clinic and not be offered a test, but we must go so much further. When someone presents at A&E or registers with a GP and the NHS or whoever else is taking blood, an HIV test must be carried out—so not opt-in, but opt-out. The default assumption is that it will happen.

We know that that can happen. Maternity services have shown that it is possible. Midwives test pregnant women for HIV, in non-judgmental settings, and there is a 99% take-up and therefore near zero vertical transmission to newborn babies. It could be the same elsewhere if we get this right, but there are many challenges in doing that. The funding is with local government. The testing needs to happen in primary care as well as secondary, but it is all possible with political will. In short, it is a policy of test, test, test, and if ever there was a time when we can successfully land that message, it is surely at the end of this ghastly 2020.

Underneath these recommendations lies a 20-point action plan to bring all this to life. Rarely has a commission been presented with such an implementation-friendly set of actions. If the Government are minded—and they have one or two other things on their plate right now—they could do a lot worse than copy and paste our findings into the first draft of the aforementioned HIV action plan. Each action is assessed for its impact on health inequalities and its contribution to fighting stigma. It looks to everyone who is and could be affected by HIV, and that was important to us. We are not denying that some of this will require investment, but I think that it is investment worth making, because bluntly, it will change and save lives, and we have shown how to do that after the Government asked us to.

If the moral case does not persuade people listening to this debate, hard cash might. Modelling by the Elton John AIDS Foundation found that over £200,000 in future healthcare costs were saved per person who was diagnosed and linked into the right treatment and care, so, not unlike the dynamic we face in cancer care, early diagnosis is the magic key in HIV as well.

Finally, to the wider sector, I say this: I hope that we have done you proud in our work with the HIV Commission. You got us here. We now need to come together to get this done. To my colleagues in the House tonight and listening elsewhere who will join us in campaigning for exactly what we are asking, I say: many thanks in advance. We will be in contact.

We could end HIV transmission on our watch. How amazing would that be to that 12-year-old schoolboy and many others who saw that advert in 1986? Let us not pass up the opportunity and, with this man as Secretary of State, I do not think we will.

Smokefree England: Covid-19 and PHE Abolition

Steve Brine Excerpts

Thursday 12th November 2020 Commons Chamber

[Steve Brine (Winchester) (Con)]

It is a pleasure to follow the hon. Member for Blaydon (Liz Twist), who I have been questioned by many times. Thinking about today’s debate, I remember in early summer 2017, when I was standing down there at the Dispatch Box answering Health questions, being pressed by my then shadow, the lovely lady the hon. Member for Washington and Sunderland West (Mrs Hodgson), on when I was going to publish the long-awaited tobacco control plan, which, as the hon. Member for Blaydon reminds us, was due to be out in December 2015. Rather to the surprise of my shadow that day and my officials sitting in the box, I said that it would be out “before the summer recess” and, true to my word, it was.

That was an early lesson for me in how to focus minds in the civil service, because I have never seen them move so fast, but more importantly, it set out some of the key ambitions for us to hit by 2022. The prevention Green Paper a few years later then set the course for England to be smokefree by 2030. I stand by the ambitions, both in the plan and in the Green Paper, 100%, and I believe with all my heart that they are completely achievable, but we will have to get our skates on, as has been said by the first two speakers, the hon. Members for City of Durham (Mary Kelly Foy) and for Blaydon. We will have to be very bold and make the most of one of the rare opportunities afforded to us by the covid pandemic.

I want to make just a few points today. On public health reorganisation, I have previously raised my concerns in the House about the future of Public Health England’s work to tackle issues such as smoking, obesity, inequality and air quality after the new National Institute for Health Protection comes online. I have no issue with the desire to take the health protection functions out and create the new institute based on the German model—it makes a lot of sense, and I have said so to the Health Secretary in public and in private. My concern is about the health prevention parts of Public Health England. On 1 September, I asked the Secretary of State whether he was considering bringing Public Health England’s expertise and significant experience in this area back into the Department. When I was travelling abroad representing the Government and I needed briefing on these issues, I always knew that there would be somebody who knew infinitely more than me inside Public Health England. I do not want to see that wasted.

I note that the Department has now established a programme of work to pick through this. The snappily titled population health improvement stakeholder advisory group has been formed and there are some notable names on there, such as Seema Kennedy, who was my successor as Public Health Minister; Professor Helen Stokes-Lampard, formerly of the Royal College of General Practitioners and now chair of the Academy of Medical Royal Colleges; Professor John Newton from Public Health England; Dr Jenny Harries, whom many of the public will be familiar with as deputy chief medical officer; and Professor Paul Cosford, emeritus medical director of Public Health England and a truly excellent official—one of the best I ever worked with. There are some good people on there.

On balance, I would restate my call for the Department to recover these functions, and I refer the Minister to a pretty comprehensive piece of work published just this week by Policy Exchange, examining how a new deal for public health can build a healthier nation. It calls for the creation of a new institute for health improvement housed in the Department of Health and Social Care, reporting directly to Ministers and the chief medical officer, for a new funded national mission to improve the health of the nation. There is a lot of sense in that, and I recommend the report to the Minister.

Let me dwell for a moment on the word “funded”. I do not think—the record will show that I was always lukewarm at best on this idea—that the Government should proceed with the idea of ending the ring fence of the public health grant. I think it would be a mistake. That should be kept. It should be measured much more tightly and, if anything, I think it should be increased to help our directors of public health to do what works towards smokefree 2030. I am not making unfunded spending commitments. The prevention Green Paper, which I helped to draft and still think is a very credible piece of work, talks about the principle of making the polluter—that is, the tobacco firms—pay, as has been done in France and in the United States, and we should progress that to create a smokefree 2030 fund. I would be grateful if the Minister could reassure me that the Government are at least considering this option and what it might look like in practice.

