Homeopathy and the NHS

Debate between David Mowat and David Tredinnick

Wednesday 29th March 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I congratulate my hon. Friend the Member for Bosworth (David Tredinnick) on yet again leading the charge—we have debated this issue in various parts of Parliament—and on securing this debate in close proximity to Homeopathy Awareness Week, which starts on 10 April. He normally corresponds with my colleague, the Minister for Public Health and Innovation. I apologise that he has to put up with me today, but I will do my best to address the points he raised and set out as specifically as possible the Government’s and the NHS’s position on homeopathic remedies.

The Government have no particular position on the efficacy or not of any type of treatment, but we have a position on evidence-based medicine, and I will come on to talk about how we expect an evidence base to determine how we spend public money. There is an acceptance that there is great popularity for some parts of this medicine across the world, as my hon. Friend said. The Government have no particular control over how people spend their money in terms of these treatments. He was involved in the Walker report and review, which put in place a regulatory environment involving the Professional Standards Authority system and the voluntary lists for that.

As well as that popularity-led issue, there is the issue of how we spend public money in the NHS. I will come on to that process, but it is about the evidence base. It is right that there is a method of evaluating competing drugs, technologies and treatments. I will come on to talk about that and what it means in this context. We have no overall position on this issue. My hon. Friend made a good point about the over-prescription of antibiotics. He said that, in certain areas, homeopathic remedies may be an alternative.

I used the phrase “evidence-based medicine”, which means that the medicine is clinically cost-effective. Typically, the drugs that are used across the NHS are subject to trials—possibly lasting many, many years and involving large populations, statistically clear correlation and all that goes with it. A requirement of those drug trials is that their results are not anecdotal, but clearly repeatable. The drugs must demonstrate efficacy. When the National Institute for Health and Care Excellence evaluates them, it uses a threshold to measure their cost versus the quality of life and the years that are obtained by their use. Precisely the same criteria would be applied to any homeopathic or alternative remedy; they would be evaluated in that way. The Department’s position is that medicine must be evidence-based. Within that constraint, we use what the evidence tells us to use. For non-NHS expenditure, it is up to the public to buy what they wish, provided it is safe. There are some controls, and if I have time I will talk a little about the Walker review and what the controls are.

The NHS’s commissioning power is set locally by CCGs, which are GP-led. They set out their policies, in terms of what the CCG uses, but as they do that we expect them to be advised and informed by best practice and, where they are available, by NICE guidelines. Within that, GPs have considerable discretion. As my hon. Friend knows, some GPs still prescribe such remedies, where that is permitted by the CCG. That is not something that the Government have chosen to interfere with, although the drive towards evidence-based medicine means that over the past decade the amount of prescribing has decreased considerably. Last year, something like 9,000 separate prescriptions were made in primary medicine at a cost of about £100,000. A decade ago, the figure was nearer £150,000. That decline has been driven not by a Government diktat, but by our requirement that all CCGs use an evidence base for their decisions.

My hon. Friend gave various views about the evidence base. In 2010, the House of Lords Science and Technology Committee said:

“There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious.”

More recently, NICE said that it is not aware of any evidence that demonstrates therapeutic effectiveness, and it does not currently recommend that homeopathy should be used as a treatment for any health condition. As a consequence, there has been a tail-off in the use of such remedies.

I accept that, in certain circumstances, patients may feel that they have tried many other things, and a physician working with them might say, “Let’s have a go at one of these things. What have we got to lose?” As I say, it is not the Government’s job to stop a GP taking that position in that situation. Very often, that will be done in conjunction with a patient who, as my hon. Friend said, feels as though they have tried everything else, and will have a go at it as a last resort. It may well be that, anecdotally, it works, whether that is through a placebo effect or for whatever other reason. It is not the Government’s job to stop that.

In the last minute that I have, I want to talk about the Walker review, of which I think my hon. Friend was the vice-chairman—he certainly helped to inform it. A system of regulation was brought in. We have been talking about the potential need for statutory regulation of the use of such remedies outside the health service. The Walker review looked at a variety of issues with respect to such medicines and concluded that we should put in place a voluntary system of regulation accredited by the PSA—something of a middle way.

[David Tredinnick]

The Society of Homeopaths is now regulated by the Professional Standards Authority, and will be looking to the health service to make better use of its services.

