Dermatology Funding

Jane Ellison Excerpts

Wednesday 4th December 2013 Westminster Hall

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

It is a pleasure to speak under your chairmanship, Mr Turner. I pay tribute to the hon. Members who have spoken today and particularly to my hon. Friend the Member for Gainsborough (Sir Edward Leigh) for securing the debate. As has been illustrated throughout, this is an under-discussed area and it seems to be neglected in other ways, too. The debate has been valuable, and I have certainly learnt a lot during its course and in my preparation for it. Inevitably, there will be some points on which I cannot give a full answer today, but I shall endeavour to follow up with hon. Members if I cannot. I also pay tribute to the all-party parliamentary group on skin. I have looked at the recommendations in its recent report, and I pay tribute to the members of the group who have spoken today.

We have heard from several Members how many people are affected by skin disease and I shall not go over those numbers, which are very large indeed. There is a huge range of skin diseases; some are manageable and others are life-threatening, as we have heard. All have an impact on people’s lives and, in particular, can affect their personal appearance, as Members have highlighted in moving terms. In that way, skin problems perhaps represent more of a day-to-day challenge than many other conditions. They impact on all aspects of life, such as employment and personal relationships. It is, therefore, important to ensure that people with skin disease receive both the treatment and support that they need. As today’s debate has highlighted, considerable challenges remain, many of which we have not necessarily bottomed out during the debate, but we have begun to highlight some.

Let me first plug the national framework. Skin disease is a long-term condition, and through the NHS mandate we have made it clear to NHS England that we want to see the NHS among the best in Europe at supporting people with long-term conditions. We want them to live healthily and independently, with better control over the care that they receive. Those improvements are monitored through the NHS outcomes framework, for which ambitious expectations have been set out. In turn, the NHS will monitor the performance of clinical commissioning groups through the clinical commissioning group outcomes indicator set, on the quality of the services and health outcomes achieved through that commissioning.

As my hon. Friend the Member for Gainsborough highlighted, commissioning for most dermatology services is a matter for CCGs. They are better placed to use their clinical insight, local knowledge and local relationships to do excellent commissioning at a local level than Ministers in Whitehall, but I take on board the challenge about the more specialist areas. We are not leaving CCGs to commission without support. NHS England is working closely with them to ensure high-quality commissioning, and it has established commissioning support units and quality surveillance groups across the country. However, as my hon. Friend the Member for Mole Valley (Sir Paul Beresford) said, it is certainly something that I can raise on appropriate visits when the opportunity arises. As the Public Health Minister, given that so much of my portfolio is localised, I am very keen to draw attention to good practice where we see it.

There is an example in the area of my hon. Friend the Member for Gainsborough, where his local CCG has introduced a teledermatology pathway, which allows patients to be reviewed at their own practice. We also heard of an excellent example from Buckinghamshire, which I was speaking about with my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) during the break for the Division. The pathway in the area of my hon. Friend the Member for Gainsborough is being implemented across 10 practices from September. If it is successful, it will be rolled out across all the practices in the Lincolnshire West CCG. I am always interested to hear about good practice. A number of kind invitations for visits have been made during the debate and I look forward to following those up with Members so we can highlight people who are being innovative in a way that will help other commissioners.

As has been mentioned, with some highly specialist dermatology services for conditions that cannot be treated locally, it is appropriate for NHS England to commission them directly. NHS England has set out detailed service specifications for the services that it directly commissions. I realise that a number of Members have made points about the national clinical director, and that issue has been raised in other contexts, too. It is a matter for NHS England whether it appoints a national clinical director. I understand, from asking it the question, that there are no current plans to introduce an NCD for dermatology, but it is continuing to discuss with the British Association of Dermatologists the best ways to improve outcomes for patients.

As has been said, aspects of treatment of people with skin conditions can be considered under any of the five domains. That change in the new NHS focuses on people as individuals rather than on their conditions, which is why the patient pathway and not the organisations that treat them is given the closest attention. Many of the national clinical directors have cross-cutting roles—I have come across that in other areas of my portfolio—rather than roles that are related to individual medical conditions, so it is not the case that dermatology is being singled out. Clinical directors often cut across.

There is interest in the research—points have made about it—that is going on to get better results in dermatology and to come up with new treatment, so I shall touch on that. I reassure the Chamber that investment by the National Institute for Health Research in skin research increased from £4.7 million in 2010-11 to £8.7 million in 2012-13. That includes the NIHR investing £2.6 million over five years in the biomedical research centre at Guy’s and St Thomas’s and the King’s College London centre, which is leading the way in research on cutaneous medicine. The NIHR is dedicated to translating these scientific discoveries into improvements in treatment, which we hope will benefit patients at the earliest opportunity.

The NIHR has also awarded nearly £2 million to Salford Royal NHS Foundation Trust to undertake a programme of research on psoriasis. The studies will look at crucial issues, including individual patient experience, difficulties faced by service providers and identifying levels of risk in populations. I hope that the hon. Member for West Lancashire (Rosie Cooper) will take particular comfort from that, and I am sure that she will be interested in the outcome of that programme. The NIHR is also investing nearly £1 million in a trial of silk therapeutic clothing for the long-term management of eczema in children.

My hon. Friend the Member for Gainsborough will know that NICE has also published guidance on a range of dermatological conditions, including atopic eczema in children and psoriasis, and it has issued quality standards on those topics. NHS England is statutorily required to have regard to NICE quality standards, and we expect health and care professionals to take NICE guidance on the treatment of relevant conditions fully into account when deciding how to treat a patient.

NICE has also recommended a number of drugs for the treatment of dermatological conditions such as eczema and psoriasis. Patients have a right in the NHS constitution to access drugs and treatments recommended by NICE technology appraisal guidance that their clinicians want to prescribe.

As I acknowledged earlier, and as has been very much illustrated during the debate, skin disease can have adverse psychological effects on patients. The NICE quality standard on psoriasis recognises that and sets out that people with psoriasis should be offered an assessment of how their physical, psychological and social well-being is affected when they are diagnosed and when they undergo treatment. It is the responsibility of all commissioners, providers and clinicians to ensure that patients receive the psychological and emotional support that they need. Hon. Members may be aware of the IAPT—improving access to psychological therapies —programme, which is an NHS programme rolling out services across England offering interventions for people with depression and anxiety disorders. I understand that as part of that programme, NHS England is looking at how best to support people with psychological problems arising from their physical problems. That issue was raised a number of times during the debate.

I listened carefully to the comments of my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), who highlighted that the issue of Roaccutane was discussed only yesterday in the Chamber. It is associated with rare, serious side effects and can only be prescribed by or under the supervision of a consultant dermatologist. The BAD has published guidelines for its members about when to prescribe it and how best to monitor patients for adverse effects during treatment. I will certainly make a point of catching up with my hon. Friend the Minister of State, who responded to that debate. I will ensure that we touch base with regard to the important subject that my hon. Friend the Member for Romsey and Southampton North has raised today.

The issue of GPs’ and other health workers’ education and training has come up a lot. My hon. Friend the Member for Mole Valley made it the focus of his speech. It is important that health professionals have the right training. Training and education of health professionals is a matter for Health Education England and the royal colleges. NHS England is statutorily required to have regard to the NICE guidelines, and we expect health professionals to have regard to them, too. I am aware that the BAD has produced toolkits and guidance. They are valuable resources for health professionals and should be promoted widely. NHS England has responsibility to support CCGs, as I said, with commissioning guidance and tools and it can flag up the relevant dermatology guidance and standards.

I understand that NHS England’s domain director for long-term conditions regularly meets the president of the BAD, who is also an adviser to the all-party group on skin. I am sure that the issues about the education of GPs are raised at those meetings.

The current framework for accreditation and re-accreditation of GPs with a special interest remains under review, following the transition to the new arrangements for the NHS in England. NHS England is working with the Royal College of General Practitioners and with dermatologists to produce an improved and consistent accreditation system. It is expected that there will be a report early next year, and I am sure that there will be interest from hon. Members in that.

I am concerned about the point that has been made about the shortcuts being taken on some of the training courses. I thought that what was highlighted today was quite alarming. I have heard that before. It is certainly something that I will put on the agenda for my forthcoming meeting with the Royal College of General Practitioners. I will report back to my hon. Friend the Member for Gainsborough, who raised the matter and said that there was considerable interest in it in the House.

Since 2002, there has been a 40% increase in consultant dermatologists, but I accept that that is from a modest base. It is clear that, although there was an increase of 28% between 2002 and 2012 in the total number of staff, we still have more to do, but things are improving. Health Education England needs to ensure that we have the right dermatological work force. I will ensure that it is aware of the issues that have been raised today and highlight the concerns of hon. Members.

Many of the problems highlighted in the debate have not really been funding issues, which I suppose makes a change in an NHS debate. They have actually come out of a lack of engagement that hon. Members have highlighted. I think that some hon. Members have even alluded to there being a sense of complacency sometimes with regard to skin conditions and they asked whether such conditions are taken sufficiently seriously. I am not sure that in this debate we have quite got to the bottom of why clinicians perhaps do not choose to specialise in or pursue this line of work, but today’s debate is useful in highlighting that.

[Sir Edward Leigh]

Will the Minister take away to her fellow Ministers the point that the psychology of all this is very important and, in particular, read the report from the group chaired by my hon. Friend the Member for Mole Valley (Sir Paul Beresford)? A lot of people, when they poke fun at others because of their appearance —their skin colour or something else—do not realise that they are causing them psychological damage. That is the particularly the case with children. It is an important point that we want to be taken away from the debate.

[Jane Ellison]

I am very happy to give a commitment to take that point away and I will certainly bear it in mind in other discussions that I have.

I am glad that some hon. Members have taken the opportunity offered by the debate to highlight the growing issue of malignant melanoma. It is absolutely right to say that we need to make more people aware of the dangers of skin cancer. I was struck by the point made by my hon. Friend the Member for Romsey and Southampton North about the regional variation and the fact that in her area it is a particular problem.

The Department has funded Cancer Research UK to continue to test approaches to encourage, in particular, men over the age of 50 to visit their GP if they have signs of skin cancer. I have to say that, if anyone can come up with a magic way of making men over 50 approach their GP about anything, that would be very welcome and they would be rewarded by all parts of the NHS.

[Sir Paul Beresford]

There is a largish American community in Surrey, just outside my constituency. They are very aware of skin protection, to such a degree that there is a slight recurrence of rickets.

[Jane Ellison]

That is perhaps a debate for another time, but I note the concern. There is a happy medium to be struck.

Hon. Members might be interested to know that in autumn 2013 Cancer Research ran a campaign in south Devon, utilising text message communications, phone consultations with specialist nurses and volunteer community outreach to try to address some of the barriers to getting harder-to-reach groups to seek advice about skin concerns. Between 2003 and 2011, Cancer Research also collected data via the Office for National Statistics monthly omnibus survey to measure awareness, attitudes and reported behaviour of adults in relation to sun protection. The Department is funding a repeat of that survey in 2013, so that Cancer Research can track changes over time. I think that the results will be very interesting.

Public Health England, in partnership with the Department, NHS England and other stakeholders, proposes to run a local “Be Clear on Cancer” pilot campaign in early 2014 to encourage the early detection of malignant melanoma. The South West Strategic Clinical Network will host that pilot. It will build on evidence from the work in this area that I have just described.

This is a sizeable challenge. We can only, as individual Members of Parliament, take every opportunity that we can to encourage people to seek help from their GP and not to put that off, because for some cancers, the only thing that explains different outcomes for men and women is the fact that men refer themselves later and therefore do not benefit from early diagnosis.

With regard to the point made by the shadow Minister, the hon. Member for Copeland (Mr Reed), on sunbeds, I can respond to him separately on some of the specific things that he asked. I will make the point that the figures that I have seen for the problems associated with sunbeds are highly regionalised and that is one reason why public health is now devolved to local government. Some local government areas are giving the issue real attention and making it a priority. It is perhaps better suited for that sort of local and regional priority than it is for a national campaign, but I take the point that he makes.

A range of support is in place to help GPs to identify malignant melanoma. There is NICE guidance, “Improving Outcomes for People with Skin Tumours including Melanoma”, and there are the “Referral guidelines for suspected cancer”. We cannot highlight them too often.

I would like to take this opportunity to recognise the hugely important role that patient support organisations play. As has been said, they sometimes operate on a shoestring. They make an enormous contribution in helping patients to understand and cope with their conditions. Sometimes, knowing someone who can stand alongside us and say, “I know how you feel and this is how we have learned to cope with it,” is very important as a supplement to clinical guidance.