The Government’s ambition for what we call “smokefree” is for a smoking prevalence in England of 5% or less in the next 10 years, but, as we have heard, significant action is clearly needed if we are to achieve this. The rate in Winchester, which I represent, may be 8.3%, but the national average is 14.1%, so there is a way to go. Smoking remains the biggest single cause of preventable death in our country today, and it is a leading cause of health inequalities. The issue is also one of inequality. About one in four people in routine and manual occupations smoke—about two and a half times more than people in managerial and professional occupations—and this gap has widened significantly since 2012, according to the Office for National Statistics. The inequalities are also geographic, as we have heard.

As a Conservative Member, I see becoming smokefree as a vital step towards delivering our manifesto pledges on extending healthy life years by five by 2035, reducing inequalities across the board, and, as the Prime Minister calls it, levelling up every part of our country. However, as the Green Paper concluded, this is an extremely challenging ambition for any Government. The all-party group on smoking and health has recommended a new tobacco control plan focusing on delivering the 2030 ambition, and that is an eminently sensible suggestion. Given how long it takes to get a tobacco control plan, even when making promises at the Dispatch Box, has the Minister commissioned officials to start work on renewing the TCP to set a course for the smokefree ambition? I think that Ministers will be doing that, with smoking prevalence going in the right direction, albeit not fast enough to meet our agreed ambition, but also off the back of the opportunity afforded to us by the by the pandemic.

The University College London smoking toolkit indicates that the pandemic has been a driver of quitting among smokers across all social groups, with the highest rate of people stopping smoking seen in the past 30 years. That is the good news. However, we cannot be complacent. Although it is true that many people have quit, there are signs that some have relapsed into smoking. In particular, there are worrying signs among the 18 to 24-year-old group that smoking rates may be increasing again and have certainly stopped declining.

Turning to the alternatives, the UK has long been a leader in traditional tobacco control measures such as the use of taxation, as we hear at Budget time; the smoking ban, which was a great credit to the Blair Government; plain packaging; readily available smoking cessation services; and numerous tobacco harm reduction policies using less harmful alternatives to smoking. I was often criticised in office both for promoting e-cigarettes too much and for not promoting them enough as an alternative. That suggested to me that I may have had the balance about right, but I will go further. Data from the ONS tells us that over half of smokers in this country want to quit and that, on average, smokers try some 30 times or more before giving up successfully. Of those who are successful, only 2% quit through stop smoking services, and over 40% use an e-cigarette. However, while many have quit using vaping, the fact remains—we cannot deny this—that nearly half of smokers in Britain have tried vaping but did not stick with it. On top of that, the figures now show that the number of vapers is falling, while some 1.3 million vapers have not fully made the switch and still continue to smoke at the same time.

Since the early 2000s, tobacco policy in the UK has been driven by the European Union through the tobacco products directive. That is about to change. May I therefore ask the Minister to speculate, as I know Ministers love to do, on what opportunities Brexit brings to advance our leading role as a tobacco harm reduction advocate? We may be leaving the political structures of the European Union, but I sincerely hope that we are not leaving our leadership role in this area when many countries around the world look to see what the UK does.

Our prevention Green Paper pledged—as, indeed, did I when in office—to

“run a call for independent evidence to assess further how effective heated tobacco products are, or are not, in helping people quit smoking and reducing health harms from smoking.”

The Government said that the call for evidence would be announced in summer 2020. Of course, we all understand why that has slipped, but I wonder if we might get a reaffirmation today, because recent word, including a parliamentary written answer on 21 September to my hon. Friend the Member for Broxbourne (Sir Charles Walker), who I know wanted to speak today, said that the Government would merely

“consider looking at this at a later date”.

It is imperative that the Government recommit to holding that call for independent evidence as soon as possible, so that the effectiveness of heated tobacco products can be assessed and smokers can have confidence that they are switching to a less harmful alternative.

I say that because there is growing evidence that adult smokers’ misperception of the risks surrounding vaping may be preventing them from transitioning to less harmful alternatives. Last month the excellent UK charity Action on Smoking and Health, otherwise known as ASH, which campaigns against smoking and is run by Deborah Arnott, published survey data showing that vaping in the UK had stagnated as a percentage of the total smoking population, after year-on-year growth. The charity blamed what it called

“unfounded concerns about the relative safety of e-cigarettes”

as a likely cause.

Given that public health authorities in the UK actively support and champion vaping as an alternative to smoking, that statistic shows how damaging inaccurate media coverage can be. To maximise the public health benefits of e-cigarettes, I think regulations should be risk-proportionate and reflect the scientific evidence base on the relative harms of cigarette alternatives and their potential for harm reduction. For example, when this Parliament’s Select Committee on Science and Technology, chaired so ably by my right hon. Friend the Member for Tunbridge Wells (Greg Clark), reviewed the scientific evidence on e-cigarettes, it recommended that the Government should move to a

“risk-proportionate regulatory environment; where regulations, advertising rules and tax/duties reflect the evidence on the relative harms”

of vape products compared with combustible cigarettes.

