Oral Answers to Questions

Debate between Fiona Bruce and Jane Ellison

Tuesday 17th November 2015 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

T3. This is alcohol awareness week. In Scotland, the number of drink-driving offences dropped by 17% in the first three months after the introduction of a lower drink-driving limit. In the light of this encouraging evidence, is the Minister’s Department looking at the public health implications of reviewing the drink-driving limit in England and Wales as part of its alcohol review?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Obviously, tackling drink-driving remains a priority for the Government. We will be interested to see a robust and comprehensive evaluation of the change to the Scottish drink-driving limit, and I can confirm that Public Health England’s review of the public health impacts of alcohol will include drink-driving. Obviously, some of the issues my hon. Friend raises are for the Department for Transport, but I can confirm that we will be looking at this issue, and I will be interested to see the evidence.

Alcohol Harm and Older People

Debate between Fiona Bruce and Jane Ellison

Thursday 15th October 2015 Commons Chamber

[Fiona Bruce]

The Minister is quite right about variation. One of my concerns is about the increase in drinking among older women. Is anything being done specifically to look at how they can be helped to reduce the effect of alcohol harm?

[Jane Ellison]

I will come on to matters relevant to that, but I will also say more about a possible opportunity for a wider debate on this important issue a bit further down the line.

It is important to consider what can be done through secondary care. About 139 district general hospitals already offer some level of specialist alcohol service. I saw for myself such specialist work when I visited Blackpool in 2014. One team told me about how it took the opportunity of people being admitted for something related to alcohol to talk to them about their drinking. They described, with huge understatement, as a “teachable moment” the time when someone is in hospital having suffered, either through a disease or an accident, an unfortunate effect from alcohol. They are right: the idea of talking to people at the moment when they are most receptive is vital.

We would like to have similar alcohol care teams in every hospital to take such opportunities to identify the problem and provide brief advice to patients, as well as medical management. That is again based on the evidence that higher-risk and increasing-risk drinkers who receive brief advice are twice as likely to have moderated their drinking six to 12 months after an intervention—a quick response—compared with drinkers who get no intervention. We want greater use of such really good opportunities. It is not costly or, indeed, lengthy; it is about timeliness.

There are means for people to monitor and manage their own alcohol intake. Technology is increasingly deployed to good effect in a number of areas of personal health monitoring, and alcohol intake is no different. Apps such as the one developed by Drinkaware, which my hon. Friend mentioned, can help people to track how much they are drinking, what it costs them and even the number of calories. We know that personal estimates of weekly drinking are not always as accurate as keeping a log. That is quite well documented, so individuals may find apps and tracking mechanisms particularly helpful.

The Big Lottery Fund, in partnership with the support charity Addaction, is investing £25 million in an alcohol-related harm prevention and awareness programme for the over-50s. Rethink Good Health is a UK-wide programme aimed at those aged 50 and over. My hon. Friend very thoughtfully explored some of the reasons why people may find themselves in such a situation in later life. We would recognise from our constituency case load and perhaps from our social circles how life events can take a toll on health and lead to people drinking more. She mentioned some of them, but I would highlight how such problems can be a driver, and sometimes a product, of loneliness and isolation.

As the House will know, Dame Sally Davies, the chief medical officer, is overseeing a review of the lower-risk alcohol guidelines to ensure that they are founded on the best science. We want the guidelines to help people at all stages of life to make informed choices about their drinking. The guidelines development group, made up of independent experts, has been tasked with developing the guidelines for UK chief medical officers to consider. The group has researched and is developing a proposal on the guidelines, including a UK-wide approach for guidance on alcohol and pregnancy. We expect to consult on that.

I know that that is an issue, and that there are worries about people receiving different advice, so let me say a word about the consistency of health messages. As I have said before at the Dispatch Box, where the evidence base is not completely certain—leading experts to reach slightly different conclusions—there will be a certain level of debate. I appreciate that that can be extremely challenging for the public and that there is a role for trying to provide clarity, but guidance must always be based on the best evidence base.

