Rickets

Anne Milton Excerpts

Tuesday 4th September 2012 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I congratulate the hon. Member for Stretford and Urmston (Kate Green) on securing the debate. She is right that these are important opportunities to raise awareness. Although we sometimes underestimate our impact, such debates are sometimes picked up by the media, and anything is useful.

As the hon. Lady eloquently set out, with vitamin D, we are talking about children, strong and healthy bones, and bone health generally. Often, rickets occurs because a child is born without enough vitamin D due to the mother’s deficiency in pregnancy. Alternatively, it can be a post-natal condition due to a poor diet or lack of sun exposure. That is why successive Governments have long recommended that young children and pregnant and breastfeeding women take a daily supplement of vitamin D.

As the hon. Lady says, most people would imagine that rickets is something from the Victorian era. The incidence of rickets fell dramatically in the 1920s, and, in the past, several public health policies have helped to reduce its incidence further. The law now requires the addition of vitamin D to all infant formula, and vitamin supplements containing vitamin D are made available for pregnant women free of charge and to young children from low-income families via the Healthy Start scheme.

Unfortunately, we do not have good data on the national prevalence of rickets in the UK. The hon. Lady has been provided with data on episodes of rickets recorded by hospitals in England, but sometimes a problem when we produce data is that they are about episodes, not people. I believe that she was given that information through an answer to a parliamentary question. The figures appear to be slightly higher, and looking at the percentage increases, the statistics are startling, but episode data do not represent the number of patients, because a person may be admitted more than once in a year. The number of patients diagnosed with rickets is therefore a better measure, and that has increased from 134 to 395 in 2010-11. It is important to consider those figures in the context of increased population size and improved reporting and recording. Those numbers appear quite low when compared with other diseases, but rickets is still a problem, particularly since hospital episode statistics do not show the number of children who may have been treated as outpatients or those diagnosed by a GP. We are aware that over the past few years there have been several reports of clinically apparent vitamin D deficiency and rickets in children from doctors in Manchester, London, Glasgow and Burnley. That is not an exhaustive list; there will be other places.

As the hon. Lady pointed out, the tragedy is that rickets is preventable. That is why it is so important that at-risk groups such as pregnant women, babies and toddlers take those vitamin D supplements. As she also rightly pointed out, that is particularly important for women of south Asian, African, Caribbean or middle eastern family origin, because people with darker skin do not produce as much vitamin D in response to sunlight. It is also important for women who are not exposed to much sunlight, either because they cover their skin for cultural reasons or because they do not spend much time outdoors. The hon. Lady referred to older people who might, due to immobility problems, not be able to get out.

Our national infant feeding survey tells us that about half of mothers across the UK reported taking some form of vitamin or mineral supplement other than folic acid during their pregnancy. On the one hand, that is encouraging but on the other it means that 50% do not. There is a problem and clearly more needs to be done.

[Kate Green]

The Minister is right that we should worry about the 50% that may not be taking the supplements that they may need, but another concern is the lack of clarity among pregnant women and others about what supplements they should be taking and in what dose.

[Anne Milton]

The hon. Lady is absolutely right. A huge amount of data and confusing information are given to women. That is one thing we need to tackle in our public health changes. She also talked about joining up services and having a strategic approach. Given the many different information sources, particularly on the internet and some very reputable websites, it is hard for women to know exactly what to do.

The 2005 infant feeding survey found that only 7% of infants aged eight to 10 months were given any type of vitamin supplement. The hon. Lady talked about raising awareness, which is indeed what we need to do. We need to ensure that GPs, midwives, health visitors and other health professionals—she talked about schools—are fully aware of the need for those groups of the population to take vitamin D supplements. That is why in February all four of the UK’s chief medical officers wrote to GPs, health visitors, practice nurses and community pharmacists to reiterate the Department of Health’s recommendations. I would put particular emphasis on the role that pharmacists can play in informing the public, as they have quite a lot of contact.

The chief nursing officer for England also highlighted the issue in her February newsletter bulletin for all nurses and midwives in England. The Department of Health is liaising with the Royal College of Midwives to explore how we can work with them to spread advice further. It was also encouraging to hear that the Royal College of Obstetricians and Gynaecologists welcomed the CMOs’ letter and that it, too, promotes the importance of daily vitamin D supplement during pregnancy.

The National Institute for Clinical Excellence’s public health guidance on maternal and child nutrition, and clinical guidance on antenatal care—quite a mouthful—also support the Department of Health’s advice on vitamin D, reiterating the importance of consistent messages. We have also asked NICE to develop public health guidance on how to improve implementation of the advice on vitamin D and on safe sunlight exposure for the UK.

As the hon. Lady alluded to, there have been issues concerning the availability of prescribable vitamin D preparations. The NHS London Medicines Information Service has produced a document that lists the preparations with appropriate levels of vitamin D for different age groups, so health professionals know exactly what to prescribe. That list was sent to pharmacy organisations in March.

Healthy Start vitamins are not available on prescription, but the Department encourages NHS organisations either to sell the vitamins or consider supplying them free of charge to target groups who are not eligible for the scheme. I was pleased to see the positive effect of the CMOs’ letter—I do not know whether the hon. Lady is aware of this—on the number of orders placed. Orders for the children’s drops have increased from around 72,000 bottles in quarter 4 of 2010-11 to more than 97,000 bottles in quarter 4 of 2011-12. That is a significant increase, which demonstrates, although we are starting from a low base, that we can have an impact. Similarly, orders for the women’s tablets have increased from around 58,000 to more than 105,000 in the same period—an 80% increase.