The UK Government have invested a lot of resources to understand the science behind these products, which I think has informed the pragmatic and progressive approach that successive Governments have taken to vaping regulation over many years. The results have been impressive, suggesting that it would be a strong regulatory model for other countries to consider. Given competing public health priorities, of course I appreciate that it is not as simple as it sounds, but I believe we should dedicate sufficient time and resource to understanding the science around vape products and their potential to improve public health. That is why I would like us to recommit to what it says in the Green Paper that I partly wrote.

Will the Government consider increasing the age of sale from 16 to 21? That could be a useful tool in the toolbox. ASH has suggested that the Government should consult on that as a means of reducing youth uptake. The call has been backed by more than 70 organisations, including Cancer Research UK, the British Heart Foundation and the Royal College of Physicians. I think it is well worth considering.

In conclusion, we should keep the ambition. We have never been short on the ambition, across the last Government, the coalition Government and this Government. We should tighten and update the plan, to bring it in line with the ambition in the Green Paper. We should stick to what we know works and be honest enough to say what does not. We should fund the directors of public health on what does work, and I have given a suggestion as to where I think that can happen. There is a lot riding on getting this right. A lot of people’s lives depend on us getting this right, and we need to do so for their benefit and for that of the next generation, so that another generation of young people is not weaned on to the damaging lifestyle that smoking can lead to. I have given a few ideas and look forward to hearing the Minister’s response at the end of the debate.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is a pleasure, as always, to appear opposite the shadow Minister, the hon. Member for Nottingham North (Alex Norris). It is happening with regularity: three times on three different days last week and again today. Indeed, it is happening with a fair degree of regularity that I am speaking in front of you in this Chamber, Madam Deputy Speaker, which is always a pleasure.

I thank all hon. Members for their participation in today’s debate with typically well-informed and important speeches. As the shadow Minister has alluded to, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), within whose portfolio this matter would normally fall, has been taking a simultaneous debate in Westminster Hall, so it is a rare pleasure for me to be able to speak at the Dispatch Box on this matter.

I thank the hon. Member for City of Durham (Mary Kelly Foy) for securing this important debate. As the hon. Member for Strangford (Jim Shannon) said, I think this is her first debate in her name in this Chamber, and, consistent with the principled approach that she adopts in this place to raising issues that she passionately cares about, she has done that today, and I pay tribute to her for doing that.



We should all recognise the significant achievements made on tobacco control over the past two decades through cross-party working. In that context, as my hon. Friend the Member for Winchester (Steve Brine) said, while I may not agree with everything that the former Prime Minister Tony Blair did, it is right that I recognise and pay tribute to him for his work in this space when he was leading the country. Smoking rates are now at their lowest ever level in England and the UK, and that is a great public health success story.

However, as Members have highlighted powerfully, there is no room for complacency. Smoking still causes more than 78,000 deaths each year, and there is much more still to do, which is why we announced our smokefree 2030 ambition. As Members will know, the UK is a global leader in tobacco control. Our commitment to tough tobacco control will continue after 1 January 2021. We laid the Tobacco Products and Nicotine Inhaling Products (Amendment) (EU Exit) Regulations 2020 on 28 September to reaffirm that commitment, which the hon. Member for Nottingham North and I debated recently.

The covid-19 pandemic, as we well know, has put a huge strain on our health and care system. The Government have published guidance regarding covid-19 and the risks from smoking, so this debate is very timely. The message has been clear that quitting smoking will improve a person’s health and recovery prospects if they are unfortunate enough to contract covid-19. It is important that we recognise the great work of local authorities—I will come to that later—and the NHS, along with the third sector, in their support to help smokers quit during these exceptionally challenging times. They have ensured that stop smoking services have continued and used the opportunity of the pandemic to reach out to more smokers to encourage them to quit. I thank them for the work they have done and continue to do.

Action on Smoking and Health has estimated that around 1 million smokers may have made a quit attempt during the pandemic, and that is good news. The Government have provided funding to support ASH’s “Today is the Day” campaign, to enable the stop smoking message to reach as many smokers as possible in some of the most deprived areas, and I pay tribute to ASH for its work. Public Health England’s Better Health Stoptober annual campaign has also continued at a national and local level to support people quitting during the pandemic.

I thank the hon. Member for Strangford for his speech, which brought an important perspective from Northern Ireland to this issue. He mentioned two things that I want to pick up on. He asked whether I would engage with the Health Minister in Northern Ireland, Robin Swann, on this issue. Although this comes under the portfolio of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds, I am due to talk to Robin Swann next week about other matters, so I will endeavour to shoehorn it into the conversation in the way that the hon. Gentleman so elegantly does with a number of topics in this Chamber in various debates. I thank and pay tribute to Robin Swann for all the work he is doing in partnership with us at this difficult time.

The hon. Gentleman also mentioned the role of Ofcom. I know that the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston), who is due to respond in the Adjournment debate, is very near to the Chamber, if not present at this moment, and I suspect he will have heard the points made by the hon. Gentleman and will reflect on those in his work.

The Government are committed to levelling up society to ensure that no communities get left behind. That is why we announced our bold ambition for England to be smokefree by 2030 in the prevention Green Paper consultation. I am grateful to the hon. Member for Nottingham North for rightly highlighting the importance of this being a cross-party issue, which typifies the approach that he takes to these matters in the House.

