NHS Commissioning (Pre-Exposure Prophylaxis)

Andrew Gwynne Excerpts

Tuesday 7th June 2016 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

(Urgent Question): To ask the Under-Secretary of State for Health if she will make a statement on NHS commissioning in relation to HIV pre-exposure prophylaxis.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am grateful for the opportunity to respond to this urgent question. As the House knows, HIV can be a devastating illness, and we know that pre-exposure prophylaxis—PrEP—can make a difference to those at risk of contracting HIV and to those who are already HIV positive. However, it is crucial that we have a full understanding of all the issues surrounding PrEP.

As with any new intervention, PrEP must be properly assessed in relation to clinical effectiveness and cost-effectiveness. That is why we have today asked NICE to conduct an evidence review of Truvada for PrEP of HIV in high-risk groups. This evidence review signifies the next step forward and will inform any subsequent decisions about commissioning. It will look at the evidence for effectiveness, safety, patient factors and resource implications. The NICE evidence summary will run alongside a pilot scheme in which we are investing up to £2 million. Public Health England is currently identifying the most effective places for the pilot to take place.

It is also important to remember that Truvada, the drug used for PrEP, is not yet licensed for this use in the UK. That is why, as well as the pilot scheme, the Government want to see the evidence review, which will help to inform future commissioning decisions about PrEP.

PrEP is only one of a range of activities designed to tackle HIV, which is of course a Government priority. It is also important to stress that the challenge remains of tackling high rates of some sexually transmitted infections, particularly in high-risk MSM—men who have sex with men—communities. Our £2.4 million national HIV prevention and sexual health promotion programme gives those at highest risk the best advice to make safer choices about sex.

The UK has world-class treatment services and is already ahead in reaching two of the three UNAIDS goals of ensuring that we have 90% diagnosed infection, 90% of those diagnosed on treatment and 90% viral suppression by 2020. In 2014, 17% of those living with HIV had undiagnosed infection, but 91% of those diagnosed were on treatment, of whom 95% were virally suppressed. We are determined to continue to make real progress to meet these goals, and we are considering carefully the role that PrEP can play in helping us to get there.

[Andrew Gwynne]

I thank the Minister for that reply. This is a subject we do not debate enough in the House, and I am grateful to Mr Speaker for giving us the opportunity to debate it today.

Seventeen people are diagnosed with HIV every day. Each year, there are thousands of new infections. In the UK, there are more people living with HIV than ever before. We know that PrEP has the potential to be a game-changer—it has proved effective in stopping HIV transmission in almost every case—yet as a result of this latest decision, this life-changing drug will remain inaccessible to people at risk of HIV. Does the Minister therefore share my concern about the precedent this decision sets in terms of NHS England shunting other preventive costs on to local government? Will she explain why pre-exposure prophylaxis is being dealt with differently, compared with the correct commissioning model for PEP, or post-exposure prophylaxis?

I want to ask the Minister three specific questions. First, does she accept that, under section 7A of the National Health Service Act 2006—a mechanism by which the Secretary of State can delegate power—the Health Secretary can give NHS England the power to commission PrEP? If so, why has he not done so? Secondly, if the Government expect local authorities to commission PrEP, how much additional funding will the Minister make available to them? Can we assume that there will be no further cuts to public health grants, or is this just a case of passing the responsibility and the financial buck? Thirdly, on the next steps, I understand that key stakeholders, including the National AIDS Trust, have written a joint letter to the Public Health Minister requesting an urgent meeting. Will she today agree to meet them to see whether a way forward can be found without the need for costly, protracted legal action?

PrEP has been described as the beginning of the end for the HIV epidemic. It is time for the Minister to show some leadership, to use the section 7A powers she has and to think again.

[Jane Ellison]

Some of the shadow Minister’s questions are simply ahead of the moment, as it were. As I said clearly in my statement, NHS England has made clear how it feels about being the commissioner, based on a legal argument that it has published. No decision has been made about who the commissioner is. Clearly, we need to reach a decision, and we discussed that earlier today in the Health Committee. However, there are a number of stages we have to go through—as I say, the drug is not even licensed for use as PrEP in the UK.

We have set out a series of stages we will go through, which will help to inform a final decision. On the questions the hon. Gentleman posed, we are not in a position to make a judgment. There is more we need to know about clinical effectiveness and cost-effectiveness and about the pilot—

[Andrew Gwynne]

We know.

[Jane Ellison]

No, that is not the case. There has been an important study—the PROUD study—but that looked at clinical effectiveness. There is a wider piece of work to be done—of which the pilot programme that we have announced is part—to enable us to understand where PrEP fits in in terms of clinical and cost-effectiveness, and how it fits into the HIV prevention landscape more broadly, alongside other HIV interventions that are commissioned. There is work yet to do, but we are not standing still. We have announced this important pilot and committed money to it, and we have asked NICE for an evidence review. All this will go into our consideration.

HPV Vaccinations for MSM

Andrew Gwynne Excerpts

Tuesday 7th June 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I add my congratulations to the hon. Member for Finchley and Golders Green (Mike Freer) on securing this debate, and on the important cross-party work he does in the House on championing the cause of men’s sexual health. I also thank other hon. Members for their contributions.

