Type 1 Diabetes (Young People)

Ian Lavery Excerpts

Wednesday 30th April 2014 Westminster Hall

[Mark Field (Cities of London and Westminster) (Con)]

From our joint experience on the Intelligence and Security Committee, I am well aware that the right hon. Member for Knowsley (Mr Howarth) has a robustness at times, and perhaps he would have liked to be judge and jury in today’s debate. I congratulate him, above all, on bringing the subject to the House. I am well aware that, as alluded to earlier, these are issues that are very close to his heart, and he speaks with immense knowledge and passion about this particular affliction.

I wish to contribute a few words to the debate, because the subject has been raised a number of times with me at constituency level in recent months. As we have heard, type 1 diabetes is a chronic and life-threatening auto-immune condition, which is caused when the body mistakenly attacks the insulin-producing beta cells in the pancreas. It is a separate and distinct condition from the more common and perhaps more widely known type 2 diabetes.

Estimates put the number of people in the UK with type 1 diabetes at as high as 400,000, which means that each and every MP in the UK has, on average, some 500 constituents suffering with type 1. As recently as 2010-11, it was thought that the direct and indirect cost of type 1 diabetes alone to the UK was around £1.9 billion; judging by the growing rate of increase, it is feared that by 2036 that figure could rise to some £4.2 billion each and every year.

A few months ago, a mother in my constituency wrote to me explaining exactly what life was like, day by day, hour by hour, caring for her young child with type 1 diabetes. She described how her experience reminds her daily of the urgency and importance of finding a cure. My old friend and colleague on Kensington and Chelsea council, Rupert Cecil, has a delightful 10-year-old daughter, whom I have got to know throughout her life; she has similarly suffered from type 1 since infancy and requires constant monitoring. Rupert and his wife, Juliet, have tirelessly raised funds for and awareness of the condition since Polly was diagnosed with this life-threatening and incurable illness at the age of two and a half.

From the outside, Polly is just like any other 10-year-old, but a close look may reveal a wire poking out from under her school uniform and attached to something resembling a money belt. This is the insulin pump that Polly relies on from day to day. It is the artificial pancreas to which the right hon. Gentleman referred. She is attached to it each and every day and will be for the rest of her life. Without it, she could not survive longer than 24 hours. In addition to her insulin pump, her parents must test her blood by pricking her finger at least five times a day. They often have to wake her in the middle of the night to give her glucose if her sugar levels have dropped dangerously, or some insulin if they are running high. That is the daily tightrope that is walked by each and every parent of a young child with type 1 diabetes.

[Ian Lavery (Wansbeck) (Lab)]

I understand what the hon. Gentleman is saying about his friend’s young child, but many young people, particularly in areas of social deprivation, cannot access insulin pumps unless they buy them, and I believe that they cost around £1,500 or £2,000. If people do not have the money, many of them suffer greatly.

[Mark Field]

That is a fair comment and I hope the Minister will comment on it.

I want to touch on an imaginative and innovative scheme in my constituency at St Mary’s hospital, Paddington, which is part of the Imperial College Healthcare NHS Trust and which I visited recently. I hope that it will not only raise awareness, but reduce the cost to which the hon. Gentleman referred. During my recent visit, I discussed the everyday realities for diabetes sufferers.

The International Centre for Circulatory Health is based on the St Mary’s hospital campus of the Imperial College Healthcare NHS Trust, just behind Paddington station. Imperial college has published some of the lowest amputation rates in the world from its diabetic foot service, led by Dr Jonathan Valabhji. It has a large diabetes technology centre that is closely linked with a research programme developing closed-loop insulin delivery for type 1 diabetics and novel continuous glucose sensor devices. Its clinical technology research is led by Dr Nick Oliver, who talked me through the pioneering work he is doing to develop the artificial pancreas system for everyone with type 1 diabetes. I hope that that will also reduce the costs to which reference was made earlier.

That ground-breaking research aims to offer the next best thing to a cure for type 1 diabetes patients in the future. I saw for myself how a small, discreet device, connected to the blood stream via micro-needles, can monitor glucose levels. When paired with insulin and glucagon pumps, the artificial pancreas should be able to give diabetics an approximate response to blood sugar levels close to what a body would normally produce. With consistent levels of insulin delivered, sufferers are liberated from the constant monitoring and worrying that comes with the daily management of the disease. The St Mary’s site is just one research centre forming part of a global effort that could help to change the lives of many of the 400,000 people who are living with type 1 diabetes, and save the NHS a significant proportion of the money that is currently spent on treatment.