I pay tribute to my hon. Friend the Member for Winchester, who was an incredibly effective public health Minister. He is missed in that role and in Government, and I hope one day he will return to the Dispatch Box. He played a hugely important role in drawing up the current tobacco control plan for England. He also gave us some very good tips on how to speed up delivery within our excellent civil service if a Minister decides that he wants to accelerate clearance and implementation of a policy. The recent prevention Green Paper highlighted the urgency of tackling disproportionate smoking rate harms in deprived areas, which the hon. Members for City of Durham and for Blaydon highlighted. The Green Paper also highlighted the disproportionate smoking harm rates among the LGBT community, pregnant women and those with mental health conditions, which again goes to points that hon. Members made. I will endeavour to address those in just a moment.

In terms of that tobacco control plan, the points made about what happened last time and the fear of a gap, I reassure Members who highlighted the need for no gaps and for continuity that it is something of which my hon. Friend the Member for Bury St Edmunds is very much aware. I know she would want me to reassure the House that she is working extremely hard on ensuring that effective measures and effective planning continue to be in place to address the challenges of smoking. Smoking, as has been alluded to, is one of the biggest behavioural drivers of health inequality in England and reduces life expectancy by 10 years on average. That accounts for half the difference in life expectancy between the richest and the poorest, which again Members have made very clear.

Turning to some of the points made by the hon. Member for Blaydon, although rates for smoking in pregnancy are the lowest recorded, they remain around 10%. Clearly she is right to highlight that that must remain a concern for all of us in government, in this House and in this country. More needs to be done to reach our national ambition of a rate of 6% for smoking in pregnancy by the end of 2022.

Public Health England continues to work closely with NHS England and NHS Improvement on their long-term planning commitments to offer all patients NHS-funded treatment services over the coming years, including a new smokefree pathway for expectant mothers and their partners. I am confident that progress will continue to be made to hit that target, but I know from experience that the hon. Lady, in her typically courteous but firm way, will continue to hold Ministers to account in achieving that.

[Steve Brine]

While we are on the subject, as the song goes:

“The saddest thing that I’d ever seen / Were smokers outside the hospital doors”—

name the band. It is not a national problem, but it is a big problem in some areas, which is why I made the point to the Minister—will he convey this to the public health Minister?— that it has to be a regional and local approach through the directors of public health. It is a much bigger problem in some towns than it is in others.

[Edward Argar]

I will not seek to outdo my hon. Friend in his knowledge of music or, possibly, his expertise in this area, but I will certainly convey that point to my hon. Friend the Member for Bury St Edmunds.

Alongside tackling smoking in pregnancy, a big challenge is to reduce smoking rates in those with mental health problems, as the hon. Member for Blaydon said, which remain significantly higher than the general population at 42%. The NHS long-term plan will also offer a new universal smoking cessation offer, available as part of specialist mental health services for long-term users of those services and in learning disability services. The Minister for Patient Safety, Mental Health and Suicide Prevention, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries) will be looking into that, working in close partnership with my hon. Friend the Member for Bury St Edmunds, because it is important that we have a joined-up approach. The hon. Member for Blaydon highlighted in her speech the excellent practice in some parts of the country and in some parts of the NHS and the fact that that is not replicated everywhere, which goes to the point made by my hon. Friend the Member for Winchester. It is important that we level up, to coin a phrase, across the country in using and sharing that best practice.

The Government are committed to a smokefree 2030, and we are developing the plans to ensure that is a reality. The plans will build on the good work already under way in the tobacco control plan and the commitments being delivered in the NHS long-term plan, to which, while the pandemic has obviously impacted on the NHS, we remain committed.

I said in my introduction that the UK is a world leader in tobacco control. That is demonstrated by how seriously the Government take our obligations as a signatory and party to the World Health Organisation’s framework convention on tobacco control, the FCTC. Tackling the harms caused by smoking is a global effort, with 8 million deaths a year worldwide linked to tobacco, 80% of which are low and middle-income country deaths.

The Government have invested up to £15 million in official development assistance funding to support the WHO’s FCTC 2030 five-year project, supporting up to 24 countries to improve their tobacco control and improve their population’s health. The project has received considerable praise from global public health and development communities and helped to raise the UK’s profile and strengthen our global reach. I am proud to say that the Department recently received a UN Inter-Agency Task Force on the Prevention and Control of Noncommunicable Diseases award for 2020 for the project. The project is in its final year and we are considering plans to extend it, depending on the Department’s spending review settlement for official development assistance. In a second, I shall address the point about the spending review raised by the hon. Member for City of Durham—I shall be very brief, as I am conscious that I need to leave a couple of minutes for her to reply at the end.

We continue to review the evidence on e-cigarettes, including their harms and usefulness in aiding smoking cessation. Although they are not risk-free, there is growing evidence that they can help people stop smoking, and they are particularly effective when combined with expert support from a local stop smoking service. The Government’s approach to the regulation of e-cigarettes has been and will remain pragmatic and evidence-based. The current regulatory framework aims to reduce the risk of harm to children, protect against the re-normalisation of tobacco use, provide assurance on relative safety for users and provide legal certainty for businesses. We will continue our work to appraise the evidence on new products, including e-cigarettes, and their role in helping smokers quit.

I note comments about proposals for future regulatory changes to help smokers quit smoking. Post transition period, this country will no longer have to comply with the EU’s tobacco products directive, and there will be opportunities to consider in the future regulatory changes that can help people quit smoking and address the harms from tobacco. Although there are no current plans for divergence, I would reassure the House that any future changes will be based on robust evidence in the interests of public health and will maintain this country’s ambitious and world-leading approach in this area.

The Department will be carrying out a post-implementation review of the Tobacco and Related Products Regulations 2016 and the standardised packaging of tobacco products by 20 May 2021 to see whether the regulations have met their objectives. Part of this review process will involve a public consultation to start before the end of the year for people to submit their views and evidence, and I hope that gives some greater clarity about timescales.

