Nutrition Labelling

Anna Soubry Excerpts

Wednesday 19th June 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Today we are launching the new front of pack nutrition labelling scheme across the UK.

This will introduce more consistent nutrition labelling across the UK by providing, on the front of food and drink products, clear information on energy and those nutrients of public health concern that the majority of us should be aiming to limit in our diets.

The scheme incorporates reference intake (previously known as guideline daily amount) information together with the levels of energy and the levels of fat, saturates, sugar and salt, highlighted by red, amber or green colour-coding. The combination of this information will allow people to judge how much energy and nutrients a portion of the labelled food will contribute to their overall diet, and also enable them to compare products and make healthier choices.

Two new public health responsibility deal pledges are also being launched today in order to enable food businesses to commit themselves to adopting the new scheme and, more widely, to enable businesses, non-Government organisations and others to help promote it.

The “Guide to creating a front of pack (FoP) nutrition label for pre-packed products sold through retail outlets” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper office.

It is also available at:

https://www.gov.uk/government/publications?departments[]=department-of-health.

Copies of the two new responsibility deal pledges have also been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper office.

The two pledges are also available at: https://responsibilitydeal.dh.gov.uk/.

Employment, Social Policy, Health and Consumer Affairs Council

Anna Soubry Excerpts

Tuesday 18th June 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 20-21 June in Luxembourg. The health and consumer affairs part of the Council will be taken 21 June.

The main agenda items will be the following legislative proposals:

the tobacco products directive—it is expected that the presidency will aim to agree a general approach;

clinical trials regulation—where the presidency will report progress on negotiations;

medical devices regulations—where the presidency will report progress on negotiations.

Under any other business, the presidency is likely to provide information on the serious cross-border threats decision and matters relating to the import of active pharmaceutical ingredients in accordance with the falsified medicines directive; the transparency directive; and the EU drugs action plan.

The Lithuanian delegation will also give information on the priorities for their forthcoming presidency, which will run from July until December 2013.

Genetic Medicine

Anna Soubry Excerpts

Thursday 13th June 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Mid Norfolk (George Freeman) on securing this debate and pay a warm tribute to him for the great work he does as the Government’s life sciences adviser. I also thank him for his kind words about me. I pay tribute, too, to my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown), who yet again, quite properly, advances the campaign of his constituent, Mr Les Halpin. There is much merit in that campaign, and my hon. Friend has brought it to the Floor of the House before, and so he should. We wish Les Halpin all the very best, and I pay tribute to the great work he has done and the valid points he makes in his campaign. I should also congratulate all the charities my hon. Friend the Member for Mid Norfolk mentioned that are concerned with prostate and breast cancer and Alzheimer’s disease; I pay tribute to them for all the work they do on those diseases, and all the campaigning work they do in advancing this topic.

It is a good time to hold this debate, but I fear I will not have enough time to address the subject in as much detail as I would wish. Numerous questions have been asked, and the usual rules apply: if I do not answer any of them, I will, of course, write a letter—or, rather, my officials will write a letter—to my right hon. Friend. I just called my hon. Friend the Member for Mid Norfolk my right hon. Friend, and why not?

[George Freeman]

That is very kind.

[Anna Soubry]

Yes, it is very kind of me.

It is a good time to hold this debate, as the development of genomic technologies, based on the individual’s genetic data, is a rapidly developing field that will bring benefits for NHS patients and the economy. The UK is a recognised world leader in scientific research in genetics, and the services that are available to NHS patients are among the best, if not the best, in the world. The NHS, in its unique position as a single, national health care provider, is ideally placed to harness this new technology and reap the benefits.

The data that are obtained from sequencing part of, or the whole, genome are limited in their usefulness unless they are linked to more information on the individual and the results of their treatment. That is why controlled access to patient records will be vital in our efforts to improve diagnostic capability, understand better the epidemiology—I hope I do not struggle in pronouncing that word—of disease and develop better health care tools and treatments.

On generating more data, the issue of ensuring we protect data obtained from an individual’s DNA has been discussed in many different forums, including the 2009 Lords inquiry into genomic medicine in health care and the consequent work by the Human Genomics Strategy Group, which was led by the Department of Health.

In December last year, the Prime Minister announced that we would be the first country in the world to put in place a programme to sequence 100,000 whole genomes. That is part of a programme that will receive an extra £100 million in funding over the next three to five years. The result will be the building of safe platforms of data that will open access.

Now that it is becoming a reality, access to genetic data will continue to be a subject of keen interest to many. It is only right that it is debated on the Floor of this House because it is so important. As with other data, DNA sequence data will be governed by strict legal controls. It will not be shared with other parties in a form that identifies the individual unless there is a legal and appropriate basis for so doing, and where such a legal basis exists, the patient has the right to be informed about how their DNA sequence data are used. The sequencing information will be strictly controlled within existing NHS arrangements and managed in a way that protects patient confidentiality.

As I said, the raw read-out data are of little value to clinicians, researchers or indeed the industry if they cannot be linked to phenotype and clinical data, so we need to ensure that information-rich data sets are developed that have been value-added through linking genetic and genomic data to disease development, treatment and results. Data need to be made available in an environment that fully meets consent and data protection requirements. To ensure that we harness that potential as part of the growth agenda, which my hon. Friend mentioned, we must develop an industry ecosystem that helps to promote innovation within a healthy, competitive economic atmosphere, which respects data protection and consent boundaries and allows open data sharing for academic research.

While the protection of personal data is important, we should not forget that sharing data has immense benefits. Those patients with cancer or rare diseases who will have their whole genome tested as part of the Prime Minister’s initiative may well argue that they want more of their data to be shared, to help research into their condition and to help fellow sufferers. The recent review carried out by Dame Fiona Caldicott recognised that people’s concerns about what happens to their information, who has access to it and for what purposes, is hugely important; but people also raise concerns about why their data are not shared more frequently when common sense tells us all that it really should be. On the other hand, there was high level of anxiety among some clinicians about when it is safe to share information and what safeguards are required, including concerns about breaching data protection laws or threats to their professional status.

Clearly, a cultural change is required to rebalance sharing and protecting information in patients’ and service users’ interests. We believe that the Caldicott recommendations strike a good balance between the rights of the individual and the need to develop new treatments and services for the greater good. There is no contradiction between demanding rigorous safeguarding of personal information and enthusiasm about sharing information. We want to develop systems that provide open data from what we call safe platforms. There should be no surprises to patients or service users about who has access to their information, and they should be fully informed about their rights in relation to their data. That includes explaining to individuals how their information will be used, including de-identified information, and that it may be used for public health prevention and research, as well as providing assurance that any misuse will be tackled vigorously.

If we are to get better, less fragmented care and to harness the potential of genetic and genomic data for the benefit of all, any lack of trust between individuals, be they individual patients or organisations, in relation to their practice of information governance has to be overcome. The Department of Health research indicates clear public support for using health and care information in research to better inform and develop new treatments. We want to ensure that individuals retain consent to any use of their personal information. That is why we have asked the chief medical officer, Professor Dame Sally Davies, to retain oversight of the programme to sequence 100,000 whole genomes, to ensure that the patient and public interest is protected.

I pay tribute again to my hon. Friend the Member for Mid Norfolk. We could have a huge debate on this subject, and I apologise again that we do not have the time to take it further today, but as I said, I shall ensure that he has a response to all his questions. He has kindly provided me with many of them already, and my officials have compiled a long, long set of answers—far too long for this short speech. He will be in full possession of our responses, and I am sure that he will share them throughout the industry. I thank him again for all his hard work.

Question put and agreed to.

Oral Answers to Questions

Anna Soubry Excerpts

Tuesday 11th June 2013 Commons Chamber

[Gavin Shuker (Luton South) (Lab/Co-op)]

9. When the Government plan to respond to their consultation on standardised packaging of tobacco products.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The Government have yet to make a decision. We are still considering the lengthy consultation, and in due course we will publish a report on that.

[Paul Flynn]

We heard on the radio this morning about the poor state of the country on levels of cancer. The Government have an opportunity to reduce those levels by the Bill and by the minimum price for alcohol, but when it comes to the Queen’s Speech, have they again been persuaded by the blandishments of lobbyists, and instead of putting the health of the nation first, have put the needs of big business first?

[Anna Soubry]

I certainly do not agree with the latter part of that. Just because something was not in the Queen’s Speech does not preclude us from introducing legislation should we take that decision. The hon. Gentleman makes some important points when he talks about the link between mortality and choices about how much alcohol one drinks or whether one chooses to smoke, but we await a decision from the Government.

[Gavin Shuker]

Many of my constituents, including Cancer Research UK ambassador, Elizabeth Bailey, are asking a simple question: why is it taking the Government so long to respond to this consultation? Is not the truth that they are caught up in interdepartmental squabbles while public health suffers?

[Anna Soubry]

No, it certainly is not, and I have given my views. The hon. Gentleman will know that like many decisions on public health, these are complicated matters. Most importantly, it is vital that we take the public with us. I have said before that I welcome a debate, and perhaps he and the hon. Member for Newport West (Paul Flynn) might come to you, Mr Speaker, and ask for a debate in this Chamber or in Westminster Hall. Let us have the debate, because taking the public with us is always important when we make these sorts of difficult and controversial decisions.

[Philip Davies (Shipley) (Con)]

Does the Minister agree that some of the proposed standardised packaging is more colourful than the existing packaging, and given that we have a display ban on cigarettes, what on earth is the point of having standard packaging for something that cannot be displayed?

