Antibiotics (Intensive Farms)

Anna Soubry Excerpts

Wednesday 9th January 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Richmond Park (Zac Goldsmith) on securing the debate, which is on an important subject. I shall say at the outset that, although I just about heard all the many questions that he asked me, I can say with complete confidence that I fear that I will be unable to answer any—well, a large number of them—in my speech this afternoon, but I undertake to ensure that he receives full written answers to them all. As you will understand, Mrs Main, and as I am sure he will too, it is impossible to answer them all in this short debate, especially because it is such a technical matter, with so many important questions that require technical, detailed responses.

I must begin by saying that of course we all recognise that antimicrobial resistance poses a threat to human and animal health. I can assure my hon. Friend and others that the Government take this resistance very seriously. DEFRA and its agencies have been collaborating for many years with the Department of Health, the Health Protection Agency and the Food Standards Agency on this issue. The Government’s collective objective is to ensure that antibiotic use in animals does not become a significant clinical problem for human health. I am told that there is little evidence on antimicrobial resistance transmission routes from animals to humans. The concern is that if bacteria in food-producing and companion animals develop resistance to drugs used in human medicine, those could be transferred to humans via food or through direct contact.

Controls in the veterinary sector need to be carefully balanced to minimise undesirable animal welfare issues and not hamper the efficiency of UK food production in a way that could disadvantage the industry in relation to other countries where controls may be implemented less well or less effectively enforced. Good farm management, biosecurity measures and animal husbandry systems underpin the health and welfare of food-producing animals. When applied appropriately, they enable the use of antibiotics to be minimised. We all want and welcome that.

We agree that the routine use of antibiotics in animals is unacceptable. I am assured that relevant guidance and regulation is given to the sector to make that absolutely clear. I will ask my hon. Friend the Minister of State, Department for Environment, Food and Rural Affairs, to consider whether current guidance on the responsible use of antibiotics can be strengthened to make it clear that the routine administration of antibiotics is not acceptable. I am also told that intensive farming systems do not necessarily use large amounts of antibiotics. Some have high health status livestock and so use very limited quantities of antibiotics.

The Government fully appreciate that effective controls are needed in the environmental, agricultural, food production, animal and human health sectors. Failure to act promptly and comprehensively could mean that we face impending problems with implications for animal health and welfare and knock-on effects for food supply and safety, as well as, ultimately, human health and patient safety.

Although the link between antimicrobial use in animals and the spread of resistance in humans is not well understood, there is scientific consensus that the use of antimicrobials in human medicine is the main driving force for antimicrobial-resistant human infections. The majority of resistant strains affecting humans are different from those affecting animals. Bearing that in mind, we have developed an integrated strategy to tackle the challenge of antibiotic resistance, and resistance to other antimicrobials, such as antifungals.

We have been working with DEFRA and other stakeholders to develop a new UK five-year antimicrobial resistance strategy and action plan, which we aim to publish shortly. The strategy will address all sectors, including veterinary use. To have maximum impact, the new integrated strategy will focus on a wide range of intervention measures to safeguard human and animal health, including: promoting responsible prescribing; improving infection prevention and control; raising awareness of the problem; improving the scientific evidence base; facilitating the development of new treatments; strengthening surveillance, and strengthening collaboration, data and technology.

There is general agreement that responsible prescribing is central to slowing down the development of antimicrobial resistance in humans and animals. Antibiotics, used responsibly, remain a vital part of the veterinary surgeons’ toolbox, without which animals suffering from a bacterial infection could not be treated effectively. The use of antibiotics in veterinary medicine is controlled by veterinary prescription and is equivalent to arrangements for humans. In that way, we are encouraging the responsible use of antibiotics and minimising their routine use.

In addition, the use of antibiotics as growth promoters has been banned in the EU since 2006, as my hon. Friend the Member for Richmond Park informed us. In the dairy industry, if a cow has been treated with antibiotics, the milk should be isolated, and there is regular routine testing of tanks to ensure that there are no traces of antibiotics. Those are some of the many checks in place to ensure that antibiotics do not get into the human food chain.

[Zac Goldsmith]

Antibiotic use on farms is increasing not decreasing, so despite the initiatives and efforts we have heard about, the trends are heading in the wrong direction. Will my hon. Friend commit on the record to reviewing and reading the references, with which I will provide her at the end of the debate, for all the points I made in my speech and checking the science behind them, so that she is certain that the brief she received from her Department is accurate?

[Anna Soubry]

I am more than happy to do all those things. As my hon. Friend will appreciate, I am no expert in this field and would not pretend to be for one moment. I shall make a very important point: my briefing does not come from the Department of Health only; we work in collaboration with the Department for Environment, Food and Rural Affairs.

One important thing about this debate is that my hon. Friend rightly asked for a Minister from the Department of Health to respond, so I am not, as others might have thought, someone from DEFRA. Many people are concerned about whether how an animal is treated has an impact on them if they consume some or part of it. Although we might not always make too many friends in the farming industry, we are all responsible for ensuring that we know what we are putting into our bodies and feeding our families. We bear that responsibility, so we need good, informed advice. Many people, but often those with the financial means to do so, will not buy fresh meat unless they know its antecedents—that it has come from a good butcher and a good beast.

[Caroline Lucas]

I am grateful to the Minister for her openness to looking at more of the evidence that the hon. Member for Richmond Park presented. Having examined the greater body of evidence, will she also consider the need for legally binding measures as well as more information and awareness raising? The trends are going in the wrong direction, and we therefore need legally binding measures.

[Anna Soubry]

I am sort of grateful for that intervention; I fear that I could be in terrible danger of agreeing to do almost anything, and so would be able to do nothing else, because I would spend most of my time on this. I will do all that I can. It is very important. As individuals and parents, we all should be concerned, as many of us are, about what we eat and what we feed our children and loved ones. This is as much a public health issue as an animal welfare issue.

The Government have published a code of practice on the responsible use of medicines on the farm and a leaflet on antibiotics, which, like the above code, is on the Veterinary Medicines Directorate’s website. We just have to hope and pray that such things are read, but in my experience, responsible producers pay heed to all such advice. There are also regulations.

We continue to work actively with the farming industry to promote the responsible use of antibiotics in farmed animals, and industry organisations have also developed guidance. Furthermore, I am pleased to say that the Veterinary Medicines Regulations 2011 will be changed this year to prohibit the advertising of antibiotic products to professional keepers of animals. In addition, as my hon. Friend the Member for Richmond Park mentioned, from January 2012, the British Poultry Council introduced a voluntary ban on the use of certain critically important antibiotics in chick production, which should be welcomed.

Veterinary use of antibiotics is also being addressed at a European level. It forms a significant component of both the 2011 EU action plan against the rising threats from antimicrobial resistance and the 2012 EU Council conclusions. The EU legislation on veterinary medicines is currently under revision, and the UK, with other member states and the Commission, is examining the available evidence to establish whether there is a need for additional controls on antibiotics used in animals. The Government will continue to press for measures to strengthen controls on antibiotics that are critically important for human health, to make it clear that they should be used for animals only when no effective alternatives exist.

The Veterinary Medicines Directorate at DEFRA closely monitors the use of veterinary medicines in the UK. It analyses samples from food producing animals and their products for residues of veterinary medicines and environmental contaminants. There is no conclusive scientific evidence that food-producing animals form a reservoir of infection in the UK. Food is not considered a major source of infections resistant to antibiotics. Any bacteria associated with food or the environment can be reduced by thorough washing and cooking.

As I mentioned, the scientific consensus is that veterinary use of antibiotics is not a significant driver for human multiresistant infections. However, we are keen to see greater improvements in prescribing in all sectors and are actively working to encourage that. A wide programme of work to tackle antimicrobial resistance has been under way across the UK in the human and animal health sectors for several years. Although much has been achieved, I fully acknowledge that there are a number of areas that require attention and more radical thinking, if we are to have an even greater impact. I am confident that the new UK strategy will move us forward in that respect.