We all need to keep up our efforts. The hon. Lady raised the issue of awareness and training, which, I suggest, should apply to all the professions. There would be no harm in the person who takes blood from a pregnant woman also reiterating some of the simple advice.

The Department of Health has produced a leaflet entitled “Vitamin supplements and you” as part of its Start4Life campaign. That contains up-to-date advice on the importance of vitamin D. Health care and child care professionals can download it. On top of that, in May we launched what I think will be one of the most significant initiatives, the new NHS information service for parents. Through regular e-mails, online videos and texts, it gives parents information and advice as they progress through their pregnancy and beyond. The service is very new. About 47,000 parents have already signed up, and I would urge those who are reading or listening to this debate to encourage the people they know to do so, too. Members of this House can have a significant impact by raising the issue in their local press and getting people to sign up. This is about trusted advice from the Department, cutting across a lot of the confusion.

We have also asked the Scientific Advisory Committee on Nutrition to undertake a comprehensive review of the scientific evidence on vitamin D and health. That will include a review of the existing dietary recommendations on vitamin D for all population groups, as well as looking at the options to improve the amount of vitamin D we get as a population. The risk assessment is due to be completed in 2014. In the meantime, it is important to ensure that the existing recommendations are put into practice, which is what this debate is all about.

The hon. Lady raised a number of other issues. I probably cannot give them the time they deserve today but I am happy, if she would like to know more detail, to talk to her on another occasion. We strayed a little into EU legislation—worthy of a three-hour debate—about health claims of vitamin supplements. She also asked about universal access and food fortification. Some of those issues are quite tricky. One needs to be sure that what is done has the desired impact. There is also quite a lot of resistance to fortification of food from another quarter.

In the final minutes, I would mention the public health outcomes framework, which she mentioned, the health and wellbeing boards and the opportunities that lie ahead. To some extent we now have an opportunity we have not had before, with public health moving into local authorities. Local authorities will have a remit to do a lot more work in this area. The hon. Lady mentioned schools. I think we will see an opportunity for local areas emerging, particularly when the joint strategic needs assessment reveals some of the issues. There may be opportunities, for example, where there is a high proportion of people who may be at risk from low vitamin D, for local areas to take action. That can be across the board, involving not just GPs and midwives, but schools. We will see changes. We will keep this under review; we know how important it is. The numbers might be relatively small but the increase is significant.

Question put and agreed to.

Fluoridation of Drinking Water (Consultation)

Anne Milton Excerpts

Tuesday 4th September 2012 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The Department of Health is publishing a “Consultation on the arrangements for consideration of proposals on the fluoridation of drinking water” today.

The Health and Social Care Act 2012 provides that, from 1 April 2013, responsibility for consultations on proposals on fluoridation will transfer from strategic health authorities to local authorities. The proposals could be for a new fluoridation scheme or the variation or termination of an existing fluoridation scheme. The consultation document sets out options for the making of water fluoridation regulations under the Act on the conduct of consultations, ascertaining public opinion and the decision-making process.

Our aim is to put in place a fair and practical way to amend powers for consideration of proposals on fluoridation schemes. The merits of fluoridation itself will be considered locally in accordance with the regulations. We welcome views and will use these views to inform our thinking on the regulations.

A copy of “Healthy Lives, Healthy People: Consultation on the arrangements for consideration of proposals on the fluoridation of drinking water” 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.

Informal Health Council

Anne Milton Excerpts

Tuesday 17th July 2012 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

EU Health Ministers met in Nicosia, Cyprus, on 10 and 11 July. The United Kingdom was represented at official level. The agenda included discussions on organ donation and transplantation, the health work force, and health security.

The meeting began with a discussion on organ donation and transplantation. This discussion was followed by a lunch debate on the health work force, centring on the priorities outlined in the EU’s action plan for the EU health work force. There was also broad consensus that the EU could support the pursuit of these priorities in member states by facilitating the sharing of experiences and best practices, but that member states alone were competent to define their own work force strategies.

Following presentations from the presidency, the Commission, the World Health Organisation (WHO) and Greece, health security was also discussed, in particular risk and crisis communication strategies.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 17th July 2012 Commons Chamber

[Diana Johnson (Kingston upon Hull North) (Lab)]

6. How many children received milk through the nursery milk scheme in each of the last three years.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

In 2009-10, the number of portions funded was 218 million. In 2010-11 it was 262 million, and in 2011-12 it was 271 million. Of course, children do not necessarily attend nursery five days a week, so the number of portions does not equate to the number of children, so, say, 1 million children attending full- time or 2 million attending 2.5 days a week.

[Diana Johnson]

In Hull the nursery milk scheme has never been more needed, at a time when poverty is increasing and food banks are expanding. Will the Minister guarantee that no child who currently receives nursery school milk will lose out after the results of the consultation have been published?

[Anne Milton]

As the hon. Lady will know, we are consulting on a range of options to modernise the operation of the scheme. The cost rose to £53 million in 2010-11, and is due to rise to about £67 million in 2012-13. Given those massive increases, we need to look at the scheme’s operation to ensure that we are getting good value for money.

[Lisa Nandy (Wigan) (Lab)]

10. Does the Minister accept that the cost may well have risen because more children are receiving free milk? Because the consultation is being launched during the school holidays, it will be extremely difficult for schools to respond. If this is a genuine consultation which aims to ensure that milk reaches the children who need it, will the Minister consider extending the deadline into September and October?

