Leaving the EU: Tobacco Products and Public Health

Desmond Swayne Excerpts

Monday 7th January 2019 Commons Chamber

[Steve Brine]

I will briefly address some of the points that have been raised. The hon. Member for Washington and Sunderland West (Mrs Hodgson) says she hopes that no-deal contingency will not be needed. Fortunately, I have a cunning plan to ensure that it is not needed, which is to vote for the deal next Tuesday. I look forward to her support.

A number of Members talked about e-cigarettes. The best thing a smoker can do for their health—I have always said this—is to quit smoking. E-cigarettes are not harmless: the nicotine is toxic and addictive, and there are unanswered questions on the long-term effects of their use. There is, however, evidence that e-cigarettes are significantly less harmful to health than smoking tobacco. The control plan that I published last year commits to monitoring the safety, uptake, impact and effectiveness of e-cigarettes and novel tobacco products. We will review all the regulations as part of our post-implementation plan by May 2021. A number of Members referred to that, for which I am grateful.

My hon. Friend the Member for Harrow East (Bob Blackman), the hon. Member for Washington and Sunderland West and the hon. Member for Central Ayrshire (Dr Whitford) talked about the rotation of warning images and the deal with the Australian Government. The deal is indeed to use their picture warnings free of charge. That is very kind of our friends down under. The rotation of picture warnings so that people do not become desensitised to them is very important. We are aware of the benefits of rotating the warnings. In the medium to long term we will consider our options, and they may well include the option of developing new domestic picture libraries. My hon. Friend the Member for Harrow East said that there are plenty of images. I am sure we can access them domestically, and I will be looking at that.

My hon. Friend the Member for Harrow East talked about products that have already been notified. A new notification system, which will be in place on exit day in a no-deal scenario, has been developed. If there are novel products, they will be notified through the new system. Products notified between now and exit day will continue to be notified through the EU system. I have to say that I am not aware of any novel products that are due to be notified by the current or new notification processes, but they will be able to deal equally effectively with any novel products that appear on the market.

This is an important statutory instrument. The hon. Member for Central Ayrshire said that we must not in any way water down or lose our ambition on tobacco control. I think she knows me well enough to know that I certainly do not lack ambition in this space. One of the first things I did in this job was to publish the tobacco control plan. Tobacco is still our biggest preventable killer. She is absolutely right to say that, and it is why such a central part of the long-term plan is prevention. One of the simpler things we can do to prevent ill health and the cost it brings to our health service in England, as well as in Scotland, is to stop people smoking.

The hon. Lady asked whether the notification system will be ready. I think I said in my opening remarks that the feedback we have had from the industry is that that will be challenging, but the advice we get from experts is that it will be ready. She also asked about fees being charged on an ongoing basis. I will have to write to her on that point, but I will endeavour to do so this week so that she gets the answers she wants. I have already answered the question about lowering standards, which we most certainly do not want to do.

We are absolutely committed to the tobacco control measures I set out in the plan. I want to ensure that we maintain discipline and our focus on preventing ill health by driving down smoking rates, and we will review all our tobacco control legislation by 2021. Of course, if the House supports the deal next Tuesday, the draft regulations will not be necessary, but in the event that they are, we will be ready.

Question put and agreed to.

[Sir Desmond Swayne (New Forest West) (Con)]

On a point of order, Madam Deputy Speaker. We are about to debate a matter of huge constitutional significance. Hitherto, the sole criterion for voting in Committees of this House has been election. If this measure passes, we will change that to allow people who have not been elected to vote in Committees of this House. That would be a huge change, which we are about to rush through in 40 minutes, without proper scrutiny. The Government have already withdrawn one motion from today’s proceedings. Is there any way that, through your offices, you can ask the Government whether they would be prepared to withdraw this motion so that we can debate it fully and properly at an appropriate time?

[Madam Deputy Speaker (Dame Eleanor Laing)]

I fully understand and have some sympathy with the point the right hon. Gentleman makes. It is indeed the case that we have a very short amount of time for this important debate. Of course, as he knows, I have no power from the Chair to do anything about the timetabling of matters in the Chamber. As I look at the Leader of the House, I see that she has a determination to get on with this debate now. I can well understand that. It is in the power of the Government to change the business, but as the right hon. Gentleman knows, the House is very busy. All I would say is that I hope people will speak succinctly and briefly, and that it is unfortunate that the earlier business took so long, with so many people saying the same thing over and over again but insisting on having their voices heard, which has curtailed the debate on this very important piece of business.