[Anna Soubry]

Unfortunately, I do not have enough time to advance all the arguments, but I am more than happy to meet my hon. Friend to discuss this with him at length and show him a packet of the said cigarettes from Australia, and he may see the light.

[Dr Sarah Wollaston (Totnes) (Con)]

Does the Minister agree that there is nothing plain about plain packaging? It just shows the reality of gangrene of the foot with graphic images, which is not very attractive to hand round at a party.

[Anna Soubry]

Yes.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Minister is aware that smoking is the biggest single cause of health inequality, and she will know that the Labour Government took difficult, complicated and controversial decisions that were successful in driving down smoking from 27% to 20%, saving thousands of lives. Why are this Government stalling? When will they announce a decision? Or is it that the business interests of Lynton Crosby matter more to these Ministers than the health of the nation?

[Anna Soubry]

I am sure that Mr Crosby would be grateful for that bigging-up. I can assure the hon. Lady that, as she knows, if standardised packaging was as simple as she tries to suggest, no doubt the last Government would have introduced it in some way. I am proud of the fact that we have made sure that the point of sale legislation has been achieved. As she knows and as I have said before, this is a difficult and complex issue. It requires a good and healthy debate. Let us bring on that debate. Perhaps the Opposition would like to use one of their Opposition days to bring it forward. I will be more than happy to take part.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

5. What estimate he has made of the optimal level of bed occupancy in NHS hospitals.

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[Stephen McPartland (Stevenage) (Con)]

6. What progress he has made on improving cancer waiting times and diagnosis.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Cancer waiting time standards set out a maximum two-month wait from urgent GP referral for suspected cancer, through to diagnosis, to the first definitive treatment. Quarterly performance in the past 12 months has consistently exceeded the performance measure of 85%; indeed, the current data show that 86.3% of patients were treated within this time frame.

[Stephen McPartland]

I am a firm believer in bringing cancer care closer to people’s homes. My constituents have to travel thousands of miles during the course of their radiotherapy treatments. Will the Minister support my campaign for a satellite radiotherapy unit to be based at Lister hospital in Stevenage?

[Anna Soubry]

I pay tribute to my hon. Friend’s campaign, which he has been running for some time, and to all the great work that he does for Lister hospital. I am slightly worried that if I give him any support it might be the kiss of death for his campaign, but I wish him all the very best and all power to his elbow.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

One group of people greatly affected by a cancer diagnosis are the carers who suddenly find themselves to be carers of people with cancer. Yesterday I met some people who are carers of people with cancer, and they told me that they did not get the information, advice and support that they needed to tackle that important caring role. Does the Minister agree that it is about time that we recognised those carers and started to give them the advice and support that they need because they suffer financial loss, hardship, loss of career and impacts on their own health?

[Anna Soubry]

I very much do agree. That is why I am so pleased that the Care Bill that is making its way through both Houses has special provision for people who are caring for others with cancer in the way that the hon. Lady describes.

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

Last week Monitor, the regulator for foundation trust hospitals, said that cancer patients are now waiting longer for treatment and diagnosis because of the A and E crisis in hospitals. Official NHS figures published that same day show that the number of patients waiting over three months for cancer, heart disease and other life-saving tests has more than doubled compared with only last year. Is it not obviously the case that this Health Secretary’s failure to cut the spin and get a grip on the A and E crisis is now seriously damaging patient care?

[Anna Soubry]

That was a very interesting speech but I am afraid that I do not accept the hon. Gentleman’s analysis at all. All cancer waiting time standards are being met, with over 28,000 patients being treated for cancer following a GP making an urgent referral for a suspected cancer. We have already heard about the action that this Government are taking to address the situation in accident and emergency; it was very well explained in last week’s debate

[Gavin Barwell (Croydon Central) (Con)]

7. What steps he is taking to increase accountability in the NHS.

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[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

We will shortly be seeking cross-Government clearance to publish the UK strategy, which addresses the challenges raised in the chief medical officer’s annual report and sets out the priority areas for action, such as slowing down the spread of resistance, maintaining the efficacy of antimicrobials and supporting the development of new antimicrobials.

[Zac Goldsmith]

In January, the chief medical officer warned that the threat from antibiotic-resistant infections was so serious that it should be added to the Government’s national register of civil emergencies, the national risk register, alongside deadly flu outbreaks or catastrophic terrorist attacks. My hon. Friend is preparing a new cross-Government strategy on antibiotics. Given the growing evidence linking the routine use of antibiotics on intensive farms with antibiotic-resistant infections in humans, can she confirm that the strategy will tackle that reckless practice, regardless of pressure from industry?

[Anna Soubry]

I could give my hon. Friend a long answer, but in short, the matter will be raised at the next G8 meeting. Further to that, as a result of his excellent debate earlier this year, I undertook to write, and have done so, to my hon. Friend the Minister of State, Department for Environment, Food and Rural Affairs. He has replied that the Government recognise that we should look at the guidance issued to farmers. I am more than happy to share the Minister’s letter with my hon. Friend.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

16. What the status is of the capital programme for the refurbishment of St Helier Hospital.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am sorry, Mr Speaker, I am all over the place and do not have now the answer to give the hon. Lady. I believe the programme was signed off in 2010—[Interruption.] In fact, I am right—[Laughter.] Well—[Interruption.] Now, now; that is very naughty from the right hon. Member for Leigh (Andy Burnham). As you get older, Mr Speaker, you sometimes start to forget things—[Laughter.] Not you, Mr Speaker, of course; you would never do such a thing, and in any event you are much younger than I am.

The Government re-approved the business case for the redevelopment of St Helier hospital in May 2010—I was right—as part of the review the previous Government’s spending commitments. As the hon. Lady knows, because of the various configurations and proposed configurations, no final decision has been made yet. We need to ensure that all the plans come to some sort of fruition.

[Siobhain McDonagh]

At my age, I share with the Minister a problem with memory loss, but I do not forget the years when we were trying to get the £219 million redevelopment of St Helier hospital agreed, or that the proposal was supported by the Chancellor in his first Budget. The money is now being used as a slush fund by Better Services Better Value, but its idea is to increase the sizes of A and E and maternity units of all the hospitals around while closing those at St Helier. Does the Minister agree that that was not the intention of the money, and that any future development plans must go back to the Department of Health for agreement?

[Anna Soubry]

I pay tribute to the hon. Lady, who campaigns hard for her hospital, and quite rightly so. I have met my right hon. Friends the Members for Sutton and Cheam (Paul Burstow) and for Carshalton and Wallington (Tom Brake) and am more than happy to meet her to discuss all the important matters she raises.

[Chris Heaton-Harris (Daventry) (Con)]

T1. If he will make a statement on his departmental responsibilities.

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[Simon Hughes (Bermondsey and Old Southwark) (LD)]

T2. In my borough of Southwark we have higher than average smoking rates, and the Cabinet member responsible for health has said that hundreds of people are dying early because they smoke. Can Ministers help me to persuade our Labour council that it is inconsistent to say “Don’t smoke” on the one hand and invest £2.6 million of pension funds in British American Tobacco on the other?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

That is a good point, but I have to say that I am not convinced that it is just a Labour-run council that might have chosen to invest their staff pensions in this way; I strongly suspect that all political parties are guilty of this. While this is, of course, a matter for local authorities, it is also the sort of great campaigning work that MPs can do with their local councillors. It is even more important that they do that, given that they now have this great responsibility for public health.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

T3. I welcome the leading role that the Department is taking in the formulation of a national strategy for TB. Its importance was reinforced by a recent all-party group report on resistant forms of the disease. One of the key points in the report was the importance of joint working in the development of the strategy, and that it should be public health-led. Does the Minister agree that NHS England also has a crucial role to play in the development of the strategy? Will she ensure that it works closely with Public Health England to develop it?

[Anna Soubry]

The short answer is yes. I pay tribute to the hon. Gentleman for the work of his APPG. We had a good meeting in December and I am looking forward to our follow-up meeting tomorrow when we will discuss this matter further.

[Steve Brine (Winchester) (Con)]

T7. Now that public health responsibilities have, as has been discussed, moved to local authorities and Public Health England, can the Government confirm that raising awareness of the signs and symptoms of cancer and early diagnosis, which is of course so important, will be key priorities for those bodies? Will the Minister tell the House how the Government will assess progress?

[Anna Soubry]

Again, that is a very good point. I completely agree with my hon. Friend and pay tribute to the work of his all-party group on breast cancer. Screening is important. This is also a good opportunity to pay tribute to the Secretary of State’s announcement today of the publication on the website of such outcomes, which will not only drive huge improvement in public health, but, most importantly, ensure that we reduce health inequalities. The previous Government failed to do that; this Government are determined that we will improve them.

[Gavin Shuker (Luton South) (Lab/Co-op)]

T4. An enormous number of people—largely women—involved in on-street prostitution are caught in a cycle of drug and alcohol abuse, and are working to feed their habit, but at the same time, beyond managing drug dependency, many drug and alcohol services do not offer any practical pathways out of prostitution or even ask whether the client wishes to exit prostitution. Will Ministers look into this issue, consider issuing guidance and write to me?

[Anna Soubry]

Absolutely yes on all those very important points. The hon. Gentleman makes an extremely important point to which I absolutely subscribe. I have regular meetings on this matter, and I hope that our sexual health strategy addressed exactly those points, but I am more than happy not only to write, but to meet him to discuss the matter further. If I might say, I think that all Members, whatever the party political divide, could do far more both here and locally to reduce the number of women who find themselves working on the streets as prostitutes. I have long taken the view that these are some of the most vulnerable people in our society, and without exception I have never met a prostitute—I used to represent many of them—who has not herself been abused, usually as a child. They are vulnerable people and we should recognise them for that.