Human Fertilisation and Embryology

Debate between Fiona Bruce and Jane Ellison

Tuesday 3rd February 2015 Commons Chamber

[Jane Ellison]

We have made it clear that the removal of the faulty mitochondria will be passed on to the next generation. That is exactly what we have been describing, but I do not accept my hon. Friend’s description of it as genetic modification. It has to be said that there is no universally agreed definition of genetic modification, but for the purposes of these regulations, we have used a working definition and it involves not altering the nuclear DNA.

[Fiona Bruce (Congleton) (Con)]

rose—

[Jane Ellison]

I know my hon. Friend is going to make her own contribution. If she will forgive me, I want to outline for the benefit of Members less familiar with the regulations their detailed content.

Turning to that detail, the regulations are made under the powers in the Human Fertilisation and Embryology Act 1990. They were added to in 2008 to permit mitochondrial donation to prevent the transmission of serious mitochondrial disease, anticipating the advancement of science to this point. Regulations 3 to 5 set out the circumstances for mitochondrial donation techniques using eggs; regulations 6 to 8 set out the circumstances for mitochondrial donation using embryos. They would allow the use of the two techniques that have been subjected to extensive UK-wide review and consultation: maternal spindle transfer and pro-nuclear transfer.

Regulations 11 to 15 and 19 set out the information that can be provided about a mitochondrial donor to any child born from the donation and information to that donor. Regulations 16 and 17 set out special provisions around consent that were identified through the public consultation process. These regulations apply UK-wide, and the devolved Administrations have been kept informed of development and progress.

[Fiona Bruce]

Does the Minister consider that the Government’s own regulator, the HFEA, was wrong to state, in a consultation document that “PNT involves genetically modifying a human embryo”?

[Jane Ellison]

I shall deal shortly with the regulatory regime that the HFEA would introduce. However, that and many other points have already been examined in great detail and responded to in great detail in parliamentary answers, to which I refer my hon. Friend.

Oral Answers to Questions

Debate between Fiona Bruce and Jane Ellison

Tuesday 21st October 2014 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

Mitochondrial technique was last tried on humans in 2003 by John Zhang, resulting, I understand, in two still births and an abortion. Last week, one of the members of an expert panel of the Human Fertilisation and Embryology Authority said he had only just become aware of Zhang’s study. What action will Ministers take to ensure that this worrying study is properly examined before any steps are taken to bring this issue before the House?

[Jane Ellison]

My hon. Friend takes a great interest in this matter and led the Back-Bench business debate on 1 September. I will certainly ask the HFEA and the expert panel to look at the study to which she refers, but I can provide the reassurance I have given before—that the wide body of expertise and information out there about mitochondrial disease is regularly reviewed over a long period of time.

Abortion (Disability)

Debate between Fiona Bruce and Jane Ellison

Wednesday 9th April 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing a debate on this subject, in which she has a long-standing interest. She made a very personal, moving and thoughtful speech to which we all listened intently. I thank other Members for their interventions. I know that there are views on this issue that are deeply and strongly held.

I am aware of the independent inquiry into abortion on the grounds of disability, which my hon. Friend chaired and which reported in 2013. Although I was not in post at that time, I have looked at the report. I have not had a chance to look at all the detail, but I have seen some of the recommendations. I have responses to one or two of the recommendations that she highlighted. As she knows, I will always go away and look at the points she has made, and those that I cannot cover tonight I will of course write or talk to her about.

Obviously, the House remains divided on the issue of abortion, which is a very personal matter. A number of concerns have recently been raised that we in the Department are working hard to address. On some issues, such as abortion on the grounds of gender alone, there is a strong parliamentary consensus. My hon. Friend has raised this with me in the House and in private, and we are working hard to deal with it. In other areas of abortion law, there are a range of views and differing interpretations.

It is crucial that everyone, regardless of their views on abortion, feels assured that the law on abortion is operating as Parliament intends. This is particularly important for clinicians directly involved in certifying and performing abortions, who need to know that they are operating within the law, and for women seeking an abortion, who need access to safe, legal, high-quality abortion services. I recently had discussions with the General Medical Council and the Royal College of Obstetricians and Gynaecologists, and we will be publishing strengthened guidance and revised procedures for the approval of independent sector places. That puts the debate into some context.