Prevention of Ill Health: Government Vision

Desmond Swayne Excerpts

Monday 5th November 2018 Commons Chamber

[Matt Hancock]

On medicinal cannabis, I announced more research today and there is now a route in England. The hon. Gentleman will of course have to talk to the Scottish health service to ensure that a constituent in Scotland gets access, but I am very happy to look into specific English cases.

On the broader point about alcohol, it is important that we tackle alcohol abuse and it is vital that we do it in the right way. I do not want to punish people who drink responsibly at responsible levels, including myself. I occasionally drink at a responsible level, and I am sure that the hon. Gentleman does—certainly his colleagues enjoy a wee dram. Nevertheless, 5% of people in this country drink 30% of the alcohol. It is the small minority who present significant problems for the NHS and we need significant, targeted action.

[Sir Desmond Swayne (New Forest West) (Con)]

We have cut salt dramatically and the Secretary of State now wants to cut it further; life will certainly seem longer, will it not?

[Matt Hancock]

There are many ways to make one’s food taste good and make it healthy, too.

Hospice Funding and the NHS Pay Award

Desmond Swayne Excerpts

Wednesday 31st October 2018 Westminster Hall

[Liz McInnes]

My hon. Friend makes an important point: hospices seem to be facing a choice of asking the community to give them extra money, or reducing the service they provide.

[Sir Desmond Swayne (New Forest West) (Con)]

Am I incorrect in my understanding that hospices adopting the full Agenda for Change will receive Government assistance? Perhaps the Minister will clarify that. The difficulty for hospices in adopting it is that they lose control of their salary budget. The difficulty is in getting that balance right, and I hope that the Government will be able to help.

[Liz McInnes]

The right hon. Gentleman is absolutely right. I will explore the Agenda for Change later, because adopting it presents huge difficulties for non-NHS organisations.

The three points from the chief executive of Springhill Hospice were tabled as parliamentary questions. Sadly they received identical answers that included:

“We are considering carefully the impact of any agreement on non-NHS organisations such as hospices that may be affected by the proposed pay deal; however no decisions have been made. Staff in hospices do a fantastic job in delivering world-class care and the Department remains fully committed to improving palliative and end of life care.”

In July, I wrote to the Secretary of State for Health and Social Care, asking for an update on the issue. The response stated that he “understood concerns” that

“hospices may find recruitment and retention challenging if some of their staff choose to leave in favour of organisations that employ staff on the Agenda for Change contract”.

In summary, the Government will finance the pay award for non-statutory, non-NHS organisations only for organisations employing staff on the Agenda for Change contract, which is the nationally agreed set of terms and conditions for most NHS staff. The rationale for that was that:

“Additional funding relies on organisations employing staff on the Agenda for Change contract, because it is the Agenda for Change pay and non-pay reforms that together will help deliver the productivity improvements the Chancellor asked for in return for additional pay investment”.

What are the reforms that can only be made under Agenda for Change? On examination, it seems to be an emphasis on training and apprenticeships and a programme of appraisal and personal development. There is also a slightly vague statement on the improvement of the health and wellbeing of NHS staff, to improve levels of attendance, with a reference to

“positive management of sickness absence”,

whatever that may mean.

The response from Springhill Hospice was grim. The chief executive wrote to me:

“Very few charitable hospices employ their staff on Agenda for Change contracts, and as a result, Springhill Hospice, along with many other hospices, will miss out on the funding being set aside by the Government. This will place us at a considerable disadvantage in recruiting and retaining essential staff to deliver the services that we offer to people with life-limiting illness in this community, and will leave us with a significant additional cost.

Recruiting and retaining skilled staff is a critical challenge for us, and in order to remain competitive, we will have little choice but to increase pay for clinical staff. Over the course of the three-year NHS pay deal, we estimate that this will bring an additional cost to the hospice of in excess of £250,000. Without support from the Government, this extra cost can only be met by asking our communities to give more, or by reducing the services that we provide.