The artificial pancreas system has three components. Two, the insulin pump and continuous glucose monitor, are available. However people with type 1 diabetes face difficulties trying to access insulin pumps despite a supportive technology appraisal from the National Institute for Health and Care Excellence. Indeed the national uptake of insulin pump therapy stands at just under half the NICE benchmark, set as long ago as 2008, which is extremely low and means the UK is lagging behind many western countries. There seems to be consensus among those working in diabetes research that greater investment from the Government is vital to drive developments in this area. At present, our Government invest less per capita than the US, Australia and Canada in type 1 diabetes research.

I am aware that there is some joined-up thinking, not least by my right hon. Friend the Minister for Universities and Science, but I would be grateful if the Minister here told us how the Government will work to ensure that the sort of treatment for type 1 diabetes sufferers will be matched up to the level of other western nations, what more can be done to fund pioneering research, and how we can roll out the level of service received by patients at Imperial college to patients throughout the country.

I am pleased that so many hon. Members are here today. We all have our contribution to make and I look forward to hearing what they have to say. The 400,000 sufferers and their many millions of relatives and carers will be cheered that we are treating the issue seriously.

Oral Answers to Questions

Ian Lavery Excerpts

Tuesday 25th February 2014 Commons Chamber

[Jane Ellison]

I am aware that this is a very difficult, complex and emotive area. I have heard before the point that the hon. Lady makes about GPs. I am very happy to take up her points and discuss them with her.

[Ian Lavery (Wansbeck) (Lab)]

12. What recent meetings he has had with representatives of the private health care sector.

[The Secretary of State for Health (Mr Jeremy Hunt)]

In the past three months, I have had two meetings with private sector health care providers, both in China, helping them to win export orders. In the same period, I have had 20 meetings with traditional NHS providers.

[Ian Lavery]

Private health companies with strong links to the Conservative party have been awarded contracts to run NHS services worth about £1.5 billion, which surely raises serious questions about the level of influence of Conservative donors on health policy. In the interests of transparency, will the Secretary of State commit to publishing a list of private health care companies that have made donations to the Conservative party?

[Mr Hunt]

The difference between donors to the Conservative party and donors to the Labour party is that our donors do not write our policies. While we are talking about private sector health care providers, I remind the hon. Gentleman of what an unnamed shadow Cabinet Minister told The Independent last week:

“We all remember when Andy was Health Secretary and happily contracting out bits of the NHS to the private sector… You have to ask yourself what’s changed.”

NHS Funding (North-East and Teesside)

Ian Lavery Excerpts

Tuesday 5th November 2013 Westminster Hall

[Tom Blenkinsop]

Yes, the police, and particularly the police and crime commissioner for Cleveland, have raised that with me in private meetings on first responder calls. They have funding worries about what will happen if such practices continually recur.

The NEAS letter shows that there will be more cuts, more private ambulances and possibly a less responsive service. It is not me saying that, but the chief operating officer of the North East Ambulance Service. The figures are stark. In 2008-09, 865 call-outs were attended by private ambulances in our region, costing £86,000. In 2009-10, some 1,816 call-outs were attended by private ambulances, costing £151,000. In 2010-11, however, 6,429 call-outs were attended by private ambulances, costing £477,000, which is a huge jump. In 2011-12, there were 9,000 call-outs attended by private ambulances, costing £639,000. In 2012-13, 13,524 call-outs were attended by private ambulances, costing £754,000. So since 2010, there has been a fivefold increase in private ambulance costs in the north-east, with the funds going to private contract firms. It is obvious that from 2010 onwards, there has been an explosion of private ambulance usage by the trust, costing a huge amount of taxpayers’ funds. The chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

A third issue of particular concern to my constituents is that both the NHS trusts that serve them—the South Tees Hospitals NHS Foundation Trust, and the Tees, Esk and Wear Valleys NHS Foundation Trust—have found themselves under investigation by Monitor in the past 12 months. Since May 2010, the South Tees trust has failed on seven occasions to meet its referral-to-treatment target, most recently between March and August. That has resulted in the Monitor investigation, because the trust has failed to ensure that 90% of patients commence treatment within 18 weeks of referral. Furthermore, there has been an increase in reported “never” events at the trust, and an increase in the incidence of clostridium difficile.

Despite the seriousness of those issues, Health Ministers have taken no action. My constituents would at the very least expect Ministers to have had conversations with Monitor and the trust on the issue, and on what support the Department of Health can provide, yet the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), confirmed to me in a written answer that

“No such discussions have taken place with Ministers.”—[Official Report, 22 October 2013; Vol. 569, c. 83W.]

Will the Minister please assure me that he will closely monitor the situation and have discussions with both Monitor and the South Tees trust on how the Department can provide support, including additional funding if necessary?

My final point is on allocations to the north-east’s clinical commissioning groups.

