Oral Answers to Questions

Anne Milton Excerpts

Tuesday 29th June 2010 Commons Chamber

[Toby Perkins (Chesterfield) (Lab)]

3. If he will take steps to increase the number of dentists providing NHS services in Chesterfield; and if he will make a statement.

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

I assure the hon. Gentleman that the Government have committed to improving access to NHS dentistry, and the introduction of the new dental contract, focusing on achieving good dental health and increasing access to NHS dentistry, will be vital.

[Toby Perkins]

I thank the hon. Lady for her response. The Stubbing Road medical centre is a brand-new building in Chesterfield providing doctor services to people who are among the most deprived in Derbyshire. One floor there was also meant to provide dental services, but in the last week we have been told that that might not—indeed, that it will not—go ahead, although the primary care trust is paying the rent on the building and its new suite. Can the hon. Lady assure the people in the Rother ward who have been waiting so long for those services that the guarantee that everyone in Chesterfield will have access to an NHS dentist by March 2011 will remain in place?

[Anne Milton]

I cannot comment on the specific circumstances, but I would be happy to meet the hon. Gentleman if he would like. I must point out to him, however, that the number of people now seeing an NHS dentist remains lower than when the previous Government introduced the new contract in 2006. He mentions children, but there is no doubt that the inequalities in the oral health of children are scandalous.

[Sir Paul Beresford (Mole Valley) (Con)]

rose—

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[Sir Paul Beresford]

Thank you, Mr Speaker. Given my declared interest, it was too great a temptation not to contribute.

Does my hon. Friend not agree that for dentists, the biggest disincentive to providing an NHS service in Chesterfield—and, in fact, in the rest of England too—is the contract that she just mentioned, with its targets, its “units of dental activity”, its clawbacks and so on? Will she ensure that any new system that she introduces enables and encourages dentists to offer a choice between national health and private dentistry, thus encouraging those who have opted out to opt back in again?

[Anne Milton]

I thank my hon. Friend for his question—he speaks eloquently and with much knowledge on this subject—and for highlighting the perverse incentives in the contract. It is absolutely critical that we take those out of any new contract.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

4. What steps he plans to take to implement the Government’s proposals to end the target culture in the NHS.

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

I thank the hon. Lady for her question. May I correct the hon. Member for Bolsover (Mr Skinner), who suggested from a sedentary position that one of us might be getting the sack, by saying that I doubt it, because it is the previous Government who have just got the sack? In answer to the hon. Lady’s question, I say that there is no doubt that anything that the Government do must have a strong evidence base. It is for individuals to take responsibility for their health, and that includes healthy eating. However, the Government can help people make better choices—for example, by providing information, advice and so on.

[Kate Green]

I am little disappointed in that answer. Maternal nutrition before and during pregnancy is essential to the birth of a healthy baby. The Joseph Rowntree Foundation has shown that a healthy diet costs a minimum of £43 a week. A young woman on jobseeker’s allowance receives only £51.85 a week, so can the Minister explain what she will do to ensure that young women on such low incomes can choose a healthy diet?

[Anne Milton]

I am sorry that the hon. Lady was disappointed. Clearly, she does not feel that the Government should take a strong evidence-based approach to public health. I should point out to her that although life expectancy has increased, the gap between the rich and the poor has widened. If we look at the difference between spearhead areas and the country as a whole, we can see that the gap went up by 7% for men and 14% for women. We are determined to reverse that.

[Greg Mulholland (Leeds North West) (LD)]

Will the Minister join me in condemning the vote in the European Parliament not to back the traffic light system of food labelling, which is the clearest way of communicating nutritional messages? That followed a lot of lobbying by companies such as PepsiCo, Tesco and Kellogg’s. What will she do in terms of speaking to European colleagues to get that important scheme back on the agenda?

[Anne Milton]

Again, the hon. Gentleman raises the point that anything we do must have a strong evidence base. We are considering a number of schemes at the moment. What is important is that people have the information on the pack of food that they buy, so that they can make good choices about what they eat.

[Mary Creagh (Wakefield) (Lab)]

Last week’s Budget scrapped the health in pregnancy grant, which helps all pregnant women to eat healthily in the final 12 weeks of their pregnancy. The previous week, the Government scrapped the free school meals pilot for 500,000 children, thrusting 50,000 children back under the poverty line. They have also scrapped free swimming for under-16s and pensioners just as the long summer holidays begin. Is that not the most extraordinary start for a Government who promised to rename the Department of Health the “Department of Public Health”? With so many broken promises in their first seven weeks, how can we trust a word that they say about public health?

[Anne Milton]

The hon. Lady and I have exchanged niceties in a slightly calmer atmosphere in another setting. I find it staggering that Opposition Members cannot understand that what matters is not what we spend but how effective that spending is. They simply cannot understand it. In fact, Labour has said that it would cut the NHS, whereas we have said that we will not. The sick must not pay for Labour’s debt crisis. We did not get us into this mess, but I would point out to the hon. Lady that everything that we do must be based on evidence. It is not what you spend, but what you spend it on, that matters.

[Clive Efford (Eltham) (Lab)]

8. What recent representations he has received on the new community hospital for Eltham; and if he will make a statement.

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[Nia Griffith (Llanelli) (Lab)]

10. What plans his Department has for health warnings on labels of alcoholic drinks.

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

A public consultation on options for improving health information on the labels of alcoholic drinks closed on 31 May. The responses to that exercise are now being analysed, and we will set out our plans for next steps through announcements in the coming months.

[Jim McGovern]

I welcome all those on the Government Front Bench to their new posts. The tobacco health warning regime introduced by the previous Government has produced excellent results in improving the health of our citizens. Does the Minister believe that a parallel scheme for alcohol would achieve similar progress and benefits?

[Anne Milton]

I thank the hon. Gentleman for his warm words of welcome. It is important to note that sometimes such warnings are not transferrable between products. As he rightly says, there have been a number of initiatives on smoking that have, without doubt, had an impact on the number of people who smoke and the number who have given up. Whether those are transferrable to alcohol we do not yet know, but we will be looking at all the evidence available.

