Liver Disease and Liver Cancer

Alison Thewliss Excerpts

Thursday 25th April 2024 Westminster Hall

[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to see you in the Chair, Sir Christopher. I am very grateful to the British Liver Trust for its comprehensive briefings and support for this debate. The Alan Morement Memorial Fund, the cholangiocarcinoma charity, has also provided a very helpful briefing on liver cancer.

I often do not speak in debates on health matters, because they are devolved to the Scottish Parliament, but I have a personal link to this issue. My husband, Joe, was diagnosed with stage 2 non-alcoholic fatty liver disease in 2019. He has taken significant efforts to deal with that condition, because when caught at that stage it is reversible. Like many men, he did not go to the doctor for far too long, and he had that diagnosis when he finally went to get it checked out. He has been clear that tackling it has been challenging—we consciously have to do an awful lot more to keep ourselves healthy; we live in an obesogenic, alcohol-focused environment, so there are always things to tempt us back into bad habits—but he continues to go on with that challenge.

Joe has talked about the stigma around the disease. Almost three quarters of people with a liver condition have experienced stigma, and almost a third feel that it has prevented them from receiving medical care. It often comes from the association of liver disease with alcohol misuse and viral hepatitis. We must do everything we can bust that stigma so that people go and get the treatment they require as soon as possible, rather than putting it off, because the risks of doing so are very serious.

I also want to mention the read-across to the contaminated blood scandal. Some of those infected with hepatitis C did not know they had been infected because of the subsequent cover-up of their medical records, and some did not find out until serious damage had been done to their livers. For some, the news sadly came too late. I have heard stories at the all-party parliamentary group on haemophilia and contaminated blood about people whose death certificates cite chronic alcoholism as the cause of the disease, even though they had never touched a drink. There is a real stigma around liver issues, which we must do our best to bust.

We have a public health emergency that the Government ought to take very seriously indeed. Liver disease and liver cancer continue to be significant issues in Scotland. Liver disease is a leading cause of premature deaths in Scotland, above breast cancer and suicide, and deaths due to chronic liver disease in Scotland have increased by 85% in the last three decades. There was an impact during the pandemic, as the hon. Member for Stockport (Navendu Mishra) and my hon. Friend the Member for East Renfrewshire (Kirsten Oswald) also mentioned. I think that speaks a little to the alcohol culture that we are all focused on. I mean, how many people have heard the phrase “wine o’clock”? It has been minimised and reduced to not really mattering at all, but that alcohol culture leads people into harmful habits, and society downplays that.

I was glad to see the Scottish Government respond to the alcohol culture with minimum unit pricing, which has reduced the consumption of alcohol in Scotland by 3%, reducing deaths wholly attributable to alcohol by 13.4% and hospital admissions due to chronic conditions such as alcohol-related liver disease by 4.1%. Alcohol-specific deaths have risen more slowly in Scotland than in England, highlighting that the situation could have been much worse had Scotland not taken the bold step of introducing minimum unit pricing. The greatest harm reduction impact has been among the more deprived groups in Scotland, so there is an important protective factor.

Will the Minister consider bringing in minimum unit pricing in England? The small weakness of minimum unit pricing is that it puts the profits back into the hands of those selling the alcohol, because we do not have full control over the taxation system for alcohol in Scotland. It would be incredibly useful if we had all those powers in Scotland, but an intervention in England might provide an opportunity to do that. Removing the duty escalator on alcohol has meant that alcohol has got relatively cheaper.

I also want to mention the work happening in Scotland, which is showing signals of incremental improvements following the Scottish Government’s focus on prevention and earlier diagnosis. The same progress has not been seen in England, where liver disease mortality rates are at their highest level in decades; hospital admissions for liver disease have risen by almost 80% over the last decade alone.

In Scotland, by comparison, liver disease death rates between 2021 and 2022 decreased from 17.9 per 100,000 to 17.4 per 100,000, and hospital admissions caused by liver disease decreased by 1.5% between 2021-22 and 2022-23. My own health board area, Greater Glasgow and Clyde, has seen the largest fall in chronic liver disease death rates, which is really quite impressive given the health challenges that we have faced. That is quite significant.

When the British Liver Trust “Love Your Liver” roadshow was on Argyle Street in my constituency, I was struck by the number of people interested. Glaswegians are a very curious bunch; you cannot do anything without somebody asking a question and stopping to find out what is going on. People were like, “Oh, a liver test. I’ll queue up and wait for my liver test in a van in the middle of the city centre.” Around 100 people were scanned that afternoon and 15 of my constituents were later given a referral to their GP as a result, so there needs to be more testing and encouragement of people to go forward and check. It really is important.

Such screening in a community setting is a lifesaving intervention—we should make no bones about that. People should be able to access that at a simple community level. I am sure many colleagues in this place will have had their liver scanned in Parliament, which was welcome. Fibroscan readings have been reassuring in a lot of ways although, with health charities’ propensity to come in and do tests on MPs, I am sure they will find something wrong with me at some stage. However, it is welcome and important that people feel they can go for tests and that there is not a stigma in doing so.

So, there has been progress in Scotland. The intelligent liver function testing pathway developed by the University of Dundee uses an automated algorithm-based system to further investigate abnormal liver function test results based on initial blood samples from primary care, so further important development is happening in Dundee. I am sure the Minister would be interested to hear that the technology is also cost-saving to the NHS by over £3,000 a patient, which is significant. The tests are now being rolled out and piloted in parts of England.

I will touch on what my hon. Friend the Member for East Renfrewshire said about austerity and its impact on public health. The Glasgow Centre for Population Health in my constituency has done a lot of research into the subject over the years. It says that the years of Tory austerity have cost people dearly, through damage not just to public health services but to people’s life outcomes. My hon. Friend was correct to point out further cuts to social security for people from the Westminster Government, because that makes it more difficult for people to make good and healthy choices in the foods they buy and the lifestyles they have. The Glasgow Centre for Population Health said that it will take another decade just to get us back to where we were in 2010. That is 20 lost years of people’s good health, which will have a significant impact for a long time to come.

[Navendu Mishra]

The hon. Member is making an excellent speech. We already know that people who live in lower-income and more deprived areas have a lower life expectancy than people who live in more wealthy areas. The data from Alcohol Change UK tells us that people from more economically deprived groups experience higher rates of liver cancer and are less likely to receive treatment. There are also higher rates of liver cancer among people from Asian and black African backgrounds than among people from white backgrounds. That tells us that people who have a lower income or live in more deprived areas will die sooner. On the hon. Member’s point about austerity, does she agree that the Government have not done enough in the last 14 years to address the issues?

[Alison Thewliss]

I absolutely agree. I see that very much from the varied communities that I represent. It is baffling that the more recent Marmot findings have come as a surprise to some in government. I remember doing modern studies at high school and learning about the Black report and the inverse care law. It feels as though this Government are no further forward. In fact, in some respects they are much further back in tackling long-lasting health inequalities.

I shall now discuss the public health aspects. The Scottish Government are consulting on advertising restrictions on food and drinks that are high in fat, salt and sugar, which again are disproportionately marketed towards children and vulnerable groups. That marketing is also found in poorer areas, where there is often a lack of availability of fresh fruit and vegetables. That is significant because one in four children with obesity are estimated to have fatty liver disease, which has huge implications for their health and wellbeing for the future. It is caused by an accumulation of harmful fat in the liver and is present in around 70% of people who are overweight and obese. Fatty liver disease and excess weight together significantly increase the risk of premature death due to cardiovascular disease and a range of cancers, including liver, colon, breast, prostate, lung and pancreatic cancers.

Although Scotland tries to do its best within the devolved settlement that we have, sadly a number of key commitments from the UK Government to curb childhood obesity are yet to be implemented, including the 9 pm watershed plans to protect children from junk food advertising on TV and the ban on multibuy junk food deals. We have brought in some of those things in Scotland where we can. It does make a small difference but an awful lot more needs to be done, particularly for those in younger age groups. They are being targeted with all kinds of multiple snack-type foods, which are largely unnecessary. Both Labour and the Tories need to stand up to the multinational companies that wish to push those foods on our young people. These things do not come cost-free, certainly not to society.

