Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Wednesday 27th June 2012 Written Statements

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

Health Ministers met on 22 June in Luxembourg for the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council. I represented the UK.

The Council agreed a partial general approach on the proposal for a regulation on establishing the health for growth programme 2014-20, the third successive public health programme. The Commission and some member states preferred approach was not reflected in the text on the table, particularly the amended title and measures around differential co-financing. However, with one exception, all member states supported the partial general approach. The UK lifted its parliamentary scrutiny reserve and supported the proposal, stressing that the negotiation of sectoral programmes should not be prejudicial to the wider negotiations on the multi-annual financial framework.

There was an orientation debate on the draft decision on serious cross-border threats to health. Most member states, including the UK, agreed with the presidency’s proposal to delete the article giving the Commission power to introduce common temporary health measures to contain serious health threats. There was also broad consensus that the co-ordination of response planning was primarily an issue for member states, and best achieved through the Health Security Committee, without any need for binding measures.

Council conclusions on combating antimicrobial resistance were adopted without comment.

Under any other business (AOB), the presidency ran through the achievements in the field of health under their presidency, touching upon the conclusion of discussions between the Council and the European Parliament on proposals concerning pharmacovigilance, and on the presidency’s conclusion that it would not be possible to make further progress on the information to patients proposal. The Commission drew delegations’ attention to their communication on the innovation partnership on active and health ageing, and gave an overview of its contents. France presented two AOB points (the first jointly with Luxembourg) on the safeguarding of the supply of raw materials for pharmaceuticals, and on the MEDICRIME convention.

Finally, there was a lunchtime debate on the joint procurement of medical countermeasures in response to major outbreaks of communicable diseases (such as a pandemic flu). Some member states were reserved in indicating whether they intended to participate in such a programme, and whether it should be extended to facilitate the procurement of non-emergency countermeasures. The UK maintained that it did not intend to participate in a joint procurement exercise at this stage.

Genetics and Insurance

Anne Milton Excerpts

Tuesday 26th June 2012 Written Statements

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

I am announcing the outcome of a planned review of the concordat and moratorium on genetics and insurance. The concordat is an agreement between the Government and the Association of British Insurers (ABI) which provides for insurers’ use of predictive genetic test results and includes a voluntary code restricting the use of predictive genetic tests in life, critical illness and income protection insurance up to specified financial limits.

The concordat now includes clearer compliance and monitoring arrangements and outlines arrangements for assessing new applications by insurers to use the results of predictive genetic tests.

The Government have heard concerns from consumers regarding the potential uncertainty for those who decide to take a predictive genetic test now—under the moratorium—but who may only wish to take out insurance at a later date and who fear they may be caught out if the moratorium should suddenly end.

Therefore, to reassure consumers, the Government and the ABI have agreed to strengthen the agreement. The moratorium has already been extended until November 2017. The next planned review of the concordat will be in 2014. As a result of the current review, the ABI will not end the agreement outside of the review process or before the end of the moratorium. In addition, future reviews will be at least three years before any extended end date of the moratorium. Consumers can therefore be reassured that they will always have at least three years to prepare.

With the above provisions in place, the Government believe that the concordat provides a proportionate and effective framework which will help to maintain consumer confidence in the agreement while also ensuring that insurers have access to relevant information. It is an effective and successful example of industry self-regulation.

A copy of the “Concordat and Moratorium on Genetics and Insurance” 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.

Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Monday 18th June 2012 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 21and 22 June. The health and consumer affairs part of the Council will be taken on 22 June.

The presidency is expected to seek to agree a partial general approach on the proposal for a regulation on establishing the Health for Growth programme 2014-20, the third successive public health programme. There will also be an orientation debate on the proposal on the decision on serious cross-border threats to health.

The presidency is expected to propose the adoption of Council conclusions on combating antimicrobial resistance, which the UK supports.

Under any other business, the presidency will provide information on the outcomes and conferences of its presidency. In addition, information will be provided from the Commission on its communication on the strategic implementation plan for the European innovation partnership on active and healthy ageing. The French delegation will introduce two points about the MediCrime convention and the supply of raw materials for pharmaceutical use in the EU. Finally, the Cypriot delegation will also give information on the priorities for their forthcoming presidency, which will run from July until December 2012.

Nursery Milk Scheme

Anne Milton Excerpts

Monday 18th June 2012 Written Statements

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

Today I am publishing “Next Steps for Nursery Milk”—a public consultation on the measures by which, through the nursery milk scheme, we can secure the most effective delivery, to all children under the age of five, of free milk in their childcare setting.