[Nia Griffith]

The Minister will be aware of a recent Alcohol Concern report that points out that a minimum alcohol price of 50p a unit would cost a moderate drinker only about 23p a week, but would reduce alcohol-related illness significantly, and would save the NHS millions. What discussions has she had with colleagues in other Departments about such a minimum price?

[Anne Milton]

We have had a number of conversations about all aspects of alcohol policy, and what to do about the 7% of hospital admissions that are due to alcohol and the £2.7 billion cost—some estimates put it much higher, at about £5 billion—to the NHS. Without doubt, we have to change the public’s relationship with alcohol. We are committed to a ban on selling below-cost alcohol, which is important—but it is also important not to disfranchise responsible drinkers, as plenty of people enjoy alcohol responsibly. What we have to do is stop irresponsible drinking and protect people’s health.

[Mr Don Foster (Bath) (LD)]

I thank the Minister for that answer. She will recognise the problems that binge drinking causes our health service, our police and our local communities. I am delighted that she has recognised that there has been an agreement to ban the sale of alcohol at below cost price, but will she assure us that the Government are taking this issue seriously, and that we will hear an early announcement?

[Anne Milton]

The hon. Gentleman is right; this is a cross-departmental issue. This is not just about health; it is important for local government as well. We need a multi-faceted approach. As I have said, we will look at all the evidence to see what works, and to make those changes not only in law and order, as he pointed out, but in people’s health.

[Caroline Flint (Don Valley) (Lab)]

There are cross-references between the labelling on alcohol and on other products, and the evidence clearly shows that with food labelling, the public find colour-coded, front-of-pack labelling far easier to understand. What has the Minister learned from that, and will her Department, with other Departments, seek an opt-out for retailers that want to continue, voluntarily, with front-of-pack colour-coding on their products?

[Anne Milton]

It is important not to pre-empt the consultation that has already gone on, and to collect all the evidence together. To find out the best method for getting that information to the public in a way that they find accessible, we have to look at what works.

[Mr Dominic Raab (Esher and Walton) (Con)]

11. What steps his Department is taking to increase participation by local people in NHS decision making.

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[Phil Wilson (Sedgefield) (Lab)]

13. What assessment he has made of the effects on public health of plain packaging of cigarettes.

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

Evidence of the impact on public health of plain packaging of tobacco needs to be developed further, because no jurisdiction globally has yet introduced it. However, Australia will do so from 2012. We will monitor developments there with considerable interest.

[Phil Wilson]

Smoking costs the NHS £2.7 billion a year, six times the cost of a new hospital for north Tees and Hartlepool. In the north-east, approximately 10,000 children between the ages of 11 and 15 are smoking. We want all of them, not just half of them, to lead a fulfilled life. Will the Minister ensure that the assessment of plain packaging is expedited, so that we can be given an answer as soon as possible?

[Anne Milton]

The hon. Gentleman is right to raise the impact that smoking still has on the health of children in particular—I believe that 200,000 take up smoking each year. We still have 80,000 smoking-related deaths in this country. It is important to watch what happens in Australia and see where the evidence points for the future.

[Vernon Coaker (Gedling) (Lab)]

14. What his policy is on provision of healthcare services to those with autism.

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[Dr Julian Huppert (Cambridge) (LD)]

T5. Does the Secretary of State accept the conclusions of the Science and Technology Committee’s report “Evidence Check 2: Homeopathy”? Earlier, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) gave a commitment to an evidence-based approach and today the British Medical Association passed a motion about homeopathy. Given the financial constraints in which we all share, can the Secretary of State defend spending millions of pounds of NHS money on methods that simply do not work?

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

I thank the hon. Gentleman for his question. He obviously knows how much is spent on homeopathic treatments, although no one else seems to know exactly. The decisions should be taken by doctors locally, and the effectiveness, safety and efficacy of a treatment should be taken into account. The estimate is that 0.001% of the drugs bill is currently spent on such treatments. At present, we are looking at the Science and Technology Committee’s report. We hope to respond to it before the summer recess.

[Toby Perkins (Chesterfield) (Lab)]

T2. My right hon. Friend the shadow Secretary of State referred to the Commonwealth Fund report, which said that Britain’s NHS was the most efficient. Does that not make it clear that after 13 years of a Labour Government, the NHS is not just so much better for patients, but efficient? To say that it is not is an insult to the people who have worked so hard to make it great.

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[Dr John Pugh (Southport) (LD)]

T10. I have here a letter from my local PCT indicating that the clinical review of the safety of a proposed children’s walk-in centre in Southport is to be conducted by Dr Sheila Shribman and the Minister’s Department. Will the Minister arrange to meet me and relevant officials to ensure that the Department is properly aware of the background to this vital access issue and that we have a clinical network suitable for patients, as well as for practitioners?

[Anne Milton]

I thank the hon. Gentleman for that question, of which he gave our office prior warning. It is important that decisions made locally focus on outcomes for people, that they are about choice, that they have support from local clinicians and commissioners, and that they are based on sound clinical evidence. I would be happy to meet him to discuss this further.

[Mrs Mary Glindon (North Tyneside) (Lab)]

T6. Every year in the north-east, 300 children are born with congenital heart disease. These very sick children receive expert treatment locally in the world-class cardiothoracic unit at Newcastle’s Freeman hospital. Can the Minister assure my constituents, who value this vital local service, that the findings of Sir Ian Kennedy’s review of children’s heart surgery centres will be implemented without financial constraint?

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[David Tredinnick (Bosworth) (Con)]

Would my right hon. Friend accept that there is widespread anecdotal evidence of the effectiveness of homeopathic medicines? There are 500 doctors in this country who use them, and nobody is obliged to have them if they do not want them. Will he therefore heavily discount the illiberal views of our hon. Friend the Member for Cambridge (Dr Huppert)?

[Anne Milton]

May I thank my hon. Friend for his question and pay tribute to him for his continued and persistent lobbying on this subject? I gather that he has been elected a member of the Select Committee on Health, so I welcome him to that position and I am sure that we will meet again at some point.

What is important is that decisions about treatment are made by clinicians, and they will base their decisions on the safety, efficacy, efficiency and outcomes that a particular treatment will provide.

