Liver Disease and Liver Cancer: Diagnosis

Clive Betts Excerpts

Tuesday 11th October 2022 Westminster Hall

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I beg to move,

That this House has considered the diagnosis of liver disease and liver cancer.

It is a pleasure to serve under your chairmanship, Mr Betts. I am proud to sit as a vice-chair on the all-party parliamentary group on liver disease and liver cancer. I am delighted to have succeeded in securing today’s debate.

While health policy may be devolved in Scotland, I believe that work in this area across our four nations is vital. We can support each other in cutting mortality rates and improving outcomes across the UK. The liver is a remarkable organ. Like something from science fiction, it can regenerate. It is one of the more forgiving pieces of our anatomy. We can make lifestyle changes and treat it a bit better, and it has the capability to heal itself and undo some of the damage we may have caused in the past.

Considering that the liver is one of our most important organs in terms of its function, we probably do not give it the attention it deserves. Some 49% of liver cancer cases in the UK are preventable, and 20% of liver cancer cases in the UK are caused by smoking, according to Cancer Research. There are around 6,200 new liver cancer cases in the UK every year and 5,800 deaths. That is roughly 17 diagnoses a day and 16 deaths. There are five types of liver-affecting cancer, with hepatocellular carcinoma, or HCC, being the most common, accounting for more than three quarters of liver cancer cases globally.

While mortality rates for other cancers have improved over the decades, liver cancer mortality has more than doubled since the ’70s, with only 13% of patients surviving more than five years from diagnosis. Right now, the United Kingdom is facing a liver disease crisis. The number of deaths from the disease have doubled in the last two decades, while other disease outcomes, for example from diabetes or respiratory diseases, have stabilised or even improved. Around 10,000 people die from liver disease and liver cancer each year in the UK. It is the second leading cause of premature mortality in England and Wales after suicide. These statistics come in spite of the fact that 90% of liver disease is preventable.

As a Scottish MP representing a Scottish constituency, this hits even closer to home. Scotland has the highest mortality rate for liver disease in the whole United Kingdom. We also have one of the highest mortality rates for chronic liver disease across central, northern and southern Europe. This health crisis is affecting my constituents, and the statistics are sobering. In 2020, Scotland saw an 11% rise in chronic liver disease deaths on the previous year. It is one of the leading causes of premature deaths, above breast cancer and suicide. Approximately seven in 10 people who died of liver disease were of working age, so under 65. In a country with an average life expectancy at birth of 76.6 years for males and 80.8 years for females, these are premature deaths.

I want to look at why liver disease and cancer outcomes are so poor in Scotland and across the UK and at what work needs doing to address that. Let me start with the why. One of the biggest barriers to effective diagnosis and treatment is the social stigma that continues to cloud how we view patients with liver disease and cancers. It is crucial to acknowledge and understand the part that poverty has to play in the demographic of patients with these conditions. As the UK grapples with the cost of living crisis and a drastic drop in living standards, this is not a contributing factor that can be overlooked or ignored—it will be a huge risk to public health and the lives of those living in our most vulnerable communities—and it would be a catastrophic mistake to do so.

There are over 100 causes of liver disease, but the ones that contribute to the most cases are also factors much more likely to be present in poorer communities: alcohol misuse and obesity. In Scotland, 58% of liver disease deaths are alcohol related. Across the UK, alcohol-related liver disease accounts for 60% of diagnoses. Like most addictions, alcohol abuse is statistically higher in poorer communities and carries a heavy stigma: the resulting harm is seen as self-inflicted. To improve outcomes for alcohol-related liver disease, we need to look at alcohol dependency and the reasons for its prevalence. Most importantly, we need to support patients in making positive lifestyle changes. Access to the right care is paramount, and increasing the availability and quality of support available at a primary care level is essential.

On the impact of obesity, which is also higher in Scotland than the rest of the UK, non-alcohol related fatty liver disease, or NAFLD, is expected to become the leading variation of the disease in the UK within the next decade. Nearly one third of Scottish adults are obese and two thirds are overweight, but the statistics across the UK are similar. Again, obesity is more prevalent in deprived communities; it is seen as a choice. Obese people are seen as greedy or lazy, and societal conditioning teaches us that we do not need to look much closer at the reasons why.

There are many reasons why obesity is on the rise in those communities, including underlying health conditions, eating disorders and a lack of access to high-quality healthy foods. Like alcohol abuse, this challenge needs to be met with increased access to the right support, such as weight management programmes, but by far the most important tool on the road to prevention is early detection. That goes for alcohol-related liver disease, NAFLD or viral hepatitis, autoimmune or genetic-related.

