Surrogacy

Jane Ellison Excerpts

Tuesday 14th October 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Edward. We have had a thoughtful debate, which is no surprise given the expertise of my hon. Friend the Member for Erewash (Jessica Lee). I thank her for raising this important subject, and other hon. Members and the shadow Minister for their speeches. This occasion makes me even sadder that my hon. Friend is leaving Parliament at the general election; it is an ample illustration of the fact that Parliament’s loss will be the family Bar’s gain. My hon. Friend has shown that she is good and knowledgeable lawyer, and I am conscious that I am not a lawyer of any description, let alone a good one. I hope that she will therefore understand that I may want to respond on some of the more complex legal issues after the debate. There is a significant cross-Government interest in the area, with some issues falling within the Home Office’s area of responsibility, and others in that of the Ministry of Justice.

Surrogacy is, obviously, an emotive issue, and it is good that we have had such a calm debate. It is recognised by all that it is not an easy area in which to make progress, but a case has been made that the time has come to examine it, not least because of the complexity of the international situation. My comments are partly about where we may begin to direct our attention, and to caution against the idea that it will be easy to make significant progress, particularly internationally. A cursory look at the different regimes in the world, and at different countries’ approaches, would give rise to caution.

Surrogacy is a way forward for couples who, for any of a range of reasons, cannot have their own children. Hon. Members have made the point that these days new families can be formed that we would not even have thought about a few decades ago. Happily, new and different shapes of family are emerging all the time, and the issue will become more relevant, more rapidly, to more people than we perhaps anticipated 20 years ago. We always recommend that ideally surrogacy should take place in the UK, with sound legal advice and the use of licensed premises, for all the reasons that have been shown in the debate. However, we recognise that that will not always happen and that, for some individuals and couples, achieving a much-wanted family will involve going abroad and taking one of a range of approaches.

The law is aimed at striking a balance in protecting the rights of the surrogate mother and her family, the child and the commissioning couple. The overall aim is the safeguarding of the child’s welfare, which should be kept as a paramount consideration. There is consensus about that, I think. The two ways in which that happens in the UK legal framework are by criminalising commercial surrogacy and by facilitating the transfer of legal parenthood to the natural commissioning parents. My hon. Friend the Member for Erewash is right to say that that sometimes proves difficult.

The Surrogacy Arrangements Act 1985 makes commercial surrogacy, including negotiating and advertising for surrogacy, a criminal offence, although individuals and not-for-profit organisations can make those arrangements without offending under the Act. However, as my hon. Friend pointed out, a surrogacy arrangement is not legally enforceable, and any prosecution requires the relevant consent of the Director of Public Prosecutions. For those parents who use their own sperm and/or eggs in a surrogacy arrangement, sections 54 to 55 of the Human Fertilisation and Embryology Act 2008 enable legal parenthood to be transferred to the commissioning parents by way of a parental order and the rights of the surrogate and any husband or partner of hers to be extinguished for ever. Section 54 sets out the criteria that must be fulfilled for a couple to apply for a parental order. Recent cases that have been mentioned show how the courts have interpreted the legislation to ensure that the long-term welfare needs of the children are met. The Government, like my hon. Friend, are still reflecting on the interesting order made in a recent judgment. I understand that the judge returned to the parliamentary debates on the legislation before issuing the judgment that Parliament did not intend that going one day over the limit should prove such a barrier.

International surrogacy is an even more difficult matter, as the debate has showed. We are well aware that some UK couples choose to travel abroad for surrogacy, and the reasons why that trend is likely to accelerate—and probably already has done in recent years—have been explained. However, fundamental issues arise for the family and child when they return to the UK. The law does not provide for the automatic recognition of an overseas surrogacy arrangement, and as we have heard, there is no international agreement on surrogacy arrangements, or harmonisation of the law and practices on surrogacy overseas. We would take the welfare of the child to be paramount. The Government have an obligation to protect children from abduction or trafficking and not to seem to sanction any situation or arrangements that might too easily tip into that. We must proceed cautiously.

The UK legislative framework for surrogacy has some international application, in the sense that a surrogate for the purposes of obtaining a parental order is defined as a woman anywhere in the UK or elsewhere. Applicants for a parental order need only be domiciled in the UK—not habitually resident here. However, as my hon. Friend the Member for Erewash pointed out, there is no harmonisation of that.

At the 2014 general affairs council meeting of The Hague conference on private international law, member states considered issues to do with legal parentage, the legal status of children and international surrogacy. In view of the sensitivity of these matters, the conference agreed at its meeting in March 2015 to make a decision on the feasibility of undertaking further work in these areas. The Hague conference is probably the best placed international body to consider what is achievable, but it should be noted that there is considerable divergence in the attitude and approach of different countries. I suspect that this is not something on which the World Health Organisation would take the lead, as the shadow Minister suggested it should, but we will look at the matter to see whether that is the case. Our feeling is that The Hague conference is more likely to make progress in this area, not least because I understand that it made progress on adoption.

We do not have precise figures on exactly how many people who are domiciled in the UK or are British citizens use surrogacy services at home or abroad, nor how many go on to apply for a parental order. There is no obligation to obtain a parental order, but people in the UK are clearly advised and encouraged to do so to achieve a recognisable transfer of parenthood. That order provides legal certainty for the commissioning parents and the child, and there are clearly psychological benefits in linking the child’s identity with that of his or her parents. There are also practical reasons—some were illustrated by hon. Members today—for ensuring that those caring for the child are able to do so legally without recourse to surrogate parents.

When an application for a parental order has been made, the Children and Family Court Advisory and Support Service is asked to report to and advise the court on the desirability of granting the order. I am advised by Ministry of Justice that 675 parental order applications were made to the court in England and Wales in 2013-14 and that 302 applications were made in the first two quarters of 2014. However, as many hon. Members have said, including my hon. Friend the Member for Erewash, anecdotal evidence, which we accept, suggests that many more surrogate arrangements take place. That illustrates that we can do more work to emphasise to all commissioning parents the benefits of a parental order.

As my hon. Friend described, surrogacy is evolving. I accept that she feels strongly—she made the case eloquently—that it should evolve much more quickly and that the time has come for proper momentum in looking at some of the provisions. We are considering the implications of recent judgments and the various issues that cross Departments. We are evaluating these matters while reflecting on our approach to surrogacy more generally. The Department of Health is working with other Departments that are involved with international surrogacy issues and is looking at ways to improve the information and guidance available to potential commissioning parents, so that they are fully aware of the processes involved, the potential pitfalls during their journey and the benefits of good legal advice, and not just from my hon. Friend. I note her generosity in providing support to another hon. Member in that regard.

As we have heard, there are pitfalls in the difficult journey to much-wanted parenthood and there are benefits to parental orders. That has been amply illustrated, which has been helpful for me because I have not previously responded to a debate on this subject during this Parliament. It is good that we have had this chance to hear about individual cases, which hon. Members know often illustrate a wider legal point more movingly and resonantly that just looking at the principle of the law.

The Government have no plans to make the commercialisation of surrogacy lawful in the UK; I do not believe that would have the support of the majority of people in this country. I do not believe there is agreement within the surrogacy stakeholder community about the approach to take in that regard.

My hon. Friend raised the issue of pre-birth contracts and immediate birth certificates for commissioning parents. That would amount to pre-birth provisions and would go further than any UK Government—and, probably, the majority of other countries’ Governments—have felt comfortable with going. I recognise that in the past people have been cautious and a little concerned about creating a commercial framework for surrogate babies while reducing the scope to consider the child’s welfare. My hon. Friend made the case thoroughly, and we will reflect on that and the fact that she and other hon. Members believe that it is possible to exaggerate the concerns and to get the balance between the some of the benefits wrong.

My hon. Friend suggested that the Government should introduce some form of regulation into the sector. That would, of course, involve significant changes in the law and would give rise to many questions to consider. Today’s debate has given us plenty to reflect on, not least the point that we all want to safeguard the rights and future welfare of children born under these arrangements.

Surrogacy is highly complex, and I suspect that in a wider debate outside this calm debating Chamber it would be slightly more contentious. It is an evolving area that society requires to evolve quickly, both legally and ethically. The current legislation seeks to strike the difficult balance between what is right for parents and children, but hon. Members have made the case today that they do not believe that that balance is being achieved, and I hear that. We recognise that there is scope for improving information—we could perhaps do that more quickly than changing the law for those considering surrogacy to clarify the position and to ensure that the child’s welfare is safeguarded.

