Diabetes: Artificial Pancreas

Steve McCabe Excerpts

Wednesday 12th December 2018 Commons Chamber

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. He is right in what he says, and I will be covering precisely that point later in my speech.

A recent JDRF-funded trial found that the artificial pancreas is better at helping people to manage their glucose levels than the best currently available technology. People who used the artificial pancreas spent 65% of time with glucose levels in range, which compares with 54% of time for people using a continuous glucose monitor and an insulin pump. Unfortunately, as my hon. Friend mentioned, there are significant regional variations in access to existing diabetes technologies, such as insulin pumps, in many parts of the country. The most recent national diabetes audit, published in July 2018, shows that although the overall uptake of insulin pumps has increased, the proportion of people with type 1 diabetes attending specialist services who are treated with pumps varies from a pitiful 5% to 40% at best.

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

I do not know whether my right hon. Friend is familiar with a group called #WeAreNotWaiting. They are people who are developing their own equipment, pumps, monitoring system and computers, because they are not prepared to wait for technology that could be made available to help them.

As my right hon. Friend says, the pumps are available but not widely available on the NHS, despite being a leading British technology. Of course, the other problem is that there is no push from the Government for concerted commercial development of these systems in this country.

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. I am aware of the #WeAreNotWaiting group and as recently as earlier today I had an email from one of them. I will not name them, because I do not have permission to do so.

--- Later in debate ---

[Mr Howarth]

My hon. Friend may have been late, but he is never behind. Of course I agree with him.

In October, I tabled a written parliamentary question to the Secretary of State for Health and Social Care, asking how many patients with type 1 diabetes had been referred for psychological support, psychiatric support, and treatment for an eating disorder or diabulimia in the last 12 months. I was told that the information is not held centrally. I then took the matter up with Knowsley clinical commissioning group, but it turns out that it does not hold that information either.

The lack of psychological support for adults and young people with type 1 diabetes is a real and important issue. It was one of the key points in the national service framework for diabetes when that was first brought into being. Most patients on Merseyside, which is my part of the world, still cannot get the support that they need.

Diabulimia, which is a syndrome, rather than a condition, is an eating disorder present among those with type 1 diabetes. It involves the omission of insulin doses, which leads to high blood glucose levels and the body’s cells being deprived of oxygen and energy. The available research suggests that around 40% of females between the ages of 15 and 30 with type 1 diabetes deliberately induce hyperglycaemia and diabetic ketoacidosis in order to bring about weight loss. Anyone can go on the internet and quite easily find out that if they omit to use their insulin, they can probably lose half a stone in a week, but of course the risks in involved in doing so, including damage to vital organs, should not be taken at all.

According to the charity Diabetics with Eating Disorders, 60% of all females with type 1 diabetes will have experienced a clinically diagnosable eating disorder by the age of 25, and new research suggests that 11% of adolescent males also engage in insulin omission for weight loss. I just want to pause at this point and say a word: although I am describing something that affects type 1 diabetics, it is all part of a wider problem of body image and an obsession with a particular type of weight range. Although diabetics, because of their condition, have a different means of achieving that weight loss, it is an issue that has to be addressed nationally. I know that the fashion industry, for example, has started to make some moves in that direction, but it is a national problem, particularly for many young women who feel that they have to look a certain way to be acceptable. That is, of course, nonsensical, but, nevertheless, it is the way that some of them feel.

Sandie Atkinson, a PhD candidate at Liverpool John Moores University, believes that there is a lot more that clinics can do to reduce the psychological impact of type 1 diabetes and, as a consequence, reduce the prevalence of diabulimia. She says:

“By being empathetic to the issues that impact blood glucose level outside of the realm of an individual’s ability to manage and having realistic expectations of them in light of these uncontrollable factors, individuals might feel less inclined to hide their true condition from Healthcare Professionals.  The likelihood of them being more open would undoubtedly be in the best interest of the patients and the NHS at large.”

While conducting her research, those whom Sandie spoke to described the problems that they had in accessing support in clinics. One participant said:

“Eating disorders thrive on secrecy and yet people feel with diabetes they can’t be honest about the expectations of where they are with control so there’s two lots of secrecy there that really does a lot more damage”.

A second interviewee said:

“There’s something about the way that we treat diabetes and I don’t know if it’s maybe because there is some internal stigma, but there’s something needs to be done…I just kind of feel like we’ve got it all wrong…right from the off you should have a psychologist…at least for the first year. I mean the research is all there, suicide risk goes up, self-harm risk goes up, mental health declines…We know this but we’re like, ‘oh yeah, we’ll see you in six months’ time’.”