Will the Government build on the simple, cost-effective diagnostic pathways already in place across the devolved nations? Will they commit to sustainable funding in the next spending review for new technology to improve earlier detection of liver disease? The fact that early intervention—that technology—can permit treatment before things get worse is significant. Will they also introduce a new nationally endorsed pathway to improve early diagnosis, and will they ensure that every community diagnostic centre can provide an assessment for fibrosis? All of those things will help to improve this public health emergency that we have.

It is important that we have discussed the issue today, but I hope that the Minister will listen and make the changes that she can, and that the Labour Front Bench, should they form the next Government, take this seriously. The alcohol-soaked and obesogenic society that we have poses fundamental challenges that Government should intervene on to prevent the next generation of people developing liver disease and liver cancer; we can prevent that progression if the public health imperative is there.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I have to say that I am a bit disappointed, because the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), in particular, knows very well my personal commitment to the best start to life, so to hear her saying that the Government have done nothing and Labour is going to fix it is a bit rich, but there we are.

I congratulate the hon. Members for Stockport (Navendu Mishra) and for Glasgow Central (Alison Thewliss) on securing this important debate; it is an absolutely vital debate. All hon. Members, including the hon. Members for East Renfrewshire (Kirsten Oswald) and for Washington and Sunderland West (Mrs Hodgson), have raised the importance of prevention, early intervention and, in particular, early diagnosis. I commend them all for doing that. The Government are taking significant steps. The hon. Member for Glasgow Central talks about what the Scottish Government are doing. I can absolutely assure her that the Government of the United Kingdom are totally committed to improving early diagnosis and treatment, and I will go on to explain exactly what we are doing.

First, it is important to set out that we know that there are 6,000 new cases of liver cancer each year, making it the 18th most common cancer, with 5,000 deaths a year; that is 5,000 deaths too many. As my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) said during his tenure as Health Secretary, regional inequalities are “the disease of disparity”. He was absolutely right because—as the hon. Member for Stockport stated in his opening speech—economic and health inequalities go hand in hand.

Blackpool is a perfect example. It is one of the most deprived cities in England and flashes red on every indicator—for life expectancy, alcohol dependence and liver cancer. No fewer than 40% of the people unemployed there are not fit to work due to ill health, and the rate of death from chronic liver disease is almost two and a half times the average for England. That is an area that I have visited a number of times, to visit its family hubs and to look at the excellent work and huge efforts that go on there to level up to improve the disparities. Nevertheless, there is so much more to be done, and our strategy to eliminate disparities in liver disease and liver cancer is based on two key facts.

First, 90% of liver diseases are caused by alcohol dependency, obesity or viral hepatitis. Secondly, the five-year survival rate for liver cancer is only 13% precisely because people do not come forward with their symptoms until it is too late; early detection is vital. We know what causes liver disease, and we know that diagnosing it more quickly will save thousands of lives. That is why prevention and diagnosis are the twin pillars of our strategy to end inequalities in liver disease and liver cancer across our country.

To be clear, this is not about criticising people for drinking alcohol, but stopping the level of drinking that leads to liver disease and liver cancer. We know that rates of alcohol dependency are double in the most deprived local authorities. That is why, in December 2021, we published our drugs strategy, which does three things. First, it has brought the greatest-ever increase in funding —an extra £780 million—for drug and alcohol treatment, over £500 million of which is going straight to local authorities with the highest levels of deprivation and alcohol dependence. Secondly, the strategy is boosting screening capacity for liver disease, and thirdly, it is beefing up referral pathways to build a seamless system from diagnosis to treatment.

Since we published our strategy, we are treating more people than ever before for alcohol use. In February, almost 135,000 people were receiving treatment, compared with just over 117,000 just under two years ago, which is an increase of more than 15%. NHS England is investing almost £30 million to bring specialist alcohol care teams to hospitals in the most deprived parts of England. Those experts in addiction identify people in hospital with alcohol dependence, start their treatment and refer them to local authority community services where they can complete their treatment, overcome their dependence and move forward with their lives. I pay tribute to all those brilliant clinicians who are helping vulnerable people to turn their lives around.

Obesity is another major risk factor for liver disease and is a real scourge on the poorest parts of our country. During last week’s debate on the Tobacco and Vapes Bill, we came under fire from hon. Members on both sides of the House who said, “Well, what about sugar? Are you going to ban that too?” This Government are not in the habit of banning things, but I am proud of our record on sugar reduction, healthy eating and obesity.

We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks industry levy: we almost halved the sugar content in soft drinks between 2015 and 2019. I want to make the point that that is not with people saying, “Oh, this drink I used to like, I don’t like it anymore because it’s not sweet enough,” but was actually the result of reformulation that nobody noticed, which is the great thing about reformulation. If we can reduce the sugar, salt and fat content in foods so that people can carry on as normal without having to undertake some punishment routine, that is a good way to tackle the obesity problem.

[Alison Thewliss]

Having paid close attention to the sugar tax when it was brought in, there was a particular exemption in the products that required reformulation. Milkshakes could contain as much sugar as any of the full-fat fizzy drinks, but were somehow exempted because they had milk in them. Will the Minister perhaps take the opportunity to go away and think about whether they ought to be contained within a future iteration of the scheme?

[Dame Andrea Leadsom]

The hon. Lady will not be surprised, because she knows me well, that I am absolutely determined to tackle childhood obesity in particular, so that we can reverse the problems that we have seen in recent years, especially the spike in unhealthy eating and overeating during the covid pandemic. We know that people—both adults and children—are consuming too many calories. As she would expect, I am all over this and I am happy to debate any point with her. I agree on the sugar content in milkshakes, but there are many other foods that we also need to focus on. I hope I can reassure her on that.

For two years, we have been restricting the placement of less healthy products in shops and online to help consumers to make healthier choices. We are building on that progress. By the end of next year, further restrictions on price promotions on television and three-for-the-price-of-two offers in shops will come into force. I have been encouraging the big takeaway companies, the big supermarkets and so on to try to do it anyway— to get ahead of the regulations and to take action now. A number of them, I am pleased to say, are doing just that.

I am also pleased to update the House on the recent success of the NHS digital weight management programme. This week, the Obesity journal published a study showing that almost 32,000 people achieved sustained weight loss with the programme over a single year, which is really positive news. The programme is helping people from deprived backgrounds: more than a third of those referred were from black, Asian and minority ethnic communities. It is obviously early days, but there are positive signs.

The other major contributor to liver disease is hepatitis. Thanks to increased testing and improved access to treatment, we have reduced the number of people living with chronic hepatitis C virus in England by more than half since 2015. Deaths related to hepatitis C have fallen by just over a third since 2015, well above the World Health Organisation’s 10% target.

Liver disease is known as the silent killer because many people are unaware of their condition until it is too late. That is why, as part of our ambition to detect 75% of cancers at an early stage by 2028, NHS England has launched the early diagnosis programme for liver cancer, which aims to prevent liver cancer by actively checking for liver disease in our most deprived areas.

An important part of the early diagnosis programme includes 19 community liver health check pilot sites that were launched in 2022. The most recent data shows that the CLHC programme reached more than 7,000 people in our most deprived areas using mobile units between June ’22 and January ’23. These units are equipped with fibroscans, which is a fantastic new technology, as many hon. Members have mentioned, for detecting liver damage and identifying liver disease before it becomes life threatening. These non-invasive tests have diagnosed more than 830 patients with cirrhosis or advanced fibrosis. I am pleased to update hon. Members that there are now eight community diagnostic centres providing fibroscans and a further 14 planned.

For my entire career, I have fought for the principles of fairness and equal opportunity—from helping children and babies in deprived areas to get the best start in life to levelling the playing field for small businesses when I was Secretary of State for Business, Energy and Industrial Strategy and encouraging young women in my constituency to get into politics. I have done that throughout my career and I will not stop now. I am passionate about making our health service faster, simpler and fairer for all who use it, and tackling liver disease and liver cancer is at the heart of that mission. We have already delivered significant progress and, through prioritising prevention and driving early diagnosis, we have a plan to go further and faster in the years ahead.

Oral Answers to Questions

Alison Thewliss Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Victoria Atkins]

I thank my right hon. Friend for his question, and of course for his integral role not just during the pandemic, but in setting up the UKHSA. He will understand that I and others are keeping this under very close review, and the chief medical officer is briefing me as and when needed.

