Childhood Cancers

Jane Ellison Excerpts

Wednesday 25th February 2015 Commons Chamber

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

I apologise in advance for my cold and for possibly not bringing the healthiest of tones to the Dispatch Box tonight. I do not want that to detract from the excellent and typically sensitive way in which my hon. Friend raised this debate. I also commend Skye’s family for their work. They have shown enormous courage, as have so many other children and families who are affected by this terrible disease. Many of us, both constituency Members and Ministers, meet other such families and stand in awe of their courage in bringing these issues to the fore. The work of the charity set up by Skye’s family, Blue Skye Thinking, highlights some of the key issues, including the importance of research into and the treatment of childhood brain tumours.

I will make a few general points, but I hope to speak to some of my hon. Friend’s specific asks as well. On those that I cannot respond to—as she knows this is a complex situation—I undertake to ensure that responses are provided.

Improving cancer outcomes, including for children, is a major priority of this Government, as Members who have been at recent debates on cancer will know. The annual report on our cancer outcomes strategy in December showed that we are on track to save a projected 12,000 more lives a year by 2015, which is more than double our ambition of 5,000 lives. As my hon. Friend said, the strategy is bearing fruit.

Further to that, we were delighted that, on Sunday 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services that will improve survival rates and save thousands of lives.

That taskforce has been set up to produce a new cross-system national cancer strategy to take us through the next five years to 2020, building on NHS England’s vision for improving outcomes set out in the five-year forward view. The taskforce is formed in partnership with the wider cancer community and other health system leaders and is chaired by Dr Harpal Kumar, chief executive officer of Cancer Research UK. It aims to cover the whole cancer pathway, from prevention to end-of-life care, including improving outcomes for children and young people with cancer. The taskforce will produce a statement of intent by March 2015 with the new five-year cancer strategy to be published in the summer. We did ascertain during a recent Back-Bench business debate on cancer that the taskforce had asked the leading all-party groups on cancer to submit evidence. That might be something that other parliamentarians wish to do.

My hon. Friend mentioned issues around diagnosis. In cancer debates, we always talk about the importance of tackling late diagnosis. To increase the awareness of a number of childhood cancers among GPs, the Department funded BMJ Learning in 2012 to provide an electronic tool for GPs through a two-part module on diagnosing osteosarcoma—a type of bone cancer—and brain tumours in children and young people. That module helps GPs to understand osteosarcoma and types of brain tumour in children and young people and their common presentations, and to recognise when patients need that urgent referral. Those modules were developed with help and contributions from various charities including the Brain Tumour Charity, the Teenage Cancer Trust and CLIC Sargent.

As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working with Cancer Research UK and Macmillan Cancer Support to test new approaches to identifying cancer more quickly. They will be familiar to those who ask whether the system can do better. They include: offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. For parents with children, that is a welcome development. We want to reduce the stress of multiple journeys into health care settings.

NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England, collecting evidence with a view to implementation in 2016-17. My hon. Friend will also want to know that the National Institute for Health and Care Excellence is updating its current referral guidelines for suspected cancer, with a final version due in May to continue to help GPs to identify and refer patients promptly, including children and young people with symptoms that could be cancer.

Obviously, once diagnosed, it is critical that children and young people receive the most appropriate treatment. The NICE improving outcomes guidance for children and young people serves to assist the NHS trusts in planning, commissioning and organising services for children and young people with cancer. It recommends, among other things, that all care must be provided in age-appropriate facilities. NICE also published a quality standard for children and young people with cancer in February 2014.

Over the past four decades there have been major advances in the development of successful treatment strategies for childhood cancers, as my hon. Friend generously acknowledged. Much of that has been due to the use of standardised protocols in clinical trials and specialisation of care, as evidenced in the neuroblastoma trials run at Great Ormond Street children’s hospital, for example.

