IVF: Welfare of Women

Jane Ellison Excerpts

Wednesday 20th January 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Alan.

I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) for raising this important subject for debate. I will take the opportunity to offer, I hope, some assurance to interested Members about what is being done to safeguard women’s health in the area.

IVF has been an amazing gift for millions of people throughout the world, bringing the joy of a child to those who would otherwise not have been able to have one. The treatment was a groundbreaking one that we can be proud to say was invented and developed in the United Kingdom.

Recognising the special ethical approach needed for the creation of human life, the Government introduced the Human Fertilisation and Embryology Act in 1990 to bring a strong legislative framework to the provision of fertility treatments, establishing the HFEA as the specialist regulator. That legislation was supplemented by a review and amendments in 2008, providing a legislative settlement agreed by Parliament, and it has served the United Kingdom well since then.

The hon. Lady eloquently outlined the effects of OHSS, which is a well recognised side effect of the use of ovarian stimulatory drugs. In its most severe form, it can be fatal for the patient if not treated, although thankfully that is rare. There are more than 60,000 cycles of IVF each year, with between 150 and 200 instances of what would be regarded as more serious incidents, known as grade A and grade B. That represents about 0.33% of all cycles.

--- Later in debate ---

[Sir Alan Meale (in the Chair)]

The debate may continue until 4.42 pm but could conclude before then if circumstances permit.

[Jane Ellison]

If the debate has to conclude early, which would be a great shame, I shall certainly undertake to write in detail to the hon. Member for Mitcham and Morden, to respond to the various points she made in her speech.

As I was saying, thankfully, very severe incidents for women undergoing IVF are very rare. There are more than 60,000 cycles of IVF each year, and around 150 to 200 instances of what would be regarded as more serious incidents. That represents 0.33% of all cycles. To put that in context, in 2013-14, there were four grade A incidents that involved a serious threat to health, while in 2012-13 there were none. It is helpful to explain that.

It would also be helpful for me to put on the record that ovarian stimulatory drugs are generally self-administered after being prescribed, and each patient is given instruction from the clinic with appropriate warnings about side effect symptoms to be aware of. Patients are monitored at the clinic through regular ultrasound scans and blood tests to check how the ovarian stimulation is progressing and to look out for any signs of OHSS.

I note the suggestion from the hon. Lady about amending the Human Fertilisation and Embryology Act 1990 to require the UK regulator to collect data on the dosage of drugs prescribed to women during fertility treatment and birth rates and information on any adverse outcomes for the patient. That proposal would also place a duty on all fertility clinics to consider the welfare of women proposing to undergo these treatments. It is important to put on the record that drug dosage levels do not determine the risk to individual women of OHSS. Patients react differently and individually to the same dosage levels, so it is not possible to identify those who may be at the highest risk of an adverse reaction.

In response to the suggestions made, I want to stress that all clinicians have a general duty to consider the welfare of patients when deciding whether it is appropriate to offer any treatment service. The 1990 Act also requires that same assessment to be made of any child born as a result of fertility treatment and any existing children who might be affected by it.

The prescription of stimulatory drugs is not an activity regulated by the HFE Act 1990, as amended, or by the HFEA. Prescribing is a matter for clinical judgment, taking account of professional guidance, of which there is a considerable amount, and the individual circumstances of the patient. All patients who undergo ovarian stimulation as part of their IVF treatment are given information on the symptoms to look out for and are advised to contact clinics immediately if they suspect they may be developing the condition. That includes being given contact details for out-of-hours arrangements, so that they can report immediately. In addition, it is a requirement under the 1990 Act that a woman shall not be provided with treatment services unless she has been provided with information relevant to the treatment, including the potential side effects, and a suitable opportunity to receive counselling about the implications.

Although the HFEA does not collect data about the overall incidence of OHSS, clinics are asked to report treatment cycles to the HFEA where a cycle has been abandoned due to there being a risk of the patient developing OHSS. All severe cases of OHSS must be reported to the HFEA as a serious adverse incident. Depending on the nature of the incident and the patient outcome, the HFEA will either expect an incident report from the clinic or will conduct an incident review itself. The HFEA publishes a detailed annual analysis of the data it receives, and information is also available on the HFEA’s website on outcome rates for each clinic, including information on live birth rates as a percentage of embryo transfers.

I reiterate that the administration of drugs is a matter for clinical judgment. The HFEA’s code of practice advises licensed fertility clinics to provide women seeking treatment with information on the likely outcomes of the proposed treatment and the nature and potential risks of that treatment. That includes the risk of children conceived having, for example, developmental defects, as well as the potential side effects and risks for the woman, including OHSS. That requirement is examined as part of the HFEA inspection regime. The HFEA also asks to see a clinic’s OHSS management protocols before a licensed renewal inspection, so it is part of the regulatory process for each clinic.

In its fertility guidelines, the National Institute for Health and Care Excellence advises clinics that they should inform patients about any potential long-term safety implications associated with IVF. That includes specific reference to limiting the use of ovulation induction or ovarian stimulation agents to the lowest effective dose and duration of use. In addition, the HFEA code of practice sets out the expectation that clinics should follow relevant and appropriate professional guidance in the care of patients, which obviously includes NICE guidance. Clinicians must have the clinical discretion to make decisions about the care of individual patients, taking account of their individual circumstances.

I want to give the hon. Lady assurance about some of the work the HFEA has in the pipeline. In its business plan, the HFEA sets out an intention to increase focus on learning from incidents and adverse events through, for example, publication of a report on clinical incidents between 2010 and 2012; dialogue with the sector about how best to learn from incidents and adverse events; and exploring, with professional groups, whether more data need to be collected better to understand factors contributing to ovarian hyperstimulation syndrome, in order to reduce its incidence. That is in the HFEA’s business plan, which is publicly available.

I would like again to thank the hon. Lady for raising this important and complex subject. I understand and appreciate the concerns she rightly has about the possible impact on women’s health of a reaction to stimulatory drugs during the process of fertility treatment and the consequences. However, I believe that the existing UK regulatory system is second to none in its approach to safeguarding women’s health. I am assured that, within its statutory and regulatory remit, the HFEA is taking proportionate action.

I know that the debate must end here, Sir Alan, so I will write to the hon. Lady with responses to additional points made in her speech.

Question put and agreed to.

Swine Flu Vaccination: Compensation

Jane Ellison Excerpts

Tuesday 12th January 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Chope. I congratulate the hon. Member for Liverpool, West Derby (Stephen Twigg) on securing this debate. I am aware that he has sought to support his young constituent and his family on this difficult matter for a number of years, and we have written to each other about this case previously. I was very pleased that, despite this sad case, the hon. Gentleman emphasised his general support for vaccination programmes. We are lucky to have a world-class national immunisation programme. Such programmes are a vital way of protecting individuals and the community as a whole from serious diseases, so I am grateful for his sentiments in that regard.

The hon. Gentleman referred to the global swine flu pandemic and the arrangements for licensing drugs during a pandemic. Flu pandemics are natural phenomena. They occur when a new flu virus emerges and spreads around the world and most people do not have immunity. Each pandemic is different. The nature of the virus, the population groups most likely to be affected and the impact cannot be known in advance. It is impossible to predict the severity of a new virus strain. Large swathes of the population can become infected over a relatively short period if transmission spreads rapidly. The potential impact of pandemic flu makes effective measures to limit the spread and morbidity of virus infection a public health priority. Countermeasures are employed in combination. Vaccination, when possible and appropriate, is one such countermeasure.

Thankfully, the H1N1 strain of swine flu turned out to be relatively mild, but we should not forget that it still caused more than 450 deaths in the UK. Pandemrix, the vaccine that the hon. Gentleman’s constituent received, was developed specifically for use in a flu pandemic when the number of lives lost and people with serious illness could not be known. Once a new pandemic strain emerges, it takes several months to produce batches of a specific vaccine to protect against it. As a pandemic strain of flu generally spreads rapidly, there is of course little time to undertake large-scale clinical trials. To address such constraints, the European Medicines Agency has a mechanism for the fast-track licensing of pandemic vaccines to address the immediate public health threat. The mechanism includes accelerated clinical trials while permitting the use of the vaccine in advance of receipt of all the required clinical trial data.

It would be unfeasible to conduct very large clinical trials in the midst of a pandemic, when time is of the essence, to identify risks that are very rare. Indeed, regardless of the pandemic situation, very rare potential risks can generally be identified only after a medicine or vaccine has been licensed and used in the wider population. All Governments have a responsibility to protect public health. The decision to commence the swine flu vaccination programme, which was made by previous Ministers in 2009, would have been based on the expert advice of the Joint Committee on Vaccination and Immunisation, an independent expert committee that advises Ministers in the Department.

Pandemrix was used against H1N1 swine flu in the UK from October 2009 to March 2010. It was used again on a limited basis in the following flu season until March 2011. The hon. Gentleman has noted that his constituent received Pandemrix in January 2011, during the seasonal flu vaccination programme for winter 2010-11, rather than the specific response to the swine flu pandemic in 2009-10. As he noted, that is highly relevant. He summarised his constituent’s experience and described the impact that narcolepsy and cataplexy can have on an individual. I very much assure him that I do not underestimate how distressing narcolepsy can be, for both those with the condition and their carers. Indeed, I was talking to a constituent about that very issue only this past weekend. I fully recognise the impact that narcolepsy can have on quality of life. It is important that anyone with narcolepsy, with or without cataplexy, receives the appropriate care and attention so that they can manage their illness.

At the time Pandemrix was used in the UK, no potential association with narcolepsy was known. Following suggestions of a possible association with narcolepsy, its use was stopped in the UK in March 2011, on the advice of the EMA. The hon. Gentleman referred to the Vaccine Damage Payment Act 1979, which was designed to help to ease the burdens on those individuals to whom, on very rare occasions, vaccination has caused severe disablement. The degree of disablement is assessed on the same basis as for the industrial injuries disablement benefit scheme. It would not be appropriate to comment on the case raised by the hon. Gentleman.

Despite the title of this debate, I would like to clarify for the House that the vaccine damage payment scheme is not a compensation scheme. The hon. Gentleman referred to compensation ranging from £120,000 to millions of pounds; in fact, the VDPS provides a one-off, tax-free lump-sum payment of £120,000. The scheme does not prejudice the right of the injured person to pursue a claim against the manufacturer of the vaccine. As the hon. Gentleman alluded to, his constituent is pursuing that course of action and, again, it would not be appropriate for me to comment further on that case.

[Stephen Twigg]

I appreciate that the Minister cannot comment on an individual case in this forum and that the discussions are ongoing, but is she able to comment on the affected time period? It is the definition of the time period that is denying my constituent access to the scheme.

[Jane Ellison]

I am aware of that and will address it shortly, although I suspect the hon. Gentleman might be disappointed by what I have to say.

A VDPS payment is for those who are severely disabled as a result of a vaccination against those diseases listed in the 1979 Act and those that have been specified by statutory instrument since then. As I have already mentioned, the hon. Gentleman noted that his constituent received Pandemrix in January 2011; however, the Act relates to diseases, not vaccines. The list of specified diseases covered by the Act includes pandemic influenza A (H1N1) swine flu, where vaccination was administered from 10 October 2009 to 31 August 2010—the period of the swine flu pandemic. That was a temporary addition considered appropriate by Ministers at the time. The hon. Gentleman’s constituent’s vaccination was administered in January 2011, so it was not given for pandemic swine flu, which is covered by the Act.

