Tobacco Products (Standardised Packaging)

Jane Ellison Excerpts

Thursday 3rd April 2014 Commons Chamber

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

With permission, Mr Speaker, I wish to make a statement about the publication of Sir Cyril Chantler’s report on the standardised packaging of tobacco products.

Smoking kills nearly 80,000 people each year in England alone. One out of two long-term smokers will die of a smoking-related disease and our cancer outcomes stubbornly lag behind those of much of Europe. Quite apart from the enormous pressure that this creates for the NHS, it is a cruel waste of human potential. Yet we know that the vast majority of smokers want to quit, and we also know that, tragically, two thirds of smokers become addicted before they are 18. As a nation, therefore, we should consider every effective measure we can to stop children taking up smoking in the first place.

That is why, in November last year, I asked Sir Cyril Chantler to undertake an independent review of whether the introduction of standardised packaging of tobacco is likely to have an effect on public health, in particular in relation to children. Sir Cyril has presented his report to me and my right hon. Friend the Secretary of State, and yesterday we had the benefit of a personal briefing from Sir Cyril, in which he highlighted the key conclusions of his review. Having reviewed Sir Cyril’s findings, I was keen to share this important report with the House without delay, as I recognise the significant interest shown by many Members. I will of course place copies in the Libraries of both Houses.

The evidence has been examined, the arguments for and against have been thoroughly explored and their merit assessed by Sir Cyril, who visited Australia in the course of the review. I asked in particular that the report focus on the potential of standardised packaging to have an impact on the health of children. It is clear that smoking is a disease of adolescence and we know that across the UK, more than 200,000 children aged between 11 and 15 start smoking every year: in other words, about 600 children start smoking in the UK every day. Many of those children will grow up with a nicotine addiction that they will find extremely difficult to break, and that is a tragedy for those young people, their families and the public health of our nation. Sir Cyril points out that if this rate of smoking by children were reduced by even 2%, it would mean that 4,000 fewer children took up smoking each year.

Sir Cyril’s report makes the compelling case that if standardised packaging were introduced, it would be very likely to have a positive impact on public health, and that the health benefits would include benefits for children. The chief medical officer, Dame Sally Davies, has read Sir Cyril’s report. She sent me a letter with her initial views in which she said:

“the Chantler review only reinforces my beliefs of the public health gains to be achieved from standardised packaging”.

I have placed copies of Dame Sally’s letter in the Libraries of both Houses.

Importantly, the report highlights that any such policy must be seen in the round, as part of a comprehensive policy of tobacco control measures, and that is exactly how I see the potential of standardised packaging working in this country. In the light of the report and the responses to the previous consultation in 2012, I am minded to proceed with introducing regulations to provide for standardised packaging. However, to ensure that that decision is properly and fully informed, I intend to publish draft regulations, so that what is intended is crystal clear, alongside a final, short consultation in which I will ask in particular for views on anything new that has arisen since the last full public consultation and that is relevant to a final decision on the policy. I will announce details of the content and timing shortly, but I invite those with an interest to start considering any responses they might wish to make now. The House will understand that I want to proceed as swiftly as possible. Parliament gave us the regulation-making powers in the Children and Families Act 2014.

I pay tribute to Sir Cyril and his team for the excellent job they have done in preparing such a thorough analysis of the available evidence on the standardised packaging of tobacco products. I believe that the report will be widely acknowledged for its forensic approach and authoritative conclusions. We want our nation’s children to grow up happy and healthy, and free from the heavy burden of disease that tobacco brings. I commend the statement and Sir Cyril’s report to the House.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank the Minister for an hour’s advance notice of her statement. May I take this opportunity to put on record my thanks to Sir Cyril Chantler and his team for their excellent review? I welcomed some of what the Minister said, but I want to probe her on several issues.

We know that the cost to the NHS of treating diseases caused by smoking is approximately £2.7 billion a year. One in two long-term smokers die prematurely due to smoking-related diseases, and two thirds of adult smokers took up smoking as children. As Sir Cyril says, if we can reduce that figure by even 2%, 4,000 fewer children will take up smoking each year. For that reason, I strongly welcome the fact that Sir Cyril’s review confirms what public health experts have been arguing for some time: standardised packaging makes cigarettes less attractive to young people and could help to save lives.

Sir Cyril’s remit was to consider whether standardised packaging would lead to a decrease in tobacco consumption. Does not the Minister accept that his conclusion is clear that

“standardised packaging would serve to reduce the rate of children taking up smoking”

and could lead to an “important reduction” of uptake and prevalence, and have a “positive impact” on public health? Of course, that is something that all the previous evidence reviews have already shown. Indeed, Sir Cyril says:

“my overall findings are not dissimilar to those of previous reviews.”

Did not the Government’s own systematic review in 2012, which Sir Cyril describes as “extensive” and “authoritative”, conclude that standardised packaging is less appealing than branded packaging, makes health warnings more prominent and refutes the utter falsehood that some brands are healthier than others? All the royal colleges and health experts are united on this and the majority of responses to the Government’s consultation favoured such an approach, so does the Minister finally accept that there is an overwhelming body of evidence in favour of standardised packaging and that there can be no excuse for further delay?

You will know, Mr Speaker, that Labour has long been calling for the immediate introduction of standardised packaging. For every step that we took in government, the tobacco industry adopted a new approach. After we banned advertising, tobacco manufacturers developed increasingly sophisticated marketing devices for their packaging. In the words of Simon Clark of the tobacco-funded lobby group FOREST and the “Hands Off Our Packs!” campaign:

“It’s like showing them a picture of a Lamborghini and a beaten up Ford Escort and saying, ‘Which one do you prefer?’”

When my right hon. Friend the Member for Leigh (Andy Burnham) was Health Secretary, he was clear that the next front in the fight against tobacco should be packaging. The question is why have we had to wait so long? More than 70,000 children will have taken up smoking since the Minister announced the review, and today she has announced yet another consultation. The Government have already had a consultation that reported less than a year ago. What does the hon. Lady expect to change? Let me remind her of the words of the Health Minister in the other place, Earl Howe, who said:

“we will definitely introduce the regulations should the case be made and should we be persuaded of the case that Sir Cyril presents. I hope that I have been clear about that.”—[Official Report, House of Lords, 29 January 2014; Vol. 751, c. 1251.]

Why is the Minister now kicking the matter into the long grass? How many more children will take up smoking before this Government make a decision? Does the Minister not accept that it was the clear will of both Houses of Parliament to proceed with standardised packaging, and is this not yet another example of how her Government are caving in to vested interests and standing up for the wrong people?

[Jane Ellison]

The hon. Lady’s response serves to illustrate the difference between opposition and government. I agree that Sir Cyril has produced a compelling report; I recommended it to the House and urged everybody to take the opportunity to read it. He has made a compelling case on the public health evidence, but to make robust policy in this area it is essential that we follow a careful process. That means we have to look at everything in the round, and we have to give everybody who has a stake in the decision an opportunity to make their case. That is what we will proceed to do. I have drawn the House’s attention in the past to the fact that the Australian Government are still engaged in litigation in this area. We need to proceed in a sensible way, but I could not have given the House a clearer indication of the fact that we are moving at the pace dictated by a sensible and robust policy approach. That is the requirement for making good policy.

I am glad the hon. Lady drew attention to Sir Cyril’s review of the evidence from the Stirling review. He did more than just look at the Stirling review; he commissioned independent academic review of its methodology and concluded that it was robust. That is part of his review. As I said, I urge Members to look at that.

Members will have heard the hon. Lady’s response. I can only say to her that at every stage we have proceeded in a sensible, measured but clear way. We took the regulation-making powers in the Children and Families Act 2014, for which there was a large parliamentary majority. We will publish draft regulations alongside the final short consultation to look at the wider issues, and we will then move as swiftly as possible to a final decision based on all those elements. That gives the House a clear sense of our direction of travel. I want to make sure that, whatever decision the Government finally take, it is robust and one that everyone can have confidence in.

[Sir Gerald Howarth (Aldershot) (Con)]

It is most unfortunate that this statement has been made today, when so few Members who take an interest in these matters are present. The logic of my hon. Friend’s argument is that we should ban tobacco altogether if it does so much damage to our people. I do not believe this is a Conservative measure. It is an example of the nanny state. I see the Secretary of State whispering into my hon. Friend’s ear—I hope he is whispering some sound advice to her. At present 13% of packs sold are illicit, denying the Treasury £3 billion. If the Australian experience is anything to go by, that number is likely to rocket. What does the Minister say to that?

[Jane Ellison]

I thank my hon. Friend for his comments. Taking every possible effective measure to stop children smoking is the mark of a sensible state, not a nanny state. I do not think any Member of the House would want any extra child to take up smoking, so every Government should look clearly at any effective policy that can serve to advance the achievement of our ends in that regard. Sir Cyril devotes a significant chapter in his report to illicit tobacco products, and I urge my hon. Friend to read it. Of the arguments in that area, Sir Cyril says, “I am not convinced”.

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

The House listened with care to the Minister’s statement, and the backlash from her own Back-Benchers was predictable. The medical profession and doughty campaigners such as Action on Smoking and Health will be very glad that we are making progress on this issue. Can she confirm that she will bring forward the regulations before Christmas, so that standardised packaging is a reality before the general election?

[Jane Ellison]

I welcome the hon. Lady’s response. I know that she, as a former shadow Public Health Minister, takes a great interest in this area. I want to publish the draft regulations this month, alongside the short final consultation. The timetable that the Government are contemplating once a final decision is made should allow us to introduce the measure during this Parliament.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

I support my hon. Friend’s measures to reduce the number of young people smoking, but she will not be surprised to hear that I do not support this measure. Only 5% of under-15s smoke, which is the lowest level for a generation. The Government’s anti-smoking measures that are already in place are clearly working. There are smoking cessation classes and posters in the streets and in every publication we pick up; there are television adverts warning people constantly about the health risks of smoking. Nobody in this country smokes in ignorance. The people who smoke make a deliberate choice to do so—they deliberately ignore all the warnings that are made available to them. We also must not forget parental responsibility in this, because parents are responsible for their children’s habits and for how much money they have to spend unsupervised—

[Mr Speaker]

Order. We are deeply obliged to the hon. Lady.

[Jane Ellison]

I welcome my hon. Friend’s support for measures that can be effective in preventing children taking up smoking and urge her to read the detail of Sir Cyril’s report, which addresses directly some of the points she raises. She is right to draw attention to the fact that all these measures are taken in the round as part of a wider package of anti-tobacco measures. We are considering standardised packaging against the backdrop of some important steps taken in recent months, not least Parliament voting overwhelmingly for a ban on smoking in cars with children, and we have also brought forward measures to prevent proxy purchasing of tobacco by adults for children.

[Several hon. Members]

rose—

[Valerie Vaz (Walsall South) (Lab)]

I obviously welcome the Minister’s statement, but given the evidence from Sir Cyril, from Australia and Canada and from the Health Committee, will she update the House on a possible time frame? “Before 2015” is too vague.

[Jane Ellison]

As I said, I want to publish the draft regulations alongside the short final consultation to look at any final points people want to make about the wider aspects of the policy. It is important that we do that to move forward in a way that is robust and sensible and that shows that we have considered everything in the round. I want to do that this month; then, if we decide to proceed, we will move to give the House a final decision before the summer recess. There is no reason why the legislation could not be brought before the House before the end of this Parliament.

[Philip Davies (Shipley) (Con)]

The Minister’s nanny state instincts do not come as a great surprise. Can she tell us why she set up the review in the first place? Is it because she was not capable of assessing all the evidence herself and making a decision, or because she had already decided what she wanted to do but did not have the guts to announce it and so wanted to use taxpayers’ money to hide behind a review? Whichever it is, it does not inspire confidence. Such decisions should not be farmed out to someone who is unelected and totally unaccountable.

--- Later in debate ---

[Jane Ellison]

My hon. Friend does not surprise me with his response. Ministers will make the final decision following the process I have outlined, having had regard not only to Sir Cyril’s excellent report but to the other matters I have said we will consider. On this, I cannot agree with him. No one is bringing forward measures to ban smoking; rather, we are all now able to show our support for measures that might have the potential to stop children taking up smoking. I cannot believe that he cannot agree with that. The vast majority of the public are with us, and I fear that in this case he is in danger, very rarely, of being an unpopular populist.

[Keith Vaz (Leicester East) (Lab)]

The Minister is very passionate about these issues, but she needs to recognise that tobacco smuggling costs the taxpayer £2.2 billion every year. It is clear from evidence given by Her Majesty’s Revenue and Customs to the Home Affairs Committee, which is looking at tobacco smuggling, that the data do not exist to support the view that plain packaging will make that much difference. Will she work with the tobacco companies, within her time frame, to make sure that we can track those who use legitimate production for illicit and illegal means? We have to stop illicit smuggling.

[Jane Ellison]

I welcome those comments by the Chair of the Home Affairs Committee. I know that his Committee is undertaking work on illicit tobacco, and it would be very welcome and helpful if it put its draft report or final evidence into the consultation. If he has not already had the opportunity to do so, I urge him to look at the chapter of the report that Sir Cyril devotes to this matter, which I think he will find of great interest. This is one of the wider issues on which the final short consultation will enable people to put their concerns on record so that they can be weighed in the balance.

[Mr Mark Harper (Forest of Dean) (Con)]

I listened very carefully to my hon. Friend’s statement. I am slightly surprised by Labour Members’ response, given that when in government they said that they needed

“strong and convincing evidence of the benefits to health, as well as…workability”.––[Official Report, Health Bill [Lords] Public Bill Committee, 25 June 2009; c. 305.]

Their response was therefore a little churlish. The right hon. Member for Leicester East (Keith Vaz) made some sensible points on the risks of smuggling. I will look at Sir Cyril’s report carefully, including the section on that subject, before I study the regulations when the decision is put to the House. I thank the Minister for her careful and thorough statement.