Although outcomes for children with brain tumours are often poor, medulloblastoma has an outcome of disease-free survival of around 80%, as my hon. Friend said. That is achieved through timely sequences of surgery, radiotherapy to the whole brain and spine—to mitigate the tendency for the tumour to spread to the central nervous system—and adjuvant chemotherapy. That treatment protocol is standard throughout Europe and America and has been developed and refined as a result of clinical trials carried out throughout the UK, Europe and America over recent decades.

It is obviously vital for children with cancer to have the most appropriate treatment, so it is very sad to hear that Skye’s treatment did not succeed. My hon. Friend referred to the Milan protocol. I can confirm that it was suspended by the Children’s Cancer and Leukaemia Group in May 2014 due to indications that in some instances, as in this tragic case, it resulted in neurotoxicity. NHS England has recently set up a children, teenagers and young adults group, reporting to the independent cancer taskforce, which will look to address those issues, particularly single-arm studies such as the Milan protocol, because although the way they are set up is innovative, they do not recruit high enough numbers to qualify for a randomised control trial, as my hon. Friend mentioned. NHS England is currently drafting terms of reference for the group. I will certainly ensure that, in so doing, it is aware of this debate and of the concerns she has raised. The major children and young people cancer charities have agreed to participate, and the first meeting will take place in the near future.

My hon. Friend mentioned the routine collection of side effects data from single- arm trials. I understand—this was mentioned in the letters she received—that at present these data are not routinely collected, but obviously ideally they would be. I am advised that there are problems in being able to collect the data, although the National Cancer Intelligence Network is continually working to improve the range and quality of the data it collects and analyses. I hear her challenge to say, “That is not good enough”, because she wants it actually to happen, rather than just to be worked on. As she said, she was advised that adverse effects data were not originally part of what the Childhood Cancer Research Group or the Children’s Cancer and Leukaemia Group themselves collected outside a clinical trial. Of course, there is added complexity when considering the sharing of adverse reaction data on an international level, as I am sure Members appreciate.

I have asked my officials to discuss those issues with Public Health England and the National Cancer Intelligence Network to consider how those data might be collected, and I will ask to be updated on that work so that I can fully understand what the barriers might be. Clearly, without knowing exactly what those are it is very difficult to know whether they are essentially clinical, administrative or the result of something else. I know that it is important to my hon. Friend to understand that, so I will ask for that work to be undertaken.

I am also really sorry that my hon. Friend did not receive a substantive reply from my ministerial colleague, which was not good enough—there was clearly a mix-up on that front. As she said, Dr Michael Peake, the National Cancer Intelligence Network’s clinical lead, who wrote to her, is happy to meet her and Mr and Mrs Hall to discuss in detail how these issues might be addressed, which I hope will be of help. Clearly that would feed into the work that I have asked to be done to understand what the barriers to making progress are.

My hon. Friend spoke about the vital issue of research, so let me give her an update. Research is critical to improving outcomes. The Government and the charities work closely together on childhood cancer research through the National Cancer Research Institute. The national cancer research initiative’s children’s cancer and leukaemia clinical studies group interacts with clinical research networks, funders and researchers to develop studies aimed at improving outcomes.

The National Institute for Health Research clinical research network is currently recruiting patients to a study assessing quality of life in paediatric, teenage and young adult patients treated for medulloblastoma. A study looking at treatment for children with neuroblastoma has recently been approved for funding through the health innovation challenge fund, which is jointly supported by the Department and the Wellcome Trust.

In conclusion, I thank my hon. Friend for bringing this important and sensitive issue to the House tonight. I reiterate the respect and admiration in which we all hold the parents and families of children who have died in these tragic circumstances, and their intention to take from their personal and family tragedy the desire to do better for other people’s children and to try and ensure that we learn those lessons. That intention is shared by all hon. Members in all parts of the House and by the Government. I thank them, through my hon. Friend, for doing that.