In 1990, Parliament decided that in some circumstances abortion should be available without time limit, including abortion where

“there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.”

I should clarify that abortions for fetal abnormality are listed as ground D in the Abortion Act 1967 but are set out differently in the regulations and certification forms, where they are listed as ground E. The grounds in the regulations are those most commonly referred to, but that is why there is sometimes a discrepancy with regard to grounds D and E.

In 2012, it was reported that 2,692 abortions had taken place under ground E of the regulations and that 160 of them took place at gestations beyond 24 weeks. It is important to note, as my hon. Friend has said, that Parliament did not define “serious handicap” in the Act. Indeed, it chose to leave it to the expert clinical judgment of the two doctors involved, who were required to form their own opinion about the seriousness of the handicap the child would suffer when born, taking into account the facts and circumstances of each individual case.

Some Members have expressed the view that the Act and, in particular, the provision that allows abortion on the grounds of disability should be revisited. Of course, by convention it is for parliamentarians, not the Government, to suggest amendments to the legislation, but that does not mean that the Government do not reflect carefully on any points made and there will be opportunities to provide clarification in some areas through guidelines.

Concerns have been expressed, not least this evening, that abortions are taking place for abnormalities that are rectifiable after birth. The Act requires doctors to assess the level of risk that the child would suffer from serious handicap if it were born. It should be noted that conditions such as cleft lip and palate, which have been mentioned this evening, can in some circumstances be an indicator of far more serious problems with the fetus.

The availability of remedial treatment that might alleviate suffering is obviously a factor that doctors will take into account in making their assessment. Guidance from RCOG states that the assessment of serious handicap should be based on a careful consideration of a list of factors, one of which is the probability of effective treatment either in utero or after birth. RCOG already says that that must be taken into account. However, the fact that remedial treatment may be available does not automatically mean that it will be successful, and the child may suffer from a serious handicap. Remedial treatment may be prolonged and painful.

I firmly believe, and I hope my hon. Friend will agree, that such decisions are exceptionally difficult ones for patients, women and parents to make, and that they are often finely balanced. Doctors and other professionals need to work hard to ensure that parents are properly supported and have all the information they need to come to a decision. I think we all share my hon. Friend’s concern that some people have reported feeling rushed and that they have not been given proper information. Ultimately, such decisions should be taken on a case-by-case basis and always according to the Act.

[Fiona Bruce]

Will the Minister confirm that she will look at the production of best practice guidelines, because there is a clear indication that practice differs across the piece? If she agrees that we should give every mother and father in this situation the best possible opportunity to make the right decision, appropriate guidelines, which do not appear to exist in a functional format at present, would be the best approach.

[Jane Ellison]

I will certainly reflect on that point. RCOG has published best practice guidelines and I am sure it would be concerned to hear that my hon. Friend feels they are being inconsistently applied. I will give her some information from the guidelines. I have regular conversations with RCOG representatives and will raise her point with them. There is no absence of guidance, but she is clearly concerned that it might be being inconsistently applied.

RCOG has published guidance for its members on terminations for fetal abnormality. It notes that palliative and other care must be made available to women who decide to continue with their pregnancy. The guidance also makes it clear to women and their partners that they should receive appropriate information and support from a properly trained, multidisciplinary team who must adopt a supportive and non-judgmental approach, regardless of whether the decision is to terminate or to continue the pregnancy. Support for parents faced with a similar diagnosis is available through the charity Antenatal Results and Choices.

The RCOG guidance also states that women and their partners must be fully supported before screening for fetal abnormality and during any decision that they may need to make about termination, as well as in continuing the pregnancy following a screening and during any aftercare. That should include referral to other professional experts, including palliative experts, as I have mentioned, and referral for counselling, where it can be part of a co-ordinated package of care. I will of course put my hon. Friend’s concerns about that not being consistently applied to RCOG, which I am sure will want to consider that matter. However, as I have said, RCOG has looked to address the issues, and I know that it is aware of her commission of inquiry and its report.

My hon. Friend mentioned adoption. That is a matter for the Department for Education, but I will of course draw the concerns she has raised in this debate to its attention.