[Jane Ellison]

I thank my hon. Friend for those comments. The issue is looked at in some detail, and as I said, Sir Cyril said that he was not convinced by the arguments in this respect.

[Barry Gardiner (Brent North) (Lab)]

I came to the House prepared to attack the Minister because I thought she was going to kick this into the long grass. I am absolutely delighted that she has assured the House that she is not going to do that. In the light of the reception from her own Back Benchers, which I am afraid has not been friendly, she can at least be assured of the friendliness from those on the Labour Benches. She is doing exactly the right thing. My father died of lung cancer when I was eight, so I never took up smoking, but many of my friends did. They are now dead and I am still going. What the Minister is doing today will mean that more children will not take up smoking in the first place.

[Jane Ellison]

I thank the hon. Gentleman for those generous comments. I think that many people in the House will have had their personal family situation touched in the way that he mentions. I never knew my grandparents, so I recognise the power of what he says. We are proceeding, as I hope the House can see, in a sensible but robust way. I have signalled my view that I am minded, as a Health Minister, to accept Sir Cyril’s report and the evidence therein, but there are other considerations, and we will take those into account and bring a final decision to the House as soon as possible.

[Andrew Bingham (High Peak) (Con)]

Is the Minister aware of the anti-counterfeiting measures that are taken in relation to the current packaging of cigarettes? Is she worried, as I am, that the introduction of plain-paper packaging would remove those measures and thus increase the possibility of counterfeiting and misrepresentation of—let us say—illicit tobacco?

[Jane Ellison]

The report is not about plain packaging but standardised packaging, which is quite different. Sir Cyril’s report helpfully pulls apart the differences and makes them clear for the reader. The issue that my hon. Friend raises is addressed in the report, and it was given a lot of consideration in the 2012 consultation. I can pay testament to the fact that that was an exhaustive and very thorough consultation, because I have spent much of the past few days, as has my right hon. Friend the Secretary of State, reviewing the evidence and submissions to it. These points have therefore been put on the record, but there will be a final opportunity in the forthcoming consultation to make them again, and they will be considered.

[Mr Gerry Sutcliffe (Bradford South) (Lab)]

I am a non-smoker and I do not want to see young people smoking, but I have concerns about standardised packaging, for two reasons. One is illicit trade, and I will give evidence on that and perhaps meet the Minister and her colleagues about that illicit trade and its impact on our constituencies. Also, I represent a number of print workers. There is an issue about jobs and the effects on the packaging industry. I hope she will take that into consideration.

[Jane Ellison]

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

[Fiona Bruce (Congleton) (Con)]

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

[Jane Ellison]

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

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

If the Minister is able to get the regulations past her own Back Benchers—and I note that the hon. Member for Hornchurch and Upminster (Dame Angela Watkinson) failed to declare an interest, as she registered hospitality from Japan Tobacco International on 12 June 2013—when will we see standardised packaging on the shelves? When will that be, should she get the regulations through in the last Session of this Parliament?

[Jane Ellison]

Once the Government have made a final decision—and in the event that that decision is to proceed and it is approved in this Parliament—there will be a transition period, as there always is with any tobacco regulations. Because we have not yet made a final decision, we have not decided what that period will be, but there would always be a sell-through period—that has been the precedent set in the past. We are not able to be absolutely definite at this point because of that sell-through period, but I am happy to talk to the hon. Lady about previous sell-through periods for similar legislation.

[Jacob Rees-Mogg (North East Somerset) (Con)]

I thank the Minister for making it possible for Back-Bench MPs to go to the Ministry to read the report this morning. That was a great courtesy and was helpful to parliamentary scrutiny. I bring to her attention two points from that report. First, Sir Cyril Chantler notes that it is

“too early to draw definitive conclusions”

from what has happened in Australia. Secondly, in paragraph 4.21, he says that the research that has been done has been based on “stated intentions” and that those are known to be ones that have to be used with care. He says:

“This caution is justified, and to that extent the findings are essentially indirect and ‘speculative’.”

As the Government may be taking away a freedom from the British people, ought they not to be more certain of their ground than they can be of the ground they currently have from Sir Cyril Chantler?

[Jane Ellison]

The Government are not proposing to take away anyone’s freedom. Our tobacco control measures aim to prevent children from taking up smoking in the first place, which is quite a different thing. On my hon. Friend’s detailed point, Members of Parliament will, like anyone else, be able to make submissions to the final consultation. Once Members have had the chance to read the report thoroughly, any submissions they may wish to make will, of course, be most welcome and they will be considered.

[Andrew Miller (Ellesmere Port and Neston) (Lab)]

I welcome the hon. Lady’s statement and although she is right to take into account factors other than the health of the nation that have been raised by hon. Members, will she confirm that her primary consideration in handling this policy will be the health of the nation and that she will drive it through as quickly as possible?

[Jane Ellison]

I am the Minister for public health and as I said in my statement we are currently minded, based on the compelling evidence to which Sir Cyril alludes in his report, to proceed, but the hon. Gentleman will understand that policy is made in the round.

[Andrew Miller]

Health is what is most important.

[Jane Ellison]

Health is, of course, very important, particularly the health of our nation’s children, and I welcome the hon. Gentleman’s support.

[Mike Thornton (Eastleigh) (LD)]

Given that eight out of 10 people start smoking under the age of 19—in their teens—does the Minister agree that one of the most effective child protection measures we can take is to help them not to start smoking in the first place?

[Jane Ellison]

My hon. Friend is exactly right and I believe that all Members want to see fewer children taking up smoking. I also draw the House’s attention to the fact that the places where children take up smoking are very unevenly distributed. On maintaining the Government’s duty on health inequality, which we have put in statute, measures to prevent young people and children from taking up smoking directly address some key health inequality issues.

[Paul Flynn (Newport West) (Lab)]

Of course, this is not a Conservative statement, because it is evidence-based, prejudice-free and intelligent. Will the Minister add further lustre to her reputation by starting an investigation into the potential danger of electronic cigarettes normalising smoking?

[Jane Ellison]

I thank the hon. Gentleman for his comments. Sir Cyril’s report makes a brief reference to the normalisation issue and I think the hon. Gentleman will be interested to read that. Of course, the Government have moved to ban the selling of e-cigarettes to under-18s—a move that was supported by the e-cigarette industry for the most part.

[Mr Christopher Chope (Christchurch) (Con)]

I draw attention to my entry in the Register of Members’ Financial Interests. What evidence is there that young people do not access illegal drugs as much because they are sold in plain packages?

[Jane Ellison]

I refer my hon. Friend to Sir Cyril’s report, where he will find 30-odd pages of extremely well-argued, authoritative comment by someone who has looked very deeply and widely at the issues over the past few months.

[Ian Paisley (North Antrim) (DUP)]

May I also place on record my thanks to the Secretary of State for making available an early copy of the report so that we could study it? The Minister said that there is compelling evidence, but Sir Cyril Chantler’s report says that he has

“not seen evidence that allows me to quantify the size of the likely impact of standardised packaging”,

other than a “modest” reduction.

Will the Minister now commit to awaiting the outcome of the Home Affairs Committee report on illicit trade, which will be important in determining the impact of the policy? Will she also consider the outcome of the Northern Ireland Affairs Committee report on illicit trade, which showed that illicit trade is on the increase and is costing this Government billions of pounds a year? Finally, will the Minister have a word with and say something to 1,000 of my constituents who have been put on notice by today’s decision that they are not valued and that their jobs are over because of this Government?

[Jane Ellison]

I have already said quite a lot about illicit trade. It is mentioned in the report, which the hon. Gentleman has obviously had a chance to look at. He quoted the word “modest” but, as I said just a moment ago, even a modest impact on a major killer is very important. As a Health Minister, I regularly answer parliamentary questions and letters from colleagues throughout the House on issues that affect far fewer children than 4,000 a year. We have spoken privately and exchanged correspondence on the issue of jobs. The impact assessment will reflect on it and the hon. Gentleman will have an opportunity to make a submission to the final consultation.

[Mr David Nuttall (Bury North) (Con)]

Human nature being what it is, does my hon. Friend not agree that one unintended consequence of hiding cigarettes behind shutters and putting them in standardised packages is that it may only increase the desire of inquisitive children to take up smoking?

[Jane Ellison]

I urge my hon. Friend to look at the report and to reflect on the fact that anything we can do to discourage children from taking up smoking is likely to have a lifelong effect not only on them, but on their families. I urge him to look at the detail of Sir Cyril Chantler’s report.

[Kevin Brennan (Cardiff West) (Lab)]

I urge the Minister not to be swayed by those lobbying on counterfeiting and packaging, because this is a deadly, addictive drug. Coffin nails are coffin nails whatever packaging they come in. Given the interest in this subject, does she intend to introduce regulations on the Floor of the House to be debated and voted on?

[Jane Ellison]

It is indeed our intention to put the regulations through the affirmative procedure, so the House will have the opportunity that the hon. Gentleman mentions. He is right to draw the House’s attention to the issue of children and addiction. There are some extremely interesting points about that in Sir Cyril’s report, reflecting academic studies on children and addiction, including the fact that children become addicted at a faster speed than adults.

--- Later in debate ---

[Sir Paul Beresford]

I am ignoring the interruptions. I am particularly pleased by what the Minister has said and I thank her for it. I encourage her to move this nation ahead first, as I hope she will, rather than to wait for the Australians.

[Jane Ellison]

I thank my hon. Friend for his comments and support. He speaks from a position of knowledge, which is always a good position from which to speak. Sir Cyril and his team visited Australia, and hon. Members can find reflections on the Australian experience to date in the report. We are proceeding on our own timetable, not waiting for the end of Australian litigation on this subject.

[Jackie Doyle-Price (Thurrock) (Con)]

My hon. Friend has made many references to Sir Cyril’s conclusions on illicit tobacco, but what conversations did she have with Her Majesty’s Revenue and Customs and the UK Border Force before making this statement? At the port of Tilbury in my constituency, we are waging a war against tobacco smuggling, and my fear is that standardised packaging will make beating it in that war even more difficult.

[Jane Ellison]

In the course of policy making, HMRC’s views have very much been sought and taken into account, and it will certainly be part of the final consultation. It is fair to put on the record the fact that HMRC has had considerable success in fighting smuggling over recent years. I of course acknowledge my hon. Friend’s concerns, but I urge her to read the report and to understand the connections between price and illicit tobacco, and to read what Sir Cyril says about the information gleaned from Australia and from our own experience.

[Sir Peter Bottomley (Worthing West) (Con)]

Since Richard Doll and Bradford Hill’s report in 1950 and the 50-year study of British doctors from 1951 to 2001 by Richard Doll and Richard Peto, we have known that an over-£50-a-week habit, after tax, does no good to anybody at all. As well as talking about standardisation, which may or may not make a difference, will my hon. Friend make plain to those who smoke that they should not smoke in front of someone younger and that they should not be the first person in a group to light up? That way, we can reduce the incidence of smoking, which will also reduce the number of smokers.

[Jane Ellison]

My hon. Friend is right to emphasise again the importance that we all place on children not taking up smoking in the first place. Children who start smoking when they are young find it especially difficult to quit. We know that that particularly affects children in more deprived communities, and it often adds to the burden of disease that they carry through their lives.

[Sir Tony Baldry (Banbury) (Con)]

Does my hon. Friend agree that the House should always pay careful attention to advice from knights like Sir Cyril? Will she confirm that this is a forensic report that is based on the best evidence, and that the Government are approaching the matter entirely on the basis of the best science? Is not the answer to the hon. Member for Liverpool, Wavertree (Luciana Berger) that if the Government did not consult properly on the regulations, far from speeding up matters, it would delay them? I assure the hon. Lady that my colleagues in the Temple would be over the road with an application for judicial review before one could say ban on anything.

[Jane Ellison]

I very much welcome my right hon. Friend’s comments. He is in danger of becoming my second favourite knight of the day. I know that he speaks from personal experience. He is right to draw the House’s attention to the need to make policy carefully in this area. That is what we are proceeding to do. He illustrated the point better than I could have done.

[Dr Matthew Offord (Hendon) (Con)]

I stand in support of the statement. I congratulate my hon. Friend on the action that she has taken. Has she had an opportunity to look at the Australian experience to see how we might reduce the illicit trade in cigarettes and cigarette smuggling?

[Jane Ellison]

I thank my hon. Friend for his support. There is a significant chapter about illicit trade in the report and there are reflections on the Australian experience throughout it. If the Government’s final decision is to move ahead, we will look to glean everything we can from the Australian experience.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

In November 2009, the right hon. Member for Leigh (Andy Burnham) wrote in a letter to the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) that

“no studies have shown that introducing plain packaging of tobacco would cut the number of young people smoking or enable people who want to quit, to do so.”

I would be grateful to hear, because not all of us have had a chance to read the report, what additional studies have led Sir Cyril and my hon. Friend to reach the conclusion that she has set out today?

[Jane Ellison]

When my hon. Friend has a chance to look at the report, she will see that there have been a number of new reports in recent years. Sir Cyril commissioned an independent academic review that considered not just the Stirling review, which looked at more than 37 academic reviews on the subject, but the supplement to that, which was published in 2013. He concluded that the reviews were very robust. Much of his report is devoted to a scientific and forensic examination of the methodology used in those reviews. I commend it to her.

[Robert Halfon (Harlow) (Con)]

Is my hon. Friend aware that 15,000 people die from alcohol-related diseases every year in Britain? The logical extension of what she is proposing is that we put brown paper bags over all alcohol. Does she not agree that Conservatives believe in freedom and that the best way to stop smoking is through education, not by banning things? This measure will have a significant impact not just on smuggling, as my hon. Friend the Member for Thurrock (Jackie Doyle-Price) said, but on small shops and small businesses.

