Public Health
Daniel Zeichner Excerpts(3 years, 11 months ago)
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Daniel Zeichner (Cambridge) (Lab) [V]
Sadly, the new restrictions are as inevitable as they are necessary. The Government say that it is the new variant that is to blame for the problems, but frankly it has been obvious for months that the NHS was going to come under huge stress during the winter. It is time for less flowery language from the Prime Minister. Too much bluster, too much over-optimism—frankly, we are all tired of it, just as we are tired of the lockdown itself.
The chaotic way in which the latest measures have been introduced has caused particular and understandable fury, because it was all so unnecessary. Leaders in educational establishments in Cambridge have been left in an impossible position, on Monday trying desperately to set up testing measures demanded by Government, and trying to reassure pupils and parents that they would be open the following day, only to get texts and emails late in the evening completely contradicting the previous advice. Now they are suddenly expected to switch to delivering teaching remotely. BTEC exams in further education colleges have had to be cancelled at the last minute.
On schools, the front page of today’s Cambridge Independent tells the story: “a disgrace”, say teachers. The headteacher at St Matthew’s in Cambridge, Tony Davies, describes a day of chaos and observes:
“So much heartache could have been saved if they had made this decision in a timely manner.”
Niamh Sweeney of the National Education Union rightly observes that, because of the chaos,
“the Government has jeopardised public health.”
The problems in education go further still. While local education authorities such as Cambridgeshire have stepped up, they are hampered by the patchwork of competing Government arrangements now in place. They can advise, but for multi-academy trusts the decisions in some cases are made far from Cambridgeshire—out of sight, beyond local scrutiny or influence.
The diminished powers of local authorities, particularly second-tier districts, are brought into stark focus when councils such as Cambridge City Council find that they do not have the powers necessary to deal with public health hazards. The temporary closure of Cambridge market is a case in point, where the lack of the precise powers needed has led to an overall closure that no one wanted.
I will support the legislation today, but I also want to highlight another Government failure. We have heard a lot about testing and vaccination, but precious little about isolating. Behavioural scientists advise that people do what they are asked when they are motivated and have the opportunity and capability to do so. Sadly, the Government have failed to motivate. They have not celebrated those who isolate, and they have not provided accommodation or the right financial support to ensure that people have the opportunity to do so. That is why it has not worked.
I drew the Secretary of State’s attention to that weeks ago, when I learned that just 14 people in Cambridge had taken up the offer of financial help to isolate. The Secretary of State kind of shrugged. It is that kind of failure from Government that means that the situation we are in today was not inevitable. It could have been different, but this is a Government unwilling to acknowledge mistakes or learn from experience, and we are all at risk because of it.
Covid-19 Update
Daniel Zeichner Excerpts(4 years ago)
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Matt Hancock
I take my right hon. Friend’s views on this very seriously. I would say to everybody in Bournemouth and across the country that the best way they can help their area to go into a lower tier is by exercising personal restraint—not seeing the rules as something to push against but rather acting well within them as much as possible to ensure that this virus does not spread.
Daniel Zeichner (Cambridge) (Lab)
The Secretary of State talks a lot about testing and tracing but far less about isolating. The shadow Secretary of State made important points that I do not think the Secretary of State addressed. In my city, a couple of weeks ago, only 14 people had received the £500 payment. The reasons why people are not isolating are complicated, but what has gone wrong with the system? It really is not working, is it?
Matt Hancock
I am glad to say that thousands of people are receiving the payment. Of course it is aimed at those on the lowest incomes who need the financial support in order to isolate.
Oral Answers to Questions
Daniel Zeichner Excerpts(4 years, 3 months ago)
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Edward Argar
The Department is putting in place a multi-layered approach to help to ensure continuity of supply of medicines and medical products in any case that might fall out of the negotiations and the end of the transition period. We are confident that we will maintain continuity of supply.
Daniel Zeichner (Cambridge) (Lab)
The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries)
GPs with symptoms can be tested through the self-referral portal. In addition, we are launching pilots in Northamptonshire, Peterborough and Cambridgeshire to provide regular covid-19 testing for professionals who visit care homes regularly and provide services within 1 metre of residents.
Daniel Zeichner
That is all in the future, of course. I was talking to GPs in Cambridge last week, and they told me about the difficulty they have with getting tested before going into care homes. Indeed, one of them told me she had to pretend to be a care worker to get a test. That cannot be right after all this time, can it?
