Childhood Obesity
Caroline Johnson Excerpts(5 years, 6 months ago)
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Ms Nadine Dorries (Mid Bedfordshire) (Con)
Let me first declare an interest: I am currently taking part in a television experiment relating to obesity.
The United Kingdom is now the third most obese nation in the world. That is a shocking fact, especially when, as we know, the second biggest preventable cause of cancer is obesity. This is a crisis, and as always when there is a crisis, the innocent victims are the children. The obesity crisis that is hitting the UK is no exception: the victims are the vulnerable, the poor and the children.
I pay tribute to Andy Cook, the director of the Centre for Social Justice. The work of that prestigious organisation does not receive the praise or recognition that it should. A report produced by the CSJ, “Off the Scales”, provides an in-depth analysis of the obesity crisis facing the UK and makes a series of recommendations that complement the Government’s own obesity strategy report of 2016. However, the difference between the two reports is fundamental.
The CSJ report takes a holistic, headline view that is workable and suggests pathways towards the measuring of deliverable outcomes and progress. It highlights the success of implementing a joined-up cross-organisational and cross-departmental strategy to solve a problem that is costing the taxpayer more than £30 billion a year, and, more importantly, costing the lives of a future generation. It highlights some of the weak areas in the Government’s childhood obesity plan, which was published by the Department of Health in August 2016 and aimed to reduce childhood obesity rates in England over the next 10 years. It is a good plan, but it has little chance of making any impactful difference, as there is little in the way of joined-up thinking or leadership, or accountability, on the part of individual Departments.
Let me explain, in the starkest terms possible, why this issue is so important. For the first time ever, one in four children of the next generation will die younger than their parents. Nearly a third of all children aged between two and 15 are overweight or obese, as the Government report itself highlights. Younger generations are becoming more obese at earlier ages, and obesity doubles the risk of dying prematurely, so this is an incredibly serious problem. I am not sure that many parents know that, but they should, and we should be doing more to make sure that they do.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I congratulate my hon. Friend on securing this debate on such an important topic. Does she agree that this is a major health crisis affecting young children? Not only will those children die younger than their parents and before they would have expected to, but they will experience more suffering during their life due to the ill health caused by obesity.
Ms Dorries
I thank my hon. Friend for that intervention. She is a doctor and knows more than most about the health impacts of obesity, which include diabetes and other illnesses that are costly both to life and the Government.
Ms Dorries
The hon. Gentleman nearly got a speech in there. As I said, I will go on to address funding issues.
The parents on whom this issue impacts the most, and who are most likely to be affected, are those who make the poorest nutritional choices. They do not take The Times, or spend time on the internet reading the news or visiting any other sites where information about the effects of obesity on their children is likely to be repeated. They are also the parents who live in areas of higher deprivation. The fast-food, junk-food giants place more of their outlets in such areas than in areas of affluence, which makes the temptation easier and the consequences more impactful.
What can we as a Government do? I want to praise the headteacher and staff at Shillington Lower School in my constituency. Every morning after assembly, every child joins in with 15 minutes of vigorous exercise. Some are outdoors, running around the field perimeter, while others are in the hall doing boot camp with the cyber coach. That is in addition to their normal PE lessons and physical activities. The school actively encourages walking to school, and I have to say that Shillington Lower School’s efforts are there to be seen, but that is one approach, in one school in one village.
I am doing my little bit by embarking on a tour of schools in my constituency, and I am speaking to public health officers at Central Bedfordshire Council to find out how much more we can do locally in my Mid Bedfordshire constituency. However, this piecemeal approach is part of the problem. We have local council initiatives, as well as individual schools, teachers, parents, elected Mayors, public health officers, social workers and health visitors all doing their own little bit, and while that is all incredibly worth while, no one knows what the other is doing. The approach is taken on the basis of good intentions, but it is far from being an effective plan to deliver any measurable results.
This issue should be a governmental and departmental priority, regardless of Brexit and the noises off. This crisis has nothing to do with Brexit and everything to do with the lives of our children, yet there is no plan that co-ordinates a national strategy to make dealing with this issue a priority, and there is zero leadership from the top—I am very sad to say that. A national crisis requires leadership and a holistic, co-ordinated headline plan. Tackling this problem needs to be one of the Government’s top five priorities, and that needs to include funding.
The Minister is very much doing his bit, in line with the Government’s obesity plan. That is a great achievement, but sadly it is nowhere near enough to tackle the problem. The Minister is a good, conscientious and pragmatic man, and the father of healthy and very beautiful young children. I know that he personally is as worried about this as anyone else, but he is just one Minister in one Department, although I accept that his is the Department that should be leading on this, in accordance with the Government’s aims and objectives in this area. However, if we had some high-level leadership and direction, we could have all the Departments working together towards one strategy and working together as one taskforce to establish our short, medium and long-term goals to reduce the weight of the nation and in particular of our children.
In fact, the Minister is the only person who is accountable for tackling this national crisis. As “Off the Scales” highlights, there is little or no direct accountability among Departments for the childhood obesity plan, other than the Department of Health and Social Care and a small requirement on the Department for Education. What about the Ministry of Housing, Communities and Local Government? What about the Department for Digital, Culture, Media and Sport, given that sport is one of the biggest players in the fight against obesity? What about the Department for Environment, Food and Rural Affairs, the Department for Transport and the Treasury? We know that the Treasury is the place where all good ideas go to die, regardless of which party is in power, and it is not giving this national crisis serious consideration. So many people—from the wonderful staff at Shillington Lower School all the way up to the Department of Health and Social Care—are doing their own thing, but, sadly, none of this can be monitored or measured, because it is all entirely disjointed and unconnected.
The NHS has recently enjoyed a £20 billion cash injection. At present, only 0.2% of the NHS budget is allocated to Public Health England to deal with obesity and to put in place preventive strategies with regard to childhood obesity, yet the Government’s plan places huge responsibility on Public Health England to tackle this issue.
Dr Caroline Johnson
Does my hon. Friend agree that money spent on managing obesity is money well spent? In fact, the money that is invested in helping people to be more healthy will be recouped, because there will be less NHS spending on their ill health.
Ms Dorries
I think that my hon. Friend has seen my speech; my next point is that we are putting the cart before the horse.