I again congratulate my hon. Friend the Member for Gainsborough on securing the debate and raising the profile of what is an important issue. As I said at the outset of my speech, I have learned a lot in researching my response to the debate, and I will now have these important issues firmly in my mind in my meetings and visits, where I can raise them. I pay tribute to the work that my hon. Friend is doing and to the all-party group. I assure the House that I will make NHS England and all the relevant bodies that I have mentioned today aware of the issues raised in the debate and the depth of feeling expressed about them.

Tobacco Packaging

Jane Ellison Excerpts

Thursday 28th November 2013 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Government’s policy on standardised packaging of tobacco products.

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

In accordance with the notice I gave the House yesterday afternoon, this morning I made a written statement announcing that Sir Cyril Chantler will carry out an independent review of the evidence on the impact of standardised tobacco packaging on public health.

Tobacco use, especially among children, remains one of our most significant public health challenges. Each year in England more than 300,000 children under the age of 16 try smoking for the first time. Most adults who smoke started before they were 18 years of age. As a result, we must do all we can to stop young people from taking up smoking in the first place, if we are to reduce smoking rates.

We have listened to the strong views expressed on both sides of the House, including when we debated standardised packaging in a Back-Bench business debate earlier this month, to which I responded. Many Members then told me that the evidence base for standardised packaging continued to grow and urged the Government to take action. Similarly strong views have been expressed in the other place. As a result, I believe the time is right to seek an independent view on whether the introduction of standardised packaging would be likely to have an effect on public health. In particular, I want to know the likely impact on young people.

I have asked Sir Cyril to undertake a focused review, reporting in March next year. It will be entirely independent, with an independent secretariat, and he is free to draw evidence from whatever sources he considers necessary and appropriate. It will be up to him to determine how he undertakes the review, and he will set that out in more detail in due course. As the House will know, Sir Cyril has confirmed that he has no links with the tobacco industry. The review is not a public consultation. The Government ran a full public consultation in 2012 and the responses will be available in full for the review. To maximise transparency, the Department will also publish the substantive responses received as soon as possible.

The Government will also take advantage of the opportunity offered in another place by tabling an amendment to the Children and Families Bill to provide for a regulation-making power. If, on receiving Sir Cyril’s review, the Government decide to proceed, that will allow standardised tobacco packaging to be introduced without delay. The Government have been consistent in their desire to take an evidence-based approach to public health, and we will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised, we are satisfied that there are sufficient grounds to proceed.

[Luciana Berger]

We have seen plenty of U-turns over the past three years, but only a Government as shambolic as this one could U-turn on a U-turn. It is not so much that they have lost their way on public health—they are running around in circles.

Will the Minister answer a straight question: does she support standardised packaging for cigarettes—yes or no? In the week running up to this being debated in the other place, does she honestly expect us to believe that this has nothing to do with the fact that the Government are on the brink of a humiliating defeat?

The Minister says that we need another review, but the Government have already had a review and the evidence is clear for all to see. Did that not already find that standardised packaging made cigarettes less attractive to young people and health warnings more effective, and did it not refute the utter falsehood that some brands are safer than others? All the royal colleges and health experts are united behind the case for standardised packaging—I commend everyone who has campaigned for this measure—but is it not the case that if the lobbying Bill goes through in its current form, it will prevent charities such as Cancer Research UK from ever raising such issues in an election year?

Is not the Prime Minister more interested in listening to Lynton Crosby and the vested interests of big tobacco than cancer charities and health experts? What further evidence does the Minister need? What do Ministers know now that they did not already know when they U-turned on this before the summer recess? Why are the Government delaying this still further? Some 79,230 children will have taken up smoking in the 139 days since the Government U-turned on standardised packaging in July, and about 70,000 more will have had their first cigarette by the time the review reports next March. We should be legislating now, not delaying.

[Jane Ellison]

I thought that was a rather disappointing and naive response. This is a complex area of public health policy, and it is important to follow a clear process and to follow the evidence. The hon. Lady might not believe me, but perhaps she will believe the right hon. Member for Leigh (Andy Burnham), who in November 2009, when he was Health Secretary, wrote:

“we would need…convincing evidence showing the health benefits of this policy before it would be acceptable”.

[Hon. Members]

We have got that evidence.

[Mr Speaker]

Order. I gently say to the House that the Minister is among the most courteous of Ministers, and in fairness she deserves also to be treated with courtesy. There are strong views, but let us hear the Minister.

[Jane Ellison]

The Government have held a consultation, but we have not had a review before. We said in July that we would pause to consider the emerging evidence base, and that is exactly what we have done. I am happy to account for my actions, but it appears that I am being asked to account for the cynicism of the Opposition, too. This weekend sees the anniversary of the passing of the legislation in Australia, and new evidence is emerging rapidly, as was pointed out in the very good Back-Bench business debate to which I responded earlier this month, as well as in the other place, so this is the right time to do this.

Of course we have listened to what Members of the other place have said. They rightly take extremely seriously such an important public health issue as stopping children from smoking, but we have to proceed in a measured, step-by-step way to ensure that, if and when a decision is made, it will be robust and will deal with all the inevitable challenges that might come its way.

[Several hon. Members]

rose—

[Philip Davies (Shipley) (Con)]

Idiotic, nanny state proposals such as the plain packaging of tobacco are what we expect from the Labour party. What we expect from Conservative Ministers is for them to believe in individual freedom and individual responsibility, and to stand up to the health zealots and nanny state brigade who, if they could, would ban everything and have everything in plain packaging. Will the Minister commit to sticking to those Conservative principles and to ignoring the nanny state brigade of Labour Members?

[Jane Ellison]

I know my hon. Friend feels strongly about this issue, but nobody is banning anything. Were the Government to proceed following receipt of the review, the proposal would be about packaging, not the ability to purchase tobacco. All the sorts of points that my hon. Friend has often articulated were well made during the consultation, which, as he knows, received an enormous response, and all the responses will be made available to Sir Cyril.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Some 190 health organisations recognise that plain packaging will cut smoking, particularly among the young, and have urged action. Is this not just a further delay while the Government get their house in order so that they know how and when to introduce the legislation that is so urgently needed?

[Jane Ellison]

The hon. Lady is right to say that many charities feel strongly about this issue and I was pleased that the chief executive for Action on Smoking and Health said this morning:

“This decision is a victory for public health, for common sense and for future generations”.

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

Smoking is a childhood addiction, not an adult choice. The announcement is welcome, in that it moves us in the right direction, but if the review should recommend what is, in my judgment, a much-needed change when it is published in March, just how quickly would the Government be able to bring in the necessary regulations?

[Jane Ellison]

My right hon. Friend is right that we would need to be able to act quickly if, following the recommendation, we decided to proceed. The power to make regulations is being proposed in the other place exactly so that we may move quickly at the point we receive Sir Cyril’s review. I have looked at the draft schedule, and if the Government were minded to go forward with this policy, I see no reason why it could not be put through before the end of this Parliament.

[Chris Ruane (Vale of Clwyd) (Lab)]

As chair of the all-party group on heart disease, I pay tribute to the work of the British Heart Foundation, Cancer UK, ASH and other campaigning organisations that have helped to bring about this U-turn. My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) specifically mentioned the impact on such charities if the lobbying Bill goes through—they will be neutered and silenced in the run-up to the general election. What lessons should be learned from this?

[Jane Ellison]

The hon. Gentleman refers to another Bill, rather than the issue we are discussing now. I have heard none of those concerns from the charities he mentioned, which I understand have warmly welcomed today’s announcement.

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

I, for one, very much congratulate the Minister on this welcome news. As she well knows, the all-party group on cancer has been one of many that have argued for added urgency on this issue. The Government have listened and responded, which is a sign of strength, not weakness. To follow up a previous question, will the Minister give an assurance that the regulations will be in place before the end of this Parliament, because if the recommendations are in favour of introducing standardised packaging, they will need to be implemented quickly?

[Jane Ellison]

That is certainly the objective of the timetable that has been drafted, once the Government have received the review and made a decision. I see no reason why what my hon. Friend suggests could not be the case.

[Heidi Alexander (Lewisham East) (Lab)]

The Minister said that she had not held a review, but had carried out a consultation. Is that not just a pathetic excuse for inaction, and does she not accept that for every day she delays this policy, another 570 children start smoking?

[Jane Ellison]

We have had a consultation and now we are having a short review of the emerging evidence base. I think that that is sensible. We want to make good policy that is robust, and this is the right way to do it.

[Bob Blackman (Harrow East) (Con)]

I congratulate the Minister on listening to the arguments and acting far more quickly than any Opposition Member did in 13 years. Will she assure us that the House will have the opportunity to vote in favour of standardised packaging so that we can demonstrate our cross-party support for this much-needed health measure?

[Jane Ellison]

At present, we are strongly minded to introduce regulations under the affirmative procedure.

[Pete Wishart (Perth and North Perthshire) (SNP)]

I, too, welcome the Government’s U-turn. I am sure that the Minister has been following attentively the progress made on this issue by the Scottish National party Government, who have been able to make that progress because Lynton Crosby’s remit does not extend north of the border. Will she commend the SNP Government for taking the lead and work closely with Scottish Ministers to secure the best possible outcome for everyone on these islands?

[Jane Ellison]

I repeat that the Government are proceeding along the track that they laid out in the summer. We know that the Scottish Government have expressed clear views, and we will be working closely with all the devolved Administrations.

[Jeremy Lefroy (Stafford) (Con)]

I welcome the statement and trust that we will see a Conservative-led Government introduce standardised packaging. When that happens, will the Minister take the opportunity to step up health education on this subject?

[Jane Ellison]

My hon. Friend is right to remind us all that, even if the Government decide to implement the policy at the end of the review, there will still be many other things to be done in relation to this important issue. Major public health campaigns will proceed as they have been doing under Governments of all colours.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

My hon. Friend the Member for Bridgend (Mrs Moon) pointed out that 190 health organisations were in favour of standardised packaging. While I appreciate that there may be tensions within the Government, the hon. Lady is Minister for public health. Will she tell us whether any health organisation is opposed to plain packaging?

[Jane Ellison]

We have asked Sir Cyril to conduct an independent review and to weigh all the different evidence. I do not wish to seem to pre-empt the review, because it is important that it is independent, but I will say that I am not aware of any health organisations that are not in favour of plain packaging. Indeed, as the hon. Lady can imagine, such organisations have expressed the opposite view to me with considerable strength.

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

Will the Minister remind the House of all the investment that the Government have already made in anti-smoking strategies so that no one smokes out of ignorance? Does she agree that the main responsibility for children’s smoking habits lies with their parents?

[Jane Ellison]

Of course we want parents to set a good example to their children and to try to prevent them from starting to smoke. The important public health measures to which my hon. Friend has referred are proceeding but, sadly, a great many children start smoking at a very young age.

[Clive Efford (Eltham) (Lab)]

This is just a cynical ploy to get beyond the humiliating defeat that the Government face in the House of Lords. Notwithstanding what has been said by the Minister’s hon. Friends, no decision has been made to introduce plain packaging. Who does she think will win this war of attrition for the ear of the Prime Minister: Lynton Crosby, or both Houses of Parliament?

--- Later in debate ---

[Jane Ellison]

I could not have made myself plainer during my first session of Health questions and when I responded to the Back-Bench debate. The policy is under active consideration, and it was under active consideration before—this is evidence of that.

[Nigel Mills (Amber Valley) (Con)]

Will my hon. Friend confirm that Sir Cyril is not only independent of big tobacco, but independent of the health lobby?

[Jane Ellison]

One of the reasons we asked a distinguished paediatrician to conduct the review, rather than someone from a public health background, was that he would be able to bring a fresh mind to it. Sir Cyril will set his own terms, which he will announce in the next few weeks.

[Sheila Gilmore (Edinburgh East) (Lab)]

Does the Minister appreciate that one of the reasons for the scepticism among Opposition Members is that in the summer last year, either there was a U-turn or the policy was still under review. Why was an independent review not requested then? If that had happened, it would have been completed by now, and we could have gone ahead.

[Jane Ellison]

As Members on both sides of the House reminded me forcefully during the Back-Bench debate earlier this month, new evidence has recently emerged, and we are also coming up to the anniversary of the legislation being passed in Australia, so this is the right time to do this.

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

Will the Minister reassure me that this will not be the thin end of the wedge, and that the Government will not look for evidence to support the contention that selling children sweets in brightly coloured packets contributes to childhood obesity and, as a result, seek to ban such packaging?