I undertake to write to any hon. Member who raised a question in the debate. Again, I congratulate my hon. Friend and assure him that I will answer all his questions. It now seems that I will read a great many documents and other evidence, but it is important work. If I feel that there is any need to make any changes, I will make them.

Diabetes

Anna Soubry Excerpts

Wednesday 9th January 2013 Westminster Hall

[Mr Sanders]

That is a very good point. There is the 4 Ts campaign on diabetes. If I remember correctly, the four Ts are thirst, tiredness, toilet and one other— I always remember three, but not four. Anybody who feels thirstier or more tired than usual or is visiting the toilet more often should see their GP. A simple test—it is not an invasive test—can be conducted and after an appropriate early diagnosis a patient can start to feel better very quickly. An ancient fear of great big hypodermic needles being stuck in their skin deters many people from going to a GP, but only 15% of diabetics are put on to an insulin regime on diagnosis and that is because they suffer from type 1. Most type 2 sufferers never have to take insulin via an injection device, and, in any case, those devices are subcutaneous and really nothing to fear. I speak as someone who has to inject four or more times a day, and it really is not as bad as people fear. People should see their GP. If they do not, matters will get worse, complications will set in and they will rue the day that they did not sort out the problem early on.

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

I know that it is unusual for a Minister to intervene at this stage, but will the hon. Gentleman help me in this matter? Is it not right that there have been huge advances in the administration of insulin? A constituent of mine showed me the pump on his stomach that gives him the right amount of insulin. He even had a device on his mobile phone that could calculate from a photograph of a particular meal the amount of insulin that should be administered to his body. He clicks on the app and the insulin is given to him at the appropriate time, before or after he has his meal. Does the hon. Gentleman agree that those are wonderful devices that should be prescribed to people as much as possible?

[Mr Sanders]

I cannot fail but to agree with every word that the Minister has said, and I am absolutely delighted that she has said that. Children in particular benefit from pumps, because they can go to school and lead normal lives alongside their school friends. It is difficult for them to find the space and time to inject, and these little devices are doing the job for them all the time. The technological advances are such that we may well reach a point in the not too distant future where there is a device that both tests a person’s blood sugar level and then injects an appropriate level of insulin, without them having to check what they are eating. The little device is like having a pancreas attached to the side of the body. That is where we are going. At the moment, however, pump usage is very low in the UK. It is about having not just the pump but the services behind the pump—the trained nurses who can train and educate the person to use the pump properly, the technological support that needs to be there to back it up and the medical expertise to understand the difference between a pump regime and any other regime. That is the detail, and I am really glad that the Minister is on the ball here.

The provision of education about diabetes seems to be somewhat of a lottery in terms of who is actually receiving information and advice. There needs to be a standardised programme of education on the condition that is accessible and effective for all.

We must not miss the opportunity to encourage healthier lifestyles as a consequence of the Olympic legacy. It is essential that funding and provision for sports facilities and physical education continue to be given priority in the coming years to capitalise on increased interest in active sport. The Olympics have given people who have perhaps never before enjoyed individual or team exercise a new drive and desire for sport, which needs to be harnessed and nurtured. Gym membership and even one-off sessions for swimming still seem to be extremely pricey, which makes those forms of exercise inaccessible for many who could perhaps benefit from them. However, I am aware that some inner-city areas have set up programmes that allow residents to use facilities at a reduced rate or even at no charge. I wonder whether that idea should be taken hold of by more UK communities, and whether the Government could assist all local authorities to find ways to subsidise it, perhaps by working in partnership with private sector organisations.

Having facilities and making them affordable is an issue, which is why I find it unbelievable that some local authorities, including my own, give permission for building on sports facilities; in Torbay, the only public grass tennis courts in the local area are about to be built on. Andy Murray won his Olympic gold medal on grass and generated more interest in the sport last year, and my area has produced some of the great British tennis players down the decades, including British men and women No. 1s in Mike Sangster and Sue Barker. That makes that act by my local authority one of unforgivable short-sightedness.

I have outlined many of the issues surrounding diabetes care, but I will concentrate now on some of the things that I hope the Minister will focus on delivering in the coming years. There needs to be a comprehensive national implementation plan, containing measures to ensure that local leadership is robust and long term in its thinking. Such a plan also requires measures to focus on detection and prevention, and it needs to ensure that best practice can be effectively disseminated. Three priorities face our NHS and other health care systems around the world: prevention; diagnosis; and care. We have a long way to go to meet the challenges of each one.

--- Later in debate ---

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

It is a pleasure, as ever, to serve under your chairmanship, Mr Crausby. I pay tribute to my hon. Friend the Member for Torbay (Mr Sanders) for securing this debate and to every hon. Member who has spoken. As you may have gathered, Mr Crausby—and as those hon. Members who have heard or will hear or read about the debate will gather—this is a huge topic. We could have had a 90-minute debate simply on diabetes 1 and diabetes 2. We could have other debates about the causes of diabetes 2. I am the first to put my hands up and admit that, until I was lucky and fortunate enough to be appointed last September to the position that I hold, I did not know a great deal about diabetes, but, goodness me, I have learned a great deal in the months since my appointment. I thank the all-party group on diabetes, chaired by my hon. Friend, for all the great work that it does. I paid the APPG a flying visit and learned a lot; a number of matters were raised with me that caused me great concern.

I hope that you will forgive me, Mr Crausby, if this sounds like a mutual admiration society, because in many ways it is. The right hon. Member for Leicester East (Keith Vaz) and I go back many years. I pay tribute to him for all the work that he has done. I know about his Silver Star charity and I look forward to its coming to Beeston in my constituency and to the van doing some work there. That highlights one thing that has come out of this debate and goes to the heart of the Government’s reforms of the NHS: the remarkable work that can be done and now has to be done locally to ensure that we improve the diagnoses and treatments—in addition to other matters raised by hon. Members—because it is fair to say that, although many localities share common themes, this disease will be more prevalent in certain communities, even down to ward level. My hon. Friend the Member for Southport (John Pugh) raises concerns and, as ever, ideas. My hon. Friend the Member for Torbay makes a good point about how we can ensure that these improvements are delivered locally.

I pay tribute not only to the work of Silver Star, but to Diabetes UK, which must be an outstanding charity, because such was its ability to campaign on this issue that it persuaded Mr Paul Dawson, a constituent of mine who has suffered from diabetes 1 for many years, to visit me on Friday. I thought that that was just a remarkable coincidence, but he told me that Diabetes UK suggested that he visit me. The serious point is that he raised concerns, as a sufferer of diabetes 1, that I had heard at the APPG, so I had already taken up many of those, notably what seems to be a rationing of strips. Frankly, this is bonkers; people with diabetes who use strips need to use them and often need to use many in a day. I am not happy if there is any form of rationing of those strips. I have already met officers in the Department and inquiries are being made of primary care trusts, and beyond. Mr Dawson also told me about the great advances, which I have already alluded to, that have been made in medicine, which my hon. Friend the Member for Southport and others have mentioned.

I have been asked a number of questions and I cannot answer them all in the short time available, but I undertake to answer every question in letters.

[Ms Abbott]

The issue of rationing strips has been brought to my attention. What would the Minister suggest that people do if their general practitioner is attempting to ration strips?

[Anna Soubry]

I am concerned about it. It is unacceptable. I have already held a meeting with my officials and they are making further inquiries. I discussed with Mr Dawson what was happening locally in CCGs, which is where this will make a difference, when we see the power of our doctors and other health professionals to commission services, and the power and influence that patients and sufferers of diabetes will have. I am told that NHS Diabetes has now identified a diabetic lead in every CCG. There is an opportunity, through the reforms, to ensure that we now deliver locally as we should. All hon. Members who have contributed to this debate have identified a failure in respect of good outcomes and good practice throughout the NHS, right through to local level. That needs to be, and is being, addressed as a matter of urgency.

I have been alerted to problems with glucose meters and pumps—various new advances in technology. Some of this excites me. However, I am still concerned if there is not the availability that there should be, right across the NHS, notably for all sufferers of diabetes 1.