I understand the importance of the quasi-independent nature of the JCVI, and I do not want to change that, but I believe the Minister has an important duty to the country to ensure that the JCVI operates efficiently and with the right priorities in mind. In that spirit, I have a series of questions to ask her on this important matter, some of which have been covered in the debate. First, I will raise the long delay in the decision on whether all boys should be vaccinated. The JCVI began its assessment on whether boys should be included in the national vaccination programme in 2013. A decision was originally expected last year, but was subsequently rescheduled for 2017. Experts in the field are already convinced that boys should be vaccinated, and I urge the Minister to ask the JCVI to make its recommendation this year, so that implementation can begin as soon as possible.

Secondly, I want briefly to discuss the JCVI’s approach to making the decision. As we have said in other debates in this Chamber, the JCVI is far too constrained in its approach. Its analysis of cost-effectiveness focuses solely on the cost to the NHS and takes no account of social costs, the costs of care or welfare benefits, or the costs to employers and to individuals and families affected, in this case, by HPV-related diseases. For example, 50% of people with mouth cancer never return to work, so there really needs to be a wider assessment.

Thirdly, I would like to raise the issue of the implementation of the vaccination programme for men who have sex with men. The JCVI was right to recommend that men who have sex with men should be offered the vaccine via sexual health clinics, but since the recommendation was made in November last year, no announcement has been made about the implementation.

I asked the Public Health Minister about this matter in a written question last month. She replied that a pilot project was beginning this month, which I was pleased to hear. I would be grateful if she could explain what is being planned and the timetable to which that will happen. We already know that the vaccine works, and I have some fears that this could be an attempt to kick it into the long grass. I hope not and that she can offer some reassurances to Members today. Given the level of risk currently being faced by men who have sex with men because of HPV infection, including not least the very high rate of anal cancer in that group, there is surely a strong case for a national roll-out now so that as many men as possible can be vaccinated without delay.

Fourthly, I am concerned that the UK is in danger of being left behind other countries in its approach to HPV vaccination. As we have heard, Australia, Austria, Canada, Israel, Switzerland and the United States are among those now recommending gender-neutral vaccination. That is now under active consideration in the Republic of Ireland and Norway as well.

If I may, I will make a slightly tangential point. Is the Minister aware of the complaint made to the European Medicines Agency by the Nordic Cochrane Centre about the alleged maladministration of the safety review of the HPV vaccination? If side effects have been ignored or people more susceptible to side effects have been given the vaccine unnecessarily, that is a breach of trust and I expect that she will want to look into the matter.

Finally, I have been asked by HPV Action to announce that a letter from 13 eminent scientists and clinicians in the field of public health has been sent to the Secretary of State for Health, calling on him to ask the JCVI to accelerate its assessment of the vaccination of boys. The signatories include the director of the World Health Organisation collaborating centre for oral cancer, the president of the British Association for Sexual Health and HIV and the vice-president of the Royal College of Surgeons. Their views should carry weight in the corridors of Richmond House and I trust that the Secretary of State will listen very carefully to their points.

I also hope that the Minister has listened to the very valid points that hon. Members have made this afternoon. It has been a short but well informed debate, and I am pleased that we have had the chance, thanks to the application made by the hon. Member for Finchley and Golders Green, to be able to debate this issue in such a timely manner.

Dietary Advice and Childhood Obesity Strategy

Andrew Gwynne Excerpts

Monday 23rd May 2016 Commons Chamber

[Alistair Burt]

I am delighted to welcome the question from my hon. Friend the Member for Bury North—may God bless all who live there. I had a small bet with the Secretary of State on how long it would be before the words “nanny state” were uttered, and I was not disappointed.

My hon. Friend is right to ask the question, and we still want to encourage children to move more and eat less—there is nothing contradictory about that. However, a Government who take children’s health seriously, whether in relation to dentistry, deprivation and the environment, or indeed their physical health, weight and wellbeing, are as entitled to comment on this issue as anyone else. The childhood obesity strategy will not contradict efforts to encourage physical activity, but it will, I hope, have elements that my hon. Friend and everyone in his constituency welcomes.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Obesity, and in particular childhood obesity, is one of the biggest public health challenges facing our country. Today’s report not only questions official Government advice, but says that it may have had disastrous consequences. Whether that is right or wrong is a matter for debate.

Let me start by asking the Minister about today’s report. It makes a number of recommendations, but perhaps the most controversial has been the call to stop recommending the avoidance of foods with a high saturated fat content. I am pleased that the Minister has reaffirmed that he has no plans to review the Government’s official advice in the light of that call, and has also reaffirmed that the evidence on the current dietary advice remains valid, but does he share the views of experts, including the British Heart Foundation, who have today stressed the importance of official guidance being informed by robust evidence, free from interference by industry?

On the childhood obesity strategy, as my right hon. Friend the Member for Leicester East (Keith Vaz) said, in September we were told that it would be published before Christmas. Then at Christmas we were told that it would be published in the new year. In the new year we were told that it would be published in the spring, and now we are told that it will not be published until the summer, so can the Minister explain this delay? May we now have a cast-iron guarantee that the strategy will be published before the House rises for the summer recess, so that Members will have the chance to question Ministers on the contents of that strategy?

We welcome the recent announcement of a sugar levy, but does the Minister agree that alongside action on cost, we need action on advertising and labelling? Perhaps the real cause of rising childhood obesity has been not the Government’s dietary guidance, but their failure to take tough action on the marketing and packaging of unhealthy products. Will the Minister confirm that the strategy will contain comprehensive and co-ordinated action to tackle this growing public health challenge? Some of the best advances in public health have come about because past Ministers have shown leadership and vision, so may I say politely to this Minister: “Enough of the delay. It is now time to act”?