The Department has already conducted another post-implementation review and public consultation on various tobacco legislation, as the hon. Member for City of Durham mentioned, and we will publish a Government response shortly. I understand that the aim is to do so before the end of this year, although obviously a lot of work is being put into tackling the pandemic.

I hear what Members have said about the importance of public health grants and local authorities. Like the shadow Minister, I am a former cabinet member for public health. He would not, I suspect, like me to be tempted to try to fulfil the role of the Chancellor of the Exchequer by pre-empting the spending review. As for Public Health England and the future, we are engaging with stakeholders and will consider the best future arrangements for the wide range of non-health protection functions that currently sit in PHE. Our commitment to smokefree 2030 and to working collaboratively to maintain our ambitious agenda and our high standards in this area is undiminished; indeed, it is enhanced.

Breast Cancer Diagnosis and Services: Covid-19

Steve Brine Excerpts

Thursday 12th November 2020 Westminster Hall

[Steve Brine (Winchester) (Con)]

Another debate about breast cancer. There have been many—too many. For my first five years in this place, I was proud to lead the all-party parliamentary group on breast cancer, and it is in good hands now with my hon. Friend the Member for North Warwickshire (Craig Tracey). For more than two years, it was the privilege of my life to serve as the cancer Minister and to be part of what I call team cancer. Heaven knows, I spent my fair share of time sitting in the Minister’s seat in Westminster Hall, as she—the current Public Health Minister—now knows.

For each of the 10 years that I have been an MP, we have lost around 11,500 women a year in the UK to this menace, as has been said. That number has come down thanks to advances that we have made and investments that all Governments have put in, but we have to do so much better. That is 115,000 mums, sisters, grans, aunties and friends over the decade that I have served in this place. I have never spoken before about which one of them it was for me, and I do not think I will go there today, but I will say this: I have fought and lost to breast cancer more than I have won.

And let us not forget the guys. I was glad that the previous speaker, the hon. Member for Dulwich and West Norwood (Helen Hayes), mentioned them. Yes, breast cancer is rare in men, but around 370 men a year are diagnosed in the UK. It still kills, so I welcome the Male Breast Cancer Study that was established to pinpoint some genetic and environmental lifetime causes in men.

Going back to the title of today’s debate, it is true that covid has not helped, but the breast cancer toll goes on regardless. That is as true today as it was pre-pandemic. Breast cancer remains a largely beatable and treatable cancer if it is detected early. Primary breast cancer can be fatal, but we know that almost all deaths are attributable to the development of metastatic, or secondary, breast cancer. As Breast Cancer Now puts it so well—this has been quoted before, but it is worth saying it again—coronavirus is the biggest crisis secondary breast cancer has faced in decades.

We know that some patients with breast cancer had their treatments changed or paused to protect their immune systems. We wait with nothing but fear for the impact of those periods on keeping the disease stable. Let us stop for a moment to consider the reality of those pauses. There is that sinking feeling in a person’s stomach every morning when they wake up and remember that they have breast cancer but they cannot take any action to beat back the disease, because of the pandemic. When they are busy doing something else—maybe enjoying a child or a grandchild being super-cute—it rushes back in, like a punch to the stomach, and they realise they cannot take any action to beat the disease, because of the pandemic. For the children of breast cancer patients who call up on Zoom because they cannot meet, things look and sound the same, but mum cannot take any action to beat back the disease.

Many of these covid delays have had a negative impact on the emotional wellbeing of patients and their families. Never before has the clinical nurse specialist role been more important. We have heard from research undertaken by Breast Cancer Now, an excellent charity, that patients feel they have had less contact with their CNS during the pandemic. When the Minister sums up, could she update us on that? I know she will.

The flip side to that emotional support is the third sector. Many charities, including Wessex Cancer Trust and the Winchester and Eastleigh Cancer Support Group in my area, have switched from physical to virtual, and I thank them for their work. However, there are other charities that have had to pull back just when we need them most, including Breast Cancer Haven, Wessex, which opened only a few years ago, and Breast Cancer Haven, West Midlands, in Solihull. They have closed permanently, and the charity is now operating only online services out of its London base.

Breast cancer incidence in my area, Wessex, is significantly higher than the England average. The rate is 184 per 10,000, compared with 168 across the country. Our mortality rate is spot on the average, but that still has us losing 118 people every year, almost all from secondary cancer.

I was alarmed that my trust had to cease the local breast screening programme in March, because of “did not attends” and cancelled appointments in the first lockdown. Three weeks later, the trust got formal guidance, and the service was suspended for 17 weeks. I fear that this is going to be one of the terrible legacies of lockdown.

The good news is that the restoration of the screening service is well under way, and I thank the team at Hampshire Hospitals for that. The tragedy for us is that, pre-covid, Winchester had a very high uptake of screening in the local population. We have to get back to that.

We have a battle royal on our hands with breast cancer; that was the case before the pandemic, and it is after. When I sat in the Minister’s seat, many hated me describing cancer and breast cancer as a fight, but they are just that. They always were. We needed to up our game pre-covid, and we certainly need to up our game post-covid, if we are not to be here in another 10 years having exactly the same conversations.

Covid-19 Restrictions: South Yorkshire

Steve Brine Excerpts

Wednesday 21st October 2020 Commons Chamber

[Edward Argar]

I reiterate the tribute I paid to the hon. Gentleman for his approach throughout this. It is abundantly clear that he and all of his colleagues have the best interests of his region at heart and have worked constructively throughout this process to get the right health and economic outcome for his area. I can absolutely give him that commitment. I and my colleagues look forward to continued close working and co-operation with him as we move forward to beat this disease in his area.

