NHS Patient Data

Jane Ellison Excerpts

Thursday 27th February 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Amess. I congratulate my hon. Friend the Member for Mid Norfolk (George Freeman), as has everyone else, on securing the debate, as well as all the Members who have contributed to this thoughtful debate. I must start with an apology for not being the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is otherwise engaged on important business, but I will do my best to stand in for him in this area of his portfolio. If there is anything to which I am unable to respond during the debate, I undertake to do so afterwards.

I add to the voices that have welcomed the work of my hon. Friend the Member for Mid Norfolk on developing the Patients4Data website and other work, and have praised its co-founder, Graham Silk, and all its supporters. I particularly thank my hon. Friend for bringing such a calm, rational and well-informed voice, which is ever more needed in our public discourse. He has become a respected voice throughout the House in this area of expertise for that reason, and has amply demonstrated it again.

The Government support the sentiments outlined in the private Member’s Bill that my hon. Friend introduced. They are in line with the Government’s information strategy for health and care in England, “The power of information: Putting all of us in control of the health and care information we need”, which was published in 2012. His proposed Bill would provide for ownership of, and access to, patient records and health data to empower patients in everyday health care and research. He has outlined the principles in more detail today. The Bill would create a new statutory duty of care on NHS professionals to use and update information and ensure that the next professional on the patient’s care pathway is using properly maintained patient records.

I want briefly to deal with those two areas in turn, and, as Members would expect, I will then touch on some of the aspects of care. Data that have been explored during the debate. The Government feel that there is no need for legislation to provide ownership and access to patient records—the shadow Minister touched on that. Patients already have the legal right to access information in their own health and care records, but it has not been easy get it because it means requesting paper copies, and people might be charged. Easily accessing records online does not require changes to the law, but it is a big challenge to the culture and practices of many health and care organisations and professionals.

The NHS Future Forum emphasised the required cultural shift and the importance of health and social care operating

“as if it is the patient’s or service user’s data”.

The shadow Minister made a good point about the fact that integrating data naturally follows integrating care. The Government’s information strategy stresses the need for a change in culture and mindset, in which health and care professionals, organisations and systems recognise that information in our care records is fundamentally about us. It can therefore become normal for us to access our records easily.

The information strategy also makes it clear that patients will be able to access their own health and care records online; review those records, including test results; refer back to them during the course of care; and benefit by sharing, if they choose, that information with a range of other people who they want to help them with the care and support they need, when they need it. However, to alter legal ownership of patient records is a difficult way forward. Information is not property in the sense in which physical objects are, but is subject to intellectual property rights, common law confidentiality rights and obligations, and rights and obligations under the Data Protection Act 1998. Ownership implies a level of control over a record that is unrealistic and impractical for NHS medical records.

Let me outline why that is the case. Patients cannot, and should not, control what a clinician writes in a record, nor should they be able to delete items from a complete record. However, it is right that patients should be empowered to use the information in their records, for example by scrutinising their records for potential errors, or accessing them to help to manage their care. Colleagues might find it interesting to know that NHS England has committed to ensuring that people will be able to access their GP record online by March 2015. That is a real commitment and is in the NHS mandate. Ministers will, of course, hold it to account on that.

The law already provides individuals with considerable control over medical records should they choose to exert their rights, but it also provides a balance that protects the interests of those who provide care, and enables them to respond to complaints or litigation, monitor the quality of care they are providing, and learn lessons to improve the care of others. My hon. Friend the Member for Mid Norfolk gave a personal example of where that would have been helpful to him, and I have similar personal experience of where someone being able to give such easy access to their data would have been enormously useful. That is also ever more relevant to a sandwich generation of the age of some of us in the Chamber who are caring for the generation below and the generation above. My hon. Friend brought that relevant point very much to life.

On the duty on professionals to share data, sharing information is pivotal to improving the quality, safety and effectiveness of our care, as well as our own experiences of care. It is also critical to modernising care through raising quality, improving outcomes and reducing inequalities—now a legal duty—as well as improving productivity and efficiency. My hon. Friend the Member for Salisbury (John Glen) mentioned the Caldicott review, which outlined the many benefits of sharing data, as well as the cultural change required to create a rebalancing of sharing and protecting information that is in patients’ and service users’ interests.

[Sir Peter Bottomley]

My hon. Friend has prompted me to remember half a sentence I meant to say when I was talking about the baby P case. If all the medical contacts with baby P had been brought together in one place, any clinician would have known that there was a major problem.

[Jane Ellison]

My hon. Friend gives a perfect illustration of the point. We have all, particularly as MPs, encountered people who say, “Oh no—data protection!” and obfuscate in some way, but what they say is almost always absolute nonsense. There are lots of existing legal requirements to share data where needed to protect and look after people. We recognise the valuable role that my hon. Friend has played in making and championing that point.

The Secretary of State has challenged the NHS to go digital by 2018. That will help the sharing of patient records across the whole medial pathway. I echo and welcome the general point made by my hon. Friend the Member for Mid Norfolk on technology and its empowering possibilities. As public health Minister, that is very close to my heart. Of all the demographic surveys and insights into people’s situations that I see, the factor that defies the usual arc of deprivation is the ownership of a mobile phone. That is a great democratising piece of technology and I am keen to see that we use it more and give it more potential to put power into the hands of the previously powerless in this sphere of our lives.

On Government support for the concept of data sharing and the unique identifier, my hon. Friend has been working closely with officials from my Department. We have welcomed that working relationship. Officials have been exploring possible avenues for legislation to ensure that the sentiments outlined in my hon. Friend’s private Member’s Bill and his speech can be taken forward. We are all hoping for a successful outcome in the private Member’s ballot so that we can make progress.

Data-sharing options and the provision of clear guidance that underlines the need for sharing and clarifies what the law already allows are being considered. We are considering placing a duty to share on commissioners and providers. That would force such organisations to ensure that contracts include such a duty to help to change the culture and mindset so that we share data when we need to.

In addition, we are considering introducing a measure to ensure the consistent use of the unique patient identifier—the NHS number—across the whole health and care system. The intervention made by my hon. Friend the Member for Worthing West (Sir Peter Bottomley) illustrated why it is so important that, when we know critical things about a patient, we join them up. The easiest way to do that is by consistently using their unique identifier. The use of the NHS number will unify and standardise the recording and use of information for the benefit of both patients and clinicians. We have heard examples, and I am sure we can think of others. The Government are working on ways in which to ensure that measures are introduced on the duty to share and the use of NHS numbers.

Sharing information for medical research has demonstrated the many benefits that it can bring to us all in society, and that has been extremely well articulated today. I will shortly address the concerns expressed by the hon. Member for Leeds East (Mr Mudie). Members have touched on issues—including cancer, heart disease and diabetes, to name just a few—that have benefited greatly from the sharing of data, and treatments have been found for seriously ill patients.

For reasons I will explain, I want to turn relatively briefly to the care.data programme. It has been much discussed in the House, sometimes heatedly but sometimes calmly, as it has been today. Members have made various points about the programme. My view, which I think is shared in principle by everyone in the Chamber, is that overall the care.data programme is, or has the potential to be, a good thing, for all the reasons outlined by my hon. Friend the Member for Mid Norfolk and others. It offers a great deal to help us to bring benefits to patients. We have heard examples about detecting the problems at Mid Staffs, about autism and the disproven link with MMR, and about thalidomide.

I want to add an example that falls within my portfolio. In health care discussions, there is sometimes a tendency to think that we are moving forward only from the base we already have—that we bank all the existing benefits, progress and discoveries and move forward from that point. However, an area of great concern to people in this country and around the world is the development of anti-microbial resistance and the work required on that. The number of drug resistant conditions is growing, and that is frightening.

We hope that the ability to scrutinise the data will allow us to understand the pattern of growth of drug resistance, because that threatens to take us several steps back from what we assume to be our basic level of health care: the things that we have in our armoury against disease. It is something we need to take very seriously, otherwise there will be a great economic and human cost.

It is clear that most people agree with care.data’s aims, but they have justifiable concerns about how they are being implemented. People want more information and details about how the programme will actually work. That has been well articulated by various colleagues during this debate. People want rights over how their health and care data, especially data that identify them, are used.

Before I became an MP, I worked for a large national retailer organising large national marketing campaigns, so I could probably entirely occupy another debate on the vagaries or otherwise of door drops and the mix of communications needed to reach most people. I say “most people”, because it is almost impossible to design a programme that reaches everyone in a way that they remember. We might reach everyone, but an awful lot of quite good factual detail has proven that there will always be some people who do not believe they have been reached. We have to reach a reasonable level of breakthrough and cut-through with the messaging. I think that is well understood after the last couple of weeks of debate.

I understand but do not entirely share the cynicism of the hon. Member for Leeds East with regard to big Government and large institutions. I lean slightly more towards my hon. Friend the Member for Salisbury—perhaps for the same reasons, because we both came into the House in 2010—and his slightly more optimistic view on life. I meet people in the health system all the time—every day, every week—who have dedicated a lifetime to patient care and to trying to understand how we can make the human condition better. I also meet people wanting to achieve great things, and perhaps we all sometimes forget that we have to take people with us on the journey, and we need to explain.

The hon. Member for Leeds East also touched on a point that has been well made recently, which is to be honest about the benefits versus the risks. I agree, but I think he overdid the risks; he focused almost exclusively on them. However, he is right to say that we have to have a balance between the two, and we have to articulate that. Ironically, people will trust us more if we tell them about the risks as well as the benefits. I really believe that transparency drives greater trust, and I think that point has been made elsewhere. I read the article by Ben Goldacre, and my hon. Friend the Member for Totnes (Dr Wollaston) has articulated it as well. The more transparent we can be about the balance, the better it is.

On the way people view data and balance risk in everyday life, we see the world rapidly changing all the time. The information that people put out about themselves in the public domain in exchange for ease of access, convenience, speed or economy is quite surprising, so perhaps attitudes are changing around where the balance lies. Nevertheless, we need to explain it. Picking up the shadow Minister’s point, we particularly need to explain it and be open about it with those who perhaps are least able to understand the risk versus benefit balance. That is a good point, and I will take it away with me.

We have a period for reflection. The delay in the extraction of the first data means the data collection from GPs’ surgeries will now begin in the autumn, rather than in April this year. It will allow for more time to build up our understanding on the benefits of using the information, the safeguards in place, and how people can opt out. NHS England informs us that it does know how to make it easier for people to opt out if they wish to and that that can be done by phone. That is one of the points picked up in the debate.

We need to highlight the interdependency of trust and the levels of opt-out, because we do not want people to opt out for the wrong reasons. If they want to opt out for the right reasons, because they have made a balanced assessment, that is absolutely fine; it is their right. I share and echo the sentiments of those who are concerned, but I would advise them to wait a bit, see what happens during this time of reflection and make an assessment of where we get to before doing something that might be based on what is going on in the media at the moment.

I want to reassure the Chamber that the Secretary of State for Health, my ministerial colleagues and I are listening to all the concerns. I am not in a position to respond to some of the specifics. We recognise the points made by Opposition Front Benchers—articulated again today—and we are looking carefully at the issues. If need be, safeguards will be put in place over and above what NHS England does as part of its own engagement, and that will help to build public confidence. I cannot go into detail today, but considerable thought is being given to the issues, and when we can comment and add clarity, we certainly will.

Today’s debate has been a timely opportunity. It goes without saying that I will report back to ministerial colleagues who lead on this to draw their attention to the points that have been made, particularly the points about transparency, security and information for the public. Both aspects of the private Member’s Bill championed by my hon. Friend the Member for Mid Norfolk are being worked on. They featured as the main thrust of his speech today. The Government are keen to ensure that the measures are taken forward. We believe that sharing information for medical research has demonstrated the many benefits it can bring to us all in society.

Before I close, I should mention—I think it is useful for colleagues—the Institute and Faculty of Actuaries and the data it used. I think the shadow Minister also alluded to it. I want to put on the record that the data it used was publicly available, non-identifiable and in aggregate form. They were used not to analyse individual insurance premiums, but general variances in critical illness. The information was used to ensure premiums were fair, not to calculate individual premiums.

The moneys paid to the Health and Social Care Information Centre were for administration costs to compile the data, and of course the Health and Social Care Act 2012 has set stronger legislative safeguards. That does not mean that the information was wrongly given; it does not mean that that organisation has said that greater scrutiny should not be applied. However, for the sake of being straight with the public about the balance of risk, it is important to put what happened in that particular instance on the record.

To conclude, the Government are actively looking at what we can do to promote the sharing of data in a safe and secure way, using the NHS number to help connect medical records across the whole health and care system as we move between services. That, as well as professionals being able to access relevant records online simply, securely and all in one place—for example, via clinical portals—will enable more joined-up care. Together with the points I have made about care.data and the potential that that has, which others have articulated, I think we know there is an enormous prize in our grasp, but we know we will win that prize only if we are very careful and thoughtful about how we proceed, taking the public with us. This afternoon’s debate has greatly added to our thinking around that.

Mitochondrial Donation

Jane Ellison Excerpts

Thursday 27th February 2014 Written Statements

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

We are today publishing for consultation draft regulations to allow mitochondrial donation to prevent the transmission of serious mitochondrial disease from mother to child. The regulations will be subject to full scrutiny by the public and Parliament through the affirmative procedure.

It is estimated that one in 200 children born every year in the UK have some form of mitochondrial DNA disorder. These disorders can range from mild and asymptomatic to severe enough to be fatal. However, at present, mitochondrial donation techniques to prevent the transmission of serious mitochondrial disease are prohibited.

In anticipation of significant advances in this field, the Human Fertilisation and Embryology Act was amended in 2008 to include a regulation-making power that, if introduced, would enable mitochondrial donation to take place in treatment. This legislation is reserved to Westminster.

The Government gave very careful consideration to advice they received from the Human Fertilisation and Embryology Authority (HFEA) in March 2013 about the comprehensive public dialogue and consultation process the HFEA has undertaken into the acceptability of new techniques for mitochondrial donation. As a result, in June 2013 we announced our intention to consult on draft regulations which would allow this.