[Alison Thewliss (Glasgow Central) (SNP)]

T9. I have had concerns raised about a company based in England but operating across the UK online that shape shifts and is known variously as Young Vibes, Peaky Parents, Kactus Kids, “themumsnet” and, currently, Anxiety Recovery. It offers to fix children’s anxiety in mere weeks, but it is preying on vulnerable families, drawing them into expensive treatments, and inciting them to take out loans and get into debt. It is operating outside regulatory frameworks, so may I ask what Ministers can do about such unscrupulous and exploitative companies?

[Victoria Atkins]

The hon. Lady raises an important point, and I ask her to write to me, please, so that we can look into it.

Tobacco and Vapes Bill

Alison Thewliss Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Alison Thewliss (Glasgow Central) (SNP)]

The proliferation of vapes has happened almost overnight. Does my hon. Friend share the concerns of my constituent, who runs a newsagent and tobacconist, that he is holding the fort on legislation about the sale of tobacco, yet vapes are not subject to the same controls? He may refuse somebody because he does not think they are of age to buy a vape, but he finds they just go down the street to purchase it at another shop that does not have the controls and responsibilities that he has as a tobacco salesperson.

[Kirsten Oswald]

I am grateful to my hon. Friend for making that important point. I can understand the concerns of her constituent; these devices are far too accessible and far too easily available. They are in all of our schools and on all of our high streets. We need to open our eyes to the damage that is being done. ASH Scotland does great work in that regard. It tells us that, in Scotland, data from the health behaviour in school-aged children survey showed that current e-cigarette use—that means those who have used them in the last 30 days—among 15-year-olds increased from 7% in 2018, which I would have thought was scary enough, to a horrifying 25% in 2022. Obviously we are a bit beyond that now, so I wonder exactly what the figure is, but we have heard enough in the Chamber today to know that, whatever that current figure is, it should cause us grave concern.

These products are designed to be attractive. They are undoubtedly attractive—we have all seen them. They are disposable, so young people can chuck them before their parents find out, they are pocket-money prices, and they are appealing—green gummy bear flavour, anyone? In fact, the green gummy bear flavoured one is on sale for £1.50, which is a disgrace. Vapes should not be accessible in that way, and should certainly not be sold at £1.50. They could not be designed any more obviously to attract young people. Very often, we are talking about children who have never smoked, but who are now getting hooked on these vapes and getting hooked on nicotine. There is also the worry about the unknown harms that vapes cause to their bodies and their health. The sooner that we can change all of that the better.

I also have a personal gripe: vapes being advertised via sports. There is no reason for that—no justification at all. Yes, I am looking at Blackburn Rovers among others. When I raised the matter previously, Blackburn Rovers, based in the vaping capital of the UK, said:

“At no point during our long-standing relationship has the idea that the Totally Wicked brand might appeal disproportionately to children been raised, and we have seen no evidence to suggest that our sponsorship has encouraged an uptake of vaping among children.”

Well, I am raising it, and raising it again. I urge all sports clubs—because there are others—to have serious thought on this. We want to see our sporting heroes as positive influences on our young people and their health and wellbeing.

To be clear, I support measures to help people stop smoking. It is hard to do and all help is welcome, but that help does not come in the form of candy-coloured, candy-flavoured, pocket money-priced disposable vapes. Let us deal seriously with smoking cessation. Let us deal seriously with the terrible harms caused to our young people by disposable vapes, and let us have the backbone to take the chance now to stop smoking killing so many of our loved ones.

I wish to end by reflecting on the words of William Roberts, chief executive of the Royal Society For Public Health, who said:

“Smoking continues to cut lives short, killing up to two in three long-term users, and placing significant strain on an already overstretched health and social care system. Protecting future generations from the dangers of tobacco is vital if we want to build a healthier future. It is vital that the Bill passes and MPs of all political stripes put prevention at the heart of public policy when it comes to protecting our health.”

I sincerely hope that we do.

Oral Answers to Questions

Alison Thewliss Excerpts

Tuesday 5th March 2024 Commons Chamber

[Victoria Atkins]

Let me put on record my admiration for my hon. Friend’s action in sharing her own experiences in order to improve healthcare for women across the country. She will know of yesterday’s important announcement about suicide prevention, elements of which addressed exactly the concerns that she has rightly raised. Thanks to her hard work, we have also announced that within eight weeks or so of giving birth mums will be asked by GPs whether they are okay, and we hope very much that that will open up the conversation with women who may be struggling.

[Alison Thewliss (Glasgow Central) (SNP)]

Amma Birth Companions has just been recognised in the 2024 GSK IMPACT awards. The charity is doing really important work to support vulnerable asylum seekers and refugees who would otherwise face giving birth alone. Will the Secretary of State meet the charity to discuss its work and research, given the disparities that continue for this group of women?

[Victoria Atkins]

The hon. Lady describes a very interesting piece of work. I will ask my ministerial colleague to meet the charity, as we want to support women. Indeed, part of our work across the women’s health strategy is ensuring that maternity services are not just safe, but trusted by mums-to-be.

Cost of Living: Healthy Start Scheme

Alison Thewliss Excerpts

Tuesday 23rd May 2023 Westminster Hall

[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to see you in the Chair, Mr Twigg. I thank the hon. Member for Stretford and Urmston (Andrew Western) for bringing this important debate to Westminster Hall. As the chair of the all-party parliamentary group on infant feeding and inequalities, I have worked on this issue for many years. The cost of formula is not a new problem; it is a continual problem, and one that the UK Government have completely ignored for many years.

A number of years ago, the all-party group did some research on the cost of formula. Even at that time, it was already a struggle for many families. Despite all the evidence, the Government did nothing about it. I have asked questions about inflation and the cost of infant formula, and the Government have said that they are monitoring it. Monitoring is one thing, but actually doing something about it is quite another.

I was glad to see the hon. Member for Stretford and Urmston introduce the debate. I am also grateful to Sky News, which has done stellar work in exposing the many, multifaceted impacts that the cost of infant formula is having on families up and down these islands. Sky News has been out there listening to people’s heartbreaking stories, and telling them. In 2023, we should not have people foraging on Facebook or stealing from shops to feed their babies. It is absolutely desperate.

As hon. Members have said, there is nothing more distressing than a hungry baby. The Minister needs to be dealing with this issue as a matter of urgency. Quite frankly, the Prime Minister is living in a different world if he suggests that the Healthy Start vouchers are sufficient to meet the needs of families. Not enough people are eligible, not enough people are claiming and the vouchers do not meet the cost of a tub of infant formula. Suggesting that people should somehow fall back on discretionary payments from local councils is not much help to a family with a screaming baby at 3 o’clock in the morning. The Prime Minister does not have a clue.

This issue is vital to the development of babies. Babies’ brain development is crucial to their future health and wellbeing, and not being fed properly at this very young stage can have a significant impact on their development. Families are watering down formula beyond the composition it is supposed to be. If they are adding things to formula, such as flour, rusk or other things, children are not getting the nutrition that they need. If people are buying it on the black market, or buying half tubs off Facebook or from friends, the quality of the milk is not guaranteed. Formula in itself is not sterile and it has to be made up properly. If it has been lying open for a while, it could be unsafe for the baby and cause them health problems.

In addition to that, people are struggling to pay their electricity bills. I am grateful to Mumsnet for providing a briefing for this debate. A person on that website said:

“I used to have a client family, a young couple with a newborn, who were really struggling financially...The poor mum just couldn’t breastfeed her newborn, despite the health visitor’s best efforts...The cost of formula was crippling, even with the healthy start vouchers. To make matters worse, they were being really ripped off for electricity through a coin meter and it cost them about 20p to boil a kettle to make up the formula.”

Families are being hit at all angles.

There is also a risk with bottles of formula that are made up. They should be discarded after a period because they do not remain safe and sterile, but if a family cannot afford the next bottle, they will just keep it and feed it to the baby regardless. In those circumstances, parents will likely feel that some formula is better than no formula at all, despite the risk to the child’s health.

Food price inflation is at 19.2% and general inflation is at 10.4%. I pay tribute to First Steps Nutrition Trust for its long-standing research that tracks the price of formula. It has found that the cheapest own brand, and the only own brand of formula on the market in the UK, has gone up by 45% in the last two years. Other formulas went up by between 17% and 31% in the same period. The market is out of control, and the Government have done nothing to address it.

First Steps Nutrition Trust has pointed out that the situation is much the same for other items people may buy with Healthy Start vouchers, such as fruit, fresh vegetables, bread or milk. The trust says that in 2006 someone could get seven pints of milk with Healthy Start vouchers, whereas in 2023 they can get only 4.7 pints. The money is being stretched in all kinds of ways—not just for babies but for older children too.