[Alistair Burt]

I am sure the Under-Secretary, my hon. Friend the Member for Battersea, will be able to pick up a number of issues that the hon. Gentleman has raised, but let me respond to some.

First, in relation to the report, as I emphasised by quoting the remarks from Public Health England, any advice that goes into the public domain which is to have credibility and upon which people should want to rely must be fully evidence based and as thoroughly researched as possible. If there is any doubt about that—if the evidence appears to be scant—it is right that such advice should be dismissed as irresponsible. We should continue to urge people to look at far more in-depth studies and internationally accepted views on health, diet and wellbeing. I made that point and I am pleased that the hon. Gentleman agrees.

In relation to the Government’s activity, the childhood obesity strategy will come forward in due course, but it cannot be said that nothing has been done in the meantime. The sugary drinks tax has been taken forward, and I can assure the hon. Gentleman that advertising, labelling and promotion definitely come into the strategy and will be looked at. Having spoken to my right hon. Friend the Secretary of State for Health, I am sure that the intention is to get the report out at a time when the House will be able to consider it. There is little likelihood of the House not having an opportunity to discuss and debate such an important matter, but it is important to get the report right. It is important that it meet exactly the challenges that the hon. Gentleman made from across the Dispatch Box. If it is not seen to be thorough, well researched and well evidenced, it will fall foul of the concerns raised by the irresponsible report today. I am grateful for his support. The outcome is something we all want to see, and I can assure him that my hon. Friend the Minister will be studying his remarks carefully.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 10th May 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to what is, in a way, the most fundamental point of the five year forward view, which is getting care to people earlier to help them live healthily and happily at home. Perhaps the most significant announcement we have had in the past few weeks has been the extra £2.6 billion a year that will be invested by the end of the Parliament in general practice. That is a 14% increase that will allow us to recruit many more GPs and, I hope, dramatically improve care for her constituents and others.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Yesterday the Health Secretary admitted to the Health Committee that “we didn’t protect the entire health budget” in the last comprehensive spending review. I am pleased that he appears to have adopted a bit of straight-talking, honest politics, so in that spirit will he now admit that the very real cuts to public health budgets over the next few years will make it harder to deliver the “radical upgrade” in public health that his five year forward view called for?

[Mr Hunt]

In the spirit of straight talking and honesty, which I think is an excellent thing, perhaps the hon. Gentleman might concede that those cuts and efficiencies that he is talking about would have been a great deal more if we had followed Labour’s spending plans—that is, £5.5 billion less for the NHS than this Government promised, on the back of a strong economy.

North East Ambulance Service

Andrew Gwynne Excerpts

Wednesday 4th May 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this very important debate and on the eloquent way she made the case for her constituents, as have other right hon. and hon. Members for their constituents. People deserve a better service from the North East Ambulance Service.

I join other Members in praising the dedication and commitment shown by the thousands of paramedics who work in the NHS today. They are the best the NHS has to offer and they work under incredibly difficult circumstances delivering life-saving treatment. I add my thanks for the service they provide to us and to all our constituents every day of the week. Although ambulance services continue to deliver a good service for most, as we have heard today, they do not do so for everyone and the service is patchy across the country.

Members have spoken in detail this afternoon about the difficulties facing the North East Ambulance Service and the poor care that many patients have received from it. Over the past few years, the North East Ambulance Service has seen a dramatic deterioration in its performance against national response time standards. Between June 2012 and March 2013, the trust responded to 77% of the most serious emergency calls within eight minutes but, three years later, only 70% of ambulances were arriving within eight minutes. That is compared with the national target of 75%. The decline in standards is even worse for other emergency calls: that figure has fallen from 77% to 62%.

Behind each of these statistics are seriously ill patients and tragic stories of failed care. I hope that my hon. Friend will allow me to say that, when researching this matter, I was deeply shocked to read about an elderly man in her constituency who was told in December that he faced a five-hour wait for an ambulance after collapsing from a suspected stroke—a five-hour wait for an ambulance on the street in the middle of December. That is not what we should expect for our loved ones from our NHS.

When the Minister responds, I hope she will set out what actions the Department of Health is taking to prevent such incidents from ever happening again. The sad truth is that that decline in performance is not restricted to the north-east. The House of Commons Library has forecast that this year only three trusts in the whole of England will meet the national performance target for responding to emergency calls. The service in England has met the target only twice during the past 12 months, and more than 45,000 seriously ill patients have had to wait longer than eight minutes for an ambulance to arrive.

That is a worrying decline in performance. Too many people are being failed by the system and services are starting to fray at the edges. What does the Minister intend to do to improve the quality of care provided by ambulance trusts in England? What conversations has she or her colleagues in the Department had with NHS England about the performance of this ambulance service? What assessment is the Department making of the impact the decline in standards is having on the rest of the NHS in this region?

As we have heard, the truth is that that decline in performance is a symptom of a system that is at breaking point. All aspects of emergency care, from ambulance services to A&E departments, are struggling. In February, A&E departments in England reported their worse performance on record, with just 88% of patients being treated within four hours, compared with a target of 95%. During that period, every hospital in the north-east missed its A&E target and one in 10 patients had to wait more than four hours in A&E before receiving treatment.