[Jane Ellison]

First, I must correct my hon. Friend on one thing. The Government are not proposing to ban anything. I made that quite clear. Secondly, alcohol that is enjoyed in moderation does not do people great harm, but there is no way of enjoying tobacco in moderation that does not harm people’s health. Smoking is a completely different subject from all the others that Members seek to link it to. My hon. Friend wrote to me recently to ask what Health Ministers were doing about cancer in Essex. The more we do to bear down on tobacco use among children, the greater our chances of tackling cancer in Essex and elsewhere.

[Nigel Mills (Amber Valley) (Con)]

The Minister must know that she will never satisfy the health lobby on this issue. It has moved on to the idea of banning smoking for anyone born after the year 2000. Will she confirm that that is not part of her strategy?

[Jane Ellison]

The Government have a tobacco strategy that has been published. Today, I am presenting a statement about standardised tobacco packaging and nothing else.

[Chris Skidmore (Kingswood) (Con)]

In my constituency the printer Amcor prints more than 5 billion cigarette packets a year and is one of the largest manufacturing companies of its kind in the country. The factory employs 150 local people and there is a manufacturing train of more than 1,000 local people. I support any measures that will reduce smoking among impressionable young people, but when the Minister talks of standardised packaging, is there any chance that after the review is conducted she can talk of “standardised and complex” packaging, to secure those local jobs at Amcor and other printing companies across the country?

[Jane Ellison]

My hon. Friend is right to draw attention to the fact that standardised packaging is complex and far from the plain brown paper packs sometimes portrayed. Sir Cyril mentions that issue and draws a clear distinction in his report. I would welcome my hon. Friend making a submission to the consultation about the impact of this measure on employment in his constituency. That will of course be weighed in the balance, but it is important constantly to remind the House of the enormous economic impact of the burden of disease on our population.

[Jeremy Lefroy (Stafford) (Con)]

I welcome and support the statement, but what about the 196,000 children a year who take up smoking and who will not desist as a result of this measure? Can my hon. Friend give any feedback on the success of the measures the Government have already introduced in education and other areas to stop children starting to smoke?

[Jane Ellison]

I welcome my hon. Friend’s support for the statement and thank him for it. In April next year, tobacco displays will be behind closed doors, and tobacco vending machines have been banned. He will know that a great deal of money and effort has been put into education, and we are starting to see the fruits of that as the number of smokers in our country has dipped below 20% for the first time. The Government are always open to ideas about effective measures that will stop children taking up smoking in the first place, and I am always extremely happy to hear from my hon. Friend about that.

[Priti Patel (Witham) (Con)]

The Minister will be aware that the all-party small shops group has been following this issue with a great deal of interest for some time. Will she ensure that the impact on small shops will not be overlooked in the process she has outlined today, and will she acknowledge the work of independent retailers who already do a tremendous job in preventing the sale of tobacco to young children?

[Jane Ellison]

As a former retailer, I know only too well that a responsible retailer can play an important role in stopping children who should not be buying cigarettes doing so. Indeed, I alluded to that and gave credit for it when we introduced regulations on proxy purchasing, which I know were welcomed by many small retailers. Retailers gave extensive evidence to the 2012 consultation, and they will be able to give any updated evidence on anything that is new to the final consultation.

[Nick Smith (Blaenau Gwent) (Lab)]

I commend the Minister for her statement. Will she clarify for the House whether the regulations will be applicable to Wales, and whether she has had the opportunity to raise them with the Welsh Government?

[Jane Ellison]

We have sought at all times to keep the devolved Administrations aware of progress in this area, and our officials have spoken to officials in those Administrations about the matter. I hope to have the chance to speak to fellow Health Ministers in the next 24 hours, and if we proceed to bring forward the draft regulations, those are the points we will clarify.

[Simon Hart (Carmarthen West and South Pembrokeshire) (Con)]

The Minister will be aware that it is already an offence to smoke in public under the age of 16 and to purchase tobacco under the age of 18. Would it be a good start to ensure that the current laws work before we start imposing new ones?

--- Later in debate ---

[Jane Ellison]

The Government are seeking to consider all measures that have an impact on children taking up smoking in the first place, and many of our laws and measures are beginning to bear fruit as smoking is at its lowest ever level in this country. Every child who takes up smoking is one child too many, and I urge Members to read Sir Cyril’s report and examine the evidence and what he says about the pressures on children. When Members have reflected on that, I hope they will join me in supporting any measure that can make an impact in this area.

[John Glen (Salisbury) (Con)]

I welcome today’s statement and I support sensible evidence-based measures to curb smoking among the very young. However, I seek reassurance from the Minister about mission creep. Does she agree that chocolate, alcohol and sugary drinks are considerably less addictive and do not kill when consumed in moderation, and that the Government should not be looking to extend their remit into areas where we do not need more regulation?

[Jane Ellison]

Some of the issues to which my hon. Friend alludes have been debated on many occasions in the House. Today’s statement is about standardised tobacco packaging, not about banning anything. It is to consider the potential of this policy to stop children taking up smoking, and I welcome my hon. Friend’s support for that.

[Mr Philip Hollobone (Kettering) (Con)]

The Minister keeps saying that this is not about banning anything, but she is proposing the banning of promotional packaging—that is what she is doing today. Before she does that, will she consider bringing the law in England into line with that in Scotland, where the sale to, purchase by, or possession in public of cigarettes by anyone under the age of 18 is illegal? That is not the case at the moment in England.

[Jane Ellison]

My hon. Friend draws attention to the Scottish regime, which has regulatory differences to our regime. It is a matter that I consider and that we keep under review. Indeed, where measures have proved to be effective in any jurisdiction, we take great interest in that.

[Mr Speaker]

I am grateful to the Minister and to colleagues.

Social Science Research Committee (Triennial Review)

Jane Ellison Excerpts

Thursday 3rd April 2014 Written Statements

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

I am today announcing the publication by the Food Standards Agency (FSA) of the findings of the triennial review of the Social Science Research Committee (SSRC). Triennial reviews of non-departmental public bodies (NDPBs) are part of the Government’s commitment to ensuring, and improving, the accountability and effectiveness of public bodies.

The SSRC is an advisory NDPB that provides the FSA with independent expert advice on the use of social science evidence.

The review concluded that the functions performed by the SSRC are still required and that it should be retained as an advisory NDPB. It also identified a number of areas of good practice and made 13 recommendations to improve the efficiency and impact of the committee’s work and to ensure it continues to meet the highest standards of governance.

The review was carried out with the participation of a wide range of internal and external stakeholders, including the committee’s chair and members and the FSA chief scientist. The FSA is grateful to everyone who contributed to the review.

“Triennial Review of the Social Science Research Committee” 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. It is also available at: http://www.food.gov.uk/news-updates/news/2014/apr/triennial-review-ssrc

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 1st April 2014 Commons Chamber

[Ann Coffey (Stockport) (Lab)]

4. What representations he has received on community pharmacies.

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

We receive a number of representations about community pharmacies over any period. Of course, they play a vital role in their local area, providing high-quality care and support and improving people’s health, especially in hard-to-reach communities. For example, more than 5,000 pharmacies assist with smoking cessation work.

[Ann Coffey]

I thank the Minister for her reply. With GPs managing demands on their time by operating longer waiting lists for appointments, to the increasing frustration of my constituents, is it not time for a more radical change in the role of community pharmacists in primary care? Does the Minister agree that any proposals to reorganise health services in Greater Manchester should fully explore the contribution that pharmacists can make—for example, in supporting people with long-term conditions or prescribing for minor conditions?

[Jane Ellison]

The hon. Lady is right to say that pharmacists have a great role to play, and she has given a good example of their helping people to manage long-term conditions and helping people with their medication. NHS England’s community pharmacy call to action has stimulated the debate about where community pharmacies should sit. We see them as a vital part of front-line services, and I am glad that the NHS is looking at their role in the round, because it is a really important one.

[Bob Blackman (Harrow East) (Con)]

What representations has my hon. Friend received in relation to the sale of e-cigarettes in community pharmacies, given that they form part of the smoking cessation process?

[Jane Ellison]

I have received no specific representations on that matter, but my hon. Friend will know that we have taken measures to ban the sale of e-cigarettes to under-18s. He will also know that, as we transpose the new tobacco directive into our country’s law, there will be opportunities to bear down on some of the advertising and on the ways in which e-cigarettes are placed, about which we have some concerns. We recognise that e-cigs can be a way for some people to quit smoking, but we also recognise the concern that they could be a gateway into smoking for young people.

[Keith Vaz (Leicester East) (Lab)]

Does the Minister agree that one way in which community pharmacies can play a larger role in the NHS is in the provision of testing for, and raising awareness of, diabetes? Has she received any representations on that matter? Let us get diabetes testing on to the high street.

[Jane Ellison]

I think that I received a representation from the right hon. Gentleman in person when he was kind enough to visit my constituency with the Silver Star diabetes charity that he founded. That visit perfectly demonstrated the role of testing in the community; it was fantastic to see people queuing up to be tested in a day-to-day setting outside a supermarket. He is quite right to say that community pharmacies have a big role to play. I recently visited Tesco to learn about its work with Diabetes UK, and about the many tens of thousands of people that those two organisations, working together, have tested.

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

Does the Minister recognise that not only pharmacists but—here I declare a professional interest—optometrists represent a huge reservoir of underused professional skill and expertise in an unrivalled network of premises? Can we not find ways of using that expertise more effectively in primary care, diagnostics and—as the right hon. Member for Leicester East (Keith Vaz) suggests—screening?

[Jane Ellison]

I echo my previous point that all our front-line health care services have a role to play in the community in helping people to keep well, to stay out of acute care and to manage their medicine. Indeed, the NHS is looking at this question more widely, and I understand that the central message of Simon Stevens’s speech today is that we need to look in the round at the way in which all our front-line services work together to deliver great care in the community.

[Karen Lumley (Redditch) (Con)]

5. What progress he has made on improving out-of-hospital care for frail elderly people.

--- Later in debate ---

[Mr Dominic Raab (Esher and Walton) (Con)]

6. What steps he is taking to reduce the time taken to diagnose brain tumours in children.

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

We have committed £450 million to enable earlier diagnosis of cancer, including direct GP access to MRI scans for suspected brain tumours. We have also funded a BMJ learning module for GPs on diagnosing brain tumours in children. Of course, I have also met my hon. Friend to discuss this issue, and I am planning to attend the all-party group on brain tumours very shortly.

[Mr Raab]

May I thank the Minister for her answer, and welcome her decision to write to local health boards, and Public Health England’s decision to write to heads of public health, to promote the delivery of the HeadSmart campaign’s brain tumour symptom awareness cards via schools? That gives us a shot of cutting the diagnosis delay in children to five weeks. Will she join me in urging councils to deliver the cards? This will not cost the taxpayer a penny, but it will save hundreds of lives.

[Jane Ellison]

I would like to thank all the organisations behind the excellent HeadSmart campaign for their amazing work. To mark the first anniversary of the new public health arrangements, I am planning to write to local health and wellbeing boards to make them aware of the issues of particular interest to Parliament, and this is one that I intend to highlight. Public Health England has also agreed to contact all directors of public health. We fully support the HeadSmart campaign’s aims and encourage local bodies to help drive improvements in this crucial area of care.

[Fiona Mactaggart (Slough) (Lab)]

My constituent Raj Rana, who is now four, is a survivor of a brain tumour. One group that really can assist in this area is schools. Will the Minister talk to the Department for Education about how they can become alert to early symptoms of brain tumours?

[Jane Ellison]

That is one of the points people from the HeadSmart campaign raised when I met them, and of course I am happy to draw the attention of colleagues in the Department for Education to the hon. Lady’s concerns and make them aware of this exchange.

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

7. What estimate he has made of the number of patients who have waited for more than four hours in accident and emergency departments in 2013-14 to date

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

Despite 1.2 million more A and E attendances in England, nearly 96% of patients have been seen, treated, transferred and discharged within four hours of arrival at A and E. That excellent level of service is a credit to the hard work of front-line NHS staff across the whole NHS, and I am sure the whole House would want to thank them for that.

[Rushanara Ali]

I am disappointed that the Minister has not bothered to answer the question. I will answer it for her: nearly 1 million patients have had to wait for longer than four hours in A and E over the past 12 months —it is one of the worst figures in a decade. Will she and her Government get a grip and sort this out?

[Jane Ellison]

I did answer the question—I told the hon. Lady exactly how the NHS was performing. I have to say that Government Members slightly despair at the constant churlishness of Opposition Members who try to talk down the NHS and talk up a crisis. They are trying to talk the situation into fitting the rhetoric, but the NHS has performed really well this winter and many more people have been seen within the target. The average waiting time for someone to be seen is actually 30 minutes. The NHS has done well and she should join us in congratulating it on that.

[Sir Tony Baldry (Banbury) (Con)]

Does my hon. Friend agree that one of the ways to reduce pressures on A and E is to ensure that people do not go to A and E if they do not need to? Will she compliment the Oxford clinical commissioning group for the work that it is doing in Abingdon and is about to do in Banbury in setting up a primary triage unit at the entrance of A and E to ensure that those who need primary care get it, and that those who do not require A and E care get the proper and appropriate care?

[Jane Ellison]

I congratulate my right hon. Friend’s local CCG. Increasingly, I am seeing, right across the country, imaginative and innovative ways in which people, local clinicians, public health professionals and people in wider health services are looking at how we keep people who do not need to go to A and E out of A and E. Some of them are doing remarkable work. We will be celebrating that this week by recognising some of those unsung heroes who are doing that great public health work in our communities.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

Calderdale Royal hospital’s A and E is well run and very busy at times. Why does the Minister think that the proposed closure of it will improve the health care of my constituents?

[Jane Ellison]

I responded to a debate on that issue a few months ago. As the hon. Lady knows, there are no plans for what she suggests, but the local trust has begun a process, in which she and other local politicians are engaged. At the heart of that process is care for local people, looking at what is clinically best for them and what the best outcomes are for them in the long term. That will have regard to Sir Bruce Keogh’s review of urgent care. What we want are the best outcomes for people, and I am sure that that is what she wants too.