The nursery milk scheme has been running since the 1940s. The scheme currently funds free milk for around 1.5 million children under five-year-olds in 55,000 childcare settings throughout Great Britain. The scheme will continue.

In recent years, the prices claimed for milk purchased under the scheme have risen significantly, with a corresponding increase in the total cost of the scheme. The purpose of this consultation is therefore to explore three different options for reforming the operation of the scheme, looking at where we can make it more efficient as well as improving its value for money, while ensuring that all children under five attending a childcare setting for more than two hours a day continue to receive free milk.

Nursery milk is a universal benefit, meaning that childcare settings can claim the cost of milk provided to any child, regardless of the child’s home circumstances. We have ensured that all the options explored in the consultation ensure that the scheme will continue as a universal benefit.

In parallel with the public consultation, we are asking all childcare providers currently registered with the scheme to complete a simple survey about how the scheme works for them now and how potential changes might affect them and the children they care for.

We will publish a formal response to the consultation. To make any significant changes to the operation of the nursery milk scheme in Great Britain, we will, with the approval of Parliament, need to change the regulations governing it. New guidance will then be made available to all local authorities and childcare providers registered with the scheme, well in advance of any changes coming into effect.

“Next Steps for Nursery Milk” 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.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Rob Wilson (Reading East) (Con)]

4. What estimate he has made of the cost of alcohol-related admissions to accident and emergency departments in (a) England, (b) the south-east and (c) Reading East constituency in the latest period for which figures are available.

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

We estimate that alcohol misuse cost the NHS in England about £3.5 billion in 2009-10. The published estimate for the number of alcohol-related admissions was 1,168,300 in 2010-11. However, that is admissions to hospital. We reckon that the cost of alcohol-related accident and emergency visits was about £696 million in 2009-10.

[Mr Wilson]

As my hon. Friend is aware, the Government’s alcohol strategy proposes that more hospital staff have powers to fine troublesome drunks. Will she work with the Home Office to ensure that these fines are not just punitive, but work to recoup a reasonable part of the £700 million cost that she mentioned, so that A and E departments in places such as the Royal Berkshire hospital in my constituency can recoup some of that money?

[Anne Milton]

Indeed, that is why we have a cross-Government strategy. We will be working with the Home Office and many other agencies and Departments to ensure that we deliver the savings. It is not just about the financial cost; it is also about the human cost. Identification, brief interventions and alcohol liaison nurses are all part and parcel of making sure that we reduce the harms of alcohol.

[Mrs Jenny Chapman (Darlington) (Lab)]

Again, the north-east tops the league of alcohol-related admissions to hospital. Availability, advertising and price all seem to be encouraging more and more people to buy more and more alcohol in supermarkets. When will the Government do something about the pricing and advertising of alcohol? In case the Minister is worried about the politics of this, she should know that she has the support of drinkers in Darlington’s working men’s clubs.

[Anne Milton]

I can assure the hon. Lady that I am not at all worried about the politics of the issue. To ensure a brief answer, I refer her to the Government’s alcohol strategy, which mentions all those factors and draws attention to the substantial progress we expect to see on those figures.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I welcome the Government’s commitment to supporting GP screening for alcohol misuse, but given that less than a third of GPs use an alcohol screening questionnaire, and of those a third use them for an average of only 33 patients a year, how can the reformed national health service incentivise those GPs to ensure that they support early intervention and minimise alcohol harm?

[Anne Milton]

We will introduce an alcohol check within the NHS checks for adults from April 2013. My hon. Friend is right to highlight the substantial impact that identification and brief interventions in the GP’s surgery and elsewhere can have.

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

Labour Members share the hon. Lady’s concern about the human, economic and public order cost of alcohol abuse. We understand that the question of a minimum price per unit, to which the Secretary of State is a belated convert, has gone out to consultation, but does the Minister recognise the need to align our minimum price with that in Scotland, because otherwise there will be problems with cross-border smuggling?

[Anne Milton]

I can assure the hon. Lady that we will be talking with the devolved Administrations, and indeed all other agencies, and welcome any input on this. It is good to hear her welcome our strategy, and I am sure she will agree that the only way we can reduce alcohol harm is by working across Government.