Part of the issue is the unregulated nature of the formula market in the UK. According to recent research in The Lancet, formula companies bring in £55 billion annually. They spend £3 billion at least on marketing. That amount adds to the price people pay when they buy a tub at the till. The companies are also spending significant money on developing new products, apparently for specialist needs, but these products can be bought over the counter uniquely in the UK. In many cases, they are not necessarily products the Government have failed to regulate, but desperate families are choosing them as an option.

There are also follow-on milks, which are completely unnecessary. I would say to any families out there spending their precious money on follow-on formulas: do not spend that money. They are simply a tool to market formula. They are not required for children. First-stage formula is perfectly adequate for the first year. Do not waste money. If all first-stage formulas are exactly the same—which they are by regulation—why does one cost £9.39 when a different tub costs £19? The Government have very little curiosity about why there is a variation in these prices if all compositions are essentially the same.

The Government should do an awful lot more to interrogate this industry and make sure there is provision for parents out there. It could be like something of the past—perhaps a plain-labelled Government-branded formula that is accessible to people. The Government should be looking at what they can do. It is very clear that the market left to itself is not able to control the prices. The Government should be stepping in to regulate the price of formula. Formula is unique. Unlike all other food products, it is required by babies; they cannot get nourishment any other way. It is a very different type of food product to everything else.

The hon. Member for Strangford (Jim Shannon) mentioned breastfeeding. As chair of the all-party parliamentary group on infant feeding and inequalities, I am a massive supporter of breastfeeding. It is the best way to feed a baby. For many families, breastfeeding can be very challenging and formula is necessary—if, for instance, the mother has an HIV diagnosis and breastfeeding is contraindicated, they require infant formula. In other families, children may be adopted or there may be childcare issues, so breastfeeding can be difficult. I would always encourage the Government to invest more in infant feeding support, because inconsistency in support, alongside a very rapacious infant formula industry, is undermining breastfeeding in this country. I would like to see full implementation of the international code of marketing of breastmilk substitutes, because that would also help to support families.

I also want to talk about the holes within the system. The Healthy Start vouchers are not keeping up with the pace of things. Families cannot simply rely on food banks or baby banks to provide something as a fall-back option, because, as I have said, infant formula is incredibly expensive and if food banks are trying to feed the most people they can, do they buy a whole load of tins of beans or do they buy one can of infant formula? That is a very difficult position to put food banks in and they should not be the emergency service to make up for where the Government have failed.

I will finish with a point of contrast. As has been mentioned, the Best Start Foods scheme in Scotland, which is a devolved benefit that the Scottish Government have set up, is—importantly—more generous than the Healthy Start scheme. It stands at £9.90 per week in the first year. The Scottish Government have increased that, with inflation, and the UK Government should do likewise with their schemes.

In addition, in Scotland there is the Scottish Child Payment of £25 a week, which makes a massive difference to families; whether they have babies or older children, that is £25 per child per week. And from speaking to people at food banks in my constituency, I know that that is making the difference between families coming in desperate for food or not. That £25 payment is paid up to the age of 16. As I say, it makes a massive difference for families in Scotland and provides a clear contrast with what the UK Government are providing.

In Scotland, we have also looked at increasing the eligibility for that benefit. We are trying to make sure that those who have no recourse to public funds and who would not be eligible ordinarily for Healthy Start vouchers can get the Best Start grant in some circumstances. Of course, if the UK Government would abolish no recourse to public funds, we could give the Best Start grant out to far more people and make sure that all babies are fed, regardless of their parents’ immigration status.

In Scotland, there is also a range of other grants, in addition to Best Start Foods. So, there is a Best Start Pregnancy Payment of £707.25 for someone’s first child and of £353.65 for subsequent children, with no limit on the number of children, unlike the two-child limit for some other schemes. There is also the Best Start Grant Early Learning Payment between the ages of two and three and a half, and a School Age Payment for when a child is old enough to start school.

Those grants are incredibly important in the landscape of benefits available to parents, because families are pressed from all different directions at the moment, whether that is buying school uniforms or putting food on the table. The Scottish Government are making a real difference in this way, by making sure that children are fed and that families are not on the absolute brink of survival. I believe that it is up to the UK Government to meet that challenge, to regulate the infant formula sector and to uprate the payments under the Healthy Start scheme to match—or exceed if possible, which would be nice—what is available in Scotland, because we are doing everything we can.

I thank First Steps Nutrition Trust, Leicester Mammas, Feed UK, the British Pregnancy Advisory Service and the Food Foundation for their work, and I thank the hon. Member for Stretford and Urmston for securing this debate today. There is a lot of work going on and the Government need to meet the challenge that they have been set.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I am grateful to the hon. Member for Stretford and Urmston (Andrew Western) for securing this debate and to the other Members who have participated. The hon. Member for Strangford (Jim Shannon) made a typically compassionate speech.

The Russian invasion of Ukraine has had a global impact. We have seen a rise in inflation, with increased food costs and higher energy prices, and that has impacted on the cost of living. The challenge of the increase in the cost of living is felt by everyone across the country. The Government understand and recognise the challenges that many face as a result of the huge increase in inflation.

The Government have taken, and will continue to take, decisive action to support people with the cost of living. In response to higher food costs, the Department for Environment, Food and Rural Affairs continues to work with food retailers and producers on ways to ensure the availability of affordable food—for example, by maintaining value ranges, price matching and price freezing measures.

In response to higher energy prices, the Department for Business, Energy and Industrial Strategy put in place the energy price guarantee to shield households from the unprecedented rises in energy prices. The guarantee will run until April 2024, and the Government are working with consumer groups and industry to explore the best approach to consumer protections from April 2024 onwards, as part of wider retail market reforms. As set out in the energy security plan, we intend to consult on those options this summer.

In response to the higher cost of living more generally, the Department for Work and Pensions is providing up to £900 in three lump sums for households on eligible means-tested benefits, a separate £300 payment for pensioner households and a £150 payment for individuals in receipt of eligible disability benefits. From this April, the Government have uprated benefit rates and state pensions by 10.1%. In order to increase the number of households who can benefit from those uprating decisions, the benefit cap levels were also increased by the same amount.

Also from this April, the national living wage that this Government introduced increased by 9.7% to £10.42 an hour for workers aged 23 and over. That is the largest ever cash increase for the national living wage. For those who require extra support, the Government are providing an additional £1 billion of funding, including Barnett impact, to enable the extension of the household support fund in England this financial year. That is on top of what we have provided since October 2021, bringing the total funding up to £2.6 billion. This is used by local authorities to help households with the cost of essentials.

[Alison Thewliss]

It is interesting to hear about all the things that were uprated with inflation. Will the Minister explain why Healthy Start was excluded from that?

[Neil O'Brien]

If I can just complete the thought, the total cost of living support that the Government have provided is worth more than £94 billion across 2022-23 and 2023-24. That is, on average, more than £3,300 per UK household. It is one of the most generous support packages for the cost of living anywhere in Europe.

I turn to the critical role that the Healthy Start scheme plays in supporting hundreds of thousands of lower-income families across the country. Eating a healthy, balanced diet, in line with “The Eatwell Guide”, can help to prevent diet-related disease. It ensures that we get the right energy and nutrients needed for good health and to maintain a healthy weight throughout life. The Healthy Start scheme is one way that the Government continue to target nutritional support at the families who need it most, which is increasingly important in view of the cost of living.

Healthy Start is a passported benefit, one of a range of additional sources of help and support that the Government provide to families on benefits and tax credits. It is a statutory scheme that helps to encourage a healthy diet for pregnant women, babies and young children under four from lower-income households. Women who are at least 10 weeks pregnant and families with a child under four years old are eligible for the scheme if they claim: income support; income-based jobseeker’s allowance; child tax credit, if they have an annual family income of £16,190 or less; universal credit, if they have a family take-home pay of £408 or less a month; or pension credit. Pregnant women on income-related employment and support allowance are also eligible for the scheme.

Anyone under 18 who is pregnant is eligible for Healthy Start, regardless of whether they receive benefits. Following the birth of their child, they must meet the benefit criteria to continue receiving Healthy Start. The scheme offers financial support towards buying fresh, frozen or tinned fruit and vegetables, fresh, dried and tinned pulses, plain cow’s milk and infant formula. Beneficiaries are also eligible for free Healthy Start vitamins.