The new independent cancer taskforce, in partnership with the cancer charities and health system leaders, is leading the way towards making a real difference. With the ground-breaking research that I mentioned, we can look forward to cancer outcomes that are among the best in the world, and in particular to improved cancer outcomes for those precious children.

Question put and agreed to.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 24th February 2015 Commons Chamber

[Andrew Griffiths (Burton) (Con)]

14. What support the Government are giving to people with Ehlers-Danlos syndrome.

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

The Government acknowledge the challenge posed in supporting patients with Ehlers-Danlos syndrome, which encompasses a complex range of conditions with a wide variety of symptoms. Diagnosis and investigation of suspected EDS takes place in dedicated regional genetics clinics, with specialist clinics, as my hon. Friend will know, at Sheffield Children’s NHS Foundation Trust and London North West Healthcare NHS Trust.

[Andrew Griffiths]

People in Burton have raised £130,000 to pay for a life-saving operation that is not available in the UK for Nina Parsons, my constituent, who suffers from EDS. I have another constituent, Sarah Pugh, who is having to pay for vital physiotherapy and an MRI scan. Will my hon. Friend look at what more can be done to help people suffering the misery of EDS, and will she agree to meet some sufferers to discuss the matter further?

[Jane Ellison]

I am certainly very happy to talk to my hon. Friend about his particular constituents. I am aware of the work that he has done in his local area. He will be interested to know that in 2013 the Government published “The UK Strategy for Rare Diseases” precisely to address such issues and the complexities around them, and aspects of that strategy speak directly to the challenges that he has just outlined. May I also take this opportunity to mention that there is an event tomorrow in Parliament organised by Rare Disease UK to mark rare disease day, at which the Under-Secretary of State for Women and Equalities, my hon. Friend the Member for East Dunbartonshire (Jo Swinson), will be speaking?

[Philip Davies (Shipley) (Con)]

15. What estimate he has made of the number of admissions to A & E in the last three years for patients with palliative care needs in (a) areas with a 24-hour palliative care helpline or palliative co-ordination centre and (b) areas that do not offer such services; and if he will make a statement.

--- Later in debate ---

[Mr Andrew Robathan (South Leicestershire) (Con)]

18. With reference to the recent Francis report, if he will investigate (a) the case of Meirion Thomas at the Royal Marsden hospital and (b) cases where staff have been disciplined or required to sign confidentiality agreements.

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

The Government welcome any individual who has the courage to shine a light on malpractice, wrongdoing or patient safety issues in the NHS, and the House will be well aware that that is something the Secretary of State has very much championed. Professor Thomas has a right to express his views on the health service and on wider issues, and I understand that the trust has confirmed that. The Department is not responsible for investigating cases involving individual members of staff, but I want to be clear that confidentiality agreements cannot be used to prevent individuals from making a protected disclosure in the public interest.

[Mr Robathan]

I am glad to hear that, and I note that the Secretary of State has had dealings with Professor Thomas. However, I think it is very important that this is looked at closely in the light of the Francis report. If it is the case, as is said in media reports, that Professor Thomas has been forced to sign a confidentiality agreement—a so-called gagging order—I think that is disgraceful and shows a very dire state in the NHS in the Royal Marsden. Perhaps the Minister would like to comment on that.

[Jane Ellison]

I can only reiterate this Government’s complete commitment to openness when it comes to patient safety and say again that confidentiality agreements cannot be used to prevent individuals from making a protected disclosure in the public interest.

[Mr Andy Slaughter (Hammersmith) (Lab)]

22. What plans he has for the NHS in west London.

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

Clinicians in west London are leading a process that is very much aimed at improving services for people in west London. As the hon. Gentleman is well aware, the local NHS is pressing ahead with the implementation of service improvements as part of the clinically led reconfiguration programme, “Shaping a healthier future”.

