Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

4. What assessment he has made of the role of the comprehensive delivery dashboard in holding clinical commissioning groups accountable for their one-year cancer survival rates.

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

NHS England uses a range of data, as my hon. Friend will know, including data from the delivery dashboard, to assess the performance of CCGs. That includes the data from the composite cancer one-year survival indicators. NHS England will take action— it has quarterly assurance meetings between area teams and CCGs—if there are concerns about CCGs’ performance.

[Mr Baron]

May I suggest to the Minister that if the Government are to meet their target of saving an additional 5,000 lives a year and to promote diagnosis, we need to hold underperforming CCGs to account. Why is it, then, that the one-year survival rates, which are designed to promote earlier diagnosis, are not in the delivery dashboard, which, unlike the outcomes indicator set, has teeth, particularly given that CCG chief executives have said that they see no reason why the one-year figures could not be included in the dashboard?

[Jane Ellison]

We will certainly look at that, but I emphasise that all those things are important as part of the conversation between area teams and CCGs. I remind the House that the CCG outcome indicators set for 2014-15 include a range of important indicators for cancer, including one-year survival for all cancers, one-year survival for breast, lung and colorectal cancers combined, cancers diagnosed via emergency routes, and cancers diagnosed at an early stage—something I know my hon. Friend has, quite rightly, championed consistently in this House.

[Jim Shannon (Strangford) (DUP)]

Does the Minister agree that the inclusion of more innovative drugs in the NHS medicine cabinet is essential for improvements in one-year cancer survival rates? Does she also agree that information shared between the devolved Assemblies, such as the Northern Ireland Assembly, is a vital part of that process of improvement?

[Jane Ellison]

We want people in England to have the best cancer outcomes, and to bring those outcomes up to the best in Europe. We know we are not there yet, but we have done a range of things to try to make that happen, including putting a lot of money into early diagnostics. In my area of public health there are award-winning public campaigns such as Be Clear on Cancer, and I know that the cancer drugs fund has been appreciated by many people. I hear what the hon. Gentleman says about the Northern Ireland example.

[Dr Sarah Wollaston (Totnes) (Con)]

High-quality data will play an essential role in improving cancer outcomes. Will the Minister confirm that NHS England has addressed the concerns raised about the care.data programme, and that we are on track for a successful roll-out?

[Jane Ellison]

I confirm that we are.

[Mr Jamie Reed (Copeland) (Lab)]

Last month, for the first time ever the NHS missed a target for beginning cancer treatment within 62 days of patients being urgently referred. Cancer Research UK stated:

“This isn’t just a missed target—some patients are being failed,”.

We know that the key to ensuring that more people survive cancer is to start treatment as soon as possible after diagnosis. Is it not shocking that cancer charities, including Macmillan Cancer Support and Cancer Research UK, now say that cancer is being overlooked in this Prime Minister’s national health service?

[Jane Ellison]

We all appreciate the wonderful work done by cancer charities such as Macmillan Cancer Support and Cancer Research UK, and the Department works closely with those charities. We want outcomes for cancer patients in England to be among the best in Europe. As I said, we know we are not there yet, but a great deal of effort and money is going into getting there. The NHS is treating more cancer patients than ever. Since 2009, we have seen numbers rise by 15%—that is 1,000 more patients with suspected cancer referred to a specialist every day. That is the success of some of the early diagnosis and awareness raising activity. Of course we want any local dips in performance to be addressed, but let us give credit where it is due to clinicians who are diagnosing more cancers and catching them earlier, because that is the key to treating cancer successfully.

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

5. If he will meet the chair of the College of Emergency Medicine to discuss A and E units.

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[Mr Philip Hollobone (Kettering) (Con)]

6. What recent assessment he has made of the performance of the A and E department at Kettering general hospital.

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

We are aware that the trust did not meet the four-hour standard for a period, and obviously Monitor took action and worked with the trust. In the week ending 1 June 2014—the most recent period for which data are available—99.7% of patients who attended Kettering A and E were treated, admitted or discharged within four hours, continuing a recent improvement in performance. I am sure that the staff are justly proud of that, and I know their local Member of Parliament will want to champion it.

[Mr Hollobone]

In April 2013, Kettering general hospital was one of the worst performing acute hospitals in England on the A and E target, admitting only 74% of patients within the four-hour A and E target time. Now, as the Minister has said, it is almost 100% and the hospital is one of the best performing trusts in the country. Will the Minister congratulate all involved at the hospital on that rapid turnaround, and tell the House how the lessons learned at Kettering might be applied elsewhere?

[Jane Ellison]

I absolutely join my hon. Friend in congratulating everyone involved in turning that performance around—it is really, really impressive. He is right to say there are lessons to be learnt everywhere from people innovating, joining up services and the various things that have gone on in the background. I know that the local Members have been involved and engaged in the process and I congratulate them on that. That is really valuable and I urge everyone to get involved. We should congratulate A and E staff everywhere on dealing with the pressures they are under. We know they are considerable, but they do a great job.

[Mr Peter Bone (Wellingborough) (Con)]

May I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on the work he has done to help with this amazing turnaround? The Minister is aware of the plans to have a community urgent care centre at Isebrook hospital in my constituency, which will mean that my constituents will not have to go to Kettering hospital. Is this not another way forward to improve A and E results?

[Jane Ellison]

My hon. Friend highlights that there are a lot of different approaches to reducing the pressures on A and E. The great thing is that we are seeing real innovation from local clinicians, supported by local Members of Parliament. That shows what can be done when we address these problems with an innovative approach, and think about how we can reduce these pressures and ensure that as many people as possible are served in the right way and treated outside A and E, if that is not the place they should be.

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

7. What discussions he has had with NHS England on the future of the cancer drugs fund.

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[Kelvin Hopkins (Luton North) (Lab)]

10. What statistics his Department keeps on babies damaged by alcohol consumed in pregnancy; and if he will make a statement.

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

Hospital episode statistics include finished admission episodes where there was either a primary or secondary diagnosis of a foetus or newborn affected by maternal use of alcohol or foetal alcohol syndrome. I have supplied some detail on that in parliamentary answers this week. These records cover both patients treated in NHS hospitals in England and by independent providers whose services are commissioned by the NHS.

[Kelvin Hopkins]

The Minister has confirmed that thousands of babies are born every year damaged by alcohol, and yet there is still no statutory requirement for all alcoholic drinks containers to display specific health warnings about the dangers of drinking in pregnancy. When will the Government introduce the necessary legislation?

[Jane Ellison]

Before I respond to the substantive point, it is worth saying that there is a spectrum of disorders and some of the diagnoses on certain parts of the spectrum are quite difficult. We have statistics on foetal alcohol syndrome and there is no evidence that that is increasing, although we seem to be diagnosing more in younger children. Also, the women to whom this tends to happen are extremely difficult to reach through public education campaigns as many are subject to additional, complex factors.