[David Mowat]

The Society of Homeopaths is accredited by the PSA, as my hon. Friend says. When somebody gets accredited, that is an endorsement that that practitioner is committed to safety and to work of good practice. It is not necessarily an endorsement of the technique that is being used, but it is accreditation that it is a safe technique. We accept that, and we would like more professionals working in that area to go down that route. I will finish on that note. I hope that I have been successful in setting out the Government’s position.

Motion lapsed (Standing Order No. 10(6)).

Cancer Strategy

Debate between David Mowat and David Tredinnick

Thursday 8th December 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to respond to this really important debate. I, too, would like to start by paying tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron). I wish him and his wife the best in the journey they are on. I have been in this job a few months now and he has been extremely diligent in coming to see me and talking to me to ensure that cancer is, as it should be, right at the top of my radar screen. He also organised, with the hon. Member for Scunthorpe (Nic Dakin), an excellent Britain against Cancer event on Tuesday, which was attended by 400 people.

What has happened to my hon. Friend and his family reinforces what we all know: cancer affects us all. One person is diagnosed with cancer every two minutes. During the course of this debate, 100 people will have received a cancer diagnosis in England. That shows how important the issue is and how we need to make progress. There are a lot of chairs of all-party groups in the Chamber and all Members have spoken from a lot of personal knowledge and experience. I will not have time to respond in detail to every point raised.

I will start by making a generic point that this debate and others like it remind us that our health service is not principally about bricks and mortar. Survival rates are far more important. The hon. Member for Scunthorpe gave a very fair and reasonable introduction to the debate in terms of what the priorities ought to be. On a typical day, when I walk across the Chamber and the Lobby about two Members will talk to me about their concerns in relation to some aspect of hospital reconfiguration or A&E downgrades and so on. Those are fair concerns, which we all need to be concerned about in our own patches. However, I am not accosted by Members saying they are concerned that their clinical commissioning group has lower than average survival rates. Over time, we need to learn to think about them, too. We have not talked about this in any detail, but the Government have published four indicators that rank every clinical commissioning group in the country. The news was not brilliant when it came out, but that transparency is very powerful. We all ought to get used to this being as important to our constituents—arguably more so—than some of the bricks and mortar concerns that we tend to spend our time on.

As I said, the hon. Member for Scunthorpe was fair. I think the phrase he used was that a lot has been done, but that more needs to happen. I think all Members would probably agree with that. A lot of good things are being done. Our one-year, five-year and 10-year survival rates are all improving for all cancer types. What we have learned in this debate is that we talk about aggregate cancer survival rates, but there are very large variabilities. My hon. Friend the Member for Castle Point (Rebecca Harris) made a very good point with regard to brain tumours having a 19% five-year survival rate, against a target for all cancer types of 70%. That is absolutely true. One of the themes of the debate has been that we are making less progress on some rarer cancer types and we need to do better.

We are making progress on early diagnosis. There are eight cancer targets and we are now meeting seven of them. As Members have pointed out, however, not least the hon. Member for Washington and Sunderland West (Mrs Hodgson) who speaks for the Opposition, one very important cancer target is not being met: the 62-day target. The strategy needs to drive and develop that and we need to work harder.

We have been reminded that, in spite of the progress made, we are not, by any means, the best in the world at this. We are not even the best in Europe. Indeed, there is evidence that we are below the average in Europe for most cancer types. It is fair to say that we are catching up in many cases but not in all. In particular, we are not closing the gap with the rest of Europe on lung cancer, which several hon. Members have talked about. We need to be aware of that and focus on it.

As I said on Tuesday at the conference, when I started this role I was struck by the discovery that we had had five cancer strategies in the last 20 years. We can deduce two things from that: first, this is a cross-party issue—all Governments do cancer strategies—and secondly, and more importantly, we do not need another strategy. We do not need more ideas about what we need to do; instead, we need to deliver, with a strong focus, the 96 points set out in the cancer strategy and drive them through over its final four years. We need to make that happen.

The hon. Member for Washington and Sunderland West used a very good phrase when she said we must be “critical friends” in this process, and so we must. Every Member, despite their having different perspectives, needs to support Cally and her team in driving this strategy through. My role is to ensure clear accountability around what is being done, by when and by whom, and to ensure that we have milestones, targets and deliverables. Frankly, though, we have some way to go before we get that as clear as it needs to be. My hon. Friend the Member for Basildon and Billericay has pointed out to me several times that we need to focus on output measures, not on process and input measures, and that, too, is true. It is something we could make work better.