[Jim Shannon]

It is not just about the provision of the insulin pumps; it is also about training. There are two facets to that.

[Anna Soubry]

Indeed. I was going to end this part of my speech by saying that my constituent, Mr Dawson, paid tribute to what he described as his brilliant diabetic nurse at the Queen’s medical centre in Nottingham. He highlighted, as the hon. Gentleman has done, that it is all well and good having wonderful, great technology, but if people have access to it they need, critically, the support to be able to use it themselves. We must ensure that they have the highest-quality support, not just from their GPs, but from diabetic nurses and others who are trained and specialise in this condition.

Diabetes is common and is increasing, as hon. Members have mentioned. It is estimated that, by 2025, 4 million people will have diabetes.

[Nick Smith]

What are the Minister’s views of Mayor Bloomberg’s plan in New York to ban super-sized soft drinks in cinemas? Does she agree that that could be a good symbolic action that would help bring down diabetes?

[Anna Soubry]

It could be, but I make it clear, as I said on Monday in various media interviews, that at the moment the responsibility deal is working, which is why we have some of the lowest salt levels in the world. Other countries are coming to us to find out how we have achieved that by working with industry, retailers and manufacturers to reduce salt levels. On the reduction of trans fats, under 1% of our food now has trans fats in it. Again, we have done that by working with the manufacturers and retailers.

My natural inclination is against legislation, and I say that as an old lawyer. At the moment, I am confident that the responsibility deal is delivering in the way that I want it to. I make it clear that, if there is a need to introduce legislation, we will not hesitate to do that. I am almost firing a warning shot across the bows of the retailers and food manufacturers and saying, “Unless you get your house in order and accept responsibility, we will not hesitate to introduce legislation or regulation, because we know that we in this country have an unacceptable rise in obesity, to levels that are second only to those in America.” I will therefore consider everything. I always have an open mind. I am currently content, however, that the responsibility deal is delivering, but it has a great deal more to do. I hope that those who are signed up to the calorie reduction scheme later this month will encourage more manufacturers and retailers to sign up to the responsibility deal on calories. I want to ensure that we make some real, serious and tangible progress.

Ultimately, however, as the right hon. Member for Leicester East and the hon. Member for Strangford (Jim Shannon) identified, the responsibility is ours. Nobody forces us to eat the sugar buns or whatever it may be. When we go into the Tea Room and we are faced with the choice between fruit or a piece of cake, my natural inclination might be for a piece of cake, especially since I have developed a sweeter tooth as I have got older and since I have stopped smoking. We all make the choice whether to eat a piece of cake. The ultimate responsibility lies with us as individuals and as parents, but I always have an open mind.

Diabetes is a growing problem and a major factor in premature mortality with an estimated 24,000 avoidable deaths a year—10% of deaths annually are in people with diabetes. A variation exists in the delivery of the nine care processes, with a range of 15.9% to 71.2% achievement across PCTs, which is not acceptable. However, 75% of diabetes sufferers receive eight out of the nine care processes, which is a huge improvement. In 2003-04, only 7% of sufferers received all nine care processes. In 2010-11, that figure was at 54.3%, but there is much more to be done. In the coming months, several documents will be published to guide the NHS in delivering improved diabetes care, including the response to the Public Accounts Committee report, the work undertaken on diabetes as a long-term condition and the cardiovascular disease outcome strategy.

We must ensure that people get an early diagnosis. I must commend again the work of Diabetes UK. Other hon. Members have mentioned how it is raising awareness of the early signs and symptoms of diabetes with its latest campaign on the 4 Ts, which has my full support. One in every two people diagnosed with diabetes already has complications. I thank the hon. Members for West Lancashire (Rosie Cooper) and for Blaenau Gwent (Nick Smith) for their contributions. I will not be able to answer their points specifically in my speech, but I hear what they say and will write to them if necessary to answer their questions. I am acutely aware of the complications and the devastating effects that those can have on people’s lives.

[Mr Sanders]

Can the Minister respond to the important point made by the right hon. Member for Leicester East (Keith Vaz) about pharmacists? Some private pharmacy groups offer diabetes tests, which other pharmacies should be encouraged to do. I hope that we can see the roll-out of more collaborative working between the private sector and the health service in order to identify people with diabetes, so that they start to get treated.

[Anna Soubry]

I am grateful for that intervention not only because I was coughing but, most importantly, because I was going to mention that subject only in passing. I will now expand on that a little. I absolutely agree with the points of my hon. Friend and the right hon. Member for Leicester East about the importance of pharmacies. They are important for so much of the NHS’s work, but here is a good example of where we can link them in far more with delivering the successes, outcomes and diagnoses that we need so desperately. There is absolutely a role for pharmacies, and I look forward to clinical commissioning groups, which are already thinking in new ways about how to deliver better health care at a local level and working in exciting and imaginative ways, collaborating with pharmacies far more than has been done before. It is a good point, and I hope to see more action on it.

When people get a diagnosis, we need to ensure they are managed according to the latest clinical guidelines. The quality and outcomes framework, introduced in 2003-04, has incentivised primary care to perform the nine care processes for people with diabetes, but we know that there are difficulties—I have given the figures—and not enough people are receiving all nine. The National Institute for Health and Clinical Excellence has been asked to review the quality and outcomes framework and diabetes indicators, and we await its response and findings.

Last year, the National Audit Office reviewed the management of adult diabetes services in the NHS. While that highlighted the progress made over the past 10 years, it also highlighted the unwarranted variation that exists across the NHS and the significant challenges that we face over the next 10 years. There is no excuse for poor diabetes care. No one with diabetes should lose a leg or their vision if it can be prevented. We know what needs to be done and we need to ensure that we meet the challenge head on.

The prime objective of the NHS Commissioning Board will be to drive improvement in the quality of NHS services, and we will hold it to account for that through the NHS mandate, which makes it clear that we expect to see significant improvement in the outcomes, diagnosis and treatment of diabetes. In addition, through the NHS outcomes framework, we will be able to track the overall progress of the NHS on delivering improved health and outcomes. Diabetes is relevant to all five domains in the outcomes framework, so when work programmes are developed it is important to consider diabetes and how optimising care can deliver improvements.

My hon. Friend the Member for Torbay asked specifically about NHS Diabetes and whether it will continue to play a central role. NHS Diabetes is one of six current improvement organisations that are being replaced by the new NHS improvement body in the NHS Commissioning Board. In the overall context of what I have said, I hope that he will take comfort, will believe and be sure that diabetes is something that the NHS Commissioning Board has put much higher up its list of priorities. It is aware that much more needs to be done and is the ultimate driver of all of that.

Many hon. Members have mentioned diabetes 2, which is largely, but not always, a preventable disease. I have already paid tribute to those hon. Members who have raised the issue both in their local communities and nationally.

I want to end my comments by discussing an undoubtedly serious problem in our society, which is that almost all of us eat too much. We are overweight. Some 60% of adults are either overweight or obese. As a society, we find ourselves in a situation where one third of our 11-year-olds—our year 6 pupils—are either overweight or obese when they leave primary school. Those figures should truly shock each and every one of us, and something can be done about the problem. We can all take responsibility for how we feed our children and for our own lives and diets and what we eat and drink. The Government, however, can also do things, especially at a local level. When health and wellbeing boards identify the needs of their communities, if it is not a unitary authority, they can work with borough councils.

My hon. Friend the Member for Torbay made a good point about leisure services. We are already seeing evidence in shadow form. In my constituency, GPs are issuing prescriptions for activity, and the borough council is offering real assistance. It is almost as if there are no excuses not to go along to the various leisure centres and take up a class or gentle exercise. We even have walking football in Broxtowe. The point of all this is that local authorities are beginning to knit together all the various services to ensure that we all live longer, healthier and happier lives. The ultimate responsibility is ours, but local and national Government can do so much. It is all coming down to a local level. When we see the roll-out in the spring, I am confident that we will see great progress.