[Steve Brine (Winchester) (Con)]

The three-tiered local approach has to be right, and I pay tribute, as the Minister just did, to the cool heads of some local leaders for working with Ministers so sensibly. Surely people in South Yorkshire and elsewhere need to know where they are at and be confident that the goalposts will not move, so can the Minister please comment on stories this morning that plans are being worked up by the chief medical officer for local—not national, but local—three-week circuit breaker lockdowns in tier 2 and tier 3 areas?

[Edward Argar]

I can reassure my hon. Friend that that is not something I have been involved in or had sight of.

Local Contact Tracing

Steve Brine Excerpts

Wednesday 14th October 2020 Commons Chamber

[Rachel Reeves]

That is exactly why I am urging the Government to use the local expertise we have in all our local authorities around the country. We should not reinvent the wheel, but use that local expertise, rather than wasting hundreds of millions of pounds of taxpayers’ money.

The Prime Minister promised a world-beating test and trace system, yet we have one that is barely functioning. We have a system that is now so broken that SAGE is saying it is making next to no difference. We are all paying the price for these terrible mistakes. The truth is that as soon as the Government looked to a privatised solution, a political choice was made about how to respond to a public health crisis.

Serco is not integrated into the fabric of any of our communities. Ministers could have spoken to the Local Government Association. They could have spoken to the Association of Directors of Public Health. Instead, they chose to speak to Serco. There is a cosiness between the Conservative Government and these outsourcing companies, despite their failures to deliver.

Let us look at Serco’s record. Last year, Serco was fined £23 million as part of a settlement with the Serious Fraud Office over electronic tagging contracts. In December, two former senior executives at Serco were charged for that offence. In 2018, Serco was fined £2.8 million after it was revealed that it was providing asylum seekers with squalid, unsafe slum housing.

One would think that whenever Serco bids for a contract, sirens would be going off all over Whitehall, except that Serco did not bid for the contact tracing contract. It was handed it on a plate, with no competition, no rigour and no transparency. Ministers may claim that it is a coincidence that hundreds of millions of pounds of public contracts have been awarded to companies with clear links to the Conservative party, including Serco. That would be a heck of a coincidence, wouldn’t it?

[Steve Brine (Winchester) (Con)]

I am glad to see the old tendency is back in the Opposition of private bad, public good. With the hon. Lady’s proposal around local authorities wanting to do more on test and trace, presumably they would not be doing it for free. They would have to be paid, and it would cost a lot of money. Presumably she has costed that. Will she just put on the record for the House at what price she has costed that?

--- Later in debate ---

[Jo Churchill]

I believe that the Minister for Universities answered an urgent question in this House last week, and I am sure that if the hon. Gentleman refers the challenges he has on the university to her, she would be more than happy to work with him. I just refer him back to the fact that we are working with all local authorities.

While talking about testing, I would like to take the opportunity to remind the House about the scale of testing. It was 2,000 people a day when the pandemic began in March, and when NHS Test and Trace began our capacity was over 128,000. The capacity is now over 340,000. We have processed over 25 million tests, and one in eight people in England have been tested for the virus. I am really keen that we understand the size of this challenge. We have built the largest diagnostic network in British history, including five major labs, 96 NHS labs and Public Health England labs, and we are expanding further. We have pilots going with some of our greatest universities. We are working with hospitals, with the addition of new Lighthouse laboratories in Charnwood, Newcastle and Bracknell, as well as new partnerships only last week with Birmingham University and Health Service Laboratories in London, so we are expanding.

Right at the start of NHS Test and Trace, we worked with all 152 local authorities to help them develop their local outbreak plans. We have ensured access to data, and when it was highlighted that there was a need for better data flow, we worked on it to provide them with additional support to respond to outbreaks, such as with enhanced testing. We have also published the covid-19 contain framework—the blueprint for how Test and Trace is working in partnership with local authorities, the NHS, local businesses, community partners and the wider public so that we can target outbreaks. We introduced new regulations to give local authorities additional powers when they ask for them to stop the transmission of the virus, giving them the ability to restrict local public gatherings and events, and the power to close local business premises and outdoor spaces if it is deemed necessary. This includes more support for local test and trace, more funding for local enforcement and the offer of the armed services in areas of very high alert.

[Steve Brine]

I feel sorry for the Minister and her colleagues now that constructive opposition has ended, but let me ask her about the local tracing partnerships she mentioned. She will remember the thousands of volunteers who signed up to help during this pandemic. Have Ministers given any thought to using that army of volunteers for the local tracing partnerships?

[Jo Churchill]

I thank my hon. Friend. Those local volunteers were in some cases employed in other jobs and have returned to those jobs, but where they have indicated they are available, obviously they have been used.

Public Health: Coronavirus Regulations

Steve Brine Excerpts

Tuesday 13th October 2020 Commons Chamber

[Matt Hancock]

Yes, as the hon. Lady will know, three Nightingale hospitals were put on alert yesterday to be reopened. The closest Nightingale is in Manchester, but we keep that under review because expanding the capacity of the NHS is one of the things that we can do. Nevertheless, no matter how big the NHS is, if the virus is not under control it will make more people need hospital treatment than there could possibly be hospital treatment available for. While we are, of course, restarting the Nightingales, which have been mothballed for months, that is only a precaution; it cannot be the full answer to the question. We had a very good discussion yesterday about the measures in Liverpool city region, which I will come on to in some detail.