[Anne Milton]

The consultation has been running for some time now, and I should have thought that local authorities in particular would have had plenty of time in which to respond. Given that 8,962 settings are paying more than 90p for a pint, which is an outrageous amount, it is extremely important for us to hear from everyone. If the hon. Lady feels that there has been any problem with responses to the consultation and would like to drop me a line, I shall be happy to respond.

[Mark Menzies (Fylde) (Con)]

7. What steps he is taking to reduce health inequalities.

--- Later in debate ---

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

14. What steps his Department is taking to ensure that confidentiality agreements do not discourage NHS whistleblowers from coming forward.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The Department wrote to the NHS trusts most recently in January 2012 reminding them that compromise agreements should not prevent information from being disclosed in the public interest. It also said that they should satisfy themselves that their organisational policies are in line with previously issued guidance.

[Stephen Phillips]

I am grateful to my hon. Friend for that answer. She will be aware of the case of my constituent Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust, who has been prevented by a confidentiality agreement from raising his concerns about the effect on patient safety of the previous Government’s targets. I want to hear Mr Walker’s concerns and my constituents are entitled to hear them. I hope that my right hon. Friend the Secretary of State will look into this matter and give a categorical assurance that the concerns that Mr Walker has told us about will come into the public domain.

[Anne Milton]

I thank my hon. and learned Friend for his supplementary question. I cannot comment on the individual details of the case, but I appreciate his concern that NHS staff could be prevented from speaking out by confidentiality agreements. Confidentiality and compromise agreements are allowed in contracts, but the Public Interest Disclosure Act 1998 provides that any clause in that contract or compromise agreement between employer and employee is void in so far as it acts to stop the employee making a protected disclosure.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Given the proliferation of new bodies being created to deliver NHS services, including a number of private sector organisations, can the Minister be confident that the NHS constitution protects whistleblowers working for private companies but delivering NHS public services?

[Anne Milton]

I assure the hon. Lady that all must have regard to the NHS constitution. In fact, we issued guidance to NHS organisations that all contracts of employment should cover whistleblowing rights. In September 2010, we amended terms and conditions of service and guidance to the NHS on supporting and taking action on concerns raised by staff. The changes made to the NHS constitution make very clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing. As I have pointed out, all those providing services on behalf of the NHS must have due regard to the NHS constitution.

[Laura Sandys (South Thanet) (Con)]

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

--- Later in debate ---

[Nick Smith (Blaenau Gwent) (Lab)]

Given that every year, 1.2 million admissions to accident and emergency units are alcohol-fuelled, when will the Government help the NHS and legislate for a minimum alcohol unit price?

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am sure that the hon. Gentleman is very familiar with the alcohol strategy and has read it in detail. It is one of the things that we need to do. Brief interventions, specialised treatment, the NHS alcohol check and, of course, changes to licensing will all make a difference. As I say, the alcohol strategy, a cross-Government document, is out. We will respond further in due course.

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

Last week, the Royal Cornwall Hospitals NHS Trust cleared an important milestone towards becoming a foundation trust. An historical debt remains, largely as a result of punitive accounting measures under Gordon Brown. Will my right hon. Friend the Secretary of State do everything that he can to ensure that when the Royal Cornwall becomes a foundation trust, it is debt-free?

Adult Social Care

Anne Milton Excerpts

Monday 16th July 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I was heartened by some of what I read in the motion tabled by the Opposition. Welcoming the measures laid out in the care and support White Paper was a good start to a process that will be immensely easier with genuine co-operation and communication. However, the speeches from the Opposition Front Bench were partisan and contained no acknowledgement that for 13 years they did nothing. The hon. Member for Leicester West (Liz Kendall) seems to have amnesia. Cheap party political squabbling is not attractive. I remind the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that she was very political by trying not to be political. I remind her also that 40,000 people a year had to sell their homes to pay for their care. It reflects badly on her and on the House and does nothing to improve the lives of service users, carers and staff. A White Paper seven days before the general election announcement counts for little.

Care has to be funded in a way that is fair on service users and fair on the taxpayer. We agree with Dilnot that financial protection through capped costs and an extended means test are the right basis for any new funding system. Given the extra public spending that will be involved, we need to consider that alongside other priorities. An issue that has been raised throughout the debate is the funding for the means-tested system. The right place—the responsible place—to consider that is in the course of the spending review and I do not intend to pre-empt that tonight. I draw hon. Members’ attention to the progress report. Many of the answers to the questions that they raise are included in that. The hon. Member for Hackney North and Stoke Newington would do well to refer to figure 4 in the report.

We have allocated an extra £7.2 billion to improve care and support as part of the spending review. That comes as part of what we know is a tough settlement for local government. If spent well, it will go far and will help local authorities maintain people’s access to care and support. The recent report from Demos and Scope shows that this can be done, and that reduced funding does not have to mean a reduced service. By putting more into reablement services that help people regain their independence, for example, or by supporting people to live in the community instead of in expensive residential care, local authorities can provide the best standards of care while saving money.

My hon. Friend the Minister of State mentioned the £32.5 million for better online services and traditional communication methods to help people see what services are available, whether their care is paid for by them or by the state. Likewise, there is an additional £200 million for specialised housing. That additional money more than pays for the White Paper proposals leading up to the comprehensive spending review. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said, the issue was ducked repeatedly by the previous Government in far more favourable economic times. He also drew attention to the absurd distinctions between health and social care and the need for integration.

