North-east London STP

Baroness Blackwood of North Oxford Excerpts

Friday 16th December 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the hon. Member for Ilford South (Mike Gapes) on securing this important debate. He is rightly known as a fierce defender of his local NHS services, and his constituents should be proud of his record.

As both a patient with a chronic and complex illness and a daughter of a cardiologist and a nurse, I know from both sides exactly how much heart and soul our NHS workforce put into their day jobs. It is easy in debates such as this about structures and processes to lose sight of that, so I wish to begin by paying tribute to all of those who work at Barking, Havering, and Redbridge University Hospitals NHS Trust in the constituencies of the hon. Gentleman and the hon. Member for Walthamstow (Stella Creasy) for their dedication, determination and commitment to providing first-class services to all those in their care. We should just take a moment to note that.

The NHS’s own plans for the future, set out in the five-year forward view, recognise three great challenges facing the NHS: health and well-being; care and quality; and finance and efficiency. The five-year forward view also recognised that challenges facing different areas of the country will inevitably be buried. The problems facing Ilford will, by definition, not be the same as those facing Ipswich, and a single national plan would not be effective or appropriate. That is why NHS England’s 2015 planning guidance called for local commissioners to come together with their providers across entire health economies to develop a collective strategy for addressing those challenges in their own areas. In much the same way, in fact, Labour’s 2015 general election manifesto on health, “A Better Plan for NHS Health and Care”, said that to reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides. The hon. Gentleman mentioned the King’s Fund, which has been clear that we need to strengthen parts of the STP process. It will be of interest to him that Chris Ham, the chief executive, has also been clear that STPs are the only chance the NHS has to improve health and care services. We have to drive this through and we have to get it right.

All local STPs are now published and, as the hon. Gentleman said, local areas should be having conversations with local people and stakeholders including Members of Parliament to discuss and shape the proposals, understanding what matters to them and explaining how services might be improved. These conversations will inevitably gain pace over coming months and we should all want and encourage as many people as possible to get involved. Where relevant, areas should build on existing engagement through health and wellbeing boards and other existing local arrangements. They should also look for innovative ways to reach beyond those existing relationships and into local communities.

There are 44 STP areas, as the hon. Gentleman will know. They cover the whole of England, bringing together multiple commissioners and providers in a unique exercise in collaboration. That is why this is quite a challenge.

[Stella Creasy]

It is good to hear the Minister say that she wants to see local people involved in these plans. Will she therefore commit not just to a conversation but a consultation with teeth to give people confidence that the very difficult decisions that we all know have to be made about changing the NHS can be done with their consent, and not simply given to them as a fait accompli?

[Nicola Blackwood]

Perhaps if the hon. Lady lets me continue with my speech, she will hear a little more about how the process will go forward.

The geographies have been determined not by central bodies, but by what local areas have decided makes the most sense to them. In the case of the constituency of the hon. Member for Ilford South, that has involved five providers, seven CCGs and eight local authorities covering the whole of north-east London. Each area has also identified a senior leader, who has agreed to chair and lead the STP process on behalf of their peers. In north-east London it is Jane Milligan, the chief officer of Tower Hamlets CCG, who is co-ordinating the development of the plan.

I was concerned to hear what the hon. Gentleman said about local authorities not feeling as involved as they should. It is important to emphasise that local authorities must play a role in developing these plans. Reflecting the social care needs of an area, which councils are obviously best placed to represent, will be key to the success of the NHS in the coming years, so they must be closely involved.

The plans offer the NHS an opportunity to think strategically and open up the public discussion about how we will meet the challenges facing the NHS in terms of demand and rising costs. It is inevitable that debate will become heated; it is simply a reflection of how important local NHS services are for us all. By planning across multiple organisations—both commissioners and providers—STP footprints can seek to address in an holistic way the health needs of an area and all the people within it in a way that we have never had the opportunity to have before.

We all know that the NHS faces tough choices about how we will design future services to meet rising demand, rising costs, and more chronic and complex illnesses. Choices have often previously been postponed again and again because they were too hard and because the discussions are too uncomfortable. I do not think anyone in the Chamber would think it is fair or safe for our local populations for us to keep putting them off in this way.

In north-east London, as elsewhere, that has meant having an honest conversation about the best way forward for services that are unsustainable as well as how to integrate services to give patients a clearer route through the system. All those conversations will help ensure that patients maintain access to high-quality care.

As I understand it, the north-east London October STP draft looks at these challenges in a number of different ways. The hon. Gentleman has described some of them. It also proposes embracing integrated services, from urgent and emergency care to mental health care and support as well as public health, which is important to me as the Minister for Public Health. The STP is also exploring how to improve patient outcomes through community-based care and preventive measures, which must be important if we are to manage demand. For example, the proposals include utilising initiatives to provide adequate housing in the area, and using new models of care to give health education. It also highlights three enablers for change for the area—workforce, digital enablement and infrastructure—and investigates how to improve its position with each.

I share the view of the hon. Gentleman and the hon. Lady that the public, key stakeholders and elected representatives should be closely involved in the development of STPs. With the plans now published, preparation for STP implementation must begin in the new year. Now is the time for STP leaders to reach out actively and engage patients and the wider public, and I expect nothing less. That means having frank, engaging and iterative conversations across areas, as well as some potentially difficult conversations about what the NHS could and should look like. Simon Stevens and Jim Mackey—the heads of NHS England and NHS Improvement—have written an open letter to STP leaders making that expectation absolutely clear. The letter reiterated that now is the time for local engagement to help develop the proposals and for those involved to make it clear that these plans must have a real benefit to patients.

I should also be clear that, nationally, all reconfigurations must meet the four tests mandated by the Government to NHS England in 2010, which require all local reconfiguration plans to demonstrate support from GP commissioners, strong public and patient engagement, clarity on the clinical evidence base, and support for patient choice. We would not expect any proposal to move forward that has not met all four tests. Patients must be at the heart of the NHS, and no plan can be successful unless they are fully engaged.

I close by saying that the hon. Gentleman has raised some very serious questions around details of his local STP plan and the quality of public consultation. I will ask the Minister responsible for community health—the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat)—to meet him and the hon. Lady to discuss the details to ensure that they are properly ironed out and that the public consultation and discussion are of the highest possible quality.

Question put and agreed to.

Public Health Grants

Baroness Blackwood of North Oxford Excerpts

Thursday 15th December 2016 Written Statements

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

Today we are publishing the ring-fenced public health grant allocations to local authorities in England for 2017-18.

We are committed to supporting improvements in public health and are making available £3.3 billion to local authorities for this purpose in 2017-18. Over the five years from 2016-17 to 2020-21 we will be investing over £16 billion to support local authorities’ public health responsibilities, which include sexual health, tackling obesity, supporting physical activity, prevention, treatment from drugs, alcohol misuse, stop smoking services and other interventions. This is in addition to what the NHS spends on preventative interventions such as immunisation and screening.

We are expecting the 10 local authorities in Manchester to fund their public health activities from April 2017 through retained business rates as part of a wider pilot of business rate retention. Those 10 local authorities will not receive a central Government grant to fund their public health activities.

Full details of the public health grants to local authorities can be found on www.gov.uk. This information will be communicated to local authorities.

Attachments can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-12-15/HCWS363/.

[HCWS363]

Draft Consumer Rights (Enforcement and Amendments) Order 2016

Baroness Blackwood of North Oxford Excerpts

Monday 12th December 2016 General Committees

[The Chair]

I know that the Minister is unwell, so I will allow her, if she so wishes, to move the motion from a sedentary position.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I beg to move,

That the Committee has considered the draft Consumer Rights (Enforcement and Amendments) Order 2016.

Thank you, Mr Davies. It is a pleasure to serve under your chairmanship, and I am very grateful for the Committee’s indulgence.

The Consumer Rights Act 2015, which came into force last year, simplifies UK consumer law, empowers consumers, improves consumer choice and drives competition. It provides clear rights for consumers when buying goods, services and digital content, and clear remedies so that consumers know what they are entitled to when things go wrong, and action can be taken where needed. It also provides enforcers such as trading standards offices with a set of updated powers to aid them in investigating potential breaches of law while ensuring that businesses have the relevant rights of appeal.

The order makes a number of small but essential amendments in relation to schedule 5 to the 2015 Act. It adds a number of pieces of legislation to the list in schedule 5 so that enforcers such as trading standards can access the updated investigatory powers in the schedule. The order will ensure that a comprehensive range of powers is available to enforce the Tobacco and Related Products Regulations 2016, which harmonise trading rules on how tobacco products are manufactured, produced and presented, and the Standardised Packaging of Tobacco Products Regulations 2015, which require cigarettes and roll-your-own tobacco to be packaged in a standard colour with a standard typeface.

The order also makes consequential amendments to two pieces of legislation to make them refer to the investigatory and enforcement powers contained in schedule 5. The legislation that the order affects is the London Local Authorities Act 2007, which tackles rogue traders by requiring mail-forwarding businesses in London to register with their local authority, and the Weights and Measures (Northern Ireland) Order 1981, which regulates the quantity of goods and measuring equipment used by traders.

The Government consider that the order provides for the application of the most modern suite of enforcement powers to those pieces of legislation. Importantly, it will allow trading standards offices to play their full part in enforcing new tobacco legislation introduced by the Government. In turn, it will continue to drive down smoking rates in this country. I therefore commend the order to the Committee.

--- Later in debate ---

[Nicola Blackwood]

I thank the shadow Minister for her support and the spirit of bipartisanship in this festive season. The Government share her view that reducing variation in smoking, especially among vulnerable groups, is a top priority. That is exactly why we are working hard on the tobacco control plan to ensure that it is the best possible plan and that it delivers on its aims. I would be happy to update the House as soon as that is possible.

Consumers and businesses benefit from the Consumer Rights Act 2015 in all sectors. The Act was introduced to strengthen, simplify and modernise the law and to consolidate enforcement powers. It is right that the powers are applied to the specified legislation without further delay to provide legal certainty for enforcement authorities. Through that, we can see the benefits of the tobacco legislation that we have delivered and that has made us one of the leading countries in the world on tobacco enforcement. I commend the order to the Committee.

Question put and agreed to.

Variant CJD and Surgery

Baroness Blackwood of North Oxford Excerpts

Tuesday 29th November 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this important debate on variant CJD and surgery. It is clearly an area on which he has a great deal of knowledge. I recognise that prion disease is the causative agent of transmissible spongiform encephalopathies such as variant CJD. It remains in many ways obscure and there are many aspects of these rare diseases that we are still in the early stages of researching. However, one thing I am confident about is that the UK system for ascertaining CJD case numbers has been for the past 20 years reliable and accurate. Our national CJD research and surveillance unit, which is based in Edinburgh and funded by the Department and the Scottish Government, leads pan-European work and has leadership from expert clinicians and scientists who, in 1996 following BSE, were the first to identify variant CJD as a separate form of the condition.

The Department recognises the potential seriousness of secondary—person-to-person—transmissions of vCJD and has since the late 1990s introduced a series of measures to reduce the risk of such spread, whether by blood transmission or by surgery. We are reassured that there have to date been no cases attributable to surgical transmission and only three cases of clinical disease attributable to blood transfusions, all of which occurred in or before 1999. However, our risk assessment models, which we use in our impact assessments of potential risk reduction measures, continue to take into account the potential for secondary—person-to-person—transmissions by both routes, in people with all genotypes and over potentially very long incubation periods, which my hon. Friend mentioned. This is why the scientific advice we have is that the surgical instrument measures in place are sufficient irrespective of the genotype.