A recent working paper issued by NHS England on allocation and indicative target allocation outlines proposals that will reduce per-capita funding for CCGs across the north-east. People in Sunderland will each face a £146 cut, people in south Tyneside a £124 cut, people in Gateshead a £104 cut, and people in my constituency a £60 cut.

[Ian Lavery (Wansbeck) (Lab)]

Is it not perverse that deprivation and health inequality indicators are not part of the overall calculation, as regards the funding allocation for the north-east? That will potentially result in the north-east losing up to £230 million of NHS funding per annum.

[Tom Blenkinsop]

Yes, the cumulative effect of all the funding allocations in different areas is very worrying. If those allocations are all reduced, my genuine worry for my constituents, and for constituents across the north-east, is that all the hard work and financial effort in Teesside in the past 15 years to reduce cardiac risk, bad outcomes for cancer, and other problems will be undermined, and we will not build on the momentum gathered over the past 15 years.

--- Later in debate ---

[Dr Poulter]

No, I will not give way. I have said things clearly for the record, without any political smoke.

As a Government, when we had control of the funding formula, we clearly put in a weighting for deprivation and for some of the poorest communities. I am proud that we did so, but it is now for an independent body to look at the case and at the independent advice that it has been given. I would find it extraordinary, however, if it were not to factor deprivation into its decision making, although there are other factors that it will want to put into the equation, such as the fact that older people are the greatest users of health care, so places with lots of older people also need to be recognised. A number of factors will be taken into consideration, and deprivation will be one of them. I have been reassuring about that, and I will not allow the Labour party or any hon. Member to make mischief with something that the Government have stood by.

[Ian Lavery]

Will the Minister give way?

[Dr Poulter]

No, I will not give way any more. I have clarified the point considerably, and the hon. Gentleman would do well to listen. I will not allow the Labour party to make political mischief, when my party has made it clear that we value the deprivation weighting. In fact, if we look at the public health allocations to every local authority, they have been generous. As I hope to reassure hon. Members, we can see that the health care funding allocations to the north-east have also increased under this Government, so the assertion that funding to the north-east is being reduced is clearly not the case.

The Government have increased the NHS budget, which the shadow Secretary of State described as “irresponsible”. At the same time, the Labour-led Welsh Assembly Government have cut the budget by more than 8%; in England, however, we have ensured that we have increased the health care budget in real terms. In the north-east specifically, CCGs have received an above-real-terms increase in funding for 2013-14 of 2.3%, compared with the primary care trusts’ funding for the equivalent set of services last year. Opposition Members should be pleased about increases in funding for the north-east, because if the Opposition spokesman were Secretary of State at the moment, he would have considered that irresponsible.

[Ian Lavery]

If the proposals in the consultation document had been implemented this year, can the Minister confirm that the north-east would have lost out to the tune of a little more than £228 million?

[Dr Poulter]

The hon. Gentleman is right in saying that had the Government followed the advice of the Advisory Committee on Resource Allocation in the past, we would potentially have cut the budget for the north-east. I can reassure him that we maintained the resource allocation budget, and the north-east has received an increase in real terms. Those are the facts. He may want to create political smoke, but there is none. We preserved and increased funding to the north-east for patients in Opposition Members’ constituencies and in those of my hon. Friends.

NHS Funding

Ian Lavery Excerpts

Wednesday 12th December 2012 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I rise to speak in favour of the motion tabled by my right hon. and hon. Friends on the Opposition Front Bench. The Deputy Speaker suggested that we might introduce a bit of Christmas cheer into the proceedings, and the hon. Member for Stevenage (Stephen McPartland) certainly painted a very rosy picture of investment in his constituency. I thought he made a very good speech, incidentally.

In case Ministers are making their Christmas lists, let me tell them that one of the first things that this Government did was cancel a new hospital that served part of my constituency in order to save £464 million. Restoring that funding might be a good use for some of the £3 billion underspend. It was not a private finance initiative scheme but a scheme that was approved by the Department of Health and the Treasury but stopped in the emergency Budget.

I want to concentrate on two specific issues that are directly linked to the motion and on the important question of trust in the Government’s pledge on the funding of our NHS. I believe that the Government are keeping the public in the dark about a range of issues relating to publicly funded contracts delivered by private sector organisations, including on cancer care.

On trust, none other than the Prime Minister broke yet another pre-election promise. Having said before the election that he would extend the Freedom of Information Act 2000 to all publicly funded organisations, he did not do so. As a result, the public cannot access information about private sector providers in the NHS. This does not apply just to the NHS. In his comments, the Prime Minister referred to other publicly funded organisations such as the Carbon Trust, the Energy Saving Trust, the Local Government Association, and traffic penalty tribunals. It is increasingly apparent that many of the large corporations that apparently enjoy cosy relations with this Tory-led Government are extremely anxious that the Prime Minister does not extend the Freedom of Information Act to them. Currently, it instead allows them to hide behind a cloak of commercial confidentiality as billions of pounds of taxpayers’ money are awarded to them in barely transparent contracts. The public are deliberately being kept in the dark, and I have no doubt that an expensive lobbying campaign is under way to ensure that the Prime Minister and the Tory party do not change their minds on this issue.

