Leaving the EU: Tobacco Products and Public Health

Debate between Baroness Laing of Elderslie and Steve Brine

Monday 7th January 2019 Commons Chamber

[Steve Brine]

In conclusion, Madam Deputy Speaker, taking my lead from your look—Members will have a chance to contribute—this instrument constitutes a necessary measure to ensure that our tobacco control regulations continue to work effectively after exit day. I should, however, emphasise that, due to the instrument being made under the withdrawal Act, the scope of the amendments in the instrument is limited to achieving that objective. Therefore, at an appropriate point in the future, the Department will review where the UK’s exit from the EU offers us opportunities to reappraise current regulation to ensure that we continue to protect the nation’s health. That is timely on this day of all days, when we have published our long-term plan.

I urge Members to support the instrument, to ensure the continuation of effective tobacco control and harm reduction. I commend the regulations to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I apologise to the Minister for my moment of inattention a minute ago. It was not inattention to what he was saying; it was that I had happened to look at the statutory instrument before us, which for the first time in parliamentary history is illustrated. The illustrations are shocking. Having listened carefully to what the Minister said, I was making a mental note to ensure that every teenager I know sees these illustrations. It is not for me to make any value judgment on whether one should smoke, vape or otherwise. The Minister has done that very well.

HIV and World AIDS Day

Debate between Baroness Laing of Elderslie and Steve Brine

Thursday 29th November 2018 Commons Chamber

[Steve Brine]

I thank my hon. Friend for his intervention.

As I was saying, much has changed since the late ’80s: health needs are different; we have better drugs and better diagnostic tools; and, as has been said, attitudes towards HIV and AIDS are totally different and totally transformed.

The hon. Member for Kensington mentioned Princess Diana—the original one, as opposed to the new one—and that incredible moment. I will repeat what I said the other night in Speaker’s House. I was in secondary school at that time, and I remember that powerful image being broadcast. I was only a teenager at the time, and little did I know that I would one day be the public health Minister talking about these issues. It was one of those images that is really seared into our national conscience. What a great loss that lady is to so many social causes, as well as of course to her family. It was an incredible image.

As the hon. Member for Brighton, Kemptown has said, today, it is not about dying of AIDS, but about living with HIV. I would go further, however, because it is about more than that, is it not? It is not really “living with”; it is just “living”. I am also very privileged to be the cancer Minister, and how many times cancer patients say to me—my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), knows this, because people very often used to say this to us when we ran the all-party group on breast cancer together—that, “I am not my cancer. It is just something that I do and something that I have as well.” Happily, HIV is now just part of the hon. Gentleman: I am sure he would rather it was not, but it is not just something he lives with; it is something that he lives.

A big public health display in the foyer of the Department of Health and Social Care currently shows all the different public health campaigns over the years. The terrifying tombstone image is obviously something that we have, rightly, moved on from, but it is still an incredible part of our public health campaign history. Back then, the Government made the bold move to run a major public information campaign on HIV—“Don’t die of ignorance”—and we piloted needle exchange schemes, introduced HIV testing and raised the prospect with the public. If we consider the HIV epidemic in this country, we can be proud of the record of Governments of all parties over many years.

As figures released today show, the UK has met the UNAIDS 90-90-90 target—yes!—and it is one of the first countries in the world to do so. Members from across the House are proud of that, and the latest report from Public Health England showed that in 2017 an estimated 92% of people living with HIV in the UK were diagnosed, 98% of those were on treatment and 97% of those on treatment were unable to pass on their infection. That is a major achievement that we should be proud of. More importantly, those who work in our health service and have done so for years—like the partner of my hon. Friend the Member for Walsall North (Eddie Hughes)—should be even more proud.

Prevention is one of my passions, and one of the Secretary of State’s priorities. We do not yet have a cure for HIV, which is why prevention is so important. Our efforts to prevent HIV and AIDS have been highly successful, and much has been said about the international dimension, which I will touch on. The UK is a world leader in efforts to end the AIDS epidemic, including through our major investment in the global fund. Our largest investments are through multilateral organisations such as the Global Fund to Fight AIDS, UNAIDS and Unitaid, given their greater reach and scale. I met Lelio from Unitaid at the G20 in Argentina last month, and it is doing such good things with the investment that we announced in Amsterdam, to which the hon. Member for Cardiff South and Penarth (Stephen Doughty) referred. I work closely with my hon. Friends in the Department for International Development and the Foreign Office, and these three Departments are very tight and work closely together on this issue.