To progress towards artificial pancreas systems, there are a number of things that the Government must do. The NHS needs to establish a new national framework that encourages innovation. The framework could include some of the following elements: first, a national strategy, with allocated funding, for diabetes technology, allowing all people with type 1 diabetes to self-manage their condition by considering individual medical need and the potential to improve quality of life and psychological aspects of care.

[Steve McCabe]

If the NHS were to develop that approach, would it not, as well as giving people much more freedom, autonomy and control over their life, produce massively more data—the strongest commodity in the NHS at the moment—which would mean that we could predict this condition, and look at other possible methods of controlling or treating it?

Breast Cancer

Steve McCabe Excerpts

Thursday 18th October 2018 Westminster Hall

[Steve McCabe (in the Chair)]

This debate can last for up to three hours, but hon. Members are not obliged to fill the entire time.

[Laura Smith (Crewe and Nantwich) (Lab)]

I beg to move,

That this House has considered the future of breast cancer.

It is a pleasure to serve under your chairmanship, Mr McCabe, and to have been selected to introduce this important debate. I welcome my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and, of course, the Minister. Their presence underlines the importance of this issue. I also welcome everybody in the Public Gallery, many of whom have had personal experience of breast cancer, and all other hon. Members here today. It is important that we demonstrate our commitment to raising the profile of this issue across the party political divide. I am sure we have all been touched by this terrible disease in some way in our own lives.

I pay tribute to the remarkable people up and down the country who raise awareness of breast cancer and fight against it in their everyday lives. I want to take this opportunity to mention Rachael Bland, the BBC Radio 5 Live newsreader and presenter, who sadly passed away on 5 September. She did a remarkable thing by blogging about her experience in “Big C. Little Me.” and bringing down the barriers when it comes to living with breast cancer. Her strength and courage touched many of us, and her family and friends should be incredibly proud of her.

Between 2014 and 2016, an average of 457 women a year developed breast cancer in the South Cheshire clinical commissioning group area, which covers my constituency of Crewe and Nantwich. Sadly, in the same period, an average of 101 women lost their lives to the disease.

Today is World Menopause Day. It may seem odd that I have chosen to start my speech by talking about what might, at first glance, appear to be an unrelated issue, but the reverse is true. Breast cancer is most commonly diagnosed in women between the age of 50 and 65—the age at which women undergo the menopause. Some breast cancer treatments can bring about menopause symptoms, because they reduce oestrogen levels in the body. To make matters worse, women diagnosed with breast cancer usually cannot use hormone replacement therapy, the primary treatment for menopause symptoms, because there is strong evidence that it can increase the risk of breast cancer coming back. Some might ask whether it is really a big enough issue to warrant special attention, but we cannot afford not to pay special attention to it.

It is absolutely vital that we continue the fight to ensure that those diagnosed with breast cancer live, but we must also fight to improve their quality of life. About 70% of women with breast cancer experience severe night sweats and hot flushes, which cause major physical discomfort and anxiety, and affect their confidence. In some cases, they can even lead to serious sleep deprivation. Such problems can persist for many years. The severe and persistent symptoms of menopause are one of the main factors contributing to women discontinuing their treatment. Given that doing so can increase the chance that their breast cancer will come back, we have simply got to take this issue seriously.

What can be done? Professor Fenlon of Swansea University believes that cognitive behavioural therapy can help to ease physical symptoms, and is leading a clinical trial to assess how feasible it would be to train breast cancer nurses to deliver it. If clinical trials deem it to be effective, it has the potential to improve the quality of life of half a million women living with or beyond breast cancer in the UK, so I urge the Government to provide the NHS with resources to make the programme available in all our hospitals.

That brings me to the next issue I want to focus on: the geographical inequality in treatments and related services. It is important that the advances that I hope we are about to make in this area benefit everyone. The main CCG covering my constituents is NHS South Cheshire. I am proud to say that it was recently rated outstanding based on four pan-cancer measures, including waiting times, one-year survival rates and patient experience.