[Mr Jim Cunningham (Coventry South) (Lab)]

5. What recent progress he has made on the evaluation of the thalidomide grant pilot scheme.

--- Later in debate ---

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

10. What improvements in public health outcomes he anticipates by the end of the decade.

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

This year, we published our public health outcomes framework, which will last from 2013 to 2016. It sets out two high-level outcomes: to increase healthy life expectancy and to reduce differences in life expectancy and healthy life expectancy between communities. This is the first time that a Government have published a public health outcomes framework, and the first time that there has been ring-fenced money for public health.

[Alec Shelbrooke]

On 31 July 2010, I smoked my last cigarette. Every day since then has been a struggle and I still consider myself to be a smoker. Will my hon. Friend outline for the House what support the hundreds of people in my constituency and the tens of thousands of people around the country who are in the same boat are getting to improve public health outcomes?

[Anne Milton]

I heartily congratulate my hon. Friend on his considerable success, which he has put on the record. We have a number of initiatives, not least the NHS’s quit helpline. There has been a rise in the number of people phoning it and in the number of people who are attempting to quit. He is an example not only to his constituents, but to many Members around the House.

[Mr Speaker]

On both the Front Benches and the Back Benches in all parts of the House, I suspect.

[Valerie Vaz (Walsall South) (Lab)]

How do the Government intend to ring-fence the public health money that will be given to local authorities?

[Anne Milton]

Quite literally, by putting it in a ring fence. That money can be spent only on improving public health among the local population. There are 66 supporting indicators in the outcomes framework. The money will be given to local authorities on the basis that they will make progress towards achieving those outcomes.

[Stephen Mosley (City of Chester) (Con)]

11. What his policy is on the national authorisation process for clinical commissioning groups; and if he will make a statement.

--- Later in debate ---

[Nadine Dorries (Mid Bedfordshire) (Con)]

13. What improvements in health inequalities he anticipates by the end of the decade.

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

The legal duties that we have introduced will ensure that health service commissioners have regard to the need to reduce health inequalities. The NHS and the public health outcomes framework will set out ambitions to reduce those inequalities in both health services and the health of the population. That is an ongoing area of work. We already have the indicators in the framework, but we also need the ambition to work on those inequalities.

[Nadine Dorries]

Central Bedfordshire council has a number of public health challenges such as establishing health and wellbeing boards. Does the Minister agree that those challenges would be much easier to achieve and more effective if agencies such as social services, education services and others worked together? Are the Government doing anything to help facilitate that?

[Anne Milton]

My hon. Friend is absolutely right that education, social services and health services need to be brought together. That is exactly why bringing public health into local government is critical. If we add to that list housing and local business services, we have the mix to turn around many people’s fortunes. Some of the 66 indicators in the framework are school-readiness, social connectivity, air pollution and chlamydia, and they will all require local government to work at every level with all agencies to reduce inequalities.

[Nic Dakin (Scunthorpe) (Lab)]

What steps is the Department of Health taking to address the inequalities in regional health outcomes for pancreatic cancer?

[Anne Milton]

We are doing a number of things, and the most important is devolving responsibility for public health to local areas. It is clear that delivering improvements in diagnosis, outcomes and so on for people with pancreatic cancer relies on different actions in different areas. The important thing is to give local people the power and money to do what they know is right.

[Patrick Mercer (Newark) (Con)]

I am sure the Minister would agree that Newark hospital is performing outstandingly in stamping out inequalities. However, given the expansion of population in Newark that is expected by the end of the decade, will the Minister allow me and some of my constituents to meet her to discuss the inequalities we anticipate?

[Anne Milton]

I am always delighted to meet any hon. Member or hon. Friend and their constituents, particularly if they face inequality concerns.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

14. What his policy is on the resource distribution formula for primary health care commissioners.

--- Later in debate ---

[Gareth Johnson (Dartford) (Con)]

T4. The Minister is aware that a form of postcode lottery operates in the provision of IVF treatment at the moment. Does she agree that the Health and Social Care Act 2012 provides an excellent opportunity to end this lottery and allow a more equalised approach to IVF treatment?

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

Yes, and may I commend my hon. Friend on the work he has done in this area? In the reformed NHS, infertility treatment services will be commissioned by clinical commissioning groups, with the NHS Commissioning Board providing oversight and support. That will include the provision of resources and tools to enable CCGs to collaborate to commission infertility services. We will continue to expect those commissioning infertility treatment services to be fully aware of the importance of having regard to the National Institute for Health and Clinical Excellence fertility guidelines.