In April 2021, as has been mentioned, we increased the value of Healthy Start by 37%, from £3.10 per week to £4.25 per week. Unlike the Scottish Government’s scheme, which is for the under-threes, Healthy Start is for the under-fours. Pregnant women and children aged over one and under four each receive £4.25 a week, and children aged under one each receive £8.50 a week—twice as much. For a family with a six-month-old and a three-year-old, that is £12.75 a week to help towards buying nutritious foods. That comes on top of the benefits and all the other measures, such as the increase in the national living wage, that I mentioned.

[Neil O'Brien]

We have chosen to spend over £3,300 per UK household, on average, on the cost of living support. Putting that into the schemes that are available and targeted at people with low incomes, and indeed at the entire population, is the choice that we have made. To reiterate my earlier point, and since the hon. Member says that I am rattling off the figures, it is worth stressing that we have invested £3,300 per household—a colossal sum of money. That is unprecedented. There has never been a cost of living intervention anywhere of that magnitude, so that must be an important part of the discussion about Healthy Start.

[Alison Thewliss]

Will the Minister give way?

[Neil O'Brien]

I will continue with my points and perhaps come back to the hon. Lady in a moment.

Healthy Start is delivered by the NHS Business Services Authority on behalf of the Department. Following user research and testing by the Department and NHSBSA, the scheme, as various Members have mentioned, was switched from being paper-based to a digitised service to increase uptake and usability. We have introduced an online application to replace the previous paper-based application form and a prepaid card to replace paper vouchers. The digitised scheme opened to the public for the first time in September 2021. The online application provides an instant decision for many families. The prepaid card can be used in any retailer that sells Healthy Start foods and accepts Mastercard.

I am pleased to see that the number of new families joining the scheme continues to grow following the introduction of the prepaid card. Since September 2021, there have been more than 500,000 successful applications, with 48% coming from new families. The scheme now supports more than 375,000 families on lower incomes, and that continues to grow month on month. The current uptake is 64.6%, which is higher than the paper scheme, which had a 59.9% uptake in August 2021.

The hon. Member for Stretford and Urmston asked whether we published the figures on eligibility. Yes, the total number of eligible and entitled beneficiaries are published on the NHS Healthy Start website and are broken down by local authority.

[Alison Thewliss]

Will the Minister give way?

[Neil O'Brien]

If this is on the point about data.

[Alison Thewliss]

The Minister is making an interesting point about the uptake, but can he account for why things are so much better in Scotland, where the uptake of Best Start Foods sits at 88%?

[Neil O'Brien]

The schemes are not completely comparable because the Healthy Start scheme covers a wider base of people, as I mentioned. It goes up to age four rather than age three, so it has a wider field of benefit than the Scottish scheme. That may be part of the story, but there could be other reasons, and there may be important things that we can learn from the Scottish scheme. I am always keen to have those discussions.

To increase take-up, NHSBSA actively promotes Healthy Start through its digital channels and has created free toolkits to support stakeholders to do so. NHSBSA uses a range of communications activities to engage parents, pregnant women and healthcare professionals to help to raise awareness of the scheme. NHSBSA has attended Maternity & Midwifery Forum events and placed advertisements in the Bounty packs, which many people receive when they have children, and the “You and your pregnancy” magazine, which is given to pregnant women in the first trimester.

We constantly review the materials produced for the Healthy Start scheme to ensure that communications reach those who need support the most. That is why, following user research by NHSBSA, promotional material was translated into the top five languages spoken by Healthy Start families, to reach a wider demographic. NHSBSA continues to engage with national and local stakeholders to improve the delivery of the scheme and increase the uptake.

Healthy Start is an important part of the support provided by the Government, but it is only one aspect of the support available for families. We are funding 75 English local authorities with high levels of deprivation to ensure that parents and carers can access Start for Life services locally. The healthy child programme is a universal offer across all 150 local authority areas—led by health visitors and school nurses—that supports families from the antenatal period up to school entry. The nursery milk scheme provides reimbursement to childcare providers for a daily third of a pint portion of milk to children and babies. The school fruit and vegetable scheme provides around 2.2 million children in key stage 1 with a portion of fresh fruit or vegetables each day at school, and 419 million pieces of fruit and vegetables were distributed to children in 2022-23.

The Government have extended free school meals eligibility several times and to more groups of children than any other Government over the past half a century, including the introduction of universal infant free school meals and further education free meals. Under the benefits-based criteria, 1.9 million of the most disadvantaged pupils are eligible for and are claiming a free school meal. That saves families around £400 per year. To make it easier for families to find support, the Government also created an online resource so that families can easily check what help is available to them.

At a time when families need support, and with the cost of living increasing, the Government are committed to helping as many families as possible to access the Healthy Start scheme, as well as all those other schemes, to help those most in need.

Government Support for Breastfeeding and the 2023 Lancet Series

Alison Thewliss Excerpts

Monday 20th February 2023 Commons Chamber

[Alison Thewliss (Glasgow Central) (SNP)]

I have repeatedly brought matters to this House concerning infant feeding. For an issue that concerns every child ever born, it generally gets remarkably little attention from Governments. Madam Deputy Speaker, I can assure you that breastfeeding is an issue of the utmost importance. According to the World Health Organisation, breastfeeding has the potential to prevent 800,000 child deaths globally each year. As The Lancet paper editorial states:

“Breastfeeding has proven health benefits across high-income and low-income settings alike: it reduces childhood infectious diseases, mortality, and malnutrition, and the risk of later obesity; mothers who breastfeed have decreased risk of breast and ovarian cancers, type 2 diabetes, and cardiovascular disease.”

Yet despite those clear health benefits, around the world and here in the UK, we see a growth and embedding of commercial milk formula in our culture.

I stress that this is not a criticism of individual parents, or a value judgment. This is not about formula versus breastfeeding; it is a structural issue, relating to recognition of the importance of breastfeeding and to the lax regulations that have allowed a commercial industry to flourish. The recently published Lancet papers tackle the structural reasons for which breastfeeding does or does not happen. Commercial milk formula is a multibillion-dollar industry which directly targets families with multifaceted and sophisticated marketing practices—practices that influence our beliefs and values, prey on our insecurities and weaknesses, and are exacerbated by the absence of comprehensive Government support for breastfeeding.

There are three Lancet papers, each highlighting the impact of several aspects of commercial milk formula marketing. The second states:

“The marketing of commercial milk formula…for use in the first 3 years of life has negatively altered the infant and young child feeding ecosystem.”

Successful breastfeeding depends on a network of policy and society responses. It is the responsibility of Government to regulate the industry, and to implement structural policies to mitigate the impact of formula marketing. Women who do breastfeed do so despite billions of pounds’ worth of marketing designed specifically to undermine them.

However, this commercialisation does not just affect breastfed babies and their families. The cost of the marketing literally adds to the price of commercial formula on supermarket shelves. Research by Leicester Mammas—presented recently to the all-party parliamentary group on infant feeding and inequalities, which I chair—shows the influence of advertising, with many parents choosing the most heavily advertised first- stage formula rather than the cheapest. All first-stage formulas are exactly the same by law.

In 2018, the APPG produced a report highlighting the significant impact of the cost of commercial milk formula on family budgets. Inflationary pressures are much worse now than they were in 2018, with profound consequences. Feed UK has highlighted the increased costs in its own more recent research, and just yesterday an article in The Guardian revealed that supermarkets such as the Co-op are now keeping formula behind the counter to prevent shoplifting. It said:

“The cost of infant formula has soared over the past year - with the price of the cheapest brand increasing by 22%. Even if a parent is able to access the cheapest brand, Aldi’s own label, the cash value of Healthy Start vouchers, £8.50 a week, is no longer enough to pay for the amount of infant formula needed to safely feed a baby in the first six months of their life.”

That is a very difficult increase for many families to bear. The Minister should be concerned about the risks of parents’ watering down formula, feeding babies under a year old cows’ milk, or thickening milk with porridge because they simply cannot keep up with the spiralling costs of infant formula. Inadequate nutrition at an early stage can have devastating long-term health and developmental impacts. I have raised this matter with Ministers before, and I encourage them to take it seriously. I am presenting the debate this evening because I feel that it is important for the Government to engage meaningfully with the findings of The Lancet report.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for initiating the debate, and for the leadership that she brings to the APPG. Her voice on behalf of breastfeeding women throughout the United Kingdom has been welcome.

