Oral Answers to Questions

Debate between Ben Bradshaw and Jane Ellison

Tuesday 28th February 2017 Commons Chamber

[Jane Ellison]

As the Chancellor just said, I will take that as a Budget representation. Of course we recognise the contribution of the beer and pubs industry across the UK—I am particularly aware from my previous job of the role pubs play in promoting responsible drinking— but it is worth noting that the public finances assume that alcohol duties rise by retail prices index inflation each year, meaning that there is a cost to the Exchequer from freezing or cutting alcohol duty rates. As I say, however, we consider all representations carefully.

[Mr Ben Bradshaw (Exeter) (Lab)]

When considering beer duty, will the Minister maintain, or at least not further erode, the differential with cider duty? Labour’s lower cider duty has led to a fantastic renaissance in both cider drinking and orchard planting in England, but if the differential is narrowed any further I am afraid it will do untold damage to our cider makers.

[Jane Ellison]

I am well aware of the sensitivities around the duty bands, on which we have received a number of representations, and of the renaissance not just in the industry to which the right hon. Gentleman refers but, for example, in respect of the number of microbreweries and the flourishing investment in that area. There have been a number of good news stories in this sector in recent years.

NHS Commissioning (Pre-Exposure Prophylaxis)

Debate between Ben Bradshaw and Jane Ellison

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

My hon. Friend is quite correct on his latter point about the impact of PrEP. Whether it was commissioned or not, and whoever it was commissioned by, we would still have the significant challenge that he describes around STIs. Drug-resistant gonorrhoea, for example, is a problem that we are increasingly aware of.

There are international comparisons that we can look at, as my hon. Friend mentions. I have looked at the matter in some detail, and the picture across the world is that many countries are in broadly the same position as the UK. They are trying to understand, leaving aside the question of clinical effectiveness, more about how PrEP can be used as part of an HIV prevention programme in broader cost-effectiveness terms, and how it compares in cost-effectiveness terms with other available interventions. My hon. Friend is right that there is work to do, and we are not resting easy on this. We are moving forward, and we are working on and planning these pilots now.

[Mr Ben Bradshaw (Exeter) (Lab)]

When does the Minister expect the damaging buck-passing between NHS England and local authorities, which is one of the disastrous results of the Health and Social Care Act 2012, to be resolved? Does she agree that it would be far more appropriate for NHS England to be the commissioner of something like PrEP than for local government to commission it? Finally, will she be very cognisant of the danger that we are going back to the bad old days when certain groups were stigmatised? Stigma is disastrous for public health policy, and it will result in an explosion of sexual disease in this country if we do not always bear in mind the danger that decisions by NHS England—not just on this, but on drug treatment for hepatitis C —may have a disastrous impact on public health.

[Jane Ellison]

The NHS England position is based on a legal argument, and as the matter is likely to go before the courts, it is not really appropriate for me to comment further. There was a little discussion this morning on this subject in the Health Committee, for which some Members were present. I have laid out a process by which we will work out how and where this is commissioned. Clearly, we need to identify the commissioner.

I do not accept the right hon. Gentleman’s challenge about fragmentation, simply because if we look around the world at a series of very different health systems, we see that they are all going through broadly the same process of understanding where PrEP sits. There are a number of options, but first we need to go through this work. On his latter point about stigma, he is right to identify that it is a significant concern, but I do not accept that that is what this represents. He knows my personal commitment to tackling stigma, and we could not have made it clearer that addressing rising HIV rates, addressing STIs in the MSM community and looking at the challenges surrounding things such as chemsex are all very much front of mind, and we have given considerable time and thought to them. We must challenge stigma wherever it rears its head.

Oral Answers to Questions

Debate between Ben Bradshaw and Jane Ellison

Tuesday 10th May 2016 Commons Chamber

[Jane Ellison]

The Government take extremely seriously the issue of making sure that only those who should have access to NHS services do access them. Let me make an important point about the figures that I have just given. Some 80% of that imbalanced statistic represents our pensioners who choose to retire to Europe, typically for sunnier weather. The figure is 80% because many more UK pensioners retire to Europe than European pensioners retire here, and there will always be an imbalance. I am sure that even the keenest Brexiteer would not claim that Britain would be sunnier outside the EU.