[Andrew Percy (Brigg and Goole) (Con)]

Every weekend, as a first responder volunteer in the NHS, I see too many people taken off to hospital unnecessarily. One way of addressing that is to have a proper strategy for community paramedicine. We have had a trial running in Goole, which the Secretary of State has seen, where an emergency care practitioner delivers care in people’s homes, thereby reducing visits to hospital. Do we not need a national strategy on community paramedicine?

[Jane Ellison]

I know of my hon. Friend’s extraordinary work as a first responder, and we all greatly admire it. He makes another great point about how we tackle this long-term challenge of the sustainability of our acute services. I am happy to draw his comments to the attention of NHS England. I am sure that it is one part of all the things it is looking at as it addresses this issue.

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

The complacency of this Minister knows no bounds. In 2011, the Prime Minister said:

“I refuse to go back to the days when people had to wait for hours on end to be seen in A and E.”

In 2013-14, the first year after the Government’s reorganisation, we saw the worst year in A and E for a decade, with almost 1 million people waiting longer than four hours to be seen in accident and emergency. As A and E is the barometer of the whole health and care system, is this not the clearest sign that the NHS is getting worse on their watch?

[Jane Ellison]

So desperate are the Opposition, I think the shadow Minister actually used the same opening line that he used at the last Health orals. It really is time to change the script. The NHS has seen more people in A and E than ever before. Waiting times have halved since the last Government left office. If he wants to come to the Dispatch Box and highlight problems in A and E, why does he not try the 86.6% of people being seen in Wales, which is a truly shocking performance statistic.

[Andy McDonald (Middlesbrough) (Lab)]

8. What progress has been made on achieving parity of esteem between physical and mental health.

--- Later in debate ---

[Nick Smith (Blaenau Gwent) (Lab)]

13. What steps the Government is taking to reduce the amount of sugar in children’s diet.

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

The Government’s focus is on reducing calories overall rather than focusing solely on sugar, and informing consumers so that they eat fewer calories, including sugar, is key to the responsibility deal. We have 36 companies cutting calories under the calorie reduction pledge, which is often through the reformulation of popular products, and our Change4Life campaign informs families how they can improve their diet and health. Some of the early evidence from Public Health England’s January smart swaps campaign is really encouraging.

[Nick Smith]

Blimey, what a cop-out! With a third of children under 18 either obese or overweight, what action has been agreed with the Secretary of State for Education to stop the consumption of sugary drinks in schools?

[Jane Ellison]

My understanding is that the consumption of sugary drinks is banned in schools. I have discussed that with the Department for Education, but I am happy to take up the point.

I must correct the hon. Gentleman on his point about childhood obesity. Let us give credit where it is due. Childhood obesity levels are for the first time levelling off and we are beginning to see some progress, although there is much further to go. We have a straightforward disagreement. The Government believe we need to give people information. The Opposition believe in a top-down, state-driven approach.

[Mr Ben Bradshaw (Exeter) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Bob Blackman (Harrow East) (Con)]

T6. In 2010 the Chancellor specifically set aside funding for the rebuilding of the Royal National Orthopaedic hospital in my constituency. The site has planning permission. Will my hon. Friend update the House on progress so that we see work on the ground before 2015?

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

My hon. Friend will be interested to know that the NHS Trust Development Authority is reviewing the trust’s business case and is working with the trust to ensure that its plans are affordable. I know that my right hon. Friend the Secretary of State has visited the hospital and is a great champion of it. I will ask the TDA to keep my hon. Friend fully up to speed.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

T4. I have a question for the Secretary of State on performance-related pay. He will know that a year ago part of the Greater Manchester ambulance service was privatised to Arriva. For the first nine months of its contract, every single month it missed its targets for getting patients to hospital on time and for collecting patients within a scheduled time frame, yet over the same period it was awarded £400,000 in performance-related pay. Is that good use of public money?

--- Later in debate ---

[Mr Stewart Jackson (Peterborough) (Con)]

In the absence of a definitive policy decision on the fortification of basic foodstuffs with folic acid, what steps are Ministers taking to encourage women of child-bearing age to take folic acid to reduce the incidence of neural tube defects such as spina bifida and hydrocephalus?

[Jane Ellison]

My hon. Friend is right to highlight this important nutritional need for women who are planning to get pregnant or are pregnant. He and I are meeting soon to discuss fortification as a policy area. I urge all GPs and health services to take every opportunity to highlight to women this important nutritional requirement.

[Jim Shannon (Strangford) (DUP)]

Last week at Queen’s university in Belfast, a significant breakthrough for ovarian and breast cancer means that women who might otherwise opt for an oophorectomy can still have children. Does the Minister agree that money spent on cancer research can increase quality of life and life expectancy? What help will Government give to cancer research at Queen’s university in Belfast?

[Jane Ellison]

The hon. Gentleman is right that research is vital, and a great deal of it is going on in this area. I recently met the all-party group on ovarian cancer to update it on that research, and I will be happy to update him after questions. He has mentioned before how research applies across our United Kingdom. As he knows, whatever we learn through research in England is always shared across the different countries.

[Dr Julian Huppert (Cambridge) (LD)]

Health care in Cambridgeshire has been underfunded for years, and mental health care particularly so. This is getting worse as a result of the private finance initiative contracts that were signed, the differential deflator for mental health and physical health, and the simple fact that mental health demand is up. Will the Secretary of State meet me and the mental health trust to work out a way out of these problems that will not harm patients?

Stillbirths and Infant Mortality

Jane Ellison Excerpts

Wednesday 26th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Davies. Like others who have spoken today, I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing a debate on a sensitive issue that it is incredibly vital that our nation makes more progress on. I apologise that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), whose portfolio covers this policy, is not here to respond, but I undertake to report back to him and to refer him to colleagues if I am unable to respond to anything today.

The death of a baby, whether during pregnancy or following birth, is of course a tragedy. Colleagues have eloquently described the devastating impact on families of losing a baby to stillbirth or during the first year of life. Although stillbirth is now at its lowest recorded rate in England since the definition changed in 1993, a study published in The Lancet in 2011 ranked the UK 33rd worldwide on stillbirths, below a great many other high-income countries. As has been said, being in that place in the league table is not a record we can be proud of. We are making progress, which I will describe, but as everyone accepts we clearly need to do more and to be in a better place. Similarly, infant mortality rates are at historic low levels, but still higher than the European Union average.

Although the stillbirth rate has decreased dramatically over the past 50 years, until recently it had not declined significantly since the 1990s. My hon. Friend referred to that sense of stalled progress. Thus, the rate for England and Wales in 1993, when the current definition was introduced, was 5.7 stillbirths per 1,000 total births. By 1999 the rate had fallen to 5.3, but 12 years later, in 2011, it had not really changed, at 5.2. It is encouraging that the rate has now started to fall. The rate for 2012 was 4.8 stillbirths per 1,000 total births, which is the lowest rate recorded in England since the definition changed. Although that is a statistically significant fall, which we all welcome, we recognise that the decline in stillbirths in the UK has not kept pace with that in other comparable countries. My hon. Friend also demonstrated that across the UK we do not necessarily have even rates of progress. The decline in the infant mortality rate has been more encouraging, that in England falling from 5.2 to four deaths per 1,000 live births between 2002 and 2012, although that remains higher than the EU average, as I said.

Such reductions are welcome, but the rates in England are still high and there is considerable scope for future reduction. That is why we have a wide range of initiatives in place that will help to reduce stillbirth and infant mortality rates, and tackle health inequalities. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), and others, were right to refer to the relevance of this issue. It remains a source of concern that we sit where we do in international league tables.

What can be done to reduce the number of stillbirths? As colleagues have said, stillbirth has many causes, some of which are known and some not. That is one of the challenges: we are so used to identifying exactly what a problem is, what we need to do and the resources necessary to tackle it; but here we are in slightly strange terrain, in that we know some things but not enough. The known causes include lifestyle issues such as smoking and obesity; medical causes affecting the woman, baby or placenta; demographics; and the safety and effectiveness of the maternity care given.

On reducing the risk of stillbirth, an important first step is to raise the issue’s profile, so that people are aware that it needs to be dealt with and is not simply one of those things to be accepted and about which little can be done. It is not acceptable to have one of the worst stillbirth rates in comparison with similar countries. We have therefore included stillbirth and neonatal mortality as an area of improvement for the NHS in its outcomes framework. We have identified it as an area in which we need to do much better.

A range of research has been conducted that demonstrates that women who access antenatal care late have poorer outcomes. Early access to antenatal care is therefore pivotal to improving health and well-being outcomes for women and their babies. In line with the guidelines of the National Institute for Health and Care Excellence, women should have an assessment of their health and social care needs, risks and choices as early as possible in pregnancy. That enables midwives to provide pregnant women with important lifestyle messages —for example, about diet, exercise, smoking and drinking —and to identify any pre-existing conditions that might require additional support. I will say more about public health later, but I can only share in the alarm expressed by Members at some rates of drinking—quite heavy drinking—during pregnancy, for example. According to the national statistics on that, there is great variation between local authorities. I will touch later on one of the reasons why we think public health sits so well within local authorities, which are in a position to tackle that regional variation.

The Department and NHS England are working with a number of key partners, including the stillbirth charity Sands, Public Health England, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, to take forward a stillbirth prevention work programme. The programme covers a range of initiatives, including raising awareness of the known risk factors among pregnant women and health professionals. That will ensure that women receive consistent advice on how to minimise the risk of stillbirth—including the importance of healthy eating and the other lifestyle issues that have been raised—are aware of foetal movement and what is normal for their baby, and know where to go for help if they suspect there is a problem. It is important that each stillbirth is investigated and lessons are learned. We are therefore working with NHS England to explore how standardised perinatal death reviews could be introduced.

Growth-restricted babies are up to eight times more likely to be stillborn than non-growth-restricted babies. My hon. Friend the Member for Chatham and Aylesford is aware of the encouraging results we have achieved in reducing the stillbirth rate in the three regions where uptake of the Perinatal Institute’s growth assessment protocol training package—the GAP programme—was most prevalent. Following discussions with the Perinatal Institute, NHS England is encouraging uptake of the programme across the NHS in England. More than 75% of trusts in England have already signed up for that training.

[Tracey Crouch]

Will the Minister elaborate slightly on that training? Given the example of my constituent whose son, Henry, was stillborn at 38 weeks but had not grown for 16 weeks, the measurement tools currently available to midwives are clearly simplistic and some more sophisticated technology for measurement could well be of use. Will she elaborate on whether the new system is using more sophisticated technology? That is one reason why having an extra scan could help with early intervention, by identifying any growth problems sooner.

[Jane Ellison]

My hon. Friend has asked an extremely good question. I hope she will allow me to reply after the debate—I do not have an answer readily to hand, as the subject is not in my policy portfolio. I will come back to her on that, because it is a good question.

Although we know some of the risk factors for stillbirths, other causes are unknown, and it is important that we gain a greater understanding of those. The NHS National Institute for Health Research funds a range of research relating to causes, risk factors and prevention of stillbirth and neonatal death. Both the NIHR Cambridge and the NIHR Imperial biomedical research centres have ongoing research programmes on women’s health, including research relevant to the prevention of stillbirth and neonatal death.

In addition, the NIHR health technology assessment is funding three significant trials. The first is a £6 million trial of an intelligent system to support decision making in the management of labour using the cardiotocogram, or CTG. The second is a £1.4 million trial of nicotine replacement therapy in pregnancy, led by the university of Nottingham. The third is a £1.2 million trial of physical activity as an aid to smoking cessation during pregnancy, led by St George’s, university of London.

My hon. Friend referred to the Tommy’s stillbirth research centre at the university of Manchester, which is conducting innovative research that focuses on the unborn baby’s life support machine—the placenta. It has opened the Manchester placenta clinic, which combines specialised antenatal care for pregnancies affected by foetal growth restriction with front-line research into why the condition occurs and how it might be treated. The Government also fund MBRRACE-UK, or Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the United Kingdom, which is continuing the national Confidential Enquiry into Maternal Deaths and national surveillance of late foetal losses, stillbirths and infant deaths.

I turn now to bereavement support and counselling, which were quite rightly raised during the debate. It is obviously important that women who have suffered a miscarriage, stillbirth or neonatal death receive evidence-based care, in an appropriate location, which supports both their physical health and their emotional well-being. In December 2012, NICE published clinical guidance that offers evidence-based advice on the diagnosis and management of ectopic pregnancy and miscarriage in early pregnancy—that is, up to 13 completed weeks of pregnancy.

We expect maternity care providers and commissioners to give due regard to NICE guidance and to ensure that there are comprehensive, culturally sensitive services and facilities for the management and support of families who have experienced a miscarriage, stillbirth or neonatal death. Skilled staff should of course be available to support parents. I take on board entirely the point that that picture might sometimes be inconsistent. Clearly, we have to work towards greater consistency. As I often say when we have debates such as this, it can only be a good thing that Parliament continues to demonstrate its great interest in this area, as we can demonstrate to those who provide and plan our health services in which Parliament has shown a particular interest. Today’s debate provides another opportunity for us to do that.

In May 2012, the then Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), pledged that women who have suffered a miscarriage would get more support from the NHS. Over the past two years, the Department has awarded £35 million in capital funding to improve NHS birthing environments, including facilities for bereaved parents.

My hon. Friend the Member for Chatham and Aylesford raised the issue of scans. There are currently no plans to introduce routine scans in the third trimester of pregnancy to monitor foetal growth and development. I recognise that there is a challenge to that policy. The UK national screening committee advises Ministers and the NHS in all four countries of the UK about all aspects of screening policy, and supports implementation. It uses evidence based on research, pilot programmes and economic evaluation, and assesses the evidence for programmes against a set of internationally recognised criteria. If stakeholder organisations, individuals or Members feel that there is enough evidence published in peer-reviewed journals to consider screening for a condition in the third trimester of pregnancy, they can submit a policy proposal to the national screening committee. That might well be something that my hon. Friend wishes to consider.

