Oral Answers to Questions
Debate between Caroline Johnson and Steve Brine(5 years, 4 months ago)
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Steve Brine
Of course, health is devolved, but we talk to our opposite numbers all the time, as do our officials. Our north star ambition to halve child obesity by 2030 is right and it is shared and matched by our colleagues in Scotland, and we look to our colleagues in Northern Ireland to do the same. Any advice and support that they want from our world-leading plan is more than on offer.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Does the Minister agree with the campaign being advanced by Jamie Oliver to ensure that doctors in training are given more extensive training in nutrition and its benefits for health?
Steve Brine
Yes, I do. I was fortunate enough to visit Southend pier before Christmas to talk to Jamie and Jimmy about this. Nutrition training and the understanding of what is involved in achieving and maintaining a healthy weight varies between medical schools. Some courses have only eight hours over what can be a five or six-year degree. Together with the professional bodies and the universities, we will—as we said in the long-term plan—ensure that nutrition has a greater place in professional education training.
Paediatric Cancers of the Central Nervous System
Debate between Caroline Johnson and Steve Brine(5 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I, too, wish we were not here, but let me congratulate my friend the hon. Member for Ogmore (Chris Elmore) on securing this evening’s debate. I commend him on his support and the incredible tribute he gave to Cian and Cian’s family this evening, and on the way he has handled the debate. For those who know him, in both the Government and the Opposition, it is rather typical of the man.
From what we have heard this evening, it is clear that Cian was a very special little boy who touched many people in his short life. I have seen his “Cian’s Kicking Cancer” campaign online, including the picture of him with his hands out in front of the No. 10 Downing Street door—it is a lovely photo—and I pay tribute to the determination of Cian’s parents to raise awareness of paediatric cancers. The way that they have been supported by their local MP is brilliant.
As the cancer Minister, I all too often hear of the devastation that this terrible disease can bring to people and their families, but nothing is as heartbreaking as when a child is affected. I said last week in the breast cancer debate that a life lived long or a life lived short is still a life lived, and I passionately believe that a life lived, short or long, still leaves an indelible mark on this world and still changes this world forever, even in a small way. From what the hon. Gentleman has told the House this evening, there is no question but that Cian has left his mark and changed the world a little bit. We will do our best to honour that and see whether we can change it a bit more.
Every day, at least 12 children and young people are told that they have cancer. When they are born—I have children myself—we all imagine bright futures for our children and the things that we want them to do, but cancer robs many children of that future and the opportunity to fulfil their potential. As the hon. Gentleman said, it is relatively rare in young children, but that is absolutely no consolation to the parents of a child with cancer. It can even be worse to know that and inevitably leads to questions such as, “Why me? Why my child? They haven’t made any lifestyle choices.” Cancer is indiscriminately cruel, and that is one of those awful truths that we face in life.
It is great that we have so much time for this debate. I know that there has been a bit of knockabout that the business finished early again this evening, but I genuinely believe that there is a reason why that happened, and we are going to make the most of it. I start by reassuring the House and those watching that cancer absolutely is a priority for me—I think most people know that—and for this Government.
I happened to be in the Tea Room before coming into this debate and the Prime Minister popped in after her marathon stint on her statement this afternoon. She asked me what I was working on and I said that I was doing this debate tonight. We spoke about how remarkable the way in which the House comes together in these debates is and how there is a concentrated audience for such debates. I know that the hon. Gentleman has put out on social media networks, as I am sure many others have, the fact that this debate is happening tonight, and I know, many people will be watching, so let us be clear: fighting cancer is absolutely central, as the Prime Minister said in her conference speech, to our long-term plan for the national health service in England—I have to say “in England”, because I am an English Health Minister, and the English cancer Minister. It will build on the progress already achieved in the cancer strategy and will set out how we will achieve our ambition that some 55,000 more people in England will survive cancer for five years each year from 2028.
I am absolutely committed to ensuring that our plan transforms outcomes for children with cancer over the next 10 years. The fantastic work being done by NHS cancer doctors and nurses, as well as the invaluable support that we get from our incredible cancer community, is helping us to achieve our vision of transforming cancer services for children and young people.