[Mr Ben Bradshaw (Exeter) (Lab)]

Will the Minister encourage her Back Benchers to study the expert evidence that was given recently to the Select Committee on Health on the issue that the hon. Member for Kettering (Mr Hollobone) has just raised, our access to free healthcare in Europe, and the economic shock that our leaving the European Union would cause to the NHS finances and to major public health measures such as clean air and clean water that benefit us immensely? Every single one of them told our Committee that leaving the European Union would be disastrous for the NHS, disastrous for health and disastrous for public health.

[Jane Ellison]

On this, I am happy to say that I very much agree with the right hon. Gentleman. I encourage all colleagues to look at the evidence deposited with the Committee. Just last year, UK European health insurance card holders—5.5 million people—were able to travel to any other EEA country or Switzerland safe in the knowledge that they would be able to receive free healthcare or reduced costs arising from healthcare if they needed it. That offers great peace of mind and shows that Britain is safer in a reformed EU.

Oral Answers to Questions

Debate between Ben Bradshaw and Jane Ellison

Tuesday 22nd March 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is worth saying that the National Institute for Health and Care Excellence does not recommend homeopathy to treat any health condition. My hon. Friend mentioned antimicrobial resistance, and an increasing number of studies from around the world show that resistance to common treatments is growing, which serves to underline the importance of the responsible stewardship of all drugs and medicines and why the international efforts on AMR, in which the UK is at the forefront, are so important.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given the latest, very worrying reports about goings on at the office of the Parliamentary and Health Service Ombudsman, does the Secretary of State still have confidence in the leadership of this vital regulator?

Health and Social Care

Debate between Ben Bradshaw and Jane Ellison

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

No, I am sorry, I will not give way. As they have demonstrated today, the hon. Lady and many of her colleagues sought to weaponise the NHS in the last Parliament and they are seeking to do so again.

In return for NHS staff stepping up and working so tirelessly for their patients, the Conservatives have committed the money that the NHS says it needs. Two elections running, the Labour party failed to commit the money that the NHS says it needs. Until the Opposition do that and explain how they can deliver the strong economy that is needed to do it, they have no right to speak about this. It is only possible to deliver that if we have a strong economy and a long-term economic plan. Listening to the NHS, not running it down—that will continue to be our approach in this Parliament.

[Mr Bradshaw]

I regret that the Minister missed my speech, because she, like her right hon. Friend the Secretary of State, has so far failed to mention the elephant in the room: the record deficit facing the NHS. She knows about this, because we have debated it in this House; she knows exactly what I am talking about. What is she going to do about that deficit? When is she going to address it? When is she going to fulfil the promises she made to my constituents in Exeter and the population of Devon, which faces one of the worst deficits in the country? Without action, patient care and services will suffer.

[Jane Ellison]

I am sorry that I was not in the Chamber for the right hon. Gentleman’s speech. I was briefly attending a meeting of directors of public health, but I know he asked a specific question about the turnaround plan in his area. I believe it has been presented to the new governing body of Devon CCG, but I am happy to pick up the detail. As he says, we have debated the issue.

On the deficit in the NHS, my right hon. Friend the Secretary of State for Health responded in great detail in his opening address, but the thing about NHS finances that the Labour party never gets its head around is that, yes, they are under pressure, but one has to have a long-term plan for how to address that—plans for integration, out-of-hospital care and prevention. One has to be able to say—[Interruption.] The hon. Member for Denton and Reddish asks where the money will come from. That is a question the electorate asked the Labour party all the way through the election—that was the No. 1 question the electorate of this country asked the Labour party, and answer came there none.