Liver disease is largely asymptomatic in the early stages. Three quarters of patients with cirrhosis are diagnosed only when it has progressed too far for intervention or treatment. Without early detection pathways and investment in treatment, we will continue to see mortality rates rise. The British Liver Trust’s 2021 survey showed massive disparities in access to patient care pathways for early diagnosis in primary care settings region to region. It revealed that just 26% of local health bodies in the UK have effective pathways in place. It is calling for every integrated care system or health board to ensure that there is a named person responsible for liver disease and the identification of high-risk patients, and for all GPs to have the means to assess fibrosis.

CT and MRI scans are a critical tool for diagnosis and informing treatment plans, but this is an area that has been overlooked. The key problems are access to the right equipment and the quality of the equipment available. Some 41% of clinical radiologists state that they do not have the equipment they need to deliver a safe and effective service for patients. Industry surveys show that one in 10 CT scanners and almost a third of MRI scanners are more than a decade old—the age at which the equipment is considered obsolete. That is shocking.

This area of the NHS, like so many others, it is struggling with workforce numbers. The British Liver Trust welcomed the Government’s 15-year workforce strategy earlier this year, and I back its calls for gastroenterology and hepatology to be given due recognition through that process.

In May, I visited the Royal Free Hospital in Hampstead with the hon. Member for Caerphilly (Wayne David), as part of the APPG’s work, and we saw the Sheila Sherlock Liver Centre, a leading centre for liver disease treatment. It is well equipped with excellent, highly skilled staff. I would like every area of the UK to have something similar in place for patients. I met the chief executive, John Connolly, and Dr Thorburn, a consultant hepatologist, along with some of the patients. My conversations with Lucy and Hannah, two young women undergoing treatment at the centre, really brought home the human aspect of the disease. I am grateful to them for taking the time to speak to me about their experiences.

This morning, I received some very disappointing statistics from my local health board, NHS Lanarkshire, which is categorised as “red”, with no effective pathways in place for early detection and disease management. I have reached out to NHS Lanarkshire to request an urgent meeting so I can discuss this and seek assurances on its plans for improvement. The stats for my local board have cemented just how fundamental it is to properly fund detection and treatment of liver disease and liver cancer, and to give the NHS the tools it needs to support our communities.

While NHS Lanarkshire falls under the remit of the Scottish Government, I want to make some requests to the Minister here, too. The all-party parliamentary group on liver disease and liver cancer, along with the British Liver Trust, is calling for a full review of adult liver services by NHS England. I urge the Minister to make that a priority. I hope that I have set out enough reasons to illustrate why that is so essential, and I am sure that other Members will have more to add.

As part of the plans to improve early detection rates, the NHS health check must routinely include assessment for non-alcoholic fatty liver disease, as it looks to become the leading cause of liver disease over the next 10 years. Pathology is also vital, providing the study of disease and informing the development of treatment. I back calls for a new, nationally endorsed pathology pathway. That is another area that desperately needs support with its workforce supply and funding. I hope that the Minister will be able to address her Department’s plan for that support. Overarching all of this is the need for Government commitment and direction to address the disparities in access to care through policymaking and implementation.

Before I finish, I thank several organisations for supplying briefings to inform so much of this speech, and for their ongoing work in this area. I thank The British Liver Trust—particularly Paul, Richard and its chief executive officer, Pam—as well as Cancer Research, the Royal College of Pathologists and the Royal College of Radiologists. I look forward to the Minister’s response; I hope that, through collaboration, we can accelerate progress across the four nations to improve outcomes for patients and for our constituents.

[Mr Clive Betts (in the Chair)]

The wind-ups have to start at about quarter past, so that is six Back Benchers in about an hour. I think you can probably work out the time limits for yourselves in that respect. First of all, from the Government Benches, I call Peter Gibson.

[Peter Gibson (Darlington) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this debate. I also welcome the Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), to her place. I wish her every success in her new role. I have known her for over 30 years, and I have every confidence that she will be a thoughtful, listening Minister in a Department where she has professional experience and expertise.

Last month, my father should have celebrated his 80th birthday. Instead, his life was cut short by liver and pancreatic cancer. He died at 47—the age I am now—exactly six weeks to the day from being diagnosed. Looking back on the events of his passing in 1990, I would have assumed that things had improved. Advances in screening, treatment and diagnosis surely must have led to a very changed picture. However, in preparing for today’s debate, I have sadly learned that things do not look better. The British Liver Trust reports that there were around 200,000 deaths from liver disease in 1990, and in 2018 that figure had risen to almost 400,000.