We are already asking our community for in excess of £2 million contribution each and every year, and in an area of high deprivation, I can only envisage that any additional ‘ask’ will not be able to be met by our community, so sadly we may have to look at service reduction, which in turn will place additional burden on an already stretched NHS.

NHS staff will start to see the pay increase reflected in their pay packets from this month onwards. Without government support, Springhill Hospice will see a significant additional cost fall to the charity as a consequence.”

--- Later in debate ---

[Liz McInnes]

I thank my hon. Friend: that is exactly the point that I wanted to make. A deal has been done in Plymouth for a social enterprise provider that is not a hospice but a provider of mental health services. Obviously, smaller deals are being done. My hon. Friend the Member for Plymouth, Sutton and Devonport is not able to be with us today, but I was very interested in the evidence that he sent me. The Department of Health and Social Care needs to look at the smaller deals that have been done and ask itself what on earth is going on.

To return to the issue of physiotherapists, they are clinical staff whose role in hospice care is sometimes forgotten. The CSP told me that its members overwhelmingly backed the pay changes when consulted earlier this year. It pointed out to me the importance of the physiotherapist’s role in enabling people with a terminal illness to stay active as long as possible—a really important role—and went on to say that with the current shortage of physiotherapists, it is relatively easy for staff to change roles if they wish to do so, and that employers who cannot broadly match NHS pay rates will find it increasingly difficult to recruit staff.

There is clearly real concern that the NHS pay award will have an unforeseen but damaging impact on charitable hospices and other organisations that are already at a significant disadvantage compared with other non-NHS providers in not receiving reimbursement for the costs of the care that they provide to NHS patients. A sustainable hospice movement is an essential component of delivering the improvements in end of life care that the Government have rightly sought. The Government must look again at the conditions imposed on non-NHS providers and consider how funding may be made available to prevent a diminution of the end of life care service.

[Sir Desmond Swayne]

May I therefore, through the offices of the hon. Lady, put in my bid to the Minister for just such a local agreement for Naomi House and the Oakhaven Hospice in Hampshire?

[Liz McInnes]

I thank the right hon. Gentleman for that intervention, but we want a national agreement rather than a piecemeal set of local agreements. I hope that that will be addressed today.

I shall conclude by quoting NHS Employers:

“Patients are at the heart of everything the NHS does.”

How does that square with the Department of Health and Social Care’s refusal to finance the pay award for hospices, and how is that refusal putting terminally ill patients, at the time when they are most in need of care, at the heart of our NHS?

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

As ever, it is a great pleasure to serve under your chairmanship, Mr Davies. I add my voice to those congratulating the hon. Member for Heywood and Middleton (Liz McInnes) on securing a debate on this important matter, and congratulate every Member who has been involved, either through a speech or an intervention. As MPs, we are all aware of the crucial role that hospices play in supporting and caring for our communities at a time of great need. I understand the concerns that have been raised, and have listened carefully to the strong arguments that have been made.

Hospices across England are delivering excellent end of life care and contributing to their local communities, as they have for many years. The Care Quality Commission’s “State of Care” report, published on 10 October, is testament to that. That report showed that hospices have continued to provide high-quality care at the end of people’s lives, even improving on their performance last year, which saw them rated as the highest performing secondary care servicer, with 27% of hospices—more than a quarter—rated as outstanding. I know that Springhill Hospice in the constituency of the hon. Member for Heywood and Middleton was rated as good overall in the CQC’s most recent assessment, but was rated as outstanding in the delivery of care and effective services, and people spoke highly of the kindness and caring attitude of staff. That is why the hon. Lady is right to raise this debate. I add my thanks to all those working and volunteering in the hon. Lady’s hospice, and in hospices up and down the country, for the quality of care that they offer.

We all know that palliative care can take many forms, whether at home, in a hospice, or in a hospital. There is never a more important time to make sure people get the right level of care. My hon. Friend the Member for St Ives (Derek Thomas) spoke about the immeasurable support that was given to his mum by his local hospice, and he rightly mentioned the crucial role of local commissioners in ensuring that hospices can do their amazing work, which I will speak more about in a moment. My mum was responsible for fundraising to build the Naomi House children’s hospice that my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) mentioned earlier.

[Sir Desmond Swayne]

Will the Minister address the question that was raised about local deals, and will she acknowledge the bid that I made?

