Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Chris Davies (Brecon and Radnorshire) (Con)]

11. What progress has been made on improving cancer survival rates.

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

Before I answer the questions, may I start by saying that I am sure the thoughts of the whole House are with the people of Brussels today after the shocking events that they have witnessed? As the Prime Minister made clear this morning, we will do all we can to support them.

Cancer survival rates are at a record high. We are on track to save an estimated 12,000 more lives a year for people diagnosed between 2011 and 2015, but we know that we need to strive to be better. The independent cancer taskforce report, “Achieving World-Class Cancer Outcomes”, which was published last summer, recommends improvements across the cancer pathway and sets a clear ambition for further improvement of survival rates.

[Andrew Stephenson]

I thank my hon. Friend for that answer, and I associate myself with her comments about the terrorist outrage in Brussels.

As my hon. Friend may be aware, the Rosemere cancer foundation has been fundraising for a new chemotherapy unit at Burnley general hospital, which will be a huge boost for cancer patients in my area. Because of the huge generosity of Pendle residents, Rosemere has already raised £90,000 towards its target of £100,000. Will she join me in congratulating Rosemere on its efforts and encouraging residents to help it to meet its full target?

[Jane Ellison]

Absolutely. It is a delight to associate myself with my hon. Friend’s support for that excellent local group. The Rosemere cancer foundation supports world-class cancer treatment throughout Lancashire and south Cumbria. Around 4,000 chemotherapy treatments are delivered each year at Burnley general hospital, and the new unit will be of real benefit to local cancer patients from my hon. Friend’s constituency—for which, as he knows, I have great affection—and from the surrounding area.

[Chris Davies]

Is there anything further that my hon. Friend can do to incentivise NHS trusts to replace linear accelerators that are more than 10 years old, and thereby allow more patients to access cutting-edge radiotherapy techniques?

[Jane Ellison]

This, of course, is one of the areas covered by the cancer taskforce, and it is a very important matter. Cally Palmer, the NHS national cancer director and chief executive of the Royal Marsden, is leading on taskforce implementation. The replacement of LINACs is being taken into consideration in planning improvements across the pathway. That can only be done because we are putting into the NHS and into cancer treatment the money that we need to achieve those world-class outcomes.

[Colleen Fletcher (Coventry North East) (Lab)]

Each year, 38,000 people in the UK are diagnosed with a blood cancer, but very few people are familiar with the term blood cancer. Patients have expressed concern about the fact that a lack of awareness has a significant impact on them throughout their patient journey, from causing confusion and uncertainty at diagnosis to making them unaware of the organisations that provide the support and care that they need. Will the Minister tell us what more the Government can do to tackle that lack of awareness in order to improve outcomes and survival rates for all patients affected by the 137 types of blood cancer?

[Jane Ellison]

The hon. Lady is absolutely right to draw the attention of the House to the challenge of joining up thinking across the cancer pathway. That is exactly the approach that Cally Palmer and the taskforce implementation team are looking at. I recently had a conversation with her and with NHS England representatives in which we talked about how we get that joined-up approach. That is at the heart of the taskforce’s recommendations, and we will be taking it forward for all the reasons that the hon. Lady has eloquently expressed.

[Julie Cooper (Burnley) (Lab)]

Cancer Research UK has said that cancer waiting targets have been missed so many times that failure has become the norm. Does the Minister agree that failure to tackle that is undoing the good work of the last 15 years on survival rates?

[Jane Ellison]

These days, we are dealing with the fact that a hugely greater number of people are being diagnosed. The increase in the number of people being referred by GPs is extraordinary. For example, last year GPs referred nearly half a million more patients to see a cancer specialist. That is an increase of 51%. When it comes to waiting lists, of course we want to make sure that everyone is seen. The Government have committed more money to diagnostics, for example, but we expect the NHS to look urgently at any local dips in performance and to take action to make sure that all patients get access to treatment as quickly as possible.

[Maria Caulfield (Lewes) (Con)]

Will the Minister join me in welcoming the Government announcement of funding for a new radiotherapy machine in Eastbourne district general hospital, which will improve cancer survival rates for patients from Seaford, Alfriston, Polegate and East Dean in my constituency?

[Jane Ellison]

Absolutely. My hon. Friend again highlights where we are investing, upgrading machines and putting in money, effort, people and resources to make sure that we can achieve world-class cancer outcomes. As I say, we are on course for record outcomes in terms of patients surviving 10 years beyond a diagnosis. However, we always want to do better, so I applaud the local efforts that she has highlighted.

[Margaret Ferrier (Rutherglen and Hamilton West) (SNP)]

I would like to reiterate what the Minister said. As I sure my hon. Friends would agree, our thoughts go out to everybody in Brussels at this time.

Will the Minister please inform the House of what consideration has been given to bringing the bowel cancer screening age into line with that in Scotland—at 50 rather than 60—following the recent Westminster Hall debate on this subject?

[Jane Ellison]

We had an excellent debate. An extraordinary number of colleagues turned up in Westminster Hall, a debate of just half an hour, demonstrating how many people are interested in this important subject. I outlined in my response to the debate the fact that we have the bowel scope screening programme and the bowel cancer programme in England, which complement each other. The result, particularly of bowel scope screening, is that we can actually make a huge impact on mortality rates for people who are caught. I went into that in more detail in my response to the debate, but that is the key to making sure we identify more people and stop them dying from this dreadful disease.

[Ann Coffey (Stockport) (Lab)]

2. What recent representations he has received on the effect on health budgets of the administration of deprivation of liberty safeguards.

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[Roger Mullin (Kirkcaldy and Cowdenbeath) (SNP)]

3. If he will make it his policy to eliminate hepatitis C.

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

The UK Government take the issue of prevention, diagnosis and treatment of hepatitis very seriously. I can confirm that Public Health England and NHS England, together with key stakeholders, are continuing to develop a strategic approach to tackling hepatitis C, including plans which have now been published for treatment through operational delivery networks.

[Roger Mullin]

So far as I am aware, the Scottish Government provide treatment for all those with sensitive hepatitis C, including those infected with contaminated blood, and that transforms the lives of patients and reduces the risk of further infection in the population. Will the Minister commit to providing similar access to treatment in England?

[Jane Ellison]

The National Institute for Health and Care Excellence has provided guidance on the new drug, so the hon. Gentleman is right to highlight how effective the new treatments are compared with what was previously available. The NHS is in the process of rolling out its response. It has already treated a number of people, and there is a commitment to treat 10,000 people with those treatments in 2016-17. We are of course looking more widely at how we can tackle these issues, not least in the context of the tragedy of those infected with contaminated blood, which he has highlighted.

[Jim Shannon (Strangford) (DUP)]

What discussions has the Minister had with her counterpart in Northern Ireland regarding the reduction and eventual eradication of hepatitis C? Does she agree that it is important to have a strategy that encompasses the whole United Kingdom of Great Britain and Northern Ireland?

[Jane Ellison]

Absolutely. The consideration of all aspects of how we eliminate hepatitis C over time is important, but we should not underestimate what a difficult job that is, largely because an awful lot of people are not aware that they have it—they are asymptomatic and therefore much of the burden of the disease is not visible to us. However, there is always more we can do, and we continue to make this issue a priority.

[Kirsten Oswald (East Renfrewshire) (SNP)]

4. Whether the terms and conditions of the junior doctors contract were finalised before he took the decision to introduce that contract.

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[Catherine West (Hornsey and Wood Green) (Lab)]

15. What the timetable is for the launch of the public consultation on HIV pre-exposure prophylaxis for adults at high risk of contracting HIV.

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

NHS England will invest £2 million over the next two years in order to run, together with Public Health England, early implementer test sites which will seek to answer the remaining questions about how PrEP could be commissioned in the most cost-effective and integrated way to reduce the incidence of HIV and sexually transmitted infections for those at the highest risk.

[Catherine West]

Yesterday NHS England scrapped plans to fund PrEP. Is there anything that the Minister can do to end this erratic and inconsistent decision making? Does she agree that yesterday’s decision to abandon the roll-out of a game-changing drug totally failed those who are at risk of contracting HIV?

[Jane Ellison]

NHS England’s senior specialised commissioning management team made that decision, and I think NHS England recognises that it could have been made earlier. However, it is also recognised that NHS England has already done valuable work. Some important lessons have been learned, and we do not want to lose that. We must now work with both NHS England and Public Health England to understand how we can continue to learn from, for example, the test sites.

[Mike Freer (Finchley and Golders Green) (Con)]

I share some of the concerns expressed by the hon. Member for Hornsey and Wood Green (Catherine West) about the roll-out of PrEP, but it is only one tool in HIV prevention. Will my hon. Friend update the House on the progress of the HIV prevention innovation fund?

[Jane Ellison]

My hon. Friend is right to draw the House’s attention to the fact that PrEP is only one part of prevention, although obviously we understand its importance. He is also right to mention the innovation fund, which, of course, he championed. We have invested up to £500,000 in new and innovative ways to tackle HIV. Some excellent organisations have come forward with some very innovative approaches, and we have also established the first national HIV home sampling service.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

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

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[David Tredinnick (Bosworth) (Con)]

T7. Is my right hon. Friend aware of the agreement struck by President Obama and Prime Minister Modi of India to collaborate on the research and development of traditional medicines for preventive and palliative cancer care? Should we not be aiming for a similar agreement, bearing in mind antimicrobial resistance?

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

It is worth saying that the National Institute for Health and Care Excellence does not recommend homeopathy to treat any health condition. My hon. Friend mentioned antimicrobial resistance, and an increasing number of studies from around the world show that resistance to common treatments is growing, which serves to underline the importance of the responsible stewardship of all drugs and medicines and why the international efforts on AMR, in which the UK is at the forefront, are so important.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given the latest, very worrying reports about goings on at the office of the Parliamentary and Health Service Ombudsman, does the Secretary of State still have confidence in the leadership of this vital regulator?

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[Dr Sarah Wollaston (Totnes) (Con)]

Following the very welcome announcement of a graduated levy on sugar, sweet and drinks manufacturers, will the Minister please tell the House what discussions she is having with manufacturers to speed up the reformulation process and also to introduce a differential in price at the point of sale? Given the importance of childhood obesity, will the Department welcome the opportunity to take over the lead on this strategy so that we can make progress on this vital issue?

[Jane Ellison]

There are a number of invitations there, some of which I will resist. My hon. Friend is absolutely right to highlight the importance of this announcement. Obviously, it is the first step towards the Government’s comprehensive childhood obesity strategy, which we will be launching in the summer. The Chancellor of the Exchequer was absolutely right to go ahead with this and to move forward. The burden of childhood obesity, as she knows all too well, falls very, very heavily on poorer communities, and my right hon. Friend was absolutely right to champion that measure, because it will make the most difference in the poorest areas.

[Greg Mulholland (Leeds North West) (LD)]

Families with boys with Duchenne muscular dystrophy are anxiously awaiting the NICE guidance to be published next week. Can I get an assurance from the Minister that, with this drug already being licensed and available in 18 countries, if NICE approves it, NHS England will bring the funding forward very quickly?

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[Mark Durkan (Foyle) (SDLP)]

When will we have a decision on the future of the human papilloma virus vaccination programme? Will it be clear, and is there due engagement with the devolved counterparts?

[Jane Ellison]

As the hon. Gentleman knows, two programmes are going on. There is a very large-scale piece of modelling work going on with regard to the HPV vaccination for boys, and that work, as I have previously told the House, will look to report in 2017. We already have guidance on HPV for men who have sex with men from the Joint Committee on Vaccination and Immunisation, and we are working through it in some detail to see how we can take it forward in practical terms.

Bowel Cancer Screening Age

Jane Ellison Excerpts

Tuesday 8th March 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. The quite extraordinary level of participation in this half-hour debate speaks volumes about the level of interest in and engagement with this issue from parliamentarians. I congratulate my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing the debate. I am grateful that I had the opportunity to speak to Lauren at the Beating Bowel Cancer reception here in the House in January and to have heard her story in person. My officials and I enjoyed that conversation. As my hon. Friend said, she is a remarkable young woman.

Bowel cancer is one of the most common types of cancer. The statistics around the number of people who die from it each year have been eloquently explained. We accept that we as a country want to do better. That is why, looking at cancer in the round, NHS England set up the independent cancer taskforce, which produced the new strategy “Achieving world-class cancer outcomes”. That was widely welcomed when it was published last July. The Government are committed to implementing the recommendations of the taskforce, and that will see improvements right across the cancer pathway, including in screening. The strategy sets a clear ambition for a further improvement in survival rates. They have improved, as my hon. Friend said, but we want to go further.

Today’s focus is very much on screening, which is a crucial part of diagnosing bowel cancer early. We know that outcomes are significantly better for people diagnosed at stages 1 and 2 as compared with stages 3 and 4. When deciding whether to undertake bowel cancer screening, we have to remember that it is a choice for each individual, so it is important that people are provided with the information they need to make an informed decision. I will go on to talk a little about how many people either decide not to do it or do not get round to doing it. Screening is a significant challenge, and I welcome attention being given to it.

On the advice of the UK National Screening Committee, the expert body that advises Ministers and the NHS in the four UK countries about all aspects of screening policy, bowel cancer screening using the faecal occult blood self-sampling test is offered in England. The bowel cancer screening programme offers screening using the kits every two years to men and women aged 60 to 74 who are registered with a GP. Men and women aged over 74 can self-refer for screening every two years if they wish. People eligible for screening receive an invitation letter explaining the programme, along with an information leaflet explaining the benefits and risks of bowel cancer screening. By the end of January 2016, nearly 29 million men and women in England had been sent a home testing kit and more than 17.5 million had returned a kit and been screened. More than 24,000 cancers have been detected, and nearly 70,000 patients have been managed for high or intermediate-risk adenomas, or polyps, including polyp removal.