There is a huge responsibility on Public Health England, yet it has only 0.2% of the NHS budget. The Government have reduced the public health budget by £600 million between 2015 and 2018 and increased the NHS budget for acute and hospital care. This complements my hon. Friend’s point, because they are pumping all that money into hospitals and acute care, but putting very little into strategies to prevent people from going into hospital in the first place. This imbalance in the NHS budget demonstrates how little attention and importance are being given to this crisis at the top of the Government by No. 10 and No. 11—particularly No. 11 and the Treasury.
As I said, the cart is being put before the horse. As a nation, we are allowing people to become ill. We are failing to prevent that from happening, but we are providing state-of-the-art hospitals and doctors in our amazing NHS to treat them. We should be placing our focus on preventing obesity, which is the second biggest preventable cause of cancer after smoking, and keeping people out of hospital.
Of all the nations that fund healthcare, we have one of the highest healthcare budgets in the world. We spend more each year on treating obesity and diabetes then we spend on our police, our fire service and our judicial system combined, yet we allocate only 0.2% of the NHS budget to Public Health England. When we cost out Public Health England and take out its accountable costs, we see that only a tiny fraction of that 0.2% is given over to obesity prevention and treatment in real terms. The chasm between treatment and prevention highlights the critical need for the Government to develop their approach to the delivery of public health services further and to ensure that prevention receives the investment it so desperately requires.
It is time for the Treasury to think forwards, not backwards, by reversing the reduction in councils’ public health budgets and providing local councils with the funding they need to tackle this problem head on. Local councils should be the major player in this strategy, yet they have seen their funding for public health services cut. They know their own demographics. They know the problems in their area, and they know how to deal with them. Local councils have already engaged as much as they can with this issue, and they are saving the lives of the next generation.
I cannot say it often enough or strongly enough: one in four children will die younger than their parents. If we lined up 50 parents and told them that figure, they would be shocked. Parents needs to know that information.
How much of the new £20 billion that the Government are allocating to the NHS will be made available to Public Health England and, in turn, towards funding the Government’s childhood obesity plan of 2016? As much as people scream and shout that the NHS is being starved of funding, the truth is that the recently announced £20 billion, along with savings from the £20 billion Nicholson challenge, amounts to a £40 billion uplift to treat people who are taken to hospital with illnesses induced by obesity.
Given that Public Health England has been given responsibility for decreasing the proportion of children leaving primary school overweight over a 10-year period, why is so little of the NHS budget allocated for preventive medicine? What uplift was PHE given to address this childhood obesity crisis? How is it supposed to achieve the aims and objectives set out in the 2016 plan? Does the Minister not believe that there should be a cross-departmental strategy, devised by Ministers, to set out in detail what each Department will do to achieve pre-determined goals? If that is not the case, we should engage in a national information and media drive to warn parents of the dangers of obesity. Allowing a child to become obese is almost as dangerous as putting cigarettes in their mouth.
I understand why the Department of Health and Social Care introduced a policy to cap the calories in various types of junk food, but it will not work—people will buy two. The voluntary sugar reduction targets in the 2016 plan have not been met by the main producers and providers of these foods.
Is it not time to introduce a mandatory approach? I am aware that the money raised by the sugar levy—I probably should have mentioned this earlier—is to be allocated to implementing some of the aims and objectives set out in the 2016 plan, and the Government’s approach is a welcome step, but where and to whom will that money go? Will it be allocated to local councils? Is it enough?
As we have seen with food producers that are not meeting the requirement to reduce sugar in food, will the same happen with the sugar levy? Will it actually make a difference? Will it give us the funding that we need to tackle this crisis? I would say not, because we are basing our plans on something subjective and unknown. We do not know how much the levy will raise. We do not know whether producers will reduce sugar in drinks and food. We do not know to what degree the sugar levy will work. As this is such a crisis, should we not be looking at more quantifiable measures?
Where will the money go? Is it not time to consider the recommendations of the Centre for Social Justice and develop a frontline approach? I cannot think of any Government policy on which all Departments work together and on which there is a non-political taskforce above the Departments run by an independent body to pull together policies from each Department to tackle an issue—that goes entirely against our culture—but that is what we need. Should we not work with companies that load food with sugar and set them mandatory goals, not voluntary goals, to reduce the amount of sugar over a period of time? Should we not introduce financial penalties? We have seen producers of products such as breakfast cereals do just that, but the problem is that it is not happening fast enough, it is not consistent and it is not equitable, because only some producers are doing it.
Only by adopting a long-term approach that is nationally led and locally driven, with the councils involved and heading it, that is overseen by an independent body outside the influence of party politics and that is championed by committed political, cross-party leaders will an effective childhood obesity plan ever be delivered. I do not want to chuck a bucket of cold fizzy drink over the Minister’s 2016 plan, because it is a great initiative and I hope it will make some difference, but I hope he understands my concern that the money just is not there to tackle this problem head on now. I go back to the substantive point in what I have just said: 0.2% of the NHS budget going to Public Health England, despite the sugar levy and the taxes we are going to raise, is just not saying, “We are committed to doing this,” and the money has to go to local councils.
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Let me start by reiterating what my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), my good friend, has said: childhood obesity is one of the top public health challenges for this generation, if not the top one. I thank her for mentioning my two beautiful children—we are not sure where they get it from, although undoubtedly it is Mrs Brine. They are watching us right now, so for once I shall be useful to Mrs Brine and say, “Surely it must be time for bed after you’ve seen daddy.”
As Members will be aware, figures released only last week in the national child measurement study continue to show that our child obesity rates remain far too high. About a fifth of children are overweight or obese when they start primary school, and that rises to about a third by the time they leave. What is worse, as we have heard, is that the burden of obesity does not fall evenly across our society. The number of severely obese children living in the most deprived areas is more than four times that of those living in the least deprived areas—this is one of the burning injustices of our age. The effects of obesity have a profound impact on a child’s opportunities in life—on both their physical and mental health. We know that obese children are more likely to be bullied and have low self-esteem as a result. They are also more likely to become obese adults, which will give them a higher chance of developing certain types of cancer, type 2 diabetes, and heart and fatty liver disease.