[Peter Dowd]

GlaxoSmithKline was indemnified because there was an issue of risk—that is the whole point. Why are the Government not as quick to effectively indemnify the victims of this vaccine?

[Jane Ellison]

Perhaps it would be easier if I wrote to the hon. Gentleman after the debate to clarify that point.

As I have said, it appears from the timing that the constituent of the hon. Member for Liverpool, West Derby received the vaccine during the 2010-11 flu season. The 1979 Act did not cover seasonal flu vaccination at that time as it was not part of the routine childhood immunisation programme. Influenza was added to the Act as a specified disease in February 2015, but the order stipulated that the vaccination against influenza must have been administered after 1 September 2013, when flu vaccination became part of the routine childhood immunisation programme. Unfortunately, that will not assist the hon. Gentleman’s constituent. I am afraid that it is not possible to accept a claim outside the conditions laid down in the Act. I recognise that that aspect of the scheme has produced an unfortunate result in this case, but we must work within the confines of the law. The Act has been in place for many years on the basis of disease rather than vaccine, and the Government currently have no plans to change how the scheme is run.

Of course, I have sympathy for the case that the hon. Gentleman has made on behalf of his constituent, and I recognise the frustration and disappointment that his constituent and his family will feel at my response. This is a complex topic, with no quick or easy answers, as successive Governments have found. I stress, though, that the VDPS is only one part of the wide range of support and help available to severely disabled people in the UK. Other examples include the disability living allowance, which provides an important non-contributory, non-means-tested and tax-free cash contribution towards the disability-related extra costs for severely disabled children. I encourage the hon. Gentleman’s constituents to consider what other entitlements might be available. I know that the hon. Gentleman will continue to offer Lucas and his family every support in that regard.

Question put and agreed to.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 5th January 2016 Commons Chamber

[Mr David Hanson (Delyn) (Lab)]

4. How many people have diseases classified by his Department as rare.

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

A rare disease is a life-threatening or chronically debilitating disease that affects five people or fewer in 10,000. Research shows that one in 17 people will suffer from a rare disease at some point. In the UK, that equates to approximately 3.5 million people.

[Mr Hanson]

Same But Different, which is based in my constituency, is concerned about a number of the challenges faced by people with rare diseases. One key issue that it has raised with me is the level of support available at the time of diagnosis, particularly for parents of children with rare diseases. Will the Minister examine how we can signpost better help and support to those who have been diagnosed?

[Jane Ellison]

I am glad the right hon. Gentleman mentions that point; the House may not be aware that we recently added four new rare diseases to the newborn heel-prick test, which has helped to detect more than 1,400 children with a rare disease. I am disappointed to hear that he feels that some parents had issues with follow-up, and of course we will look into that, but I think he will find that the UK rare diseases strategy, which was published in 2013 and contains 51 commitments from government, covers that. The first report back on that strategy will take place this spring and it is being done by the UK Rare Disease Forum. I am happy to speak to him afterwards about whether the excellent organisation he names is part of that.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

One such rare disease is Duchenne muscular dystrophy. I am sure the Minister is aware that we are awaiting what we hope will be a positive decision from NHS England on a drug called Translarna, which could help boys with the disease. We were due to have that announcement yesterday. Does she have any further and better particulars on that? Will she update us on when we can expect an announcement, which we hope will be a positive one?

[Jane Ellison]

I know that my colleague, the Under-Secretary of State for Life Sciences, is working very hard on that matter, and is hoping to make an announcement soon. I am sure that, at that point, he will be able to update my right hon. Friend.

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

With regard to ultra-rare diseases, I will be joining the family of seven-year-old Sam Brown on 23 January to celebrate the funding of Vimizim. I thank all those involved in that decision, including those in the Department. As well as an update on Translarna, can we also have an update on the possibility of funding another drug that we have been campaigning for, which is Everolimus for tuberous sclerosis?

[Jane Ellison]

I thank the hon. Gentleman for his words, as does my hon. Friend the Under-Secretary of State for Life Sciences. With regard to the matter that he just mentioned, I know that it is something that NHS England is reviewing and it will come forward with a view in due course.

[Michael Fabricant (Lichfield) (Con)]

Will my hon. Friend join me in praising the work of the Institute of Translational Medicine at the University of Birmingham Medical School? It is doing outstanding, world-wide standard work in developing cures and treatments for such rare diseases, and indeed for more common diseases such as cancer.

[Jane Ellison]

I absolutely join my hon. Friend in that and agree with his very well-deserved words of congratulation. I know that the Under-Secretary of State for Life Sciences has visited the institute and is—as everyone is—hugely impressed with it. I also join my hon. Friend the Member for Lichfield (Michael Fabricant) and others in congratulating Charlie Craddock on his CBE in the new year honours list.

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

Patients living with rare cancers often have fewer treatments available to them. Often, the only option is to use off-label treatments. The cancer drugs fund has helped patients gain access to those treatments, but, despite a Conservative party manifesto commitment to continue investing in it, the fund is now under threat because of central Government cuts. What assurances will the Minister provide to people living with rare cancers that off-label drugs will still be funded? Will she apologise for the uncertainty that those cuts are causing to the thousands of people who are affected by cancer in England?

[Jane Ellison]

I certainly do not recognise the shadow Minister’s characterisation of the cancer drugs fund. Some £1 billion has been committed to it and it is being reviewed. The fund was introduced by the previous Government, and we are very proud of it. It has made a big difference to the lives of more than 80,000 patients. More widely, the recent cancer taskforce published its report, “Achieving world-class cancer outcomes”, and it made many recommendations, which are particularly relevant to rarer cancers and blood cancers, many of which focus on improving access to diagnostic testing.

[Mark Pritchard (The Wrekin) (Con)]

Of the 7% of the population that will suffer at some point in their life from a rare disease, 75% are children. Unfortunately, 30% of those will not reach their fifth birthday. What more can be done for Great Ormond Street hospital and for Birmingham children’s hospital, which do such excellent work?

[Jane Ellison]

My hon. Friend is quite right to highlight the number of people who will be affected by such diseases. There are between 6,000 and 8,000 rare diseases. Among the things that the Government are doing that will make a really big difference to some of the institutions that he mentioned and others, and particularly to sufferers, is the 100,000 genomes project, in which the Government have invested. The creation of a network of genetic medicine centres will underpin that further development of genetic testing services. As a very large proportion of rare diseases are genetically based, we want to make significant progress with that genomic work.

[Christian Matheson (City of Chester) (Lab)]

5. What assessment he has made of the effect of changes to social care budgets on A&E attendances.

--- Later in debate ---

[Matt Warman (Boston and Skegness) (Con)]

T7. In Boston in my constituency, as many as one in four children are classified as obese. Will the Minister reassure me that in the forthcoming obesity strategy, the Government will acknowledge that they are allowing families and, indeed, children the opportunity to take the control of their own lifestyles that will fix this problem, rather than seeking to do it for them?

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

My hon. Friend is right that there is a really important role for families. More than anything, the Government want to make the healthy choice the easy choice for families. However, young children are not in control of the whole of the food environment around them, as I am sure he would acknowledge. The Government’s forthcoming strategy is focused on children. Obesity is a complex issue and, frankly, everyone needs to play their part—the Government, local government, health professionals, industry and families.

[Pat Glass (North West Durham) (Lab)]

T2. The Health Secretary just tried to tell us why we have 8,500 more nurses in the NHS. Let me tell him why it is. It is because we have record recruitment from abroad. Since the Chancellor announced the scrapping of bursaries for trainee nurses and midwives, there has been a worrying reduction in the number of applications for next year’s training, compared with what we would expect to see at this time of year. That can only have a negative impact on the number of trained nurses from this country and on net migration. Was there any discussion between the Department of Health, the Home Office and the Chancellor before this idiocy was introduced?

--- Later in debate ---

[Ben Howlett (Bath) (Con)]

In the previous Parliament, many people who suffer from a rare disease were pleased with the publication of the Government’s rare diseases strategy. What progress is the Minister making on publishing the ultra-rare diseases strategy?

[Jane Ellison]

I am happy to look into that and get back to my hon. Friend. With regard to the 51 recommendations made in the UK rare diseases strategy, he will be pleased to know that the first report on that will be in spring. I will take up the other issue with him after questions.

[Danny Kinahan (South Antrim) (UUP)]

Health is a devolved matter, but devolved Governments may choose not to spend when it comes to expensive rare diseases and diagnoses. What more can Westminster do to help my constituents?

[Jane Ellison]

One example, which I am sure the hon. Gentleman will welcome, is the fact that the four UK Health Departments, along with Cancer Research UK, are jointly funding a network of 18 experimental cancer medicine centres aimed at driving the development and testing of new anti-cancer treatments to deliver benefits for patients, including those with rarer cancers. That is just one example of how we can work together.

Health Council

Jane Ellison Excerpts

Thursday 17th December 2015 Written Statements

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

The Health Council met in Brussels on 7 December 2015 as part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council meetings. I represented the UK.

Member states adopted Council conclusions on the reduction of alcohol-related harm, personalised medicine for patients, supporting people living with dementia and lessons learned from the Ebola outbreak. A number of member states called on the European Commission to commit to a new EU alcohol strategy. The UK recognised the huge pressure on public services which results from alcohol misuse and welcomed the presidency’s work. The UK stressed the importance of sharing information on best practice but cautioned that any further EU action on alcohol had to focus on areas of existing competence and had to fully respect member states’ primary responsibility for the public health of their populations. On dementia, the UK underlined the importance of the issue and highlighted the considerable alignment with the Prime Minister’s challenge on dementia 2020.

The Luxembourg presidency gave a brief update on trialogue discussions regarding medical devices and in-vitro devices regulations and outlined progress made through the general approach agreed in October. The presidency outlined that further positive steps had been taken on a number of issues through trialogue discussions.

The Commission gave an update on its report on trans fats in foods published on 3 December 2015. The Commission stated work would now begin on an impact assessment that would consider the available evidence.

The Dutch delegation set out its priorities for its upcoming EU presidency, which begins on 1 January. These include anti-microbial resistance, innovative medicine, and healthy foodstuffs.

[HCWS416]

Tobacco Control Strategy

Jane Ellison Excerpts

Thursday 17th December 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Betts. What an excellent and extremely well-informed debate we have had. I thank the right hon. Member for Rother Valley (Kevin Barron) for raising this important issue for debate. In a way, the timing is more helpful for me than for right hon. and hon. Members, inasmuch as this is a piece of work to which we in the Department of Health are turning our minds, so it has been enormously helpful to hear the views of colleagues from across the House on how we go forward. There are some areas of the topic on which I can respond, but some on which Members might have to wait until a little way into the new year.

The Government have a very clear position on tobacco control, recognising that smoking is and remains one of the most significant challenges for public health, with all the devastating social and personal consequences that Members have outlined. The Government have been proactive and, I think, ambitious in their approach to tobacco control. That was reflected in the comments made by both Government and Opposition Members, for which I thank them. It is also reflected by the fact that many other countries approach us for advice on tobacco control matters. Over the time I have been in this post, it has been a pleasure to attend a number of international events at which we were asked to provide a leadership role. I will say a little more about international matters before I finish.