The age issue has been the focus of much of the comment today. The NHS bowel cancer screening programme began in 2006, with full roll-out completed in 2010. The programme initially offered screening to men and women aged 60 to 69 because the risk of bowel cancer increases with age. More than 80% of bowel cancers are diagnosed in people aged 60 or over. In the pilot, which was conducted in Coventry and Warwickshire and in Scotland in the late 1990s and early 2000s, more than three times as many cancers were detected in people aged over 60 than in those aged under 60, and people in their 60s were most likely to use a testing kit. Only 47% of men aged 50 to 54 completed a kit, compared with 57% of men aged 60 to 64.

There are also issues of capacity, particularly for endoscopy services, as has been mentioned. The roll-out of screening required that the NHS bowel cancer screening programme take into account and help balance the increasing workloads and pressures placed upon services providing diagnosis and treatment to all people with bowel cancer, not just those found through the screening programme. I emphasise that point to the House, because it is important. The latest routes to diagnosis figures from Public Health England show that in 2013, only 9% of bowel cancers were diagnosed through screening. That 9% is important, but it compares with the more than 50% of bowel cancers that were diagnosed following a GP referral. Sadly, 25% were diagnosed via emergency routes, and those have very poor survival rates because the cancers tend to be at a later stage. The programme has to be able to respond. The skills and the clinicians we need to respond to those GP referrals have to be available, so there is always a difficult balance in terms of the resource we need.

The programme was also required to consider possible changes to it. One such change—this is an important point that has not quite come out in the debate so far—is bowel scope screening, also known as flexible sigmoidoscopy, for people in their 50s. It is a one-off examination that is an alternative and complementary bowel screening methodology to the self-testing kit. It aims to find polyps before they turn into cancer, so it actually prevents cancer ever developing. Evidence has shown that men and women aged 55 to 64 attending a one-off bowel scope screening test could reduce their individual mortality from the disease by 43% and their individual incidence of bowel cancer by 33%.

In 2011, the UK National Screening Committee recommended offering bowel scope screening for bowel cancer. The NHS bowel cancer screening programme is currently rolling it out to men and women around their 55th birthday. They will be invited to take part in the self-testing part of the programme from age 60. Although Scotland is piloting bowel scope screening for some people in its programme, England is the only UK country committed to a full roll-out. Some 77% of bowel scope screening centres in England are currently operational. The Secretary of State is committed to rolling out bowel scope screening to all screening centres in England by the end of 2016, and we are on track to deliver that commitment.

As of the end of January, more than 230,000 invitations had been issued and more than 85,000 bowel scope screening procedures performed. Although that is very good, Members who can do the maths quickly will realise that uptake is currently running at 44%, compared with nearly 60% for the self-sampling part of the programme. If, on the back of this debate, Members can do anything to raise awareness in their constituencies and to empower men and women to make informed decisions about taking up these free tests, I encourage them to do so.

[Margaret Ferrier]

Will the Minister give way?

[Jane Ellison]

I am afraid that I cannot take any interventions because there were so many in the opening speech. I do apologise, but I really want to get through my response.

So far, nearly 3,500 people have attended colonoscopy following bowel scope screening, with 125 cancers detected, and 1,688 people with high or intermediate-risk polyps and 1,270 people with low-risk polyps have had them detected and managed or removed.

Delivering the bowel scope screening programme will obviously place huge demands on endoscopy services, but it can be safely delivered by members of the hospital team other than trained doctors, such as nurses. That is why we announced in September last year that Health Education England is developing a new national training programme for an additional 200 non-medical staff to get the skills and expertise to carry out endoscopies by 2018. The first cohort began training at the end of January. In addition, NHS England’s sustainable improvement team is working intensively with trusts that have significant endoscopy waiting lists, in order to improve performance. That learning will then be shared widely. NHS England is also exploring ways to improve endoscopy performance through pricing changes.

I have already mentioned low uptake rates. We know uptake is lower in more disadvantaged groups, in men—as has been referred to—and in some black and minority ethnic groups. Public Health England is providing support and technical advice to its partners in the NHS on reducing the variation in coverage and uptake. Local screening providers are working with commissioners to address that, which is really important, because some of the variation in these important programmes is astonishing. Again, if any Member can do anything to reduce the variation, it would be greatly appreciated.

The Independent Cancer Taskforce has also recommended an ambition for 75% of people to participate in bowel screening by 2020. To facilitate that change, it recommended a change to a new test, the faecal immunochemical test—FIT—which is more accurate and easier to use than the current FOB test and also improves uptake. I encourage Members with an interest to compare the two tests and try to understand how different they are and why they are likely to have such different effects.

My hon. Friend the Member for Eastbourne will be aware that in November last year the UK National Screening Committee recommended that the FIT test should be used as the primary test for bowel cancer screening instead of FOB. We are currently considering that important recommendation. If it is accepted, it is worth remembering that it will be a major change to a programme that saves hundreds of lives, so we will have to ensure that it is rolled out in a safe and sustainable way, which will include the procurement of cost-effective kits and IT systems.

In any debate about cancer screening it is important to underline the difference between population screening programmes and people going to see their GP with the symptoms of cancer. Information for the public on the signs and symptoms of bowel cancer is available on the NHS Choices website. The Department advises people who are concerned about their risks to speak to their GP. Many of the cancers we have heard about in the debate were found at a very late stage. It is probable that there were some symptoms that could have led to a GP referral.

Since 2010-11, the Department and Public Health England have run 10 national “Be Clear on Cancer” public awareness campaigns, including two national campaigns to promote the early diagnosis of bowel cancer. The first campaign ran from January to March 2012, raising awareness of blood in poo as a sign of bowel cancer. It was the first ever national TV campaign to raise awareness of the symptoms of this cancer and to encourage people with relevant symptoms to go to their doctor without delay. A second campaign ran later that year.

The National Institute for Health and Care Excellence has guidelines on the recognition and referral of suspected cancer, which were updated in June 2015. That is important because in updating them NICE urged GPs to lower the referral threshold when they are assessing whether a referral is appropriate and to think of cancer sooner when examining patients. Switching the way we think and lowering the referral threshold is a critical change that NICE estimates will save many thousands of lives. Of course, professional advice is also available through the various expert bodies.

I emphasise that all screening programmes are kept under review, and the UK National Screening Committee will always look at new evidence. I will of course make sure that our expert advisers are aware of the significant parliamentary interest that has been demonstrated today. In responding to this short debate, I have been trying to illustrate the interaction between the two different parts of the programme—bowel scope screening and the original screening. I have also been trying to underline the point about take-up. Of course it is about individuals making an informed decision, but beyond rolling screening out to different ages, we must ensure that people in the highest risk groups, particularly the over-60s, are aware that they can choose to be screened. Many lives could be saved, so it is really important that we get that message across. We can do more.

In conclusion, I thank my hon. Friend the Member for Eastbourne again for securing this debate and drawing the important issue of bowel cancer screening to the attention of the House. I assure her and the families of all those affected—including, of course, Lauren, who started the petition—that preventing premature death from cancer is of the utmost priority for the Government. I hope I have set out how we are responding to that vital challenge.

Question put and agreed to.

Diabetes Care

Jane Ellison Excerpts

Thursday 3rd March 2016 Commons Chamber

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

I should start by saying that, as a Spurs season ticket holder, I shall dwell on the kind words of the right hon. Member for Leicester East (Keith Vaz) about my time in office and ignore his cruel jibes about what can only be described as a disappointing night last night.

I thank the right hon. Gentleman for bringing this important issue to the House for another debate. He has rightly issued a number of challenges to me and the Government, and it is vital that we keep up the drumbeat of debate, which is key to making sure that we keep this serious and increasingly prevalent disease on the agenda.

Fantastic work has been done by the right hon. Gentleman and other members of the all-party group, by the right hon. Member for Knowsley (Mr Howarth), who is also in the Chamber, by the Silver Star charity and by so many others. There is very high awareness of the issue in Parliament, and I will come back to what more we might be able to do to mobilise Members even more on this important subject.

As the House will be aware, tackling diabetes is of great concern to the Government. The Department of Health is committed to preventing type 2 diabetes and to tackling the variation the right hon. Member for Leicester East highlighted in the delivery of care, because we, too, want the best possible care for those with diabetes.

There were encouraging signs from the latest national diabetes audit that progress is being made in some important areas of management and care. For example, there are clear trends of improvement in blood pressure control for people with type 1 and type 2 diabetes and in glucose control for type 1 diabetes. It is also reported that a far greater number of people are being offered structured education within a year of diagnosis. However, I will come back to structured education, because it is uptake, not offer, that I am interested in.

The report again highlighted a concerning and continuing issue of variation in care process completion and treatment target achievement for people with diabetes. I am particularly troubled by the statistics on younger people and those with type 1. The audit found that in 2014-15 just 39% of people with type 1 diabetes received all eight care processes compared with 59% of those with type 2. There is an even greater contrast with regard to age range.

[Mr George Howarth]

As the Minister will be aware, because I have discussed it with her before, there is a specific group of young type 1 diabetics who manipulate their insulin intake to achieve rapid weight loss. Will she give some thought as to how that group, which is relatively small, can be supported to get out of that problem, which is life-threatening?

[Jane Ellison]

I will certainly take that issue away and reflect on it, and we will speak about it again.

For people under 40, only 27% with type 1 diabetes and 41% with type 2 received all care processes, compared with 58% and 65% respectively for those aged between 65 and 79. I have some sense of why that is, but it does highlight the challenge we face. Encouragingly, 77% of those newly diagnosed with type 2 diabetes were offered structured education, but again the percentage was lower for type 1. That is clearly unacceptable, because everyone with diabetes should receive the best possible care regardless of age, postcode or the type they have been diagnosed with. That is why, in our 2016-17 refresh of the mandate to NHS England, we have made tackling variation in the management and care of people with diabetes a key priority over the lifetime of this Parliament.

[Alex Chalk (Cheltenham) (Con)]

Does the Minister agree that we need consistently early diagnosis? Early intervention is particularly important in diabetes care, as it saves the NHS from unnecessary expenditure in the long run, and, just as importantly, saves patients from unnecessary suffering.

[Jane Ellison]

That is absolutely right. I am going to talk about the national diabetes prevention programme, which goes to the heart of the problem. When I spoke to the all-party group, I mentioned the conveyer belt that can start with weight in childhood developing into type 2 and go through to the serious complications that have been alluded to. At all points along that continuum, there are things we can do, and must be doing, to make life better for people with diabetes.

Because of the mandate, diabetes is now right at the heart of NHS England’s agenda. We want it to lead a step change in preventing ill health and supporting people to live healthier lives. Our 2020 goal is for a measurable reduction in variation in the management and care of people with diabetes. However, there is some way to go, so this debate is an opportunity to update the House on some of the areas where we are going to make progress.

We have increased transparency through the creation of the Healthier Lives website, which is a major online tool from Public Health England. I encourage Members who have not looked at it to do so. It highlights variation in the prevalence and treatment of diabetes, allowing clinical commissioning groups and GP practices to compare how well they deliver diabetes care and so drive improvements and iron out variation. I will come on to the support that we are offering them as well.

The CCG outcomes indicator set provides clear comparative information. As was said, it will soon be replaced by the improvement and assessment framework, which will have two diabetes indicators aimed at reducing variation in the achievement of the NICE treatment targets and the referral and take-up of structured education. Consultation on the framework has just closed, and we expect it be published in the summer. It goes to the heart of tackling variation and the cohesive approach that was spoken about.

The NHS Right Care programme is a very practical approach to tackling variation that uses the “Atlas of Variation”. In the case of diabetes, NHS experts help CCGs and other local health system partners to make the step change they need in some areas to improve care, because transparency alone is not enough if we do not offer people support and hands-on advice. In Slough, for example, huge improvements have been made through a clinical mentorship programme that has upskilled healthcare professionals in general practices. That has resulted in an increase in patients who have had their blood glucose, blood pressure and cholesterol controlled. The Right Care programme will be rolled out across CCGs nationally by 2018.

I urge the all-party group on diabetes and the right hon. Member for Leicester East to continue to engage colleagues. It is absolutely right that Ministers are brought to the House and scrutinised about what we can do, but the very nature of our health system and the variation under discussion are also highly susceptible to pressure at local level from well-informed Members and senior councillors. I encourage him to continue to engage Members in asking the right questions at a local level.

[Keith Vaz]

I will be brief, because I know that the Minister has a lot to tell us. When Members of Parliament write to local health and wellbeing boards, it would help enormously if they were able to tell us how much they spend on diabetes awareness. They cannot do that at present.

[Jane Ellison]

Part of the challenge is because much of the effort that is put in relates to the preventive agenda and the contributory factors. That is one of the challenges in teasing such figures apart. However, I will reflect on whether we can do more in terms of health and wellbeing boards.

To incentivise improvements in the treatment and care of children and young people with diabetes, the best practice tariff for paediatric diabetes provides an annual payment for every child and young person under the age of 19 with the condition, providing that 13 standards of care are met. One of those standards relates to structured education. As the right hon. Members for Leicester East and for Knowsley know, I am passionate about making changes to the way in which we do structured education. We know that it works and that it is very good when people do it, but we also know that a lot of people are not accessing it. I am looking really hard at how we could take a new and radical approach, including whether there are any tech solutions, and I look forward to reporting back on that.

Our ambitions extend further than creating a level playing field. We want the management of and care for diabetes to be driven up right across the board in order to improve outcomes. The NHS is working with a number of other organisations to help to promote services that are integrated around patients’ needs across all settings. It is implementing a customer service platform to empower patients with diabetes to self-manage by booking their own appointments, managing their prescriptions, monitoring the care they have received and viewing their personal health records.

I fear that time will not allow me to touch on prevention in as much detail as I would have liked, but I want to emphasise just how seriously we take it. The right hon. Member for Leicester East has outlined the reasons why it is important, including the escalating figures and how much the rising tide of type 2 diabetes associated with lifestyle will cost the NHS in the future. The factors can be modified, and one of the most powerful weapons in our armoury is the NHS diabetes prevention programme, which is the first national type 2 diabetes prevention programme to be delivered at scale. Its aim is to help people identified as at the highest risk of developing type 2 diabetes to lower their weight, increase physical activity and improve their diet through intensive lifestyle intervention programmes. I am pleased to inform the House that the first providers will be announced by the NHS shortly, and the programme will move ahead.