However, the report by the all-party parliamentary group on breast cancer states that there is a postcode lottery for breast cancer outcomes. All hon. Members will agree that it is simply unacceptable that women in some areas are more than twice as likely to die prematurely as women who are treated elsewhere. My CCG is set to merge with three others in the near future, and I want to ensure that my constituents continue to see waiting times fall, survival rates rise and the patient experience improve. I was shocked to read that women in some areas are one third less likely to have attended breast cancer screenings in the past three years than women living in other parts of the country.

Patients have had issues accessing off-patent drugs such as bisphosphonates, which were originally licensed for the treatment of osteoporosis but were discovered to be effective in preventing breast cancer recurrence in some post-menopausal women. When CCGs were asked last year whether they routinely fund bisphosphonates for that purpose, only 42—20%—said that they did. At the time, South Cheshire CCG said it was not doing so. I hope that the situation has improved, given that the National Institute for Health and Care Excellence has recently published updated clinical guidelines that recommend bisphosphonates. I am currently waiting to hear back from South Cheshire CCG. Is there an opportunity for the Government to make some specific interventions in the NHS long-term plan to prevent more cases of secondary breast cancer?

There is currently little incentive for manufacturers to license off-patent drugs for new uses in breast cancer. Breast Cancer Now is calling on the Government to introduce a catalyst fund in the NHS long-term plan to provide that incentive. That would make it quicker and easier for patients routinely to access cheap off-patent drugs. Breast Cancer Now commissioned York Health Economics Consortium to model how many lives we could save if the best outcomes were reached everywhere. It found that more than 1,100 lives could have been saved in 2016 if all CCGs in England had been able to reduce their mortality rates to match the lowest. Geographical inequality is not just an issue of principle; we have the potential to save lives, and if we save only one life, does that not make it worth addressing?

I would be grateful to hear from the Minister about the steps he is taking to facilitate the sharing of best practice between cancer alliances to reduce those variations. What conversations has he had with the Chancellor and his Treasury colleagues to ensure the long-term funding of cancer alliances?

If cancer alliances are properly to invest in the future of services and plan strategically, we must provide them with multi-year budgets. The APPG’s report on geographical inequality highlights that there are still worrying gaps in data collection, including in relation to the number of people living with secondary breast cancer. It is absolutely essential that we improve the cancer dashboard with more detailed performance data. After all, identifying and understanding these inequalities is the first step towards addressing them.

Universal Health Coverage

Steve McCabe Excerpts

Thursday 5th July 2018 Westminster Hall

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Steve McCabe (in the Chair)]

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

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 6th February 2018 Commons Chamber

[Steve Brine]

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

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

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

[Mr Hunt]

Public money is public money, and Members have a right to know how it is being spent, so we will absolutely ensure that those contracts are signed in a fair way.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Dunne]

An all-party parliamentary group has been established this week, I believe, to take this issue forward, and I look forward to speaking to that group, if invited, next month. The remedial order will follow due parliamentary process, which involves its being laid for 60 days and then, after an interval, for a further 60 days.

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

There have been 15,000 violent assaults on mental health workers in the west midlands over the last five years. What is the Government’s response to the Care Quality Commission’s opposition to routine searches of all mental health service users for weapons on admission or return to acute in-patient units?

[Mr Hunt]

I have a great deal of sympathy with what the hon. Gentleman has said. We are putting a lot of effort into patient safety and staff safety in mental health trusts, and we are discovering that there is a wide variation between practices. The hon. Gentleman has made an important point, and, if I may, I will write to him to inform him of our progress.

Deafness and Hearing Loss

Steve McCabe Excerpts

Thursday 30th November 2017 Westminster Hall

[Steve McCabe (in the Chair)]

I draw hon. Members’ attention to the fact that our proceedings are being made accessible for people who are deaf or have problems with hearing, and the interpreters are using British Sign Language. If Members bear that in mind while making their contributions, that will be helpful for everyone.

--- Later in debate ---

[Jim Fitzpatrick]

On a point of order, Mr McCabe. I asked my staff to monitor the transmission of the sign language. It is not being broadcast; the cameras do not meet the interpreters. Westminster Hall debates do not have subtitles, unlike in the main Chamber. Obviously I would very much appreciate it if you took that matter back to the Panel of Chairs and discussed it in due course.

[Steve McCabe (in the Chair)]

I understand that the sign language is being filmed today, and when the debate is re-broadcast it will appear in a box, as is normal in other TV transmissions. Obviously this is an early stage. I will report back on how the whole debate goes and any points that Members raise, but I understand that the arrangements for today are that when the debate is re-broadcast, the sign language will appear.