[Paul Blomfield (Sheffield Central) (Lab)]

T2. Speaking on 24 April, the Secretary of State indicated that the NHS distribution formula should no longer take account of deprivation. That would have cost Sheffield £73 million a year and benefited Surrey by £400 million. His ministerial colleague, the Minister of State, the right hon. Member for Chelmsford (Mr Burns), seems to have denied that that is the case. Will the Secretary of State therefore confirm that this is the Government’s latest U-turn?

--- Later in debate ---

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

The Government blocked Labour’s plans to introduce public health as one of the licensing conditions. I wonder whether, in the spirit of localism, this power should now be given to health and wellbeing boards.

[Anne Milton]

As I am sure the hon. Lady is aware, we have proposed in the alcohol strategy to make sure that public health and other health considerations can be used in making decisions about licensing applications. This is what we have achieved from having a cross-government strategy and approach, moving public health responsibilities back into local government.

[Iain Stewart (Milton Keynes South) (Con)]

May I emphasise to my right hon. Friend the strength of local feeling in Milton Keynes that we should retain our integrated community health service, which has worked incredibly well and provides a good role model for elsewhere in the country?

NHS (Foreign Nationals)

Anne Milton Excerpts

Tuesday 22nd May 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship this morning, Mr Streeter. I thank my hon. Friend the Member for Kingswood (Chris Skidmore) for securing the debate, which has provided a useful opportunity for hon. Members from all parties to come together and share their views. I express some disappointment at the fact that the shadow Minister, the hon. Member for Copeland (Mr Reed), was somewhat party political, but I commend the hon. Member for Ealing, Southall (Mr Sharma) for his generous comments. It is important to have that on the record: we all want clarity and fairness in the system.

I have met my hon. Friend the Member for Kingswood before to discuss the matter and, again, I commend his efforts in raising the subject, which has provided an opportunity to put some things on the record. Access to NHS care is very poorly understood—indeed, that is also the case for Members of Parliament. This is about foreign nationals using and potentially abusing the NHS. Like the health system of any country, the NHS provides for foreign nationals. Millions of people come to this country every year for various purposes and stay for different periods of time. Some become ill or have accidents, and have immediate health care needs that need to be met. We have a duty to treat them, just as other countries have a duty to treat British citizens who become ill abroad. I assure the shadow Minister that there is no question of anybody wanting to undermine that duty—nobody has raised that in the debate, it is not being discussed either and that will remain the case. However, we have a duty to taxpayers who pay for the system.

Questions were raised about who should be charged. To clarify the situation again regarding ordinary residence—settled, lawful residency in the UK—access to the NHS is not based on nationality, the payment of taxes or national insurance contributions. I accept that that is not widely understood. The service is paid for by taxpayers, so they have an interest in who has access to it. We exempt some categories of visitor from charges, such as those working or studying and those visiting from countries with which we have bilateral health care agreements. A few services are free to all—my hon. Friend the Member for Kingswood may have mentioned them—such as treatment in an A and E department, which I have mentioned, and treatment for certain infectious diseases, as there are wider public health reasons for ensuring that people receive prompt treatment.

Under the legislation, charges can only be made for hospital treatment. Charging is not in place for registering with or seeing a GP, although prescriptions are subject to the usual charges. GP registration or the holding of an NHS number does not trigger free hospital treatment. The hospital to which a non-resident has been referred should check separately for eligibility, but I know that that does not happen as it should. Current legislation allows only for charging overseas visitors for NHS hospital treatment. There are therefore no rules of entitlement governing overseas visitors’ access to GP services, and visitors are able to register.

GPs are self-employed and are contracted to provide primary medical services for the NHS. Under the terms of their contract, GPs have a measure of discretion in accepting patients on their list, but they can only turn down an applicant on reasonable, non-discriminatory grounds. My hon. Friend discussed that at length and made it quite clear what the guidance says. In practice, a GP’s discretion to refuse a patient is limited, and a GP cannot refuse to register a patient just because they cannot provide identification or proof of address—that is unlikely to be considered reasonable grounds.

The European economic area confuses the issue further, but our obligations are simple. Each country is responsible for the cost of providing treatment for their own citizens while they are in other EEA countries, unless they are working. Workers are entitled to the same access to health care as that country’s own residents, on the principle that the country to which an individual makes social security contributions is liable for that person’s health care needs. In practice, that means we pay other EEA countries for treating our state pensioners who have retired there, and for the emergency needs of our own citizens who need health care when visiting another country, using their European health insurance card. The same is also true in reverse—other countries must reimburse the UK for treatment provided to their citizens. EEA nationals who come here to work are entitled to free NHS provision.