My hon. Friend the Member for Congleton (Fiona Bruce) spoke from the heart about the needs of carers, the £400 million we have provided for carers’ breaks and the end of permanent billing. My hon. Friend the Member for Southport (John Pugh) spoke of the contribution older people make and how to stop the fit becoming frail. My hon. Friend the Member for Stourbridge (Margot James) reiterated the ADASS figures and the desire for people to stay in their own homes. My hon. Friend the Member for Truro and Falmouth (Sarah Newton) spoke with passion and knowledge of the unity and commonality of purpose we need and the divisive nature of the Opposition’s motion. My hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) pointed out the huge need to address the needs of people with disabilities.

These are ambitious plans. As well as setting out a comprehensive package of reform for the longer term, the White Paper announces changes that will make a difference immediately: a national eligibility threshold; proper and meaningful portability; duties to share information to ensure that people can move without losing their care; a focus on housing; provider quality profiles so that people can finally have clear information on the quality of care providers; mandatory adult safeguarding boards; and a requirement to assess carers’ needs and actually meet them—much neglected help and support. It also announces a code of conduct and minimum training standards for care workers so that people know that their care is underpinned by high standards of training and ethics. We will train more care workers, with 50,000 more apprenticeships by 2017, double the current number.

[Mr Anderson]

rose—

[Anne Milton]

The hon. Gentleman should welcome that.

The White Paper opens for business the new national information website so that people can find out more about all parts of the care and support system. It sets out legal entitlements to personal budgets so that care users, their families and their carers can choose what services they get. There are improvements to the transition from children’s services to adult services. These are big changes, egalitarian changes and, most of all, they will be effective changes. We are also reforming the existing social care legislation through the draft Care and Support Bill. The White Paper is about keeping people well and helping them to take control, get independent and live the lives they deserve with the certainty and security they need to do so with dignity.

There are times when we, as politicians, need not only to open our eyes and ears to the world outside this House, but to stand in the shoes of those we represent. They do not want to see us argue, squabble and bicker over their lives. On this issue, perhaps more than any other, we need to work together. If we do that, we can improve the system for millions of people, whether they use the services or care for someone who uses them. The system is funded until the next spending review.

I urge Opposition Members and Front Benchers to put aside party political differences and work alongside us to ensure that we have a system that is sustainable not only for this year and next, until the next general election, but for the years ahead. Older people in this country, the carers who support them and people with disabilities deserve that. The White Paper gives us a foundation on which to work, a foundation that has been missing for far too long. In 13 years in government, in favourable economic times, those now on the Opposition Benches did nothing that was sustainable in the long term. We need a foundation that gives us a chance to build a care and support system that future generations will be proud of. I urge the House to reject the motion.

Question put,

High Energy Caffeine Drinks

Anne Milton Excerpts

Wednesday 11th July 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I congratulate my hon. Friend the Member for Reading East (Mr Wilson) on securing this debate and applaud his desire not to be alarmist, as it is easy to be alarmist on occasions such as this, particularly given the tragic stories he quoted this evening. I also applaud his desire to have an evidence-based approach. Such an approach always sounds simple, but it is not always that easy to obtain in practice, because the evidence is sometimes conflicting and confusing.

There is no doubt that nothing is more important than the food and drink we give to our children. Innumerable studies have been done on how it affects their education, their behaviour and their development. It is our responsibility as politicians, as adults and as parents to make sure that all children are eating a good and varied diet. My hon. Friend is clearly well aware that caffeine appears in many different foods, from various sources. It occurs naturally in things such as tea, coffee and chocolate, and is traditionally used as a component for the flavouring of cola drinks. In addition, of course, the reason for this debate is that it is also added as a stimulant to energy drinks. What is interesting for me in doing this job is that it is sometimes staggering how low awareness is. I think that most people are aware that caffeine is present in coffee, but they are perhaps not so aware that it is also present in tea and chocolate.

We need to recognise, of course, that in sensible doses caffeine is perfectly all right. However, as my hon. Friend will no doubt know if he has ever drunk one too many espressos, it does have its side effects. In 2003, the European Scientific Committee on Food specifically looked at high-caffeine soft drinks, finding that in its opinion those drinks did indeed cause increased excitability, irritability, nervousness or anxiety in some people who drank them, particularly if those people were normally low consumers of caffeine—that is where we get into the issue about children. Such effects were seen when someone consumed about 5 mg of caffeine per kilogram of bodyweight. That is the equivalent of about 300 mg of caffeine for an average adult and 150 mg for an average 10-year-old child. As a comparison, the amount of caffeine in a can of a typical high-caffeine energy drink is 80 mg, which is about the same as that found in a mug of instant coffee.

The committee said that caffeine appears to affect people’s heart rate and blood pressure, but it also said that those effects were short term and did not appear to have any long-term effects or cause heart attacks. I remind my hon. Friend that that study was conducted in 2003. The Committee did not at that time consider it necessary to establish a recommended daily limit for caffeine.

There are many anecdotal reports of young people having heart attacks after drinking too many energy drinks—my hon. Friend mentioned some of those cases—but those reports are not always complete, and these cases have often involved someone drinking such drinks along with consuming alcohol or drugs, thus clearly limiting the ability to draw conclusions. That shows why building up a good evidence base can be quite difficult.

The independent UK Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment is currently investigating the interaction between caffeine and alcohol, and is expected to report back later this year. My hon. Friend mentioned a number of tragic cases and the campaign started by some of the families who have been affected, and I want to applaud their efforts. It is always remarkable to see how families can turn a tragic incident into a campaign to do good for others. The committee’s study will be important in further informing us about the effects of caffeine.