[Jane Ellison]

That is a slightly different topic. I know that my hon. Friend feels strongly about these issues, and he will know that, through the Government’s responsibility deal, we are working in voluntary partnership with business to make good progress on public health issues relating to obesity.

[Alex Cunningham (Stockton North) (Lab)]

Now that the Government have started to make this U-turn on standard packaging, will they also back the amendment in the other place that would ban smoking in cars when children are present?

[Jane Ellison]

We are not persuaded that legislation is the right way forward on that matter. There is still a lot of room for education, and I am sure that the hon. Gentleman would like to believe, as I do, that when parents are made aware of the dangers of smoking in cars when children are present, they will wish to desist from doing so.

[Steve Brine (Winchester) (Con)]

I welcome the Minister’s statement. In September, I visited the Cancer Research UK centre in Southampton to meet my constituent, Tim Underwood, who leads the oesophageal cancer team there. I suspect that the team will be pleased to hear today’s announcement. Will she assure us that, whatever happens at the end of this process, it will remain the Government’s intention resolutely to prevent young people from picking up this habit that kills in the first place?

[Jane Ellison]

Preventing children from smoking is a major priority for the Department of Health and for the Government, and my hon. Friend is absolutely right to suggest that, irrespective of this piece of policy—important though it has the potential to be—the Government are committed to spending significant amounts on public health campaigns and all the other mechanisms available to us to prevent children from smoking.

[Bill Esterson (Sefton Central) (Lab)]

The Minister keeps mentioning the evidence, but the evidence from Australia is overwhelmingly in favour of plain packaging for cigarettes, so why on earth is she waiting? She should bring in plain packaging now to save children from taking up smoking in the first place.

[Jane Ellison]

The hon. Gentleman refers to the evidence, as have other Members. That is exactly why we have asked someone who, with all due respect, is far more expert than he is or I am to look at the evidence and report to the Government swiftly. That will be a productive way forward. It will ensure that, however the Government decide to proceed, we do so in a way that is robust.

[Lorely Burt (Solihull) (LD)]

Does my hon. Friend agree with the EU majority decision that e-cigarettes should not come under the same regulations as medicines? Does she agree that they should be subject to the same marketing controls as cigarettes, whether that involves plain packaging or not?

[Jane Ellison]

The hon. Lady will know that that is the subject of negotiations, so I hope that she will forgive me if I do not comment on it further at this point.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Far from doing nothing in 13 years, the Labour Government legislated to ban smoking in public places. We said that we would need convincing evidence on plain packaging, and this Government’s own consultation has now provided that convincing evidence. What further evidence does the Minister think the review will uncover?

[Jane Ellison]

As I have said, I am not going to pre-empt the findings of the independent review, and I am sure that Members understand why it is important not to do so. It will be good to have a review of the evidence, and I am sure that the hon. Gentleman will share my confidence that the review will be extremely worth while and useful.

[Robert Halfon (Harlow) (Con)]

I confess that I enjoyed a Henri Wintermans Café Crème after breakfast this morning on the way to work. Does my hon. Friend agree that there are many lawful smokers who want to be sure what they are buying? Has she made any assessment of the effect that plain packaging could have on the black market by making it easier to smuggle counterfeit cigarettes?

--- Later in debate ---

[Jane Ellison]

That point came up during the consultation. To be clear, the review that we have asked Sir Cyril to undertake will cover the public health aspects of the policy. It will then be for Ministers to decide how to take forward the findings of the review and to make policy. The points that my hon. Friend and others have made will be borne in mind at that time.

[John Pugh (Southport) (LD)]

The Minister says that this is a complex matter, but I am a bit puzzled. What exactly is the downside of plain packaging, apart from fewer fags being sold?

[Philip Davies]

A left-wing, nanny state wallah like you would not understand.

[Jane Ellison]

The hon. Member for Southport (John Pugh) may be aware that there has been a challenge to the policy in Australia, so it is important to proceed in a measured and evidence-based way.

[Mr Speaker]

The sedentary remarks of the hon. Member for Shipley (Philip Davies) are almost as entertaining as those he makes when he is on his feet.

[Mr Peter Bone (Wellingborough) (Con)]

I sometimes feel sorry for the Government. We have an excellent Minister at the Dispatch Box who is listening to Parliament and asking for an independent report, yet she gets Members of Parliament complaining about that. That is ridiculous. I think I understood her to say that if regulation is to be introduced, it will be done by statutory instrument. I hope that the Government are not going to proceed in that way, because we can only reject or approve a statutory instrument—we cannot amend it. Will she think again on that point?

[Jane Ellison]

I thank my hon. Friend for his support. The exact technicalities are still under review. As I said, we are strongly minded to use the affirmative procedure, but that matter is not completely resolved. Of course, we do have a little time, because we expect the review to report in March 2014.

[Mr Philip Hollobone (Kettering) (Con)]

What steps are being undertaken with other Departments to enforce against the illegal sale of tobacco products to young people?

[Jane Ellison]

My hon. Friend is right to draw attention to the issue. He may or may not know that when I responded to a recent Adjournment debate that was secured by the hon. Member for Solihull (Lorely Burt), we discussed that point, and I invited trading standards officers to submit evidence on the enforceability of just those sorts of measures. I will be interested to hear from Members and others about how they think those might work.

[Mr Speaker]

I thank the Minister, in particular, and colleagues for being so succinct.

Tobacco Control

Jane Ellison Excerpts

Thursday 28th November 2013 Written Statements

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

I am today announcing that we have asked Sir Cyril Chantler to carry out an independent review of the public health evidence on standardised packaging of tobacco products.

Tobacco use is a significant public health challenge. Our evidence-based tobacco control strategies play an essential part in delivering the Government’s continued commitment to reduce the number of people in this country who are dying prematurely.

It is important to explore avenues that have the potential to contribute to this long-standing aim. In July we said that we would keep the policy of standardised packaging under review as we examine the emerging evidence. As part of this ongoing work we have therefore commissioned a review with the following terms of reference:

To give advice to the Secretary of State for Health, taking into account existing and any fresh evidence, as to whether or not the introduction of standardised packaging is likely to have an effect on public health (and what any effect might be), in particular in relation to the health of children. It will be a matter for the chair to determine how he undertakes this review and he is free to draw evidence from whatever source he considers necessary and appropriate.

The review will report by March 2014.

It will be an independent review, with advice to the Secretary of State contained in a report. An independent secretariat will be appointed by the chair, who will set out the method of how he will conduct the review in more detail in due course. The secretariat will be wholly accountable to the chair, and it will be for the chair to guide and task them in their work as he sees fit.

We intend to reach a decision on standardised tobacco packaging once Sir Cyril has made his report. 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 proceed, including public health benefit.

The Government also intend to take advantage of the opportunity offered by the Children and Families Bill, which is currently being considered in the House of Lords, to table a Government amendment to take enabling powers now which would allow regulations to be made to introduce standardised tobacco packaging later, if it is decided to proceed with this policy.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 26th November 2013 Commons Chamber

[Glyn Davies (Montgomeryshire) (Con)]

11. What discussions he has had with NHS hospital trusts on taking account of the interests of patients in Wales who depend on hospitals in England.

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

As my hon. Friend knows, officials from NHS England frequently meet the Welsh Government to discuss the issue of health care provided in England for Welsh patients. He will know that NHS England has a duty to consider the likely impact of any commissioning decision it makes on people who reside in an area of Wales that is close to the border.

[Glyn Davies]

Does my hon. Friend agree that when commissioners for NHS hospital trusts in Shropshire are considering where to locate services, account must be taken of the needs of patients in Montgomeryshire, the vast majority of whom are dependent on Shropshire hospitals, particularly the Royal Shrewsbury hospital?

[Jane Ellison]

My hon. Friend is absolutely right to highlight the fact that cross-border health care is an area of great concern. There is a requirement to take note, as he says. The work is ongoing and I am happy to have those discussions with him.

[Hywel Williams (Arfon) (PC)]

It is not only patients local to the border who access treatment in England. Patients from as much as 90 or 100 miles away in the west of Wales—for example, young babies—access treatment on the Wirral. However, does the Minister agree that it is in the interests of hospital trusts in England to take patients from Wales, as it has been demonstrated that they often make the difference between a viable and non-viable service?

[Jane Ellison]

Of course, it is possible, depending on clinical need, for clinicians to recommend treatment in England. The hon. Gentleman knows that there are ongoing discussions, some of which are quite difficult, but the intention is obviously to ensure that we get the best health care for everyone. I would urge the Welsh Government, in particular, to consider ways in which they can review how arrangements are made in Wales. There have been calls for a review of hospitals in Wales, not least the one today from the Royal College of Surgeons.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

Hospitals such as the Royal Shrewsbury hospital, dealing with patients from both sides of the border, have historically incurred additional administration costs in dealing with the two separate authorities. What work is the Minister doing to find out what the costs are and whether she can help meet them in the future?

[Jane Ellison]

We are aware of those additional costs, and I know that my hon. Friend recently met my right hon. and noble Friend the Under-Secretary of State for Health. We are very conscious of those costs and of the difficult decisions. It is the subject of ongoing negotiation between the Welsh Government and NHS England.

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

12. What lessons he has learnt from the findings of the report of Professor Timothy Briggs on improving the orthopaedic surgery published in September 2012, entitled “Getting it right first time”.

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

In 2012 Ministers welcomed the publication of the report and acknowledged that its recommendations could help build on improvements in orthopaedic care. I believe that my right hon. Friend the Secretary of State met Professor Briggs.

NHS England is now responsible for securing high-quality outcomes. Peter Kay, the national clinical director for musculoskeletal services, is also supportive of the report’s findings.

[Andrew Selous]

Growing numbers of orthopaedic consultants accept that collaboration across networks of hospitals could improve the quality of orthopaedic care, which frankly has not always been good enough in the past. Will my hon. Friend accept the recommendations of the “Getting it right first time” report?

[Jane Ellison]

We know that NHS England has welcomed Professor Briggs’ recommendations. They are contributing to a substantial body of work on orthopaedics, with the sole objective of improving outcomes for patients. I am sure that my hon. Friend will welcome the fact that this year for the first time data about surgical outcomes have been published at both hospital and consultant level, with the objective of driving up quality and supporting patient choice.

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

14. What steps he has taken in response to the findings of the report by the Chief Medical Officer, “Our Children Deserve Better: Prevention Pays”, published in October 2013.

--- Later in debate ---

[David Mowat (Warrington South) (Con)]

16. What recent consideration he has given to banning the use of NHS funds for provision of alternative therapies.

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

As my hon. Friend will know, the provision of alternative and complementary therapies is decided by clinical commissioning groups, which obviously must take into account local health needs and priorities.

[David Mowat]

I thank the Minister for that answer. Many parts of the NHS are under intense, relentless financial pressure, so how can it be right that we spend millions of pounds a year on remedies that have no scientific basis, other than through their placebo effect?

[Jane Ellison]

My hon. Friend is quite right to highlight that value for money is very important. It is for local commissioners, not the Department, to decide how funding is spent to meet the needs of the populations whom they serve, but crucially, clinical commissioning groups are responsible for achieving value for money as regards the services that they commission, as well as for delivering improvements in the quality of care, and better outcomes for patients.

[Simon Danczuk (Rochdale) (Lab)]

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

--- Later in debate ---

[Jonathan Evans (Cardiff North) (Con)]

T7. Given the more than 30% increase in the past five years in the cost to the NHS of prescribing stoma appliances, what action is the Minister taking to promote training for stoma patients in alternative management techniques, such as colostomy irrigation?

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

My hon. Friend may know that specialist NHS stoma nurses offer a range of support and advice to help patients adapt to life with a colostomy, and this advice can cover colostomy irrigation, if appropriate. This is supplemented with patient literature on colostomy, which is widely available in the NHS.

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

Further to question 15, I understand that responsibility for walk-in centres has been devolved. Why does that necessarily prevent central Government from collecting those figures centrally? It is pretty staggering that a Minister should turn up and say, “Well, the decisions are made locally so we just don’t bother finding out.”

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

T8. The Secretary of State is well aware that the all-party group on cancer has campaigned long and hard for the monitoring of one and five-year survival rates as a means of promoting earlier diagnosis, cancer’s magic key. Is he confident, though, that the mechanisms are sufficient to ensure that those clinical commissioning groups that are underperforming in relation to their one and five-year survival rates will face concrete action to improve earlier diagnosis, given the recent OECD report suggesting that 10,000 lives a year could be saved in this country if we matched European average survival rates?