Dr Cliff Mann, president of the Royal College of Emergency Medicine, told a national newspaper the month before last:

“The pressures have become unrelenting. In recent days I’ve been contacted by a number of senior doctors, medical directors, high-level people, who are saying the situation now is like nothing they’ve seen before…My own hospital had the busiest day I had ever experienced two weeks ago—these are situations where every time you turn round, there are another four ambulances queueing.”

Those are worrying reports. I ask the Minister to address some of the concerns raised by Dr Mann and to say whether she believes that they are isolated incidents or whether those pressures have become the norm in our NHS.

The North East Ambulance Service’s board has acknowledged that the decline in A&E services has had an impact on its performance. The trust’s most recent board paper said that there were 59% more handover delays of more than one hour in the first quarter of 2015-16 compared with the previous year and 60% more delays of more than two hours. The reality is that too often ambulance crews with vulnerable patients have to wait outside A&E departments because hospitals just do not have the space to admit them. I hope that, when the Minister responds, she will offer an explanation for that decline in A&E performance and explain how she will help trusts to turn the situation around, because A&E is struggling and in need of help.

Staff shortages are also a key factor contributing to the challenges facing the North East Ambulance Service. The region currently reports 15% vacancy rates for paramedics, which puts added pressure on existing staff. Local unions have warned that nine in 10 north-east ambulance staff are suffering from work-related stress due to excessive hours and staff shortages. Across England, the recent NHS staff survey found that almost half of ambulance staff felt unwell as a result of work-related stress and one quarter say that their employer does not take positive action on health and wellbeing.

It is clear that not enough is being done to support ambulance staff, and that is bad for patient care. Unhealthy staff mean unhealthy patients, and we cannot allow that situation to continue in the north-east or elsewhere in England. I therefore ask the Minister what steps her Department is taking to address staff shortages in the ambulance services in the north-east and across the country. Does she agree that more needs to be done to support the health and wellbeing of front-line paramedics?

It is clear from the speeches that we have heard today that this trust is struggling against a number of key performance indicators that are widely available. I hope that, when the Minister responds, she will agree that patients in the north-east deserve better than that. I hope that she will also agree that we cannot allow that dramatic decline in performance to continue and that something has to be done to stem the tide.

Meningitis B Vaccine

Andrew Gwynne Excerpts

Monday 25th April 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies, as it was to serve under that of Mr Pritchard earlier. I pay tribute to the hon. Member for Bath (Ben Howlett) for opening the debate in such an eloquent and detailed fashion. The way he set out the terms of the debate is a credit to the petitioners, and we have heard a set of powerful contributions from right across the Chamber.

A week ago, I said that the Petitions Committee debate on brain tumour research was a credit to the way in which the House of Commons operates. That has followed through to this week’s debate. I thank my hon. Friend the Member for Walsall North (Mr Winnick) and the hon. Members for Foyle (Mark Durkan), for Faversham and Mid Kent (Helen Whately), for Erewash (Maggie Throup), for Bury North (Mr Nuttall), for The Cotswolds (Geoffrey Clifton-Brown), for North Devon (Peter Heaton-Jones), and for Arfon (Hywel Williams), as well as the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), and the hon. Member for Central Ayrshire (Dr Whitford), who leads on health for the Scottish National party. It is always a pleasure to follow her expertise on such matters. Mainly, I congratulate all 823,000 petitioners for the enormousness of their campaign, which led to the petition becoming, I think, the most popular e-petition so far. This is a huge issue for so many families affected by the disease.

The impact of meningitis B is felt long after initial contraction, and about one in 10 suffering from it will die. According to research published in The Lancet, one in three survivors will be left with lifelong disability. There is, necessarily, a huge cost to society and the individual when people are left without the ability to lead a normal life. Considering that there is a possibility of tackling the disease with just one vaccine, the issue deserves our undivided attention. Some hon. Members who are regulars in debates on health will know that I am always banging the drum for prevention, and I am not the only one. Simon Stevens, in his “Five Year Forward View”, identifies £5 billion of savings later in the review period that could be made as a direct consequence of prevention early on in that five-year forward view. Meningitis B is one instance where the case for prevention is very strong indeed. The ongoing cost to the NHS of a patient who survives meningitis can run into millions of pounds in the worst cases.

The UK is leading the world in the fight against meningitis. Our immunisation and surveillance programmes are world-class, and everybody involved in them should be proud of the lives that have been saved and the lifelong disabilities that have been prevented over the years. However, as I will explain, we still have a long way to go. The joint work of the Petitions Committee and the Health Committee has been instrumental in really getting to the bottom of an issue that has been trundling along for far too long.

The notion of Committees taking evidence on matters raised in e-petitions is quite new, and it is right that scrutiny work is guided by the public. That was recognised by my hon. Friend the Member for Warrington North (Helen Jones), who chairs the Petitions Committee. That the Petitions Committee is proactive with other Committees of the House will be of great importance for the future work of not just the Petitions Committee, but the other Select Committees of the House of Commons. I hope that in this instance, this work will be of some comfort to the many hundreds of thousands of people across the country who are signing petitions on a variety of issues. Indeed, I checked just before the debate and 1,240 people in my constituency signed the petition before it closed. Almost exactly the same number signed it in the constituency of the Chair of the Petitions Committee, and a similar number—1,311—signed it in the constituency of the hon. Member for Bath. I am sure that the Minister appreciates the depth of feeling on the matter right across the country.

