Infected Blood Payment Scheme

Jane Ellison Excerpts

Thursday 14th July 2016 Written Statements

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

On 21 January 2016 the Government launched their consultation on reform of the current ex-gratia payment schemes for individuals infected with HIV and/or hepatitis C following treatment with NHS-supplied blood or blood products before September 1991. They sought views particularly from the beneficiaries of the current schemes and their clinicians but the consultation was open to all to respond. The full analysis of the responses, the detail of the final decisions for the new scheme and an overview of the transition arrangements are set out in the Government’s formal consultation response published today.

The response is attached and can be found on the Department of Health’s website at: https://www.gov.uk/government/consultations/infected-blood-reform-of-financial-and-other-support. The impact assessment and equalities impact assessment will be published on the same website before summer recess.

The Government recognise the suffering experienced by people as a result of this tragedy and the Prime Minister apologised on behalf of the Government in March 2015. Since 1988, successive Governments have set up five schemes to provide financial and other support to those affected. This Government committed further funding of up to £100 million (in January 2016) on top of the additional £25 million pledged by the Prime Minister in March 2015 and the existing baseline budget. This additional money will more than double the Department of Health’s annual spend on the scheme over the spending review period. This is significantly more than any previous Government have provided for those affected by this tragedy.

Over the years, there has been criticism from different groups of beneficiaries and their representatives about the way that the current system has been set up and operates. It was clear from this criticism that a more accessible and equitable system of care and support was needed.

In making their decisions for the new scheme, the Government have taken full account of the 1,557 formal responses to the consultation and considered other feedback such as backbench debates on the issue, 21 parliamentary questions and 69 individual pieces of correspondence related to the consultation. The detailed description of the reformed scheme is contained in the consultation response document published today.

The key principles for the reformed scheme are that support will be simple, equitable and responsive to individuals’ circumstances, and available resource will be focused on those whose health is most affected.

Specifically, the key aspects for the reformed scheme will be:

All infected individuals will now receive an annual payment. These annual payments will be linked to the consumer price index (CPI) and include the £500 winter fuel payments as a standard payment without the need to apply for it:

Those infected with hepatitis C at stage 1 will receive a new flat rate annual payment of £3,500 (rising to £4,500 from 2018-19) that is not linked to an individual assessment, as was proposed in the consultation—this will be the first time ongoing financial support will be provided for approximately 2,500 stage 1 beneficiaries.

Those with hepatitis C at stage 2 or those with HIV will see their annual payments increase to £15,500 (rising to £18,500 from 2018-19).

Those co-infected with HIV and hepatitis C at stage 1, will receive £18,500 (rising to £22,500 from 2018-19)

For those co-infected with HIV and hepatitis C at stage 2, will receive £30,500 (rising to £36,500 from 2018-19)

Discretionary support will not only continue but will be enhanced from 2018-19

A new special appeals mechanism for those at hepatitis C stage 1 who consider that the impact of their infection on their health may mean they could qualify for stage 2 payments will be introduced from 2017-18

Continuation of a £50,000 lump sum payment for those infected with hepatitis C stage 1 who progress to stage 2

In addition, partners/spouses at the time of death of a primary beneficiary will be entitled to a £10,000 one-off lump sum where the HIV/hepatitis C infection contributed to the death of their partner/spouse. This will apply to those already bereaved and newly bereaved.

All elements of the published reform package apply to the current spending review period of FY 2016-17 to FY 2020-21, during which a review of the scheme will be undertaken. This review will particularly take account of the numbers being treated for Hepatitis C and the implications for the future operation of the scheme.

All payments will continue to be ex-gratia, which means they are funded voluntarily by Government. These payments will also continue to be additional to any other income a person may receive, and are disregarded for the purposes of calculating income tax and eligibility for other state benefits.

Increased annual payments and new annual payments will take effect this year and be backdated to April 2016. Lump sum payments for bereaved spouses/partners will also be implemented this year. Arrangements for a single new scheme administrator will be progressed in the current financial year and become operational in 2017-18.

The proposals for scheme reform described in the consultation document are for beneficiaries infected in England. Information gathered through the consultation has been shared with the health departments in the devolved Administrations and we will continue to work closely with them.

Attachments can be viewed online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-07-14/HCWS88/

[HCWS88]

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 5th July 2016 Commons Chamber

[Maggie Throup (Erewash) (Con)]

16. What plans the Government have to lead the international response to the recommendations of the final report of the Review on Antimicrobial Resistance, published in May 2016.

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

The O’Neill AMR review is galvanising global awareness, as I have seen for myself, and it is greatly to the Prime Minister’s credit that he showed the foresight to commission it. The UK continues to play a global leadership role on antimicrobial resistance. We co-sponsored the World Health Organisation’s 2015 global action plan on AMR, we created the Fleming fund to help poorer countries to tackle drug resistance, and we are now championing action, including taking forward the O’Neill review’s recommendations, through the United Nations, the G7, and the G20.

[Andrea Jenkyns]

I recently met biotech firm Matoke Holdings, which has developed a new technology—reactive oxygen technology. It has found that this technology forms the basis of a whole new generation of antibiotics that has been proven to combat multi-resistant bacteria, including MRSA. This is an incredibly exciting development. Will my hon. Friend and her team agree to meet Matoke Holdings to hear about the new technology and the pace at which it has developed? What are the Government doing to support research into new antibiotics?

[Jane Ellison]

My hon. Friend will be aware that a key focus of the O’Neill review was how to incentivise the development of new antimicrobials. It is scary to think that there has not been a new class of antibiotics for some decades now. The Government are funding an extensive AMR research programme. Matoke Holdings has been in contact with the Department, and we are in the process of arranging a meeting to discuss reactive oxygen technology in the coming weeks. My ministerial colleague the Under-Secretary of State for Life Sciences has indicated that he would also be happy to have such a meeting.

[Maggie Throup]

I recently hosted a parliamentary drop-in session to highlight the benefits of C-reactive protein testing as a way of reducing the number of antibiotics inappropriately prescribed in primary care. Will the Minister agree to look again at the case for rolling out CRP testing as standard across primary care as part of the Government’s strategy to tackle antimicrobial resistance?

[Jane Ellison]

My hon. Friend is right to champion these new technologies. In fact, the Department has already invested in research into CRP. We look forward to seeing what that brings and, in due course, to seeing how it might move forward. It is very much already on our radar.

[Andrew Gwynne (Denton and Reddish) (Lab)]

There is an impending public health issue in this regard, not least with strains of gonorrhoea, for example, that are starting to show resistance to antibiotics. A number of doctors are incredibly concerned about this. What more can be done to incentivise research and development to ensure that this public health concern does not become a public health crisis?

[Jane Ellison]

The hon. Gentleman, who knows a great deal about these matters, is right. Incentivising discovery is absolutely at the heart of the O’Neill review. O’Neill has made a series of recommendations about unblocking the drugs pipeline, and we will respond to that in full. It is a critical issue. In the meantime, conservation of the antibiotics we have and sensible prescribing is critical to making sure that, as the hon. Gentleman says, drug-resistant strains of gonorrhoea, for example, do not take hold.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

This is an incredibly important issue on which I urge the Minister to communicate with the public more effectively, because inappropriate use of antibiotics could have severe effects. Some of the medical interventions that are reliant on antibiotics, whether gut surgery, joint replacements, caesarean sections or chemotherapies, could become too dangerous to perform if we do not get this right.

[Jane Ellison]

That is exactly right. Things we take for granted now could become risky procedures again. Globally, old diseases could make a comeback because of drug resistance—diseases such as TB which, around the world, people are winning the battle against. This is why it is so important to pay tribute to the Prime Minister’s foresight in commissioning the independent review and taking this issue global. The Government, along with the chief medical officer, are championing this at an international level, but, at the same time, we are not resting closer to home, where we are working with GPs and so on to deal with the prescribing issue. However, it is a big challenge and the hon. Gentleman is right to highlight it.

[David Tredinnick (Bosworth) (Con)]

Is my hon. Friend aware that there is strong evidence that herbal medicine can help treat conditions currently treated by antibiotics, but there is a desperate need for more research? Is she also aware that homeopathic medicine can do the same, particularly with upper respiratory tract infections, and that homeopathic treatments are now the second largest medical system in the world, according to the World Health Organisation?

[Jane Ellison]

The Government are always interested in anything that can be proven to be cost-effective and efficacious.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Millions of people around the world are dying annually from resistant infections. In the light of that and the positive correlation between antibiotic resistance rates and antibiotic consumption, urgent action needs to be taken. What steps and cross-departmental work is the Minister taking to address the findings of the Review on Antimicrobial Resistance and to reduce the unnecessary use of antimicrobials in agriculture?

[Jane Ellison]

There is consensus on the importance of this issue. It is worth highlighting the work that the Government are doing internationally, through the creation of the Fleming fund, in which we are investing £265 million, to help poorer countries to tackle drug resistance and to make sure that we have proper monitoring systems in place. Without a baseline to understand where we are even starting from, it is very difficult. We will respond more fully to all the issues highlighted by the hon. Lady when we respond formally to the O’Neill review, but it goes without saying that we are trying to take this work forward internationally and we are working towards further meetings at the United Nations this autumn.

[Chris Green (Bolton West) (Con)]

2. What assessment his Department has made of the uptake of the Target antibiotics toolkit among NHS commissioners and GPs.

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

Continuing with the same important theme, it is excellent to see Parliament taking such a close interest in antibiotic resistance. In England, 60% of clinical commissioning groups reported reviewing the Target toolkit, which has been designed to help GPs in particular, in a primary care survey in November 2014. A patient safety alert went to providers and commissioners in 2015, highlighting the importance of programmes such as Target. The House might be interested to know that the Target programme gives GPs help in understanding how to deal with the pressure from patients, because a lot of inappropriate antibiotic prescribing comes from the pressure from patients to walk away with an antibiotic script. Work is being done, but we know that we have more to do.