[Mr Slaughter]

The Minister does not sound very convinced by that herself. I wonder whether she saw the comments from the College of Emergency Medicine yesterday, which said that attempts to dissuade people from going to A and E have been a dismal failure and that what we should do is locate primary care services alongside A and E. That is the model we have at Charing Cross hospital and in the rest of west London, and it is succeeding. What is failing is the closure of emergency departments, which is creating an intolerable strain. Will the Government look again at the issue? Will you stop closing A and Es in west London?

[Jane Ellison]

I am afraid that the hon. Gentleman has a dismal track record of campaigning on this issue. We have all seen the leaflets being put out in west London. I can only say to his constituents that in the run-up to the election they would glean more from reading their tea leaves than from reading his leaflets if they want to know the truth about the NHS in west London.

[Sir Nick Harvey (North Devon) (LD)]

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

--- Later in debate ---

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

A constituent of mine has pointed out that, despite it being a long-term condition, drugs for cystic fibrosis are not subject to an exemption from prescription charges, apparently because, when it was first diagnosed, it was considered to be only a children’s disease. Will Ministers look into this anomaly?

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

This issue came up in a debate on cystic fibrosis last year and I am very happy to look at it again. I looked at it subsequent to that debate, in response to an inquiry from, I think, the hon. Member for Colchester (Sir Bob Russell), but I am happy to look at it again and get back to my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton).

[Paul Blomfield (Sheffield Central) (Lab)]

T8. When I asked the Minister last June what guarantees he would give to GP practices at risk because of the withdrawal of the minimum practice income guarantee, I was told that NHS England would ensure threatened practices “get to the right place.”—[Official Report, 10 June 2014; Vol. 582, c. 400.]Over the past seven months, those discussions have not alleviated the threat to two highly regarded practices in my constituency that face closure. Will the Minister agree to meet me and representatives of the practices to discuss what is really happening, and to consider what can be done to save them?

Oesophageal Cancer

Jane Ellison Excerpts

Monday 23rd February 2015 Commons Chamber

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

I congratulate my hon. Friend the Member for Hove (Mike Weatherley) on both securing this debate and moving it in such a personal way and giving us an account of his own experience of this dreadful disease. I am sure his words will resonate with all of us who have listened tonight, and in particular the way he took us on that journey from the first difficult moments of diagnosis through to treatment. It was a vivid and thought-provoking, but also a heartening, account.

My hon. Friend is absolutely right to draw attention to the dedicated and inspirational NHS staff, who work so passionately up and down the country for their patients. How nice it was of him to take the opportunity to put that on record this evening; that was tremendous. Never is the debt of gratitude we owe the NHS staff felt more keenly than when we personally benefit from the care they provide, often at our most vulnerable and weak moments. They are, as he says, not just care-givers, but life-savers in those situations.

My hon. Friend rightly challenged us to do better in this area. Improving cancer outcomes is a major priority for this Government and, as the annual report on our cancer outcomes strategy last December showed, we are on track to save an extra 12,000 lives a year by 2015. That is the projection based on the figures to date. We all want to see the best possible results for all cancer patients, but he was right to highlight the fact that outcomes are particularly poor for patients with oesophageal cancer. I am aware, from all our debates, that this is an area in which we have not seen the sort of movement that we have seen with other cancers. Each year in England, about 7,000 people are diagnosed with oesophageal cancer and 6,000 people are diagnosed with stomach cancer. Those diseases cause around 10,200 deaths in England each year.

We had some exciting news recently: the NHS England cancer taskforce was announced on 11 January. NHS England announced that this new independent cancer taskforce would develop a five-year action plan for cancer services with the aim of improving survival rates and saving thousands of lives in England. The cancer taskforce has been set up to produce a new cross-system national cancer strategy to take us through the next five years to 2020, building on NHS England’s vision for improving cancer outcomes that was set out in the NHS’s “Five Year Forward View”. It was formed in partnership with lots of different cancer charities and other parts of the cancer community, along with other health system leaders, and it is chaired by Dr Harpal Kumar, the chief executive of Cancer Research UK.