Ms Dorries
As I said, the pilots are now being launched in Peterborough and Cambridgeshire to provide regular covid-19 testing for professionals, and I think that problem has probably been resolved.
Covid-19
Daniel Zeichner Excerpts(4 years, 3 months ago)
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Matt Hancock
Yes, I emphatically agree with my hon. Friend. I could not have put it better myself.
Daniel Zeichner (Cambridge) (Lab)
Over the next few weeks, hundreds of thousands of students will be returning to universities, which is very, very welcome, but what we are seeing at the moment is each institution having to make its own decisions. Universities UK tells us that most students will be getting in-person teaching, but what advice is the Secretary of State giving to those universities and what support is his Department giving?
Matt Hancock
We are working very closely with the Department for Education to have a successful and safe return of universities, just as, from today onwards, we are seeing a successful and safe return of schools.
Covid-19 Update
Daniel Zeichner Excerpts(4 years, 8 months ago)
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Matt Hancock
Yes, I will get my right hon. Friend an answer from the Department for Business, Energy and Industrial Strategy.
Daniel Zeichner (Cambridge) (Lab)
The Independent Food Aid Network oversees the work of many food banks, and I listened carefully to the Secretary of State’s comments about volunteering. That organisation is worried about the closure of community centres and churches. Will he reassure it that its valuable work and volunteers will be covered by the guidance?
Matt Hancock
We will set out the breadth of the guidance precisely on gov.uk.
Oral Answers to Questions
Daniel Zeichner Excerpts(4 years, 10 months ago)
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Matt Hancock
I am really pleased that my right hon. Friend has driven forward, and is holding us—and, in turn, the NHS—to account for delivery of this vital agenda; it is incredibly important to get this right. The number of people with learning disabilities and/or autism who are in in-patient settings is falling, but not as fast as I would like. We have a clear commitment in the long-term plan to bring it down by half. As she says, there is a target to bring it down by the end of March. The Minister for Care has done a huge amount of work to drive this forward, and we will do everything we can to ensure that all these people, who are some of the most vulnerable in the country, get the best support they can in the right setting. I welcome my right hon. Friend’s scrutiny.
Daniel Zeichner (Cambridge) (Lab)
The Minister for Health (Edward Argar)
I would not draw that conclusion about my right hon. and hon. Friends. What I would say, though, is that I want all staff to feel that they can speak up and have the confidence that anything they raise will be taken seriously. That is why I requested on 17 January that NHS England and NHS Improvement commission a rapid and independent review into how the West Suffolk NHS Foundation Trust has handled this issue. I will be happy to update Members, including the hon. Gentleman, when that review reports.
Oral Answers to Questions
Daniel Zeichner Excerpts(5 years, 1 month ago)
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Matt Hancock
I can assure my hon. Friend, who has campaigned long and hard on the issue of access to Kuvan, that we are working on that as well. I hope very much that we can come to a positive conclusion.
Daniel Zeichner (Cambridge) (Lab)
The system did finally work, but did it not take far too long, and is it not time to introduce transparency into this opaque system, particularly when the Americans are waiting to pounce on our pharmaceutical industry?
Matt Hancock
The NHS is off the table in trade talks and pharmaceutical pricing is off the table. Transparency over pharmaceutical pricing would not benefit this country at all because we get the best deals in the world because we can keep them confidential, so it is a slight surprise to hear a Labour Member argue for what would effectively lead to higher prices for drugs in the NHS. Instead, we will protect the NHS.
Artificial Intelligence in Healthcare
Daniel Zeichner Excerpts(5 years, 3 months ago)
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Daniel Zeichner (Cambridge) (Lab)
It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for Crawley (Henry Smith) not only on securing the debate but on his thoughtful and comprehensive introduction to an extraordinarily complicated subject that I suspect will require much more debate in this place in future. I chair the all-party parliamentary group on data analytics and represent a constituency that is, of course, well known for its health services, innovation and tech cluster, not just in the city but around it.
The issue is therefore close to my heart. When I was elected as the Member of Parliament for Cambridge, I never imagined that I would spend quite so much time on such issues, but there are many jobs involved and huge opportunities available, exactly as the hon. Gentleman said. However, I suspect that I will be slightly less optimistic than him, because as I have begun to look at the issue more closely, it has struck me, as he said, that the only way that we will make it work is by maintaining the trust of patients, which is difficult—particularly given the behaviour of some of the major tech companies. It is not a lost cause, in my view, but we are going to need a qualitative change in regulation and protection if we are to secure some of the benefits that have already been referenced. Every day in Cambridge, I hear about new innovations and developments that convince me and, I think, many others that we really are on the cusp of a technological revolution across a range of sectors. Everywhere one goes in Cambridge, one sees people working on the most extraordinary things, and the gains are potentially huge, not just for our citizens but across the world.