I turn briefly to the subject of the registration of stillbirths. I say briefly, because I know that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, is meeting my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) in early April to discuss his ten-minute rule Bill on the registration of stillbirth. That Bill aims to amend the Births and Deaths Registration Act 1953 to provide that parents may register the death of a child stillborn before the threshold of 24 weeks’ gestation. That Act, as amended by the Still-birth (Definition) Act 1992, provides for the registration of all babies stillborn after 24 weeks’ gestation. When a baby is stillborn, the doctor or midwife who attended the delivery or who examined the baby’s body after birth gives the parents a medical certificate certifying the stillbirth.

Although some parents are very distressed that they cannot legally register the birth of a baby born before 24 weeks who did not breathe or show any signs of life, others would be distressed at the possibility of having to do so. Getting the right balance between those conflicting wishes is challenging, but the existing system, whereby hospitals can issue local commemorative certificates—my hon. Friend the Member for East Worthing and Shoreham alluded to those in his remarks—for those parents who want them goes some way to addressing the issue. I know that he will have more questions and challenges for my hon. Friend the Member for Central Suffolk and North Ipswich, and will want to discuss those at that meeting in April. I recognise that he has signalled his intention to take the matter forward.

Although infant mortality rates are at an historically low level, health inequalities remain and often reflect inequalities by socio-economic group, ethnicity, geographical area and age. There is a threefold difference in infant deaths rates between professional groups and manual groups. Mothers born in the Caribbean, west Africa, Pakistan and Bangladesh have rates between one and a half times and twice the national average. The greatest numbers of infant deaths and the highest rates are to be found in the most deprived parts of big cities such as Birmingham and Bradford. Young mothers under 20 have the highest risk of infant mortality—almost 60% higher than that for mothers aged 20 to 39, with young lone mothers at even greater risk. That is a terrible catalogue of loss, for the families concerned, for their communities and for the nation as a whole.

There has, however, been some progress in reducing those inequalities in recent years. The difference in the infant mortality rate between the routine and manual group, for example, and the population as a whole has narrowed from 18% in 2002-04 to 9% in 2009-11. We are looking to build on that progress, and that is why we have made reducing these inequalities a priority for the whole of the new health system, working with PHE and NHS England, and backed that up with new legal duties on access to and outcomes from services.

Professor Sir Michael Marmot has been referred to during the debate. He said in his post-2010 health inequalities review that there is a social gradient in health, whereby the lower a person’s social position is, the worse his or her health will be. He recommended that action should be proportionate to the level of disadvantage, including on his first priority of giving every child the best start in life, with which none of us would disagree.

On a practical note, we are strengthening the health visitor service, which Members were right to highlight. We are conscious that it is an important pledge and crucial to infant health and early child development. We are increasing the number of health visitors by 50%—4,200—by 2015. We are also doubling—by 1,600—the number of places on the family nurse partnership programme, which supports vulnerable young mothers over the same time scale. Sure Start children’s services also have a role to play.

The family nurse partnership has an exceptional record of successful intervention, particularly in the lives of young and vulnerable mothers. It has supported many thousands of them throughout the country through pregnancy and birth, and sustained the life chances of the child and the mother. I will quote a nice comment from one of the young women who were helped by this service. She said of her family nurse:

“Margaret doesn’t tell me what to do but helps me make good decisions about my baby, my life and how to be a great mum. I’m excited about my future and seeing my baby grow up. My partner and I became engaged last October and next year I start university”.

That is typical of a young life that has been turned round by effective intervention at a critical moment—not just the mother’s life but, critically, the life of her child also. We are delighted to support the family nurse partnership and to see it grow.

As expected, reference was made to midwives. It is vital to have the appropriate number of trained midwives available in the NHS. Since May 2010, the number has increased at twice the rate of the number of births. There are now 1,500 more midwives than in May 2010, and more than 5,000 in training who are due to qualify in the next three years. Obviously, Health Education England has been given a mandate by the Government in this area, but I completely accept the point about consistency of midwife care and support. That very good point was well made, and I will ensure that it is made to the NHS.

[Tracey Crouch]

I am delighted to hear that there are 5,000 midwives in the training programme. Are they receiving dedicated bereavement training?

[Jane Ellison]

Again, if my hon. Friend will forgive me, I will respond to that question after the debate. I would not want to get the answer wrong.

We have touched throughout the debate on public health, which sits within my portfolio. National action must be complemented by local action. I mentioned the extraordinary range of indicators that I see regularly on issues such as drinking in pregnancy. It makes the case for why the transfer of responsibility for public health from the NHS to local government is sensible. We have backed that with £5.4 billion over two years, and a public health outcomes framework that focuses on health inequalities and key indicators in infant mortality such as low birth weight, which is associated with prematurity and is a significant cause of infant mortality and poor infant and child health.

Some of that local action is already being taken. My home city of Bradford has an excellent record in addressing infant mortality, despite having some of the worst outcomes. It established the Born in Bradford project, a long-term cohort study of 14,000 pregnant women and their children to improve understanding of health and sickness in babies and children, tracking their health throughout pregnancy and childhood into adult life.

In Salford, which is closer to home for the shadow Minister, the city council’s health improvement service offers activities to support new mums and children, including breastfeeding, weaning, exercise and socialising, and it is working to improve MMR vaccine uptake among black and minority ethnic and other groups, where uptake remains low despite our good national statistics.

In Birmingham, pregnancy outreach workers employed by the social enterprise, Gateway family services, tackle health inequalities in infant mortality by bridging the gap between women who need support and the agencies that provide it. Those are three illustrations of some of the imaginative projects that are under way. I hope we will see more and more local government adopting best national practice and responding to the particular challenges in their areas. Some of the contrasts are stark, and local government, which knows its communities well, is well placed to respond to them.

My hon. Friend the Member for Chatham and Aylesford referred to cot deaths. We have made reducing infant mortality an area of improvement for the NHS. Comprehensive advice to parents about reducing the risk of cot death is available on the NHS Choices website, which includes a wealth of other advice. In 2012, the NHS launched the Start4Life information service for parents. They can receive regular e-mails, videos and texts about pregnancy and the first eight months of their baby’s life. It is a free digital service to provide quality-assured advice at the right moments for parents, who can sign up online for it.

The Department has also included advice about the risk of sudden infant death in the Healthy Child Programme, which is the universal programme for all children from the start of life and includes preventive services for children with additional risks. Obviously, anything more we can do to highlight the available advice and support would be valuable, and Parliament has a great role to play in that regard, as do MPs in their constituencies, and local government. The advice is there, but the challenge is always to ensure that it gets to vulnerable groups, and accessing advice across a whole range of health information is difficult.

I thank my hon. Friend for securing this debate, and other Members for their contributions. It further raises the profile of this vital issue of stillbirth and infant death. I assure the House that the Department is working collaboratively with partners, including charities such as Sands and Bliss, the royal colleges and others on a range of initiatives to help to reduce the number of tragic deaths. The Department is always open to new ideas and to working with partners throughout the health sector. We welcome these debates and the opportunity to engage further in any way that Members believe will help us to move forward in this vital area of policy for all our constituents.

Health Care (Gloucestershire)

Jane Ellison Excerpts

Wednesday 19th March 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Kingswood (Chris Skidmore) on securing this debate, as well as my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), on his speech. It is good that all three of south Gloucestershire’s MPs are in the Chamber, including the hon. Member for Thornbury and Yate (Steve Webb), who I know is listening to the debate with great interest, because it also affects his constituents.

Before I respond to some of the points that have been made, may I, as I always like to do, take the opportunity to highlight the wonderful work carried out every day by those who work in the NHS, particularly those in my hon. Friends’ constituencies? Carrying on great work and serving the public against a backdrop of uncertainty, as we have heard about this evening, is sometimes quite difficult, but I pay tribute to the staff there and right across the country.

As my hon. Friend the Member for Kingswood will be aware, the South Gloucestershire CCG is leading proposals for the future provision of health care services provided in the area, under the auspices of the Bristol health services plan. I hope that he will forgive me if, for the benefit of the House, I put on the record some of the twists and turns of the past 10 years. I recognise the frustration that has been expressed today. I felt some sense of it just on being briefed about the situation, so I can understand how it must feel from a local MP’s point of view.

The 10-year strategic plan, which began in September 2004 with an extensive public consultation, aims to improve the quality of care provided in the region; to move services closer to people’s homes and reduce travelling time for patients and carers; to bring together specialist hospital services; and to improve the quality of old hospital buildings. Under the plans, Southmead was selected as the location for a new acute hospital to replace acute services at the existing hospital in Southmead and the Frenchay hospital in south Gloucestershire. The new acute hospital at Southmead is due to open this spring. The West Gate centre in Yate and Cossham hospital will continue to play a role by providing medical and surgical out-patient services, hosting therapy out-patient services and providing X-ray, ultrasound and echocardiogram services.

I will turn first to the proposals for Frenchay. As my hon. Friends are aware, the 2010 proposals called for a new community hospital at the Frenchay site to provide up to 68 in-patient rehabilitation beds, out-patient therapy and diagnostic services. However, a 2012 review by the primary care trust concluded that the proposals for out-patient and diagnostic services were unaffordable and inflexible, and duplicated other services.

I understand that that was disappointing, but CCGs are charged with using their resources in the most effective way for the benefit of all residents. I am assured that the local NHS is committed to finding a long-term solution for the provision of in-patient beds at Frenchay. Although the CCG is commissioning 68 beds at Southmead for May 2014, that is a temporary measure while the Frenchay site is being improved to accommodate them after April 2016.

I will turn to the questions about the recent council referrals. My hon. Friend the Member for Filton and Bradley Stoke said that my right hon. Friend the Secretary of State had seized the challenge to refer the matter, and he mentioned some of the comments of the Independent Reconfiguration Panel. As he said, South Gloucestershire council’s public health and health scrutiny committee has the power to examine the proposals for service change and refer them to the Secretary of State if it considers that there are grounds to do so. The committee made two referrals to the Secretary of State. The first, which was made in October 2013, concerned the temporary provision of rehabilitation beds at Southmead hospital. The Secretary of State asked the IRP for initial advice on that referral on 2 November 2013.

Before that advice was completed, a second referral was received in December 2013 regarding the wider set of proposals under the plan, including the decision no longer to provide out-patient, therapy and diagnostic services at the Frenchay site. Specifically, the committee cited concerns that the new proposals for diagnostics and out-patient services would not be as convenient for patients as the option of maintaining three sites at Frenchay, Yate and Cossham. Additionally, the committee raised concerns about rehabilitation capacity in the light of population growth and financial sustainability.

In January 2014, the Secretary of State asked the IRP for further advice to take into account both referrals. That has now been received, as we have heard. After careful consideration, the panel does not believe that the referral warrants a full review. Acting on the advice of the IRP, the Secretary of State has decided that there should be no barrier to the local NHS continuing the implementation of the proposals in their current state. The Secretary of State wrote to South Gloucestershire council on Monday to confirm that he accepts the IRP’s advice and to agree that the implementation programme should be allowed to proceed. Both sets of initial advice are available on the IRP’s website.

The panel acknowledged, and I acknowledge from the Dispatch Box tonight, that the debate about the provision of health services in the area has been long and difficult. Delays, changes, pauses and amendments to the plans have all played a role, and the progress to date has suffered from a lack of trust and from poor communication. As I have said, I can only imagine the frustration that is felt by the local community at seeing that stop-start approach to commissioning and the reconfiguration of its local health services. My hon. Friends are right to raise these issues on the Floor of the House. Their constituents are fortunate that they have done so with such tenacity.

I will turn briefly to Cossham. As my hon. Friend the Member for Kingswood will be aware, the 2009 business case for Cossham hospital highlighted the fact that it serves a fast-growing population in the Kingswood catchment that has more older people and people suffering from long-term health conditions than other parts of south Gloucestershire. I understand that the growth in the number of older people has put increased pressure on local urgent and emergency care services, posing a significant challenge for commissioners.

My hon. Friends will be aware that in 2013, NHS England commissioned Sir Bruce Keogh to undertake a comprehensive review of how urgent and emergency care services are organised and provided in England. The report from the first phase of the review was published in November 2013. I think it is fair to say that it has transformed our national debate about the future of such services, and that all parts of the NHS in England are having to judge themselves against Sir Bruce’s recommendations and his road map for future excellence in urgent and emergency care. The subsequent phases of that review could have implications for how those services are organised for the benefit of local communities in future.

In parallel with that, the CCG decided to revisit the plans for a minor injuries unit at Cossham, in order to take account of local evidence and the themes emerging from the national review. It is clear that many local people want to see the MIU that was originally planned, which has been so ably argued for this evening, open as soon as possible and are frustrated about the decision to revisit previously agreed plans. For urgent care as for all services, the CCG’s priority has to be to ensure that the best possible combination of services is provided to meet the needs of the whole population, and that those services are sustainable and excellent for the long term. Achieving the right mix of services at Cossham will be an important part of the solution.

My hon. Friends the Members for Kingswood and for Filton and Bradley Stoke have made powerful cases. Although the task of getting the right mix of local health services is ultimately a decision for local clinicians, I would of course be happy to meet them to discuss the matter and hear their case, so that I can ensure that I have the clearest possible understanding of the issues that affect their area.

Once again, I pay tribute to my hon. Friends for their work on behalf of their constituents on the proposals. They have ensured that they have explored every possibility to ensure that they are part of an engaged process that will ultimately deliver what we all want for our constituents—excellent local health care. I congratulate them on that and look forward to continuing to engage with them on the issue.

Question put and agreed to.

Mitochondrial Transfer (Three-Parent Children)

Jane Ellison Excerpts

Wednesday 12th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. With the limited time available to me, I will set out some of the process by which we got to this point, but it goes without saying that these are extremely serious issues. I listened respectfully to colleagues’ concerns. There were some technical interventions and I will get back to colleagues about any concerns that I cannot answer now.