Meanwhile, private companies benefit by gaining intimate knowledge of public sector bodies through their own submissions of freedom of information requests. That information is then used to undercut or outbid the very same public sector bodies when contracts are tendered or put up for renewal. Members might ask what the relevance of this is in the NHS context, but as someone who worked in the NHS, who is passionate about it, and who has tremendous admiration for the people who deliver the service, I can say that it is a huge concern to me. The area that I worked in—the pathology service that carries out diagnostic tests—is under threat. This huge uncertainty continues, and we need to know precisely what the position is.

Virgin Care, Circle, Serco, Care UK and any other private sector companies awarded a public contract to provide hospital, community or even specialist diagnostic cancer services are not subject to the FOI Act. We have no idea how these companies went about winning those lucrative, taxpayer-funded contracts. Under current arrangements, the best that may be hoped for in terms of any rudimentary accountability is achieved through a Commons Select Committee inquiry of the type conducted by the Public Accounts Committee chaired by my right hon. Friend the Member for Barking (Margaret Hodge). However worthy this process, it is by its very nature very limited in scope, and such inquiries can only ever touch the tip of the iceberg.

This is a national scandal that has prompted me to table early-day motion 773, which has attracted quite a wide range of support, mostly from Labour Members. It calls for the FOI Act to be extended to private sector bidders for public service contracts, particularly in organisations such as the NHS.

My concern is that this has overtones of the Government’s response to Leveson, in so far as I do not believe that the Government want their corporate friends to be accountable to Parliament, even though our public services are being awarded to those companies in ever greater numbers. We should follow the public pound and ensure that we know who is getting it, and how and why they are spending it.

The Secretary of State has said that there will be no large expenditure projects that are not fully thought out and properly costed. That brings me to my second point. Responses to FOI requests from my hon. Friend the Member for Leicester West (Liz Kendall) have made it clear that the Secretary of State is presiding over cuts to essential cancer networks, yet we know that he is planning to spend £250 million of taxpayers’ money on two proton machines, even though, according to the Department of Health’s own report, there is little evidence that they provide any benefit. There are no clinical trial data and no randomised control trials, which are the gold standard by which the National Institute for Health and Clinical Excellence judges the effectiveness of clinical therapies. Indeed, the new chair designate of NICE appeared before the Health Select Committee earlier this week and said exactly that.

The economic justification for purchasing those two machines has been based on informal discussions with the manufacturers who make them. If the machines are to be viable for the two hospitals that are to have them, they will need to treat 1,350 patients a year at a cost of £40,000 per patient. However, according to the Department of Health’s own dataset, the highest number of patients ever treated with proton therapy in one year is 79.

I would like to draw the House’s attention to the situation in Germany, which has invested more than most in proton therapy. Today, two of the three proton machines in that country are being mothballed. In Kiel, €250 million was spent last year on a machine, but it is now being dismantled and put into storage because of a lack of demand.

[Ian Lavery (Wansbeck) (Lab)]

Can my hon. Friend explain to the House what a proton machine actually is?

[Grahame M. Morris]

Probably not, in the very limited time available, but I can tell my hon. Friend that proton therapy is a form of advanced cancer treatment.

My argument is that the money the Department is proposing to spend on those incredibly expensive machines would be far better spent on advanced radiotherapy machines such as the stereotactic body radiation therapy machines that the hon. Member for Stevenage mentioned. There are other forms of therapy that are far more cost- effective. I might add that we in the northern region have no access to such therapies. Indeed, whole regions of the country do not.

The one remaining proton machine in Germany is at the university of Heidelberg, and it treats a maximum of 1,200 patients each year. The German Radio-oncology Society has said—[Interruption.] I hope that the Minister will listen to this. The society has said that

“for the vast majority of cancers there is no proof that proton therapy is more beneficial than other forms of innovative radiotherapy that are one hundred times less expensive”.

This proton debacle highlights the perversity with which the Government are running the NHS budget, and these questions lie at the very heart of whether we can trust Conservative promises on the NHS.