In Northern Ireland, our community midwives team are extremely focused on aiding breastfeeding, yet, as the hon. Lady will know, we have the lowest breastfeeding rates in the UK. Does she agree that providing breast-milk pumps for women in low-income families who are put off by the prohibitive cost of the pumping equipment, but who need their child to be minded after the end of their all too short maternity leave, may be a useful tool to help mums to realise that “breast is best” can work in tandem with their return to work?

[Alison Thewliss]

The provision of those pumps can indeed make a huge difference to working families by giving women the flexibility to return to work. Many of them want to breastfeed, but find that returning to work presents a barrier to it. I will say a little more about the pressures from maternity leave later in my speech.

In this post-Brexit landscape, health industry professionals are making it clear that there should be no reduction in regulation on commercial milk formula. Existing regulations should be maintained as a minimum, and work should be conducted to improve on them.

Let me now take a bit of time to discuss the different angles of the three papers. The first explores the challenges of breastfeeding in a market-driven context. Many of us will be familiar with the stress of having a newborn: are they feeding enough, too much, too little? Are we getting enough sleep? Why are they still crying? Commercial milk formula companies thrive on this self-doubt. They want to exploit what are normal developmental phases and present them as problems to which only they can provide a solution. Online forums and baby clubs, apps, emails and pop-up ads are rife. They consistently undermine parents’ confidence, so that a product can be sold as the answer to their problems. When you are exhausted and your baby has been crying for hours, commercial milk formula companies are there to sell you a good night’s sleep, peace of mind, or a special type of formula to stop your baby fussing.

No one would judge parents in that position. We have all been there, and would gladly hand over all the money in our wallets to get that peace of mind. Companies have stepped into this space to offer specialist formulas in a quite unregulated way: formulas sit on the supermarket shelf offering solutions to colic and spitting up, for “hungry babies”, and to deal with allergies. The truth is, however, that there is no solution—not one that comes in a tin, anyway. Fussing and crying and disrupted sleep patterns are all extremely normal parts of human development and baby behaviour. Normal sleep patterns of babies sadly do not align with the sleep patterns of adults, no matter how they are fed. The responsibility lies on us, as policymakers, to ensure that parents are informed and helped to make the best choices for their babies. We need to ensure that any vacuum of information is not filled by aggressive marketing.

The second paper looks at the marketing playbook used by commercial milk formula companies. I should say at the outset that I am not arguing that marketing is inherently bad, or that companies should not make profits, but there is a case for an overhaul of the regulations. When marketing impacts human development and health outcomes to such an extent, Governments need to step up to the plate.

Commercial milk formula sales were worth $55.6 billion in 2019. Let me put that figure in context: it far exceeds the Scottish Government’s budget in the same year. Sales per capita have increased substantially across the world over the last decade. There are many reasons for that—poor breastfeeding support, work constraints, perceived issues with milk supply or fussiness—but the major contributor is marketing. Between $2.6 billion and $3.5 billion is spent on milk formula marketing every year, and that is likely to be the tip of the iceberg, because it does not include the costs of lobbying, social media or sponsorship of health workers, all of which are key entry points in shaping beliefs and altering consumer decisions. Industry lobby groups work to influence policy environments in favour of the milk formula industry and their shareholders.

Medical professionals are targeted as well, through deliberate efforts by formula companies to encourage the diagnosis of health issues which they claim that their products can alleviate. Dr Chris van Tulleken is among several health professionals who have explained how this has led to over-diagnosis of health issues such as cows’ milk protein allergy, an activity that is being led by formula companies presenting their products as a “solution” to normal baby behaviour. He found that, astonishingly, between

“2006 and 2016, prescriptions of specialist formula milks for infants with CMPA increased by nearly 500% from 105,029 to over 600,000, while NHS spending on these products increased by nearly 700% from £8.1m to over £60m annually.”

There is little evidence to suggest that prevalence has increased, but it is clear from those figures that industry influence has. This is a cost to the NHS of which the Government should be mindful.

The report finds that the World Health Organisation’s “The International Code of Marketing of Breast-milk Substitutes” has been routinely blocked, reinterpreted, circumvented, or ignored entirely in order for companies to achieve astronomical profits. One example is the creation of follow-on milks as a response to the marketing constraints that do exist: they are completely unnecessary, and often contain additional harmful sugars. The aim is to sell them to promote first-stage formulas that cannot be advertised on television. In the UK, the existing regulations are poorly enforced, and could well end up being scrapped in the bonfire of regulation that is the Retained EU Law (Revocation and Reform) Bill. I seek an assurance from the Government that that will not happen. I also ask the Government to use their voice at the meeting of the Codex Alimentarius Commission to tighten regulations globally, instead of allowing industry to have its own way.

The third paper highlights the way in which the political economy influences breastfeeding outcomes. The paper finds that inadequate maternity rights and poor working conditions make it difficult for many mothers to breastfeed, and, as was pointed out by the hon. Member for Strangford (Jim Shannon), a rise in insecure and underpaid work has made it even more difficult. There is evidence from around the world that where Governments fail to protect maternity rights, formula companies thrive.

This paper highlights how women’s labour is systematically undervalued. If a tin of formula is purchased in a shop, that contributes to GDP figures, which the Government record as an expression of national wealth. If that same baby is breastfed, it does not count towards GDP because women’s time is just not valued the same way as a commercial product. The paper found that if we were to put a monetary value on the milk produced by breastfeeding women globally, it would amount to an astonishing $3.6 trillion. Commercial milk formula companies are aware of that, and this report exposes how their interests are aligned with poorer maternity protections. The incentives and resources are there for lobbying companies to persuade Governments to reduce workplace rights. This acts as a distortion on the labour market and needs to be actively resisted.

Scotland has legislation specifically protecting breastfeeding in public, for which I thank the former Labour MSP Elaine Smith. The SNP Scottish Government also put breastfeeding into their programme for government, with investment which led to an increase in breastfeeding rates. It is progress, but so much more needs to be done. As I hope I have outlined, this matter goes far beyond individual choice. Ultimately, a healthier population is a positive externality: it benefits everyone, saving money for the NHS through infant and maternal health, a healthier workforce and better outcomes in education. Encouraging breastfeeding and regulating formula effectively should be seen not as a drain on the public purse but as an investment for the future.

I have some asks for the Minister. Almost exactly six years ago, I published my Feeding Products for Babies and Children (Advertising and Promotion) Bill, and I would be glad to speak to the Minister further about it, because it presented the Government with credible options that could make a difference. As I mentioned earlier, we are also at an important juncture with the retained EU law Bill, which could see current infant formula regulations being scrapped. Let us not forget that these important regulations across Scotland, England, Wales, and Northern Ireland protect the health of our youngest citizens. They must be retained, but they must also be strengthened.

Prior to Brexit, when I asked about the prospect of the UK Government joining the countries that have fully implemented the World Health Organisation’s international code of marketing of breastmilk substitutes, I was told that our membership of the EU presented a barrier to doing that. That excuse has now vanished, so I would like the Minster to tell me tonight when he aims to implement the code in full.

Will the Minister meet the authors of The Lancet reports and representatives of the all-party parliamentary group on infant feeding and inequalities to discuss further what the Government intend to do in response to these findings? Will he accept that child and maternal health should come before the profits of commercial milk formula producers? Will he commit today to exploring the role of the UK Government in stopping the aggressive marketing of the formula milk industry? As The Lancet so clearly set out, superficial slogans to encourage breastfeeding are a poor substitute for addressing the sociocultural, economic and commercial determinants of infant and young child feeding. I urge the UK Government to engage with the reports and to do much better by our youngest citizens.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I congratulate the hon. Member for Glasgow Central (Alison Thewliss) on securing this timely debate. I know that she has a keen interest in this important matter and shows great leadership in ensuring that infant feeding remains a priority Government policy, perhaps most notably as chair of the all-party parliamentary group on infant feeding and inequalities. I welcome the publication of the 2023 Lancet series and the information it provides to add to the debate on promoting breastfeeding.