This proposed change in the legislation would give women who carry mitochondrial DNA disease the opportunity to have genetically-related children without risk of serious conditions. It would also keep the UK in the forefront of scientific development in this area. In framing the draft regulations, we have largely accepted and taken account of the advice contained in the HFEA’s report of 28 March 2013.

Consultation on the draft regulations begins today and will run until 21 May 2014. We welcome responses from everyone with an interest in this area. We have also asked the HFEA to reconvene the expert panel to review the latest evidence of safety and efficacy. We will consider their advice alongside the responses to the consultation.

Expert briefing meetings for hon. Members and peers will be arranged during the consultation period, and will be an opportunity to discuss issues arising from the consultation document.

“Mitochondrial Donation: A consultation on draft regulations to permit the use of new treatment techniques to prevent the transmission of a serious mitochondrial disease from mother to child” 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.

Health

Jane Ellison Excerpts

Thursday 27th February 2014 Ministerial Corrections

[Jane Ellison]

There is no complacency on the Government Benches, and attendances are half what they were under Labour. Week after week we have heard those on the Opposition Front Bench come to the House to talk up a crisis in our NHS, but the NHS has responded incredibly well throughout the winter. I pay huge tribute to the staff of the NHS for what they have done in responding to this. The Government are taking long-term action to reduce pressure on A and E; even the College of Emergency Medicine rebuts the Opposition line that there is a crisis in A and E this winter.

[Official Report, 25 February 2014, Vol. 576, c. 157.]

Letter of correction from Jane Ellison:

An error has been identified in the response given on 25 February 2014.

The correct response should have been:

[Jane Ellison]

There is no complacency on the Government Benches, and waits to assessment are half what they were under Labour. Week after week we have heard those on the Opposition Front Bench come to the House to talk up a crisis in our NHS, but the NHS has responded incredibly well throughout the winter. I pay huge tribute to the staff of the NHS for what they have done in responding to this. The Government are taking long-term action to reduce pressure on A and E; even the College of Emergency Medicine rebuts the Opposition line that there is a crisis in A and E this winter.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 25th February 2014 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

4. What assessment he has made of the role of dispensing doctors in the NHS.

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

Patients can take their prescriptions to any pharmacy where they wish to have their prescriptions dispensed, but we know that in remote and rural areas, where pharmacies may not be viable, NHS England may authorise GPs to dispense to patients, provided that certain criteria set out in regulations are met.

[Nic Dakin]

Dispensing doctors play an important part in rural areas, as the Minister said, but they face particular challenges at the moment. Will she meet me and representatives of the Dispensing Doctors’ Association to discuss these challenges?

[Jane Ellison]

I am always happy to meet colleagues. I think that Earl Howe leads on the matter in the Department, and I shall draw the hon. Gentleman’s concerns to his attention. It is for NHS England to ensure that everyone has a pharmacy available to them, and I am aware that the CCG allocation formula includes allowances for rurality, but we know that this is a particular challenge.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

5. Whether patients are able to opt out of the general practice extraction service by telephone or online.

--- Later in debate ---

[Mr Andrew Turner (Isle of Wight) (Con)]

7. What proportion of medicines prescribed in the NHS are alternative medicines; and what the annual cost is of dispensing such prescriptions.

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

The net ingredient cost to the NHS of homeopathic preparations dispensed in the community in England was £143,000 in 2012, which represents 0.002% of the overall NHS prescription cost in the community for the same period. The prescription cost analysis data from which we extract this information do not separately identify other alternative medicines.

[Mr Turner]

I thank the Minister for that answer. At the urging of Councillor John Nicholson, Isle of Wight council has asked the health and wellbeing board to recognise the value of alternative and complementary therapies and elect a representative to the board. Will the Minister and her Department work with that representative to evaluate the cost-effectiveness of such treatments?

[Jane Ellison]

I am aware that there has been interest in this matter in my hon. Friend’s clinical commissioning group. The provision of alternative and complementary therapies is decided by CCGs, which have to take into account National Institute for Health and Clinical Excellence guidance and local health needs and priorities. The responsibility is with CCGs to achieve value for money and to make sure that they are delivering improvements in the quality of care and patient outcomes, and it is against those standards that we would expect them to measure those therapies.

[Jim Shannon (Strangford) (DUP)]

In the past 12 months there has been great advancement in new medications and alternative medicines, with new drugs for multiple sclerosis, for type 2 diabetes and for hepatitis C, and advancements in heart operations, rare diseases, and so on. Will the Minister indicate the time scale for the announcement of new medications and their availability on the NHS?

[Jane Ellison]

The hon. Gentleman, who follows these matters closely, is aware that medicines go through a process by which they are approved and recommended. Once they are in that position, it is, as I say, down to CCGs to make decisions about which treatments are appropriate for their patients and to measure them against the standards that I laid out.

[David Tredinnick (Bosworth) (Con)]

I congratulate right hon. Friends on setting up the herbal working group to improve regulation of herbal medicine and its practitioners. Is the Minister aware that there is a problem of supply, in that most people have to pay for their herbal medicine and it is not necessarily available from clinical commissioning groups? Will she issue guidance? Perhaps we should have a mapping exercise in order to understand where the demand is in this country.

[Jane Ellison]

As I have just said, there is guidance for CCGs on how to operate in the area of alternative and complementary therapies and we have no current plans to add to that guidance.

[Margot James (Stourbridge) (Con)]

8. What steps his Department is taking to tackle female genital mutilation.

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

We recently announced that all NHS acute hospitals must provide information on patients who have undergone female genital mutilation, but that is just one element of a wider-ranging programme of work that is under way in order, most importantly, to improve the way in which we care for girls and women who have undergone FGM and to follow up on, respond to and prevent FGM. I will make further announcements in due course.

[Margot James]

I congratulate my hon. Friend on all the work she has done to combat this abhorrent crime since she entered Parliament. Will she confirm that the data reported to her Department will be used to mount educational campaigns to stamp out FGM in the vicinity of hospitals reporting patients who have been abused in this way?

[Jane Ellison]

We anticipate that we will be able to share the data collected with all appropriate Government Departments and partner organisations. On local education campaigns, I see no reason why requests to access the data would not be approved. We want to build a proper national picture of what is going on with FGM so that we can do all we can both to care for victims and to stamp out this abuse.

[John Cryer (Leyton and Wanstead) (Lab)]

On the issue of widening education, could the Minister encourage her colleagues at the Department for Education to write to schools to raise awareness of this abhorrent practice?

[Jane Ellison]

Fahma Mohamed, the brilliant young woman who has led the campaign on this, will meet the Education Secretary today and there is a lot of work under way across all Government Departments. There was recently a cross-Government declaration on the things that are going on to stamp out FGM and to care for its victims. The hon. Gentleman’s question is a matter for the Department for Education, but I assure him that the Government as a whole are hugely committed to wiping out FGM within a generation and to caring for its victims.

--- Later in debate ---

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

The World Health Organisation is currently developing the 11th version of the international classification of diseases, which it aims to publish in 2017. No discussions have taken place between the Department and the WHO on the reclassification of ME/CFS, but the WHO has publicly stated that there is no proposal to reclassify ME/CFS in ICD-11.

[Annette Brooke]

I thank the Minister for her answer. Many people will be greatly relieved about that. As chair of the all-party group on myalgic encephalomyelitis, I receive many representations about GPs in this country still not necessarily recognising the condition. Will she look into that, and will she work with her counterparts in the DWP on the benefits side as well?

[Jane Ellison]

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

[Ian Lavery (Wansbeck) (Lab)]

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

--- Later in debate ---

[Fiona Bruce (Congleton) (Con)]

15. When he plans to publish his Department’s new guidelines on sex-selective abortion.

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

The Government will publish more detailed guidance on compliance with the Abortion Act 1967 shortly. That will include guidance on sex-selection abortions and restate our view that abortion on the grounds of gender alone is unlawful.

[Fiona Bruce]

Britain’s biggest abortion provider, the British Pregnancy Advisory Service, has advice on its website claiming that the law is “silent on the matter” of gender-selective abortion. In a leaflet, it actually states that it is not illegal. How does the Minister propose to address that, and to send out the clear message that strong legal action will be taken against anyone who is involved in that wholly unacceptable practice?

[Jane Ellison]

Although the Abortion Act does not mention gender specifically, the Government are clear that abortion on the grounds of gender alone does not meet the criteria set out in the Act. If evidence comes to light that doctors or organisations are sanctioning abortions for that reason alone, we will refer it to the police.

[Nadine Dorries (Mid Bedfordshire) (Con)]

The Minister is quite right that the Abortion Act does not state that the practice is illegal. Organisations such as Marie Stopes International operate under an ethical and professional framework in which they state that they will not perform abortions on the basis of sex selection. However, the chief executive of BPAS has said that

“there is no legal requirement to deny a woman an abortion”

if she wants to abort a female. The Government commission abortion services from BPAS and Marie Stopes. Does the Minister not think it is about time to have a closer look at BPAS, which is headed by a chief executive who condones sex-selection abortions?

[Jane Ellison]

That is exactly why we want to reissue the guidance on this matter. I cannot add to what I have said. I say with complete clarity that the Government’s view is that sex-selection abortion—abortion on the grounds of gender alone—is illegal and we will report it to the police if we are given evidence of it.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

16. What assessment he has made of trends in the number of attendances at type 1 accident and emergency departments since 2009-10.

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

We have debated the hon. Gentleman’s concerns about the A and E services in his area in the past. I want to reassure him that, despite the overall growth in attendances at A and E—we know that there is pressure on A and E—the changes that are recommended for his area have enormous clinical support across all the local CCGs and trusts.

[Mr Sharma]

I thank the Minister for her response. Will she explain why attendances at hospital A and E departments increased by 16,000 in the last three years of the Labour Government, but by 633,000 in the first three years of this Government?

[Jane Ellison]

As the hon. Gentleman knows, we have often debated in this House the many reasons for the increased pressure on A and E. However, the rate of growth in the first three years of this Government has been lower than the rate of growth in the last three years of the last Government. We are responding to the pressures. That is why the Secretary of State has addressed issues such as named GPs for older patients and the integration of social care. We acknowledge that there is pressure on A and E; it is the action that the Government are taking to respond to it that really counts.

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

Ministers again deny that England’s A and E departments are in crisis. The Secretary of State did so in response to my right hon. Friend the Member for Leigh (Andy Burnham) earlier. It just will not wash any more. In the past two weeks, 10,743 patients waited on trolleys for up to 12 hours because no hospital beds were available and 52 patients waited for even longer. Does the Minister really think that it is acceptable that patients are experiencing the worst fortnight in A and E this winter while she is complacently sitting on her hands?[Official Report, 27 February 2014, Vol. 576, c. 10MC.]

[Jane Ellison]

There is no complacency on the Government Benches, and attendances are half what they were under Labour. Week after week we have heard those on the Opposition Front Bench come to the House to talk up a crisis in our NHS, but the NHS has responded incredibly well throughout the winter. I pay huge tribute to the staff of the NHS for what they have done in responding to this. The Government are taking long-term action to reduce pressure on A and E; even the College of Emergency Medicine rebuts the Opposition line that there is a crisis in A and E this winter.

[Julian Sturdy (York Outer) (Con)]

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

--- Later in debate ---

[Pauline Latham (Mid Derbyshire) (Con)]

T6. What assessment have the Government made of the decision by the National Institute for Health and Clinical Excellence not to recommend ipilimumab as a first-line treatment for advanced melanoma, except in clinical trials? Will the Minister join me in calling on NICE to reverse this decision and ensure that patients receive earlier access to this treatment to improve their chances of survival?

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

I know that my hon. Friend is really concerned about this, but NICE is an independent body so it would not be appropriate for me to interfere in an ongoing appraisal. NICE has recommended a number of other treatments for advanced melanoma, and NHS commissioners are required to fund them where clinicians want to use them. I want to give her some encouragement: this spring a trial will begin of an awareness programme on melanoma in the south-west of England, working with Cancer Research UK.

[Gavin Shuker (Luton South) (Lab/Co-op)]

T7. I am grateful to the Minister for her previous answer on female genital mutilation. With that in mind, what action will she take regarding the three Tory MEPs Nirj Deva, Sajjad Karim and Timothy Kirkhope who voted against the motion, in the European Parliament on 11 December, strongly condemning the disgraceful practice of FGM?

[Jane Ellison]

I am aware of this case. The point made is rather unfair. My colleague Marina Yannakoudakis MEP has dealt with this issue in correspondence with other Members. The motion was a composite motion. All Conservative MEPs completely condemn FGM, but there was a technical reason why they voted in that way. It is clear that the Conservative party—along, I think, with all Members—absolutely condemns this practice. I am happy to give the hon. Gentleman the detail on that vote afterwards.

[Dr Julian Huppert (Cambridge) (LD)]

T8. Papworth hospital is a world-renowned heart and lung hospital. For years, it has wanted to move to Cambridge, supported by Addenbrooke’s hospital, Cambridge university, the British Heart Foundation, AstraZeneca and many more, but it has been put on hold yet again. Will the Secretary of State make sure that this move, which will help patients, help to develop new treatments and save money, will happen?

--- Later in debate ---

[Jane Ellison]

I thank my hon. Friend, and I know that many hon. Members have raised this issue because pancreatic cancer outcomes remain extremely difficult. We want to see the best outcomes for all cancer patients. There has been a big investment by the Government in diagnosis and screening—£450 million—and last year we were involved in piloting a tool to support GPs in diagnosing cancer earlier, including pancreatic cancer, in over 500 GP practices. That pilot is currently being evaluated.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

The Manchester Evening News recently highlighted the enormous pressures faced by Wythenshawe accident and emergency after the downgrading of Trafford accident and emergency. Will the Secretary of State meet me to discuss this and to tell me when Wythenshawe will receive the extra funds that it has been promised?