It is hard to explain a lot of this to the public. I feel that I am in a privileged position going around Cambridge; I sometimes feel that I am the only person who is seeing all the various things that are going on, and one of my challenges is to try to spread the word about all the stuff that is happening. My worry is that often it is poorly communicated and poorly understood, and that misunderstanding can easily lead to a public backlash. I read with great interest the report from the all-party parliamentary group on heart and circulatory diseases; a very distinguished panel of people was behind it, and I will highlight some of the crucial points.
Ensuring that artificial intelligence really does enhance patient healthcare—and that it does not, as some of us fear could easily happen, get diverted on to a profit-seeking route—requires the following key elements: stakeholder engagement; an exact explanation of the risks and benefits; keeping researchers and academics involved; digital inclusion in general; proper development of policy, focusing on AI for public values; and the development of standards.
There are others, of course, working in a similar field. I am delighted to see present a fellow member of the APPG on data analytics, the hon. Member for North East Derbyshire (Lee Rowley). A few months ago he and my hon. Friend the Member for Bristol North West (Darren Jones) led a very good inquiry and produced, with a similarly illustrious panel of experts, an excellent report entitled “Trust, Transparency and Technology”. It is amazing how many people are working in this field at the moment. Part of that report—I suspect the hon. Gentleman will refer to it when he speaks—was focused on healthcare. He did the work, so I do not want to steal his thunder, but I will pick out a particular couple of things.
We drew on a 2018 survey by the Open Data Institute, whose statistics reflected those cited by the hon. Member for Crawley. Some 64% of consumers trusted the NHS and healthcare organisations with their personal data, which is more than the 57% who trusted their family and friends. Consumers also trusted the NHS more than they trusted their bank, the figure for which was also 57%; local government, for which it was 41%; and online retailers, for which it was 22%. I do not think they asked about the level of trust in politics; that is probably not recorded. Nearly half of respondents—47% of them—were prepared to share medical data about themselves. I have seen different figures, and I would also reflect on the fact that 53% were not prepared to share data. However, those people were prepared to share their data provided that it helped develop new medicines and treatments. In terms of the trade-offs for data sharing, they were most keen to participate when it was for medical research.
As we know in politics, however, trust is hard won and easily lost, and we have to be careful. A few months ago, I was asked to write a foreword to a report by the think-tank Polygeia, entitled “Technology in Healthcare: Advancing AI in the NHS”. The report is consistent with other work in this field and comes to broadly similar conclusions to those we have already heard. There is also a sense that NHS staff need to be closely involved in these developments, to ensure that they are not just kept informed but given a sense of understanding and confidence about how this can work. The black box algorithm to which the hon. Member for Crawley referred is still a little baffling and scary to a lot of people. If we are going to make this work, it is crucial that we consult, educate and take people with us. We must rely on the advice of medical and healthcare professionals, who are best placed to understand the concerns of both their patients and their colleagues.
We are constantly seeing new developments in the news. One of the joys of modern life is that when we go on holiday, we still watch our iPad. This summer I noticed the debate about DeepMind and its new ability to predict acute kidney failure; it wins an extra 48 hours by looking at huge volumes of data and doing the number crunching. That is bound to be a good thing but, typically, there were people who questioned the methodology and who raised concerns about unforeseen consequences. I also think there are some unforeseen consequences to these kinds of changes, and I will touch on one or two.
So far, I have been profoundly non-partisan and non-political, but I have to say that the new Secretary of State for Health and Social Care did rather wade in early on with his support for Babylon Health and GP at Hand. Those kinds of technologies provide tremendous opportunities but, as the hon. Member for Crawley said, such developments can be disruptive to the organisation of the national health service. There has been disruption to funding flows, particularly across London, and I hope the Minister will be able to reassure us about that. Simon Stevens made a commitment, but these changes are happening quickly and one of the things that we know about the NHS is that it is quite a tanker to turn around. Quick, unintended consequences are not always benign ones for the people on the receiving end.