This is exactly why we are having consultation, and why I can confirm that the matter will be debated on the Floor of the House. The regulations will be subject to the affirmative procedure and there will be every chance to return to the issue and to debate it in full. I give that assurance. I know that I will not have time to respond to some points that are technical and scientific and I do not want to get them wrong, so I will write to hon. Members after the debate.

[Robert Flello]

On that point, will the Minister allow me to intervene?

[Jane Ellison]

I have not said anything yet, but go on.

[Robert Flello]

When the debate does come before the House, right hon. and hon. Members will look at things such as Library briefing notes and Parliamentary Office of Science and Technology notes, which normally I commend in the highest terms. My concern about the POSTnote entitled “Preventing Mitochondrial Disease”, which is Number 431 from March 2013, is that it talks about people who oppose this as simply being in a pro-life camp. That sort of language is very unhelpful, because the opposition is far wider than that.

[Jane Ellison]

I did not write that brief. I have never used that language and I would not. I accept—indeed, it is right—that this will be a subject of parliamentary debate, because it involves important issues. Just as Parliament has previously debated advances in science, such as IVF, and considered and weighed in the balance the concerns and the potential benefits, so that will happen again. I am certain that people will come to their own conclusion. These matters are normally decided by votes of conscience. I would be very surprised if this matter was not decided in the same way; in fact, I am sure that it will be.

Let me try to respond to some of the points and at least go through the process by which we have got to this point. I should say, though, in response to the intervention that was picked up by colleagues that we will arrange parliamentary briefings with, for example, some of the scientists involved and with the chief medical officer. I hope to be able to give hon. Members the opportunity to put questions directly to some of the people involved. There will be opportunities at all stages along the way, I hope, for colleagues to ask questions and get answers. What they think of the answers will obviously be down to them, but we will try to make it possible for people to come to a very informed view.

I am grateful for this opportunity. I am grateful that hon. Members have had a chance to put some of their concerns on the record, because that helps us in preparing for debates ahead. It gives us a heads-up on some of the areas of particular concern. Obviously, I have also been receiving correspondence about the matter.

The chief medical officer for England announced last year that the Government would go ahead with the development of draft regulations to allow mitochondrial donation in treatment. The consultation began on 27 February and will run until 21 May. I have already recognised the deep sensitivity of these issues. Since we were first approached in 2010 to make the regulations, we have been comprehensively collecting expert opinion and public views, and I will explain how that has been done. However, I understand that for many hon. Members and for many members of the public, this will ultimately be an ethical question. There will be strong views on both sides of the House, as we have seen today.

My hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) touched on what mitochondrial disease is. It is a genetic condition of mitochondria—the part of the body’s cells that produces the energy that they need to function. It tends to be described, for the benefit of the general public, as the “battery pack” that powers a cell.

A person’s mitochondria come from their mother’s egg. Therefore, if a woman has mitochondrial disease, it is likely that she will pass it on to any children she may have. Mitochondrial DNA is separate from an individual’s genomic DNA, which is in the nucleus of the body’s cells. Mitochondrial DNA disease can be devastating, but the disease affects everyone differently. The range of different effects can include heart disease, liver disease, poor growth, loss of muscle co-ordination, visual and hearing problems and mental disorders. Rare conditions caused by faulty mitochondria include forms of Leigh’s syndrome, which can cause multiple symptoms in infancy, such as muscle weakness, heart and kidney failure and nervous system dysfunctions.

Some affected children live short and painful lives. They are constantly in and out of hospital. The quality of life for them and their families is seriously diminished. I have been contacted by a family in that position in my constituency and I suspect that other hon. Members will be as we continue to engage in this debate in the coming weeks and months.

The condition affects approximately one in 5,000 adults, although one in 6,500 babies are born with a severe form of the disease that can lead to death in early infancy. It is estimated that about 12,000 people live with a mitochondrial disease in the UK, and there is no cure. However, research has been ongoing at the Newcastle centre for life, among other places, for many years. In anticipation of significant advances in this field, the Human Fertilisation and Embryology Act was amended in 2008 to introduce a regulation-making power to allow mitochondrial donation to treat serious mitochondrial DNA disease. At the time that amendment was made, Parliament was made aware that there was the potential for these techniques to be developed. The Act was thus amended and that was included.

The mitochondrial donation techniques involve removing the nuclear genetic material from an egg or embryo with unhealthy mitochondria and transferring it to a donor egg or embryo with healthy mitochondria, as my hon. Friend the Member for North East Somerset said.

[Sir Edward Leigh]

Will the Minister give way?

--- Later in debate ---

[Jane Ellison]

If my hon. Friend will forgive me, I will not. I have been left with very little time to respond. I doubt that I will even get through the remarks that I have prepared. However, I would be very happy to talk to him after the debate, and of course we will have much lengthier opportunities to debate the issue, so I do not think that I am cutting off debate.

Allowing the new treatments would give women who carry mitochondrial DNA mutations the choice to have genetically related children without the risk of serious disease. Recent estimates from the scientists leading the UK research in this area are that about 10 to 20 families a year could be helped initially. The scientists and clinicians at Newcastle university believe that allowing these techniques will also advance their understanding of mitochondrial function and mitochondrial diseases. It will enable them to gain a greater understanding of the way in which mitochondrial DNA mutations are passed from mother to child. It could also provide them with a better understanding of how mutations vary in different cells, which may lead to the development of new treatments for those currently suffering from mitochondrial conditions.

The use of the techniques would also keep the UK at the forefront of scientific development in this area and demonstrate that the UK remains a world leader in facilitating cutting-edge scientific breakthroughs. I know that that might be an uncomfortable point for some hon. Members, but other hon. Members have expressed great support for that. There are different sides to the argument. I completely accept that.

I understand that some hon. Members—this has been touched on today—are concerned about a slippery slope. Let me be very clear. Parliament has only provided a power to allow

“a prescribed process designed to prevent the transmission of serious mitochondrial disease”.

That is all that is prescribed in relation to the regulation-making power. We are proposing only to allow the donation of mitochondrial DNA, not nuclear DNA, so that is a further strengthening in terms of the regulation-making power. There is no intention or legal mechanism to go any further.

The draft regulations that are now out for consultation set out how the techniques would be allowed in treatment, the regulatory tests that the Human Fertilisation and Embryology Authority would have to use to give approval to a clinic on a case-by-case basis and how the mitochondrial donor would be treated in terms of information available to any children conceived through the new techniques.

In 2010, the Newcastle researchers approached the Department and requested that, in the light of their progress, we give consideration to the introduction of regulations. Recognising the complexity and sensitivity of this subject, we asked the HFEA to arrange public consultations and oversee a number of independent scientific reviews. An expert advisory group was established and a report passed to the Department in spring 2011. It found that the techniques were not unsafe, but recommended that some further research be undertaken.

After careful consideration of the report, the Department of Health and the Department for Business, Innovation and Skills commissioned the HFEA in autumn 2011 to undertake a comprehensive public dialogue and set of consultations in order to understand the public’s views on and understanding of this issue. The HFEA consultation was held between July and December 2012. It looked at the social and ethical issues raised by mitochondria replacement, as well as addressing a range of practical regulatory issues. Sciencewise, which plays a key role in helping the public to understand complex scientific issues, commended that public dialogue and the HFEA as an exemplar in its approach to gathering public views on a complex issue. As I am sure colleagues can understand, it is never enough, on an issue as complicated as this, to do a press release-style consultation. A simple “for and against” does not suffice to explore the complexity of the issue and ensure that when people express an opinion, they are doing so with a slightly wider understanding of it.

The HFEA gave a full set of advice to the Government in March 2013 based on the findings of the public dialogue and including further advice from the expert panel that it had reconvened. That concluded that although there continues to be nothing to indicate that the techniques are unsafe, further research on some specific aspects should be undertaken. Overall, the advice from the HFEA, informed by the balance of views from the public and stakeholders, was that the new treatment techniques should be allowed so long as they are safe and carefully regulated.

We have also taken account of other published reviews—for example, the 2012 report by the Nuffield Council on Bioethics entitled “Novel techniques for the prevention of mitochondrial DNA disorders: an ethical review”.

Some press headlines have suggested that a child born as a result of the new techniques would have three parents. My hon. Friend the Member for North East Somerset also alluded to that. I do not have time now to go into the detail of why we do not believe that that is the right characterisation. It is important to understand that mitochondrial DNA comprises a very small proportion—0.1%—of total DNA. However, these are issues that we can explore further. I have heard the concerns that have been put on the record today. It is also the Department’s view that this process does not constitute a form of human cloning. The techniques are not equivalent to reproductive cloning, because any children resulting from the use of the techniques would have arisen from fertilisation and be genetically unique.

However, there is clearly a great deal more for us to explore. Today’s debate has been a very helpful chance to hear the concerns of hon. Members expressed on the record. It gives me time to go away, look at the issue with officials and with the experts and ensure that we put in place the right advice and the right level of consultation as we go through the parliamentary process, in terms of—

[Mark Pritchard (in the Chair)]

Order. We now come to the final debate of the day.

Cancer Treatment and Prevention

Jane Ellison Excerpts

Tuesday 11th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray. We have certainly had a wide-ranging debate. I think I would need another hour and a half to respond to all the points made, but I hope that hon. Members present know me well enough to realise that if I am not able to respond to their points in detail, I will get back to them after the debate. The shadow Minister and I have many opportunities to debate the wider public health issues, so I will devote most of my response to specific points, particularly those made by my hon. Friend the Member for Mid Derbyshire (Pauline Latham), who called for the debate. I will, however, try to touch on all points made in some way.

I congratulate my hon. Friend the Member for Mid Derbyshire on securing the debate. She always speaks movingly on this subject, not least as a result of her personal experience. She has been a tireless campaigner on behalf of her constituents and others, in particular with regard to melanoma. Before I respond to her specific points, I would like to restate the Government’s ambitions, as those apply across the debate. All Members have referred to this, but improving cancer outcomes is a major priority.

We aim to save an additional 5,000 lives a year by 2014-15 and halve the gap between cancer survival rates in England and the best in Europe. As my hon. Friend the Member for Basildon and Billericay (Mr Baron), who is the chair of the all-party group, said, we are not as good as we could be, so there is great effort and commitment to make us better. Our debate has been on how we do that, not why that is the right ambition. To achieve that, more than £750 million has been committed to deliver our cancer outcomes strategy, which includes £450 million to support earlier diagnosis of cancer by improving public awareness and GP access to key diagnostic tests.

Early diagnosis came up many times during the debate. It is worth making the point that most GPs will see relatively few cancers in a typical year. Because we all know someone affected, whether in our family or our group of friends, we imagine that GPs see cancer all the time, but they do not; certainly, they do not see many of the rare ones. The challenge of early diagnostic testing and training to get those tools into GPs’ hands is serious, because that is also a challenge for GPs, of whom we ask a great deal. That is why it is important that the Government are putting money and effort into those early diagnostic tests. That money also goes towards paying for extra testing and treatment in secondary care.

I want to touch on the architecture of the system. It has been mentioned a few times and hon. Members have expressed concerns about the changes to the system. The first general comment I would make is that the main thrust of the debate is that we can do a lot better on cancer, which would seem to lead to the conclusion that the old system was not necessarily delivering the outcomes we wanted. Although caution is understandable when major change has happened, Members are perhaps being unnecessarily gloomy about the changes that can be delivered under the new architecture for the NHS and the health system. Many of the criticisms that have been made this morning were made under the old structures as well.

Cancer is a priority for NHS England. Clinical expertise is at the heart of commissioning decisions and NHS England has established a range of clinical reference groups, and is leading on delivering clinical strategy. NHS Improving Quality is working with the strategic clinical networks and has played a key role in working with the NHS on early diagnosis, especially on awareness campaigns. NHS England has also created national service specifications for a wide range of cancers to ensure consistent, high-quality service across England.

[Grahame M. Morris]

I know that the Minister is trying systematically to get through all the points that were raised, but I challenge the point that there is no fundamental difference under the new arrangements. There really is a fundamental difference in the commissioning of specialist cancer services. Those were previously commissioned on a local basis, effectively, by primary care trusts coming together in London, but now it is done by NHS England. That has caused a huge hiatus for the patient cohort I identified. Will she agree to look at that and, if necessary, meet me and a group of clinicians to highlight the nature of the problem?

--- Later in debate ---

[Jane Ellison]

The point I was making was not that there has not been change—of course there has—but that it is far too early for hon. Members to be drawing the conclusions they have about the new system. The Government have put a great strategic priority on cancer and NHS England has been charged with delivering against a mandate and against that strategic priority. I take the hon. Gentleman’s point, but NHS England leads on this subject and is quite clear about the priority that the Government and Parliament put on it. I want to make that point. I understand why people have expressed concern.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

No, I am going to press on, because I will have no chance of getting through all the specific points that were raised if I get into a debate with the hon. Gentleman.

I turn now to skin cancer. I should mention that NHS England has recently published a service specification—I mentioned that it has those across a number of cancers—on adult skin cancer services. That sets out what the NHS must have in place to offer high-quality skin cancer treatment, care and support. I am happy to send that to my hon. Friend the Member for Mid Derbyshire if it would be useful.

My hon. Friend and other hon. Members expressed great interest in what we are doing to ensure earlier diagnosis. It goes without saying that identifying cancers early has a huge benefit in terms of improving outcomes for individuals and for the whole health system. That is why we have committed over £450 million to improve diagnostic services. Later, I will consider in more detail prevention in the context of public health, but it is worth making the point that although diagnosis and treatment are vital, prevention is the biggest prize of all, because we can stop people even having to get to the point of being diagnosed. The more work on awareness and prevention that hon. Members and local councils—particularly given their new public health leadership role—can do, the more we will save the costs in money and in human misery.

Access to early diagnosis is most effective when people visit their GP early. That is why we are running a local Be Clear on Cancer campaign specifically on melanoma in the south-west in April and May, to raise awareness before the summer. We will evaluate the programme as part of our wider programme of Be Clear on Cancer campaigns, which, as the shadow Minister said, has done so much good work in so many areas.