Bringing this important matter to the attention of the House and my hon. Friend’s expertise show that there is a case for looking more widely at it and for opening a wider dialogue. I shall be interested to hear the responses she receives after this debate. People with a particular interest in a matter often cannot attend our debates, but may express a view afterwards. I shall be interested to hear about the interest in the debate throughout the House. It is obvious from the shadow Minister’s response that there is a cross-party appetite for looking at the matter and a feeling that we must ensure that our laws reflect the modern world. That is on the record and noted.

I mentioned the cross-Government working group on surrogacy. Perhaps the next step following this debate is to invite my hon. Friend the Member for Erewash to address that group and to make her points to it. I would be happy to facilitate that and afterwards to see where the debate and evolving discussion might go. She has made her case eloquently, and I thank her for that.

Foetal Alcohol Syndrome

Jane Ellison Excerpts

Tuesday 14th October 2014 Westminster Hall

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

I thank all hon. Members who have spoken during this thoughtful and sometimes passionate debate. Many hon. Members have pursued the issue over many years. The time available is not too bad, but I will not be able to respond to every point, and if I fail to respond to a specific point, I will do my best to do so to hon. Members after the debate.

I congratulate the hon. Member for Sefton Central (Bill Esterson) on securing this debate. It comes at an auspicious moment, because I understand that the National Organisation for Foetal Alcohol Syndrome UK is holding its conference today. The hon. Member for Luton North (Kelvin Hopkins) is passionate about the subject, but I take issue with his description of direct responsibility. Absenting personal responsibility for one’s body, and the life of one’s unborn child, is wrong. I am not saying that the Government do not have a huge responsibility to society at large to provide education, but to talk about direct responsibility is to miss the point that we want all adults to take responsibility for their health and that of their unborn children.

[Kelvin Hopkins]

The fact is that other countries have taken that responsibility and acted, and they are ahead of us. We have more babies being damaged than they do. There is a responsibility on the Government—not necessarily on individual Ministers, but on the Government in general. That applies to both Labour and Conservative Governments.

[Jane Ellison]

I am absolutely comfortable with the fact that Governments have responsibility, and I will try to address some of the points that have been made. My point to the hon. Gentleman is simply that encouraging personal responsibility in any individual for their own health and particularly that of their unborn child is vital throughout life, not just during pregnancy. I put it on the record that we must encourage people to take responsibility for themselves. Let me mention an example given in the debate. Everyone knows about smoking. No one would knowingly damage their own child, and the damage that smoking can do is well known, but the most recent figures I have seen show that smoking in pregnancy varies throughout the country from 0.5% in one borough to more than 26% or 27% in other places. Even when people know about the damage being done, they do not always change their behaviour. We must always put personal responsibility in the frame.

The majority of people who drink alcohol do so responsibly, but it has been amply illustrated during this debate that too many women are unaware of the health risks. More generally, too many people are unaware of the health risks associated with drinking too much. It is important to remember that throughout the debate. Understanding what is a healthy level of alcohol to consume is vital because, as has been said, not everyone knows when they are pregnant. We understand that around 50% of people do not plan their pregnancy, so encouraging a healthy intake of alcohol and understanding the harm that it may do if taken in the wrong quantity is important. There are encouraging signs among the younger generation of a dramatic drop in smoking and drinking during the past 10 years, which is encouraging.

The focus today is on foetal alcohol syndrome and foetal alcohol spectrum disorders. Some hon. Members described facial abnormalities and a range of other conditions associated with alcohol exposure by the mother. Although there is wide international agreement on the diagnostic criteria for foetal alcohol syndrome, the criteria for diagnosis of foetal alcohol spectrum disorders are less clear, although other hon. Members have cited various pieces of academic research. For both disorders, the diagnostic features may not be clear until later in childhood, so yes, we do struggle with diagnosis and with accurate prevalence data. Prevalence figures for FAS are not routinely collected or recorded by the British Paediatric Surveillance Unit, although hon. Members might be interested to know that the World Health Organisation is leading a review on agreeing common diagnostic criteria to measure prevalence better internationally in future. That would be very welcome, and we are lending expertise to that review. There are limits on some of the data, even though we hope that they can be improved.

On advice and prevention, let me talk about what Public Health England does. Its Start4Life campaign provides advice to pregnant women on establishing healthy habits to give their children the best start in life and to reduce the risk of poor health in future. One of the key behaviours covered in the campaign is focused on the consumption of alcohol and why it is best avoided in pregnancy. It promotes alternatives to alcoholic drinks during pregnancy and emphasises the negative impact that alcohol consumption can have.

In May 2012, we launched the NHS Start4Life information service for parents. That is a digital service that enables parents-to-be and new parents to sign up to receive regular free e-mails, videos and SMS messages offering high-quality NHS advice and information based on the stage of pregnancy and the age of the child. The service also signposts parents to other information about parenting, relationship support and benefits advice. Parents-to-be are encouraged to sign up to the information service for parents during their early contacts with health professionals. The take-up target was exceeded two years early, with 385,000 parents signed up to the service as of the end of last week.

Advice on alcohol consumption and other health issues during pregnancy is also routinely provided by health visitors, midwives and GPs. I think it is a fair challenge—

[Kelvin Hopkins]

Will the Minister give way?

[Jane Ellison]

Let me respond to this point. I think it is a fair challenge to say that not everyone is administering that advice and that we can do more. A piece of work is going on to educate thousands more doctors about that, and a good question hon. Members can ask health leaders, when they meet them in their area, is “Are people routinely challenged, and is there a sense of concern in terms of talking about these issues?”, as has been voiced during the debate.

I turn to the National Institute for Health and Care Excellence, which publishes clinical guidance that includes recommendations for doctors and midwives on the advice that they should give. As we know, the NICE antenatal guidance, which was published in 2008, gives further advice. I accept the point that there may seem to be some confusion. In my understanding, the honest truth—I have done a number of debates and questions on this, and queried it quite heavily—is that the reason for the mix of guidance is that there is a mixed clinical view. There is not a settled clinical view in all these areas, but work is under way.

In 2007, the chief medical officer for England published revised guidance on alcohol consumption during pregnancy. The advice is that women who are pregnant or trying to conceive should avoid alcohol altogether—in other words, adopt the precautionary principle. The CMO is overseeing a UK-wide review of all alcohol guidelines, so that people can make better informed choices. That review is under way and I can assure hon. Members that it will take into account any relevant new evidence since the guidelines were last published. I am aware that in some cases, experts have, over recent years, started to change their view, moving from a view about a lower-alcohol intake to one about a no-alcohol intake. All that emerging evidence will be put into the review.

[Kelvin Hopkins]

Will the Minister give way?

[Jane Ellison]

I am very conscious of time, so I give way very briefly.

[Kelvin Hopkins]

I am interested in what the Minister is saying, but what is wrong with requiring all drink containers to have a health warning, as they do in America, Canada and elsewhere? What is the problem with requiring notices in every doctor’s surgery and every antenatal clinic that say: “Do not drink alcohol for fear of causing birth defects to your baby.”?

[Jane Ellison]

One of those challenges was touched on by the hon. Member for Sefton Central: there is some concern that a message that did not have clinical consensus behind it might cause undue alarm to somebody, bearing in mind the statistic, which has been quoted in the debate and which we believe to be true, that 50% of people do not plan their pregnancy. There is some concern about that. I accept the point that the hon. Member for Luton North makes—I think one hon. Member said that scare tactics should be used—but nevertheless that is a significant factor in considering this issue.

Let me finish off the point on the CMO’s review, because it is important and I am inevitably not going to get through all the points that I would like to make. That will be an evidence-led approach, considering whether current advice needs to be revised, and it is for people at all stages of their life, not just in pregnancy.

The reason why we need the consensus view and to get agreed guidelines—I see hon. Members shaking their heads, but I have to tell them that in so many areas of my life as Minister with responsibility for public health, somebody will say one thing in the newspapers in the morning, and by afternoon, experts will be all over every news channel disagreeing with it. We need to try to get, wherever possible, a consistent message, and that is exactly what the CMO-led review is undertaking to do.

[Bill Esterson]

Will the Minister give way?

[Jane Ellison]

I will not, I am afraid, because I have given way twice and I have four minutes left. [Interruption.] All right, then.

[Bill Esterson]

May I just urge the Minister to look at what I and other Members have said about Canada, the United States and France, where there is labelling? Canada especially cannot believe that we are not taking this action. I urge her to speed up her look at the evidence and the research. Other countries are doing this, so why can we not?

--- Later in debate ---

[Jane Ellison]

The review is not my review. The review is being led by the chief medical officer together with—

[Bill Esterson]

But you are the Minister.