The wider point, of course, is that some of us are worried that the NHS, which is free at the point of use, is being undermined by the creeping in of a potentially competitive system. That can be resolved in some ways: we can change the administrative structures, for example, and sort out the financial flows. My bigger fear relates to confidentiality and what is happening with patient data. It is frequently argued that the data will be anonymised, and this is where we get into the realm of the techies. Plenty of people have explained to me that it is possible to reverse that anonymisation process, because as clever as these machines are in terms of machine learning, they are also pretty clever at doing the reverse. I am now pretty much persuaded that there is no such thing as anonymity. We must face the fact that there are consequences to these tremendous gains, and think through how we should deal with some of them.
This does not necessarily matter. I remember years ago when, under the previous Labour Government, Alistair Darling unfortunately had to come to Parliament and explain that his Department had lost millions of people’s data. That week, everyone thought the world was going to come to an end, but it did not. An awful lot of data is out there already, which is not great because we do not know who knows what about us. That is not necessarily a disaster, but if data is being used for the wrong purposes, it could be very difficult. This is my key point, I suppose: I am afraid that the evidence from the big tech companies, as we see almost daily, is that they have been doing things with our data that we did not know about. That is a problem that we previously experienced with the Care.data failure in the NHS, which damaged public trust. It is absolutely essential that we do better in future if we are going to keep the public on board.
The report from the APPG on data analytics states:
“Key lessons from this failure are around data security and consent, and reinforce the need for proper public engagement in the development of data collection programmes, and gaining the right level of consent, if such consent is not subsequently to be withdrawn with major clinical and value for money implications. In the case of DeepMind, Dame Fiona Caldicott, the National Data Guardian at the Department of Health, concluded that she ‘did not believe that when the patient data was shared with Google DeepMind, implied consent for direct care was an appropriate legal basis’.”
There is a significant number of concerns and the issues are profound and difficult. We have a whole range of structures in place to try to deal with some of them, and I have huge respect for the Information Commissioner’s Office. The Information Commissioner frequently tells those of us who ask that that office does have the appropriate resources. Given the scale and difficulty of the task, I must say that I find that hard to believe, because it is a very big task indeed. The hon. Member for Crawley mentioned the Centre for Data Ethics and Innovation, which is at an early stage. Frankly, it, too, will struggle to find the resources to meet the scale of the task.
I sat on the Bill Committee for the Data Protection Act 2018, which introduced the general data protection regulations. Some parts could have been strengthened. I tabled amendments that would have tightened up the assurance that research institutions must process healthcare data ethically for patient gain, but sadly, the Government chose not to adopt them. I hope that they might look at the issue again. A feature of the lengthy discussions in Committee, particularly in the Opposition’s observations, was that although the legislation is worthy, it felt like it was for the previous period, rather than the future, given the pace of change that we are likely to encounter. We were not convinced that it would keep up.
We need a much more radical set of safeguards. To stray slightly into the technical areas, when my local paper asked what my summer reading was going to be, it was surprised to hear that it was Shoshana Zuboff’s magnum opus, “The Age of Surveillance Capitalism”. It is a thought-provoking work and astonishing in the way she untangles the range of uses to which our data is being put every time we pick up our smartphone—or, in some cases, when we do not even turn it on. Many people are surprised to find that, far from being a phone, it is a tracking device. As she says, the question is not just who knows about us, but who decides what data is used, and who decides who decides what that data is used for. She talks about a shadow text, effectively; there is the data that we put on there and then there are all the connections that are made.
Staggeringly, huge amounts of information are being held about all of us that we do not have any access to—that we do not know about. At the moment, those companies consider that it belongs to them. We have to change that, because I think if it is about us, it belongs to us. That is a huge challenge, because if it were to happen, it would fundamentally challenge the business model of those hugely fabulously wealthy tech giants, which are hardly likely to give it up easily. The only way to tackle it, however, is through Governments and regulation. I hate to mention the issue of the hour, but that is one reason, of course, why those companies dislike the European Union—because we need large organisations to counter the giant power that we face.
We have a fantastic opportunity, particularly with our national health service, which, as is often observed, has access to huge amounts of data that no other health system in the world has. In this country, we have the fantastic raw material and a fantastic data science industry. We have the expertise and the knowledge. We also, just about, have the good will of our citizens. We have a great opportunity, but we will need much tougher regulatory frameworks to unlock that potential in the right way. I fear that, so far, compared with what we have to do, we have merely been tinkering.