On bottling, through the responsibility deal, there was a commitment to get 80% of alcoholic drinks on the market labelled. That is being independently audited and is something we champion, not just with messages about drinking in pregnancy, but through guidance from the chief medical officer on drinking generally.

[Henry Smith (Crawley) (Con)]

Prevention is of course better than cure. What is my hon. Friend’s Department doing on better guidance and support for midwives and other groups such as the National Childbirth Trust to discourage expectant mothers from drinking alcohol?

[Jane Ellison]

One of the slight challenges in this area is that quite a lot of pregnancies are unplanned and people have sometimes been drinking alcohol before they know they are pregnant. However, a lot of advice is available. Along with health visitors and midwives—we are putting more resource into those areas—Public Health England’s “start for life” campaign provides advice to pregnant women. There are National Institute for Health and Care Excellence guidelines, including for those women to whom I referred earlier with complex social factors. A lot of information is available, and the chief medical officers are reviewing the guidance to people generally. The simple message to women who are hoping to conceive or who are pregnant is that it is best to avoid alcohol.

--- Later in debate ---

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

The review is being undertaken by NHS England, which has been engaging with a wide range of stakeholders, of whom my hon. Friend is one. He is a doughty champion for his city, and for these services. I understand that NHS England will consult on draft service standards later this year, but will not do so in July as was previously expected. All information relating to the review can be found on the organisation’s website, which is updated fortnightly. I spoke to officials yesterday in order to update myself, and I know they will post another update very soon, if not today.

[Stuart Andrew]

According to the mortality case section of the Secretary of State’s review of the closure of services at Leeds, many of the recommendations could apply more widely to other units throughout the NHS. Given that no other unit has received anything like as much scrutiny as Leeds, will my hon. Friend ensure that any continuing audits take place in the other units as well, so that standards can be maximised?

[Jane Ellison]

That is a very good point. This Government and this Secretary of State have championed transparency more generally, because we all believe that it is essential to our ability to build on the success of the health service and maximise its service to patients.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Am I right in understanding that the Minister has just announced a further delay? The key recommendation to the Government on children’s heart surgery, which was made in 2001, was that fewer units should be centres of excellence, because that was in the best interests of patients. Now, 13 years later, none of that has actually happened. Do the Government still accept the premise that fewer units should be centres of excellence, and will the Minister tell us what accounts for the delay?

[Jane Ellison]

I understand the right hon. Gentleman’s frustration, but the review is very important. NHS England has confirmed that it will not be able to consult quite as early as it had wished, but it should be appreciated that this review is more comprehensive than the last one. For example, NHS England has developed a comprehensive set of commissioning standards which have never existed before. For the first time, the whole patient pathway will be covered, from foetal detection through childhood, into adult services and all the way to palliative care—on which one of my hon. Friends led a debate relatively recently—and bereavement.

It is always frustrating when things do not happen according to schedule, but what really matters is getting this right and being as transparent as possible. The level of engagement with stakeholders has been much more satisfactory than before, and we continue to make progress.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

13. If he will bring forward proposals to widen the range of services and treatments available in community hospitals in rural areas.

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[Alex Cunningham (Stockton North) (Lab)]

T4. Health inequality on Teesside is a major issue, but the Government axed plans for our new hospital four years ago. I am told that Ministers now accept that a new hospital to replace the two hospitals at North Tees and Hartlepool is the right way forward. When will they remove the barriers to the project and give the support that is needed?

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

That is certainly something that we will look into.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

T6. The new specialist emergency hospital is nearly 60 miles from Berwick. Given the serious delays in ambulance attendance in recent cases in Northumbria, how can we be sure that serious cases will get paramedic attendance and delivery to the hospital within the critical hour?

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[Duncan Hames (Chippenham) (LD)]

When will the public health Minister publish the regulations for the plain packaging of tobacco products, on which she proposes to consult?

[Jane Ellison]

As my hon. Friend knows, Parliament has already granted us the regulation-making powers in the Children and Families Act 2014 and we have said that we are minded to proceed with those. We are still committed to consult. The regulations are being drafted. I had hoped to publish them before the end of April. We were caught by the pre-election purdah period, but I hope to publish them soon.

[Several hon. Members]

rose—

[Barry Gardiner (Brent North) (Lab)]

I am grateful, Mr Speaker. In Brent we have the highest incidence of TB and of type 2 diabetes in the country. We have just received a cut of £450 million in the money allocated to the CCG. The Secretary of State says that this is fair, but my constituents want to know whether it is in accordance with need.

[Jane Ellison]

The hon. Gentleman is right to draw attention to the problem of TB in London. As a London Member myself, I know what he is talking about. I encourage him to participate in the current consultation on Public Health England’s comprehensive TB strategy. It is a very important document which marks a step change in the way we confront the problem. That will help us to allocate resources to need and to address serious problems.

[Mr Speaker]

Last but not least, I call Sir Kevin Barron.

[Kevin Barron (Rother Valley) (Lab)]

Will the Minister give us an update on the proposed licensing of e-cigarettes by the Medicines and Healthcare Products Regulatory Agency? Does her Department believe that e-cigarettes could be used in smoking cessation programmes?

[Jane Ellison]

When I brought the regulations before Parliament, we were clear that those e-cigarettes for which a medicinal claim is made must be subjected to medicinal licensing arrangements. Once they are licensed as medicine, they can be prescribed as part of NHS smoking cessation services.

Health

Jane Ellison Excerpts

Monday 9th June 2014 Commons Chamber

[Andy Burnham]

It is well documented that the policies of this Government in a range of areas are damaging the health of the nation, but what we get instead is drift from the Government on public health. There is no momentum at all to improve children’s health and the Queen’s Speech had absolutely nothing to say on it. Where are the measures that the Minister has been proposing? What has she been doing? Why does she not introduce them?

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

The right hon. Gentleman will be aware that the legislation for both the measures to which he alludes has already been passed by this House.

[Andy Burnham]

But regulations are needed. If the Minister does not know that—[Interruption.] It was the Opposition who brought forward the vote on smoking in cars and she committed to introduce regulations to implement it. She cannot duck the question. When will she do that? If she does not realise that she is going to introduce regulations, she needs to go back and do a bit more homework.

It is not hard to guess why the Government want a period of silence. On every measure, the evidence is clear that the NHS is getting worse. When the Prime Minister was challenged—

Ambulance Resources and Response Times

Jane Ellison Excerpts

Wednesday 14th May 2014 Westminster Hall

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

I congratulate the hon. Member for Hartlepool (Mr Wright) on securing the debate. Given the wide range of topics that he and his colleagues raised, I am not sure whether I will be able to cover them all in the time available, so if I do not, I will attempt to respond to any substantive points after the debate. I will also certainly alert my noble Friend Earl Howe to the points made.