[Jane Ellison]

Indeed, and I will pass on the message that Members would like to see the review speeded up. It has a whole range of the right experts on it, and I will undertake to supply to the review, in evidence, the Hansard of this debate, so that those hon. Members who have cited other research and made very forceful points can feel that those are being taken into account. The CMO’s guidance about avoiding alcohol while pregnant or trying to conceive is the message that we advise to be carried by our producers. If I can, I will come briefly to that point. However, I will undertake to ensure that the message is passed on to that expert review.

I have touched on some of the health professionals who are being trained. By 2018, around 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems—that picks up some of the points about pregnancy.

The hon. Member for Huddersfield (Mr Sheerman) and others—including the hon. Member for Sefton Central—mentioned the US model for early intervention; I think he was talking about the family nurse partnership, which we have adopted here. The family nurse partnership provides dedicated one-to-one support for young, at-risk, first-time mothers, and that will be expanded to 16,000 places by 2015. It is really important to make the point that although sometimes it is not possible to educate people for a first pregnancy, we can pick up second pregnancies. Although teenage pregnancy is at a 40-year low, the family nurse partnership is a very important programme based on an American model that has a very strong evidence base.

I will touch briefly on labelling in the bit of time I have left. We feel that the industry has a big part to play, and we are pushing it hard. We got an agreement from 92 companies, which committed to displaying warnings on drinking in pregnancy on 80% of bottles and cans by the end of last year. Subject to publication of the final independent market survey, we believe that just under 80% of bottles and cans had that information, and the warning is the CMO’s advice. Companies can either have a picture struck through of a pregnant women or carry the CMO’s advice, which is that women who are pregnant or trying to conceive should avoid alcohol altogether. There was some concern that that was not the message we were using, but that is the one that people who have signed up to the responsibility deal are using. We believe that is now getting more widespread market coverage. However, there is more that industry can do, and we are pushing them hard.

One thing that we could do is around duty. Personally, I would love to see the ability to vary the duty by alcohol content in wine, but it is difficult in an EU context. I do not quite know—I have never really had the answer to this—how the French managed to pass their law without suffering EU infraction, but I continue to ask the question and look into that. It is something that we are pushing to be able to do, because we want to see those warnings on as much alcohol as possible. My current understanding is that doing this through the EU would be a very lengthy process, because of the need to get that consensus.

In the 30 seconds I have left, I apologise to those Members whose points I could not respond to, but so many points have been raised. I will reflect further on what has been said in the debate and speak to the chief medical officer about it. I welcome the opportunity we have had in this debate to reinforce some of those points. There is an opportunity, when the revised guidelines are issued next year, really to put some information behind them. I am seeing the head of social marketing campaigns for Public Health England imminently—within the next week—and I undertake to have a preliminary conversation about what might be done, when the new guidelines are issued, to reinforce this very important message.

Informal Health Council

Jane Ellison Excerpts

Monday 13th October 2014 Written Statements

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

EU Health Ministers met in Milan on 22 and 23 September The UK was represented by a senior official from the Department of Health. The agenda included discussions on therapeutic innovation for patients’ benefit, the Ebola outbreak and the European Union’s response, cancer prevention and pharmaceutical policy in the commission.

The meeting began with a discussion on therapeutic innovation for the benefit of patients, led by the Italian presidency. The discussion encompassed a broad range of issues including the increasing interaction between industry, patients, prescribers and regulators, the need for greater transparency and sharing of data, and the budgetary challenges posed by high cost new medicines. The UK strongly supported the better use of regulatory flexibilities to support patient access, highlighting the introduction, in the UK, of the early access to medicines scheme, and recognised the importance of encouraging innovation within sustainable healthcare systems.

In terms of the Ebola outbreak, there was a discussion informed by presentations from the Italian presidency, the Chair of the European Parliament Public Health committee and the WHO European Regional Director. The UK recognised the importance of maximising collective resources by sharing information through the EU’s early warning system and in terms of work in-country invited international partners to join their 700 bed initiative (which involves providing 700 beds for Ebola patients in Sierra Leone).

Discussions concerning the prevention of cancer centred on tobacco control, inequalities, screening and a cross-sectoral innovative initiative. The UK stressed the importance of investing in prevention, regarding obesity, tobacco control and alcohol misuse and agreed on the importance of a cross-sectoral approach, also stressing that healthier choices should be the easiest for consumers. The need for flexibility for member states to take initiatives to promote public health was also emphasised by the UK.

A ministerial lunch meeting also took place which focus on palliative care in the context of an ageing population.

Local Authority Funding (Public Health)

Jane Ellison Excerpts

Tuesday 9th September 2014 Written Statements

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

Today I am announcing public health allocations for local authorities in England for 2015-16 and details of a new health premium incentive pilot scheme.

After the significant increases in 2013-14 and 2014-15, in real-terms funding for local authorities will remain at £2.79 billion for 2015-16. This funding will remain ring-fenced for use exclusively on public health measures, and we are confident of local authorities’ continuing ability to sustain and improve the quality of their services in the coming financial year.

Taken together over the period 2013-14 to 2015-16 we have increased public health spending by 4.7% in real terms and over 10% in cash terms. This represents a major investment in health and the prevention of illness.

We will also allocate an additional £5 million towards a new health premium incentive pilot scheme in 2014-15, meeting our commitment to introducing a health premium that will encourage local authorities to improve the health of their populations and will reduce health inequalities. Local authorities are invited to give us their views on this scheme.

“Health Premium Incentive Scheme 2014-15 and Public Health Allocations—A Technical Consultation”, which contains details of the allocations and the incentive scheme, has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Pancreatic Cancer

Jane Ellison Excerpts

Monday 8th September 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Davies. It has been an excellent debate, with excellent contributions from all hon. Members. I will try to do justice to all questions that I have been asked, but inevitably there will be some that I cannot pick up in my speech. I may stick more broadly to pancreatic cancer and research and perhaps pick up points on other matters outside this debate with the shadow Minister; we are happy to update him on all those.

I, too, congratulate the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and thank the public for their role in it. I served for more than two years on the Backbench Business Committee and was present when the e-petition system first came in. As others have said, it illustrates how swiftly we can bring an issue of great concern to the public to the Floor of the House and, I hope, do justice to the subject in a way that they feel justifies their faith in us and their efforts to get it here. I believed in the e-petitions system then, and now, on the receiving end, as Minister responding to the debate, I am equally happy that we have it.

I reassure the public—both those who have taken care to come here today and those listening or reading afterwards—that they are very well served by the all-party group on pancreatic cancer. It is fair to say that one or two all-party groups in our Parliament do not put in much of an appearance from one year to the next, but this is an excellent all-party group that genuinely takes its mission and its role within Parliament seriously. Its members have achieved much in highlighting the needs associated with this dreadful disease, not least through their report, “Time to Change the Story” and through their current inquiry on research, which is where I will focus most of my remarks in a fair bit of detail.

Hon. Members have spoken of the impact of pancreatic cancer on those who get the disease, their friends and their families and of the need for improvement in research and services. Obviously, I will look at as many points as I can. I reassure Members that it is certainly not a low priority for me. Of all the debates on cancer that I have responded to in my time as a Health Minister, I have responded to debates on pancreatic cancer more than any other, so this subject is certainly not low on my radar and—I reassure hon. Members again—not the Government’s.

I understand why people feel frustrated. Hon. Members have mentioned awareness levels, neglect or fashion and some of those things play a part, but fundamentally this is hard: it is a hard disease that is hard to diagnose and research. The scientific opportunity is not as readily there as it is in some other areas of human medicine. This is not easy territory, but we need to do better; we all know that and that is acknowledged.

As many hon. Members and the petitioners have said, investment in research is crucial. The Government are investing a record £800 million over five years to 2017 in a series of biomedical research centres and units—my hon. Friend the Member for Pudsey (Stuart Andrew), among others, mentioned this—including £6.5 million of funding for the Liverpool pancreas biomedical research unit. So that advancements in science can lead to benefits for patients, that unit is working in partnership with industry and leading research institutions to develop new treatments for, and ways of diagnosing, pancreatic cancer. This includes research on biological markers, which might be one way to help achieve earlier diagnosis.

[Grahame M. Morris]

The Minister’s knowledge is far superior to mine in relation to advanced radiotherapy and the funding of trials—the hon. Member for Lancaster and Fleetwood mentioned the NanoKnife and the CyberKnife—so will she clarify whether there are any such trials in relation to its efficacy for pancreatic cancer?

[Jane Ellison]

The hon. Gentleman will like my next page. I move on.

The unit that I mentioned is involved in a major European collaboration. I want to put that on the record because a lot of hon. Members have asked, rightly, whether we are learning from international examples, collaborating and learning what we can from those who are best in Europe—and that happens in that unit. It is also involved in the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer, looking at hereditary factors as well.