With regard to information, the RCOG guidance does not make specific reference to the element of the life ahead that the child might have, but that is a matter for RCOG and other professional and training bodies, such as Health Education England, to take forward in their training procedures. Again, I undertake to bring that point to their attention.

On my hon. Friend’s concerns about a discrepancy between the numbers, I know that the independent inquiry recommended that funding should be made available to ensure that there are independent congenital anomaly registers covering all congenital anomalies across the whole country. She made another point about inconsistency. I can confirm that work is under way to support the increased coverage of congenital anomaly registers across the whole of England. That work is led by Public Health England. I have regular meetings with Public Health England, and I will draw to its attention Parliament’s interest in this matter. I undertake to update her on the progress of that work.

My hon. Friend made several other points. If she will excuse me, I will come back to her about fetal pain. RCOG has looked at and written about fetal pain in some detail, and has offered guidance about it. I will revert to her on that, as well as on some of the other matters that she raised about which I cannot now comment in any detail.

I thank my hon. Friend for her very thoughtful speech, for drawing the attention of the whole House to this issue and for how she expressed the potential that people have in their lives. I think that the whole House was thrilled to hear the story she told about her own family, and to hear about the great success that her son has enjoyed. I congratulate her on securing this debate, and on the tone in which she always conducts such difficult and sensitive debates. I will return to her with more detail when I have given her points further consideration.

Question put and agreed to.

Tobacco Products (Standardised Packaging)

Debate between Fiona Bruce and Jane Ellison

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

The hon. Gentleman mentions illicit trade. As I have said a number of times, it is addressed in the report, but there will be other opportunities to discuss that. I also draw the House’s attention to the fact that stopping illicit tobacco coming into the country is the job of Her Majesty’s Revenue and Customs. It has had great success in that regard over recent years. With regard to the hon. Gentleman’s point about jobs, we will publish a full impact assessment alongside draft regulations at the same time as the final consultation. Jobs will be one of the issues in that impact assessment.

[Fiona Bruce (Congleton) (Con)]

I strongly support the Minister’s statement and proposals. Does she agree that if 4,000 children a year can be discouraged from taking up smoking there will be a double public health win—not only better health outcomes for those 4,000, but the release of funds for the health treatment of others in their generation for illnesses and disease? Those funds would otherwise have to be used, in time, to treat many of those 4,000 for smoking-related diseases.

[Jane Ellison]

I thank my hon. Friend for those comments. She is absolutely right to draw the House’s attention to the fact that the extent to which we can bear down on smoking and stop people taking it up the first place has a major impact on the sustainability of our health services and will, as she says, free up more resources to be spent on other things. It is a very important health priority. She is also right to allude to the impact of, for example, 4,000 children not taking up smoking. Even a modest impact on a major killer is really important.

Oral Answers to Questions

Debate between Fiona Bruce and Jane Ellison

Tuesday 25th February 2014 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

15. When he plans to publish his Department’s new guidelines on sex-selective abortion.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Government will publish more detailed guidance on compliance with the Abortion Act 1967 shortly. That will include guidance on sex-selection abortions and restate our view that abortion on the grounds of gender alone is unlawful.

[Fiona Bruce]

Britain’s biggest abortion provider, the British Pregnancy Advisory Service, has advice on its website claiming that the law is “silent on the matter” of gender-selective abortion. In a leaflet, it actually states that it is not illegal. How does the Minister propose to address that, and to send out the clear message that strong legal action will be taken against anyone who is involved in that wholly unacceptable practice?

[Jane Ellison]

Although the Abortion Act does not mention gender specifically, the Government are clear that abortion on the grounds of gender alone does not meet the criteria set out in the Act. If evidence comes to light that doctors or organisations are sanctioning abortions for that reason alone, we will refer it to the police.

Oral Answers to Questions

Debate between Fiona Bruce and Jane Ellison

Wednesday 14th July 2010 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

3. What plans he has to reduce the regulatory burden on the voluntary and community sectors.

[Jane Ellison (Battersea) (Con)]

9. What plans he has to reduce the regulatory burden on the voluntary and community sectors.