Breastfeeding is a crucial aspect of infant health and nutrition, and this Government are committed to promoting and supporting breastfeeding policy to ensure that all infants have the best start in life. The Government understand the many health benefits that come with breastfeeding for both the mother and the child, and it is our priority to encourage, support and empower women to breastfeed. We recognise that for some women, breastfeeding may not always be a viable option—for some, it may simply not be what they want to do—but the Government continue to create a supportive environment that informs and supports families when starting the infant feeding journey, ensuring that they are able to make informed decisions about how best to feed their babies. This includes providing breastfeeding advice and guidance through a range of approaches, including paid-for social media activity, personalised email programmes and the NHS Start for Life website.

In line with these commitments, we have taken a number of steps to improve support for infant feeding. From 2022-23 we are investing around £300 million in family hubs and Start for Life services, targeting the three years of funding at 75 local authorities in England that have high levels of deprivation and disproportionately poor health and educational outcomes. These 75 participating local authorities have already received at least half their year 1 allocation. As part of this, 14 local authorities have been identified to become trailblazers to lead the way and support other local authorities to improve the services offered to families. This funding package includes £50 million to invest in infant feeding services, which will enable participating local authorities to design and deliver a blended offer of advice and support for families in line with local needs to help all families to meet their breastfeeding goals. Services will enable parents to access face-to-face, virtual, and digital infant feeding support when and where they need it.

The Government also recognise the importance of creating a breastfeeding-friendly work environment, and we recommend that employers take steps to enable women to breastfeed as a matter of best practice. For example, the Health and Safety Executive has published comprehensive guidance on how employers can meet their legal requirements to support new mothers, and it advises employers that it is good practice to provide a private, healthy and safe environment for breastfeeding mothers to express and store their milk. The Advisory, Conciliation and Arbitration Service has also published guidance to support employers in accommodating employees who return to work while breastfeeding or expressing milk.

As is recognised in The Lancet series, it is critical that Governments gather reliable data on rates of breastfeeding to ensure that policies are having their desired effect and to better target our interventions. Therefore, work is currently under way on the delivery of a new infant feeding survey, commissioned for England by the Department of Health and Social Care’s Office for Health Improvement and Disparities. The new survey, which last ran in 2010, will provide valuable information on infant feeding behaviours and other related factors. Data collection is expected to commence this year and we anticipate that the results of the survey will be available in 2024.

These investments and strategies all build on existing measures that this Government continue to uphold. This includes legislation that governs the marketing, composition and labelling of infant formula and follow-on formula. The legislation reflects the latest scientific advice on the essential composition of infant formula and follow-on formula. This legislation upholds the Government’s commitment to the general principles and ambitions of the World Health Organisation’s international code of marketing of breast milk substitutes by prohibiting the promotion, marketing and advertising of infant formula to ensure that breastfeeding is not discouraged. The legislation mandates that the labelling of infant formula and follow-on formula includes information stating the advantages of breastfeeding, includes the necessary information on the appropriate use of the products and does not include pictures or text that idealise the use of the product.

I understand that there have been calls to strengthen this legislation or even go further than is specified in the WHO code, as is suggested in The Lancet series that prompted this debate. The Government of course welcome challenges to our existing ways of doing things and we are committed to ensuring that our legislation continues to be based on comprehensive evidence and sound analysis.

[Alison Thewliss]

The UK Government’s current legislation falls far short of the code’s recommendations, and it is not enforced in any meaningful way. Many tins found in shops do not comply with the legislation as it exists, never mind the code’s stronger recommendations. These tins of formula have idealised images, such as cartoon bears and animals, on their labels, which would not happen if the Government enforced even their current legislation.

[Neil O’Brien]

I will come to the hon. Lady’s point about legislation in a moment, but I will first complete my thought.

We must not forget that there are non-legislative routes by which we can achieve many of the same goals. For example, as part of the NHS’s ongoing vision to improve post-natal care, the long-term plan includes a commitment that all maternity services that do not deliver an accredited, evidence-based infant feeding programme, such as the UNICEF UK baby-friendly initiative, will begin the accreditation process with a view to all services achieving full accreditation by March 2024. Local maternity systems in England are responsible for ensuring that all maternity services are on track to achieve this commitment, which will help to improve standards and reduce variation in the care that women and families receive. Targeted support is now available for local services to fulfil the commitment.

I recognise there is always room for improvement, and we continually work to enhance our efforts and to ensure our legislation and policies reflect the latest scientific advice and evidence. The UK has strict legislation in place that gives effect to the aims and principles of the WHO international code of marketing of breast-milk substitutes, which is governed in Great Britain through retained EU legislation. There are currently no differences in GB legislation on the areas covered by the code. The protocol on Ireland/ Northern Ireland provides that EU legislation relating to nutrition continues to be directly applicable in Northern Ireland, and this includes Commission delegated regulation 2016/127 on infant formula and follow-on formula, so we have precisely the same rules in place as the European Union. I know that, in general, the SNP is always keen on that.

The Government have demonstrated, through our continued significant policy development and ongoing investment, a steadfast commitment to promoting and supporting breastfeeding, where appropriate, to ensure that all children have the best start in life. We remain committed to protecting our children, and we will continue to take the necessary steps to ensure that all mothers and families have the information and support they need to make informed decisions about how to feed their babies.

Question put and agreed to.

Oral Answers to Questions

Alison Thewliss Excerpts

Tuesday 24th January 2023 Commons Chamber

[Maria Caulfield]

I prefer to deal with facts rather than—[Interruption.] The BMJ has ranked the UK mid-table in Europe for mortality figures, which makes it comparable with Italy. In fact, Germany has higher excess deaths, at 15.6%, as do Finland, at 20.5%, and Poland, at 13.3%. However, if the hon. Gentleman wants to hear about what is happening in Labour-run Wales, the statistics available on the gov.wales website show that Wales, in December, had the highest number of red calls ever and that only 39.5% received a response within eight minutes—the lowest figure on record. Those are clinical reasons for excess deaths, not political ones. Perhaps the hon. Gentleman needs to recognise that fact.

[Alison Thewliss (Glasgow Central) (SNP)]

9. What recent assessment he has made of the potential impact of the UK’s departure from the EU on recruitment in the health and social care sector.

[David Linden (Glasgow East) (SNP)]

15. What recent assessment he has made of the potential impact of the UK’s departure from the EU on recruitment in the health and social care sector.

[The Minister of State, Department of Health and Social Care (Helen Whately)]

We have record numbers of staff in the NHS in England. We are on track to hit our target of 50,000 more nurses since 2019. Speaking of 50,000, there are more than 50,000 more people working in social care since 2016. We are boosting the home-grown workforce, recruiting from the EU and welcoming health and social care workers from all around the world.

[Alison Thewliss]

It is undeniable that EU-trained medics and social care staff face extra bureaucracy and higher costs as a direct result of Brexit, making working and staying in the UK a much less attractive option. Given the pressures on all four NHSs and the social care sector, we cannot afford to turn anybody away right now, so what discussions has the Minister had with the Scottish Government about removing the barriers that the hostile environment places on people who want to come here, work and contribute to our NHS and social care sector in Scotland?

[Helen Whately]

Of course the hon. Lady would like to make everything about either Brexit or the Union—or, most often, both—but the fact is that a doctor, nurse or care worker from the EU who wants to work here can do so. We are also welcoming people from the rest of the world, and there are 12,000 more staff in the NHS in England from EU and European economic area countries since the referendum.

Covid-19: PPE Procurement

Alison Thewliss Excerpts

Thursday 24th November 2022 Commons Chamber

[Neil O'Brien]

I set out earlier what the high priority route was and was not: it was absolutely not a guarantee of any kind of contract; it was a way of managing the huge numbers of contacts and offers for help that we were all receiving. It delivered something in the order of 5 billion items of PPE, all of which helped to save lives and protect workers in our NHS and social care settings. Of course, we had to take up those offers of help and respond to them when people wanted to help in the middle of a huge national and global crisis. We had to process those offers, but they were processed in exactly the same way as every other bid for a contract.

[Alison Thewliss (Glasgow Central) (SNP)]

After Lord Agnew resigned, he wrote in the Financial Times:

“Fraud in government is rampant. Public estimates sit at just under £30bn a year. There is a complete lack of focus on the cost to society, or indeed the taxpayer.”

The Economic Crime and Corporate Transparency Bill, which is currently in Committee, is full of holes and the Government have refused sensible requests by the Opposition to fill those holes. Will the Minister reconsider those amendments in the light of the rampant corruption in Government?