As a number of hon. Members have eloquently described, the challenges of a stubbornly low survival rate are great, so it is also important that we consider new treatments for pancreatic cancer. For example, due to the limited evidence currently available, stereotactic ablative body radiotherapy—SABR—is available only for certain patients with lung cancer. To address this, NHS England has agreed to make up to £6 million available over the next five years to fund the treatment costs of new clinical trials for SABR. I am pleased to inform the hon. Member for Easington (Grahame M. Morris) and other hon. Members that one of these trials will be in pancreatic cancer.

I join hon. Members in welcoming the commitment made by Cancer Research UK to increase spending on pancreatic cancer research. That will in turn drive further investment by the National Institute for Health Research. I want to explain how that happens in two principal ways. First, scientific breakthroughs are translated into interventions benefiting patients, through infrastructure for experimental medicine, for example, with the Liverpool pancreas biomedical research unit. To talk to the point made about pancreatic cancer losing out and being the poor relation, Members might be interested to know that this is the only biomedical research unit that is organ-specific, with a focus on cancer.

Secondly, new investment, including NIHR investment, is driven by support from Government spend, as emerging interventions are investigated in studies and trials through the NIHR clinical research network. I was talking to the chief medical officer earlier this afternoon, ahead of this debate, to understand how this comes about. This is essentially known as NHS research support costs. For example, there might be, in a trial considering a specific treatment for people with pancreatic cancer, a lot of wrap-around care needed for the patients in that trial that might be beyond pure treatment for that cancer. That is where NHS research support costs come in and support the work going on in a specific trial.

The National Cancer Research Institute is a UK-wide partnership—it has been mentioned in this debate—between the Government, charity and industry, which promotes co-operation in cancer research among the 22 member organisations. In turn, NCRI is a member of the International Cancer Research Partnership, which includes cancer research funders from all over Europe, the United States, Canada and Japan.

The NCRI clinical studies groups—I apologise for the number of acronyms that crop up in health debates; I am afraid that it is just one of those things—bring together clinicians, scientists, statisticians and lay representatives to co-ordinate development of a strategic portfolio of trials within their field. The upper gastrointestinal cancer clinical studies group has a pancreas sub-group that plays a vital role in developing pancreatic cancer trials. It is effectively doing the same job as the US Recalcitrant Cancer Research Act—looking strategically at what is needed and where the gaps are.

My hon. Friend the Member for Pudsey made the point about looking at inter-regional and international comparisons and variation. We would expect the NCRI to look at that area, but I will make a point of making it aware of the strength of feeling in this debate on a number of issues, although I am sure they will be following it closely.

More broadly, improving cancer outcomes is a major priority of this Government. Our ambition is, as has been said, to save an additional 5,000 lives a year by 2014-15 and, crucially, to halve the gap between cancer survival rates in England and the best in Europe. Tackling late diagnosis, as many Members have said, is vital, as is raising public awareness and encouraging earlier presentation. Significant money has been put into that, and to put a cost in human lives on that, we know that we could save an additional 75 lives a year from pancreatic cancer if we matched the best in Europe. As many Members have illustrated, with so many examples from their constituencies, that does not begin to tell the story of the human suffering that could be averted if we did that.

To touch on Be Clear on Cancer, symptom awareness campaigns are a difficult area. Since 2011, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns, some of which have had excellent results. Public Health England now leads on that work in partnership with the Department, NHS England, charities and others. New campaigns are tested locally and then regionally to ensure that messages are correct for the target audience and to assess the impact on NHS services. That is important, because in some cases the balance has to be found when sending a lot of people in for diagnostics that might not be there or might stretch capacity. We ask experts to strike a careful balance and, if appropriate, we run the campaigns nationally.

The focus of those campaigns so far has been on cancers with the largest number of avoidable deaths, but the campaigns are under constant review and we work with relevant experts to see what more can be done to tackle the cancers, including pancreatic cancer. The group that makes decisions on the campaigns is called the public awareness and primary care steering group. It is chaired by the national clinical director for cancer, the excellent Sean Duffy, who I am sure a number of Members have met. Those who have met him will know what an important and serious clinician he is and how dedicated he is to making progress in this area. The group has considered pancreatic cancer for a possible campaign. Although it could not recommend that at this time, because symptoms are not always clear, it will keep that under review and would be happy to look at it again in the light of new evidence. Again, that group will note this debate and the interest in it.

During the debate, Members have raised the issue of how we support GPs to recognise signs and symptoms, particularly for such a difficult to recognise and difficult to diagnose cancer. Pancreatic cancer is often symptomless. When symptoms do develop, however, diagnosis can be complicated because, as Members have said, those symptoms are often similar to a range of benign conditions. We therefore have terrible rates of presentation through emergency routes, and that is clearly unacceptable. NICE is updating its guidelines on the referral of suspected cancer to ensure that they reflect the latest evidence. A number of Members raised that issue, and we anticipate a publication date of May 2015.

In early 2013, the Department of Health part-funded a six-month pilot, run by Macmillan Cancer Support, of an electronic cancer decision support tool for GPs. It is designed to recognise the symptoms of five cancer types, including hard-to-detect cancers such as pancreatic. Some 500 GP practices across England participated in the pilot, and I am aware that the all-party group is keen to see that tool being widely used by GPs, if evaluation shows that it can help to identify patients with symptoms. Initial indications were that the cancer decision support tool influenced a GP’s decision on around half the occasions that it was used. A full formal evaluation of the pilot has been undertaken by Cancer Research UK and one of the Department’s policy research units, and we hope to publish the results in an academic journal. I want to see that happen as quickly as possible, if the tool can do good, and I have made that clear. Macmillan has already begun to address many of the issues, which were highlighted by the draft evaluation that was shared with it, through changes made to the diagnostic software. It will continue to make further changes as it rolls the system out across the country.

In introducing the debate, the hon. Member for Scunthorpe spoke about allowing GPs to refer patients directly for MRI scans, as did my hon. Friend the Member for Milton Keynes South (Iain Stewart). I thank the hon. Member for Scunthorpe for giving me advance notice of that point. We have promoted direct referrals through the cancer outcomes strategy and have increased funding for GPs to access a range of diagnostic tests. NHS England is now working with providers to identify innovative ways of diagnosing cancer earlier, which could include extending direct referrals by GPs. Again, I will make sure that the strength of feeling expressed today, which I share, about looking seriously at whether that work can be accelerated is brought to the attention of NHS England.

Recently, the Secretary of State for Health announced a joint piece of work with Cancer Research UK and Macmillan to look at a number of innovative ways in which we can support GPs to ensure that cancers are diagnosed as quickly as possible. It is worth saying that last year GPs referred nearly half a million more patients to cancer specialists than were referred in the last year of the previous Parliament. A number of Members have said that this is not an easy one for GPs, because they see this cancer very rarely. The average GP actually sees some of the more common cancers surprisingly rarely, and this cancer is particularly rare, so anything we can do to support GPs is important.

Further policies have been unveiled that will improve the quality of life of cancer survivors. NHS England is rolling out additional support, in co-operation with Macmillan, so that cancer survivors will have their needs fully assessed and plans agreed for meeting those needs. In that regard, we are drawing heavily on the cancer patient experience survey, which has been mentioned.

The work going on to help to support cancer survivors to take regular physical activity will help. Physical activity is important in recovery and might help prevent recurrence. We have not touched a lot on lifestyle factors, but they are definitely an issue in some instances of pancreatic cancer. I undertake to talk to Public Health England about what more can be done. A major piece of work will be announced this autumn on physical activity, and I will have that conversation with Public Health England in that context. That new package of measures adds to the extra £750 million that the Government invested at the beginning of the Parliament.

At the end of August, the Health Secretary announced that thousands more cancer patients in England will be offered vital treatment through the £160 million boost to the cancer drugs fund in 2014-15 and 2015-16. I note the concerns of my hon. Friend the Member for Lancaster and Fleetwood about the interactions between NICE and the cancer drugs fund. I am happy to talk to him further about that, but NICE, for lots of good reasons, is an independent expert body, free from ministerial intervention. I do, however, note his concern. We discussed and explored that in a bit more detail in the Adjournment debate that he so ably led earlier in the year, when we looked specifically at NICE and new drugs.

In conclusion, I thank all those who have contributed to the debate. There is a huge challenge for us all, and we need to make a significant improvement to outcomes for people with pancreatic cancer. I do not underestimate the nature of that challenge—I know that Members do not—and I hope that my response has illustrated to the Chamber and to the many thousands who have signed the e-petition that pancreatic cancer is a priority and that more money is going into research, and not only what is directly invested. I have tried to illustrate what the wrap-around research support is.