[Chris Green]

I thank the Minister for her reply. Disappointingly, the most recent data show Bolton to be one of the highest prescribers of antimicrobial agents in Greater Manchester, and it is in the highest quartile nationally. Although Bolton CCG has seen reductions in antibiotic prescribing following guidance given to GPs, when will the Target antibiotics toolkit be fully implemented across all CCGs in England?

[Jane Ellison]

Public Health England is doing a huge amount of work on this. There has been a very welcome drop in prescribing in the last year and that appears in the data available for this year. That gives us encouragement. Of course, 79% of antibiotic prescribing occurs outside hospital, so my hon. Friend is right to highlight general practices. I draw his attention to Public Health England’s Fingertips portal, which allows both providers and commissioners to assess how they are doing compared with other areas locally. That is allowing us to see where we have particular problems. It varies around the country and Public Health England is leading the action being taken in that regard.

[Chris Evans (Islwyn) (Lab/Co-op)]

The growth of antibiotic resistance is a massive problem worldwide, as the Minister knows. No new antibiotics have been classified for more than 25 years. This is a real problem, as antibiotic resistance increases. What are the Government doing to address the issue?

[Jane Ellison]

As I have said, it was our Prime Minister who commissioned the independent O’Neill review, showing astonishing foresight, and that review is now galvanising the discussion. I was at the World Health Assembly in Geneva in May, and the review was the talk of Geneva. Lord O’Neill presented it to many delegations from around the world and we now need to move forward. As well as working on human health, we are also looking to work with animal health organisations, as we take forward the very important recommendations on prescribing and the use of antibiotics as growth stimulators.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

3. If he will make an assessment of the potential effect of the UK leaving the EU on the availability of NHS services for (a) EU nationals living, studying and working in the UK and (b) UK citizens abroad.

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[Andrew Stephenson (Pendle) (Con)]

T5. In May, the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), gave me a very encouraging answer about improving the treatment and diagnosis of Lyme disease. Will she meet me and other concerned colleagues to discuss what more can be done to tackle that terrible condition?

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

I am pleased to report that the commissioning of the systematic reviews of the diagnosis and treatment of Lyme disease, which I mentioned at that time, is under way. We expect that work to start in the autumn, and the researchers will approach relevant stakeholders. Once that work is under way, I would be happy to organise a meeting for colleagues at which the experts leading it can brief them further.

[Patrick Grady (Glasgow North) (SNP)]

T3. Will the Secretary of State join me in welcoming the formation of the all-party parliamentary group on blood donation? Will he agree to take part in and perhaps give evidence to its inquiry into the criteria for blood donation, particularly those regarding men who have sex with men?

[Jane Ellison]

As Members will know, the Department has asked the Advisory Committee on the Safety of Blood, Tissues and Organs—SaBTO—to review the donor selection criteria for blood donation that relate to men who have sex with men. SaBTO has approved the remit, the terms of reference and the work streams, and it is cracking on. It has a second meeting coming up later this month. The chair of the working group has written to the chair of the all-party group, welcoming its inquiry and inviting it to contribute evidence during the autumn.

[Andrea Jenkyns (Morley and Outwood) (Con)]

T7. To expand on the question asked by the shadow Secretary of State, I too would like to raise the case of my constituent Abi Longfellow who suffers from dense deposit disease and is awaiting a decision by the NHS’s specialised commissioning body. She and her family have been subjected to frequent delays and miscommunications. I first met Health Ministers, NICE and NHS England a year ago to discuss Abi’s situation. What steps will the Government take to ensure that decisions on treatments such as this are taken in a timely fashion and that families are kept updated on the progress of those decisions?

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

T4. In March, the Scottish Government made a commitment to substantially increase the financial support for the victims of contaminated blood. Initially, that will have to be administered through the current system, but the Department of Health appears to be dragging its feet. Will the Secretary of State explain the cause of the hold-up and say how he plans to expedite these payments to people with life-threatening illnesses?

[Jane Ellison]

No one is dragging their feet and we are trying to get this matter sorted out. I have had a number of discussions with the Cabinet Secretary for Health and Sport, Shona Robison, most recently last Thursday. We are working together to facilitate the increased payments, using the current scheme administrator. We want the payments to be made as quickly as possible to people who were infected in Scotland and across the UK. Officials in the Department of Health and officials in Scotland are working closely together to expedite the matter.

[Sir Edward Leigh (Gainsborough) (Con)]

T8. Community hospitals such as John Coupland in Gainsborough are very popular, yet health authorities seem intent on centralising services. Will the Secretary of State today make clear his absolute commitment to supporting local community hospitals and giving them work, and state that there will be no closures without his personal authorisation?

--- Later in debate ---

[Ms Margaret Ritchie (South Down) (SDLP)]

Will the Minister responsible for public heath confirm when a statement on contaminated blood will be made to the House, and in particular on the response to the consultation that closed in April?

[Jane Ellison]

I am not in a position to be specific about when we can make a statement, but I can give the hon. Lady and other interested Members the absolute assurance that we continue to look closely at the issue. We have read every single response that we have received. I was at a well-attended all-party group meeting on 25 May and gave people a sense of the direction of travel of our analysis. I hope to keep the House updated.

[Dr James Davies (Vale of Clwyd) (Con)]

Will the Minister confirm how he plans to implement the General Practice Forward View? Will he also confirm that sustainability and transformation plans will be returned to for further development if they fail to deliver the investment in general practice mandated by the forward view?

--- Later in debate ---

[Mhairi Black (Paisley and Renfrewshire South) (SNP)]

An elderly constituent of mine came to my surgery to explain that, sadly, her husband had passed away as a result of being infected with hepatitis C during the contaminated blood scandal. She has applied to the Skipton Fund four times, and has been turned down because her husband’s medical records have been destroyed since his death. Can the Minister offer any advice on how I can best move forward with this? I am also happy to meet her to give her more background information.

[Jane Ellison]

I think the latter suggestion might be the better one. I am happy to meet the hon. Lady and talk about the matter in more detail.

Alcohol Consumption Guidelines

Jane Ellison Excerpts

Tuesday 28th June 2016 Westminster Hall

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

I thank colleagues for bearing with our rather interrupted debate. I am fairly confident that I will not have time to discuss all the issues in my response, but as some colleagues are aware, my door is always open, and I have a proposal towards the end of my speech for how we might continue the discussion.

First, I congratulate my hon. Friend the Member for Gower (Byron Davies) on securing this debate and on opening it so authoritatively. We are all aware of the impact of alcohol misuse, which was well summed up by the shadow Minister, who is knowledgeable about that. She reminded us of some of the pressure it puts on our vital public services. It is right that we give this issue our attention.

I know that people have asked why we need new guidelines when alcohol consumption is falling. My hon. Friend, in introducing the debate, talked about some of the areas in which we have had welcome improvements in the statistics. The majority of people drink alcohol in an entirely responsible way. In 2014, 59%—just over 25 million adults—drank within the new guidelines, so it is important to stress that quite a lot of people drink that amount or less at the moment.

As a Government who believe in informed and empowered consumers, we have a responsibility to provide clear information to help people make informed choices about their drinking. The guidelines are not about preventing those who want to enjoy a drink from doing so. Goodness knows, as a passionate remainer, I can certainly say that guidelines of all sorts have been suspended in my household for the past week or so. This is about ensuring that people get common-sense advice and practical information, and some of that will be about things like taking days off from drinking. There is an appetite for that; we know that from the research we have done with people.

The new low-risk drinking guidelines are the means by which the four UK chief medical officers, working together, provide the public with the latest and most up-to-date information about the health risks of different levels and patterns of drinking. Let me clarify at the outset, in case I run out of time, what the guidelines are not. Nobody has said that more than 14 units is considered harmful or problem drinking. It is just not recommended as low risk. To be clear, there is no public policy on abstinence. The guidelines are not about the rate at which alcohol affects men and women in terms of intoxication, but how it affects their long-term health.

[Andrew Griffiths]

Will the Minister give way?

[Jane Ellison]

If colleagues will forgive me, I have very little time. I will not even have 10 minutes. I will give way, but it means I will not get through my speech.

[Andrew Griffiths]

I have a very simple question. Does the Minister think there is no such thing as safe drinking?

[Jane Ellison]

I will come on to deal with some of the issues, but I will also make a suggestion for how we take this discussion forward. The issue outlined was about the extent to which alcohol affects people. The second part of the consultation, to which a response has not yet been published—I will come on to talk about that—is about how we express and communicate the new guidelines. That is slightly different from the science that sits behind them. I want to try to pull those two things apart. Clearly we have a job of communication to do, because we want to be helpful to the public.

Perhaps it would be useful to remind Members how we arrived at this review. It was not Ministers who asked the chief medical officers to do it but Parliament. The previous guidelines came out in 1995, and in 2012 the Science and Technology Committee recommended that they should be reviewed because they had not been for so long. It is fair to say that there are a lot of places around the world where such guidelines have not been looked at for a long time, so the evidence base is not as up to date as it could be. There was a lot of parliamentary interest, especially in the previous Parliament, in guidelines—for example, in the harmonisation of the pregnancy guidelines when we had debates about foetal alcohol syndrome.

At the request of the four UK chief medical officers, three independent groups of experts have met since 2013 to look at both the scientific and the behavioural evidence of the health effects of alcohol. Those groups were made up of international experts in the field of epidemiology, public health, liver disease, behavioural science, science communications and evidence-based alcohol policy. None of those people were members of the temperance movement.