[Steve Brine (Winchester) (Con)]

To follow on from what my right hon. Friend said about our strategy being to suppress the virus until a vaccine makes us safe—until science saves us—the Prime Minister yesterday was, very wisely, cautious in his answer to our hon. Friend the Member for Wycombe (Mr Baker) on the vaccine. What if it does not come, and what if it comes and the efficacy of it is not good enough, and there are challenges with roll-out and all sorts of other challenges that he and I know about—the anti-vaxxers notwithstanding? Can he give those of us who are nervous about—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. This is not a question but a very quick intervention. I have 89 people who want to speak. If there are to be interventions, they must be short.

--- Later in debate ---

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

Madam Deputy Speaker, I have heard your message loud and clear; I will endeavour to be brief and not to detain the House for too long, given the points you have rightly made.

The House will understand that we are grappling with a virus that spreads with speed and severity. Throughout this crisis, we have urged the Government to adopt an approach with the strategic aim of suppressing the virus and bringing the R below 1 in order to save lives, minimise harm and keep our children in school. That has to be our priority, and no one should be surprised that, as we are in autumn and going into winter, that presents us with immense challenges.

Before the summer, the Academy of Medical Sciences, in a report commissioned by the Government, modelled that we could see 119,000 deaths between September 2020 and June 2021. The academy also warned, as did we, that without an effective test, trace and isolate regime the virus would get out of control. Sadly, we were proved correct. The Secretary of State has run through the numbers on the prevalence of the virus, but I will just underline the point that hospital admissions are rising.

Yesterday, there were 3,665 patients in hospital in England, 568 more than on 23 March when we went into lockdown. Since September, 856 patients have been admitted to critical care across England, Wales and Northern Ireland—more with every week that goes by. The largest number of critical admissions are in the north-west, north-east, Yorkshire and the midlands. More than 100 patients are on ventilation for covid across the north-east and Yorkshire. More than 130 patients are on ventilation across the north-west.

A disproportionate number of those in critical care today are from poorer backgrounds and from black, Asian and minority ethnic communities. That is a reminder that covid thrives on and exaggerates inequalities, and that any long-term covid strategy cannot just rely on a vaccine but demands an all-out assault on health inequalities as well.

Just as hospital beds fill, there are more concerns about the availability of beds for the rest of winter. Last week, there were warnings that some hospitals across the north of England are set to run out of beds for covid patients within days, and NHS Providers reminded us that the sustained physical, psychological and emotional pressure on health staff is threatening to push them beyond their limits. The British Medical Association is saying that without stringent measures rapidly introduced, the NHS and its workforce will very quickly be overwhelmed. This House cannot overstate how serious the situation is.

Yes, as the Secretary of State said, our clinicians have made extraordinary strides in treatment. We know that steroid and antiviral drugs will help improve mortality, but we also know that when infections rise, as night follows day, hospitalisations rise, and, sadly and tragically, that means that more will die as well. For those who avoid hospitalisation, many can be afflicted with serious, long-term, debilitating health problems—so-called long covid. None of us knows whether those conditions—that syndrome—will last for the rest of their lives or whether they will recover in the next 12 months.

Just as we have to protect our NHS, we cannot allow the mass, industrial halt to elective surgery and delays in treatment never seen before in the history of the NHS. We have to mobilise our national health service to perform the care for non-covid patients as well. The decision in March, although entirely understandable—I do not criticise the Government for taking it—has bequeathed us waiting lists of 4 million. Today there are 111,000 people waiting beyond 12 months for treatment. In January of this year, there were just 1,600. Three million people have missed out on vital cancer screening. One in three cancer patients has said that their treatment has been impacted by the effects of covid. I make these points not to criticise the Secretary of State but to reinforce the point that we have to protect our national health service as we go into the winter months.

I know that no Member across this House is complacent about these matters. Every hon. and right hon. Member is united and determined to see infection rates reduce and care improved. I know that everyone across this House wants to see the immense backlog in non-covid care tackled. I know that none of us wants to see this virus let rip and leave the weakest and the frail to fend for themselves. So I do not come to this House to caricature the position of any hon. Member. Our differences are about how we apply the tools we have at our disposal, and how we confront this, the biggest public health crisis for 100 years.

We know, as the Secretary of State said, that the virus thrives on close human contact, especially where air is stagnant and in conditions that are poorly ventilated. We know that the virus is airborne. We know that fundamentally our best defences are hand hygiene, distancing, mask wearing, and avoiding crowds. But we also know that a full national lockdown stretching for weeks and weeks, like we had through April, with a rule, effectively, of one-household contact—a rule of one, indeed, for some people—would be disastrous for society. Again, I do not believe that anyone in the House is proposing that.

The question is what measures can be taken now to bring R below 1 without resorting to that full lockdown. We know that when 8 million children returned to school, that would have put upward pressure on infection rates. I am critical of the Government for not providing the extra testing capacity that would have been needed, as should have been obvious. Yet we must do everything we can to keep our children in school. The implications of children not being in school are devastating for their life chances and development. We know that crowded public transport puts upward pressure on infection rates, but I do not believe that any Member of this House would consider it sensible to close public transport networks—to close the underground or to close the Metrolink across Manchester. We know we have to encourage people to work from home, and many are doing that, but we also know that there are many who cannot work from home, and they should be protected with access to mass testing—particularly NHS staff. I hope that the Government get on with routine testing of frontline NHS staff. We have repeatedly called for the Government to do that.