My hon. Friend was right to mention the recent case. It was always anticipated on the basis of a wide body of published scientific work that, following the BSE epidemic, further cases of vCJD, including MV cases, might arise from time to time. We have seen that with similar diseases, such as kuru in Papua New Guinea, and studies suggest MV cases could be seen in small numbers for more than 30 years after exposure. Having reviewed the information about the case of vCJD in a patient with MV genotype, the Advisory Committee on Dangerous Pathogens has advised that no changes in the current risk reduction measures are needed at present. It advises that the measures in place are sufficient, irrespective of genotype, although of course the matter will remain under review.

It is important to stress that modern surgical equipment in the UK is very safe and that robust guidance is in place for the NHS on procedures and practices to reduce the risk of contamination of any kind, including the use of single-use instruments where possible and of decontamination practices. Where it is not possible to use single-use instruments in higher-risk procedures, there are processes in place to track the use of specialist equipment. As my hon. Friend will know far better than I do, there is a potential risk of vCJD transmission via dental surgery, and this has been recognised by the UK’s chief dental officers. In 2007, they issued letters to all dentists to advise that endodontic root canal reamers and files should be used as single-patient or single-use instruments.

[Sir Paul Beresford]

I am a little worried that the Minister appears to accept that surgical procedures are as good as they can be, given that the Department is inviting research to find a RelyOn equivalent, to improve the situation. The Department must therefore see a flaw in what we have at present.

[Nicola Blackwood]

My hon. Friend anticipates my next words as only an experienced Member of Parliament can do. I think it is right to say that there has so far been no evidence of any secondary, person-to-person, vCJD transmissions via surgery or dentistry. Nevertheless, we are maintaining and updating our precautionary approach. Surgical instruments guidance has recently been refreshed to support health organisations in delivering the required standard of decontamination of surgical instruments and to build on existing good practice to ensure that high standards of infection prevention and control are developed and maintained. My hon. Friend mentioned a number of these points.

The major change in this latest revision takes account of recent changes to the Advisory Committee on Dangerous Pathogens transmissible spongiform encephalopathy subgroup’s general principles of decontamination. This establishes a move towards in-situ testing for residual proteins on instruments. Residual protein is important because of the potential risk of the transmission of prions, though vCJD has not been shown to have been transmitted person-to-person in this way. The guidance provides information on how sterile services departments can mitigate the patient safety risk from residual protein with the objective of reductions in protein contamination levels through the optimisation of decontamination processes.

The ambition is that all healthcare providers engaged in the management and decontamination of surgical instruments used in acute care will have implemented this guidance by 1 July 2018. However, providers whose instruments are likely to come into contact with higher-risk tissues—for example, neurological tissue—are expected to give the guidance higher priority and to move to in-situ protein detection methodologies by 1 July 2017.

The chief medical officer has also recently written to NICE supporting the need to update its guidance on patient safety and the reduction of risk of transmission of CJD via interventional procedures, to ensure that it is fit for purpose, appropriately targeted, and can command the confidence of those who use it. We would expect this to take account of available evidence, including decontamination methods that are safe and effective against human prions; the epidemiology of CJD, including data on the prevalence of vCJD infectivity in the UK population from the appendix prevalence studies; and the availability and performance of single-use instruments in high-risk specialties. We would also expect the guidance review to be considered in the context of the latest research on prevalence, particularly for those born after 1996, who are currently considered unlikely to have been exposed to the BSE agent.

My hon. Friend is right, however, to say that adopting the precautionary principle alone is not sufficient. That is why successive UK Governments have been supportive of the development of new measures that might help in vCJD risk reduction. The Department of Health has provided over £70 million for CJD-related research in the last 15 years. That research has focused on infectivity, pathogenesis and transmission risk; decontamination of surgical instruments and the development of more sensitive methods to detect residual proteins to improve instrument cleaning; test development, treatment and diagnosis; and surveillance, screening, epidemiology and case finding.

[Sir Paul Beresford]

I accept everything that my hon. Friend says. However, a test solution is on the market and waiting to come through. The prion unit test has reached the point at which it just needs a final run to ensure that it does come through. I hope that I can count on the Minister to back me in persuading the MRC to support that last round of testing. If we could test blood, we would not have to import blood products from overseas. We could separate out the one in 2,000 or whatever the figure is and cut down on the costs of instrument storage.

[Nicola Blackwood]

That is one reason why the Department has continued in difficult financial times to ring-fence £5.5 million a year for CJD-related research. We are keen to see safe, evidence-based, cost-effective measures to reduce the risk of vCJD. At the moment, however, there is no validated diagnostic blood test that can be used before the onset of CJD symptoms to diagnose whether someone is infected or incubating the disease. We will of course take advice from the ACDP and the Advisory Committee on the Safety of Blood, Tissues and Organs on the use of any potential test in any proposed Department of Health-funded research study or deployment by UK blood services, but there are established systems for applying for research funds. We have put such funds out there, and any applications for those funds must go through the standard processes. To do otherwise would be to undermine the reputation for research excellence that the UK scientific community has fought hard to establish.

To that end, we recently launched an open competition, inviting proposals for research to further inform our risk-management and health-protection measures, including our understanding of vCJD infection in the UK population, the development of a test able to detect pre-clinical levels of infection in blood, and the development of decontamination technologies for reusable medical instruments. I understand that Professor Collinge’s RelyOn is one application that is currently going though that process, so it would be inappropriate for me to intervene.

I assure the House that the Department recognises the fatal consequences of all forms of clinical CJD and the devastating cost to individual patients, their families and carers, which my hon. Friend described movingly. That is why we set up the vCJD Trust in 2001 in recognition of their wholly exceptional situation and the fact that the Government are their last resort for help. The trust provides a no-fault compensation scheme for vCJD patients and their families, providing payments to be made in respect of 250 cases from a trust fund of £67.5 million. Over £41 million has been paid out by the trust to date.

[Jim Shannon]

In my intervention on the hon. Member for Mole Valley (Sir Paul Beresford), I asked whether compensation should be increased because of the number of years since the agreement was first made. With great respect and humbleness, I ask the Minister whether the Government would consider that.

[Nicola Blackwood]

The scheme is considered to be particularly effective. I shall look at it in the light of the hon. Gentleman’s comments, but it seems to be meeting current concerns. It is also important not to overstate the risks of CJD compared with other disease threats we face. The incidence is now low, with only two new cases in the UK since 2012. While every death is an individual tragedy and we must be alert, we need to ensure that finite resources—research funding, policy development or committee activities—are applied proportionately and are appropriately evidence based.

The ACDP continues to provide independent risk assessment advice on prion disease, informing both research priorities and public health measures to mitigate against risks from healthcare interventions, including the surgical, medical and dental procedures issues that were raised today. The ACDP is clear that risk to both patients and the general public is extremely low. Nevertheless, the current robust systems of active surveillance for CJD continue, and our experts maintain a close watch on new evidence, reviewing it as it becomes available. I assure the House that neither the Government nor the NHS has drawn back from our responsibilities to ensure that precautionary and proportionate measures are in place to protect patients from the risk of acquiring infection with prion agents during their healthcare. We have put in place robust research investment to ensure that the situation can only improve.

Question put and agreed to.

Child Cancer

Baroness Blackwood of North Oxford Excerpts

Monday 28th November 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is, as always, a pleasure to serve under your chairmanship, Mr Davies.

I begin by acknowledging and thanking the many thousands of people who have supported the petition in memory of Poppy-Mai Barnard. I extend my deepest sympathies to Poppy-Mai’s family and friends. I also thank my hon. Friend the Member for Bath (Ben Howlett) for the thoughtful way in which he presented the petition. The debate has been moving. I shall do my best to respond to as many comments as possible; if I fail, I shall write in response.

I acknowledge the success of Poppy-Mai’s family in raising more than £100,000 in her name, with the aim of building a sanctuary for children with terminal illnesses and their families to make memories. I know that they would, in the spirit of the petition, want action to ensure that fewer and fewer children have to suffer from cancers, and that they would want to know that the Government are investing in key research and innovation to that end. I hope that there is some comfort to be derived from hearing of the work of the NHS and its partners to benefit children and their families in the future. I thank colleagues on both sides of the House for their moving and highly informed contributions and all who have bravely shared personal stories. They remind us forcefully of why we must fight harder in the battle against childhood cancer. The importance of that cannot be overstated.

At this point, I want particularly to respond to the hon. Member for Alyn and Deeside (Mark Tami), who made some extremely important and pertinent points, in particular about ensuring that there is the right support for families. They must battle on many fronts, not only at the point of diagnosis but in the longer term. As the Minister responsible for mental health I share the hon. Gentleman’s view that we must do better in taking into account the mental health implications of long-term and critical illness. I shall certainly take up his challenge to consider the issue of higher suicide rates among childhood cancer survivors. At the moment we are in the process of refreshing the suicide strategy, targeting vulnerable groups. I shall consider the issues that the hon. Gentleman raised.

We can take heart from the fact that we are making progress in a number of areas. National statistics reveal a general trend of increasing five-year survival for children aged up to 14 diagnosed with cancer in England. In 1990 only 67% of children diagnosed with cancer survived five years; in 2009 that had increased to 80.9% of children. The figure was about 40% in the 1970s, which enables us to understand how far we have come. However, some types of children’s cancers, as we have heard, remain hard to treat, with longer-term physical and psychological consequences. In the past few decades we have improved our understanding of the consequences and have been able to manage them better; but we must and can do better. As the hon. Member for Birmingham, Selly Oak (Steve McCabe) said, we need to speed up the translation of basic research into patient care, and to improve the quality of survivorship.

As my hon. Friend the Member for Bath said, the five-year cancer strategy for England is at the forefront of our efforts. That was produced on behalf of the whole cancer community by the independent cancer taskforce. It is our aim through that strategy to save an extra 30,000 lives of all ages by 2020. The taskforce, as hon. Members would expect, brings together all the major players supporting people with or at risk of cancer. It includes patient groups and voluntary sector organisations, which we know are crucial to the support of cancer patients. I join colleagues in paying tribute to Oliver, the nephew of the hon. Member for Barnsley East (Michael Dugher), and to Be Child Cancer Aware, Anthony Nolan, Cancer Research UK and many other charities that do so much in this area. Without the outstanding work of many medical charities, our work would be less robust and innovative and there would be less hope of bringing about the step change that we need.

The strategy was published in July 2015 and was followed by an implementation plan to take it forward in May 2016. The first annual report was published last month. The Government accepted all 96 recommendations of the strategy, some of which are directly related to children, including a review of children’s and young people’s cancer services to inform actions. The aim is to deliver improvements across the cancer pathway and to improve the quality of care and survival rates—to make exactly the Herculean effort, and with the same co-ordination, called for by my hon. Friend the Member for North Thanet (Sir Roger Gale).

I am relieved that the taskforce found that cancer services for children and adults, and the outcomes in those services, have improved in recent years. The strategy is specifically designed to build on that momentum. Many of the recommendations relate to all cancers and cancer services; but of course some are relevant to, and greatly benefit, children and their families in their experience of care, and improve outcomes.

NHS England is leading the health and care system in delivering the strategy and investment is being targeted to support that. Key elements include: investing up to £300 million a year by 2020 to increase diagnostic capacity to meet a new faster diagnostic target—many people have spoken of the importance of early diagnosis —so that all cancer patients will be given a diagnosis or the all-clear within 28 days of GP referral; investing £130 million to modernise radiotherapy across England, ensuring that over the next two years older Linac radiotherapy equipment being used in hospitals will be upgraded or replaced, so that patients get access to the latest leading-edge technology regardless of where they live; establishing cancer alliances throughout the country to drive clinical leadership; and supporting the national cancer vanguard to test new models of care.