So the Government are determined that we will lead the way in tackling childhood obesity. We have already heard from my hon. Friend about our 2016 childhood obesity plan, part 1—there was a clue in the title—and I agree with her that it is a good plan. It introduced bold, world-leading measures, such as the sugary drinks levy. I was in Argentina at the G20 earlier this month, giving a presentation about the work we are doing in this area. Many other countries around the world look to what is happening in England and are copying it. Since bringing in the levy, we have seen the equivalent of a staggering 45 million kg of sugar taken out of soft drinks through reformulation. As a result, hundreds of millions of pounds have been poured into improving opportunities for physical activity for children. My hon. Friend asked where the money was going—that is where it is going. It is going into the sport premium in schools. The Treasury has kindly agreed to double that sum. I will expand on the point about where it is being spent. She mentioned one example, but I have others.
We also challenged manufacturers to reduce the sugar content in some of the foods children eat most, and they responded. Tesco, Lucozade Ribena Suntory, Kellogg's, whose people I met this afternoon, Waitrose and Nestlé are just some of the companies that deserve credit and deserve a mention, as they are dramatically lowering levels of sugar in their products.
Dr Johnson
I have a quick question: are these manufacturers of food and drinks products removing the sugar and making the products less sweet, or are they replacing the sugar with artificial sweeteners?
Steve Brine
They are doing both. As the representatives from Kellogg’s were at pains to say to me today, it is about healthy eating and quality taste. I passionately believe that that is true.
We were always clear that our 2016 plan was just the start of the conversation, and we are clear that more needs to be done. We always said that we reserve the right to do more, which is why in June this year we published chapter 2 of the child obesity plan. My hon. Friend the Member for Mid Bedfordshire asked whether there is a cross-departmental strategy; yes, chapter 2 is very much a cross-departmental strategy. It sets a bold ambition—what we like to think of as a north star—to halve child obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030. As with our initial plan, the new policies were informed by the latest research and emerging evidence, including from many debates in Parliament and various reports from key stakeholders. Those stakeholders include the Health and Social Care Committee and, yes, the Centre for Social Justice. In fact, the latter’s “Off the Scales” report is on my coffee table in the Department. It was the Centre for Social Justice that told me all about Amsterdam and it is because of it and its good work that I went to Amsterdam to see the work being done there.
Key measures in the next chapter include looking to address the heavy promotion and advertising of food and drink products high in fat, salt and sugar on television, online and in shops. Alongside that, we want to equip parents with the information that they need to make healthy and informed decisions about the food that they and their children eat when they are out and about.
My hon. Friend mentioned Brexit. Of course, there is never a debate in which we do not mention it, but there is a Brexit connection for this debate. One thing that campaigners call for is traffic-light labelling on the front of products. We are unable to do that while we are an EU member state, but once we are no longer, we will have new freedoms in that regard. I do not know whether that is what was meant by taking back control, but I put that on the record for the House.
I was pleased to hear of the efforts of Shillington Lower School in my hon. Friend’s constituency. Staff there are obviously doing all the right things to encourage children to take part in physical activity. I have seen great examples in my own constituency, most recently at Western Primary School, and I am sure that many other Members have seen good examples, too. Yes, it is about recognising that we need foods to be reformulated, but it is also very much about the importance of physical activity in tackling obesity. Yesterday, I opened a major physical activity and health conference across the way at the Queen Elizabeth II centre. It is going on all week and will consider the benefits of physical activity and health. As part of chapter 2, we are promoting a new national ambition for all primary schools to adopt the initiative of an active mile—or healthy mile; people call it different things.
I agree with my hon. Friend that achieving our ambition to reduce child obesity will require a concerted effort from many others, including families, schools and local authorities, which she mentioned. At the recent Local Government Association conference, I announced the trailblazer programme, which will work closely with local authorities to show what can be achieved and find solutions to barriers at a local level to address child obesity. I took great inspiration from what has been done in the city of Amsterdam. My hon. Friend is absolutely right that local authorities know their local areas best. By sharing ideas with each other—some very good things are going on—they can achieve the full potential of the powers and levers that they have. Many local authorities already have great powers and levers to change their areas. For instance, they have powers over junk-food advertising in the areas around schools. We want to see those powers used better.
As part of the second chapter, we have already launched the consultation on banning the sale of energy drinks to children—the message is clear: we do not think that they are appropriate for children—and the consultation on calorie labelling for food and drink served outside the home, or in the out-of-home setting, as they say. Later this year, we will launch consultations on restricting the promotion of fatty and sugary products by location and by price, and we will consult on further advertising restrictions, including a 9 pm watershed on high fat, salt and sugar products. Currently, products deemed HFSS are banned from being promoted only during programmes predominantly aimed at children. We will consult on taking that through to a 9 pm watershed. That work is with the Department for Digital, Culture, Media and Sport, the sugary drinks levy—the sugar tax—work is with Her Majesty’s Treasury, and the trailblazer programme work is with the Ministry of Housing, Communities and Local Government, so I gently reject the idea that this is not a cross-Government strategy. These consultations are genuine and are open to everybody, and we welcome full and considered responses from across society and industry.
So far as the future is concerned, we continue to learn from the latest evidence; my hon. Friend mentioned evidence. The Policy Research Unit informs us all the time of new approaches from across the UK. We welcome the action taking place in Scotland, which is consulting on its own obesity plan at the moment. It is good to see that many of our ambitions align. As I said, I often talk to partners in other countries about work going on internationally—I have mentioned Amsterdam a couple of times—and about where we can learn from them and, possibly, where they can learn from us..
My hon. Friend is also right to mention the additional £20.5 billion a year for the NHS that will support the new long-term plan. I cannot pre-empt what the NHS will put into the plan—the Prime Minister set NHS England the challenge of writing it—but we have been clear from the outset, and the new Secretary of State has been clear, that prevention should be a key part.
Our ambition is bold but simple. We have a lot to gain by reducing obesity, and we have an awful lot to lose. We believe that the hard, evidence-based actions that we propose will encourage healthier choices and will make those choices more readily available and identifiable to parents. Taken together, we are confident that those actions will have a real impact on child obesity. We will continue to monitor progress and emerging evidence. As we have always said, this is not the end of the conversation. We watch things like a hawk.
Finally, I reiterate my thanks to my hon. Friend for securing the debate, and to you, Madam Deputy Speaker, for facilitating it.
Question put and agreed to.