The programme will also link to the NHS health check programme. Almost 3 million NHS health check offers were made in 2014-15 and almost 1.5 million appointments taken up. That is vital for first awareness and my constituency knows how important early diagnosis can be as a result of the checks carried out by Silver Star when it visited us.

The right hon. Gentleman talked about other important referral routes, including engagement with pharmacists, and I will pass on his concerns to the Minister for Community and Social Care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has responsibility for community pharmacies.

The right hon. Gentleman criticised the responsibility deal, but I think it has achieved a lot. We have made some important gains working in voluntary partnership with industry, such as the voluntary front-of-pack nutritional labelling scheme, which has greatly empowered consumers to know what is in their food. That accounts for about two thirds of the market for pre-packed food and drinks, but I accept that the challenge is to go further.

We will announce more about our childhood obesity strategy this summer. We will also monitor the impact of NHS England’s proposal for the introduction of a sugar tax on the NHS estate. It will be interesting to see the results of that consultation. The Sugar Smart app has empowered 1.6 million consumers to date to know more about what is in their food.

I thank the right hon. Gentleman again for bringing these important issues to the House. I am absolutely sure that we will discuss them again, because this vital agenda is right at the heart of the Government’s health programme.

Crohn’s and Colitis Treatment: England

Jane Ellison Excerpts

Wednesday 24th February 2016 Westminster Hall

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

It is a pleasure to respond to this debate under your chairmanship, Sir Roger. We have had a good debate with many first-class contributions. I hope it demonstrates to those watching and those who participated in such great numbers in the Facebook debate that Parliament is taking this issue seriously, as we have filled the time available to us with various contributions. I hope to be able to respond to most of the points made. If not, as ever, I will try to respond post debate.

I congratulate my hon. Friend the Member for St Albans (Mrs Main) on securing the debate. It is always interesting for a Member of Parliament with a great charity in the constituency; the MP ends up becoming quite expert, and my hon. Friend has done an excellent charity proud this afternoon in raising the issues. Crohn’s and Colitis UK is the national charity campaigning on these issues. I pay tribute to its work as it campaigns tirelessly to raise the profile of Crohn’s and colitis and to provide support and advice to all those affected. My hon. Friend is a keen supporter of its work.

I will not spend time describing the diseases themselves or the number of people affected, because others have eloquently done so. Instead, I will talk about some of the ways in which we are responding. A great many of our fellow citizens are affected, so it is right that we have this debate today.

Some hon. Members raised the issue of GPs, diagnosis and training. Digestive health features both as part of the undergraduate medical curriculum and GP specialty training. For GPs the required competencies include: understanding the epidemiology of digestive problems as they present in primary care; how to interpret common symptoms in general practice; and how to demonstrate a systematic approach to investigating digestive symptoms such as IBD. IBD also features in the content guide for the Royal College of General Practitioners applied knowledge test, a key part of the assessment of trainee GPs, which must be passed in order to qualify.

As others have said, diagnosing the symptoms of IBD can be challenging for a GP. Even though the numbers are quite large, as we have heard, if we divide the numbers by GP practice across the country, it might be the case that some GPs are not seeing people very often. The variety of symptoms and the range of their severity differ from patient to patient. Problems may also arise owing to the fact that the symptoms of IBD, such as abdominal pain and weight loss, are shared with other more common, less serious conditions, such as IBS, which is estimated to affect 12 million people in the UK, as opposed to IBD, which affects around 300,000. However, as others have said, a misdiagnosis or a delayed diagnosis can lead to a range of further complications for IBD suffers, so it is important that clinicians have the tools and resources to help them to identify symptoms when a patient presents.

In addition to their clinical training and experience, a number of tools and resources are now available to clinicians to help them to diagnose and manage IBD. The “Map of Medicine” is an excellent free online evidence-based guide and clinical decision support tool, which is available to GPs and other healthcare professionals working in the NHS. It has published diagnosis and treatment maps for patients with IBD. The map supports GPs on issues such as differential diagnosis and helps them to identify “red flag” IBD symptoms and provide advice on appropriate diagnostics and referrals. NICE has produced a clinical guideline specifically to support clinicians in using faecal calprotectin testing to help doctors to distinguish between IBD and less serious conditions as it highlights inflammation specifically.

NICE’s role in setting standards in the diagnosis and management of a range of diseases is well known, and IBD is no exception in that regard. NICE published best practice clinical guidelines on the management of Crohn’s and colitis in 2012 and 2013 respectively. Once diagnosed, a number of treatment options are available for patients. The Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), outlined some of the related challenges and some of the treatments in which she has participated. When treating IBD, the aim is either to heal the inflammation and so reduce the symptoms during a flare-up, which is known as inducing remission, or to prevent flare-ups from happening in future, which is known as maintaining remission.

The routine monitoring and follow-up of patients is a key feature of the guidance on the management of Crohn’s disease and ulcerative colitis. It ensures that patients can access specialist care when flare-ups or relapses occur. Protocols for monitoring should be agreed locally. Various drugs are recommended by NICE and funded by the NHS, and they can help with both of those aims. Although there is currently no cure for IBD, we know that some treatments can ease symptoms and improve quality of life—we heard Members talk about a particular member of staff and bring quality-of-life issues to the fore in their speeches. Management options include drug therapy, dietary and lifestyle advice and, in severe or chronic active disease, surgery.

I turn briefly to prescriptions. In addition to medical exemption, there are extensive exemption arrangements in England, based on age and income, via various means- tested benefits. For people who need multiple prescriptions and have to pay NHS prescription charges, such as those with long-term conditions, prescription prepayment certificates are also available, and it is worth highlighting that. I take the point about the challenge of prescriptions, but not everyone is aware of PPCs. This is the fifth year that the cost of an annual certificate has been frozen, and the third year that the cost of a three-month certificate has been frozen. Next year, both certificates will remain at £104 and £29.10 respectively. There is no limit to the number of items that can be obtained through a PPC. The annual certificate benefits anyone needing more than 12 items a year and the three-month certificate benefits anyone needing more than three items in that three-month period.

The IBD quality standard was mentioned. In general, quality standards are important in order to set out to patients, the public, commissioners and providers what a high-quality service should look like. NICE issues them, and they enable services to benchmark themselves against one another. The quality standard for IBD was published in February 2015 and contained priority statements covering important areas such as specialist assessment, drug monitoring and surgery, all of which is designed to drive improvements in IBD care. Although providers and commissioners must have regard to the quality standards in planning and delivering services, the standards themselves do not provide a comprehensive service specification and are not mandatory.

The six inflammatory bowel disease standards were published in 2013 by the IBD standards group, an independent organisation made up of a number of professional clinical organisations and the charity itself. The standards were designed to support clinicians and commissioning organisations in the development of local IBD services. If appropriate, they may be considered alongside sources of guidance such as the NICE guidelines.

A number of important issues have been raised in the debate that are very much matters for NHS England to look into. I am sure it will be really interested to hear about the challenges that have been raised in the debate, as well as about the Scottish strategy. As the shadow Minister said, the consideration of best practice throughout the United Kingdom is often common, as are many research outcomes, not only throughout the United Kingdom, but internationally.

Some Members mentioned the importance of nurse specialists. It was lovely to hear the hon. Member for Great Grimsby (Melanie Onn) pay tribute to the specialists with whom she has dealt and the standard of care and support she has experienced. Obviously the recruitment of staff is ultimately a local matter but, again, the NICE guidance states that local services should ensure that patients with Crohn’s or ulcerative colitis have support from an IBD multidisciplinary team, which should comprise a range of experts, including dieticians, who were mentioned, and clinical nurse specialists with particular expertise and specialist interest. That MDT care is a key feature of the quality standard, which sets out what great-quality care looks like.

The shadow Minister mentioned mental health support. It is worth noting for the record that we invested more than £400 million over the previous spending review period in improving access to psychological therapies—the IAPT programme—to ensure access to talking therapies for those who need them. That includes people with long- term conditions who are suffering from anxiety and depression. Recent positive announcements include the Prime Minister announcing £1 billion to start a revolution in mental health, which is a shared interest right across the House. No one has done enough on mental health in the past, and the matter is now much more front and centre in our thoughts. As part of that announcement, £247 million has been allocated to ensure that every emergency department has mental health support. That money reaffirms the Government’s commitment to parity of esteem between mental and physical health.

Several Members quite rightly asked about toilets. As others have said, it is essentially a matter for my colleagues in the Department for Communities and Local Government, but I will of course draw their attention to this debate. Local authorities in England are forecast to spend just over £60 million on such services in 2015-16. It is also worth noting that more than 400 local authorities and thousands of businesses have joined the national RADAR key scheme, meaning that some 9,000 toilets in shopping centres, pubs, cafés, department stores, bus and train stations and many other locations are now listed as being accessible through the scheme. I am sure that we have all seen them in our local areas. Official RADAR keys cost about £5 and can be bought from participating local authorities or Disability Rights UK shops. While noting that initiative, we must recognise that there is always more to do in that regard.

Members quite rightly drew the House’s attention to research and the need to know more. Dealing with a disease that currently has no cure is a big challenge, and research is key. The Department of Health currently spends more than £1 billion a year on research. As for IBD, the Department’s National Institute for Health Research awarded a £1.5 million research professorship for five years from 2013 to 2018 at the University of Oxford to examine the use of molecular techniques to re-stratify Crohn’s disease, aiming to get into the detail of identifying patients amenable to new treatment approaches and to develop new therapies. The NIHR is also investing just under £1 million in a study comparing the accuracy of MRI imaging and small bowel ultrasound in assessing the extent and activity of newly diagnosed and relapsed Crohn’s disease. The final report from the study is expected to be published in September 2017, and I am sure that there will be interest in that among Members.

My hon. Friend the Member for St Albans also mentioned the IBD BioResource. It is a really exciting project that brings together the Medical Research Council and the NIHR, supporting groundbreaking studies looking at the genetics of and new treatments for IBD that have the potential to make a real difference to patients’ lives. It will undertake a major new genetic analysis based on genome sequencing, and it will keep a database of 25,000 patients with IBD.

I have tried to cover most of the points raised in the debate. I hope that I have given hon. Members a sense of the Government’s ambition to make progress on research. I again pay tribute to the charity for contributing to the research. Partnerships between Government bodies, medical research bodies and specialist charities are an important part of making progress, not least because recruiting people to studies is important, and we cannot do that without the work of the charities.

I will write to Professor Sir Bruce Keogh, the medical director of NHS England, to outline the concerns that hon. Members raised today and to ensure that he is aware of Parliament’s interest in this issue and of the challenge to the NHS that has been outlined today. I urge Crohn’s and Colitis UK, as I do all relevant stakeholders, to continue to engage with NHS England to build valuable long-term relationships. I will write to the Royal College of General Practitioners, as a number of the issues that were raised relate to it. I once again thank my hon. Friend the Member for St Albans for securing today’s debate and for making such a meaningful contribution to raising awareness of this very important issue.

Ring-fenced Public Health Grants

Jane Ellison Excerpts

Thursday 11th February 2016 Written Statements

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

I am today publishing the public health allocations to local authorities in England for 2016-17 along with indicative allocations for 2017-18.

Through the public health grant, we are investing £3.39 billion for public health in 2016-17 and £3.30 billion in 2017-18. I believe this is a fair settlement, which will ensure the long-term sustainability of public health services. We will be investing over £16 billion over the next five years for public health, in addition to what the NHS spends on preventive interventions such as immunisation and screening.

The indicative allocation for 2017-18 will help local authorities to develop and extend their planning, including initiatives better delivered across more than one year. During 2016 the Government plan to consult on options to fund local authorities’ public health spending from retained business rates receipts.

We are asking local authorities to adjust the way they report their spending from the grant on a number of subjects in 2016-17, and for the first time are including public mental health as a separate heading in spending returns.

Full details of the public health grants to local authorities can be found on gov.uk. This information will be communicated to local authorities in a local authority circular.

Attachments can be found online at: http://www.parliament. uk/writtenstatements

[HCWS527]

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 9th February 2016 Commons Chamber

[Johnny Mercer (Plymouth, Moor View) (Con)]

1. What steps his Department has taken to ensure that public health grants are spent only on public health responsibilities.

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

The local authority public health grant is ring-fenced and must be spent in line with published grant conditions set by the Government. Local authority chief executives and directors of public health are required to certify that grant spend is in line with these conditions. In addition, Public Health England further reviews spending information and local authority spend against the grant is subject to external audit.

[Johnny Mercer]

In 2014-15, my city of Plymouth received £47 per head. Portsmouth, which is statistically healthier, received £77 and Kensington and Chelsea got £136. I absolutely understand that this is a legacy issue with the funding formula, and the Government are committed to dealing with it, but I cannot stress enough how important it is that we speed this up. How does the Department plan to achieve this? The current situation is grossly unfair to my constituents.

[Jane Ellison]

I applaud my hon. Friend for being a champion of public health in his community. We have had several conversations on this issue. As he says, there are historical differences, of which I am conscious, in the levels of local public health spending. They mostly arise from historical primary care trust spending priorities. We have made some progress in addressing the matter, but, as regards future allocations, we are considering a full range of factors, including the impact on inequalities and existing services. Those will be announced shortly. As I have told him before, the chief executive of Public Health England is happy to talk to him about the specific challenges facing his community, and that offer remains open.

[Emma Reynolds (Wolverhampton North East) (Lab)]

The NHS “Five Year Forward View” states that

“the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

How will the in-year cuts this year and the future 4% real cuts in public health help to achieve that objective?