A theme of the strategy is the improvement of information on services and outcomes, including, from 2017-18, exploring approaches to collecting data on the experience of care of children who are cancer patients.

[Thangam Debbonaire]

On the point about upgrading Linac machines for radiotherapy, one of the key problems that Cancer Research UK raised with me was radiographer and radiologist staffing shortages. Can the Minister add anything to reassure us that when the Linac machines are upgraded there will be sufficient staff?

[Nicola Blackwood]

There is also work being done on making sure the workforce are in place; and there is an overall strategy with Health Education England to do that. I am happy to write to the hon. Lady to give her details. I am slightly concerned that I have a lot to get through and I am going to bore everyone.

The taskforce has also recommended a new drive to deliver chemotherapy e-prescribing, which makes a significant difference to the experience of families who are supporting children being treated for cancer. Providers are working to implement plans for children by September 2017. Under the strategy, proposals will have been developed by March 2017 to improve the transition of young patients with cancer between children’s and adult services. As the hon. Member for Bristol West (Thangam Debbonaire) has said, transitions continue to pose a problem in some areas, with paediatric services stopping at 16 in some hospitals, but adult services not starting until 18. In addition, pathways between specialist centres and shared care units currently cause great difficulty for patients. The strategy says that there is a need to address that, and I hope that the hon. Lady will be reassured that work is being done on it.

An important recommendation of the strategy is that NHS England, the National Institute for Health Research and cancer research charities should work together to consider how to achieve a significant increase in access to clinical trials for teenagers and young adults with cancer—the shadow Minister, the hon. Member for Burnley (Julie Cooper) spoke about that. A far smaller proportion of teenaged and young adult patients than of younger children take part in clinical trials. There is obviously an opportunity that we need to grasp. The strategy recommends that we explore ways in which clinical trials for children and young adults with cancer could be significantly increased. As the shadow Minister said, NHS England should set an expectation that all centres should aim to recruit at least 50% of their patients for those trials by 2025. That is the target that we are reaching for.

Outside London, only four centres treat more than 100 children with cancer a year, across all types of cancer. The strategy recommends that NHS England, working through the children, teenagers and young adults clinical reference group, should consider whether outcomes could be improved through further reconfiguration of services, as the shadow Minister said. Any review should again be based on patient outcomes, including patient experience, as few centres offer comprehensive specialist services for children at the moment.

Many hon. Members have rightly called for research to be prioritised in that context. It is good that, since 2010-11, we have increased annual investment in cancer research through the National Institute for Health Research, including research into childhood cancers, from £101 million to £142 million. However, we know that a lot more needs to be done if we are to deliver the changes that we want to see. That is why the Government announced the largest ever investment in health research in September— £816 million over five years from April 2017. Some 20 NHS and university partnerships across England have each been awarded funding through the NIHR, and we expect to see significant research activity in childhood cancers within that programme of investment.

The NIHR is also collaborating with three charities—Teenage Cancer Trust, Children with Cancer UK and CLIC Sargent—to identify gaps and unanswered questions in research into young peoples’ cancer and to then prioritise those gaps that patients and clinicians agree are the most important. The initial survey opened just last month, so we expect to see progress on that soon.

A new working group has brought together clinicians, charities and officials to discuss how we can increase the level and impact of research into brain tumours, including those in children. The group first met in October and the Government anticipate that it will complete its tasks by September. I will be co-chairing the next meeting in January with the Department of Health’s chief scientific adviser, Professor Chris Whitty, to make sure that we make the progress needed.

[Julie Cooper]

Does the Minister agree with the important comments made by brain tumour charities that EU funding is fundamental, and will she commit to ensuring that, should we not have access to EU research funding post-Brexit, the UK Government will make sure that that gap is filled?

[Nicola Blackwood]

The shadow Minister has made some important points about the EU, as have a number of colleagues, and I will come on to them before I finish. First, let me complete my remarks on the amount of funding that we have put into research, because it is important that it is seen as a package. Less than two weeks ago, the Government announced a further £112 million of funding to support the skilled personnel and cutting-edge facilities needed to help at the forefront of clinical research—experimental clinical research in particular, including research into child cancers. I visited one of those facilities myself, and they are an important aspect of the research we are supporting. The Chancellor announced £2 billion additional funding per year for research and development by 2020-21 in the autumn statement, including for scientific research at universities and businesses. That is another part of the picture.

The hon. Member for Birmingham, Selly Oak, who is not in his place, spoke of the importance of precision cancer medicines. The Government agree, which is why we have funded the 100,000 genomes project, to diagnose, treat and prevent rare disease and cancer, including childhood cancers. The Government have invested hundreds of millions of pounds in that project to date and it is already making a difference—the first children with rare diseases have received diagnoses through the project at Great Ormond Street Hospital. The project promises to offer a genuine step-change in diagnosis and precision treatment, which is encouraging.

[Ben Howlett]

The Minister is being very generous with her time. I am pleased about the rare diseases aspect of what she has just mentioned. However, when engagement exercises are being undertaken with charities, it is often the case that the larger cohorts are focused on. Will she give assurances that in those engagement exercises with charities, some of the rarer cancers will also be a focus?

--- Later in debate ---

[Nicola Blackwood]

My hon. Friend is absolutely right. It is important to make sure that all different groups and diseases get the attention that they deserve. That takes me on to the issue of patient cohorts and the importance of collaboration across Europe.

For particularly rare diseases or cancers, it is sometimes necessary to look across borders to make sure that research includes the right numbers of patients. That has been a particular focus of the Department, and I am confident, owing to the work that we have been doing, that international—particularly European—networks and data sharing for research purposes will continue. We need to make sure that initiatives that have facilitated research, such as the paediatric medicines regulations, continue. My noble Friend Lord Prior is leading on that area of policy. I know that he is closely involved in all of those issues, and I am going to ensure that the specific concerns that have been raised today are passed on to him and are not dropped.

I assure the shadow Minister that the Chancellor has guaranteed that the UK will continue to have all of the rights, obligations and benefits that EU membership brings, including EU funding—up until the point that we leave, obviously. The Treasury has also committed to underwrite the payment of awards to UK organisations that make competitive bids to the European Commission —for example, for universities bidding for Horizon 2020. In addition to all of the funding I have spoken of, those moneys are protected.

My hon. Friend the Member for Bath made a couple of points about reviewing the work undertaken by NHS England to ensure that more children receive the treatment that they deserve. We will be working closely with NHS England and all partners to make sure that the strategy we have put in place becomes a reality and that the right performance metrics are in place, although that is a challenging process. Our best measure of success will be the cancer survival statistics. Those are currently provisional, but the Office for National Statistics will hopefully be assessed by the UK Statistics Authority in the future.

We have heard from many hon. Members of some deeply moving cases of young people battling cancer. We have heard of their courage and resilience, and of the fortitude of their parents and siblings.

[Wes Streeting]

I am grateful to the Minister for giving such a thorough and thoughtful response to the debate. As I mentioned, Kaleigh’s family are campaigning on DIPG. It would mean a lot to them if the Minister or one of her Departmental colleagues met them to talk about their experience and their hopes for how research funding in this area might improve the search for a cure going forward. Is the Minister able to make that commitment?

[Nicola Blackwood]

I am sure that either I or a Departmental colleague will be delighted to meet the hon. Gentleman and his constituents. It was moving to hear of their campaign.

Holding the Government and the NHS to account in this way could not be more important. I hope that my response has made completely clear not only my personal commitment but the Government’s wholehearted commitment to funding life-changing innovation and research into cancer, to delivering the cancer strategy in a way that transforms cancer care for current and future generations and to improving the long-term quality of life of childhood cancer survivors. That is surely the greatest memorial that we can offer to each and every one of those brave children who, like Poppy-Mai, have lost their battle with cancer. That is our task, and as I look around the Chamber, it is clear to me that each and every Member here will work as hard as they possibly can to make sure that they hold us to it.

Contaminated Blood and Blood Products

Baroness Blackwood of North Oxford Excerpts

Thursday 24th November 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) and all the members of the all-party parliamentary group on haemophilia and contaminated blood on helping to secure this debate, and I thank the Backbench Business Committee for providing time for it. It has been a highly informed, very personal and moving debate, but it has also been non-partisan. I thank all Members from across the House for the constructive way in which they have approached the debate.

I would like to begin by formally adding my personal apology to all those who have been affected by these tragic circumstances and the impact that this has had on so many families. I thank all colleagues’ constituents for their bravery in allowing their personal circumstances to be shared in the House today. It brings this debate to exactly where it should be, reminding us all what we are trying to achieve through the process. The importance of that cannot be overstated. I wish I could refer to all the constituents who were mentioned today. I listed them, but that would take most of the debating time that we have today, so I say thank you to all those who allowed their stories to be told. That is exactly why the Government are introducing the reforms we have been debating today to existing support schemes, alongside a commitment within this spending review period of up to £125 million until 2020-21 for those affected, which will more than double the annual spend over the next five years.

At the beginning, however, we should be up front in recognising that nothing can make up for the suffering and loss these families have experienced, and no financial support can change what has happened to them. However, I hope all of those here today will recognise that the support provided is significantly more than any previous Administration have provided, and recognise how seriously the Government take this issue. I would like to join colleagues in paying tribute to the previous Prime Minister and to my predecessor, my hon. Friend the Member for Battersea (Jane Ellison), for all their work on the issue. I reiterate their statement that the aim of this support scheme is that no one will be worse off.

It is, as many colleagues have said, time for our reforms to bring an end to the tortured road that far too many of those affected have been down. It is time for a more comprehensive and accessible scheme that gives those affected their dignity back. However, as I hope is clear from the debate, not all the details are yet resolved. I hope to answer as many questions as I can today, but I am certain that the noble Lord Prior will be listening closely to the debate, and he will be in contact with all those here today to make sure we can resolve details that I cannot get to in the time available.

Let me turn to where we are. The reforms guarantee that all those who are chronically affected will, for the first time, receive a regular annual payment in recognition of what has happened to them. That includes all the 2,400 individuals with hepatitis C stage 1, who previously received no ongoing payment, but who will now expect to receive £3,500 a year.

Increases to existing annual payments have also been announced. These are not designed in themselves to guarantee a reasonable standard of living. The package needs to be considered in the context of the whole range of support that is available for the patient group, including support being exempt for the purposes of tax, and benefits being claimed by beneficiaries of the schemes, as the hon. Member for Glasgow South West (Chris Stephens) rightly mentioned.

I would like to address a couple of the issues raised by the hon. Member for Kingston upon Hull North about finances. We do expect to spend all the budget allocated to the scheme in the year, but the budget for the scheme does come within the Department of Health’s budget, not the Treasury budget, so if there is an underspend in any one year, the money will remain in the Department of Health. If any payments that should be made within that year fall into the next year, we can take that money forward.

I would also like to address the concerns that have been raised about the tendering for the scheme. The shadow Minister is, I am afraid, not quite correct that Capita and Atos have already bid to administer the scheme. The invitation to tender has not yet been issued, so no initial bids have been received so far. We intend to issue the invitation to tender shortly, and I am absolutely sure that, as the tender is being designed, the concerns that have been raised in the debate will be heard, and that the concerns about trust and the history of this situation will be well understood by all those involved in the design.

[Diana Johnson]

I am grateful to the Minister for clarifying the position around the tender, but could she confirm that the only organisations or businesses that have been invited in for conversations with the Department of Health were the two that have been mentioned by a number of hon. Members today? Is that correct or not?