As the hon. Gentleman said, ambulance services are vital to the health care system and provide rapid assistance to people in urgent need of help. Many lives are saved by the hard work of ambulance service personnel. He is right to place his congratulations on the record and I want to place on the record my appreciation of the work done by staff in ambulance trusts. I gently suggest that I do not recognise some of the words and phrases used in the debate to characterise the service provided, but I am sure that they were used to stress a point.

[Pat Glass]

Will the Minister give way?

[Jane Ellison]

No, because I have only just begun and the hon. Gentleman took many interventions.

Emergency services are the first port of call for many of us when serious illness or accident strikes. The total number of emergency calls to ambulance services in England in 2013-14 was 8.4 million, which is a 0.9% drop over the previous year. Unfortunately, a small proportion are unnecessary or frivolous, but the overwhelming majority are from people who feel in need of urgent help.

The growing number of people living with chronic conditions and the ageing population to which the hon. Gentleman referred are placing increasing pressure on urgent care services, something that we all acknowledge. It is important for my Department to work with Public Health England, local commissioners and health care providers to educate and engage the public on measures to prevent chronic health problems from developing. There are a number of people who end up in A and E because they have not taken medication properly or who suffer acute problems as a result of a chronic condition. Hon. Members will be aware of some of the longer-term problems in their region, which result from difficult public health challenges. Tackling those is my own particular portfolio, and is one way in which we can make the emergency services more sustainable in the longer term.

I hope hon. Members recognise that. At times, it seemed that they were merely committing themselves to significant additional future spending rather than also turning their minds to the longer-term challenges.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

I am going to continue and try to make a few substantive points. If I have time, I will give way.

All 999 calls are triaged into two basic categories, red and green, depending on the seriousness of the call. Those placed in the red category are calls where the patient is in a life-threatening condition; an example would be someone suffering a cardiac arrest. Such calls require assistance on the scene as quickly as possible and the Government have set targets for all ambulance services in England of a response within eight minutes in 75% of cases. The latest figures, for March 2014, show that in north-east England—the area of the hon. Member for Hartlepool—the median average response time for red category calls was 6.4 minutes. Nationally, those figures show that 76.2% of red 1 calls, which are the most critical, received a response within eight minutes. In the north-east the target was also met, with 75.2% of patients receiving a response within eight minutes. That is not to say that there are not significant problems in some cases, but it is important to place on the record the service’s effective work in meeting that target.

Less critical 999 calls placed are in the green category. Those calls are not subject to national targets. Some ambulance services set their own targets for response times, and NEAS uses a one hour standard. It is important that such calls receive a timely and appropriate response, but red calls must be prioritised, as a person’s life may be in immediate danger.

There has been recent media coverage of long waits for ambulances, and hon. Members have alluded to constituents’ experience of such waits during this short debate. Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means there will always be incidents where unfortunate timing leads to a situation in which someone who is assessed as being in a non-life-threatening situation calls 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members recognise that that would be the case under any Administration.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

Briefly.

[Grahame M. Morris]

I am grateful to the Minister for giving way, but I cannot let that pass, because the situation is different now. I have had the honour of representing Easington for four years and it is evident from the cases that are coming to me and to colleagues from the region that the situation is worsening. One case was that of a young man who broke his hip playing football and waited for two and a half hours in the rain. He was in the centre of the constituency, in an area that is readily accessible. Another was of an old lady who waited two and a half hours for an ambulance. She died the following day. Something is sadly wrong with the North East Ambulance Service and the situation is deteriorating. We have all had cases that are really quite shocking, and something needs to be done.

[Jane Ellison]

I am not familiar with the cases that the hon. Gentleman mentioned, but I will draw them to the attention of my ministerial colleagues and of the trust. I spoke to the head of the trust yesterday, and will make sure that the debate is brought to the trust’s attention. However, I gently say to hon. Members that they surely cannot be suggesting that at no previous time, under any previous Government, have there been any cases in which a service did not get this right. It is important to—

[Pat Glass]

It’s a service in crisis!

[Jane Ellison]

I do not recognise that description, and I do not think the service would recognise it.

Very rarely, as we have heard, waits may be unacceptably long, but it is important to remember that the vast majority of people receive a timely response when they dial 999. I am aware of the case of William Gouldburn, who was the constituent of the hon. Member for Hartlepool and who sadly died in April last year as the result of an existing heart condition. He waited two hours for an ambulance after his collapse at home. His case is distressing, and his MP is right to champion it and make us aware of it. The trust acknowledges that it failed by not getting an ambulance to Mr Gouldburn within the one-hour target it had set itself. It has been accepted that that was not good enough.

Difficult as his story is to hear, it is important to note that Mr Gouldburn’s 999 call was categorised as a green call—that is, a non-life-threatening situation—and at the inquest the coroner accepted that the call had been correctly triaged and categorised. That is not to say that there were not things that clearly should have been done differently, but it is right to put on the record what the coroner said. There is no denying that Mr Gouldburn waited an unacceptably long time for an ambulance, but the decision on his call’s priority was made when other calls were at the same time being prioritised as red.

It is a matter for local commissioners to agree with ambulance trusts the appropriate protocols for dealing with green calls, based on available clinical guidelines and local circumstances. I know that in the case of the hon. Member for North West Durham (Pat Glass) those local circumstances have been recognised with the introduction of a specific response vehicle in her constituency. There has been increasing demand on ambulance services—the North East Ambulance Service says that it saw a 5% increase in the volume of emergency incidents in the year up to March 2014—but thanks to the hard work of service staff, fast response times have been delivered in the vast majority of cases.

NEAS advises that over 40% of the calls it receives are categorised as red, so its consistent ability to exceed the national target for response times should be commended. NEAS has also told me that in 2013-14, 74.8% of calls categorised as green 2, or serious but not life-threatening, received a response within 30 minutes.

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[Mr David Crausby (in the Chair)]

I will adjourn the sitting at 5.15 pm. I call the Minister.

[Jane Ellison]

Thank you, Mr Crausby. Welcome back to the hon. Member for Hartlepool—I think some colleagues may not have been able to rejoin us.

As I was saying, NEAS tells me that in 2013-14, 74.8% of calls categorised as green 2, meaning serious but not life-threatening, received a response within 30 minutes, and 71.2% of calls categorised as green 3, meaning non-emergency, received a response within 60 minutes. Although that does not in any way diminish the tragedy of cases such as Mr Gouldburn’s, which are never acceptable, it is important that we recognise the generally excellent service provided by the trust and its staff.

[Mr Wright]

I appreciate what the Minister is saying, but when it goes bad, it goes catastrophically bad, with life-threatening consequences. Surely she realises that we should make sure that we minimise that as much as possible.

[Jane Ellison]

I think we can all agree that those are circumstances that we want to minimise.