As I said, I spoke today with the chief medical officer. She heads up the Government’s research policy, and some of the bodies that I have referred to report to her. Given the strength of feeling in this excellent debate, which has had thoughtful contributions, I will ask the chief medical officer if she is happy to meet with me and the debate’s co-sponsors to look in a bit more detail at the research package and to understand the research journey and where it might go. I will get back to my hon. Friend and the hon. Member for Scunthorpe after the debate about that.

We all know that change needs to come, and that it will not be easy, but we can make change. We have seen it in other hard areas of medicine, so it is not impossible; it is just difficult. Through the Government working in partnership with patients, charities, the nation’s excellent research teams, the pharmaceutical industry and the NHS, as well as by drawing on international data, we can make progress, and we all know that we must.

Wanstead Hospital

Jane Ellison Excerpts

Thursday 4th September 2014 Commons Chamber

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

Thank you very much, Mr Deputy Speaker—Madam Deputy Speaker, I apologise.

[Stephen Pound (Ealing North) (Lab)]

It has been a long day.

[Jane Ellison]

Yes, it has.

I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this debate on issues that are clearly of great importance to him and his constituents. Before I try to address some of the issues he has raised—I have listened carefully to what he has said, and if there are issues to which I cannot respond now, I will certainly take them up with NHS London—I would like to put on the record my thanks to all those who work in the NHS, not only in his constituency but right across the service, for their dedication to providing first-class services to his and all our constituents.

As the hon. Gentleman is aware and as he described in his speech, Wanstead hospital closed in 1986 so the services that are the subject of this debate are provided from the Heronwood and Galleon unit on the site of the former hospital. As he said, it houses 48 rehabilitation beds in two wards, and it is one of three community rehabilitation units providing intermediate care for people in the three boroughs of Barking and Dagenham, Redbridge and Havering. The two other units are located at Grays Court in Dagenham and the Foxglove ward at King George hospital. The proposal put forward by the clinical commissioning groups for the three boroughs is to centralise these services at King George hospital, and that is the subject we are addressing this evening.

As the hon. Gentleman described, the three local CCGs outlined five possible options for the future of intermediate care services in the document issued on 9 July. I understand what he says about the preferred option steering people, but we would also probably be critical if local health leaders did not tell us what their preferred option was. I suspect we would want them at least to tell us what their thinking was in order to guide the public and be transparent. The proposals are currently the subject of a full 12-week public consultation. I understand that he has recently met Redbridge CCG and has expressed his concern, as he has done again tonight in the House, about the current length of the consultation, asking for an extension. That is being considered by the CCGs and I have asked that they respond to him as soon as possible after this debate, having given that further consideration and heard the strength of his feeling on the subject.

On support for the proposals, I know that in June, as partners on the local integrated care coalition, the three local authorities all agreed the content of the intermediate care pre-consultation business case. That includes the case for service change and the proposal for the local CCGs to go to public consultation. Subsequently, the three local CCG governing bodies all agreed to go to consultation and to consult on the preferred option, which we have described. I also understand that the Havering health and wellbeing board is very supportive of the proposals, urging the CCGs to get on with the proposed changes more quickly. Discussions are to be held next week with the health and wellbeing boards for Redbridge and Barking and Dagenham.

The head of nursing at the Partnership of East London Co-operatives has described the proposals in positive terms, and a number of positive comments have been made about the innovative ideas on home care, which the hon. Gentleman has been fair to describe as positive and good for his constituents. I know that in Redbridge the CCG is continuing to engage with community groups, some of which he has alluded to, in order to explain the proposals in more detail, and that is quite right. I was concerned when he said that members of the public locally are not clear about what is happening and do not feel that they are in the know, because these processes should always have at their heart the desire to convey what is being proposed to the public in order that they can comment meaningfully on them.

Under the preferred option, the overall number of rehabilitation beds provided would reduce from 104 to 40, with the capacity to increase to 61 should the need arise. On the face of it, that does sound like a very significant reduction, and I can understand why the hon. Gentleman and other local people may be concerned when they hear those figures. Local people needing intermediate care have generally been cared for in beds at community rehabilitation units, which means that the number of intermediate care beds across his area is relatively high compared with many other areas. However, I am advised—he made mention of this in his speech—that many of those beds are not being used because there is insufficient demand. The latest bed figures for August show that 49 intermediate care beds—47% of the total capacity—were unused across the area for that month. I note that he disputes those figures, and he makes a fair point about the waxing and waning of demand across the year. I would certainly hope that the local clinicians and managers who put these plans together would take into account those shifts in demand across the year.

The CCGs have also heard from the public that people want to be cared for and supported in their own homes wherever possible. That is a consistent message we get from the public across a range of health services. Keeping people at home helps them to stay independent for longer, and they recover just as well, and in some cases better and more quickly, at home. That is why the CCGs are developing a model of care where people are cared for and supported in their own homes, not in hospital. That model has been developed by clinicians, with, properly, input from patients and carers. However, patients who need a community bed will still be able to get one. The CCGs believe that concentrating all the rehabilitation beds on one site is the best way to develop high-quality care for the hon. Gentleman’s constituents and other patients who need to stay in a rehab unit.

Clinicians locally believe that that is the safest way to provide care and the best way to provide care of consistent quality. Concentrating the service on one site would enable staff to maintain their practice standards and share expertise more easily. The hon. Gentleman referred to the fact that the CCGs have been trialling two new services—the community treatment team and the intensive rehabilitation service. The community treatment team provides short-term intensive care and support so that people can be cared for in their own home, rather than in hospital. That is something that my constituents, his and other Members’ constituents say all the time: they would much prefer to do that. The intensive rehabilitation service provides support, such as physiotherapy, for people in their own homes and further reduces the need for patients to stay in community beds.

Figures for the last seven months are very encouraging. They show that nearly all patients supported by the community treatment team—90%—do not go on to be admitted to hospital. There are important issues to consider such as knock-on effects and the sustainability of local health services. The intensive rehabilitation service is similarly successful, with 90% of patients able to recover at home without needing to go to hospital.

Before the trial of the new services, patients waited an average of five days to access bed-based care. Since the trial, patients are able to access community beds or the intensive rehabilitation service in less than two days on average. Most people who need the community treatment team are contacted within two hours. We should pay tribute to the innovation that has taken place and to some excellent local service delivery.

I understand that patient satisfaction ratings for both the new services have been consistently high across the three boroughs since the trials began. The results of the latest satisfaction survey, published in June, were taken from patients recently discharged from the community treatment team, and it is good to hear patients being positive about their experience. In Redbridge, patient satisfaction with the service scored an overall average of 9.5 out of 10; 94% of patients and relatives said they would be “extremely likely” to recommend the community treatment team service to family and friends—the new family and friends test is being introduced across the NHS and is a good measure of what people really think of the service—and 100% of community treatment team patients were responded to within two hours.

Most of the patients surveyed felt that they either would have attended A and E or would have been admitted to hospital if that service had not been available, which goes to my point about the sustainability of local acute services. Since the trial started, 7,600 patients have been seen by those two new services, 1,000 from Redbridge. Only 1,300 patients would have been seen in a “beds only” service. Therefore, we can see service change bringing great quality of service to the hon. Gentleman’s constituents and others in the area.

Demand for rehabilitation beds has further reduced during the trial of the new services as more people are being cared for at home. I am advised that, during July, 46 of the available 104 beds were unused, as I have mentioned.

The Government are clear that reconfiguration of front-line health services is a matter that should be led by the local NHS. It is best placed to know the needs of local people and it knows how to deliver them. Putting the patient first is central to that, although it always concerns me when hon. Members bring to the House their worries that consultation and transparency have not been as good as they could be. I note the hon. Gentleman’s points, as will local health leaders, with concern. I know that they have met him on a number of occasions. I am sure that we will meet him again to take up those points, but at the heart of reconfiguration is the all-important issue of putting patients first and delivering a better service for all patients. The NHS in London, as elsewhere, has to constantly evaluate the way in which services can best be tailored to meet the needs of local people and improve standards of patient care.

I recognise that proposals for service change inevitably arouse public concern, and that is why it is important that we get consultation processes as good as they possibly can be. It is absolutely the role of hon. Members to express those concerns, to hold all of us who are involved to account, to engage with local clinical and operations leaders and to test the NHS’s response to those concerns.