[Zac Goldsmith (Richmond Park) (Con)]

T8. More than 5,000 schools across the UK now serve good-quality, sustainable meals with the Food for Life catering mark, but only three hospitals have achieved the same. It is often said that hospitals cannot do so because of the cost implications, but the three that have done so not only have incurred no extra costs, but, in the case of Nottingham hospital, have actually saved significant amounts. May I urge my hon. Friend actively to encourage take-up of the Food for Life catering mark as a model of best practice?

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[Alex Cunningham (Stockton North) (Lab)]

T6. Three Health Ministers have indicated their support, and one even voted for it, so will the Secretary of State either introduce his own legislation or back new clause 17 to the Children and Families Bill to ban smoking in cars with children present?

[Anna Soubry]

Well, it is a very good point, and the hon. Gentleman knows my own feelings. [Laughter.] No; it is important that we always get the balance right between good public health measures and not getting the accusation from both sides of being a nanny state. [Interruption.] No, no; it is all right his getting agitated, but he knows my view, and I am happy to give him any assistance I can—my door is always open.

[Charlotte Leslie (Bristol North West) (Con)]

Does the Secretary of State agree that any criminal investigation into the 200 to 300 deaths at Mid Staffs should extend not only to front-line staff, who risk getting scapegoated, but to all managerial levels, Department of Health officials and the heart of Government, so that we get answers about who knew what and when, and what action they took or—more importantly—did not take that could have prevented this tragic scandal?

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[Jim Shannon (Strangford) (DUP)]

When a patient is ill and visits their GP, they will do as the doctor orders. One hundred thousand people will die of lung cancer this year. When will the Government do as the doctor orders and bring in plain packaging for tobacco?

[Anna Soubry]

I refer my hon. Friend to answers that I have given beforehand. I know the great work that he does on lung cancer and I am pleased to see that, yet again, we will have a national campaign following the great success of the last one. We can talk further.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

This is cervical screening awareness week. What plans does the Minister have further to encourage women aged 60 to 64 to attend cervical screening, given the declining levels of screening uptake and the increasing levels of incidence in this age group?

[Anna Soubry]

Screening is one of the most important aspects of the work of Public Health England and we are keen to make sure that it is addressed both nationally and locally. Great work can be done by local authorities in making sure that women have this vital screening.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Is the Secretary of State aware of the alcohol treatment centre in the middle of Cardiff, which treats people who are drunk on Friday and Saturday nights and therefore takes pressure off A and E, ambulance services and the police? Will he look at this model, as we are in Swansea, and pilot it elsewhere?

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[Jane Ellison (Battersea) (Con)]

In April, the BBC’s “Casualty” programme highlighted the vital role that health professionals have in spotting young girls at risk of being taken abroad or of having female genital mutilation carried out on them in this country. We are approaching the most difficult time of the year over the long summer holidays, when girls are most at risk. Will Ministers do all they can to draw the attention of health professionals to the vital role that they have in these critical next two months?

[Anna Soubry]

Absolutely, and I pay tribute to my hon. Friend and to other hon. Members on both sides of the Chamber for the great work that they have done on FGM. I am really proud that the Government have produced the FGM passport, which is available to many young women. It does—I hope that it will continue to do so—protect women, especially younger women who are going abroad for this appalling abuse to be carried out upon them. We have done great work already with health professionals who increasingly realise, first, that they must be aware of it; secondly, that they must report it; and thirdly, that they must take action to prevent this appalling abuse of women, especially young women.

[Ian Austin (Dudley North) (Lab)]

I listened to the answer to Question 7 earlier, but surely the best way to improve accountability in the NHS would be much greater consumer choice and competition when it comes to GP services, for which there are virtually no comparative data at the moment. With modern IT, why can patients not choose to have their own medical records and then ring round to find a GP who will treat them when they want to and not when their own GP deigns to see them?

111 Telephone Service

Anna Soubry Excerpts

Wednesday 5th June 2013 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

rose—

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Will my hon. Friend give way?

[Miss McIntosh]

If I may, I will give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

[Miss McIntosh]

I know what I am going to say is controversial but perhaps I, as a woman, can say it. Some 70% of medical students are women and they are well educated and well qualified, but when they go into practice, many marry and have children—it is the normal course of events—and they then often want to work part time. Training what effectively might be two GPs working part time obviously puts a tremendous burden on the health service. I will now give way to my hon. Friend the Minister.

[Anna Soubry]

On the point my hon. Friend made about any rationing of or charging for GP appointments, let me assure her that that was an idea floated on a website and is not Government policy. It is reasonable for people who have an interest in such issues to be able to debate whatever they wish to debate, but it is certainly not Government policy, and I know of no good reason why it ever should be. She makes a very important point when talks about, rightly, the good number of women who are training to be doctors, but the unintended consequences.

[Miss McIntosh]

The problem is similar in other professions, such as my original profession of law. The Chamber will welcome the Minister’s confirmation that it is not Government policy to ration or to charge for GP appointments, as we have heard under successive Governments. We are very reassured to hear that it is not their policy to ration GP visits.

How is the interface with GP out-of-hours providers being addressed? In the rural area of North Yorkshire, three and a half clinical commissioning groups cover one constituency, which poses some real practical problems. Where there are multiple GP out-of-hours providers, what regard has the Department had to the potential difficulties of rolling out the 111 service? Furthermore, are there any issues relating to delivery in rural as opposed to urban areas? I am talking in particular about the distances that GPs or nurses might have to travel to respond to calls under the 111 system.

Most worryingly, there seems to be a political vacuum here. Will my hon. Friend the Minister reassure us that there will be political accountability? Where does the political responsibility and accountability lie for any potential failings or successes of the 111 service? Does the Department plan to review the system further? I ask that because my own experience in the pilot area of County Durham has not convinced me that the review has borne any fruit. Does the Department plan to review the system after three or six months?

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[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Robertson, for what I believe is the first time.

My hon. Friend the Member for Thirsk and Malton (Miss McIntosh) made an admirable speech, raising many points and asking many questions—some of which, I will say bluntly, I will not be able to answer in my speech. I assure her that she will receive an answer to those by way of a letter. Before I discuss her speech, I want to deal with the points raised by the hon. Member for Copeland (Mr Reed). It does neither him nor his party any credit to use the serious problem in A and E as a political device to attack the coalition Government. It is not as simple as that. To suggest that the problem has been caused by the Government is plain, simple rubbish. It is accepted that there are many complex reasons for the situation, although I am reliably informed that the number of people being seen within the four-hour target is improving and that many accident and emergency departments are achieving the target, and have been doing so for some weeks. Some, indeed, are exceeding it.

There is much evidence emerging that a firm grip is being taken on the situation, but things are complex. There is no magic bullet. It does not matter which party is in power, the Government would face the problem that we have, because there are many causes. One of them, which people on all sides of the argument have identified, is the fact that we do not have the out-of-hours service we want.

[Barbara Keeley]

The Minister says that the issue is complex and accuses the shadow Health Minister of making political points. It is about time that Health Ministers stopped making excuses. They have been in office three years and it is time they started to take responsibility for what they are doing.

I have gathered evidence, and the causes of what has happened clearly include insufficient call handlers, which is not complex—it is just a shortage of staff. Another factor is the replacement of trained nurses and trained clinician input for phone triage with computer-led or non-clinician advice. Those things are not complex. They are just wrong.

[Anna Soubry]

I am not for a moment saying that there are not difficulties and problems in 111. We know there are, but if only the issue were as simple as solving the 111 problems. The out-of-hours service is just one of many factors. [Interruption.] I want to make some progress on this point: 111 is one factor among the failings in relation to the sort of out-of-hours service that people want. We have also had the difficulty of a long, cold winter, which has added pressures—that is something that often happens. Also, there are 1 million more people attending A and E. That is not the fault of the Government. We have not suddenly caused it. It is because of changes—

[Andrew Percy]

rose—

[Anna Soubry]

I will take interventions, but I want to make these points first.

The population is also living considerably longer. That is good and welcome, but there are many frail elderly people with complex illnesses and diseases, so they attend A and E in a way they did not previously. In addition, we suffered under the previous Government from a lack of integration between health and social care. That was one of the things that the Health and Social Care Act 2012 addressed, and will solve. It is about better integration. The hon. Member for Copeland sneers at that.

[Mr Jamie Reed]

I do not sneer; I laugh.

[Anna Soubry]

He laughs at it, Hansard will record. It is not a laughing matter at all. What I was describing is one of the achievements of the Act. I am confident it will deliver.

[Andrew Percy]

The Minister is making sensible points. As to manufactured indignation, if that is what it is, mine comes from the fact that I spend 30 to 40 hours a week volunteering in the NHS as a first responder, and I spent 30 hours doing so last weekend.

A big issue that creates pressure in the NHS is the lack of integration between social care and health services, and a lack of proper intermediate care facilities. We do not have the step-up, step-down facilities that we need to deal with the ageing population. That is one of the biggest problems in my area and a reason for increased pressure.

[Anna Soubry]

I, too, know that it does no one any favours to make out that someone forcefully and passionately giving a view based on their experience is manufacturing it. I know that that is not true of my hon. Friend, and I thank him for his valuable contribution. He is right.

[Mr Jamie Reed]

I think casual outside observers will struggle with the concept that politicians from different political parties should seek to have different political opinions about the services and Department for which the Minister is responsible. She makes an almost Kafkaesque defence of the Government’s NHS record, but will she accept that the awful implementation of the 111 scheme, the collapse of adult social care, the closure of walk-in centres and the huge pressures on the NHS elsewhere in the system have resulted in the crisis in A and E?

