Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

We have had a big increase in the number of medical students choosing to go into general practice, but we have also had an increase in the number of GPs retiring early. That is a problem that we are urgently addressing.

[David Tredinnick (Bosworth) (Con)]

May I congratulate my right hon. Friend on serving as Health Secretary for three Parliaments, and say to him that besides doctors and nurses, he should look to increase the use of properly regulated acupuncturists, herbalists, homeopaths, chiropractors and osteopaths, who would reduce the burden on doctors and nurses in the health service.

[Mr Hunt]

Over those three Parliaments, I have learned to expect questions from my hon. Friend in a similar vein, and I commend him for his persistence in championing that cause. As he knows, I think the most important thing, with all such issues, is to follow the scientific advice.

Homeopathy and the NHS

David Tredinnick Excerpts

Wednesday 29th March 2017 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

I beg to move,

That this House has considered homeopathy and the NHS.

Mr Hanson, it is always a pleasure to serve under your chairmanship, particularly when before we have even started the match, you have given us extra time. It is not often that we are able to start a debate earlier than expected.

This debate has come about for two reasons. The first is the attacks on the long-established national health service homeopathic service. Secondly, we are approaching a very happy moment, Homeopathy Awareness Week, when the homeopathic community comes together to tell people about what it can offer in providing support to doctors and alternatives where other treatments have not worked.

Homeopathy Awareness Week takes place from 10 to 16 April in a celebration of homeopathy: a safe, gentle, natural system of medicine that I have used for 30 years to great effect. In the UK, it might surprise people to hear that 15% of our population already use homeopathy and a further 80% have heard about it. Many people are not sure what makes it different from other medical systems. The week aims to get people to have a better understanding. A lot of events have been organised, including the film première of “Just One Drop”.

To put things in a global perspective, some 450 million people use homeopathy each year. If homeopathy did not work, why would so many people choose to use it and carry on using it? It is a global medical system, the second largest medical system in the world, and is used particularly in very poor communities, which I will come on to.

On British practitioners, a survey recently showed that 72% of homeopathic patients rated their practitioners either very good or excellent. The 4Homeopathy group recent study showed that practitioners are treating all kinds of things, from irritable bowel syndrome—30%—to depression—20%. More than three quarters of teenagers and 41% of adults receive homeopathic treatments for skin disorders. About a third of adults and 40% of teenagers go to homeopaths for anxiety and stress. It is a service that delivers both in and out.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this debate. I certainly would not dispute the testimony of those who have benefited from homeopathic treatment, but does he not agree that scientific evidence of its effectiveness would help in a decision on whether to use it?

[David Tredinnick]

The right hon. Gentleman, who has been in the House as long as I have, has made a good point. There is scientific evidence out there, although we could use more. One of the problems is that, when scientific evidence is produced, it is pooh-poohed. However, that does not stop people using, for example, arnica cream when they get wounds. It is a standard preparation and it is a homeopathic medicine. So there is a degree of need for more studies, but there are studies out there that are ignored.

I have said homeopathy is the second biggest medical system in the world. Some would say it is the most prestigious. It has always been held in very high regard by people who are widely respected. It is no secret that the royal family and many celebrities have used homeopathic medicine over the years. It has become increasingly important in an age when drug dependency is epidemic and when there are serious worries about the effectiveness of antibiotics.

The homeopathic private sector is growing fast not only in this country, Europe and America, but everywhere. However, in the NHS, we are under attack from people in the medical establishment. This goes back to 2005, when a letter was put out attacking homeopathic services in the health service. It was actually a bogus letter on NHS letterhead. The Countess of Mar and Lord Palmer asked a question about it and the reply acknowledged that

“this document was not issued with the knowledge or approval of the Department of Health and that the use of the National Health Service logo was inappropriate in this instance. The document does not represent any central policy on the commissioning of homoeopathy”.

Anti-homeopathy groups such as the so-called Good Thinking Society, which is a front for one individual, a sceptic called Simon Singh, are threatening clinical commissioning groups with legal action for commissioning homeopathy. People such as Simon Singh are anti-patient, anti-choice and closed-minded individuals who have never studied or used homeopathy. In the UK, we have a robust system of homeopathic regulation. We have the Faculty of Homeopathy, which was formed in the 1950s for doctors. Doctors are, of course, regulated by the General Medical Council as well. In 2015, the Professional Standards Authority took on oversight of the regulation of the 2,000 members of the Society of Homeopaths. Such enhanced regulation is important and is a good reason why homeopathy should be more greatly available in the health service.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[David Tredinnick]

I will give way to my hon. Friend from Northern Ireland.

[Jim Shannon]

It is always good to have debates on anything to do with health, but particularly with homeopathy. There have been several reviews of the scientific evidence on the effectiveness of homeopathy. Indeed, this House had a report in 2010, which the Minister will be aware of, from the Science and Technology Committee. In my constituency of Strangford is a major shop in Newtownards that deals in nothing else but homeopathy medicine, which clearly shows a demand. Does the hon. Gentleman feel it is perhaps now time for the Government to look at homeopathy in a new light because of the demand that there is, and also to see what homeopathy can offer?

[David Tredinnick]

My hon. Friend makes a powerful point. There is insanity about this subject. The amount of money spent on homeopathic prescriptions in the health service is about £110,000 per annum. So why are those who are against it so fanatically against it? What is it that gives them the swivel-eyed look? Why do they take so much trouble to rub out an alternative at a time when the mantra of the Government is patient choice? It is quite bemusing. Many of the patients that go to homeopaths have contraindications to pharmaceutical drugs, or chronic illnesses that have not been helped by conventional medicines. I say to the Minister that there are no cost savings to be made by banning homeopathic prescriptions, as patients will still need other interventions instead. The Government should assess how much money the health service has spent on other interventions for these patients before the successful use of homeopathic medicine.

If we look around the world, we see a much more developed landscape. In France, 70% of pregnant women use homeopathy. You can go to any chemist in France and find homeopathic preparations and chemists who are qualified to talk about them. If we go further afield, I particularly like the example of India where there is a Ministry for complementary medicine called the Ministry of AYUSH—the “H” in AYUSH stands for homeopathic medicine. I will say a little about that later.