The Prime Minister tells the public that by April next year every cancer patient who needs innovative radiotherapy will get it, while at the same time the Secretary of State for Health starves dozens of hospitals and cancer networks of vital money needed to buy innovative radiotherapy equipment. We now know that money is being redirected into those two highly dubious projects. The Secretary of State needs to cancel those projects now and redirect the money into radiotherapy machines that will help tens of thousands of people in my constituency and across the country. This has the potential to be a monumental scandal and a waste of public money. I urge hon. Members who share my concern to sign early-day motion 773, to lobby the Health Secretary and ask him to reconsider his spending priorities in relation to cancer therapies, and to support the motion on the Order Paper.

NHS Risk Register

Ian Lavery Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Grahame M. Morris]

Most of the health care professionals—indeed 90%; the ones who were not invited to the summit—oppose the changes in one form or other. Also, 80% of Lib Dem voters want the risk register published—an even bigger percentage than that of Labour voters.

[Ian Lavery (Wansbeck) (Lab)]

Does my hon. Friend agree with the Secretary of State about the huge support for the Government from GPs over these reforms?

[Grahame M. Morris]

A number of Members on the Government Benches have referred, in Health questions and at other times, to the huge support among clinicians and GPs in their area, but Clare Gerada, the chair of the Royal College of General Practitioners, has said that just because GPs are compelled to man the lifeboats does not mean they agree with the sinking of the ship. That sums things up.

Hon. Members on the Government Benches should be particularly concerned by some recent polling figures. According to a poll by ICM, the over-65s—the category of people who are most likely to use the NHS and most likely to vote—want to drop the Bill by a margin of 56% to 29%, or two to one, which is the largest such margin. Sadly, not one Conservative Member, as far as I am aware, has had the courage to sign the early-day motion or to call publicly on the Health Secretary to publish the risk assessment. I know that, privately at least, some of the more thoughtful Conservative Members have been advising the Secretary of State to publish, but he seems to be flatly ignoring them. The risk register contains an objective list of the Department’s view of the risks, an estimation of the likelihood of each specific risk occurring and an estimation of its severity if it did occur. To be clear, what the Health Secretary is determined to conceal are the severe and likely risks of his own reckless attack on the NHS.

The Prime Minister must also be held to account for his broken promises on the NHS, for allowing his Health Secretary to put the NHS at risk and for standing by him while he tries to cover up the mess that is the Health and Social Care Bill. I remind the House that the coalition agreement that was signed by the Government parties stated:

“The Government believes that we need to throw open the doors of public bodies, to enable the public to hold politicians and public bodies to account.”

How does that statement square with this decision? Where is the accountability now? No one in the country voted for these health reforms, the Health and Social Care Bill has no mandate and we in the House will be asked to vote on reforms in the knowledge that the Department of Health and the Health Secretary are complicit in hiding the associated risks.

Health Inequalities (North-East)

Ian Lavery Excerpts

Tuesday 24th January 2012 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Riordan. I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate. The number of Opposition Members who are present today is a testament to the issue’s importance. I wish we had a little longer to speak, because I will have to truncate my remarks.

I served on the Committee that considered the Health and Social Care Bill, and I am a member of the Health Committee. As someone who has worked in the health service for more than a dozen years, I can say that the subject is very close to my heart. I am grateful to a number of organisations for their work, including the Association of North-East Councils, the National Education Association, the Campaign for Warm Homes, Durham county council, the North East Public Health Observatory and Health Works, which won a national award last week for its innovative and pioneering work in tackling health inequalities at the very heart of my constituency, and I thank that organisation for the information that it provided to Members for this debate.

The NHS reforms contained in the Health and Social Care Bill are only one aspect—a very important aspect—of how Government policies will increase health inequalities. We must make it clear that there is no consensus on this matter. There is clear blue water between the views of the Opposition, who think that resources should be applied to the areas of greatest need to address real and fundamental problems, and the attitude of Government Members. Across every Department, coalition policies will exacerbate socio-economic inequalities and, ultimately, health inequalities, as indicated by Professor Sir Michael Marmot in his report. I wanted to mention some figures in my region, but I do not have enough time.

Chronic obstructive pulmonary disease, or COPD, is particularly prevalent in the north-east. It is often associated with heavy industry, coal mining and the like. Last year, my own primary care trust received a national award for its innovative approach to tackling this public health issue within our community. COPD costs the NHS an estimated £491 million every year.

Mortality rates in the north-east are higher than in the rest of England, accounting for 6% of all deaths in England, and the inequality gap appears to be increasing, which is a real concern.

I want to focus on two significant issues in the limited time that I have: first, inequalities in access to health service, which is a key factor that influences health outcomes; and secondly, the broader problem of health inequalities produced by deep-seated differences of social class.

As we have heard, in 1979 the Government’s chief scientific adviser, Sir Douglas Black, produced a report on the extent of health inequalities in the UK, and he acknowledged that the NHS could do much more to address those inequalities, alongside other improvements across the Government. As I mentioned earlier, those improvements include ones to child benefit, maternity allowances and pre-school education, as well as an expansion in child care and better housing. All those changes would address health inequalities.