[Nicola Blackwood]

I have had no meetings on this issue, because it is obviously not within my departmental brief. I am happy to try to find out about that issue, if the hon. Lady would like.

[Christian Matheson]

rose—

--- Later in debate ---

[Nicola Blackwood]

I would like to move on to some other issues because we are quite tight for time.

I would like to talk about the budget that has been allocated, because it has been mentioned on a number of occasions. The pressures on the health budget will come as no surprise to anyone here today—we had an animated debate about that just this week. I would like to assure everybody in the House that, even in the context of those pressures, we fought hard to protect the money for this scheme through tough budget negotiations so that we could fulfil commitments that were made and ensure that the concerns of those affected are addressed as far as possible.

In that context, I would like to talk in a little more detail about some of the concerns that have been raised today by colleagues. Colleagues have rightly raised the issue of support for the bereaved and those relying on discretionary payments. That is why we have introduced the one-off payment of £10,000 to bereaved partners or spouses of primary beneficiaries, where infection contributed to the primary beneficiary’s death, and in recognition of their relationship at the time of death.

[Jim McMahon]

Will the hon. Lady give way?

[Nicola Blackwood]

I will in one second. I just want to respond to a point made by the hon. Member for Kingston upon Hull North about the certification of death. We understand that death certification may not state a direct contribution, so the policy that is to be published will recognise other ways to show a causal link between infection and death. We would like to make sure that issues around that are not a barrier to support under the scheme.

[Jim McMahon]

I thank the Minister for giving way on that point, which she has partly answered in her contribution. However, could we just get some clarity on cases where the death certificate is marked “unascertained” and on whether there will be more flexibility around that, providing that the hepatitis can be proven?

[Nicola Blackwood]

The hon. Gentleman makes an important point. Those are exactly the issues that are being wrestled with at the moment by the Department, and we are trying to resolve them.

We realise that the accessibility of the payment scheme for the bereaved, but also of the discretionary support scheme, will be important, as mentioned by the hon. Member for Glasgow South West and my hon. Friend the Member for Worthing West (Sir Peter Bottomley). I am not able to give the complete details of the discretionary scheme at the moment. In 2017-18, a new, single discretionary scheme will replace the three discretionary support schemes that are currently in place. It will have an increased budget, and it will be transparent and flexible so that it can support the beneficiaries who are most in need. However, until those details are fully worked out, it would not be fair for me to speculate on exactly what they will be. I want to reassure hon. Members, however, that until we are in a position to introduce that new system, the current discretionary payments will stay in place.

I would also like to reassure hon. Members that the policy of paying bereaved partners and spouses £10,000 will be published by the Department of Health, and it will be communicated to all major stakeholders, including the APPG, to ensure that we reach out to those who were bereaved a long time ago and make both these policies as accessible as possible.

We realise that these payments can never make up for the personal loss bereaved partners or spouses have experienced, but we are trying to make sure that the process is as smooth and effective as possible, with as few barriers as possible, so that individuals do not feel as though they are trying to jump through hoops.

[Chris Stephens]

On the point I made earlier, which was echoed by the hon. Member for Worthing West (Sir Peter Bottomley), will death certificates be dealt with in a very sympathetic fashion, so that someone’s death certificate will not say HIV or hepatitis C, although we will know through their medical records that that was the cause of death? Will the Government look at that?

[Nicola Blackwood]

The issue of death certificates is one that we are very alive to. It is one that the Department is trying to address, and I hope that we will be consulting closely with the relevant groups to make sure we deal with it in as sympathetic a manner as possible.

[Ms Ritchie]

Could the Minister comment on the points I made about the inactivity of the Northern Ireland Executive? Would it be possible for further phone calls to be made to the Minister for Health in Northern Ireland to accelerate the process and to enable payments and a scheme to be made available?

[Nicola Blackwood]

If the hon. Lady will have a little patience, I have an entire section on the devolved nations coming up. Before then, however, I would like to move on and speak a little about the other sections of the scheme. As well as the one-off payment to bereaved partners and spouses, the Government’s response to the consultation makes it clear that partners and spouses will be able to continue to access discretionary schemes on a means-tested basis. However, that is not the end of the story. My officials will continue to work with a reference group of experts on the details of the policy for this new payment for the bereaved and on elements of the wider discretionary payment. As soon as the policy is confirmed, the Department will publish it and give guidance on who is eligible and how to access the payment as easily as possible.

I recognise that, as has been clear from this debate, some do not feel that the new payments that have been announced are sufficient. However, they are based on the consultation response, and a judgment was made to provide support to the widest group of people possible to recognise the pain and suffering of those who have been affected by this tragedy. There are never really any right answers when designing a support scheme in recognition of such awful circumstances. Difficult judgments have to be made in relation to prioritising support. We consulted on the proposals and used the responses gathered to announce reforms that, for the first time, provide annual payments to all infected individuals rather than waiting for more people to get sicker before they receive support.

The hon. Member for Kingston upon Hull North raised issues about other viruses. We have not expanded the scheme to include other viruses, including vCJD. In that case in particular, that is because there is already a vCJD compensation scheme that offers no-fault compensation. It was set up by the Government for vCJD patients and their families in recognition of their wholly exceptional situation. The scheme provides for payments to be made, in respect of 250 cases, from a trust fund of £67.5 million. Over £41 million has been paid out by the trust to date. There are currently no proposals to extend the infected blood system of ex gratia payments to include other viruses or infections that were contracted through routes other than NHS-supplied infected blood. This is based on the advice of the Advisory Committee on the Safety of Blood, Tissues and Organs. For example, hepatitis B was not involved in the schemes when they were set up because the blood donor hepatitis B screening test had been introduced in the 1970s. There are other reasons for not including hepatitis E that I am happy to write to the hon. Lady about in more detail should she wish me to do so.

We now arrive at the devolved nations section that I mentioned to the hon. Member for South Down (Ms Ritchie). Many colleagues have referred to the Scottish Government’s reforms. We are working closely with officials from Northern Ireland in keeping them up to date on our progress with implementation. These beneficiaries, as the hon. Lady said, will be eligible under the Northern Irish scheme to continue to receive support at their current levels. I am happy to ensure that my noble Friend Lord Prior is made aware of her concerns about the potential impact on Northern Irish victims.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) rightly raised the importance of co-ordination between the devolved nations on the support schemes. Given the significance of the points that he raised, and some complexities about the co-ordination of business, it is important that I ask my noble Friend Lord Prior to contact him directly on those points so that these matters can be co-ordinated effectively. I can reassure the hon. Gentleman on one point: the £500 winter fuel payment is now automatically included in the payment that people in England are getting as part of the support scheme. That means that they do not have to apply for it, as was the case previously. I hope that he will accept that that is a degree of progress.

Many colleagues point to the Scottish scheme as a blueprint for what they would like to see introduced in England, but there are some differences, as the hon. Gentleman noted. In England, there are about 2,400 individuals with hepatitis C stage 1 who were not receiving any annual payment. We have introduced a new annual payment for all those individuals so that they can get support now rather than waiting for their health to deteriorate before they are eligible for it. The Scottish Government have made their own judgments. They have chosen to provide a lump sum payment, and there are currently no proposals for annual payments to the hepatitis C stage 1 group.

We have put in place other measures to avoid the sense that, as the hon. Member for Hammersmith (Andy Slaughter) suggested, this support could be grudging, or that, as the hon. Member for Kingston upon Hull North mentioned, people could feel as though they were being treated as beggars. We have specifically put in measures to avoid this. For example, as we announced in response to the public consultation, people should not feel as though they have to jump through hoops to prove that they are worthy of support. We have no intention of introducing individual health assessments to registrants of schemes as a means of making people feel as though they have to prove their eligibility. Another key element is a special categories mechanism, with appeal, for those with hepatitis C stage 1 who consider that the impact of their infection, or the treatment for it, is similar or greater than for those at stage 2, such that they could qualify for stage 2 annual payments. This is a particularly beneficial aspect of the scheme.

Members have raised the issue of those who could clear hepatitis C infection. They will remain entitled to compensation under the scheme. The shadow Minister is right that those who clear the virus during the acute phase are not included in the scheme, but that is because the body fights off the infection before the severe health impacts occur. That has been the judgment of the expert advisory group, which we have been pleased to listen to.

[Chris Stephens]

Will the Minister deal with the question of tax rules? Has she had any discussions with HMRC on that issue?

[Nicola Blackwood]

I thought I had already answered that. These schemes are exempt from tax and we are continuing to ensure that the ongoing schemes will be subject to the same tax rules.

Several colleagues raised the issue of a public inquiry. The Prime Minister has been very clear that we do not believe that a public inquiry would provide further information. The things that a public inquiry could achieve, according to media reports, are establishment of the facts, learning from events, preventing a recurrence, catharsis, improving understanding of what happened, and rebuilding confidence and accountability. It is difficult to see what more information could be made available through a public inquiry given that action was taken as soon as possible to introduce testing and safety measures for blood and blood products as these became available, with the introduction of health and heated products, and that the Government have published all documents associated with this event from the period 1970 to 1985, in line with the Freedom of Information Act 2000. However, I am sure that campaigners will continue to make their case.

We have heard a lot about when this year’s payments will be made. I share that concern. When I was appointed as Parliamentary Under-Secretary of State with responsibility for public health and innovation, I made resolving this issue one of my highest priorities. I am not prepared to suffer any further delays. It is not fair that affected patients should suffer the continuing uncertainty that has been raised by colleagues. I have told the Department that it must announce the scheme immediately. I am pleased to announce that letters to all hepatitis C stage 1 sufferers were sent out on 11 November informing them of their new annual payment and asking them to claim this through the existing schemes. The schemes have said that they will be able to make these payments by 22 December. Letters to those at stage 2 and those with HIV have been sent this week, and their additional payments will be made shortly before Christmas. The schemes are also planning to send all letters to bereaved partners and spouses before Christmas with the aim of paying their new lump sums before the end of the financial year, and certainly during March 2017. Details of the payment schedules are now available on the schemes’ website. In addition, as already announced, all new and increased payments will be backdated from April 2016 or the date of joining the schemes, if later.

I believe it is right that the Government’s focus is on considering how best to create and implement a system with the increased budget that is affordable, that redesigns the inconsistencies that we have heard about, and supports those most affected by these tragic events now and into the future. I will continue to listen to the concerns of those affected. I hope that I have responded to those concerns as effectively as I possibly can.

Reducing Health Inequality

Baroness Blackwood of North Oxford Excerpts

Thursday 24th November 2016 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I welcome the opportunity to speak in the Chamber for a second time today, on yet another important topic. This time we are debating health inequalities and I thank the Backbench Business Committee for allowing this debate to take place following the application by the hon. Member for Totnes (Dr Wollaston) and other hon. Members across the House. The hon. Lady made an excellent speech, and we are very grateful to her for that. I also want to thank other hon. Members across the House for their excellent contributions today. I especially want to highlight the excellent speeches by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and my hon. Friends the Members for Stockton North (Alex Cunningham), for Bradford South (Judith Cummins), for Heywood and Middleton (Liz McInnes) and for Hackney South and Shoreditch (Meg Hillier).

I enjoyed the speeches by the hon. Members for Plymouth, Sutton and Devonport (Oliver Colvile)—a fellow member of the all-party parliamentary group on basketball—and for Erewash (Maggie Throup), who made an excellent speech on obesity and childhood obesity. I also enjoyed the speech by the hon. Member for Glasgow Central (Alison Thewliss). As she knows, I agree with most of what she says, especially about breastfeeding. We have had an excellent debate, with excellent contributions all round.