Baby Loss Awareness Week
Caroline Johnson Excerpts(5 years, 7 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I wish to join my colleagues in commending the Members who have so bravely recounted their own experiences of baby loss here tonight and at last year’s baby loss debate. As many have said, the loss of a baby is one that no parent should ever have to bear. I am fortunate not to have suffered such a loss, but as a children’s doctor I have, unfortunately, been the bearer of such bad news on too many occasions.
In my experience, the first reaction of a parent confronted with the tragic death of a baby is to ask, “Why? Why did this happen? Why my child? Why me?” In these agonising circumstances, answers as to why this situation has occurred can help to provide respite. The second reaction, one that is testament to the incredible empathy human beings have, even in the most difficult circumstances, is the desire to ensure that lessons are learned from their personal tragedy so that no one else has to endure that same heartbreak. I am in awe of colleagues, such as those here this evening, who have been through such a traumatic experience and found the strength not just to share that experience, but to use it to campaign successfully for improvements in care and to highlight areas to improve so that others do not experience such suffering in the future. I commend the work of the all-party group and my hon. Friends the Members for Colchester (Will Quince), for Eddisbury (Antoinette Sandbach) and for Banbury (Victoria Prentis) for their work to develop the bereavement care pathway. I have worked in hospitals where there has been excellent bereavement care, with the bereavement suite that has been described, and in others where the care has been less well developed, and I have seen the importance of the national bereavement care pathway. I congratulate them on it.
Although he is no longer in his seat, I also congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on his private Member’s Bill, which has developed child bereavement leave. As my hon. Friend the Member for Colchester has said, it will enable mothers to have an extra two weeks of maternity leave and fathers to have a doubling of their leave—some extra time to reflect and be at home with their family.
One recent improvement that the Government have made is the introduction of independent investigations by the Healthcare Safety Investigation Branch, which will look at every case of stillbirth or life-changing injury. That will help to meet the needs of parents in respect of that first question—“Why did this happen?”—and to prevent it from happening again. When the lessons are disseminated throughout the health service, doctors and midwives will be able to learn from previous experience to ensure that problems do not occur in future. It will be important—I look to the Minister to respond on this—to ensure that health professionals can speak openly in investigations without fear of blame. A blame culture will deter people from speaking openly and prevent improvements to patient safety. I have spoken numerous times in the Chamber about patient safety, and I am hopeful that the national roll-out of investigations will help us to meet the NHS’s goal of becoming the safest healthcare system in the world in which to give birth.
One development in neonatal care that I have seen in my 17 years of practice is the increasing centralisation of neonatal care, with the smallest and sickest infants now transported to specialist centres. I have worked in these centres and, although they provide exceptional care, they are often many miles away from the hospital where the child was first admitted or where the family live. For example, if a baby’s family live in Sleaford and North Hykeham, their nearest tertiary centre is in Nottingham. If the centre in Nottingham is full, the family may be sent many hours away to Norwich, Sheffield or Leicester. For working families on low incomes, the need to visit their sick baby several hours away imposes significant travel costs. Some families go through intense financial difficulty to meet that need to travel, while others have the distress of being physically unable to travel to see their baby as often as they would wish because they do not have the money to get to the tertiary centres. I raised the very same issue in the debate last year and would be interested to hear an update from the Minister on any measures being taken to help struggling families, many of whom work, to meet the travel costs in such an extremely distressing situation.
Tim Loughton (East Worthing and Shoreham) (Con)
My hon. Friend makes a good point about safety. In respect of smaller hospitals retaining maternity services, some years ago there was an attempt to downgrade Worthing Hospital and St Richard’s Hospital, such that they would lose their maternity departments and the service would be centralised in Brighton or Portsmouth. Fortunately, we defeated those proposals, and Worthing maternity department is now rated outstanding. It is also rated as the safest maternity department in the country; indeed, many mums now come from Brighton to Worthing because of its success. There is clearly a case for larger specialised hospitals for particular ailments and problems that need specialist treatment, but in most cases we need a good-quality, safe and trusted maternity service closer to where the parents live.
Dr Johnson
I congratulate the hospital in Worthing for its outstanding success. My hon. Friend is right that there is a balance to be struck between the centralisation of care for babies who require very low-volume but high-specialist care, and the need for care to be delivered as close as is reasonably practical to the individual family concerned. That is true of all medical specialties, really. In the case of neonates, we probably have the balance roughly right, but a trend may be starting whereby people ask for things to be centralised that in my perception do not really need to be centralised. As a professional, I often see babies who are not returned to the step-down care as quickly as they could be. Babies are sometimes kept in the tertiary centres for longer than is absolutely necessary. There are complex reasons for that, but I would be grateful if the Minister looked into the issue so that babies can be returned closer to home as soon as possible.
I welcome the Government’s ambitious aims to halve the rate of stillbirths and neonatal deaths by 2025. That will be possible only by reducing the number of pre-term deliveries, which are the leading cause of neonatal death in the UK. The Department of Health and Social Care’s goal of reducing pre-term birth from 8% to 6% will require a lot more research and intervention. We have a healthier population of women, but the number of pre-term babies continues to increase. More funding is needed for pregnancy research, and particularly for research into the causes of pre-eclampsia, cervical length and infections such as group B strep, as well as for the identification of small babies with early scanning. There must also be more work to discourage smoking, which we already know is an established risk factor for pre-term delivery. I welcome the previous Secretary of State’s saying in November 2017 that the Government will reduce smoking during pregnancy from 10.6% to 6% and raise awareness of foetal movement. All those things will contribute towards the reduction of the number of neonatal deaths and stillbirths. Through that work, the Government are best placed to meet their “halve it” aim, and in doing so save 4,000 lives.
Finally, I wish to discuss those babies who die in the post-neonatal period—that is, under the age of one but after 28 days of life. Currently, 1.1 in every 1,000 babies die in the post-neonatal period. The major reason is babies having congenital malformations, and the second most common reason is sudden infant death, the rate of which has recently increased, although the cause is not clear. What is the Minister doing to identify the reasons for the recent increase in sudden infant deaths? What is being done to prevent the number of sudden infant deaths from rising further and, indeed, to bring it down?
Dangerous Waste and Body Parts Disposal: NHS
Caroline Johnson Excerpts(5 years, 7 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I welcome the fact that there has been no gap in service provision and no public health risk and that the Minister has confirmed that nobody’s operation has been delayed because of this build-up of clinical waste, but it is still concerning that the contract was not properly delivered. How long has he given the site to return to compliance and what action is he taking to supervise the remaining contracts?