We have already discussed evidence and there is always a need for good studies. There was a study in France, which I sent to the Secretary of State a long time ago for consideration by the chief medical officer. I have not had a reply yet, although I accosted him about it in the Division Lobby this week. A bullet-proof study named EPI3, which looks at the integration of homeopathy into general practice in France, showed positive outcomes, as does a randomised double-blind, double-dummy, multi-centre, non-inferiority clinical trial, which covers everything possible to follow the protocol, looking at the effect of an echinacea-based hot drink versus oseltamivir in influenza treatment. There are also promising indications that homeopathy could be helpful in combating the increasing problem of antimicrobial resistance. That is an example of a good study. I will come back to the EPI3 study.

The attacks on homoeopathy in the NHS come pretty much from one person. They come from an organisation called the Good Thinking Society, a charity that is not supposed to campaign for changes in the health service, but its website states that it wants to raise money because it

“Helps us campaign against the funding of homeopathy”.

According to the website, its leader, the Good Thinking Society’s chairman, largely funds the whole operation and another charity. It launched an attack on the Liverpool homeopathic service to shut it down, and eventually it was shut down. It worked like this. There was a consultation for local people at the end of 2015, at which I had a representative. Some 90% of those present were in favour of retaining or extending the service. Voting was by secret ballot, using hand-held remote controls, and 90% were in favour. One lady present, who suffered from a range of chronic conditions that conventional medicine had been unable to treat, was close to tears. She said that the only thing that had allowed her to live a relatively normal life was homeopathy. She pleaded with the clinical commissioning group not to cut the homeopathy service.

The next stage was a formal consultation open to everybody, with no restriction by area and no checking of who was contributing. That consultation found 73% against keeping the homeopathic service. It is my belief that that consultation was hijacked by the Good Thinking Society—that it got people to call in and distort the result. The right hon. Member for Oxford East (Mr Andrew Smith) and I have been here for a long time—nearly 30 years—and I think we can smell electoral fraud when we feel it. I cannot see how the results can go from 90% in favour to 73% against.

Patients who relied on that service have nowhere to go now, except for being a charge on the health service. That decision caused immense pain. One patient, Mr T, aged 58 from Liverpool, said in an interview from October 2015:

“After 3 years of trying everything my doctor gave me homeopathy, and within 4 months my stomach problems were better. 18 months later I can lead a normal life again.”

A London patient with arthritis said:

“It is the only thing that has helped me find remission from a disease that previously left me wheelchair-bound.”

The core of this debate is the most recent, and most serious, attack on NHS homeopathy—the attack on the Royal London Hospital for Integrated Medicine, the largest public sector provider of integrated medicine in Europe, formerly known as the Royal London Homeopathic Hospital. It offers an innovative patient-centred service, integrating the best of conventional and complementary treatments for a wide range of conditions. All clinics are led by consultants, doctors and other registered healthcare professionals, who received additional training in complementary medicine. This is a flagship hospital that is admired around the world. Instead of threatening it with closure, it should be hailed as an example of best practice and used to develop integrated medicine and to spread understanding of its benefits to the public and the health community.

For greater accuracy, I spoke to the director, Peter Fisher, and I have a briefing note from him. Apart from being a director of the hospital, he happens to be—as he described himself when he came before the Select Committee on Health in the last Parliament, during an inquiry into long-term care and conditions when I was acting Chair of the Committee—physician to Her Majesty the Queen. This is not somebody with a little training; he is a highly proficient, highly trained doctor—so much so that he is a doctor at that level.

Dr Fisher says:

“The Good Thinking Society is harassing the Royal London Hospital for Integrated Medicine by threatening legal action against its host clinical commissioning group, Camden. The RLHIM has an agreement with the north London cluster of clinical commissioning groups, led by Camden, for clinical care pathways for 13 conditions. Patients who do not have these conditions can be treated if normal treatments have failed or have caused serious adverse effects, and in certain other circumstances. The GTS is attempting to close the latter pathway. This would cripple the hospital, preventing it from providing homeopathy, herbal and other treatments and from treating cancer patients. The GTS has harassed the RLHIM and other complementary medicine providers with legal action, reporting to the ASA”—

the Advertising Standards Authority—

“and the Charity Commission.”

I will say more on that if we have time. He continues:

“The RLHIM is the largest public sector centre for integrated medicine in Europe with a strong record of provision, innovation and research. A large scale study in France comparing conventional and homeopathic GPs showed that homeopathic GPs prescribe far fewer drugs, with the same or better clinical results, at 20% less cost.”

So there is an economic argument here, which I will say a word about in a moment.

In the year ending March 2016, the Good Thinking Society had an income of about £100,000. It gave £25,000 to something called the Nightingale Collaboration, which is not a charity, so that it could use the money more freely. That organisation has attacked osteopaths, who are regulated by an Act of Parliament—I was on the Bill Committee for that—and homeopaths, and has waged a campaign against complementary therapies with the Advertising Standards Authority.

The individual, Simon Singh, is a strange and inconsistent individual. He sent me an email before Christmas explaining why he could not send me a Christmas card. I am not sure I would have expected one, as I absolutely despise him. In 2015, it was reported that the charity made claims that processed sugars are not deadly and do not feed cancer, but he did not reveal that the charity was receiving funds from a very large soft drinks manufacturer. I think it is accepted that large amounts of sugar are not necessarily a good diet for cancer patients. I think that is why he got his nickname, “Sugar Drinks Simon”.

Mr Singh also criticised the lyrics of the Katie Melua song “Nine Million Bicycles” for inaccuracy, referring to the size of the observable universe. He proposed correcting the lyrics, saying that the value of 13.7 billion light years would be correct. I looked into that and found that the correct figure is 46.5 billion light years from home. Even on that subject, on which Mr Singh professes to have knowledge, he was wrong—so there is no surprise that he is wrong about homeopathy, about which he has absolutely no knowledge.

To recap, we have what my daughter would call the absolutely bonkers situation where an individual, Singh, who is a physicist, not a physician, with no understanding or experience of homeopathy, is trying to cripple our leading academic medical centre, part of the University College London Hospitals NHS Foundation Trust, whose director—the man running it—is the Queen’s doctor. How mad can you get?