[Jim Fitzpatrick]

I am grateful for that clarification, Mr McCabe.

Children’s Oral Health

Steve McCabe Excerpts

Tuesday 31st October 2017 Westminster Hall

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

I beg to move,

That this House has considered childhood oral health.

Good morning, Mr Bone; it is a pleasure to serve under your chairmanship today. I am glad that we have been granted this debate by the Backbench Business Committee, because child tooth decay represents a much bigger public health issue than appears to have been recognised so far. It is a problem affecting millions of children, including some of the most vulnerable. It should be a real concern to us all.

As well as thanking the various parties for their help in raising this matter, I also want to thank the Faculty of Dental Surgery at the Royal College of Surgeons and the British Dental Association for their efforts in helping to bring this issue to Parliament’s and the public’s attention.

Public Health England reports that 25% of all five-year-olds in England experience tooth decay in at least three to four of their teeth, and that in some parts of the country it can affect as many as 50% of all five-year-olds. Perhaps not surprisingly, there is a link between deprivation and childhood tooth decay, with the poorest areas suffering the worst levels of oral health and the least contact with dentists. A report, shortly to be published by the Nuffield Trust and the Health Foundation, shows that five-year-olds eligible for free school meals are significantly less likely to attend dental check-ups and have more difficulty in finding an NHS dentist.

If we look at the scale of the problem, we will see that more than 45,000 children and young people aged 0 to 19 were admitted to hospital in England over the past year because of tooth decay. They included 26,000 five to nine-year-olds, making tooth decay the leading cause of hospital admissions and emergency operations for that group. Last year more than 40,000 hospital operations for tooth extractions were performed on children and young people, which is the equivalent of about 160 operations every single day.

[Catherine West (Hornsey and Wood Green) (Lab)]

My hon. Friend is making an excellent speech. Does he agree that it is extraordinary that it appears that more children go into hospital because of poor oral health than because of broken arms, whereas when we were children it was definitely the other way around?

[Steve McCabe]

I absolutely agree with my hon .Friend. That gives us some sense of the scale of the problem.

Those 160 operations every single day are not only detrimental to the health and wellbeing of the children; they are also costly to the NHS. In the financial year 2015-16, more than £50 million was spent on tooth extractions for those aged 0 to 19. The average cost of a tooth extraction for a child up to the age of five is approximately £836, and there were some 8,000 such procedures during 2015-16. Dental treatment is a significant cost to the NHS, with spending in England amounting to £3.4 billion on primary and secondary dental care.

In Birmingham, 29% of five-year-olds suffer from tooth decay, which is significantly higher than the national average. Five-year-olds in Birmingham are three and a half times more likely to suffer tooth decay than those in the South West Surrey constituency of the Secretary of State for Health, and yet Birmingham is a city with fluoride in the water. In Manchester, where the water supply is non-fluoridated, the percentage of five-year-olds with tooth decay is 4% higher than in Birmingham. Hospital admissions related to tooth decay for those under the age of 18 in Birmingham have almost doubled in the past four years.

The way in which data are collected and the regional nature of the information sometimes mask the scale of the problems in the same towns and cities. We know that 20% of five-year-olds have tooth decay in south-east England, compared with 34% in north-west England. In Sutton Trinity ward in the Sutton Coldfield constituency, the figure is less than 10%, but the figure for another part of the same city—the Selly Oak ward in my own constituency—is 47%, which is almost twice the national average. Shocking as those figures might be, tooth decay is almost entirely preventable.

Many health experts now agree that early tooth decay can have a broader impact on health and wellbeing, affecting physical and mental health, and impacting on the child’s development and confidence. Poor oral health can also cause children problems with eating and sleeping, which often results in time away from school. Public Health England has conducted research on the number of school days lost due to tooth decay in north-west England. It shows that the average number of days lost per year was three, but many children missed as many as 15 days owing to dental problems.

Some might wonder why childhood tooth decay matters, because children lose their primary teeth which are replaced by new, permanent teeth. The issue is that a high level of disease in primary teeth increases the risk of disease in the permanent teeth. The child’s self-confidence may also be damaged. More than a third of 12-year-olds said in a recent survey that they are embarrassed to smile or laugh because of the condition of their teeth, and that can often make it harder for them to socialise.

So what can we do? There seem to be three crucial steps to addressing the problem: getting children to brush their teeth twice a day; ensuring they see a dentist regularly from a young age; and reducing the amount of sugar that children consume.