We are also working with GPs to ensure they have the information they need. Cancer Research UK and the British Association of Dermatologists have developed a GP skin cancer toolkit. Evaluation shows that it has reached almost 10,000 GPs and helped to increase confidence in referring suspicious lesions.

My hon. Friend the Member for Mid Derbyshire spoke quite a bit about the NICE approval process, which was also mentioned by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). I know that my hon. Friend the Member for Mid Derbyshire is concerned about access to NICE’s approval of drugs for late-stage melanoma. As she knows, our priority has to be to get the best possible results for all NHS patients with the resources we have. NICE’s methodology is the best guide we have to the clinical value and cost effectiveness of different treatments.

We have asked NICE to look at the way drugs are assessed so that patients can get the treatments they need at the best value for the NHS, and the price the NHS pays is more closely linked to the value a medicine brings. NICE will carry out a full public consultation before implementing any changes to its methodology. I understand that NICE plans to launch its consultation later this month, and I urge all Members to contribute. I am sure they will, as many Members present take a significant leadership role in Parliament on cancer.

I turn now to the particular concerns my hon. Friend the Member for Mid Derbyshire raised about yervoy or ipilimumab. Although NICE has recommended yervoy as an option for treating advanced melanoma in people who have received prior therapy, I understand her concern that it should be approved as a first-line treatment. I have been advised that NICE is currently considering yervoy as a treatment for previously untreated stage three or stage four malignant melanoma. Although it is not appropriate for me to intervene in an appraisal, I have been advised that NICE’s initial draft guidance, issued on 25 February, recommends yervoy only in the context of clinical trials, as I outlined to my hon. Friend at Health questions recently.

That is not a refusal, however. Instead, it reflects NICE’s view that the technology is promising but there is insufficient clinical evidence for the appraisal committee to recommend its use as a first-line treatment at this stage. However, I hope I can reassure my hon. Friend that the manufacturer is currently conducting a further trial, which, along with other research, is due to complete in 2016. Once that research is available, I am sure NICE will wish to reconsider its guidance. NICE is currently running a consultation on its interim guidance. Again, I would also recommend that hon. Members, and particularly my hon. Friend the Member for Mid Derbyshire, make their views known to NICE. I always make a point of referring Parliament’s views, as expressed through debates such as this, to the relevant people making the decisions. I did so the morning after the debate on pancreatic cancer last week, when I sent a personal letter with a copy of Hansard to the decision makers concerned to make them aware of Parliament’s views. I always undertake to do that where relevant.

In the interim, I understand that NHS England’s national Cancer Drugs Fund panel has considered including yervoy for first-line treatment of advanced melanoma. The panel has decided to refer yervoy to NHS England’s chemotherapy clinical reference group for consideration for inclusion under baseline commissioning. If that is agreed, clinicians would be able to prescribe the drug for use in first-line advanced melanoma according to the commissioning policy that would be developed by NHS England. NHS England will make its decision known in due course.

I also want to reassure my hon. Friend the Member for Mid Derbyshire that NICE is currently developing a clinical guideline on melanoma. It expects to issue final guidance in July 2015. I hope that gives her some sense that a lot is going on this area. We will endeavour to make sure that we keep her updated.

I will have to canter through some of the other points, Mr Gray, but as so many were raised I hope you will be generous and give me a little time to do so. I turn first to the points made about the Cancer Drugs Fund and the concern that no new medicines are being accepted, which my hon. Friend the Member for Lancaster and Fleetwood raised. Just for the record, so far in 2014 the panel has added a number of drugs to the national list—I will probably stumble over pronouncing some of them, but I hope the House will forgive me. They include kadcyla for breast cancer, tafinlar for melanoma and radium-223 dichloride for prostate cancer.

I turn now to the topic of CCG accountability, which I have often discussed with my hon. Friend the Member for Basildon and Billericay, who chairs the all-party group on cancer with such vigour and passion. I entirely share his view that it is a critical point. He has articulated all the wins over the years in making sure that early outcome indicators are part of the CCG outcomes indicator set, and the importance that early outcome indicators have for early diagnosis and more information about survival rates, which we all want to see. It is important to remember that NHS England can intervene where a CCG is found to be failing in its duty to secure high-quality outcomes, although I accept that that is a high-level intervention. I think my hon. Friend is driving at what we will do with the information when we get it. NHS England is considering how it can better respond to the functions in the outcome indicator set and how all permissions and system structures work together to improve outcomes.

This is the first time we have had this indicator set and I know that my hon. Friend has talked to the national clinical director for cancer, Sean Duffy, about this, which is the right thing to do. I will also meet him to talk about it. It is helpful that Parliament returns to the issue regularly because it helps me to emphasise to NHS England how much store hon. Members set by local outcomes and how important it is for us to have a response throughout NHS England to indicators and outcomes that are not as good as they could be. I accept his challenge, which he knows that I am working on. I am having ongoing conversations about it, but it is always good that Parliament returns to the point and challenges the levers of change.

We have introduced GP inspection, and more and more data will be available to the inspectorate to ensure that it is asking questions not just about what GPs do, but about what they do not do and when we expect them to do more. There are all sorts of ways to challenge the system, and it is ongoing work.

I cannot respond to all the points made by the shadow Minister, but I will touch briefly on one. She referred to a report that highlighted the use of out-of-date equipment. To encourage NHS providers to update existing medical technology infrastructure, the Department established a £300 million fund in March 2012, which is operated by NHS Supply Chain to bulk purchase medical equipment to achieve better prices. In August 2013, NHS Supply Chain announced the signing of a deal with Varian Medical Systems to secure 20 new linear accelerators. More detail is available about that innovation fund and the radiotherapy innovation fund, but I do not have time to go into it now.

As ever, the hon. Member for Strangford (Jim Shannon) is present. He often attends debates and makes forceful points about the need for us to work together. The National Institute for Health Research is funded by my Department, so it is focused primarily on England, but I assure him, as I have tried to previously, that the published research is available to anyone. NICE guidance applies formally only to England, but it is available online to all who want to use it. It makes sense for all the Administrations to share that information and expertise, and to ensure that they make use of it when framing their own response.

We have previously discussed human papilloma virus in more detail in this Chamber and during an Adjournment debate on 13 January. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) made many good points about the wider take-up of vaccination to reduce the incidence in females of that and other cancers, and in males. The HPV vaccine was introduced to tackle cervical cancer, which is why the strategy started with girls. He makes a good point about the potential benefits, which are well recognised, of extending that to protection against other cancers, particularly oral cancers.

Since 2008, more than 6 million doses of vaccine have been given in the UK with 87% of the routine cohort of girls completing the three-dose course in the 2011-12 academic year. I was concerned to hear the figure my hon. Friend mentioned from his own area. Hon. Members rightly come here to challenge Ministers about what we are doing, but when there is local information, I urge them also to challenge their local systems and to ask what it being done to bring them up to the national rate. We know that there are challenges about some of hard-to-reach groups, but I am surprised to hear the statistic my hon. Friend mentioned. I urge all hon. Members to recognise that we cannot drive the change solely from Whitehall, and that it is good if they also ask questions about accountability locally.

My hon. Friend referred to the fact that work is continuing through the Joint Committee on Vaccination and Immunisation to look at the matter in more detail. He said that the JCVI is also looking at adolescent boys and men who have sex with men, and highlighted the problem that they do not benefit from herd immunity as HPV vaccination is more widespread among girls. The JCVI is considering whether it is cost-effective to extend the programme to both those groups. The issue is complicated, especially concerning adolescent boys. The evidence base, mathematical modelling and deliberations will take time, but the work is ongoing and it helpful that the House continually expresses its interest.

I recognise that I have not responded specifically to some of the points made by my hon. Friend the Member for Lancaster and Fleetwood about pancreatic cancer, but I responded in the House only last week. I hope he will accept that it is not discourteous to say that my response has not changed substantially since then, but I took the actions I promised last week. He has put on the record his concern about the need to value the additional months of life in a disease that sadly takes people so quickly. Early diagnosis and GP training in that is critical in pancreatic cancer, which is so hard to diagnose. That is well recognised, and I thank my hon. Friend for making his point.

In the remaining few minutes, I cannot respond to all the public health issues raised, but smoking is a factor in so many of the cancers that have been discussed, as the shadow Minister said. Smoking in this country is at an historic low, and has dipped to below 20% of the population for the first time. There is a significant legislative programme and the shadow Minister said she hopes we will keep up the momentum. I assure her that I have no option given the programme that we must deliver in the coming year. I look forward to her co-operation. I also look forward to support from hon. Members in the Chamber when we introduce those measures in the House.

It is always good to remind people why leadership on smoking cessation and legislation is so important. It plays a role in prevention, which is important in many areas that hon. Members have highlighted this morning. There is a big role for leadership at local council level because the figures on smoking cessation are extremely patchy throughout the country. We must drive change at local level.

The hon. Member for Easington (Grahame M. Morris) referred to Gamma Knife, and I will respond to him in more detail after the debate if that is acceptable to him. I am sure he did not mean to say that NHS England is callous and cold. Clinicians must make difficult decisions every day on behalf of all of us in balancing competing health priorities. He used those words, but I know he did not mean them in connection with the people who must make the difficult decisions. Many of our clinicians and health leaders must perform difficult balancing acts. Just the challenges made to me as the Minister in this debate this morning would have an enormous cost. We must make difficult decisions all the time about where we can best spend resources to bring the best results for the population. I know that that is at the heart of hon. Members’ concerns.

I thank hon. Members who are present. Many are long-standing champions of particular issues in Parliament and I urge them to continue their awareness-raising work. NHS England will continue to respond to that, as will Ministers. I thank hon. Members for attending the debate this morning.

St Helier Hospital

Jane Ellison Excerpts

Monday 10th March 2014 Commons Chamber

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

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing one of a number of debates that she has led in the House on this issue. I know that it is important to her—we have had many private conversations about it over the past few years—and to her constituents. She has great faith in my powers, but I fear that so soon after the collapse of Better Services Better Value, I am inevitably not in a position to say anything particularly definite to her tonight. However, I will try to respond to some of the points she makes and explain to the House what the road map ahead now looks like. Overall, although I understand her frustration, which is felt by many of us who represent south-west London, I think her analysis is a little bleak, but I will try to give her some assurance about the potential for the future, if not about some of the specific points that she asked me to address.

Before I comment on the issues that the hon. Lady has raised, I want to pay tribute to all those who work in the NHS in her constituency and in all our constituencies in south-west London. Throughout all the uncertainties of the past few years, they have continued to show their commitment to providing first-class services to all those in their care. For that, we thank them.

As I said, I share the hon. Lady’s frustration about this programme—I say that straight away on the record—as, I am sure, do all those of us affected in the area covered by the six clinical commissioning groups. For many of us, having spent so much time in consultations, meetings and discussions, it is, to say the least, very frustrating to find ourselves in this position on BSBV.

I give the hon. Lady the assurance that the Department of Health remains committed to investing in NHS infrastructure. The most recent Government spending review has ensured that capital spending in the NHS is protected in real terms. That means that the NHS will be getting a real-terms increase in spending in 2015-16 compared with 2014-15. There is, therefore, money available for capital infrastructure, but I realise that the hon. Lady’s interest is in her own local capital investment.

At the same time, I fully understand the hon. Lady’s disappointment that Epsom and St Helier University Hospitals NHS Trust has been unable to progress its plans for developing St Helier. However, as the hon. Lady knows, the problem is that in the absence of a local agreed strategy for south-west London and a decision on which services will be located at the redeveloped site, the trust has recently decided to reconsider the scheme.

As the hon. Lady is also aware, the proposed redevelopment has been closely linked to Better Services Better Value and the review of clinical services right across south-west London. That has gone on for so long that, in many ways, events have overtaken it and there is now a need to look at it afresh.

The six clinical commissioning groups in south-west London announced on 18 February that they did not propose to continue with the BSBV programme or to consult on the options that emerged from it, so they have now been withdrawn. As a result of that decision by the CCGs, the trust now needs to reconsider the business case for the hospital redevelopment and it plans to work with the local CCGs to see whether they can agree a level of investment in the hospital that is affordable and that ensures that the services provided are sustainable.

The trust has confirmed that over the next five years it plans to invest up to £78 million in modernising its estate, improving facilities for patients and updating IT systems and equipment. I think, therefore, that the picture the hon. Lady painted was a little bleak, because it suggested that there was to be no investment at all, when in fact the trust has announced that it intends to go ahead with plans that will enhance some of the services for her constituents.

[Siobhain McDonagh]

It is my understanding that any capital works of that size would have to be approved by the Department of Health and the Treasury, and as yet I do not believe they have been drawn up to the extent that they have any such permission, so at the moment this is wishful thinking on the part of the trust.

[Jane Ellison]

The trust has announced its intentions, and a proper process will be followed. I am trying to make the point that it is wrong to suggest that there are no plans to invest in and enhance services at St Helier. That process will be followed and we will respond in due course. That is my understanding of the trust’s plans and it wants to progress with them.

[Paul Burstow (Sutton and Cheam) (LD)]

I am grateful to the hon. Member for Mitcham and Morden (Siobhain McDonagh) for calling for this debate. Will the Minister use her good offices to ask the trust to set out very clearly to all hon. Members representing constituencies with an interest in St Helier its plans and the timeline for this capital investment?

[Jane Ellison]

That is an entirely reasonable request and I will, of course, convey it to the trust following this debate.

The local CCGs have listened to feedback from local people and they have now told us that they want to look at local health services in a more holistic way. Although they have decided against proceeding with BSBV, the local CCGs have unanimously supported the clinical case for change in south-west London and propose to use the detailed analysis provided by that exercise to plan their future strategy. I accept that that is a broad-brush explanation and that we have yet to see the detail, but that is essentially the direction of travel. Obviously we are not as far forward as we would have wanted to be after all the consideration given to the issue over the past few years.