The core problem is not about whether or not homeopathy is effective. There have long been arguments about evidence-based medicine. Professor Sackett, who was responsible for the phrase, did not say it is about whether medicines work or not. He said it is about integrating individual clinical experience and the best external evidence; it is not just about external evidence. It is not just about the medicine—it is about the patient’s and the clinician’s experience. The nub of it is that complementary medicine can reduce the costs on the health service. I have quoted the French EPI3 study, which said that French GPs who integrate homeopathy in their practice use about a third of the antibiotics and psychotropic drugs and half the analgesics, with very similar results, at 20% less cost. That is not taking into account antimicrobial resistance or the adverse effects of analgesics, sleeping tablets or whatever.

There is a turf war here between two sides of the medical establishment, which is actually about resources. We have to resist that. The Secretary of State said, very sensibly, on LBC on 10 September 2014:

“There are some bits of the NHS where it”—

homeopathy—

“is sanctioned by GPs, but it wouldn’t be done without a doctor saying they thought that that was the right thing to do. And what doctors say is the right thing.”

He signed early-day motion 1240, which was about supporting homeopathic hospitals, in the 2006-07 Session of Parliament. It was signed by more than 200 Members—nearly a third of the Members of the House of Commons.

Today of all days—Brexit day—when the Prime Minister will be writing to the European Commission, I found this written answer in the Scottish Parliament from 23 February 2011. The then Health spokesman—no less an individual than the current First Minister, Nicola Sturgeon—replied. This is what she said in reply to a question about the effectiveness of homeopathy in relation to the Scottish Government’s integrative approach to patient care:

“In primary care, costs will relate to the cost of the remedy, which can be cheaper than the cost of orthodox drugs. Practitioners have also noted a reduction in side effects and dependency risks in some cases. In secondary care in Scotland, homoeopathy is only employed within a broader integrative care approach, with surveys showing both enhanced wellbeing and symptom reduction across a broad range of long term conditions, and a resultant reduction in NHS costs through reduced GP and hospital visits and repeat prescriptions.”

Well, there we are. That is what the First Minister in the devolved Administration thinks.

Homeopathy is a wonderful system of medicine. It has been part of the national health service for a long time, and I look forward to hearing from the Minister about the Government’s position.

[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)).

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

During my time as Health Secretary, the real-terms investment in general practice has gone up by £700 million or 8%, and we are planning to increase it by 14%—£2.4 billion—over this Parliament. A lot of extra money is going in, but I recognise that there are still a lot of pressures.

[David Tredinnick (Bosworth) (Con)]

The Secretary of State’s plans to recruit doctors will be widely welcomed in Leicestershire, but should he not be making greater use of already properly regulated practitioners—those who are regulated by the Professional Standards Authority—of whom there are 20,000, including hypnotherapists?

[Mr Hunt]

My hon. Friend’s ingenuity in bringing these issues up in question after question never ceases to amaze me. As he knows, we recognise that the pressure in primary care cannot just be borne by general practice, but we must always follow the science as to where we get our help from.

O’Neill Review

David Tredinnick Excerpts

Tuesday 7th March 2017 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

The O’Neill report focuses on many things, but I would like to focus on three key points. One is unnecessary prescribing. The second is the so-called disappeared antibiotics—those that should be available, but are not. The third is alternatives—something that Jim O’Neill talks about, but does not elaborate on.

Jim O’Neill says:

“Huge quantities of…antibiotics, are wasted globally on patients who do not need them”.

That is a key challenge for us, but he also says that a study in 2012 of 38 high-income countries found that

“two thirds of the antibiotics surveyed were not available in more than half of the countries. The main reason for this is that drugs manufacturers and distributors discontinue the stock where it is not profitable enough to maintain it.”

The point is that those antibiotics are available, but are not being used because of economic factors.

We looked at this issue in the Select Committee on Science and Technology, of which I was a member in the previous Parliament, and we found:

“Of the 18 to 20 pharmaceutical companies who were the main suppliers of new antibiotics 20 years ago, just a handful of companies persist in this field.”

It is all down to money, and we will clearly have to address that with funding.

If we go through the back of the O’Neill report, we find that there are hardly any contributions from anyone who knows anything about anything other than mainstream medicine. Between one third and one half of the world’s population live in China and India, where there is integrated healthcare using herbal medicine and mainstream medicine. There are 60,000 hospitals in China, and there will be a larger number of herbal clinics. In India, the Ministry of AYUSH regulates Ayurveda of different types, yoga and homeopathy, of which there are 200 colleges —we probably will not get on to that this afternoon.

In the previous Parliament, the then Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), asked a group led by the deputy chief medical officer, and me as his deputy, to look at regulation of herbal medicine. My hon. Friend the Minister has just published her response. I congratulate her on it and am very much in favour of the idea of getting better regulation through the Professional Standards Authority. However, I have to tell her that she has been badly advised in one respect. She says, on herbal pharmacies:

“Allowing people with no qualifications to put together medicines and carry this out on unregulated premises conflicts with everything else the MHRA does”.—[Official Report, 28 February 2017; Vol. 622, c. 8WS.]

I have to tell her that that is not the case. Professor David Walker, who wrote to her predecessor, my hon. Friend the Member for Mid Norfolk (George Freeman), made this clear:

“The idea of herbal dispensaries was to allow the preparation of herbal remedies on behalf of individual practitioners, for individual patients, but at a distant location by a third party. This would be safer than unskilled practitioners making products in unsuitable environments.”

So that is completely the opposite. He said:

“We consulted the MHRA about the feasibility of this change in our deliberations and the advice that we received was that it was feasible but…would take considerable work”.

That is the problem—the MHRA do not want to do the work. He went on:

“We felt that this effort would be worthwhile and that dispensaries would improve access to herbal medicines, generate business and improve patient safety.”

If we marry that with the new regime that the Professional Standards Authority has put in place, and if we give the herbal pharmacists from China and India and the phytotherapists in this country oversight of regulation through the PSA, my hon. Friend the Minister will have a powerful tool. However, that will not be the case if she does not have another look at the herbal pharmacies proposal, which we worked on for nearly 18 months. The former Minister, who commissioned the report, is not in his place at the moment, but he would agree.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing this very well attended debate and on his ongoing commitment to highlighting this issue. I pay tribute to the all-party group on antibiotics, my hon. Friend the Member for York Outer (Julian Sturdy) and the right hon. Member for Rother Valley (Sir Kevin Barron) for their leadership. I also commend my right hon. Friend the Member for Tatton (Mr Osborne), who is no longer in his place. He really set the issue squarely on the international agenda during his time as Chancellor.