Overall, we pay out more than we receive, simply because many more of our state pensioners choose to settle in Europe than vice versa. This is sometimes the subject of large tabloid headlines, but it is important to make that point. We may see that change in the coming months. I acknowledge, however, that we need to do more to recover income due to us from other EEA countries for providing health care to their visitors and pensioners. We have an extensive programme of work under way to address that.

As the shadow Minister said, unpaid debts are a small amount of the total spent on the NHS. However, as my hon. Friend pointed out, £30 million or £40 million pays for a lot of treatment, a lot of care and a lot of medicine. Although it is a small percentage of the total budget, for an individual it is significant. We need to recognise that in any system that charges, debts are sadly inevitable. Guidance is clear that hospitals should not provide non-urgent treatment until a chargeable patient has paid in full, but they have a legal duty to provide emergency care. When a patient is responsible for repaying a debt, if a debt is incurred, the NHS has a duty to the taxpayer to recover that debt. Audited NHS trust accounts and data from Monitor show that last year, £14 million was written off due to unpaid debts—a small but significant amount for taxpayers. We are determined to reduce that write-off without compromising the provision of urgent treatment. My hon. Friend related the terrible story of the American visitor for whom the hospital could not even provide any documentation for him to claim from his health care insurer. The statistic of a third of NHS trusts not even pursuing debts is shocking. On the other hand, we have the example of West Middlesex, which is clearly doing an excellent job.

The hon. Member for Ealing, Southall expressed his frustration with some immigration and Home Office issues, and he is absolutely right to discuss the UK Border Agency. My hon. Friend the Member for Kingswood discussed the fact that GPs do not want to be gatekeepers on immigration issues. We are therefore reliant on UKBA to ensure that people who are entitled to be here are here, and that people who are not entitled be here are not here. He also made a distinction regarding foreign nationals who come here specifically to access NHS care. I remind the shadow Minister, probably because I am significantly older than him, that this issue goes back a great deal further than the previous Labour Government. It probably goes back further than previous Conservative Governments, which have to be thanked for making the NHS such an attractive option that people came here as health-care tourists a long time before 1997.

I share the concern and frustration of the hon. Member for Ealing, Southall about immigration status. I have a university in my constituency. A lot of foreign students try to regularise their status in this country and fail to do so—their passports are left with the Home Office for goodness knows how many months and the situation becomes very confusing. I think that the people he is talking about are in the grey area in the middle. We need to address this matter and will continue to work with the Home Office. To repeat for the record, the recently amended immigration rules state that a person with a debt to the NHS of £1,000 or more can now be refused a new visa or extension stay. That should not only assist in recovering more debts, but act as a deterrent against failing to have health insurance when visiting the UK.

[Mr David Crausby in the Chair]

[Mr Reed]

Will the Minister help with a genuine question about the new NHS commissioning arrangements? If clinical commissioning groups procure services from hospitals where that is a particular problem, what advice will the Government give them?

[Anne Milton]

It will bring the focus closer to home. I would expect the shadow Minister to welcome this change, because GPs will now be much more acutely aware that registration with them should not automatically entitle people to NHS acute trust care. We are undertaking a review that I will mention in my concluding remarks. It is early days in respect of the UK Border Agency and the change in the immigration rules, so we do not have sufficient information adequately to evaluate how effective they are, but I think that we will see a significant impact. The shadow Minister asked specifically about the Olympics.

[Jim Shannon]

The Minister said that £14 million in debts was written off by the Government. Do the Government contact the countries that people have come from to try to recover some of those debts, or is it too costly administratively to do that? Is it cheaper to write off debts than to chase them up?

[Anne Milton]

That is true of all debts. Trusts are not always aware of the rules and the obligations placed on them. Sometimes, they do not have the infrastructure in place to chase such debts and sometimes the costs of chasing debts are greater than the debts themselves, so they write them off. Either way, it is clearly not fair on the taxpayer. West Middlesex is an exemplar. We in the NHS are not good at sharing best practice, but practice at West Middlesex should be spread more widely.