Our efforts are paying off, and have paid off. As the shadow Minister said, they build on the good work done by previous Governments in previous Parliaments, and we continue to see year on year reductions in smoking. Since 2010, its prevalence has decreased by almost 3%, saving thousands of lives and, of course, countless families from the pain and harm caused by smoking. At various events in the past I have been open about discussing my experience of that harm in my own family. I know that I speak for other Members who have seen that as well.

Before I talk about the new strategy, it is worth reflecting on progress against the current tobacco control plan. We have met, or are on track to meet, the three national ambitions. Adult smoking prevalence is now at 18%, which is the lowest rate since records began; only 8% of 15-year-olds smoke, which is also an all-time low; and rates of smoking in pregnancy are falling, with the most recent figures showing a rate of 10.5%, so we have a high degree of confidence that we will meet that national target as well. On 1 October, it became an offence to smoke in a car carrying children and for adults to buy tobacco for those aged under 18. Making the latter—also known as proxy purchasing—an offence has been called for a great deal in the past. As has been noted, we have also passed legislation to introduce standardised packaging and consulted on how we intend to transpose the revised EU tobacco products directive into UK law.

Despite those achievements, smoking is still the leading cause of premature death and health inequality, and Members have rightly focused on that throughout the debate. About 8 million people still smoke, and the resulting number of premature deaths has been recorded. There continues to be enormous regional variation, which weighs heavily on me—I know that the right hon. Member for Rother Valley is very conscious of that as well. In some areas the prevalence rate is as high as 29%. With that backdrop, we can by no means think that the battle is won.

There is similar variation in ill health and death rates associated with smoking, as the hon. Member for Central Ayrshire (Dr Whitford) eloquently outlined. That variation means that there can be 472 deaths per 100,000 people in one area and fewer than 200 deaths in the same population in others. Throughout the country, we see variation in rates of smoking by pregnant women from more than 25% to about 2%. I know that some areas are working really hard to address that variation. I pay tribute to the people working in places that, despite the high rates that they battle, have seen encouraging results, such as the public health and NHS teams in Blackpool. They are bearing down on their high rates with some success and have done very well.

While we are discussing the ill health caused by smoking, perhaps this is a useful moment to give the shadow Minister a little reassurance in two regards. He made a good point about oral cancer, and I can confirm that one of the pictures in the new library of photographs being introduced with the tobacco products directive will feature throat cancer, so that will draw attention to it. Also, we received welcome information today from the British Dental Association setting out how dentists can help with smoking reduction and the identification of oral cancer. We will consider that further as we develop the strategy. That is welcome and timely news.

As we are talking about the work that people have done in different areas, such as the efforts to bear down on smoking in pregnancy, which have seen some welcome drops, I want to mention the role of health professionals. Their role has run as a thread through the debate, and I suppose it will be ever more relevant as some services look to integrate more with health professionals in the NHS and elsewhere. The movement of health visiting into local government in October—it is now commissioned through local government, as are public health services—offers a welcome opportunity to get some really close working between those two functions in local government right across the board.

As we look at the new tobacco strategy, we are working with Health Education England to identify how NHS health professionals can be further supported to act on smoking. Nevertheless, progress has been made, and I congratulate the midwives and health visitors who have done such good work to identify women who smoke during pregnancy. We have seen their work reflected in the ongoing reductions in the level of smoking during pregnancy, but there is more to do, so we are looking to build on that success.

As I have said, the Government remain committed to tobacco control, and our goal is to drive down the prevalence of smoking in England. At this point, I should say that we are working very closely and constructively with colleagues in the devolved Administrations on that shared objective. Our officials speak to each other regularly, and we are always interested to look at what measures are introduced. As always, it was good to hear the contribution from the hon. Member for Central Ayrshire. Tobacco-related deaths are avoidable, so we want to do more to avoid them.

Although I have said this in an event in the Palace of Westminster, I have not yet confirmed it in the Chamber, but I can confirm that the Government will publish a new tobacco control strategy for England next summer, which I think is a sensible timetable. I hope Members agree that, given the significant measures coming into force in the spring and the fact that we want a little time to reflect on the current strategy, that strikes the right balance. The work is under way already, which is why this debate is a timely opportunity to hear Members’ thoughts. I will ensure, throughout the timetable for developing and producing a new strategy, that there are ample opportunities for Members on both sides of the House to contribute to the strategy development. Important stakeholders, such as those who contributed through Members’ speeches today and supplied useful briefing materials ahead of the debate, will have important and regular opportunities to influence the strategy and have input into it.

In developing the strategy, we will review the current national ambitions, and we will further empower local areas and support action within them, particularly where tobacco control strategies can be tailored to the unique needs of local populations. We cannot ignore the stark differences in the results of different areas across our country, so the new strategy has to focus on those discrepancies. Robust activity at that level is vital if we are to tackle the impact of health inequalities in England and ensure that smoking prevalence continues to decline in all communities. We will, of course, need to support local authorities in pursuing collaborative partnerships and securing a high return on investment as they prioritise and streamline their budgets.

A number of questions were asked about funding, and we will give careful attention to it. I am not in a position to comment in detail on the funding of the strategy itself, about which hon. Members made a number of points and expressed concerns. It was made clear in the spending review that the public health budgets are to be ring-fenced for the next couple of years and protected, with conditions stipulating that the whole budget must be spent on public health duties.

If any right hon. or hon. Members are concerned about what is happening in a particular area, I ask them to please speak to me. The chief executive of Public Health England remains the accounting officer for how the ring-fenced public health grant is spent, and I am always extremely happy to ask him to speak to Members about their concerns about what is happening in their own areas. Manchester was mentioned specifically. I can confirm that we are aware of Manchester City Council’s decision, and Public Health England is currently working with it to identify how it can provide cost-effective support to local people who want to stop smoking. The new control strategy has not been finalised, so we cannot commit to the level of funding that will be needed, but Members have made their views on that extremely clear.

I gently say to my hon. Friend the Member for Harrow East (Bob Blackman) in particular that we have championed the way in which, over the past five years, local government has done extremely well in providing excellent services for less cost. It has focused far more on outcomes than on the money spent. It is relevant to bear that in mind, given that Members have expressed reasonable concerns about the local government spending landscape.

[Kevin Barron]

rose—

[Jane Ellison]

I sense an intervention coming.

[Kevin Barron]

I entirely accept that there are regional variations. We must all accept that, but the mass media—the news and the national media—cut across all regions. Will an evidence-based mass media campaign be part of the strategy that will be published in the summer?

[Jane Ellison]

I can give the right hon. Gentleman a broader assurance than that. Our approach to the subject has at all times been evidence-led, so the new tobacco strategy will clearly encompass a range of evidence-led activities. I hope that reassures him more broadly than just on that point. We must at all times be led by the evidence, as those who contributed today highlighted.

The new strategy is an opportunity to shine a spotlight on what local councils are doing locally, and to learn from innovative work. We cannot stand still in that regard. We must be open to evolving the way we do things, and that is already happening. The new devolution deals are an opportunity to focus on the exciting new ways in which local areas are reimagining the way they do things, and we have seen councils of all colours doing that. We must be optimistic in that regard and pay tribute to the innovation of local government across a range of areas. I have seen that in a host of different public health areas in the two-plus years that I have been doing this job.

But the picture in some communities and areas is not positive. Smoking rates vary across social groups—those from poorer communities and backgrounds experience higher tobacco use and much greater health burdens, as the right hon. Member for Rother Valley and others said in their speeches. Although the right hon. Member for North Norfolk (Norman Lamb) has left, I want to put it on the record—I am sure he will follow this up after the debate—that a particular focus of the new strategy will be on reducing health inequalities and their impact on people who suffer from a mental health condition. We are conscious of the great differences in smoking rates, so that will be a focus of what we do. A quarter of cigarettes are smoked by people with mental health conditions, so I can confirm that that group will be a key priority for the new strategy. We seek to embed the importance of tackling health inequalities both in the new strategy and locally, to cement the national gains that we have made.

We have introduced a significant tranche of legislation, some of which is still to come into force, so we are unlikely to commit in the strategy to a package of legislative interventions. I think colleagues appreciate the reasons for that. Rather, we will set out what we must do to identify and develop new and more effective measures for reducing smoking and smoking harm.

It might be useful to update the House on prisons, which hon. Members mentioned. We are conscious of the great differences in the rates for prisoners and non-prisoners. The Ministry of Justice has announced a programme to make prisons smoke-free, which will be implemented in stages, and prisoners will be given support to stop smoking. Public Health England continues to improve the support that it offers to prisoners who quit in prison to stay smoke-free when they leave.

Of course, tobacco control is not a matter just for legislation or for the Department for Health. There are a range of measures that can choke off the supply of new smokers and help those already addicted to quit. We will work with Her Majesty’s Treasury on tax, as Members would expect; with Her Majesty’s Revenue and Customs on the illicit trade; with local authorities, as I have already said; and, of course, with the NHS on smoking cessation services. I am conscious, as we look at the preventive landscape, that there has rightly been a focus on the five-year forward view. I am looking at several strands of that key piece of work, and this strategy is part of it. Our colleagues in trading standards, who do so much great work on enforcement, are also part of the solution. We will work with academia, the royal colleges and the wider tobacco control community to look at what works and how the Government can play their part.

Next year, in addition to publishing the new tobacco control strategy, we will introduce the stricter packaging requirements, and the revised EU tobacco products directive will come into force. The directive sets out harmonised rules on the composition and labelling of tobacco products that will apply from May 2016, and it will strengthen the functioning of the EU internal market. We look forward to its helping to improve public health. Examples of the impact of the directive are that the minimum pack size for cigarettes will increase to 20, and all flavours, including menthol, will be banned by 2020.

I will come to e-cigarettes in a moment, as I want to respond to the right hon. Member for Rother Valley and others and hopefully give them some helpful updates. First, on the international element, which was rightly raised, I can confirm that the UK has a significant role to play. The UK Government have signed the framework convention on tobacco control, and are now working in the UK and with the Commission to ensure that everything is in place to ratify that protocol. That is something we are committed to doing. The Department for Health has been awarded an overseas development assistance fund to assist other countries with developing their tobacco control policies. That funding will be used to protect people from the harms of tobacco internationally and to tackle the problem of health inequalities globally. A dedicated team will be established to deliver that work. I look forward to updating the House on that in due course.

I turn to e-cigarettes. Of course, the best thing a smoker can do for their health is to quit smoking, and to quit for good. There are now more than 1 million ex-smokers who have used e-cigarettes to help them to quit smoking completely. The evidence indicates that e-cigarettes are significantly less harmful to health than smoking tobacco. I thank Public Health England for the important piece of work it provided to advise us in the summer.

However, the quality of products on the market remains variable. It is therefore important that we have regulation that is proportionate—that is exactly the right word, and I echo that view—to ensure that we have minimum safety requirements and that the information provided to consumers allows them to make informed choices. That is exactly the aim of the regulatory framework set out in the revised directive.

In implementing the new EU rules, we intend to work towards regulation that will permit a range of products, which people want to use, to remain on the market, but with those products positioned as alternatives to smoking, not as products that introduce children to vaping or smoking.