As many hon. Members have described well today, antimicrobial resistance has the potential to lead to 10 million deaths by 2050—more than are caused by cancer—and a loss to global productivity of £100 trillion. As my hon. Friend the Member for Thirsk and Malton said, the figures are on a scale that is hard to comprehend, but the good news is that the ramifications of AMR are now widely acknowledged, and we can be proud that the UK has played no small part in that. Our chief medical officer, Dame Sally Davies, has led a global campaign to get AMR and the lack of new drugs in the development pipeline high on the global political agenda.

We have used the UK’s antimicrobial resistance strategy and our response to the O’Neill review, which we published last September, to drive change at home and abroad. This has led to the landmark UN declaration on AMR in September, which was adopted by 193 countries. The declaration recognises that AMR is an issue that relates not just to human health, but—as my right hon. Friend the Member for Chipping Barnet (Mrs Villiers) and the hon. Member for Bristol East (Kerry McCarthy) rightly said—to animal health, agriculture and the environment, with a significant social and economic impact. It puts AMR squarely not just on the global development agenda, but on the global security agenda.

As numerous hon. Members have mentioned, a key Government commitment in response to the review was to work with international partners to develop a global system that rewards companies for bringing new, successful products to market and makes them available to all who need them. There are a number of options for addressing the market failure, but the O’Neill review suggests using a system of market entry rewards to incentivise companies to bring new products to market. A number of international organisations, including the Boston Consulting Group, commissioned by the German Government, have looked at the issue more recently and come to similar conclusions, which is helpful in building an international consensus.

The UK supports that approach, particularly options that involve private sector contributions, but although a global solution is needed, different countries have different perspectives. In some countries, lack of access to effective antimicrobials is as great a risk as resistant bugs. The WHO estimates that 30% of people in developing countries do not have access to essential medicines, rising to 50% in sub-Saharan Africa. The UK is working to reach an agreement at the G20 to acknowledge market failure. The G20 has commissioned the OECD to consider potential solutions, and it will consider a range of options. The UK will support alternative systems that can effectively tackle market failure in a cost-effective and sustainable manner that ensures a long-term, sustainable supply of new antibiotics but also provides access to all.

While Lord O’Neill made it clear that interventions to stimulate the antimicrobials market should be administered at global level, he was also clear that at national level we must have better purchasing arrangements that conserve antimicrobials and do not incentivise unnecessary use. That is why the Department of Health is working with industry, through a joint working group with the Association of the British Pharmaceutical Industry and the National Institute for Health and Care Excellence, to consider reimbursement approaches that support these aims and how reimbursement models that de-link revenue from volume can be operationalised. It is essential that such a scheme is workable, so I will report back to Members when I am able to do so.

Colleagues are right that we will not make progress if we do not improve our stewardship and diagnostics, and cut avoidable infections and inappropriate prescribing. One of our ambitions in that regard is to halve the number of healthcare-associated Gram-negative blood stream infections by 2020. Delivery of that ambition is being led by NHS Improvement. Our initial focus is a 10% reduction in E. coli infections by 2017-2018, because there are established interventions to prevent such infections, and we are making some progress in this area.

A second ambition is to halve inappropriate prescribing by 2020. This work is now being led by the chief pharmaceutical officer at NHS England, with support from Public Health England, but the challenge is to identify the proportion of current prescribing that is inappropriate, so that we can safely reduce our use. Our experts are working to set a baseline, so that we can clarify our ask to prescribers. This will build on work that is already under way to reduce unnecessary prescribing.

I can report that there has been some progress in this area. In November 2016, data showed that total consumption of antibiotics by humans in England fell by 4.3% between 2014 and 2015, which is the greatest change that we have seen since the early 2000s. We are making progress, but our experts believe we can go further so we have put incentives in place through the NHS quality premium and commissioning for quality improvement schemes—which is quite a mouthful—to encourage further reduction, and we will maintain that system for a further two years, so that we can embed those changes.

My hon. Friend the Member for Thirsk and Malton also said that over-the-counter antimicrobials were a key area. It is illegal for websites based in the UK to sell antibiotics online without a prescription. Some websites offer online consultations with doctors, but they must abide by the General Medical Council guidance on remote prescribing, and it is extremely important that people exercise caution in how they use online care providers, especially when it comes to seeking medicines or treatments that may not be appropriate for them.

Regulatory agencies, such as the Medicines and Healthcare Products Regulatory Agency and the Care Quality Commission, are monitoring the safety and efficacy of prescription medicines and those selling them. Following an internal review of all 43 online services that are registered, the CQC has brought forward a programme of inspections, prioritising those services that it considers might pose a risk to patients. It will obviously report soon on that work.

My right hon. Friend the Member for Chipping Barnet and the hon. Member for Bristol East were absolutely right that the Department of Health needs to work closely with the Veterinary Medicines Directorate to reduce the use of antimicrobials in livestock and in fish farmed for food. Between 2014 and 2015, we saw a drop of 10% in sales of antibiotic for food-producing animals, but we know that we need to go further. So we are now in the process of setting sector-specific targets, as my right hon. Friend the Member for Chipping Barnet said, to ensure that we achieve our ambition of 50 milligrams per kilogram weight of animal by 2018.

My hon. Friend the Member for Erewash (Maggie Throup) was also right to highlight the need for better diagnostics if we are to achieve our stewardship ambitions. O’Neill was clear that that was necessary for better clinical decision making in both animal and human health. There is great potential to make better use of the diagnostic tests that are already available in a range of settings, including for self-care and monitoring in pharmacies and other high-street services. So NHS England has a programme in place not only to improve the use of the diagnostic tests that we already have but to identify the priority needs for new tests, so that we can work with researchers and industry to support the development and uptake of those tests. NHS England is also working with NICE to identify how its programmes could support more rapid uptake of effective diagnostic tests. If my hon. Friend would like us to, we will write to her with the details of that work.

In the end, this challenge is a global one that requires global leadership, as my right hon. Friend the Member for Tatton has said. The UN declaration was the start of a longer process to make sure that all countries develop and implement a national action plan, and it is essential that the follow-up process, which was agreed in the declaration, is put in place as soon as possible, to ensure that no time is lost in getting to where we want to be before we go back to the UN General Assembly in 2018. Within that timeframe, we will continue to support other countries to tackle antimicrobial resistance, including providing help to build capability and capacity to develop good surveillance systems in low and middle-income countries, through our £265 million Fleming fund and our £1 billion Ross fund, exactly as the hon. Member for Glasgow North (Patrick Grady) has said.