[Neil O'Brien]

We keep all those things under review, but the Economic Crime and Corporate Transparency Bill is part of addressing some of the issues that the hon. Lady is concerned about. We are blurring together two different issues slightly—[Interruption.] Let me finish the point. Lord Agnew was talking about the loan scheme, but that relates to the same issue of the need for pace, which all hon. Members were calling for at the time. There was a need to get loans out to small businesses, which saved tens of thousands of jobs in my constituency and, I am sure, her constituency as part of the huge and unprecedented £400 billion spend to preserve lives and livelihoods.

Oral Answers to Questions

Alison Thewliss Excerpts

Tuesday 19th July 2022 Commons Chamber

[Maria Caulfield]

I think we can do both. We have already reduced emissions in the NHS by 30%, and there are a number of ways in which we can reduce them further, from changes in procurement—the NHS will no longer purchase from suppliers that are not aligned with net zero ambitions—to the delivery of estate change.

[Alison Thewliss (Glasgow Central) (SNP)]

3. If his Department will take steps to fully implement the international code of marketing of breastmilk substitutes.

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

The Government recognise that the code is intended to promote breastfeeding. Existing legislation in the UK implements its general principles, giving effect to its aim of covering marketing, accounting, information and the responsibilities of health authorities. As well as restricting advertising to scientific and specialist babycare publications, it sets requirements for labelling, presentation and advertising so as not to discourage breastfeeding. Guidance on working within the code is available to service commissioners, providers and practitioners.

[Alison Thewliss]

As the World Health Organisation’s recent status report on implementation of the code gives the UK a mark of only 40 out of a possible 100, the UK could clearly be doing a great deal more to implement a code that was intended to protect breastfeeding, and to protect those who are bottle-feeding from marketing influence. Will the Minister meet me and the all-party parliamentary group on infant feeding and inequalities to discuss the issue further?

National Strategy for Self-Care

Alison Thewliss Excerpts

Tuesday 26th April 2022 Westminster Hall

[Sir George Howarth (Knowsley) (Lab)]

I beg to move,

That this House has considered the potential merits of a national strategy for self-care.

As ever, Sir Charles, I am pleased to have this debate with you in the Chair. In October 2019, I chaired a roundtable event on self-care, which involved healthcare professionals, pharmacists and other experts. It was organized by the consumer healthcare association the Proprietary Association of Great Britain, and following the event we produced a report that the Minister, or at least the Minister who was supposed to be here—the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield)—is aware of. I am indebted to PAGB, the Juvenile Diabetes Research Foundation and Diabetes UK for the briefing they have provided for this debate.

It might be helpful if I define what I mean by self-care. Essentially, it is about the actions individuals take for themselves, on behalf of others or with others to develop, protect or maintain their health. It can be summarised as a spectrum that includes the promotion of everyday wellbeing, taking care of self-treatable conditions, and the management of long-term conditions. It is important, however, to point out that self-care is not no care. Those who need medical support on a more traditional basis should be entitled to that type of care.

The covid-19 pandemic has revealed the important role that self-care can play in reducing the burden on GPs and hospital A&E departments, so that those with the most serious ailments can be treated with greater urgency. Prior to the pandemic, it is estimated that 18 million GP appointments and 3.7 million A&E visits were for minor ailments, including a blocked nose, dandruff and travel sickness, at an estimated cost of £1.5 billion annually. A survey of frontline healthcare professionals carried out by the self-care academic research unit at Imperial College in 2021 indicated that 95% of those who responded felt that self-care was important during the pandemic, compared with 55% pre-pandemic. However, a further survey carried out by PAGB later in 2021 found that the percentage of members of the public saying that they were more likely to self-care had fallen from 69% in 2020 to 55%, which illustrates that the trend in that direction has reversed.

My key point in this debate is to highlight the necessity for a new national strategy for self-care. The previous such strategy, “Self-care—A Real Choice”, was published in 2005. Since then there have been many new developments and the case for a new strategy has been more clearly recognised.

Before I move on to describe what the elements of a new strategy might be, I will use the example of those with diabetes to illustrate how self-care can work well. Other conditions could also serve to make that point, but, to avoid taking up too much time, I will use this single example. JDRF has pointed out that 79% of the management of type 1 diabetes is carried out by the individual with the condition, often with the help and support of their families and carers. That makes type 1 diabetes a case study in how to successfully promote self-management. JDRF also draws attention to the need to invest in technology as a crucial benefit to the long-term sustainability of the NHS post-covid.

JDRF’s 2021 report, “Covid and Beyond”, concluded that people with type 1 diabetes who had access to relevant technologies felt more confident in managing their diabetes in the absence of routine NHS care and support. The charity Diabetes UK points out that diabetes is

“the fastest growing health crisis of our time”,

with the equivalent of one in 14 people—that is 4.9 million in total—living with the condition, and that it accounts for 10% of the NHS budget—that is a staggering figure—80% of which is spent on treating largely preventable conditions.

Diabetes UK draws attention to the fact that, to live well with diabetes, avoid complications and successfully self-manage diabetes, those living with the condition require five things: first, access to education about diabetes and how to manage it; secondly, emotional and psychological support, which is increasingly important; thirdly, access to technology to support self-management; fourthly, access to weight-management support when needed, and I will say more about that in a moment; and finally, facilitated peer support.

Typically, those with diabetes spend about three hours a year with their doctor, nurse or consultant, and a staggering 8,757 hours managing the condition themselves. As Diabetes UK points out:

“Managing diabetes day-to-day can be difficult. This is why it’s important people have the knowledge and skills to manage their diabetes so they can live well and avoid complications.”

[Alison Thewliss (Glasgow Central) (SNP)]

I appreciate what the right hon. Gentleman is saying and I understand that he has spoken to my constituent Scott Craig. Does he agree that there needs to be awareness of the risks, and training for people who are self-managing and for their families? I understand that my constituent’s husband’s device failed, leading to his untimely death. Does the right hon. Gentleman agree that there needs to be greater awareness of how these devices work and what people need to do should things go wrong?

[Sir George Howarth]

As the hon. Lady is aware, I spoke to her constituent about that point earlier today. She makes a good point and I agree with her, and I would add that it is important that those who use technology are properly trained in how to use it best. The devices need to be reliable, so that technology can provide effective help with these conditions.

Those with type 1 diabetes who also struggle with eating disorders experience problems if they omit to take their insulin in order to lose weight. I know that you are familiar with this issue, Sir Charles. The right hon. Member for Maidenhead (Mrs May) and I will shortly carry out an inquiry into this growing problem, with the support of JDRF. We hope to point to how self-care can play an important role in dealing with this worrying trend. Hon. Members may be aware that there is a storyline in the soap opera “Coronation Street” that covers this subject. It has not yet concluded, but it offers a helpful perspective of how the problem has arisen, what it is and what the dreadful consequences can be.

I will refer to the recommendations from the report following the roundtable I chaired in October 2019. First, the Department of Health and Social Care should develop a national self-care strategy. Secondly, NHS England and Improvement should explore the implementation of self-care recommendation prescriptions, to support clinicians to discuss self-care with patients and refer them towards it. Thirdly, primary care networks should consider ways to improve self-care in local populations as part of the development of the network across the local health system. Fourthly, NHS England and Improvement should enable community pharmacists to refer people directly to other healthcare professionals. That has become even more apparent during the covid-19 pandemic.

The fifth recommendation is that NHS England and Improvement should support moves towards community pharmacists being granted read and write access, to give them full integration and interoperability of IT systems as part of local health and care records partnerships, and promote national support for such data-sharing agreements. That would unlock the door to a hugely increased, positive role for community pharmacies. Sixthly, the Government and royal colleges should include in the healthcare professional curriculum and the national curriculum self-care modules that can be delivered sustainably by schools. Finally, NHSX should explore technologies that could be used to promote self-care and manage demand on the NHS.

Before concluding, I would be grateful if the Minister, or his colleague, could consider some questions. It is not necessary for them to be answered today; theyj could respond by letter if that would be more effective. First, will the Minister undertake to look closely at the recommendations for a new self-care strategy? Secondly, will he give consideration to the report’s seven recommendations, which I referred to earlier? Thirdly, will he agree to meet a representative group of healthcare professionals, other interested parties and me to discuss potential ways forward? Finally, will he meet diabetes charities, the right hon. Member for Maidenhead and me to discuss the relevance of the two conditions—it is often overlooked that type 1 and type 2 diabetes are two distinct conditions—and to explore how the condition can serve as an example for self-care management? I look forward to the Minister’s response.