I am proud of the work we have done in the past five years, in which the NHS has built capacity and improved the care it delivers. It is worth reiterating the facts that my right hon. Friend the Secretary of State gave at the beginning of the debate. The NHS is now performing more than 1 million more operations; it has 9,400 more doctors and 7,700 more nurses; it sees, treats and discharges more than 3,000 more people within four hours every single day. By the end of the last Parliament, public satisfaction with the NHS was up 5% and it was deemed the best performing health system in the world by the Commonwealth Fund.

HIV Prevention

Debate between Ben Bradshaw and Jane Ellison

Thursday 12th March 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer)—my friend in every sense—on securing this debate on a very important subject. As he said, it is one that we perhaps do not discuss enough. I am delighted to have the opportunity to respond. I pay tribute to him for his long and distinguished record of campaigning in this area, and for the important work he has done in our party on equalities and in this Parliament in championing HIV prevention and other important matters.

Other distinguished colleagues are in the Chamber this evening. The right hon. Member for Exeter (Mr Bradshaw), a former Health Minister, has done long and distinguished service in this field, and it is good to see him in his place. It is also good to see my hon. Friend the Member for Ribble Valley (Mr Evans) in his place, and he highlighted the important issue of homophobic bullying in a telling intervention. I also wish to place on record my thanks to my hon. Friend the Member for Brighton, Kemptown (Simon Kirby), who has done great work, with others, in lobbying Ministers extensively on the subject of HIV prevention.

Many good points have been made, and I will pass on the passionate views on sex and relationship education to my right hon. Friend the Secretary of State for Education. I am sure that she will want to be aware of those comments, but I shall not attempt to respond to them myself.

I am proud of the Government’s record on tackling HIV, including on prevention. In 2012-13, the Government spent an estimated £630 million on HIV treatment and care, which has been key in enabling people with HIV to live long and healthy lives. The success of that treatment is shown by that fact that 90% of those on treatment are virally suppressed, substantially increasing their lifespan and significantly reducing their risk of passing HIV to others. However, as my hon. Friend the Member for Finchley and Golders Green said, we need to do far more to stop people getting HIV in the first place.

On top of the money I have just mentioned, we have given local authorities a ring- fenced public health grant of £8.2 billion over three years and mandated the provision of sexual health services as part of that. We welcome the fact that new HIV diagnoses have fallen from 6,333 in 2010 to 6,000 in 2013, and the proportion of late diagnoses continues to decline—down to 42% in 2013 from 50% in 2010—but we have a lot more to do, and my hon. Friend outlined some of the concerns in his speech.

The Government have taken action beyond awareness-raising and testing, for example through lifting the ban on the sale of home testing kits. Reducing the number of HIV infections, especially in men who have sex with men—MSM—is important because we have seen a worrying trend in new infections. In 2013, there were an estimated 3,250 new diagnoses, the highest number ever reported. That really is a cause for concern and one of the reasons why it is good that we are debating the subject this evening. We also know that transmission is continuing among black African men and women who are acquiring their infection within the UK.

It is estimated that one in eight gay men in London are HIV positive, and while that might sound alarming, it also reflects the success of treatment and that more and more people are now living into old age with HIV. My hon. Friend rightly put a focus on being more innovative, and the importance of preventing the spread of HIV is one of the reasons why the Government have committed to protecting the HIV prevention budget—but I am clear that we need to be more ambitious and innovative. That is why we are redesigning our HIV prevention programme for England in 2015-16. I see this as a transitional year towards the updated long-term strategy for HIV prevention and sexual health promotion more widely. In future, this work will be led and managed by Public Health England, which is consistent with its wider work on health promotion and social marketing. I expect PHE to work closely with local authorities to promote the health of their populations.