Consumers need to be aware that there is information about caffeine content on the labels of high-energy drinks. Because some people may be particularly sensitive to caffeine, legislation was introduced across Europe in 2003 that stated that drinks with high levels of caffeine had to be labelled with the words “high caffeine content”. Those drinks also had to carry an indication of the actual caffeine content in milligrams per litre, so people can see exactly how much caffeine they are drinking. That labelling is not needed for tea and coffee, or drinks based on them, because it is generally accepted that people already know they contain caffeine. We do need to be much better at informing consumers, and persuading them to be better consumers and to read the labels of the products they eat and drink. The labelling requirement comes into play when a drink contains more than 150 mg of caffeine per litre. A typical high-caffeine energy drink would contain 320 mg of caffeine per litre, and therefore would have to be labelled.

In line with the May 2010 voluntary code of practice developed by the British Soft Drinks Association, many high-caffeine drinks also carry extra labelling to make it clear that such drinks are not suitable for children or people sensitive to caffeine. My hon. Friend praised the BSDA for its action and mentioned that recent changes at European level will make such labelling mandatory by December 2014. I am always pleased to see UK manufacturers acting responsibly by pre-empting legislation and making sure such labelling is already the norm. The code of practice also states that high-caffeine soft drinks should not be advertised, marketed or promoted to those under 16.

Finally, Government advice is that children and other people who are sensitive to caffeine should be careful with high-caffeine soft drinks, just as they should be with other products with lots of caffeine, such as coffee. Our advice is that they should be sensible and drink them only in moderation. If only it was that easy, and people just took the advice they were given; sadly, however, they do not always do so.

[Mr Rob Wilson]

My hon. Friend seems to acknowledge that children under 16 should not be drinking these drinks, and I think that that is even the advice of the industry. However, while a 12-year-old can go to their corner shop and buy those drinks there is no deterrent and nothing to stop them. What can the Minister say to me tonight about what will help to stop 12-year-olds going into local shops and buying these drinks unless we do something about it in this place?

[Anne Milton]

I thank my hon. Friend for his question and I will go into that point in a little more detail. We live in a world where children and adults are bombarded with information and it is not always possible to legislate our way out of a problem. I will say something more about that in a minute.

My hon. Friend referred to a report by the University of Miami on the possible effects of energy drinks on children and young people. Officials at the Food Standards Agency consider the study a useful review of a great deal of existing information, but it does not provide conclusive evidence to change the conclusions previously drawn by the EU Scientific Committee on Food. It does, however, add to our information base, to which we must continue to add.

I want to reassure my hon. Friend, just as I would like to reassure everyone, that the Food Standards Agency will continue to monitor the situation. It is extremely important that all Governments remain open minded and continue to look at any new evidence that becomes available. At the moment, the scientific advice is that the effects of caffeine are short term and information labelling is thorough and widespread, but, as I have said, that is not the end of the story.

My hon. Friend quoted extensively from the experiences of other countries. It is critical to remain open minded as new evidence emerges. I do not often have the privilege of being able to talk about this but I sit on the European Health Council, which gives me an opportunity to meet Health Ministers from other European countries and, indeed, such issues come up at those meetings. It is important to share experiences. He talked about raising awareness and I have no doubt that the opportunity he has taken to raise the issue tonight will play its part in doing just that.

The difficulty and the challenge in considering evidence, of course, is filtering out the impact of the particular ingredients in these drinks when there are so many confounding factors. That is why the Government need to be mindful of the research that is produced, particularly when there are also obvious and immediate commercial pressures. We are always battling against that.

I note my hon. Friend’s quote from Jamie Oliver. Passion is never a bad thing. It is good to feel the passion from other people and it helps raise awareness. The problem of the sale of alcohol to under-age children is not easy in itself. I note and commend the action taken by some schools that have taken a lead, presumably because they have had problems with the behaviour of children and are concerned about the quantity of high energy drinks their children are drinking. My hon. Friend has covered a lot of detail, particularly about the impact of taurine. Sadly, I cannot respond specifically on the question of that one ingredient this evening, but if there is any more information that I feel will be useful or helpful to him I will ensure that he receives it in a letter.

Responsibility for public health will move to local authorities. We are keen to achieve much better informed consumers, and that includes children. Smoking is taken up by 320,000 children each year, and we have a big battle on our hands. In my role as Minister with responsibility for public health, it is important that I understand that some of the choices that children face are very complex. We need to ensure that they have the skills they need to make good decisions about their life and that they have the information on which to base those decisions.

My hon. Friend strayed into type 2 diabetes, and there is a danger of my straying much further tonight. However, I finish by commending my hon. Friend for raising this issue and for the work that he has obviously done with some of those people and families who have been affected. I look forward to working with him in the future to ensure that we do all that we can to further the cause he has raised.

Question put and agreed to.

Consultation on Standardised Packaging of Tobacco Products

Anne Milton Excerpts

Thursday 5th July 2012 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

My right hon. Friend the Secretary of State for Health announced on 16 April the Government’s consultation on standardised packaging for tobacco products, Official Report, column 11WS. A large number of responses have already been received from a variety of individuals and organisations.

The Government have been asked to provide more time for people to respond to the consultation. We want to maximise the opportunity that people have to provide their views and evidence.

The Government are, therefore, extending the consultation period for an extra month. The new closing date of the consultation is Friday, 10 August 2012.Through this consultation, we are exploring whether action on tobacco packaging has the potential to bring public health benefits over and above those from our current initiatives. The Government have an entirely open mind on standardised packaging, and want to know more about the possible benefits and consequences of taking action in this area.