Cancer Priorities

Jane Ellison Excerpts

Thursday 13th February 2014 Commons Chamber

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

Before addressing only some—I fear—of the many points raised in this debate, I would like to thank the all-party group, which, as the shadow Minister and others have said, does astonishing work. It rightly, and regularly, holds Ministers’ feet to the flames—my feet regularly feel the heat—but that is a good thing, because this is about driving up standards and pushing us all to work harder and do the right thing in this important policy area.

I also pay tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron), who brought this debate, and to the Backbench Business Committee—it used to be more fun being on it than responding to its debates—and I also warmly welcome the contribution from, and the presence of, the hon. Member for Ashton-under-Lyne (David Heyes), whose personal testimony greatly enhanced the debate this afternoon. We should also pause to think of our colleague, my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), who is being treated for bowel cancer; our thoughts are with him.

I shall try to reply to some of the many points raised in this fascinating debate. I shall try to respond, to some extent, on the structure of the report and the different domains, and to pick up on some other points made, and I absolutely undertake to get back to colleagues where I cannot respond substantively. As my hon. Friend the Member for Basildon and Billericay said, this is part of an ongoing dialogue, and I am delighted that he will be meeting the national clinical director soon. Out of that dialogue, I think we can progress in some of these areas. Some of the issues are inevitably a work in progress. However, important points have been made and I shall try to respond to as many as I can while updating the House more generally on what the Government are doing.

Many of the report’s recommendations are for NHS England. As I said, I am pleased that the national clinical director is to meet the all-party group later this month. He will find the meeting a helpful opportunity to discuss the report in detail. As I prepared for this debate, I was particularly struck by the fact that NHS England is considering the report in great detail—indeed, it contributed during the consultation phase. I am really encouraged by that, as NHS England is absolutely critical in our new health structures. It is very aware of its responsibilities. Some of the challenge today has been about how we interact and how those new responsibilities settle.

I want to set out some of the actions under way that I hope will provide reassurance about the Government’s and NHS England’s commitment to delivering on our ambition, articulated by other Members, to make England among the best in Europe on this issue. My hon. Friend the Member for Hertsmere (Mr Clappison) said that we had major challenges and a long way to go in that regard, although the shadow Minister was right to say that we are beginning to make significant progress in some areas. However, we recognise that we have a long way to go.

I was first asked to respond formally to the report, and it would be improper if I did not respond to such a thoughtful and well put together piece of work. Obviously, I hope to respond to some degree today, but I will take the report away and certainly respond formally later. Some of that will be about the Government’s responsibilities in holding NHS England to account. I will think about how we can do that.

The first domain that the report addresses is preventing people from dying prematurely. It raises concerns about responsibilities and accountability in the new health system. It is right to challenge on such issues; we cannot pretend that, when there is such major change to a system, everything will immediately be settled and clear. I accept that there is a challenge. Our progress must be as speedy as possible in understanding who is responsible for what—particularly in understanding how we make accountability as transparent as possible and a driver of change and improvement.

We are responding to the new system and the inevitable tensions between devolving power on delivery in a way that empowers clinicians while also being accountable to Parliament. No one could pretend that that is not challenging. I certainly feel that challenge as a Minister; the responsibility for delivering most of that clinical care sits somewhere else, so the issue is about how we respond and account to Parliament for that.

I gently say that we should be careful not to suggest that, in such a large and complex health economy, all was perfectly clear and beautifully directed from the centre before. I respect the shadow Minister’s enormous knowledge of the NHS and I know that neither she nor anyone else is suggesting that. However, in highlighting concerns about where the new system is settling down, it is sometimes tempting to think that previously Ministers had a big lever under their desks that they could pull to make everything right. Even if that was the theory, it certainly was never the practice, as is evidenced by our persistent lagging in some of the key survival statistics discussed today.

The challenge is to respond to the new system and get clarity where there is none at the moment. A number of Members, including the shadow Minister, have mentioned how we hold people to account at the most local level. That issue emerges from this debate as the one on which we have the most work to do and to which we must give the most thought.

I want to discuss how the system is set out. I accept that the way in which we make it work in practice is not necessarily the same as that, but I will go through how we have set out the different frameworks and processes of accountability.

The indicators in the NHS outcomes framework provide the basis against which the performance of the NHS will be monitored. NHS England is responsible for delivering year-on-year improvement and is accountable to the Secretary of State. Those arrangements are set out in the Health and Social Care Act 2012, under which the Secretary of State set out the strategic priorities for NHS England through the mandate. The mandate makes it clear what is expected of NHS England with regard to contributing to the prevention of ill health through the better early diagnosis and treatment of conditions such as cancer.

The outcomes framework sets out different measures against which we hold people to account, and the Department has quarterly accountability meetings with NHS England, through which NHS England’s progress in delivering those improved outcomes is monitored. We will continue to monitor its progress in delivering against the mandate. The evidence showing how it has met the mandate is published, and forms the basis on which Ministers can ultimately judge the success or otherwise of NHS England’s performance.

I entirely accept the point that that is quite a macro way of looking at things, and that Members are also seeking a sense of what can be done on the ground. Perhaps I need to respond in more detail after the debate on the challenges relating to the role of the strategic clinical networks. Cancer has been made a priority for those networks. Making the new networks work is also a challenge for the national clinical directors and other colleagues in NHS England. Their role in relation to cancer is obviously to drive quality and innovation in prevention and screening, survivorship and end-of-life care. I know that NHS England is keen to see the links between the national clinical directors and those respective networks strengthened. There is clearly more to do, and I welcome the fact that the all-party group is in direct dialogue with the national clinical director. I will pick this up with the group and with him after their meeting.

With regard to clinical commissioning group accountability, NHS England is responsible for ensuring that the CCGs secure the excellent outcomes that we want, through commissioning. The assurance framework provides the basis for that assessment. It is an integral part of the agreement of improvements to be delivered locally. When CCGs are found to be at risk of failing to deliver improvements, NHS England will provide the necessary support. Statutory intervention powers exist, but they are to be used as a last resort only when CCGs are demonstrably lacking the capacity to make improvements.

Through “Everyone Counts”, the planning guidance for 2014-15, NHS England has asked CCGs to set a level of ambition for reducing premature mortality as part of their strategic and operational plans. They will be expected to demonstrate progress against those plans. The 2014-15 CCG outcomes indicator set is used as a tool by CCGs to understand trends in outcomes and to help them to identify potential priorities for improvement. It has a range of new cancer measures covering early detection, stage at diagnosis, and diagnosis via emergency routes. I pay tribute to the all-party group for championing the inclusion of those indicators, which have now been adopted, as the hon. Member for Basildon and Billericay said. The indicators will help to ensure that progress is being made on early diagnosis and, in turn, on survival rates.

With regard to the various bits of data, we will shortly have the one-year cancer survival information for patients diagnosed in 2012, which will tell us the stage at diagnosis. This will allow us to calculate stage-adjusted one-year survival, and that will probably represent the most accurate and timely cancer data that have ever been available in England. Using those data, we will be able to populate important indicators in order to drive up improvement, including the public health outcomes framework and the CCG outcomes indicator set, in relation to the proportion of cancers diagnosed at stages 1 and 2—the early stages.

On the five-year data, I am sorry that things have changed since the answer that I gave to my hon. Friend the Member for Basildon and Billericay at Health questions. That was the information that I was working on at the time. NHS England has been working with the London School of Hygiene and Tropical Medicine to establish whether the five-year indicator was statistically valid. When I answered my hon. Friend’s question, the data had not been fully gathered in. Having gathered them in, however, the conclusion was that because of the small number of survivors at five years, disaggregating the data down to individual CCGs would not leave the data statistically robust enough to draw conclusions. It would therefore be unsafe to do so. They are not therefore planning to publish at the CCG level, but they are considering how it can be published at a level that is not only meaningful and helpful, but statistically safe. I understand that this has been disappointing, but I think that the all-party group and Members will understand that the data set is so sensitive that if it was not felt to be safe and robust, it could not be published in that way. We will talk to NHS England about it.

[Mr Baron]

I very much welcome that explanation, which goes a long way towards explaining the reason for the change in such a short period. May I leave the Minister with the thought that there appeared to be almost a complete disregard of the need to consult? Although I accept that this is NHS England’s ultimate responsibility, the cancer community came together on this issue and it seemed to be completely ignored from the point of view of consultation. Perhaps the Minister will look at that.

[Jane Ellison]

That is a fair challenge, and I will certainly take it up and raise it. On what we can do with data and transparency at the local level, the Department is looking at a number of things. The Government have tried to use data transparency in lots of different ways to drive improvement and accountability, and we are currently looking at some other ideas which I hope will produce a far greater sense of what is happening on the ground and in someone’s local area. We are very open to suggestions, and some have been made during the debate. I am happy to look at those, but this is an area under active consideration.

There has been a lot of discussion in this excellent debate about awareness and early diagnosis, and we know that it is one of the keys to getting better survival rates. It is central to meeting our ambition of saving the additional 5,000 lives each year by 2014-15, and we have committed more than £450 million in funding to achieving that and doing more on early diagnosis. To date, we have run national campaigns on tackling bowel and lung cancers; we have the Blood in Pee campaign, which hon. Members will be aware of, to raise awareness of bladder and kidney cancers; and we are currently running a breast cancer campaign for women aged 70 and over. The early response to that campaign has been really encouraging.

The shadow Minister raised some of the core public health issues which I spend much of the day job discussing: obesity, alcohol and smoking. I am slightly surprised that we have had relatively little discussion of those in the context of early diagnosis and prevention. Public health has been devolved to local authorities. They have more than £5 billion of ring-fenced money over two years, and all the local authorities I speak to—I was at the Local Government Association public health conference two weeks ago—are excited by the possibilities that that holds for them. There is a fair challenge about where the responsibility sits, but if everyone is doing work on awareness and early diagnosis, that can only be a good thing. Many local authorities are taking seriously the challenge of raising their game locally, and that is in addition to the national campaigns.

As hon. Members will be aware, many of the indicators are very mixed; there is a variety of statistics and variation around the country. I pay tribute to my local Wandsworth authority, whose six-week “get to know cancer” pop-up shop closes this Sunday. A local shopping centre gave the authority an empty unit and it worked with NHS London, staffing the unit for six weeks during the same hours as the shopping centre. It was run on a walk-in basis, and hundreds of people in my local community have popped in to that non-threatening environment to talk to trained nurses and get advice about cancer and some of those important awareness issues. Such local initiatives can only help us in our ambition to do much better.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) has had to leave us for a constituency engagement, but he touched on the work of charities. I met people from the excellent HeadSmart charity recently and I undertook to write to health and wellbeing boards about its work, so I will give him that assurance when I next see him. I also pay tribute to the work that Cancer Research UK has been doing on pilots dealing with melanoma, which my hon. Friend the Member for Mid Derbyshire (Pauline Latham) mentioned.

NHS England works with Public Health England and the Department to determine the focus of campaigns and to manage the development of the Be Clear on Cancer campaign. Decisions on the 2014-15 campaign activity will be based on the evidence and learning from the evaluation campaigns of the past two years, and it will be subject to all the normal clearances in terms of delivering really good value for money.

To deliver access to the best treatment, we have committed more than £173 million to improve and expand radiotherapy services. That includes £23 million for the radiotherapy innovation fund, which has supported centres to deliver increased levels of intensity modulated radiotherapy—a more accurate form of treatment that can reduce side effects.

The cancer drugs fund featured heavily in the debate. More than 44,000 patients have benefited from the fund so far, and last September we announced a further £400 million to extend it to the end of March 2016. Going forward, we will consider what arrangements can be put in place to deliver access to drugs previously funded through the CDF at a cost that represents value to the NHS. I recognise the nervousness that exists among those who understand what the fund has done and the impact it has had on individual patients. My hon. Friend the Member for Mid Derbyshire highlighted that matter, but clearly it is something that NHS England will be taking forward, and it will be aware of the concerns that have been expressed in the House.

Regarding the all-party group’s specific concern about NHS England’s duty to promote research, NHS England recently carried out an open consultation on a draft research and development strategy to deliver its statutory responsibilities and the NHS mandate duties. Again, we will learn more about that when the meetings take place, and as NHS England delivers that project.

The all-party group rightly highlights the importance of supporting cancer survivors. Increasingly, cancer is viewed as a long-term condition—that was certainly not the case when many of us were younger—as more are living with and beyond the disease. In March 2013, the Department’s national cancer survivorship initiative published “Living with and beyond cancer: taking action to improve outcomes”. It set out key recommendations to improve survivorship care, which were drawn from two years of evidence gathering.

I understand that the national clinical director is working closely with Macmillan, which provides the secretariat so ably to the all-party group, to encourage implementation and spread of the recommendations, including around stratified care pathways. The all-party group will be pleased to learn that ensuring all survivors benefit from the survivorship recovery package is a priority work programme.

We want to support people to stay in and return to work. A specific concern of the all-party group is how NHS England intends to support people to do that, as set out in the mandate. I can confirm that NHS England has issued an invitation to tender for a piece of work to examine the factors that impact on the employment rate of people with long-term conditions and to identify the useful interventions that can be made. It will be looking to consider the next steps. I think it is expecting to report on that in 2015.

The all-party group has also said that it would like to see wider use of the patient reported outcomes measure—PROM—data. This month, we have already seen the publication of “Quality of life of cancer survivors in England—one year on”. That is a survivorship update commissioned by the Department, which provides important information on recovery, unmet needs and the consequences of treatment. NHS England has already begun work to extend the PROM programme. A new pilot PROM data collection has recently started looking at quality of life issues for survivors of womb, ovarian and cervical cancer. For men, NHS England is supporting Prostate Cancer UK on a nationwide PROM data collection.

The all-party group makes a number of recommendations on the national cancer patient experience survey, which was referred to by the shadow Minister. I think we all acknowledge that it has been an invaluable tool in driving improvement in cancer care. When I first heard about it and looked at it in response to an earlier debate in Westminster Hall, I was very impressed with the level of detail that it can drive down to individual trusts. It uses what the best are doing to drive performance among those that are not meeting the highest standards.