Lord O’Neill also recommended the establishment of a global innovation fund of $2 billion by 2020. The UK co-hosted a side event at the UN in September 2016 that brought together a package of pledges from Governments around the world to tackle AMR, totalling more than £675 million, which is a really considerable start in achieving that recommendation.

All of this work means that we now have unprecedented levels of global collaboration in research in the UK, co-ordinated by the AMR Funders Forum and supported by the Medical Research Council. We are now working hard to promote research and innovation in AMR globally, which includes making a further £50 million commitment towards setting up a global AMR innovation fund, to increase global investment in AMR and support the development of new drugs and diagnostics.

In closing, I thank all Members—

[David Tredinnick]

On that note, will the Minister give way?

[Nicola Blackwood]

I will close now but follow up later.

I thank all Members who have attended today. The high turnout and the quality of debate speaks to the fact that AMR is more than a domestic health challenge and more than a global development challenge. It is truly a global security challenge, of a scale that requires long-term political leadership to drive through the international change, the up-front investment to break the cycle of market failure in drugs development and the urgent action needed to improve diagnostics and cut inappropriate prescribing, and to ensure that patients complete their courses of medicines in an appropriate way.

We can be proud of the genuinely leading role that the UK has already taken, both domestically and on the international stage, but my commitment to all Members here today is that we shall not miss a step in driving forward on research and development, on stewardship and on international co-operation. As a science superpower with an integrated healthcare system, we are uniquely well placed to meet this challenge and we are determined to do so.

Mental Health and NHS Performance

David Tredinnick Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I am afraid that I reject that suggestion. The right hon. Lady wants to know what we have been doing over the course of the year. As I said in the statement, we have 1,600 more doctors than we had just a year ago, over 3,000 more nurses, the biggest flu vaccination programme in our history and 12,000 additional GP sessions booked over the festive period. A huge amount of work has been done, with a particular focus on distressed areas. Many of those distressed areas coped extremely well—not all of them, which is why there is more work to do.

[David Tredinnick (Bosworth) (Con)]

When the Health Committee in the previous Parliament looked at children and adolescent mental health services, one of the main concerns was the distance travelled by patients—sometimes halfway across the country—to get treatment. Will the Secretary of State expand on his plans to reduce attendance at A&E? Does he envisage a new form of gatekeeper and does he intend to try to keep drunks out of A&E?

[Mr Hunt]

I would probably use the word “streaming”, rather than gatekeeper, to ensure that we have good, alternative offers for people who do not need to be in A&E. Frankly, it is not safe for an A&E department to have people there for six, seven or eight hours with a minor injury and no urgent health need. It is distracting for staff and can make it more difficult for them to deal with people who have more immediate needs.

On distances travelled, as the Prime Minister said this morning it is completely unacceptable for people to have to go 400 miles for a mental health bed. What is the solution? We are commissioning more beds, but the actual solution is to intervene earlier so that people do not get to that stage in treatment where they need in-patient care. We know that if we intervene earlier we can in many cases head off that need and help people to get better more quickly.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Speaker]

The constituency of the hon. Member for Bassetlaw (John Mann) was just mentioned and he came in on cue. Unfortunately, he was not within the curtilage of the Chamber at the material time. No doubt we will hear from him at a later date, to which we look forward with eager anticipation.

[David Tredinnick (Bosworth) (Con)]

2. What his Department’s definition is of evidence-based medicine; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

Evidence-based medicine is about using high-quality research to guide clinical practice and to achieve optimal results for all patients. The National Institute for Health and Care Excellence plays an important role in supporting evidence-based medicine by translating research into authoritative guidance for healthcare professionals on best practice.

[David Tredinnick]

Is the Minister aware that the author of “Evidence-based Medicine” in 1992, Professor David Sackett, said that it is

“about integrating individual clinical experience and the best external evidence, not just internal evidence”?

Is she further aware that in respect of the interpretation of evidence-based medicine, I have reported the so-called Good Thinking Society to the Charity Commission for the abuse of its charitable status through its use of legal threats to force the Department and health providers to change the law on healthcare?

[Nicola Blackwood]

NICE obviously considers complementary and alternative medicines when developing its guidance, where there is evidence, and it has been able to recommend some therapies, such as acupuncture for tension headaches and a range of complementary medicines for multiple sclerosis. We expect healthcare professionals to take that guidance into account when designing local services, but they must use their best understanding when treating the individual patients in front of them.

Cancer Strategy

David Tredinnick Excerpts

Thursday 8th December 2016 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

I am most grateful to you, Mr Deputy Speaker, for calling me to speak in this important debate.

I listened with great interest to the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) talking about his experiences of smoking. I gave up smoking before a flight with a parliamentary delegation coming back from Bahrain nearly 15 years ago, and I have never looked back. One of the drivers that made me give up smoking was a conversation with the then Member for Manchester, Withington—I would call him an hon. Friend, but he was an Opposition Member—who is now Lord Bradley. Like the hon. Member for Poplar and Limehouse, I remember smoking in the House. I remember lighting up in a Standing Committee and being reprimanded, but we could smoke in the Library Room C then. I offered the then Member for Manchester, Withington a cigarette in the Tea Room—we could smoke anywhere then, as well as in the Smoking Room—and he said, “David, no thanks. I’ve got an emphysema hospital in my constituency.” That really hit home.

The hon. Member for Scunthorpe (Nic Dakin) is nodding. May I pay tribute to him? He was at the Britain against Cancer conference on Tuesday, which I attended as an officer of the all-party group on cancer. He has served on that group for much longer than I have, and he chaired the meeting in the absence of my hon. Friend the Member for Basildon and Billericay (Mr Baron). Other hon. Members have paid tribute to my hon. Friend, and of course to his wife, who is undergoing treatment at the moment. I want to say what a great job my hon. Friend has done to drive this agenda on the Conservative Benches. It just shows that if you follow something you believe in in this House, you can get dramatic results.

As a politician, I often think that we should be able to sum up something, such as a very wordy report, in just a phrase or a sentence. That may be because of my background in advertising many years ago. Those dramatic results were clearly illustrated by Simons Stevens, when he said that in 1999, 60% of cancer patients survived, but in 2014, the figure was 70%. We went over some of those figures, which I thought were truly remarkable and really very encouraging.