[Anna Soubry]

I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No, I will not. The responsibility, if we are honest—would not it be refreshing if we could for once have an honest debate about the national health service?—probably goes back 10 or 20 years, a period encompassing Governments of different political colours. I am happy to say that—by which I do not mean I am happy that those Governments have failed, but people may think the honesty is refreshing.

I want to deal now with the excellent speech of my hon. Friend the Member for Thirsk and Malton. I pay tribute to her and her work in this place, but also to the considerable efforts and work of her late father. I am sure that if he could have heard his daughter’s speech he would have been very proud. I remember my own father saying that out of all evil comes some good, and perhaps some good may come from her late father’s terrible experience of 111 and the fact that he died shortly thereafter.

I pay tribute to all GPs. There are huge difficulties with the GP contract, which was introduced in, I think, 2004. The consequences have included the loss of the out-of-hours service that I enjoyed as a child, teenager and young woman. With few exceptions, we have wonderful general practitioners, and many whom I know, including my own, and others who are friends of mine, work long, difficult hours. It is important to make that point.

As you know, Mr Robertson, during the recess, far from enjoying holidays, as the popular press makes out, we go back to our constituencies and use the time to make or renew contact with, for example, our local clinical commissioning group or ambulance trust. Alternatively we just go out and about, as I have done, knocking on doors and talking to people. One of the things I did during my recess was meet the head of the A and E department of the Queen’s medical centre, which is the local hospital in my constituency of Broxtowe in Nottingham. The head happens to be one of my constituents, and they tell me that there is much improvement at the Queen’s medical centre, as I know from the stats and so on. I also talked to GPs, and the CCG in my constituency now opens its doors for Saturday morning surgeries, which do not replace any other surgeries; they are extra facilities. The CCG has done that for two simple reasons: first, to improve the service it gives to its patients, and, secondly, in recognition of the need to reduce the pressure on the A and E department of the Queen’s medical centre.

It is right and fair to say that many GPs look with concern at what is happening in many of our A and Es, and with 111, which is commissioned in some areas by CCGs and in other parts of England by clusters of GPs. They are by no means fools. What motivates anyone to enter the medical profession, in my experience, is a real desire to serve people. They want to help and treat people. They are motivated by the very best of motives, so of course our GPs are concerned about the situation.

There is much work to be done with the GP contract to improve out-of-hours service, but we also have to be honest in this debate. There are often urban myths and anecdotes, but it is a fact that many GPs have already said that, far too often, people who come to see them in their surgeries, who attend A and E or who dial 999 or 111, are calling when they do not need to make that call or that appointment. They might be better off making their pharmacist their first port of call.

[Miss McIntosh]

I thank my hon. Friend for allowing me to intervene and for recognising not only the work my father did, but the work that all GPs do in very trying circumstances. May I bring her back to the Government’s framework, to which I referred, and the very real issues that GPs have raised in North Yorkshire about different GP out-of-hours providers suddenly working with one 111 provider? How will those issues be resolved?

[Anna Soubry]

Indeed. I will answer as many of my hon. Friend’s questions as I can. There are some questions I will not be able to answer, but I will certainly write to her.

One of the reasons we introduced pilot schemes was to learn from them, and I can tell my hon. Friend a few things as a result. The university of Sheffield did an evaluation report, which said that there was “no statistically significant” impact on services in most of the pilot areas. Importantly, NHS England is collecting data on 111 and its impact on other services, especially, as one would imagine, on A and E. NHS England is in a position to monitor that, and it will report in due course. I am told that the April data will be published this Friday.

I am reliably informed that the A and E performance of York Teaching Hospital NHS Foundation Trust, which serves my hon. Friend’s constituency, is that in 2013-14 so far, 96.1% of people have been seen within the four-hour target. That is above target. I think the average across England for people being seen in A and E is some 55 minutes.

[Mr Jamie Reed]

This question is not a trap in any way, shape or form. The Minister just said that NHS England is assessing data on the performance of 111 thus far, which will be made available in due course. This is an empirical question: will the system be rolled out across the country without the data on the effect of the 111 service on the rest of the system being fully understood?

[Anna Soubry]

I do not know the answer, and I will not start speculating because it invariably gets one into terrible trouble.

[Mr Reed]

Will the Minister write to me?

[Anna Soubry]

I am more than happy to write to the hon. Gentleman with some sort of answer from either NHS England or the Department.

I should say, of course, that we know that 111 has not been successful in the way it should have been in many parts of the country, and we know that there were particular problems over the bank holiday and Easter periods, but we also know that it has now been rolled out to 90% of England. NHS England is monitoring, overseeing and collecting the data, as we would all hope.

I will do my very best to respond to the content of today’s debate and the questions that have been raised, with apologies for those questions that I do not answer.

The ratio of call handlers to professionals, about which my hon. Friend the Member for Thirsk and Malton asked, is 4:1. That ratio is not specified, however. There is no prescription that it must be 4:1. As 111 is locally commissioned in the way that I have explained, it is for local commissioners to decide whether to change that ratio, depending on the particular needs of the people in their area. One of the great benefits of the 2012 Act is that we have enabled local commissioners, either as a CCG or as a cluster, to commission services to meet the specific needs of their patients. I hope that will mean that a cluster or CCG in a rural area, obviously knowing that its patients live in a rural area, will ensure that its service is tailor-made to suit the needs of those patients, which may be different from the needs of patients in, say, a city and its surrounding suburbs. That is one of the joys of local commissioning.

My hon. Friend asked whether the three to three-and-a-half hours—in truth, I think it was really four hours—before her father was seen is normal, and the unequivocal answer is no. Is it acceptable? In my view, it is certainly not acceptable.

My hon. Friend then asked who pays. She is concerned about whether the debt in which her primary care trust found itself will have an impact. The 111 service is paid for by CCGs, which is one reason why CCGs are involved in the local commissioning of the service.

How are the concerns of GPs being addressed? The NHS is having a review in the way that I described. My hon. Friend the Member for Brigg and Goole (Andrew Percy), who must be a member of the Select Committee on Health—that shows my profound ignorance, and I apologise to him—has helpfully reminded me that Dr Gerada, who is the chair of the Royal College of General Practitioners, said in her evidence yesterday that she has not seen such queues since the flu epidemic of two to three years ago. She said that the reasons for the high demand are mixed and complex, including the nasty flu virus that went around earlier this year and at the end of last year. I reiterate my point: if only it were so simple to cure the problems in A and E.

[Barbara Keeley]

The Minister talked earlier about the issue being about out-of-hours service. The NHS 111 problems in Greater Manchester put greater pressure on our out-of-hours service. She said there was a long winter, but 111 was rolled out at the end of March. Does she think that was a sensible time? It was not even the end of a very hard and long winter. Finally, she said that we have had more A and E attendances, but the problems have caused further pressure on A and E. The point many hon. Members have made, which I hope she accepts, is that the chaotic launch of NHS 111 in the end part of winter caused more problems than it solved.

[Anna Soubry]

Again, I do not think it is as simple as that. Of course we have not been happy with the roll-out of 111, which is accepted. The service has not been the success that we had hoped. We agree on that.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No; forgive me. The most important thing, though, is that things are improving.

[Andrew Percy]

We on the Health Committee were provided with figures yesterday showing that referrals to A and E from NHS 111 were about half the amount of those from NHS Direct, but that there had been an increase in referrals to out-of-hours and GP services. The link between NHS 111 and pressures on A and E is perhaps not proven.

[Anna Soubry]

I am grateful for that intervention. I know that the university of Sheffield specifically examined the pilot and found that in most pilot areas, there was no impact. However, we also know that NHS England is monitoring the situation, reviewing the data and analysing all the different, complex problems causing pressure on A and E to ensure that we make the improvements that we want.

My right hon. Friend the Member for Thirsk and Malton—[Interruption.] Well, I am going to make her right hon. for the moment. It will not be put into Hansard, so no one will know; it is just between us. She made an important point about providing for people receiving palliative care, catheter treatment and so on. She said that perhaps they needed a different script. There is much merit in that. Again, I would hope that the commissioning services would put that aspect in the script. She asked specifically about the script. I am reliably informed that it has been written by clinicians at the highest levels, but I also know that there is concern at a senior level about the fact that it takes an average of 20 minutes to go through a prescriptive script.

There is a wider problem here. We live in an age in which it is increasingly difficult to rely on common sense. When somebody rings up and says, “My father is a retired GP. We’ve been here before, and he has all the symptoms of a urinary tract infection,” they should not be asked whether he is still breathing. A large dose of common sense would mean that that question would not be asked, nor would “Is he bleeding?” and so forth. That is the stuff of nonsense.

[Margot James (Stourbridge) (Con)]

I apologise for not being here at the beginning of this excellent debate, and I congratulate my hon. Friend the Member for Thirsk and Malton (Miss McIntosh) on securing it. I have been in regular correspondence with the 111 service in the west midlands region, and with the other related services. I am satisfied that some of the teething problems will be resolved, but my local hospital asked me to raise one question with the Minister. Will she look into the treatment algorithms used by 111? There is a belief in the hospital that they are more likely to result in a referral to A and E than those used by the previous service.

[Anna Soubry]

I am grateful for that intervention, because I have heard that anecdotally as well. It is an important question. I cannot give my hon. Friend a full answer, but I will do all that I can to provide it in a letter if she will allow me. That concern has been raised with me on a constituency basis.