[Caroline Dinenage]

Sadly, I cannot comment on individual cases. I am not aware of any individual deals being done with the Government, but of course, this could be a local arrangement. For 2019-20 and the remaining two years of the deal, funding will follow the usual route. It goes through CCGs, so I imagine that the instance that the hon. Lady mentioned is due to that, but I am keen to hear more.

--- Later in debate ---

[Caroline Dinenage]

That is a very good point. NHS England will bring forward its report on hospice care very shortly, in November.

I want to talk about staff funding. In common with much of the sector, I know hospices have faced financial challenges. I recognise the concerns of hospices that the recently announced NHS pay rise is putting them under pressure to match the uplift awarded to staff employed on the Agenda for Change contract not only to retain the incredible staff they already have, but to attract the staff they need. We have agreed that for 2018-19, non-NHS organisations that employ existing and new staff on the Agenda for Change contract will be eligible to receive additional funding. Most hospices do not employ their staff on the Agenda for Change contract because of the cost that would entail and so are ineligible.

[Sir Desmond Swayne]

Is it possible for a hospice to employ some staff on those contracts and then achieve the benefit of doing so without handing over its entire employment budget and losing control over it?

[Caroline Dinenage]

That is a very good question, which I will drop my right hon. Friend a note to answer, if he does not mind, as we need to make a few more inquiries about that.

It is important to stress that the Agenda for Change pay deal does not seek to make any distinction between the value we place on staff working in NHS and non-NHS organisations. Staff work incredibly hard to provide services, always putting patients and service users first. Funding is linked to the direct costs of implementing the Agenda for Change pay deal, which includes both pay and non-pay reforms. As the hon. Member for Heywood and Middleton mentioned, it is not just about headline pay. It is right that those organisations that employ existing and new staff on the Agenda for Change contract and must implement the entire pay deal should receive additional funding for 2018-19.

The hon. Lady is right to raise the matter, and I thank her again for doing so. I have listened carefully to the issues that have been raised, and we will look again at all of them and what we can do to better support our hospices to continue doing their vital work.

Childhood Obesity Strategy: Chapter 2

Desmond Swayne Excerpts

Monday 25th June 2018 Commons Chamber

[Steve Brine]

I will work with local authorities on a new pathfinders programme, which the hon. Lady may not have had a chance to look at as it was published only this morning. We want to work with them to model solutions and barriers to action through the pathfinders programme. There are already some good examples, some of which are set out in the plan, including in Blackpool and at Derbyshire County Council, which are doing good things. Many local authorities already have a number of substantial levers and powers. We want to model the best so that others, such as Liverpool, can follow.

[Sir Desmond Swayne (New Forest West) (Con)]

Why are the poorest children disproportionately among the fattest? It is not because they watch more adverts, is it?

[Steve Brine]

It could be that, but it is a job of education and about helping their parents make sensible choices, because it is the poorest in society who miss out when we get this wrong. It is about what the Prime Minister described as a “burning injustice” when she was first elected, and I agree with her.

ME: Treatment and Research

Desmond Swayne Excerpts

Thursday 21st June 2018 Westminster Hall

[Luke Pollard]

Absolutely.

I want finally to mention Maya, who got in touch about her sister, who is affected by ME. She says:

“Chronic illnesses need far more support and recognition than they get.”

Her sister—like Maya herself, who has fibromyalgia—

“faced repeated uphill battles to get the help she needs, and that’s even been with health professionals.

It’s so little talked about that even doctors and nurses have been stumped as to how to help her. This disease cripples and takes lives and we need to be doing more.”

There is something that we can take from the debate today, which was mentioned by the hon. Member for Cheltenham in relation to brain tumour research—the fact that the power of talking about a condition can bring about change. We saw that with Baroness Jowell, and it is happening today with motor neurone disease, as it is global MND Awareness Day. People are talking about their condition. We also see it in the work on fibromyalgia being done by my hon. Friend the Member for Chesterfield (Toby Perkins). It is a matter of talking about things that are not often talked about. The importance of debates such is this is in raising awareness. People with ME are not invisible. They are as human as we are, and need to be seen and heard. That means investing in proper medical research and in medical education for practitioners, and in a relentless fight against stigma for all people with ME.