[Jane Ellison]

My hon. Friend is right to champion early diagnosis and he has raised these issues in the House on many occasions and with me. Improving cancer survival is a key priority for this Government. We aim to save an additional 5,000 lives each year by 2014-15. Clinical commissioning groups have a duty on early diagnosis. It is part of their crucial outcomes indicators set, and they will be held to account for that because we cannot deliver those improvements in cancer outcomes without early diagnosis.

[Helen Jones (Warrington North) (Lab)]

When the Government decided to slash council budgets and, therefore, adult social services, did they know what effect that would have on hospitals, particularly A and E, and decide to carry on anyway, in which case they are too callous to be running the NHS, or did they not know, in which case they are too stupid to be running the NHS?

--- Later in debate ---

[Stuart Andrew (Pudsey) (Con)]

The new review into children’s heart units feels very different, and I am pleased that everything is on the table. However, I was concerned to learn that the task and finish group has decided to meet in private. Given the group’s importance in decision making, and remembering the experience of the Safe and Sustainable review, does my hon. Friend agree that, in the interests of openness and confidence, the group should meet in public?

[Jane Ellison]

My hon. Friend has been a great and sustained champion of that cause in this House and in speaking up for his local hospital and his constituents. NHS England is clear that all substantive decisions on the new review on congenital heart disease will be made by its full board, which meets in public, so there is no question of a major decision being taken in private. With regard to the sub-groups, including the one he mentioned, their papers and minutes are all published, but for practical reasons none of them meets in public, and that is normal practice. However, all major decisions will be taken in public by the full board.

Tobacco Packaging

Jane Ellison Excerpts

Thursday 7th November 2013 Commons Chamber

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

It is a genuine pleasure to respond to this Backbench Business Committee debate. I was a member of the Committee when my hon. Friend the Member for Harrow East (Bob Blackman), who initiated the debate, made a bid for it, although at the time I did not expect to respond to it, so I am in an interesting position. My hon. Friend made a great bid and we have had a terrific debate. I am grateful for the contributions from all hon. Members.

It is good that we are debating this important issue now. It has been helpful for me, as a new Minister, to hear arguments put so eloquently from across the House, and I will try to respond to some of the specific points made and to set out the Government’s position. I recognise that I will disappoint some people, but I will try to give a flavour of the Government’s current position and mention some of the important measures we are taking on tobacco control.

As many hon. Members have said, tobacco use remains one of our most significant public health challenges. For me as a new Minister, over the past month briefing after briefing and chart after chart have illustrated how important and what a significant public health challenge tobacco control is. There is no question in my mind that it is an essential aspect of any Government’s commitment to reduce the number of people dying prematurely in our country, and it is essential to promoting the health and well-being of children. A number of speakers have made the point that two thirds of smokers say they were regular smokers before they became adults. Many have spoken about adult choice, but we must recognise that by the time many people are addicted to smoking, they are already an adult and the addiction started as a child.

As hon. Members know, the Government have decided to wait before deciding on standardised packaging, but I do not recognise some of the time frames that people have ascribed to our position. I said that during Health questions, and I repeat that the policy remains under active consideration.

Interesting points have been raised in the debate, including about emerging evidence from Australia and studies carried out elsewhere, some of which the shadow Minister referred to in her contribution. Evidence and information are emerging all the time, and we want to spend more time assimilating that information and considering the likely effect that standardised packaging would have in this country. It is sensible and sound politics, particularly when dealing with a controversial area and a litigious industry, to show the stages by which we reach a decision, and I am sure that Members appreciate that we must be able to evidence that decision.

[Alex Cunningham]

If we are going to allow another half a million young people to take up smoking over the next three years while the Government decide whether to introduce plain packaging, what measures will the Minister take to hit the big numbers that we know plain packaging—or standardised packaging—could affect?

[Jane Ellison]

I am glad that the hon. Gentleman corrected himself, because it is important that we do not call it plain packaging—it is standardised. I hear his point and will move on to address some of the specific issues. Many people have cited such numbers.

[Mr Barron]

If the other place legislated to introduce standardised packaging, we would be able to have a vote in this Chamber. May we have a free vote, just as the current Prime Minister argued for a free vote on smoking in public places?

[Jane Ellison]

The Government are following discussions in another place closely. Beyond that, I am not able to comment in this debate, but we are well aware of those discussions and Ministers are participating in them.

Australia introduced standardised packaging in December 2012, and New Zealand and the Republic of Ireland have committed to do that. In addition, other academic studies are emerging about the effects of that policy.

The UK has a long and respected tobacco control tradition internationally, although at times in this debate it has been possible to miss that point. Under successive Governments the UK’s record has been good, and we will continue to implement our existing plan to reduce smoking rates while keeping the policy of standardised packaging under active review. The tobacco control plan for England sets out national ambitions to reduce smoking prevalence among adults, young people and pregnant mothers. As the plan makes clear, to be effective, tobacco control needs comprehensive action on a range of fronts.

I will talk a little more about this in the context of devolved powers of public health to local government, but there is a slight danger that by focusing only on one aspect of tobacco control, we forget that there are other—and indeed more—things that we could do. Even if it was possible to say today that we would do this tomorrow, we would still be debating how we could effectively control tobacco and stop children taking up smoking. As various hon. Members have said, including the right hon. Member for Rother Valley (Mr Barron), this is an ongoing battle to protect children’s health.

[Barbara Keeley]

Is the Minister concerned about the fact that between April 2012 and March 2013, there was an 11% decline in the number of people setting a quit date? We are concerned about children, but if they are still watching their parents smoking, it is more likely that they will start. I hope that she is disturbed by the fact that the numbers setting out to quit are falling—it is the first fall since 2008-09. The Minister should address that point.

[Jane Ellison]

We are aware of that, but smoking in this country has dipped below 20% for the first time ever. I am aware of the hon. Lady’s concerns and I shall talk a bit about some of the public health campaigns and the new opportunities, not just for the Government but for local government and individual Members, on tobacco control policy.

As our plan makes clear, effective tobacco control needs comprehensive action on many fronts. The Government are taking action nationally. We are committed to completing the implementation of legislation to end the display of tobacco in shops. Since 2012, supermarkets can no longer openly display tobacco. In 2015 all shops will need to take tobacco off view. Tobacco can no longer be sold from vending machines, which has stopped many young people under 18 accessing smoking.

I do not want to downplay the importance of this policy—we are conscious that it could make an important contribution—but we can do many other things. The reasons why children, in particular, take up smoking are very complex, and are to do with family and social circumstances. One policy alone will not address that. Local authorities have a vital role to play, which is why we have given local government responsibility for public health backed by large ring-fenced budgets—more than £5.4 billion in the next two years. I encourage all hon. Members who have participated in today’s debate to ask tough questions of people locally. I hope that they are talking to their public health directors, health and wellbeing boards and clinical commissioning groups about where tobacco control sits in the armoury of local government. That is why this power has been devolved. The local insight and innovation made possible by that policy will help us to tackle tobacco use at a local level as well as through policies that the Government can put in place.

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

I congratulate the Minister on her obvious grasp of the subject. She is right to say that this will be a continuing debate beyond the issue of standardised packaging. Does she agree, however, that an increasing welter of evidence suggests that standardised packaging would help in the fight against smoking, particularly among the young? Will she give an assurance that the Government will increase the urgency of their review of the situation, and especially of the growing evidence in favour of standardised packaging?

[Jane Ellison]

I can give my hon. Friend that commitment and I am giving this my urgent consideration. It is impossible to sit through a debate such as today’s, and hear the passion expressed by many hon. Members on both sides of the House, without going away, as the public health Minister, to give it one’s serious, urgent and active consideration.

I have laid out a little challenge to hon. Members to take this issue up at the local level. I appreciate that it is right that I should be held to account on this issue, but in the new world of devolved public health powers, I urge hon. Members to have those conversations with their health and wellbeing boards and with public health directors. In areas of the country where smoking prevalence among children is a difficult issue—some examples have been cited in the debate—our belief is that by devolving some of the power and, importantly, the ring-fenced budget to local authorities who know their communities best, they can begin to tackle the problem with great urgency and added innovation in a way that central Government cannot.

Public Health England has an important part to play. As a new, dedicated, professional public health service, it will be available to advise on local action to promote public health and encourage behaviour change to help people live healthier lives. It will put expert advice at the disposal of local authorities.

[Alex Cunningham]

The Minister has outlined some good ideas, but will she say whether she would support a free vote on this issue on the Floor of the House?

--- Later in debate ---

[Jane Ellison]

With respect, I am outlining these other aspects to underline the point that one policy is not sufficient to tackle this problem. There is a slight danger of believing that the approach is a silver bullet. It is an important policy that has been given serious consideration, and the case has been made for it, but we would still be debating how to stop children smoking, even if it were introduced.

[Alex Cunningham]

What about a free vote?

[Jane Ellison]

I will move on as I have tried to respond to the hon. Gentleman’s point.

Our local stop smoking services are among the best in the world. The fact is that smokers trying to quit do better if they use them. Research has found that

“English stop smoking services have had an increasing impact in helping smokers to stop in their first 10 years of operation”—

although I hear the challenge that has been made on the recent drop—

“and have successfully reached disadvantaged groups.”

The latter are obviously particularly important from a public health point of view.

This year, Public Health England has launched a new dedicated youth marketing programme. This marketing strategy aims at discouraging a range of risk behaviours, including tobacco use, among our young people. In this financial year, that is worth more than £1.5 million.

[Barbara Keeley]

The Minister does not seem to be saying what the Government will do about the decline in quitting—the fact that stop smoking services are not reaching people to the extent that they should be. Does that concern her, and is she going to do something about it?

[Jane Ellison]

That is something that I will look at carefully, but I point out to the hon. Lady that obviously this issue now falls under the remit of Public Health England. It will be on my agenda for the next meeting with the chief executive, and I will write to her after I have had that discussion, if that would be helpful.

[Jake Berry]

Does the Minister think that there is any connection between a record low number of people smoking and relatively few people contacting the quitting helpline? Does she think that we might be down to the core of people who actually choose to smoke and do not want to give up?

[Jane Ellison]

I hope that my hon. Friend will forgive me, but after four weeks in this job, I do not know that. I am not prepared to speculate on such an important issue, but I am happy to come back to him with more detail when we have given it further consideration.

Through Public Health England, we will continue to run national marketing campaigns, such as the hard-hitting health harms “Mutation” campaign, in the new year. I am sure that no one who saw that can forget the images in the campaign, which reminded smokers about the physical damage caused by smoking. We have just finished Stoptober—we have now moved on to Movember—a new approach launched in 2012 challenging smokers to stop for 28 days, all at the same time. We know that that can be a key turning point if people want to quit for ever.

The Government will continue to play their part. To discourage smoking, we have some of the highest-priced tobacco in Europe and we will carry on with our high tax policy. That is coupled with an effective strategy, led by HMRC, to reduce the illicit tobacco trade, which has been mentioned in the debate. However, we must not forget the great progress that has been made. As I said, fewer than 20% of adults in England now smoke, compared with 39% in 1980. However, we want that number to fall, and there is no room for complacency.

On standardised packaging and illicit tobacco, some 21% of the UK’s cigarette market was illicit in 2000. Latest estimates from HMRC for 2012-13 suggest that that proportion has dropped to around 9%. Enforcement is having a real impact on illicit tobacco and we want to see the figure fall still further. The Government, working with other interested parties, are trying to drive down the size of the illicit tobacco market through improved enforcement and reducing opportunities for fraud. I am grateful to those hon. Members who have made the point that if we were to adopt standardised packaging, it would not mean plain packaging. Approaches such as anti-smuggling devices could be built into standardised packaging, if we choose to go down that route.

A few hon. Members were concerned about the possible impact of the policy on jobs. Obviously, the Government need to consider all aspects of the policy, including any impact on employment, alongside possible health benefits. Others made a point about small retailers, and some might have been present for a recent late-night Adjournment debate to which I responded that was led by the hon. Member for Solihull (Lorely Burt), who is not in the Chamber. She made some very interesting points, especially by citing evidence from a small retailer who told her that tobacco constituted 14% of his profits, but 50% of his turnover, and who was actively trying to diversify his business into areas that yielded greater profit.

I want to place on record our position on tobacco industry lobbying, which several Members mentioned. We are well aware that the tobacco industry opposes the introduction of standardised packaging, as has been the case on many other tobacco control policies, and we are equally aware of our commitment to protect public health policy on tobacco control from the commercial and other vested interests of the tobacco industry. We encourage tobacco companies to respond in writing to consultations so that we can understand and take account of their views about the implications of policy options. Members will fully appreciate why we have to take such steps properly to inform a robust public policy in this area.