NHS England recognises the value of the survey and currently has no plans to halt the programme. NHS England is the lead, but I think the more often we in Parliament recognise how important the programme is, and show how much parliamentarians value it and regard it as central to understanding the cancer patient experience, the more NHS England will feel that it is the right decision to go forward with it. I know that NHS England intends to examine the potential for a survey-related indicator as part of the future development of the clinical commissioning group outcome indicator set. That is a good thing. The shadow Minister made some interesting points and constructive suggestions in that regard, which I will happily look at after the debate and draw to the attention of NHS England.

The all-party group was concerned that more could be done to understand the experience of those who are close to people affected by cancer, and its members might be interested to know that following the NHS’s commitment to carers event, held last December, a number of priorities for supporting carers were identified. An action plan is in development and although it focuses more on the experience of carers in general, NHS England will consider cancer care as part of that. The 2014 cancer patient experience survey will begin in March and report in late summer. I am sure that there will be parliamentary interest in that report.

In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality will establish a new patient safety collaborative programme to spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country.

NHS England is undertaking work to improve the collection and analysis of patient safety data, including introducing “safety thermometers” for medication error, maternity care and mental health, and revising the NHS serious incident framework further to support best practice. It is working with the Care Quality Commission and others to provide consistent and clear information for all on what patient safety data are available.

Let me try to pick up on some of the points made by hon. Members. My hon. Friend the Member for Hertsmere expressed a concern about older people with cancer. I will respond to him in more detail after the debate, but we know that older people sometimes do not get the support they need and what happens during diagnosis is often the primary driver of poor outcomes. He might be interested to know that we have worked on a £1 million project with Macmillan Cancer Support and Age UK to improve uptake of treatment in older people. That has established some key principles for the delivery of age-friendly cancer services and, as I mentioned earlier, we are seeing encouraging take-up of the over-70 breast screening programme in response to the current campaign.

Finally—I apologise, Madam Deputy Speaker, but I had many points to respond to and although I have not reached all of them, I will draw my remarks to a close—I am advised that NHS England will engage with the vision for the management of complaints and concerns developed on the recommendations of the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. I think the whole House acknowledges the amazing work done by our parliamentary colleague in that regard. The plan is to establish an advisory group of patients and patient representatives to feed into the complaints improvement work.

My hon. Friend the Member for Salisbury (John Glen) talked about palliative care. Work is going on in that area and I shall write to him after the debate. He might also be interested to know that NHS England is considering the potential for an indicator based on death in a preferred place of care. I will get back to him with more detail on that.

My hon. Friend the Member for Harrow East (Bob Blackman) mentioned issues to do with work and pensions, which I shall refer to the Department for Work and Pensions. He also talked about procurement issues and smoking. I am afraid that at the risk of sounding a little boring after Monday I must put on the record the fact that the Government have not yet made a decision about standardised packaging. We have instead introduced regulation-making powers so that we can make a decision when we have received the Chantler review and considered the wider aspects of that policy while taking its findings into account. Ministers will make the final decision. I am sure that my hon. Friend understands why we must put that rather legalistic sounding statement on the record.

In conclusion, I apologise for the length of my response, but this was such a good debate and many interesting points were made. I will take away those that I have not been able to respond to in detail. Once the all-party group has met the national clinical director, that might be a good time for us to meet again, to reflect on the meeting and to consider what more we can do to take this important work forward. I thank everybody who has contributed to the debate, and the all-party group for its continued detailed work and the challenge it puts out to us all to do better in this area on behalf of all our constituents.

Children and Families Bill

Jane Ellison Excerpts

Monday 10th February 2014 Commons Chamber

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

I beg to move, That this House agrees with Lords amendment 125.

[Madam Deputy Speaker]

With this it will be convenient to discuss the following:

Lords amendments 121 to 123.

Lords amendment 124 and amendments (a), (b) and (c) thereto.

Lords amendment 150.

[Jane Ellison]

I am very pleased to speak to this package of Government amendments aimed at protecting young people from tobacco and nicotine addiction. I will also speak to the amendment on smoking in cars carrying children, which was agreed in another place.

I am sure that I need not remind hon. Members that tobacco use is a leading preventable cause of death, accounting for nearly 80,000 premature deaths per year in England alone and being a contributory factor in many other aspects of poor health. Taking action to prevent young people from taking up smoking in the first place is vital in our efforts to reduce rates of smoking.

When I first became the Minister responsible for public health I was made very aware of just how critical the teenage years are in smoking addiction, and that came up repeatedly in a Backbench Business Committee debate at the time. Almost two-thirds of smokers take up smoking regularly before they are 18—that is, they were addicted before becoming adults. That is a shocking reality, which many hon. Members have spoken about in this Chamber.

Stopping smoking can be extremely difficult because the addiction is so powerful. While two-thirds of smokers say that they want to quit, only a small fraction succeed in doing so. That is why we must stop young people taking up smoking in the first place. We want to see our young people enter an adulthood that is healthy and long-lived, but half of all long-term smokers will die from a smoking-related disease.

The amendments we have introduced seek to do the following: introduce regulation-making powers to enable the Government to bring in standardised tobacco packaging, if such a decision is made; introduce regulation-making powers to prohibit the sale of nicotine products to people under the age of 18; and to create a new offence of the proxy purchasing of tobacco. Also returning to this House from another place is an amendment which would provide the Government with regulation-making powers on smoking in cars carrying children, which is for hon. Members to consider.

[Sir Greg Knight (East Yorkshire) (Con)]

Will the Minister clarify the Government’s position? Is she saying that the Government are agreeing with the Lords amendment to ban smoking in vehicles because that is what she wants to see achieved, or is she saying that the Government are agreeing with the Lords amendment because it is a passive one and even if passed by this House she intends to ignore it?

[Jane Ellison]

Actually it is neither of those two things. Technical amendments are needed to the wording of what was passed in another place and the Government’s view was that the House needed the chance to consider something that was legally workable. I will cover that in a bit more detail later.

[Ian Paisley (North Antrim) (DUP)]

Does the Minister not agree that this is actually premature and that we should await the outcome of the Sir Cyril Chantler review? That is an independent review and we should not try to shape his opinion in advance of it. In a famous statement in this House on 12 July last year—a date I will always remember—it was made clear that this was about gathering evidence. Surely we should await the gathering of evidence before we put legislation in place that will allow the implementation of something for which there may not be sufficient evidence.

[Jane Ellison]

I will discuss that point in more detail in a moment. We have had these discussions before. The Government are seeking regulation-making powers, but we will await the outcome of the independent Chantler review. Ministers will take all other factors into consideration at that time before making a decision.

I want to set out the key elements of the Government amendments. Let me start with standardised tobacco packaging. As I told the House on 28 November last year, we have asked Sir Cyril Chantler for an independent view of the public health evidence on standardised packaging of tobacco products. Sir Cyril’s report is due in March. During debates in the House, many hon. Members have told me that the evidence base for standardised packaging continues to grow. The Government will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised by this policy, we are satisfied that there are sufficient grounds to do so, including public health benefit.

We have therefore introduced provisions that would give Ministers the power to make regulations to standardise the packaging of tobacco products, should a decision be taken by the Government to do so. Ministers would be able to regulate internal and external packaging and any other associated materials included with a tobacco product, including the cellophane or other outer wrapper of a cigarette pack. The powers will extend to other forms of tobacco such as hand-rolling tobacco.

[Ian Paisley]

The Minister has touched on two important points. One involves the packaging rights of companies. Is there anything in the legislation that would enable compensation to be granted to those companies if the Government chose to remove their trademarks and branding rights? I understand that, under European law, billions of pounds of compensation could be payable in those circumstances. Secondly, will the Minister clarify whether the Chantler review—

[Ian Paisley]

I apologise for the longevity of my intervention, Madam Deputy Speaker, but these important issues affect many jobs in my constituency. My second point involves the illicit trade in tobacco products. Will the Minister tell us whether that will be covered by the Chantler review?

[Jane Ellison]

As I said in my earlier statement to the House, the Chantler review is looking specifically at the public health aspects of these matters. Sir Cyril is perfectly free to look at whatever he wants, but those are his terms of reference. Other issues will be considered in the round when Ministers come to make their decisions. Those issues were of course fully explored during the consultation that took place before the review.

The amendment sets out the elements of tobacco packaging that could be regulated—for example, the use of colour, branding or logos, the materials used and the texture, size and shape of the packaging. It also sets out the aspects of the tobacco product itself that could be regulated.

[Mr Charles Walker (Broxbourne) (Con)]

My hon. Friend will know that one of the main scourges for young people is alcohol. Why are the Government not proposing standardised packaging for alcohol?

[Jane Ellison]

My hon. Friend makes an interesting point, but that is probably a debate for another time.

The Government would not necessarily use all the powers I have just described, and if we proceed, we will need to decide which aspects would be included in any regulations. However, it is prudent to take a comprehensive approach now, so that we are prepared for the future.

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

My hon. Friend will know that every packet of cigarettes carries the bold message “Smoking kills”. However, that does not influence the purchasing habits of smokers. There is also no evidence yet that the appearance of a cigarette packet will deter anyone from smoking.

[Jane Ellison]

This is a matter for the Chantler review; it is one of the things we have asked Sir Cyril to look at. I am not going to second guess the outcome of his review.

[Mrs Anne Main (St Albans) (Con)]

Will the Minister clarify a point that she has just made? I understood, perhaps wrongly, that she said that the Government were getting these powers into their armoury in case they needed to be used. Are the Government putting these measures into legislation for potential future use, rather than because there is evidence of a need for them now?

[Jane Ellison]

This question came up in the other place, and we have always made it clear that we are seeking the power to make regulations in the event that the Government should decide to proceed with standardised packaging, having received the Chantler review and considered everything in the round. Making the decision on those powers now would enable us to proceed apace at that point. I hope that that clarifies the matter for my hon. Friend.

As I was saying, the Government would not necessarily use all the powers I have just described, and if we proceed, we will need to decide which aspects would be included in any regulations. The House would have the chance to comment further on the matter, through the affirmative resolution procedure, were the Government to decide to go ahead. It is prudent to take a comprehensive approach now, however, so that we can be prepared for the future.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Having had a background in multinational brand management, I know why multinationals invest hundreds of thousands of pounds in brand graphics and mnemonics to exaggerate sales. Does the Minister not agree that that proves that blank or standardised packaging would have an impact on sales?

[Jane Ellison]

That is for the review to comment on. I hope that hon. Members will understand that I am not trying to be unhelpful in not responding in detail to their interventions. We have put in place a process that we think will be the most robust way of making policy in this area, and I hope that the hon. Gentleman will forgive me for not commenting in detail on his point. I am sure that the review is looking in detail at all these aspects; they were certainly explored during the consultation.

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

Just to finish this point off, will the Minister make it clear that she and her colleagues will consider a wider range of factors alongside the outcome of the review before deciding how to proceed?

[Jane Ellison]

That is something we have put on record a number of times, and I can confirm it again tonight. We have always said that Ministers would proceed having received the review and given consideration to all the wider aspects of the policy. I hope that that reassures my hon. Friend.

The requirements would apply only to the retail packaging of tobacco products, which means the packaging that will be, or is intended to be, used when the product is sold to the public. Manufacturers, distributors and retailers would still be able to use branding such as logos and colours on packaging, provided that they were used only within the tobacco trade—for example, on boxes used for stock management in a warehouse that are not seen by the public.

These provisions would apply on a UK-wide basis, as the necessary legislative consent motions have been secured. As I have already said, I will not pre-empt the outcome of Sir Cyril’s review or of the decision-making process, but these provisions mean that we would be able to act without delay if we were to decide to go ahead. I want to emphasise that Sir Cyril will not be making the decision for Ministers on whether to proceed with standardised packaging. That decision will be made by Ministers in the light of the wide range of relevant considerations.

My hon. Friend the Member for Shipley (Philip Davies) has tabled three amendments on standardised packaging. The first five clauses of the packaging provisions set out the test that Ministers will need to consider before bringing forward regulations. The regulation-making powers in the Bill will allow Ministers to take a reasonable and balanced view of the available evidence regarding the effect that regulations as a whole would have on the health and welfare of children. This approach to ministerial decision making is absolutely appropriate and these clauses are in keeping with the approach that Minsters would ordinarily take in decision-making processes of this kind.

My hon. Friend’s three amendments seek to remove the ability of Ministers to take a reasonable and balanced view of the evidence, and we feel that they would put unnecessary and unwarranted constraints on Ministers’ consideration of how any proposed regulations would impact on children’s health or welfare. Constraining Ministers’ decision making in that way would probably have the effect of stopping the use of the powers altogether. For that reason, I do not support my hon. Friend’s amendments. I also remind the House that the regulations would be subject to the affirmative resolution procedure.

I should like to move on to the age of sale for nicotine products. We have introduced provisions for a regulation-making power to prohibit the sale of nicotine products such as e-cigarettes to people under the age of 18. Public health experts, many retailers—particularly small retailers—and the electronic cigarette industry support the introduction of an age of sale restriction for e-cigarettes. At present, no such general legal restriction is in place, and we want to correct this situation.

As e-cigarettes are novel products, we have very little evidence on the impact of children using them. For example, we do not know what impact their use might have on the developing lungs of young people. Public health experts have expressed concern to me that nicotine products could act as a gateway into smoking tobacco, as well as undermining efforts to reshape social norms around tobacco use. Young people can rapidly develop nicotine dependence, and nicotine products deliver nicotine and cause addiction. Attempts were made last year to include an age-of-sale provision applicable throughout the EU in the revised European tobacco products directive, but that was not achieved. We therefore want to take this opportunity to put such a provision in place domestically through this Bill.

--- Later in debate ---

[Mr Simon Burns (Chelmsford) (Con)]

I fully understand and accept what my hon. Friend has said. Do these proposals in any way affect adults who may buy e-cigarettes for people under the age of 18?

[Jane Ellison]

That is a good point, to which I will return, if my right hon. Friend will allow me. I will consider that and we will have an answer for him.

[Mrs Main]

How does this affect 17-year-olds who have already taken up smoking and wish to try to stop through using e-cigarettes? How would they manage to buy this product?