I want to turn briefly to one or two specific local points, and then to one or two wider points. Most recently, the Government recognised the importance of investment in front-line services with £14 million provided to ambulance services last December. Obviously, it is for local commissioners and trusts to decide how that money is used. I recognise that in the hon. Gentleman’s region, local commissioners see that more investment is needed for ambulance services, and we recognise that the trusts are working with local commissioners on that, making sure that they get that commissioning piece right.

More generally, there is also an issue about staffing in the ambulance service. Since 2010, the NHS has recruited 16% more paramedics, but we know that in some areas of the country, there is insufficient academic capacity, for example, to produce paramedics in the numbers required. Again, the Association of Ambulance Chief Executives is working with Health Education England to address that issue in the medium term.

The hon. Gentleman also alluded to ambulance handover delays. We absolutely recognise the role that they can play in making the job of the ambulance service more difficult. I believe there has been an ongoing issue, to which he alluded, for NEAS at County Durham and Darlington NHS Foundation Trust hospitals. Local commissioners have advised that there has been recent improvement, helped by winter initiatives supported by the urgent care working group. That has included support from the fire and police service, but I know there is more to be done.

Indeed, my colleague from the east of England, my hon. Friend the Member for Suffolk Coastal (Dr Coffey), who has not been able to rejoin us, was talking as we went to the vote about work that had been done specifically in her area to look at some particular issues that affect handover delay. As she said in her intervention on the hon. Gentleman, it is well worth local Members exploring some of that detail with their board as well to see whether lessons can be learnt from other parts of the country.

The urgent and emergency care review is being led by Sir Bruce Keogh, the national medical director of NHS England. He was asked to undertake a review of urgent and emergency care, looking at all aspects of the sustainability of the urgent and emergency care system. That does not exclude ambulance services. The review proposes the development of 999 ambulances; they would become more like mobile treatment services, not just urgent transport vehicles. There is a lot of fresh thinking in all sorts of areas of delivering excellence in emergency health care, and it is right that we look at new ways of delivering that health care with regard to ambulances as well, rather than just looking at the old model.

I want briefly to put a point on the record in the 30 seconds left to me. Let us not minimise the importance of people being asked about a rash as a symptom on the phone. It is one of the signs of meningitis and the royal colleges have advised that that should be asked as a question, so it is not an insignificant point.

With regard to private ambulances, that provision was brought in by the right hon. Member for Leigh (Andy Burnham), when he was in office—

[Mr David Crausby (in the Chair)]

Order.

Livestock: Diseases

Jane Ellison Excerpts

Wednesday 14th May 2014 Ministerial Corrections

The full answer given was as follows:

[Jane Ellison]

The following table states how many instances of the cystic stage (C Bovis) of the human tapeworm Taenia Saginata have been identified during official post mortem inspection and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency since April 2012.

[Jane Ellison]

The following table states how many instances of the cystic stage (C Bovis) of the human tapeworm Taenia Saginata have been identified during official post mortem inspection and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency since April 2012.

[Huw Irranca-Davies]

To ask the Secretary of State for Health how many instances of (a) Cysticercus Tenuicollis (adult tapeworm - Taenia Hydatigena), (b) Cysticercus Ovis (adult tapeworm - Taenia Ovis), (c) Hydatid Cysts (adult tapeworm - Echinococcus Granulosus), (d) Generalised (cysts identified in multiple parts of the animal including the musculature the consumer would define as meat) and (e) Cysticercus Ovis have been identified at official post-mortem inspections and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency since 1 April 2012.

[Official Report, 1 April 2014, Vol. 578, c. 572W.]

Letter of correction from Jane Ellison:

An error has been identified in the written answer given to the hon. Member for Ogmore (Huw Irranca-Davies) on 1 April 2014.

The full answer given was as follows:

[Jane Ellison]

The following number of instances have been identified at official post mortem inspection and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency (FSA) since April 2012:

Some conditions are not recorded by the FSA. The list of conditions for cattle, sheep, goats, pigs and poultry were created following expert working group workshops for each species over the last five years. Members of the workshops included stakeholders from the Department for Environment Food and Rural Affairs, Animal Health, EBLEX, BPEX, private veterinarians, industry vets, FSA, Association of Meat Inspectors.

The data for sheep, goats, deer and horses is from April 2012 to December 2013 all other species is April 2012 to March 2014.

[Jane Ellison]

The following number of instances have been identified at official post mortem inspection and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency (FSA) since April 2012:

Some conditions are not recorded by the FSA. The list of conditions for cattle, sheep, goats, pigs and poultry were created following expert working group workshops for each species over the last five years. Members of the workshops included stakeholders from the Department for Environment Food and Rural Affairs, Animal Health, EBLEX, BPEX, private veterinarians, industry vets, FSA, Association of Meat Inspectors.

The data for sheep, goats, deer and horses is from April 2012 to December 2013 all other species is April 2012 to March 2014.

Informal Health Council

Jane Ellison Excerpts

Thursday 8th May 2014 Written Statements

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

EU Health Ministers met in Athens on 28 and 29 April. The UK was represented by a senior official from the Department of Health. The agenda included discussions on e-health, migration and public health, and the economy and health care.

The meeting began with a discussion on e-health. The Greek presidency chaired a discussion on the potential for electronic prescriptions and mobile technology to improve the quality and efficiency of health care and boost economic growth. The UK underlined the importance of innovation and sharing best practices.

On migration and public health, there was a discussion on the screening of migrants for infectious diseases. The UK argued in favour of evidence-based national approaches to screening, and outlined the current position in the UK particularly in relation to TB.

There was also discussion on the need to reform health care systems in light of pressures on public budgets across the EU, the ageing population and the rising burden of chronic disease.

Points were made on the advantages of investing in health prevention, health indicators and using medicines more cost effectively. The UK intervention highlighted the importance of taking action on dementia, the need to focus on prevention, and other measures taken in the UK to ensure the best use of resources, while stressing that matters such as health technology assessment are issues of member state competence.

Cervical Cancer Screening

Jane Ellison Excerpts

Thursday 1st May 2014 Commons Chamber

[Mr Baron]

The hon. Lady makes an excellent point, which leads me neatly on to the report that the all-party group produced back in 2009 on reducing cancer inequalities—I should perhaps declare an interest as the chairman of the group. The report, which was extensive and took in much written and oral evidence, found that this country’s health care system stood as much chance as any other of getting patients from the one-year point to the five-year point after diagnosis. However, where we fell down was on getting them to the one-year point in the first place. That suggests that the NHS is as good as any other health care system at treating cancer once it is detected, but very poor at detecting it. That underperformance in diagnosing cancer means that we trail other health care systems. We never catch up from that original loss.