As I said from the outset, 111, which is a good service in theory and should be of considerable benefit to health professionals and, most importantly, to patients and all others concerned in the national health service, has not gone as smoothly as we had hoped. That is conceded, and one should not make party political points from it. However, the service has improved, it continues to improve and it is being monitored. I am grateful to my hon. Friend the Member for Thirsk and Malton for bringing this matter to the attention of the House, and I apologise to her for any questions that remain unanswered. I will reply to her and will address all the other points raised by hon. Members in this debate.

Accident and Emergency Waiting Times

Anna Soubry Excerpts

Wednesday 5th June 2013 Commons Chamber

[Dr Wollaston]

I commented on that on Twitter. The remark was unfortunate; I think women GPs contribute enormously, but there we are. I would say that, wouldn’t I?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

rose—

[Dr Wollaston]

I am short of time, I am afraid.

I go back to how we get people directed to the right place. We need NHS 111 to do the job it is intended to do—direct and signpost people to the right place. Some 42% of people do not know how to access their out-of-hours service; they will go to where the lights are on. We need to make sure that there is good-quality information about how to see the right professional in the right place at the right time and about communication in all parts of the system.

We also need to consider how commissioners can be supported to keep people at home, which is the right place for frail elderly people, by using community resources. There are some wonderful organisations in my area—Brixham Does Care, Totnes Caring, Saltstone Caring and Dartmouth Caring. Having the flexibility to commission small local units is vital, rather than there being a push to commission larger units that do not have that local focus. The issue is about local focus helping to have local solutions. What works in Lewisham will not work in rural Devon, so let us get the solutions right and have flexibility.

Let us make sure that we address the delays within casualty departments and the pressures that cause that. Very often the issue is to do with diagnostics. Let us look at the groups of people who constantly re-attend. I do not want to bore the House too much with my views on minimum pricing, but anybody who wants to spend a Friday or Saturday night in an inner-city casualty department will see what the delays are due to. I hope to win my bet eventually with the right hon. Member for Exeter (Mr Bradshaw).

Let us have a sensible policy that considers mental health, for example. A huge number of readmissions in casualty departments involve people with mental illness. In the west midlands, liaison psychiatry is being used to help reduce readmissions among those with mental illness—again, it is about getting people the right support at the right time in the right place. Some 5.6% of bed days in the NHS are taken up by people who have been readmitted within a week of discharge. That is simply not acceptable.

There is also the issue of designing the tariffs. I was pleased to hear the Secretary of State refer to tariff reform. If the financial drivers are in the wrong place, we will not solve the problem. Let us try to take the party politics out of this debate and focus entirely on how we can support NHS England and our clinical commissioning groups to get the right care in the right place at the right time.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Oh dear, what a pity. Until the hon. Member for Denton and Reddish (Andrew Gwynne) rose to speak, it was going rather well. There was almost an outbreak of consensus after a number of thoughtful contributions from Members on both sides of the House. Unfortunately, as ever, the hon. Gentleman had to fall back into the old ways of cheap party political points and cheap partisan comments. I agree with him on one point. [Interruption.] Hon. Members may want to calm down and chill out a little. The hon. Gentleman rightly paid tribute to all the doctors, consultants, nurses, receptionists and everyone who works in our accident and emergency departments.

[Helen Jones]

Even the women?

[Anna Soubry]

That sort of cheap comment does the hon. Lady no justice whatsoever or credit. Let me explain to her—I was here for the debate, and she was not—that I did not in any way blame women doctors. As someone who has worked as a woman professional all my life, I really do not want to hear any lessons from Opposition Members. What I did was echo the comments of the president of the Royal College of General Practitioners, and I paid tribute to all our GPs for their hard work and dedication to our NHS, and to their patients.

There are immense pressures on the NHS as a whole, and on A and E in particular. Our A and E departments are dealing with 1 million more people than they did when the previous Government were in power. The causes of that increase in demand are complex: a long, cold winter; an ageing population; and more people with long-term conditions. The system itself, let us be honest, has not helped, from poor integration between health and social care to the lack of public confidence in out-of-hours primary care services. We can have an argument about the 2004 GP contract, but as the hon. Member for Southport (John Pugh) rightly said, it has not helped. Today, we have a situation in which, if people do not know where to go, or they are not sure that they will get a good service, they go to A and E. In a recent hearing by the Select Committee on Health, Dr Patrick Cadigan, a registrar from the Royal College of Physicians, set out the position perfectly:

“Patients will go where the lights are on. In many of these alternatives, the lights are not on after five o’clock in the evening or at weekends.”

That presents a set of challenges that the Government are determined to address. First, it is important that we deal with the current situation, and we are.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No.

Already, emergency departments have recovered from the dip in performance over the winter. [Interruption.] The hon. Member for Denton and Reddish did not give way, and I am adopting his admirable approach in this debate.

For each of the past five weeks, the four-hour waiting time target has been either reached or exceeded. The average wait in A and E is currently 50 minutes. More importantly, we are making the NHS fit for the future: a future where care is designed and delivered around the specific needs of an individual patient; where care is integrated across primary and secondary care and across health and social care; and where local clinicians, not national politicians, decide what is best for their communities. The Government have taken tough decisions that will create a strong and sustainable NHS, now and for generations to come. The Health and Social Care Act 2012 has finally brought local health and social care communities together to design integrated services around the needs of their patients, building in strength for the future. So if more services are needed outside hospitals, local clinicians working with community partners can make those decisions, without having to wait for a Minister to tell them what to do.

We have not stopped there. We have provided £7.2 billion to local authorities for social care. We have given hospitals the ability to carry over underspends—free to pool their budgets locally to improve care for patients. We have new urgent care boards which will use the savings from the marginal rate emergency tariff to reduce pressure on A and E. The NHS Medical Director, Sir Bruce Keogh, is currently reviewing the provision of urgent and emergency care. This autumn the vulnerable older people’s plan will set out how we will improve primary and out-of-hours services for the frail and the elderly and how we can remove barriers to integrated care. At every step of the way we are putting local doctors and nurses in charge and designing care around the patient.

I shall deal briefly with some of the very good speeches that were made on both sides of the House. We heard first from two former Secretaries of State for Health, the right hon. Member for Holborn and St Pancras (Frank Dobson) and my right hon. Friend the Member for Charnwood (Mr Dorrell). Both were eloquent and informed. I have to say that the speech and the comments of my right hon. Friend found more favour with me. The hon. Member for Lewisham East (Heidi Alexander) asked for a grown-up debate, and we had a good contribution from my hon. Friend the Member for Totnes (Dr Wollaston). I have addressed the unfortunate remarks that she made, perhaps not having read Hansard, if I may say so.

I turn to other valuable contributions. The right hon. Member for Cynon Valley (Ann Clwyd) made a contribution, as we would expect. Then we heard from my hon. Friend the Member for Brigg and Goole (Andrew Percy), who spoke briefly about his local experience in his constituency and brought those experiences, rightly, into the debate. He touched on walk-in centres, an issue that was raised by—I nearly said my hon. Friend; I beg his pardon if that is in any way disparaging to him—the right hon. Member for Rother Valley (Mr Barron), who beautifully forgot that any decision about the future of any walk-in centre is a local decision. It is for local people—[Interruption.] I am not knocking anybody; I am explaining the facts. I appreciate that the right hon. Member for Leigh (Andy Burnham) has a problem with the facts, but the facts are that these are local decisions made by local communities and local clinicians.

My hon. Friend the Member for Bracknell (Dr Lee) gave a thoughtful and challenging speech, and I hope that many will take that away and listen to what he said. I shall deal briefly with the comments of my hon. Friends the Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Stevenage (Stephen McPartland) and the hon. Member for Cheltenham (Martin Horwood), who spoke about some of the difficulties that we have with the recruitment of doctors. Departmental officials have met. We know that it is a problem. We have worked with the College of Emergency Medicine and we know that we need to tackle the problem. We did that in 2011 and those issues will in due course be considered. I hope we will see some changes.

The hon. Member for Mitcham and Morden (Siobhain McDonagh), as ever, championed her local hospital, as I expect her always to do, but she spoke about a lack of public consultation and many of us will take away her wise observations on that. It is important to remind the House of the comments of my hon. Friend the Member for Lancaster and Fleetwood. He, like others in the debate, reported that his constituents get a good service from good staff. All of us should remember that.

To conclude, in challenging circumstances, and with this Government’s support, the people of our NHS are performing admirably. There are over 400,000 more operations now than under Labour. The proportion of cancellations remains unchanged. Fewer than 300 people—276—are waiting more than a year for an operation, compared with 18,000 under the Labour Government. Some 8,500 more clinical staff are working in our NHS, including 5,700 more doctors. MSRA rates have halved. Mixed-sex wards have been practically abolished. We are finally moving towards a paperless NHS by 2018. In addition, in stark contrast to the Labour party’s plans, we now have a protected NHS budget, with real terms—

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.

Gender Birth Ratios

Anna Soubry Excerpts

Tuesday 21st May 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Following a request from the Council of Europe Parliamentary Assembly, the Department of Health has undertaken an analysis to investigate whether the gender birth ratio in the United Kingdom varies by mothers’ country of birth beyond the range that might be expected to occur naturally. The analysis concludes that when broken down by the mothers’ country of birth, no group is statistically different from the range that we would expect to see naturally occurring. However, there are significant limitations in what these data can show. As there are small numbers of births for most groups, large differences in birth rates would be needed to identify ratios outside the normal range.

The UK gender ratio is 105.1 male to 100 female births and is well within the normal boundaries for populations.