[Jane Ellison]

My understanding is that if a nicotine-containing product is licensed for medicinal use—licensed as a quit-smoking tool—it can already be prescribed by doctors. Some e-cigarette manufacturers have already indicated that in order to make a medicinal claim about their product’s ability to help people quit, they will seek to use the medicines regulations. If such a product becomes licensed as a medicine, it will be able to be prescribed as a smoking cessation aid in the same way that other nicotine-containing products can be. I hope that answer is helpful.

On proxy purchasing, we believe we must take action to address both the supply of and demand for tobacco products among young people if we are to reduce the uptake of smoking. Many retailers over the years have felt a little left alone to bear the burden of enforcement in this area, so I welcome both the work of responsible retailers to ensure that tobacco is not sold to people under the age of 18, and the support provided to them by retailer bodies such as the Association of Convenience Stores. There is support in both Houses for creating a proxy purchase offence for tobacco, and the Government have carefully reflected on the arguments that have been made. Retailers feel it is unfair that it is an offence for retailers to sell cigarettes to children and young people, yet there is no offence of proxy purchasing on behalf of children and young people. Retailers also feel it is inconsistent to have a proxy purchase offence for alcohol but not for tobacco. The Government want to continue to tackle the access that young people have to tobacco, which is why we have proposed this amendment.

The provisions would make it an offence for an adult to buy, or attempt to buy, tobacco for someone under the age of 18. That will be enforced by local authority trading standards officers, who will be able to issue a fixed penalty notice if they believe an offence has been committed, rather than taking prosecution action in the first instance. Local authorities will not be required to carry out regular programmes of enforcement in the way they have to on age of sale of tobacco, so we do not believe that this offence will bring into place any significant new regulatory burdens. Local authorities know their communities better than anyone and will know how best to address their public health priorities. We have devolved wide public health responsibilities and ring-fenced budgets to local authorities, and this amendment allows them to take targeted enforcement action on proxy purchasing where they consider it is needed.

The arguments relating to effective enforcement have been well rehearsed in previous debates. Experience in Scotland suggests that we should not to expect a vast number of convictions, and we should not measure the success of this new offence by the number of prosecutions or fixed penalties issued. I expect, however, that the new offence will generate worthwhile deterrent effects. As I said, in a new public health landscape where more powers are devolved to directors of public health there may be opportunities to explore work where there is a particular local problem.

Finally, I will address the issue of smoking in private vehicles carrying children. In another place an amendment was agreed to enable the Government to make regulations to make it

“an offence for any person who drives a private vehicle to fail to prevent smoking in the vehicle when a child or children are present”.

The amendment we are debating today was drawn up by the Government, with the support of the peers who tabled the initial amendment, to deliver the intention of the amendment in a legally workable way. We have a responsibility to be sure that any amendment that could make its way on to the statute book should work in practice. The technical amendment was agreed on Third Reading in another place.

[Tim Loughton (East Worthing and Shoreham) (Con)]

My hon. Friend says that she wants this to be workable. If a 17-year-old was driving a car and smoking at the same time, but nobody else was in the car, would they be guilty of an offence?

[Jane Ellison]

We have been discussing the issue earlier today, but we will look in more detail at that sort of detail when the House has voted on the principle of this and we have the view of both Houses. Today, the House is examining the principle, not detailed regulations, which would need to be brought forward and which would be subject to the affirmative resolution.

[Ian Paisley]

I appreciate the Minister helping us to get to the bottom of this. I understand that under rule 148 of The Highway Code a driver is prohibited from smoking, eating, drinking, doing a crossword or listening to a loud radio at the wheel, for very obvious reasons. If that is the case—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I think we have got the message. The hon. Gentleman has had two interventions. We are going very well, so let us not challenge the Minister too much so early on.

[Jane Ellison]

Thank you very much, Mr Deputy Speaker. Clearly there will be a lively debate about this provision, and I wish to draw my remarks to a conclusion soon—

[Simon Kirby (Brighton, Kemptown) (Con)]

Will the Minister give way?

[Jane Ellison]

I am just responding to another intervention. Let me deal with that one before I take another. Clearly there will be a debate about this provision. The Government have sought to reflect the views expressed in another place by introducing an amendment that is technically workable. There will be a debate on it, we will see what the view of the House is and we will take our steer on the principle of the issue having heard the views of both Houses.

[Simon Kirby]

Will the Minister assure me that if this amendment is passed, it will be only part of the solution and that we should continue to educate people of the dangers of passive smoking?

[Jane Ellison]

My hon. Friend anticipates some of my next remarks, and I agree wholeheartedly with what he says.

The amendment would amend existing smoke-free legislation in the Health Act 2006 to make it clear that the Secretary of State and Welsh Ministers have the powers to make regulations to provide for a private vehicle to be smoke-free when a person under the age of 18 is present. During the passage of the 2006 Act, Ministers at the time said they did not want to use the powers in that legislation to make private vehicles smoke-free. This amendment, if enacted by Parliament, would make it clear that regulations could be made, if the Government so decided, to prohibit smoking in private vehicles carrying children.

[Dame Angela Watkinson]

My hon. Friend described this measure as “workable”, but I wonder how she envisages it being enforced. Are we going to have smoking police weaving in and out of the traffic, looking in car windows? There must be a serious answer—how could this be enforced?

[Jane Ellison]

Enforcement has been the subject of much of the debate in both Houses over a number of years, and clearly the detail of that would be looked at in regulation, if the House is minded to give the Government a steer on the principle of this. So that is not a matter for today’s debate, but I am sure it will be—[Interruption.] It is not for me to comment on the detail of it, but I am sure it will be explored during the debate that follows my speech.

[Several hon. Members]

rose—

[Jane Ellison]

I am going to give way to someone I have not given way to yet.

[Ian Mearns (Gateshead) (Lab)]

As with legislation on the use of seatbelts and mobile phones in cars, we will want everyone to abide, but if the vast majority of people abide, it will have a positive impact on the health of children who would otherwise be affected by passive smoking.

[Jane Ellison]

The hon. Gentleman anticipates the debate to come, during which the Government will listen carefully to the range of views expressed by Members on both sides of the House.

[Mr John Leech (Manchester, Withington) (LD)]

When the House decided to ban smoking in pubs and clubs, we were told exactly the same thing—that that would not be enforceable—but it has proved to be perfectly enforceable.

--- Later in debate ---

[Jane Ellison]

I thank my hon. Friend for putting his view on record. I am sure that we will hear further views in the debate that follows.

[Mr Charles Walker]

Will the Minister give way?

[Jane Ellison]

I want to make a bit of progress because I sense that a lively debate will follow my speech, so I want to leave time for that.

The Government—and all Members—are clear that children should not be exposed to second-hand smoke, which can be particularly harmful to young children, and we know that young people often have little choice about being in places where they are exposed to smoke. Nevertheless, there are obviously many ways of trying to achieve that aim, which takes me on to the point about education raised by my hon. Friend the Member for Brighton, Kemptown (Simon Kirby).

We need smokers to protect children not only in the family car, but in any enclosed environment, including the home. Many argue that legislation is the answer, and we will debate that today, but social marketing campaigns to help smokers and parents to understand the risks of second-hand smoke and strongly to encourage voluntary behaviour change are also vital. We would all like to think that the vast majority of parents would not knowingly risk the health of their children. In the event that legislation is introduced to stop smoking in cars carrying children, we should measure its success not by the number of enforcement actions, but by the reduction in exposure to second-hand smoke.

As I have said, the Government will listen carefully to what Parliament has to say about the important principle of whether we should have the power to legislate to prevent smoking in cars when children are present. We will then consider what needs to happen next, which is why, if hon. Members will forgive me, I am not able to talk in great detail about some of the points that they have raised—they are questions for the next stage, once the will of Parliament has been expressed. However, in any event, I have asked Public Health England to continue its work on behaviour change in this area, including through social marketing campaigns. I have asked it to carry out targeted work with local authorities and public health directors in places where we know that there are problems. When Parliament’s will is known and we can assess the maximum impact that can be achieved through education, we will consider putting in place wider public information campaigns.

Arguments about effective enforcement were well rehearsed during the passage of this Bill and the consideration of private Members’ Bills on this matter, including that promoted by the hon. Member for Stockton North (Alex Cunningham). I look forward to hearing the debate on smoking in cars with children present and to finding out the will of the House on the principle of the Lords amendment. I also hope that the House will support our proposals on other aspects of tobacco control: the regulation-making powers on standardised packaging; and measures on the age of sale for electronic cigarettes and the proxy purchasing of tobacco.

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

Today the House has the opportunity to vote for a number of measures that will protect children, help to transform attitudes and improve our nation’s public health. I am proud to speak in favour of all the amendments in the group, with the exception of amendments (a) to (c) to Lords amendment 124, and I hope that hon. Members from all parties will support the Lords amendments in the Lobby.

It is worth remembering that when the Bill left the House, it did not contain any of the tobacco measures before us today. Those provisions are a credit to those in the other place who successfully argued for them, for which I commend them. The package of measures was passed with a great deal of agreement in the other place, so I hope that we can preserve that consensus in this House.

While I shall focus my remarks chiefly on smoking in cars carrying children, let me first speak to the other measures in the group. I welcome Lords amendment 124, which deals with the standardised packaging of tobacco products. It must be said that the Government have taken a rather long and winding route to get to here, with a few sharp turns along the way. As we heard from the Minister, the Lords amendment is only an enabling provision, because while it gives Ministers the power to introduce standardised packaging, we have no 100% assurance that that will happen. It is no secret that the Opposition would prefer more immediate action, but it is good that we finally see legislation in black and white. Labour Members sincerely hope that, once Sir Cyril has reported, Ministers will do the right thing and use the power. Will the Minister update us on when Sir Cyril will report? Will she guarantee that if he does recommend standardised packaging for tobacco products, secondary legislation will be brought forward before the general election?

Early Childhood Development

Jane Ellison Excerpts

Thursday 30th January 2014 Westminster Hall

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

It is good to serve under your chairmanship, Mr Amess, and to respond to such an interesting debate.

I shall focus my remarks fairly narrowly on the subject of the debate, because I have a feeling that I will get the chance to talk about smoking in cars quite a bit in coming weeks. I have had the chance to discuss today’s subject many times with my hon. Friend the Member for South Northamptonshire (Andrea Leadsom), and her passion and knowledge have shifted parliamentary opinion in that important area. I remember sitting through a late-night debate which, unusually, attracted double-figure attendance; she has moved the dial for political discourse about the importance of early years. She has a positive and constructive relationship with several Departments’ officials, who enjoy working with her on that agenda; I think that will continue.

The debate has been fairly consensual. I accept that there is some challenge with respect to numbers to do with Sure Start, and funding issues; but, to be honest, whoever was in power would have faced the same issues over the past few years. I shall therefore focus on what we are doing in response to the manifesto “The 1001 Critical Days”. I shall try to pick up on points that have been made. I am standing in for the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is the lead Minister and is at present in a Bill Committee. He is sorry not to respond to the debate in person, but my hon. Friend the Member for South Northamptonshire will know that the issue is close to his heart and is the focus of much of his work. However, it is an honour for me to sit in on such an amazing debate, with so many excellent contributions.

Like the shadow spokesman, I pay tribute to the other hon. Members who contributed to the manifesto, and to the hon. Member for Nottingham North (Mr Allen) for his tireless campaigning on early intervention. I have had several stimulating and fulfilling conversations with him on the subject. He is passionate about the issue. What he has done to formalise matters through the Early Intervention Foundation—and the information, knowledge and evidence base that has been established because of that—will be extremely important. Evidence is important in this context because, to pick up the point about pressure on resources, the more evidence that can be presented to show that interventions work, the easier it will be to persuade people that such interventions are a good investment of public money, when that is in relatively short supply.

A clear case has been made, and the manifesto has support from across the political spectrum. The message is clear and simple: prevention and early intervention can improve outcomes and transform the life chances of children. Several hon. Members ably explained where the costs pop up in the system when people suffer damage and how much better, safer and kinder it is to make interventions early in people’s lives, to prevent such problems. That message sits well with the Government’s pledge to improve the health outcomes of children and young people so that they become some of the best in the world. That is a challenging goal, but the Government are determined to rise to it.

I want to touch on the risks associated with pregnancy. A healthy pregnancy provides the best foundations for a healthy life. Poor diet, smoking, using illicit drugs and consuming alcohol at that time can all have an impact on the child’s later cognitive functioning and on their health and well-being. As my hon. Friend the Member for South Northamptonshire said, a fetus exposed to extreme stress in the womb will have higher levels of the stress hormone cortisol, which can create higher levels of stress later in life. There is a highly relevant example of that in another part of my portfolio. Domestic violence can peak during pregnancy and, as a very significant stress factor, it can cause the very conditions in the womb that have long-term consequences for children.

Hon. Members have articulated the early years risks very well during the debate. There is a growing consensus about the agenda and the fact that early years intervention offers the greatest opportunity to create secure, happy and healthy adults. Moving forward in accordance with that shared agenda is the key. I will mention one or two of the risk factors. Smoking in pregnancy is highly relevant to much of my work in public health. It can lead to low birth weight, which is linked with heart disease later in life. The key messages on smoking in pregnancy are getting through to many people, although not to everyone. We still have some way to go, but in 2012-13, 12.7% of mothers were smoking at delivery. That is lower than the 2009-10 figure of 14%. However, the regional variation is extraordinary. Figures that recently came across my desk showed enormous regional variation, and responding to that is a challenge that I have put to public health directors in the regions. It is a good example of the way that a regionalised public health system can focus intensely on problem areas.

Experts are still unsure exactly how much alcohol it is safe to drink during pregnancy, so the safest approach is not to drink any at that time. Drinking heavily in pregnancy can lead to low birth weight and damage brain development in the womb. Fetal alcohol spectrum disorders are a range of cognitive and functional disabilities that can be caused by exposure to alcohol in the womb. In short, smoking and drinking alcohol while pregnant can cause irreparable damage to a child and make them more susceptible to illness throughout life. The manifesto highlights the numbers of babies affected by those issues, and I reassure the House that those are on our radar.