In the north, the picture is quite bleak. It has the highest levels of liver disease, the highest admissions and the highest deaths. Liver disease is the second biggest cause of premature mortality and lost working years of life. We have seen a 400% increase in deaths from liver disease over just the last two generations. Liver cancer has seen the second fastest increase in incidence of any cancer in the UK, and the fastest increase in mortality rates over the past decade of any cancer for both men and women. Liver cancer mortality rates have more than doubled since the 1970s. I am reliably informed by the British Liver Trust that, sadly, the mortality rate in Darlington is the worst in the north-east, at 46 deaths per 100,000. Those are the worst results of any constituency in the north-east, which in itself is the worst in the country.

Those figures are not worrying or troubling; they are shocking. That is why I am pleased that we are having this debate. It is essential that the Government focus on tackling the causes of liver disease and cancer, so that we can prevent further families from losing a loved one prematurely.

As we know, liver disease is largely preventable, however symptoms often do not present until the damage is irreversible, making early diagnosis difficult but key to tackling disease. We know that liver disease deaths are higher in more deprived areas and are increased by higher levels of alcohol harm and obesity. When we talk about levelling up—improving our roads and railways, improving our homes and hospitals—we must not forget, and indeed must have a keen focus on, the health mission element of our levelling-up goals: to narrow the gap in healthy life expectancy and increase healthy life expectancy by five years.

The British Liver Trust’s “Make early diagnosis of liver disease routine” campaign in Parliament earlier this year was welcome, as are the Government’s efforts to improve diagnosis times and make testing more readily available. The evidence from this debate, however, is clear: we need to go much further and much faster to have a real impact on the dreadful mortality figures.

As I said at the beginning, I know that the Minister is someone who listens and who will have listened closely to the debate. I know too that, as someone who was born in the north-east, she will share my concerns about those families robbed of their fathers or mothers too early. She will want to do all that she can to reduce those losses in the future. I look forward to her response to the debate.

[Mr Clive Betts (in the Chair)]

Those Members who were listening intently to what I said earlier will have noticed that I tried to extend the debate by a further half hour, although we do have to start the wind-ups at about quarter past. For guidance, that gives about five minutes for each speech.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Clive Betts (in the Chair)]

I remind hon. Members to try to keep to five minutes. The next Member indicated that he has to leave before the end of the debate, and I accept his reasons, so I call Anthony Mangnall.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this important debate, as well as on the important work that she and my hon. Friend the Member for Caerphilly (Wayne David) do with the APPG.

While there are multiple causes of liver disease, such as from viral hepatitis, obesity and alcohol, I particularly want to focus on alcohol. Successive Health Ministers will know that, over a period of time, I have consistently raised concerns about the absence of a comprehensive alcohol strategy. This afternoon we have heard only too clearly why that is so important. For too long, alcohol has been promoted as a social norm, and not to imbibe as an anomaly, yet the scale of alcohol harm, psychologically and physically, is off the radar. It is something that is causing me significant concern, whether it is used for pleasure or to address pain. It must become a priority of this Government.

In a city where I see more and more licensing of premises, I am aware of the impact and harm that that is having on livers. We see it in the statistics. My discussions with the British Liver Trust over the summer highlighted the fact that more and more people with liver harm were younger and sicker. Our excellent public health team in York says that it is their No. 1 concern. When we match that against the fact that 90% of liver harm is preventable, we realise that there must be a more comprehensive strategy. As the profile of those with liver disease changes, so must investment in prevention, diagnostics and disease management.

Astoundingly, since 2010 hospital admissions for liver disease have risen by a staggering 45%. NHS Humber and North Yorkshire ICS currently has no clinical pathway for the early detection of liver disease. I have written to express my concern, and the ICS tells me it will respond on 4 November.

There are many causes of liver disease and cancer, but prevention and early detection can make a significant difference to outcomes. In Yorkshire and the Humber, our pressurised NHS is seeing a 13% increase on the national average for admission rates due to liver disease, and rates are 38% higher for alcohol-related liver disease. In York, alcohol is a major factor in A&E attendance. For women in York, admissions due to liver disease are 30% higher than the national average. As we focus on York being a drinking capital, we have to look at those correlations.

Over the covid period, many people turned to alcohol as a means of addressing other needs. When so many people are dying from alcohol-related disease, the Government must turn their attention to that matter—not least because we know the impact it has on the most deprived communities, as we have heard. In York, the mortality differential is 10 years between the most deprived communities and the wealthiest. One in four with alcohol-related liver disease will die in hospital within 60 days of detection.

I know from working on a ward specialising in hepatology how important this subject is, but also how tragic it is for families. That is why I urge the Government to focus attention on this public health matter in a way akin to Dame Carol Black’s work on drug-abuse harms. There were 4,859 drug deaths in 2021. I am not belittling that statistic at all, but the fact that there are 10,000 liver deaths—over double—really demands the Government’s attention and a strategy. However, there is none in place.