Evidence suggests that a number of factors can influence the sex of a child. These include paternal and maternal age, coital rates, number of children and sex of previous children. However, ratios above 108 and below 103 are unlikely to occur naturally other than as a product of the random variability associated with small numbers of births.

Recorded birth ratios vary widely by mothers’ country of birth. Initial analysis identified a small number of countries for which there were indications that birth ratios may differ from the UK as a whole and potentially fall outside the range considered possible without intervention. However, departmental analysts emphasised that it is possible that this was the product of natural variation and that further analysis would be undertaken.

The further analysis was quality assured by the methodology team at the Office for National Statistics and identified 10 countries which over the period 2007 to 2011 had over 10,000 births and recorded gender ratios either lower than 103 (seven countries) or higher than 108 (three countries). However, the tests undertaken indicate a strong probability that this is occurring by chance. Only one country, Sri Lanka, was found to have a birth ratio significantly different from the figure of 105.1 for the UK as a whole. Mothers born in Sri Lanka have a birth ratio of 99.2 or 99 male children for every 100 female children. However, this is not statistically significantly lower than the 103 threshold and again is likely to be the result of random variation, particularly given the relatively small numbers involved.

The Department of Health will repeat this analysis on an annual basis following publication of birth data.

“Birth ratios in the United Kingdom: a report on gender ratios at birth in the UK” has been placed in the Library. Copies are available for hon. Members in the Vote Office and for noble Lords in the Printed Paper Office.

The documents can also be accessed at:

www.gov.uk/government/publications/gender-birth-ratios-in-the-uk.

Parliamentary Written Answer (Correction)

Anna Soubry Excerpts

Thursday 16th May 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I regret that the written answer given to the right hon. Member for Leeds Central (Hilary Benn) on 17 April 2013, Official Report column 418W, contained some incomplete figures in the table.

It has been brought to my attention that the information provided by the Care Quality Commission (CQC) in the table in the original answer did not contain every instance where information of concern about an organisation was received by the CQC. The table below shows the full number of times information of concern was received. I have also taken this opportunity to clarify that the numbers provided in the table are for all information of concern raised about an organisation, and do not specifically relate to children’s heart surgery.

The corrected answer is as follows.



Under the Health and Social Care Act 2008, the CQC does not have the responsibility for investigating specific complaints about providers. The CQC is responsible for checking that providers that are registered meet standards of quality and safety. The CQC’s role does not include investigating individual complaints about these services. Under the NHS complaints procedure, formal complaints are raised with the service provider in the first instance. The CQC’s predecessor, the Healthcare Commission, did have responsibility for second stage complaints, once local resolution had been unsuccessful. This responsibility ceased on 1 April 2009.



When the CQC receives information of concern from people who use services, their relatives and members of the public, it uses the information to inform its inspection programme and the quality and risk profile of the service provider.

The CQC has provided the following information:



The following table shows the number of times information of concern has been received by the CQC under the Health and Social Care Act 2008 for specified hospitals by location or provider, by fiscal year. The table shows data for all locations at each provider. Due to the manner in which CQC records this data, it cannot determine the nature of the concern, which may not therefore be related to children’s heart surgery.

Mental Health

Anna Soubry Excerpts

Thursday 16th May 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I would not normally intervene, but will my hon. Friend join me in paying tribute to the right hon. Member for Knowsley (Mr Howarth) for the great work he has done to raise with me and my Department this often unheard of, certainly unrecognised and very serious problem of type 1 diabetics with eating disorders? In considering how to tackle it, it is indeed important that we look at the mental conditions and problems my hon. Friend has identified.

[Caroline Nokes]

I certainly join the Minister in paying that tribute. I am delighted to hear her make the point that we must start addressing the underlying mental health conditions, when in too many cases the physical treatments are the sole emphasis.

I want to touch briefly on the significant impact eating disorders can have on future career opportunities and in the workplace. As I said earlier, eating disorders are often trivialised and generalised as being conditions affecting teenage girls. That is far from the truth, as the highest rate of increase is among male sufferers. In addition, many eating disorder sufferers are managing their conditions over many years or even decades. I am the first to emphasise that sufferers can be of any age and of either gender, although I acknowledge that the age at which an eating disorder is most likely to manifest itself is 17, and that it is most likely to do so in girls. It often occurs in academically high-achieving individuals who put themselves under immense pressure to be absolutely perfect in every way they can. That frequently manifests itself in a control of food intake. Those determined to put themselves under significant academic pressure also put themselves under massive physical pressure and wish to conform to a body ideal that is actually far from healthy.

I want to pay tribute to the work of April House in Southampton—a specialist unit that focuses on eating disorders in the city. I paid a very enlightening visit to the centre just over 12 months ago and met a number of sufferers, several of whom came from my constituency. Although April House serves the wider Southampton area, three of them were Romsey residents. They have kept in touch with me since my visit, and have emphasised that they have not only benefited from the work done at April House, but have undertaken other therapies.

I am very aware of the work of an organisation in Southampton called tastelife, which was set up by the families of people suffering from eating disorders. The aim was to move the focus away from the physical, and, through self-help groups, to encourage sufferers to talk about their issues, work through them with other people and concentrate on not just physical but mental wellness.

I pay tribute to the hon. Member for North Durham (Mr Jones), who drew attention to the stigma experienced not only by those who suffer from mental health problems, but by their families. Before the Westminster Hall debate, I was contacted by many parents, husbands and, indeed, wives of people with eating disorders, who told me that not just their relatives but they themselves suffered that stigma. A number of them believed that they must be in some way to blame for the fact that their relative, perhaps their child, suffered from an eating disorder. Many were suffering from massive levels of guilt and introspection because they felt they must have somehow caused it.

I have tried to emphasise during discussions of this topic that it is not possible to identify a single trigger, and that a parent cannot do anything to prevent the descent of a child into a form of mental illness, but what that parent can do is help. I was pleased to hear various Members stress the importance of having a parent or other relative as an advocate. In the case of eating disorders, it is almost inevitably the parent who will know the young sufferer best. I think it very important that we be prepared to talk openly about the subject and to move away from the stigma.

Many of those who attended the Westminster Hall debate will remember my hon. Friend the Member for Braintree (Mr Newmark) talking about a pea. He described how he had suffered at school from anorexia nervosa, and had decided to address his condition by seeking to tackle it one step at a time. The first step involved a single green pea on a plate, which he pushed around endlessly, trying to summon up the ability to eat it. His was a moving and interesting account, which gave those of us who had by then been debating the issue for some hours something on which we could really focus: that vision of a plain white plate with a single green pea on it.

Unfortunately the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), is no longer in the Chamber. I am sure the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), will do an admirable job in responding to the debate, but the point I am about to raise is one that I raised with the Minister of State after it was raised with me by an organisation called Anorexia and Bulimia Care.

Once a young person suffering from an eating disorder has turned 16, they can choose to accept or refuse treatment and their parents no longer have a say. In order for them to be force-fed, they must be sectioned. That brings me back to what I said earlier about teenagers who are in the middle of academic exams and approaching A-levels. Being sectioned could have a significant impact on their future career choices.

I am not necessarily suggesting that we should insist that the parents must be in charge until a child reaches the age of 18. The Children’s Minister explained to me carefully and clearly about previous rulings in this place and in the courts which have granted people Gillick competence at an earlier age. I am not saying we should insist that that right be taken away from eating disorder sufferers. I think it important for us to work with health care professionals, and with mental health experts in particular, to find a solution to what I regard as a very knotty problem.

Among the sufferers to whom I have spoken during various meetings at April House and elsewhere, one sticks especially keenly in my mind. She was a lady my own age, and, although she was not one of my constituents, she came from Hampshire. She had suffered from anorexia for decades, and was incredibly frail. When I mentioned April House she shuddered visibly, because she regarded it as a place where she had been effectively force-fed. She had not come through the treatment successfully; here she was, 20 years on, still suffering from anorexia nervosa.

I always find myself—with good reason, I believe—on the side of the sufferer or the patient, and I am therefore not suggesting to the Minister that when it comes to the debate about whether parents should have the right to insist on force-feeding young people until they reach the age of 18, we should enter the fray. I recognise it is a very difficult area. However, I want to leave that thought with the Minister. I have raised the issue with her colleague the Minister of State, and no doubt I will raise it again over the coming months and years.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Islington North (Jeremy Corbyn), who made some powerful points. Perhaps I might add to what he said about the appalling difference in respect of the use of compulsory detention under the Mental Health Act 1983 for those from black and ethnic minorities. We heard in evidence that the fear of this among some communities is acting as a deterrent to seeking early help. We must address that, making sure that people do have that access and that that fear is removed from communities in order to improve health for everybody.

I wish to begin by stating for the record that I am married to a consultant NHS psychiatrist who is also chair of the Westminster liaison committee for the Royal College of Psychiatrists, which provides impartial advice to all political parties on psychiatry. He is also now a clinical director of NHS England’s mental health and dementia network in the south-west.

The corresponding debate last year focused importantly on the issue of stigma in mental health, and I congratulate the ongoing work of Time to Change in reducing stigma. The other issue that was raised, which many Members have focused on today, was parity of esteem. It is wonderful that that important principle is established within the Health and Social Care Act 2012, but we now need to ensure that that translates into action and practice on the ground. As we have heard, 23% of the overall disease burden lies in mental health, but we all recognise from stories that we hear in our constituency surgeries, and from clear evidence, that that does not translate into either funding or our constituents’ experiences of services. How are we going to see that translated into action? We need to look at the evidence of what works and to focus on the outcomes.