Perhaps less obvious is the impact of events in early childhood on later health and well-being. A drive towards wider understanding of that, among parliamentarians and in local government and the voluntary sector, is very important. I think that initially it is difficult to take on board the detail of the issue, and that is why it is so important that my hon. Friend the Member for South Northamptonshire has persisted in making the case to colleagues, and explaining it in detail, with the evidence to back it up. Many of us now have a wider understanding of what may not be as intuitively grasped as messages about not smoking or drinking during pregnancy. Traumatic emotional experience in childhood can translate into a greater risk of disease and mental health problems. Many hon. Members focused on that during the debate. We have, I think, learned that the old adage that time heals all wounds is not true. Adverse events in early childhood can resonate down the years.

According to the emerging research, growing up with exposure to multiple adverse childhood events can have a lasting impact. For instance, growing up in a household where the mother is treated violently, where a parent is chronically depressed, mentally ill or suicidal, or where someone uses drugs can increase a child’s risk of a range of conditions. Those who experience multiple adverse childhood events achieve less educationally, earn less and are less healthy. All those consequences were articulated in the debate. The hon. Member for East Lothian (Fiona O'Donnell) spoke of some sad examples, and about sitting with very young children and talking about their personal experience.

One of the saddest papers that I have read as a Minister was one that I submitted to the Chair of the Select Committee on Home Affairs, about gang violence. It was about the early lives of children who, at a young age—under 10—were on the fringes of being drawn into gang violence. I set myself a challenge, before reading the attached case history, of guessing what was happening in the child’s life. Every guess I made about the factors that were present was right, and I am sure that other hon. Members would have made the same ones. The case history showed that a child much younger than 10 was already showing signs of post-traumatic stress disorder. There is a lot of emerging evidence to show that such children are far more likely to be drawn into gangs. Good work is being done, particularly in London, on understanding how to diagnose that. It all goes to support the case being made through the debate for intervening very early; otherwise, children grow used to high levels of stress and aggression.

High-quality care during pregnancy is crucial and we want women to receive excellent maternity services that focus on providing the best outcomes for them and their babies. There has been significant investment in maternity services. Since 2010 the midwifery work force has grown by 6.9 %—that is 1,380 additional midwives. I of course understand the challenge, in that there is always a call for more midwives; that is an important area. There has been £35 million of capital investment in the environment where maternity care is provided and where women give birth to their baby. We are working with NHS England to ensure that women receive better care during pregnancy, with every woman having a named midwife responsible for providing personalised antenatal and post-natal care. Women can now make more informed choices about their care. Again with the support of Health Education England, we have increased the number of midwives and are working to ensure that specialist mental health support is available in every birthing unit by 2017.

The NHS does an excellent job in nearly every case of delivering babies safely, but it is crucial, as has been highlighted, to ensure that we do more to look after mothers’ mental health. More than 10% of women will have a mental health problem or mental illness during pregnancy, and we must ensure that we provide all-round support for women to detect and treat such conditions. Again, Health Education England is taking forward work with a range of partners to ensure that training is available for health care professionals in perinatal mental health. It is working with the Nursing and Midwifery Council and the Royal College of Midwives to ensure that midwives’ undergraduate training includes a core module focusing on perinatal mental health and with the medical royal colleges to provide postgraduate training on maternal mental health by 2015.

For a relatively small number of women, specialist perinatal mental health services are required. Through maternity and children’s strategic clinical networks, NHS England is supporting the development of maternity and perinatal mental health networks, as recommended by guidelines from the National Institute for Health and Clinical Excellence on antenatal and post-natal mental health. The networks will develop action plans and collaborative working to drive improvements in access to and quality of care.

[Andrea Leadsom]

As I understand it, NICE guidelines still only approve video interaction guidance, which is an effective but quite short-term intervention, and cognitive behavioural therapy as talking therapies for the perinatal period. There is a wealth of evidence that parent-infant psychotherapy, a psychodynamic form of therapy, is far more effective in parent-infant situations. As randomised controlled trials are the only acceptable evidence base to NICE, and as psychodynamic therapy does not lend itself to that, there is a bit of a chicken-and-egg situation. How do we improve the availability of specialist parent-infant mental health services if NICE will not approve them because they do not undergo randomised controlled trials?

[Jane Ellison]

If my hon. Friend does not mind, I will write to her after the debate to respond in the level of detail that she asks for, as that is not in my brief. However, I can reassure her that I think there are trials, supported by Government research funds, to consider some of the areas that she is interested in. I think that there is room to give her encouragement in that regard.

To return to the networks that I was describing, for women at risk of poor mental health during pregnancy and following childbirth, services do exist. Ministerial colleagues have visited excellent services in Blackpool, for example, that support women who have or are at risk of developing mental health or substance misuse problems in pregnancy or post-natally.

The key messages on smoking in pregnancy are also getting through. We have some way to go, but as I have said, the figure is beginning to drop. Teenage pregnancy can, of course, lead to poor outcomes for both teenage parents and their children. Teenage mothers have three times the rate of post-natal depression and a higher risk of poor mental health for three years after the birth. They are three times more likely to smoke during pregnancy and 50% less likely to breastfeed, with consequences for their children. It is imperative that we reduce the numbers of young women and girls getting pregnant and mitigate the impact of having a child when young.

The good news is that our rate of teenage pregnancy now stands at a historic 40-year low. In 2011, the last year for which we have figures, our conception rate for young women under 18 was 30.7 per 1,000, down from 35.4 per 1,000 in 2010. That is due to a lot of hard work, dedication and passion from our health care professionals, many of whose efforts have been described by Members in this debate. I pay tribute to their efforts and the important results that they are yielding.

Reducing conception by under-18s is one of a basket of indicators in the public health outcomes framework and our sexual health improvement framework, which was published in March 2013, to drive continual improvement. Despite our best efforts, though, some young women and girls will become pregnant, and we must do our best to mitigate the risks to those young mums-to-be and their babies. Several hon. Members, including my hon. Friend the Member for Winchester (Steve Brine), have paid tribute to the family nurse partnership, a preventive programme for vulnerable first-time mothers under the age of 20. It offers intensive and structured home visiting delivered by specially trained nurses from early pregnancy until a child is two. There are now more than 80 teams covering 91 areas across England, and the Government are committed to increasing the number of places on the programme to 16,000.

The family nurse partnership successfully engages with disadvantaged young parents, including fathers, to pick up a point mentioned by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place. Of those who are offered the family nurse partnership, 87% enrol and a high proportion continue to engage until their child reaches their second birthday. My colleague the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, witnessed—other Members have referred to this during the debate—the transformational power of the programme, and he met family nurses and their clients in London in 2013.

Thankfully, we have 30 years of evidence from the USA and elsewhere that shows that the family nurse partnership programme improves outcomes for mothers and children in the short, medium and long term. That includes health and behaviour during pregnancy, reduced child abuse and neglect, improved school-readiness for the child and improved economic prospects for the mother. That list is the mirror image of all the different threats to health and wealth that have been articulated during the debate. It shows that the impact of some of these powerful early interventions can ripple down the generations, as other hon. Members have said.

To pick up a point made at the start of the debate, such interventions have also made great savings to the public purse in health, social care and the criminal justice system. I am glad that my hon. Friend the Member for Winchester mentioned the US research. We are undertaking a large-scale independent randomised control trial that will rigorously evaluate the programme’s effectiveness in the English context, and the initial findings will be reported later this year. I am sure that hon. Members present will be interested to see that, because it will be useful to see those data expressed in an English context.

The Healthy Child programme is a universal evidence-based preventive programme to improve the health and well-being of all children and to identify and treat problems early. Effective implementation of the programme should improve many of the outcomes highlighted in the “The 1001 Critical Days” manifesto, including the strong parent-child attachment, positive parenting, better social and emotional well-being among children and care that helps to keep children healthy.

[Fiona O'Donnell]

The Minister speaks about bonding between mother, father and baby in the early days. May I draw her out on the issue of maternity and paternity pay being included in the cap on benefit spending announced by the Chancellor in his autumn statement? Will she give an undertaking that that will not lead to a freeze or a reduction in maternity and paternity pay?

[Jane Ellison]

The hon. Lady will understand that that is not in my portfolio, but I am happy to draw her concerns to the attention of colleagues in whose portfolio it rests. I undertake to do so after the debate.

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, has asked Public Health England to commission a rapid review of the evidence base for the Healthy Child programme, with a focus on primary prevention. The Department of Health is also working with the WAVE Trust, which was instrumental in developing the evidence base for the manifesto, with the Early Intervention Foundation and with others to explore how valuable work in prevention can be built upon. We will be interested in the outcomes of that evaluation.

[Mark Durkan (Foyle) (SDLP)]

The Minister has referred to looking at the issues by drawing on data and evidence that are available in the English context. As well as sharing that, importantly in this context, will she ensure that questions in the “The 1001 Critical Days” manifesto are addressed at the level of the British-Irish Council? That would enable all eight Administrations throughout these islands who face such challenges in common to share their experience, good practice and piloting. The work could be elevated to that level rather than all the different Administrations trying to do the same things back to back.

[Jane Ellison]

The hon. Gentleman makes a good point, and I have regular dialogue on matters in my portfolio with Members of the devolved Administrations. I am happy to look into that point after the debate, because some of the lessons to be learned are universal across different countries in the UK.

There has been a lot of interest in health visitors. They and their teams lead the delivery of the Healthy Child programme, and of course they are the bedrock of our children’s public health services. They are often the first professionals to recognise that a mother is depressed or that parents are struggling with the negative effects of many sleepless nights; we have had a few descriptions of those from colleagues in this debate. Through their work, health visitors can have an impact on the well-being of the whole family. Because of their vital preventive role, the Government are committed to growing the health visitor work force by 4,200 by the year 2015 and to transforming health visiting services to improve outcomes and reduce inequalities in the nought-to-five age group.

Taking up the point about whether recruitment is on track, and weaving in the point made by my hon. Friend the Member for South Northamptonshire, we believe that we are on track. There have been a couple of challenges in one region, to which we are now responding, but the rate of increase in health visitors will increase. It is determined by training intakes, which determine the rate of qualification and entry into the profession. We are happy that that is on track. I give that assurance to the shadow Minister. The latest health visiting work force data that we have, which are from October 2013 and were published this month, show that the total number of health visitors nationally is 9,770 full-time equivalents. Overall, there are 1,678 more health visitors than the May 2010 baseline of 8,092. That is a growth of 21%, but we intend to grow that number more, as we have said, because we think it is so important and crucial to the aims of the manifesto.

On troubled families, we know that some families have multiple problems and cause problems in the community around them. I will not go into a lot of detail, but there is clearly relevance and read-across from some of the early years issues that we have been discussing in this debate. In particular, I have seen the Troubled Families programme in my area encouraging critical working together and getting everyone around the same table to consider people and families as a whole.

That programme will have done a great deal of good to embed that idea and approach as good practice for many local authorities. There is a strong read-across to the other things that we are discussing about earlier years, and in some cases, of course, they will be the same families, depending on the nature of the family. I have certainly seen in my area, and in lots of the other pilot areas, how services have embraced the opportunity to stop working in silos and consider a whole family’s needs instead. I hope that that will become orthodoxy in how we move forward with Government policy in numerous areas and in the local government approach to things.

The Government are increasing local authority budgets by £448 million over three years on a payment-by-results basis to support troubled families across England. Again, my ministerial colleague is meeting those involved in the Troubled Families programme to discuss the health contribution to this valuable programme, and he can then address some of the points to which I will draw his attention as a result of this debate.

I do not have time to go into much detail, as I am aware that I have already made a long speech, although I am drawing to the end of it. I have many points to respond to, but I wanted to touch on the points about social mobility made by my hon. Friend the Member for East Hampshire (Damian Hinds), which I have heard him articulate before. He discussed how to support parents. I think that my hon. Friend the Member for South Northamptonshire was present when Alan Milburn, presenting his most recent social mobility report, urged Government and politicians generally to break what he called one of the “last taboos” of public policy, which is telling people how to be good parents and supporting them to be good parents. That is an interesting challenge for us all to consider and respond to, because it is undoubtedly difficult terrain for both Governments and individual politicians.

[Andrea Leadsom]

I would just like to make the point that although politicians attempt to say, “Family and the first couple of years are really private, and you mustn’t interfere,” often, in my experience of 15 years’ work with charities, people are actually desperate for help, and they do not know where to go. It is completely the opposite. It is not as though we were trying to ram support down people’s throats and tell them how to live; it is that they are desperate for it. I have lots of meetings with people who have set up charities to support mums who are desperately depressed or tearful or who cannot cope. They do that because they themselves went through it and there was nobody there to help them. I think it is the exact opposite. We kid ourselves if we think that we are interfering. We are not; we are simply providing support that people desperately want.

[Jane Ellison]

I think that is right. My experience mirrors my hon. Friend’s. I suppose the sensitivity is always about people being tempted to stray into saying how everybody should live their lives, but I agree with her. My experience is just the same as hers. Most people are crying out for support. I guess that the key thing is how that is delivered and how people are asked whether they would like to receive it. There are ways of doing that, and I think we are close to breaking that taboo. It is all about how the support is offered. Rather than telling people, it is about saying, “We are here to support you and we think that we can nurse you through this difficult time,” so I think she is right. Common sense dictates that that is nearly always the case, but it is not an area that Governments have previously dealt with. It is an area that people have been nervous to go into.

I am glad that my hon. Friend mentioned charities. I want to touch on some work done in the area, because giving people the best possible start in life is not only a job for parents, the NHS and Government. Charities such as the WAVE Trust—Worldwide Alternatives to ViolencE—and the Early Intervention Foundation, which is funded by the Government, are contributing to, even leading, the debate in crucial areas about early child development. The Big Lottery Fund is working with both those charities and many others on the “A Better Start” initiative, where it will invest £165 million over the next 10 years to stimulate new and innovative preventive approaches in pregnancy and the first three years of life, again to improve life chances. I congratulate it on that work, and Ministers and parliamentarians will want to keep in touch with that significant programme of work and look at the outcomes it achieves.