[Jane Ellison]

The challenge of being serious about prevention is one for the entire health and social care system. We acknowledge that, like many parts of government, public health grants have had to absorb some of the fiscal challenge. We are dealing with the problems we inherited at the beginning of the coalition Government. Despite that, local authorities will receive £16 billion in public health grants alone over the spending review period, but that is not the only way we invest in prevention. On my many visits, I have seen some of the great work being done to work with local authorities, and I am confident of the great things they can do with that money.

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

19. Given the report by the Crisp commission, released in the last few days, on mental health provision and treatments, can the Minister provide any assurance about the equitable treatment of physical and mental health to ensure an equal allocation of funds?

[Jane Ellison]

There is rightly a great deal of attention on this area—more tier 4 beds have been commissioned, for example—but I want to stress what is being done in my area of public health. Right at the heart of our new tobacco strategy, which we are beginning to work on, is a concern for the inequity facing people suffering from mental ill health in terms of smoking levels. I can reassure the hon. Lady that across the piece we are considering how we can do more for those who suffer with mental health problems.

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

Access to contraception is not only a fundamental right but a cost-effective public health intervention—every £1 spent on contraception saves the NHS £11—yet the Government are presiding over savage cuts to public health services. It is predicted that £40 million will be cut from sexual health services this financial year alone. Is that what the Minister means when she says the Government are serious about prevention? Why does she not finally admit that these cuts not only make no financial sense but could put the nation’s health at risk?

[Jane Ellison]

I reject that analysis. It is for local authorities to take decisions on local public health spending, but they are mandated by legislation to commission open-access sexual health services that meet the needs of their local population, and in fact there is a great deal of innovation around the country in how people are doing that. For example, in Leeds, they are redesigning services to enable people to access sexual health. [Interruption.] The shadow Minister laughs, but the question of how much they would have invested in the NHS goes unanswered by the Opposition—a question that was never answered at the general election. On prevention, as I have said, the public health grant is not everything. In the next financial year alone, for example, the Department will spend £320 million on vaccines. We have introduced two world firsts: the child flu programme and the meningitis B immunisation programme. Right across the piece, this Government are investing in prevention and in our NHS.

[Rehman Chishti (Gillingham and Rainham) (Con)]

2. What progress his Department has made on improving the performance of hospital trusts in special measures.

--- Later in debate ---

[Andy Slaughter (Hammersmith) (Lab)]

4. What assessment he has made of the implications for his policies of the findings of the Independent Healthcare Commission on the NHS in north-west London.

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

It might assist the House if I were just to mention that this commission was commissioned by five Labour councils and was chaired by Michael Mansfield, QC. On the assessment of the commission’s findings, I can put it no better than the lead medical director for the “Shaping a Healthier Future” project, who said:

“The unanimous conclusion of the board’s clinicians was that the report offered no substantive evidence or credible alternative to consider that would lead to better outcomes for patients…above the existing plans in place”.

I concur with that judgment.

[Andy Slaughter]

Last July, the Minister held a constructive meeting with west London MPs and agreed that information on the review of our hospital services would be shared. We understand that a plan B is being considered that will still move hospital services from Charing Cross and Ealing but, because of rising costs, will retain and mothball existing buildings rather than redeveloping the sites. Can we see the current plans?

[Jane Ellison]

The hon. Gentleman rightly says that we had a constructive meeting but, as with everything in this area, it is time to move on. There is a grave danger of him appearing to be like one of those soldiers discovered on a Pacific island after the second world war still fighting the old war. Part of the reason for cost escalation in NHS projects is the constant challenge and delay, and “Shaping a Healthier Future” has complete clinical consensus across north-west London. The clinicians say that this

“will save many lives each year”.

It is time to get on with this project.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

The report heavily features Ealing hospital, where the radiographer Sharmila Chowdhury blew the whistle on consultants taking bungs—extra payments. She is now jobless and, as a widow with a mortgage, soon to be homeless. Will the Minister urgently look into her case, because despite a plethora of reports—this one and the Francis review—this Government do not seem to be doing anything for her?

[Jane Ellison]

I do not think that is fair. In fact, my right hon. Friend the Secretary of State of State has met the clinician in question, and the Francis review recommendations, as we have adopted them, make it quite clear that staff have a right to speak out. Of course we want everyone to speak out on behalf of patient safety.

[Derek Twigg (Halton) (Lab)]

5. What proportion of hospital trusts are in deficit?

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

13. What progress his Department has made on making the UK a world leader in tackling antimicrobial resistance.

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

The UK continues to play a global leadership role on antimicrobial resistance. We co-sponsored the World Health Organisation’s 2015 global action plan on AMR, created the Fleming fund to help poorer countries tackle drug resistance, and are promoting action through the G7. The O’Neill AMR review is galvanising global awareness.

[Kevin Hollinrake]

Antibiotic resistance is one of the biggest global challenges for public health, making routine operations impossible within 10 or 15 years unless action is taken. I welcome the Government’s action on this. Antibiotic Research UK is the world’s first charitable organisation, set up in my constituency, to tackle this issue. Will the Minister look at how we might fund such organisations in the charitable sector?

[Jane Ellison]

I very much welcome the fact that my hon. Friend is becoming a real champion of this important international and national agenda. I am aware of the important work of the charity he mentions, and I believe it has already had some contact with the Department. I do not make the decisions on these sorts of funding issues, but I am happy to look at the issue he mentions and to meet him to discuss it.

[Margaret Greenwood (Wirral West) (Lab)]

UK health and medical research projects benefit hugely from European Union funding, with the UK at the top of the table for approved grants. That funding is vital if we are to tackle global health challenges such as resistance to antibiotics. Does the Minister accept that pulling Britain out of the EU may have a detrimental impact on the UK’s role as a world leader in health research and development?

[Jane Ellison]

I reassure the House that the vital funds mentioned by the hon. Lady are protected in the spending review.

[Mr Speaker]

Last but not least, Sir Simon Burns.

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

T8. Comparative research has shown that proton therapy is as effective as radiotherapy for certain cancers, but has fewer side effects. Do Her Majesty’s Government accept the use of comparative evidence in deciding the availability on the NHS of emerging treatments such as proton therapy?

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

I will reflect on the wider point my hon. Friend makes, but the House will be keen to know that we are investing in building two proton beam therapy facilities at the Christie in Manchester and University College London hospitals. Work has already started on that £250 million project, and the first facility is due to become operational in 2018.

[Steven Paterson (Stirling) (SNP)]

T3. Will the Secretary of State provide an update on efforts and contingencies to combat the Zika virus, and on how that is being co-ordinated with the devolved Administrations, including Scotland?

[Jane Ellison]

The Government are taking the matter extremely seriously, and they have it under active review. Up-to-date medical guidance has been cascaded to the NHS in England. As the hon. Gentleman will know, the UK is at the forefront of some of the world’s response. We are a major funder of the World Health Organisation. We have got people on the ground helping in Brazil, in particular. I assure him that we are maintaining close links with the devolved Administrations at official level, and I am always happy to speak to colleagues. We take very seriously keeping those links live.

[David T. C. Davies (Monmouth) (Con)]

T9. Has the Secretary of State seen the comments of Professor Angus Dalgleish, who is widely reported in the papers today as suggesting that EU rules are forcing us to spend billions of pounds treating health tourists and preventing us from undertaking important clinical trials? Has the Secretary of State made any assessment of Professor Dalgleish’s comments?

[Liz McInnes (Heywood and Middleton) (Lab)]

T5. Despite the prevalence of pancakes in Parliament today, I am pleased to be asking a food-related question. A recent opinion poll performed by Diabetes UK showed that three quarters of British adults think food and drink manufacturers should reduce the amount of saturated fat, salt and sugar in their products. Does the Minister support introducing mandatory targets for industry to reformulate food and drink products to help people to eat more healthily, and will that form part of the Government’s childhood obesity strategy?

[Jane Ellison]

We made considerable progress in this area in the last Parliament, under the responsibility deal, but we have always said that there is more to do and the challenge to industry remains. We will say more about that when we publish the childhood obesity strategy in due course.

[Nusrat Ghani (Wealden) (Con)]

Midwife-led units, such as the brilliant Crowborough birthing centre in my constituency of Wealden, are key to the provision of high-quality, safe and compassionate maternity care. Last year, it scored 100% satisfaction on a friends and family survey. Will my hon. Friend outline the Government’s plans for midwife-led care, particularly given this weekend’s launch by The Sunday Times of the safer births campaign?

Zika Virus

Jane Ellison Excerpts

Friday 5th February 2016 Written Statements

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

I would like to update the House following the declaration earlier this week of a public health emergency of international concern by the World Health Organisation (WHO) in relation to the Zika virus and its possible link with microcephaly.

The Government are determined to support the international community in responding to the Zika virus and to ensure that UK citizens travelling to Zika affected areas are properly protected.

On Monday 1 February, the Director General of the World Health Organisation, Dr Margaret Chan, declared that recent clusters of microcephaly cases and other neurological disorders in Brazil and in French Polynesia in 2014 are strongly suspected to be linked to the Zika virus. The Government fully supports Dr Chan’s call for international action and will continue to work with the WHO to ensure it has the resources required to respond effectively.

The UK is the second largest donor to the WHO, contributing £29.5 million in 2015 and a further £6.2 million to the WHO’s contingencies fund for emergencies. The UK is also among the first countries in the world to contribute significant funding to support research into the Zika virus and will play a crucial role in helping to develop vaccines, diagnostics and treatments. Already £1 million has been provided from the UK’s medical research council to fund Zika related research. Finance has also been provided through the UK’s Newton fund to a joint research project between the University of Glasgow and Fiocruz, a leading biomedical centre in Brazil. The UK vaccine network will launch a funding call at the end of February 2016 to support the development of vaccines for some of the world's most prevalent diseases, including Zika. The network is a part of the wider £1 billion Ross fund, announced in December 2015, which includes over £188 million for development of vaccines and diagnostic tests for diseases with epidemic potential.

Domestically, Public Health England (PHE) has advised that the risk to the UK population from Zika remains extremely low. Aedes aegypti is the primary type of mosquito which transmits the virus, and is extremely unlikely to be able to establish itself in the UK as the temperature is not consistently high enough for these mosquitos to breed. PHE have issued updated travel advice with guidance on minimising the risk of catching Zika by taking scrupulous measures to avoid insect bites. Specific advice has also been published for women who are pregnant (or planning to be) to seek advice from a health professional before travel, to consider avoiding travel to areas where Zika outbreaks are ongoing, or if travel is unavoidable, to take stringent insect bite avoidance measures. PHE has further provided updated guidance for healthcare professionals on the management of any symptomatic patients returning from affected countries. The guidance is accessible online and has been cascaded directly from PHE to healthcare professionals as well as via professional bodies, including the Royal College of Obstetrics and Gynaecology and the Royal College of General Practitioners.

The Government are currently in discussion with airlines to ensure that they follow WHO Europe advice that disinfection should take place on all flights that travel to the UK from countries with confirmed active transmission of Zika virus by mosquitoes. This is a highly precautionary measure to protect passengers in transit, and will be reviewed as further evidence about the virus emerges. Disinfection involves spraying an aerosol insecticide inside aircraft either before or during the flight and already occurs on the great majority of flights from the region as a precaution against malaria. This will offer additional highly precautionary protection to those on the flight as well as helping to mitigate the extremely low risk of a mosquito surviving in the UK for a short period of time and transmitting the disease.

I can also confirm that NHS Blood and Transplant have introduced a precautionary deferral period for those returning from countries where the Zika virus is endemic. All returning travellers are being deferred from donating for 28 days.

The chief medical officer, Professor Dame Sally Davies, requested a scientific advisory group to consider the risk Zika poses to the UK and what action can be taken to ensure the UK is as protected as possible. This was co-chaired by the Government’s chief scientific adviser, Sir Mark Walport, and the Department of Health’s new chief scientific adviser, Professor Chris Whitty. Experts will continue to review new evidence as it emerges.

[HCWS512]

NHS (Charitable Trusts Etc) Bill

Jane Ellison Excerpts

Friday 22nd January 2016 Commons Chamber

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

What a fascinating morning this has been. I add my congratulations to my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton), who has dealt with some of the amendments. I hope to add some additional information and clarification, and to provide the useful history behind the need for and origins of the Bill. It is good that it has been debated with such thoroughness and that it has been given clear attention.

[Michael Tomlinson]

I am grateful to the Minister for mentioning the thoroughness of this debate. Does she agree that one of the reasons for the short Committee stage was that this House was debating the important matter of Syria? The Bill is important, but some might argue that the Syria debate was more important. Perhaps that explains why the Committee stage was so short.

[Jane Ellison]

That is probably a helpful thing to put on the record. All Members have to use their time wisely and appropriately, whatever the business of the House is at any one time. That seems to have been a sensible thing to do. Thankfully, we have been able to give this small but important Bill the time and attention it deserves this morning.

I thank my hon. Friend the Member for Mid Dorset and North Poole (Michael Tomlinson) for tabling amendment 4, which seeks to oblige the Secretary of State to carry out public consultation that he considers appropriate—we have dwelt on that somewhat—before making regulations that make provisions consequential on the removal of the Secretary of State’s powers to appoint trustees to NHS bodies and to appoint special trustees. I do not believe that the amendment is necessary, for some of the reasons covered by others and on which I will try to elaborate.

Schedule 1 already makes a range of amendments to primary legislation that are consequential on the removal of the Secretary of State’s powers. They remove references to trustees in other legislation, because they would no longer make sense given that such trustees will no longer exist. The regulations that the Secretary of State does have the power to make under clause 1(2) are technical and remove any outdated references to such trustees, so that, in effect, tidies up all related provisions in primary or secondary legislation that might come to light in future.

It would, therefore, be unusual to consult the public. Members have given interesting examples of consultations in their own constituencies. It is fair to say that a degree of cynicism has been expressed, perhaps unduly, but I certainly agree with the principle that one should go into a consultation with an open mind. I assure the House that the Government seek to do that when they enter into consultations.