We know that 30% to 65% of hospital in-patients have a mental health condition and that mental health and physical health are inextricably linked. Not only is someone more likely to suffer from a mental illness if they have a chronic long-term condition, but someone who has a mental illness will find that there is an impact on their physical health. We have heard again about the scandal that the life expectancy of people with a serious mental illness will be shortened by between 20 and 25 years.

[Anna Soubry]

My hon. Friend is picking up on the point made by the hon. Member for Islington North (Jeremy Corbyn) about there being a real link between public health issues such as smoking and alcohol, and mental health issues. Does my hon. Friend agree that we can do great work in this area at a local level, especially under the new arrangements whereby public health is devolved back down to local authorities, where it used to be and always should have been?

[Dr Wollaston]

I am grateful to the Minister for that intervention. There has been a consistent tendency to ignore physical health problems in those who have severe mental health illness. She is right to say that putting in primary prevention work locally is important, but the Government could perhaps do more on primary prevention, through having a relentless focus. I am grateful to her for the personal support she has given to addressing issues such as alcohol pricing and the availability of ultra-cheap alcohol. Such issues are very important, and the Government need to deal with them to support the work that is being done. Minimum pricing is, of course, not a magic bullet, but unless we address the issue of ultra-cheap alcohol all the other measures that public health directors wish to take within local communities risk being undermined.

[Anna Soubry]

Does my hon. Friend agree that we can do great work on the minimum pricing of alcohol at local level? I urge her to examine the work being done in Newcastle and, in particular, in Ipswich, where all the agencies are coming together. We have seen supermarkets and many off licences agreeing not to sell cheap beer and lager. Does she agree that such an approach has the potential to be a better way—I think it is one—of dealing with this issue than minimum unit pricing?

[Dr Wollaston]

Although I absolutely agree that those projects in Newcastle and Ipswich are impressive, there will, unfortunately, always be ways in which they can be undermined. In my area we can find an example of maximum alcohol pricing, whereby white cider is being sold at a maximum price of 23p a unit, and that is destroying areas. There will always be a way for people to get around a minimum pricing level and, although we can see real benefits from these projects, particularly for street drinkers in isolated pockets, I feel overall that minimum pricing would be a good way of addressing this issue on a wider level. But I will not focus on that today.

I want to draw attention to the evidence on providing integrated services. Mental health and physical health services should be much better integrated. Is the Minister aware of the recent report by the Centre for Mental Health and the London School of Economics, which evaluated the use in Birmingham city hospital of the RAID service—the rapid assessment interface and discharge psychiatric liaison service? Is the Minister aware of the role that liaison psychiatry plays? Such services are greatly appreciated by patients and provide an excellent way for them to receive services; moreover, they are incredibly cost-effective. By providing rapid access to a professional service, not only for in-patients but for people who attend accident and emergency services and those who are seen by the poisons unit, it reduces re-admission rates, provides better care and far better outcomes, and saves money. The pressure on A and E services has been much in the news in recent weeks. Liaison psychiatry reduces re-attendance at minor injury units and A and E departments, so such services are vital. It would be really helpful to know whether the Minister is aware of the evidence base and will be promoting liaison psychiatry services.

I want to talk about social exclusion and the role of mental health services in social exclusion. If a person is homeless, they are far more likely to suffer from mental health problems. Equally, if a person has mental health problems, they are very much more likely to end up homeless and on the streets. In my area of Totnes, we tragically have suffered some deaths among our homeless population. We know from those who provide help to the homeless in south Devon the level of dual diagnosis—the number of people who have both mental illness and, for example, addiction problems. I would very much like to hear from the Minister in her summing up what work will be done to improve access to dual diagnosis. I pay tribute to Mark Hatch and the work that he has been doing, alongside very many dedicated volunteers, with the Revival Life Ministries and with Shekinah, providing an outstanding service to our local community.

I want to raise a point about access to GP services for the socially excluded and homeless. In coming months, there will be much focus on how we reduce health tourism. If, in reducing health tourism, we require people to bring a passport to their GP in order to be registered, very many people who are socially excluded will not be registered because they simply do not have access to identification. I ask the Minister, in addressing an important problem of great concern, to be particularly careful to avoid making it even harder for the socially excluded to obtain help with their problems. That would be a real avoidable tragedy.

Prior to the debate, a constituent wrote to me most movingly about the Cinderella service around autism, and lack of access to mental health services for those who suffer from autism, which has a knock-on effect on their carers. Listening to accounts from parents, who have been struggling for so long to obtain the help that their children need, and their description of what happens as their children move into adult services, it becomes clear that that is an area where services genuinely need to be improved. I look forward to hearing from the Minister what more can be done.

Finally, I return to the Health Committee’s review of the Mental Health Act. Would the Minister look at the evidence on the variation in the use of community treatment orders around the country, and tackle that variation? It cannot be right that in some parts of the country they are not used at all, while in others they are heavily used. The evidence base on their effectiveness is very poor. Should the Government lead on that, or should the royal colleges take a lead, so that we have a system that is transparent and used equally around the country?

Childhood Obesity and Diabetes

Anna Soubry Excerpts

Wednesday 24th April 2013 Westminster Hall

[Keith Vaz]

The hon. Lady is absolutely right. I do not want to steal lines from the Minister’s speech, but when she recently addressed a forum on diabetes, that was exactly what she said: diet is extremely important. We are all busy people and when we walk into the Tea Room for our cup of tea, we are faced with Club biscuits, Jaffa Cakes, Victoria sponges—plural—and all kinds of other things that entice us, so even if I go in saying that I must have a banana or an apple, I end up, as the hon. Member for Strangford has seen, picking up a Club biscuit. The hon. Member for Mid Derbyshire is absolutely right: diet is crucial. That is why I wish the newly appointed diabetes tsar, Dr Jonathan Valabhji, the best of luck in dealing with those figures.

How do we cope with this situation? There are practical steps that health care providers, local authorities and the general public can take, but the key is prevention. The new NHS health checks will offer those aged between 40 and 74 a check to assess their risk of heart disease, stroke, kidney disease and diabetes. If only I had had that check when I was 40, I would have discovered six years earlier that I had diabetes. However, new research revealed by the university of Leicester on Friday suggests that the checks could detect at least 158,000 new cases of diabetes or kidney disease, but they are not being taken up. I pay tribute to the work of Professor Kamlesh Khunti of Leicester university, who was behind the research that revealed the number of cases that could be discovered. The health check has enormous potential to find those in the early stages of diabetes or even with symptoms of pre-diabetes.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I apologise, Mr Davies, for what may become something of a love-in. I will probably pinch some of the right hon. Gentleman’s speech, and I pay tribute to the great work that he has done. Does he agree that great work has been done in Leicester with the health checks that are being rolled out there? The approach is forward-thinking. Anyone who registers with a doctor and is in the right age group automatically gets a health check. The work is also being driven by the excellent charity with which the right hon. Gentleman is associated. Does he agree that real, positive work is being done in Leicester from which the rest of the country can learn?

[Keith Vaz]

Absolutely. I thank the Minister for her kind words. I know that she has to pass Leicester in order to get to London and I know that she has made a number of visits to the city; she was there recently. I thank her for the compliment that she has paid to Leicester and to Silver Star. The Government must not miss this opportunity to set targets for GPs, because it is only through setting targets that we can secure real change.

Another avenue that could be explored is the role of pharmacies in testing for diabetes. According to the Royal Pharmaceutical Society, there are more than 10,000 community pharmacies in the UK. I believe that those pharmacies are under-utilised. My mother, before she died, had absolute faith in her local pharmacist. Of course she listened to her doctor and she got her prescription. On occasion, she would listen to her son and her daughters. However, the person she really respected was the pharmacist, and because pharmacies are on the high street, they are available to local people, so they can get their tests. The benefits of testing for diabetes in pharmacies are twofold. Bringing testing into the community because the pharmacies are there means that hundreds of thousands of people who have not been diagnosed with the condition can discover whether or not they have it and, more importantly, it would reduce the pressure on already over-burdened GPs.

Finally, I want to talk about the new landscape of health care and its role in tackling diabetes. The Health and Social Care Act 2012 offers an unparalleled opportunity to revolutionise diabetes care and prevention. I warmly welcome the introduction of health and wellbeing boards, which will put local councils firmly in the driving seat to address public health. I have always believed that local authorities have a role in providing those services. Importantly, the boards will be able to work with charities, such as Diabetes UK, which have done outstanding work over many years and provided so much help to so many people. The first thing I did when I discovered I had diabetes was become a member of Diabetes UK. I receive constant updates about what I should do and a little loyalty card, which I have not used yet, but it has the telephone number.

It would be remiss of me not to bring up Silver Star, which the Minister mentioned and with which I am privileged to be associated. It targets at-risk communities. Indeed, having been established in Leicester, sent buses to Mumbai and Goa, and supported charitable work in Yemen, the charity opened its first London diabetes centre in Edgware only two weeks ago with the help of Mr Speaker, in the place he was born—not quite the hospital, because Edgware general is down the road. He was born in Edgware however, and it was great to have him back to open the new unit.

The charity has sought—this takes us back to the point made by the hon. Member for Mid Derbyshire—to deal with issues relating to children and sport; the importance of diet; and the role of parents and professionals. On Friday, the charity and I will unveil the winners of a painting competition held by Silver Star in association with Leicester City football club. All the school children of Leicester were asked to paint a picture showing the importance of a healthy lifestyle. I thank the football club’s chairman, Mr Raksriaksorn, and his son Top for naming the charity as one of their charities of the year and for working with it to ensure that children realise the importance of sport. I hope that on Friday not only will the winner of the competition be announced, but Leicester City football club will at last get into the play-offs where we belong, as it is one of the last games of the season.