[Alex Cunningham (Stockton North) (Lab)]

The North Tees and Hartlepool NHS Foundation Trust believes that its strategy for one hospital to replace the North Tees and Hartlepool university hospitals is the right strategy, despite the project being dropped by the Government. Does the Minister accept that the trust’s strategy to provide a new hospital and health facilities closer to communities to meet their health needs is correct, that the trust should be encouraged to press ahead with alternative funding models that could still deliver the new hospital, and that its members and the public at large can expect Government support to realise that strategy?

Human Tissue (Availability)

Anne Milton Excerpts

Wednesday 23rd June 2010 Westminster Hall

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

I welcome the debate, and congratulate my honourable colleague the Member for East Dunbartonshire (Jo Swinson) on securing this debate. Although we are not great in number, clearly the matter is important to some people, and this has been a brilliant opportunity to have a good run-around with some of the issues. My honourable colleague has worked extremely hard to promote the supply of quality tissue for research, and to encourage closer co-operation between everyone in the sector. If nothing else, the debate has highlighted the need for much greater co-operation.

Human tissue-based research is vital for advances in medical science. That is an obvious statement, but it needs to be reiterated. We want better and more effective treatments, and if that essential research is to flourish, everyone involved in procuring, storing and using tissue must work together. None of that work can take place without the generosity of people who are willing to allow their tissue to be used for the benefit of others. We can proceed only if we have their trust and confidence in what I believe is a difficult climate. The public’s trust of anyone outside their immediate family is low, so this is a good time to raise the matter.

My honourable colleague outlined some of the significant benefits of using human tissue. It allows for testing to reduce harm, reduces the need to use animals, and allows for placement refinement and reduction, which the hon. Member for Cambridge (Dr Huppert) also discussed at some length. I should point out that I am in the fortunate position of having a group of people to advise me, so I know all sorts of little facts that I did not know when I was an Opposition spokesperson. I should possibly have started my speech by congratulating the hon. Member for Wakefield (Mary Creagh) and thanking her for her kind comments.

My colleague the hon. Member for East Dunbartonshire said that the Human Tissue Act 2004 applied to Scotland, but I understand that there is separate Scottish legislation—the Human Tissue (Scotland) Act 2006. I am sure that she is aware of that Act, but I thought I would mention it for the sake of clarity.

The hon. Member for Dumfries and Galloway (Mr Brown) mentioned people who suffer from Parkinson’s. My mother-in-law suffered from Parkinson’s and, during my career, I have nursed many people who suffer from the illness, which is very cruel. Parkinson’s is very difficult not only for the individual to live with, but for those around them. Donated organs can clearly make a difference to research in that field, and I know that many people who suffer from Parkinson’s and their families look forward to a day when there is real relief from the symptoms and in time, I hope, a cure.

Of course, Parkinson’s is not the only illness, and there is possibly more publicity than ever for some of the severe, enduring and sometimes life-limiting illnesses that people have to go through. It is a shame that the opportunity is not always taken to highlight the difference that we can make as individuals who are not necessarily connected with people suffering from such illnesses. One of the ways that we can make a difference is by donating tissue.

The hon. Member for Dumfries and Galloway mentioned the tissue database. We are possibly in a fortunate position in the new coalition Government. I do not feel entirely responsible for what went on before I came into post, so this is a brilliant time to raise with Ministers some of the issues that hon. Members know create obstacles, particularly in relation to the subject that we are discussing today. This is an opportunity to raise issues, and I always welcome any feedback people can give me.

The hon. Member for Alyn and Deeside (Mark Tami) mentioned the need for media support. There is no doubt that the media have a huge role to play. The recent death from cervical cancer of a celebrity meant that the incidence of cervical screening shot through the roof. There is no doubt that the media have both a responsibility and, to some extent, a duty to raise some of the issues, as we all do.

[Mark Tami]

Further to the comments of the hon. Member for Cambridge (Dr Huppert), the problem is that the tabloid press provides a twisted, simplistic view of science, but the scientific press is too detailed and writes and speaks in a language that ordinary people do not understand. We need somehow to get a balance that crosses those two divides.

[Anne Milton]

I thank the hon. Gentleman for his intervention; he is absolutely right. I agree with the hon. Member for Wakefield—I call a sperm a sperm. The hon. Member for Cambridge strayed into areas that are way beyond me, but such matters are important. I welcome him to the House. At the last election, we lost a number of scientists and it is extremely important to have voices such as his in the House to inform journalists, particularly if there is not sufficiently extensive scientific journalism out there, although I am not in any position to judge on that matter. Such issues are important, and perhaps we should all take the opportunity to send a copy of this debate to our local press. That will perhaps highlight the issue of organ donation locally; we all have our responsibilities.

The issue of consent was raised. Legislation in that area was reviewed following revelations about the widespread retention of organs and tissue without the consent or knowledge of families, as the hon. Member for Wakefield mentioned. The Human Tissue Act 2004 makes it clear that consent is required for the storage or use of organs and tissue for research, whether they are taken from people during their life or after death.

As was mentioned, we know from talking to patients and their families that the vast majority of people are extremely supportive of tissue research and, when asked, will happily consent to their tissue being used. However, my colleague the hon. Member for East Dunbartonshire is rightly concerned that we should not waste opportunities to tap into that incredible good will. She suggested the use of generic consent for the retention of tissue, which could be sought at the same time as consent for other medical procedures—for example, surgery or a diagnostic biopsy. I entirely agree that people should be given the opportunity to donate tissue, but consent is not a straightforward issue.

I am not sure that a top-down approach is the best way to proceed with dealing with the matter. The good practice we seek cannot be imposed from the top, and history is littered with examples where a top-down approach simply somehow relieves professionals of their responsibility; they believe that they are no longer responsible for the matter. Increasingly, we find that organisations are tailoring their consent procedures to local needs; for example, there may be specialist clinics, where specific risks can be addressed. We are aware of successful and innovative approaches that have led to greater efficiency and a better experience for the patient or person. Innovative thinking must be encouraged and not constrained. I am often concerned about the latter happening with anything that takes a top-down approach.

[Jo Swinson]

I am sympathetic to what the hon. Lady is saying about enabling local decision making, but does she accept that there is a risk that if we have very different consent procedures across the country, it will hamper researchers and industry further? It would mean that when it came to accessing tissue samples, some would be available under certain consent rules and others would be available under others. That complexity is itself a real barrier and a problem.