Back in 2005, when the Labour Government were in power, as part of the UK’s successful bid for the 2012 Olympics they committed to provide games family members with free medical care. The games family is a tightly defined group of people—athletes and their support teams, officials, accredited media and IOC members—who are directly involved in taking part in or supporting the games. We have introduced a specific exemption for those people in respect of hospital treatment that might otherwise be chargeable, which will last for only nine weeks around the time of the Games and will be limited to treatment, the need for which arises here, so pre-planned or routine ongoing treatment that can wait will not be free. Normal charging rules will apply to all other visitors, including those coming to see the games.

The NHS has been briefed to be particularly vigilant in screening visitors who seek treatment and in applying the charging rules, given the large influx of visitors to the country. Let me reassure the residents of Hackney—the shadow Minister rightly said that Homerton is one of the designated hospitals—that treatment will be given on the basis of need. Local people should not suffer at all as a result of these rules which, as the shadow Minister will be aware, were an important part of the previous Government’s bid.

My hon. Friend has mentioned some of the details of our review. It is important that there should be qualifying criteria, a full range of other criteria exempting services or visitors from charges, and criteria for charging for services outside hospital, as we move towards more care being delivered outside hospitals. We need to be mindful of costs that could be incurred, thereby ensuring that we have more efficient and effective processes throughout the NHS, including the ability to screen eligibility. Let me reassure the hon. Member for Strangford (Jim Shannon) that it is important that we work closely with the devolved Administrations, and have close discussions with them, to ensure that there are not unforeseen and unintended consequences.

Once again I thank my hon. Friend the Member for Kingswood for introducing the debate, and I thank hon. Members for the balanced, moderate nature of the discussion. It is important that we set an example—all parties desire to do so—and demonstrate to the public that such difficult issues, which can involve distinct communities, can be discussed and considered in a fair and balanced way and are matters of cross-party concern, with all political parties working together. It is not becoming for any politician to score party political points on an issue of such fundamental importance to the taxpayers of this country.

Regulation of Medical Devices

Anne Milton Excerpts

Monday 14th May 2012 Written Statements

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

My noble Friend the Under-Secretary of State for Health (Earl Howe) has made the following written ministerial statement.

I am today publishing two documents relating to the regulation of medical devices and other cosmetic interventions and stemming from the fraudulent use of non-medical grade silicone in the breast implants manufactured by the French company Poly Implant Prothèse (PIP).

The first document is my review of the actions of the MHRA and Department of Health in relation to PIP implants, announced by the Secretary of State for Health on 11 January. The review finds that there is room for improvement in the operation of the MHRA and the regulation of medical devices. However, it also finds that the regulator acted reasonably, and that, in taking difficult decisions on how to communicate the problems with PIP implants to the public, it followed clinical and scientific advice.

The review also found that the MHRA should identify ways of gathering better evidence on the safety of devices, broaden its approach to analysing reported problems with higher-risk medical devices and find better ways of communicating with the public. The operation of the European regulatory system must improve and health professionals and providers also need to be better at reporting problems when they occur.

The second document is “The Government’s Response to the House of Commons Health Committee: Sixteenth Report of session 2010-12” Cm 8351. In this response, we welcome the Committee’s analysis of the problems relating to PIP implants and their many helpful suggestions. Some of these are already reflected in the report mentioned above. Other recommendations will be picked up in the further work of Sir Bruce Keogh’s expert group on PIP implants, and in the separate review into the regulation of cosmetic interventions, also announced on 11 January. A further announcement about the review will be made in the near future.

Cigarette Packaging

Anne Milton Excerpts

Tuesday 17th April 2012 Commons Chamber

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

I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing this debate on a topic so vital to the health of the nation. The number of Members who have stayed here late to listen and, indeed, to contribute to this debate is a testament to that.

As the hon. Gentleman rightly pointed out, smoking kills more than 100,000 people in the UK every year. Fully half of all long-term smokers will die prematurely from a smoking-related disease. Smoking, of course, harms those around smokers, too. The Royal College of Physicians estimates that about 2 million children currently live in a household where they are regularly exposed to cigarette smoke. The cost of this level of ill health is huge. In England, about one in 20 of all hospital admissions among adults aged 35 and over is down to smoking. Of course, it is not just a question of the financial cost; there is a human, and often tragic, cost as well.

Although smoking rates have declined over past decades, in recent years the fall has lost momentum. Most smokers take up the habit before they turn 18. This year, in England alone, 330,000 children under the age of 16 will try smoking for the first time. Reducing the uptake of smoking by children and young people remains one of the key public health goals. We want to prevent those young people from turning into adult smokers. Most smokers say that they want to stop. Quitting can be difficult, but smokers who kick the habit for good can quickly reduce their risk of contracting smoking-related diseases and lead longer, healthier lives, irrespective of their age.