I join the right hon. Member for Rother Valley in welcoming the arrival of licensed products that can be prescribed alongside existing nicotine replacement therapies. The Government had full support from both sides of the House when we took through precautionary legislative measures on the issue of children and e-cigarettes; indeed, most parts of the industry welcomed and supported the uncontentious approach of adopting the precautionary principle with regard to children.

We will continue to take a pragmatic approach to e-cigarettes, and we will be guided by the evidence. The right hon. Gentleman was right that, in a fast-evolving marketplace, we must be guided by the evidence. To that end, we have commissioned a comprehensive review of the impact of e-cigarettes to ensure that future policy decisions continue to be supported by a robust and published evidence base. That will build on the PHE review of evidence on e-cigarettes, which was published in August.

It might be helpful if I update right hon. and hon. Members on some relevant research projects. The National Institute for Health Research is funding a randomised controlled trial to examine the efficacy of e-cigarettes, compared with that of nicotine replacement therapy, when they are used in the UK stop smoking service. I spoke earlier of the evolving world of smoking cessation services and of understanding what works, and that will be an important piece of research. The report of the trial is expected to be published in 2018.

The Department—I hope this speaks to the watching brief that the shadow Minister asked that we keep—is commissioning work through the Public Health Research Consortium to identify whether there are any early signals of e-cigarettes having the potential to renormalise use of tobacco products. That work is expected to report in summer 2016. Again, we will look to update the House when we have the results—I know there will be interest in them on both sides.

I congratulate the right hon. Gentleman on securing a debate on this important issue. As I said, it comes at a really timely moment. When I come back in the new year, I and my officials will certainly turn considerable attention to this important strategy. As I hope I have made clear, none of us can rest on our laurels. We have made some good progress, but the Government will continue to develop support and new measures to reduce the prevalence of smoking further and faster in England. We will, I hope, continue to work constructively with colleagues in the devolved Administrations, with the objective of preventing more people—more of our constituents—from dying prematurely as a result of smoking.

I am acutely conscious of the fact that the burden of disease and harm associated with smoking falls most heavily on the most disadvantaged. Addressing that will be right at the heart of our new strategy. Like all those who have contributed to this excellent debate, I look forward to our first smoke-free generation.

In closing, I echo the words of the shadow Public Health Minister. I wish colleagues and the staff of the House a very happy Christmas, and I thank all those who have contributed to this excellent debate.

Departmental Contingent Liability Notification: Dementia Discovery Fund

Jane Ellison Excerpts

Thursday 17th December 2015 Written Statements

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

A minute had been laid before Parliament regarding the Department of Health’s £15 million investment into the dementia discovery fund (DDF) and specifically in relation to incurring a contingent liability. A copy of the minute is attached.

The DDF was publicly announced on 21 October and is an investment fund that currently stands at £100 million for the discovery of new approaches to dementia research and drug development.

The limited partnership deed for the DDF includes clauses relating to indemnification. The majority of indemnifications are made by the DDF itself rather than the investors and is therefore limited to £15 million. However, there is also a direct indemnification made by all the investors, including the Department of Health. The direct indemnification is triggered in certain circumstances largely relating to where the Department of Health has provided inaccurate or misleading information. Such circumstances are highly unlikely and most are within the Department’s own control. The Department was advised by external legal advisers that it is not possible to quantify any potential liabilities. The Department has taken steps to mitigate the risks of the liability being realised. A senior Department of Health civil servant has been allocated as the senior responsible owner (SRO) for the Government’s investment into the DDF. The SRO, among other things, has responsibility for final sign off for providing any information to the DDF on behalf of the Department.

If the liability is called, then provision for any payment will be sought through the normal supply procedures. The Treasury has approved the proposal.

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

[HCWS441]

Victims of Contaminated Blood: Support

Jane Ellison Excerpts

Wednesday 16th December 2015 Commons Chamber

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

(Urgent Question): To ask the Minister responsible for public health to make a statement on Government plans to reform the support for victims of contaminated blood.

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

I recognise that I committed in earlier debates to consulting on proposals to reform the current payment schemes before the end of the year. Despite our best efforts to meet that commitment, we are unfortunately not ready to publish the consultation before the recess. However, I confirm today that it will be published in January.

The delay will, I know, be disappointing for many who were anticipating the consultation before the end of the year. I apologise for the delay, in particular to Members of the House who have been campaigning tirelessly for a resolution on behalf of their constituents and to those who are directly affected, who continue to wait patiently for our proposals.

In the Westminster Hall debate in September, I explained that any consultation would happen within the context of the spending review and that payments for the reformed scheme would come from the Department of Health budget. The House will know that the outcome of the spending review was communicated to us only a few weeks ago.

The infected blood tragedy and reform of the payment schemes remain a priority for us. We are assessing what can be allocated above and beyond the additional £25 million to which we have already committed. That, of course, is in addition to the existing baseline spend on the payment schemes, which will remain.

Over my two years as public health Minister, I have heard regularly from those affected by this tragedy. Every week, I read a large number of letters, both to me and to the Prime Minister, from campaign groups, individuals and their families, all of whom have been affected by the tragedy in different ways. While considering our proposals for consultation, I want to ensure that all those views are reflected and that I do not miss the thoughts of those with the quieter voices.

We are currently working towards publication of the consultation, and, as part of that, we arranged an independently facilitated event with representatives of some of the leading campaign groups. The report from that event is available through those groups.

I have worked to keep Members of the House updated—you know how seriously I take my duties in that regard, Mr Speaker—and last month I invited members of the all-party group on haemophilia and contaminated blood to a meeting to discuss this issue. I told colleagues that my intention was to consult as soon as possible, but I said that that could be in January, given the timing of the comprehensive spending review.

As discussed with the all-party parliamentary group on haemophilia and contaminated blood, I am also interested in the opportunities offered by the advent of simpler and more effective treatments that are able to cure some people of hepatitis C, and which present a welcome new opportunity to make some people well. I assure the House that that work continues to establish a way forward, and a consultation will be published in January. At that time I will seek to make an oral statement.

In conclusion, because my priority is to get this issue right, I have taken the decision to take a little more time and publish the consultation in January.

[Diana Johnson]

Mr Speaker, your decision to grant this urgent question is recognition of the long campaign for justice for this group of people, and it is appreciated by everyone who has been involved. I am, however, disappointed that I have had to ask for an urgent question. On three occasions, Ministers promised a statement before Christmas, and they should not have been forced to come to the Chamber for the second time this year. When the Minister speaks about a consultation in January, I assume that she means January 2016. I would like clarification on that, because dates always seem to slip, and such action from the Government fuels distrust and resentment among people who have been let down for too long.

I have four questions for the Minister. First, she proposes a consultation that will run for 12 weeks and that she will need to assess before launching a new scheme. Will she explain how that is feasible before the start of the next financial year? Secondly, she claimed that it will be the first full public consultation, but the APPG ran a full consultation—with the same consultees—earlier this year. Can she assure me that she has considered the APPG report and all the evidence presented in it? Thirdly, as she said, the Government delayed making a statement until after the comprehensive spending review, in order to determine the total “financial envelope” available. I understand that the Department of Health currently pays out about £14 million a year, with a total future financial commitment of £455 million. Will the Minister tell the House how much more is now available following the comprehensive spending review?

Fourthly, lump-sum payments were a key issue raised in response to the APPG inquiry, but it now appears that those are off the agenda. That is a major disappointment because lump-sum payments would allow those affected to make real choices about their own lives—something they have been denied for far too long. Will the Minister support a separate request to the Treasury to use funds equivalent to the £230 million raised from the sale of Plasma Resources UK to fund lump-sum payments to those who have been affected?

[Jane Ellison]

I thank the hon. Lady for her response. Of course I understand the disappointment that we are not able to consult before the end of the year, but I informed her and her colleagues who came to the meeting on, I think, 5 November, that it was unlikely that we would be able to do so. That was recorded in the note made at the meeting, and published through the all-party group. I have tried to keep colleagues informed, and only last night I spoke to a number of campaigners about this issue, including the hon. Member for Foyle (Mark Durkan) and my hon. Friend the Member for Colne Valley (Jason McCartney), and informed them personally about the delay. I would, of course, have informed the hon. Lady today or tomorrow, along with the other Members who attended that meeting. I have done my best to keep people informed.

I understand the hon. Lady’s point about the consultation. I will consider the issue she raises, but I have always been clear that the transition to a new scheme must be done in a way that does not compromise the safety of payments to people in schemes—again, we discussed that at the meeting in early November. I therefore see no problem with consulting and then moving towards a transition, because that transition will be a gradual process anyway for some people. I want to ensure a safe transfer from the current scheme to any reformed scheme, and I do not see a real problem in that regard.

This will be the first full consultation by the Government, and the hon. Lady is right to say that the all-party group—and others, including my right hon. Friend the Member for North East Bedfordshire (Alistair Burt)—garnered many views. All views, including those put to the all-party group in its very good report, can be reiterated as part of the response to the consultation.

I made a statement on the issue of money in my response to the urgent question. I understand the point the hon. Lady makes on lump sum payments, but it would not be appropriate for me to comment at this time. I can talk about that more when I make an oral statement at the time we launch the consultation. She reiterated in her questions the principle of individual choice and treating people as individuals. Many Members have stressed to me the importance of that principle. We will very much recognise it in what we bring forward in the new year.

[Jason McCartney (Colne Valley) (Con)]

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson), with whom I co-chaired the all-party group on haemophilia and contaminated blood in the previous Parliament, on securing the urgent question. May I, too, press the Minister to please use the valuable data in the all-party group’s report? It has real testimony from the victims on how the trusts and funds—whether the Macfarlane Trust, the Skipton Fund, the Eileen Trust or the Caxton Fund—just are not delivering the day-to-day support the victims need. Will she come back to the House as soon as possible in January and not on the last day, so we do not have to secure another urgent question?

[Jane Ellison]

My hon. Friend, who has campaigned long and hard on this issue, is right to reiterate the importance of the views given in that report. I confirm that they have already informed our thinking about how we go forward, as indeed have the views of many colleagues on all sides of the House expressed over many months and years. I can assure him that the report will be considered. I have previously committed, and I reiterate the commitment today, to conducting a root and branch reform of the current schemes.

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

Thank you, Mr Speaker, for granting this urgent question. I pay tribute to all the Members of this House who have been a strong voice for the victims of contaminated blood, but in particular to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) who has been tireless in her pursuit of answers.

This scandal saw thousands of people die and thousands of families destroyed through the negligence of public bodies. Over the years, the response of Governments of all colours just has not been good enough. It is a real shame that we are here yet again wondering why action has not been taken. I do not think anyone doubts the sincerity of the commitment that the Prime Minister made back in April, but does the Minister understand the disappointment that people have felt in recent months as promises to publish arrangements and to make statements have been broken repeatedly? Does she accept that that has only raised false hope among a community that already feels very betrayed?

Given the further delay that the Minister has announced today, what guarantees do we have that the January consultation date will be met? What redress—other than an urgent question through you, Mr Speaker—will there be if it is not? A consultation is fine, but will she say when any new scheme will be implemented? It is important that any new arrangements are properly scrutinised, so will she commit to a debate in Government time to allow that to happen? Finally, does the public health Minister appreciate that the longer this goes on, the longer we leave in place a system that is not working and leaves victims without adequate support?