[Anne Milton]

As with many things, it is a matter of balance. I heard my honourable colleague’s words about what the Department of Health must do. I do not know whether the Department of Health holds the solutions in this case. I really believe that the matter needs to be dealt with locally. Anyone who has first-hand experience of routine procedures knows that they can be quite unsettling for people. Most people about to undergo surgery are understandably nervous. The hon. Member for Alyn and Deeside expressed his visible concern about donating even blood. I suggest that he comes to see me afterwards—I will give him a talking to and get rid of his nerves.

We are dependent on the professionalism and humanity of health care professionals around the country, and we can draw on their experience to find the right time to discuss tissue research. Dealing with the issue is a question of trust—trust in the relationship between clinicians and patients, trust in local health organisations to provide the right information to people, and trust in health professionals to maintain the separation between treatment and research.

My colleague the hon. Member for East Dunbartonshire mentioned the fact that it might not be convenient for a surgeon to seek consent for tissue donation. I would suggest that it is not necessarily a matter of whether it is convenient; it is about whether it is appropriate. That is the difficulty. It is also true that clinicians can duck the issue and find it difficult to talk about. That also needs addressing. However, I do think that the solutions lie with the organisations and the clinicians, and should not come from the centre.

[Mark Tami]

The hon. Lady mentioned the issues of trust and getting information across on issues such as bone marrow donation and stem cells. However, there is also the matter of getting information across to minority communities, where levels of donation are very low. If, for example, a child is diagnosed with a particular condition, their odds of finding a donor are very slim compared with those of a child from the white population. We need to get information across to people and educate them about what is being done.

[Anne Milton]

I thank the hon. Gentleman for his intervention. It is interesting that this is the first time that we have referred to the differences between ethnic groups, and that is an extremely important matter, but there is a resource out there that we do not necessarily use, which is the faith leaders in communities, who can perhaps raise the issue. That is why we need to send tentacles out, perhaps even from this debate, to ensure that we get the messages across in many different settings. We mentioned children; perhaps the issue should be talked about in school.

[Mary Creagh]

The Minister says that this is not a matter for the Department of Health, but is she not even a little curious about which hospitals do systematically collect and process the material, and about the 60% or so that do not? I am very curious about that. Her Department could easily map, with the resources that it has, where the hot spots and cold spots are. It could use the transparency that we have under the Freedom of Information Act almost to shame the hospitals that do not do it, or it could at least have a conversation with those that do not do it systematically, perhaps because they are not attached to a university or because they are not teaching hospitals. We could examine how we could encourage hospitals to do it and educate the staff about the wider benefits to the community.

[Anne Milton]

The hon. Lady is right. I think that in the end it is the differences that will spread good practice and drive up standards and professionalism in this area. She is right to say that we must examine why some places are so good on this. One example that I heard about recently is that of a trust that sends combined, personalised leaflets about consent to treatment to patients along with pre-operative medication. My colleague the hon. Member for East Dunbartonshire mentioned that. That trust is giving patients the time and chance to think about their treatments in advance. That is the type of innovative practice that we want. I do not believe that a standardised form is the answer.

I would also have some misgivings about routinely seeking consent to use tissue for research unless we could be confident that there was a good chance of its being used. One of the key complaints from the families affected by organ retention scandals was that everyone tried to justify the practice of routinely retaining tissue in the name of research, when in fact most of the material had never been used. There is a test that is applied to children, called the Gillick competence. We do not often use the opportunities that we have to raise the issue with children, or to ask them what they want to do.

Let me clarify that there are no plans to revisit the question of an opt-out system. Certainly, on a personal level, I would not be happy with such a system. It would require an extensive information and education campaign, and there would be ethical and practical issues if people were able to opt out of some types of research but not others. No doubt some people would be happy to give tissue for some types of research but not others. Everyone feels so differently about the issue; it is a very difficult area.

My colleague the hon. Member for East Dunbartonshire also raised the prospect of a tissue database and mentioned the work undertaken by onCore. I understand that onCore was originally set up to collect and store tissue in a national bank for cancer research. It now focuses mainly on bio-banking activity, and that shift reflects the research community’s local initiatives.

I also understand that there have been excellent developments through the National Cancer Research Institute’s informatics initiative. For example, there is the oncology information exchange, a free-to-use computer portal for sharing information on resources for cancer research, including tissue collections.

At the heart of the debate is the issue of improving access to tissue for research. Some initiatives are under way, and there are some examples of good practice, but a common cause of concern is the complexity of the regulatory and governance regimes. A lack of confidence and misconceptions about requirements have meant that residual tissue from diagnostic procedures may be archived for purposes such as clinical audit, but not available for research. Perhaps the appropriate consent has not been secured or the licence to store tissue for research has not been obtained from the Human Tissue Authority. Either way, the effect has been to stifle research, which is not what we want. Researchers complain of local resistance to new research programmes because they are perceived as being too risky or beset with rules and regulations. Efforts are being made to help NHS organisations to overcome those perceptions.

The HTA, in collaboration with the National Research Ethics Service, has set out the licensing, ethical approval and consent requirements to enable diagnostic archives to operate as tissue banks. The HTA’s annual review tells the story of Guy’s and St Thomas’ NHS Foundation Trust, which was one of the first establishments to license its archive of diagnostic histopathology specimens as a research resource. A histopathologist from the trust said that

“support from the HTA was very helpful for us in approaching our Trust management with proposals to license our diagnostic archive for research and upgrade consent processes”.

That is precisely the type of collaborative and supportive approach that we want and it is typified by a joint enterprise between the HTA and the National Research Ethics Service, which has helped to open up access even further.

I look forward to the outcome of the consultation by the Nuffield Council on Bioethics. This is clearly a dynamic issue, and I personally would like to keep it as such. It is about raising awareness and about the role that we in this place can play in raising the issue in our constituencies and with a wider audience. That is not just down to the scientists or those with a scientific background in this place, although their expertise is very valuable. The media can play a role. The organ donation taskforce report raised the issue of awareness, and there have been a number of reasonably successful campaigns in the past year, but I cannot re-emphasise enough how important it is to have public trust and confidence in the systems in place. It is important that we do not have burdensome legislation. It is important to raise awareness among all types of clinicians in training and to raise awareness among members of the public. Possibly it is a question of just changing the culture, so that people think, “I can change what’s happening in the area in which I work.” Sometimes we perceive barriers when they do not exist.