I want to focus on something else that Simon Stevens said, which the hon. Member for Scunthorpe has mentioned. He announced £200 million of funding at the conference:

“The £200m fund has been set up to encourage local areas to find new and innovative ways to diagnose cancer earlier, improve the care for those living with cancer and ensure each cancer patient gets the right care for them.”

That includes aftercare treatment. What do we do when a patient has had chemotherapy and then there is nothing else—they have not been given any other options, so they feel depressed and unhappy?

That is where my main experience in this House comes in, as I have worked on integrated healthcare—holistic medicine, I suppose—with the all-party parliamentary group on integrated healthcare for nearly 30 years. I have been an officer of the group for nearly 25 years, and have chaired it for quite a while. It feels almost as if our time has come. It has now been clearly recognised that part of the cancer package should be a wide range of support. We can see that all over the country. I was at LOROS last week, which is where very ill people in Leicestershire go for their last few days. A range of different therapies were being offered there. That is happening not just in my constituency but in many others.

I return to the conference mentioned by the hon. Member for Scunthorpe—[Interruption.] I see he has now been promoted to the Front Bench. That is the great thing about the Opposition—the Front-Bench team changes so quickly that we can never be sure where any hon. Members are. I remember that when I was a young Member the advice I was given was always to sit in the same place in the House so that the Speaker knew where you were. In that case, it is a wonder that any Opposition Members get called at all, because they are always moving around the Benches. The hon. Member for Scunthorpe has clearly been promoted this afternoon, so congratulations.

One battle I have had over the years has been with the medical establishment about what should be included in treatments on the health service. It has been an ongoing battle against vested interests in the medical establishment who do not want to see money leaking from their own particular silos. That is down to scarce resources. One of the most interesting stalls at the Britain against Cancer conference on Tuesday was about cancer detection dogs. Even I gasped when I saw it—my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who has also had experience of cancer and has contributed so much in her short time in this House to addressing cancer problems, is nodding and smiling. Just as we have dogs in this House—I will not say when or where they go—to detect things that may have been placed here by people who do not particularly agree with what we do, so it is possible to use dogs to detect cancer. If that is possible, I suspect that the authorities in the health service have not run double-blind placebo-controlled trials to establish whether it works. It works on the basis of experience, because the dogs are trained to detect by smell when people have developed cancer.

On the great battleground with the orthodox proponents of orthodox medicine, the battle line has in recent years been drawn on something called evidence-based medicine. We are told that in the health service medicine should always be evidence-based, and nothing should be used unless it meets that criterion. I had a look at that, and got the Library to look the papers up. It goes back to 1992 and a statement by Professor Sackett that various other academics then ran with—there was a Professor Guyatt also. But when saying how important evidence-based medicine was, Professor Sackett also said:

“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

It is hardly a secret that we were discussing Brexit in the House yesterday and that we have been very much involved in the whole debate since the summer—and for many of us, a long time before that. One problem in healthcare in relation to the EU has been the imposition of directives on the UK that have negatively impacted support services in healthcare. The traditional herbal medicines directive requires Chinese medical practitioners to show 30 years’ usage of a particular medicine in the UK, or 15 years under other circumstances, and bans a whole range of complex preparations freely available, and produced to very high standards in modern factories, in the People’s Republic of China.

Before I came to the Chamber this afternoon, I was at a Chinese medical clinic. I practise what I preach and have acupuncture once a month. I take Chinese herbal medicine and I think it has kept me away from antibiotics, steroids and other drugs for a good few years. I talked to practitioners about what they are able to do for cancer patients. There is a very long list of types of cancer that can be treated using traditional Chinese herbal medicine: cervical cancer, Non-Hodgkin lymphoma, HIV, colon cancer, head and neck cancer, breast cancer and prostate cancer. The list goes on.

I believe that several of my constituents are alive today because they have used Chinese medicine. It strengthens one’s immune system and is very effective after cancer treatment. It deals with particular symptoms. I asked the practitioner this afternoon what conditions she would expect to be able to alleviate using Chinese herbal medicine and acupuncture. She said: tiredness, lack of energy, fevers, headaches, hypertension, dry skin, seizures and involuntary muscular twitching.

We have to broaden the scope of services available on the health service to help to meet patient demand. I hope the £200 million fund will mean a further widening of the scope of services available. My hon. Friend the Minister, who is new to his post, could do a lot worse than contact the head of the Professional Standards Authority, Harry Cayton. Harry Cayton’s organisation oversees the regulation of 23 different health organisations, including about 20,000 providers. If we go to the trouble of regulating different therapies, or having oversight of that regulation, why on earth do we not use it? What is the point of having a statutory regulator that checks the oversight when we do not actually use its services? That is a great mistake.

My hon. Friend the Minister could do a lot worse than go around the country and look at some of the practices that help cancer patients in remission. One of the best is the award-winning Velindre cancer centre in south Wales. Each year, it sees over 5,000 new referrals and about 50,000 new out-patient appointments. It employs over 670 staff and has an annual budget of over £49 million. The money for that service, which is widely used by doctors, comes not from the Department but from charitable donations. At that centre, they use reflexology, reiki healing, which I have studied over the years, aromatherapy, and breathing and relaxation techniques, and they have spectacular results.

Another wonderful clinic that my hon. Friend would do well to visit—it is a few stops on the District line from here, in Fulham—is the Breast Cancer Haven. It offers a range of therapies to combat stress, and I have attended its sessions. It is wonderful to see people suffering from breast and other cancers being given hope that chemotherapy is not the end of the road and that there is something out there to support them.

Another wonderful organisation of which my hon. Friend should be aware, and which was at the cancer conference on Tuesday, is Penny Brohn UK, the living well with cancer organisation. It has worked hard to produce a report on the long-term impact of its living well course, and the results from the five-year follow-up show a high approval rating among patients. The figures are staggering: 97% of patients reported making positive lifestyle changes after the course; 75% said they had maintained the positive changes for four to five years or were still maintaining them; and 85% said the living well course had enabled them to self-manage their health more effectively.