I will get into the detail, because the debate is not as clearcut as many of us would like. Indeed, very few issues in health are simple. There is always more than one side to consider, and I appreciate the merits of the Government’s case. The Minister will argue that the Government are rightly following the recommendations of the JCVI, which the Opposition agree is correct in principle, but not, having looked at this in a bit more detail, necessarily in this instance. As we have already heard, the JCVI recommended an adolescent carriage study—this was more than two years ago—to determine what bacteria young people are carrying, and my understanding is that that study has not yet started. It takes a considerable amount of time for such a study to collect usable data, so will the Minister confirm that the funding needed to carry out the study will be made available? I have seen a reasonable timetable for the work set out by Meningitis Now and the Meningitis Research Foundation. If the Department of Health will not be following that timetable, will the Minister confirm when an adolescent carriage study will begin? Has she ensured that there are sufficient supplies of the vaccine to carry out the study?

Health economics, which other Members have mentioned, frustrates me a little because there is a bit of guess-ology, or a wet finger in the air, to it. Unless the lifetime cost and benefits of, and all the associated issues with, a particular drug can be assessed, it is difficult to assess the true costs and benefits of a particular treatment. I do not think that lifetime costs are adequately considered when looking at the cost-effectiveness of drugs and treatments. Indeed, that point was raised in the Procedure Committee’s final evidence session. Professor Andrew Pollard, chair of the JCVI, suggested that the JCVI was concerned that it “might be underestimating” the lifetime costs—that point was eloquently put today by the hon. Member for The Cotswolds. Dr Mary Ramsay, head of immunisation, hepatitis and blood safety at Public Health England, pointed out that social costs, such as out-of-pocket expenses, are excluded from the JCVI formula. Likewise, as we have heard from the hon. Member for Central Ayrshire, the peace-of-mind benefits are difficult to measure, but they are also left out of the formula.

Will the Minister assure Members here today that the working group has considered how to reform the JCVI framework so that some of the health gains for children are adequately represented, and so that prevention is prioritised in the formula? I understand that the JCVI agreed to review the impact of the vaccination programme within two years of its decision. I hope that, in light of the exceptionally strong public interest in this issue, the JCVI will, as part of that review, reassess the case for extending the vaccination to all children. The current cost-effectiveness framework used to assess vaccines tends to be a little unfair when it comes to relatively rare but severe diseases in children, and I accept that changes to those procedures do not come quickly, but that is no excuse for the unnecessary and bureaucratic delays that we saw in the introduction of the vaccine for the under-ones. I hope to see promising results this autumn, showing that the vaccine works in a mainstream programme.

Finally, if the JCVI were to make a recommendation to extend the reach of the meningitis B vaccine, I would not hesitate strongly to encourage Ministers to extend the vaccination’s coverage at the earliest opportunity. The principle of quasi-independence for the JCVI is important, and it should be defended, as we have heard from other hon. Members today, but that is not to say that its procedures and remit should not be continually re-evaluated to ensure that it takes the right factors into account. I hope the Minister will listen extremely carefully to all the arguments that have been raised on both sides of the Chamber in this debate and will see the strength of public opinion on this issue as genuine and real. Given that she has a considerable amount of time in which to respond, I am sure that we will get a thorough and full reply to all the questions put by hon. Members today. I am sure that the petitioners watching the debate, both here and through online forums, will be interested in what she has to say.

Brain Tumours

Andrew Gwynne Excerpts

Monday 18th April 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck. I also pay tribute to the work of the pensions committee—[Interruption]. Sorry, the Petitions Committee, not the pensions committee, and particularly its Chair, my hon. Friend the Member for Warrington North (Helen Jones). I have pensions on the brain because the last time we both attended a Petitions Committee debate in Westminster Hall we discussed the Women Against State Pension Inequality Campaign. I hope she forgives me.

By my count, we have had 31 contributions to this debate, which shows that there is a large degree of unanimity on this issue, and it shows the House of Commons at its best. Our constituents have recognised that there is an issue—I pay tribute to the petitioners: not just those who organised the petition, but the many constituents who signed the petition and who have lobbied us—and we have come here today to raise some important issues on their behalf.

I thank all hon. Members for their insightful and moving contributions this evening. I particularly commend the work of the hon. Member for Castle Point (Rebecca Harris), the chair of the all-party parliamentary group, who was obviously leading on these issues for some time before the debate. Like others, I congratulate Maria Lester and her family on the success of this e-petition. I think that is the reason why the Petitions Committee was established: so that we could delve in some detail into the issues that concern people outside the House and, in the case of this debate, those such as Maria Lester and all the other supporters who have come.

I thank Brain Tumour Research for its support, not just of the petition but of us as Members of Parliament. It has helped us to understand better some of the issues relating to brain tumours. The charity and its network of passionate supporters have been leading advocates in this area, and the work it has done in founding and supporting centres of excellence for the study of brain tumours has been quite remarkable.

As we have heard, in the last 40 years Britain has pioneered some of the most remarkable research into cancer. Our scientific research capability is the envy of the world and is the engine that drives the fifth largest economy in the world. Investigation of prostate cancer has seen significant improvement, with many drugs coming from Cancer Research UK, while the progress on breast cancer treatments, such as the UK-produced tamoxifen, has also seen fantastic improvements in survival rates. Those are just two examples of what well-funded research can do, and we can clearly see the benefits of that in survival rates. Over the last 40 years, British cancer survival rates have doubled, meaning that 50% of people diagnosed with cancer now survive for at least 10 years. That improvement can be traced to each pound spent on research. The money funds the years of lab work and the clinical trials that are essential for producing new treatments.