We have raised the issue of the differences between men and women, so I suggest that the men go hence and give blood. It is true that there are gender differences. It is extremely difficult to get men to go to their doctor with symptoms, particularly concerning anything below the waist. It is an issue to get men to come forward and donate tissue and blood. It is important and perhaps incumbent on all of us at certain times in the year to seek an opportunity to demonstrate by example that we are prepared to do that.

I thank my colleague the hon. Member for East Dunbartonshire not only for her contribution, but for allowing us all to have quite a collaborative discussion about the issue. There is no single solution. The NHS, the research community, clinicians and Government agencies have a part to play. In particular, the Government have a role in facilitating, but at the end of the day, they cannot take action on the ground. I hope that I have been able to reassure my honourable colleague and other hon. Members that some progress has been made, and that the various initiatives allow us to be more optimistic about the future. I reiterate that my door is open, and officials in the Department would be pleased to hear from anyone with examples of attempts to make progress that have been frustrated by rules, regulations or bureaucracy that prevent research in this important area from going ahead.

Accident and Emergency (Westmorland General Hospital)

Anne Milton Excerpts

Wednesday 23rd June 2010 Westminster Hall

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

Thank you for calling me to speak, Mr Benton; we seem to have spent a fair bit of time here today.

I congratulate my colleague the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing this debate. I know that the future of Westmorland general hospital is a matter of long-standing interest and concern to him. He spoke with passion—and some frustration, because he has clearly been fighting a long and hard campaign. As a constituency MP, I have engaged in not dissimilar exercises in connection with a community hospital and a large acute trust hospital. I possibly lost one, but won the other. I know how passionate he must feel—and how passionate his constituents feel, which is demonstrated by the size of the petition that he presented.

I know how important hospital services are to local communities, and how worrying it can be to local people when services are moved. The fact is that change has not always been well managed in the NHS. I assure my honourable colleague that the Government are determined to do these things differently, and to get local populations behind changes in the NHS. We believe that the best decisions are local and that change should be driven by local clinicians and not imposed, top-down, by politicians or decided behind closed doors by managers. That is why we introduced an immediate moratorium on new or pending service reconfigurations.

The Secretary of State for Health has made it clear that all proposed service changes must now pass four crucial tests. First, they must have the support of GP commissioners. Secondly, public and patient engagement must be strengthened; that was at the hub of my colleague’s words. Thirdly, there must be greater clarity about the clinical evidence base for any proposals—a matter also mentioned by my honourable colleague. Fourthly, proposals must take account of patient choice. As a result, the local NHS will have to make its proposals more transparent to the public, more responsive to the views of the clinical community and more firmly grounded in robust clinical evidence.

In the case brought to the House by my honourable colleague, it means that there may be new opportunities for local debate, with new clinical judgments on how services should operate. However—my colleague will be disappointed to hear me say it—this is not an opportunity to revisit reconfigurations that have already been completed. That simply is not possible. That means that the 2006 review will not be reopened, and that the decision will stand. However, I note my honourable colleague’s concerns about valuation and patient safety; the Department of Health has raised them with the primary care trust and the local NHS trust. In case I forget to say so in my concluding remarks, I know that a Health Minister will be happy to meet my honourable colleague.

I understand that following a full public consultation, Cumbria county council’s health and well-being overview and scrutiny committee approved the changes; they were not referred to the Secretary of State for review by the independent reconfiguration panel.

[Tim Farron]

The overview and scrutiny committee did indeed rubber-stamp the proposals, but its process was deemed flawed by an investigation by the independent health commissioner because it did not take any evidence from the non-trust side. It was a completely loaded investigation.

[Anne Milton]

I thank my honourable colleague for that clarification, and it highlights so well what happens when things cease to have public trust and confidence.

My honourable colleague has made the case for acute services to be reinstated at the Westmorland. The NHS trust tells me that the coronary care unit had to be closed on the grounds that it was no longer sustainable or safe. There is an increasingly difficult balance to be drawn between services that are local and accessible and those that have a significant throughput to ensure that clinical safety is maintained. A service might have been safe in the past, but that does not necessarily mean that it will be safe in the future. I understand that, on average, the service treated only three or four patients a week, and that level of throughput is simply not enough and potentially puts patients at risk.

[Tim Farron]

I have two quick things to say. First, will the Minister investigate what evidence there was at the time of the closure for the Westmorland general unit to be deemed less safe than the other two units that we have mentioned at Barrow and Lancaster? Secondly, will she conduct an assessment of the position with regard to the safety of patients now? In other words, what impact has the closure had on the safety of patients or visitors within the South Lakeland area?

[Anne Milton]

There are two issues here: what happened in the past and what happens in the future. The concerns that my honourable colleague has about safety in the future will be examined, and I am sure that Department of Health officials will help with that. I understand that Professor Roger Boyle, the national director for heart disease and strokes, has said that he does not believe that reopening the cardiac unit will be best for the local people, so that should be borne in mind. He feels that it would not be feasible to provide primary angioplasty for severe heart attacks at the Westmorland. He also thinks that for less severe heart attacks, Westmorland cannot provide the most appropriate care, such as early referral for intervention. However, I do recognise my honourable colleague’s legitimate concern over the use of pre-hospital thrombolysis, and over the fact that it is low in Cumbria. Clearly, more work is needed to ensure that heart attack patients in Cumbria get the best possible treatment.

I understand that the trust is listening to my honourable colleague’s concerns and that it is looking to increase the number of cardiologists from three to five across the regions. Those clinicians will be based at the Royal Lancaster infirmary and the Furness general hospital, but they will help to build extra capacity in the treatment of outpatients. That might not be enough here and now, but it is something that my honourable colleague can take away.

I understand that there has never been an accident and emergency department—whatever that means in this day and age—but I am also told by the NHS trust that there would be insufficient volume of patients going through Westmorland to sustain a full A and E department. An A and E department has to have back-up services, such as intensive care and CT scanning, to support the unit, and the Westmorland is not in a position to provide those facilities. The trust’s argument, therefore, is that it is safer for patients to access those services at Barrow or Lancaster, and I appreciate that that is fundamental to this debate and will be fundamental to ongoing discussions, because my honourable colleague believes that the opposite is the case.

