Hepatitis C

David Amess Excerpts
Tuesday 12th June 2018

(5 years, 9 months ago)

Westminster Hall
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David Amess Portrait Sir David Amess (Southend West) (Con)
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I beg to move,

That this House has considered elimination of hepatitis C.

I should tell the House at the outset that I am not really the instigator of this opportunity to debate hepatitis. The colleague who had succeeded in securing the motion is not able to be here, but I am delighted to share my thoughts with the House.

I was a member of the Health Committee from 1998 to 2007, and during that time we certainly spent a lot of time considering hepatitis. I am also the co-chairman of the all-party parliamentary group on liver health. I have been the chairman now for some 13 years—simply because I do not think anyone else wants to take on the mantle, to be frank. When we set up our all-party parliamentary group, we looked for a celebrity to head it all, as one does, and we chose George Best. The House might feel that George Best was an unlikely person to head up the charity, but at that time he was a reformed character, and he did a lot of good in those early years. Unfortunately, as we all know, a great toll was taken on his health and, sadly, he died.

We then looked for another celebrity, and—what a joy—Anita Roddick of The Body Shop, who was a wonderful and remarkable lady, became our patron. She died in 2007. The House may know that she contracted hepatitis C from a blood transfusion in 1971 and was unaware that she was living with the disease until 2004. A routine blood test revealed the diagnosis. She was a tireless campaigner, and we owe her a great debt of gratitude, but since 2007 we have struggled to find a patron to head up the organisation as president. If colleagues have any ideas, I know our APPG would be glad to hear from them.

The APPG recently conducted an inquiry into the elimination of hepatitis, and in March it launched a report entitled “Eliminating Hepatitis C in England”. It is my intention to refer to the report’s recommendations throughout my speech. We have an excellent Minister here, and I hope that both he and the shadow spokesperson have had sight of the report. If not, we will ensure that they get it in full; perhaps they could come back with their suggestions on how we might take the recommendations forward.

In our report, we suggest raising awareness, prevention, testing and diagnosis, care and treatment, funding and monitoring progress, so we have covered every single aspect. I take this opportunity to pay tribute to Charles Gore, the former head of the World Hepatitis Alliance, and to the secretariat of the APPG, the Hepatitis C Trust, for all their assistance. They have been wonderful in all the work they do for us, ensuring that our group is effective.

On 14 December, I visited Her Majesty’s Prison Wandsworth—not because I had been sent to prison but, ironically, to accompany the Minister who has resigned from the Government today, my hon. Friend the Member for Bracknell (Dr Lee), although I do not think his resignation was the result of our visit. It was a very good visit indeed, and of course it is in the constituency of the hon. Member for Tooting (Dr Allin-Khan).

The visit allowed us to tour the secondary screening and healthcare facilities in the prison and to participate in a roundtable on the subject of the hep C virus and the importance of testing and of attending appointments. It was a wonderful visit; I pay tribute to the governor, and I know the Government are focused on the excellent work that is being done there. We talked to inmates and the governor, and the Ministry of Justice, NHS England, the Department of Health and Social Care and Public Health England were represented.

Perhaps the Minister and I should have compared notes, but I will say a little bit about what hepatitis C is. As I am sure that most hon. Members are aware, it is a blood-borne disease that affects the liver. It can subsequently lead to liver cirrhosis and cancer, and it has been linked to cardiovascular disease, musculoskeletal pain, kidney issues and mental health problems. I see we have two practitioners present in the Chamber; they might want to contradict me if they think I have got the cause of hepatitis C wrong.

The virus is said to chronically infect some 71 million people globally. Sadly, 214,000 of them reside in the United Kingdom. That is why I welcome the United Kingdom’s decision to join 193 other states in signing the World Health Organisation’s global health sector strategy on viral hepatitis in 2016. It has the principal aim of eliminating hepatitis C as a major public health threat by 2030—and I believe that if we are serious about that, we can do it. At least one Member of the House of Lords, who regularly attends our APPGs, has the illness himself. He speaks with great passion in the other House about the challenges he faces.

I say to my hon. Friend the Minister that I also welcome the target announced by NHS England in January of eliminating hepatitis C by 2025, five years ahead of the WHO. However, many problems surround the virus and its elimination, and confusion persists over how the virus is spread. Many people do not appreciate that it is spread by blood-to-blood contact. Instead, some still believe it can be spread by sneezing, coughing, spitting or other forms of physical contact. I am advised that that is not the case and it is only blood-to-blood.