When it comes to addressing health inequalities, there are many conversations about the need for systemic change to reverse the trends. However, I want to look at tangible specifics that the Minister can get to work on in her remit as Minister for public health. I will do that by looking at the current state of health inequality and then the two key areas of smoking and childhood obesity and what more can be done to address those signifiers. I will then move on to the cuts to public health grants, which are exacerbating the situation.

The most recent intervention on health inequality came from the Prime Minister, who used her first speech on the steps of Downing Street to highlight that,

“if you’re born poor, you will die on average 9 years earlier than others.”

We have heard clear examples of that from constituencies around the country. That welcome intervention set the tone of her Government’s serious work to address health inequalities.

It is hard not to agree when the facts speak for themselves. Two indicators from the most recent public health outcomes data show that London and the south-east have the highest life expectancy while the north-east and north-west have the lowest. The same pattern appears when looking at excess weight in adults, which we have also heard about today. Rotherham comes out the highest at 76.2% and Camden is the lowest at 46.5%. Those figures prove what we all know to be true: people living in more deprived parts of the country do not live as long as those in more affluent areas. Contributors to ill health such as smoking, excessive alcohol consumption—which we heard about from the hon. Member for Congleton (Fiona Bruce)—and obesity are more prevalent in deprived areas.

There is a moral argument that it is important for the Government to address such issues, so that we can improve our nation’s health, but there is also an economic argument to be made. If we have an unhealthy population, we will not be as productive. In England, the cost of treating illnesses and diseases arising from health inequalities has been estimated at £5.5 billion a year. As for productivity, ill health among working-age people means a loss to industry of £31 billion to £33 billion each year. Those two arguments must spur the Government into action, but there are many issues to tackle and multiple ways for the Government to address them. Many such issues have been raised in the debate but, as I said, I will examine two key areas that the Minister must get right: smoking cessation and childhood obesity.

My first outing as shadow Public Health Minister was to debate the prevalence of tobacco products in our communities and the need for the Government to bring forward the new tobacco control plan.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

indicated assent.

[Mrs Hodgson]

The Minister remembers it well. The Government need to set out key actions to work towards a smoke-free society. Smoking is strongly linked to deprivation and has major impacts on the health of those who do smoke, such as being more prone to lung cancer and chronic obstructive pulmonary disease and facing higher mortality rates. If we look at that by region, which I have already established is a factor in health inequality, smoking levels are higher in the north-east at 19.9% compared with the lowest in the south-east at 16.6%. When looking at smoking by socioeconomic status, we find that the smoking rate in professional and managerial jobs is less than half that in routine and manual socioeconomic groups, at 12% and 28% respectively.

In the debate held just over a month ago, the Minister was pushed on when the new tobacco control plan would be published. Concerns have been raised by various charities, including ASH, Fresh NE and the British Lung Foundation, about how the delay could jeopardise the work already done. Sadly, the Minister evaded my specific question back then, so I will ask her the same thing again: when can we expect the new plan? Will it be this year or next year? The plan will not only go a long way to work towards a smoke-free society, but help to reduce health inequalities in our deprived areas. The Minister can surely understand that and the need to come forth with the plans.

The Minister knows that I also take a keen interest in childhood obesity. She has said repeatedly that the publication of the childhood obesity plan was the start of the conversation. Childhood obesity is the issue on everyone’s lips right now as it is the biggest public health crisis facing the country. I will not repeat the stats we all know about the number of children who start school obese and the number who leave obese—they are shocking. Many organisations and individuals, including Cancer Research UK, the Children’s Food Trust and Jamie Oliver, have made clear their dismay at the 13-page document that was snuck out in the summer and have said that it did not go far enough. Incidentally, it came out on the same day as the A-level results, so it looked like it was being hidden.

Obesity-related illnesses cost the NHS an estimated £5.1 billion a year, and obesity is the single biggest preventable cause of cancer after smoking. It is also connected to other long-term conditions such as arthritis and type 2 diabetes. When obesity is linked with socioeconomic status, we see real concern that the plan we have before us will not go far enough to reverse health inequality. National child measurement data show that obesity among children has risen, and based on current trends there could be around 670,000 additional cases of obesity by 2035, with 60% of boys aged five to 11 in deprived communities being either overweight or obese. There is a real need for the Government to come to terms with the fact that many believe the current plan is a squandered opportunity and a lot more must be done. That is why I hope the Minister will be constructive in her reply to this debate, giving us reassurances that move us on from this being “only the start”. At the end of her speech, the hon. Member for Erewash gave us a list of four or five items that we could start straightaway, which would certainly take us further on.

The Government have stalled or not gone far enough on the plans I have mentioned, but there is also deep concern that the perverse and damaging cuts to public health spending will widen the health inequality gap. The Minister knows the numbers that I have cited to her previously, but I will cite them again, even after my right hon. Friend the Member for Kingston upon Hull West and Hessle has done so. We are greatly concerned about the £200 million cut to local public health spending following last year’s Budget, which was followed by the average real-terms cut of 3.9% each year to 2020-21 in last year’s autumn statement. I want to add some further concerns that go beyond those raised by Labour.

Concerns were identified in a survey by the Association of Directors of Public Health, which found that 75% of its members were worried that cuts to public health funding would threaten work on tackling health inequalities. Those concerns are backed up by further evidence published by the ADPH, which found that local authorities are planning cuts across a wide range of public health services, because of central Government cuts. For example, smoking cessation services saw a 34% reduction in 2015-16, and that will become 61% in 2016-17, with 5% of services being decommissioned. That is seen across the board among local public health services and will be detrimental to reversing health inequalities. For the Government to fail to realise that cutting from this important budget will not help the overall vision on health inequality, set out by the Prime Minister earlier this year, is deeply worrying and shows a distinct lack of joined-up thinking around this issue.

In conclusion, health inequality is a serious issue that we cannot ignore or let the Government get wrong, as the health of our nation is so important, not only in a moral sense, but economically. I know the Minister will fully agree with the Prime Minister’s statement from earlier this year—there is no second-guessing that, as we all do—but we need radical proposals that get to the bottom of this persistent issue, which blights the lives of so many people living in our most deprived communities. We all want to see a healthier population, where nobody’s health is determined by factors outside their control, and we must all work together to get to the point where it is no longer the case that the postcode where somebody is born or lives determines how long they will live or how healthily they will live that life.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), on her characteristically thoughtful opening of this debate. I thank the Backbench Business Committee for agreeing to the debate, which has been not only highly informed, but very wide ranging. I will therefore start by apologising for the fact that I will not be able to comment in detail about all the points raised, but I will reply in writing where I am not able to respond. Colleagues are right to say that the Prime Minister has made this issue a national priority, so it is not surprising that the Government share the commitment of the House to having an effective cross-Government policy that will reduce health inequalities.

We are recognised as world leaders in public health, and that has been achieved by avoiding the temptation to put health inequality in a silo. Marmot, as many have pointed out, is clear that an approach to treating health alone will not tackle what we here know are some of the most entrenched problems of our generation. We have avoided a health-only approach in the past, which is why the Chancellor’s autumn statement yesterday announced important and relevant measures such as raising the national minimum wage, raising the income tax threshold and providing, as the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, rightly observed, an additional £1.4 billion to deliver 40,000 extra affordable homes. That provision is in addition to the Homelessness Reduction Bill.

It is right that we also look to the work of industry and non-governmental actors. I am pleased to say that the food and drink industry has made progress in recent years. Its focus under voluntary arrangements has been on calorie reduction. Billions of calories and tonnes of sugar have been removed from products, and portion sizes have been reduced. Some major confectionary manufacturers are committing to cap single-serve confectionary at 250 calories, which is an important step forward. As my hon. Friend the Member for Erewash (Maggie Throup) mentioned, some retailers have played their part by removing sweets from checkouts, while others have cut the sugar in their own-brand drinks. We welcome that and urge others to follow suit. The challenge to industry to make further substantial progress remains. We should praise those who have had success, but we will continue to challenge those who lag behind.

Colleagues are right to highlight the importance of employment, and it is encouraging to see that some gaps are narrowing. As the Chancellor said yesterday,

“over the past year employment grew fastest in the north-east…pay grew most strongly in the west midlands, and every UK nation and region saw a record number of people in work.”—[Official Report, 23 November 2016; Vol. 617, c. 900.]

But there are still some who are left behind, which is why our health and work Green Paper is specifically focused on driving down the disability work gap for those who wish to work. It is this emphasis on the social, economic and environmental causes of inequalities that convinces me that public health responsibilities as they are traditionally understood do rightly sit in local government, where national action can be reinforced and resources can be specifically targeted at pockets of inequality within local populations.

Let me respond to the concerns raised by my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) about his GP practices. When a GP practice closes, NHS England has a responsibility to make sure that patients still have access to services and are not misplaced. I am pleased to hear that he is making some progress on the matter, but if he finds that he reaches a roadblock, I will be happy to raise his concerns with the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), who has responsibility for community health.

Although, as a number of colleagues have said, councils have had to make savings and are acting in tough financial circumstances, they are still accessing £16 billion over the next five years from their public health grant. They have shown that good results can be achieved while efficiencies are found and the greatest effect is generated. There are a number of examples of outstanding practice to which we should pay tribute today. The HIV innovation fund, for example, which is funded by Public Health England in collaboration with local government, provides funding for services that meet local needs and offers the most at-risk populations free, reliable and convenient alternatives to traditional HIV testing. That is happening at a time when driving up HIV testing is a key public health priority.

As my hon. Friend the Member for Totnes rightly noted, however, we must focus on key determinants such as obesity, smoking, suicide and alcohol. That is the core of the challenge that we face, which is why we are working closely with our partners in the NHS, PHE, local government and schools to deliver the childhood obesity plan. That subject has been raised by many speakers today and I assure the House that the delivery of the plan has started. We have consulted on the soft drinks industry levy and launched a broad sugar reduction programme. Those measures will have a positive impact, particularly on lower income groups, which are disproportionately affected. As many colleagues have mentioned, the measures will have secondary benefits, such as better dental health and diabetes prevention.

As was mentioned by my hon. Friends the Members for Erewash and for Taunton Deane (Rebecca Pow), it is particularly important that we focus on effectively delivering a key plank of that obesity plan: the hour of physical activity every day. One of the ways in which we will make sure that is delivered effectively is by introducing a new healthy rating scheme in primary schools to recognise the way in which they deliver this and to provide encouragement. I believe that we have delivered the right approach to secure the future health of our children, but I am determined that we will implement it quickly and effectively, and I am very happy to enter into discussions about how we make sure that that implementation works.

I entirely agree with hon. Members on both sides of the House that mental health must not be forgotten when we are discussing health inequalities. We have made progress, but parity of esteem must be more than just a phrase; it must be backed by increased funding and effective reform. That is why we are investing an additional £1 billion every year by 2020 to help 1 million more people with mental illness to access high-quality care, including in emergency departments, as well as putting in place a record £1 billion of additional investment in children’s mental health. That money is funding every area in the country. We are working hard to make sure we drive these reforms to the frontline, including, as my hon. Friend the Member for Totnes said, by refreshing the suicide strategy with a particular focus on the alarming figures for suicides among young men and for self-harm.

There can be no complacency about the scale of the challenge, as the figures quoted today forcefully remind us. We know that inequalities can be stubborn to tackle. Variations in smoking rates, particularly in pregnancy, persist, and concerted efforts are required to tackle that. That is exactly why I am prioritising the tobacco control strategy so that we can use our combined efforts to target vulnerable groups, including pregnant women, mental health patients and children, and reduce those differences, not least by supporting local areas to use data effectively to understand how best to target their policies.