Any decisions to take further policy action on tobacco packaging will be taken only after full consideration is given to consultation responses, evidence and other relevant information.

Cosmetic Surgery

Anne Milton Excerpts

Thursday 5th July 2012 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Sadly, as I only have about five minutes left, I will not be able to answer all the issues that the shadow Minister, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), raised.

[David Tredinnick]

On a point of order, Mr Rosindell. My understanding is that the debate can continue at the discretion of the Chair.

[Andrew Rosindell (in the Chair)]

Yes, indeed that is so. I intend to let the debate run on a bit longer to allow the Minister to respond and Mr Dorrell to have his two minutes towards the end.

[Anne Milton]

Thank you very much, Mr Rosindell. I am also grateful to my hon. Friend the Member for Bosworth (David Tredinnick). I was not aware that we were allowed to run on.

I am grateful to the Liaison Committee for choosing the topic for debate and to my right hon. Friend the Member for Charnwood (Mr Dorrell) for the thoughtful way in which he introduced it. I concur with the statement made by the shadow Minister about the usefulness of the Backbench Business Committee. It has allowed us all to raise issues of interest to our constituents in a much more timely fashion.

I welcome the opportunity to set out the Government’s position. My right hon. Friend described much more eloquently than I could the events that led up to what has happened. The stress that the women concerned have gone through has been immense. I am disappointed that the shadow Minister was slightly party political in her response. The right hon. Member for Rotherham (Mr MacShane) said that the issue is not very party political. I gather from the debate that the matter has been on the stocks since 1994. It is time for us to shine a light—possibly this issue has done so—on cosmetic surgery and, indeed, on interventions. We need to make sure that we get our house in order.

The women concerned believed that they had received breast implants containing silicone that was safe and of medical quality. They certainly did not expect to discover that they had been, in some cases, cruelly and cynically deceived and that their interests had been ignored through the fraudulent activity of the manufacturer. Over the past few months, I have met a number of women with PIP implants. They all feel, as do I, that the right lessons should come from what has happened. In fact, although the women concerned certainly do not want to be in the position they are in, they are keen to know that the Government will learn some lessons.

We should start with the science. I assure the shadow Minister that, of course, as with anything, research and review of practice is ongoing. One does not just carry out a review of research and end it there, because research continues. It is extremely important, and not only in this country, that we continue to learn lessons from ongoing research on a number of issues and that we remain open-minded.

Within weeks of the discovery of the fraud, the MHRA commissioned tests to find whether the material in PIP implants was dangerous. Because of legal difficulties over similar tests in France, the MHRA was the first agency in a position to publish the results of that testing, in September 2010. For obvious reasons, the tests were based on a limited number of samples, but the conclusions at that time were relatively reassuring. More tests were then carried out in France and Australia during 2010 and 2011. The results were broadly similar to ours, apart from some inconsistencies over a test for skin irritation.

Towards the end of 2011, the French regulator began to notice that more people were reporting that their PIP implants had ruptured. There was a report of a rare form of cancer in one woman with a PIP implant. The French cancer institute looked at the data and decided that there was no excess cancer risk associated with PIP implants. Nevertheless, as a precaution, the French Government decided to advise all women with PIP implants to have them removed. A number of European countries followed suit.

We, in the UK, decided that an expert group chaired by the NHS medical director should look at the evidence and advise on appropriate policy for the NHS in England. The expert group delivered an interim report within a matter of days; it advised that the evidence at that time did not justify removing all PIP implants as a matter of course. Instead, the group advised that women should speak to their specialist and come to a decision individually. However, it also noted that the evidence base was not perfect, and said that it would collect more information and advise further in due course. I understand that the Health Committee supported that decision.

I am sorry if the shadow Minister feels that anybody from the Government has not appeared sympathetic. It is certainly not a view I have heard expressed. It would be hard not to sound sympathetic when people have been the victims of what, as I said at the beginning, were the cruel and cynical actions of a fraudulent company. I have met a number of the women concerned since then. I hope not only that lessons will be learned, but that any Government procedures will ensure that responses are more timely.

[Mr Dorrell]

On the evidence of toxicological damage, one of the things that the women most directly affected are seeking is more precise detail about the evidence that has been used by the MHRA to reach its conclusions. Will the Minister clarify whether that is to be published or whether there is a constraint that prevents its publication?

--- Later in debate ---

[Anne Milton]

My only hesitation is that there might be constraints that I know nothing about. However, I can see no reason why not if the evidence has been assessed. The evidence will, almost by definition, be in the public domain because it will be in papers that have been peer-reviewed and probably published. There should therefore be no reason why it should not be available to all women.

My right hon. Friend raises an important point: it is not just about what one does, but about what one is seen to do. Any restriction on access to information raises suspicions in people’s minds. All those women have already had a bad experience—they had their surgery and were reassured by surgeons and staff at the organisations they went to—and already feel that they have been deceived. Therefore, it is more important than ever to make sure that they have access to the information that we have access to.

As I said, Sir Bruce’s group has published its final report, which was informed by detailed tests on the silicone used in PIP implants and by large-scale data on the rupture rate of the implants. It draws on what doctors found when they removed some implants. It was painstaking work, and three main conclusions stand out. It is important to reiterate that research—data—should always be under constant review.