The situation with technical issues, however, is slightly different. The amendment seeks to consult the public on regulations that make technical, consequential changes, but proper scrutiny of such consequential changes is undertaken by Parliament. Indeed, Members have referred to such occasions. That is especially the case when consequential amendments are made by regulations to primary legislation, as the regulations are subject to debate and approval in both Houses. I hope that that gives some comfort to those who were concerned about the consultation issue.

Amendments 1 and 2 propose the retention in one form or another of the Secretary of State’s powers to appoint trustees, and we have had a good debate about that. Amendment 1 would give the Secretary of State the power to make provision, by secondary legislation, to re-establish the Secretary of State’s powers to appoint trustees to NHS charitable trusts. It would make such secondary legislation subject to the affirmative procedure and require that the draft secondary legislation be published three months before it is laid before Parliament.

Amendment 2 makes provision for the Secretary of State to appoint one or more trustees where he or she is satisfied that

“exceptional circumstances exist, or…all the trustee positions in relation to a particular charitable trust have been vacant for a period exceeding three months”.

As has been said, independence is the next stage in the evolution of NHS charities. Now that NHS charities have the choice to become independent or to remain as NHS charities with corporate trustees, the Secretary of State’s powers to appoint trustees have served their purpose and are no longer necessary.

Before the Government’s reform of the regulation and governance of NHS charities, nearly all the largest NHS charities had trustees appointed by the Secretary of State. As other hon. Members have said, particularly the Bill’s promoter, my hon. Friend the Member for Aldridge-Brownhills, such charities were frustrated by the dual regulation of NHS and charity legislation, and one can quite understand why they felt limited in their ability to best support their beneficiaries. Many of the charities wanted the opportunity to become independent so that they could fully realise their potential. Other hon. Members have made good points about their need to express their independence and distance from the Government.

The Government’s reform of the regulation and governance of NHS charities has given those that wished to do so the opportunity to convert to independent status under the sole regulation of the Charity Commission. Six of the largest NHS charities with trustees appointed by the Secretary of State have already converted to independence, having decided that that is their best option for the future. The vast majority of the remaining 15 NHS charities with trustees appointed by the Secretary of State have indicated that they, too, plan to convert to independence in the near future. Three NHS charities with corporate trustee arrangements have also indicated that they wish to convert to independence.

At this point, it might be useful for the House and assist hon. Members who have tabled amendments that question some aspects of the Bill if I go a little into the history of this reform. It has always been a challenge to develop a system of regulation and governance that is workable for both the small number of very large NHS charities and charities with income of only a few thousand pounds a year. Within the sector, income is heavily skewed towards charities linked to large, high-profile hospital trusts, some of which have been mentioned during the debate. In 2012, the top five NHS charities accounted for more than a third of the total income, the top 15 for more than half of the total income and the top 30 for more than two thirds of the total income. However, the 50 smallest registered NHS charities had an average annual income of less than £10,000. The largest NHS charities require a different level of professional management.

[Pauline Latham]

Does my hon. Friend agree that NHS charities helping to put defibrillators in public places are doing a good job for the country? I am trying to persuade all my churches to have defibrillators outside their buildings for the benefit of the community, and some have already done so. It is an important fact that charities within the health service do a huge amount of good out in the community, as well as in hospitals.

[Jane Ellison]

My hon. Friend is absolutely right. Several hon. Members have mentioned charities in their area that are doing great work to increase the public availability of defibrillators. Perhaps I may take a moment to update the House on that matter. The Government were delighted, in partnership with the British Heart Foundation, to provide £1 million for defibrillators, meaning that this life-saving equipment will be given to communities right across the country—we have heard about several examples this morning, and my hon. Friend has mentioned another great example in Derbyshire—and that more people can be trained in cardiopulmonary resuscitation. That will make it easier for people to act in an emergency, and ultimately it will of course save lives.

I can update the House by saying that applications opened last October and interest was very high. The British Heart Foundation allocated funding to applicants who could demonstrate that the criteria had been met, and the application process has now closed. We look forward to hearing more about all the places around the country—I am sure that some of them will be in constituencies of hon. Members in the Chamber—where such life-saving work will be enabled.

[Kevin Foster]

I am interested to hear the Minister’s remarks. Given the slightly negative perceptions of charitable work and the descriptions of things that could go wrong that we heard earlier, would she like to comment on the things that are going very well? Will she put on the record her thanks, on behalf of Her Majesty’s Government, to the Torbay Hospital League of Friends? Over 62 years, it has raised millions of pounds to support local people and it is currently running its “This Is Critical” campaign to provide equipment for the new critical care unit that is under construction at Torbay hospital.

[Jane Ellison]

My hon. Friend is exactly right. At times, the debate has moved into rather gloomy territory. He used the “EastEnders” analogy. During the contribution of my hon. Friend the Member for North West Hampshire (Kit Malthouse), I began to think he was speaking to the Private Frazer amendment—the “We’re doomed!” amendment.

My hon. Friend the Member for Torbay (Kevin Foster) is right to bring us back to the great work that is being done. My experience of a local league of friends is similarly positive. Often, in the cut and thrust of our debates on legislation from Monday to Thursday we do not have time to put on the record the thanks of Parliament and the Government for the efforts of groups like his league of friends. It is welcome that this morning, when we have a little more time, we are able to put on the record our thanks to people who are not in the spotlight, but who are doing wonderful work in all our constituencies. I congratulate him on doing that and join him in praising the Torbay Hospital League of Friends.

[Jeremy Quin]

On that note, may I draw to the Minister’s attention one charity in my constituency? Like my hon. Friend the Member for Torbay (Kevin Foster), we have charities that support the local hospital, but we also have Action Medical Research, which does a wonderful job for children. It was formed back in 1952 and has the distinction of being supported by Paddington Bear, which is wonderful. It runs the largest regular London to Paris bike ride to raise funds to support research into diseases that affect young children. It is not directly linked to the NHS, but it is a wonderful medical charity. I hope that the Bill will empower many more such charities to get going.

[Jane Ellison]

How nice it is to hear about that charity. I congratulate my hon. Friend on taking the opportunity to praise it and to shine a spotlight on a charity that so richly deserves it. Indeed, well done to him for name-checking Paddington in a debate that has been otherwise dominated by Peter Pan. We will see whether any more well-loved characters make an appearance before the end of the debate.

[Maggie Throup]

I cannot lay claim to any characters in my constituency. It is not just the work that charities do in hospitals that is important, but the work that they do outside hospitals to make sure that people do not go into hospital. One of my local charities, Community Concern Erewash, recently linked up with the Alzheimer’s Society to work in the community to help people suffering from Alzheimer’s to cope in their own homes and stay in their homes a lot longer. Will my hon. Friend praise that charity and recognise the contribution that such charities make to our society?

[Jane Ellison]

I am delighted to add my praise for my hon. Friend’s charity. I was honoured after the election to have dementia policy added to my portfolio as public health Minister. She is right to draw our attention to the need to work outside hospital to keep people safer in their own homes. As I know from working with dementia charities, large and small, much of that work is done by small local charities. I am delighted to echo her praise for the charity in her constituency.

To return to the amendments, although the largest charities require a level of professional management, the same is not required by many of the smallest ones. The corporate trustees arrangement, whereby the board of the trust or, prior to that, the board of the hospital acts as the trustee, is not sufficient to manage the large sums that are held by the largest NHS charities. They need a more professional approach, in many cases. The Government first took steps to address that issue in 1973. The Secretary of State took powers to appoint so-called special trustees to manage charitable property on behalf of hospital boards. Three hospitals—Moorfields, the Royal National Orthopaedic hospital and Great Ormond Street—appointed such special trustees to manage their charitable funds.

--- Later in debate ---

[Kit Malthouse]

Will the Minister give way?

[Jane Ellison]

I will; it is only fair.

[Kit Malthouse]

By no means was I trying to give the impression that charity workers and trustees across the UK are not doing brilliant work. Most of them are well-minded, and efficient in disposing of their duties as they should. As I am sure the Minister will agree, much of our legislation involves dealing with exceptions. Most people live their lives largely untouched by legislation in this House—although more and more they are touched by legislation from over the water in Europe—but we are dealing with exceptions. All I was trying to do was to deal with an exceptional circumstance where a negative situation may arise, and I have nothing but admiration and optimism for the vast majority of charities, charitable workers and trustees.

[Jane Ellison]

That is a helpful note of clarification. I sense we all felt that beneath the Private Frazer amendment lurked a Private Walker amendment instead. My hon. Friend is right to draw our attention to some very high-profile exceptions to the general rule. His exposition of the challenges that some high-profile charities face was compelling. It is helpful for us to have that on the record and to go forward with consensus on the merits of being a charity trustee.

Amendment 3 seeks to give the Secretary of State the power, in the regulations he may make, to make provision consequential on the removal of the Secretary of State’s powers to appoint trustees in clause 1(1) to make

“provision for one trustee to be appointed by the NHS institution, service or function for whose benefit the charitable trust exists.”

The guidance to NHS charities, produced jointly by the Department of Health and the Association of NHS Charities, suggests that the constitution of the new independent charity could provide for at least one trustee on the board being appointed by, or from, the NHS-linked body. It is a suggestion, rather than a binding obligation, that the new charities constitution should make this provision. The constitution of the new independent charity is a matter best decided by those nearest to the beneficiaries. In the case of an NHS charity with separate trustees, the board of the linked NHS body must support the terms of the conversion, including the terms of the new charity’s constitution, for the Secretary of State to agree to the revocation of their appointment. In the case of a charity with corporate trustee arrangements, it is self-evidently the board of the relevant NHS trust or NHS foundation trust that agrees the constitution of the new charity—again, offering that safeguard.

Ultimately, this is all about independence and local autonomy. The level and the nature of the agreement between the NHS body and the new charity needs to be a matter of local agreement. It is a matter for the local NHS and the charity to agree a constitution for the new independent charity that best meets the needs of beneficiaries.

Amendment 3 has similar technical difficulties to those I outlined in relation to amendments 2 and 4. It is unclear to which bodies amendment 3 relates, and what is meant by

“the NHS institution, service or function”.

A service or function referred to in the amendment cannot appoint a trustee. Again, I am afraid that such regulation-making power would not be workable.

Amendments 5 and 6 seek to remove the requirements that the regulations, which may make provision consequential on the removal of the Secretary of State’s powers in clause 1(1), would have to be subject to the affirmative resolution procedure if they amend legislation. Instead, the two amendments propose that the removal of the Secretary of State’s powers should be subject only to the negative resolution procedure. We believe that the affirmative resolution procedure is the appropriate form of oversight for these regulations. Parliament should have the opportunity actively to debate and vote on secondary legislation that amends primary legislation. Making such regulations subject only to the negative resolution procedure would not provide an appropriate level of parliamentary scrutiny.

There has rightly been much discussion this morning about the appropriate level of parliamentary scrutiny—and indeed the meaning of the word “appropriate”—but I think there was a strong feeling in the House that there are moments when parliamentary scrutiny is very important, particularly when it can be done with the level of detail we have seen this morning. I believe the current level of parliamentary scrutiny provided for in the Bill for this regulation is appropriate, and there are a huge number of precedents to support this approach.

I thank my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) for tabling amendments 7 and 8. The amendments seek to provide that the regulations that may be made by the Secretary of State under clause 2(1) to transfer trust property from appointed trustees for an NHS trust or NHS foundation trust back to the NHS trust or NHS foundation trust, should be subject to the affirmative resolution procedure. The amendments would also require that such transfers be accompanied by a statement by the Comptroller and Auditor General—again, a title that attracted a bit of debate in itself—that he is satisfied with the treatment of public assets and funds envisaged in the regulations.

--- Later in debate ---

[Mr Rees-Mogg]

I am grateful for the Minister’s reassurance, and I am more than happy to accept it.

[Jane Ellison]

I thank my hon. Friend. It gives me great pleasure, as a Minister at the Dispatch Box, to receive such a note of approbation from him, given that he is rather expert when it comes to Friday sittings and these technical amendments. I am honoured, indeed, by his intervention.

On amendment 9, my hon. Friend took the opportunity to praise a local charity in his constituency promoting the use of defibrillators. In common with other hon. Friends who drew attention to this, I thank his local charity for its work on this important undertaking. I am glad that, as has been mentioned, the Chancellor was able to give £1 million to this important cause, which is working with the British Heart Foundation to bring far more defibrillators into public places in North East Somerset and far beyond.

I thank my hon. Friend for his question about the use of the NHS logo. I know from his contribution on Second Reading that he has interest in its licensing. I hope I can put his mind at rest by confirming that independent charities, including former NHS charities, can use the localised NHS logo of the NHS organisation for which they raise funds. Independent charities can arrange permission to use the logo, if they are working in partnership with an NHS organisation. We heard examples of local charities working in close partnership. In addition to heaping praise, rightly, on the Torbay Hospital League of Friends, my hon. Friend the Member for Torbay mentioned a Paignton charity working closely with a local NHS body. That is a good example.

The NHS logo generates high degrees of trust and reassurance among patients and the public, as my hon. Friend the Member for Horsham (Jeremy Quin) drew out in his contribution. We all understand why. We can all cast our minds back to the many occasions when that trust and reassurance have been in the public spotlight. I think, in particular, of the opening ceremony of the Olympic games. Who can forget the spelling out of “GOSH”? I am sure will hear far more about that admirable institution on Third Reading.

The use of the NHS logo is carefully controlled because it indicates that the NHS is in some way accountable and responsible for the services or materials to which it is applied. It is a registered trademark and an important public brand, so there are strict rules governing the correct use of the NHS identity. Generally, the NHS identity guidelines do not permit independent charities to use the NHS trademarks in their names or promotional material, as it could cause confusion and give the public the incorrect impression that a charity is officially endorsed or organisationally linked to the NHS, as many hon. Friends have said. As I have mentioned, however, independent charities can seek approval to use the NHS logo, if they are working in partnership with it. An independent charity will often set up an agreement with a local NHS organisation to fundraise on its behalf. We have already heard some examples of close, long-standing links between charity organisations and the NHS, and I am sure that Members will be aware of many more in their constituencies. It is possible for a local organisation to use the NHS’s identity in a supporting position with respect to promotional and fundraising materials—on the proviso that there is a local agreement in place for the fundraising activity to benefit solely local NHS services.