Comparisons are always dangerous. When we compare our system with that in France, for example, we are comparing it with centres of excellence, so we have to be careful in our comparisons. However, the figures of 5,000 lives a year that could be saved if we matched European averages and 10,000 that could be saved if we met international averages are generally accepted. They can largely be accounted for by the early phase, when we fail to pick up cancer early enough and so do not get enough people to the one-year point after diagnosis.

The all-party group therefore decided to ask how we could focus the NHS on earlier diagnosis. We have been laser-like and dogged in our campaign on that front.

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

indicated assent.

[Mr Baron]

The Minister is nodding—kindly, I think. I thank her for that in one respect.

The solution that the all-party group came up with was to focus on outcomes. We could bombard the NHS with a lot of targets to try to encourage earlier diagnosis, but instead we decided to focus on one outcome measure—the one-year survival rate, broken down by CCG—as a driver towards earlier diagnosis.

--- Later in debate ---

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

I congratulate the hon. Members for Wirral South (Alison McGovern) and for Liverpool, Walton (Steve Rotheram) on securing and leading this debate. We all wish that we were not debating this issue, important though it is, against such a tragic backdrop. I share the view of the hon. Member for Wirral South that it is a great innovation that, through e-petitions and the Backbench Business Committee—she knows that I used to serve on that Committee—we can now bring issues of such huge public concern swiftly to the House for debate.

This has been an excellent debate, and I thank all Members for their contributions. Depending on how tolerant Mr Deputy Speaker is feeling, I may not get the chance to address all the points that have been raised, but I hope Members know that I will, as I always commit to, respond to them after the debate.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The Deputy Speaker is always generous in the time that he gives but, recognising that there are constraints, I welcome those comments.

--- Later in debate ---

[Jane Ellison]

Indeed, and I will be guided by you, Mr Deputy Speaker.

Like others, I start by paying tribute to Sophie Jones and her brave battle against cervical cancer. I also offer my sincere condolences to her family who have conducted themselves with such dignity in recent weeks and months. I assure all Members that I will try to address the important issues that they have raised. There is a lot to say, so if I do not get through it all, I will respond to them afterwards.

Although I am not able to comment in detail on individual clinical cases, we understand that Sophie’s case was one of misdiagnosis rather than of screening, to which the hon. Member for Liverpool, Walton alluded. Thankfully, cases of cervical cancer in her age group are extremely rare. I understand that the medical director for the Cheshire, Warrington and Wirral area team has requested that the GP practice undertake a significant event analysis to review the case, and ensure that all appropriate procedures are followed and that any lessons learned are put into practice. Once that is completed, it will be agreed with the practice how that will be shared. I can assure the House that I fully expect NHS England to keep the family and local MP fully informed as the investigation progresses.

Despite the tragic circumstances in this case, I reassure the House that the NHS cervical screening programme is one of the most well regarded in the world. More than 3 million women are screened every year. Experts estimate that the programme saves up to 4,500 lives in England alone. However, it has to be based on the best available evidence. The best independent evidence shows that routine screening of women under 25, on balance, does more harm than good. The UK national screening committee reviewed the age of cervical screening in 2012—although some Members have said that the last review was earlier or later than that—and confirmed the English policy of not screening those aged under 25 as it has no impact that can be seen on the detection rates of cervical cancer in young women and gives rise to a high number of false positives, which cause anxiety and, more importantly, lead to unnecessary investigations and treatments that can have side effects.

The UK NSC review in 2012 followed a review of the age at which cervical screening starts by the Advisory Committee on Cervical Screening, or ACCS, which is made up of experts in a range of disciplines, third sector representatives from Jo’s Cervical Cancer Trust and patients. The ACCS review took place in May 2009 to consider the raising of the screening age from 20 to 25, and it confirmed that decision. The 2012 review was partly a response to the Jade Goody effect mentioned by some hon. Members today and was intended to reconsider that decision. The ACCS was unanimous in deciding that there was no reason to lower the age from 25, which is in line with World Health Organisation guidelines.

Some of the reasons behind that decision have been mentioned. The research presented showed that there was little or no impact on detection rates in those aged up to 30, no clear evidence of an increase in the incidence of cervical cancer following the change to the screening age in 2004, no new scientific evidence was available to support the reintroduction of screening and one in three young women aged under 25 would have an abnormal result when screened, as opposed to one in 14 from all women who are screened. That shows a lot of false positives in young women.

[Martin Horwood]

Will the Minister give way?

[Jane Ellison]

If the hon. Gentleman is going to draw my attention to the statistics he presented, I am happy to look at them in detail and, indeed, I have a partial answer to some of his questions.

[Martin Horwood]

indicated dissent.

[Jane Ellison]

I will give way very quickly, but I need to get through my speech.

[Martin Horwood]

I was interested to know when in 2012 the UK NSC met. The second Sasieni research was only published in August 2012 and the Cancer Research UK statistics were published in the BMJ in 2013, so they have not been reviewed as far as I know.

[Jane Ellison]

As I said, the hon. Gentleman presented quite a detailed statistical submission and I shall respond to him after the debate rather than off the cuff. His statistics deserve better than that.

Cervical cancer is thankfully very rare in women aged under 25. As has been said, there were 47 cases in England in 2011, the last year for which we have figures. That is less than 2% of all cases and there were two deaths. Obviously, we will consider the statistics presented by the hon. Member for Cheltenham (Martin Horwood), but we are aware that in 2009-10—this also relates to the points made by other hon. Members, and most strongly by the hon. Member for West Ham (Lyn Brown), about health inequalities—an extra 600,000 women came forward for screening, many as a result of the publicity surrounding the death of Jade Goody. Many of those women were from lower socio-economic and hard-to-reach groups, and they are more often at risk. That is an important statistic and we need to consider that again.

It may help the House if I briefly run through the science behind the abnormal screening results in younger women. Primarily, they are caused by the fact that they have a high rate of HPV infection, as the cervix in young women is more prone to infection with transient HPV, both because it has not yet matured and because younger women might be exposed more often to different types of HPV. Furthermore, some of the few cancers found in young women are unusual and rare tumours that differ from the type we screen for, such as small cell tumours that can develop rapidly and are very dangerous. However, some are HPV-associated tumours that develop at a young age and sometimes simply as a rapidly developing cancer. The key thing in such cases is rapid referral and an appropriate medical response.

In its 2009 report, the ACCS was concerned that young women presenting to primary care with symptoms of cervical cancer were not always given the best advice. I know that that will be a concern not only to Sophie’s family but to all of us in this House and to the NHS. We know that for many GPs, seeing a patient with cervical cancer is rare, and potentially only one GP in 16 will see a new case each year. That is quite a statistic. To help GPs make the right clinical decisions, new guidance for primary care on the management of young women with gynaecological symptoms was developed and sent to all GPs in England in March 2010. The guidance was developed by a multi-disciplinary group, and supported by all the relevant royal colleges. I undertake to raise the issue again with the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners to explore the best way to remind GPs of the guidance.