That then therefore leaves us with few levers to pull. That brings me to hospitality, because—I am sorry to have to say it—pubs and bars do bring people together. Every Member across this House knows that after a few drinks people lose their inhibitions. It should come as no surprise to us that social distancing breaks down, and if bars and pubs are poorly ventilated—as, sadly, some are—then airborne transmission is more of a risk. I know that Members will point out to me, as they have in the past few days, that the data show that household interaction is the biggest driver of transmission. That is correct—but how does the virus get into the household in the first place? It does not come down the chimney, like Father Christmas: someone brings it into the house.

If we cannot close, schools, workplaces or shops and cannot shut public transport, the only lever that we have is hospitality, so, yes, we support the restrictions announced yesterday by the Secretary of State and the Prime Minister. We know from experience in Bolton and Leicester that the pub closures had an impact—the virus is still prevalent in my city and in Bolton—but without the closures the virus would have been driven up further.

We therefore support the announced measures, difficult as they are. Indeed, we support the measures aimed at constraining the time people can spend in the pub. I understand the Secretary of State’s procedural points about the instruments before us and the 10 pm curfew, and he knows that I know that many Members are deeply sceptical about that curfew. We will not stand in the way of the passing of the statutory instrument, but if the House’s procedures had allowed it, we would have proposed an amendment to implement the Welsh scenario, where there is drinking-up time, off sales are banned after 10 o’clock and there is no hard stop at 10 pm.

We have all seen the pictures that the hon. Member for Bexhill and Battle (Huw Merriman) mentioned, although I must say to many of my hon. Friends who made the point about city centres being full of revellers after leaving the pub that it is not as though we have seen such pictures only once the 10 pm curfew was introduced—we have seen them before in our city centres, sadly. I have been on public transport after 11 pm! This is a longstanding issue. The 10 pm curfew does not help it, but let us not pretend it has caused all these issues.

[Steve Brine]

If the hon. Gentleman could amend the instrument, would he amend it so that off licences cannot sell after 10 pm?

[Jonathan Ashworth]

I think I made that point, but, yes, I most certainly would. If I had proposed that amendment, I hope the hon. Gentleman would have joined us in the Division Lobby, although I know that since leaving the Government he has been very lax about going through the Lobby with the Opposition—[Interruption.] I drank my water too quickly as the hon Gentleman’s intervention was shorter than I anticipated—[Interruption.] I beg your pardon; I assure Members it is not the virus.

Many Members affected by this in recent days will know that the decisions made to put an area into restriction will be effective only if they are made in conjunction with local people. I know that extremely well as a Leicester Member, where we have had restrictions for 105 or 106 days. People in towns such as Bury or Bolton or across Greater Manchester or in boroughs such as Wolverhampton, West Bromwich or parts of Birmingham need clarity about their future and local leaders need reassurance that there is a plan. Local leaders need reassurance that if they are put into a tier there is a plan to get them out of it and moved into the lower tiers. It is not clear at the moment why particular areas are in the medium tier and not in, for example, tier 2. I do not want to pick on my near parliamentary neighbour, the hon. Member for Charnwood (Edward Argar), but I hope he can explain when he responds to the debate why the city of Leicester is in tier 2 with restrictions yet his constituency, where the infection rate is 150 per 100,000, is not. Why is North East Derbyshire, where the rate is 164 per 100,000, not in that tier? Why is Barrow, where the rate is 277 per 100,000, not in that tier? There are many other examples across the House. People living in areas where restrictions are in place would like to be reassured that there is some consistency in these matters and that decisions are made transparently. I do not want to pick on the hon. Gentleman’s area, but he will see the point I am trying to make.

Of course, the areas where hospitality has closed need support to save jobs and protect livelihoods. At the moment, there is a financial package on offer for tier 3 —the Opposition do not think it goes far enough; we do not think it is adequate—but there is no financial support for tier 2, even though there will be a significant impact on the local economy, as we have seen in Leicester. On tiers 2 and 3, could the Minister, in responding to the debate, say a little bit about care homes? What does he say to the thousands of families who, under tier 2 and now tier 3, will not be able to visit their loved ones in care homes? The impact on a loved one in a care home of not being able to see their family is immense, especially in the winter months as we run up to Christmas. What steps will the Government take to support those areas in tiers 2 and 3 so that families can safely resume visiting their loved ones? Will he commit to a 24-hour turnaround in test results in care homes so that care homes and residents are protected?

This brings me to testing and tracing. One of the great strides we made in Leicester was door-to-door testing. Can the Minister guarantee that any areas in tier 2 and tier 3 will get capacity for door-to-door testing? Back in August, the Government promised that local areas would have more control over test and trace, with dedicated teams backed up by local authorities, but under this tiered system it was reported yesterday that only areas in tier 3 would have greater local control over contact tracing and testing. Why was this not put in place months ago, and why has it not been put in place everywhere across the country, not just for tier 3? This is the point that the right hon. Member for Forest of Dean (Mr Harper) made, and he made it extremely well.

I am sorry, but the testing and tracing regime has become a broken system that continues to misfire. We even have SAGE now warning that it is having a marginal impact on transmission, as the right hon. Gentleman said. To be frank, and I know Conservative Member will groan at this, if Serco has not come up with a solution by now, it never will. Scrap the contract, put public health and local NHS partnerships in control of testing, and invest in the widespread backward contact tracing we need. It is still only in its infancy, but it is absolutely vital to getting in control of the virus, and we need to expand it at a local level.