Scotland has been running an educational programme called Childsmile since 2001, which has been credited with making a significant improvement to children’s oral health. The programme supports supervised tooth brushing sessions in primary schools and nurseries, as well as providing twice-yearly fluoride varnishes. Perhaps we will hear more about that later.

A similar initiative, Designed to Smile, was introduced in Wales in 2009. Teeth Team, which is supported by Simplyhealth, has invested £137,000 in a dental programme that takes dental education directly to children in local primary schools in the city of Hull.

[Wendy Morton (Aldridge-Brownhills) (Con)]

Teeth Team has visited one of the schools in Brownhills in my constituency. Does the hon. Gentleman agree that we need to further consider such innovative new schemes and other ways to educate children on dental health and tooth-brushing?

[Steve McCabe]

I absolutely agree with the hon. Lady. An education programme for young children and their parents is crucial. I want the Government to play a bigger role, but there are other approaches, too. As I have said, Simplyhealth is supporting the venture in the city of Hull and in East Riding of Yorkshire, as well as in the hon. Lady’s constituency.

A pilot programme called Starting Well is about to commence in 13 areas of England, although none of those pilots will be in Birmingham or the west midlands. I would be grateful for details of the pilot. How long will it run? How will it be evaluated? How were the 13 areas selected? It would also be useful to know exactly how the programme is being funded.

A new initiative by the British Society of Paediatric Dentistry, “Dental Check by One”, is seeking to raise awareness of the importance of getting young children to attend the dentist from an early age. It is supported by organisations across the dental professions. I am pleased to report that it is due to launch in Birmingham tomorrow, despite some torturous negotiations about funding. It seems likely that funding issues will prevent it from being implemented by other regional NHS teams.

What else might be done? Has any consideration been given to proposals from the Faculty of Dental Surgery to use school breakfast clubs to deliver supervised tooth brushing sessions? Analysis by Public Health England has suggested that if public health professionals such as health visitors are involved in supporting oral health improvement programmes, that can lead to significant improvements and long-term savings. Health professionals who have regular contact with children, such as midwives, health visitors, school nurses, pharmacists and early years practitioners, are all ideally placed to help identify children who may be at risk of tooth decay.

Equally, dentists look at all the soft tissues in the mouth and are often able to help identify a number of conditions, from diabetes and Crohn’s disease to oral cancer. According to recent figures on dental attendance, 42% of children aged 0 to 17 did not visit an NHS dentist in the 12 months to 31 March 2017.

[John Grogan (Keighley) (Lab)]

Does my hon. Friend share my concern that a cursory review of the NHS Choices website yesterday showed that there are many areas of the country, including Keighley, where there is no advertising at all of dentists who are available to take on new children as patients? Might one answer to the age-old problem of poorer areas having fewer dentists be an expansion of salaried dentists in the NHS?

[Steve McCabe]

There is certainly an issue with access to dentists in some areas, although it is probably also true that some parents need to realise that visiting the dentist is free for children. There is certainly a question about how we incentivise dentists and provide better coverage.

As I was saying, 42% of children did not see an NHS dentist in the 12 months to 31 March 2017; in Birmingham, that figure is 47%. The Faculty of Dental Surgery has reported that, in the same 12 months, 80% of children aged between one and two did not see a dentist, but official advice recommends that children begin dental check-ups as soon as their first teeth come through, which is usually at around six months.

We may need to reconsider certain elements of existing dental contracts to see if we can better incentivise some dentists to pursue a preventative dental strategy with children. At present, three visits for fluoride treatment equal one unit of dental activity, which is roughly worth about £60 to the dentist. Perhaps we should look at that again. I am sure that both the Minister and local authority public health officials will be keen to remind me about money if I urge greater activity, but I remind hon. Members that parliamentary questions have revealed a clawback of £95 million through undelivered units of dental activity in 2013-14, rising by 36% to £129 million in 2016-17.

Dentistry remains a highly siloed service in the NHS and has been largely neglected from future NHS plans, such as the five year forward view and sustainability and transformation plans. As I have said, education programmes and regular visits to the dentist are needed if we are to begin to tackle the problem, but we also need action to tackle sugar consumption.

There are question marks over how likely the soft drinks industry is to meet the targets agreed under the voluntary reformulation programme. Earlier this year, the Food and Drink Federation announced that it was unlikely to comply with the optional 20% reduction in sugar content by 2020. It has also been revealed that it will be March 2018 before we even know whether the industry has achieved the first target of a 5% reduction by August of this year.