Health Council

Anna Soubry Excerpts

Monday 17th December 2012 Written Statements

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

The Health part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council met on 7 December 2012 in Brussels. I represented the UK.

The Council unanimously agreed a general approach on the breakfast directives, following the lifting of the UK’s parliamentary scrutiny reserve. There was a discussion of the serious cross-border health threats proposal, during which the Cyprus Presidency gave a summary of progress made on this dossier during their presidency. The European Commission reiterated their view that it was important for the co-ordination of preparedness planning to be led centrally. A number of member states emphasised that they felt that it was better for the co-ordination of preparedness planning to be led by member states within the Health Security Committee.



The Council conclusions on organ donation and transplantation were adopted without substantive discussion. A number of member states, including the UK, intervened in relation to the healthy ageing across the lifecycle conclusions in order to underline their support for a future EU strategy on alcohol-related harm.



Under any other business, the presidency provided information about the proposal for health for growth, the third multi-annual programme of EU action in health for 2014-20. Information was provided by the presidency on the transparency directive, with several member states indicating their opposition to the proposals during the discussion. The information point on medical devices was the subject of some discussion, with interventions from a number of member states in support of the Commission proposals. During the information point on food intended for infants and young children and food for special medical purposes, the UK stated its opposition to the use of delegated acts in the proposal. The final points under any other business on salt reduction, cross-border healthcare, the WHO framework convention on tobacco control, the working party on public health at senior-level and asbestos were concluded without discussion. Ireland then outlined the priorities for its upcoming presidency.



Finally, there was a lunchtime discussion of the joint action plan on medical devices, which was brought forward by the Commission earlier this year. All member states outlined the progress they had already made, and emphasised the need for a strong EU regulatory framework for medical devices.

Sexual Health Data

Anna Soubry Excerpts

Thursday 13th December 2012 Commons Chamber

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

I congratulate the hon. Member for Stockport (Ann Coffey) on securing this important debate. I pay tribute to the work she does. Her energy and commitment to the most vulnerable people in our society are admirable and rightly well known. She has raised some important and disturbing issues. There is nothing wrong with anecdotes, because after all, that is what evidence is—it is, of course, anecdotal. As we have heard today, and as we know from the work undertaken by the Office of the Children’s Commissioner, a large number of our young people are victims of sexual exploitation and abuse. Tragically, many of them do not even see themselves as victims. This is a very difficult subject; it is all about striking the right balance.

The deputy Children’s Commissioner recently noted that in preparing her report, she asked for certain data on young people attending sexual health clinics, as the hon. Lady explained. The deputy commissioner wanted the data to enable matching with other data to give an estimate of the numbers of young people suffering from sexual exploitation. The Department of Health took legal advice on whether it would be possible to share the sexual health data requested by the deputy commissioner. Our legal advice said that, given the limits on disclosure in the legislation and the fact that the data requested might identify individual patients, they should not be shared. I understand that around 60% of primary care trusts provided some data as requested. That is clearly a good example of confusion, with one piece of legal advice seemingly at odds with another. The hon. Lady is therefore right to make the point that she did about her great concern, which I share.

I understand that the point about the advice was that it was the deputy commissioner who had made that request, which is different from the point that the deputy commissioner—as well as the hon. Lady—is most concerned about, which is: what happens with data sharing out in the real world when children come along to sex clinics? Unfortunately, we hear many stories of things going wrong—we are all aware of those—but I would say, I hope with confidence, that in the overwhelming majority of cases things go well.

I pay tribute to all those in the health and other services who do a magnificent job in protecting our children. Sometimes we forget that. My experience at the criminal Bar, for what it is worth, taught me that those professionals involved in the protection of children—the hon. Lady read out a long list of the organisations involved—use their own common sense and compassion as well as all the guidance that is available. Anyone involved in such work should always be motivated by an overriding desire and determination to protect the child. That should be at the forefront of their considerations.

We know from the deputy Children’s Commissioner that repeat attendances at a sexual health clinic are one of the key indicators of potential child sexual exploitation, which is a form of child abuse. Sexual health clinics are open access. That means that anyone can go into a sexual health clinic and receive free and confidential advice and treatment. Patients do not need to go to a clinic in the area where they live, or in the area where they are registered with a GP. They do not even have to give their correct name, age, address or other details in order to receive treatment. The purpose of that is to ensure that anyone, regardless of their age or circumstances, can get the advice and treatment that they need to protect their own sexual health and that of their sexual partners.

We know from a number of studies that confidentiality is highly valued by young people, as I know the hon. Lady will understand. They perceive that the services offered by clinics are likely to be more confidential than going to a GP. We need to reach a point at which any child sexual exploitation can be identified by the health or other professionals who come into contact with the child. Those professionals then need to build up a relationship of trust so that the child feels able to work with them and others to tackle the issues that they face and to make the necessary disclosures to enable action to be taken to protect the child and, if necessary, to bring the perpetrator to justice. Of course, that does not always happen. We know from the deputy Children’s Commissioner’s work that, all too often, the children do not see themselves as exploited or abused. That can result, in the initial stages, in the abuse not being identified by the professionals.

The starting point for everyone who receives health care is that, generally speaking, information about them is not shared without their consent. That is rightly at the heart of the working practices of all health professionals. Additional legislation limits the disclosure by the NHS of information that identifies a person who has been examined or treated for a sexually transmitted illness. That is to ensure that people do not feel reluctant to come forward for testing and treatment. There is agreement on that, too. The legislation allows the information to be disclosed in order to treat, or prevent the spread of, sexually transmitted illnesses. For example, the information might need to be disclosed to the patient’s sexual partners to prevent the spread of the illness.

For under-16s, specific concerns and issues must be addressed. The Sexual Offences Act 2003 provides that the age of consent is 16 and that sexual activity involving children under 16 is unlawful. The age of consent is there to protect children aged under 16 from exploitation and abuse. It is accepted that children under 16 are vulnerable to exploitation and abuse, and that they do not have the necessary maturity to make the decisions that young adults can make. That is why we have an age of consent. It is to protect children from exploitation and abuse.

All health professionals should be aware of the age of consent, and of child protection and safeguarding issues, and I believe that most of them are; they take the matter very seriously. When dealing with a child under 16, they should be alert to the possibility that that young person is being exploited or abused. It goes without saying that a 15-year-old cannot make a life choice to become a prostitute. Advice and guidance on child protection are available in “Working Together to Safeguard Children” and “What to do if you are worried a child is being abused”. The advice and guidance are available in sex clinics and they are also issued to workers in this field.

All sexual health clinics should have the guidelines and the referral pathways, as they are called, in place for risk assessment and management for child sexual abuse. They should use a standardised pro-forma for risk assessment for all those under 16 and also for those between 17 and 18 where there is a cause for concern or learning difficulties. They should be aware of local child protection procedures and work collaboratively under local safeguarding children arrangements to ensure victims are identified and protected. In my view, perhaps most of all, they should use their own common sense. If a child under 16 presents who has clearly been involved in sexual activity and where it is clear to the worker that there is an element of abuse or any damage caused by sexual activity, alarm bells should be ringing immediately that this is a child who needs protection, help and assistance if only to disclose what has been going on that has led them to be in that position. It is very difficult work, and it often takes a great deal of effort and intervention even to get a child to disclose what has been going on. It then requires even more work to take them through the long, difficult journey to full disclosure and, as I say, to protect them fully and, if necessary, to bring the perpetrators of the abuse to justice.

However, given the issues raised by the report from the Office of the Children’s Commissioner, we think it would be valuable to work with the NHS, Royal Colleges and other key stakeholders to develop guidance on effective information sharing within the law in order to identify and protect the victims of child sexual exploitation. As we work through those issues, we will need to strike a careful balance between sharing data in a way that achieves our goal of helping victims of sexual exploitation, without discouraging them, or other young people, from visiting a sexual health clinic.