Our approach to reducing tobacco use is comprehensive and evidence-based, and much has already been achieved, including—as the hon. Member for Coventry North West pointed out—many cross-party initiatives. We have introduced a comprehensive ban on advertising, and picture warnings on packs; we have raised the age for the sale of tobacco to 18; we have ended the sale of tobacco from vending machines; from April the open display of tobacco products in supermarkets has been banned; tobacco taxes were increased significantly again in this year’s Budget; and, of course, there is a ban on smoking in public places. I pay tribute to the right hon. Member for Rother Valley (Mr Barron) for his role in the introduction of that ban when he was Chairman of the Select Committee on Health.

It is recognised that the UK has the best “stop smoking” services in the world, and I feel proud when I go abroad and am congratulated on all that we have achieved. However, we clearly need to do more. Given the existence of all the measures to which I have referred, it is surprising that about 20% of people still smoke.

[Mr Sutcliffe]

I congratulate the Minister on the work that she is doing. However, as she is aware, a small number of people will continue to smoke because of the illicit trade. What does the Minister think we can do to stop that trade?

[Anne Milton]

I shall say something about the illicit trade shortly, because it is an important issue. However, it should not be confused with the separate issue of plain packaging, which is also important and on which we are to consult.

In March last year, we published “Healthy lives, healthy people: a tobacco control plan for England”, which described how our programme of tobacco control would be delivered over the next five years within the framework of the new public health system. The tobacco control plan included a commitment to consult on options to reduce the promotional impact of tobacco packaging, including standardised packaging. There is strong, consistent evidence that the advertising and promotion of tobacco can influence young people in particular, from the first puff to full addiction.

I am pleased to say that yesterday we published a UK-wide consultation document, with the agreement of the devolved Administrations. The consultation will consider what measures could be taken to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand and product names displayed in a standard colour and font style. At this stage, we have an open mind about the introduction of standardised packaging of tobacco products. We hope that the consultation will help us to establish whether there is evidence that it would have an additional public health benefit, over and above the existing tobacco control initiatives.

[John Cryer (Leyton and Wanstead) (Lab)]

I do not approach this issue with particularly strong views in either direction, but it occurs to me that if I were a counterfeiter, I would probably welcome the introduction of plain packaging. I know that that is a bit of a euphemism, but for want of a better term, I would welcome it, because I would find it easier to copy than other packaging.

It also concerns me that in the illicit trade some really nasty substances go into the cigarettes. Tobacco is bad enough, but the other substances that are added are even worse.

[Anne Milton]

I will come on to deal specifically with that point. Like the hon. Member for Coventry North West, I am sure that this will not be the last debate we have on this issue. It will be important to dispel some of the myths, and this week Cancer Research UK has put out a good piece of information that does so.

As I say, the Government have an open mind, and it is important that we hear everyone’s views. We will keep that open mind until the consultation closes. The consultation has four aims: to reduce the appeal of tobacco products to consumers; to increase the effectiveness of the health warnings; to reduce the ability of tobacco packaging to mislead consumers about the harmful effects of smoking; and to have a positive effect on smoking-related attitudes, beliefs, intentions and behaviours, particularly among young people and children. The consultation will be open from 16 April to 10 July, and I encourage all hon. Members, and any other person, business or organisation with an interest, to respond to it.

[Jim Sheridan]

As chair of the Unite union parliamentary group, which includes an awful lot of health service workers, who agree wholeheartedly with what the Government are trying to achieve, I wrote to the Department some weeks ago seeking a meeting to discuss the jobs implications. Is there anything the Minister can do to expedite a response to that request?

[Anne Milton]

I will certainly look into the matter, and I apologise if the hon. Gentleman has not received a timely response. I would hope that we would always give him such a response, and I will make sure that he gets one. He mentions jobs, but we have also to consider the human costs of smoking-related disease. If breadwinners in families die prematurely, that has an implication for families. This is not just about jobs.

Any decisions to take further policy action on tobacco packaging will, as I say, be taken only after full consideration of the consultation responses and of any other relevant information or evidence, which is emerging all the time. In addition, we will explore any implications relating to the sale of illicit tobacco, a matter that has been raised. I point out that existing packs are very easy to forge; covert markings are already used to distinguish illicit cigarettes and this proposal will make absolutely no difference to the situation.