That is why the Minister has a unique opportunity—one that she must take hold of. Ministers can turn their attention to so many things, but getting on top of this issue, driving a strategy that makes that difference and ensuring that every community has a diagnostic centre, as York longs to, could make a serious difference to our communities and our nation. I trust that she will embark on an alcohol strategy and ensure that there are community diagnostic centres, that alcohol harm is properly addressed and focused on, and that we also understand and focus on non-alcohol related fatty liver disease. We have an opportunity to double down on tackling liver disease, and I trust that this Government will not let this moment pass.

[Mr Clive Betts (in the Chair)]

To co-operate with the timing, we head to the Front Benches, with five minutes for the Opposition, 10 minutes for the Minister and a couple of minutes at the end for the mover to wind up.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for securing a debate on this important issue. She has been a great advocate on this topic, and I share her commitment to tackling this serious disease. I also thank my hon. Friend the Member for Darlington (Peter Gibson) for his kind words and for sharing his family story and speaking about some of the personal, family impact of these terrible conditions.

It is a year ago this month that our colleague, Sir David Amess, was tragically taken from us. He had a huge interest in liver disease. He was the co-chair of the APPG for hepatology and did so much to raise awareness of this disease in Parliament. One of the many ways we can take forward his legacy is to improve the lives of those with liver disease. That is why, although the Minister responsible for this topic was unable to attend, I wanted to ensure that I took forward this important debate and updated hon. Members on the work we are doing.

Many have talked about the scale of the problem, so I will not go further into that, but I want to talk about what we will do to address it. First, the NHS plan will help us to do that. It recognises the importance of preventing avoidable liver disease through targeted policies to address alcohol consumption and obesity. Unfortunately, most people are diagnosed with liver disease at a late stage, when it is less treatable, and they are often diagnosed during an emergency hospital admission. It is for that reason that liver disease is often called the silent killer.

To help detect early signs of liver disease, NHS England has a number of trials in train. One is evaluating intelligent liver function tests. That is when patients get a normal liver function test, and the laboratory has a process in place, based on those results, to test the same sample further, not necessitating a further appointment, so we can work out which patients need further investigation and treatment.

The NHS health check for 40 to 74-year-olds also identifies people particularly at risk of alcoholic liver disease and refers them in for further treatment and investigation. On top of that, we have the fibroscans, which have been rolled out through community diagnostic centres. They help to identify fibrosis in the liver at a time when we can try to treat it and before it becomes worse. Last year’s spending review allocated £2.3 billion for diagnostics to increase the number of community diagnostic centres to at least 100 by March 2025. That will boost diagnostic capacity to diagnose liver disease and improve earlier diagnosis and health outcomes.

The hon. Member for Strangford (Jim Shannon) talked about education for children about alcohol. Education on alcohol is now a statutory component of relationships, sex and health education in England.

My hon. Friend the Member for Totnes (Anthony Mangnall) talked about a review of liver disease and liver care. That is taking place in 2022-23, and there should be a report after that. He and my hon. Friend the Member for Warrington South (Andy Carter) raised transplant care. I will ask the responsible Minister to write to them with further details about what is being done in that area.

The hon. Members for York Central (Rachael Maskell) and for Strangford said that many liver diseases can be prevented and are preventable, particularly in relation to alcohol, obesity and hepatitis, and I want to talk a little about what we are doing in those areas. Alcohol is the leading risk factor for liver disease, and identifying disease early in those at risk and supporting them to stop drinking is critical. If they stop drinking, that can halt or even reverse damage to the liver. People at risk of alcoholic liver disease are being identified and given early access to tests, to detect emerging liver disease through the health check and other means.

The NHS has also invested in the treatment of alcoholism: £27 million has been used to establish specialist alcohol care teams in hospitals with the highest rates of admissions related to alcohol dependence. Those specialist teams will help identify alcohol-dependent patients, start them on specialist alcohol treatment in hospital and support their transfer to community alcohol services.

Since April 2022, NHS England has introduced a measure known as commissioning for quality and innovation, which incentivises providers to improve earlier detection of liver disease for alcohol-dependent in-patients in acute and mental health services. We are also committed to increasing liver health investigations in community treatment settings. Through the drugs strategy, we are making the largest ever single increase in drug and alcohol treatment and recovery funding, with £780 million of additional investment over the next three years.

As hon. Members said, another major risk factor is obesity. Tackling obesity is a major priority for the Government. We have seen some important successes since 2016. The average sugar content of drinks subject to the soft drinks industry levy decreased by about 43% between 2015 and 2019. This month, regulations have been brought in about store placement of products that are high in fat, salt and sugar, so that they cannot be displayed in areas of the store that are attractive and available to children. There have also been the provisions set out in the Calorie Labelling (Out of Home Sector) (England) Regulations 2021 and an investment in further weight management services for people living with obesity.