As I said—I hope I did say this at the beginning—we have set up a health working group on child sexual exploitation, and it is working with the experts, the professional bodies and the voluntary sector on these issues. It will produce a report and recommendations in the spring next year. That report will determine the future direction of our work. We want to work closely with bodies representing health care professionals because they hold the key to making progress. We want to make sure that they can identify and support these young people to help them get the help they need at the earliest stage possible.

Finally, I thank the hon. Lady again for bringing this matter to the Floor of the House and for raising all the issues she has about identifying the need for real work to be done in the future to make sure, frankly, that we get it right.

Question put and agreed to.

NHS Funding

Anna Soubry Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

I think that the hon. Gentleman should withdraw that remark, because there was no reduction in health spending on my watch. I left plans for an increase, as I am about to explain. He illustrates the point that I am making: we are getting half-truths, spin and misrepresentation from Government Members on NHS spending. Indeed, we just got some more, and it is about time that we had a bit more accuracy in the House from them.

The story starts with the 2010 Conservative party manifesto. Let me quote from it:

“We will increase spending on health in real terms every year”.

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

Absolutely right.

[Andy Burnham]

Mr Dilnot may be watching; the Minister needs to be careful what she says.

That promise was carried into the coalition agreement, which said:

“We will guarantee”—

guarantee, mind—

“that health spending increases in real terms in each year of the Parliament”.

The Secretary of State has stopped nodding; he was nodding earlier. [Interruption.] I will be interested to hear how the Conservatives make those claims stack up, because week after week, Ministers from the Prime Minister downwards have stood at the Dispatch Box and claimed that that is exactly what they have delivered.

Until recently, this appeared prominently on the Conservative party website:

“We have increased the NHS budget in real terms in each of the last two years”.

Then, on 23 October, the Secretary of State said to the House:

“Real-terms spending on the NHS has increased across the country.”—[Official Report, 23 October 2012; Vol. 551, c. 815.]

[Interruption.] “It has”, he says again today. Okay, but this is where the story changes, because last week, he received a letter from the chair of the UK Statistics Authority, Andrew Dilnot CBE. Let me quote the key sentence, which puts Mr Dilnot and the Secretary of State at odds, if I heard the Secretary of State correctly a moment ago:

“On the basis of these figures, we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

[Interruption.] I am coming on to it all. In other words, NHS spending is lower, in real terms, after the first two years of the coalition, than when Labour left office.

--- Later in debate ---

[Andy Burnham]

I am coming to the point made by my hon. Friend the Member for Stoke-on-Trent South (Robert Flello), because the context is that £1.6 billion, on the Government’s own figures, was spent on the back office, and taken away from the front line. The Chair of the Select Committee says that the cut was a little one, as though that is okay—“It’s really an increase, because it’s only a little cut”—but one has to add £1.6 billion to that to see the full extent of the diversion of funds from the NHS front line.

As the chair of the UK Statistics Authority has established, NHS spending was lower in the first two years of this coalition than when Labour left office. [Interruption.] The Secretary of State says that it is the same. Let us have some honesty here. Mr Dilnot says that it was a cut; accept what he says, and get on with the job. If the Secretary of State starts being a bit more honest at the Dispatch Box, he might get a bit more respect from the public.

The Prime Minister has cut the NHS—fact; but just as he airbrushed his poster, he has tried to airbrush the statistics, and he has been found out. To be fair, the Conservatives admitted it and corrected the Tory party website, but the problem is that we have a long list of similarly false claims made in the House that, as of now, stand uncorrected. Today, we invite the Secretary of State to correct the parliamentary record in person.

I am not surprised to see a few sheepish looks on the Conservative Benches, because we have been checking Conservative Members’ websites, and we found that the hon. Members for South West Bedfordshire (Andrew Selous), for North Herefordshire (Bill Wiggin), and for Hendon (Dr Offord), the hon. and learned Member for Sleaford and North Hykeham (Stephen Phillips), and the hon. Member for Mid Derbyshire (Pauline Latham)—

[Anna Soubry]

They are sheep, are they?

[Andy Burnham]

They are certainly sheepish today; they need to get back to their offices pretty sharpish to amend their websites in light of the letter from the chair of the UK Statistics Authority.

Health Services (Cornwall)

Anna Soubry Excerpts

Tuesday 11th December 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Leigh.

I congratulate my hon. Friend the Member for St Ives (Andrew George) on securing this debate and on raising what can only be described as a rich pot-pourri of topics relating to the state of the health service in his county and to his constituents, whom he serves not only in St Ives and across Cornwall but on the Isles of Scilly.

I assure my hon. Friend that the total revenue allocated to NHS Cornwall and Isles of Scilly increased by 2.8% in 2012-13, which is entirely in line with the 2.8% overall increase nationally. That represents an additional £26 million to invest in front-line care in his local area. Indeed, the total budget for NHS Cornwall and Isles of Scilly is £941.8 million for 2012-13. On top of that, I am advised that the local NHS expects to achieve efficiencies of 4%, totalling £36 million, with those funds being made available to support improved services to patients in Cornwall and the Isles of Scilly.

I understand that the independent Advisory Council on Resource Allocation has been developing a new allocations formula. I am told that allocations to clinical commissioning groups for 2013-14 will be announced by the NHS Commissioning Board later this month and that ACRA’s final recommendations are due to be published alongside those allocations.

It is not for me to say whether Cornwall should receive more or less money—it is difficult to think that Cornwall could possibly ever receive less—but if there are some inequities, I am sure my hon. Friend and his colleagues from the county will do their best, as they always do, to put forward those arguments with full force. I assure him that they will continue to be listened to.

[Andrew George]

The Government are clear that Cornwall receives less money than they say it should. I gave the figure earlier that Cornwall received more than £200 million less than the Government said it should.

[Anna Soubry]

Indeed, but it is for ACRA to come up with a new formula, and it is hoped that that can be advanced. The formula might, of course, be to the benefit of the county.

There is a rich number of topics to address, and it is difficult to know where to begin, but I will start by saying that I am disappointed that my hon. Friend chose to vote against the Government’s excellent NHS reforms. In his area, as he has already told us, the CCG was authorised yesterday. I will give some examples of how that movement of power and determination into the hands of front-line professionals will benefit his constituents.

The CCG has secured more than £500,000 from the Government’s dementia challenge fund to improve the lives of people in Cornwall living with dementia and their carers. The funding will be spent on improving dementia care in residential and nursing homes and in the community, and increasing peer support in communities and hospitals. Those are just some of the things that that successful application for £500,000 will achieve. The CCG is also investing £300,000 to expand the acute care at home programme. I have many other examples, including four services in Cornwall that have been expanded through the “any qualified provider” scheme: psychological therapies, back and neck pain treatments, adult hearing services and ultrasound and MRI diagnostic services. My hon. Friend raised concerns about the march of the private sector, but if there is such a march—I have no evidence of it—it would seem that in his county, it is by no means to be feared; indeed, it is to be welcomed.

My hon. Friend mentioned the loss of the helicopter from Penzance to the Isles of Scilly. I know that the service has ceased, and I understand the worry that that causes him and many of his constituents. I understand that the service previously fulfilled all non-emergency health transportation needs, but I am informed that emergency transport is usually carried out by RNAS Culdrose, so any interruption to routine travel affects only non-emergency appointments. The islands are also served by a passenger ferry, and the NHS has back-up arrangements in place to use a cargo ship if needed for medical samples.

In response to the ending of the helicopter service, I am told that the Isles of Scilly Steamship Company, which runs the fixed-wing aircraft Skybus and the passenger ferry Scillyonian—forgive me for not pronouncing it correctly—

[Andrew George]

The Scillonian.

[Anna Soubry]

My hon. Friend knows it better than I. The company has enhanced its services to accommodate NHS needs, and has committed to purchasing a second aircraft to enable it to increase flights. I hope that those arrangements are of some assurance to him.