Those findings by Sir Douglas Black were subsequently reinforced by further research and reports by Professor Peter Townsend and Sir Derek Wanless and more recently by Professor Sir Michael Marmot, all of whom I have had the pleasure to meet in one forum or another before and after I was elected to serve in the House.

There is a stark danger—a clear and present danger—of a downturn in the progress that has been made in addressing health inequalities because of decisions being made by the Government, both in the Department of Health and elsewhere, and severe cuts to services for the most vulnerable. That makes it all the more important that the NHS focuses on tackling health inequalities. Let us make no mistake: under Labour, good progress was made to address health inequalities, but a great deal more needs to be done.

I have served on the Health and Social Care Bill Committee for a year now, as well as on the Select Committee on Health, and I would argue that that Bill changes the fundamental aspects of our NHS. The NHS has been fragmented, with privately led commissioning, the reintroduction of a postcode lottery, an unco-ordinated health system and greater competition. That fragmentation risks entrenching the inequality of access to health services and health outcomes. Fragmentation is the antithesis of a co-ordinated approach. We need more co-ordination, more integration and a more focused approach.

Stephen Thornton, chief executive of the Health Foundation, talked about health inequalities when he was one of the expert witnesses who gave evidence to the Health and Social Care Bill Committee. He said:

“a duty needs to be placed on the national commissioning board and the consortia”—

the commissioning groups—

“to embed shared decision making in all care and treatment”.––[Official Report, Health and Social Care Public Bill Committee, 8 February 2011; c. 19.]

Only by reinforcing the duty on the commissioners themselves to reduce health inequalities is there any chance of achieving that goal.

The cuts that are falling across every Department are clearly hitting the poorest hardest. The Association of North East Councils has shown that the north-east will be worst affected by those cuts between now and 2013. Child poverty is rising in my constituency. Currently, one child in three in my constituency is living in poverty, but in the Eden Hill ward in Peterlee 48% of children are in poverty, and in Deneside in Seaham, which is next to where I live, the figure is 40%. Those figures should concern not only the local MP but the national Government.

Recently, the TUC produced figures after the unemployment figures were released that show that, on average, 7.5 jobseekers are chasing every vacancy, but in the constituency of my hon. Friend the Member for Hartlepool (Mr Wright) the figure is as high as 24 jobseekers chasing every vacancy. Youth unemployment is rocketing, and the coalition Government seem to have no intention of reducing health inequalities.

[Ian Lavery (Wansbeck) (Lab)]

I will make a very brief intervention. My hon. Friend has just mentioned statistics about child poverty, unemployment and jobseeker’s allowance applications, and earlier in the debate other colleagues talked about the inequalities in the north-east regarding the situation within the NHS. Those statistics and that situation are wholly unacceptable. The Prime Minister said before the election that he would attack the north-east first and then Northern Ireland second. That is happening. With the Welfare Reform Bill, there will be a continued attack on the north-east. Does my hon. Friend agree that that does not bode well for the future of the people in the north-east and that things can only get worse?

[Grahame M. Morris]

I am grateful to my hon. Friend for that intervention, and I agree with him. I was shocked to attend a meeting in my constituency last Friday about the contingency plans that are being put in place for emergency feeding centres after 2013. Those centres are the soup kitchens that we have not seen since the 1930s or the miners’ strike in 1984.

My final point is that the Labour Government produced the first ever targets to reduce health inequalities in the population, and the poorest were healthier when we left Government than they had been when we took office in 1997. My plea to the Minister is this: raise the standards and be a champion for public health and not an apologist.

Southern Cross Healthcare

Ian Lavery Excerpts

Thursday 16th June 2011 Commons Chamber

[Mr Speaker]

Order. I am keen to accommodate remaining colleagues, but may I remind them of the merits of brevity?

[Ian Lavery (Wansbeck) (Lab)]

Thank you, Mr Speaker.

Residents in the six Southern Cross care homes in my constituency will be horrified by the Minister’s opening remarks. He said that this is a commercial problem to be dealt with by the commercial sector, which is absolutely outrageous and will frighten the wits out of each of those 31,000 residents. This is a society problem, and it should be dealt with by the Government. What small crumbs or words of comfort can he give to people in my constituency? When will we stop abusing elderly people and using them as marketplace commodities?

Public Health Observatories

Ian Lavery Excerpts

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris]

I am grateful for that and I agree. It is fundamental to have a solid evidence base on which to plan health interventions.