The right hon. Member for Sutton and Cheam (Paul Burstow)—he is not in the Chamber, but I know he had a long-standing previous engagement—made a point about the proposed tracking and tracing scheme in the EU directive that is under negotiation. We are considering those details, particularly in the light of our obligations under the framework convention on tobacco control, to which reference has been made.

I reiterate that this policy is under active consideration, but I want hon. Members to reflect on what else we can do.

[Dame Angela Watkinson]

When looking at future policy development, will the Minister pay greater attention to how parents can be encouraged to take responsibility for the behaviour of their young children and how much money they have to spend unsupervised? Such money obviously gives children access to tobacco, but it is in parents’ hands to control it.

[Jane Ellison]

I thank my hon. Friend for that important point. We know that many children who start smoking are within a family who smoke and that they are sometimes given cigarettes by parents or other family members and friends. I will of course consider her very relevant point.

I reiterate that there are many things we can do, but we are actively considering whether standardised packaging could make an important contribution to our overall policy on tobacco control. I have noted the strength of feeling on both sides of the House. This has been a good debate, and an informative one for me as a new Minister. As I have said, I am actively considering the matter, and today’s powerful contributions have spurred me to give further and urgent consideration to this important public health issue.

Cancer Patient Experience

Jane Ellison Excerpts

Wednesday 30th October 2013 Westminster Hall

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

Thank you, Mr Owen. It is a pleasure to serve under your chairmanship.

I congratulate my hon. Friend the Member for Hertsmere (Mr Clappison) on securing this debate. I am conscious that I am still relatively new to my post—I am in my fourth week—so if I am unable to respond in total detail to some of the points raised, I will undertake to get back to the relevant hon. Members.

This has been a very good debate. Many extremely constructive points have been made, and there have been some thoughtful contributions. Members, some of whom have not been able to stay for the end, have brought great insight and experience to the topic.

Cancer patient experience is close to our hearts, and I echo the tributes paid to NHS staff and, particularly, to the charities that campaign in this area. We have all taken part in moonwalks and Macmillan Cancer Support fundraisers or gone round at the back of the race for life year after year talking to cancer survivors and people running or walking with the names of loved ones on their chests, and we know what amazing work those charities do, particularly on highlighting patient experience.

In England, each year more than 250,000 people receive a cancer diagnosis. As we have heard this morning, being diagnosed with cancer can be a traumatic experience. Like the shadow Minister, a dear friend of mine has just had that experience, so I am going on that journey with my friend to understand how she will be cared for and treated as she goes through what I hope will be a full recovery.

We know that receiving personal care that is responsive to people’s needs is vital. The Government have committed to making England a global leader in producing great cancer outcomes. We are making strides, but we know there is further to go. We are improving access to treatments, including investing £750 million during this Parliament, and we are strongly committed to saving an additional 5,000 lives by 2015.

The cancer outcomes strategy remains at the core of what we are doing and what we hold the NHS to account for in terms of delivering. However, if the NHS is to deliver high-quality care, patients’ voices and experiences are vital, and I could not agree more with what everyone has said about the end-to-end experience of care being important and a big part of recovery.

My hon. Friend rightly asked that the NHS give parity of esteem to the patient experience, alongside patient safety and clinical effectiveness. I agree, and through the mandate we have asked NHS England to deliver continued improvement in patients’ experience of care. Domain 4, which is one of the key areas of the NHS outcomes framework, is

“Ensuring that people have a positive experience of care”.

I reassure my hon. Friend that that is of equal importance to the other key areas.

[Mr Clappison]

I was remiss in not welcoming the Minister to her post. I welcome her most warmly, and I am sure she will do an excellent job. Will she take on board the fundamental plea made by Macmillan Cancer Support and echoed in the debate that the patient experience be put at the heart of the inspection process and of the assessment of different NHS organisations? Will she ensure that that is made a real priority?

[Jane Ellison]

Absolutely, and I will talk a little about some of the ways in which that will be done, but I would make the point that the Secretary of State has made this an absolute priority. He could not have been clearer recently about the priority that the Government and he personally put on the patient experience. We have never given such high-profile attention to talking about the patient experience and patient care. I hope that gives some reassurance, but I will talk later about some specifics.

In the same vein, let me pick up some of the shadow Minister’s interesting points. I was interested in some of the initiatives she mentioned. Again, they all feed into the idea of putting patient care and the patient experience absolutely at the heart of things. I certainly undertake to look at some of the specific local examples she highlighted.

To drive a good patient experience, we must listen to patients’ voices. In December 2010, the Government published the first national cancer patient experience survey report. The survey was the first cancer patient survey to take place for six years, the first to involve patients with all types of cancer and the first national survey explicitly to use the word “cancer”. The survey revealed that, while there had been substantial improvements in the patient experience since 2000, there are still unacceptable variations in the quality of care people receive, as hon. Members have highlighted.

To drive improvement locally, reports were produced for individual trusts. This is where the transparency agenda the Government set such store by is really important. The data are openly available and published, and all of us—not just people in the NHS, but hon. Members, local councillors and local government—can hold commissioners and providers to account, based on that openly published data at local trust level. Commissioners and providers can be directly challenged and incentivised to improve. Providers can benchmark their performance against each other’s. Quality Health, which provided the survey, also visits poor-performing trusts to discuss their results in detail. A number of those discussions have led to really quick improvements in local outcomes, but there is always more to do.

The cancer outcomes strategy, which we published in January 2011, built on those results. We have acted to improve the patient experience at national level by implementing the cancer information prescriptions programme and expanding the Connected national advanced communications skills programme, which is a bit of a mouthful, but which is essentially about supporting thousands of clinicians to work more effectively with patients, picking up the many issues highlighted by my hon. Friend, the hon. Member for Strangford (Jim Shannon) and others regarding how seemingly small issues and small aspects of communication actually matter an awful lot at an intensely difficult time for patients and their families.

Since 1 April this year, NHS England has been responsible for delivering improvements in the cancer patient experience. That is one reason why I cannot just stand here and make particular commitments. Such debates are, however, useful because they help NHS England to know parliamentarians’ priorities in terms of where it should focus some of its attention.

Building on the work of the 2010 and 2012 patient experience surveys, NHS England published its report on the 2013 survey at the end of August. It showed improvements in many areas and some very positive experiences of aspects of care, including on privacy, being treated with respect and being listened to. Overall, 88% of cancer patients reported their care had been excellent or good, and there were some real highlights. As my hon. Friend highlighted, some of the percentages in key areas were in the 80s and 90s, although we are obviously interested in the areas where we could do better.

It is clear that many trusts acted on the findings between 2010 and 2013, and they are to be congratulated on that. Many have reorganised their pathways and services, retrained staff and created further mechanisms for patients. Cancer charities have been involved in further analysing the data to understand particular aspects of care and particular groups of patients and to create new information for patients, where needed. Much of that has been touched on this morning.

We have also looked at some of the variations in care. The hon. Member for Strangford and others mentioned care plans. Over the past three years, more work has been done on them, but given that only 22% of patients were offered care plans, everyone would acknowledge considerable improvement is still needed.

NHS England has convened a cancer patient experience advisory group to get direct input on priorities for service improvement. The group includes clinicians, experts concerned with cancer care and, crucially, patients. The group’s first meeting has now taken place. It examined the results of the 2013 survey, and actions have been agreed. As a result, NHS Improving Quality will develop a rapid-response programme to visit trusts with poor scores to discuss results and suggest improvements. I hope that gives Members some assurance about the fact that the survey does not just sit there; it is very much being acted on.

NHS England also wants to highlight high-performing trusts and identify best practice. It will put that information into toolkits that other trusts can use to develop better service in response to poor scores. NHS England is also encouraging the use of the Macmillan values-based standard and other patient-led tools, which engage patients and staff in co-creating and measuring some of the things that matter so much with regard to dignity and respect. All organisations involved in delivering care are urged to look at the survey and take it extremely seriously.

Time is a little short, so I will try to answer some of the specific questions raised. First, we recognise that making relational care a priority is important. That includes communication, trusting nurses and all the other things that have been talked about today. Rather than include references in the mandate, we have included important pledges in the NHS constitution, setting out what patients have a right to expect. All NHS services have a duty under the constitution when carrying out their functions, and we have a range of indicators to capture how well the NHS is performing in delivering dignified and personal care.

On the CQC inspection regime, I can reassure my hon. Friend that the CQC has made a commitment to listen and to take the experiences of people using services very much to heart. The new inspection teams include trained members of the public called “experts by experience”. In addition to public listening events, that will be an important way of putting patient experience at the heart of inspections.

A specific question was asked about including secondary breast cancer in the survey. NHS England is trying to ensure the survey catches the needs of all patients and looks across all cancers, but my hon. Friend’s point will have been taken.

I was asked about the future of the survey, including by the shadow Minister. NHS England has confirmed it will be run in 2014. The organisation will then undertake a review of all the surveys it runs. The debate will have highlighted to it the value that so many people place on the survey and the important role it has played in driving improvement. I cannot say whether NHS England will continue it, but I will certainly vividly describe to NHS England how strongly Members feel and what role they think the survey has had in driving change.

My hon. Friend’s last question was about using the survey to improve cancer care, and I have alluded to the ways in which we are trying to do that. In particular, I give him the assurance that the patient experience, putting the patient first and championing their care is absolutely at the heart of what all of us at the Department of Health are doing, taking our lead from the Secretary of State.

I thank my hon. Friend for highlighting the issue, and I echo his words from the start of the debate. I, too, thank the NHS staff and charities that do such amazing work in this area, and I hope hon. Members will continue to debate this important topic.

[Albert Owen (in the Chair)]

I am grateful to the Minister, the sponsor of the debate and all the Members who took part.

Hepatitis C (Haemophiliacs)

Jane Ellison Excerpts

Tuesday 29th October 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dobbin. I thank all hon. Members who have contributed. This is not the first such debate I have sat through; as a member of the Backbench Business Committee, I helped to allocate the Back-Bench debate in 2010. I sat through that whole debate, so I came to this post at least familiar with the strength of feeling on this issue and with the way in which so many hon. Members have worked so hard over many years to represent their affected constituents.

Inevitably, at the beginning of week four of my time in office, I must, I fear, disappoint those hoping for new policy announcements. The debate has perhaps been more useful for me, listening to Members’ contributions, than it will be for those listening to me. It has been incredibly helpful to hear the many comments that have been made, and I will try to answer as many as I can. If I do not have the knowledge or time to answer any points, I undertake to write to hon. Members about them. Let me also say straight away that I am more than happy to have the meetings that have been asked for. I have some thoughts about how we can get the most out of them and make sure they give us a platform on which to move forward.

I thank all those who have contributed to the debate. I congratulate the right hon. Member for Wythenshawe and Sale East (Paul Goggins) on securing it on behalf of those with haemophilia who were, sadly, infected with hepatitis C as a result of treatment with blood products before 1985. Many Members have talked about the impact on constituents, and that has come home very forcefully to me.

Members have given me much to reflect on, but I would like to take some time to lay out the current position. Everyone who has spoken has said they would prefer us to be somewhere different, but it is relevant to lay out the practical support that has been offered to date and where successive Governments have got to. Indeed, the presence of a former Secretary of State at the beginning of the debate rather underlined the fact that successive Governments have struggled to achieve a final resolution. I very much welcome the cross-party tone of the debate and the shadow Minister’s commitment to work with the Government.

The Government are fully committed to supporting affected haemophilia patients, by ensuring that haemophilia and hepatology services in the NHS are as good as possible and by providing direct financial assistance. There is the prospect of some good new treatments for hepatitis C, with fewer side effects than the current treatment and less of an impact on day-to-day life. We all welcome that, but I recognise that although these new therapies may treat the infection, they may not alleviate all the associated health effects. For many of those affected by hepatitis C, there is a continuing need for support.

In January 2011, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), then the Secretary of State for Health, informed the House that we would provide additional support for those affected. It is important to remember that that support was available to not just haemophilia patients, but any patient infected with HIV or hepatitis C by an NHS-supplied blood transfusion before 1991.

Although many who have spoken this morning are seeking a longer-term resolution, let me quickly go through the additional practical support that the Government have put in place. We linked the annual payment for HIV awarded by the previous Government to inflation, so it does not lessen in value. We introduced a similar payment for those most seriously affected by hepatitis C, and we increased the value of the lump sum for that group to £50,000. I very much hear the concerns some Members expressed about the divisiveness of separating different groups, but the lump sum for that group was nevertheless increased substantially.