[Alex Cunningham]

Can the Minister offer us a timescale for the tobacco strategy?

[Nicola Blackwood]

I cannot, because I am not yet satisfied that it is as effective as I want it to be.

In addition, I am pleased with the action we have taken to introduce standardised packaging for cigarettes and other legislative measures. We have also launched the world’s first diabetes prevention programme, as mentioned by the hon. Member for Heywood and Middleton (Liz McInnes), and we had a very good debate just yesterday about how we can improve diabetes care. We also have one of the most effective immunisation programmes in the world. That shows our commitment to take firm action where the evidence guides us, but as I have said, that action must be cross-government, at both a local and a national level.

Our job is to put prevention and population health considerations at the heart of everything we do, as the five year forward view makes clear. Devolution deals are giving local areas more control over many of the social determinants of health, such as economic growth, housing, health and work programmes, and transport. The focus on integrated public health services within devolution promises to remove many of the structural barriers to prevention that we have discussed today, and it makes public health everyone’s business, exactly as the SNP spokesman, the hon. Member for Glasgow Central (Alison Thewliss), said.

However, with devolution, to which the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) referred, and as we move towards business rates retention, transparency will be ever more vital to ensuring that public health outcomes improve. That is happening, but we need to go further, and we need to do more to engage local people and their elected councillors in highlighting the unjustifiable inequalities that persist. Ensuring that transparency translates into accountability is a key priority for me, and I assure the House that I am actively involved in this matter.

Members on both sides of the House are right to launch this challenge today, and I take fully on board their suggestions of how we can collectively reduce health inequalities. However, I hope that I have made it clear that the only way we are going to make progress on this issue is to adopt a whole-Government, whole-society approach. We have to constantly remind ourselves that reducing these inequalities is for not just the NHS or Public Health England, but the whole of Government, as well as local areas, industries and, indeed, all Members of this House. Today I reaffirm my commitment to work together with the widest range of partners, inside and outside Government, to make progress on this agenda. I hope that every Member here will do the same, because we owe our constituents nothing less.

Diabetes Technologies

Baroness Blackwood of North Oxford Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) both on raising this very important subject and on the constructive and helpful manner in which he raised it.

I intend to confine my remarks to type 1 diabetes and, in particular, young type 1 diabetics. I should say that I am indebted to both Diabetes UK and the Juvenile Diabetes Research Foundation for the very helpful briefing that they provided and for the important work that they do on behalf of people with diabetes.

Diabetes, whether type 1 or type 2, is a life-changing condition regardless of the age at which it is diagnosed, but for young type 1 diabetics, it is also a lifelong challenge. Young type 1 diabetics face a daily and lifelong routine of monitoring glucose levels and administering the appropriate doses of insulin. It is not insignificant that one quarter of hospital admissions for ketoacidosis are of 16 to 25-year-olds; that is quite a shocking statistic.

At the same time, dealing with the transition to adulthood, with all the attendant biological, psychological and physiological changes that occur, can be even more challenging for young diabetics and their families. Many young diabetics face bullying. The hon. Member for Upper Bann (David Simpson) referred to a problem in schools. Quite often, because of the misconception about what type 1 diabetes is, young diabetics will face taunts: “Well, it’s your own fault because you don’t eat properly”, “You’re overweight” and so on. It is bad enough that young diabetics face bullying in school. Very often, as the hon. Gentleman signified, schools simply do not know how to deal with this issue.

One thing about being a type 1 diabetic is that because their blood glucose levels can be very unreliable, they sometimes need to take glucose, which means that at a certain point their absolute priority is to eat something. They have to be able to eat something to even out their blood sugar levels, yet all too often teachers will not allow them to use the classroom in those circumstances.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

indicated assent.

[Mr Howarth]

I see the Minister nodding. This really is a problem. Schools need to be advised on how to deal with these situations, so that in every classroom the teacher is aware, whether or not they have a type 1 diabetic in their class, of what they are supposed to do in those circumstances. The lack of understanding in many schools—not all of them, as some deal with the matter very well—must be tackled.

However, I do not want to be overly gloomy about the problem. Organisations such as the JDRF and Diabetes UK, in conjunction with others, including the all-party parliamentary group for diabetes, of which I am a member, are both raising the profile of the way type 1 diabetics are being failed by the healthcare system and suggesting constructive ways of improving the situation. Later today there will be the launch of a report, not specifically on type 1 diabetes but on how services can be better organised. That is the result of many months of taking evidence from expert organisations. I hope that Ministers will study that report closely.

With regard to progress, scientific research is making great headway. The hon. Member for St Ives, who opened the debate, highlighted some of the scientific research going on and the technologies that are available. It is in my view highly likely that a cure will be found well within the lifetime of today’s young diabetics. Building on the technology that already allows automatic continuous glucose monitoring and automatically pumped insulin, an algorithm for combining the two into an artificial pancreas already exists. The hope is that it will not be long before that technology becomes the norm. More development work is going on, but the research and tests that have been carried out indicate that that system works and can bring about a massive improvement in the lives of young people and others who suffer from diabetes, because it enables them to keep their blood glucose at an even level.

I want to say a few words about a particular problem that some young type 1 diabetes sufferers experience. As we know, as a society we face a problem—particularly, although by no means exclusively, among young women—as regards body image. The media, magazines and society in general put forward an idealised view of what a woman or, for that matter, a man should look like. We know about eating disorders that arise from that wholly inappropriate promotion of a “perfect” shape. I do not profess to be an expert on this issue, but my experience of life is that human beings come in all shapes and sizes, none of which is more acceptable than another—but that is just a personal view. However, some young type 1 diabetics discover—this is easy to find out through social media—that by manipulating their insulin intake, they can achieve rapid weight loss. To some young people, that sounds like a great thing to be able to do. Someone can lose perhaps half a stone in a week simply by not taking the amount of insulin that they require. Of course, the problem is that it leads to major medical complications and, in some cases, can end fatally.

Those who do fall into the habit, which amounts to a highly specialised eating disorder, need to be able to access support from diabetologists and from either psychological or psychiatric specialists. All too often, though, that support is not available—at least not in one place—at the time when the young person needs it most and they are left trying to negotiate a sort of medical specialists ping-pong game between, on the one hand, diabetologists, who do not understand the psychological problem that the young person is experiencing, and on the other hand psychologists or psychiatrists, who do not understand all the scientific and medical issues about their diabetes. I know that that is not the Minister’s specific area of responsibility—[Interruption.] Oh it is, she tells me, great—but I put in a plea for her to really give some thought to how those services can be co-ordinated in such a way that means those young people are not left travelling from one place to another, often with long distances involved, to try to access support, when all they can get is somebody who understands one aspect of their disease and the particular manifestation of that disease they have. We are not talking about tens of thousands of young people; we are talking about hundreds, but nevertheless these are young lives and they need to have proper access to all the services that they require.

I will conclude with a couple of questions, which are asked in an entirely constructive spirit. Can the Minister give an assurance that the Government will take an active interest in the research that is going on into technology, and that it will be properly supported? Does she agree that the achievement of making these technologies normal, particularly the artificial pancreas, needs to be pursued with absolute rigorousness? That could be delivered very quickly if the Government took an active interest in it. Will she commit—both through the technological means and better treatment design—to ensuring that the various services that can prevent serious complications are properly integrated so that the medical ping-pong is overcome?

I hope that I have not gone on for too long. Knowing you as I do, Mrs Gillan, I know that you would have told me if I had. Again, I thank the hon. Member for St Ives for giving me the opportunity to say the things that I wanted to say. I am sure that the young diabetics around this country who have the opportunity to do so, will be glad that at least their plight has been raised by at least one Member of this House.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I thank my hon. Friend the Member for St Ives (Derek Thomas) for giving us the opportunity to have such an important debate. His timing is impeccable, as always, as I found on the Science and Technology Committee, of which he was such an excellent member—we exist in a mutual admiration society. This debate follows on from world diabetes day last month. I want to add my voice to the tributes already paid to the all-party groups on diabetes and on vascular disease and to Diabetes UK for the work they do on this issue. It is invaluable, as we have heard from the very high quality and personal contributions this afternoon.

As the shadow Minister says, diabetes is one of the biggest health challenges facing this country today. The figures are truly sobering. Almost 3 million people in England are currently diagnosed with diabetes and we estimate that a further 940,000 remain undiagnosed. Furthermore, around 5 million are at high risk of developing type 2 diabetes. If nothing changes, by 2025 more than 4 million people will have the condition. As the right hon. Member for Knowsley (Mr Howarth) said, type 1 diabetes affects 400,000 people in the UK and its incidence is increasing by about 4% a year. It is not preventable, so the emphasis is on improving the lives of people with type 1 diabetes and helping them to manage their condition.

I absolutely associate myself with the words of the Prime Minister: the message should be that people are able to live full and active lives, and the Government are there to do whatever they can to support them to do so. I shall certainly undertake to study the upcoming report mentioned by the right hon. Gentleman and consider its proposals carefully.

Type 2 diabetes is much more common. Diabetes as a whole is a leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack and stroke. As my hon. Friend the Member for St Ives said, diabetic foot disease, including lower limb amputations and foot ulcers, account for more days in hospital than all other diabetes complications put together. We are determined to change that.

According to Public Health England and Diabetes UK, 5 million people in England are at high risk of developing type 2 diabetes, and one in 10 will develop the disease if current trends continue. Type 2 diabetes is largely preventable and manageable through lifestyle changes, as the shadow Minister has testified—I was very impressed by her testimony today.

There is also a huge financial cost—as well as a personal cost—to diabetes and its complications. It already costs the NHS in England more than £5.6 billion a year, and that continues to rise. In addition, the annual social care costs associated with supporting people with diabetes are estimated to be £1.4 billion. Managing the growing impact of diabetes is one of the major clinical challenges of the 21st century. That is why preventing type 2 diabetes and promoting the best possible care for all people with diabetes is a key priority for me and for the Government.

It will not surprise my hon. Friend the Member for St Ives to hear that, as the Minister for Public Health and Innovation, I believe he is absolutely correct to highlight the role that modern technologies, properly used, can play in the care of people with diabetes. We are extremely fortunate to have a thriving, world-class life sciences industry in this country—it is one of the jewels in the crown of our industrial sector. That is why we are investing an extra £2 billion a year in research and development by the end of this Parliament to help to put post-Brexit Britain at the cutting edge of science and technology, as the Chancellor announced today.

The development of new, innovative technologies is continuing at pace and is revolutionising health systems throughout the world. However, that will not help if patients do not benefit from it, so we want to make sure that patients here benefit as quickly as possible. As my hon. Friend the Member for St Ives said, we can do better. That is exactly why we commissioned the accelerated access review to support the NHS to become a system that embraces innovation and works in collaboration with innovators to get products to patients more quickly. The review was published last month. We are carefully considering its recommendations and will respond as soon as we can.

It is not surprising that we are seeing the emergence of technologies that have real potential to improve the lives of people with diabetes in the context of such a thriving life sciences sector. As many colleagues have mentioned, key to managing diabetes is monitoring and controlling glucose levels. Various technologies are available. Insulin pump technology is prime among these and is recommended by NICE as an option for people with type 1 diabetes. Many people are already benefitting from blood glucose monitoring with testing strips and a machine to read blood glucose levels, as well as continuous glucose monitoring. The shadow Minister went into great detail about how that already provides hundreds of readings a day to provide a clear picture of people’s glucose levels.