I know that the hon. Gentleman has both corresponded and met senior staff from the local NHS, and I have met local health leaders, and I hope the response he received from the chief officer of Redbridge clinical commissioning group has gone at least some way towards addressing his concerns about the proposed reconfiguration of intermediate care services. The consultation on the proposals is open until at least 1 October and, as I said earlier, an extension is being considered. I undertake after this debate to further draw to the attention of local health leaders the strength of feeling the hon. Gentleman has expressed tonight about the need for more time for him and his constituents, but I urge him to participate and to make his constituents’ views known during the course of that consultation, as he has done tonight in the House.

Question put and agreed to.

Public Health England Hub Programme and Porton Down

Jane Ellison Excerpts

Wednesday 3rd September 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing this debate. It is not his first on this subject, but he is right to use his opportunities to highlight such important topics. I also thank my hon. Friend the Member for Harlow (Robert Halfon) for his contribution.

The future of Porton Down is important not only to the constituents of my hon. Friend the Member for Salisbury, but to the whole country, given its work on a wide range of public health threats—including, as he highlighted, most recently the Ebola outbreak in west Africa. Scientists have been doing invaluable work at Porton Down since the 1950s, but its buildings are more than 60 years old and, based on independent surveys of the estate, they are increasingly unfit for purpose. My hon. Friend agrees that we need to find a solution to that problem to ensure that this vital work is able to continue in top quality facilities.

We all agree it is important that scientists have the benefit of state-of-the-art facilities that reflect the latest technological advancements, including, as my hon. Friend alluded to, the shift from the Petri dish to big data. Public Health England put forward the case that significant benefits would result from not only re-providing the facilities at Porton, but bringing together the range of public health science functions that it manages across disparate sites to create an integrated national science hub. That would enable the UK to punch above its weight on the international stage in preventing, and reducing the burden of, both communicable and non-communicable disease.

As my hon. Friend knows, Public Health England is considering a number of options to meet that challenge and its preferred option is to create a public health science hub based at the former GSK facility, in the constituency of my hon. Friend the Member for Harlow. To reach that position, it has had to consider a wide range of long and short-listed options and demonstrate which offers the best value for money.

The main focus of those options has been on Porton, Colindale—it is good to see my hon. Friend the Member for Hendon (Dr Offord), who represents Colindale, in his place—and Harlow. Public Health England has briefed the local Members, including my hon. Friends, and the local authorities about the three sites affected and considered those views in the option appraisal.

The case submitted by Public Health England is being scrutinised by the Department of Health, the Treasury, the Cabinet Office and the Major Projects Authority. I assure my hon. Friend the Member for Salisbury that the process will be thorough and robust. Following that process, the business case will require ministerial approval, as he mentioned, and will be published once finalised.

It is not appropriate for me to give further details on the business case until the review has been completed and I hope that my hon. Friend will understand that. As he may be aware, that is to protect commercial confidentiality and the integrity of decision making. It is established practice that outline business case documents are not shared outside the Government before decisions have been made, but the Department and PHE are committed to being open and consultative throughout this process.

When I am being briefed on these issues ahead of debates, my first question is always whether we have had regular and open contact with the Members involved. I am assured that regular contact has been made between PHE and those hon. Members who are rightly concerned for the future of the facilities in their constituencies. We want to ensure transparency on the progress of the process, and at all stages we are providing opportunities to comment on the case, with this debate being the most recent example. That commitment to a consultative process has, for instance, led to all three affected authorities submitting statements about how the science hub would link with the local economy, which have been included in the business case.

[Dr Matthew Offord (Hendon) (Con)]

I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing the debate. We have focused on the business side, which is very important when we introduce a national hub, but I am concerned that my constituents’ views about what will happen to them and their extended families have not been considered. Many of my constituents who work at Colindale are responsible for elderly family members and children, and they feel that that has not been taken into account. Will the Minister respond to that point?

[Jane Ellison]

I would be disappointed if that issue had not been considered. There have already been some meetings with staff, but this is an ongoing process. My understanding is that at the point at which any firm decisions are made there will be an extensive consultation process. I have time set aside to meet with my hon. Friend, who is right to highlight those concerns. We can explore them further and I can respond to any specific concerns. Those valuable members of the scientific community make an enormous contribution in lots of ways to our country and we want to ensure that they and their families are considered carefully in this process.

On the point about the consultation process, I recently received a letter from the Minister responsible for PHE’s neighbours at Porton, the Defence Science and Technology Laboratory, which praised PHE’s open, collaborative approach to discussions about the use of specialist high-containment facilities. That reassures me that a good level of communication is being achieved.

The business case contains a summary of the collaborative work. When my predecessor, my hon. Friend the Member for Broxtowe (Anna Soubry), outlined the Department of Health’s position in a debate a year ago—also secured by my hon. Friend the Member for Salisbury—she said:

“We need to be clear that although PHE and DSTL will continue to collaborate closely, PHE needs dedicated high-containment facilities to ensure that public health work can proceed in the event of the DSTL facilities being fully occupied. This will provide resilience if DSTL’s facilities are closed for any reason.”—[Official Report, 11 September 2013; Vol. 567, c. 1136.]

As my hon. Friend the Member for Salisbury said, issues of national security and our national response capability must be carefully considered before a final decision is made. It is therefore key that Public Health England continues to develop links not only with DSTL, but with all the other agencies involved in the national security response.

Another important consideration that my hon. Friend drew out in his speech is the commercial impact of the chosen solution, which must ensure that PHE can continue to work in partnership with industry to support wider growth in the UK life sciences sector. Like him, I celebrate the important work and development that has taken place in that area in recent years. I reassure my hon. Friend that PHE has undertaken a survey of its current key customers, and only one has said that moving from the Porton site would be important for their future business relationship with PHE.

In Harlow, PHE proposes that the science hub would link with the Harlow enterprise zone and the London-Cambridge corridor, which my hon. Friend the Member for Harlow mentioned. It is one of the key international centres for the life sciences sector and PHE has had discussions with Cambridge university about the opportunities for collaboration based around Harlow.

Even if a decision were made to relocate research functions and staff, PHE has confirmed that it remains fully committed to the recently announced Porton science park, which would involve PHE facilities—consisting of some 300 staff in the development, production and regional laboratories—remaining at Porton. I know PHE has briefed my hon. Friend the Member for Salisbury on the work it is doing to maximise the commercial potential of the production facilities at Porton, which he highlighted in his speech. I want to reassure him that his important concern has not been overlooked.

The final decision on the outline business case will be made as soon as possible. My hon. Friend’s wish to have certainty on the case sooner rather than later is entirely reasonable and understandable, but—as he said—it is important that we get this vital decision right. I have listened carefully to his arguments—this is the first opportunity I have had to hear them laid out first hand—and to the important short speech by my hon. Friend the Member for Harlow. I will look at the document to which my hon. Friend the Member for Salisbury referred and ask PHE to respond to it. My hon. Friend is right to champion that renowned facility and his constituency, and I congratulate him on using this further opportunity to highlight his concerns, to which we will give a serious response.

Question put and agreed to.

Mitochondrial Replacement (Public Safety)

Jane Ellison Excerpts

Monday 1st September 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing this debate at the Backbench Business Committee and all the right hon. and hon. Members who have contributed. It has been an extremely thought-provoking debate. Inevitably, in the time available to me, which I believe is 10 minutes, I will not be able to do justice to every point, but I hope that Members know that if there is a point that I am unable to cover in my remarks, I will follow it up afterwards and attempt to respond to them.

I welcome this opportunity to discuss mitochondrial donation and to reflect on the scientific and policy journey that has brought us to this point. As many Members have said, children are being born with and are dying from devastating conditions that are caused by mitochondrial disease. Scientists and clinicians have developed a treatment to tackle it but, rightly, Parliament will need to approve new regulations for it to be used.

As Members have said, this is not a new subject for Parliament to be debating. In 2008, Parliament agreed amendments to the Human Fertilisation and Embryology Act in anticipation of these groundbreaking developments. That provided a power to introduce regulations that would allow mitochondrial donations. It is that next stage that is the focus of our deliberations.

I will explain the thorough and open approach that has been used to assess the safety and efficacy of the proposed donation techniques, and to gauge the public’s views. This has not been a rushed process and I do not agree that Parliament is being asked to vote blind, as some have said—far from it, as others who have been in this House for longer than I have testified. We have asked the HFEA to convene a panel of experts three times since 2011 to review the scientific evidence on the safety and efficacy of the proposed donation techniques. All three reviews have indicated that the donation techniques—maternal spindle transfer and pronuclear transfer—would be effective, and all three reviews have found no evidence to indicate that either technique would be unsafe. To quote the chair of the expert panel, Professor Andy Greenfield, whom I have met to discuss the reports:

“In three years’ study the expert panel has seen no evidence which suggests that these new mitochondrial replacement therapies are unsafe.”