A discretionary payment mechanism was also introduced to meet specific financial needs for all those infected with, or affected by, hepatitis C. None of those affected now have to pay for their prescriptions. In addition, £300,000 has been made available over a three-year period to provide counselling services to those affected by hepatitis C. All those payments are tax-free and are disregarded for the purposes of benefits and determining eligibility for social care services.

To pick up the point about the exemption regarding employment and support allowance, one of my predecessors made representations in that regard. The issue is not in my remit, and the decision is obviously for the Department for Work and Pensions, but I certainly undertake to raise the issue as a result of the debate and to revisit it with the appropriate DWP Minister.

A combination of fixed and discretionary payments was previously decided on as the best way of ensuring greater financial certainty for people facing the most severe consequences from infection. The idea was that it would retain a degree of flexibility so that assistance could be tailored to an individual’s personal situation, and the debate has clearly shown how different the situations of hon. Members’ constituents are.

The set-up put in place could also complement the other support people might receive, such as through the benefits system. The flexibility that gave was thought to be important, because an individual’s needs vary significantly. However, I know there is concern among haemophilia patients and others infected with hepatitis C that there is insufficient support—this has been the focus of much of the comment today—for those who have developed chronic infection, particularly Skipton Fund stage 1 beneficiaries, on whose behalf many Members have eloquently spoken.

The scientific and clinical advice that the Department received during the review did not support the case for making regular annual payments to all those infected with hepatitis C. I am advised that some people with chronic hepatitis C infection clear the virus, and that those numbers could increase with the new therapies that are emerging. Decisions on financial support have been informed by the evidence, where that is available.

The spectrum of possible consequences of hepatitis C infection appears to be wide-ranging, and, in many cases, causal association has not been established. That has been a problem in the past. Ministers were grateful for the advice of experts on that area—a complex one, obviously—ahead of the 2010 review. Following the review, the then Minister with responsibility for public health, my hon. Friend the Member for Guildford (Anne Milton), promised that new evidence would be assessed regularly. That challenge was put to me several times in the debate. Those assessments will help with future decisions whether to make changes to the payments system.

The advisory group on hepatitis recently completed its first assessment of the clinical and scientific evidence published since the 2010 review, and the Department has sought further detail from the group on some of the information in the report. Some people affected by hepatitis C dispute the expert interpretation of the evidence, so Department of Health officials have commissioned a systematic review of the scientific and clinical evidence on the natural history of hepatitis C. That will report in autumn 2014. I shall raise with officials the question whether that could be brought forward. An earlier report could be useful in the light of other events.

We hope that, in addition to providing a definitive analysis of the available evidence, the systematic review will be of value for service planning in the NHS. Several hon. Members have referred to other parts of the NHS and the provision made for continuing care, so I think that the exercise has additional value. The hon. Member for Kingston upon Hull North (Diana Johnson) made the case, and although I cannot respond to her detailed points and questions about some distinctions that are made, we are aware of the dispute. I undertake to write to her if I can respond in more detail.

Several trusts have been mentioned this morning, but I understand that beneficiaries of the Caxton Foundation have not always found it responsive to their needs. This morning, hon. Members have expressed concerns about how it has operated since it was established in 2011. I have seen recent correspondence between campaigners and Caxton Foundation trustees, so I am aware of some of the unhappiness.

I want to give reassurance on one point: the foundation has £2 million for payments in England and has not yet spent all the money available to it. If it needs more money, it can make a business case to the Department. I understand that it will be doing so this year, and we shall consider that on its merits. It has been working hard to improve its services in the past year and has already established some processes to: reduce the time between application for and payment of straightforward grants, an issue mentioned by several hon. Members in the debate; make payments in the form preferred by the beneficiary; and continue to review where it can improve further.

The hon. Member for Kingston upon Hull North made points about published criteria for the application process, means-testing and specialist doctors. Those are all detailed points that I shall consider, and on which I shall respond to her, but I shall need to make contact with the foundation, because all decisions about payments are made by the trustees. I do not have the power to direct them on how to make decisions, but after the debate I intend to write to remind them that the trust deed enables them to meet any charitable need and not just those that arise directly from an individual’s hepatitis C infection. If hon. Members have other points that they want to raise with me, I shall be happy to put them to the foundation. Clearly, some of those that have been raised this morning are matters for concern.

Several right hon. and hon. Members have talked about public inquiries, or a process of truth and reconciliation. The right hon. Member for Wythenshawe and Sale East made interesting points about different approaches in recent years. I shall reflect carefully on what he said, which I think other right hon. and hon. Members supported, about considering different approaches.

The Department of Health has put relevant facts for the period in question—1970 to 1985—in the public domain, on its website; however, colleagues have called for more material to be put in the public domain, and I shall reflect on that, as well as on what has been said this morning about the different models of truth and reconciliation processes. It was interesting, and it is something for me to reflect on.

[Alistair Burt]

I thank the Minister for what she has said about her openness with respect to the inquiry. I recognise that she is new to her post, but if there is one subject that the Department knows all about, it is the one we are debating. It has all the information it needs.

I do not expect the Prime Minister to come to a definitive decision at the meeting in a couple of weeks about what he or the Department can do, but I hope that the Department will give a briefing of the right tone, saying that there is an opportunity to settle the matter. Somewhere among the options—either the first or the last—is the one that settles things. It has existed for some time. I ask my hon. Friend to do all she can, using the same spirit as is in her response on opening things up through an inquiry, to point the Prime Minister in that direction, so that as he deliberates on the question and she finds her feet in dealing with it, we can, as the debate has urged, move towards finding a way to close the matter.

[Jane Ellison]

My hon. Friend makes fair points. I spent much of the past three years chasing him in his previous role to put right a continuing historical wrong, and he is right to push me in the same vein. I take his remarks, as I have always taken his advice and thoughts, extremely seriously, and will reflect on them.

I want quickly to mention the Penrose inquiry, of which I am very aware. As the hon. Member for Kingston upon Hull North said, it will report in the spring. Right hon. and hon. Members may be interested to know that the Department of Health has provided all reasonable assistance to Lord Penrose, explaining what documents are held in the Department.

[Mr Tom Clarke]

Will the Minister give way?

[Jane Ellison]

May I continue, as I fear I will not get through the remaining points? I will be happy to speak to the right hon. Gentleman straight after the debate.

We have made available to Lord Penrose any additional documents that he has felt are necessary to his inquiry. While it is continuing, I shall not comment on the inquiry or evidence given to it, but I shall consider whether the Department will make a response. Given that Lord Penrose is considering pre-devolution matters, it is hard to imagine that there will not be implications to which I and the Department shall need to respond. We do not know the exact shape of things, but the inquiry is on my radar, and we shall be considering it.

The hon. Member for Easington (Grahame M. Morris) made a point about specialist hepatitis C nurses. That is the responsibility of NHS England, and I undertake to write to that body to draw its attention to his comments.

I think that I have now covered most of the specific points that I can answer today; unfortunately, I cannot respond to some of the detailed points. There was a challenge about the number of Skipton Fund stage 1 beneficiaries; there are difficulties in identifying the numbers, but we will examine that issue and see whether we can respond in more detail to the challenge given by the hon. Member for Kingston upon Hull North.

Inevitably the debate has been, for me, an invaluable opportunity more to hear some of the arguments than to give specific answers on the important points that colleagues have raised so well on their constituents’ behalf. I am happy to have the meetings that have been suggested.

[Nadhim Zahawi]

Will the Minister give way on that point?

[Jane Ellison]

If my hon. Friend will forgive me, I need to conclude.

I have heard the big challenge that I have been set this morning. It is one that many of my distinguished predecessors have been set, and I do not underestimate its nature or scale. There is, and has been for a long time, great unhappiness about this topic; many people have wrestled with it. I assure right hon. and hon. Members that I will do my best to rise to the challenge.

Tobacco Products Directive

Jane Ellison Excerpts

Monday 28th October 2013 Commons Chamber

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

It is a pleasure to see you in the Chair, Madam Deputy Speaker. I congratulate the hon. Member for Solihull (Lorely Burt) on securing a very timely debate. I enjoyed her thoughtful speech. I suspect that there will be things on which I cannot respond in quite the level of detail she would want, but she has posed all the important and current questions, and I will try to cover as many of them as I can.

We all agree that smoking has an enormously harmful impact on health. Nearly 80,000 people die in England every year from smoking-related illnesses, and the Government are obviously committed to reducing the number of those premature deaths—it is a priority for us—so this is a welcome opportunity to debate tobacco control. I will first take a moment, however, to highlight the UK’s international reputation on tobacco control. Successive Governments have demonstrated a commitment to improving public health through effective tobacco-control policies, and a wide range of measures have contributed to our long-term success. Over the past decade, complementary domestic and EU legislation has contributed to a decline in smoking prevalence among both adults and young people, and in England today the rate of adult smoking prevalence is under 20% for the first time. But clearly we want to keep making progress.

Since the 2001 tobacco products directive, there have been several scientific and international policy developments on tobacco control, an obvious one being the World Health Organisation’s framework convention on tobacco control, to which every EU member state and the European Commission are parties. It has become necessary to update the current directive, however, and that work is ongoing. The revised directive, to which the hon. Lady devoted much of her speech, proposes new requirements across a range of areas, including: the ingredients and emissions of tobacco products; labelling and packaging; product traceability and security features; cross-border distance sales; and novel and nicotine-containing products. The UK Government welcome the revised tobacco products directive and believe that the proposals will be good for public health across Europe, particularly in helping to prevent children from taking up smoking—it is of concern to us all that the vast majority of smokers started before they turned 18.

Our key objectives for the directive include: bigger pictorial health warnings; ending tobacco with characterising flavours, which the hon. Lady described, including menthol and fruit flavours; and requiring nicotine-containing products such as e-cigarettes to be regulated as medicines. During the negotiations, my predecessor and officials worked to secure adequate freedom for member states to introduce domestic policies within the scope of the directive that aim for a higher level of health protection where justified. That is important because we want to retain the freedom to do more if we want to. For example, we need the ability to introduce standardised packaging if we wish to do so.

[Ian Swales (Redcar) (LD)]

Does the Minister share my concern that some packaging is clearly aimed at children—for example, there is one with a Lego-style pattern called “14”—and women, through pastel colours and so on?

[Jane Ellison]

Yes, I share that concern. I saw a presentation only last week with some of those adverts and imagery. As I said, it is a key priority of ours to prevent children and young people from taking up smoking, so anything that might contribute to their taking it up is extremely worrying.

The UK’s support for the general approach agreed at the June Health Council was important in securing the qualified majority needed to avoid losing hard-won negotiated improvements to the text of the directive. Hon. Members will also be aware that the European Parliament has been scrutinising the proposal, and this is obviously where we have had some recent pushback in some areas. We were pleased to see that, on 8 October, the Parliament agreed with the Council and voted to ban packs of cigarettes with fewer than 20 sticks, to increase health warnings to 65% of the front and back of packs, to make pictorial warnings mandatory throughout the EU—as they are already in the UK—and to prohibit characterising flavours.

It should be noted that the Council and the European Parliament rejected the Commission’s proposal to ban slim cigarettes, so that will not form part of the final revised directive. As the new Minister, I made inquiries into why that was the case, and I understand that there was not enough support among EU member states or parliamentarians for such a ban. We in the UK felt that we had to go with the majority to ensure the progress of the directive, as it will be good for public health overall. That was a pragmatic decision. Like the hon. Lady, I believe that this package of measures will help to reduce the number of young people who take up smoking in the UK.

We are currently considering the detailed amendments that the European Parliament would like to make. We were disappointed that the Parliament did not support the regulation of nicotine-containing products as medicines. We believe that the medicines regulatory regime, applied with a light touch, is the best fit for these products. Although I cannot say too much more about that now, we recognise that there is a lively ongoing debate on that subject, and it is one that we are engaged in. It is also vital that we maintain momentum on the overall negotiations over the coming months, so as to finalise the directive as soon as possible.

The hon. Lady devoted some time to considering what the tobacco products directive will mean for small retailers. As a Back Bencher, I was co-chairman of the all-party parliamentary retail group, and I heard many of the same representations that she mentioned. I recognise those concerns. We recognise that some of the proposals will have impacts on tobacco retailers in regard to the range and pack size of tobacco products that they will be able to sell. During the negotiations, as with all of our tobacco control measures, we continue to consider the impacts on all areas of society, including businesses large and small.