It is fair to say that there has been some slightly wild speculation in the course of our debate about some of the far-flung places to which people might go, using NHS charity resources inappropriately. It is important to ensure that the association with the NHS is guarded. From a legal perspective, however, the amendment would make no change to the current position. The Secretary of State is the registered owner of a number of NHS trademarks. As such, the Secretary of State is already free to license trademarks to independent charities in accordance with his statutory powers and duties. Furthermore, as the registered trademark owner, the Secretary of State may set the terms of any such licence as he chooses, including specifying the notice period required for termination—an important power, as I think Members would agree. In some circumstances, it may be more appropriate to make provision for a licence to be terminated at shorter notice or immediately—where, for example, a charity is in breach of the licence terms.

On that important point, about which Members were rightly expressing a degree of concern, I hope I have been able to provide reassurance. I hope, too, that I have provided clarity as well as reassurance on some of the other amendments.

[Mr Rees-Mogg]

May I ask the Minister about one further point? When the NHS logo is licensed to small charities, I hope the process will not be too bureaucratic or onerous for them and that the application of the regulations will not be too pettifogging.

[Jane Ellison]

My hon. Friend is wholly consistent on this issue. Since he came here in 2010, I have been delighted to hear him stand up on many occasions for people who find overbearing state bureaucracy at either the national or local level. He seeks to ensure that any such bureaucracy is always light touch and appropriate. He rightly seeks reassurance and I think I can give him that. We would never seek to make the process overbearing. It would obviously be inappropriate, given that the central drive of the first part of this important private Member’s Bill is to bring clarity and to avoid double-regulation. It would be nonsense if any aspect of what we have discussed this morning added to the bureaucratic burden. We are trying to head in an entirely different direction—one of which I hope my hon. Friend, given his long-standing role as a champion in this House, will approve.

[Pauline Latham]

My hon. Friend has twice referred in her speech to defibrillators and the money that the Chancellor has given to the British Heart Foundation to provide more of them. I urge her to continue to lobby the Chancellor on this issue. In his forthcoming Budget, he might be prepared to consider adding to that fund so that more people in the community could benefit from defibrillators.

[Jane Ellison]

My hon. Friend has effectively just undertaken such an act of lobbying. The take-up of this fund is extremely encouraging, and I would be happy to give her more information, as I know she has spoken about this subject here on many occasions—as, indeed, have other Members. We had Backbench Business debates on it in the last Parliament, and I am sure it is one to which we will return. It is an area in respect of which parliamentarians can be great champions in their local areas. I greatly welcome hearing my hon. Friend speak with such enthusiasm about this matter.

[Nigel Huddleston]

May I encourage the Minister to continue her lobbying efforts in that regard? In my area, the west midlands, just 12% of the population feel confident enough to use a defibrillator. What is important is not just the provision of defibrillators, but the training that accompanies it, which I know is being promoted by the British Heart Foundation.

[Jane Ellison]

rose—

[Madam Deputy Speaker (Natascha Engel)]

Order. Before the Minister responds, I should point out that the subject of defibrillators is some distance away from any of the amendments. The hon. Gentleman might like to save it for Third Reading.

[Jane Ellison]

I am sure we all recognise the truth of your judgment, Madam Deputy Speaker, but the example was given earlier of an NHS charity that had championed defibrillators in the local community, and I think that that is how the topic was introduced. My hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) has made a good point, and I shall be happy to give him more information about the proportion of the fund that the British Heart Foundation has been able to spend on the training that he described.

I hope that what I have said about the amendments has been of assistance to the House.

[Michael Tomlinson]

In the light of the reassurances that have been given, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Third Reading

--- Later in debate ---

[Jane Ellison]

We have had a productive debate on this Bill. I thank hon. Members from both sides of the House for their contributions—well, there was a contribution from the Opposition Front Bench—and put on the record my appreciation of the consensual way in which the Bill has been approached by all parties. This has been a welcome opportunity to name-check a number of excellent local charities and some well-loved characters from fiction.

As others have done, I put on the record my thanks to my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) for her dedication to piloting the Bill through the House. She has put a great deal of time and effort into understanding the issues that face charities. She has met the Association of NHS Charities, attended the annual business meeting for its members and wrestled with the complexities of charity law and its relationship with NHS legislation. I am sure that the House will join me in thanking her for her dedication to ensuring that the Bill has made such great progress.

Although I do not want to repeat what my hon. Friend has said, I will quickly summarise the aim of each of the measures in the Bill. The Bill completes the reform of the regulation and governance of NHS charities. It delivers the Government’s commitment to repeal at the first opportunity the Secretary of State’s powers in England to appoint trustees to NHS bodies and special trustees. Those powers are no longer needed. NHS charities can choose to become independent under the sole regulation of the Charity Commission or remain as NHS charities with the linked trust as corporate trustee, in which case they are subject to dual regulation by the Charity Commission and the Secretary of State.

The reform of NHS charity regulation and governance delivers the changes that NHS charities have asked for. A number of the largest ones, which we have spoken about in the course of this debate, have made it clear that they need those changes. The Charity Commission believes that dual regulation—being under both NHS and charity law—can make it difficult for NHS charities to achieve and demonstrate independence. That is why in 2014, following the public consultation, the Department announced its intention to allow NHS charities to move to independent charity status under charity law. Charities that decide to become independent are no longer NHS charities, but independent charities that appoint their own trustees.

The Department also made it clear in its response that, given the new freedom for NHS charities to become independent, the Secretary of State’s powers to appoint trustees were no longer necessary. The charities with trustees appointed by the Secretary of State need to decide whether to move to independence or revert to corporate trustee status before the powers are removed. Independence is not an option solely for NHS charities with trustees appointed by the Secretary of State. Many of the charities that we have discussed with corporate trustee arrangements are large enough to be able to consider independence as a viable option for the future. Corporate trustees should also actively consider whether independence is in the best interests of their beneficiaries.

The Department has indicated that the powers to appoint trustees will not be revoked before April 2018 to provide a period of grace for trustees appointed by the Secretary of State to determine the most appropriate legal form for their charity.

Should any NHS charity not have resolved its future by the time the powers are repealed, the Bill confers powers on the Secretary of State to make regulations to transfer charitable property from the trustees of an NHS trust or NHS foundation trust to the trust itself. There are strong grounds for believing that those powers will not need to be exercised. However, it is necessary to take such powers to ensure that all NHS charitable assets are appropriately protected and dealt with before the powers for the Secretary of State to appoint trustees are repealed.

The Government have listened to NHS charities and delivered what they asked for: the choice to become independent under the sole regulation of the Charity Commission or to remain NHS charities. Some of the largest and most successful have already taken the opportunity to become independent; others are preparing to follow in their wake. The vast majority of NHS charities with trustees appointed by the Secretary of State have indicated that they intend to become independent. All are actively considering the legal form that most favours their beneficiaries. It is therefore clear that the Government’s decision to repeal the Secretary of State’s powers to appoint trustees at the earliest legislative opportunity is right. The powers are no longer necessary and should therefore be removed from the statute book.

As we have heard from the measure’s promoter, the Bill will also secure Great Ormond Street Hospital Children’s Charity’s rights in perpetuity to royalties from performances and publications of the play “Peter Pan”. The hospital has always relied on public support, even after the founding of the NHS in 1948. It is important that that can continue.

The mission of Great Ormond Street Hospital Children’s Charity is to raise money to enable the hospital to continue to provide the very best care for its young patients and their families and to do all the groundbreaking work that we have heard about in the debate. Great Ormond Street Hospital Children’s Charity was eager to take the opportunity to become independent and it became partially independent on 1 April 2015. However, it was unable to complete its conversion to become an independent charity as the NHS charity had to remain in existence until the Copyright, Designs and Patents Act 1988 was amended, to avoid its statutory rights to “Peter Pan” royalties being lost. The Bill confers the rights to royalties from the play “Peter Pan” on the new independent charity for Great Ormond Street hospital.

The two parts of the Bill are very much related in that Great Ormond Street Hospital Children’s Charity needs to be able to complete its conversion to independent status without losing its rights to the “Peter Pan” royalties so that the Secretary of State’s powers to appoint trustees to NHS bodies may be repealed. The Government would not remove those powers until the charity no longer needed its Secretary of State-appointed trustees to receive royalties from “Peter Pan”.

The Bill is about completing the reform that NHS charities asked for. The Government have enabled NHS charities to become independent if they decide that that is in the best interests of their beneficiaries. Great Ormond Street hospital is one of the most cherished institutions in the NHS. The royalties from the play “Peter Pan” have been a hugely valuable source of funds for Great Ormond Street Hospital Children’s Charity in its support of the amazing work that we have heard about today. We want the charity to continue to receive those royalties in perpetuity, as J. M. Barrie would have wished. The Bill will secure the charity’s rights to the royalties from the play “Peter Pan”, enabling it to complete its conversion to an independent charity.

My hon. Friend the Member for Aldridge-Brownhills has shown, in steering the Bill so ably through the House, what we all know from our childhoods: Peter Pan and Wendy make a great team.

Question put and agreed to.

Bill accordingly read the Third time and passed.

Infected Blood

Jane Ellison Excerpts

Thursday 21st January 2016 Commons Chamber

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

In the urgent question on 16 December, I committed to publishing the consultation on infected blood scheme reform in January. I am pleased, therefore, to announce the launch of that consultation. I recognise that for some this will come too late. I cannot right the pain and distress of 30 years, and the truth is that no amount of money could ever make up for the impact that this tragedy has had on people’s lives. As I have said before, for legal reasons, in the majority of cases, it is not appropriate to talk about compensation payments, but I would like to echo what has been said before in the House and say sorry on behalf of the Government to every person affected by this tragedy.

Scheme reform is a priority for me and the Government, and for that reason I can announce that the Department of Health has identified £100 million from its budget for the proposals in the consultation. This is in addition to the current spend and the £25 million announced in March 2015, and it will more than double our annual spend on the scheme over the next five years. This is significantly more than any previous Government have been able to provide for those affected by this tragedy.

I know all too well of the ill health and other impacts on many of those affected by the tragedy of infected blood. I have corresponded with many of those affected and their MPs—they each have their own story to tell—and I have reflected carefully on all this in developing the principles on which the consultation will be based. These are: that we focus on those infected; that we can respond to new advances in medicine; that we provide choice where possible; and that we maintain annual payments to everyone currently receiving them. The consultation is an opportunity for all those affected to have their say, and it is important that it extends to the quieter voices from whom we hear less often.

It is not appropriate, and I do not have time, to go through the whole consultation document today, but I would like to highlight some of its key components. A large population within the infected blood community currently does not receive any regular financial support. These are the people with hepatitis C. I believe it is important that everybody receives support from the new scheme and that it be linked to the impact infection has on their health. I therefore propose that all those registered with the schemes with hepatitis C at current stage 1 be offered an individual health-based assessment, completion of which would determine the level of annual payment received. This would also apply to anyone who newly joins the scheme.

The consultation document outlines our proposal that those currently receiving annual support should have their payments uplifted to £15,000 a year. Those who are co-infected and currently receive double payments would continue to do so. I often hear that people are unhappy about applying for discretionary charitable payments. I hope that the introduction of new regular annual payments will remove this requirement. I am keen that those who respond to the consultation take the opportunity to answer all the questions about the support proposed so that I can make informed final decisions on the shape of any new scheme once all the responses have been collected and analysed.

During the urgent question, I said I was interested in the opportunities offered by the advent of simpler and more effective treatments that can cure some people of hepatitis C. The NHS is at the start of its programme to roll out the new hepatitis C treatments previously approved by the National Institute for Health and Care Excellence. As Members will know, the NHS must prioritise treatment on clinical need and not on route of infection, which means that, although some in the infected blood community will be eligible for treatment right away, others might have to wait.

More than anything, I want, if we can, to give the chance to limit the impact of hepatitis C on the infected community by making an offer of treatment. Over recent months, I have received many letters from people expressing a wish to halt the progress of their infection—one of the many letters that particularly struck me asked simply: “Please make me well”—so my intention is that the new scheme will provide an opportunity to enhance access to treatment, especially for those who fall just short of the current NHS criteria. I hope that we can treat more people if finances allow. That is why the consultation is seeking views on offering treatment to those with hepatitis C in the infected blood community not yet receiving treatment on the NHS.

In keeping with the principle of offering choice where possible, I am pleased to announce that we are consulting on a choice of options for the bereaved. Currently, bereaved partners or spouses are eligible to apply for means-tested support from the charities. As I have said, I have heard concerns from many people who do not like having to apply for charity. With that in mind, the consultation offers the choice of continued access to discretionary support or a one-off lump-sum payment for the bereaved based on a multiple of their current discretionary support. There are questions on this in the consultation document, and I am keen to hear from those affected so that I can understand their preference.

Having listened to concerns about the complex nature of the five schemes, the consultation proposes that, following reform, there will be one scheme run by a single body with access to expert advice, including from National Institute for Health and Care Excellence, so that we can keep pace with any new advances in treatment for hepatitis C and HIV that emerge.

On the next steps, the consultation will be published today on gov.uk and will run until 15 April. This is a 12-week consultation to ensure that all those who wish to respond have time to do so. The consultation document contains questions about the proposals on which I would welcome views. I recognise that there has been disappointment that we have not consulted sooner, but the outcome of the consultation will be crucial to informing our final decisions about how to proceed, and I give the House, and those affected, my commitment that we will proceed as rapidly as possible to implementation thereafter.

We need, as a priority, to make progress in rolling out the health assessments as quickly as possible to ensure that people get access to the support and clinical advice they need. I should be clear, however, that my intention is that annual payments for the current stage 1 cohort should be backdated to April 2016, regardless of when each individual’s assessment takes place.