People also benefit from flash glucose monitoring, where the glucose concentration and trend is shown when the monitor is waved over the sensor. Other devices are also available; I understand that many people are already finding them useful in reducing hyperglycaemic and hypoglycaemic attacks. In some cases, as my hon. Friend the Member for St Ives said, such devices can offer life-changing support to patients living with diabetes. They can play a particularly valuable role for certain patient groups, including children and teens, when they are properly managed, as the hon. Member for Upper Bann (David Simpson)—who is not in his place—said earlier.

Clinical commissioning groups are responsible for commissioning diabetes services. In doing so, they need to ensure that the services they provide are fit for purpose, reflect the needs of their local populations and are based on the available evidence, taking into account national guidelines. In the end, none of the guidelines can supersede the best judgment of clinicians, formed with their patients, about the best treatment option for them. I know that NHS England is actively investigating the potential of technologies for use within the NHS with manufacturers and patient groups to understand and identify areas of need and barriers to adoption so that they can improve access.

Looking to the future, artificial pancreas technology, as was mentioned, continues to be developed. One system has recently been approved by the US Food and Drug Administration, and a European licence is being pursued. Large randomised clinical studies of similar systems are now beginning, and several are expected to come to market in the next five years. Teams in the UK, including in Cambridge and London, are leading on some of this work, but these technologies need to be used optimally as part of holistic treatment pathways so that we get the best patient outcomes from them. That is exactly what the NHS innovation accelerator aims to deliver.

The NHS innovation accelerator is supposed to realise the commitment in the five-year forward view to create the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically through the NHS for the benefit of patients. This is being delivered in partnership with all 15 academic health science networks. AHSN initiatives are patient-facing. Monster Manor, for example, is a free app launched by the Oxford AHSN—which I mention very selfishly—diabetes clinical network to encourage children with type 1 diabetes to track their blood glucose readings and become more engaged in their diabetes management. By logging readings, players earn rewards that help them to advance through the game.

The Yorkshire and Humber AHSN is implementing a locally developed set of tools to support general practice and community pharmacy in fostering greater self-care and health literacy among patients with diabetes and encourage them to do something to prevent severe hypoglycaemic episodes. A particular benefit of the AHSN network is the best practice sharing system, which is now in place, to ensure that improvements in one area can more quickly spread across the whole country.

Another example of accelerator innovation is the internet of things innovation diabetes test bed, which is funded by the Department. This enables people with type 1 or type 2 diabetes to do the right thing at the right time in self-managing their condition. It can be difficult to manage any long-term condition, so help is particularly valuable. People get a real-time view of their own data so they can take prompt action to prevent their condition from getting worse. This also encourages more timely and appropriate interventions from healthcare professionals. It is hoped that using technology in this way will also create genuine partnerships between patients and their healthcare professionals.

Realistically, the only way we are going to make measurable progress in halting the diabetes epidemic is to put strong measures in place to prevent those at risk from developing type 2 diabetes in the first place. Healthier You, the diabetes prevention programme, is the first type 2 diabetes prevention programme of its kind to be delivered at scale nationwide anywhere in the world. By 2020, the programme will be made available to up to 100,000 people at risk of diabetes each year across England. Those referred will get personalised help to reduce their risk, including education on healthier eating and lifestyles, and physical exercise programmes tailored to the individual. Building on that, NHS England is investing an additional £40 million each year to support CCGs in promoting evidence-based interventions to improve the care that all people with diabetes receive. In line with the points that my hon. Friend the Member for St Ives made, NHS England is encouraging GPs to refer people who are at high risk of diabetes into the national diabetes prevention programme, although referrals also come through the NHS health check, so there are two routes.

The role of structured education is widely recognised to be hugely important. The Department, NHS England and Diabetes UK are working together to improve the take-up of such education, including through digital and web-based approaches. Furthermore, NHS England is planning to make additional investment from 2017-18 to support the expansion of structured education to help patients to understand their condition better and manage it themselves more successfully.

The right hon. Member for Knowsley made some important points about the interaction of mental health services and diabetes provision. There is already significant activity to tackle the challenges of negative body image, and the Government announced a body image taskforce in 2010. It reports annually and is led by the Government Equalities Office. Simultaneously, in response to the priorities put forward in the five-year forward view on mental health, we are currently significantly improving care pathways for eating disorders. I have not so far investigated the specific challenge of how young diabetic patients interact with that context, but as a result of the right hon. Gentleman’s comments I undertake to do so.

I hope I have demonstrated not only the Government’s commitment but my personal commitment to harnessing new and innovative technologies as part of our drive to improve outcomes for the millions of people already living with diabetes and the many others at risk of developing the disease, as well as to sending out the clear message that diabetes does not in any way limit the ability to live an active life and to contribute well.

Oral Answers to Questions

Baroness Blackwood of North Oxford Excerpts

Tuesday 15th November 2016 Commons Chamber

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

8. What steps he is taking to implement his Department’s childhood obesity strategy.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

The Department is working closely with Public Health England, the national health service, local authorities, schools and other partners as we implement the childhood obesity strategy. We have already taken firm action, including consulting on the soft drinks industry levy and launching a broad sugar reduction programme.

[Stuart C. McDonald]

Channel 4’s “Dispatches” programme has comprehensively demonstrated how the former Prime Minister’s obesity strategy was drastically watered down by the time of the final publication. Both Public Health England and the Health Committee agree that control of in-store promotions of unhealthy food is absolutely vital. Why was regulation of such promotions ditched from the Government strategy?

[Nicola Blackwood]

We have made no secret of the fact that we considered a range of policies before publishing the childhood obesity strategy, which is a world-leading strategy and one of the most ambitious in the world. It will cut childhood obesity by one fifth in the next 10 years, and I am determined that we do not get lost in a debate about what it could or should have been, but instead get on with implementing it. Our children deserve no less.

[Gavin Newlands]

A few weeks ago, I hosted a Westminster forum on the implementation of the strategy, at which there was much consternation about why another important recommendation—the creation of a 9 pm watershed to reduce children’s exposure to junk food advertising—was cut. Does the Minister not realise the seriousness of the obesity crisis, and can she explain why that important measure was dumped?

[Nicola Blackwood]

Current restrictions on the advertising of less healthy food and drink in the UK are among the toughest in the world, so I am pleased to reassure the hon. Gentleman and his constituents on that fact.

[Mr Mark Harper (Forest of Dean) (Con)]

May I draw the Minister’s attention to some excellent leadership from the private sector? Lucozade Ribena Suntory, which is based in my constituency, announced last week —rather buried in the news from the United States of America, I am afraid—that it was going to take 50% of sugar out of its soft drinks by reformulating all its new and existing products. That demonstrates really good leadership and is an example to other companies.

[Nicola Blackwood]

I welcome my right hon. Friend’s question. He is absolutely right. We very much welcome the actions of not only Lucozade but Tesco in cutting the sugar in their drinks. It is proof that doing so is possible and meets the expectations of many consumers.

[Maggie Throup (Erewash) (Con)]

Recent data from the national childhood measurement programme shows that obesity rates have risen for the second consecutive year. With that in mind, will the Minister outline what further steps she has taken to make the childhood obesity plan for action into a true strategy?

[Nicola Blackwood]

As I have been saying during this Question Time, I am absolutely determined to focus on implementing the plan that we have. It is one of the most ambitious in the world, and it will deliver a reduction of a fifth in childhood obesity over the next decade. However, we have been clear that this is not the final word; it is just the beginning of the conversation. I would welcome contributions from my hon. Friend, who is a dogged campaigner on this issue.

[Keith Vaz (Leicester East) (Lab)]

Yesterday, on World Diabetes Day, the Prime Minister opened the new headquarters of Diabetes UK and said that the number of cases of diabetes increased by 75% in the last decade. The Minister and I attended the launch of the Food Foundation’s declaration on how to tackle obesity. Which of the 10 measures put forward by the foundation has she decided to accept?

[Nicola Blackwood]

The right hon. Gentleman is absolutely right to raise this issue, and we are considering the contributions from the Food Foundation, which are very important. He is right about the role that obesity plays in triggering diabetes. That is why we are focusing on preventing type 2 diabetes through the world’s first national diabetes prevention programme, which aims to deliver at-scale, evidence-based behavioural change to support people to reduce their risk of developing type 2 diabetes.

[Philip Davies (Shipley) (Con)]

May I urge the Minister, in tackling childhood obesity, not to go down the line of nanny-state proposal after nanny-state proposal, but instead to look at Active Movement, which is in operation in a number of areas around the country? It builds exercise into the average day of children in schools, and it is already making a great difference to childhood obesity levels.

[Nicola Blackwood]

I very much welcome the hon. Gentleman’s support for a key plank of the childhood obesity strategy, which is helping all children to enjoy an hour of physical activity every day and which will include physical movement as well as specific physical education.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Another target that “Dispatches” uncovered was to be scrapped was the target to halve childhood obesity by 2026. This was compounded by recent national childhood measurement data showing that obesity is on the rise and that obesity rates are more than double in deprived areas compared with more affluent ones. Instead of squandering this opportunity, the Government should be pushing ahead with a comprehensive and preventive strategy. Can the Minister explain, therefore, why this significant target was dropped from the Government’s plans to tackle childhood obesity?

[Nicola Blackwood]

The hon. Lady is right to say that the childhood obesity strategy is one of our key priorities for tackling health inequalities in the UK. Obesity prevalence for children living in the most deprived areas is double that for those living in the least deprived areas, and the gap continues to widen. That is exactly why we will press ahead with the plan, but, as she has said, this is just the beginning of the conversation and we will continue to fight obesity as a government priority.

[Ms Angela Eagle (Wallasey) (Lab)]

6. What discussions he has had with local government representatives on the sustainability and transformation plan process.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

The Secretary of State and the Minister will be aware that Capita has wreaked havoc in GP surgeries across the land, placing extra pressures on already overstretched NHS staff, compromising patient safety and breaching confidentiality. Last week, I met a group of practice managers who told me that some patient records have been missing for months, while others have turned up apparently half-eaten by mice. Given that this contract was introduced to save the NHS money, will the Minister tell us how much it is costing to rectify the mess and what steps she is taking to compensate GPs for the expenses they have incurred as a result of ill-conceived and poorly implemented contracts?

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

The hon. Lady is right that the current delivery of this contract by Capita is unacceptable. I have met NHS England and Capita regularly to make sure that rectification plans are in place. We are assured that these steps are now in place and that the programme will improve.

[Tom Pursglove (Corby) (Con)]

T4. Across north Northamptonshire there is an enormous appetite for the new urgent care hub to be built at the site of Kettering general hospital, relieving pressure on A&E and improving services for patients. Will the Minister update us on progress?

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

T2. Diabetes is a big problem in my constituency, and the number of unnecessary lower limb amputations due to diabetes is on the rise. Will the Minister ask clinical commissioning groups to provide fully staffed community podiatry foot protection services to avoid amputations, keep people in work and make huge cost savings?

[Nicola Blackwood]

The hon. Gentleman is absolutely right that diabetes is a major health risk in the UK. That is why we have rolled out the first ever NHS diabetes prevention programme this year on 27 sites, covering nearly half of England and referring nearly 10,000 people. Next year, the second wave of the programme will reach a further 25% of the English population. The aim is for the NDPP to be rolled out across the whole of England by 2020 to support 100,000 people at risk of diabetes each year.

[Robert Neill (Bromley and Chislehurst) (Con)]

T6. Proper integration of adult social care and health services requires co-operation on both sides. Does the Secretary of State agree that it is really not acceptable that in a borough such as Bromley, the CCG top-sliced only 3.5% of its funding to go into the better care fund—nowhere near enough to make a difference to hard-pressed local services?