As I have said, childhood cancers are mercifully rare, but 1,600 children under 15 are still diagnosed each year in the UK. Central nervous system cancers are estimated to account for 25%, with 400 children diagnosed each year. Brain cancers alone account for more than 100 CNS cancers, making each cancer extremely rare.
It is true that survival for children’s cancer has gone up over the past decade, with five-year survival for children’s CNS cancers at 75%—that is how we measure it, but, of course, if people develop a cancer in their 70s, a five-year survival rate is a more significant achievement than for those who develop a cancer when they are under five. The survival rates have gone up, but there is not an ounce of complacency in me; we will and must keep working hard to go further and faster.
Treatment of CNS cancers varies depending on several factors—age, the tumour growth rate and the location and size of the tumour—but, as the hon. Gentleman said, it will usually involve a combination of surgery, chemotherapy and radiotherapy, depending on the clinical need. To ensure that patients have access to the latest, most cutting-edge technology wherever they live, we have invested heavily—some £130 million—to modernise NHS radiotherapy equipment. Over the past two years, 73 trusts have had their older linear accelerators, as they are known, upgraded or replaced, and that is an important thing that we have done—[Interruption.] Cheltenham is one of them, says my Parliamentary Private Secretary, my hon. Friend the Member for Cheltenham (Alex Chalk)—who says that PPSs do not speak in the House? He sits there diligently day in, day out, so why not?
The hon. Member for Ogmore mentioned proton beam therapy and I want to touch on that. In the past few years, there has been an increase in the use of PBT—for those who do not know, it is an advanced form of radiotherapy—for treating children with CNS tumours. It uses high-energy proton beams to treat the cancer much more precisely. These targeted doses of treatment have less impact on surrounding healthy tissue and fewer side-effects. In childhood cancers, that is critically important—the hon. Gentleman mentioned side-effects of treatment with regard to fertility, for instance.
Until now, PBT for children has been commissioned from overseas. We have sent children to America and to Germany. That is why we have invested £250 million to provide PBT services in England. I am delighted that the first NHS centre, at the Christie in Manchester, is scheduled to begin treating patients this autumn. A second facility is due to open at University College London Hospitals in London in 2020. I had the pleasure of visiting the Christie shortly after delivery of the giant ProBeam proton system, which is a significant engineering feat. The scale and complexity of the technology is truly breath-taking, and I am tremendously excited that we will shortly be providing PBT on the NHS in England, sparing patients the upheaval, discomfort and cost—I will come on to that—of travelling abroad for treatment.
Although survival rates for CNS cancers have been improving, some children will unfortunately suffer relapse, as we heard in Cian’s case, and treatment options can sadly be limited, even for palliative care. That is why NHS England is reviewing whether additional radiotherapy treatments, such as stereotactic radiosurgery and stereotactic radiotherapy—there is a difference—would be suitable for these patients. I am following that work closely, as I am interested in and excited by its potential.
This month, NHS England published the draft national genomic test directory for cancer, setting out how whole-genome sequencing for paediatric brain tumours and other genetic tests are now being considered for CNS cancers. I hope that introducing those tests will support better tumour identification and more targeted treatments for CNS cancers in children, and give hope to many others.
Perhaps the most exciting development in our efforts to treat childhood cancers successfully is the increasing availability of personalised treatments such as CAR-T therapy, about which there is understandably a lot of excitement in the medical community. With the introduction of more personalised and targeted treatments and different treatment options for children with CNS cancers, NHS England is reviewing how best to ensure that children receive the available treatment and from the relevant clinical team, now and in the future. We expect the availability of more personalised treatments to be a real game-changer for childhood cancers. The work is still in its early stages, and it will involve clinicians, service providers and charities as it progresses, but I will of course update the all-party group, which I will come to in a moment, as it develops.
Research, which the hon. Gentleman mentioned, is a crucial part of the fight against brain tumours. In May, we announced £40 million over five years for brain tumour research through the National Institute for Health Research, as part of the late Tessa Jowell’s brain cancer mission, which includes research for children with brain cancer. I only met Baroness Jowell once, unfortunately, but I was left in no doubt about what she wanted me to do—her legendary determination was very much in evidence. I very much enjoyed meeting her and Jess, her daughter, who is carrying on much of the work.