However, despite the undoubted success, some patients, tragically, have been left behind—in particular, many of the 16,000 patients who are diagnosed with a brain tumour every year. The five-year survival rate for brain tumour patients is under 20%. It is not widely known that brain tumours are the largest cancer killer of children and adults under the age of 40. Hon. Members have referred to that umpteen times in the course of the debate, but a lot of work still has to be done with the general public to raise awareness of just how serious this issue is. Those statistics are even more shocking when compared with the improvements in survival rates for other cancers.

We know that research better to understand cancers and find new treatments is the way to improve survival. That makes it even more shocking that brain tumours, which account for 3% of all cancer deaths in the UK, have received just 1% of national cancer research funding. The Petitions Committee report, which we have been debating, found that brain tumour patients and their families have been consistently let down by a lack of research. That compounds the pain and suffering that these vicious diseases already cause.

The Government have a responsibility to lead research and ensure that every patient, regardless of disease, age or background, has the chance to beat their cancer and live a full life. The Government can be an extraordinary instrument for good and should be at the forefront of shaping the future of science and medicine. The current level of research into brain tumours is a stain on what in general is one of the UK’s greatest strengths. It is essential that the Government make research into brain tumours much more of a priority than it is. We have heard that from across the House today.

The Petitions Committee report makes a series of recommendations that would undoubtedly make a phenomenal difference to the lives of thousands across the United Kingdom. The report calls for the Government to support young scientists who wish to pursue a career in brain tumour research. It calls for the removal of red tape and a clear statement on how usage of off-patent drugs can be widened. Those are excellent ideas that will make a significant difference. The recommendations can be supported by the creation of a national register of all current research to track all grants and current work, which will help to prevent duplication and increase the transparency of research taking place in the UK. I urge the Government and the Minister to accept the recommendations.

Before I finish, I want to raise two particularly pertinent points from the report. First, in order for the survival rate of brain tumour patients to catch up with other cancers, the Government must begin to prioritise research into cancers with lower survival rates and take into account the historical improvement in treatments. That is essential if we are to ensure that research is targeting the diseases and patients with the greatest need and the areas where the money can make the biggest impact.

Secondly, the Government must dedicate a consistent amount of money, far above the current level, to research into brain tumours. The charity Brain Tumour Research, which, as I have mentioned, champions research across the country, has estimated that between £30 million and £35 million a year over 10 years is needed to make a significant impact on brain tumour treatment. The Government must consider committing to a similar level of funding.

I hope that the Minister, whom I greatly respect, takes on board many of the points made not just by me, but by other right hon. and hon. Members from across the Chamber in this debate and in the excellent Petitions Committee report. It is the Committee’s first report, and undoubtedly not its last. I know that my hon. Friend the Member for Warrington North will continue to be a fastidious and assiduous campaigner on behalf of petitioners who raise issues that have not received enough attention in Parliament. I say to her that brain tumour research funding was an excellent choice for the Committee’s first report. We have had unanimity across the House today. It is now time for the Government to act.

Contaminated Blood

Andrew Gwynne Excerpts

Tuesday 12th April 2016 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

I start by paying tribute to the 21 hon. and right hon. Members who have today provided a strong voice for the victims of contaminated blood. In particular, I pay tribute to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who has been tireless in her pursuit of justice. I remember her forceful arguments when she asked an urgent question on the subject about a year ago, to which my right hon. Friend the Member for Leigh (Andy Burnham) responded on the Opposition’s behalf, and when she asked her urgent question in December, to which I responded for the Opposition. She does real credit to the cause of those who are suffering as a result of this scandal. We must never ever forget the personal tragedies behind scandals such as this one, and I want to pay tribute to the families who have travelled down here today to listen to the debate. They deserve their day in Parliament, and I hope that the Minister will carefully consider the points that have been raised by all Members and by the families of the victims.

[Mr George Howarth (Knowsley) (Lab)]

I apologise for not being here throughout the debate; I was chairing a Committee elsewhere in the building. Would my hon. Friend accept that one of the defining characteristics of the modern world is that we have an expectation that an individual, a company or a Government will accept responsibility when things go wrong, and that they will accept the consequences of taking that responsibility? Does he agree that it is high time the Government accepted responsibility in this case?

[Andrew Gwynne]

My right hon. Friend is absolutely right, and I will come on to that point later. We owe it to the victims and their families to find some kind of justice for them.

I am not frequently on the same side as the editorial line taken by the Sunday Express, but I congratulate that newspaper on its tireless campaign for justice. This scandal has seen families torn apart through death and illness caused by the negligence of public bodies. I am willing to accept that, over the years, the response of Governments of all colours has just not been good enough. When the consultation was published in January, I was clear that while no amount of money could ever make up for the impact that this tragedy has had on people’s lives, the victims deserved some form of justice. We have three days until the consultation closes and I want to use my remarks to push the Minister on four points relating to the current proposals.

First, in the 1970s and 1980s, around 7,500 people were infected with hepatitis C or HIV as a result of this scandal. Many of those people were being treated for haemophilia. The viruses have had a devastating impact on their lives and those of their families, not least through loss of earnings and the cost of treatment. The failure of successive Governments to accept liability for this issue means that many of the victims have lost financial security through no fault of their own.

[Mims Davies]

Will the hon. Gentleman give way?

[Andrew Gwynne]

I am afraid that I will not; I do not have enough time now.