My hon. Friend, being well aware of Government policy, will know that patient choice is, according to the Health Secretary in the last Parliament, at the heart of the health service. If we are to give patients choice, we have to give them the provision to choose from. I was a member of the Health Committee for the whole of the last Parliament—I chaired it for a while when Stephen Dorrell stood down, before my hon. Friend the Member for Totnes (Dr Wollaston) took over—as well as a member of the Science and Technology Committee, both of which looked at the complex problems of polypharmacy and polymorbidity, which is jargon for too many people taking too many drugs and nobody really knowing what those drugs do. We need to reduce that.

There is a crisis in this country with antimicrobial and antibiotic resistance—we are not getting new antibiotics into the pipeline—and part of the problem is that we are trying to create new drugs while also trying to reduce antibiotic use. There is a range of other therapies that can help patients stay away from antibiotics. I will not get called to order, Madam Deputy Speaker; I know that this is a cancer debate, but a lot of alternative therapies—I will get to the H word, homeopathy, in a minute—offer options at a time when mainstream medicine is running out of solutions.

I have always championed the cause of homeopathy in this House, and I want to relate that strictly to cancer this afternoon. Homeopaths do not claim to cure cancer, but my goodness they can assist people who have had cancer and who are in remission by helping them to adjust their moods and to deal with anxiety and sleeplessness. It is a great tragedy that a tiny number of people, whom I regard at best as foolish and at worst as wicked, are trying to erase the tiny sum of money—£500 million—spent on homeopathy in the health service. Without looking at the benefits, they argue that it is a waste of money.

We have seen the pressure on institutions at Liverpool and elsewhere. What could be more stupid than to attack a medical system that is widely used in France, that voters went for in Switzerland, and that is used across the world, including in India and Brazil? What is the problem here?

I was in Toulouse to look at British Aerospace work recently, and I found a homeopathic chemist right in the middle of the main square there. Some 90% of pregnant women in France use homeopathy. The Minister must not be bludgeoned by the tiny number of people who use legal threats and resist it. Simon Stevens is now coming up with new money for aftercare for cancer, so we need to look out of the box and consider new possibilities. We are not even looking at some possibilities that are orthodox.

As I said, I am an officer of the cancer group, and I chaired a meeting the other day to hear anxious and anguished professors of medicine from this country talking about a new mainstream treatment called Target for breast cancer. Target is about putting a small device the size of a tangerine on the end of a cricket stump into an incision in the chest. The chemotherapy treats the tumour and not all the other organs in the chest. The professors saw this as a great breakthrough. It was invented in Britain, and it is widely available in Europe. How come NICE has only given it draft clearance? What is going on? Professors of medicine are saying that this is hugely important, yet we are not actually dealing with it.

[Jo Churchill (Bury St Edmunds) (Con)]

On that particular point about targeted interoperable radiotherapy, I too have spoken to these professors, and I understand where they are in the clearance process. I find it a little bit concerning when there is a lack of money in the system. Is my hon. Friend aware that there are half a dozen machines around the country that could deliver that targeted therapy? Perhaps we need to look at what we should do first—whether it is purchasing the machines or giving the clearance in full.

[David Tredinnick]

My hon. Friend makes her point very well. In his excellent presentation, Simon Stevens talked about bringing new equipment onstream for radiography, I believe. [Interruption.] Yes, my hon. Friend was there, and she confirms this. I certainly agree with what she said, and we need to wake up to what is being invented in Britain and used across the world.

I shall conclude shortly, in case anyone else is hoping to catch your eye, Madam Deputy Speaker. I want to finish with a couple of other points. There are other treatments out there, to which people turn in desperation when they reach the end of their conventional treatments. One of them is called oxygen therapy, and broadly speaking it means getting more oxygen than is normally received, from a container. It is not a very expensive treatment, and the information I am getting is that it produces spectacular results when it comes to energising people and improving their sense of self-worth and wellbeing.

My final point is one that I find amazing. In the great cancer hospitals and clinics of this country, diet is seen as a sideline. In some of these institutions, the diet is, frankly, appalling, but I am not going to name of any of them this afternoon. Like most colleagues, I have a big enough postbag already and I do not want to hear the defence. Anyone attending a big clinic in America, such as the Mayo Clinic, can say goodbye to dairy and sugar, and hello to more juices. The Haven in Fulham certainly uses a lot of raw juices and raw vegetables. Diet is absolutely fundamental. When I worked in the computer industry, we used to say “Garbage in; garbage out”—and the same applies to humans. Our outputs as a being—[Interruption.] The hon. Member for Scunthorpe (Nic Dakin) does me the honour of laughing, but it is true. Diet is such a soft ball to hit, is it not? We are spending millions of pounds on all these expensive treatments, but what about telling people to cut back on sugar? Well, there we are.

I have tried to address some of the issues following the landmark speech at a landmark conference on Tuesday. For the first time, we have seen a lot of money set aside for developing aftercare for patients and improving services around mainstream medicine.

My hon. Friend the Minister has a great opportunity to make his mark in the House. His Department is, I believe, the fourth largest employer in the world. I think the Red Army comes top and McDonald’s second; I expect another burger provider comes third; and my hon. Friend is presiding over part of an organisation that comes fourth. His brief gives him enormous opportunities to improve the quality of life of cancer patients in this country, and by the time he has finished, there should not be just an increase in the cancer survival rate from 60% to70%—his target should be 80%.

Madam Deputy Speaker, I rest my case.

--- Later in debate ---

[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?

National Health Service Funding

David Tredinnick Excerpts

Tuesday 22nd November 2016 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

Speaking for myself, I was impressed by the pace of the hon. Lady’s speech.

In this short contribution, I want to address the supply of practitioners, not just the supply of money. I suggest to my hon. Friend the Minister that since we have regulated many more practitioners, many more practitioners should be available on the health service. The Professional Standards Authority chief Harry Cayton has called for a much greater use of those on his register. He says:

“We all know we need to deliver new, innovative ways to improve people’s health…That means looking beyond the traditional confines of our health and care system and the traditional health professions.”

The 23 organisations on his register—including the Federation of Holistic Therapists, the Society of Homeopaths and the British Acupuncture Council—regulate 20,000 practitioners.

The treatment of lower back pain needs much greater consideration. Since the regulation of chiropractors and osteopaths in Bills that I was involved with 20 years ago, there has been far too little communication with orthopaedic surgeons. There is an organisation called ARMA—the Arthritis and Musculoskeletal Alliance—but I ask my hon. Friend to look at the matter and see how much more effective integration can be. NICE now recommends acupuncture for lower back pain, as I hope it will continue to do, and that should be brought in.