Furthermore, it is estimated that between 40% and 50% of the approximate number of people chronically infected with the virus in England do not know they have it. At the start of the debate, I pointed out that Anita Roddick did not know she had it until she was tested in 2004. Between 64,000 and 80,000 people are living in England without the knowledge that they have the virus. Even more worrying is the Polaris Observatory’s prediction that the UK is set to miss the WHO target of eliminating hepatitis C by 2030.

Jim Cunningham Portrait Mr Jim Cunningham (Coventry South) (Lab)
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I welcome the efforts the Government are making to tackle this problem. I do not want to digress too much, but there is still the outstanding problem of contaminated blood. The hon. Gentleman knows that as well as I do, because we have had many debates on this in the House of Commons. Even the previous Prime Minister said he was going to do something, but nothing has really happened yet, and there have also been allegations that some of the records—for want of a better term—have disappeared somewhere. We asked for an inquiry into that in the last Parliament.

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David Amess Portrait Sir David Amess
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The hon. Gentleman makes an excellent point. The hon. Member for Kingston upon Hull North (Diana Johnson) has done a fantastic job in bringing this issue to the attention of the whole House, but we must not take our eye off the ball. The hon. Gentleman is certainly right to remind me how important that issue is.

This country unfortunately lags behind Australia, Brazil, Georgia, Egypt, Germany, Iceland, Japan, the Netherlands and Qatar, which are all predicted to eliminate the virus within the proposed timeframe. I have said to my hon. Friend the Minister that we cannot really compare those countries with the UK, but it would be good if we could perhaps make even more progress on eliminating hepatitis C in this country. In the words of Polaris Observatory, the UK is “working towards elimination” of hepatitis C.

The APPG’s report highlighted awareness. First of all, it noted that awareness of hepatitis C has gradually improved in recent years, which we celebrate. However, awareness is still relatively low, and the stigma of having the virus remains a hurdle to people actually getting tested, diagnosed and treated in the first place. The report also found that there is low awareness of transmission risks among at-risk groups, with many people underestimating the seriousness of the condition and the urgency of accessing treatment. Even so, there are still misgivings among those with greater knowledge of the condition. Within that group, there is still a lack of awareness of new treatments that are available, and many still have worries regarding the side effects of former treatments.

The same is true of the stigma attached to the virus. Although it has decreased over time, the report found that progress still needs to be made in this area, as that stigma often acts as a barrier to people presenting themselves for testing or seeking treatment. The APPG therefore recommended initiating local and national publicity campaigns in an attempt to increase awareness. That is why I mentioned celebrities. Although I am not big on celebrities, I suppose that people do not listen so easily to us politicians—they tend to switch off. However, a so-called celebrity who is prepared to speak out publicly attracts more attention.

The report suggests two ways to increase awareness. One is among primary care professionals, through targeted testing initiatives in primary care, together with additional resources—it is always about securing more money—and support for primary care workers. The second is to raise awareness among at-risk groups through peer-to-peer messaging programmes. During my visit to HMP Wandsworth, I witnessed a peer-led group operated within the prison by inmates. It was wonderful what they had achieved.

However, it should be said that raising awareness of hepatitis C is in fact a short-term goal. Our long-term goal of eradicating the infection should see a switch to the offensive—to preventing the disease in the first place. That is what we are really aiming for.

Dan Poulter Portrait Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
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I congratulate my hon. Friend on securing the debate and more generally on all his work on this issue and on promoting effective liver health during the many years he has been an MP.

On prevention, given that intravenous drug use is one of the primary causes of the transmission of hepatitis C, does he agree that at the moment a lot of drugs policy is seen far too much through the prism of the criminal justice system? We need to bring that much more into the health domain. Effective working with prisons and with the Ministry of Justice is vital if we are to get on top of this issue, reduce infection rates and provide proper treatment for people who are infected.

David Amess Portrait Sir David Amess
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My hon. Friend was a Health Minister and has real expertise in this area. I shall use the expression “joined-up government”. He is absolutely right that we need Departments to work together. That is why it was so good that we visited the prison.