The health clock on diabetes has reached 11.59 pm. We need either to toughen the responsibility deal or to pass legislation. Schools need to take immediate action to remove vending machines that sell sugary drinks. We need local councils to give fewer planning permissions for fast-food outlets near schools, or, better still, no planning permissions. We need a radically different approach to ensure that everyone at risk is tested for diabetes. If we do not do so, the NHS will be overwhelmed and it will not only affect our generation, but our children’s generation. That is why we must act now.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the right hon. Member for Leicester East (Keith Vaz) on securing this debate and pay tribute to him for all the work that he has done over the years on the issue of diabetes and the subsequent work that flows from that in relation to obesity. It has been a pleasure to have his Silver Star van come in to my constituency, and I know that it has gone into many other constituencies as well.

I congratulate the right hon. Gentleman on the work of his charity not just in this country but in India. It was a great pleasure earlier this year to go to India for the first ever Anglo-Indian conference on diabetes. Unfortunately, there is a higher prevalence of diabetes in the south Asian community. It is one of the subjects that I will touch on in what will inevitably be a short speech, notwithstanding the fact that this is a large topic.

If I do not answer all the questions that have been raised in the debate today, I will reply to hon. Members in writing. I agree with the right hon. Gentleman that we must wage a war on sugar, fight fat and that we must all engage in the battle of the bulge. In relation to Ella’s Kitchen, I have seen its excellent report and have asked to meet the group. The right hon. Gentleman is absolutely right about the role that pharmacies can play. I pay full credit to Boots, which is already beginning to do that work, and to Diabetes UK—it is a great charity—which is the chosen charity of Tesco.

I want to talk about the great work that Silver Star and Diabetes UK have done with Boots testing people for diabetes, weighing and measuring them and finding out their blood sugar levels. Following that, we want to ensure that there are then referrals to dieticians, nurses and even GPs where that is necessary. We want to make sure that it all flows and works together.

I pay full tribute to my hon. Friend the Member for Torbay (Mr Sanders), who chairs the all-party group on diabetes. I will not repeat all the statistics that he gave. He rightly made the point about the difference between type 1 and type 2 diabetes; type 2 diabetes has a clear link to being overweight or obese, and I pay tribute to all the fine work that he has done.

The hon. Member for Inverclyde (Mr McKenzie) made a fine point about vending machines in schools. I completely take the point, if I may say so, that he made about academies. I have already spoken to the Secretary of State for Education on that issue. He knows my views on it, but equally I understand why he wants to ensure that our academies are free from—if I can put it this way—central control. Nevertheless, I have made that very valid point.

The hon. Gentleman made a compelling comparison between our statistics on diabetes and our statistics on cancer. We do not flinch—none of us—from talking about how we can prevent cancer. We do not flinch from talking about the fact that cancer is something that kills many people. Of course, many people live with cancer and there are great success stories. Obesity, as everyone attending this debate knows, is effectively a killer. If we were absolutely honest about it, if obesity were a disease, Governments of whatever political colour would have taken action many, many years ago to tackle the growing problem—no pun intended—of obesity and being overweight, notably in our children.

I could use up most of the remainder of my speech effectively debating with my hon. Friend the Member for Southport (John Pugh). Having listened to the hon. Member for Hackney North and Stoke Newington (Ms Abbott), there is a great danger of this “love-in” extending to my shadow as it were, because I absolutely agree with many of the things that she said in response to my hon. Friend. However, we need to take these points away.

Let us talk about something that did not exist when I was young—the concept of snacking. I was positively told not to eat between meals. If we now look in the real world at how young people live and at what they feel is acceptable, it includes going into the many coffee shops that exist. I have no problem with coffee shops, but young people go in and have a large coffee—not a small one, and we could talk endlessly about portion control; I absolutely get that point and think that it is valid—which has syrup in it. It might have marshmallows on top, and then perhaps another little dollop of cream, because it is just a snack, a treat or elevenses. “And by the way”, they say, “I think I’ll have one of those very nice muffins.” They do not know how many calories that is. I absolutely agree that they do not understand that, and there was a great outbreak of nodding at the point made by my hon. Friend the Member for Southport. That is why I absolutely congratulate all those places that have put up on their boards the number of calories in different foods.

The hon. Member for Hackney North and Stoke Newington is right that it is a surprise to people—even to supposedly intelligent, grown-up people such as ourselves—when they find out the calorific content of foods that we see and perceive as treats and snacks. Equally, I want to make it clear that we should never demonise any food. There is nothing wrong with chips, or burgers; what is important is that it is all good food in moderation.

I thank the hon. Member for Strangford (Jim Shannon) for his very kind words, and I will only say this in relation to the team he supports: come on Nottingham Forest. Moving on to more serious matters, I thank him and other hon. Members for raising the profile of diabetes and accordingly raising the issue of obesity. It is a difficult subject, because when we start to talk about people’s weight, they take it personally, and rightly and understandably so. There are many people who say, “Well, it’s not the role of Government to tell people what they should or shouldn’t eat”. They are absolutely right; it is not my role to tell people what they should or should not eat. However, it is the role of the Government, as stewards of the NHS, to make sure that the NHS budget is spent as responsibly and sensibly as possible. We know that obesity costs, not just in human terms but in NHS terms; it costs billions of pounds.

It costs in human terms as well, and many of us who see children who are overweight or obese are upset and concerned about that, because we know that many of those children will not only suffer from health issues—that is one of the things that I learned when I went to see a project in Rotherham, and I will discuss that project in a moment—but will be bullied. Many of them are unhappy that they cannot, as they perceive it, join in the sport or physical activity enjoyed by their friends. There is a real human cost to overweightness and obesity.

I will not repeat the many facts and figures that have quite properly been given in this debate. However, 1.3 million children are obese, which is one in six children. According to the national child measurement programme, which is the programme in England whereby we measure 1 million children—so, if I may say so, we know what we are talking about—4.1% of boys and 2.9% of girls are morbidly obese. That is serious stuff; 17,400 children are morbidly obese.

As has been identified, there is a clear link between obesity prevalence and deprivation. That is why this is a health and equalities issue; not just because citizens from south Asian backgrounds and indeed, I believe, from Afro-Caribbean and African backgrounds have a higher prevalence of type 2 diabetes. We know that 12.3% of reception children who are overweight or obese are from the most deprived backgrounds, as opposed to 6.8% who are from the least deprived backgrounds. I do not know why, but we cannot use the word “poor” anymore. By year 6, 24.3% of overweight and obese children are from the most deprived backgrounds, compared with 13.7% from the least deprived backgrounds.

I perhaps used the wrong language some months ago when I talked about the responsibility that falls upon us all as individuals, because we all take responsibility for our own health and, most importantly, for the health of our children. I was talking to the Food and Drink Federation about the responsibility that I believe it, too, bears, for reasons that I will not go into in too much detail. However, I put forward the fact that those who are overweight and obese as children are more likely to come from the most deprived backgrounds. There was much criticism, misreporting and all the rest of it, and, if I may say so, some political cheap shots were aimed at me. However, I hope that those facts speak loudly, and I also hope that everybody takes this away: the reason why I feel this way with such a passion is that if someone comes from a poor, deprived background, they have enough problems as a child, and enough bad things going against them to prevent them from having a great start in life, without the burden of being overweight or obese.

[Ms Abbott]

The Minister referred to fat children being bullied. Does she agree that being fat as a child can be the beginning of a downward spiral? They feel fat and ungainly; they are unwilling to take their clothes off for PE, particularly girls, so they take less and less exercise, so they get even fatter. It is a downward spiral.

[Anna Soubry]

Yes, I agree, and I also think that there is no doubt that there is a link between being overweight or obesity and mental health. Which comes first, I do not know, but it is certainly all connected.

The call for action on obesity set out the steps that we are taking to help people to make healthy choices. That is what we aim to do: provide people with the education and knowledge they need, then ensure that they have the opportunities and options to make healthy choices. We have the national child measurement programme; we have change for life. The hon. Member for Strangford may like to know that 1 million families have joined change for life, and 684,000 people have downloaded the “Be food smart” application.

There is much more that we can do, and obesity in children is one of my absolute top priorities. I want to know why we have stopped weighing pregnant women. It seems absolutely bonkers. I am looking at the advice that we give to new mothers on how to feed their babies, and I am also looking at the role of health visitors, midwives and our great NHS workers. As I have said, in Rotherham there is a wonderful project, which anyone who has an interest in this subject really needs to go and see, because one of the things that is happening there is that everything is integrated. The project has been up and running for three to four years, and the NHS, dieticians, GPs, nurses and health visitors all work with schools, teachers and the local authority—in many ways, it is driven by the local authority. It is a wonderful experience, where the project workers do not demonise food, but look with kindness and care at the causes of problems. They help people, not only with their diet through the information that they provide, but by helping them to exercise.

I have completely run out of time. In no way have I completed my speech, and I apologise profusely for that. However, I pay credit and tribute to everybody who has signed up for the responsibility deal. There is much more that we can do; I completely accept that. Nevertheless, I would say that the labelling on packaging is something that we are particularly proud of. We are getting a standardised system that will enable people to make healthy choices and take responsibility. I could talk about schools and the great work that they are doing, but that will have to be the subject of a letter.

[Philip Davies (in the Chair)]

Order. We now come to the next debate.