The hon. Gentleman talked about research projects. Baroness Jowell’s mission is about stimulating quality research projects—a point that the late baroness was able to nail as soon as she started to look into it. Although the NIHR spent £137 million on cancer research in 2016-17—the largest ever investment in a disease area—it does not allocate funding for specific disease areas. It does not have a basket for each disease area. Spending has to be driven, therefore, by scientific potential and the number and scale of quality funding applications.
The baroness was very pithy and understood immediately that we needed to stimulate the market in brain tumour research to enable quality research proposals to come forward. After that, the clinical research network, which is recruiting for or setting up more than 700 cancer trials and studies, including studies into childhood cancers and brain tumours, can press forward and do its work. Funding for paediatric cancer research is critical.
The hon. Gentleman also talked about international research. I absolutely agree that international collaboration is key for successful research on rare diseases such as CNS and childhood cancers. The Prime Minister has made it very clear that we want to work closely with Europe in science and research and that the UK is committed to establishing a far-reaching science and innovation pact with the EU, facilitating the exchange of ideas and researchers and enabling the UK to continue to participate in key programmes alongside our EU partners. Whatever “take back control” meant—one day I will be told—it did not mean that we are not to work with our EU partners in such areas. I am determined that it will not mean that, as are the Government. The Chancellor has also made it clear that he will guarantee EU structural and investment funding and underwrite payments for competitive EU research awards through the Horizon 2020 underwrite guarantee, which is a very important project.
The hon. Gentleman mentioned the Eliminate Cancer Initiative, which the late Baroness Jowell made sure I was acutely aware of. Its tagline “Making cancer non-lethal for the next generation” is really neat, and we certainly support it. It has huge global potential and reach. As he mentioned, given my international health brief, I travel to talk to Ministers from around the world. I was at the G20 earlier this month. The G20 and G7 have Health Minister meetings, as they should do; I certainly hope they will when we have the chair. I would like to see international research collaboration, specifically on cancer, on one of the G20 or G7 agendas. The hon. Gentleman’s point was well made. I will take it up with my officials so that, as we lobby for the chair of the next meetings, we talk about that. It would be an interesting piece of work that we as fellow Ministers could do. I know that people think that sometimes these international meetings are talking shops, and of course there is an element of that, but actually an awful lot of good stuff goes on and an awful lot of other agencies—the OECD, the World Bank, the EU—are part of those meetings. If Ministers decide that this is part of our agenda, that will make a difference and move the dial.
Several Members have talked about awareness of childhood cancers and I thank the hon. Gentleman for what he said about the all-party group on children, teenagers, and young adults with cancer. I am pleased to see my friend the hon. Member for Bristol West (Thangam Debbonaire) in her place. I welcome the establishment of that all-party group on the specific needs of children and young people with cancer. It is an excellent all-party group—several of its members are or were here. I was delighted to give evidence to its patient experience inquiry earlier this year. She had some of her patient advocates there, who asked great questions as well, and I commend it for an excellent report. I do not have to do this for all-party groups—I do for Select Committees—but I have undertaken that the Department will respond line by line to its report. I will definitely do that. It is not ready yet, but it will happen.
One of the all-party group’s recommendations was on signs and symptoms, which I will come on to, and another was on the cost of travel. The hon. Member for Alyn and Deeside (Mark Tami) mentioned the CLIC Sargent report that highlighted the financial impact of travel on the families of young cancer patients. It is a really good piece of work. I assure hon. Members that the Government are working to review the service specifications for children and young people with cancer. This will help us to consider how some aspects of the patients pathway might be provided more locally to reduce the travel burden for patients and their families. There is the other element: sometimes that cannot be done and people have to travel for treatment. The NHS cannot do everything brilliantly everywhere—clearly, specialisms are sometimes needed. That is why we have the healthcare travel costs scheme, which is part of the NHS low income scheme. It allows for patients’ travel costs to be reimbursed if they are in receipt of a qualifying benefit or are on a low income. The scheme helped some 337,000 applicants to receive financial help with their NHS treatment. I am very interested in the recommendations of the all-party group on that and I assure its members that I am taking great note of them.