The taskforce will cover the whole cancer pathway through prevention, diagnosis and treatment to provide support for those living with and beyond cancer and end-of-life care, as well as covering how all those services will need to develop and innovate. My hon. Friend was right to challenge us to look creatively at different ways of doing things, and that is exactly what the taskforce has been charged with doing. NHS England is assessing the opportunity for improved cancer care and will produce initial views by March—next month—with the new five-year cancer strategy to be published in the summer.

As my hon. Friend emphasised, early diagnosis is absolutely key. Tackling late diagnosis will be an important element if we are to achieve our ambition to improve cancer outcomes, which is why our cancer strategy invested £450 million during this Parliament in improving earlier diagnosis. As his own experience has attested, it can be difficult to diagnose oesophageal cancer, especially in its early stages. I congratulate him again on securing this debate and I hope that there is someone out there tuning into the debate who has heard his words. I am sure that they will help to publicise the message about taking notice of symptoms.

When symptoms do manifest themselves, it is often an indication that the cancer has developed. That is why early diagnosis is crucial. Just under 70% of people diagnosed with oesophago-gastric cancers at the earliest stage survive for at least five years. My hon. Friend has highlighted what it means in human terms for those who are diagnosed at a very late stage. It has been estimated that around 950 lives could be saved in England each year if our survival rates for oesophageal and stomach cancers matched the best in Europe, and that clearly has to be our aim: we have to do better.

NHS England has launched a major early diagnosis programme, working together with Cancer Research UK and Macmillan Cancer Support to test new approaches to identifying cancer more quickly. I hope that that programme will give my hon. Friend some encouragement, because it touches on some of the issues that he has mentioned. It will include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day.

[Steve Brine]

Southampton has been mentioned, as has my constituent Tim Underwood, who leads the team there. What the Minister is saying is absolutely right. Does she agree that regional centres such as Southampton—which do things that, quite rightly, not everyone does—are the key to providing regional areas of specialism to help us to do even better on the diagnosis and treatment of oesophageal cancer?

[Jane Ellison]

In a recent Back-Bench debate on cancer, mention was made of the tension that we all feel as constituency Members between the desire to have services nearby and the recognition that the expertise resulting from seeing lots of cancers, particularly the rarer ones, is really important to developing clinical excellence. We have to be clear that there are areas where concentrating excellence and clinical experience will save lives, and my hon. Friend perhaps highlights one such area. We often underestimate just how few cancers of any kind the average GP sees, and that is especially true of rarer cancers.

Let me go back to the different ways of looking at earlier diagnosis. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17. In 2013, Macmillan Cancer Support, partly funded by the Department, piloted an electronic cancer decision support—CDS—tool for GPs to use in their routine practice. It covers lung, colorectal, pancreatic, oesophagus and stomach, and ovarian cancers. Following the pilot, the CDS tool has been refined and is currently installed in more than 1,000 GP practices across the UK. It is designed exactly to deal with the point about helping people who do not see certain things very often with those diagnostics. Macmillan is working with software companies to adapt the CDS for different IT systems and make it available to GPs as part of their standard software offer.

I just wish to mention the Be Clear on Cancer campaign, which I am glad my hon. Friend the Member for Hove mentioned.

[Steve Baker (Wycombe) (Con)]

The Minister has said many things that give me the impression that there is potential for a huge additional demand on consultants. One of the most striking things that my hon. Friend the Member for Hove (Mike Weatherley) said was that a consultant will get only six minutes with a patient. Will the Minister explain what the Government are going to do to make sure that consultants have enough capacity to deal with the extra demand that is likely as a result of these laudable new methods?