No amount of money can ever fully make up for what happened, but we owe those still living with the consequences the dignity of a full, final, fair and lasting settlement. This injustice has gone on for far too long. The time for action is now.

[Jane Ellison]

As I have already said, I of course regret the delay. This is a very complex area. I appreciate the tone with which the shadow public health Minister responded, because, as he said, Governments of all colours have not turned to this issue. We have turned to the issue and we are addressing it in a great deal of detail. It is a complex area. There is a very diverse range of affected groups impacted by this tragedy and we must get the consultation on reform right for all of them. I have been clear, in my response to the urgent question, that we have been considering the funding issue. We are, of course, aware of potential litigation in relation to the scheme as it stands. I cannot comment further on that, but the House will appreciate that that adds a level of complexity to dealing with this matter.

I am always extremely happy to come to the House to explain. The scheduling of debates in Government time is not a matter for me, but it goes without saying not only that I would be delighted to debate the matter but that I am happy to talk to colleagues, including shadow Front-Bench colleagues, privately or otherwise, about this matter. That commitment remains.

[Chloe Smith (Norwich North) (Con)]

I echo the spirit of these exchanges; we need to do this job fast and well. May I highlight the tragic circumstances of some of those affected, including a constituent of mine who has sadly got more ill as we have been debating the fine details of the scheme? There is no more time to lose.

[Jane Ellison]

That point is well made and very much on my mind. When I can say more about the shape of our proposed reformed scheme, I hope my hon. Friend will see that we have tried to respond to her concerns and those of many other right. hon. and hon. Members.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Penrose inquiry was held in Scotland—there has not been a UK inquiry—and, in response, the Prime Minister made his statement about the £25 million transitional payment. These people are awaiting a final settlement and compensation for what the NHS did to them, but their suffering goes on. We were told that the transitional payment would be made this financial year to help people get to that settlement. The consultation is on the final arrangement, but we need some action now and people need access to the new hep C drugs. The Scottish Government have written about support for fuel payments, but we need the transitional money now. It should not be kicked into the long grass.

[Jane Ellison]

This certainly has not been kicked into the long grass. As I have told the House, it is my intention to consult in January. I have said before, but it is worth repeating, that although we are working to establish a fair resolution, liability has not been established in the majority of cases, so it is not appropriate to talk about compensation payments, particularly on the scale that some campaigners and colleagues envisage. I have been open about that for many months. The hon. Lady is right to make the point about treatments, and all those things will be considered. I can confirm to the House that, although the £25 million was allocated to be spent in this financial year, it will be carried forward. The money that the Prime Minister announced in March was to support the transition of the scheme, which we envisaged beginning next spring, following the consultation. The money will support that, and it will be carried forward.

[Craig Mackinlay (South Thanet) (Con)]

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing the urgent question. I speak today on behalf of a constituent, a Mr Steve Dymond, who has hepatitis C as a result of contaminated blood products. Although he is in remission, a normal life for him is impossible. I know that new drugs and treatments are available. Will the Minister assure me that those advanced new treatments will be available to all sufferers without restrictions? I hope that, despite this delay, the closure we need will be delivered very shortly. This is a big subject in my part of Kent. It is trailed massively in the Kent on Sunday, which covers it regularly. We need closure and those affected need certainty in their lives. Can the Minister assure me of that?

[Jane Ellison]

I have corresponded directly with Mr Dymond’s partner, so I know the level of suffering he endures. On the new treatments, the drug landscape on hepatitis C infection, which is very different from even a couple of years ago, is uppermost in my mind as I consider how to reform the scheme and support those who suffer.

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

This announcement comes after the shambles of a meeting at the Department last month, when hon. Members from both sides of the House arrived for a stated time, only to be told, after waiting, that the meeting was over. We then received an apology from an official promising further information that was never supplied. Does the hon. Lady understand what being a Minister entails? It means being in charge and only making promises that can be kept. This has been a travesty, but it would not matter so much were it not for the sick people, including those in my constituency, who are living lives of hell and were looking to the Government, after the promises were made, for some kind of alleviation during their lifetimes. They have not got it.

[Jane Ellison]

I slightly regret the right hon. Gentleman’s tone, and I am totally mystified by his point about the meeting. A meeting was organised with the all-party group and his colleague the hon. Member for Kingston upon Hull North. I think the meeting might have been moved once, at the request of the all-party group, but the details and arrangements for the meeting with me were circulated by that group, and six right. hon. and hon. Members attended the meeting. I am sorry if there was some confusion, but I do not think it was on the part of me or my officials. A number of colleagues came to the meeting. We had a very useful discussion and I have sought to update others since.

The right hon. Gentleman is right that we need to move towards a conclusion, but it is also a matter of record that he was, at times, a member of the last Labour Government, who, for 13 years, did not move forward on this matter.

[Nadhim Zahawi (Stratford-on-Avon) (Con)]

The Minister will be aware of my frustration in dealing, on behalf of a constituent, with the Macfarlane Trust, which she knows, from the weight of evidence in the consultation, is not fit for purpose. Will she confirm that any full and final settlement will not be administered by that trust?

[Jane Ellison]

I am well aware of the shortcomings of some of the schemes identified by colleagues and those affected by this tragedy, and I have obviously read the details from the all-party group and other Members’ communications. I have confirmed before that reducing the number of schemes will be part of the consultation on reforming the schemes, so my hon. Friend’s point is well made. For the record, though, I should add that I had a meeting recently with the staff of the schemes—the people who man the phones and deal on a day-to-day, week-to-week basis with sufferers—and I am clear that they, as distinct from the people who head up the trusts, are working hard to offer a service to people in difficult circumstances.

[Norman Lamb (North Norfolk) (LD)]

Is this not one of those situations where there is an absolute moral obligation on the Government to act and end the uncertainty and delay? Is the Minister reassured that the spending review gives her the ability to bring a lasting and fair settlement, and will she do everything she can to ensure it is in place by the start of the next financial year?

[Jane Ellison]

I am happy to assure my former colleague in the Department that the Secretary of State and my departmental colleagues take this matter extremely seriously. It is a matter on which we are seeking to move forward. It will be for those who respond to the consultation on the reformed scheme to give their views, but we are seeking to move towards a reformed scheme that responds to the criticisms of the existing schemes and offers sustainability for people who have suffered for so long. I hope I can satisfy the right hon. Gentleman in that regard, although I will be able to say more in the new year, when we publish the scheme details.

[Tom Pursglove (Corby) (Con)]

One of my constituents, Sue Wathen, is trying to access the Harvoni drug, but it is proving incredibly difficult, because she has not developed cirrhosis. She does, however, have an underlying medical condition that is being exacerbated by the contaminated blood. Much is being reported about greater access from February. Is that the case and will Mrs Wathen be able to access the treatment she so desperately needs? I would love a yes or no answer, because it is incredibly frustrating.

[Jane Ellison]

I would never give a yes or no answer to the individual health problems of a constituent I do not know, and I am not a clinician, but if my hon. Friend would like to write to me, I will certainly make sure I give an individualised response. Ultimately, however, the right clinical route for any one individual would come at the suggestion of their consultant hepatologist. Towards the end of November, NICE published new guidelines on three more drug treatments, so the drug landscape for hepatitis C is changing rapidly, but I am happy to ensure that hon. Members are kept fully informed. As I said in a previous debate, if people are concerned that their constituents are not aware of what is out there or do not feel they are getting the support they need to access treatment in line with the NICE guidance, we can offer advice to Members on how to make sure that happens. However, I am well aware of the general point he makes.

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

Will the Minister clarify whether individuals affected by this terrible scandal will receive individualised letters? How will they know that this consultation is opening next month?

[Jane Ellison]

My officials have been giving considerable thought to how to do that. A number of people are members of the existing schemes, so we have a means to communicate with them, but it is clear from experience of following up previous inquiries’ recommendations—for example, the one recommendation of the Penrose inquiry—that we make exhaustive efforts to inform everybody. In particular, we will want to inform people who have had a lump sum payment but are not members of the current scheme. We will make exhaustive efforts to inform people by every means possible. Members of Parliament can of course be of great assistance in that regard.

[Mr Peter Bone (Wellingborough) (Con)]

Going back to the issue of medication, my constituents want to know the answer to this question: available drugs that have not yet been approved by NICE but that can be prescribed are not being prescribed locally on financial grounds. Is that not wholly unacceptable?

[Jane Ellison]

The NHS is looking at its response to the most recent NICE guideline—it was very recent, on 25 November, from memory. The NHS has commissioning arrangements in place for previous treatments that met NICE guidelines. It would be useful if my hon. Friend contacted me separately about the particular situation in which his constituents find themselves, and we might be able to provide some helpful support.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her response to the urgent question. Brian Carberry from County Down contracted hepatitis C from contaminated blood in July this year. Compensation is always important, but the really important issue for those affected is that it is not enough when a problem is health related. What discussions has the Minister had with the Northern Ireland Health Minister, Simon Hamilton, to tackle this issue?

[Jane Ellison]

My officials are working closely with their opposite numbers in all the devolved Administrations. As we move towards publication of the consultation, I will look to communicate directly with my opposite numbers in the devolved Administrations and pick up all these points.

[Kevin Foster (Torbay) (Con)]

I know from her statement that the Minister will appreciate the frustration that my constituents, some of whom have been waiting for an outcome for some decades, will feel at another delay. Given her comments on the carrying over of transitional funding, will she give me a clear idea of when she expects the new system to be in place?

[Jane Ellison]

We aim to consult, and we want to make sure that the final shape of the reformed scheme is informed by that consultation. As I have said, we look to start transitioning to a reformed scheme in the spring. At this stage, however, it is a little difficult to be more precise. We are working hard to ensure that aspects of the transition are being planned and thought about, and this will be informed by the final outcome of the consultation.

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

The Minister wrote to me on 6 November and stated:

“The shape and structure of a new scheme will be decided following the consultation process that will begin by the end of this year as previously committed”—

as it had been committed in an Adjournment debate on 9 September. I am deeply disappointed today that neither that scheme nor that consultation is in place. My constituent, Brian Carberry from Downpatrick in South Down, whom my Adjournment debate was about, has told me in the last few weeks that he now has a form of cancer, with four tumours identified, as a result of the connection with contaminated blood. Will the Minister give me and the House an undertaking today that a full and final settlement will be in place before the end of this financial year.

[Jane Ellison]

I have already made my comments about the timing of the consultation, and I cannot add to what I said in response to the hon. Member for Kingston upon Hull North (Diana Johnson), who put the urgent question. I have often spoken to the hon. Member for South Down (Ms Ritchie) about this and I responded to her Adjournment debate. I think that the language she uses is applicable to circumstances before this exchange. I have already explained the issue of compensation and the principles that we shall try to apply to the reformed scheme. I cannot really add to the comments I made in my response to the hon. Member for Kingston upon Hull North.

[Andy Slaughter (Hammersmith) (Lab)]

Let me challenge the Minister on the phrase “quieter voices”, which I have heard her use several times. It seems to be a code for addressing the important but less costly issues of treatment and reform of the current scheme rather than a full and final settlement to what Lord Winston rightly called the

“worst treatment disaster in the history of the NHS”.