I reiterate that whatever her age, if a woman is concerned about abnormal symptoms she should contact her GP, who will be able to examine and refer her urgently to a gynaecologist if clinically appropriate. The House might not be aware that the guidance is explicit that in any case where a woman is showing symptoms, best practice is that she should not be referred for screening. That is because a cervical screening test is aimed at women without symptoms. It is a screening, not a diagnostic test, and waiting two weeks for the result could delay examination by a gynaecologist. That is a really important point to bring out in the debate. If someone has symptoms, we want to get them urgently from symptom to diagnosis via a referral, and a screening test could further delay that.

I want to talk a little, as others have, about the human papilloma virus, or HPV. Many Members have mentioned the fact that we have identified high-risk types of the virus and that the vaccination programme sprang from that identification of risk. The programme was introduced in 2008 for girls aged 12 to 13. Its aim was to prevent cervical cancer related to the HPV types covered by the vaccine, which covers about 70% of all cervical cancers. The programme has been a big success. More than 7.8 million doses have been given so far in the UK since 2008, and we have among the highest rates of HPV vaccine coverage in the world, with 86% of girls eligible for routine vaccination in England in the 2012-13 academic year completing the three-dose course, and 90% receiving at least two doses.

It may be of interest to Members to hear that the Merseyside area team reports a higher than national average take-up of the HPV vaccine, with 87.8% of girls vaccinated with all three doses in 2012-13. In Wirral and Sefton, that figure was 90%. However, we cannot be complacent and we want to get the fullest possible coverage. That is something about which MPs, as well as Ministers, can do a lot to spread the word. When we go into schools, a good question to ask might concern the coverage and whether there are particular groups of parents or people from particular backgrounds who do not take up the vaccine.

It is expected that the programme will eventually save more than 400 lives a year from cervical cancer. The first indication that the programme is successfully preventing infection with HPV types 16 and 18 in sexually active young women in England was published in the scientific journal Vaccine, and showed that the proportion of infected rates in 16 to 18-year-olds fell from 17.6% in 2008 to 6.6% between 2010 and 2012. That is major progress, so the take-up of the vaccine is really important.

We encourage all girls, irrespective of religion or ethnic background, to receive the HPV vaccination. NHS England is responsible for making arrangements to implement the programme for eligible girls and young women in the local area, taking into account local circumstances, such as the number of independent or special schools and the number of girls who are not in school. Interestingly, I was informed that Surrey has a much lower take-up, so perhaps we need to consider how to deal with girls in independent schools, or other local circumstances. NHS England is also responsible for ensuring that local programmes meet the national specifications.

We are using our growing knowledge of HPV to modernise the NHS’s cervical screening programme by considering HPV infection alongside the screening programme and looking for abnormalities and seeing how they can interact. Public Health England is also promoting the use of the HPV test as a primary screen, which is very interesting. A lot of work is going on, and the first evaluation report of the pilot is due in spring 2015. Cancer Research UK has estimated that, when fully implemented, HPV primary screening could prevent hundreds of cancers a year.

There are some particular matters to which I would like to draw the attention of the House, as I have a little time. The Prime Minister’s £50 million GP access fund will support more than 1,400 practices covering every region to offer extra services for those who struggle to find appointments that fit in with family and work. That is important and responds to one of the points made by the shadow Minister.

I hope we can show that despite tragic cases such as Sophie’s, the age at which screening starts in England is based on sound evidence. It has been carefully considered by members of expert committees pretty recently. However, I am very aware that we need to keep all evidence under review. I have already had a brief conversation with the chief medical officer about this. Members may be aware that one of my fellow Ministers is a specialist in this area of medicine, so we will make sure that we look again at the points that have been made in the debate.

There is much we can do as a House and as a country to reduce the number of women who suffer from this devastating disease. I urge every woman invited to screening to take up the opportunity, as we know that 25% of women in the 25-to-30 age group do not. On screening, I do not have time to describe the work in detail, but I can assure Members that Public Health England has work under way specifically to look at low coverage in certain areas and to work on local action plans to improve that coverage.

I want to do more to urge employers to support their staff. Again, evidence from Jo’s Cervical Cancer Trust, representatives of which I met on Monday evening and discussed some of these issues with, suggests that many younger women do not want to ask an employer for time off for a smear test. I will look at what we can do through work that is already going on with employers to see how we can encourage them to make it clear to young women that they do not have to go through an embarrassing conversation to get time off for that. I will be looking at that further with Jo’s Cervical Cancer Trust.

If Members who called the debate and spoke in it have the appetite for it, I am happy to devote a special day in Parliament to what we can do on take-up of screening and of HPV vaccination. I would love to do that piece of work with hon. Members if they want to work with me on that, because much of this is down to local and specific community factors. A one-size-fits-all national programme is not adequate. As part of Be Clear on Cancer, we have a pilot programme on ovarian cancer which will be running this spring, so we are moving into those gynaecological issues. We will look at the review of that to see whether there is more we can do in this area. Work is under way, but there is so much more we can do working together.

[Lyn Brown]

I am grateful to the Minister and I will certainly take her up on that. May I remind her of the hysteroscopy campaign, which we could perhaps dovetail into that work?

[Jane Ellison]

Of course. I remember that I responded to the hon. Lady on the detail of that.

I have started to write routinely to the chairmen of health and wellbeing boards to make them aware of issues that are of interest to parliamentarians and changes in law or guidance. I undertake to mention this subject, particularly in the context of Sophie Jones’s case, in my next letter to health and wellbeing board chairmen, to draw it to their attention. There is a 1 million study under way by the National Institute for Health Research under its health technology assessment programme to look at the issues of effective interventions for younger women on the take-up of screening, so work is in progress.

[Mr Baron]

Will the Minister update the House briefly on whether there has been any progress on work regarding how we will hold underperforming CCGs to account, once the one-year cancer survival figures are published from June onwards?

[Jane Ellison]

I applaud my hon. Friend for taking a further opportunity to draw that to my attention—we met on Monday evening and discussed it. That will be part of the Department’s response to the all-party group’s report, and I undertake to update him further. I note, as he does, that he raised the matter with the Prime Minister recently and I will keenly pursue the points that he has made.

Finally, I thank all the staff involved in the national screening programme and those who deliver the important HPV vaccination programme for all their hard work. More power to the elbow of those who are looking for ways at local or national level to reach more young women, for all the reasons outlined by so many Members in so many excellent speeches. We can do so much more to achieve greater awareness and greater take-up, to get greater numbers of people screened and taking up the HPV vaccine. All that is work that we as Members of Parliament, I as a Minister and many people involved in our health services around the country can take part in. I recognise that for Sophie’s family, nothing we do can make up for her loss, but it can be part of her legacy. I thank Members for bringing this debate to the House.