I would like to turn to hepatitis B and C, which are also important risk factors for liver disease and primary liver cancer. Through the NHS hepatitis C virus elimination programme, we have reduced the number of people living with chronic hepatitis C virus infection in England by 37% since 2015. New treatment with direct-acting antivirals has massively improved the success of the treatment, with mortality from hepatitis infections falling by 35% since 2015. So that has already reaped rewards.

There is a new opt-out pilot programme of testing for HIV, hepatitis B and hepatitis C in emergency departments in areas of the country where HIV is most prevalent, which is a proven way of identifying new cases. During the first 100 days of the pilots in London, Blackpool, Brighton and Manchester, 328 people with hepatitis B were newly diagnosed, with 30 found to be lost to care. Each of them is an individual who will now be able to be treated effectively for the condition, which will reduce the risk of passing it on. Similarly, 137 people were newly diagnosed with hepatitis C, of whom 23 were found to be lost to care. Those are promising early results in just the first 100 days, and we now looking at what we can do to perhaps roll this programme out to other centres.

Many hon. Members talked about primary liver cancer, which has a tragic impact. As my hon. Friend the Member for Darlington said, the number of recorded deaths has more than doubled in the last two decades. Cancer Research UK statistics show that there are around 6,200 new cases diagnosed each year and, tragically, 5,800 deaths. Unfortunately, the five-year survival rate for people with liver cancer is poor, at only 13%, and that could be markedly improved by earlier diagnosis, as I mentioned.

To contribute to achieving a long-term plan ambition to diagnose 75% of cancers at an earlier stage by 2028, the NHS cancer programme has launched the early diagnosis liver programme. The programme aims to detect more liver cancers at an earlier stage, so that more patients can benefit from treatment. More people at a high risk of liver cancer are referred to six-monthly liver surveillance. The national cancer programme is working in partnership with the hepatitis C virus elimination programme to deliver 11 community liver health check pilots.

The pilots aim to support early detection and diagnosis of liver cancer by identifying and referring people with cirrhosis or advanced fibrosis into a liver surveillance pathway, and providing them with a peer supporter who can help and guide them through future appointments. The pilots will target people experiencing significant inequalities and those who disengage from the healthcare service, including homeless people, those with alcohol and substance addiction, sex workers, people in the justice system, disabled people and others. The hon. Member for Enfield North (Feryal Clark) mentioned the workforce; she will be interested to know that over the last five years there has been a 20% expansion in the number of consultant hepatologists.

This is an important debate on a very important issue. We have heard some heartfelt contributions about the pain that liver disease and liver cancer bring to so many people and their loved ones across the United Kingdom. This Government are determined to take action and to make the changes that are needed to tackle this deadly disease.

[Mr Clive Betts (in the Chair)]

Margaret Ferrier has one minute to wind up.

Health and Social Care Leadership Review

Clive Betts Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

Yes, I absolutely agree.

[Mr Clive Betts (Sheffield South East) (Lab)]

I hope the Secretary of State will agree that it is key that managers in the NHS and local authorities can work together effectively. I give great credit to the leaders in the clinical commissioning group, the hospital trust, the director of public health, the social care directors and the city council, who worked really well together in Sheffield during the pandemic to deliver a joined-up service and have kept us as MPs thoroughly involved.

As we move on to the slightly wider integrated care system and integrated care board, will he give a commitment that the place-based working that has been so effective in the past will be allowed to continue at local authority level?

Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022

Clive Betts Excerpts

Wednesday 26th January 2022 General Committees

[Mr Clive Betts (Sheffield South East) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Murray. I shall not detain the Committee long; I just want to put on the record that the Levelling Up, Housing and Communities Committee is currently conducting an inquiry into social care and its funding. I will not go into the details of that as I would be straying from my remit this afternoon.

I want to draw attention to two or three issues that are directly relevant and came up, on which we will be reporting as a Committee in due course. We talked to care users and carers the other day and heard some heart-rending stories: “Please when you reform and review, will you do it with us and not to us?”

[The Chair]

Order. I am sure you meant the Minister and not me.

[Mr Betts]

I did mean the Minister; I am sure you would do it only too well, Mrs Murray, without having to be directed in that way. I was explaining what the carers and the people receiving care were saying. I hope the Minister reflects on that message in future.

There are two direct issues to do with Care Quality Commission inspections that came out from our conversations as well; the Minister may at some point wish to think about discussing these with the CQC. One is: “Why does it always announce inspections before they happen? They change the arrangements in our home before the inspectors come, so what’s the point of the inspection? If you’re really going to find out what is happening, go in and inspect without giving the warning.” That is a matter directly to do with the regulations—how they are implemented in future.