First, the evidence supports the fact that impurities in silicone gel do not pose a threat to health. That fits with the conclusions of tests on the gel carried out in the UK and other countries. Secondly, there is clear evidence that the rupture rate for PIP implants is significantly greater than for other silicone gel implants on the UK market. Thirdly, although some ruptures are associated with local clinical reactions, in the great majority of cases, that was already apparent before removal of the implant. So-called silent ruptures detected by scanning, but with no outward signs or symptoms of a possible rupture, are not in general associated with significant clinical reactions when the implants are taken out. The group therefore concluded that PIP implants are clearly substandard—there is no doubt about that—but that if the implants are still whole inside the body, there is no evidence of an increased risk of clinical problems.

I stress that that is not what the Government say; it is what an expert group says. I am happy to send anybody who wants it the list of who made up that expert group. It is important and it is about confidence in what we are doing. Ministers are not scientists. It is important that we rely on and get the best possible scientific advice, and that we remain vigilant in scrutinising that advice.

[Mr Joe Benton in the Chair]

[David Tredinnick]

My hon. Friend might be about to move on to this, but did the expert group consider the points made about two operations for people having problems with implants? She will probably deal with that in a moment, but she will forgive me for nudging her.

[Anne Milton]

I need no nudging, but I take my hon. Friend’s intervention in the friendly manner in which it was intended. I will move on to that.

The group reiterated the earlier advice that women with evidence of ruptured implants should be offered removal, and women with no sign of rupture should talk to their specialists, discuss the pros and cons of removal and decide with their doctor the best way forward.

In January 2012, in line with the interim advice, we published the NHS offer: women who originally received implants from the NHS are entitled to a consultation and a scan if appropriate. Then if the woman and her doctor so decide, the NHS will offer to remove and replace the implants. From the start, we made it clear that we expected private providers to match that offer. Many have done so. In fairness and for balance, I point out that some have been very responsible. I hesitate to mention some, as the list will not be conclusive, but BMI Healthcare, Linea Cosmetic Surgery, Nuffield Health, Ramsay Health Care, Spire Healthcare, The Hospital Group and Transform have been responsible and stepped up to the plate. It would be a shame if this debate cast negative views on all those involved in the plastic surgery industry, but I will come to some of the other points raised before I finish.

Where a private provider has gone out of business or fails to meet its moral and legal obligations, the NHS will provide a consultation, a scan if appropriate and removal, but not normally replacement, of the implants. That policy remains in place today. My hon. Friend the Member for Bosworth (David Tredinnick) wanted me to go on to the question whether the policy should be varied. As has been reiterated today, the Select Committee on Health suggested that women should be able to pay a fee for new implants to be put in place by the NHS during the same operation in which the old ones are taken out. I completely understand why, and I have discussed the issue at length.

There are several points. Allowing a mixture of NHS and privately funded care within a single operation risks undermining a founding principle of the NHS that care is free. I take the point made by my hon. Friend the Member for Totnes (Dr Wollaston) about co-payments in the NHS for dentistry, glasses and so on—I could go on. I believe that Bevan resigned within two or three years of the formation of the NHS, on that very point. The issue of co-payments goes back a long time. However, I feel that this situation, although complicated, is different. If the NHS were to carry out replacement breast augmentation, it would become responsible for all the aftercare, including possible future replacements. As my hon. Friend the Member for Totnes and my right hon. Friend the Member for Charnwood mentioned, the rupture rate is significant anyway. Breast implants do not last a lifetime; it is unlikely that they will.

[Dr Wollaston]

Does the Minister accept that if someone has a gold filling, for example, for which they paid a top-up on the NHS, if that gold filling fails, the NHS will still treat them, rather than expecting them to take responsibility for having the gold filling replaced in the private sector? There is a precedent. Again, I make the point that we must put women first in this situation and not subject them to two operations.

[Anne Milton]

The NHS is free at the point of delivery on the basis of clinical need. The point is that the NHS might not put in a gold filling. I would hate to stray from the issue of co-payments. When I was on the Health Committee, we considered co-payments, and there are numerous areas of inconsistency. My hon. Friend’s point is well made, but—

[Mr Dorrell]

I am sorry, but I am going to have a go at my hon. Friend the Minister, and not on the subject of gold fillings. Her point is that if a provider removes the faulty implant on the NHS and then goes on to provide a paid-for replacement of the implant, the NHS somehow becomes responsible for the ongoing maintenance of the replacement implant. However, that assumes that we consider the provider hospital as the NHS for that purpose. We all know that NHS hospitals provide private care. The NHS does not accept responsibility for that private care. If the patient pays in an NHS hospital for care, it is private care, and the NHS is not responsible for paying for follow-on care. If a patient who happens to be in a private NHS hospital pays for a new implant and that half of the procedure is private, I genuinely do not understand why the NHS would suddenly become responsible for it on an ongoing basis.

[Anne Milton]

That may be a subject for a Backbench Business Committee debate on co-payments and what the NHS is and is not responsible for. The difficulty is—

[Ms Abbott]

Because the Minister mentioned Nye Bevan, I feel obliged to intervene to say that there is no more vigilant defender of an NHS true to Nye Bevan’s principles than me. However, when women will be faced with two separate invasive operations, we ought to make an exception to the rule.

[Anne Milton]

I thank the shadow Minister for her intervention. I accept the strength of feeling on the issue in this debate. The clinching argument is that if the NHS were to offer what is in effect subsidised breast augmentation for non-clinical purposes—I stress the use of the word “clinical”; it is not that cosmetic surgery is unavailable on the NHS, but that it is available if there is a clinical need for it—

[Mr MacShane]

Will the Minister give way?