One of the most exciting innovations to promote HIV testing is postal home sampling kits. Public Health England and local authorities will establish, for the first time, a national home sampling service. Through this, we will be able to deliver up to 50,000 home sampling kits in 2015-16, around three times as many as last year. That will augment the continued growth in HIV tests performed in genito-urinary medicine clinics—more than 1 million tests in 2013, which was 100,000 more than in 2010. People knowing their HIV status is important not only in getting treatment and allowing them to live a long and healthy life, but, critically, in preventing HIV from being passed to others. We now know that being on treatment substantially reduces the risk of passing on HIV. That testing is critical and a key component of our public health response to HIV.

We will continue to contract with the Terrence Higgins Trust in running public awareness campaigns. Changes to that contract have been made for 2015-16, but it is a respected charity in the field and its work remains an important strand of our HIV prevention programme. THT will have an increasing focus on digital platforms to meet the needs of the 21st century, including using Facebook and Twitter. The potential is huge. A single push on a phone app has consistently generated more than 1,000 postal test orders. In addition, those contacted through Facebook have turned out to be three times more likely to return a postal test than those contacted through any other route. Facebook is used by all age groups. It is therefore an important access point, particularly given the middle and older age profile of many of those diagnosed HIV positive.

THT will also continue to work with local partner organisations to talk to those at highest risk face to face, particularly those without access to the internet or to more traditional media. Those conversations include encouraging tests in GUM clinics, use of postal test kits and offering point of care tests in a diverse range of settings, including in churches and shops. That work is particularly important in reaching black African populations who are less likely to attend GUM clinics, but more likely to be diagnosed late.

[Mr Bradshaw]

I thank the Minister for her kind comments about the Terrence Higgins Trust. I refer hon. Members to my declaration in the Register of Members’ Financial Interests—I am a trustee. Can she clarify whether she has announced specifically how the Government’s public health HIV prevention budget will be spent? If not, will she tell us when she expects to make that detailed announcement?

NHS Services (Devon)

Debate between Ben Bradshaw and Jane Ellison

Thursday 11th December 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing this debate. He is right to say that Parliament is intended to bring these very important topics to the fore. In securing this debate, he rightly brings a very important subject to the Floor of the House, and I welcome the opportunity to respond. It is a matter of great importance to him and his constituents, but also to other Members in the area. My right hon. Friend the Member for East Devon (Mr Swire), as a Minister in the Foreign Office, and my hon. Friend the Member for Central Devon (Mel Stride), as a Government Whip, are unable to speak in the debate, but let it be noted for the record that they are here in attendance, representing their constituents, and have shown a keen interest in the matter and discussed it with me, as has the right hon. Gentleman.

I start by commending the work carried out every day by those working in our NHS, particularly in the area of Devon that we are discussing. At every opportunity in this House, we should, particularly as we approach the Christmas season, pay tribute to the fantastic work of our front-line NHS workers.

I turn to the service changes to Northern, Eastern and Western Devon—NEW Devon—clinical commissioning group. As the right hon. Gentleman set out, the CCG is facing significant financial pressures, with an end-of-year deficit of £14.5 million for 2013-14 and a similar deficit predicted for this financial year. To address these pressures, the CCG proposed some changes, which it described as “temporary”, to some of the services it commissions in the area. On 3 December, as he said, it announced that it was taking urgent measures to prioritise essential services and the requirements laid out in the NHS constitution.

We recognise that CCGs have to take resourcing decisions based on the needs of their local community, but blanket restrictions on procedures that do not take account of the individual health care needs of patients are unacceptable. Decisions on treatments, including suitability for surgery, should be made by clinicians, based on the individual clinical needs of patients. The Deputy Prime Minister made that point in response to the right hon. Gentleman at Prime Minister’s questions, and I reiterate it now. The right hon. Gentleman has given some very serious and moving examples of patients who would be affected by such blanket restrictions. National Institute for Health and Care Excellence guidelines represent best practice, and we expect NHS organisations to take them fully into account as they design services for their local populations and work towards full implementation over time.