The CCGs have also made it clear that if they do not address the challenges identified under BSBV or, at a national level, those in NHS England’s “Call to Action”, local services might decline in quality and not be able to meet the required safety standards. The CCGs have agreed that all future hospital services should be commissioned against the London quality standards and that all hospitals must provide seven-day-a-week, consultant-led services.

I referred earlier to events overtaking the BSBV programme, and the CCGs need to take into consideration some of the more recent developments, not least Sir Bruce Keogh’s review of urgent and emergency care. We need to look at the whole of the south-west London health economy in the light of those new expectations, particularly that for seven-day-a-week, consultant-led services. That is a challenge right across the NHS, not least for those of us in south-west London. Hospitals are expected to comply fully with the recommendations set out in the Keogh review and, of course, to be financially sustainable.

Should the outcome of discussions mean major changes at any trust in south-west London, proposals will, of course, be subject to public consultation. Most importantly, the local NHS has stated that it will involve local people in the work to develop these new solutions to the longer-term challenges faced by the NHS in the area.

As well as involving local people, it is absolutely essential to involve local Members of Parliament. I take the point made by the right hon. Gentleman in his intervention. Whenever I meet representatives of NHS London, as I do from time to time—another meeting is in the diary—I always stress the importance of liaising very closely with Members of Parliament so that they can best represent their constituents and make sure that they are fully in the picture about developments. For the record, I was not particularly impressed by the notice I got of BSBV not going forward, given that I have to respond in this House about it, and I have made that view clear to some of the people in my local area.

Epsom and St Helier trust has made it clear that the broad range of in-patient, out-patient and day services remains available at its two hospital sites. Local CCGs will work together—the new umbrella name is South West London Collaborative Commissioning—to develop a five-year commissioning strategy. The trust will work with its commissioners in the coming months to contribute to those plans. I understand that the trust expects to see the strategy in June, which will give it a clear idea of the future direction of local health services and its role in delivering them. As local Members of Parliament, we all expect to see the strategy at the same time.

Once a decision has been made on which services will be located at St Helier, the trust will need to revisit its original business case for the redevelopment of the site. I realise that that is frustrating, after everything that local people have campaigned on, but that is in its nature: it was only ever an outline business case. Any new or updated business case for redeveloping St Helier would initially need to be considered by the NHS Trust Development Authority, which is responsible for approving capital funding and ensuring that the repayments are affordable for the trust. As much is likely to have changed in the four years since the business case was last considered, it will probably be reviewed again by the Department of Health and the Treasury.

It is obviously essential that any options must be sustainable in the long term, both financially and, as I mentioned in relation to the Keogh review, clinically. When local consultations have taken place and have determined a sustainable service configuration for the locality and the hospital, we anticipate that requests for capital funding will be submitted to the Department of Health for consideration.

In conclusion, I urge the hon. Lady and other Members of the House to continue to represent their constituents, engage with the process and participate in future consultations. What we all want to emerge from the process is a sustainable, safe and excellent local health economy for south-west London that works to the most modern standards of care and is sustainable for the long term.

Question put and agreed to.

Pancreatic Cancer

Jane Ellison Excerpts

Tuesday 4th March 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and leading it in the knowledgeable and able way that he has led other debates on this important subject. I will do my best to respond to his specific points, but there may be some that I will need to respond to after the debate.

It goes without saying that cancer is a terrible disease, and my hon. Friend spoke movingly of his experience, but all hon. Members know ways in which it has touched them and their families and friends. I pay tribute to the work that he and colleagues in the all-party parliamentary group on pancreatic cancer have done to raise awareness of the disease. Its excellent report, “Time to Change the Story”, does much to counter common misconceptions about the disease.

My hon. Friend drew the House’s attention again to the particularly poor outcome for people who get the disease and the challenges in diagnosis. If we could match the best survival rates in Europe we could save an additional 75 lives a year. Clearly, if we exceeded those survival rates, more people would be saved.

Before I tackle my hon. Friend’s specific point about Abraxane, it is worth giving the context of other work that the Government are doing to support earlier diagnosis. We committed more than £450 million in funding over the four years to 2014-15. Sadly, there is currently no easy way of detecting pancreatic cancer and it can be particularly difficult for GPs to detect and diagnose it, especially in its early stages. However, to try to address the situation, the Department helped to fund a six-month pilot with Macmillan Cancer Support of a cancer decision support tool for GPs to help them to identify patients whom they might not otherwise refer urgently for this suspected cancer. Evaluation of the pilot is under way, and if it is found to be helpful, we will work with NHS England actively to promote its use. That tool was highlighted at a recent parliamentary event that some hon. Members might have attended.

We need to do more about earlier diagnosis and public awareness of the symptoms, which are often limited. As is often the way, I suspect that the recent “Coronation Street” story line has done more than many public health campaigns could have done to raise awareness. Yet again, well done to our broadcasters for covering some difficult issues and providing through Hayley’s sad story some important health education. It has reached many people, and we thank them for that.

On Abraxane, I am obviously aware of Pancreatic Cancer UK’s Two More Months campaign, and I congratulate my hon. Friend on this particularly well-timed debate. I am fully sympathetic to his points. As he says, two more months can mean so much to those who are affected by this cancer, and he gave some moving examples. We do not associate the disease with younger people. Sufferers are predominantly older but, as he illustrated, many people suffer at a younger age. I thank those who contributed to the report details of loved ones they have lost. My hon. Friend bears witness to his own loss, which we feel keenly with him.

I listened to my hon. Friend’s request that the recently licensed drug Abraxane should be made available from the cancer drugs fund. As he says, in the light of new evidence from the manufacturer, NHS England’s cancer drugs fund expert clinical panel is reviewing its earlier decision not to add it to its national list. One criterion in the scoring tool used by the panel is evidence of a drug’s impact on quality of life, which is what my hon. Friend spoke about. While I cannot in any way pre-empt the panel’s decision, I can fully understand how important this will be to people with pancreatic cancer. I will ensure that NHS England is made aware of tonight’s debate and the very good attendance. As the hon. Member for Scunthorpe (Nic Dakin) said, that reflects the impatience of parliamentarians, on behalf of their constituents, to see progress on this issue, which we seem to have been stuck on for so long. I undertake to do that immediately in the morning to ensure that the information is with the panel ahead of its deliberations.

My hon. Friend will be aware that Abraxane has not yet been assessed by the National Institute for Health and Clinical Excellence. Partly because of these situations, we established the cancer drugs fund to ensure that cancer patients in England have better access to life-extending or life-improving drugs that are not routinely funded by the NHS. He may also be aware that Novartis’s drug Afinitor is included on the national list for the cancer drugs fund, alongside two other treatments for treating pancreatic and neuro-endocrine carcinomas. More than 44,000 patients have benefited from the cancer drugs fund since October 2010, and we have recently announced an extension to funding for the scheme.

Looking further ahead, NICE is appraising Abraxane for untreated metastatic pancreatic cancer and expects to publish its guidance to the NHS in January 2015. That may seem a long way away, but, as been mentioned, this reflects the robust, evidence-based technology appraisal programme that NICE provides to ensure that clinical effectiveness and cost-effectiveness is taken into account when we look at drugs and treatments. The Government believe that clinically appropriate drugs should be routinely available to NHS patients, and we remain committed to the rapid uptake of NICE-recommended drugs in the NHS.

My hon. Friend referred to recent decisions on cancer drugs made by NICE. I am sure he appreciates that there will naturally be fluctuations in the proportions of drugs recommended by NICE each year, so a more accurate picture can be gained from looking at all NICE decisions on cancer drugs to date. That shows that almost two thirds of its decisions on cancer drugs have recommended their use for all or some of the eligible patient population. Far from making appraisals tougher, the most significant change to NICE technology appraisal methods in recent years has been to introduce greater flexibility in the appraisal of potentially life-extending treatments for patients at the end of their lives, and that has helped NICE to recommend a number of new cancer drugs for use on the NHS. That speaks directly to the extremely pertinent points that my hon. Friend made about how someone who has had such a diagnosis will see an extra two months in the context of the end of life, given that the progress of the disease can be very rapid from the point of certain diagnosis.

[Jim Shannon]

Will the Minister give way?

[Jane Ellison]

Yes, very briefly.

[Jim Shannon]

In an earlier intervention I asked about a UK-wide strategy. Has the Minister considered that for all the regions?

--- Later in debate ---

[Jane Ellison]

The hon. Gentleman has made that point in other contexts before, and it is a perfectly good one. Of course, health is a devolved matter, but as regards research and what we know about drugs, there are lots of aspects on which England has taken a lead and on which the devolved Administrations co-operate. I regularly have exchanges of letters with my opposite numbers. When there are important lessons to be learned on behalf of all our constituents, we would naturally share that information and expect it to be looked at in all parts of our United Kingdom.

Our priority is to make sure that we get the best possible results for all NHS patients with the resources we have. That is why we have asked NICE to look at how drugs are assessed to ensure that patients can get the treatments they need at the best value for the NHS, and that the price the NHS pays is more closely linked to the value a medicine brings. These can sometimes sound like quite cold decisions, but they are designed to help us to have a sense of objectivity in what are always very difficult decision-making processes. I assure my hon. Friend that NICE will carry out a full public consultation before implementing any changes in the way that it makes these assessments.

My hon. Friend referred to NanoKnife, which was also mentioned in an intervention. I am advised, I am afraid, that NICE has published guidance on that procedure which states that current evidence on the safety and efficacy of irreversible electroporation for treating pancreatic cancer is inadequate in quantity and quality, and it recommends that the procedure should currently be used only in the context of research.

My hon. Friend mentioned research funding. We are often asked about the amount of funding put into one area or another and I always like to make the point that, rather than specifying subject areas, the National Institute for Health Research welcomes funding applications for research into any aspect of human health. These applications are subject to peer review and are judged in open competition, with awards made on the basis of the importance of the topic to patients and the NHS, value for money and scientific quality.

I have no idea whether parliamentary interest is part of that mix, but I cannot believe that it hurts at all. Such issues come up regularly, and whenever I meet people from different health institutions and the NHS I always make a point about the things in which Parliament has shown a particularly keen interest to debate and progress.

[Tessa Munt]

Will the Minister give way?

[Jane Ellison]

I do not think I have time, sadly, but I would be happy to speak to my hon. Friend after the debate.

I hope it will be of interest that the Government are investing a record £800 million over five years in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool biomedical research unit in gastrointestinal disease, which has a major focus on pancreatic cancer. Some really interesting things are coming out of the opportunities for biomedical centres.

Recruitment to studies associated with pancreatic cancer by the NIHR clinical research network has also increased more than fivefold, from 447 in 2008-09 to 2,744 in 2012-13, which is another measure of the increased emphasis and interest.

I again pay tribute to my hon. Friend the Member for Lancaster and Fleetwood for his campaigning on this issue and the work he has done to raise its profile in Parliament, and to all hon. Members for the interest they have shown. As I have said, it is great to see such good attendance at this debate. That is on the record and it is of great interest.

[Tessa Munt]

Do NICE and similar organisations accept reviews and evidence from other countries, be they in Europe or America, when they deliberate and make considerations, or is it only home-grown evidence that counts? Is there an acceptance of the views of clinicians from other parts of the world?

[Jane Ellison]

I will, if I may, take my hon. Friend’s question away and respond to it formally. Obviously, it is a matter for NICE and I will make sure that I get an answer for her. My understanding, however, is that an awful lot of peer-reviewed research from all around the world is looked at and that it is the quality of that research that is taken into account. I will respond formally to my hon. Friend and make sure that I have that absolutely right.

In conclusion, I thank those who have participated in this important debate and those who have stayed to show their support for it, which is valuable. This disease remains very difficult to treat, but the Government will continue to work with patients and charities—which have done so much good work—and with researchers, the pharmaceutical industry and, of course, the NHS to improve results for people with pancreatic cancer and to see whether we can make more rapid progress than we have made in the past four decades.

Question put and agreed to.

Points of Order

Jane Ellison Excerpts

Monday 3rd March 2014 Commons Chamber

[Mr Speaker]

Not at the moment. I can say to the hon. Lady that the public health Minister did indicate to me a willingness to respond to her intended point of order. The Minister is in her place, and we should hear from her now.

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

Further to that point of order, Mr Speaker. I thank you for giving me the opportunity to respond directly. In responding to the Westminster Hall debate on Thursday 27 February and in relation to the points made by the hon. Member for Leeds East (Mr Mudie) concerning the release of information to the Institute and Faculty of Actuaries, I did say that the data that were used were

“publicly available, non-identifiable and in aggregate form.”—[Official Report, 27 February 2014; Vol. 576, c. 212WH.]

I was made aware on Friday 28 February that the information I had to hand during the debate did not include the latest clarification received from the Health and Social Care Information Centre. I therefore wrote to the Chair of the debate, my hon. Friend the Member for Southend West (Mr Amess), on Friday to inform him of that. I have today formally written to him and the Members who were present at the debate to correct the statement, and I have copied that to the House of Commons Library.

The correct position was that the faculty requested pseudo-anonymised information and said it would publish it only as anonymous information with all identifiers stripped out. My assertion that the data provided to the faculty were anonymised and publicly available was therefore incorrect, for which I offer my apologies to the House, the shadow Minister, who is in his place, and Members who attended the debate. In handling this request, the NHS information centre did not treat this as a request for sensitive information.

Once again, I thank you, Mr Speaker, for affording me this opportunity and I apologise for the fact that my comments during the debate provided an incorrect impression of the actual events.

[Mr Speaker]

I am extremely grateful to the Minister for what she said. It does seem to constitute a most full apology to and an explanation for the benefit of the House. We will leave the matter there. [Interruption.] We will not have a “further to” I am afraid. This matter has been fully addressed. If Members have totally unrelated points of order on completely different subjects, we will hear from them—in other words, for the avoidance of doubt, on matters not appertaining to that which has just been said. The hon. Member for Huddersfield (Mr Sheerman) intends to embark on entirely new terrain.