The other issue is something that the local government and social care ombudsman said to us at a different hearing. He is really concerned that so many care homes do not clearly demonstrate to the residents, and their friends and relatives who visit, that if things are wrong they can access not merely a complaints procedure themselves but that procedure can lead on to a report to the ombudsman. We are all too well aware of that, but residents often are not.

The CQC could draw attention to that in their inspections and relationship with the sector. The ombudsman is asking for specific parliamentary powers, but this could be done through encouragement from the CQC when it is inspecting, saying, “Have you got your complaints procedure up there? Is there a clear indication to people that they can go to the ombudsman if they are not satisfied?” That is something positive that inspectors could do as part of the regime and regulations that we are discussing today.

Vaccination Strategy

Clive Betts Excerpts

Wednesday 12th January 2022 Commons Chamber

[Maggie Throup]

My hon. Friend is quite right that we do bear responsibility. I do not take these decisions lightly at all and neither does my right hon. Friend the Secretary of State. That is why the JCVI and the CMO continually review not just the UK data but the national data for every age range, every vaccine and every eventuality. The CMO will have heard my hon. Friend’s request and I am sure he will be completely focused on making sure that the JCVI continues to monitor the situation in the specific way my hon. Friend asks for.

[Mr Clive Betts (Sheffield South East) (Lab)]

First, I congratulate everyone in Sheffield—including GPs, the hospitals and the city council—who worked brilliantly together to deliver thousands of vaccines in the run-up to Christmas.

I want to ask about people with compromised immune systems, and I declare my own interest in that. Having the third dose, followed by a booster, is absolutely right, but to begin with there was a lot of confusion about whether the consultant or the GP should be responsible for contacting people. I think it has just about been sorted out, but I have received an email today from my constituent Jeanette, who says that although everyone in her situation should have received a letter offering the availability of new treatments, she got a letter but her husband did not; that although everyone should have been sent a PCR test in the post, she did not get one; and that although she was told to ring 119, when she did so she could not find the option to complain that she had not received a PCR test. Will the Minister have a look at who is responsible for the availability of new treatments and the sending of PCR tests, and at what happens when things do not happen properly?

[Maggie Throup]

I thank the hon. Gentleman for raising this important part of our strategy to make sure we can react quickly in respect of those with certain conditions. Giving them ready access to the antivirals is the third part of our strategy to combat coronavirus. GPs and hospital consultants should link up to make sure that the right conditions are considered. I advise the hon. Gentleman’s constituent initially to contact her GP to make sure that she fits the category. If she has received the letter but no PCR test, she should contact 119—Test and Trace—

[Mr Betts]

She can’t!

[Maggie Throup]

Or she should go online to find out whether there has been a mismatch in the data. If she has received the letter saying that she should receive the PCR so that she can do one if she has symptoms, we just need to make sure that she gets one delivered to her home.

Covid-19 Update

Clive Betts Excerpts

Monday 6th December 2021 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

I refer the Secretary of State to the issue of third doses. I welcome the Government’s policy of giving people with compromised immune systems a third dose, and I declare my own interest in that. I ask him, though, why is there so much confusion around who is responsible for advising people with an entitlement to a third dose. There is a lot of confusion between secondary and primary care providers. Secondly, why is it not possible to go online to book an appointment for a third dose as it is to book one for a first, second or booster dose?

[Sajid Javid]

The reason it is not possible to go online to book a third dose is that, often, the GP will need to make a judgment on the particular individual. A lot of cases are different, and often it depends on the reason why that individual is immunosuppressed. It could be for a temporary reason. It could be a long-term issue. It also depends a lot on whether that individual has had any other recent infection. It is a clinical decision. It is right that it is made by a GP, but as soon as that decision is made by the responsible clinician, that person should of course get their third dose as soon as possible.

Adult Social Care

Clive Betts Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

I thank my right hon. Friend for recognising that reaching this point is actually a milestone. It is the first time that any Government have reached this point.

Housing is key. We will increase the capacity of local areas to deliver supported housing. We will increase local expenditure on support services for those living in supported housing. We will adapt more supported housing units to make them suitable for use, as well as incentivising longer-term investment in new supported housing by local areas and housing providers. In the coming months, we will be working in partnership with local authorities, housing providers and others to design and establish our new investment in housing.

[Mr Clive Betts (Sheffield South East) (Lab)]

I welcome the measures to enable people to stay in their own homes. That is exactly what the Housing, Communities and Local Government Committee recommended some years ago in our report into older persons’ housing.

Will the Minister confirm that in the statement there was no money to improve the pay and conditions of the workforce, without which we will carry on getting churn; no money to help companies that are now exiting the social care sector; and no money to deal with the crisis in funding that local authorities are facing, which both the Health Committee and the Housing, Communities and Local Government Committee recognised? Does she accept that without money for any of those things, nothing at all will change?