We have a moral duty here, so simply saying “the Chancellor will not give me the money” will not wash.

[Jane Ellison]

Again, I have said here today and previously in Westminster Hall what I believe the position to be with compensation. I accept that the hon. Gentleman has a different view and we had an exchange when he contributed to the discussion in November. I think it would be wrong to dismiss the idea of listening to quieter voices, which I have had the opportunity to do over the last couple of years, and as a result it has become clear that a number of people want a number of different things from a reformed scheme. It will not be possible to do everything that everyone wants. We are going to try to respond as best we can with a scheme that is sustainable, fair to all and responds to many of the points made here today.

[Alison Thewliss (Glasgow Central) (SNP)]

I thank the hon. Member for Kingston upon Hull North (Diana Johnson) for tabling the urgent question. Only this Friday a constituent raised a number of issues about this very topic at my surgery and she will be most disappointed at this further delay. If the Minister has not done so already, will she take up the issue of continuing assessments by the Department for Work and Pensions? My constituent feels it is extremely strenuous that she has to continue to prove her case to qualify for benefits. She also found—she cannot be unique in the country—that the NHS treatment she received was not the most sensitive, and she would like to see some guidance issued for healthcare professionals.

[Jane Ellison]

I thank the hon. Lady for those comments and I will reflect on them. The DWP matters are outside the remit of the Department of Health, but I will take on board the general issues she raises and refer them to colleagues. As I have said, we continue to work with the devolved Administrations on NHS matters; if her constituent is being treated in Scotland, it is a devolved matter for the Scottish NHS.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I appreciate the contrite tone of this question, but this is so very disappointing. My affected constituent simply wants to be able to buy a home and provide security to his family, but that is not available to him at present. Can I tell my constituent that next year a new scheme will be in place and that he will be eligible to receive support from it?

[Jane Ellison]

It is clearly my intention to have a reformed scheme in place next year. I do not know the circumstances of his constituent, so I cannot make that individual commitment. I have said that we want to move to a reformed scheme next year. I understand the frustration of Opposition Members, but, as the hon. Member for Denton and Reddish (Andrew Gwynne) acknowledged, Governments of all shades and descriptions have not stood up to tackle this issue. We are going to try to do something; it will not satisfy everyone, but I hope we will be able to come forward with a scheme that will respond to many people’s concerns.

[Chris Stephens (Glasgow South West) (SNP)]

I, too, thank the hon. Member for Kingston upon Hull North (Diana Johnson) for raising this question. The Minister will recall a meeting I attended on 5 November, in which two main issues were discussed. The first was the setting up of a contingency fund, rather than having to rely on the spending review every year. Will the Minister confirm that she has written to the Treasury about that? Secondly, will the consultation consider the issue of family members who have lost loved ones as a result of contaminated blood?

[Jane Ellison]

I covered the issue of funding in my response. The hon. Gentleman attended the meeting, at which a number of matters were discussed. I do not think I can add much to what I have already said. This is a priority for the Department of Health, and we are seeking to identify the amount of money, on top of the transitional £25 million and the baseline spend on the current scheme, that we can use to support the reformed scheme.

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

Six thousand infected, 2,000 dead, a 30-year struggle—this delay is just one part of the continuing nightmare that victims face. Can the Minister tell my constituents Fred Bates and Peter Mossman when the nightmare will come to an end?

[Jane Ellison]

I cannot right the wrongs of 30 years; I can only try to do what I can in the circumstances, and with the money that we will allocate. We will present plans for a reformed scheme, and I invite the hon. Gentleman and his constituents to respond to them. In developing those plans, I must look to the future, and ask what we can do to support people with a reformed scheme. In particular, I must ask how we can respond to some of the ways in which the circumstances in which we address this terrible, difficult tragedy have changed, and ensure that our response reflects those new circumstances.

[Mark Durkan (Foyle) (SDLP)]

The Minister may recall that when the all-party group met her in early November we warned her that any slippage would be greeted as slipperiness by people who had suffered delays for too long. Does she appreciate that people will worry about the possibility that the extra time has been taken to ensure that the consultation is more controlled and options are sealed off? Will she also address the underlying question that people want to ask? Why, if liability could be admitted by the Irish health service on the basis that the risk was known, can liability not be admitted by the NHS, and why cannot compensation be forthcoming?

[Jane Ellison]

Payments made by the Republic of Ireland are a matter for the Republic, and they were made in response to circumstances in Ireland relating to the use of blood products. We have covered that before, in debates.

Of course I understand the hon. Gentleman’s frustration—I spoke to him informally last night to alert him to the fact that there was some delay—but I reiterate that it is better for us to produce a scheme into which we have had a chance to put more effort and a little more detail than, for the sake of a few weeks, to rush out something that would not give people any real sense of what was being consulted on. Although the delay is frustrating, as I have acknowledged a number of times, I think that it will give rise to a better and more meaningful consultation.

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

The victims are clearly identified, and a final settlement is well overdue. Weeks ago, in the Chamber, I asked the Government whether they would provide additional support for victims during the coming winter. It may be mild here, but it is not mild everywhere, and many of them are suffering from fuel poverty. It is Christmas. Given the ever-stretching time that it is taking to resolve this matter, will the Minister commit herself to providing the additional support? The Scottish Government have already asked her to do so, but will she make that commitment now?

[Jane Ellison]

The matter has been raised with me by Shona Robison, the Scottish Health Secretary, and I intend to respond to her in the next few days. The Northern Ireland and Wales Administrations are still considering the matter, and have not fed anything back to me about Shona Robison’s proposals. I did raise them with the Members who attended the all-party parliamentary group meeting in early November, but there was relatively limited interest at that time.

Employment, Social Policy, Health and consumer Affairs Council

Jane Ellison Excerpts

Thursday 3rd December 2015 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 7 December in Brussels. The Health and Consumer Affairs part of the Council will take place in the afternoon.

The main agenda items will be the following:

Council conclusions—the Council will adopt conclusions on:

“An EU strategy on the reduction of alcohol-related harm”

Personalised medicines for patients

Supporting people living with dementia: improving care policies and practices

Lessons learned for public health from the Ebola outbreak in west Africa—health security in the European Union

Under any other business there will also be presentations on three other points:

Regulations on medical devices and in vitro diagnostic medical devices—the presidency will provide an update on the state of play, with negotiations currently at trialogue stage.

The regulations seek to address weaknesses in the current regulatory system, ensure a more consistent level of implementation across the EU, and ensure that the EU will continue to be viewed by business as an innovation-friendly regulatory environment. The UK has broadly supported the Commission’s proposals in order to ensure high standards of patient safety.

Public health conferences—information from the presidency of conferences it organised in this field

Dutch presidency—the Dutch delegation will set out priorities for their forthcoming presidency, which will run from January until June 2016.

A copy of the latest agenda can be found online at:

http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-12-03/HCWS354/

[HCWS354]

Sugary Drinks Tax

Jane Ellison Excerpts

Monday 30th November 2015 Westminster Hall

[Dr Huq]

Yes, sorry. I am a secret lemonade drinker—no, I’m not.

I want to be brief, but we are discussing something important. Voluntary agreements do not seem to be moving fast enough. As everyone has said, we need a range of different approaches, and hiking up sugary drink prices by pennies is part of that. As for the industry’s worry that the cost would have to be passed on to consumers, the industry itself could absorb or partly absorb the cost.

Eleven to 18-year-olds will choose drinks based on price, because they are short on cash, although other factors could come into play—peer pressure, habit, availability and so on. We need to think smartly about things such as advertising bans, which have been mentioned, encouraging physical activity, curbing “buy one, get one free” types of promotions, discounting fruit and veg, and considering portion sizes. In New York the authorities have banned the largest size of soda cups.

I want to ask the Minister what happened to the ban on fried chicken shops at school gates, because I still seem to have them in my constituency. Such a ban was talked about, and it would be good if its implementation could be accelerated. Also, what about minimum unit prices for alcohol? If sugary drink prices go up but alcohol prices are low, there could be some awful, cataclysmic thing going on as a result, possibly—

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

Hopefully not at primary schools.

[Dr Huq]

No, but alcopops and such things have always been popular with young people, because they look harmless, but some of them have a high alcohol content. We have a golden opportunity, because the Government are working on a childhood obesity strategy, and we must not waste that opportunity We must think long-term and heed the BDA chief’s words:

“Public health policy must be guided by evidence, not by personal prejudice or commercial interests.”

So happy Sugar Awareness Week, one and all. I will be interested to hear the summing-up speeches.

--- Later in debate ---

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

What an excellent debate we have had. It has been a real pleasure to listen to so many extremely well-informed contributions. Let me start by acknowledging the strength of public feeling about the issue. We are responding today to an e-petition with a great many signatories, and I thank everyone who signed it. I also praise the passion and commitment shown by Jamie Oliver, as other Members have, in raising the profile of healthy eating and, in particular, the impact of sugar on our diets and health. I will attempt to respond to most of the specific points made, but I am a little constrained by the timing of the debate.

Let me reflect on where we start from. A number of Members have cited the current obesity statistics. The most recent figures, published only last Thursday, show that there has been a relatively small overall change in overweight and obesity prevalence in the past five years. In that sense, levels remain unacceptably high, but there is a degree of stability. We saw some slight encouragement in the figures for children in reception, but we then see obesity prevalence more than double between reception and year 6. As the Chair of the Health Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), and others have rightly underlined, there is a very wide gap in obesity prevalence between the most deprived and the least deprived areas. I share the deep concerns expressed in all parts of the Chamber about that.

We have seen some good progress made on school food in recent times, so there are reasons to think this is a good moment to move forward, as there are areas in which we have encouraging building blocks. This debate, alongside the Health Select Committee report published today, is a valuable and timely opportunity for Members to make their views known at a critical juncture in the development of our comprehensive cross-Government childhood obesity strategy. That is a perfectly sensible reason for the timing of this debate and the publication of the Committee’s report; it is extremely helpful to have them.

Earlier in the debate, one Member wondered whether I was feeling isolated. Far from it: it has been wonderful to spend the past few hours with Members from across the House who feel as passionately as I do about tackling this issue and, in particular, to hear the challenge of tackling childhood obesity framed in the context of improving the life chances of so many children, particularly those from the most deprived communities. That is certainly a strong strand of my thinking as I look at this issue. I have listened carefully to the comments made and will look in greater detail at the Select Committee’s report, to further inform our ongoing policy development.

It is no secret that the Government have no plans to introduce a tax on sugar, although all taxes are kept under review. Such decisions are a matter for the Chancellor, as part of the Budget process. That being said, driving sustained behaviour change will require broad-ranging and concerted action of the kind we have discussed. It is extremely welcome that, whatever Members’ views on a sugar tax, there is consensus across the House on the fact that there are no silver bullets in this debate. That is a really important point.

[Geraint Davies]

I happen to have introduced econometric modelling to Unilever. Would the Minister accept that if a sugar tax is introduced, less sugar will be consumed, and the Government will make money and save money on the health service? Is it not a no-brainer? What is the justification for her resistance to this obviously sensible measure?

[Jane Ellison]

I will touch on some of those points, but I want to take this opportunity to update the House on what we are already doing, to give some sense of our direction of travel and, in particular, to reassure people who have been urging us to look widely at a whole range of things beyond the silver bullet arguments. I hope to give some reassurance in the course of my remarks that we are, indeed, doing that.