Excellent initiatives such as the MenStar Coalition aim to get more young men tested and on to life-saving HIV treatment to protect them and their partners. There is the Elton John AIDS Foundation and other partners, and MenStar is rolling out a self-testing campaign in east Africa. The UK is the second largest donor to Unitaid—a charity that does so much work against stigma—and provides an annual contribution of around €60 million as part of our 20-year funding commitment.

There has been much talk about the domestic situation, and NHS England launched the world’s largest pre-exposure prophylaxis—PrEP—trial last year. To be honest, I had never heard of that until I became a health Minister—why would I have?—but once officials had explained it to me, it did not take me long to think that it sounded like a real no-brainer. I know that many people are eagerly awaiting the results of the trial. I am one of them, and my officials know of my impatience, which is legendary in our Department. It is crucial to have the right information to address the major questions and effectively implement the PrEP trial on a larger scale.

The point about savings was well made and not lost on me. I am not in a position to make a policy promise at the Dispatch Box today, but on the point about places made by the hon. Members for Brighton, Kemptown and for Cardiff South and Penarth, I say only that I am listening closely and they should continue those discussions with me—I know they will. The Department met members of the all-party group on HIV and AIDS to discuss these issues, and they should continue those discussions with me. We are listening. Many of the public health challenges we face today require different approaches and fresh thinking if we are to make progress. Indeed, in the past few years many innovative ways to tackle HIV have emerged, including HIV testing options such as self-sampling and home testing services, which I know are very popular.

I would like to mention the HIV prevention innovation fund, which I am very proud of. Innovative community-led interventions have had a significant role to play in limiting the HIV epidemic in England, so we set up the HIV prevention innovation fund in 2015 to support voluntary sector organisations. The fund has supported many projects since it started. I announced them at an event here in the House last year—the hon. Member for Cardiff South and Penarth, who chairs the all-party group, was present. In 2017, we awarded just under £600,000 to 12 projects. I am very pleased to say that we are running the fund again this year. The principle of the fund is something we are carrying over into other areas of policy, because it has been so successful. I want to see us do more of that.

This year we celebrated the 70th birthday of the NHS. I have already mentioned the incredible staff who work across the service. England has an outstanding record of achievements in HIV treatment and care. I want to take this opportunity to recognise and thank everyone for doing that. Care for people with HIV is now highly effective, and increasing numbers of people are living with HIV into older age with normal life expectancy. Antiretroviral therapy has transformed the outlook for people living with HIV, from what used to be a tragic death sentence to a very manageable long-term condition, as we heard so eloquently this afternoon.

Our policy is to make sure that HIV testing is as accessible as possible, in particular to those at increased risk. It is therefore very important that testing is available in a range of clinical and community settings—hence why the innovation fund and its programmes are important. Over the years, local authorities, which are now public health authorities up and down the land, have introduced innovations and improvements of their own, in particular on testing. We know it is working. Testing activity at sexual health services, which we know are under great pressure—we do not deny that for one moment—continues to increase and HIV diagnoses have fallen. HIV testing in sexual health services has increased 15%, from 1.07 million tests in 2013 to 1.24 million in 2017. Most significantly, we have seen a 28% drop in new HIV diagnoses between 2015 and 2017. That is encouraging and good, but we must not be complacent. I assure the House that we are not complacent and we want to continue to maintain this progress.

The hon. Gentleman mentioned the prevention strategy. That was a very top line document. I had a meeting this afternoon to discuss the prevention Green Paper, which will follow next year. I can assure him that the long-term plan, which will follow before that, will absolutely have sexual health and HIV in it. I am being very ambitious with officials on that. I know that he will rightly hold us to account and I thank him for giving me a chance to say that.