I share the hon. Lady’s doubt that introducing the proposed revised directive, if and when agreed, will have any immediate or drastic effect on small retailers. As she said, retailers face an ongoing challenge to diversify the range of products that they sell so that they are not over-dependent on tobacco sales. British retailers are, and always have been, the most innovative in responding to consumer needs and diversifying. The earliest any new requirements would be likely to take effect in the UK would be 2016, meaning that shopkeepers have time to start making changes now.

The hon. Lady made some interesting points on illicit tobacco. Like her, I have heard that some tobacco manufacturers and retailers believe that certain measures in the proposed directive could drive more smokers to purchase illicitly traded tobacco products. We are not aware of any peer-reviewed and published studies that show that that would happen. However, we are not complacent when it comes to counterfeit or non-duty-paid tobacco products in the UK. The illicit tobacco market is complex and decisions by individuals to get involved in purchasing illicit tobacco depend on a range of factors. The proposed directive envisages a Europe-wide tracking and tracing system for tobacco products, the details of which we are still negotiating in Brussels. The European Commission says that that will reduce the amount of illicit products in the EU. Security features against counterfeiting will also allow consumers to verify the legal status of the products. The hon. Lady suggested that we were perhaps paying insufficient attention to the security features on the packaging, because they are often not very plain at all.

I am glad that the hon. Lady has pointed out that the illicit market in cigarettes and roll-your-own has diminished significantly since the launch of the first Government tobacco strategy in 2000, with the mid-point estimate of the tax gap for illicit cigarettes decreasing from 21% in 2000-2001 to 9% in 2012-13, for example, according to Her Majesty’s Revenue and Customs data. The UK’s success in reducing illicit tobacco is in no small part due to successive Governments’ commitment to, and investment in, enforcement, and that remains a key part of our policy. We should also see further progress on illicit tobacco on a global scale when the new framework convention on tobacco control protocol on illicit trade is implemented.

The hon. Lady made some interesting points about proxy purchasing. Obviously that is something that, as a new Minister, I have just begun to look at, and I was glad that she explored some of the arguments. I want to emphasise the valuable contribution that the majority of retailers make to ensuring that legitimate tobacco products are sold according to the law, including by not selling tobacco to people under 18 years old. Retailers get frustrated that we hear only about the occasional instances of poor practice that hit the headlines, and that decent, ordinary retailers do not get any credit for the way in which they uphold the law. I want to place on record my thanks to all those retailers who make strenuous efforts to uphold the law and who do not sell tobacco products to children.

I sympathise with the difficulties retailers face in ensuring that they do not make sales to under-age people. I also understand why some retailers feel that buying tobacco on behalf of a child should be an offence. However, we need to think carefully before introducing a proxy purchasing offence. I understand that the supply of cigarettes to children is a problem, but an offence of proxy purchasing would not necessarily tackle the wider problem of supply.

[Lorely Burt]

Will the Minister tell us whether any lessons have been learned from Scotland’s introduction of an offence of proxy purchasing that might be transferrable to the rest of the UK?

[Jane Ellison]

I was going to say that we are interested to see what will happen in Scotland. It is relatively early days yet, but I am certainly interested in looking at that.

Many children who smoke get their cigarettes from friends and family, and from other children who share cigarettes in parks and playgrounds. An offence of proxy purchasing would be unlikely to stop family members or friends giving cigarettes to young people. The offence was introduced in Scotland, where there is a slightly different regulatory regime, as part of a package of measures. Also, we cannot draw a comparison with alcohol because the regulatory regimes for the sale of alcohol and tobacco are different.

Enforcement of a good deal of tobacco control legislation, including age of sale, is the responsibility of local authority trading standards officers. I have asked questions about the capability of enforcing any such rules introduced. Currently, the Trading Standards Institute, while supportive in principle of any additional measures to tackle under-age access to tobacco, has told us that experience with the alcohol offence shows that there are likely to be difficulties enforcing a proxy purchase offence for tobacco. In practice, it is sometimes difficult to prove the offence and effective enforcement would entail surveillance of shopper and retailer behaviours, which can be time consuming and resource intensive. As I say, I am aware that, since 2011, there has been a proxy purchasing offence in Scotland, which was brought in as one of a number of changes—and we will keep a very close eye on how it has been implemented.

Having heard what the hon. Lady has said tonight, I would encourage Members who have evidence about the potential impact of introducing an offence for proxy purchasing to write to me, particularly if they have feedback from their local trading standards officers about the realistic potential for effective enforcement.

Let me finally touch on a couple of further points that the hon. Lady raised. As I have mentioned, the tobacco products directive does not seek to introduce standardised packaging, but it would allow the UK to proceed with that if we wanted to do so. The Government published a summary of the consultation responses, issued a written statement earlier this year and responded to an urgent question. As the hon. Lady knows and as I mentioned several times at Health questions last week, the Government have decided to wait before making a final decision on standardised packaging. The policy remains under very active consideration and the Government have not ruled out its introduction. We are assessing all the information available to us from Australia and elsewhere. I cannot give the hon. Lady a time frame, but I repeat the fact that the policy is under very active consideration. Some interesting information is coming in from around the world, not just from Australia.

We want member states to have the flexibility to make further progress on domestic tobacco control measures in certain key areas, potentially going beyond the new directive, and we have been helping to shape the final text of article 24 to try to achieve that as an objective. I hope the hon. Lady agrees that it is sensible to see what we can learn from other countries’ experience, but it is hard for me to speculate about what different impacts might be seen and when.

It has been a key strand of the Government’s commitment to reducing the take-up of smoking among young people that the display of tobacco has been prohibited in large shops such as supermarkets since April 2012. That display consultation happened under the previous Government. In April 2015, legislation extending the covering up of tobacco in all retail outlets will come into force.

I have endeavoured to try to cover all the points that the hon. Lady raised in her very thoughtful speech. As she recognises, the topicality of this debate is notable; many of the issues are being debated here and in the European Parliament. We are very much engaged in that debate. I look forward to hearing what other Members think and to hearing further from the hon. Lady on the important subject she has raised.

Question put and agreed to.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 22nd October 2013 Commons Chamber

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

1. If he will bring forward legislative proposals to introduce standardised packaging of tobacco products.

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

As the hon. Gentleman knows, the Government have decided to wait before making a decision on standardised packaging, but the policy remains under active consideration. As he can imagine, I have spent much of the past two weeks, as I get to know my brief, looking at that carefully.

[Gavin Shuker]

I welcome the Minister to her new role. Stirling university’s systematic review of plain packaging concluded that it made cigarettes less attractive and health warnings more effective. Will she give me a straight answer: has she read the report, and if not, why not?

[Jane Ellison]

The straight answer is that I have not read the whole report, but I have read the summary, and it reaches some interesting conclusions. It is one of a number of interesting new pieces of information and evidence coming forward to support decision making in this policy area, and from work going on in countries right around the world as well as Australia.

[Bob Blackman (Harrow East) (Con)]

Three hundred thousand young people a year start smoking, and the tobacco industry’s last vestige of advertising is packaging. Will my hon. Friend, in her new role, look at the proposal very seriously so that we can stop young people starting this terrible habit?

[Jane Ellison]

Stopping children and young people smoking is a priority for us all; all Members care deeply about the health of their constituents. I can certainly assure my hon. Friend that we are looking at that very seriously and assessing all the new information available, not just from this country but from around the world.

[Mr William Bain (Glasgow North East) (Lab)]

The vast weight of not only expert opinion but of public opinion says that standardised packaging cuts the risk of people taking up smoking. When will the Government act on that and ignore what is coming from the vested interests—the lobbyists and the big tobacco companies—as an excuse for doing nothing?

[Jane Ellison]

I can only repeat what I have said: I am a new Minister and I am looking at this very carefully. There are interesting new pieces of information coming through all the time to assist us in making public policy in this area. It is under very active consideration.

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

I welcome the Minister to her new role. Will she, when considering the evidence, look at the fact that the tobacco industry, in its marketing and packaging strategies, is aiming at certain markets, particularly children and young people, whom they want to start smoking? Given her desire to ensure that children do not take up the practice, surely she should act on the evidence by ending the existing packaging arrangements and having standardised packaging so that we can deal with this problem.

[Jane Ellison]

At the risk of repeating myself, all I can say to my right hon. Friend is that I am looking at that very carefully. He is right that we all want to stop children and young people smoking. There is a mass of evidence out there, and we are gaining new evidence and information all the time to help us make decisions. I will continue to look at it as one of the absolute priorities within my brief.

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

I welcome the hon. Lady to her new post. We knew that her predecessor supported standardised cigarette packaging: Labour will table amendments to the Children and Families Bill in the other place and in this place to make that a reality. I have listened to contributions from Members on the Government Benches supporting the policy. Will the Minister tell us today whether she supports standardised packaging?

[Jane Ellison]

We are very aware of the discussions that have been going on in the other place and the amendments that have come forward, in which we have taken considerable interest. At this stage, we want to look at all the available evidence, because new information is coming through, before coming to a view. I take this opportunity to welcome the hon. Lady to her new post.

[Neil Carmichael (Stroud) (Con)]

2. What assessment he has made of the adequacy of provision of maternity services in Gloucestershire.

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[Kerry McCarthy (Bristol East) (Lab)]

7. What recent assessment he has made of the effect of the public health responsibility deal on the products and marketing practices of the fast-food industry.

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

We appreciate the contribution that the fast-food sector is making to the responsibility deal. More than 5,000 fast-food restaurants have labelled calories clearly, which means that more than 70% of high street fast food and takeaway meals are labelled. There is always more to do and we are keen to take this forward. Progress has been made through voluntary responsibility deals with industry.

[Kerry McCarthy]

I welcome the Minister to her new post. I do not suppose she has yet had time to look at the authoritative international study of asthma and allergies in childhood, which shows a clear link between the consumption of fast food and asthma and allergies. The Government, however, have refused to discuss that with the public health responsibility partners. When will the Government start to take public health seriously and hold companies to account?

[Jane Ellison]

The idea that the Government do not take responsibility for public health seriously is ridiculous. Public health will never be improved just from Whitehall. The work has to be done together, among local government—which is keen and has been given the tools and resources—central Government, business and industry. Such long-term partnership working to improve the public’s health can only be done together. I will look at the hon. Lady’s specific point, but I reject the idea that the Government are not taking this issue seriously—far from it.

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

Will the Minister confirm that as far as fast food is concerned, personal responsibility will not be replaced by Government-imposed nanny state regulation?

[Jane Ellison]

It is good as a Minister to hear the phrase “nanny state” get its first airing. We believe in the informed consumer, and that is the idea behind so many restaurants labelling calorie content on their food. Most of us want to be healthy and most of us know when we want to diet and lose weight. By working with business, we can enable the consumer to make an informed decision about their health.

[Keith Vaz (Leicester East) (Lab)]

I declare my interest and welcome the Minister to her new portfolio. I wish to support the nanny state to this extent: it is fine for companies to sign up to the responsibility deal, but they have to deliver. As her first act as Minister with responsibility for diabetes, will she ban sugar from all Department of Health canteens, and stop selling in our hospitals fizzy drinks that contribute to diabetes?

[Jane Ellison]

As the right hon. Gentleman might know, my first outing as public health Minister was to attend a diabetes think-tank, which I hope indicates how seriously I take the issue. I do not think what he asks for is within my powers, but obviously I will take a close interest in the Department of Health canteen. The right hon. Gentleman is right. We have never said that other measures will not necessarily be taken, but the responsibility deal has taken us a long way when many predicted it would not, and we are keen to inject new energy into it.

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

When I was in the classroom as a school teacher, people used to come to school having had Micro Chips for breakfast. I do not wish to see a nanny state imposed on anybody, but we must do a lot more education. I urge the Minister’s Department to work cross-departmentally with the Department for Education to ensure that we get proper health and food education in our schools. Those using fast food at the moment are often those who can least afford it.

[Jane Ellison]

I am glad my hon. Friend has raised the issue of working with schools and education, and I have already had initial discussions with my opposite number at the Department for Education. We think we have an exciting agenda to take forward, and I hear what my hon. Friend says.

[Jim Shannon (Strangford) (DUP)]

In 2011-12, childhood obesity rose by 37% across the United Kingdom. Will the Minister take into account the child marketing strategy of the fast-food industry when considering how best to address the issue?

[Jane Ellison]

I am interested in looking at what the hon. Gentleman says, and I will be happy to talk to him about that.