With regard to the latest position, things have moved quite rapidly in the past 24 hours, as the right hon. Gentleman outlined. NEW Devon CCG announced today that it will no longer compel patients to undergo weight loss or stop smoking ahead of routine surgery. It confirmed that patients will instead be offered evidence-based guidance, as we would expect, on the benefits of weight loss and smoking cessation as part of their health care. As a former Health Minister, he would, like me, draw attention to the fact that both those things are generally desirable in terms of good health and the efficacy of treatment. The CCG also confirmed that it would not be restricting in vitro fertilisation treatment or caesarean sections on non-medical grounds.

In announcing its decision on weight loss and stopping smoking, the CCG confirmed that it will continue with a series of other measures that have already been announced, but those will be subject to public consultation in the new year, where appropriate. Discussions are under way to confirm the extent of that consultation. Today I had a telephone discussion with some of the key people involved, including the chief officer of the CCG and the NHS area lead. I know that the right hon. Gentleman and my right hon. and hon. Friends will want to take a full part in that consultation. Indeed, the right hon. Gentleman indicated some of the areas that he will wish to explore in that consultation process.

NHS England has confirmed that it is currently scrutinising the CCG’s proposals and is in close dialogue with it. That has been confirmed to the right hon. Gentleman, with a good level of detail, in a letter to him from the chief executive of NHS England, which I have had sight of. I hope that he has had that letter; I think he has.

[Mr Bradshaw]

indicated dissent.

[Jane Ellison]

If not, I apologise on behalf of NHS England. I was informed that the letter had been sent to him. I very much hope that it has pinged into his inbox by the time he returns to his office. If, by some chance, it has not reached him, I will certainly make sure that my office passes him a copy. I will also make sure that other right hon. and hon. Members who would want to have sight of the sentiments in the letter have sight of them.

NHS England has confirmed that it is currently scrutinising the CCG’s proposals. They are in close dialogue and I confirmed that myself in my conference call today. NHS England is seeking assurance that the proposals are in the best interest of patients, which we would all echo; that they are based on sound evidence, to which the right hon. Gentleman alluded; and that they are subject to a well-planned process, including, if appropriate, public consultation.

On the next steps on financial issues—the right hon. Gentleman put this in the context of a longer-term concern—the CCG has stated that its financial projections are being updated in the light of the current pressures and the five-year system-wide assessment of a potential finance gap between resources and the cost of health demand, which the CCG considers will be £430 million, which is a considerable sum.

Devon was one of the 11 financially challenged health economies to be provided with intensive support by NHS England. I understand that the report of that work is due to be published shortly, along with planning guidance, which will be a joint publication with the NHS Trust Development Authority, Monitor and NHS England. The right hon. Gentleman does not have long to wait to see that detailed piece of work on the broader, long-term picture.

[Mr Bradshaw]

Does the Minister have any idea why it has taken quite so long? Did the CCG drop its smoking and obesity proposals before or after her telephone conversation with it?

[Jane Ellison]

I will write to the right hon. Gentleman with a response to his first question, as I am not abreast of the detail. The letter to him from the chief executive of NHS England is dated the 10th, so I think that answers his second question. I apologise that he has not received notice, but discussions were under way prior to my phone call with the local NHS leads, during which we touched on the issue.

As part of the work I was just referring to, an extensive, detailed analysis of services and costs in the NEW Devon health economy was undertaken. The NHS England area team director of finance has given significant support and challenge to the CCG to understand its financial position and to support the development of a financial recovery plan. The area team has also been engaged with the CCG through the quarterly assurance process and agreed a set of actions with time scales to improve the financial position.

I stressed in my conversation today the urgency of the matter and the clearly enormous public and parliamentary interest in it. Parliamentarians have a very important role to play in being a bridge between health officials and the public and the constituents they represent, as reflected by the interest shown in this debate by Devon MPs. The CCG and NHS England will meet next week to consider the CCG’s medium to long-term financial plans. It is an important meeting and I have asked to be kept abreast of those developments.

I will ask the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), to write to the right hon. Gentleman with more detail on the mental health issues he has raised.