On registered nurse staff ratios and the skill mix, we know that patient care in the 21st century is different from what it used to be. Hospitals report that the type of demand that they face is changing. In particular, the average lengths of hospital stays are about one third shorter than they were 10 years ago. It is true that the number of nurses has been decreasing, but the total number of professionally qualified clinical staff in the NHS is rising.

Planning the number of nurses and the shape and size of the work force must be based on the needs of the people in our care. Services must be properly designed around the care and treatment that people need. Those decisions could result in a need for nursing numbers to change, but that must be based on properly redesigning services, not just on affordability. Changes must be decided at a local level, based on evidence that they will improve patient care. It is important to use this valuable staffing resource wisely, in properly constructed multi-professional teams with appropriately blended skills focused on the care and treatment needed by patients, families and communities.

The Government are committed to improving quality standards in the NHS. Our role is to clarify the standard of patient care demanded of the NHS through the mandate and to underpin it with robust external monitoring and validation by appropriate bodies. We are not here to impose management solutions.

[Andrew George]

I am interested in what the Minister says. However, is she saying that she and her fellow Ministers are content that registered nurse staffing levels are currently adequate in all settings within the NHS?

[Anna Soubry]

With great respect, I could not possibly say either yea or nay to that, because I do not know what they are, but I always look forward to the continuing representations made by hon. Members urging Ministers to raise or change the numbers.

I turn to the concerns expressed about the financial situation of the Royal Cornwall Hospitals NHS Trust. I hope that those concerns will now be allayed; the trust is forecasting a surplus of £3.8 million for 2012-13, and is progressing well on its path to achieving foundation trust status. Yesterday, through a video link, I spoke to one of the trust’s officers, who told me with much encouragement about plans for the future of the hospital and said that the trust believes that it is now on top of its financial situation. By way of example, I asked specifically about the trust’s preparations for winter, as it looks like we are going to have one of the hardest winters in this country for a long time. I was heartened by not only the trust but the PCT and others to whom I spoke about the high level of preparedness in Cornwall and Devon, two counties that are used to unusual snaps of weather, quick changes and sudden emergencies. I was left with a feeling of great confidence that those two counties are doing everything that they should to be ready. For what it is worth in this short time, I urge all counties to be in as great shape as Cornwall and Devon are.

In my remaining few minutes, I will turn to one particular point. My hon. Friend may have raised others. If I have not answered them, I will write to him. He rightly talked about a foundation trust set up by one of his constituents in memory of another of his constituents. I did not catch their names, so if he will forgive me, I will not make a hash of them, as it is a serious matter and a young woman lost her life. I am told that 80% of eligible women in Cornwall and the Isles of Scilly took part in the NHS cervical screening programme in the previous five years. That uptake has increased from the previous year and exceeds the percentage of women who took part nationally.

My hon. Friend’s point was about screening for women under the age of 25. He said that it concerns him, and asked why the age should not be reduced. In May 2009, the advisory committee on cervical screening reviewed the screening age specifically and considered all the latest available evidence on the risks and benefits of cervical screening in women aged between 20 and 24. The committee was unanimous in deciding that there was no reason to lower the age from 25, which happens to be in line with the World Health Organisation’s recommendations. The committee gave a number of reasons, which I cannot read out given the time available. I am more than happy to supply him with a list of those reasons.

That is not to say by any means that my hon. Friend and his constituents should cease their campaign to achieve better levels of screening and awareness among young women about the fact that cervical cancer can affect them even though they are young. I say that as the mother of two daughters, one aged 21 and one 22. It may be of some interest to him that by complete coincidence, I was stopped today by my hon. Friend the Member for Loughborough (Nicky Morgan), who approached me because she too, unfortunately, had a constituent under the age of 25 who died of cervical cancer. She raised the same issue with me. I gave her an undertaking that I am more than happy to meet with her and her constituents to discuss it further, and I extend that invitation to my hon. Friend the Member for St Ives and to his constituents who are campaigning. It may well be that the matter should be revisited. As I said, the advisory committee considered the issue in 2009. The technology may have changed—I know not—but it is certainly a matter that needs to be considered, and I am more than happy to meet hon. Members to talk about it and see whether anything can be done.

It would appear that I have dealt with all the items on my list of notes, and so—

[Dan Rogerson (North Cornwall) (LD)]

I am absolutely delighted that the funding formula is being reviewed, but a crucial question for us in Cornwall, when the formula arrives at a solution saying how much Cornwall should get, is whether we actually get it. It has not necessarily been a problem with the formula; it is that we have never reached the existing formula. It is about renewed determination that there will be a road of travel.

[Anna Soubry]

With 50 seconds remaining, this is a perfect opportunity for any other Member to stand up and make exactly the same point. It is a good point, and it is about to be made again.

[Sarah Newton (Truro and Falmouth) (Con)]

I am pleased that we have made a lot of progress through the coalition—the gap has decreased from minus 7 to minus 2 —but a great enough rate of change to get Cornwall up to where it should be within this Parliament is essential for the people of Cornwall.

[Anna Soubry]

I am grateful for my hon. Friend’s intervention. She makes a good point. Like others who have spoken in this short debate, she advances her county’s cause eloquently and undoubtedly with some merit. I cannot make any promises, but I can ensure on my return to the Department that the matter is raised yet again at the highest level so that we can see whether we can make some progress.

Employment, Social Policy, Health and Consumer Affairs Council

Anna Soubry Excerpts

Thursday 29th November 2012 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 6 and 7 December. The Health and Consumer Affairs part of the Council will be taken on 7 December.

The presidency is expected to seek a general approach on a proposal for a regulation amending Directives 1999/4/EC, 2000/36/EC, 2001/111/EC, 2001/113/EC and 2001/114/EC (the “breakfast directives”) as regards the powers to be conferred on the Commission. There will also be a progress report on a proposal for a decision on serious cross-border threats to health.

The presidency is expected to propose the adoption of Council conclusions on organ donation and transplantation and health ageing across the lifecycle.

Under any other business, the presidency will provide information on a proposal for a regulation on establishing a health for growth programme; and on a proposal for a directive amending Directive 89/105/EEC relating to the transparency of measures regulating the pricing of medicinal products. Information will also come from the presidency on a proposal for a regulation on food intended for infants and young children and on food for special medical purposes; on the working party on public health at senior level; and on conferences organised by the presidency.

In addition, information will be provided from the Commission on proposals for two new regulations on medical devices and in vitro diagnostic devices as well as progress on implementation of the joint action plan on medical devices following the PIP crisis; on member states’ implementation of the EU framework on salt reduction; and on transposition of the cross-border healthcare directive.

The presidency and the Commission will jointly provide information on the fifth session of the conference of the parties to the world health organisation (WHO) framework convention on tobacco control.

The Italian delegation will provide information on working towards a common EU strategy on asbestos health threats. Finally, the Irish delegation will also give information on the work programme for their forthcoming presidency, which will run from January until June 2013.

Unsustainable Provider Regime (NHS)

Anna Soubry Excerpts

Wednesday 28th November 2012 Commons Chamber

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

I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and on speaking with such eloquence and passion. That is what one would expect from a Member of this place; we would expect Members to bring to Parliament the concerns and the anger of those whom they represent so that Ministers can hear all that is to be said. In this case, perhaps most importantly, even if the trust special administrator and his team did not hear the hon. Gentleman’s speech they will certainly read it and take it on board.

These matters are always difficult and, as I have mentioned, they make people angry. I hope that the hon. Gentleman’s speech will be reported in his local media and that my remarks might also be reported.

It is important to make it clear—and I hope that the hon. Gentleman will take this back to Lewisham and the people he represents—that this is not a question of cuts. Anyone on a march bearing a banner saying, “Stop the Government cuts” does not represent the situation fairly, and does their cause no great service. It is about how to make sure that people receive the finest health care that can be provided, and that that service is sustainable. As the hon. Gentleman said, it stems from a profound problem at South London Healthcare NHS Trust.