To ensure that the guidelines are as practical as possible, after their publication the Government held a public consultation to gather views on their clarity, expression and usefulness. I should clarify something that is important: the Royal Statistical Society supported the evidence review and the conclusions. It was very specific in its challenge about how the Department of Health presented it in the launch. That is exactly why there was then a consultation about how we express and discuss the guidelines. To be clear, though, the RSS did not question the evidence review or its conclusions.

As part of the consultation process, Public Health England has undertaken market research to test understanding and acceptance of the guidelines—just the points that colleagues have asked about. Overall, the results were positive, showing that the language was understood and accepted and the tone appropriately informational. That is the tone we are trying to achieve: informational, not hectoring or nannying. The expert group has now reviewed the consultation responses and market research and has put its final recommendations to the four CMOs for their consideration. We intend to publish the final guidelines and the Government response to the consultation as soon as possible.

We of course recognise that industry has a key role in communicating the new information to consumers, particularly through labelling. I thank my hon. Friend the Member for Burton (Andrew Griffiths) for his remarks. As he knows, as a Back Bencher in the previous Parliament I was an active member of the all-party groups on pubs and beer. I had the honour of being the guest judge of the pale ale category at the Battersea beer festival on more than one occasion. To declare an interest, I am a member of the Campaign for Real Ale. I could not agree more that a well-run pub or bar can be a great way to help people to drink responsibly while maintaining social contact.

Nevertheless, the industry needs to enable those who want to moderate what they drink to do so. It has done some really good work on that. The work with the industry in the previous Parliament on alcohol units was very useful. I always have a further challenge for the industry. One thing we can do to reduce the number of units people consume and to develop that wider choice is to put more emphasis on lower-alcohol products. When I have spoken to them, I have always been very honest with industry spokesmen that greater promotion of lower-alcohol drinks can help people to get into healthier habits. Simple switches can help. I want to put on the record that just by swapping from a pint of beer or lager at 6% strength to a pint at 4% strength, people could cut their units by a third—that is, they could take out 1.1 units. They could still enjoy their pint but cut their alcohol intake by a third.

The chief medical officer had a successful meeting with the Portman Group yesterday, confirming willingness on both sides to continue to work constructively together and to deliver benefits to the public and good information to our constituents. There are reasons for optimism in some of the alcohol statistics, but the shadow Minister is right that there are some significant and often highly concentrated problems. We need to give people the best and most up-to-date advice. We recognise that it is not for the Government to tell adults what to do in their private lives, but we do have a role in enabling the public to make informed decisions about their health based on up-to-date guidelines and the best science.

I am grateful to the chief medical officer, who has confirmed that she is happy to hold a parliamentary drop-in briefing for colleagues to discuss the matter further. It simply is not possible to pick up many of the detailed points that have been made on the various international studies in the time available. For the record, the review scrutinised all the available high-quality evidence and covered the findings of 63 systematic reviews from the evidence worldwide. It was a major undertaking. I think it would be useful for colleagues to be able to come along and discuss some of the studies that have been cited. Some of them are in different countries and some, it must be said, are based on different situations in terms of the nature of the national health service and the health support in those countries. I do not have time to go into that factor, but it is relevant for some of the comparative remarks that were made.

I hope I have reassured colleagues that we want to move forward in a sensible way. We want to give people the best information and we want to communicate it with clarity. Change will not happen overnight, but we want to raise awareness of the health risks, particularly around some of the links, such as between breast cancer and alcohol. We have a vastly better understanding of that than we did in 1995, and that has come through in recent years. It is important that we reflect that and continue to communicate it. I hope we can move forward constructively from here. I will set up the meeting that I offered. I sense from the Chamber that there is an interest in having further constructive dialogue. I leave a couple of minutes to my hon. Friend the Member for Gower to close the debate.

Employment, Social Policy, Health and Consumer Affairs Council: June 2016

Jane Ellison Excerpts

Tuesday 14th June 2016 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 16 and 17 June in Luxembourg. The health part of the Council will take place on 17 June in the morning.

The main agenda items will be the adoption of Council conclusions on:

Food products improvement;

The next steps under a one health approach to combat antimicrobial resistance;

Strengthening the balance in the pharmaceutical systems of the European Union and its member states.

Under any other business there will also be:

Information from the Dutch presidency on:

The state of play of negotiations concerning the regulations on medical devices and in vitro diagnostic medical devices

Public health conferences that were organised and held by the presidency

Information from the Commission on:

The European fund for strategic investments and the investment plan for Europe

The EU response to Zika

Health systems performance assessment (HSPA)

Proposed new analytical products to support better knowledge and stronger evidence-based policy making, under the banner of the “State of Health in the EU”

Information from the French delegation on the election of the WHO Director-General

Information from the Polish delegation on the European Committee for Standardisation’s (CEN) work programme for 2016 with regards to health-related activities

Information from the Slovak delegation on the priorities for their forthcoming presidency, which will run from July until December 2016.

A draft copy of the latest agenda can be found online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-06-14/HCWS40/

[HCWS40]

HPV Vaccinations for MSM

Jane Ellison Excerpts

Tuesday 7th June 2016 Westminster Hall

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

Thank you, Mr Hollobone, for giving me the opportunity to respond to the debate. I have to say at the outset that we are actually announcing good news in this debate. I accept that Members of this House wish to challenge me on a whole range of areas in which we might go further, but this is the announcement of a major pilot, and I will go on to talk about what we are actually doing. I really think that we should see this as an important step forward and an important part of delivering on LGBT health. I just wanted to say that at the outset, because it was a bit hard to get that from some of the contributions. I will talk a bit about the issue of action, which I have been challenged on.

Let me start, as I should, by congratulating my hon. Friend the Member for Finchley and Golders Green (Mike Freer) not only on securing the debate, but on championing the issue so consistently and passionately. The point has been made that we should be talking about these issues more often—well, he has been talking about them consistently over many years and the persistence of parliamentary prioritisation is showing results. It is really good to see him in his place and I congratulate him on what he has done.

As hon. Members know, and as many people have mentioned, we are advised on all immunisation matters by the Joint Committee on Vaccination and Immunisation. Back in 2008, on the advice of the JCVI, an HPV vaccination programme for girls was introduced across the UK. It is worth reminding the House that the primary objective of that programme was to protect against cervical cancer. The latest data—just to remind people—shows that there are about 2,500 cervical cancer cases a year and up to 900 deaths from that terrible disease. To give some sense of comparison, there are around 300 anal cancer cases among all men in a year. Those are the origins of this programme.

The HPV vaccine has been given to more than 3 million teenage girls across the UK since the programme started, and coverage is actually among the highest in the world. Hon. Members have, again, made reference to international comparisons. I was recently in Geneva for the World Health Assembly, discussing HPV vaccination with a small group of other Health Ministers; our rates are the envy of much of the world, so we must accept that this is an important and world-leading programme. The number of young women with pre-cancerous lesions is falling, here and around the world, and we expect protection against cervical cancer to be long term, eventually saving hundreds of lives each year.

The vaccine has been subject to numerous safety reviews and I have gone over that in some detail in other debates. I will write to the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), about the specific issues that he raised today, but I want to assure him about the EMA reviews and the WHO reviews, which are all publicly available.

Protecting girls against HPV has wider benefits and will result in fewer HPV infections and less disease in heterosexual males. However, I recognise, as the House has today, that men who have sex with men—MSM—receive little or no benefit from the programme for girls. It was the increasing evidence of the link between HPV and oral, throat, anal and penile cancers, alongside the incidence of genital warts, that led the JCVI to decide to consider the possibility of HPV vaccination for MSM, and to reconsider the case for HPV vaccination of boys. I will come to the issue of boys, which has been raised by several hon. Members, if there is time—I think and hope there will be. However, I want to focus most of my time on MSM, which is the subject of the debate.

I do not intend to include a lot of statistics in my speech, as my hon. Friend the Member for Finchley and Golders Green has set them out and described the context well. However, I want to point out, with regard to the detail behind the figures he quotes, that some of it is not directly relevant to an HPV/MSM programme, as the figures include both male and female cases and cases of cancer unrelated to HPV.

MSM are one of the groups at highest risk of sexually transmitted infections in the UK and the Government are already taking a number of steps to improve their health and wellbeing. Again, I reject any suggestion that this issue is not a priority. It is quite the opposite: there has been a focus in the last year or so on MSM health and on LGBT health—that is something that we had previously not even begun to do. That includes, for example, the first LGBT health conference run by Public Health England and a number of other things that we have done. I am happy to speak to the hon. Member for Glasgow South (Stewart Malcolm McDonald) about that separately on another occasion.

The JCVI’s advice was that a targeted HPV vaccination should be introduced for MSM aged up to 45 who attend genito-urinary medicine and HIV clinics, if procurement of the vaccine and delivery of the programme is possible at a cost-effective price. Everything in that sentence is the JCVI’s advice. It is not just about the vaccine but about the delivery of the programme and the interrelationship between vaccination and attendance at GUM and HIV clinics, which is germane to the way that we are introducing this pilot.

In the JCVI’s formal advice to us, it acknowledged that commissioning and delivering such a programme would be complex and challenging. It made it clear that the Department of Health and Public Health England would need to work together, and with others, to consider the commissioning and delivery routes for the programme. Over the last few months that is exactly what we have been considering with stakeholders, and on several issues. Demand is one such issue, and we have had to consider whether the programme will result in a greater than expected increase in attendance by MSM at GUM clinics, and the impact of that on broader sexual health services.

We have also had to consider administration costs and what is a reasonable and realistic price to pay for administration of this vaccine in GUM and HIV clinics. Stakeholders raised that during the consultation on the original JCVI advice. How do we monitor the success of a three-dose programme when data collected in GUM clinics are anonymised and MSM could go to different GUM clinics for each dose? There are complexities in this programme that are not present in, for example, the school-based HPV programme for girls.

[Stewart Malcolm McDonald]

Briefly, can the Minister tell me why those complexities exist here in England but not, presumably, in Scotland and Wales?