My honourable colleague also mentioned travel times, and I am told that the North West Ambulance Service advises that across Cumbria, the average time for it to get to the scene is 10 minutes. He might dispute that, but that is what I have been told. The average time on scene assessing and treating a patient is 20 minutes and the average time from Kendal to Lancaster under normal driving conditions—not with blue lights—is 20 to 30 minutes. I acknowledge that patients on the far reaches of his constituency have further to travel.

[Tim Farron]

I simply reiterate my earlier point: in rural areas, the bulk of those times record the time that the first responder arrives—the ambulance probably arrives another 20 minutes later.

--- Later in debate ---

[Anne Milton]

And let us pay tribute to first responders; I have them in my constituency and they do a fantastic job.

[Tim Farron]

Indeed.

[Anne Milton]

It is not always about the time spent getting to the hospital, but the treatment in the first crucial half hour or so.

Provided paramedics can reach the patient quickly, they can provide treatment and stabilise them en route, which is often preferable, and then go to a hospital or an A and E department further away. However, the expertise has to be provided by the ambulance staff. “Dead on arrival” incidents would be reported, and NHS Cumbria has advised me that no such cases have been reported in the past 18 months, but the hon. Gentleman may have data that goes back further.

Unfortunately, when it comes to serving rural populations, the NHS has to balance what is safe with what is desirable. This is very tricky and it is held in the balance. There is no doubt that across the country the NHS is facing considerable challenges, and the local NHS in Cumbria is no different from any other. We made an historic decision, as a coalition Government, to protect health spending during this Parliament and to secure the front-line services that our constituents value so highly, but it is clear that local health services need to change and to become more efficient to secure their long-term future. That will not always be a smooth process; there will be tough calls to make in the future, as there have been in the past, but a clearer and more open process, led by clinicians and putting the local people firmly in the picture, will, I hope, reduce the anxiety that my honourable colleague has spoken about today. I hope that it will also build the trust that we need around such decisions. That is how we can achieve higher standards and better outcomes.

I said to my honourable colleague that I am sure that the Minister will be happy to meet him. The question is: how does my honourable colleague move forward with his constituents and how do we ensure that, even if we cannot right what has happened in the past, we move forward constructively? This is just a suggestion, but if he and local GPs formed a small informed group to work with the trust, I would hope that the local NHS organisations could take into account some of his concerns about the future of health services. What matters now is what happens in the future. I hope that they can provide the service that he wants to see.

[Tim Farron]

I am grateful to the hon. Lady for giving way so often. Would that include the possibility of the local GP community, should they so wish, moving towards something akin to the Fort William situation that I mentioned earlier?

[Anne Milton]

I thank my honourable colleague, but I am always very nervous about stepping outside my pay grade. The crucial thing now is how we and local MPs who have fought closures and reconfigurations move forward constructively; and we cannot reopen what has gone in the past. Local GPs and clinicians forming a group to work with and alongside the local primary care trust could ensure that good and improving decisions are made about NHS services.

It is not always about how close someone lives to a hospital. Across his constituency, life expectancy will vary by 10 years or more, and that has nothing to do with proximity to the hospital, but with deprivation. The issue of health care is much wider than this debate. There is an open door for my honourable colleague, so he feels that he can get the access to Ministers; I hope that will restore his trust and the trust of his local community.

Question put and agreed to.

Health Protection Agency (Porton)

Anne Milton Excerpts

Tuesday 22nd June 2010 Commons Chamber

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

I congratulate you, Mr. Deputy Speaker—I do not think I have stood at the Dispatch Box with you in the Chair, so it is a pleasure to be here this evening.

I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing his first debate. I also congratulate him on securing his seat, and thank him for continuing the work of his predecessor, who also argued passionately on behalf of the establishments at Porton Down. He is sadly missed in this place. My hon. Friend has taken up the cause and pursued it with similar vigour. I am grateful to him for his correspondence on the matter and for sharing some of the issues that he mentioned this evening, including planning, relocating staff, skills availability, costs and the detailed synergies.

I also thank my hon. Friend the Member for Harlow (Robert Halfon). Oh my, the difficulties of government. In time, I will upset one hon. Friend and please the other.

As my hon. Friend the Member for Salisbury knows, the issue came before the House just a few months ago, when he was still a candidate and I was an Opposition Member. How times have changed. Our roles have substantially changed since then, and I am grateful for the opportunity to set out the Government’s position. For the benefit of Members present, I will set out the situation as it stands before responding to my hon. Friend’s points in detail.

As my hon. Friend pointed out, the history of chemical and biological research at Porton Down is long. Throughout many changes in name and number, the centres continued to provide research and production programmes of the highest international quality. Today’s debate concerns the future of the Health Protection Agency’s facilities at the Centre for Emergency Preparedness and Response. The centre is a specialist facility providing protection against some of the most dangerous organisms in the world. From identification to containment, and from research to production, it fulfils a critical national security function, as well as providing valuable expertise internationally.

As the world of microbiology has grown, so the centre’s responsibilities have also expanded, yet its current home says more about its past than its future. The site is 60 years old, the building structures are in a poor state of repair and the laboratories clearly do not meet modern safety standards, so something must be done. The centre’s work is vital to protect the nation’s health, and it is important that the facilities at Porton Down are fit for purpose not just over the next Parliament, but over the next dozen years or so. That is why it is so important that we make the right decision about the centre’s redevelopment. I appreciate that both my hon. Friends believe they have the right solution to the problem of the centre’s location.

I understand that in September 2008, the Department of Health authorised the HPA to develop an outline business case for the improvement of the laboratory facilities, a process known as Project Chrysalis. That case was submitted to the Department on 4 June 2010, and the Government have not made a decision on it. As I am sure my hon. Friend the Member for Salisbury will appreciate, a proposal with so many implications—not least cost, safety and security—must be thoroughly scrutinised. His concern that that will not be the case is probably the basis for this debate. Officials at the Department are considering the business case and will make a recommendation to Ministers as soon as possible. Provided that we are content, the business case will then be passed to the Treasury, where it will be subject to further scrutiny before final sign-off by the Chief Secretary.