Our tobacco control plan explicitly complements Her Majesty’s Revenue and Customs and the UK Border Agency’s strategy to tackle the illicit trade in tobacco products, which was published in April 2011. There is absolutely no room for complacency, but thanks to the hard work of HMRC, local councils, the NHS and civil society, good progress is being made in reducing the amount of illegal tobacco products finding their way on to the market. According to the latest information collected by HMRC, fewer people are using illicit tobacco. Illicit sales of cigarettes were down to 10% in 2010 from 21% in 2000—that is a marked reduction. The figure for hand-rolling tobacco remains high, at 47%, but it has reduced from 61%. So the trend is in the right direction. I particularly wish to compliment the north of England tackling illicit tobacco for better health programme—some of these programmes have ghastly names, do they not? None the less, it is an example of how organisations can work together to tackle the supply of and demand for illicit tobacco. In coming to a view on the impact of standardised packaging, the availability of illicit tobacco will obviously be important, but we do want to see good, hard evidence on this.

[Ian Paisley]

rose—

[Anne Milton]

I shall give way briefly.

[Ian Paisley]

I thank the Minister for being very generous with her time. Has she given any thought to the view that if the Government are ultimately successful and stop people smoking, the Treasury will lose £11.1 billion in resources? How will that gap be filled?

[Anne Milton]

I will happily cross that bridge when we get to it; of course the Treasury would lose revenue, but as Minister with responsibility for public health, my aim is to improve the public’s health. Premature deaths would be prevented, and there is a huge human cost, let alone the financial cost to families, of people dying early.

Under the terms of the World Health Organisation’s framework convention on tobacco control, to which the UK is a signatory, we will be asking all respondents to consultations on tobacco control measures, including the consultation on tobacco packaging, to disclose whether they have any direct or indirect links to the tobacco industry. Responses from the tobacco industry, or from those with links to the industry, will always be carefully considered alongside other views received.

I hope Members will make their constituents aware of the consultation. The hon. Member for Paisley and Renfrewshire North (Jim Sheridan) raised the issue of jobs, and we must take that into account. We must also make sure that this consultation is real and meaningful and that the public know that we value their input.

I welcome having had a chance to discuss this matter, and I hope this will not be the last opportunity to do so. I look forward to hearing the views of all Members.

Question put and agreed to.

Public Health Workforce Consultation

Anne Milton Excerpts

Tuesday 27th March 2012 Written Statements

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

Today I am publishing “Healthy Lives, Healthy People: Towards a workforce strategy for the public health system”.

The consultation document aims to:

set out proposals for a work force strategy that would support highly qualified, motivated public health specialists who will be employed in a range of settings including local authorities, the NHS and Public Health England in the future public health system; and

explore opportunities for employers to develop and embed public health knowledge and skills into the wider work force.

The skills of people working throughout the public, voluntary and private sectors are crucial to protecting and improving the health and well-being of the population, and addressing health inequalities. The consultation document considers how future systems for education and training can support the development and use of those skills to help achieve this goal and make the progress we need to address our big health challenges. It considers what roles people working as specialists in public health and in a wide range of other sectors can and should play to make public health everyone’s business and how they can support individuals to promote their own health and well-being and make more informed decisions.

The development of this consultation has been an inclusive process, with involvement from key stakeholders to help us build a work force that can transform public health. The subsequent strategy, which we plan to publish in autumn 2012, will be shaped by a range of views. It will be an important contribution to making the future public health system a success.

Under the proposals in the Health and Social Care Bill, local government will take on a significant new leadership role in public health, employing a substantial proportion of the public health work force. The consultation document has been developed, and is co-branded, with the Local Government Association.

“Healthy Lives, Healthy People: Towards a workforce strategy for the new public health system” 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.

Alcohol Guidelines (Science and Technology Committee Report)

Anne Milton Excerpts

Monday 26th March 2012 Written Statements

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

Today we have laid before Parliament the Government’s response to the Science and Technology Committee Report on Alcohol Guidelines (Cm 8329). Clear and easily understood information is central to ensuring that everyone is aware of the risks of excessive alcohol consumption and can make informed choices about responsible drinking. The response sets out the Department of Health’s intention to commission a review, led by Dame Sally Davies, as the UK Government’s principal medical adviser to look at the current drinking guidelines, and the evidence base.

Copies of the Government’s response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper office. It is also available at:

www.dh.gov.uk/health/2012/03/response-alcohol-guidelines/.