The current system of support is only partial; it does not offer the full and final settlement that those affected and their families need in order to live with dignity. Indeed, it falls well below the level of support available in the Republic of Ireland.

We must be honest that the development of support, financial or otherwise, for the victims has been haphazard over the years, and support is always delivered too slowly. However, I remain concerned about aspects of the Government’s proposals. A number of those affected have made it clear to me that removing discretionary payments will make them worse off, potentially by thousands of pounds a year. It makes little sense to announce more funding for a reformed scheme only to remove the critical day-to-day support that so many people rely on. I wrote to the Minister a few weeks ago on that point, so she will know that this is a basic issue of fairness and openness. The victims of the contaminated blood scandal deserve better than this, so I will be grateful if the Minister confirms what is intended for the future of the payments.

Secondly, I welcome the introduction of support for people at stage 1, as so far they have been denied the annual payments to which they should be entitled, but I want to ensure that the impact that a person’s illness has had on other areas of their lives, such as employment or educational opportunities, will be taken into account. Many people have had their professional lives cut short or have missed out on higher education, so I hope that the impact on quality of life will be considered as a fundamental part of the settlement. Furthermore, an assessment every three years strikes me as excessive given that, generally speaking, these conditions will not improve. Many beneficiaries will be receiving either employment and support allowance or personal independence payments and will be regularly assessed for them, so it is unnecessary and punitive to impose a further layer of assessment on the victims. Why not have some form of joined-up approach with the Department for Work and Pensions to make life easier?

Thirdly, I am concerned about the plans to freeze the existing annual payments. Many victims of the scandal had promising careers cut short or were not given the chance to embark on one after being infected. They had that taken away from them in the most damaging of circumstances, and it is just plain wrong of the Government to fail to recognise the loss of standard of living, as well as the effects on health and longevity.

Finally, I want to mention the discrepancies between the responses of the Scottish and UK Governments. As we have heard, the Scottish Government will increase annual payments for those with HIV or the hepatitis C virus, increasing the initial lump sum from £20,000 to £50,000. Will the Minister elaborate on what alignment there might be with the English system?

I do not doubt the sincerity of the Prime Minister when he made a pre-election pledge to do more after the publication of the Penrose report, nor that of the public health Minister, who is doing her best with a constrained spending envelope, but I am sure that she will understand the real disappointment that people have been feeling. This drawn-out process has only exacerbated the despondency in the community. Will the Minister tell me when any new scheme will be implemented? The community of people affected need assurances that any improvements to the system will be introduced as soon as possible and sustained long beyond that. Will she commit to a debate in Government time to allow for appropriate scrutiny of the package? We should have a full day of discussions on the matter once the Government have responded to the consultation.

I am sure that the public health Minister appreciates that the longer this goes on, the longer we leave in place a system that does not work and leaves victims without adequate support. No amount of money will ever fully make up for what happened, but we owe to those still living with the consequences the dignity of a decent lasting settlement. It is time to act.

Draft Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016

Andrew Gwynne Excerpts

Tuesday 1st March 2016 General Committees

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure, as always, to serve under your chairmanship, Ms Dorries. I thank the Minister for his useful overview of the effects of the draft order.

No one will disagree with the overall aim of improving standards and practice in the distribution and use of medicines. Medicines are a critical and essential part of the healthcare system in this country, and the accurate dispensing of medicines and the quality of the advice given by pharmacists are of paramount importance.

Overall, the draft order is eminently sensible, but it must be looked at in the context of where community pharmacy is going. Around 1.6 million people visit pharmacies every day. Pharmacies are among the most high-frequency interfaces of the health and social care system, so they have huge potential to fulfil many of people’s most regular requirements of that system and potential to take the strain off accident and emergency departments and GP surgeries. I am therefore a little confused that the Government are pushing ahead with reductions in the community pharmacy budget, which I understand will be the subject of an oral question in the other place tomorrow afternoon.

Ministers themselves estimate that between 1,000 and 3,000 community pharmacies will have no option but to shut their doors. Those closures will mean job losses and worsening pay for people across the sector. Pharmacists are often seen as simply suppliers of medication that others prescribe, but I am sure that the Minister will agree that they are so much more than that. The Opposition worry that this will become a self-fulfilling prophecy. Pharmacists carry out legal and clinical checks, administer vaccinations and emergency contraception, and review the effectiveness of people’s medication. The changes in the sector will be regressive, and I hope that the Minister will reconsider them.

My colleague Lord Hunt of Kings Heath made an excellent point when the draft order was debated in the other place. When the Health and Social Care Bill was debated in 2012, there were discussions about whether community pharmacists could be represented on the boards of clinical commissioning groups. The Government decided against that, but I suspect that because pharmacists are not around the table we often miss their valuable contributions in discussions on various parts of the healthcare system, of which they are usually a crucial part. Lord Hunt was right to say that we are missing a trick here.

We are happy to support the draft order and we note that the responses to the Government’s consultation were overwhelmingly positive, but I have placed on the record the concerns of Her Majesty’s Opposition with the Government’s approach to the pharmacy sector and I hope that the Minister will take those concerns away.

Crohn’s and Colitis Treatment: England

Andrew Gwynne Excerpts

Wednesday 24th February 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I, too, commend the hon. Member for St Albans (Mrs Main) not only on securing the debate and the eloquent way in which she opened it, but on the work she is doing to help raise awareness of Crohn’s and colitis. Although the debate is about the situation in England, we have had a valuable set of contributions from Members from Wales and Scotland. While it is right that the public health Minister is responsible for this policy area in England, there is a lot of experience and research that we should be sharing. We should also be sharing a lot more understanding of what each part of the NHS in each respective part of the United Kingdom is achieving in the work to try to tackle some of the issues.