As I mentioned, the Government propose in the Health and Social Care Bill to transfer health improvement functions from PCTs to local authorities, and to create a new body, Public Health England, to be rooted in the Department of Health. Public Health England is expected to take on full responsibility for overseeing the local delivery of public health services, as well as dealing with national issues such as flu pandemics and other population-wide health threats from next year. The majority of public health services will be commissioned by local authorities. However, the revolution under way in the NHS is just as important to the future of public health in England.

The Bill, which proposes the abolition of strategic health authorities and primary care trusts, raises more questions than it answers. The responsibilities currently held by PCTs could be moved to local authorities, to the Department of Health, to commissioning consortia or to the NHS commissioning board. How the important work of public health observatories will be safeguarded for the future is still unknown. The decision to divide public health responsibilities between the Department of Health and local authorities will fragment any cohesive approach to tackling health inequalities. Whether new commissioning consortia will carry out some functions is at this stage unknown.

There are further concerns about whether Public Health England should be outside the Department of Health to protect its independence. If it was placed within the NHS, perhaps as a special health authority, surely that would better meet the Government’s own aim, often stated, of liberating the NHS from political control.

The Minister will be aware of the response to the White Paper by the public health observatories in March 2011. That response calls for a sub-national level of organisation of Public Health England to be created, with sufficient critical mass to ensure that the outputs of Public Health England continue to be valuable locally as well as nationally. There are many examples where that is the case, not least in my own region, the north-east, where the public health observatory has done excellent work on addressing inequalities that affect people with mental health issues and inhibit their ability to access services. The lessons of that can be rolled out across the country.

The important work of the observatories over the past decade has been self-evident. On 24 June 2008 the health profiles for every local authority and region across England were published jointly by the Department of Health and the Association of Public Health Observatories, an organisation which, as I mentioned earlier, has lost all its funding. Using key health indicators, public health observatories were able to pinpoint national health statistics at a local level, providing valuable information to address health inequalities and improve health outcomes.

As the Minister at the time, my right hon. Friend the Member for Bristol South (Dawn Primarolo), now the Deputy Speaker, noted, the importance of those statistics was

“to target local health hotspots with effective measures to make a real difference.”

In my constituency, Healthworks, an excellent clinic established in Paradise lane in Easington and opened by Sir Derek Wanless, is a prime example of how that information collected by the observatories was used to great effect to target the areas in greatest need.

The Association of Public Health Observatories, with the Department of Health, also published a health inequalities intervention toolkit to enable every English local authority to model the effect of high-impact interventions on the life expectancy gap. As far back as 1977, the Department of Health’s chief scientific adviser, Sir Douglas Black, was asked to produce a report on the extent of health inequalities in the UK and how best to address them. The report proved conclusively that death rates for many diseases were higher among those in the lower social classes. It acknowledged that the NHS could do much more to address the situation. It called for increases in child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care and better housing. A further report was subsequently produced by Professor Peter Townsend. Indeed, only last week I attended a seminar, in which the principal speaker was Sir Michael Marmot, on the impact of cold homes on health outcomes. The report indicated that the cost to the NHS of illness resulting from poorly insulated houses and cold homes is £2 million a year.

[Ian Lavery (Wansbeck) (Lab)]

Is my hon. Friend aware of the Marmot report—

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Marmite?

[Ian Lavery]

The Marmot review, published in 2010, stated clearly, as one of its nine objectives:

“Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.”

[Grahame M. Morris]

I am grateful to my hon. Friend for mentioning that important and contemporary report. I completely agree with Sir Michael Marmot’s findings— and Marmite is also very good for public health. Building on the work of Professor Townsend and Sir Douglas Black, Sir Michael Marmot states as one of his recommendations:

“Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.”

I mentioned the economic benefits of insulating houses. It would be a real step forward if the Marmot report’s six principal recommendations were incorporated and linked to quality standards in the public health outcomes framework that the National Institute for Health and Clinical Excellence is working on.

Oral Answers to Questions

Ian Lavery Excerpts

Tuesday 25th January 2011 Commons Chamber

[Mr Lansley]

Of course we will support the efforts of my hon. Friend and his local council to tackle alcohol abuse. He will have heard what was said earlier by the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), which I entirely endorse.

Local authorities and their communities should have a greater say in what happens in their areas. We will enable them to do so, through the Health and Social Care Bill, the establishment of local health improvement plans, and—as my hon. Friend the Under-Secretary said—the alcohol strategy that we will introduce following the public health White Paper later in the year.

[Ian Lavery (Wansbeck) (Lab)]

T3. Does the Secretary of State envisage a time when GP consortia may be purchased by foreign companies, and operated and administered thousands of miles away across the globe?