Before I move off charities, I pay my own tribute to Home-Start and many other charities like it. I am privileged to be the patron of Home-Start Wandsworth, so I have seen at first hand the great work that it does, which I know is mirrored up and down the country. I have spoken to many mums who said that Home-Start were the people who stood by their side when they felt they had no one else to help them. They talked about the difference that it made to them at a difficult time in their lives.

On the points about integration, we can definitely do more to look at ensuring that all those initiatives are joined up. My ministerial colleague the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, is hosting a round table on the subject of integration, with a specific focus on the early years. That will look at what more we can do to ensure that children and families get that integrated support. A number of Members have mentioned that.

That is only one part of the system, however. The challenge of data sharing was brought up in earlier contributions. The sharing of information between NHS services and across the health, education and care system underpins good integrated working. It is not really possible to do it without that, and it is important for promoting good outcomes. In recent years, there have been a number of attempts at a national level to improve information sharing, including through specific work in foundation years services.

As my hon. Friend the Member for South Northamptonshire and other Members will know, the Government commissioned Jean Gross, a former communication champion for children, to explore ongoing barriers to information sharing in early years and to identify examples of good practice. I reassure my hon. Friend that Ministers from the Department for Education and the Department of Health welcome that report and its excellent analysis of the issues on information sharing. Much local good practice is outlined in it, and we are working with places such as Wigan, Warwickshire and Hackney to move that agenda forward through the programme to introduce integrated assessment of children aged two to two and a half. We know that there is variation across local areas, but we are working to try and understand how to reduce that.

The Department for Education’s statutory guidance for children’s centres is clear that health services and local authorities should share information, such as live birth data, with children’s centres on a regular basis. The Department of Health is taking forward work with NHS England and others, including the Health and Social Care Information Centre, to explore how regular updates of bulk data on live births can be provided to local authorities, including the benefits of local sharing versus sharing nationally held data. My hon. Friend the Member for East Worthing and Shoreham said in an intervention that sometimes there is a culture of using it as an excuse. As highlighted in the Caldicott reviews and reports, we know that culture and relationships need to change, and we need to make sure that there is an understanding of the existing framework in law that supports much greater information sharing than perhaps is always undertaken.

Jean Gross’s report also made recommendations about training on information sharing. We are working with the Royal College of Paediatrics and Child Health and with the DFE’s strategic partner, 4Children, to explore how an e-learning package on information sharing can be developed that is accessible to and appropriate for both health and early years professionals. We are hoping to see progress there.

To summarise, system-wide change is required to achieve all of this. Each part of the system, at each level, has a vital contribution to make. As the response to the debate has illustrated, work is going on across different Departments, and how we integrate them is critical to it. All of us see the manifesto “The 1001 Critical Days” as a rallying point for all those who have an interest in ensuring that, as the Government state in their pledge, we improve the health outcomes of children and young people so that they become among the best in the world.

The manifesto comes at an exciting time, because the evidence on the importance of a healthy pregnancy and on the early years is growing. As I have said, the evidence is becoming clearer, which makes it easier to make the case. It makes it easier for those who make decisions about how to structure services to do that with the confidence that they are doing something that will make a real difference, and that the consequences of a poor start for long-term physical and mental health will be addressed. Government, the NHS, charities and others are working well together to take the agenda forward, and I know that my hon. Friend the Member for South Northamptonshire will continue to champion it in Parliament and continue to improve the understanding that we all have of this important agenda.

I pay tribute to everyone who has taken part in such a good debate. I will follow up a number of points, and I will of course report back to the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, on the debate that we have had. I look forward, as do officials in the Department of Health, to ongoing, dynamic and constructive relationship working to take the objectives of this important manifesto forward into the future.

Croydon NHS (Financial Losses)

Jane Ellison Excerpts

Tuesday 21st January 2014 Westminster Hall

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

I tell my right hon. Friend the Member for Croydon South (Sir Richard Ottaway) at the outset that if I cannot respond today to some of the concerns he has outlined, I will be happy to follow them up later. I have already had a couple of meetings about the details of the matter and my officials tried to contact him yesterday.

I congratulate my right hon. Friend on securing the debate. I know that the issue is a big one in his constituency; as he said, it is also a big issue for the NHS. I share his frustration at the catastrophic situation that arose at the former Croydon primary care trust. As we have heard, a stated surplus of £5.4 million in NHS Croydon’s accounts for 2010-11 was revealed to be a deficit of £22.4 million, so there was a funding gap of £27.8 million.

I understand that the gap arose from an overspend on the provision of health services, but my right hon. Friend makes a fair point when he says that such an overspend, in as much as it is not controlled, is hardly likely to have been directed to the most beneficial places. It is probably fair to say, and the Ernst and Young report pointed out, that patient care was not compromised as a result of what happened. The situation is slightly different from money being misappropriated and not spent on health care. That does not make the situation better, but there is a difference.

I am not going to try to defend the indefensible. The Government position is clear: overspends are not acceptable and all NHS organisations must live within their means. As my right hon. Friend is aware, an independent review commissioned by NHS London was published in spring 2012 and it identified a series of failures in financial management. I realise that my right hon. Friend is not happy with the use of the word “systemic” but I would dispute his view slightly. There were several systems, none of which picked up the problem, so to that extent “systemic failures” is a fair description. The question is what we have done to change the systems and make it more likely that such a combination of circumstances cannot occur again. I think that we have made progress on that, but there are probably further things we can do.

The failings in question, together with substandard financial processes and poor management reporting—and, indeed, poor management—led to an inaccurate picture of the organisation’s financial position. The report highlighted contributory factors, including limited scrutiny and challenge by NHS Croydon’s board and scrutiny committee; a lack of leadership in the finance team during the finance director’s sick leave—as my right hon. Friend said, the interim finance director was insufficiently qualified—and difficulties with leadership and operational continuity during the move to the cluster.

The PCT commissioned an internal audit and the Audit Commission commissioned an external audit, both of which failed to uncover the significant financial irregularities. That is extraordinary. One of the audits was conducted by a well known firm of auditors; in a discussion of the matter yesterday with officials there was a feeling that that money was not well spent and should ideally have been refunded, given that it did not uncover the issue. The Ernst and Young report found that no individual was entirely at fault—rather than that no individual was at fault—but clearly there were people who performed poorly. It also found no adverse effect on patient care and no evidence of personal gain.

As I said in the House last week, it is important to note the measures that have been taken to prevent what happened at Croydon from happening again. Understanding what happened will give us an understanding of prevention methods. Following publication of the report, NHS London wrote to all primary care trusts outlining the lessons to be learned, as one would expect. In south-west London, the joint boards of the PCTs established a work programme to ensure that all the recommendations from the independent report would be addressed. That programme was overseen by the audit committee of the joint boards, implemented by management and assured by internal audit.

Furthermore, since their establishment the clinical commissioning groups have adopted a harmonised ledger system, ensuring that they all approach their accounts in a similar manner. That will make it more difficult to conceal irregularities, and will allow more effective scrutiny by NHS England and others. Someone coming to look at the books of another CCG would not be thrown by a different ledger system but instantly encounter a familiar system, making it more likely that they could spot what was going on. Problems would not be concealed by a particular version of the system.

I know that my right hon. Friend is frustrated about the fact that no former officers of NHS Croydon have been held to account, and I understand that. He wrote to my right hon. Friend the Secretary of State in support of a recommendation, from the joint health overview and scrutiny committee in south-west London, that such committees be given powers to enable them to compel former employees of NHS bodies to appear.

As my right hon. Friend knows, the Secretary of State was unable to accept that recommendation. Employees attend before local authorities to answer questions on behalf of the relevant body and not in a personal capacity. Accordingly, the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 do not impose duties on people who are no longer employees of the NHS body in question. Where employees have moved, we would expect the relevant body to have appropriate handover arrangements and to identify another suitable person to attend. It should not be the case that people can move on and no one else will attend as a result; someone else should be able to respond as part of the handover arrangements.

The Department of Health will, however, publish new guidance shortly on local government health scrutiny, and I am happy to ensure that it is discussed when available. In addition to supporting local government, the guidance will help to ensure that NHS organisations are aware of their duties and responsibilities. We want to start to tackle the culture that my right hon. Friend describes of people being able to move on without their mistakes catching up with them.

It is extremely unfortunate that Croydon’s clinical commissioning group is now operating with a deficit as a result of overspending by the former primary care trust. It is important, however, to concentrate on what has happened since, such as the measures being taken to bring the local health economy back to financial balance.

My right hon. Friend is rightly concerned about the impact on his constituents and others in Croydon. I have already touched on some of the steps being taken to minimise the risk of such a situation arising again, but there are other steps to take and further questions to ask. The CCG has developed a five-year financial improvement plan and is working closely with NHS England to help to achieve its target. I understand that NHS England’s London regional team is meeting the CCG monthly to track delivery against the plan. Furthermore, Croydon will be receiving budget growth of around 3.5%, compared with the national minimum of 2.1%. Setting aside the problems of the past, that reflects Croydon’s being some 7% below target and the growth, which is above average, should help to ease its return to financial balance and to close the gap faster.

I am also advised that the Croydon financial management team has been restructured with new leadership, clear accountability and new team members in post since April 2013. NHS England has retained reporting oversight through the national financial reporting system, which is another substantive change since the unfortunate events took place. I am pleased to assure my right hon. Friend that, as I mentioned briefly in the House last week, when CCGs were established all chief financial officers were subject to a rigorous independent assessment and appointment process. I hope that he agrees that that is a welcome development.

Furthermore, NHS England has been involved in the appointment of all substantive chief financial officers in London. I have asked officials to consider the appointment of interim CFOs, as it was clearly a real weakness in Croydon. I have not yet received assurance that there is the same level of scrutiny for interim CFOs, so I have asked for more work on that. NHS England and NHS London are looking at how to bring in more oversight in the same way as they have with substantive chief officers. Going right to the heart of what my right hon. Friend says, I have also asked how we can prevent people from popping up in another position where they could repeat the mistakes that they made in the past. Some such systems are in place, but oversight of appointments is critical, so more work must be done there.

The clinical commissioning group has established a finance committee, as part of its membership constitution, to oversee the financial performance of the organisation and to provide additional time for board members to scrutinise the financial position. I am assured that Croydon CCG’s governing body remains committed to achieving its financial targets—I would hope that it would say that, but I have no reason to believe otherwise and know that it is taking the matter seriously—based on clinical and quality led service improvement programmes.

I understand and share the frustration of my right hon. Friend. I think that I have picked up on some of the points made in his very good speech, but we accept that others need further investigation. I am happy to discuss those with him after the debate, so that he can feed through any other questions or concerns.

It is not enough just to say that we have learned lessons; we need to do everything in our power to reduce the chance of such things happening again. I have met NHS England specifically to discuss the issue and, obviously, I communicated my concerns. I will follow that up after this debate and look at what more can be done to ensure that such catastrophic events cannot happen again. I hope I have given my right hon. Friend some reassurance, although I accept that he will continue, rightly, to campaign for more satisfaction.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 14th January 2014 Commons Chamber

[Glyn Davies (Montgomeryshire) (Con)]

1. What steps he is taking to promote awareness of atrial fibrillation.

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

NHS England is responsible for promoting awareness of atrial fibrillation among health care professionals, and the new NHS improvement body, NHS Improving Quality, is encouraging GPs to detect and manage atrial fibrillation by promoting the use of GRASP-AF risk assessment tools. My hon. Friend will know about that as it is supported by the all-party group on atrial fibrillation, which recently published a helpful report on AF. I pay tribute to the work of my hon. Friend and his colleagues on that.

[Glyn Davies]

What steps are the Government taking to improve the uptake of National Institute for Health and Clinical Excellence-approved medicines and alternatives to warfarin for the treatment of atrial fibrillation to reduce the incidence of AF-related stroke?

[Jane Ellison]

NICE has issued technology appraisal guidance to the NHS on the use of newer anticoagulants—I think there were three in 2012—for the treatment of atrial fibrillation. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Mr Speaker, there is a crisis here. The fact is that half of those who suffer from AF—as a member of my family does—do not know they are suffering from it and are not diagnosed. If they are not diagnosed, that leads to great expense to the health service because they are very prone to having a stroke. Even when doctors know about AF, they say inappropriately, “Have an aspirin as part of your medication.” Some 25% of doctors recommend aspirin, and that is very dangerous. When will the Minister wake up? AF is a dangerous condition and it is very expensive.

[Jane Ellison]

The hon. Gentleman is right to say that it is a serious condition, which is why GPs need to take it extremely seriously and ensure that they look at the tests, and particularly at those who are susceptible to AF. We will get new NICE guidance in the summer on some aspects of self-monitoring, which will be an opportunity to remind all clinicians of their responsibilities.

[Jim Shannon (Strangford) (DUP)]

There is a community resuscitation strategy for the whole of Northern Ireland, and my constituents in Strangford, the Ards peninsula and Crossgar have examples of that. Will the Minister consider a community resuscitation strategy for England and Wales, similar to the one we have in Northern Ireland? It would help in this case.

[Jane Ellison]

I am happy to look at that. It is obviously an NHS England responsibility, but I will ensure that I draw its attention to the scheme that the hon. Gentleman mentions in Northern Ireland.

[Chloe Smith (Norwich North) (Con)]

2. What steps his Department has taken to ease the short and long-term effects of winter pressures on the NHS.

--- Later in debate ---

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

3. How many mesothelioma cases are being treated by the NHS; what strategies have been adopted for treatment and prevention of mesothelioma; and if he will make a statement.

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

In 2011, 2,238 people were diagnosed with mesothelioma. NHS England has set out guidance on the diagnosis, treatment, care and support of patients with that serious disease. That will deliver access to high-quality and consistent services across England. Both clinicians and patients are involved in the development of the guidance. UK legislation requires the active management of asbestos in buildings to prevent further exposure.