When changes to an NHS service are mooted, people become anxious and feelings run high. This is the first time that the trust special administration regime has been used, so people are anxious, and that has a knock-on effect on patients, staff and members of the public. This may sound like weasel words, but it is important. It would be wrong to comment on specific recommendations of the trust’s special administrator, because the matter is out for public consultation, which closes on 13 December. As the hon. Gentleman explained, the matter will go to the Secretary of State, who will consider the recommendations and the full report. He will make his decision at the beginning of February. At this stage, it is not for Ministers to comment. Our minds must remain completely open.

I want to explain the process. The previous Government created the trust special administration regime in the Health Act 2009. The regime creates a transparent, time-limited process to deal with trusts in failure. We have alluded to that timetable, and have given details of it. A trust special administrator appointed to an NHS trust must make recommendations to the Secretary of State about the future of the organisation and its services. Significantly, they must set out how high-quality services can be provided in a financially and clinically sustainable way. Before making final recommendations to the Secretary of State, the administrator must consult publicly on draft recommendations, and that process has been undertaken. A summary of all consultation responses must be included in the final report to the Secretary of State. I am sure that the hon. Gentleman will ensure that his response and the responses of other MPs representing Lewisham are included in that report.

South London Healthcare NHS Trust was formed in 2009, and it was the product of a merger of three trusts, each with long-standing financial issues. When the Secretary of State appointed the special administrator to the trust in July, it was losing over £1 million a week. Last year, the trust had a deficit of £65million—the largest in the country—which is £65 million a year being taken away from well-run trusts to subsidise one that is clearly failing. There are two private finance initiatives with which the trust is struggling. They are incredibly burdensome, with a cost of £60 million a year.

To be blunt, the situation cannot go on indefinitely. The NHS simply cannot afford to spend huge sums on keeping non-viable organisations afloat. Even if we had all the money in the world, it would not be right to have such a deficit and loss. In my opinion, the Government are to be commended on having the courage to tackle the long-running challenges facing South London Healthcare NHS Trust. Sometimes, tough decisions have to be made to make sure that NHS services are improved and are put on a clinically and financially sustainable footing.

I fully accept that the hon. Gentleman is concerned about the administrator’s recommendations in the draft report that impact on Lewisham Healthcare NHS Trust. The remit of the trust special administrator is to develop recommendations for the Secretary of State on the action that should be taken in relation to South London Healthcare NHS Trust. The aim is to secure the sustainable provision of health services which meet patients’ needs and deliver value for money. For those recommendations to be viable and credible, the trust special administrator must consider all relevant factors, including the intentions of NHS commissioners and the consequential impact on the local health system. This has required him to consider implications for other health care providers that are part of the local health care system. That is why his remit is so large and so broad.

As we all know, an NHS trust does not exist in a vacuum. All trusts are part of a complex, integrated health care system. In making recommendations about South London Healthcare NHS Trust, the trust special administrator must consider the consequences of those recommendations on neighbouring trusts, such as Lewisham, and patients in those neighbouring areas. I am aware that in developing his draft recommendations the trust special administrator has had continuing dialogue with patients and the public, staff, clinicians, local authorities and other partners, and so he should. That is continuing through his public consultation, which is now under way.

In addressing the long-standing challenges facing South London Healthcare NHS Trust, the administrator’s recommendations must take into account the objective of delivering safe, high quality, sustainable health care for the people of south-east London. That, of course, includes Lewisham. To ensure that this happens, he must have regard to the Secretary of State’s four tests for NHS service change when developing his recommendations. Perhaps this may give some comfort to the hon. Gentleman. Those four tests are: support from GP commissioners; the strength of public and patient engagement; clarity on the clinical evidence base; and support for patient choice. Those are four very important principles.

The hon. Gentleman touched on many of those principles. He spoke with passion and some anger. Much of that anger is understandable in all the circumstances. The draft report is out to the public, as I said. I hope that everybody will now engage and make sure that their voice is heard, as individuals or through their elected representatives. The recommendations will go to the Secretary of State, who will consider all of them. He will then make his decision.

Question put and agreed to.

Balance of Competences Review

Anna Soubry Excerpts

Tuesday 27th November 2012 Written Statements

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

My hon. Friend the Parliamentary Under-Secretary of State, Department of Health, Earl Howe, has made the following written ministerial statement:

Further to the oral statement by my right hon. Friend the Secretary of State for Foreign and Commonwealth Affairs launching the review of the Balance of Competences on 12 July 2012, Official Report, column 468, and his written ministerial statement on the progress of the review on 23 October 2012, Official Report, column 46WS, we are today publishing a call for evidence for the health report.

The health report will be completed by summer 2013 and will cover the overall application of EU competence in health. While responsibility for health policy is a matter for individual member states, the EU has an important role in various issues related to public health and health care. The health report is an opportunity to look at this role and to examine the evidence concerning the impact of EU competence in health on the UK’s national interest.

The call for evidence period will last for 12 weeks. The Department will draw together the evidence into a first draft, which will subsequently go through a process of scrutiny before publication in summer 2013.

We will take a rigorous approach to the collection and analysis of evidence. The call for evidence sets out the scope of the report and includes a series of broad questions on which contributors are invited to focus. The evidence received (subject to the provisions of the Data Protection Act) will be published alongside the final report in summer 2013.

The Department will pursue an active engagement process, consulting widely across Parliament and its Committees, the health sector and the devolved Administrations in order to obtain evidence to contribute to our analysis of the issues. Our EU partners and the EU institutions will also be invited to contribute evidence to the review.

The result of the report will be a comprehensive analysis of EU competence in health and what this means for the United Kingdom. It will aid our understanding of the nature of our EU membership; and it will provide a constructive and serious contribution to the wider European debate about modernising, reforming and improving the EU. The report will not produce specific policy recommendations.

“Review of the Balance of Competences: Health—Call for Evidence” has been placed on the Library. It is also available at: www.dh.gov.uk/health/2012/11 //eu-balance-competence-review/.

Oral Answers to Questions

Anna Soubry Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mary Macleod (Brentford and Isleworth) (Con)]

2. What steps the Government are taking to raise awareness of and help those who have brain tumours.

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

Forgive me, Mr Speaker, but as you can hear—you may indeed be pleased to hear this—I am losing my voice. This is a serious matter, as you know, and I pay tribute to all the work you did on behalf of people suffering from brain cancer. The Government are proud to have been behind some important initiatives, such as promoting among general practitioners direct access to MRI scans. From January next year we are introducing a pilot scheme to alert people to the particular symptoms of common cancers, and we are confident that that will improve awareness about brain tumours.

[Mary Macleod]

I thank the Minister for her answer, but in the UK about 4,800 adults and 100 children lose their lives to brain tumours each year. Brain tumours kill more children than any other cancer, kill 65% more women than cervical cancer and kill more males under 40 than any other cancer, yet only 0.7% of Government funding goes to brain tumour cancer research. Will the Minister meet my constituent, Romi Patel, and others who have had brain tumours to discuss with them what more the Government can do to save lives?

[Anna Soubry]

The short answer is yes, I am more than happy to meet my hon. Friend’s constituent to discuss this matter. The figures she relies on for the amount of money going into brain tumour research are based on 2006 data, but the simple answer is that of course we can do far more. I pay tribute to the great advances made by a number of charities, including Headcase Cancer Trust, in my constituency, and others such as the Joseph Foote Trust. They are all raising considerable amounts of money specifically for research projects such as the one at Portsmouth university. I am more than happy to meet my hon. Friend’s constituent. This is an important topic on which we can do more.

[Mr Speaker]

I thank the Minister for her answers, including her very generous and gracious remarks. I wish her a full and speedy recovery.

[David Tredinnick (Bosworth) (Con)]

Does my hon. Friend the Minister agree that Penny Brohn Cancer Care, based near Bristol, which offers a unique combination of physical, emotional and spiritual support designed to help patients live well with the impact of cancer, is an organisation that should be supported? Can she confirm that such organisations are eligible for funds from the cancer drugs fund?

[Anna Soubry]

It is important that we consider all aspects of how we can treat cancers. We also need to bear in mind the people who care for those with cancer, as we sometimes forget them. Any organisation—especially in the charitable sector—that offers treatments that help people and their families and carers is to be welcomed.