[Chris Law (Dundee West) (SNP)]

T5. Both Public Health England and Food Standards Scotland support restricted advertising of junk food to children, yet this was entirely omitted from the Government’s completely underwhelming obesity strategy. Given that we clearly cannot rely on the UK Government to take this forward, will the Secretary of State support the devolution of broadcasting powers to allow the Scottish Government to tackle the obesity crisis and its devastating impact on society?

[Nicola Blackwood]

The obesity plan is one of the most ambitious in the world. It will reduce obesity by a fifth by cutting the amount of sugar in our food, helping all children to engage in an hour of physical activity a day, and making it easier for families to make healthy choices. We already have some of the toughest advertising rules in the world, and we have consulted Scotland closely on these arrangements.

[Henry Smith (Crawley) (Con)]

T7. The anti-coagulation service at the Furnace Green general practice was recently moved to Crawley hospital, which has caused concern to some local patients. Will a member of the health ministerial team agree to meet me to discuss that further?

[Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP)]

Climbing obesity rates are expected to lead to increases in type 2 diabetes, cardiovascular disease and the need for joint replacements, which will put even greater pressure on the NHS. Given such threats to health, does the Secretary of State really think that now is the time for timidity and sucking up to business?

[Nicola Blackwood]

As I have made absolutely clear today, I am determined not to allow the House to get lost in a debate about what the plan could or should have been. Our children deserve more from us. We should not politicise this debate; we should get on with delivering the plan that we have before becoming involved in a lengthier conversation about what a long-term obesity programme should be.

[Antoinette Sandbach (Eddisbury) (Con)]

T8. General practices in Winsford are being underfunded by 3.6% in terms of the formula that should apply to them because of the slow rate of change, while nearby Merseyside practices are being overfunded by 5%. That is resulting in a £30 million loss to my local surgeries. Will the Minister commit himself to looking into it and introducing a quicker rate of change, so that local residents can benefit from the funds that they should be receiving?

--- Later in debate ---

[Andrew Bridgen (North West Leicestershire) (Con)]

T9. According to a report published recently by the British Lung Foundation, 1.2 million people are suffering from and have been diagnosed with chronic obstructive pulmonary disease, while many more sufferers have not been diagnosed. Will the Minister support the establishment of an independent respiratory taskforce to help diagnosis and improve lung health for everyone?

[Nicola Blackwood]

I know that the British Lung Foundation has called for a taskforce on lung health. Given that a million people have been diagnosed with COPD and a further million remain undiagnosed, the Government and the NHS are keen to work with the NHS and the voluntary sector to find practical and innovative ways of improving outcomes for patients with respiratory disease, and I will consider my hon. Friend’s proposal as part of that process.

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

The number of nurses working in mental health has fallen by 15% since 2010, from 45,384 to 38,774. Why is that, and does the Secretary of State believe that it will achieve real parity of esteem for mental health in our country?

--- Later in debate ---

[Bob Blackman (Harrow East) (Con)]

We recently had an excellent debate in Westminster Hall on the Government’s tobacco control strategy. When will they publish the new strategy, which was promised for publication this summer?

[Nicola Blackwood]

The UK is a world leader in tobacco control and we have a proven record in reducing the harm caused by tobacco. We should be proud of the fact that smoking rates among adults and young people are at the lowest ever level, but my hon. Friend is right to push for the tobacco control plan because there is unacceptable variation. We are working on developing that plan, which we will be publishing shortly.

[Danny Kinahan (South Antrim) (UUP)]

In Northern Ireland in 2014-15, 870 deaths were due to the cold weather. Will the Minister engage with other Ministers to ensure that fuel poverty is looked at by all Departments, so that the pensioners who raised this in Parliament do not suffer from the health matters that are killing them off?

Capita Contract (Coventry)

Baroness Blackwood of North Oxford Excerpts

Tuesday 8th November 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing a very important debate. As the hon. Member for Stretford and Urmston (Kate Green) said, his business acumen was clearly on display. The importance of this debate is clear from the presence of a clean sweep of Coventry Members, but I know that the issue is important to colleagues across the House, so I am pleased to respond to the debate this evening.

I will start with Coventry, as it is in the title of the debate. Coventry is at the forefront of providing extended access to GP services seven days a week through the GP access fund, and it is doing excellent work to ensure that frail or elderly patients can avoid unnecessarily long hospital stays, using integrated neighbourhood teams to make sure that patients have the right primary and community care in place. As has been made clear by the speeches and interventions that we have just heard, excellent primary care such as this relies on effective and efficient support services. The hon. Member for Coventry North West is therefore right to be concerned that the service provided by Capita under the primary care support services contract in Coventry and elsewhere has so far fallen well short of the standards that we expect, and GPs have borne the brunt of these failings, as we have heard today.

It is true, as the hon. Member for Bristol South (Karin Smyth) said, that NHS England needs to make efficiencies. I was pleased to hear that the hon. Member for Coventry North West supports that in principle, and I am happy to confirm that all the savings that are made through this contract are ploughed straight back into frontline NHS services.

It was always clear that Capita’s services needed to be at least as good as those that they replaced. Quality was always part of the tender process. The contract was let via a competitive tendering process, which was subject to scrutiny not only by the Department of Health but by the Treasury, and the bids were assessed for quality, not just cost. Capita put forward the most credible of any of the bids accepted on the short list, and at the time both the Department and NHS England had every confidence that the programme would be a success. However, it is evident that Capita was inadequately prepared for delivering this complex transition.

[Mr Robinson]

First, does the Minister agree that part of the process preceding the award of the contract should have been to assess whether Capita was ready for it? That is precisely the point that I was trying to make and that my hon. Friends referred to in the debate. Secondly, how can the Minister talk of savings? How can any savings have been made when 9,000 patients records have been missing for more than two months, without which they cannot attend doctors surgeries? It is illusory to speak of savings. There are none, unless the Minister would care to tell us where they are and how they came about. I would be pleased to hear that.

[Nicola Blackwood]

The hon. Gentleman’s point about scrutinising whether Capita was competent as part of the tendering process is purely common sense and obviously that should have been done as part of the process. If he will allow me, I will come to the other points in the course of my speech. I would like to concentrate on how we resolve the problem that we find. We need to make sure that GPs and their patients receive the service to which they are entitled.

We want to restore acceptable services, and the contract contains sufficient financial incentives to ensure that Capita shares that goal, which is an important part of the contract and process. Let us be clear that the problems encountered with medical record transfers and overdue payments are entirely unacceptable. The Department shares that view. Both Capita and NHS England are co-operating fully with the Information Commissioner’s Office to address the implications for information governance, and I accept the need for urgent action to address the impact that this is having on patients and practitioners. That is why I have been holding regular meetings with Capita’s chief executive for integrated services, Joe Hemming, its new managing director for primary care support, Simon England, and NHS England’s national director for transformation and corporate operations, Karen Wheeler, and I will continue to hold such meetings.

Both NHS England and Capita openly acknowledge that the service has not so far been good enough. NHS England has demanded and received rectification plans from Capita for the six most affected service lines and has embedded a team of seven experts within Capita to support it as it resolves these issues.

As the hon. Member for Coventry North West said, it is also about having the right resources in the right place at the right time. Capita has informed me that it is adding around 500 more full-time equivalent staff to the service, at its cost, and that it is improving the training provided to ensure that new staff understand the importance of the service to both patients and practitioners.

I know that these problems have caused great inconvenience and distress, but with reference to risk—the hon. Member for Bristol South raised this point—NHS England has assured me that it is not aware of any direct cases of patient harm that can be attributed to service issues. However, NHS England is working closely with regional and local medical directors, so that we can be assured of patient safety. In particular, Dr Raj Patel, medical director of NHS England Greater Manchester, has joined the embedded team to ensure that clinical risks and concerns are appropriately addressed.

The priority now is to deal with any backlogs, particularly with medical record requests, and to ensure that services are stabilised with the capacity to deal properly with new requests. There has been progress on that, which is encouraging. The backlog of medical record requests has reduced from 17,262 to 3,465 in the past two weeks. Capita assures me that it has an effective triage system in operation for new requests and is confident that the situation will not recur. However, I will be monitoring the situation closely.

[Kate Green]

On the point about reducing the backlog, which is something the Bodmin Road practice in my constituency has raised with me, it is not just Capita that needs to put in extra resources; the GP practice is now receiving an onslaught of incoming records, but it does not have the personnel to manage them.

--- Later in debate ---

[Nicola Blackwood]

The hon. Lady is absolutely right to raise the impact on GP services in recent weeks and months, and I will move on to that point later.

Capita has piloted a new way to move medical records. I think that is the pilot in west Yorkshire to which the hon. Member for Stretford and Urmston referred, but it was not a pilot for the overall Capita project. Capita assures me that ultimately it will be more reliable and secure by tracking the end-to-end movement of every record. It is piloting that approach in west Yorkshire and plans to be ready to roll it out nationally in March 2017. I am aware that some GPs were left short of basic supplies as a result, including syringes, and that they have had to source those from other suppliers at their own expense. NHS England tells me that it has reimbursed practices for any costs incurred from having to buy local supplies of needles and syringes.

I know that many of the hon. Members’ GP constituents have experienced frustration with Capita’s contact centre. I share those frustrations. Capita assures me that the contact centre has improved the way it responds to urgent queries by investing in more staff, improved processes and enhanced training. Capita is confident that these measures will deliver a quality service to customers. We will monitor its progress closely, including through meetings.

[Karin Smyth]

I am listening carefully to the Minister, and it is obviously reassuring to know that Capita, NHS England and the Minister are having these conversations at a national level. In those discussions, has any consideration been given to my point about the loss of local, specialist knowledge and expertise? Is any consideration being given to putting back some of those local arrangements, given the importance of primary care to the entire system?

[Nicola Blackwood]

I shall come a little later to the problems with the existing system that meant it needed to be replaced. However, the hon. Lady’s point about the value of institutional knowledge, especially among NHS workers and personnel in other roles, is very important. They have been engaged in a lot of consultation processes as we try to put this issue right with NHS England and Capita. If the hon. Lady writes to me, I will be happy to give her more detail.

I also expect Capita to address issues with the courier service. I am aware of several steps that have been taken to ensure that all practices receive regular collections and deliveries. Both NHS England and Capita have taken steps to demonstrate that they are committed to restoring their reputation and re-establishing a quality service, and I am encouraged to see them working in partnership to do so. That said, I recognise that GPs, and ophthalmologists in particular, have suffered financial detriment as a result of late processing of payments. NHS England is working with Capita to explore what can be done to support affected stakeholders, and I have made it clear to Capita that I expect it to consider compensation as an option.

Some have suggested that the old model for provision of primary care support should be reinstated, but we must remember that it relied on localised services that did not connect with one another, with much duplication across processes. The quality of these services varied greatly—in some areas, it was outstanding; in others, it was quite poor. That was simply unsustainable. Furthermore, the system was unable to generate useful management information and so, honestly, issues such as the ones that we now face would be very unlikely to have surfaced. They would have gone unreported.

A new model, with efficient and modernised processes, is the right approach to deliver to our primary care providers the service that they deserve. The Department and I will continue to closely scrutinise Capita and NHS England as they work to resolve current problems and build a quality service that is sustainable. I acknowledge fully that there is a long way to go before the service can be considered acceptable and that Capita has much to do to earn the trust of practitioners and patients.

This is clearly a live issue. I want to be clear today: I am listening. The issue is at the top of my priority list and will remain there until I am satisfied that an efficient and effective service is being delivered that meets the needs of patients and providers.

Question put and agreed to.