We desperately need to make significant progress towards reducing the amount of sugar in soft drinks and other products. The Government need to look again at their obesity strategy. As luck will have it, it is Sugar Awareness Week. What better time could there be for the Government to seriously consider the suggestion of the Local Government Association and others that we introduce teaspoon labelling on the front of high-sugar products? We should certainly look at advertising, and consider a ban on two-for-one offers and other price promotions on high-sugar products.

Childhood tooth decay is a problem that affects millions of children. It can be extremely painful and it often results in costly tooth extractions under general anaesthetic. Addressing tooth decay is not complicated; we know what works, and the actions I have outlined today could make a real difference. I hope that the Minister will consider those arguments, and that he is in a position to tell us that the Government are considering a series of preventative measures so that good oral health can be enjoyed by all our children.

[Several hon. Members rose—]

--- Later in debate ---

[Dr Whitford]

I thank the hon. Gentleman for that intervention. I was not trying to give any other impression. I said that the core programme is the education of 90,000 children about how to clean their teeth and discussions with their parents about that. The problem is that we waste an opportunity if we stop there. There needs to be a link between health visitors, nurseries and dental practices, and there certainly needs not to be a contract that punishes and penalises dentists for investing in patients. The fact that dentists do not have long-term registered patients means that they do not look at patients with a long-term view and say, “If I do more work now, they will have better dental health later.”

In Scotland, 92% of the population is registered; the number of people who are registered has risen from 2.6 million to 4.9 million. Registration is actually higher in deprived areas than in rich areas. Unfortunately, attendance is not always higher, but people are at least already registered with a practice.

[Steve McCabe]

The hon. Lady is making an excellent speech. I am conscious that this debate is about children’s oral health, but does she accept that, given the growth in the elderly population, the problems that she has indicated will only get worse if we do not have better registration and intervention?

[Dr Whitford]

I totally agree. In so many areas, the health of an adult—even an elderly adult—is actually laid down in their first five years. That is nowhere clearer than in dental health. Laying down good foundations in childhood is critical to allowing many more older people to have healthy teeth and, in particular, healthy gums—in the end, more tooth loss is due to gum disease—and to hang on to their teeth. Registration is important, because it gives people a relationship with a dentist. For people who are frightened of the dentist, knowing their dentist and having access to extra support such as hypnosis, if that helps, is valuable.

Childsmile costs £12 million a year in Scotland in terms of total dental health, but it has saved £5 million in dental treatments and extractions. We heard from the hon. Member for Birmingham, Selly Oak (Steve McCabe) about the money that is coming back. That could be used to set up a programme in England. I welcome the pilots, but those are in only 13 of the 23 worst areas in England. Why do the UK Government feel that they need to pilot? The evidence is there from 10 years of Childsmile in Scotland. If they just looked at the data and designed a national programme for England, in the end they would save not just money but children’s dental health.

--- Later in debate ---

[Steve McCabe]

I thank the Minister and all Members who have taken part in a thoughtful and well-informed debate. I think that £130 million a year clawed back by the Treasury in unused units of dental activity could be put to much better use, and I wish the Minister well in his battle with the Treasury on that.

I was pleased to hear what he said about the dental contract, although I think that two years is a bit long when so much more coverage is required. Obviously, I would like education programmes to be rolled out as quickly as possible across the country, because that is key to what we are trying to achieve. I personally think that we need an even bigger push on sugar, and particularly sugar promotion, as that will make a massive difference to all children.

Question put and agreed to.

Resolved,

That this House has considered children’s oral health.

NHS Shared Business Services

Steve McCabe Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

I am happy to confirm that. I think that in such situations it is important to allay public concerns about what might have happened. What happened was unacceptable, but no patient data were lost.

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

The Secretary of State says that no patients were harmed and that the documents were securely stored, but 35 sacks of mail were destroyed. How does he know that he made the right call in every situation?

[Mr Hunt]

Just to be clear, what I said was that to date there is no evidence of any patients being harmed, but the process of proper clinical review, with multidisciplinary teams, will take until the end of the year. We have to do this properly to get to the answer. We hope that it remains the case that no patients were harmed, but we will not know that until the end of the year. However, throughout this whole process we have prioritised the highest risk cases and made sure that they get the most urgent attention.