[Mr Brown]

The number of full-blown mesothelioma cases is expected to peak next year and then decline. The Department of Health is best placed to say whether that is happening. Will the Minister assure the House that the Department is carefully monitoring the situation and is in close contact with the Health and Safety Executive with a view to ensuring that our public protection measures are adequate for the challenge we face?

[Jane Ellison]

The right hon. Gentleman is right to say that it is a very serious situation, and we of course keep a very close eye on it. Higher-risk work with asbestos must be licensed by the HSE, which has recently published an updated approved code of practice, “Managing and Working with Asbestos”. The code provides guidance and practical advice to companies, because we do not want more people being exposed in the way that so many have been in the past.

[Hywel Williams (Arfon) (PC)]

There is particular interest in this dreadful disease in my constituency because of the location of a factory that used asbestos. Can the Minister assure me that further research into treatment for this condition will be carried out in conjunction with research institutions in Wales and in conjunction with the Welsh Government?

[Jane Ellison]

Obviously, health is a devolved matter, but research goes across the United Kingdom. In 2012-13, we spent £2.3 million on research into this disease through the National Institute for Health Research. The hon. Gentleman may be aware that during the passage of the Mesothelioma Bill, which has recently passed through this House, ministerial colleagues agreed to write to the Association of British Insurers. The Department of Health is seeking to set up meetings with the ABI and the British Lung Foundation to explore how insurers can individually sponsor specific mesothelioma research.

[Valerie Vaz (Walsall South) (Lab)]

4. How much has been spent on medical locums in accident and emergency departments in each year since 2009-10.

--- Later in debate ---

[Sir Richard Ottaway (Croydon South) (Con)]

14. What assessment he has made of the causes and effects of the 2010-11 financial losses of NHS Croydon; and if he will make a statement.

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

As my right hon. Friend knows, an independent report published by NHS London in June 2012 identified a systemic failure of financial management within NHS Croydon, which caused an inaccurate picture of the organisation’s financial position to be presented. However, the report found that that there was no adverse effect on local patient care.

[Sir Richard Ottaway]

In 2011, NHS Croydon posted a surplus of £5.5 million. This was later corrected to an overspend of £23 million—an error of £28 million. Two years later, no one has been found culpable, no one has accepted responsibility and officials are refusing to answer questions. Does the Minister accept that unless someone is held responsible, the responsibility will lie with her?

[Jane Ellison]

My right hon. Friend is right to feel frustrated. The report did not find any one individual responsible; it found systemic failings. What really matters is what has been done to ensure that this sort of thing does not happen again, or that the chances of it happening again are minimised. Following the publication of the report, NHS London wrote to all the primary care trusts outlining the lessons to be learned, and my right hon. Friend will be relieved to hear that all clinical commissioning groups’ chief financial officers have been subject to a rigorous independent assessment and appointment process.

[Mr Speaker]

We come now to topical questions. It would be good to get through the list and beyond, so may I just remind Back Benchers and Front Benchers alike that topical questions and answers are supposed to be brief?

--- Later in debate ---

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

Last week, we heard shocking revelations about the reasons behind the Government’s U-turn on minimum unit alcohol pricing. In particular, researchers at Sheffield university have confirmed that they were asked by government not to publish a report that would have undermined the Government’s decision to shelve minimum unit pricing. Why were Ministers so keen to suppress the report? Will the Secretary of State please tell us why some of our country’s leading public health experts are accusing Ministers of deplorable practices and of dancing to the tune of the drinks industry?

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

On the hon. Lady’s substantive point, the reports for the British Medical Journal investigation, which I read in full, did not say that at all and in fact confirm that that was not asked, so what she says is not quite right.

On the wider point, over the past two weeks we have heard a succession of attacks from the hon. Lady and the Opposition about dealings with industry and business. This Government have set out to work in partnership across business and industry, with public health experts and local authorities, to tackle some of these really big public health issues. It is simply incredible that the Labour party believes that these big issues can be taken seriously without engaging with business. Instead of demonising businesses, let us hear some praise for those such as Lidl, which yesterday announced that sweets would be removed from all its checkouts across the country, in response to its customers—a voice that is too little heard by the Labour party.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T2. Will the Secretary of State join me in congratulating the UK Chronic Fatigue Syndrome/Myalgic Encephalopathy Research Collaborative for providing a mechanism for ME charities, researchers and clinicians to work together in a co-ordinated way? What support will his Department give research into the causes of and treatment for ME?

--- Later in debate ---

[Iain Stewart (Milton Keynes South) (Con)]

T9. The Secretary of State is aware of the plans being developed by Milton Keynes hospital to expand its A and E capacity. In the interim, will he set out what assistance he can provide to ease short-term pressures?

[Jane Ellison]

I can confirm that the Department of Health is investing an additional £250 million over the next two years in A and E, with NHS England also allocating an additional £150 million for the current year. Milton Keynes has been allocated £2.8 million to support local initiatives to relieve pressures on A and E, and I know that, as a great champion for his local hospital, my hon. Friend will welcome that additional support.

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

Given the ongoing crisis in A and E units in the UK, particularly in the area I represent in Northern Ireland, will the Minister confirm whether the Health Minister in Northern Ireland has had discussions about possible solutions to finding and recruiting extra doctors?

--- Later in debate ---

[Mr Simon Burns (Chelmsford) (Con)]

Is the Secretary of State aware that every fast food outlet in the United States displays the number of calories for each portion of food that it sells? Given that some fast food restaurants in this country, such as McDonald’s, already do that, does he believe that more should be done to make all fast food outlets in this country display the number of calories so that people are educated before they make a choice about what they are going to purchase?

[Jane Ellison]

My right hon. Friend is quite right to say that that is a real priority. The responsibility deal, on which we have worked with our partners, means that 70% of fast food and takeaway meals sold on the high street in the UK have clearly labelled calories, but there is always more to do. This is a priority for the responsibility deal and we are working closely with our industry partners to make more progress.

[Huw Irranca-Davies (Ogmore) (Lab)]

Does the Minister believe that social isolation, which is a key contributor to the health and well-being of older people living on their own, has got worse or has improved under this Government?

--- Later in debate ---

[Tessa Munt (Wells) (LD)]

What steps is the Secretary of State taking to ensure that the number of cancer indications treated in this financial year by stereotactic ablative radiotherapy does not fall below the number of treatments delivered in the 2012-13 financial year?

[Jane Ellison]

That is an area that the hon. Lady and I have discussed at some length. I know that she feels strongly about it. We have meetings coming up to discuss it and I think that it would be easier to deal with her detailed points in those meetings.

Oral Cancer

Jane Ellison Excerpts

Monday 13th January 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing a debate on this important issue. It is a very current one, as I responded to a debate in Westminster Hall on HPV only last week. I will return to that point.

I want to restate the Government’s commitment to making England among the best in Europe in improving all cancer outcomes, including for oral cancers. As part of that, we are committed to reducing the incidence or oral cancers, improving diagnosis rates when it occurs and of course improving outcomes for people diagnosed with the disease. My hon. Friend mentioned the fact that the earlier the oral cancer is caught, the more successful that can be.

My hon. Friend outlined the scale of the challenge and, as he said, the numbers are quite stark. In 2011, the latest year for which we have information, more than 6,000 people in England were diagnosed with an oral cancer, and in the same year, more than 1,600 people died of the disease. That is, as it were, a milestone in a significant and worrying increase in incidence since the 1970s.

My hon. Friend touched on some of the issues, and the explanation for the trend relates to changes in the prevalence of the major risk factors for oral cancer, particularly heavy alcohol consumption and smoking. It is estimated that more than three quarters of cancers affecting the upper aerodigestive tract, including oral cancers, are caused by alcohol and tobacco. There are also such factors as the chewing of betel quid, which is more common among some south-east Asian populations. That is a risk factor for oral cancer and may have contributed to the trend.

Reducing the damage done to the health of the population though smoking and harmful drinking is absolutely a high priority if we are to make progress on tackling oral cancers. My hon. Friend will be aware of some of the health initiatives that we have taken, particularly the tobacco control plan and our alcohol strategy, which we continue to pursue with some real energy.

I am grateful to my hon. Friend for raising the issue of HPV, which, as I have said, was recently a subject of interest in Westminster Hall. It is good that it is being debated so thoroughly, including in making the link to the different kinds of cancer with which HPV is associated. He will know that there is growing evidence that the human papillomavirus, which is already linked to the development of the more than 99% of cases of cervical cancer in women, is a major risk factor for about a quarter of head and neck cancer cases.

If we can reduce incidence of HPV in females through high uptake of the national vaccination programme, a reduction of other HPV-associated cancers in females and males is likely to follow, but I will pick up my hon. Friend’s good point about herd immunity. Since 2008, more than 6 million doses of vaccine have been given in the UK, with 87% of the routine cohort of girls completing a three-dose course in the 2011-12 academic year. That is one of the highest uptakes of any vaccination programme in the developed world.

I know that my hon. Friend is keen that HPV vaccination should become universal. When the Joint Committee on Vaccination and Immunisation first developed its recommendations, it concluded that should vaccine uptake among girls be high, the vaccination of boys was likely to provide little additional benefit in preventing cervical cancer in girls, which was of course the primary purpose of that vaccination programme. That result proved to be the case in the UK.

The JCVI has, however, recognised that the protection that accrues from reduced transmission from vaccinated girls under the current programme may not be provided to men who have sex with men. In last week’s debate, my hon. Friend the Member for Finchley and Golders Green (Mike Freer) introduced the idea that in some places, particularly those where a large number of people were born abroad or travel abroad, such factors are also a threat to the argument about herd immunity.

In October 2013, the JCVI agreed to set up a sub-committee on HPV vaccination to assess, among other issues, extending the programme, as a priority, to men who have sex with men, to adolescent boys or to both. The HPV sub-committee is scheduled to meet for the first time on 20 January, when it will assess currently available scientific evidence and consider what further evidence is required to advise the Committee on the suitability of possible changes to the HPV programme. Any proposals for the vaccination of additional groups will require supporting evidence to show that it would be a cost-effective use of NHS resources, as my hon. Friend would expect. Public Health England has begun preliminary modelling to assess the impact and cost-effectiveness of vaccinating men who have sex with men in anticipation of further guidance when the HPV sub-committee meets. It plans then to undertake further work to assess the impact and cost-effectiveness of vaccinating adolescent boys against HPV infection.

These are complex issues, and the development of the evidence base, including mathematical models, by Public Health England, as well as the Committee’s deliberations, will take time. That process is important for ensuring that decisions are made using the best quality evidence, so we cannot hurry it. I explored with officials the possibility of taking those decisions more rapidly, but that relates to the quality of the evidence being assessed and the necessity of building the right models. That brings with it the concerns that my hon. Friend and other hon. Members have raised about fitting in with the timetable for vaccine procurement, and on that I can give a little reassurance. Should the JCVI recommend the targeted vaccination of men who have sex with men, flexibility in the contracted volumes within the current vaccine contract may allow such a programme to be undertaken without the need for a new round of vaccine procurement, if additional vaccine is available from the manufacturer in the required quantities.

I also undertook last week to explore with officials the flexibility in our contract and the potential for extending it to give us time to negotiate different procurement arrangements in the event that the JCVI makes that recommendation for adolescent boys, who obviously comprise a much larger cohort. We are not quite certain yet, but I am fairly sure that we are getting promising signals about the possibility of flexibility in those contract negotiations. I hope that gives my hon. Friend some reassurance that if that is what the Committee recommends, we would be in a position to respond without missing an entire procurement cycle, but I will continue to look at that closely.

I want to take this opportunity to talk not just about prevention, but to remember the importance of rapid diagnosis. My hon. Friend graphically illustrated the tragic consequences of late diagnosis or of an early diagnosis being ignored. With early-stage diagnosis, five-year survival rates are more than 80%, which is very good by the standard of these things. Clearly, doctors and dentists have a vital role to play. Since 2005, the “Referral Guidelines for Suspected Cancer”, published by NICE, have supported GPs in identifying symptoms of oral cancer and urgently referring patients. That guidance is currently being updated.

Furthermore, all dentists are now aware that patients presenting for dental care is an opportunity—quite rightly, as my hon. Friend said—to assess any symptoms that might suggest oral cancer and refer them if appropriate. A new patient pathway being piloted in 94 practices—he might be aware of this—includes an oral health assessment requiring dentists to examine the soft tissue of the mouth; assess a patient’s risk factor in relation to oral cancer; and offer advice on lifestyle changes. Given what we have said about the relevance of lifestyle to the potential for developing oral cancer, that is very important. Those pilots are under way, and a great deal is being learned from them.

Once a cancer has been diagnosed, both dentists and GPs can use an urgent referral pathway to ensure patients get rapid treatment. The latest data showed that 95.5% of patients urgently referred with suspected head and neck cancer, including oral cancer, were seen by a specialist within two weeks, which is excellent progress. To ensure that patients get appropriate treatment, NHS England published a service specification for head and neck cancer last summer. This was based on NICE guidance and set out what NHS England expects to be in place for providers to offer evidence-based, safe and effective services.

The Government have committed £23 million to the radiotherapy innovation fund, which has supported radiotherapy centres across England to deliver increased levels of intensity modulated radiotherapy. That is a more accurate form of radiotherapy that reduces the risk of patients with oral cancers suffering side effects such as permanent dryness of the mouth as a result of treatment.

There is good news on research that I would like to relay to my hon. Friend. The clinical research network of the National Institute for Health Research is currently recruiting patients to 30 studies into head and neck cancer, of which five are focused on HPV-associated cancer. The NIHR also funds 14 experimental cancer medicine centres across England jointly with Cancer Research UK. Two of the centres have a disease focus on oral cancer.

I thank my hon. Friend for raising this subject. It is good that it is being brought up regularly in the House. That will illustrate to the JCVI how much interest Parliament is taking in its work as it deliberates on the potential extension of the HPV programme. I hope that he has found the debate helpful and is reassured about our commitment to reducing the incidence of oral cancer and improving the outcomes for those who are diagnosed with the disease.

Question put and agreed to.