My hon. Friend raised concerns about the way the business case is considered. For his benefit and that of my hon. Friend the Member for Harlow, let me be clear that the Department of Health’s assessment of the business case will be rigorous, fair and grounded in this simple set of principles: first, that redevelopment is necessary to protect this critical national infrastructure, and to allow it to provide an even better service to the country and its international customers; secondly, that all options must be examined on the basis of cost, value, safety, security, sustainability and strategy; and thirdly, that our assessment must be forensic in its analysis, unprejudiced in its conduct and unbiased in its conclusions. That means looking closely at the risks and benefits, and at the selection criteria. It also means checking that the proposals are affordable and sustainable and that they represent real value for money, and that the investment fits with the organisation’s long-term strategic aims. We are pressing to ensure that every consideration, particularly cost, is taken into account. There is an explicit requirement that the successful proposal must represent value for money, even when weighted for the various external factors such as relocation, staffing and business opportunities, which both my hon. Friends mentioned.

I understand that the business case also includes details of the possible effects on the work force, including the cost and security impact of any relocation. The impact of any disruption to the centre’s work, whether financial or operational, will also be taken into account, as it must be. At each stage of the assessment process, the HPA will provide any data or analysis that might be helpful in reaching a decision.

My hon. Friend the Member for Salisbury mentioned other options, including splitting the Centre for Emergency Preparedness from the HPA to create a co-operative at Porton Down. I thank him for his suggestions, and I trust he will be reassured by this debate and our correspondence on the matter that we remain open to new ideas. I hope he will acknowledge, however, that any decision about the future of the facilities must be taken with the national interest in mind. The issues facing the HPA at Porton Down will be solved not by simply changing ownership or management, but by a significant redevelopment of the existing site, or a move to a more suitable location.

The work that the centre does is vital to protect the nation’s health, but my hon. Friend rightly stated that it is vital across the world as well. It is in all our interests that we arrive at the right decision, which means taking the time properly to assess the business case put forward, and exposing it to detailed scrutiny. It also means being unafraid to listen to new ideas. As he said, every penny counts, so close scrutiny and robust analysis of the business case will be vital. I ask my hon. Friends the Members for Salisbury and for Harlow to have a little faith. The Government will take every precaution to make sure that the future of this work is secured, and we will look closely at every reasonable consideration before reaching a decision that is right for the centre and the nation.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Tuesday 15th June 2010 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council met on 7 and 8 June in Luxembourg. The health and consumer affairs part of the Council was taken on 8 June. I represented the UK.



At the meeting, following an exchange of views on the draft directive on patients’ rights in cross-border health care, political agreement between member states was reached. This text will now be forwarded to the European Parliament for their consideration.



A policy debate on the proposed regulation on the provision of food information to consumers focused on two aspects of the proposal. Member states considered the clarity of food labelling and discussed who might bear responsibility for the information provided on food labels.



Council conclusions on health inequalities and reduction of salt intake were adopted. The presidency also provided an update on progress of the proposals in the pharmaceutical package.

Integrated Health Care

Anne Milton Excerpts

Wednesday 2nd June 2010 Commons Chamber

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

I congratulate my hon. Friend the Member for Bosworth (David Tredinnick) on securing this Adjournment debate on complementary and alternative medicine and integrated health care—a subject that I know is close to his heart. His continued interest and continued efforts to raise the matter in this House, as well as his determination to keep the issue alive and uppermost in our minds, is legendary. He commented himself on his 20 years of campaigning on this issue. It is important to note that it is the efforts of individual Members—their continued efforts, sometimes against the odds—that keep these issues uppermost and alive in our minds.

My hon. Friend may be interested to know that although I trained as a nurse and worked in the NHS for 25 years in conventional medicine, my grandmother trained at the homeopathic hospital in London, and was herself a homeopathic nurse. Later, she became a Christian Scientist. I am therefore not without my own roots in alternative therapies. My hon. Friend may also be interested to know that my grandmother never, until her death at the age of 89, took any conventional medicine.

My hon. Friend raised the issue of homeopathic hospitals and his concern about them. I understand that there are five such hospitals in the United Kingdom, based in London, Bristol, Tunbridge Wells, Liverpool and Glasgow. However, the Tunbridge Wells homeopathic hospital stopped providing services in March 2009 owing to the primary care trust’s decision to end funding. All the hospitals have experienced a reduction in the number of referrals over the past three years, and it has been claimed that all of them are now in a precarious position as a result of such significant funding losses. That is a matter of concern, given that they have clearly offered valuable treatments to patients.

My hon. Friend said that a number of people turn to alternative therapies when they have either been failed by conventional medicine or have adverse responses to it. Although he referred to the current position, it may help if I make some more general points connected with our approach to health care.

Decisions about patient care are best made by clinicians. Local practitioners are best equipped to decide which therapies will ensure the best outcomes for individual cases, and are best placed to decide which services can cater for their areas’ health needs—in conjunction, of course, with patients themselves. The Government’s role in all that is to empower patients and professionals to take control of the funding and provision of health services in their areas, to encourage further research on new treatments and therapies, to support the local NHS by providing information on the clinical effectiveness and cost-effectiveness of various treatments, and, of course, to protect the public by ensuring that those treatments are safe. We do that through the National Institute for Health and Clinical Excellence, which is responsible for making recommendations on treatments to the NHS, and through the Medicines and Healthcare products Regulatory Agency, which is responsible for regulating the safety of medicines and treatments. The Government also encourage research on new medical treatments and technologies, primarily through the National Institute for Health Research. Research proposals are assessed in open competition, on the basis of scientific quality, and are subject to peer review.

My hon. Friend raised the issues of choice and cost-effectiveness. He observed that complementary and alternative medicines were often very cost-effective, and that the methods of treatment often involved limited invasiveness. It may be useful to deal with those two issues together, as they go to the heart of my hon. Friend’s concern: the fact that PCTs are not commissioning or fully using complementary and alternative medicines.

As I stated earlier, we believe that local practitioners are best placed to make decisions about individual care, and that GPs are often most in touch with the health needs of their local populations. That is why it is so important that this Government will seek to give GPs more power to commission services, and patients more power to choose health care providers. By bringing together groups of general practitioners and giving them direct control over the health budgets of their patients, we will push the decision-making process closer to patients—closer to the heart of the problem. GPs will have the power to choose how to spend resources in order to achieve the best health outcomes, and we will ensure that PCT boards include directly elected individuals who can speak for patients at board level so that local people have a voice when decisions are made about local health provision.