I put on record my thanks to Crohn’s and Colitis UK for all its hard work in briefing Members of Parliament for this debate, and for all the work it has done since its inception in 1979. I will let you into a secret, Sir Roger. I am fairly new to the shadow public health role, although I have been on the shadow Health team for some time now. I must confess to not being entirely abreast of the issues facing IBD sufferers before looking at them for this debate. Frankly, what I found stunned me. More than 300,000 people in the UK suffer from Crohn’s or ulcerative colitis, and that equates to some 460 people in my constituency alone.

While that is a lot of people, IBD is not as prevalent as some of the more common long-term conditions. That means that research funding, as we have heard over the course of this debate, is thin on the ground, and there is not the same level of awareness in the general public at large. Put simply, it is not a glamorous cause. There are few outward signs of having the condition, but the effect on lifestyle is massive for the people concerned. Many of the problems that we discuss regularly in terms of cancer are just as pronounced when it comes to IBD, and not only include pain, fatigue, sleep deprivation and disruption to life in general, but also relate to awareness, diagnosis and psychological impact, and I want to touch on those things.

First, I want to address the problems of diagnosis. GPs need to be more aware of IBD. Every medical practitioner knows of instances of general abdominal pain and irregular bowel function being written off as IBS. As I have already said, I was not fully aware of the problem of misdiagnosis until I heard from Crohn’s and Colitis UK, so the matter does come down to awareness both among the general public and, importantly, among the medical community. Because the most pronounced symptoms of IBD are often the most embarrassing to discuss, the issue often gets swept under the carpet, even in the GP’s surgery.

Studies have shown that 35% of people with Crohn’s had three or more emergency admissions before they received a diagnosis. Frankly, that just is not good enough. I accept that some delays to diagnosis are inevitable, considering the nature of the disease, and clinical judgment should receive an appropriate degree of latitude, but we can and we must do much more.

There are some welcome signs. In 2013, NICE recommended faecal calprotectin testing as one option for doctors to help distinguish between IBS and IBD, which is welcome. There can be more effective use of that at primary care level, which would save not only money but would ensure better and more efficient care for patients: an undeniable win-win situation for all involved. How will the public health Minister improve the efficiency of the identification of suspected IBD? We also need to reduce the unnecessary use of endoscopies where less intrusive tests would do just fine.

I want to spend some time talking about the psychological impact, which Members have touched on today. Last year, the Opposition established the post of shadow Mental Health Minister, a job in which my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) is making a significant impact. Mental health is of paramount importance to the Labour party, and it is often the unseen damage that is most destructive. IBD symptoms, diagnostics and treatment can have a disastrous impact on a sufferer’s mental health. The uncertainty and sense of lost potential must be absolutely awful, and I cannot help but imagine how I would feel were one of my children told that they had IBD.

An audit in 2014 found that only 12% of services have a clear process to enable people suffering from IBD to see a psychologist or professional with knowledge of IBD. That figure may have improved—we might see that when the next audit is carried out—but however we look at it, it is not good enough. About 41% of IBD sufferers experience high levels of anxiety, and so of course we must do more, because many people living with IBD feel that simply having easier access to psychiatric services at critical points would help immensely. With the Government’s laudable commitment to ensuring parity of esteem, which we are fully behind, what is the Minister’s Department doing to make sure that people with IBD across England have the appropriate level of access to tailored psychological support with professionals who are familiar with the very specific issues they face?

I am pleased that hon. Members have mentioned the access to toilets strategy formed by my Labour colleagues in Wales. Obviously, an episode of incontinence in public is extremely embarrassing, and with incredibly poor access to public toilets being endemic across England, a person with IBD can feel anxious even being in an unfamiliar place. Many people with IBD have seen a devastating impact on their capacity to lead normal lives when they are away from home. I am therefore pleased that the Welsh Government have led by treating access to public toilets as a public health issue.

The Welsh Assembly is now considering the Public Health (Wales) Bill, which is close to the final stages of the legislative process. Some fairly simple steps can have a big impact on the ability of Crohn’s and colitis sufferers to lead normal lives when out and about. Councils, for example, could make better use of the toilets that are already in the community, whether in public buildings or private businesses. The Bill will place a duty on every council to publish a local toilet strategy. The Welsh Government are leading the way, and I hope the UK Government will follow suit. I appreciate that it might require intervention by the Minister’s colleagues in the Department for Communities and Local Government to halt some of the public toilet closures that we have seen in recent years, but will the Minister offer to discuss this not only with her colleagues in DCLG, but with my Welsh Labour colleague, Mark Drakeford? I think there is plenty of potential here.

My thanks go to all hon. Members for their contributions this afternoon. Some incredibly astute points have been made, and I hope the Minister goes away better informed, as I know I will, as a result of this debate. We owe it to those 300,000 people in the UK suffering from Crohn’s disease or colitis to come up with some better ideas in the coming months and years. This debate has given us a good starting point, such as the need for better public toilet access, and the need for more widespread use of less invasive diagnostic techniques. About 18,000 new cases of IBD are diagnosed every year, so this is not some fringe problem, but an issue facing people in every single community across the country. I look forward to hearing the public health Minister’s response.