Stephen Barclay
The key issue for performance under the contracts is what, contractually, the legal requirements on HES are and whether those contractual terms have been breached. Part of the lessons learned is to look at whether contractual enforcement powers are sufficient. In terms of moving forward in respect of the other HES sites, that will depend on the contracts that the supplier has and whether it is in breach of those contracts or of enforcement action from the Environment Agency. To date, the Environment Agency has served one partial suspension, on the Normanton site. As I referred to, the Environment Agency was at the other site over the weekend. This is an area of significant scrutiny, but it will be for the Environment Agency to determine whether the company is not in compliance with its permits.
Oral Answers to Questions
Caroline Johnson Excerpts(5 years, 9 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
We published the second chapter of our world-leading childhood obesity plan on 25 June. It builds on the progress we made since the publication of chapter 1 in 2016, particularly on the reformulation of products that our children eat and drink most. We will continue to take an approach that is based on evidence and we are determined to act.
Matt Hancock
I pay tribute to my hon. Friend’s work at the Department for Digital, Culture, Media and Sport on this matter. It is critical that we have a cross-Government approach. The obesity plan is led by the Department of Health and Social Care, but it is a cross-Government plan. There is a whole range of actions we need to take—from education through to culture and broadcasting—to make sure we get it right.
Dr Johnson
One of the reasons why tackling obesity in children is so important is the fact that it has such long-term detrimental effects on health. Now that the Government have published chapter 2 of their childhood obesity strategy, will the Secretary of State outline how it will have a long-term impact on children’s health and tackle issues such as diabetes and heart disease?
Matt Hancock
My hon. Friend is absolutely right that obesity, especially in children, is one of the underlying conditions that often leads to much worse long-term health conditions. Some 22% of children aged four and five in reception are overweight or obese; that number is too high and we have to act.
NHS Trusts: Accountability
Caroline Johnson Excerpts(5 years, 10 months ago)
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Sir Mike Penning
I agree almost completely; I would just say that sometimes these people do not even leave the NHS—they stay within the structure of the NHS, but just go to a different trust in a different part of the country. Then they just reappear again and again.
I have often wondered about something. A director of nursing should clearly have come up through the nursing ranks; I understand that. Clearly, also, clinicians have to be involved in the clinical side. But why does NHS management have to be completely incestuous in how it works? If someone started as a nurse or doctor, how on earth do they have the necessary qualifications to run a massive multi-million pound organisation? Yet that is how it seems to happen. It took a long time for Mr Ron Glatter to get the figures when he was challenged. When we eventually got them, it was like pulling teeth: was it a package or a salary? “This is personal information.” This is taxpayers’ money. One of the most difficult things is to find out exactly where the money is going.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
My right hon. Friend mentioned nurses, doctors and other clinicians taking on managerial roles. To what extent is that driven by a desire to reduce the number of managers in hospitals—to call them “nurse managers” and claim they are nurses when they are actually fulfilling a management role?
Sir Mike Penning
My hon. Friend brings great expertise to the debate, and I thank her for joining us. She is absolutely right. I declare an interest: my mother was a nurse in the days of “sister” and “matron”. Then there were nurse managers and other managers—all of a sudden, we went that way, but we seem to be coming back again. We can change the name on the Titanic, but it is still the Titanic: a manager is a manager, no matter what title we put on them.
It seems to me that we are not reducing the number of managers. I vividly remember that there were 11 primary care trusts in the Dacorum area of my constituency. Then the number reduced to two—one, actually, because there was only one director of finance. When we looked at the head count, the cost analysis, which should have massively reduced, it had actually gone up.
I want clinicians to be involved in the day-to-day care of my constituents, but I am not convinced that a GP should chair a clinical commissioning group, especially given that in most cases they do not seem to be full time in the role. What qualifications do they bring? I know that GP practices are much more business-orientated now than ever before, but they employ practice managers—the partners do not run things.
More recently, there has been an understandable concern in my constituency about the proposed closure of one of the facilities called Nascot Lawn; it is not in my constituency, but was playing a vital role in looking after the most vulnerable children in my community. Brilliantly, the families and loved ones came together to challenge the closure. They got the MPs on board and we were involved. I then scratched my head and said, “Hold on a second, I remember being told that Nascot Lawn was going to provide the respite care for my constituents when they closed a place called Woolmer Drive.” Woolmer Drive was a desperately needed respite centre where young people could go, and where their carers and loved ones could spend a bit of time. So not only did Woolmer Drive close, which meant that patients had to go to Nascot Lawn, but Nascot Lawn was closing. That was challenged, but there was very, very little consultation.
I will talk about consultations in quite a lot of depth. Frankly, most consultations are a sham. The decisions are made before they consult. They make the decision to close, put it in their budgetary regime and then consult. They then come out and say, “We’ve listened to the consultation and we are going to ignore you.” So what is the point of the consultation?
Sir Mike Penning
I was coming on to that point, but let me meet it head on now. I speak to nurses and other frontline staff who look after my local patients, including some doctors, and they are petrified of telling their own MP what is going on in case of retribution. Perhaps the Minister will help me to get to the bottom of the number of gagging orders out there at the moment in my trust, whereby things have been settled and people have been gagged. The types of threats in the gagging orders that are put on them are very severe.
There was a consultation panel in my constituency about the future of health, and the people allowed on the panel had been gagged. These are members of the general public who have been told categorically not to talk to me. They are not to tell me what is going on in the NHS in my own local community. They will be thrown off the panel if they do, and it is worse for the staff who have gagging orders against them. This is very serious.
We see the amount of money the NHS uses in litigation, whereas our patients have to raise money themselves. The NHS seems to settle very easily when there are threats against it relating to malpractice or when something has gone wrong at the trivial end of things, but when things are really serious and deaths have taken place, down come the shutters. Nationally, we have seen what happens—it has happened recently in Gosport and in Staffordshire when I was a shadow Minister—unless the staff have 100% confidence that they can go to their MP or their line management and tell them what has been going on. Sometimes it can be quite trivial, but often it is very serious, and there is clearly retribution against them should they do so. That is something we need to sort out.