[Jane Ellison]

They do exist in other nations. I am making a statement of fact of how the system operates and how people access sexual health clinics. I will come to the devolved Administrations.

We have decided that the best way to resolve these and other issues is to pilot the programme. My hon. Friend the Member for Finchley and Golders Green asked who the vaccine will be available to under the pilot. The JCVI recommended a targeted programme aimed at MSM already attending GUM and HIV clinics, so under the pilot, MSM will be offered the vaccine during their existing appointment if they are at a participating clinic. Public Health England is running the pilot, which should confirm whether such a programme can be delivered at a cost-effective price.

In terms of evaluation, which my hon. Friend also referred to, data collected by clinics will be used to monitor coverage of the HPV vaccine and the proportion of MSM completing the course of vaccine. The impact of the vaccine on HPV-related cancers will obviously take many years to emerge, but the impact on the diagnosis of genital warts will be a useful proxy for that and will be seen much sooner. I expect to be updated regularly on the pilot’s progress. My hon. Friend knows that I have taken a strong personal interest in this programme, and I will of course consider how best to share the information.

I understand that some stakeholders are disappointed that we are not rolling out the programme nationally immediately and some hon. Members here today have noted that Scotland and Wales have committed to implementing the JCVI’s advice in full. However, they have yet to confirm how or when they will start. Scotland has not started yet, and we are happy to share lessons from the pilot as it is no doubt considering how to move forward. Officials from the Department, Public Health England and the devolved Administrations meet regularly on this issue and will continue to do so to share experience and learning. Health is a devolved matter.

I confirm that Northern Ireland officials are on our project board, but they do not yet have a ministerial decision on how they will respond to the JCVI advice on MSM. Obviously there are issues to be raised with that devolved Administration.

The key thing to stress is that this is a large-scale pilot and I was somewhat disappointed by some of the stakeholders’ comments, particularly talk of stalling or of small pilots. This is a large-scale pilot that should eventually reach up to 40,000 MSM— more than 35% of those who attend GUM and HIV clinics annually. It will have a good geographical spread, including areas with the highest MSM populations, as well as rural areas with smaller MSM populations. That is relevant because, although there has been some piloting of vaccination in some clinics, it has been in a very limited geographical area and would not tell us enough about how this would work in practice in a national roll-out. The pilots will have a much broader spread. I can also confirm that the pilot will use the vaccine Gardasil-4 which was successful in the recent HPV procurement exercise.

I am pleased to announce that the pilot in England has already started. Two clinics went live in the pilot yesterday and others will come on board as soon as they are ready, hopefully over the next few months. There has been a positive and enthusiastic response from clinics invited to participate, and I am grateful to all those working on the ground to make this happen.

My hon. Friend asked how long the pilot will run. It will run during 2016-17 and decisions on next steps will be dependent on the progress and outcome of the pilot.

[Jonathan Lord (Woking) (Con)]

Like other Members, I pay tribute to the leadership on this issue of my hon. Friend the Member for Finchley and Golders Green (Mike Freer) whose work is appreciated across the House.

I have been following the debate very carefully, but it is not clear in my mind how a pilot of MSM will act as some sort of proxy or in any way affect the decision on immunising schoolboys. I do not see how one will inform the other.

[Jane Ellison]

I have not claimed that one is dependent on the other. They are two separate recommendations from the JCVI, and I will explain what is happening with boys. There are many questions about extending the HPV vaccine to boys and I understand the wish for it to be available to all adolescents regardless of gender. The JCVI is reconsidering its initial advice on this and modelling is under way to inform its consideration. Public Health England expects to complete the modelling by early 2017 and the JCVI’s advice is expected to follow soon after that, after which we can respond. We will look at that as a priority when we get it.

We have discussed in this Chamber whether we can speed that up. I recognise the frustration that people have expressed and I have talked personally to Public Health England officials who are involved in the modelling work. It would be a huge programme to roll out to adolescent boys and JCVI needs to base its advice on very robust analysis of cost-effectiveness. To do that, a complex model is being built. I have been assured that this is not about additional resource. I have asked whether it is a case of needing additional resource to speed the work up, but I am assured that it is not. It is because of the complexity of the model development and the fact that some of the models are time-consuming to run. Essentially, they are modelling behaviour over time, and to do that, one needs time in order to be able to understand how different aspects of the model interact with one another. I have been told—I have no reason to doubt this, because I have asked experts involved in it—that shortcuts could undermine the validity of the results and could not be supported by the JCVI. The model is building on the cervical screening model to create an integrated model of both HPV screening and vaccination, so that we get an understanding of what the interplay is between vaccination and screening programmes in the prevention, diagnosis and treatment of HPV.

I am happy to write with more detail to hon. Members, but I hope that I have given them a sense of the fact that this is complex work: it is under way and we will look to respond to it as soon as we can. However, these are important decisions that the JCVI will take and, because the Government have always acted on its recommendations, it is important that it gets them right and they are based on the right data. This is a significant programme, but the work is well under way and I will look to report back to the House at every opportunity I can.

The HPV vaccination programme for girls is going very well, and there is now scope for an additional programme to make a difference to the lives of MSM, which this will. The pilot will provide answers to the questions that we still have and the answers that we need for a programme of this nature—I have hinted at some of the delivery complexities. We expect to see benefits from the pilot emerge relatively soon through the reduction in genital warts cases and through treatment in MSM, particularly by targeting higher risk MSM.

I hope that that updates the House as fully as possible at this stage. As I said, I will be happy to update it in the future on how the pilots are going. I want to end by again congratulating my hon. Friend the Member for Finchley and Golders Green on initiating the debate and on his persistent campaigning, and to reassure and commit to the House my determination to improve the health and wellbeing of MSM and to see this pilot as a significant step forward in that task.

Diabetes-related Complications

Jane Ellison Excerpts

Tuesday 7th June 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. What an excellent debate we have had, and I thank the hon. Member for Dewsbury (Paula Sherriff) for securing it. She is a passionate health campaigner and has made her mark in a very short time in the House. This is the second time I have seen her today, as I gave evidence to the Select Committee on Health this morning. It is excellent to see so many colleagues from both sides of the House in the Chamber today.

Diabetes-related complications are a vital issue and, sitting here, I agreed violently with much of what was said about the scale of the challenge, the need to step up and, indeed, some of the things that we need to do. I hope to use my time, as much as possible, to update the House on practical measures that the NHS and the Government are taking, as well as to hint, where I can, at policy yet to come. There is more to be said later in the summer on some areas. One reason why it is so important to have such debates is to keep up a drumbeat of discussion. One thing I have realised as a Minister is that momentum is a funny thing in politics.

[Mr Jamie Reed]

It certainly is.

[Jane Ellison]

I make no comment. Political momentum is important because it drives change in a way that is hard to pin down. We now have momentum on obesity and diabetes in a way that we did not a few years ago. The level of interest in this House is a good measure of that, so it is vital that we have such debates. It is also a measure of how seriously we take diabetes that we have included reducing diabetes care variation and preventing diabetes in the NHS’s mandate—it is right at the heart of our big asks of NHS England.

Before I continue, I take this opportunity to pay tribute to the many NHS staff who provide invaluable support to patients. Inevitably, in a debate where we are rightly stress-testing the system and asking where we can improve, it is easy to forget that masses of people out there are doing brilliant work. We have heard inspiring words today from two colleagues about their visit to see real specialists in action. Across the country there are people supporting patients with diabetes. There are also excellent third sector organisations such as Diabetes UK, with which we work closely, and JDRF, which does such great work on type 1. They both work with and independently challenge the Government, all with the aim of improving the lives of those with diabetes or at risk of it.

[Paula Sherriff]

Although I appreciate that the Minister undoubtedly has an incredibly busy schedule, I encourage her to contact the diabetes foot clinic at King's College hospital in London to arrange a visit. As my hon. Friend the Member for Heywood and Middleton (Liz McInnes) said, our visit was inspiring. I came away with much knowledge and real hope that we can make improvements.

[Jane Ellison]

I sat here thinking how interesting the visit sounded. My team has made a note of that. We had heard about the visit and how it had gone well, so it is great to hear that first-hand from the hon. Lady.

I will not repeat the shocking facts on diabetes, which have been well rehearsed and explained by Members in this debate, but suffice it to say that the impact is huge. My hon. Friend the Member for St Ives (Derek Thomas) and others have made notable contributions drawing out the human cost of diabetes. People tend not to understand how devastating diabetes can be for patients and families, as well as the cost to the NHS, which in England we estimate to be £5.6 billion a year.

We have to work together to address diabetes. Before I talk about the action we are taking now and the progress we need to make, it is worth noting that we have come a long way. I have discussed that in some detail with our national clinical director, Dr Jonathan Valabhji, over the past year. The progress we have made through the quality and outcomes framework over the past decade has driven a step change in delivering better management and care for people in GP practices. Last year’s National Audit Office report showed that the relative risk of someone with type 1 or type 2 diabetes developing a diabetes-related complication has not changed, and indeed has fallen for most complications, despite the growing number of people with diabetes, so we have made progress. Clearly, the question now is how we can go much further. Diabetes is a key priority for us, and we want to see a measurable difference in the lifetime of this Parliament. There are four main areas in which we are taking action.

[Mr Jamie Reed]

Before the Minister moves on to the progress that is being made—she is right that we have come a long way over the past 10 years—will she undertake that the Department will consider not just the cost to the NHS of all diabetes-related complications, because we have been talking about this from a very NHS-centric point of view, but the cost to the economy of such complications?

[Jane Ellison]

We have been preparing and working on the childhood obesity strategy for some months, and I assure the hon. Gentleman that we have been looking at the wider cost to society and, obviously, projecting that forward, as has been done by many other economies in the developed world. There is an interesting piece by the McKinsey Global Institute on the cost to the developed world.