This is the first time that the Government are consulting fully and widely with the entire affected community and all those who might have an interest on the future reform of the scheme. In developing the proposals to include within the consultation, I have taken account of points I have heard in debates here, of correspondence sent to me, of my discussions with the all-party group and of views gathered during pre-consultation engagement. The consultation is now open and it is my hope that all those affected by this tragedy will respond, and that we can move forward from here. I commend the statement to the House.

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

I thank the Minister for her statement and particularly for advance notice of her intention to give it and for providing me with early sight of it.

I appreciate that this is a difficult issue, but I think that the Minister’s approach today has been the right one, and we will welcome what she has said. She was right to apologise on behalf of the Government, and I would like to echo that apology, because successive Governments of all colours have failed to respond adequately to this scandal. In many ways, this failure has only deepened the injustice felt by the victims.

I want to pay tribute to all Members who have been a strong voice for the victims of contaminated blood. I would like to mention, in particular, my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), the hon. Member for Worthing West (Sir Peter Bottomley), my hon. Friend the Member for Hammersmith (Andy Slaughter), the hon. Member for South Down (Ms Ritchie), the right hon. Member for North East Bedfordshire (Alistair Burt) and indeed my right hon. Friend the Member for Leigh (Andy Burnham).

This scandal saw thousands of people die, and thousands of families destroyed through the negligence of public bodies. Although the Minister was absolutely right to say that no amount of money could ever make up for the impact this tragedy has had on people’s lives, we all owe to those still living with the consequences the dignity of a lasting settlement. With that in mind, I want to press the Minister on four points.

First, on funding, it was claimed that one reason for delaying the announcement of this consultation was to achieve clarity about how much funding would be available, following the comprehensive spending review. The Minister appeared to announce an additional £100 million for the new scheme, so for further clarity, will she set out the total amount that will be available over the lifetime of the new scheme, and how that compares to the previous scheme?

Secondly, we welcome the fact that the consultation will offer the choice of a one-off lump sum payment for the bereaved, but will the Minister say a bit more about how that might be implemented? As she knows, these payments will enable choice, and it is important that we get this right.

Thirdly, will the Minister say a bit more about widows and widowers? She will know that the Scottish review group recommended that widows should get some form of pension for the first time. Has she considered this option? It is important to recognise that widows and widowers are suffering not only from an immediate loss of income from their partner, but from the inability of their partner to save for a pension or get life insurance over the past few decades.

My final question is about the status of hepatitis C sufferers who have not developed liver cirrhosis. We welcome the possibility of ongoing payments, but can the Minister say how the assessments will work? In particular, it is important that these assessments take account of the longer-term health impacts of living with hepatitis C. Does the Minister have any figures on how many of these individuals will not have access to the new hepatitis C treatments? Given that the NHS made these people ill, and the NHS has the drugs available to help these patients, it does seem wrong that we are denying some of these people treatment—the treatment that they both need and, frankly, deserve. Will the Minister say a bit more about how the Government intend to improve access to treatment specifically for these individuals?

I hope that everyone affected will be able to take part in this consultation and have their say on the future reform of the scheme. The Minister will have our full support in implementing that new scheme and doing what we can to provide relief for the victims of this terrible injustice.

[Jane Ellison]

I thank the shadow Minister for responding in those terms. It is much appreciated. As he says, we all want to try to move forward with a consensus in support of the people affected by this tragedy. I will try to respond to his questions, although I might have to write to him on one of them because my on-the-spot maths is not quite good enough.

On funding, as I have made clear several times before, the money will come from the Department of Health budget, and we have identified an additional £100 million over this spending review period, which allows us to double the current spend on the existing schemes. This is in addition to the £25 million announced in March 2015. Spend to date is £390 million and the projected future spend is £570 million, so together with the £100 million and the £25 million, that amounts to more than £1 billion over the lifetime of the scheme. I hope that provides the hon. Gentleman with some clarity on funding.

The hon. Gentleman asked about lump sums. It can be seen in the consultation documents that we are consulting on options for both those already bereaved and those who will be bereaved in the future, and we are asking people how they feel about continuing with a discretionary approach or taking a one-off payment that would be based on a multiple of the discretionary payment they get in the current financial year—or indeed a hybrid of the two. We are trying to be as open as possible, so people can give us their views on how they see the way forward.

I have seen the Scottish proposals and I had a conversation with my opposite number in Scotland this morning before I came to the House. Because one of the options for bereaved people is an ongoing payment, albeit a discretionary one, I would not compare it with what I understand the reference group in Scotland has put forward as a pension. Obviously, we are talking about access to ongoing but discretionary payments. Again, I look forward to hearing the views expressed during the consultation on that issue.

It might be helpful for Members to know that 160,000 people in England have hepatitis C. Those affected by this tragedy make up fewer than 2% of the hepatitis C population in England. The NHS has to treat people on the basis of clinical need. The treatments are in the region of £40,000 each—quite expensive treatments. However, we believe more treatments are in the pipeline, which is one reason why I am so keen to ensure that clinical expertise is embedded within the new scheme. We are particularly keen to understand, in respect of the people who do not quite reach the current NICE guidelines for rolling out treatment in the NHS, whether, by recognising the unique circumstances of the people affected by this tragedy, we can do something within the scheme to support them. We need to understand how many people will be interested. Members might find it helpful to know that while not every genome type of hepatitis C is susceptible to the new treatment, the majority, thankfully, are. For some people, none of the new treatments is clinically appropriate.

I think I have dealt with the key questions that the hon. Gentleman asked me. I would be happy to carry on working in the spirit in which he responded to my statement and come back to him with any further clarity that he seeks subsequent to this debate.

[Maggie Throup (Erewash) (Con)]

I thank the Minister for her statement and for the measures she has outlined today, as well as for her continuing commitment to seek justice for the victims of contaminated blood, including some in my constituency. When it comes to looking at drugs for the future, will the Minister commit to continuing investment in molecular diagnostics as the way forward for victims in the future?

[Jane Ellison]

The Government and the NHS have made it very clear that we greatly welcome what we see as a rapidly changing landscape. There is huge commitment on this issue. I am joined on the Government Front Bench by the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), who is doing a great deal to accelerate some of the newest treatments and their adoption within the NHS. I can absolutely give that commitment that we always want to stay at the cutting edge of medicine. One reason for delaying this consultation, perhaps to the frustration of some, is that we now have a fuller picture of the current state of the available treatments. The last three treatments that are to be rolled out in the NHS were not approved by NICE until 25 November. I want to ensure that we are always up to date with the treatment landscape as it evolves, as we hope it will continue to do.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

We understand the terrible situation of those who have been affected by the infected blood tragedy, and empathise greatly with them. It is imperative that we take every possible action to compensate where we can, although no amount of money can truly compensate the individuals whose lives have been affected.

It appears from the Minister’s statement that what is being proposed is a step in the right direction, but we must focus on the needs of those affected, offer choice, and ensure that there is medical advancement and evidence-based practice. I understand that payments are made through a United Kingdom scheme, but there is clearly considerable involvement on the part of Health Departments in devolved Administrations.

Let me end by reiterating our support for those affected, and by asking the Minister what discussions she has had with devolved Administrations about consultation arrangements, scheme reform, payments including those recommended for widows or widowers, and other support that is urgently required.

[Jane Ellison]

The consultation is being undertaken by the Department of Health in England, but anyone in the United Kingdom can respond, and we continue to work with all the UK Health Departments. My officials have been working closely for months with officials in devolved Administrations. I offered to speak to my ministerial counterparts on the phone this morning, and had a helpful conversation with both Shona Robison and the Welsh deputy chief medical officer. I note that the chief medical officer for England also contacted her opposite numbers.

As I have said, we are in touch with all the devolved Administrations. Because health is now a devolved matter, they are responsible for providing financial support for those affected in each country, and I know that Scotland is consulting on scheme reform in its own right. However, all the devolved Administrations will have the option of joining our new scheme in the future, and an assessment will be made of the financial contribution that is necessary. I had a useful conversation with Shona Robison about some of the transitional arrangements, and about how we can work together. I said that we would try to be as helpful and supportive as possible, and I have every confidence that we will continue in that spirit.

[Chris Heaton-Harris (Daventry) (Con)]

I welcome the statement, I welcome the consultation, and I certainly welcome, on behalf of my constituents, the extra money that seems to be available.

The Minister has said that she wants the widest-ranging consultation. Every Member will have received letters from their constituents about this issue, and those letters have been have passed on to the Department. My constituent Matthew Harris, for instance, has been campaigning actively for a very long time. Will the Department be able to contact those constituents, and ensure that those who are directly affected, and with whom the Minister has already been in contact, can take part in the consultation?

[Jane Ellison]

I assure my hon. Friend that we will make every effort to reach people. My officials have already put in place extensive plans to publicise the consultation—they have met the heads of the charities and those running the current schemes, and will be writing to those who are registered with those schemes—and we will make it as easy as possible for people to get involved. One of our reasons for organising a 12-week consultation is that we recognise that some people may not be online, and we want to make sure that everyone has a chance to comment.

I will reflect on what my hon. Friend has said about direct contact. That may already be being pursued through some of our plans, but, as I have said, we have extensive plans to publicise the consultation, and it goes live today. Of course I shall welcome Members’ contributions on behalf of their constituents.

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

I thank the Minister for her statement. I am sure that the all-party parliamentary group on haemophilia and contaminated blood will want to study the details in the coming weeks, and to take part in the consultation.

At first glance it appears that the Minister’s proposals are not as generous as those that are being discussed in Scotland, although I accept that as yet the Scottish Government have not accepted those proposals. However, I want to raise the specific issue of health assessments of those who are in stage 1 of hepatitis C. A number of those people have been living with the condition for a great many years, and even if their viral load is now cleared, they will not be able to resume their lives as if they had never been infected. Will the Minister assure me that that will be taken into account in any health assessments and in any subsequent financial arrangements?

[Jane Ellison]

Let me first thank the hon. Lady for all the campaigning work that she has done, for which she has rightly been recognised by others. Although we have not always been able to agree on everything, I have been greatly informed by what she has brought to our discussions, and I take on board many of the reports that the all-party group has produced over the years.

The recommendations that are being discussed in Scotland were made by a reference group and not by the Scottish Government, who have yet to respond to them. Shona Robison indicated that they would respond in due course, but that, obviously, is a matter for them.

It is a little too early to specify exactly how the individual health assessments will be carried out, but we will be asking an expert advisory group to advise on the criteria and the evidence. As I said in my statement, it is a question of recognising the impact of ill health, and also the fact that some people’s health fluctuates. I think that we can be assured that everyone will be included in the scheme, and that everyone will receive an annual payment. I should add that we expect people’s own clinicians to be involved in the individual assessments.

[Chloe Smith (Norwich North) (Con)]

I welcome the Minister’s personal determination to see this through, and the progress that she has already achieved. I know we all agree that it has long been needed. I welcome the Government’s apology, the level of funding that has been secured, the format of the annual payments, and, in particular, the backdating offer. However, may I also urge the Minister to focus on fulfilling her promise of treatment for hepatitis C at every level of the NHS? A great deal of bureaucracy lies ahead, and our constituents have no appetite for putting up with it.

[Jane Ellison]

I thank my hon. Friend for what she has said. I am glad that she feels that we are making progress.

The NHS is just beginning to roll out many of the new hepatitis C drugs, although some people have already been treated, and obviously many more will be treated in the future. One of the benefits of individual health assessments for everyone in stage 1 of the scheme is that we shall be able to understand not just clinical need, but problems such as those described by my hon. Friend. The consultation may help us to establish whether help with navigating the health system is one of the non-financial aspects of support that people might seek.

[Norman Lamb (North Norfolk) (LD)]

I thank the Minister for her statement, and welcome the consultation. It is an important step forward.

The individual health assessment clearly marks quite an important moment for people with hepatitis C—a condition that other Members have raised—because the Minister has talked about linking it to payments. Does she envisage an entirely discretionary payment linked to the assessment, or a system involving payment bands? How will the scheme work, and will there be a right of challenge? What does the Minister mean by “enhanced” access to treatment? Is there still a risk that some people will not have immediate access to it?

[Jane Ellison]

As have I said, we will ask an expert advisory group to consider what the criteria for the health assessments should be, and we expect people’s own clinicians to be involved. Broadly speaking, we probably envisage payment bands, but that too will be subject to the consultation. We want to be able to combine speed and fairness.

People with hepatitis C are receiving NHS treatment based on NICE guidelines, but we understand that there will always be people who fall a little short of that at any one time, and we hope to be able to offer treatment to them within the scheme. Within the overall envelope of funding, however, we will not know exactly what the balance is until after the consultation. I do not know what affected individuals’ views are about the balance between treatment and some of the other options in the consultation. I genuinely want to see what they think, and how attractive the treatment offer is to them, before we reach our final conclusions.

[Mr Geoffrey Cox (Torridge and West Devon) (Con)]

I thank the Minister for the work she has been doing on this issue. I also thank her and her ministerial colleague my right hon. Friend the Minister for Community and Social Care for the impressive way this is being handled. We should never forget that this is a simple matter of justice, and it is time, after all the apologies, that those affected should feel we are doing justice to that injustice. I hope that my hon. Friend will agree with me that one of the important needs is that any scheme should be simple, comprehensive, predictable and consistent, and that it is absolutely essential that the bewildering variety of current provision is resolved into that single clear scheme. Will she give me the undertaking that, whatever emerges at the outcome of this process, that will be the Government’s abiding priority?