In the strategy, there are six programmes of work, including on prevention, early diagnoses, commissioning, high-quality modern services and, importantly, patient experience and living well beyond cancer. My hon. Friend the Member for Bosworth (David Tredinnick) made some very good points about the overall approach. This is not just a technical matter; we need to get better on patient experience and living beyond cancer. I spoke at an event organised by the all-party group on ovarian cancer. At that event, I met a lady who had been given a prognosis of six months to live, and she told me that she had no support in terms of an ongoing dialogue with a clinical nurse—that clearly is a failure and completely inadequate. My hon. Friend the Member for Bury St Edmunds (Jo Churchill) talked about clinical nurses. Our response, through the strategy, is to put in place cancer recovery packages for everyone with a diagnosis. That is important, although the point was well made about the staffing implications. We need to address that as well, and we will.

A point was made about rarer cancers, particularly brain and blood cancers. We need to make more progress more quickly on research, as we do not have as many answers on those cancers as on others. I am talking not just about research by the Government, but about Cancer Research UK and the other charities. As several colleagues said, the voluntary sector is extremely important, and of course it is. Macmillan, Marie Curie, Cancer Research UK, plus the hundreds of small charities in our constituencies, make a big difference.

We also know that the workforce matters. This is a consistent stream in the strategy and something that it needs to get right.

I was asked by the hon. Member for Scunthorpe in his opening comments how we are holding Health Education England to account on the workforce requirements. I meet Professor Cummings regularly, as does my right hon. Friend the Secretary of State, not just on this aspect of the workforce but on other related responsibilities, such as increasing the number of GPs working in primary practice.

We need to make progress quickly on certain issues. We know that we do not have enough radiographers, for example. The point was made that there is no point in having linear accelerators if we do not have people to work them. That is right, but let us at least be grateful for, and pleased about, the fact that we are now rolling out the linear accelerators that Simon Stevens announced this week at 15 locations in all parts of our country. Endoscopy has been a real area of shortage, and it has been called out as a specific work stream within the 96 aspects of the cancer strategy. We will have 200 extra endoscopists trained by 2020, 40 of whom are already in place, and we will continue to build on that. Workforce generally is of massive importance.

I have not answered all the questions and points raised in the debate. I have not so far talked about the tobacco control plan. Several Members mentioned this issue. All I can say now, I am afraid, is that it will happen soon. That is the answer. The relevant Minister has informed me that she is determined to get this right, and I guess we can all agree that getting it right is indeed important. I am probably as disappointed as some Members that the process of the strategy is not as developed as we would like, but let me say that we are doing a lot on smoking by placing explicit images on packages and that type of thing. We are doing more than many other countries on that, and we should not forget it. It is not all about strategy.

I am about to finish, but I will say that we need to come back to this debate in a year’s time. I hope that the Backbench Business Committee and the chairmen of all the cancer all-party groups will make sure that we have a debate in this place every year about the cancer strategy, so that the Government can be held to account by critical friends. We all need to make sure that we focus on getting this strategy delivered. We absolutely do not need another strategy until 2020, and we will have made massive potential steps forward if we achieve what we have set out.

[David Tredinnick]

My hon. Friend tempts me by saying that he is about to sit down with three minutes to go. May I come to see him to discuss the announcement of the £200 million for support services?

Oral Answers to Questions

Debate between David Mowat and David Tredinnick

Tuesday 11th October 2016 Commons Chamber

[David Mowat]

I will confirm that. There is a national diabetes plan, as the right hon. Gentleman will be aware. Diabetes is one of a number of long-term conditions in which these plans are charged to deliver improvements, and it would not be acceptable for a plan to be signed off or completed unless progress on diabetes had been made.

[David Tredinnick (Bosworth) (Con)]

When the Minister looks at new treatment options in the forward view, will he consider the example of Velindre NHS Trust in south-east Wales, which treats 1.5 million cancer patients every year and is now using reflexology, reiki healing, aromatherapy, and breathing and relaxation techniques to alleviate anxiety, pain, side effects and symptoms? If that was more widely spread over the health service in England, cost savings and patient satisfaction would increase.

[David Mowat]

The STP process is locally led, not led from the centre, but I would expect clinical judgments of the type mentioned to be made if they could be confirmed on the basis of scientific and trial-based evidence.