Specifically in the NHS, and going to the heart of the debate, there are four main areas in which we are taking action that we expect to deliver reductions in complications: reducing variation in the delivery of the three NICE treatment targets for blood pressure, blood glucose and cholesterol control; improving the take-up of structured education; improving foot care; and improving in-patient care. Reducing variation is always a theme of health debates and, frankly, it is a constant challenge in any system. The question is how we drive out variation, and Members have made a good point about how we support people to drive out variation. One of our goals for 2020 is a reduction in such variation in the management and care of people with diabetes.

The newly established CCG improvement and assessment framework has been mentioned by a number of Members. Diabetes is one of the clinical priorities in that framework, which will play a key role in delivering the challenge to variation. The chief executive of Diabetes UK is the chair of the panel of independent experts who are involved in the assurance process for that rating system. Diabetes is high on the IAF agenda. The framework will identify CCGs in need of improvement, and then NHS England will work with those CCGs to identify the nature of the changes needed and the type of support required to facilitate those changes.

To give some idea of the support available, we will be working with CCGs to consider the nature of the tasks they need to address. A key focus will be to help CCGs to map how their services compare with those in similar areas, to help them look at best practice from which they can learn and to introduce specific peer support through other programmes. CCGs will be supported in practical, hands-on ways. As we build the data picture of what is going on, we obviously need to support CCGs as they discover that they have variation, of which they may not even have been fully aware.

There are other areas not covered by the IAF that the Public Health England “Healthier Lives” website addresses. I encourage people to look at the vast amount of publicly available data for their local area. NHS Right Care is an important programme that has reducing variation at its core, and it is there to help CCGs and other partners to make step changes in the way they improve care. It will be very focused on diabetes care, and it has been improving services. It will be rolled out to all CCGs over the next 18 months, with practical support and sharing best practice at its heart.

The hon. Member for Heywood and Middleton (Liz McInnes) and I have discussed structured education, and I share her frustration. Essentially, we know that structured education works and that it is being offered to far more people, but that take-up is low. We cannot keep doing the same thing; we must look at things differently. For example, working people with diabetes straight away pose a challenge involving the amount of time that they can take to attend a course. We want to improve take-up. We know that structured education makes a difference to people’s quality of life and, importantly, reduces their risk of developing complications, but we also know that we are not where we need to be.

It is one of my personal priorities to change that. The Department is working with NHS England and Diabetes UK on ways to improve the take-up of structured education, particularly by considering more diversity of provision through digital and web-based approaches, as well as what can be done to improve access to more traditional forms of support. Again, the improvement and assessment framework includes an indicator for the number of newly diagnosed diabetes patients who attend a course. However, we have to make it possible for CCGs to refer people to a course that they think is likely to be taken up. There is something in why such courses are not commissioned as much as they should be: people are aware of low take-up and it is a vicious circle. We need to address that. Next week, an expert round table is taking place with the national clinical director. It will consider options to update structured education, potentially including working with employers, and practical actions that we can take to overcome barriers. I expect to be able to say more about it in due course.

We regularly discuss improving foot care. Particularly for people with late-stage diabetes, it is a challenge and a threat, for reasons that have been well explained. The number of amputations is unacceptably high, and we want to reduce it. NHS England is working with a number of key stakeholders to publish a new framework to improve the delivery of hospital-based diabetic foot services. The framework makes it clear that all patients with diabetic foot problems should have rapid and equal access to services, and describes for commissioners what key elements are in place that they need to commission. The new national diabetes foot care audit provides data on all diabetic foot care services so they can measure their performance against the NICE clinical guidelines.

I note the concern expressed about the survey and the lack of take-up. NHS England is taking action on the issue of GP participation, but I might ask NHS England to write directly to the hon. Member for Heywood and Middleton to say specifically what it is doing, because I share her concerns about having the fullest possible picture. Again, transparency of information, along with improvement support through initiatives such as Right Care, will drive improvement. Interestingly, the variation on amputations does not follow many of the traditional patterns in terms of the burden of disease that we see in some other areas. We need to be able to examine the information at quite a local level, as support for patients is variable even within local areas, and we must expose that.

On inpatient care, the NHS’s focus is on ensuring that all hospitals have inpatient specialist teams to assess and help to manage inpatients with diabetes. Again, if we get that right, it can lead to a significant reduction in complications.

I will say a few words about prevention, as it is at the heart of any public health Minister’s agenda. Preventing people from developing type 2 diabetes in the first place helps to take them off the conveyor belt that can lead ultimately to complications and all the burden of disease that we have been discussing. At all points along that conveyor belt, there are things that we can and must do, and are doing, to make life better for people with diabetes. For example, I welcome the increasing focus of our major charities on prevention and explaining the role of prevention in fending off some of the most serious diseases from which people suffer.

Healthier You, the NHS diabetes prevention programme, goes to the heart of tackling the rising prevalence of diabetes. Around 90% of adults with diabetes have type 2, and an estimated 80% of cases of type 2 are related to lifestyle; as Members have said, it is a huge factor. The national diabetes prevention programme is, we think, the first at-scale diabetes prevention programme to be delivered anywhere in the world. This year it will refer at least 10,000 people to an evidence-based behaviour change intervention that has been proven through randomised controlled trials to reduce the risk of type 2 diabetes.

I can confirm that the programme will be made available to up to 100,000 people by 2020. I know that there is great interest in it. We are learning from the seven demonstrator sites, which tested different approaches over the past year. Although the nature of the intervention is essentially common, there are different ways to deliver it, and we have learned a great deal. We are taking a phased approach, and the first wave of 27 areas covering 26 million people, or half the population, will open their doors to patients in the next few months and throughout 2016.

We are building up at pace. The interventions offer tailored, personalised help to reduce risk, including education on healthy eating and lifestyle and bespoke physical exercise programmes. If there is one thing that I ask of Members, it is to encourage their constituents to attend their NHS health check when invited to do so, as it is one of the gateways into the national diabetes prevention programme.

Of course, that is only part of a wider public health programme of preventing disease in the first place. Members have mentioned children. It is absolutely right that we should go way upstream to consider what we can do to tackle overweight and obesity in children. We will be launching our childhood obesity strategy in the summer. It will examine everything that contributes to children becoming overweight and obese and set out what can be done by all. We are looking at the entire environment around a child, so everything that Members have said that they hope will be considered as part of the strategy is being considered.

All parts of society, the public health system, Government and local government and industry have a part to play. The soft drinks industry levy announced by the Chancellor in the Budget is an important first step, and it has turbo-charged our discussions on the childhood obesity strategy. Its introduction in 2018 is driving reformulation of product, which every expert identifies as a key way to tackle obesity at population level. That is why there is a delay. I cannot comment in detail, but I assure hon. Members that we care about the same things that they do, and that all are being considered extensively.

[Mr Jamie Reed]

There are approximately 500,000 type 1 diabetics in the UK. Will the Minister undertake to ensure that continuous glucose monitors, flash glucose monitors and other emerging diabetic technologies are made available as a right on the NHS for people with type 1 diabetes?

[Jane Ellison]

Yes, I should say that many of my remarks have addressed type 2 diabetes, but that is not to say in any way that type 1 is less important. I will undertake to write to the hon. Gentleman on that, because there is work going on. As I said, many of my comments have dealt with type 2, but that is not to say that we are not also interested in addressing the challenges of type 1.

I am hugely heartened by the continuing parliamentary interest in this important subject. We will introduce the childhood obesity strategy and I have described all the other work on diabetes. It is good to know that there is so much parliamentary support from all parties for doing more, and particularly on investigating how to prevent diabetes from developing, to ensure that the next generation does not carry the same burden of disease as this one. It is a big challenge, but an unprecedented level of activity is taking place across our health system and the wider public health system, and in government at all levels. I look forward to updating Parliament further.

Question put and agreed to.

Resolved,

That this House has considered diabetes-related complications.

Points of Order

Jane Ellison Excerpts

Tuesday 7th June 2016 Commons Chamber

[Mr Speaker]

It is certainly open to the hon. Gentleman to seek such a debate—there is nothing improper about it—but I know that he would not seek advance agreement from me in respect of an application that has not yet been made, the terms of which therefore cannot be known to me and upon which it would therefore be wholly unreasonable to expect me to adjudicate. Apart from that, his point was all right.

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

It is devolved.

[Mr Speaker]

I also say to the hon. Gentleman that, as the Minister mentioned perfectly properly from a sedentary position, the issue is a devolved matter and can therefore be considered elsewhere, as well, but it is perfectly proper for it to be considered here. There are a range of opportunities for its consideration. The mechanism he mentions is a possible approach; there are also Backbench Business Committee debates, Adjournment debates and debates in the name of the relevant Opposition party. I am sure that the hon. Gentleman is on very good terms with the powers that be in his own party; if they judge it a sufficient priority, they might choose to nominate it as a subject for such a debate. Knowing the Minister as I do, I am sure that she would very courteously come along, if it was her responsibility to do so, to listen to the hon. Gentleman’s sonorous tones and speak as appropriate.

NHS Commissioning (Pre-Exposure Prophylaxis)

Jane Ellison Excerpts

Tuesday 7th June 2016 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

(Urgent Question): To ask the Under-Secretary of State for Health if she will make a statement on NHS commissioning in relation to HIV pre-exposure prophylaxis.

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

I am grateful for the opportunity to respond to this urgent question. As the House knows, HIV can be a devastating illness, and we know that pre-exposure prophylaxis—PrEP—can make a difference to those at risk of contracting HIV and to those who are already HIV positive. However, it is crucial that we have a full understanding of all the issues surrounding PrEP.