[Geraint Davies]

What is the Minister’s justification for not introducing this measure?

[Jane Ellison]

Unless the hon. Gentleman continues to chunter at me from a sedentary position, I will come to the vital issue of teaspoons, about which he and I have spoken before, and upon which a number of Members have remarked.

Today, I will principally talk about some of the steps the Government are already taking to improve children’s health, particularly in relation to food and diet. I fear my response is rather limited in its scope by the proximity to the publication of our strategy, but I want to reassure Members that this is a major priority and a manifesto commitment of the Government. There is no argument from us about the scale of the challenge, which has been outlined well in a number of speeches today. As I said, I passionately agree with the Chairman of the Health Committee, my hon. Friend the Member for Totnes, about the impact on health inequalities of childhood obesity, so there is no argument there either.

We can all agree, and have all agreed, that as a society we are eating too much sugar. It is bad for our health and can lead to excess weight gain. That, in turn, increases the risk of heart disease, as other have said, as well as type 2 diabetes—my hon. Friend the Member for Erewash (Maggie Throup) gave a very good speech about that—stroke and some cancers. The link to tooth decay has also been brought out in a number of very good speeches.

I was interested to hear the, as ever, extremely well informed contribution from the hon. Member for Central Ayrshire (Dr Whitford). As a very distinguished clinician, she will be aware of the links between obesity and many of the big health challenges of our age, but I think that is less well understood more generally in the population. We need to talk more about that—I have challenged a lot of our major charities to talk about it more—so that people become as understanding of that as they have of the link between tobacco and some of the very significant disease groups.

However, public awareness is increasing. In recent evidence, 92% of people said that they were trying to manage or reduce the amount of sugar in the foods that they buy, while 26% of households were very concerned about sugar in food and 30% reported being more concerned than they were a year ago. Concern was higher for sugar than for fat or salt.

Before I talk about the report by the Scientific Advisory Committee on Nutrition, I would just say that I regret the comments made by the hon. Member for Newport West (Paul Flynn), who is not in his place. He spoke about some extremely respected clinicians—members of that committee—who have done great service not just to the committee, but to the nation’s nutrition more generally. The point was made very well by the hon. Member for Heywood and Middleton (Liz McInnes) about transparency and the need for people to declare their interest. That is all done by the members of that committee, and I want to thank them, on behalf of the Government again, for the work they have done for the committee’s report on carbohydrates and health, which it published in July. I accepted, on the Government’s behalf, the report’s recommendations, which were that no more than 5% of energy in our daily diet should be from sugar. That is the equivalent of about seven sugar cubes or five or six teaspoons and there are wider implications for the general dietary advice from the Government from that policy shift. We are working through those with Public Health England.

As the House knows, and as many speeches have touched on, we are currently consuming more than double the recommended limit for sugar, and teenagers’ consumption is nearly three times the recommended level. Again, we are under no illusion that we need to take action in this area. Earlier in the year, I requested that Public Health England prepare evidence for the Government on effective approaches for reducing sugar consumption. That is the report that the Health Committee has had chance to respond to.

[Geraint Davies]

As the Minister would accept, there is an elasticity of demand for any product—namely a relationship between the price and the demand. Will she focus a few comments on why precisely she is resisting simply putting up the price of sugar through a tax? I appreciate what she said about my hon. Friend the Member for Newport West (Paul Flynn), but if no reasons are being given, he probably cannot understand why. If there is no rational reason for doing so, he is assuming it is because of the lobbyists.

[Jane Ellison]

That is not right. Again, I come back to the point stressed in the report by Public Health England—indeed, the Health Committee’s excellent report underlines it—that there is no silver bullet. It is really important that we address the fact that a number of wide-ranging issues need to be tackled and that several options are available to us in policy terms. PHE concluded that no single action on its own will be effective in reducing the nation’s sugar intakes. Its report shows evidence to suggest that higher prices in targeted high-sugar products, such as sugar-sweetened drinks, tend to reduce the purchases of such products in the short term.

Mention was made of the possibility of Cochrane reviews in coming years. An interesting article in the current issue of The Economist notes that the longer-term effect on public health is as yet unknown. Obviously that is because in most cases these measures have not been in place long enough, but it is an important concern—and the hon. Member for Swansea West (Geraint Davies) will have noted a degree of reticence on the part of those on his own Front Bench about the evidence, but anyway. We are, of course, well aware of what Public Health England said in its report about the evidence on higher prices. However, its report also argued strongly for implementing a broad, structured programme of parallel measures across all sectors, if we are likely to achieve meaningful reductions in sugar intakes across the population. As we have heard, it identified areas for action that include restrictions on marketing, advertising and price promotion, and work to reduce levels of sugar in food and drinks—I welcome the focus of a number of speeches on reformulation of product, as we think it has a significant role to play. Areas for action also included improving public food procurement and improving knowledge about diet and nutrition. We are considering all the evidence and working closely with Public Health England to develop our policies.

A number of Members have talked about education. This debate provides the opportunity for me to talk in more detail than I generally can in such debates about the Change4Life programme, in which we continue to invest significant sums. The Change4Life campaign has provided motivation and support for families to make small but significant improvements to their diets and activity levels. Last January, Change4Life’s Sugar Swaps campaign encouraged families to cut back on sugar through two TV advertisements focusing on sugary drinks and after-school snacks. That campaign also included radio, digital and outdoor advertising.

[Barbara Keeley]

I expressed concern about budget cuts for Public Health England. Will the Minister address that? I, too, admire the work it has done, but it is not helpful to cut the budget, is it?

--- Later in debate ---

[Jane Ellison]

As the hon. Lady will see, the campaign is going to be very significant again this coming January, so as I say, we continue to invest significant sums. It is a very important campaign and a very important brand that is being developed, and we see it as something we want to build on.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

I am going to make some progress and develop my point about Change4Life, because Members have asked questions about that.

The campaign included radio, digital and outdoor advertising; public relations and media partnerships; work with 25 national food retailers and manufacturing partners; community events and schools programmes; and, importantly, work with all 152 local authorities. More than 410,000 families registered with the last campaign. Families who signed up purchased 6% less sugary snacks by volume and 6% less sugary puddings by volume, while increasing consumption of lower-sugar snacks and puddings. For each person who signed up, another two in the general population said they had also made a food swap.

The Change4Life team is developing the next Sugar Smart campaign, to launch in early January 2016. The campaign will alert families to the problems of consuming too much sugar, reveal the amount of sugar in the most popular food and drink and tell them about the new guideline daily amounts. It will encourage people to download the Sugar Smart app, which I have seen being used and is very impressive—hidden sugars no more, I can assure the House. People will be able to see for themselves how much sugar is in the products they are buying. The campaign will include advertising on TV and online and posters, in addition to social media activity and PR. Five million information packs will be given to families through schools, commercial partners and local authorities, and there will be digital support to help families who want to cut back on sugar.

However, obesity is a complex issue, which the Government cannot tackle alone.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

I am going to come on to teaspoons, and I do not want to run out of time before I do so. I will make a bit more progress and then see how we are getting on for interventions.

The Government cannot tackle obesity alone. I welcome the fact that we have consensus across the House on that, and the Committee draws that point out in its report. Businesses, health professionals, schools, local authorities, families and individuals have a role to play, as my hon. Friend the Member for St Austell and Newquay (Steve Double) brought out.

I want to talk about some of the industry action that has been taken. There has been progress in recent years on reducing sugar consumption. The focus under the voluntary partnership arrangements, which have been discussed, has been on overall calorie reduction, of which sugar can form a part. Billions of calories and tonnes of sugar have been removed from products and portion sizes have been reduced in some areas. Some major confectionery manufacturers have committed to a cap on single-serving confectionery at 250 calories, which is an important step.

We have to be realistic about consumer relations, which are important. Before I was an MP, I worked for the John Lewis Partnership—John Lewis and Waitrose—and I know only too well the important role that retail relationships play in an average family’s life. We need to involve those partners. Some retailers have played a part, for example by removing sweets from checkouts. Interestingly, they did so after asking their customers in surveys what support they wanted, as family shoppers, from industry to help them to make healthier choices. Much of the action that retailers have taken was in response to that.

I was very interested in the point that my hon. Friend the Member for Salisbury (John Glen) made in an intervention about consumer power. There is much greater consumer power to be unleashed, but the challenge to the industry to make further substantial progress remains. Like the Chair of the Health Committee, I have had some encouraging conversations in that regard, but we need to make more progress.

Providing clear information to consumers to help them make healthier choices is important, as a number of hon. Members have set out. 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 better to understand the nutrient content of foods and drinks.

I turn to the issue of teaspoons of sugar, which has come up a lot in the debate. It is more complicated than something so simple should be; “teaspoons” sounds straightforward, but labelling is an EU competence, so member states cannot mandate additional forms of expression, such as spoonfuls of sugar, for pre-packed food. Under EU legislation, it would be possible for companies to represent sugar content in the form of spoons of sugar or sugar cubes on a voluntary basis, as long that met a number of EU criteria—I will outline what some of them are. It would sit alongside front-of-pack nutrition information, which I remind the House is voluntary, not mandated, in order to meet the same criteria.

[Dr Philippa Whitford]

For the public nowadays, “teaspoons of sugar” is more helpful than “sugar cubes”, because very few people use sugar cubes.

[Jane Ellison]

I am aware of that; the point has been made to me a number of times.

Let me mention a few of the criteria that would apply if we were to move in that direction. There would be a requirement to consult, and we would have to ensure that any measure was supported by scientific evidence and did not constitute a barrier to trade. Any such form of labelling would need to be agreed with the Commission before it was implemented, to avoid future infraction proceedings.

I have heard the strength of feeling in the House and I understand the point being made, but references to sugar cubes are quite powerful; last year’s Sugar Swaps campaign proved that they can be made meaningful. However, I will ask my officials to look carefully at the issue, because I have heard a great deal of interest in it being expressed today, and I know that the Health Committee took evidence on it. I wanted to underline the point that it is not as straightforward as it might seem, but we will look closely at it again in the light of the interest in it.

[Dr Whitford]

Did the same apply to cigarettes? Were we not allowed independently to add the warnings and so on that we put on cigarettes in this country? Did that have to be EU-wide?

[Jane Ellison]

As we approach the transposition of the new EU tobacco directive, the hon. Lady will see that the measures being taken are EU-wide, but those are two slightly different things. I am happy to come back to her in more detail after the debate, but generally speaking, packaging and labelling are EU competences.

I was delighted to hear so many hon. Members say that front-of-pack labelling was important. The scheme is popular with consumers. It provides information on calories and levels of specific nutrients in an easy-to-read, intuitive format. Businesses that have adopted the scheme account for two thirds of the market for pre-packed foods and drinks. Within the Change4Life programme, front-of-pack colour-coded nutrition labelling will continue to be included as a key message whenever there is a campaign focused on healthy eating. We use that in all the Change4Life materials, across a wide range of formats.

I want to reassure the hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke from the Opposition Front Bench, that there will indeed be a physical activity strand in our childhood obesity strategy. I agree with the balance that the Health Committee struck on tackling childhood obesity, which is an important strand of the work. The great news about physical activity, as the Committee’s report underlined, is that it is good for everyone, whatever their weight. There is no downside to being more physically active, so of course we will want to reflect that.