Dr Caroline Johnson
It is extremely important that all health professionals in hospitals are able to report any concerns that they have. I understand that there is to be a whistleblowing champion for each trust. What does my right hon. Friend know of those, and does he think they will help?
Sir Mike Penning
It is all well and good saying that there should be, perhaps in legislation, but unless people have the confidence that their career is not going to be curtailed, or unless they are close to retirement and are not going to put their pension at risk, they are not going to blow the whistle. What really upsets me is that although I was sent to this House to represent people and for them to be able to tell me, in confidence, anything that they needed to, so that between the two of us we could discuss how to take it forward—often without using their name, but if necessary we can—that is not happening. That really worries me an awful lot.
To go back to Nascot Lawn, we went to a judicial review. We have done that before in our part of the world. The judge sided with the patients, but all that happened—it was about process, of course—was that it went back to the CCG, which turned around and said, “We will consult slightly differently. We will address what the court said, and by the way, we are going to go ahead and do it.” It is a sham, and we should be honest about that in the House.
When we tried to prevent our acute hospital from being closed—I pay tribute to my community for that—we did everything in the world. We got a coffin on a trolley, and thousands of us pushed it from my A&E that was going to close to the nearest one at Watford hospital, which it was proposed people should go to, in order to show just how much passion there was. We managed to get the money together to go to judicial review—a lot of money; in excess of £60,000—and the judge said, “You have a moral case. You have an ethical case. I agree with you, but you don’t have a case in law because all the powers are with the trust and the PCT”, as it was then. I ask the Minister: how can it be right that people must be so concerned, not just in my constituency but elsewhere?
Lastly on this part of my speech, let me talk again about what happened when we lost our A&E. I have raised this in the House before, so the Minister knows what I am talking about. To go back a bit further, St Albans, Hemel Hempstead and Watford are covered by West Herts, and at one time all three had A&Es. We are a massively growing population. The largest town in Hertfordshire is Hemel, which will have a projected 20,000 new homes in the next 20 years. St Albans is expanding, and so is Watford. There was a consultation, but the public were ignored. The A&E was closed and made into an elective surgery facility in St Albans. The public promises to the people of St Albans were that Hemel’s A&E would look after them. It is not a particularly long ride—it is clearly not in St Albans town centre, but that was going to be that. However, a few years on, those responsible said, “Let’s shut Hemel’s A&E and move it to Watford, because that can look after West Herts,” so the promises went out the window. The public went mad in St Albans and in our area. They were all on the streets, and what did we get? An urgent care centre, some out-patient services and a fracture clinic. Really and truly, that is all that is left in Hemel.
Sir Mike Penning
That is absolutely what I hear every day in my constituency. I also hear, “What are you going to do about it, Mr MP? Get off your backside and do something about it!” I am doing everything I possibly can—I am meeting Secretaries of State and trusts—but what happens? I get ignored, because I have no powers at all; it is all in the hands of bureaucrats.
Dr Caroline Johnson
We have a similar situation in Grantham A&E, which serves my constituency. My hon. Friend the Member for Grantham and Stamford (Nick Boles) and I have been working to try to get Grantham A&E reopened around the clock since it was closed without consultation in August 2016.
Sir Mike Penning
If the A&E was closed without consultation, that is illegal. I think the Minister will confirm that it is illegal to make major changes to a community’s health provision without consultation.
Hemel Hempstead A&E closed after a bogus consultation, and everything moved to Watford. We were promised that it would all be okay, and that we would have a 24-hour urgent care centre manned by GPs. Let us go back to just before Christmas 2016. There had been chaos—and I mean chaos—at the acute admissions unit in Watford hospital, which has just recently come out of special measures. All the ambulances were getting held up in big bottlenecks at the A&E at Watford. The big, new, bright idea was that we would close the urgent care centre that had replaced the A&E in Hemel Hempstead, and that that would be okay.
I had a meeting with the chief executive of the trust, who told me, “Mike, we are only doing this on safety grounds, because we cannot get the GPs to cover the hours.” That was really surprising to me, because there is a GP drop-in centre in the next room—not across the other side of town or even in a different part of the complex, but in the next room. I was told, “That is a different contract. We can’t touch that, mate; it’s nothing to do with us.” The chief executive said to me, “Don’t worry, Mr Penning, we can’t close the 24-hour service, because we have not consulted. This is just a temporary, emergency measure.” She went on the local radio station—I did not ask her to do that—and reiterated exactly what she had told me. In fact, she went further and said that the centre would be closed for only a couple of months and that it would reopen, because it would be categorically illegal to change the hours without consultation.
Reducing the hours of an urgent care centre—which used to be an A&E—from 24 to 10 is a major thing. Eighteen months later, the trust consulted on a proposal to turn the 24-hour urgent care centre into an urgent treatment centre, which would shut at 10 pm. Perhaps the Minister can explain to the general public the real difference between an urgent care centre and an urgent treatment centre, because I struggled to do so. I know that there is a methodology within the Department, but all that Joe Bloggs, my constituents, saw was a downgrading.
By the time of the consultation, the centre had already been closed for 18 months, so what choice did we have? We could not rewind the clock 18 months. The trust misled us by saying that the measure was temporary. The chief executive promised me that to my face, and she repeated that promise on the local radio station. That commitment was not worth the paper it was written on—or rather the voice that spoke it. My constituents have suffered a massive loss of trust in brand NHS. Their trust has been decimated, because promise after promise has been broken.
Naturally, the vast majority of consultation responses —do not quote me on this, but I think it was about 80%—said that the centre had to be open 24 hours. Guess what, Madam Deputy Speaker? It is not. It has been renamed an urgent treatment centre, and it closes, allegedly, at 10 o’clock at night. Within the last few days, however, a very senior person in my constituency whom I trust implicitly saw someone collapse outside the centre at approximately 9.30 pm—half an hour before it was supposed to close—but the doors were locked. It was only because a member of the public opened them from the inside that the patient was seen. The doors were not opened by the NHS staff who were inside, even though they must have known that the patient was there. I hope and pray that she is okay.
I am now told that the doors are regularly locked at any time after 9 pm. That is disastrous for my constituents when they turn up there, but many of them simply do not trust the centre to be open at night. What is going on? Naturally enough, although sometimes inappropriately, they go to the A&E at Watford, which is causing it even more of a problem—but can we get anyone to listen? No, we cannot.