As with any new intervention, PrEP must be properly assessed in relation to clinical effectiveness and cost-effectiveness. That is why we have today asked NICE to conduct an evidence review of Truvada for PrEP of HIV in high-risk groups. This evidence review signifies the next step forward and will inform any subsequent decisions about commissioning. It will look at the evidence for effectiveness, safety, patient factors and resource implications. The NICE evidence summary will run alongside a pilot scheme in which we are investing up to £2 million. Public Health England is currently identifying the most effective places for the pilot to take place.

It is also important to remember that Truvada, the drug used for PrEP, is not yet licensed for this use in the UK. That is why, as well as the pilot scheme, the Government want to see the evidence review, which will help to inform future commissioning decisions about PrEP.

PrEP is only one of a range of activities designed to tackle HIV, which is of course a Government priority. It is also important to stress that the challenge remains of tackling high rates of some sexually transmitted infections, particularly in high-risk MSM—men who have sex with men—communities. Our £2.4 million national HIV prevention and sexual health promotion programme gives those at highest risk the best advice to make safer choices about sex.

The UK has world-class treatment services and is already ahead in reaching two of the three UNAIDS goals of ensuring that we have 90% diagnosed infection, 90% of those diagnosed on treatment and 90% viral suppression by 2020. In 2014, 17% of those living with HIV had undiagnosed infection, but 91% of those diagnosed were on treatment, of whom 95% were virally suppressed. We are determined to continue to make real progress to meet these goals, and we are considering carefully the role that PrEP can play in helping us to get there.

[Andrew Gwynne]

I thank the Minister for that reply. This is a subject we do not debate enough in the House, and I am grateful to Mr Speaker for giving us the opportunity to debate it today.

Seventeen people are diagnosed with HIV every day. Each year, there are thousands of new infections. In the UK, there are more people living with HIV than ever before. We know that PrEP has the potential to be a game-changer—it has proved effective in stopping HIV transmission in almost every case—yet as a result of this latest decision, this life-changing drug will remain inaccessible to people at risk of HIV. Does the Minister therefore share my concern about the precedent this decision sets in terms of NHS England shunting other preventive costs on to local government? Will she explain why pre-exposure prophylaxis is being dealt with differently, compared with the correct commissioning model for PEP, or post-exposure prophylaxis?

I want to ask the Minister three specific questions. First, does she accept that, under section 7A of the National Health Service Act 2006—a mechanism by which the Secretary of State can delegate power—the Health Secretary can give NHS England the power to commission PrEP? If so, why has he not done so? Secondly, if the Government expect local authorities to commission PrEP, how much additional funding will the Minister make available to them? Can we assume that there will be no further cuts to public health grants, or is this just a case of passing the responsibility and the financial buck? Thirdly, on the next steps, I understand that key stakeholders, including the National AIDS Trust, have written a joint letter to the Public Health Minister requesting an urgent meeting. Will she today agree to meet them to see whether a way forward can be found without the need for costly, protracted legal action?

PrEP has been described as the beginning of the end for the HIV epidemic. It is time for the Minister to show some leadership, to use the section 7A powers she has and to think again.

[Jane Ellison]

Some of the shadow Minister’s questions are simply ahead of the moment, as it were. As I said clearly in my statement, NHS England has made clear how it feels about being the commissioner, based on a legal argument that it has published. No decision has been made about who the commissioner is. Clearly, we need to reach a decision, and we discussed that earlier today in the Health Committee. However, there are a number of stages we have to go through—as I say, the drug is not even licensed for use as PrEP in the UK.

We have set out a series of stages we will go through, which will help to inform a final decision. On the questions the hon. Gentleman posed, we are not in a position to make a judgment. There is more we need to know about clinical effectiveness and cost-effectiveness and about the pilot—

[Andrew Gwynne]

We know.

[Jane Ellison]

No, that is not the case. There has been an important study—the PROUD study—but that looked at clinical effectiveness. There is a wider piece of work to be done—of which the pilot programme that we have announced is part—to enable us to understand where PrEP fits in in terms of clinical and cost-effectiveness, and how it fits into the HIV prevention landscape more broadly, alongside other HIV interventions that are commissioned. There is work yet to do, but we are not standing still. We have announced this important pilot and committed money to it, and we have asked NICE for an evidence review. All this will go into our consideration.

[Mike Freer (Finchley and Golders Green) (Con)]

I agree with the shadow Minister apart from on one thing, which is his asking my hon. Friend the Minister to show leadership. Having campaigned on many male sexual health issues as chair of the all-party parliamentary group on HIV and AIDS, I can say that this Minister has been unfailingly supportive in addressing many of the issues facing not just men’s sexual health, but particularly gay men’s sexual health. I therefore take issue with that call for leadership.

Having said that, I have lost too many friends to AIDS over the years not to challenge NHS England’s decision not to fund PrEP. HIV infection rates in this country are on the increase and existing strategies are not working. It is not acceptable to suggest that we simply continue to do the same. I have a meeting with the Minister on 13 June. Will she agree to widen that to other stakeholders?

[Jane Ellison]

I thank my hon. Friend for his kind words. I take this issue extremely seriously. He is right to say that we face a challenge in relation to HIV rates, and particularly, as I said, STI rates in the high-risk MSM community. I stress again that while it will no doubt have an important part to play, PrEP is not a silver bullet for sexual infections, particularly in some of those high-risk groups. It is important to understand that. We have to continue to look at a whole range of measures. When I recently met the chief executive of the Terrence Higgins Trust, we touched on this.

As my hon. Friend says, we have a meeting coming up. I apologise for not responding to the shadow Minister’s question about meeting stakeholder groups. Of course I will meet all the key stakeholder groups. I have already had some formal and some informal discussions on this, but of course I am very open to having further such discussions. Stakeholders were involved in the process that NHS England has been involved in. NHS England has made its position clear, and there is a matter due to go before the courts on which I will not comment further. Yes, I will engage on this. Yes, of course I accept that we need to do more, and of course we all share the concerns about rising HIV infection rates, particularly among the MSM community. I too lost friends to the AIDS epidemic that my hon. Friend mentions. I take this issue extremely seriously, but we have to follow a sensible process, and that is what the Government are doing.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Anyone in this House will be glad to see the results of the PROUD study and the 85% reduction in new infections. However, there is more to understand, in that we did not see a good response in heterosexual women. While over 40,000 HIV sufferers in the UK are men who have sex with men, 60,000 are heterosexual or bisexual, predominantly of African origin, and we need to think of them in this regard.

My main complaint is on the failure to go through a process of looking at clinical evidence and cost-effectiveness and then making a decision. Why was the company not encouraged to get through this earlier and go to NICE? I do not understand why we are only going to NICE now, because that gives the answer that we need. It is relatively poor of NHS England to have made the decision on the basis of, “It’s not our job—it’s your job.” That is the most insulting bit for the community. In Scotland, our Cabinet Secretary asked it to go through the European Medicines Agency, which it applied for in February, and then the Scottish Medicines Consortium. It is on the right path now, but that is where we should have gone first.

[Jane Ellison]

It is probably worth clarifying that we asked NICE to undertake an evidence review, not a technology assessment. What drugs are licensed for are matters for drug companies to address. The Government do not initiate the process on whether a drug is licensed— the drug company must initiate it. It also worth noting that when a drug is licensed for a new purpose, as would be the case for Truvada in PrEP, the company could apply for the patent to be extended to cover this new use. Again, that is something that the drug company would do.

On the hon. Lady’s first point, I agree that we need to consider the impact on women in the circumstances she described. That is one of the arguments for carefully planning this pilot programme and taking those sorts of factors into account.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The process that the Minister has outlined is correct, but does she recognise that the French Government have already approved Truvada for pre-exposure prophylaxis, and does she understand the urgency in this? The results of the UK PROUD study, funded by the MRC, are quite unequivocal, so we really need to get this going. Will she also reflect on the fact that the study showed no difference in the incidence of other sexually transmitted diseases, because Truvada does not protect against them, so the message has to go out that a condom is absolutely essential?

[Jane Ellison]

My hon. Friend is quite correct on his latter point about the impact of PrEP. Whether it was commissioned or not, and whoever it was commissioned by, we would still have the significant challenge that he describes around STIs. Drug-resistant gonorrhoea, for example, is a problem that we are increasingly aware of.

There are international comparisons that we can look at, as my hon. Friend mentions. I have looked at the matter in some detail, and the picture across the world is that many countries are in broadly the same position as the UK. They are trying to understand, leaving aside the question of clinical effectiveness, more about how PrEP can be used as part of an HIV prevention programme in broader cost-effectiveness terms, and how it compares in cost-effectiveness terms with other available interventions. My hon. Friend is right that there is work to do, and we are not resting easy on this. We are moving forward, and we are working on and planning these pilots now.

[Mr Ben Bradshaw (Exeter) (Lab)]

When does the Minister expect the damaging buck-passing between NHS England and local authorities, which is one of the disastrous results of the Health and Social Care Act 2012, to be resolved? Does she agree that it would be far more appropriate for NHS England to be the commissioner of something like PrEP than for local government to commission it? Finally, will she be very cognisant of the danger that we are going back to the bad old days when certain groups were stigmatised? Stigma is disastrous for public health policy, and it will result in an explosion of sexual disease in this country if we do not always bear in mind the danger that decisions by NHS England—not just on this, but on drug treatment for hepatitis C —may have a disastrous impact on public health.

[Jane Ellison]

The NHS England position is based on a legal argument, and as the matter is likely to go before the courts, it is not really appropriate for me to comment further. There was a little discussion this morning on this subject in the Health Committee, for which some Members were present. I have laid out a process by which we will work out how and where this is commissioned. Clearly, we need to identify the commissioner.