I want to touch on education and awareness. Education around HIV and how it is transmitted remains absolutely critical, as the hon. Member for Brighton, Kemptown said in his opening remarks. I am pleased to say that schools will be required to teach relationship and sex education from September 2020. The Government announced that relatively recently. I have been very involved in that in relation to the cancer brief, because I am very keen for schools to responsibly teach cancer awareness to young people. At secondary schools, there will be clear and accurate teaching about sexual matters, including factual knowledge around sex, sexual health—including HIV—and sexuality. The schools Minister was sitting next to me throughout his speech. He wanted me to pass on his congratulations to the hon. Gentleman on his speech.

Testing is the only way to be certain of HIV status. Last week was National HIV Testing Week and the Secretary of State took part. This flagship campaign promotes regular testing among the most at-risk population groups and aims to reduce the rates of late diagnosis or of those remaining undiagnosed. Sadly, stigma remains a significant factor in why people do not test for HIV. I understand that. This can mean that HIV goes untreated and can then be transmitted. It is vital that we continue to break down the stigma, normalise testing and support those most at risk of infection.

I want to mention the “Can’t Pass It On” campaign. Whoever is doing the marketing for the Terrence Higgins Trust is doing a very good job—I know it works with a very good agency. As I said at the reception the other night, I was on the tube the other day with my daughter, who spotted some advertising or branding for testing week. She asked me what it was, because it caught her eye, and I was able to explain it to her. She is only 11. If more parents did that for their children and relatives, it would help to break down that stigma. The trust’s website has a very good page on the “Can’t Pass It On” campaign that includes different people’s stories, and I have a funny feeling that before we leave the Chamber, “Lloyd’s story” will be on it, with a clip from today in Parliament. I will certainly be clipping it off the Parliament TV website and tweeting it out through the Department of Health’s social media account.

In conclusion, I congratulate the hon. Gentleman again on introducing this timely and vital debate, and I wish him and everybody well for Saturday who will be marking World AIDS Day, whether they be remembering and celebrating private, not yet able to do so publicly, and those who, like him, are able to do so publicly. They are all part of the story, and our best wishes and love go to them all. We look forward to brighter futures in this policy area, as we work towards what I am determined will be zero stigma and zero transmissions.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Would it not be wonderful if more people paid attention to the work done in the House in such debates—this excellent, positive, meaningful, emotive and successful debate this afternoon? If only.

Question put and agreed to.

Acquired Brain Injury

Debate between Baroness Laing of Elderslie and Steve Brine

Monday 18th June 2018 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Before the Minister responds, I should say that I appreciate that many want to make interventions because they do not want to stay until the end of the debate. We have only an hour and 10 minutes. A lot of people wish to make speeches and there will have to be a time limit. Interventions must be short.

[Steve Brine]

I do not know what you mean, Madam Deputy Speaker, but I will certainly be here until 11 pm.

The hon. Member for Strangford (Jim Shannon) makes a good point, which follows on neatly from the point made by the hon. Member for Brighton, Pavilion (Caroline Lucas). It also leads me neatly on to the point I was about to make. The all-party group on ABI is currently conducting a very broad inquiry into the condition—its causes, treatments and societal impact—and I am sure it will consider the wider family. When I say family, I do not just mean the nuclear family but society’s family and even the Church, which can embrace people suffering the life change the hon. Gentleman spoke about so well with regard to his brother. I want the all-party group to know that I will support its inquiry as best I can. They should know that that offer is there.

As a Health Minister, I will obviously focus on the health aspects of ABI, but I just want to highlight some of the other areas—this touches on one or two of the interventions—where its impact is felt and action is under way. On education, many children and young people with ABI are rightly in education and have special educational needs as a result of their injuries. The Government recently provided some £29 million to support local authorities with ongoing implementation of individual education, health and care plans to meet those needs. It is vital to us that health, social care and education services work jointly in developing these care plans. I know my colleagues in the Department for Education share that view.