Watford General Hospital is in the middle of Watford, next to a football club about which a great many of my constituents are passionate, Watford FC. It used to be the home of Saracens, and I am passionate about them as well. The hospital was built in Victorian days, and the best way to describe it is “not fit for purpose”. The people of Watford will probably say, “Please do not run down the hospital, because it might be closed”, and I fully understand that, but the truth is that we all need a new hospital.
Although, as we heard earlier from my hon. Friend the Member for Redditch (Rachel Maclean) about her area, the population is growing massively, we are now supposed to listen to the management telling us what they are likely to provide. I have attended meetings with the Secretary of State and NHS Improvement about the applications from my local acute trust and clinical commissioning group, and it petrifies me that yet again they are not going to listen—I do not mean to me, or to the Minister, who knows that he has no powers and will be treated with the disrespect that I often receive; they just ignore us—but to the people whom they are supposed to be serving, and who pay their wages out of their taxes.
I am not a clinician, although I was a paramedic in the armed forces and I know a little bit, but surgeons, GPs and frontline senior nursing staff have been speaking to me privately. It is fundamentally wrong and dangerous to keep saying that Watford can cope with the ever-growing population of west Hertfordshire.
I have met representatives of NHS Improvement with a delegation from my hospital action group, led by the brilliant Betty Harris, with Edie Glatter and her team, Jan Maddern and others, and we have joined forces with a separate campaign from St Albans. We were promised that the NHS management, as they looked at the applications for healthcare regeneration in my part of the world, would ensure that the CCG and the acute trust had more than one option on the table, rather than just ploughing more money into the Victorian hospital. I know that there have been conversations about a greenfield site, which is owned by us because it is Crown Estate land. It is by the M1, close to the M25, between St Albans and Hemel Hempstead. It is perfect for an acute facility—the infrastructure could not be bettered—but I think we are being ignored again. I cannot prove that, but it is my gut feeling, and it is certainly the feeling of the thousands of people in my constituency.
I am a loyal member of the Conservative party. I was a Minister for seven years in seven Departments, and I was on the Front Bench in opposition for four and a half years. I have to ask myself why I am supporting a Government who are allowing my constituents to be ignored. The Minister must not take this personally, but the present situation is crazy. The Department of Health and Social Care—I was not in that Department, but I have been in many others—actually has very little control over what is going on out there in our wonderful NHS. We have inspections, my local hospital goes into special measures and then comes out of them, it gets into debt and then comes out of it. However, the truth in my part of the world is that if NHS management are not accountable to Ministers or to me as their MP—and, much more importantly, are not accountable to the people whom they are supposed to be looking after—we have a serious problem. If my constituents cannot come to me and express their concern about what is going on in the NHS, there is a serious problem with our democracy, and that is something that I cannot live with.
Stephen Barclay
I beg to differ from my right hon. Friend on that, because this gets to the crux of the issue. The NHS must evolve. It has to move with technology and with the skills mix. Alongside the significant funding injection that the Prime Minister announced at the Royal Free Hospital, the NHS must also deliver productivity. At the specialist level, such as oncology or neuroscience, we often have populations of 3 million that need to be treated. Look at the footprint of the Christie NHS Foundation Trust, for example.
If we look at the other end, we need to deliver more care in the home and not have acute trusts soaking up so much investment. We need dynamic reconfigurations without acute trusts being the sole focus of our attention. We need service changes but—this goes to the core of my right hon. Friend’s remarks—they must be taken forward with clinical leadership and in a way that delivers trust.
I am happy to continue to engage with my right hon. Friend’s specific allegations on a case-by-case basis.
Dr Caroline Johnson
The Minister talks about dealing with things on a case-by-case basis, so I wonder whether he will consider Grantham’s A&E, which has had to close overnight for nearly two years, to see what can be done to facilitate its reopening as soon as possible.
Stephen Barclay
Again, I am happy to consider that issue. I have been up to visit the United Lincolnshire Hospitals NHS Trust and have met the chief executive and the leadership team, so I am aware of the issues, which are partly due to geography. However, we are straying slightly away from Hemel Hempstead.
As I said, I am happy to engage with my right hon. Friend the Member for Hemel Hempstead on his specific allegations. It is important that service changes are done at the local level with clinical leadership in a way that builds trust, and I will continue to engage with him in the weeks and months ahead.
Question put and agreed to.
Gosport Independent Panel: Publication of Report
Caroline Johnson Excerpts(5 years, 10 months ago)
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Mr Hunt
I thank the hon. Lady for her comments. I do not want to jump to a conclusion about any changes to the draft Bill. However, we should definitely reflect on any legislative changes that might be needed as a result of this report, and that Bill could be a very powerful vehicle for doing so.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
My right hon. Friend has mentioned trust, and as a doctor myself, I am very aware of and humbled by the fact that people come to me with their children and put their trust in me to look after them. When events such as this occur, trusts can be shaken, and it is therefore important that these things are dealt with quickly. In this case, the investigation, since complaints were first received, has been going on for far too long. What will my right hon. Friend do to reassure people that any such complaints will be dealt with much more quickly in future, and that opportunities to save lives will not be lost in the meantime?
Mr Hunt
That is the big question we have to answer for both the House and the British people. However, I would say to the hon. Lady that I am confident that, where there is unsafe practice, it is surfaced much more quickly now in the NHS than it has been in the past. I am less confident about whether we have removed the bureaucratic obstacles that mean the processes of doing such investigations are not delayed inordinately so that the broader lessons that need to be learned can be learned.
Education (Student Support)
Caroline Johnson Excerpts(6 years ago)
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Angela Rayner (Ashton-under-Lyne) (Lab)
I beg to move,
That an humble Address be presented to Her Majesty, praying that the Education (Student Support) (Amendment) (No. 2) Regulations 2018 (S.I., 2018, No. 443), dated 28 March 2018, a copy of which was laid before this House on 28 March, be annulled.
I thank the Leader of the House for scheduling this debate, which marks an important moment. In this Parliament, Members have had to assert our right to decide the law of the land—a right that some Ministers have tried to avoid by denying us votes on statutory instruments. In this case, the Government let the 40-day period lapse without providing time. They have now agreed to the step, which I think may be unprecedented, of revoking their own regulations and relaying them to allow us a binding vote. Whatever the decision tonight, I hope that we have established the right of the Opposition to secure votes on the Floor of the House. The Government cannot simply legislate by the back door.