Steve Brine Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
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I may be able to help my hon. Friend here. As he knows, the drug strategy board is a cross-government committee. It met yesterday, chaired by the Home Secretary, and its members include the Justice Secretary, Health Ministers, Home Office Ministers, Housing, Communities and Local Government Ministers and representatives from the Department for Work and Pensions, as well as senior police officers, representatives from the National Crime Agency and a representative of the police and crime commissioners. That board takes that cross-government look, and hepatitis C is certainly an issue I would like to see it look at.

David Amess Portrait Sir David Amess
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That is excellent news. I thank my hon. Friend for that positive response to looking at this issue.

The testing and treatments initiatives in place will lead to a decline in the prevalence of the disease. However, prevention will come from identifying and educating at-risk groups. To do that, we need the help of substance misuse services, sexual health clinics and peer programmes that can educate those most vulnerable sections of society on the transmission of the virus. I am advised that these services are at risk of closure without sufficient increases in their funding. Perhaps the Minister will have some news on that when he replies.

Harm reduction is another paramount mode of prevention. If we can reduce the harm to at-risk groups, we can combat one way in which the disease is transmitted. That can be achieved by providing clean and sterilised injecting equipment. Our report also emphasises the treatment-as-prevention approach towards tackling newer infections. That approach has been successful in treating drug users and other users engaging in riskier behaviours to prevent the spread of hepatitis C.

As I said earlier, between 40% and 50% of people living with hepatitis C in England are undiagnosed, which is shocking. It is therefore vital that we continue to increase testing and diagnosis levels. It is generally believed that the vast majority of those who have been diagnosed and put in touch with support services have now been treated, which I welcome. The challenge is therefore to locate those people who remain undiagnosed. That is a tricky one; it will be a real challenge.

Philippa Whitford Portrait Dr Philippa Whitford (Central Ayrshire) (SNP)
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The hon. Gentleman talks about all of those people who have hepatitis C who have been diagnosed being treated, but my understanding is that these new antivirals are given to those with the most severe disease and have cirrhosis, rather than to everyone who is diagnosed with hepatitis C on a preventive basis. Can he clarify that?

David Amess Portrait Sir David Amess
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I am concerned by what the hon. Lady says. No doubt the Minister will eventually be passed a note from his officials and will advise us on the situation. That does not seem right if it is what is happening, and I hope that the Minister will correct me if that information is wrong. It is also vital to re-engage those who have been diagnosed and have slipped through the net to the point where they are no longer in touch with those services.

The APPG thinks that the way to combat these issues is to change how we test for the virus. We recommend routine testing in substance misuse services, sexual health clinics and prisons. We also advocate increasing testing in primary care and in settings such as hostels, day centres and police custody. I know that that will not be cheap, but if it could be done it would be wonderful. Another solution is to test for hepatitis C on occasions when people are already having blood tests, which seems like common sense to me. For example, should we not consider testing people for hepatitis C while they are being tested for HIV, or when taking blood in accident and emergency centres?

Diagnosis is one thing, but accessing care is another. It is therefore essential that people who are diagnosed are referred for treatment as soon as possible, without delay. There should be a direct link between diagnosis and care. The time between diagnosis and the commencement of treatment should be minimised, to prevent patients from dropping out of the care pathway altogether. One way to achieve that would be to make treatment available immediately following diagnosis. That may be ambitious, but it is, ideally, what our APPG wants. Another way would be to streamline the referrals process. As it stands, some secondary care services will only accept referrals for treatments from general practitioners. Allowing referrals from any service at which someone might be tested and diagnosed, as the APPG recommends, would go some way to solving the problem.

Dan Poulter Portrait Dr Poulter
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I agree entirely with my hon. Friend. One challenge that we face is the fragmentation of the commissioning of substance misuse services and sexual health services. Those are commissioned by local authorities under the Health and Social Care Act 2012, which I think we have to reflect on as a mistake in this context, as opposed to many secondary care services, which are commissioned by the NHS through clinical commissioning groups. Until we sort out that fundamental issue of commissioning, we will not be able to put in place the improvements that he suggests.

David Amess Portrait Sir David Amess
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Oh dear! I say to my hon. Friend—I and, indeed, you, Mr Streeter, were in this place when we were dealing with all these issues—that the fragmentation is very worrying. My hon. Friend is right to point out that more work needs to be done on the issue.