On offending behaviour—ABI touches on a lot of different Government Departments—there is an increasing body of evidence suggesting that children and young people who survive traumatic brain injury are more likely to develop behavioural problems that can be linked to an increased vulnerability to offend. NHS England’s liaison and diversion service has collaborated with the charity Headway, which I mentioned at the start of my speech, to improve awareness of ABI in vulnerable offenders and the support available—the point raised by my hon. Friend the Member for Cheltenham (Alex Chalk). Further, the Ministry of Justice is piloting approaches to improve screening and support for prisoners with ABI to prevent a cycle of re-offending once they enter the secure estate. The Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), is very kindly on the Government Front Bench to listen to the debate and I am grateful to her. The Minister of State, Ministry of Justice, my hon. Friend the Member for Penrith and The Border (Rory Stewart), who has responsibility for prisons, had hoped to be here but was pulled away. I know he will be taking a close interest in what is said tonight, because this issue will come up again.

Sport is another area for which there is a growing body of evidence and concern about the levels of risk and response to injury. This is why the Government commissioned an independent review of the duty of care that sport has to its participants, which published its findings in April 2017, and we are now working to implement its recommendations, including around awareness and prevention of head injury while playing sport.

On trauma centres, it is vital that those with the most serious brain injuries receive the best care that our NHS —our birthday NHS—can offer. In 2012, 22 regional trauma networks were developed across England. Within those networks, major trauma centres provide specialised care for patients with multiple, complex and serious major trauma injuries, including brain injury. Two years after their introduction, an independent audit of the network, commissioned by NHS England, showed patients had a 30% improved chance of surviving severe injuries and that the networks had saved some 600 lives. There is a positive story there.

A vital part of the treatment pathway for people who have suffered ABI is neuro-rehabilitation that is timely and appropriate to their needs. There is good evidence that access to high quality rehabilitation both improves outcomes for patients and can save money.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Minister.

[Steve Brine]

I had finished, Madam Deputy Speaker. Incredibly, it was timed to perfection.

[Madam Deputy Speaker]

I beg the Minister’s pardon. I have never before heard such a feat of perfect rhetoric. Thank you for being so perfect. [Interruption.]. Yes, it was quite unusual.

NHS Winter Crisis

Debate between Baroness Laing of Elderslie and Steve Brine

Wednesday 10th January 2018 Commons Chamber

[Steve Brine]

The sustainability and transformation partnerships have been established across England—I am sure that the hon. Gentleman will have engaged with the one in his area—and they take local decisions about how services are organised in local areas. I implore him to engage with his STP; indeed, I know that he is already doing so. If he wishes to talk to me about this, he can of course do so.

Let me respond to some more of our contributors. The hon. Member for Bristol South always speaks sensibly. She spoke about the public representation and involvement in STPs. I agree that we could do more in that area, and as the Minister responsible for STPs, I want to see that we do so. Her point was well made. The hon. Member for Crewe and Nantwich (Laura Smith) spoke about her constituent, Elle, who lost her battle with cystic fibrosis. She speaks up for her constituents well, and very emotionally, and if she continues to do that, she will do extremely well in this House.

The hon. Member for Stockton South (Dr Williams) is a new Member, and I already have a lot of respect for him. In his typically sensible contribution, he made some sensible suggestions for improvement in the NHS. He went on to talk about how we could do better on prevention, and he was absolutely spot on. We all agree that prevention is part of our one NHS. He said that this was not all about money, and I agree. Money is a key part of this, however, and that is why we spend 9.9% of our GDP on healthcare, which is above the EU average.

The hon. Member for Leicester West (Liz Kendall) said that this is not what happens every year, but the NHS is under great pressure at this time every year. A headline from The Guardian newspaper on 27 October 2001 stated “NHS faces another winter of crisis”. The NHS is often under pressure at this time of year, and the important thing is how we prepare for that. As I have said, we are better prepared than ever. It is a shame that the hon. Lady is not listening to my response. [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I hesitate to interrupt the Minister, but I do not understand why there is so much noise on the Opposition Benches. I would not be surprised if Members were heckling the Minister, but they are simply making a noise, so the Minister cannot be heard. He is answering the questions that he has been asked this afternoon, and those who asked the questions ought to want to hear the answers.

[Steve Brine]

Thank you, Madam Deputy Speaker. The Members appear to be heckling themselves.