[Jane Ellison]

The cancer taskforce is charged with looking at all those challenges and resolving those tensions, but the NHS’s own “Five Year Forward View” considers some of the ways in which it can be innovative about the use of consultants and the interaction between primary and secondary care, and whether we can do more by looking at that differently. If my hon. Friend is interested in that, it is definitely worth looking at. That is very much the sense of direction and we are now looking to the cancer taskforce to examine all those issues. Parliamentary all-party groups have been asked by the cancer taskforce to contribute to its review, and we ascertained that before the Back-Bench debate. He highlights a fair point; all these things bring their challenges, and that is one reason why we put so much effort into testing the Be Clear on Cancer campaign.

I was delighted that the recent pilot of the Be Clear on Cancer campaign for oesophageal and stomach cancer in the north-east and north Cumbria was so successful. We carry out the pilots in order to understand what additional demand they create in the system, so we can model that and cope with it if the campaigns are rolled out. Following the pilot, a national four-week campaign ran from 26 January until yesterday, and was supported with national TV, radio, digital and out-of-home advertising and a public relations campaign. A variety of face-to-face events were held across the country in venues such as shopping centres.

The campaign aimed to raise awareness of the symptoms of oesophageal and stomach cancers and to encourage those with symptoms such as persistent heartburn to visit their GP. The campaign was targeted at men and women aged 50 and over. Of the nearly 13,000 people who are diagnosed with oesophageal or stomach cancer each year in England, more than nine out of 10 are aged 50 and over. The campaign was also aimed at friends and family, who can encourage those with symptoms to make an appointment with their doctor if they are concerned. We are all aware of those times when despite knowing what is good for us, we need a loved one to say, “It is time to go to the doctor.” The campaign takes that into account.

Let me deal with the clear and good points made about endoscopy, including by my hon. Friend the Member for Winchester (Steve Brine). We accept that there are issues to address on endoscopy capacity, which is why we have been working with NHS England and Health Education England to prioritise this area. A joint endoscopy working group, set up by the NHS England’s national clinical director on diagnostics and imaging, has been analysing the latest data, and an action plan has been developed to ensure sufficient capacity in the short and long term.

Let me briefly mention treatment. NHS England’s oesophageal and gastric cancer service specification clearly defines what it expects to be in place for providers to offer evidence-based, safe and effective oesophageal cancer services, in line with the National Institute for Health and Care Excellence’s clinical guideline, “Improving Outcomes in Upper Gastro-intestinal Cancers”.

I want to touch on research, because people should understand what we are doing to invest in understanding more about these specialist areas. The National Institute for Health Research has awarded £2 million for a research professorship with a focus on improving outcomes for oesophageal cancer through innovative screening and surveillance tests. It is also funding a £2 million trial of palliative radiotherapy in addition to self-expanding metal stents for improving outcomes of dysphagia and survival from advanced oesophageal cancer. The NIHR clinical research network is currently recruiting for 24 clinical trials and studies in oesophageal cancer.

In conclusion, I thank my hon. Friend the Member for Hove for securing this debate and congratulate him on the way he moved and delivered it. I do not underestimate the challenge of improving outcomes for people with oesophageal cancer. However, I hope that what I have briefly set out here shows that we are committed to improving cancer care through building greater awareness among the public; targeted and high-profile awareness campaigns, such as the Be Clear on Cancer; using technology and innovation to support GPs to better identify symptoms and improve the referral process; and taking action to ensure sufficient capacity in areas such as endoscopy. Things are improving, but there is much work still to be done. We are committed to improving cancer survival rates and building on the improvements we have made so far so that we have the best cancer outcomes in Europe. My hon. Friend’s speech tonight illustrated far more eloquently than I can, with all my facts, figures and statistics, why that is important to our fellow countrymen and women and why it is so important that we continue to make progress, and I thank him for highlighting that this evening.

Question put and agreed to.