European Health Care Payments

Jane Ellison Excerpts

Wednesday 30th April 2014 Written Statements

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

The Government have taken the decision to cease certain payments that the UK is not obliged to make under the European regulations governing health care entitlements, effective from 1 July 2014. These are payments made to UK citizens who may be visiting or residing in another member state, and removing these entitlements could save up to £7 million.

These payments are reimbursements for European health insurance card (EHIC) co-payments and residual SI forms. EHIC co-payments are the payments individuals may need to make when accessing health care in another EEA country using their EHIC card where that country requires a financial contribution from its own citizens, for which reimbursements can currently be claimed from the UK. These reimbursements will cease from 1 July 2014. It will still be possible to claim reimbursements for any course of treatment received before 1 July, and for a treatment started before 1 July and continuing beyond that date during a particular stay in another EEA member state, for example a continuous stay in hospital.

Residual SI forms are currently issued to early retirees moving to another EEA country and not taking up employment, providing a temporary period of health care cover for maximum period of 30 months, dependent upon the individual’s recent national insurance contribution record in the UK. Applications for residual SI forms will no longer be accepted after 1 July 2014. This change does not affect current holders of residual SIs or the right of UK state pensioners to access health care when they retire to another EEA country.

These payments are not required under EU law, so the UK is currently going over and above its European obligations. These proposals were outlined in the consultation in July 2013 on migrant access to the NHS and then in the subsequent Government response, published in December 2013.

Cystic Fibrosis

Jane Ellison Excerpts

Thursday 10th April 2014 Commons Chamber

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

I congratulate the hon. Member for Bristol East (Kerry McCarthy) on securing this debate. She made a wide-ranging speech demonstrating a very deep knowledge of this subject. She alluded to her own family connection to this condition. Obviously, I convey my best wishes to her constituents, particularly to her family and especially to her niece, who is, as she described, suffering from the condition.

I commend the hon. Lady’s recent achievement in raising funds for the Cystic Fibrosis Trust. That is an excellent achievement for an excellent charity; she is right to be generous in paying tribute to it. I am sure she will be interested to know that in recent weeks many Members of Parliament have contacted me in support of the trust’s current campaign on behalf of the 10,000 or so people in the UK who battle with the everyday challenge, which she so eloquently described, of living with cystic fibrosis.

Let me take this opportunity, as I like to do, to pay tribute to those who work in our NHS and their dedication, determination and commitment to provide a first-class care service to all patients, not least CF patients. I pay tribute to them for their efforts, all the time, on behalf of all of us and all our constituents.

Let me first speak more generally about organ transplants and the challenges of organ transplantation. In the UK, the need for an organ is greater than the number of donor organs available. About 8,000 people are on the national transplant list waiting for a transplant that will save their lives or significantly improve their quality of life. Unfortunately, too many people wait too long for a suitable organ to be donated. About 1,000 people a year die waiting—about three adults or children every day. That applies to organs in general. Many others lose their lives before they even get on the transplant list. As of 3 April this year, 75 people with cystic fibrosis were waiting for a lung transplant. About 50 cystic fibrosis patients receive a transplant each year, but unfortunately about 20 patients die each year on the transplant list. We can see the clear challenge to meet that need and assist those people.

This means that there has to be a system to ensure that patients are treated equitably and that donated organs are allocated in a fair and unbiased way based on the patient’s clinical need and the importance of achieving the closest possible match between donor and recipient. A number of factors are involved. The rules for allocating organs are drawn up by the medical profession in consultation with other health professionals, specialist solid organ advisory groups, and health administrations. Factors such as the blood group, tissue type, and age and size of the donor and the recipient are taken into account to direct the allocation of the organ and identify the best-matched patient or, alternatively, the transplant unit to which the organ is to be offered.

The Cystic Fibrosis Trust report “Hope for all”, published on 10 March this year, makes a number of recommendations focusing on three key aspects: increasing the number of organs donated for transplantation; making sure that we make best use of the donated organs; and making sure that patients are fully involved in decisions about their care. We continue to invest in the donation programme to optimise transplantation in the UK. In the five years between April 2008 and April 2013, donation rates rose by 50.3% and transplant rates rose by 30%. That is a record of good and significant progress in recent years. I pay tribute to NHSBT for the work it has done in this regard, alongside other health professionals and the charities. Encouragingly, donor and transplant rates continue to rise, and we see that pattern this year as well. However, we know we can do more to match the successful donation programmes in some other countries —as the hon. Lady said, there are other countries with better records—and to give more people the opportunity of a transplant.

As the hon. Lady and other hon. Members may know, a new seven-year UK-wide organ donation and transplantation strategy, “Taking Organ Transplantation to 2020”, was published in July last year. The strategy expressed the desire to make the UK system comparable with the best in the world. Within that, it aims for a rate of consent—the hon. Lady specifically talked about consent rates—of above 80%; it is currently 55%. Increasingly, consent is the most important strategic aim—interestingly, more so than donation. Spain achieved a consent rate of 84% in 2011—a remarkable achievement. We know that we have particular challenges in relation to consent rates in black, Asian and minority ethnic communities, which I have discussed at length with NHSBT and which hon. Members are aware of. I know of hon. Members not present here today who have done specific work in some of their local black and minority ethnic communities to raise awareness on this point. I would like to see us do more of that and use parliamentarians to do so.

[Kerry McCarthy]

It is perhaps remiss of me not to have mentioned in my speech the fact that in the past year Bristol has had its first Muslim lord mayor who, during his year as lord mayor, chose to focus on encouraging blood and organ donation from the BME communities. As his term of office is almost up, I ought to take this opportunity to congratulate Councillor Faruk Choudhury on that effort.

[Jane Ellison]

I join the hon. Lady in congratulating the lord mayor. That is exactly the sort of local leadership that can help. One of the big pluses of the devolution of public health to local government is that we see such leadership from people who know their community best and understand the diversity in their locality. I am keen to encourage that. Only recently we celebrated examples in other areas, where we saw that specific leadership in some communities where health outcomes were not as good as they could be. We are always looking for such opportunities, and I am delighted that the hon. Lady has taken the opportunity to highlight local leadership in that regard.

Our focus in the strategy is initially on increasing consent rates. We want people to support transplantation. We can all imagine that families are being asked to agree donation at probably one of the worst times in their life, but many families find that they get comfort from knowing they have helped others to live. We will keep a close eye on what happens in Wales following the changes there, to which the hon. Lady alluded. NHSBT also keeps international experience under careful review. I mentioned the good success rates in Spain, for example.

We need to make sure that we make the best use of the donated organs. Currently donor lungs are procured by a retrieval team and allocated to the transplant centre on a zonal basis, based on the location of the donor. The transplant team at the centre will decide whether or not to accept the lungs and will select the most appropriate recipient.