The hon. Member for Wirral West (Margaret Greenwood) said that the NHS was a political organisation. I totally disagree. The NHS is an organisation run by hard-working people who are public servants. They go to work every day to do a job for our constituents, and the NHS is not a political organisation. The Labour party is a political organisation, and it is politicising the NHS—

Southend Hospital

Debate between Baroness Laing of Elderslie and Steve Brine

Thursday 6th July 2017 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The hon. Lady’s question is slightly tangential to the subject of the debate, but I appreciate that she has made a connection. The Minister might be able to make the connection between the subject of the debate and her question, but I know that he will concentrate on the subject of the debate introduced by the hon. Member for Southend West (Sir David Amess).

[Steve Brine]

I will, Madam Deputy Speaker. I could feel you bristling at the length of the intervention. I can assure my hon. Friend that none of the options being considered includes the closure of any of the three A&Es, and all will continue to provide emergency care 24 hours a day, seven days a week.

I was mentioning the work of the Mid and South Essex STP, which was published in November 2016 as part of the work to ensure that there are sustainable services in mid and south Essex. There is now a major workstream looking at service configuration across the three hospital sites. Work led by clinicians in 2016 arrived at five possible future configurations for consolidated specialist services across the three hospitals. As well as providing the majority of routine hospital care for its local population, each hospital site would provide some centralised specialist services.

Let me briefly outline the current thinking as it has been set out to me. Southend hospital will continue, as I have said, to provide substantial emergency services 24 hours a day, seven days a week. In addition, it will be a centre of excellence, as my hon. Friend the Member for Southend West rightly said, for planned care, alongside its already well-established cancer centre and radiotherapy services. Basildon hospital will provide enhanced specialist emergency care—for example, specialising in the total management of major life-threatening illness. Broomfield Hospital in Chelmsford will provide a combination of specialist emergency and planned care, with the potential to provide a specialist centre for children. I have to emphasise that these ideas are being further developed by the clinical groups as we speak. No single preferred option for consultation has been arrived at.

Let me now turn to the proposals for emergency care. It is important to note, and I wish to reiterate, that in all potential options for hospital reconfiguration currently being discussed, Southend hospital would continue to provide emergency services 24/7. An options appraisal process was held earlier this year involving clinicians, stakeholders and local people. The higher-scoring options listed one hospital as the provider of specialist emergency care. Basildon was identified as the better location for that. Southend and Chelmsford would continue to provide emergency services, but they would be less specialised than Basildon. Southend would instead specialise in planned care, cancer and radiotherapy, building on the excellent work already being done at the hospital. There would be separate units specially designed to give fast access to assessment and care for older and frail people, children and people who may need emergency surgery. In some cases, that could include an overnight stay, if necessary. Those units would involve both health and social care so that patients could return home as quickly as possible with any continuing support and treatment that they may need.

The potential services in the A&E and assessment units at Southend would be able to respond to a range of emergency needs, some of which could be initiated by a 999 call and may involve an ambulance. The possibility of Basildon hospital being the provider of specialist and complex emergency care has benefits for local patients. It would have several teams of specialists ready to provide immediate access to state-of-the art scans and treatments around the clock, which is not always possible in the current three general hospital A&Es.

I also understand that the practice of taking patients by ambulance from Southend to a specialist centre is already established. For example, people who suffer an acute heart attack in Southend are currently taken by ambulance to the Essex cardiothoracic centre—that was easy for me to say—in Basildon. I have been advised that that arrangement has been in place for many years. Separating some of the major emergency work in that way releases capacity and resources for planned surgery and other treatments.

For the local NHS, new centres of excellence across the hospital group in both planned and emergency care have the potential to compete with the best in the country to attract high-calibre staff and bring the best of modern and world healthcare to mid and south Essex. I emphasise that in all options currently under discussion, about 95% of hospital visits would remain local at each hospital.

As I have stated previously, the programme is currently under discussion and I am advised that the aim is to launch a full public consultation at the end of the year at the earliest, centring on a single preferred option. The public consultation will explore in detail the benefits and implications of the proposals and will inform plans for implementation. Engagement with staff and local people will continue to influence and refine plans at every stage. That is a key principle, as I have said, in local reconfiguration of services, and it has to be right that the process is guided by those who know and understand the local area best.

In conclusion, as a constituency MP I completely appreciate the concerns of my hon. Friend the Member for Southend West, whom I again commend for his work.