Mental Health and Well-being of Londoners

Jane Ellison Excerpts

Thursday 12th February 2015 Commons Chamber

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

We have, unsurprisingly, had a very thoughtful debate, and this has been a welcome opportunity to discuss such an important topic. I hope that the hon. Member for Liverpool, Wavertree (Luciana Berger) will forgive me if I focus my response on Back-Bench contributions, given that this is a Backbench Business Committee debate. She regularly debates these issues with the Minister of State who leads on care issues.

I congratulate the hon. Member for Hackney North and Stoke Newington (Ms Abbott) on securing this debate on an issue that is important to her and her constituents, and to me as a London MP and my constituents. It is good to see a broad cross-section of London colleagues in the Chamber.

The fact has been well established that at least one in four people will experience a mental health problem at some point in their life. As others have said, that means an estimated 2 million Londoners, and we know that London has the highest rates of mental ill health in the country. Some Members spoke about the reasons for that—those things that we know are responsible—and others suggested alternative reasons. I would slightly guard against the over-use of the word “crisis” and exaggerating to make a political point. To prepare for this debate, as the House would expect, I met some of the leading mental health clinicians in London and put some searching questions to them. I did not gain a sense of crisis, although we all gain the sense that this area has not been given sufficient attention in the past and needs to be given far more attention in the future. We all agree on that, and I hope to outline some of the areas that the Government are paying attention to and working on.

The Government’s commitment to prioritising mental health is encapsulated in the principle of “parity of esteem”, which others have mentioned. This means equal priority for mental, as for physical, health. This commitment was set out in our mental health strategy, “No health without mental health”, in February 2011, and was made explicit in the Health and Social Care Act 2012. Planned NHS spending on mental health is expected to grow by over £300 million in 2014-15, and in our five-year plan for mental health, “Achieving Better Access to Mental Health Services by 2020”, we identified £40 million of additional spending for this year, and freed up a further £80 million for 2015-16. This will for the first time ever enable the setting of access and waiting time standards in mental health services, to which the hon. Member for Islington North (Jeremy Corbyn) alluded.

Looking at the constituency of the hon. Member for Hackney North and Stoke Newington, I am sure she would welcome the fact that the City and Hackney clinical commissioning group has increased spending on mental health services by almost 4% this year, and is investing almost £2 million in a range of new service alliances intended to reduce service variation, reduce inequalities, and improve access and recovery outcomes.

I was glad to hear my hon. Friend the Member for Hendon (Dr Offord) refer to the Mayor’s London Health Commission and the work done by the Mayor’s office. The hon. Lady also referred to the work of the Greater London authority. The commission, led by the Mayor, has identified the mental health and well-being of Londoners as a key priority for the Mayor’s office. Indeed, the Mayor has said:

“Mental ill health is an issue that affects millions of Londoners, yet we are too often frightened to discuss it, worried about what people might think, or unaware of who to turn to.”

That very much captures what was said by my right hon. Friend the Member for Uxbridge and South Ruislip (Sir John Randall).

In a report on London mental health which was published in January last year, the Mayor made clear that mental health is an issue for everyone who lives and works in the capital. The report attempted to quantify, as far as possible, the impact of mental ill health on Londoners in order to gauge the scale of the problem. I shall not repeat the statistics, but they show that there is a considerable impact not only on individuals and their families, but on the economy of our city and everything that flows from it, and on the costs of care. However, despite those substantial costs, diagnosis and treatment rates for mental disorders have remained poorer than those for most physical health conditions. NHS England has worked with partner organisations to establish a strategic clinical network for London chaired by Matthew Patrick. The network’s members include MIND, Rethink and the National Survivor User Network.