Dr Caroline Johnson
I am pleased to learn that my hon. Friend takes such an interest in reports from all-party parliamentary groups. Will he undertake to look equally carefully at the report that will be produced tomorrow by the all-party parliamentary group for children who need palliative care, known as Together for Short Lives, which I co-chair with the hon. Member for Newcastle upon Tyne North (Catherine McKinnell)? It looks at how we provide palliative care for children with cancer and other life-limiting and life-threatening conditions.
Steve Brine
I will now take an intervention from the hon. Member for Ilford North (Wes Streeting).
Childhood Obesity
Debate between Caroline Johnson and Steve Brine(5 years, 7 months ago)
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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.
Oral Answers to Questions
Debate between Caroline Johnson and Steve Brine(6 years ago)
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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.
Access to NHS Dentists
Debate between Caroline Johnson and Steve Brine(6 years, 8 months ago)
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Steve Brine
I absolutely agree with the hon. Lady, and if she will bear with me, I will come on to that point.
Dr Caroline Johnson
As a doctor, I have seen the distressing circumstances in which children as young as two come in for teeth extractions. Children sometimes have all the milk teeth in their mouth extracted. Does my hon. Friend agree that there is more to preventing caries and such extractions than just dental treatment and having more dentists? The answer, particularly for the very youngest children, lies in extra education about oral care, as well as good diet and not drinking fizzy drinks and the like.
Steve Brine
Yes, there should be a package, and I will come on to mention one or two of those points. This is as much about self-care as it is about interaction with the dental profession.
To conclude the point I was making, at a regional level in the period to 30 June, the north of England saw the highest percentage of patients seen—56.8% of adults and 63% of children. Although these access numbers are encouraging, I know that the hon. Member for Bradford South will not be sitting there thinking, “That’s all okay, then.” I know that more needs to be done to reduce the remaining inequalities in access, including in areas such as Bradford South, which she represents, and NHS England is committed to improving the commissioning of primary care dentistry within the overall vision of the five year forward view.
There are a number of national and local initiatives in place or being developed that aim to increase access to NHS dentistry. Nationally, the Government remain committed to introducing the new NHS dental contract, which the hon. Lady rightly referred to often in her speech. It is absolutely crucial to improve the oral health of the population and increase access to NHS dentistry.
A new way of delivering care and paying dentists is being trialled in 75 high street dental practices. At the heart of the new approach is a prevention-focused clinical pathway. It includes offering patients oral health assessments and advice on diet and good oral hygiene, with follow-up appointments where necessary to provide preventive measures, such as fluoride varnish, that can help the prevention agenda. Importantly, and this is of most relevance in this debate, the new approach also aims to increase patient access by paying dentists for the number of patients cared for—let me restate that: cared for—not just for treatment delivered, as per the current NHS dental contract. Subject to the successful evaluation of the prototypes, decisions will be taken on wider adoption. The prototypes are being evaluated against a number of success criteria, but let me be clear that they will have to prove that they can increase dental access before we consider rolling them out as a new dental contract.
I appreciate that this is taking a long time. It is as frustrating for me as it is for right hon. and hon. Members and for the profession, but Members will understand that rolling out a new dental contract is complicated and complex. We have to make sure that it is right and that what we put in place is better than what was there before.
Adult Social Care Funding
Debate between Caroline Johnson and Steve Brine(6 years, 10 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Improvements in medicine have enabled people to live longer, but we also want them to live more healthily. We know that investment in reducing loneliness, in improving activity and in treating conditions such as macular degeneration, which causes blindness, will help to reduce the need for social care. What is the Minister doing in this regard?
Steve Brine
Although I am not specifically the Minister with responsibility for care, I am the public health Minister and the primary care Minister. We have brought those two subjects together because we want to see a healthy population across the board. I am pleased that my hon. Friend has mentioned the Commission on Loneliness. It was probably set up before she entered this House; it was started by the late Member Jo Cox, who did some really good work that is rightly being taken forward in this Parliament.