The right hon. Gentleman has also raised concerns in the House and elsewhere about the walk-in centre. That is dealt with in some detail in Simon Stevens’s letter to him—I repeat my regret that he has not had sight of it—so if he has further concerns after reading it, he might want to raise them with the chief executive. However, he is, of course, always welcome to raise them with Ministers.

To return to the central part of this debate, I reiterate that policies providing for blanket restrictions on treatments for particular classes of patients based on lifestyle characteristics are unacceptable, and various Ministers—including, as I have said, the Deputy Prime Minister at PMQs this week—have made that clear. Any general policy on prioritisation of services must be robust, evidence-based and justifiable. In addition, any general policy must take account and make provision for an individual’s clinical situation, an example of which was given by the right hon. Gentleman.

CCGs have statutory duties to consult, inform or otherwise engage with the public about commissioning decisions, and duties to promote the involvement of individual patients in decisions about their care and treatment. We fully expect that the CCG will be mindful of those obligations when making any decisions. As I have said, I have stressed the importance of good communication, which is absolutely vital. I have had personal experience as a constituency MP, as well as a Health Minister, of communication not reaching the right people at the right time, resulting in confusion and sometimes distress for constituents and patients. It is therefore very important to get such things right, and I expect all local health economy leads to be extremely mindful of the need to involve local parliamentarians and other democratically elected people.

[Mr Bradshaw]

Does the Minister accept the importance not only of good communication, but of functional relationships? The letter from David Flory about the dysfunctionality of the relationship between Northern Devon and the rest of the heath economy in Devon is very worrying.

[Jane Ellison]

Functioning relationships are absolutely key to long-term planning. We have all recently seen the “Five Year Forward View” from NHS England, and the Government have expressed their support for the plans and intentions in that document. Co-operation and close working are at its heart, as they are at the heart of any local plans for the short, the medium and particularly the medium to long term. Functioning relationships between different parts of the health economy, as well as between the elected Members in the area, are therefore vital.

I feel confident that the right hon. Gentleman will continue to draw attention to that need. Indeed, throughout the debate my hon. Friend the Member for Central Devon and my right hon. Friend the Member for East Devon have nodded in assent in relation to the importance of good communication.

Important meetings are coming up imminently, and I expect there to be good communication on their outcomes. I have asked to be kept abreast of them. Engagement with the public and others, including MPs, will take place next year on the issues that have to be consulted on.

--- Later in debate ---

[Mr Bradshaw]

I want to put it on the record that the obviously very important and long-awaited reply from NHS England is not one of the many e-mails that have pinged into my inbox today, so I would be grateful if the Minister ensured that I get it as soon as possible.

[Jane Ellison]

I feel sure that someone is already working on that, but as I say, we will try to get it to the right hon. Gentleman as soon as possible, and to let other interested colleagues have sight of its sentiments.

I urge all right hon. and hon. Members to engage with the consultation process, and to bring all their constituents’ communications to bear by feeding them into the consultation. I have asked to be kept abreast of those matters. As the right hon. Gentleman will see from the chief executive of NHS England’s response, this important matter is being taken extremely seriously both by Ministers and at the very top of NHS England, as well as by local health leaders.

I hope that the outcome of the discussions and consultations will be a good one—as we require it to be—for the right hon. Gentleman’s constituents and other members of the public in the area. We look forward to seeing how matters progress, and I again congratulate him on bringing this important matter to the Floor of the House.

Question put and agreed to.

Oral Answers to Questions

Debate between Ben Bradshaw and Jane Ellison

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

My understanding is that the consumption of sugary drinks is banned in schools. I have discussed that with the Department for Education, but I am happy to take up the point.

I must correct the hon. Gentleman on his point about childhood obesity. Let us give credit where it is due. Childhood obesity levels are for the first time levelling off and we are beginning to see some progress, although there is much further to go. We have a straightforward disagreement. The Government believe we need to give people information. The Opposition believe in a top-down, state-driven approach.

[Mr Ben Bradshaw (Exeter) (Lab)]

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