[Jane Ellison]

I certainly think I can give my hon. and learned Friend some comfort in that regard. The area on which there was the greatest consensus right across the infected blood community and this House is on precisely what he describes: the complexity of the schemes and the fact that they are a mixture of regular payments and discretionary means-tested payments. Obviously we need to wait for the end of the consultation to see exactly what everyone’s views are, but we will not waste time. We will begin a scoping exercise on scheme reform while the consultation is under way in anticipation of finalising plans at the end of the consultation. I agree that we need a scheme that is straightforward, simple and sustainable, both giving regular support to those infected and allowing this Government and future Governments to be able to plan and sustain the support.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

Like many other hon. Members, I have met constituents who have been affected by this tragedy, and it is a simple matter of justice that needs to be righted, so I welcome much of what has been said from both Front Benches today. Has the Minister met or spoken to the Welsh Health Minister over the past few days to discuss the matter and how it will operate in Wales, specifically with regard to financing and the availability of the drugs? Will Welsh sufferers have to travel to England to take part in the assessments or will arrangements be made for them to take place in Wales?

[Jane Ellison]

One or two of those questions are probably a little too detailed to comment on now, but it is worth reiterating what I said about the devolved Administrations. I have not been able to speak to the Welsh Health Minister; we offered the opportunity of a call with other Ministers, including the Scottish Minister, but the Welsh Minister knows that he can get in touch. One of his officials was on the call this morning, and our offices have been talking to each other. I am happy to pick this up with the Welsh Health Minister if he wants to do so.

This consultation is for the scheme in England, but we have been working with counterparts in the devolved Administrations. While everyone in the UK is welcome to respond to the consultation and say what they think, health is now a devolved matter—that is different from when the first schemes were set up—so the devolved Administrations are responsible for providing financial support for those affected from each country. Treatment within the NHS is obviously a matter for the NHS in Wales, and I will look at some of the other points the hon. Gentleman made. We are happy to talk to him about the devolved aspects and write to him afterwards.

[Andy Slaughter (Hammersmith) (Lab)]

I thank the Minister for the consultation, the additional money, the scheme consolidation and the work that both she and the Minister for Community and Social Care have undertaken. I also thank, of course, the all-party group and my hon. Friend the Member for Kingston upon Hull North (Diana Johnson). Will the Minister concede that, for those of us who have worked closely with individual victims for a number of years, the resolution has to be, as far as possible, to put them in the financial position they would have been in but for the grievous harm done to them, and that that may in some cases mean a bespoke solution for individual victims—we are not dealing with unlimited numbers of people here?

[Jane Ellison]

That is clearly the hon. Gentleman’s view and I invite him to submit it to the consultation. This is exactly why we are consulting. We have made some proposals, but some of the questions are very open, and we will look at what comes back from the consultation. I urge him and other Members to take part in the consultation.

[Mark Durkan (Foyle) (SDLP)]

I welcome the statement and commend the shadow Minister’s tone. Victims in Northern Ireland share the compound frustration that we have heard from other Members on behalf of their constituents, but maybe feel more pointedly the contrast with their friends in the south of Ireland, who have had a path of justice available to them over many years. I know the Minister is absolutely sincere in her commitment to the issue of treatment, but will she give assurances that the effort she is putting into making sure people can be made well will not detract or distract from the obligation we still have to make good this travesty that people have suffered?

[Jane Ellison]

I thank the hon. Gentleman for that question and his sustained interest over such a long time, speaking on behalf of people from his area. Based on our previous conversations, I recognise there might be aspects of the proposals that the hon. Gentleman does not feel meet his own aspirations, so again I invite him to respond to the consultation. I will take note of his—and all other Members’—views. These are our proposals. Some of the questions are very open and people can give us their views. I recognise that something different happened in the Republic of Ireland, and it is down to another Government to make those decisions. The circumstances were different for reasons I have gone into previously from this Dispatch Box.

[Valerie Vaz (Walsall South) (Lab)]

The Minister will know that some of the cases go back many years and the medical records may have been destroyed. Can she say in a little more detail what evidence is required both at the assessment stage and for those applying to the discretionary fund?

[Jane Ellison]

In truth, it is a little too early for me to give that level of detail. We want to ask for expert advice on that in order to get it right and, as I said in the statement, we are looking at the impact on people’s health now. We do not want this to be an invasive or onerous process for the people, who have gone through so much already, so we envisage involving people’s own clinicians as well as gathering other evidence. This is something we will ask experts to advise us on and we will come back at the end of the consultation.

[Jim Shannon (Strangford) (DUP)]

I commend the Minister for her work on this and thank her for her statement today. We know her as a compassionate person totally committed to this case; I do not think that anyone in the House has any doubts about what she is trying to deliver, and we thank her for that.

Some 7,500 people have been contaminated by blood. Last year, the Prime Minister gave a commitment of £25 million and this morning the Minister has given a commitment of a further £100 million, which is good news. Some 10 people have passed away. The European Commissioner for Human Rights has recently ruled that Italy must pay compensation immediately to all those who received contaminated blood. I know there is a consultation process, but when will we see the money actually getting to the victims? Is there a timescale? There has not been any commitment, as I understand it, with the Northern Ireland Assembly and the Minister, Simon Hamilton. What, if any, discussions have taken place?

[Jane Ellison]

As I set out earlier, we offered a phone call this morning with the Minister in Northern Ireland, but I am more than happy to pick up on that. Our officials have been working quite closely together for some time on this, so I am more than happy should my opposite number want to have a conversation. The circumstances in Italy are different and, as I said in answer to the last question, other Governments must make decisions for themselves. I am aware of that case, but I think some of the circumstances are quite different. On timescale, our priority is to move forward the individual health assessments, and at the same time we will do some scoping work around reform of the schemes themselves. I cannot yet say how long that will take, but I obviously want to do it as quickly as possible. As I mentioned in my statement, I want to reassure Members that whenever we undertake those assessments, people will not miss out just because they are towards the end of the process. We will backdate all those annual payments, once they are awarded, to April 2016.

Childhood Obesity Strategy

Jane Ellison Excerpts

Thursday 21st January 2016 Commons Chamber

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

I am delighted to respond to the debate on behalf of the Government, and, following on from what the shadow Minister just said, I welcome the opportunity to take forward all the points made in the many excellent and well-informed—although occasionally a little confessional—contributions. It is a timely debate that will make a valuable contribution as we finalise our strategy.

The House is at a slight advantage as it has the chance to influence, but I am at a disadvantage as we have yet to publish the strategy and therefore I have to talk in slightly more general terms.

I welcome the Health Committee’s recent report, which we have debated once already, and its previous report, “Impact of physical activity and diet on health”. We will be formally responding to the Health Committee’s most recent report soon.

There is no denying that in England, and indeed globally, we have an obesity problem. Many shocking statistics have been given in this debate and I will not repeat them, but many Members on both sides of the House dwelled on the health inequalities issue—the gap that is emerging—and I will come back to that. My hon. Friend the Member for Colchester (Will Quince) drew our attention to what is, in effect, a stabilising of childhood obesity statistics, although it is at far too high a level. As he acknowledged, there is a pronounced gap between different income groups.

Once weight is gained, it can be difficult to lose and obese children are much more likely to become obese adults. In adulthood, obesity is a leading cause of serious diseases such as type 2 diabetes—as the right hon. Member for Leicester East (Keith Vaz) and others mentioned—heart disease and cancer. It is also a major risk factor for non-alcoholic fatty liver disease.

We also know that eating too much sugar is linked to tooth decay; it was good to hear my hon. Friend the Member for Mole Valley (Sir Paul Beresford) make that point. In 2013-14 over 62,000 children were admitted to hospital for the extraction of teeth. This is a serious procedure that frequently requires a general anaesthetic. Children should not have to go through this.

Many Members highlighted—I think there is consensus on this—that there is no silver bullet to tackle obesity. That means that in order to reduce rates we need a range of measures and all of us, and all the parts of our society mentioned in the debate, have a part to play, as our forthcoming strategy will make clear.

Sometimes in the national debate around obesity people question the role of the state and how it should intervene to drive change. In the face of such high obesity rates, with such significant implications for the life chances of a generation, it is right that tackling obesity, particularly in children, is one of this Government’s major priorities, and we showed the priority we place on the issue by making it a manifesto commitment.

As my hon. Friend the Member for Portsmouth South (Mrs Drummond) said, the human cost is enormous. Young children in particular have limited influence over their choices and Government have a history of intervening to protect them: we do not question the requirement that younger children use car seats on the grounds of safety, for example. Children deserve protecting from the effects of obesity, for their current and future health and wellbeing and to ensure they have the same life chances as other children, especially those in better-off parts of our society.

As I have said, I was struck by how many Members alluded to the health inequalities issue. There is strong evidence of a link between obesity and lower income groups. The obesity prevalence among reception year children living in the most deprived areas was 12% compared with 5.7%, and that gap rose to 25% as against 11.5% respectively by the time they leave primary school. That is not acceptable, and we must take action to tackle it.

Any Government with a state-funded health service also have a responsibility to take an interest in the nation’s health to ensure the sustainability of the NHS. The huge cost of treating lifestyle-related type 2 diabetes has been mentioned by a number of Members. Our election manifesto supported the programme for prevention set out in the NHS England’s “Five Year Forward View”, which states that

“the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

Tackling obesity is a key component of this work. I accept the challenge from the shadow Minister on budgets, but I can give him the assurance that over the spending review period we are still going to be spending £16 billion on public health. We can complement local action with national initiatives, and we will talk more about that when we publish our strategy.

We are continuing to invest in the Change4Life campaign, which has been going on for many years. We have learned a lot from it, and we now have valuable evidence about what works and what provides motivation and support for families to make small but significant improvements. On 4 January, we launched the new Sugar Smart app to encourage parents to take control of how much sugar their children eat and drink. Members have described how people can scan the barcode on any of the thousands of everyday products that are catered for by the algorithm. This allows people to visualise the number of 4 gram sugar cubes the product contains. In the first 10 days of the campaign, about 800,000 people downloaded the sugar app. That is a great success, and an example of how we can empower families with information so that they can make decisions about their diet. A number of Members made that point, including my hon. Friend the Member for St Austell and Newquay (Steve Double), who talked about the role of families.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

I do not think I have time. I think I know what the hon. Gentleman is about to say, and we have had the teaspoon discussion before. I recommend the sugar app to him; he acknowledged its introduction in his speech, for which I am grateful.

The Sugar Smart app builds on the Change4Life Sugar Swaps campaign, from which we learned a lot. More than 410,000 families registered with the campaign. However, we know that public health messaging and support are not enough. That is why our childhood obesity strategy will be wide ranging and involve Government action across a range of areas.

The food and drink industry also has a role to play, as many Members have said, and I am pleased that it has made progress in recent years. My hon. Friend the Member for Erewash (Maggie Throup) alluded to that fact earlier. Under the voluntary partnership arrangements and the responsibility deal, there has been a focus on calorie reduction, of which sugar has been a big part. We have made progress. Some retailers have also played their part by removing sweets from checkouts, which we welcome. We urge others to follow suit. Importantly, parents and customers have strongly welcomed that change and supported the measures being taken by the industry. But the challenge to the industry to make further substantial progress remains.

Providing clear information to consumers is vital if we are going to help them to make healthier choices. That has been a theme of the debate. The voluntary front-of-pack nutrition labelling scheme, introduced in 2013, plays a vital part in our work to encourage healthier eating and to reduce levels of obesity and other conditions. The scheme enables consumers to make healthier and more balanced choices by helping them to better understand the nutrient content of food and drinks. It is popular with consumers and provides information on the calories and nutrients in various foodstuffs. Businesses that have decided to adopt the scheme account for two thirds of the market for pre-packed foods and drinks.

As a Conservative and a former retailer I believe in customer choice, but if consumers are to make an informed choice they need information. Informed consumers can of course shape markets and drive change, as my hon. Friend the Member for Twickenham (Dr Mathias) pointed out in her thoughtful speech. That point came out strongly in the debate, and I shall reflect on it a great deal.

I want to say a little about physical activity, which is also a key theme. We are very clear that for those who are overweight and obese, eating and drinking less is key to weight loss, but we know that physical activity has a role to play in maintaining a healthy weight. It is also hugely beneficial in many other ways. For children it is a vital part of growing into a healthy, happy adult, so it has been great to hear about the work being done in schools up and down the country. We heard examples of that from my hon. Friends the Members for Mid Worcestershire (Nigel Huddleston) and for Erewash. That is why raising levels of participation in sport and exercise among children and young people is an area the Government are keen to make further progress on.

The Department worked closely with the Department for Culture, Media and Sport on the new sports strategy, published just before Christmas. We will be working with DCMS, Sport England and Public Health England in the coming months to implement the strategy. The Minister for sport and I have worked closely together on both the obesity agenda and her agenda on physical activity. We are also working to raise awareness of the UK chief medical officer’s physical activity guidelines. We have already developed an infographic for health professionals to use when they discuss physical activity with adults, but we want to go further and work on further infographics to raise awareness of the daily activity levels required for children and young people, including the under-fives. We hope that that will be a useful resource, not only for families, but for the leisure sector and for many more who have a key role in encouraging people to be more active.

A slightly different point was made by the hon. Member for Glasgow Central (Alison Thewliss), but it was an important one and she spoke knowledgeably about nutrition in the very early years and during pregnancy. I commend to her the recent chief medical officer’s report on women’s health, as it contained a number of chapters that I think she would find of huge interest if she has not already had the chance to look at them.

There has been a consensus on a number of facts, although a key one stood out: obesity is a complex issue, which the Government cannot tackle alone. Businesses, health professionals, schools, local authorities, families and individuals all have a role to play, as does Parliament. We were all struck by the contribution made by the hon. Member for Washington and Sunderland West (Mrs Hodgson), who spoke so passionately about the need to tackle health inequalities. She spoke about the influence of a good start in life and how that works all the way through one’s life. Parliament does have a role to play, so I welcome the engagement of so many Members from all parts of the House. I would be happy to provide more information if it is ever of help to Members about key public health indicators in their own local areas and how they can help to take this agenda forward. Local leadership will be important as we seek to make the critical leap forward on preventive health action described in the NHS “Five Year Forward View”.

This has been a great debate and I thank Members for their contributions. I look forward to discussing this issue further when we publish our comprehensive childhood obesity strategy.