I do not accept the right hon. Gentleman’s challenge about fragmentation, simply because if we look around the world at a series of very different health systems, we see that they are all going through broadly the same process of understanding where PrEP sits. There are a number of options, but first we need to go through this work. On his latter point about stigma, he is right to identify that it is a significant concern, but I do not accept that that is what this represents. He knows my personal commitment to tackling stigma, and we could not have made it clearer that addressing rising HIV rates, addressing STIs in the MSM community and looking at the challenges surrounding things such as chemsex are all very much front of mind, and we have given considerable time and thought to them. We must challenge stigma wherever it rears its head.

[Mr Philip Hollobone (Kettering) (Con)]

Given the challenges of HIV, I think that my constituents would be excited by the prospects that PrEP offers. They would, however, be a little disturbed by the fact that every country in the world seems to be going through the same process, and duplicating, replicating and holding up what could be a very exciting development to combat the spread of HIV across Africa. Many countries are suffering from this far worse than we are, and they would be horrified by the thought that the process could get bogged down in a court when this treatment, if it were available, could do very real good.

[Jane Ellison]

My hon. Friend is right to recognise that PrEP has potential. It is, in fact, being used in some places internationally. The point I was making was that there is no simple, one-size-fits-all solution. Different countries have different challenges. For example, the level of HIV prevalence and the services available to manage that prevalence, and to manage testing, are very different in different countries. That forms different landscapes into which PrEP might fit. To give an example from Africa, PrEP was licensed last year, and it will be available for sex workers in selected sites. HIV prevalence among female sex workers is estimated to be just under 60% in South Africa. There are different contexts in which PrEP is being taken forward, and that is just one of them.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

Local authorities’ public health budgets are being stretched to breaking point, and this is arguably one of the false economies of this Government’s approach, in terms of its impact. Does the Minister agree that in the context of such stretched budgets, the implication that local authorities should fund PrEP is simply unworkable, and will she make it clear that her position is that NHS England is the natural commissioner of PrEP?

[Jane Ellison]

I have been very clear about NHS England’s position, and I have said that no decision has yet been made about commissioning. I do not accept the hon. Lady’s challenge about spending on public health. We have committed to spend £16 billion over the next five years on the public health grant. In addition to that, we have committed more than £1 billion this year alone in the section 7A agreement and £300 million on vaccines that we buy in the Department of Health, plus system-wide leadership through things such as the sugary drinks levy and the forthcoming childhood obesity strategy. All in all, this is the radical upgrade in prevention that was talked about in the NHS “Five Year Forward View”.

[Ben Howlett (Bath) (Con)]

I join my hon. Friend the Member for Finchley and Golders Green (Mike Freer) in thanking the Minister for her work, and in particular for engaging with the LGBT community. I know that they are quite concerned about last week’s statement by NHS England. Given the disappointing outcome of NHS England’s PrEP review and the fact that we have the worst of all scenarios, which is effectively a legal challenge, will the Minister commit to finding a way round the NHS England decision while a new trial is under way? Does she agree that the accelerated medicines pathway could provide a perfect platform for bypassing the frustrating system that we are talking about?

[Jane Ellison]

I will reflect on the latter point with my hon. Friend the Minister for Life Sciences, who is sitting alongside me. I have made clear the NHS position on commissioning. The measures that I have announced today—the NICE evidence review and the trial that we are planning for, which we will move forward with later in the year—are all part of understanding how we get to the right decision. It is not something on which I will make a snap decision now, but we have set out a process by which we can get to that point.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

As a vice-chair of the all-party group on HIV and AIDS, I share many of the concerns expressed by the chair, the hon. Member for Finchley and Golders Green (Mike Freer). Many people in the LGBT community share our concerns about the current situation. Much as I respect the Minister, I was a little disappointed that she appeared to cast doubt on the efficacy of PrEP. As well as the PROUD study, there have been two other major studies, and 30,000 people are using PrEP in the US. There is clear evidence of its efficacy. Can the Minister give hope to people out there that this is not a political decision or a cost decision? Will she reverse it? Will she use her section 7A powers and take the right decision on this issue?

[Jane Ellison]

We have not made a decision on commissioning yet. We have laid out a pathway. Let me be clear: I completely understand and accept the point about clinical effectiveness. The point I was making was that there are wider considerations about how we commission something in the context of a whole series of HIV prevention services. That is slightly different from clinical effectiveness, on which the PROUD study showed very good results. I am not saying that it is not clinically effective; we just have to understand more about how it sits in the context of everything else that we do, and we have to understand more about its cost-effectiveness. The modelling work that was undertaken indicated that PrEP can be cost-effective for some high-risk groups, but the period over which that cost-effectiveness pays back needs to be more broadly understood.

[Stewart Malcolm McDonald (Glasgow South) (SNP)]

I do not doubt the Minister’s commitment to this issue, but she has to understand how it looks to the outside world. This is a Government who brought forward legislation to ban poppers, for goodness’ sake, but it looks as though they have got their head in the sand over PrEP. Israel, Kenya, Canada, France and the United States all get it. Why are we so far behind?

[Jane Ellison]

The first point is a red herring, because I understand that the matter has been resolved. I do not accept the hon. Gentleman’s criticism. It is slightly disappointing, although I understand the reason for it in the context of this urgent question, that Members are forgetting that the UK has a world-leading position on HIV treatment in all the ways that I laid out in my response to the urgent question. Our movement towards the UNAIDS goals is very significant, so to say that the UK is somehow not a leader in HIV treatment and prevention is not right. We have clearly acknowledged that PrEP has a role to play, but we need to understand more about what that is.

[Chris Elmore (Ogmore) (Lab/Co-op)]

Will the Minister clarify her previous answer in which she said that she is putting aside the clinical significance of this? I find it quite confusing that she can do that. Does she agree that although the UK has been a leader in HIV prevention for decades, our progress is under threat because of her decision? Will she now think again?

[Jane Ellison]

Not for the first time, may I clarify that no decision has been made about the commissioning of PrEP? I am therefore not sure why the hon. Gentleman would say that. I have been very clear about the clinical effectiveness. What I am saying is that there is more work to do to understand the wider cost-effectiveness of this in the context of the commissioning of HIV prevention more broadly.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

My constituency falls wholly within the borough of Southwark, which has the second highest HIV prevalence in the country. What assessment are the Minister and the Department making of the potential impact of this policy change not only on my constituents, but on the long-term costs for the NHS if PrEP is not available?

[Jane Ellison]

There is no policy change and I have laid out the position. It is important to understand that even in the modelling work that has been done, PrEP is not a silver bullet. It has an important part to play, but it is not a silver bullet in terms of HIV prevention and it does not affect some of the broader issues that I mentioned in my response, for example in respect of STIs.

[Greg Mulholland (Leeds North West) (LD)]

This is another example of the over-cluttered, over-bureaucratic and confused system for approving drugs in this country. May I draw the Minister’s attention to the fact that NHS England promised £2 million to allow 500 people to be treated in this way? Does she understand people’s dismay that it is now passing the buck and saying that it is down to local authorities, which we all know are incredibly cash-strapped?

[Jane Ellison]

The NHS is seeking clarity through the courts on its own position. No decision has been made about who will be the final commissioner for PrEP, so what the hon. Gentleman said is not quite right. The £2 million that has been committed to the pilot is important and will inform our understanding of this important intervention.

[Fiona Mactaggart (Slough) (Lab)]

Slough has an extraordinarily high incidence of HIV and AIDS, much of it undiagnosed. Our local authority is the smallest unitary authority in the country and has faced cuts to its central Government funding of 50%. It has no prospect of being able to fund a challenge of this size. Does the Minister understand that this delay in sorting out who will pay for PrEP will lead to the deaths of hundreds of people in Britain?

[Jane Ellison]

As I have mentioned, Truvada is not yet licensed for use as PrEP in this country. We have set out a process by which we can understand far more about how PrEP might fit into the landscape. The right hon. Lady mentioned undetected HIV. The Government have invested significant effort and funding into detecting HIV. We have the world’s first home testing service and last year we launched the major HIV innovation fund, which has come up with some new and extremely cutting-edge ideas on how to improve HIV detection and diagnosis. I fully accept that this is a major challenge in her area, but PrEP is only one part of a wider programme of work. [Interruption.]

[Mr Speaker]

I think his Whips are pleased to see the arrival of the right hon. Member for South Holland and The Deepings (Mr Hayes). He has never knowingly been keen to be hurried on anything.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister clarify the timescale for the decisions? Evidence reviews and trials can take months and years, but clearly, as other Members have said, people do not have months and years. Will she tell us what the process and the timescales will be, so that we can be reassured—or not?

[Jane Ellison]

We would expect to get the evidence review that we have called for in the autumn. NHS England is already working on plans for the pilot programme, which will happen over a two-year period. We hope to get that under way towards the end of this year. Both those pieces of work are under way. We expect the pilots to be informed by the review, hence we want to get it back in a relatively short time.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I am flabbergasted that the Minister has come before the House today to say that the legislation that her Government introduced on the reorganisation of the NHS was so incompetent that NHS England is having to go to court to work out who is entitled to commission these services. Can she tell us how much public money will be spent on the legal case?

[Jane Ellison]

I am not in a position to comment on that. I do not accept the hon. Lady’s central criticism. If she had been present at the Health Committee this morning, she would have heard an hour of evidence from myself, Duncan Selbie and Simon Stevens on how the new arrangements are making a significant difference to public health in this country and to the health of the public.

Excess Winter Deaths

Jane Ellison Excerpts

Monday 6th June 2016 Commons Chamber

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

I congratulate the hon. Member for Barnsley Central (Dan Jarvis) on securing the debate. As he says, this is an important issue, and I appreciate his consistent interest in it. I hope I have responses to some of the points he made, but equally, I am happy at the outset to accept his challenge and give the issue more thought, and to make this an ongoing dialogue, because, as he said, this is an important issue.