There are huge opportunities. I have raised a range of issues that go beyond the immediate ones. I hope that Parliament will find an opportunity to have those discussions in the period ahead. If I were asked whether we are in a position to meet the challenge, I would say, “Not yet.” I do not think it is impossible, but it will be difficult, so it is vital to start the discussion. I thank the hon. Member for Crawley for giving us the opportunity to do that today.
Oral Answers to Questions
Daniel Zeichner Excerpts(5 years, 4 months ago)
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Matt Hancock
The assurance I can give is that, ahead of 29 March, we put in place the measures that are necessary to ensure that the hon. Gentleman’s constituent and others get the medicines they need, and we have taken forward those proposals and that work ahead of an exit from the European Union on 31 October.
Daniel Zeichner (Cambridge) (Lab)
The Secretary of State will be aware of the expert evidence, including from the BioIndustry Association, warning that, although we may be able to stockpile the bog-standard drugs, it will be very difficult to do so for specialist treatments. What guarantees can he give that we will have access to those specialist medicines?
Matt Hancock
Ahead of 29 March, we managed to put in place a full programme to ensure access to drugs. Of course, the approach is not just about ensuring stockpiles—there are adequate stockpiles for so many medicines all the time—but is about ensuring the flow of materials and finished drugs across the channel via ferries and, where necessary, aircraft.
Living with Dementia
Daniel Zeichner Excerpts(5 years, 5 months ago)
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Daniel Zeichner (Cambridge) (Lab)
It is a pleasure to serve under your chairmanship, Mr Paisley. I thank the Backbench Business Committee for granting this debate. It is an honour to follow my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who so expertly laid out the issues. I will say a little bit about social care and then move on to research.
Some 1,179 people live with dementia in Cambridge—around 1% of the constituency population—meaning that thousands of my constituents care for or know a close friend or relative with dementia. My hon. Friend touched on some of the social care issues. It seems hard to deny that we have a crisis in social care. In March 2017, the Government said they would publish a Green Paper on ensuring that the system will be sustainable in the long term. However, two years on, and after many delays, Ministers have still not given a date for when it will be published.
I understand that 400,000 fewer older people receive publicly funded care than in 2010. With local authority budgets cut by 49.1% since 2010, including £7 billion lost from adult social care, and a further £1.3 billion to be cut in 2019-20, it is hard not to conclude that the situation for many of those living with dementia, and for their families, has been made much harsher and more difficult.
Alzheimer’s Research UK has campaigned for more money to be invested into research, so that with new treatments we can really change the lives of those who have dementia. As we all know, research has revolutionised the ways we treat, cure and prevent diseases such as cancer. There is no reason why that cannot be the same for brain diseases such as dementia. New treatments would also ease pressure on our healthcare and social care services, improving lives and saving public service resources. Public donations have allowed Alzheimer’s Research UK to invest £100 million over the last 20 years to drive forward its research, but that funding alone does not allow it to further explore emerging fields.
However, when we do invest in dementia research, look at what we can achieve. Alzheimer’s Research UK’s Drug Discovery Institute in Cambridge couples the deep disease knowledge and biology expertise of the academic community with high-quality, innovative drug discovery technologies. More than 100,000 combined hours have been committed to drug discovery by 30 new staff. The institute is currently investigating 10 new potential drug targets in its own work or through collaborations, has generated 12 new internal collaborations at the University of Cambridge and has attracted nine new partners from both the private and the academic sectors.
In addition to the institute, the Cambridge Network Centre, launched 20 years ago, has grown to include 2,200 dementia researchers across the UK. It has helped researchers to buy cutting-edge technology to carry out their research, supported grant applications and fellowship applications and enabled PhD students to buy equipment such as virtual reality technology to further their research. I suspect I am not the only one to have seen the virtual reality dementia simulation and met Helen Davies when Alzheimer’s Research UK was in Parliament. I—like others, I suspect—found it extremely interesting and slightly surreal, but also very impressive at explaining the effects of the disease.
While £269 million is invested in cancer research, only £83.1 million is invested in dementia research—just 0.3% of its total cost to society. Alzheimer’s Research UK is calling for the Government to increase that to just 1% of its total cost, which would unlock the resources needed to really cement the UK as the world leader in dementia research and to make real breakthroughs. I very much hope that the Minister will commit to discussing that with her colleagues in the Department for Business, Energy and Industrial Strategy and the Treasury—even possibly one or two Conservative party leadership candidates, for whom money suddenly seems to be no object—to ensure that we make the progress that we all need.