[Gillian Keegan]

There is money to invest in the sustainability and professionalisation of the workforce. Local authorities have a local government settlement for this three-year period. We are exploring a number of options and we will set out further detail at the local government finance settlement later this year. That is when the hon. Gentleman will hear more about the costs that councils will have.

Public Health

Clive Betts Excerpts

Tuesday 30th November 2021 Commons Chamber

[Maggie Throup]

I must continue.

They became mandatory in transport hubs, including taxis and private hire vehicles. From the same time, close contacts with confirmed or suspected cases of the covid-19 omicron variant will be legally required to self-isolate. These measures will remain in place until the end of the day on Monday 20 December. By this point, we will review the measures to see whether they remain necessary. We do not wish to keep any measures of this nature in place any longer than is absolutely necessary. However, these measures are an important step in the fight against the virus, particularly while we wait to discover the full implications of the threat from omicron.

[Mr Clive Betts (Sheffield South East) (Lab)]

The word “mandatory” was used but is that not just a word in the statutory instrument? In practice is it not unenforceable? As Darren Pearce, the manager of Meadowhall shopping centre, said in evidence to the Housing, Communities and Local Government Committee, “The biggest problem we had last time was about trying to get face coverings to be worn. I saw a group of young people going to Meadowhall, saying very loudly, ‘If they ask you, just say you’ve got asthma.’ Then they say, ‘We’ve got asthma. We’re exempt’, and there is nothing anyone can do, is there?” That causes all sorts of tensions with the shop assistants and with other people wearing face masks, who feel that some people are getting away with it. What is the Minister going to do about that situation?

[Maggie Throup]

I find it quite intriguing that the Labour party has been calling for this measure for some time and, now we are introducing it, it is unhappy about it.

--- Later in debate ---

[Maggie Throup]

I will continue.

The requirement to wear face coverings is not new. We have asked people to do their bit to stop the spread of the virus before, so we are again asking people to play their part, this time to help slow down any transmission of this new variant of concern.

[Mr Betts]

Will the Minister give way?

[Maggie Throup]

No, I must make progress. I have been very generous with my time up until now.

However, anyone who has an age, health or disability reason for not wearing a face covering need not wear one, and they need not provide proof of their exemption. The Scientific Advisory Group for Emergencies has found that face coverings are likely to reduce transmission through all routes by partially reducing the emissions of and exposure to the full range of aerosols and droplets that carry the virus. This includes those that remain airborne and those that deposit on surfaces.

[Maggie Throup]

I must make progress.

Scientific evidence also shows that all types of face coverings are to some extent effective in reducing the transmission of covid-19 in all settings. This is through a combination of source control, which limits the spread of the virus from a person, and protection to the wearer. Laboratory data shows that even non-medical masks, such as cloth masks made of two or three layers, may have similar filtration efficiency to surgical masks. As ever, we are guided by the advice of our scientific and medical experts. We will keep these measures under review, and we will take further action if necessary.

[Mr Betts]

Will the Minister give way on the point of exemptions?

[Maggie Throup]

No, I must make progress.

The self-isolation regulations were introduced to provide a legal requirement to self-isolate for individuals who have been notified that they have tested positive for covid-19 or that they are a close contact of a positive case. On 16 August, thanks to the success of the vaccine roll-out, we were able to introduce a number of exemptions to self-isolation for close contacts, including for those who are fully vaccinated or under the age of 18 years old. Given the greater threat that may be posed by the omicron variant, we have reviewed the application of these exemptions. This latest amendment to the self-isolation regulations is targeted at helping to slow its spread. From 4 am today, all individuals notified by NHS Test and Trace or a public health official that they are a close contact of a confirmed or suspected case of the covid-19 omicron variant are legally required to self-isolate for a period of 10 days, regardless of their age or vaccination status.

--- Later in debate ---

[Alex Norris]

We will now start to see how effective these regulations are—they have only been going for nine and a half hours—but I will shortly address my reticence about members of staff whose primary job has not traditionally been to enforce such measures now being put in that position. That gets to the point my hon. Friend the Member for Sheffield South East (Mr Betts) was addressing.

[Mr Betts]

The issue is that enforcement is impossible when people can just claim an exemption and we are not allowed to ask, “Why have you got an exemption; can you prove it?” Does my hon. Friend agree that we should have had a system in place from the beginning where if people wanted an exemption—a medical exemption is what the Minister called it—there had to be medical confirmation that they were entitled to it because they had a medical condition that meant wearing a mask was damaging to their health?