[Paul Burstow (Sutton and Cheam) (LD)]

3. What plans he has to improve the quality and quantity of mental health crisis care services.

--- Later in debate ---

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

8. Whether he has put in place measures to ensure that clinical commissioning groups do not become for-profit organisations.

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

Clinical commissioning groups were established in statute. They are, accordingly, public bodies and cannot become private, for-profit organisations.

[Chi Onwurah]

I thank the Minister for that answer. As we know, most GPs go into medicine to make people well, but now that her Government have made the NHS subject to competition law there is real fear in Newcastle and across the country that they will find themselves obliged to turn a profit from their patients. Is this not, as Professor Ham of the King’s Fund has said, a further step towards privatisation?

[Anna Soubry]

No. I would urge the hon. Lady, if I may, to exercise care when claiming that this is a privatisation of the NHS. It certainly is not. GPs’ surgeries, such as those in her own constituency, have always been private businesses. A GP surgery in the hon. Lady’s own constituency, where, in my view, she has been engaged in considerable scaremongering, was put out to tender under rules introduced by the previous Labour Government. Indeed, it was the previous Government who brought in privatisation to the NHS on a scale that we had never seen before in this country. I am proud that it is this coalition that is making sure that the tariffs are fair and no longer favour the private sector.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

One way that the clinical commissioning groups can support the values of the NHS is to back the new social enterprises—forms of business enterprise—that are now delivering NHS services central to our health-care reforms. Is the Minister aware that my local clinical commissioning group wants to shut down a 60-bed rehabilitation unit provided by nurses and owned by a social enterprise called Spiral, without any adequate provision for a replacement? Will she meet me to discuss this worrying development?

[Anna Soubry]

Yes, of course I will meet my hon. Friend. I hold a ministerial surgery on Monday evenings and would be grateful if he came along to one, but I would be happy to meet him in any event. These are local decisions that will be made by local commissioners, but they should always commission in the interests and to the benefit of the people whom they serve.

[Charlie Elphicke (Dover) (Con)]

9. Whether he has recently reviewed how access to health care treatment can be made easier for vulnerable groups; and if he will make a statement. [Interruption.]

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

I am so sorry, Mr Speaker, I was getting carried away. It is my hon. Friend the Member for Dover (Charlie Elphicke) who has asked a question, is it not? [Interruption.] It does not help when the right hon. Member for Leigh (Andy Burnham) shouts at me. I am at a profound disadvantage, because I cannot shout back—not that I would ever want to raise my voice, of course. I do not seek sympathy, just parity. Opposition Members should listen with great care. This Government introduced in statute an absolute duty on the NHS to ensure that health inequalities, which, of course, rose under the previous Administration, are at last reduced.

[Charlie Elphicke]

My constituents in Deal are concerned that consultant out-patient services may be withdrawn from their much-loved hospital. Is it not right that GP commissioners should be particularly mindful of services to vulnerable people in rural areas who find it hard to travel?

[Anna Soubry]

Indeed it is. That is one of the great joys of the CCGs. As other Ministers have alluded to, we are putting commissioning decisions into the hands of the people who know best—the health professionals. When they exercise their commissioning responsibilities, we urge them to ensure, as I am sure they will, that they deliver the very best services for the people they serve.

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

On the question of vulnerable groups, does the Minister support the proposal of the hon. Member for Bracknell (Dr Lee) to ration NHS drugs, either by adopting the Danish system in which people have a personal budget for drugs and have to pay to top up, or by removing the right to free prescriptions for long-term conditions such as diabetes? Does she appreciate how much harder that would make life for millions of people in vulnerable groups, or is this the real face of the coalition on the NHS—drug rationing?

[Anna Soubry]

At my ministerial surgery last night, which has been somewhat scorned by Opposition Members, I met my hon. Friend the Member for Bracknell (Dr Lee) and discussed his proposals at length. I do not agree with his proposals, but I welcome the debate. There is nothing wrong with a healthy debate. However, on this one, he and I disagree.

[Naomi Long (Belfast East) (Alliance)]

10. How much the Government have spent on (a) treatment, (b) diagnosis and (c) raising awareness of pancreatic cancer since May 2010.

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

We cannot provide the absolute figures on how much we have spent on pancreatic cancer in particular, but some £200 million has been spent on cancers of that type. This month is pancreatic cancer awareness month and I welcome all the hon. Lady’s work towards that.

[Naomi Long]

I recently met some families in my constituency who have been directly affected by pancreatic cancer. One of their main concerns is late diagnosis, which contributes to this cancer having the worst survival rate of the 21 most common cancers in the UK. What assessment has the Department made of the recommendations in the early diagnosis report by Pancreatic Cancer UK, such as improved referral pathways and assessment tools, direct access for GPs to diagnostic tools, and the development of a National Institute for Health and Clinical Excellence quality standard for pancreatic cancer as a means of improving the speed of diagnosis and survival?

[Anna Soubry]

I am very grateful for the work of Pancreatic Cancer UK. We have put the proposals from its seminar last June into the guidance that we are issuing. I am meeting Pancreatic Cancer UK, other cancer charities and other people who are involved in cancer work this afternoon. I will be happy to raise the matter with them directly and to meet the hon. Lady and representatives of this very good cancer charity. She is right to expose the fact that this cancer is difficult to diagnose. We will be launching pilots in January and I hope that more people will take advantage of that campaign and come forward if they have any symptoms.

[Kerry McCarthy (Bristol East) (Lab)]

11. What contact there has been between his Department and the director of the NHS south-west pay, terms and conditions consortium.

--- Later in debate ---

[Tessa Munt (Wells) (LD)]

T7. Since the Prime Minister made his radiotherapy promise to current and future cancer patients last month, cancer centres all over the country have been telling me that it cannot be delivered, because there is not enough investment in new radiotherapy machines and in the recruitment and training of staff to operate them. Will the Secretary of State give the same financial commitment to the annual radiotherapy fund as he is giving to the cancer drug fund, and will he meet me to discuss the matter?

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

I thank my hon. Friend for her question, because it touches on a matter of concern to me, notwithstanding the £15 million radiotherapy innovation fund, which, as she said, was announced by the Prime Minister. Indeed, last night, at my ministerial surgery, the hon. Member for Easington (Grahame M. Morris) came along to discuss this very matter, and he raised several important issues, all of which I have this morning taken up with my officials. I am more than happy to meet my hon. Friend to discuss the matter further, however, as I think there is work to be done.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

My 20-year-old constituent, Martin Solomon, has blood cancer and is currently receiving expert treatment at the Christie in Manchester. He needs a stem cell transplant, but finding a match is difficult, especially as he has mixed heritage, and his best chance is from an umbilical cord donation. Will the Secretary of State do two things to help Martin? First, will he reinvigorate the campaign within the black and ethnic minority communities to increase stem cell donations, and, secondly, will he establish a cord collection centre in Manchester, so that mothers can donate cord after the birth of a baby and give young people such as Martin an extra chance to find a match?

[Anna Soubry]

I thank the right hon. Gentleman for raising an important topic. I send my heartfelt sympathies to his constituent. As he identified, this is a real problem. Yes, is the short answer to his first question. I met officials several weeks ago to discuss exactly this problem, as we need to do more in that area. Of course, this is a national scheme. Whether there is a need for a local scheme in Manchester is a moot point, but his constituent will be able to access the national scheme. I am more than happy to discuss the matter further with him.

[Mr Peter Bone (Wellingborough) (Con)]

Neuroblastoma is a nasty cancer that affects fewer than 100 children a year. Thanks to the previous Labour Minister, Ann Keen, we persuaded the previous Prime Minister that it should be treated on the NHS without the need for a referral. Unfortunately, there seems to be some slippage, with some primary care trusts refusing to pay for the treatment. Will the Secretary of State look into the matter and see if they can be given the correct information, which is that they should be providing this treatment?