The trust’s report recommends the implementation of a national lung allocation system whereby donor lungs are given to the most urgent patients, regardless of where they live.

This is something that NHSBT’s cardiothoracic organs advisory group, which includes both lung clinicians and lay membership, will be considering very shortly, and in particular whether we should introduce a national lung allocation scheme for people who need a lung transplant urgently, with all remaining donor lungs continuing to be allocated on a zonal basis. The advisory group’s recommendations will then be considered by NHSBT’s transplant policy review committee, and if a change of allocation procedures is agreed, it will be implemented as soon as the governance arrangements can be put in place.

[Kate Green]

Will the Minister clarify whether the work that is going on now to review the allocation system is looking at the possibility of a national allocation system only for urgent cases, or whether it will also consider the advantages and disadvantages of a national allocation system in all cases?

[Jane Ellison]

I imagine that the advisory group is considering that, but I would rather check and get back to the hon. Lady after the debate. I should have thought that it was looking at the broader issue, but I will come back to her, if that is acceptable, and confirm that after the debate. It goes without saying that I will follow up this debate with NHSBT, which I am sure will be extremely interested to know that Parliament has an interest in the subject. We will revert to any hon. Member to whom I am not able to respond in detail.

The issues are complicated. I have only begun to get a sense of some of that complexity, partly in preparing for this evening’s debate. NHSBT will wish to be certain that any change of policy can be introduced in a fair and safe manner. We need also to ensure that people with cystic fibrosis receive the best quality of care for them and are involved in decisions about that. NHS England has published two CF service specifications, one for adults and one for children, recognising that, although similar, adults and children with CF have differing needs and it is important that the services provided should reflect that.

NICE has issued technology appraisal guidance recommending appropriate drug therapies—one of which has been mentioned by the hon. Member for Bristol East—in certain clinical circumstances, which NHS commissioners are required to fund where clinicians want to use them. The Government also fund a range of research on cystic fibrosis, in particular through the Medical Research Council and the National Institute for Health Research.

The hon. Member for Bristol East alluded to the need for research, so she may be interested to know that the MRC is funding a £3.3 million trial of repeated application of gene therapy for patients with cystic fibrosis. That is being undertaken by the UK Cystic Fibrosis Gene Therapy Consortium, which comprises world-leading teams at Imperial college London and the universities of Oxford and Edinburgh. The trial is testing whether gene therapy can improve the lung function of cystic fibrosis patients and its report is due to be published in May 2015. I am sure we will all await the review with interest. It has the potential for interesting and exciting breakthroughs.

I hope the hon. Lady will forgive me for responding to her points about benefits by saying that I will draw them to the attention of my colleagues at the Department for Work and Pensions. The issue is not in my remit, but her points have been noted and are on the record.

On prescription charges, I pay tribute to my hon. Friend the Member for Colchester (Sir Bob Russell), who has campaigned long and hard—but not successfully today—on the issue. I am afraid I do not have a response for him today, but I will get back to him after the debate.

I think I have covered most of the points that have been made. The hon. Lady raised specific points about local arrangements. Some interesting work is going on between the Royal United hospital in Bath and the Bristol adult cystic fibrosis centre at Bristol University hospital. They are looking at specialist commissioning and I think NHS England is looking to commission a model of adult CF care. I will look at the record after the debate and will draw that particular section of the hon. Lady’s speech to the attention of NHS England representatives, because some of the decisions about clinical care and commissioning sit with them. I will make sure they have a copy of the debate and I will ask them to respond directly to the hon. Lady on the issues within their remit.

In conclusion, I hope I have reassured the hon. Lady and other interested Members that we want to provide the best possible care for cystic fibrosis patients. Service specifications are in place to define that care and what great care looks like. We continue to do all we can to increase organ donation rates, with some notable recent success. We will look in particular at the issue of increasing consent rates so that we can give many more people the opportunity of a transplant. I have referred to the review, which is particularly germane to the current campaign, and I will ensure that interested Members are alerted to its outcome.

I will end by wishing colleagues, hon. Members, Madam Deputy Speaker and the staff of the House a pleasant Easter recess.

Question put and agreed to.

Abortion (Disability)

Jane Ellison Excerpts

Wednesday 9th April 2014 Commons Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

[Fiona Bruce]

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

[Jane Ellison]

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

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

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

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

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

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

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

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

Question put and agreed to.

Health

Jane Ellison Excerpts

Wednesday 9th April 2014 Ministerial Corrections

[Barry Gardiner]

To ask the Secretary of State for Health how many instances of (a) pneumonia, (b) septic pneumonia, (c) Pericarditis, (d) Septic Pericarditis, (e) Peritonitis, (f) septic peritonitis, (g) Oedema, (h) Emaciation, (i) Bruising or trauma, (j) Abscesses in offal, (k) Abscesses in carcases, (l) Pyaemia, (m) animals with septicaemia, (n) Animals with tumours, (o) Hydronephrosis, (p) Nephritis and septic nephritis, (q) Lymphadenitis, (r) Tuberculosis, (s) Erysipelas in pigs, (t) Steatosis, (u) Actinobacillous and (v) Actinomycosus in red meat animals have been identified at official post mortem inspection and prevented from entering the food chain by officials working for an on behalf of the FSA since 1 April 2012.

[Official Report, 1 April 2014, Vol. 578, c. 573W.]

Letter of correction from Jane Ellison:

An error has been identified in the written answer given to the hon. Member for Brent North (Barry Gardiner) on 1 April 2014.

The full answer given was as follows:

[Jane Ellison]

The following quantity of conditions have been identified in red meat animals at official post mortem inspection and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency (FSA) since April 2012:

Some conditions are not recorded by the FSA. The list of conditions for cattle, sheep, goats, pigs and poultry were created following expert working group workshops for each species over the last five years. Members of the workshops included stakeholders from the Department for Environment Food and Rural Affairs, Animal Health, EBLEX, BPEX, private veterinarians, industry vets, FSA, Association of Meat Inspectors.

The data for sheep, goats, deer and horses is from April 2012 to December 2013, all other species is April 2012 to March 2014.

[Jane Ellison]

The following quantity of conditions have been identified in red meat animals at official post mortem inspection and prevented from entering the food chain by officials working for and on behalf of the Food Standards Agency (FSA) since April 2012:

Some conditions are not recorded by the FSA. The list of conditions for cattle, sheep, goats, pigs and poultry were created following expert working group workshops for each species over the last five years. Members of the workshops included stakeholders from the Department for Environment Food and Rural Affairs, Animal Health, EBLEX, BPEX, private veterinarians, industry vets, FSA, Association of Meat Inspectors.

The data for sheep, goats, deer and horses is from April 2012 to December 2013, all other species is April 2012 to March 2014.