[Alex Norris]

We are after the fact now on that, but I think we have to protect the principle that we do not expect people to wear masks if doing so is detrimental to their health. That is the right level of proportionality, but we are reliant on good faith and people not abusing that, and I would be disappointed to hear of cases such as those my hon. Friend raised.

I particularly want to raise with Ministers a point about shop workers. Our hard-working shop workers have given us so much during the last 20 months. They have kept open the vital community assets that mean we were all able to be fed and watered. In return they have faced increasing violence and abuse. It should be made very clear that they are not being asked to police this; I hope the Minister will do that and also give more detail, as colleagues clearly wish to hear it, about how enforcement will work in practice.

The largest number of infections is now in those aged under 20, with the peak at approximately 10. This is a big part of continuing transmission, yet the changing and drifting policies on masks have created confusion across schools, colleges and universities. Can the Minister confirm what the new requirements are across all settings?

Covid-19: Government Response

Clive Betts Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

My right hon. Friend is right to say that the number of hospitalisations is now lower than it was a few months ago. People do not need to wait to be contacted by their GP, community pharmacy or the NHS to come forward for their booster jab, so long as they are six months plus one week past their second jab. We are encouraging everybody to come forward, even if they have not formally been invited, by dialling 119 or going online.

[Mr Clive Betts (Sheffield South East) (Lab)]

I have been fortunate in the past few weeks to go to both France and Italy. Both countries have vaccination rates very similar to the UK’s—in fact Italy has a slightly higher rate now—but the difference is that a person cannot go on public transport or into a supermarket without wearing a face mask, and they cannot go into a bar, restaurant or leisure centre without showing a health passport. Infection rates in those countries are now around a tenth of the infection rate in this country. Does the Minister accept those public health measures have brought down those countries’ infection rates well below our level, or does she think there are other reasons why infection rates are so much higher in our country than in Italy and France?

[Maggie Throup]

We laid before the House our autumn and winter plan, which outlines the non-pharmaceutical interventions on which people can make their own decisions, because we believe people can make informed choices. As people see the levels rising, they will look at the guidance again and perhaps make the decision to wear a face covering in more venues.

Oral Answers to Questions

Clive Betts Excerpts

Tuesday 19th October 2021 Commons Chamber

[Mr Speaker]

I call Matt Hancock—sorry, Clive Betts.

[Mr Clive Betts (Sheffield South East) (Lab)]

I do not know how to respond to that, Mr Speaker, but I will carry on. In declaring an interest, I welcome the Government’s decision to give a third jab to people with compromised immune systems. There has, however, been confusion in the NHS about the difference between a booster jab and a third jab. May I therefore ask the Secretary of State where is the responsibility in the NHS for advising people and arranging the third jab, and what will be the time gap between getting a third jab and a booster, as opposed to the second jab and a booster?

[Sajid Javid]

The hon. Gentleman will know that the gaps between vaccinations, especially for different people in different groups, is a decision that the Government would be advised on by the Joint Committee on Vaccination and Immunisation, and as soon as we get that advice, we will always publish it and act on it. It is important that everyone comes forward who is invited for their third jab if they are immunocompromised or for their third jab as a booster jab. As he will know, not everyone who is immunocompromised can benefit from the vaccine, but he might be interested to know that we are working on procuring new treatments that will help significantly.

Oral Answers to Questions

Clive Betts Excerpts

Tuesday 13th July 2021 Commons Chamber

[Kerry McCarthy (Bristol East) (Lab)]

What support his Department is providing to young carers during the covid-19 outbreak.

[Mr Clive Betts (Sheffield South East) (Lab)]

What steps his Department is taking to ensure that unpaid carers can access the support they need to provide care to family members.

[The Minister for Care (Helen Whately)]

We recognise how much carers do and the huge demands that caring places on them. We have made carers a priority group for covid-19 testing and vaccination, funded carers’ organisations and asked local authorities to meet their duties to identify and support carers. We have also provided guidance and funding through the £1.5 billion infection control fund to support the reopening of day services.

[Helen Whately]

I thank the hon. Lady for her question and her correspondence on this. She makes a very important point and I will make sure of that.

[Mr Clive Betts (Sheffield South East) (Lab)]

When the Select Committee on Housing, Communities and Local Government went to Germany about four years ago to look at its social care system, we saw that people entitled to public funding for social care could either pay the public authorities or care agencies to deliver it. Alternatively, for a slightly reduced amount of money, they could pay their family members, which meant that the person receiving care got the care they wanted, family members got paid for their efforts and the public purse actually saved some money. In reforming the social care system, would the Minister look at introducing elements of the German system into our system in this country?

[Helen Whately]

The Secretary of State has already said that we are working on our plans for social care reform, and we will be bringing them forward later this year. Of course, as part of those plans we are considering unpaid carers.