On the regulations, the Government’s actions once again seem to defy basic sense. Just last week, they rejected our motion to implement their own guarantee and manifesto commitment on school funding. Now, they are ploughing ahead with their plan to scrap bursaries for yet more nursing students, despite knowing full well the disastrous consequences that will follow.
Two years ago, the Government ignored the Opposition and those who work in the health sector when they scrapped the undergraduate bursary. The results were predictable. In 2016, before the abolition, there were more than 47,000 nursing applicants in England. In 2018, the figure fell to about 31,000—a fall of over 15,000. It is clear that this is the reason why we have seen the sharpest ever decline in nursing applications. I know what the Minister will say. He will say that the number of applications is less important than the number of acceptances; he will say that the Government have committed to create more trainee places for nurses. They promised an increase of 5,000 nursing places and said that the nursing bursary had to be scrapped to make that possible, but what have they delivered? Seven hundred fewer students training to be nurses.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Does the hon. Lady agree that what is important is that we train more nurses and that there are more applicants than the number we need to train, so that there is good competition that ensures we get the best candidates? It is not necessary to have masses more than we need; we just need enough.
Angela Rayner
I agree with the hon. Lady that we need to ensure that we have not only more applicants, but more people in training. However, 700 fewer students have been training to be nurses since 2017.
Angela Rayner
The passion from my hon. Friend reflects how people feel up and down the country. It is funny because we all know what happened at the general election—and the verdict was clear on the Government’s position on education and student debt and tuition. [Hon. Members: “You lost!”] And of course the Government lost their majority at the same time, and the weak and wobbly Prime Minister has done nothing to make anyone in the country feel more confident about her future—but I digress.
How many postgraduate students affected by this policy repay any of, let alone all, their additional loan? Will the Minister explain how this is sustainable? How much will really be saved in the long run? Or is this another example of what the Treasury Select Committee has called the fiscal illusion—in this case, of a student finance system that allows the Government to pretend they have made a saving when they are simply passing the bill down to the next generation? It is no wonder that all the devolved nations have maintained their own NHS bursaries.
Dr Caroline Johnson
The hon. Lady talked about the general election and promises on education and education funding. Will the Labour party be keeping its education promises to repay the debts of students who have already incurred them?
Angela Rayner
I should have thought that Conservative Members would have read what was a great manifesto. They have hidden theirs now—I cannot see it, because it is hard to find—but ours was absolutely clear, and we continue to be clear about the fact that we would abolish tuition fees. The debt that our students face at the moment is the result of a tripling of student debt on the Conservatives’ watch.
I hope that Conservative Members will support our motion, not least given the financial consequences of Government cuts for their own budgets, but also because I believe that we should welcome nursing students from all over the United Kingdom. If we do so, the whole country will benefit. If the House votes for the motion, that vote will be a clear call for the Government to rethink the cuts, restore the bursary, and respect the will of the House.
A few months ago, the Health Secretary said that the NHS was “nothing without its nurses”. I support that sentiment tonight, but the sentiment without substance is not enough. I am sure that there is not a single Member in the Chamber who would not acknowledge the urgent need for us to recruit more nurses, so I ask all Members to put their votes where their voices are. I commend the motion to the House.
Learning Disabilities Mortality Review
Caroline Johnson Excerpts(6 years ago)
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Caroline Dinenage
I completely hold my hands up. I am not trying to mislead the House in any way. It is an independent document and the University of Bristol decided when it was going to be published. It was published on Friday without permission from or any kind of communication with the Department of Health and Social Care. I do not know what communication the university had with NHS England, but no information was passed to us. The beauty of having an independent document is that it can be published when the organisation sees fit and the Government will have to respond to it.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
During my career as a paediatrician, I have seen huge improvements in the care of children and young people with severe and moderate learning disability, many of whom have survived into adulthood when that would not have been the case years ago. Owing to the association between severe and moderate learning disability and other medical problems that may limit someone’s lifespan, it is unlikely to ever be equal to that of the general population, but we should always ensure that the care of the most vulnerable in society is as good as it can be, and I welcome the steps that the Minister is taking to ensure that it is. Such people are cared for jointly in hospitals and in the community, so will she confirm that hospitals and community care will work together following such reviews?
Caroline Dinenage
This is something that my hon. Friend, as a healthcare professional, obviously knows an awful lot about. She is right that a person having the ability to communicate, understand and identify when they do not feel well is important. These annual health checks, which are available to children from the age of 14 and into adulthood, are important because they enable any healthcare issues to be disseminated and communicated much more effectively between different healthcare and other providers.
Oral Answers to Questions
Caroline Johnson Excerpts(6 years ago)
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Mr Hunt
I can absolutely commit that we are very conscious of the failings of PFI when we have any discussion about NHS capital funding, including the previous question. We are very conscious of the need not to make the mistakes that saddled the NHS with £71 billion of PFI debt.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Dispensing practices are a lifeline in rural constituencies such as Sleaford and North Hykeham. Does my right hon. Friend agree that patients who live far from a pharmacy and attend their local dispensing practice should all have access to that dispensing service?
Steve Brine
Yes, I do: dispensing practices are an important part of the widening primary care mix. That is important for constituents in rural areas such as my hon. Friend’s. Community pharmacy and dispensing practices, which she refers to, are increasingly important when they are part of an integrated primary care pathway. That has got to be the future.
Breast Cancer Screening
Caroline Johnson Excerpts(6 years ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I thank my right hon. Friend for his statement and for the work he is doing to ensure that women who are affected are supported and treated promptly, but what is he doing to ensure that people who are due for cervical and other NHS screening programmes are being properly called, and can he tell women who are affected—and, no doubt, very worried today—what they should do now? Whom should they call, should they be waiting for a letter, and how soon can they expect a scan if they wish to have one?
Mr Hunt
According to the advice that I have received so far, there is no read-across to other screening programmes, but obviously the independent review panel will look into that as it seeks to examine all aspects of the issue. We have made the commitment today that we will invite for scans all those who either should be scanned or should consider whether they wish to have a scan, and will offer them a date before the end of October, although we hope that in the vast majority of cases it will be much sooner than that.