[Sir Desmond Swayne (New Forest West) (Con)]

The hon. Gentleman began by talking about stigma—the stigma of laziness or of something “in the head”. We all know that the sort of people afflicted by ME are certainly not lazy. As to its being in the head, there may be some psychological causes of ME but it is none the less an illness, and to treat it as if it were not is to reinforce the stigma that has been so damaging with respect to mental health.

[Luke Pollard]

Absolutely. I think those were the most words I have heard the right hon. Gentleman say since I was elected. He is famous for short questions. I agree entirely, and the challenge of addressing stigma is understanding, because stigma builds where there is not a clear evidence base, and there is no understanding of what is happening to an individual—we do not know whether it is one or many things. That is why medical research is essential. It is also why understanding how the condition changes day to day is important—as is the way the Government prepare and support individuals. The DWP assessments are a great example. The assessment system at the moment is built around a system that does not adequately recognise the day-to-day lived experiences of those with ME.

We can carry on the relentless fight that is needed against stigma, to encourage more research, if we keep talking about ME and remember that people who have it are not invisible. They have a voice and must be heard.

Oral Answers to Questions

Desmond Swayne Excerpts

Tuesday 19th June 2018 Commons Chamber

[Sir Desmond Swayne (New Forest West) (Con)]

Does the Minister have proposals for the reform of the Medicines and Healthcare Products Regulatory Agency? I hope so.

[Steve Brine]

We keep all our arm’s length bodies, including the MHRA, under review to provide best value for taxpayers, and we are working closely with Lord O’Shaughnessy, who is the Minister responsible for this area.

NHS Long-Term Plan

Desmond Swayne Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

Let me tell the hon. Gentleman what I presided over: 10,100 more doctors; 14,300 more nurses; the Commonwealth Fund saying that our healthcare system is the best in the world; the biggest expansion in mental health provision; and improved outcomes for cancer, heart attacks, strokes and nearly every other disease category. I can do that because this Conservative Government have put the economy back on its feet. Everyone in the NHS knows that, in the end, that is how we get more resources into it.

[Sir Desmond Swayne (New Forest West) (Con)]

Clinicians tell me that half of interventions have no value to the patient whatsoever, and yet the Medicines and Healthcare Products Regulatory Agency wages war on new entrants with inexpensive and effective remedies. There is plenty of scope for reform, isn’t there?

[Mr Hunt]

There certainly is. The pattern to date had been very different in tone between the two sides. My right hon. Friend is right to challenge the NHS on this, because the truth is that we do not adopt new treatments and new medicines nearly quickly enough. I hope that this new settlement will mean that we can change that.

Education (Student Support)

Desmond Swayne Excerpts

Wednesday 9th May 2018 Commons Chamber

[Sir Desmond Swayne (New Forest West) (Con)]

Will my hon. Friend address the allegation that there are 700 fewer nurses in training?

[Stephen Barclay]

My right hon. Friend will not be surprised to learn that that is a selective picking of the facts because it does not include direct entrants, to cite just one example that was not included. I could go on, but I know the—[Hon. Members: “Go on”.] It does not take account of direct entrants; that is one population that was not included. It also—

Learning Disabilities Mortality Review

Desmond Swayne Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

The hon. Lady is right to make the point more broadly, rather than just about the healthcare outcomes for people with learning disabilities. We need to look at how we protect people more broadly, and this issue must particularly be a terrible worry for the ageing parents. I take on board what the hon. Lady said, and we will definitely feed it into the system to see what more we can do in support.

[Sir Desmond Swayne (New Forest West) (Con)]

What should the CQC be doing that it is not doing already?

Breast Cancer Screening

Desmond Swayne Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

That is a very good question. I am not aware of any such instances, but that is exactly what we want to look at in the review. It does seem strange that people who were expecting to be invited did not come forward, and that their not receiving an invitation did not set any hares running. That is one of the things that we need to look at.

[Sir Desmond Swayne (New Forest West) (Con)]

How many cancers are detected for every 10,000 screenings, and what is the clinical consensus on the effectiveness of that?

[Mr Hunt]

My right hon. Friend is testing my clinical knowledge here; there will be other people in the Chamber who are better able to answer that question. I am ready to be corrected by eminent experts on this, but my understanding is that, in relation to women in their 70s, for every 1,000 women there are around 12 cancers, and of those 12 cancers, around three are potentially life-threatening.