Giving GPs more responsibility and more control over how NHS resources are used in their areas, and giving patients the power to choose any provider that meets NHS standards, will result in a health service that is not only more flexible, which is what my hon. Friend wants, but more responsive to patient need. As he will be aware, the decision to commit NHS resources cannot be taken lightly, especially during a period when the NHS as a whole must find considerable efficiency savings. Commissioners must be sure they are funding treatments that will result in the best health outcomes. That is what we all want. They must be sure of the safety, clinical and cost effectiveness, and availability and evidence in support of any therapy, and they must be sure that there are suitable practitioners in their area to deliver it.

The issue of regulation was raised, and it is a thorny one. When I was a shadow Health Minister, I met on numerous occasions psychologists, psychotherapists and counsellors who were very concerned about the regulation of their professions. Across the professions allied to health care, there are those who are keen on regulation and those who feel regulation would be wrong and would be unable to deal with the intricacies of their work. There is no doubt that vulnerable people are often preyed upon by unskilled and unscrupulous practitioners, and I think that professions wanting to achieve the highest standards will welcome proper regulation. The issue for Government is always whether statutory regulation is the most appropriate way of dealing with that risk, or if a lighter-touch approach would be more appropriate. That is why, as I understand it, last year the Department of Health, along with devolved Departments, consulted on the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine. As my hon. Friend will be aware, the consultation closed in November, and more than 6,000 responses were received. The high response rate is a testament to the strength of feeling about public access to complementary and alternative medicines; I am sure I am not alone in having received a huge number of letters on the subject.

The consultation examined in detail the options for regulation, including alternatives to statutory regulation. Once the Government have considered the consultation responses, we will make clear the next steps in the regulatory process. In acknowledgment of my hon. Friend’s keen interest in the matter, I am very happy to keep in touch with him about it. In the meantime, the Complementary and Natural Healthcare Council provides for voluntary registration for practitioners from nine complementary therapy disciplines. I appreciate that my hon. Friend feels that that is not sufficient, but that is in place for the moment while we consider the consultation that has taken place and make a decision on what the next steps should be.

I note my hon. Friend’s comments on the Lords Science and Technology Committee report on homeopathy, and I am aware that it caused quite a lot of concern. It was published on 22 February, and we are still considering it and will formally respond in due course. He raised considerable concerns about the report, and highlighted the low cost of many alternative therapies and the important contributions they make. He also made reference to experiences from around the world—he mentioned Australia in particular, and also the USA—and he made an important point about the open-mindedness of some countries to alternative therapies.

In considering outcomes, patient-reported outcome measures must be an important factor. As my hon. Friend rightly said—and as I mentioned—individuals’ own experiences are very important, and if we want to achieve the best outcomes, one step we must take is to ask the patient whether they actually got better.

In conclusion, I wish to thank my hon. Friend for his contribution to the debate and to suggest that perhaps the picture is not as bleak as he fears—I noted a certain weariness in his voice; he feels that he has raised this issue on so many occasions and it has fallen on deaf ears.

[David Tredinnick]

As I have been in this position before, I was nervous that the Minister might sit down before I had the chance to make a final intervention. I wish to make one plea to her. I listened carefully to what she said in the past five minutes and I wish to suggest to her that it would be enormously helpful if the Department were to issue a circular to primary care trusts saying that it is not against these therapies and it is up to doctors to decide whether or not they can be used, that it has no bias against them and that it is leaving it to the clinicians to decide whether or not they wish referrals to be made to PCTs and on to hospitals. A great fog surrounds this issue. Nothing may come out of tonight’s debate apart from the fact that we have discussed the matter, but it would be very helpful if she could consider issuing a direction saying, “It’s over to you. We are not objecting to this.”

[Anne Milton]

I thank my hon. Friend for that intervention. As the new Minister in this post, I am hesitant to commit to things that I feel might be above my pay grade.

[Mr Stephen Dorrell (Charnwood) (Con)]

Quite right.

[Anne Milton]

I think that I am quite right about that, because that sort of thing is, in general, a career-limiting move. I think that what my hon. Friend the Member for Bosworth is saying, what his concern is and why he feels that the picture is rather bleak is that he has encountered minds that are closed to alternative therapies. That will not be solved by the Government issuing directives, because a number of issues need to be considered, one of which is the training of doctors and those in other professions allied to health care. Our move towards GPs having more power and control, and towards their having the ability to commission services, will, in itself, loosen the ties on how they think about where the best treatment will be found.

I am sure that my hon. Friend will be pleased that acupuncture is used widely in pain clinics and even in some maternity services, and that the Department of Health continues to fund research into new treatments, through the National Institute for Health Research, and to award funding for studies into the efficacy and value of complementary and alternative medicines. The National Institute for Health and Clinical Excellence has already published guidance that refers to complementary therapies—for example, those relating to lower back pain, multiple sclerosis, antenatal and palliative care. Our approach to all treatments, be they complementary, alternative or mainstream, is the same. Treatments must be supported by robust evidence, and they must meet safety, quality, clinical and cost-effectiveness criteria. If they are then called for by clinicians on the ground, they should be, can be and will be used in the NHS.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Wednesday 2nd June 2010 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 7 and 8 June. The Health and Consumer Affairs part of the Council will be taken on 8 June.



Items on the main agenda are: patients’ rights in cross-border health care; provision of food information to consumers; health inequalities; and national initiatives on salt.

The presidency is likely to ask Ministers for political agreement on the directive on the application of patients’ rights in cross-border health care. They also propose to adopt Council conclusions on both the reduction of health inequalities and the reduction of salt in food. The United Kingdom supports the adoption of these two proposals. A policy debate is expected on a regulation on the provision of food information.

Under any other business, information will be provided from the presidency on the two aspects of the pharmaceutical package—proposals to reduce the threat from counterfeit medicines and strengthening of community pharmacovigilance. In addition, we expect the presidency to provide information in preparation for the conference of the parties to the framework convention on tobacco control to be held later this year.