On Brexit, we have the European legislation to consider. Three directives need close scrutiny when we take them over. The traditional herbal medicines directive has struck out proven Chinese medicines and other herbal medicines, the food supplements directive is very restrictive and tougher regulation will be needed when we get our hands on the food additives directive.

The chief medical officer wrote a report in the last Parliament on antimicrobial resistance. One of the most effective ways of stopping antibiotic use is to use homeopathic medicine, which has a proven record in upper respiratory tract infection treatment. We also need to go back to the ’90s to look at the GP fundholding system that was available in John Major’s Government, whereby doctors could commission complementary and alternative medicine practitioners. A clinic known as “The Crypt” in Marylebone saved £500,000 in one year using homeopathic treatments. When that was struck out by the new Labour Government, the clinic overspent its drug budget by £1.5 million.

There have been a lot of attacks in the past few years on homeopathy, which is an honourable and well-served practice of medicine with its own doctors, regulated in this country and used in 41 of 42 European countries. Some of those attacks have been from an organisation called the Good Thinking Society, which really consists of one man and a dog. It spends £100,000 a year, £20,000 of which comes from the taxpayer through its charitable status; I think that that is an absolute scandal. I urge my hon. Friend the Minister not to listen to the siren voices of that small, badly represented group. We need to use the discipline of homeopathy. We must not allow lawyers sending letters to clinical commissioning groups and others to derail the availability in the health service of that very well-established and popular system of medicine.

Oral Answers to Questions

David Tredinnick Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I was incredibly impressed with the staff I met at Peterborough hospital—there was incredible commitment to patients and some fantastic work going on in the oncology and renal departments, which I visited. He is right: PFI was a disastrous mistake, saddling hospitals up and down the country with huge amounts of debt, which cannot now be put into front-line patient care. We are doing everything we can to sort that out and not repeat those mistakes.

[David Tredinnick (Bosworth) (Con)]

My right hon. Friend will be aware that the NHS spends only about £400 million a year on homeopathic medicine and treatments through the 400 doctors who have trained in homeopathy and are members of the faculty. If he wants to reduce antibiotic prescribing, may I suggest that he increases that budget, because there are very good scientific trials now showing that upper respiratory tract infections can be treated using homeopathic medicine? May I write to him about that?

[Mr Hunt]

May I commend my hon. Friend for his great persistence in flying the flag for homeopathic medicine? While we must always follow the science in the way we spend our money on medicines, as I know he agrees, he is right to highlight the threat of antibiotic resistance and the need to be open to every possible way of reducing it.

Earlier Cancer Diagnosis: NHS Finances

David Tredinnick Excerpts

Tuesday 18th October 2016 Westminster Hall

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered earlier cancer diagnosis and NHS finances.

I thank Mr Speaker for allowing this debate and you, Mr Nuttall, for presiding over it. I also take this opportunity to welcome the Minister to his new post. He has been in it a while now, but this might be his first Westminster Hall debate. We look forward to working with him—he comes highly recommended—and I thank him for accepting the invitation, on behalf of the Secretary of State for Health, who was unable to make the appointment, to speak at our Britain Against Cancer conference in December.

Early diagnosis has been a key theme of the all-party group on cancer for some time. We call it the “magic key” to cancer. If we can drive forward on our rates of early diagnosis, the stage at which we first detect cancer, we can improve survival rates significantly.

I should perhaps briefly explain to the Minister that there is a little history to this involvement. Back in 2009, the all-party group published the report of an inquiry it had conducted into cancer inequalities. We found that patients in the NHS at the one-year point since their cancers were detected stand as much chance of surviving to the five-year point as they would in any other healthcare system. Where we let ourselves down, however, is getting patients to the one-year point. That suggests that the NHS is as good as any other healthcare provider in treating cancers once detected, but poor at detecting them in the first place.

In this country, our survival rates have been ticking up, with the rate of improvement broadly similar to that in other countries, but our survival rates still stand well below those of many other countries. For example, in this country the overall one-year survival rate is about 70% or 71%, but in Sweden it is 82%. That might not sound like a big difference, but overlay that differential with regard to the population of the UK as a whole and it tells us that tens of thousands of lives a year are needlessly being lost because we are diagnosing too late.

We need to focus on early diagnosis, and the Minister is in a unique position to be able to make a real difference to a large number of people if we can get it right. Yes, cancer survival rates are improving, but they are improving around the world and we are still well behind international averages. We welcome the improvements, but we have still not yet seen that kick-up that will allow us to catch up with those international averages.

Our 2009 report came up with, in essence, one recommendation. Reports can always come up with myriad recommendations, but we believe in short reports and, having consulted with the wider cancer community, the good and the great of the cancer world, the charities, patients and so forth, we came up with one recommendation: to ensure that we focus the local NHS, the clinical commissioning groups— primary care trusts then, CCGs now—on their one-year survival rates.

The logic is simple: the earlier we diagnose, the better our one-year survival rates. They are therefore a good measure of how successful we are in diagnosing early. Late diagnosis makes for poor one-year figures, so we get the CCGs to focus on the one-year figure and, if there is a line of accountability there, they will be encouraged to focus on how to improve earlier diagnosis and introduce initiatives promoting earlier diagnosis.

[David Tredinnick (Bosworth) (Con)]

Has my hon. Friend seen the results of the Barts Health NHS Foundation Trust’s 2013 study at Whipps Cross hospital? It showed the effectiveness of complementary therapies in improving symptom control following diagnosis. The three-year study revealed that 90% of people noticed that side-effects of chemotherapy and radiotherapy decreased following such treatment, and patients said that their pain, sleep and emotional health improved. Should we make greater use of those supportive therapies as part of the scheme of things?

[Mr Baron]

We certainly have to be inclusive with regards to how we look at treatment generally. As my hon. Friend knows, the all-party group and, indeed, the wider cancer community are looking at such things. He comes to our meetings, and we listen carefully. Questions certainly need to be answered on that front, so he is pushing at an open door. We have an open mind, and we are listening.

Together with the wider cancer community—at the end of the day it has been a team approach—we have been successful in ensuring that CCGs are now held accountable. The one-year survival rates have been included in the delivery dashboard of the assurance framework, and that is very good news. Figures have only been published for the past one or two years, so we are still seeing what is happening with regards to improvements and how CCGs are performing, but at least we have made a start and there is an element of accountability.