[Alun Cairns (Vale of Glamorgan) (Con)]

10. What steps his Department is taking to promote a culture of openness and transparency across the NHS.

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

11. Whether he plans to close all or part of Calderdale Royal hospital’s accident and emergency ward.

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

I am advised by the NHS that there are no plans for the closure or downgrading of the accident and emergency department at Calderdale Royal hospital. Obviously, as the hon. Lady knows, the reconfiguration of local health services is a matter for the local NHS commissioners. As I understand it, they and the local authorities are currently reviewing health and social care services, including emergency care, across the wider Huddersfield and Calderdale area.

[Mrs Riordan]

I thank the Minister for her reply, but we need stronger reassurances in Halifax that the accident and emergency unit at Calderdale Royal is safe, particularly given the threatened closures of walk-in centres. Will she give that commitment now?

[Jane Ellison]

As I have said, those are matters for the local NHS commissioners. As I understand it, they have begun a review. The hon. Lady will want to be deeply engaged with it on behalf of her constituents. Everything that might be proposed will be subject to a full public consultation.

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

15. For what reasons the publication of data on one-year and five-year survival rates for all cancers within the Clinical Commissioning Group Outcomes Indicator Set has been deferred until March 2014.

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

I am aware of delays in the availability of source data at a local level. For that reason, it is not possible to publish data on one-year and five-year survival rates for all cancers before March 2014. I know that my hon. Friend is frustrated by this and that he has done a lot of work on this issue as the chair of the all-party group, but I am sure he will agree that it is better to have accurate information to make these vital clinical judgments.

[Mr Baron]

The Minister will be aware that the all-party group on cancer has campaigned long and hard for the monitoring of the one-year and five-year survival rates as a driver for earlier diagnosis—cancer’s magic key. What assurances can she give that the March 2014 deadline will be met and that appropriate action will be taken against those CCGs that underperform?

[Jane Ellison]

We have spoken to NHS England, which has advised me that it is not aware of any reason to think that the March 2014 will not be met. As my hon. Friend knows, however, the day-to-day management of CCGs is a matter for NHS England, and I am sure he would not approve of Ministers trying to micro-manage CCGs from Whitehall. His strength of feeling is clear, and I am happy to have an ongoing dialogue with him and the all-party group on this matter.

[Tessa Munt (Wells) (LD)]

Having heard the Minister’s answer on survival rates and the importance of early diagnosis, may I ask her whether cancer patients in need of life-saving treatment recommended by their clinicians who have waited for more than two weeks because of the commissioners’ delay in agreeing funding have the legal right to insist on being treated once they have gone past the two-week deadline? If so, how would they do that?

[Jane Ellison]

If my hon. Friend will allow me, we will perhaps need a separate conversation. I am happy to meet her afterwards to discuss the matter she has raised.

[Steve Baker (Wycombe) (Con)]

16. What steps he is taking to ensure that the NHS becomes a more patient-led organisation.

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[Chris Skidmore (Kingswood) (Con)]

T7. I and my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) have long campaigned for the maximum hospital facilities at Frenchay hospital, including a community hospital with an outpatients clinic—as was agreed as part of the Bristol health services plan in both 2005 and 2010. Now it seems that NHS managers are attempting to revisit these plans, something to which I am opposed, as is my hon. Friend the Member for Filton and Bradley Stoke, who has recently written to the Secretary of State to ask for a meeting to look into the situation. Will the Secretary of State agree to meet us both and investigate the situation?

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

I am always happy to meet colleagues for discussions, particularly when they are championing important health care facilities in their local area. I can confirm that the Secretary of State has received a formal referral from South Gloucestershire council in relation to these proposals, and has referred them to the Independent Reconfiguration Panel. He will of course consider the panel’s recommendations before making a final decision, and I am sure that my hon. Friend would agree that it would be inappropriate to pre-empt those deliberations.

[Toby Perkins (Chesterfield) (Lab)]

T4. My constituent Jemma Hill is 25 and suffers from chronic hip pain, for which a specialist has recommended hip arthroscopy surgery. However, she has now been told that her local clinical commissioning group does not fund such treatment. Does it not make a mockery of GP-led commissioning when a CCG will not fund the treatment recommended by a specialist to whom the GP referred my constituent in the first place?

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[Duncan Hames (Chippenham) (LD)]

A written answer from the former Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), to my recent parliamentary question has on this subject revealed that people living in the south-west of England are three times as likely to contract Lyme disease as those in the rest of the country, yet I have a constituent doing what he calls drug runs to the rest of Europe to access the medicines necessary to tackle his symptoms. Will the Minister meet me to discuss how we can ensure the continuing availability of treatments for Lyme disease on the NHS?

[Jane Ellison]

I learned a great deal about Lyme disease in the course of answering my first parliamentary questions, so I would be very happy to meet my hon. Friend to have that discussion.

[Dan Jarvis (Barnsley Central) (Lab)]

Given that at least a quarter of a million children aged 11 to 15 take up smoking across the country each year, does the Minister accept that if we wait for two to three years for evidence to emerge from Australia about the impact of standardised cigarette packaging, hundreds of thousands of children will have started to smoke in the meantime?

[Jane Ellison]

On the Government Benches, we are interested in all measures that might stop children smoking. I do not recognise at all the time scales that the hon. Gentleman mentions. We are looking now at what is emerging in Australia and around the world so that we have more information on which to base an informed decision.

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

When the Secretary of State meets the chairman of NHS England to discuss future priorities for NHS spending, will he ensure a fair deal for rural areas by ensuring that they reflect rurality, sparsity and the number of elderly patients and that we keep the minimum income guarantee for rural GP practices?

Stroke (Emotional and Psychological Consequences)

Jane Ellison Excerpts

Monday 21st October 2013 Commons Chamber

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

I congratulate the hon. Member for Warrington North (Helen Jones) on securing this debate on an important issue that affects so many of our constituents. She spoke with great knowledge and passion about the subject. I am also aware of the great work that she does as chair of the all-party parliamentary group on stroke.

Stroke is one of England’s biggest killers. It is the single largest cause of adult disability. Its effects can be devastating, both for those who have a stroke and for their families and loved ones. It is worth reiterating the great progress that has been made in tackling stroke, particularly the physical aspects, in recent years. Many thousands of people have benefited from that. Fewer people now die from stroke; mortality rates dropped by 37% between 2001 and 2010.

Treatment for stroke has improved in a number of areas, as the hon. Lady mentioned. Stroke patients do better when they are treated on a stroke unit, and over 83% of stroke patients now spend the majority of their hospital stay on a stroke unit. Access to immediate brain scanning is vital, and has improved considerably, as has access to clot-busting drugs, which give people a better chance of regaining their independence following a stroke. We all want that progress to continue, and that is why stroke remains a priority for the Government and the NHS. We also know, however, that we need to do more to improve support for people after stroke, which is the subject of tonight’s debate.

When it comes to national incentives to improve outcomes, stroke is covered in two parts of the NHS outcomes framework and the mandate to NHS England. Through the mandate we are monitoring how the NHS performs both in reducing mortality from cardiovascular disease, including stroke, and in improving recovery from stroke. Some stroke survivors are unfortunately left with long-term disabilities, as was said, so how we support people with long-term conditions will be important to them. Through the mandate, we are monitoring how the NHS is performing in supporting people to look after themselves; whether a person is able to live as normal a life as possible; and how successfully the NHS manages long-term conditions by looking at unnecessary hospital admissions and excessive length of stay in hospital.

[Helen Jones]

The Minister refers to the outcomes framework, but will she ensure that it focuses not just on physical rehabilitation, but on psychological support, because both are essential if people are to go on and build a life for themselves after stroke?

[Jane Ellison]

Quite. As the focus of the framework is about recovery from the stroke, it includes exactly what the hon. Lady says—not just physical recovery, but psychological and emotional recovery, too. Much of what we are trying to do is to set about getting people on that full pathway towards recovery, not focusing only on acute symptoms and the immediate aftermath of the stroke.

The clinical commissioning group outcome indicator set mirrors the areas we are monitoring for stroke and for long-term conditions. This is the indicator set that will be used to hold CCGs to account and to provide information for the public on the quality of services and the health outcomes achieved through that local commissioning. The CCG indicator set also contains measures to ensure stroke survivors are discharged from hospital with a joint health and care plan, and receive follow-up assessments within about six months. I have heard what the hon. Lady said—that this is not happening. I have taken note of it, and it will be discussed with NHS England and all those responsible. It is our clear objective to do that. I appreciate the information the hon. Lady has given us about the Stroke Association’s work in monitoring whether it is really happening. It is obviously a priority. The new Sentinel stroke national audit programme will also monitor the outcomes of stroke care in all patients six months after stroke.

When patients leave hospital, it is important that the NHS and social services work together to get the right services in place to ensure they have the support they need to make the best possible recovery. The measures and indicators I have talked about, alongside a shared measure in the adult social care outcomes framework on the success of re-ablement and rehabilitation services, provide an incentive for the NHS and social services to work together to ensure that happens.

The adult social care outcomes framework is helping us to gauge the progress made by local services and to promote improvement in standards across the country. A key area of the framework is to reduce the need for care and support—exactly as the hon. Lady said—and delay any dependency. Those measures will support the sector to maximise people’s level of independence and minimise their need for ongoing support. Under the framework, local authorities will be able to compare their performance with that of other authorities around the country—we obviously want everyone to match up to the standards of the best—and to make improvements based on what has been proven to work elsewhere. Through that common focus for improvement, the NHS, public health and adult social care outcomes promote joined-up, integrated care, driven by the needs of the individual. For stroke survivors, this means providing access to the support they need to get that better quality of life.

I shall now deal more specifically with the issue of emotional and psychological support for people who have had a stroke. The cardiovascular disease outcomes strategy, published earlier this year, recognises that stroke services that incorporate psychological care deliver the best outcomes for people who have had a stroke. There are also national stroke strategy recommendations and evidence-based national guidance that patients should be routinely screened for mood and cognition after their stroke. These recommendations are included in the National Institute for Health and Care Excellence quality standard on stroke. That answers the question the hon. Lady posed about whether these were at the heart of what we saw as best care—very much so.

It is, of course, the responsibility of NHS England and CCGs to ensure that stroke patients receive the psychological and emotional support they need. NHS England recognises that this area of stroke care is of great importance for many patients. Improvement in community services with greater access to early supported discharge teams and longer-term rehabilitation is also high on NHS England’s agenda.

NHS England is also exploring ways of improving the use of existing resources. The hon. Lady will be aware of Improving Access to Psychological Therapies, an NHS programme that is rolling out services across England that offer interventions for people with depression and anxiety disorders. Many areas now have IAPT, which benefits people including those who are suffering from symptoms following a stroke. I understand that there have been discussions about how the IAPT teams might increase the proportion of the time that they spend with people whose psychological problems are secondary to physical disease, but are none the less important and—as the hon. Lady said—sometimes become more important as time goes on.

Some IAPT services have developed psychological support skills through enhancing the training of nurses and therapists, and some have employed the services of counsellors to support people who have had strokes in the community. I know that some of the good local examples of support for stroke survivors and their families are in the hon. Lady’s constituency. She will be well acquainted with initiatives such as the family support service, which helps stroke survivors and their families to adjust to life after a stroke, and the communication support service, which helps people with aphasia and other communication problems to cope. Stroke sufferers and their families can also receive emotional and psychological support via the local IAPT service.

It is for NHS England to consider how to spread best practice from services such as those in Warrington, using some of the frameworks that I have described. However, I am glad that the hon. Lady has taken this opportunity to bring the issue to Parliament, because I feel strongly that Parliament has an important role to play in highlighting great practice and spreading the word about good local initiatives such as those to which I have referred.

We recognise that, while supporting those who have had strokes, we must also support those who care for them. We set out our priority areas for action on carers in our paper “Recognised, Valued and Supported: next steps for the carers strategy”, which was published in November 2010. We have also made available to the NHS additional funding of £400 million between 2011 and 2015 so that carers can be given much-needed breaks to sustain them in their caring role. Carers are central to the Government’s proposals for care and support, and, as the hon. Lady will know, the Care Bill offers significant improvements in that regard. I am sure that we shall hear far more on the subject as the Bill progresses through Parliament.

Once again, I congratulate the hon. Lady on securing the debate and raising the profile of this very important issue. I shall consider the specific issues that she raised with which I have not been able to deal tonight. I shall also be happy to engage in a continuing dialogue with her and with the Stroke Association. I have read the association’s 10 key indicators and familiarised myself with them. However, the issue is so important to so many people that there must clearly be an ongoing debate about how we can ensure that the very best care is provided throughout the country, because we need the consistency to which the hon. Lady referred.

Let me end by paying tribute not just to all those who work in the NHS, but to those in the voluntary sector who care for stroke patients and their families.

Question put and agreed to.