However, I appreciate that some Members have expressed concerns. Some are opposed in principle and some have practical concerns about whether we have looked at all the important details.

The decision on whether a new treatment can be described as safe is never absolute, as Members have said. Doctors and scientists rarely, if ever, make an unqualified statement that a procedure is safe. Instead, they proceed by hypothesis, evidence and risk analysis. Indeed, no medical procedure is without risk, from a cataract removal to a triple heart bypass.

There have been calls today for more research into mitochondrial donation, but research cannot be expected to answer every question. All that we can ask is that it adds to our knowledge and highlights areas that need to be looked into further and monitored more closely. We are currently considering the most recent report of the expert panel, the assurances that have been given on the safety and efficacy of the techniques involved and the recommendation of further experiments to confirm earlier findings.

The draft regulations to allow mitochondrial donation, on which we consulted, would also bring into place important safeguards, as others have said, through the HFEA’s strict licensing procedures. For a licence to be issued to a provider of mitochondrial donation, they would first have to demonstrate that they could carry out the procedure safely and effectively.

[Sir Edward Leigh]

Will my hon. Friend give way?

[Jane Ellison]

I will take only one intervention, if the House will allow me.

[Sir Edward Leigh]

It has been said in the debate that we are not creating three or four-parent families, but given that the cells of a second mother will be used, will a child have a legal right to know the identity of the three or four people who contributed to their creation?

[Jane Ellison]

That was one area of detail covered in the draft regulations and the responses to the consultation on it, and I will write to my hon. Friend with a detailed response. A wider point is that we should surely not reduce the notion of parenthood to genes. Many Members who have spoken in the debate, particularly my hon. Friend the Member for Congleton, who moved the motion, have often spoken in other contexts about parenthood being more about loving, nurturing and so on. It cannot be reduced simply to the donation of genes—I worry that that, in itself, would be a slippery slope.

Mitochondrial donation is supported by both the chief medical officer, Professor Dame Sally Davies, and many clinicians and IVF experts, including, I am pleased to say, Professor Lord Winston, who has been quoted a number of times in the debate. Among other comments, he has made it clear that he supports the draft regulations and would vote for them.

This is undoubtedly a really difficult area in which to gauge public opinion, because it is complex and technical and a lot of people know nothing about it. Some Members who have seen e-mails going around the House asking them to attend this debate have told me that they did not know what it was about. That means that the exercise of engaging the public needs to be carried out in a thoughtful and comprehensive way. That was exactly what the Government did—we tested the public acceptability of introducing these techniques through a comprehensive dialogue process commissioned by the HFEA and led by external experts. It included events such as workshops and focus groups, and it showed that when the process of mitochondrial donation was fully explained to them, the majority of people supported its use provided that it was carefully regulated. The Department of Health’s consultation was on the draft regulations, and those who commented on them broadly supported them. I urge people to be mindful of the way to go about testing public opinion on the matter. We have to ensure that it is done on the basis of facts.

[Lady Hermon]

rose—

[Jane Ellison]

I am really sorry, I just do not have the time to give way. I am not being discourteous.

Successive Governments have responded to advances in science that were controversial in their day. Time does not permit me to go into them in as much detail as I would have liked, but many Members will cast their mind back to the debates about IVF. I suspect that there are Members in the Chamber today who were extremely wary of IVF techniques but who have written to me in the past year asking me to help infertile couples in their constituency. We were told in the debates on IVF that the proposal for limited research on embryos, up to a maximum of 14 days’ development, was a slippery slope and that the 14-day rule would become 20 days, 50 days or even six months. Today, 25 years on, the Rubicon remains uncrossed and the important provision that research cannot take place on embryos more than 14 days old, which Parliament put in place, remains firmly in place. I hope that that gives Members some reassurance.

Mitochondrial donation will enable people to have their own, genetically related children, free of serious mitochondrial disease. The proposed donation techniques will allow unaltered nuclear DNA to be transferred only to an egg or embryo that has unaltered healthy mitochondria. I could not have put it more eloquently than my right hon. Friend the Member for Havant (Mr Willetts) did when he talked about the difference between nuclear and mitochondrial DNA.

On the issue of three parents, I mentioned—as have others—that we cannot reduce parenthood to a matter of 37 genes from a donor. It is about so much more than that, and our draft regulations refer to some of the safeguards in place.

There is no cure for mitochondrial disease, nor is there one on the horizon. The families of children born with severe mitochondrial disease face the prospect of having to watch their child suffer dreadfully, and in many cases die at an early age. Many Members have met constituents in recent months—as have I—who are facing that heartbreaking situation, and I pay tribute to the Lily Foundation for its work in helping us all to connect with those constituents.

This has been a thoughtful debate, and it is vital that Parliament discusses such matters openly and considers all the issues. For those who are not opposed in principle, we must consider all the evidence alongside the benefits that this treatment can bring, and make that consideration in a rational way. The Government will, of course, continue to consider the expert advice we have received and how that influences regulations before they are brought before Parliament for further debate. We believe that this is an important scientific advance that holds out great hope for families in this country and around the world.

Mitochondrial Donation

Jane Ellison Excerpts

Tuesday 22nd July 2014 Written Statements

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

We are today publishing the Government response to the consultation about draft regulations to allow mitochondrial donation to prevent the transmission of serious mitochondrial disease from mother to child.

Mitochondrial disease is passed from mother to child through faults in the mitochondrial DNA. It is estimated that one in 6,500 children are born every year in the UK with a serious mitochondrial DNA disorder. Serious mitochondrial disease can have a devastating effect on families, including the premature death of children, painful debilitating and disabling suffering, long-term ill-health and low quality of life.

The consultation ran between 27 February and 21 May 2014. The consultation reached a wide audience and received 1,857 responses from research bodies, patient bodies, professional organisations, faith organisations, parliamentarians and a large number of individuals. We have carefully considered all responses in deciding how to move forward with the regulations, recognising that there is a broad spectrum of widely different views.

Although the purpose of the consultation was to invite views on the detail of the draft regulations, four out of five respondents simply expressed a view for or against the principle of mitochondrial donation. Where comments were made about the detail of the regulations, respondents were generally positive about the proposed individual provisions. The Government have taken the view that our policy position on the key issues remains the correct one. As such, we will:

retain the principle behind the definition of the mitochondrial donation techniques as currently set out in the draft regulations;

retain the provision that the Human Fertilisation and Embryology Authority (HFEA) would have to be satisfied that there is both a particular risk of mitochondrial abnormality and a significant risk that a person with that abnormality would have or develop a serious physical or mental disability, a serious illness or other serious medical condition;

retain the provision that the HFEA will consider each application on a case-by-case basis; and

retain the provision that the HFEA will release only non-identifying information about the mitochondrial donor to people born following mitochondrial donation when they reach age 16.

We will also include additional provisions in the regulations to clarify the consent requirements around the use and storage of eggs and embryos used in the mitochondrial donation techniques.

Alongside the consultation exercise, the Department also asked the HFEA to reconvene the expert panel to undertake a further, third, review of the efficacy and safety of the mitochondrial donation techniques. A report of that review was published in June 2014. The report found that the techniques of maternal spindle transfer and pro-nuclear transfer are potentially useful for a specific and defined group of patients and that the evidence does not suggest that these techniques are unsafe. The panel was of the view that research has progressed well since its previous two reviews, although it recommended that further experiments should be completed before clinical treatment is offered.

The Government have decided to proceed with putting regulations before Parliament, subject to giving further consideration to the expert panel’s recommendations, refining the draft regulations to take account of changes identified during the consultation, and discussion with the HFEA about an appropriate approval process. The Government will consider the timing of the regulations in the light of these actions.

The regulations will be subject to full scrutiny by the public and Parliament through the affirmative procedure.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 15th July 2014 Commons Chamber

[Julian Sturdy (York Outer) (Con)]

2. What steps his Department is taking to tackle the issue of antimicrobial resistance.

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

We are leading cross-Government action to address antimicrobial resistance—AMR—at national and global levels. We published details of how we will measure the success of the UK’s AMR strategy, and we will publish an annual progress report in November. We are considering recommendations in the Science and Technology Committee’s AMR report. I gave evidence to that Committee and we will publish our response in September.

[Julian Sturdy]

I very much welcome the Government’s international lead on antibiotic resistance, led by the Prime Minister. Does my hon. Friend agree that increasing the unit price of antibiotics and tackling their growing misuse in developing countries is absolutely vital if we are not to face a return to the medical dark ages?