This has not been touched on much this afternoon, but there is also a significant role for the family of health professionals in giving advice and supporting families to make changes to their lives. That relates particularly to families in more deprived communities. Only this morning I was talking about the role of health visitors, for example, in family education and family support. Again, a strand of our strategy will develop that.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

Yes, but this will be the last intervention I take, because I want to leave time for the hon. Member for Warrington North (Helen Jones) to respond at the end of the debate.

[Geraint Davies]

I simply want to ask whether there will be any space for views to be heard on restricting advertising, whether that relates to high-sugar products being described as low-fat products, to watersheds or whatever. In the same way as we imposed restrictions on the advertising and pricing of cigarettes, will the Minister come forward with any suggestion on restricting advertising in this case?

[Jane Ellison]

We have already said that the childhood obesity strategy will be a comprehensive, cross-Government strategy. I commissioned advice from Public Health England, and of course I have been working closely with that organisation on policy development for many months now. I am paying close regard to the advice that it has provided us with, and I welcome the fact that the Health Committee found it so useful in producing its report.

I welcome the debate as an opportunity to respond to the important campaign on the e-petition and the important new Select Committee report. It is a timely opportunity. I want to reassure the House that the Government are considering a wide range of options for tackling obesity, and particularly for reducing sugar consumption among children and the wider population. I hope the House agrees that all of us—central Government, local government, the industry, schools, families, communities and individuals—have a part to play. I will reflect carefully on the speeches that I have heard today, on the Committee’s recommendations and on its overarching challenge to us to be “brave and bold”—a message that I have heard loud and clear this afternoon. I look forward to making progress, and I very much look forward to publishing our childhood obesity strategy in the new year and making progress throughout this Parliament, and indeed well beyond it, on one of the greatest health challenges of our age.

Antibiotics (Primary Care)

Jane Ellison Excerpts

Monday 23rd November 2015 Commons Chamber

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

Let me begin by congratulating my hon. Friend the Member for Erewash (Maggie Throup) on securing this very well-attended debate on a very important issue. The hour is late, but there are a number of hon. Members in the Chamber, reflecting the importance of the debate, and they have made well-informed interventions. I will attempt to address all the issues raised, but if there is anything I do not get to I will look to write to hon. Members.

This debate is timely. Antimicrobial resistance awareness week, a news item in The Lancet and news from other countries, in particular China, have helped to underline the issue that, on occasion, can sound quite dry. If people wonder what the issue is, it has been aptly illustrated in recent weeks. The prescribing and use of antibiotics has a direct impact on antimicrobial resistance. As my hon. Friend made clear, it is one of the biggest global health challenges we face and I spend a lot of time talking about it to Health Ministers from other countries. The costs of antimicrobial resistance are very significant. The O’Neill review on antimicrobial resistance, commissioned by the Prime Minister, estimates that a continued rise in resistance by 2050 would lead to millions of additional deaths worldwide each year and an economic cost of up to $100 trillion worldwide. This is a really big issue.

My hon. Friend described exactly the problem we face in terms of the appearance and spread of bacteria that are resistant to treatment by current antibiotics, and the threat that poses to modern medicine. She provided some examples of that threat. Without effective antibiotics, medical advances such as organ transplants, and even minor surgery and routine operations, will become high-risk procedures. Procedures we assume can now be done as minor day surgery will suddenly become again a serious threat because of serious resistant infection. Antimicrobial resistance is a global problem that needs to be tackled at a national and global level to ensure antibiotics are used wisely.

As my hon. Friend and others will know, in 2013 we published the “UK Five Year Antimicrobial Resistance Strategy” to address this significant threat. It takes a “one health” approach, addressing human, animal, food and environmental aspects of antimicrobial resistance. The hon. Member for Strangford (Jim Shannon) is, as ever, in his place. On many occasions I disappoint him by saying that matters are England-only, but I am delighted to be able to confirm that this is a UK-wide strategy. We are working on it in close collaboration with Scotland, Northern Ireland and Wales. At the heart of our strategy is the need to use antibiotics more effectively. The key is how we change both public and health professional behaviour, and my hon. Friend described the challenge we face.

The English Surveillance Programme for Antimicrobial Utilisation and Resistance—just another one of those catchy little titles we come up with in the health world—is a very important programme. The 2015 surveillance report shows that general practice accounts for 74% of prescribed antibiotics. The number of antibiotic prescriptions in primary care has declined for the last two years and are now lower than in 2011. However, analysis of the data suggests that although there have been fewer prescriptions, higher doses or longer courses of antibiotics are being prescribed. Total use of antibiotics continues to increase in the NHS, albeit at a slower rate. We still have a significant challenge. It is a challenge for all of us and, as my hon. Friend said, behaviour change is right at the heart of how we tackle the problem, both for those who prescribe and for those who use antibiotics—both are crucial to our response.

In August, the National Institute for Health and Care Excellence produced its stewardship guidelines for the health and social care system, which covered the effective use of antimicrobials, including antibiotics. We understand the pressures, as have been well described here, that primary care prescribers face every day. We know, as my hon. Friend the Member for Torbay (Kevin Foster) illustrated, that sometimes people expect to leave their doctor with a certain prescription, even if it is not the right thing. To support GPs, therefore, we have been working with the Royal College of General Practitioners to provide them with suitable tools to reduce levels of inappropriate prescribing.

Last week, research by Antibiotic Research UK found that doctors prescribed 59% more antibiotics in December than in August, despite many of the illnesses treated by antibiotics not being seasonal. That, too, touches on the challenges. One of the key resources doctors have at their disposal is TARGET—treat, antibiotics responsibly, guidance, education, tools—which is hosted on the RCGP website and aims to increase primary care clinicians’ awareness of the importance of antimicrobial resistance and responsible use. Health Education England continues to work with Public Health England to ensure that the competence and principles of prescribing antimicrobials are embedded throughout the professional curricula.

In a recent trial, the chief medical officer, Dame Sally Davies, wrote to a sample of high-prescribing GPs in England, explaining that their prescribing rates were significantly higher than those of other similar GPs and asking them to reassess their prescribing protocols. This intervention resulted in a 4% reduction in levels of prescribing in those practices. That is encouraging and more trials are planned. I put on the record the gratitude of this Government and Governments around the world to Professor Dame Sally Davies for the work she has done in spearheading not just our national AMR campaign but the international campaign. I have watched her galvanise whole countries to action on this subject. We are extremely lucky that she is leading the charge.

NHS England’s introduction of a quality premium on antibiotic prescribing for 2015-16 is another significant step. The purpose is to act as an incentive to reduce levels of antibiotic prescribing in both primary and secondary care. We are encouraged by the early results and expect a reduction in levels of antibiotic prescribing in the next set of data covering 2015-16.

We are not overlooking the consumers of antibiotics: the public. We need to improve their understanding about their appropriate use and are active participants in European antibiotic awareness day, which has just passed and which looks to engage the wider public. My hon. Friend the Member for Erewash highlighted the extremely important antibiotic guardian programme. We have set a target to reach 100,000 antibiotic guardians by next March. We also urge all colleagues—this is where MPs can be extremely helpful—to bring this up with their local NHS. If they ask about it, people will realise its importance, so I ask them to do so as part of their routine contact with local NHS institutions.

Public Health England, working in conjunction with the RCGP, has developed a range of patient information materials to help them think about how they care for themselves when they have a self-limiting infection, such as a cold, and when to consult a health professional. Critically, my hon. Friend referred to diagnostic testing, particularly the C-reactive protein test. I understand her frustration—sometimes it feels like things move rather slowly—but I hope that the attention the strategy has received illustrates our desire to move faster. In fact, the driving force behind the UK-wide strategy is about gearing up the whole health system to react more quickly.

Most antibiotic prescribing is done in the absence of a test to determine the nature of the illness and whether an antibiotic prescription is likely to help. Making better use of technology is a key part of our work. Greater access to and use of rapid diagnostic tests will help us to avoid unnecessary treatment and provide more targeted treatment where infections are diagnosed, which, of course, will mean better outcomes for patients.

[Jeremy Lefroy (Stafford) (Con)]

My hon. Friend might note that, in the case of malaria, the introduction of rapid diagnostic tests has substantially reduced the inappropriate use of important antimalarials.

[Jane Ellison]

That is an excellent illustration of the potential of rapid diagnostic tests, and of course we had exciting news on malaria recently.

In December last year, NICE recommended that GPs should consider carrying out C-reactive protein testing for people presenting in primary care with symptoms of lower respiratory tract infection if, after clinical assessment, a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed. I understand that the test is increasingly being used in primary care, although the evidence for its use is mixed and the role of normal clinical diagnosis remains critical.

We want the right test available in the right place, from patients’ homes and the high street to primary and secondary care. That work is being undertaken as part of the implementation of the UK antimicrobial resistance strategy. To further develop the use of diagnostics in clinical practice, we are investing £1.3 million of research funding through the National Institute for Health Research. That research is being undertaken by Cardiff University, focusing on GPs’ use of the C-reactive protein test to help to target antibiotic prescribing to patients with chronic obstructive pulmonary disease. It will be interesting to see how that research goes, and I am sure we will return to it.

In addition to the important work to improve appropriate prescribing, we should not forget the vital role of infection prevention and control—it was good to hear my hon. Friend the Member for Erewash note that. We have made significant progress, with dramatic reductions in some infections in recent years, but there is always more to do. We can make a significant contribution to that agenda by improving our ability to prevent infections in the first place. That includes work with NICE to develop clinical guidance and best practice information.

We have strengthened the code of practice on the prevention and control of infections to clarify for providers the measures needed to ensure effective infection prevention and antimicrobial stewardship. We will also improve infection prevention and control by introducing an indicator, as part of local antimicrobial resistance implementation plans from April next year, to help CCGs. That will be another good opportunity, from the spring, to ask CCGs how their plans are going and whether they can explain what they are doing locally. It was good to hear Erewash CCG being cited. I am sure my hon. Friend will hold its feet to the flames, as will others.

Let me touch briefly on the international scene. It was good to hear my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) talk about India. I had the pleasure of talking to the Indian Health Minister about this very topic at the World Health Assembly in Geneva in May. Tonight’s debate is not about the international aspect, but I would be delighted if any Member wanted a debate focusing on that, because the UK can be proud of our record in that regard. To give one example, as part of our focus on global antimicrobial resistance, the UK has committed £195 million over five years to the Fleming fund, which will support antimicrobial and infectious disease surveillance in developing countries, where we know drug resistance has a disproportionate effect. We were delighted to see all 194 member states agree to the World Health Organisation’s global action plan at the World Health Assembly earlier this year. The Government are now working towards the UN General Assembly in 2016 and are continuing to champion this agenda there.

Let me conclude by reaffirming our commitment to delivering improvements in the way antibiotics are used in the NHS. I take the challenge that my hon. Friend the Member for Erewash has highlighted and we will make sure that the NHS hears that from tonight’s debate. The work we have undertaken, and are continuing to undertake, means that we now have significantly better data and information on how antibiotics are used in both primary and secondary care, but we have much more to do. I welcome tonight’s debate as a reminder of the task that lies ahead of us.

Question put and agreed to.