Philippa Whitford Portrait Dr Whitford
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I am not sure whether the hon. Gentleman is aware that there is a cap on the number of patients who are allowed to receive drugs such as sofosbuvir; certainly, hepatologists I have met in recent years report having to ration it to the most severe cases. The limit was set at about 10,000 patients a year. This year, it has been increased to 15,000, but that is not a target; it is a cap. It means that despite it having been stated that 160,000 patients in England suffer from hepatitis C, it would literally take 10 to 16 years to treat them all, so this is a matter not of referral but of access to the drugs.

David Amess Portrait Sir David Amess
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I said at the start that I was totally the wrong person to lead this debate. I put my hands up: I was not aware of the cap. It, too, is a little worrying, but perhaps the Minister will have an answer. I am the first to admit that money is not always available for these things, but it is worrying that we are talking about another 16 years. That is not what our all-party group wants.

If services share data more effectively, the number of patients lost to follow-up will certainly be reduced. That will minimise cases such as prisoners who have been diagnosed being released before being referred to a service that provides the treatment that they so desperately need. Another example is where general practitioners have records of people who have been diagnosed but never received treatment.

On the subject of treatment, pioneering treatments have been in place since 2014. I am advised that they are shorter in duration and have higher cure rates and fewer side effects. They have thus been instrumental in making progress in the way we treat hepatitis C, and many people have been cured thanks to the drugs available since 2014. Notwithstanding that, we should continue to maintain targets for the number of people treated and to maintain universal access to treatment for those who have been reinfected. Those targets should be local, regional and national.

There is even an argument for making the targets more aspirational. Currently, there is a target to treat 12,500 people in England per year, and the all-party group would like that to increase to 20,000 new treatment initiations. If the target is not raised, there is little chance of achieving NHS England’s target of eradicating hepatitis C by 2025. It might be more pragmatic to have initially an even greater target, which would progressively be lowered in the future. That approach would reflect the assumption that, as overall prevalence falls and approaches minimal levels, those still living with the virus will be harder to locate within the population.

Treatment should be focused in the community. That will ensure that access is not hindered for those who have difficulty accessing secondary care services. The all-party group recommends making treatment more readily available in GP clinics and pharmacies, homeless shelters, substance misuse centres, sexual health clinics and prisons.

Funding is where the crunch comes, and we have quite a bit to say on it in our report. Although new curative treatments have considerably decreased in cost, pioneering new treatments for hepatitis C are not immune to concerns. The way in which the new treatments were initially rolled out by NHS England drew criticism at the time. For example, restrictions were placed on the number of patients able to access them each year in England. Of course, the hon. Member for Central Ayrshire (Dr Whitford) has reminded the House of that. I am sure that the Minister is aware of recent negotiations between NHS England and the industry to develop a new funding model in this area and one that does not restrict access for patients. Without such dialogue, elimination in England would be severely compromised.

The all-party group has gone further, however. We recommend that any future deal should prioritise equitable availability throughout the country—I suppose we are thinking here of the postcode lottery—that does not discriminate against patient populations. On the subject of the all-party group’s recommendations, we believe that we should continue to monitor elimination progress with reference to progressive targets. The report calls for more diverse data on the virus to be collected and shared. It is the group’s belief that that would additionally allow for improved allocation of testing and treatment resources.

As the all-party group’s report makes clear, we believe that the eradication of hepatitis C in the foreseeable future is an extremely achievable goal—we really think we can do this. It is a goal to which our international partners are committed, which is very good. Some of them are making greater progress towards achieving it than we are, for whatever reason. For the target to be met, we must change our approach to hepatitis. It is my belief that the recommendations that I have summarised today must be implemented, and as soon as possible. Failure to do so will only prolong the existence of hepatitis C in this country. We have at our disposal the means to eliminate it. Let us do that.

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David Amess Portrait Sir David Amess
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I am really happy with what my hon. Friend the Minister has said about all-party parliamentary groups because, sadly, the recommendations of the all-party parliamentary group on fire safety and rescue were not listened to over a number of years, and of course we had the Grenfell disaster. However, I get the distinct impression from my hon. Friend that he is listening to the recommendations of this report by the all-party parliamentary group on liver health.

It has been a great privilege to learn one or two things from other colleagues with more expertise in this field than I have. In every sense, this debate has been time well spent, and I am very, very optimistic about the future progress towards eliminating hepatitis C. I thank all colleagues for the time that they have spent here in Westminster Hall, participating in this debate, and I very much look forward to celebrating with my hon. Friend the Minister within a few years the elimination of hepatitis C.

Question put and agreed to.

Resolved,

That this House has considered elimination of hepatitis C.