[Mr Lansley]

No, I do not. I am glad that the hon. Gentleman has asked that question, because I think that there is a world of difference between the question of the exercising of clinical leadership by general practices as members of a consortium in an area and the question of from whom they derive management support. I believe that many will derive it from existing PCT teams, the voluntary sector and local authorities. Sometimes the independent sector will be involved, but it is a question of the consortium choosing where to go rather than being taken over.

Breast Cancer Screening (Young Women)

Ian Lavery Excerpts

Tuesday 30th November 2010 Westminster Hall

[Pat Glass (North West Durham) (Lab)]

Breast Cancer is the UK’s most common cancer. It affects thousands of families every year. Almost 48,000 people were diagnosed with breast cancer last year: 47,000 women and 277 men, and 125 women will be diagnosed with breast cancer today. Breast cancer incidence rates among women have increased by 50% over the past 25 years—5% in the past 10 years—and, because of lifestyles changes such as increased obesity and drinking in young women, those incidence rates will continue to rise, particularly for those under 50. Eight in 10 breast cancers diagnosed are in women aged 50 or over, but that means that two in every 10 are diagnosed in younger women, who may have young families. For young women the disease can be particularly virulent and aggressive, and the chances of survival are less good as a result.

[Ian Lavery (Wansbeck) (Lab)]

Does my hon. Friend agree that the time between the mammogram and the results is critical, and that the length of that period depends on the area and district a person lives in and the hospital they attend? It could be between a week and up to four weeks, depending on the hospital, which could mean the difference between life and death. At the same time, those with money have the opportunity to have a mammogram in the morning and receive the results in the afternoon.

[Pat Glass]

That is incredibly true. I am particularly concerned about young women, and in many cases the younger they are, the more virulent the disease is and the chances of survival are less good as a result, so that is particularly crucial. Every family in this country will be touched by this awful disease. Within my family, four close relatives have died of breast cancer in recent years, all aged well under 50; and a cousin, also under 50, is currently battling the disease for a second time.

However, it was an inspirational woman, Trish Greensmith, who runs the Chyrelle Addams breast cancer appeal trust in my constituency, who first brought home to me the number of young women who are being diagnosed with, and having to fight, breast cancer today. She told me that when she first visited an oncology clinic she was struck by the number of young women in the waiting room—young women who were trying to deal with virulent and aggressive cancers while bringing up young families. Under the current system, they would never be offered the opportunity for routine screening, which might have detected their cancers early and saved their lives. More women are surviving breast cancer than ever before, and the survival rates have steadily improved over the past 30 years, but 12,000 women and 70 men in the UK died from breast cancer last year.

--- Later in debate ---

[Paul Burstow]

I am grateful to the hon. Lady for that clarification. In 2006, the Institute of Cancer Research published the results of a 15-year study of the benefits of screening women from the age of 40. The study invited about 53,000 women to receive annual breast cancer screening over nine years and then compared them to a control group of women who received standard NHS treatment. The study found that the reduction in deaths due to screening was not statistically significant. I understand that, for the individual, it is 100%; I understand the hon. Lady’s powerful point. She might say that, if such measures save a single life, they are worth doing. However, the study pointed out, as she seemed to guess, that early screening had significant disadvantages. Almost one in four women in the study had at least one false positive, with all the resulting distress, anxiety and unnecessary follow-up, including invasive biopsies. Currently, there are about 7 million women aged between 30 and 49 in England. I accept that she wants to screen from 35 onwards, but if the take-up rate among that population were 75%, we would be screening about 5 million more women a year. Even if the minimum age were 35, it would create the issue of false positives.

[Ian Lavery]

Does the Minister agree that there is still a huge diagnosis problem, involving the time between mammogram and results, based on what is classed as a postcode lottery? We need to look at that and ensure that each patient, regardless of wealth or where they reside, gets her mammogram results within days, not weeks.

[Paul Burstow]

Yes. It is entirely right for the hon. Gentleman to make that point. That is why this Government will publish the first ever NHS outcomes framework, which will focus much more clearly on how we ensure that the system delivers the right outcomes in terms of cancer survival. We will publish that shortly, along with a new cancer reform strategy in due course that will say even more.

The Government’s view at present is that the risks of the change proposed by the hon. Lady outweigh the benefits. However, I want to ensure that the evidence that she has discussed is properly evaluated by officials in the Department. We will consider those points and her representations carefully, and I will write to her after we have had an opportunity to do so. However, the Department’s view and the Government’s view about maintaining the status quo is shared by most countries in Europe, as well as the Council of Europe, which recommends a breast cancer screening age of 50 to 69. The United States recommends screening every two years for women aged between 50 and 74. The position that this country has adopted for a considerable time is based on international practice and the best available evidence. One must be open to changes in evidence; that is important in an evidence-based approach to developing policy.