[Jane Ellison]

My hon. Friend is quite right to highlight this as a major challenge facing us. I pay tribute to the chief medical officer and to the Prime Minister for the international leadership they have given on this. My hon. Friend will be pleased to hear that the antibiotics market will be considered in its totality by the O’Neill review, which was announced by the Prime Minister on 2 July. It is of course important to bear it in mind that while we look at tackling global antibiotic misuse, we need to balance the need for global conservation measures with accessibility for lower-income countries.

[Mr David Heath (Somerton and Frome) (LD)]

3. What assessment he has made of the adequacy of resources made available by local authorities for the regulation of food safety.

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

The allocation of local authority food law resources is a local matter. Authorities are increasingly using a risk-based approach to target these resources and looking at ways in which they can work smarter. The Food Standards Agency monitors and audits local authority controls to ensure appropriate resources are in place effectively to regulate food safety.

[Mr Heath]

Food safety standards in this country are generally very good, happily, but that is very much dependent on the work of local authorities and of laboratories. What consideration has she given to the recommendations of the interim Elliott review that there should be better coordination and integration of local authorities and also, possibly, a public analyst service?

[Jane Ellison]

Obviously we are awaiting the final Elliott report but, as my hon. Friend would expect, consideration is being given across government to the interim report. The Government are committed to improving co-ordination and intelligence sharing. We can see some of that in, for example, smart back-office sharing, on which his authority, I believe, has taken a lead. We are working across government, local authorities and industry to protect food integrity. Professor Elliott said that we have one of the safest systems in the world but there is always more we can do to work more closely together. I know that the FSA is working more closely with local authorities and that Public Health England has begun to have constructive discussions around the issues. But we will obviously respond in more detail when we have the final report.

[Keith Vaz (Leicester East) (Lab)]

Sugar is one of the most deadly parts of our daily diets. What can be done to regulate the amount of sugar in our diets locally that will result in a decrease in the number of people with diabetes?

[Jane Ellison]

I congratulate the right hon. Gentleman on the creativity with which he has introduced sugar into this question. He is right to highlight the fact that sugar is an important factor in considering how we get the nation healthier, which we see in the overall context of trying to encourage people to consume fewer calories. A lot of work has been done. He will be aware that we have just had a very detailed scientific report on sugar and carbohydrates more generally. We are considering that but he will be pleased to know that Public Health England has already started to roll out that advice at both a local and national level to consumers and families. We will of course consider what more we might do.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

Does my hon. Friend share our concern on the Select Committee that not enough regular food analysis is being done by local authorities? Will her Department press for this to prevent any further adulteration or food scares in the future?

[Jane Ellison]

We have discussed this with the FSA and we will respond in more detail when we have the final Elliott review. But it is worth noting that the FSA is supporting local authorities financially and with expertise, but is also very much encouraging people to work smarter so that a lot of inspection is based far more on risk. That is right, as we do not want businesses with excellent records of compliance being subjected to the same regime of testing and inspection as those who give rise to greater risk. I hope my hon. Friend would agree that an intelligence-led approach is the right thing to do.

[Mr Andy Slaughter (Hammersmith) (Lab)]

4. What plans he has for hospitals in west London and their A and E services.

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

The NHS is, as the hon. Gentleman knows, implementing the plans for hospitals in west London under the “Shaping a Healthier Future” scheme. This will include 21st-century health care facilities for the local community, and it is very much led by local clinicians to provide better care for patients in the hon. Gentleman’s and other west London constituencies.

[Mr Slaughter]

Is the truth not that two west London A and E departments will close eight weeks tomorrow? Although the local NHS is paying M&C Saatchi to spin that decision, so far no one has told the 300,000 people in the catchment area for the Central Middlesex and Hammersmith hospitals that their A and Es are going to close and no evidence has been produced to show that it is safe to do so?

[Jane Ellison]

Unsurprisingly, that is another example of the hon. Gentleman putting politics before patients. We have had a slew of information put out to people in his area and surrounding areas, much of which did not highlight the new facilities that are being introduced. I would love to hear the hon. Gentleman talk up the new facilities coming into that area. Charing Cross hospital will be redeveloped as a 21st century health care facility, in line with my right hon. Friend’s decision based on the independent reconfiguration panel’s advice. Charing Cross and Ealing will have a local A and E with 24/7 access to full diagnostic support, consultant advice and specialist care—and it would be really refreshing if the hon. Gentleman, rather than following his usual line, could tell some of his constituents the good news about health care in his part of London.

[Sir Edward Leigh (Gainsborough) (Con)]

5. What steps he plans to take to improve standards in general practice.

--- Later in debate ---

[Kerry McCarthy (Bristol East) (Lab)]

10. What assessment he has made of the effects of trends in food prices on public health.

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

The Government monitor trends in food prices. We are obviously aware that for some families money is tight, but that is one of the reasons why in my area—public health—we are investing in programmes such as Change4Life. Public Health England has done a great job with Change4Life. Since its launch, more than 1.9 million families have joined, and the Meal Mixer app, for example, has been downloaded more than 1 million times and contains hundreds of quick, healthy and affordable family recipes.

[Kerry McCarthy]

I thank the Minister for that response. Some of the things that she mentioned involve people being in a position to make choices about the food that they buy, and we know the extent of food poverty is such that many people do not have the luxury of being able to do that. Is the Minister aware of the Trussell Trust and Oxfam report, which warns that people in food poverty are buying lower quality food and less food overall, giving rise to a real problem of malnutrition in children?

[Jane Ellison]

I am sure that, like me, the hon. Lady welcomes the news this morning that food price inflation is at an annual rate of 0%, so food prices are at the same level as last year. On the issue that she raises, that is exactly why programmes such as Change4Life are important. It is also important that we see other measures across government. The school food plan is important for its emphasis on nutrition, as are free school meals and the Healthy Start programme. The Government are doing lots of things to try to make it easier for less well-off families to eat healthily.

[Andrew Selous (South West Bedfordshire) (Con)]

Will the Minister applaud the work of Colin Kaye in my constituency, who, on his own farm, is producing cheap, good quality food to help reduce the cost of food so that people can eat more healthily and have lower food bills?

[Jane Ellison]

That sounds like a fantastic local initiative, and I thank my hon. Friend for highlighting it. Taken together with our advice and support for families on how to use healthy food to make healthy meals, initiatives such as that are to be applauded.

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

11. What progress his Department is making on improving the performance of failing hospitals.

--- Later in debate ---

[Stuart Andrew (Pudsey) (Con)]

T2. I recently had the pleasure of meeting my constituents Susan Childs and Doreen Smulders, who raised the issue of the inequalities that exist for men with prostate cancer. Will my right hon. Friend tell me what steps are being taken to address the shortfalls in care and support that such men are receiving across the country?

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

My hon. Friend is right to suggest that we want to drive consistency across the country, and NHS England is taking great notice of the cancer patient experience survey in a number of areas of cancer care. It has been a real driver of change where it has identified variation. I am sure he will welcome the fact that the overall range of variation for many indicators relating to prostate cancer has narrowed. None the less, we want to see NHS England working with NHS Improving Quality—NHS IQ—and others to ensure that struggling organisations are brought up to the standards of the best. The survey is a good way of driving that.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

T3. Since 2010, the percentage of patients who say that they can see their GP within 48 hours has halved from 80% to 40%. Given the pressure on the NHS, and especially on accident and emergency services, will the Secretary of State explain why the Government’s reforms are threatening to close 98 surgeries around the country, including five in Tower Hamlets? Will he publish the full list today?

[Margot James (Stourbridge) (Con)]

T4. Now that the Medicines and Healthcare Products Regulatory Agency has concluded its consultation on the use of generic asthma inhalers by schools in cases of emergency when a child does not have his or her own inhaler, will my hon. Friend update the House on the next steps? In particular, does she expect schools to be allowed to keep these inhalers in the new school year?

[Jane Ellison]

I congratulate my hon. Friend on her great campaigning on this issue, and on the really good results that she has had. As she says, we have recently consulted on changing the regulations under the Medicines Act 1968 to allow schools to hold inhalers in the way that she has described. There was overwhelming support for such a change, and we will lay the necessary statutory instrument this week to enable the change to come into force on 1 October.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

T6. On nurse-patient staffing ratios, it has been reported in the Health Service Journal that out of 139 trusts surveyed, 119 failed to fill their registered day nurse hours, 112 failed to fill their registered night nurse hours and 105 failed to fill their registered nurse hours across day and night. Is it not time for Ministers and NICE to state straightforwardly that a ratio of one nurse to eight patients or better is the only way for patient safety?