The causes of excess winter deaths are complex; I will try to draw out a little bit of that complexity in my remarks. They are linked to various factors, including, as the hon. Gentleman said, the impact of cold temperatures on the body leading to issues such as heart attacks. Circulating infections such as the flu are also significant, particularly in winter. I will look at that in a bit more detail. The Government have put in place a range of measures to address those issues and ensure that we protect the most vulnerable, including by providing financial support to keep homes warm and by working to keep people well and out of hospital.

The hon. Gentleman made a good point about the need for more cross-Government work on the issue. I agree that there is always room for closer working between Departments. He also rightly draws on the fact that there is often close working between departments at a local government level. In fact, just this evening, as I was preparing for this debate, one of my colleagues from Cornwall, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), told me that the very bodies that the hon. Gentleman has listed—all the different health bodies and initiatives—are brought together in her local area to form that combined plan. [Interruption.] My hon. Friend the Member for Hexham (Guy Opperman) says from a sedentary position that the same thing is happening in Northumberland. There is some excellent local practice. As we head towards even more local powers and devolution, it is important to say that, for those local areas that can do that really well, it is probably the single most important thing that they can do.

As a Health Minister, I will focus a little bit more on the health points, but I give the hon. Member for Barnsley Central an undertaking that we will take up those questions of his that it would be more appropriate for the Department of Energy and Climate Change to answer, and we will make sure that he gets a response.

Let me return to the flu. I want to address the hon. Gentleman’s point about the high number of excess winter deaths in 2014-15. The principal reason that excess mortality was higher that winter than in previous seasons is that the main strain of flu circulating in 2014-15, which was AH3N2, was one to which older people were particularly vulnerable. Flu affects different groups of people in different years. For example, the strain circulating in the season just gone, namely 2015-16, had more impact on children and younger people. The impact of the 2014-15 strain on older people unfortunately resulted in a large number of flu outbreaks in care homes, and higher than expected numbers of admissions to hospital and intensive care for flu. Cold snaps and other respiratory infections may also have contributed to an increase in excess mortality. The situation was not unique to the UK; 14 other European countries also reported an increase in excess mortality due to the same circulating strain of flu.

The hon. Gentleman will recall, I am sure, media reports on the effectiveness of the 2014-15 flu vaccine. There is a complex system behind understanding what goes into the vaccine, and there is a long lead time in preparing it in the required quantities. It is based on the World Health Organisation’s analysis of the circulating strains, but occasionally, for technical reasons, we do not get the match we are looking for. Although the interim mid-season figures caused concern, I am pleased to report that the final findings showed that the vaccine provided some protection against the primary strain, and good protection against the B strain that circulated later in the season. Nevertheless, it was a very difficult strain of the flu that affected older people in particular. Initial findings indicate that the vaccine for the season just gone, namely 2015-16, was well matched to the predominant circulating strain.

Vaccination remains the best protection against flu. The seasonal flu vaccination is offered free of charge to those people in whom flu can be more serious and even fatal. I urge those Members present to encourage their constituents—I am sure that the hon. Gentleman does this—to get the free vaccines. Despite the fact that they are free and that a lot of effort goes into promoting people’s eligibility, it is surprising that there is still a large number of people who do not take advantage of them. It is something with which we ask constituency Members to assist. I have always felt that our surgeries, where we may see some of the most vulnerable members of our community, give us an opportunity to do that. I am always looking for ways to promote this through Members of the House.

In September 2013, we rolled out a new programme offering children flu vaccination. This programme aims to protect children and reduce the transmission of infection in the wider population. We know that the programme works, because it reduced flu levels among children who received the vaccine and among the wider community. It is important to explain that this is why we focus on children so much. In 2014-15, GP consultations for flu-like illnesses were 59% lower in the pilot areas where the vaccine was offered to primary school children than in other areas. Those results are important, and they demonstrate why the child flu programme is essential to protect not only children but the whole community. Some commissioners refer to small children as “super-spreaders”; older members of their family and of the community are especially vulnerable.

I turn to the cold weather plan, which is at the core of what the hon. Gentleman called for. As he is aware, in addition to the flu programme, Public Health England annually publishes a cold weather plan for England, which is a collaboration between the Department of Health, NHS England and the Local Government Association. That plan provides guidance on how to keep warm in the winter and information on where support is available. That is underpinned by a cold weather alert service provided by the Met Office. The plan is aligned with additional guidance from the National Institute for Health and Care Excellence on reducing excess winter mortality and morbidity and the health risks associated with cold homes. We are trying to draw together all the key strands of the health system and local government.

Those most at risk of excess deaths include the elderly, those with long-term and severe illness and young children. To protect those who are most vulnerable, NHS England and PHE last winter ran an integrated marketing campaign, “Stay Well This Winter”. The campaign encouraged people particularly at risk of being admitted to hospital during the winter to take actions to help them stay well. Those actions included: getting a flu jab, keeping houses warm, seeking advice from a pharmacist at the first sign of feeling unwell, getting prescriptions before the Christmas period and taking prescribed medicine as directed.

We targeted the campaign at helping those with long-term health conditions. Last year, we enlisted charities that cater for people with particular conditions, because a lot of people with long-term health conditions do not realise that they are eligible for that free support. We also targeted those aged 65 or over, pregnant women and parents of under-fives. We had very positive feedback from the campaign, in the light of which we are planning to run it again this winter for a longer period.

I turn to the issue of cold homes, which the hon. Gentleman focused on to a large extent, and to the Government’s work to reduce the number of cold homes, as he rightly challenges us to do. There must be more that we can do, and it is vital to keep asking ourselves what more can be done. There has been significant progress, although too many homes are cold in the winter months, and excess winter deaths in the coldest quarter of homes are almost three times as high as in the warmest quarter. To address this, the Department of Energy and Climate Change has published a fuel poverty strategy for England with clear targets to improve housing. The Government have also made grants and sources of advice available to help people to make their homes more energy-efficient, which can improve home heating as well as helping with bills. For example, the warm home discount provides a one-off £140 discount on electricity bills for 2 million households, including 1.3 million of the poorest pensioners. The extension of the warm home discount to 2020-21 will help households who are at most risk of fuel poverty with their energy bills.

The Government also dedicate £2 billion a year to helping pensioners with their energy bills, which means that some of the most vulnerable in our society each receive up to £300 every winter. On top of that, we are ensuring that the poorest in our society get £140 off their energy bills every year, and we are requiring energy companies to help us to make 1 million homes warmer by 2020. I heard the challenge from my hon. Friend the Member for Cheltenham (Alex Chalk) to energy companies to do more, and he is quite right to make that challenge. There is more that can be done all round on this.

Last year, we invested £1 million in nine existing local schemes through the fuel poverty and health booster fund. That is about ensuring that people who are ill as a result of living in a cold home can get something done about the root cause of their illness. In addition, the Department of Health has introduced indicators for excess winter deaths and fuel poverty in the public health outcomes framework. That is what brings all those strands together at local government level to make sure that local authorities have a view of the whole system, and they are judged on that plan.

The hon. Member for Barnsley Central was right to praise his constituency for some of its initiatives. I am always happy to praise Barnsley. He may know that I stood for election in Barnsley twice, in 1996 and 1997, and I have extremely fond memories of it. He drew attention to the issues facing people in his constituency. I know that the council, together with local partners, has a range of programmes in place to help improve home energy efficiency and reduce fuel poverty. For example, a consortium that includes the district council—he referred to the consortium in his speech—received a Government central heating fund grant totalling £1,763,775. As he said, the money will be used to provide first-time central heating systems for up to 150 properties that are in fuel poverty. Barnsley Council is also running a warm homes campaign, which provides energy efficiency and fuel poverty training for front-line staff who are in contact with vulnerable people.

I know from work in my constituency that the most vulnerable people are often those who really need somebody to talk to them and guide them through the process. None of us, whether we are Ministers or Members of the House, would say that dealing with complex energy matters is the easiest thing to do. The Government want to make it easier, but there is no doubt that training to enable front-line staff to hand-hold people through the process, particularly if they are vulnerable, is really important.

I hope that I have given the hon. Gentleman some sense of the things that are going on. We are continuing to invest time and effort in learning, through an iterative process, about what has worked previously. I stress the fact that we were particularly affected by that strain of flu and the nature of the vaccine’s match to it, and it was not only the UK that was affected in that way. Nevertheless, I take his central point that we must all look at what more we can do to bear down on this problem. I am very happy to take away the points that he raised, and to bring them up with ministerial colleagues with responsibility for energy. I am sure that he will return to this subject, and I am happy to discuss it further with him outside the House and, no doubt, at some point in the future, on the Floor of the House again. I thank him for bringing this vital topic to the House’s attention this evening, and I thank all colleagues who have stayed for this late but important debate.

Question put and agreed to.

HPV Vaccination

Jane Ellison Excerpts

Thursday 26th May 2016 Written Statements

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

I am today announcing that a human papillomavirus (HPV) vaccination pilot for men who have sex with men (MSM) will start this June.

Since 2008, an HPV vaccination programme for girls has been delivered to help prevent cervical cancer, which also confers a benefit for many boys over the life course.

HPV infection is also associated with ano-genital and oral cancers, and genital warts. In November 2015, the Joint Committee on Vaccination and Immunisation (JCVI) advised that a HPV vaccination programme should be introduced for MSM aged up to 45 years who attend genitourinary medicine (GUM) and HIV clinics, subject to procurement of the HPV vaccine and delivery of the programme at a cost-effective price.

Through this pilot, the HPV vaccine will be offered during existing appointments at selected GUM and HIV clinics in England to test delivery in these settings. Public Health England is in the process of agreeing which GUM and HIV clinics will take part in the pilot. A full roll-out of an HPV vaccination programme for men who have sex with men will be dependent on the progress and outcome of the pilot.

[HCWS17]