[Anne Milton]

If we can bear on Mr Benton.

[Mr MacShane]

He is very generous. Can I inform the Minister and the House that today is the 64th birthday of the NHS? Why not give a birthday present to those lovely ladies and say that the NHS will look after them before its 65th birthday? Come on, Minister, take a decision. They will not kill you on the box. We will talk to the Secretary of State for Health and sort it out.

[Mr Joe Benton (in the Chair)]

Order. Before the Minister replies to that intervention, I point out that there is another debate to follow this one. Try to keep interventions to a minimum. The debate has gone well past 4 o’clock.

[Anne Milton]

We have tried Mr Benton’s patience. I thank the right hon. Member for Rotherham for his suggestion. I am sure that the Secretary of State will listen closely to what I say next. Changing Government policy on the hoof during a debate—

[Mr MacShane]

—gets you into the Cabinet.

[Anne Milton]

It might indeed. It might also be a career-limiting move.

The surgery must be based on clinical need. I cannot see any way out of the dilemma. It is difficult, and as I said, the strength of feeling in this debate will have been noted.

Moving on, I know that the Health Committee has criticised the MHRA for not finding a way to communicate to women with PIP implants, preferring instead to use its central alerting system, the national media and specialist associations as its main channels of communication. We should recognise that that approach clearly did not work well, although it was possibly understandable at the time. Since then, active social networking sites have developed. It is right that both the Department of Health and the MHRA need to find better ways of communicating.

I finish by talking about some of the wider issues that have been raised, specifically Sir Bruce Keogh’s ongoing review. It is a wide-ranging review of all aspects of the regulation of cosmetic interventions: the devices and substances used, the practitioners involved and the way the organisations work. It will pay particular attention to the marketing and promotion of cosmetic interventions, and the need for fully informed consent. The review is expected to report by March 2013.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) raised the issue of informed consent. Nothing could be closer to my heart. I have heard some dreadful stories from women who went in for breast augmentation and, literally two or three minutes before they were about to go under anaesthetic, somebody rushed in with a form saying, “We’ll lift your eyelids or give you a facelift at half the price if you sign here now.” Absolutely outrageous. A lot of women, even if they were informed, did not feel informed, and that is what matters. It is not good enough just to tell people. It is important that the surgeon, and all those undertaking the procedure, are satisfied that the woman, or indeed anybody else having any sort of surgery, is fully informed.

There is information about lists of medical devices. It is worth putting on the record that the EU is currently revising the regulations on them, and looking at medical devices.

On the number of substances that were found in PIP implants, we have to be very careful and stick to science. All sorts of chemicals are found in hip replacements, knee replacements and all the other things that can be implanted for medical reasons. The important point is whether they have any impact on health.

Insurance was mentioned. It will be looked at. Professional standards are two words that are rarely heard. In reviews after bad things happen, we rarely talk about professional standards. It is extremely important that we do talk about them.

Issues were raised about loss of licences and the need to keep records so that we can make timely, prompt contact with people who are affected when things go wrong, as they inevitably will from time to time. It is important that we do everything beforehand to ensure that they do not go wrong, but that if they do we have access to the women. That is why we need Sir Bruce Keogh to look at that work, and clinical licensing systems and compulsory insurance too. I am very grateful to the Committee for its many helpful suggestions, all of which will be taken forward by Sir Bruce’s team.

I end with a note about some of the women who have taken the time to talk to me. It is very hard to understand the distress caused when terrible things happen, particularly when people have previously trusted the organisation, and maybe the surgeon, that they were dealing with. Betrayal of trust is a dreadful thing. It can be awful if they go back and there is nobody to help them. In some instances, women have gone to their GPs, and even their own GPs have cast inappropriate value judgments on them and not been as helpful as they should. For many women, we cannot turn the clock back, but we can make sure that this does not happen again.

[Mr Joe Benton (in the Chair)]

There are two minutes for a winding-up speech, if the right hon. Member for Charnwood (Mr Dorrell)wants to speak.

Nursing and Midwifery Council (Strategic Review)

Anne Milton Excerpts

Tuesday 3rd July 2012 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

On 26 January 2012, I announced to the House that the Government had commissioned the Council for Healthcare Regulatory Excellence (CHRE) to conduct a strategic review of the Nursing and Midwifery Council (NMC). The review has been published today and a copy 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.

Strong regulation of nurses and midwives is crucial to ensure public protection and, as the CHRE report shows, effective leadership within the NMC is key to this. The Government will be seeking urgent assurances that the processes which are in place for the appointment of a new NMC Chair are robust, given the importance that strategic leadership will have for the future performance of the NMC.

I would like to thank the CHRE for its work. The Government expect to see the NMC implement all of the recommendations that have been made.

Human Fertilisation and Embryology Authority/Human Tissue Authority (Transfer of Functions)

Anne Milton Excerpts

Thursday 28th June 2012 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The Department of Health is publishing a “Consultation on proposals to transfer functions from the Human Fertilisation and Embryology Authority and the Human Tissue Authority” today.

In “Liberating the NHS: Report of the arm’s length bodies review (2010)” the Department of Health set out its proposals for reducing bureaucracy and increasing efficiencies. This included transferring all functions from the Human Fertilisation and Embryology Authority and the Human Tissue Authority with a view to abolishing the two organisations by 2015. This consultation sets out options for taking this work forward. We welcome views and will use these to inform our thinking.

A copy of the “Consultation on proposals to transfer functions from the Human Fertilisation and Embryology Authority and the Human Tissue Authority” 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.