Let me now deal with the important issue of race equality in mental health care, to which the hon. Lady devoted much of her speech. The issue is obviously of great concern to her, but it is of concern to all of us, because we all acknowledge London’s incredible diversity, although the degree of diversity in our constituencies varies. Our commitment to tackling inequalities in access to mental health services is set out in our mental health action plan “Closing the Gap”, which was also published in January last year. That plan recognises that people from black and minority ethnic communities are less likely to access psychological therapies. We are working with the sector to find out exactly why that is, and what can be done to change it. NHS England is also working with BME community leaders to encourage more people to use psychological therapies, and to establish the reason for those barriers. In 2012-13, as part of the Time to Change programme, the Department of Health funded a mental health anti-stigma and anti-discrimination project. It ring-fenced 25% of a fund amounting to up to £4 million for work with African and Caribbean communities, which involved building partnerships with trusted BME organisations in BME communities. I think that, to some extent, addresses the point made by the hon. Member for Islington North, who is no longer in the Chamber.

NHS England has worked with Black Mental Health UK, and has established a leadership programme for GP mental health leads for London. A BME taskforce is undertaking a root-and-branch review of mental health services in London, to ensure that they are equitable and free of ethnic bias. I am not sure whether the hon. Lady is in touch with the taskforce, but I am sure that she would want to be. I shall ensure that she is given details of who is leading it, and I should be happy to put other Members in touch with it if they want to know more.

I must put on record that the hon. Member for Islington North is now present. He may not be in the place where he was before, but he is here.

The mental health trust in east London is strengthening families, with a focus on support for BME groups, by helping the families of patients with serious mental health issues, using an approach that treats the condition as being similar to any other long-term chronic illness and providing positive support and advice. That, I think, addresses a question raised by a number of Members: why, in many instances, are such different approaches taken to physical and mental illness?

Members rightly expressed concerns about child and adolescent mental health services. It is estimated that 50% of mental illness in adult life begins before the age of 15 and that 75% of mental illness in adults starts before the age of 18, so—as others have pointed out—early intervention is key. Over the next five years, we will invest £30 million a year in improving services for young people with mental health problems, with a particular emphasis on eating disorders, which were also mentioned. We are investing £54 million between 2011 and 2015-16 in the children and young people’s IAPT—improving access to psychological therapies—programme to transform child and adolescent mental health services. I am glad that my hon. Friend the Member for Hendon mentioned that. Let me also draw attention to his distinguished record in respect of looked-after children; I was very aware of his work when we were both on Barnet council.

Public Health England also plays a role in addressing the mental health needs of Londoners and is engaging with schools, teachers and pupils to promote and build resilience among young people through the London grid for learning. As a partnership, City and Hackney, about which I was briefed in anticipation of the debate, has one of the highest spends in London and England on CAMHS—close to £5 million.

I want to pick up a point that the hon. Member for Hackney North and Stoke Newington mentioned with regard to BME children being recorded in prevalence data. I want to give her some assurance on that. The commissioning of a new prevalence survey on children and young people and mental health is a priority for the Department. Our chief medical officer has identified the need for prevalence data on the mental health of BME children and young people. Therefore, we anticipate that the new survey will look at the prevalence of issues in those groups and we hope to announce the procurement process in the near future.

More than £400 million is being invested over the spending review period to make a choice of psychological therapies available in all parts of England for those who need them. We all acknowledge that we are not there yet, but it is important that as part of the “Five Year Forward View”, NHS England has committed that, by April 2016, 75% of people referred to the IAPT programme will be treated within six weeks of referral and 95% will be treated within 18 weeks of referral; and that more than 50% of people experiencing a first episode of psychosis will be treated with a National Institute for Health and Care Excellence-approved care package within two weeks of referral. Those are important and ambitious targets to secure improvement in this area.

Data on mental health bed occupancy has not been routinely collected across the NHS London region, but NHS London has initiated a process to do that to allow year-on-year comparisons to be made. The first year of the initiative was 2014. The results of that suggested that across the different types of mental health in-patient facilities occupancy rates ranged from 78% to 100% during the period the audit was undertaken, which was September to November 2014.

London’s CCGs are committed to delivering the IAPT access and recovery targets for 2014-15. Additionally, the hon. Lady’s CCG, City and Hackney, is using a range of alliances—I was interested to hear about this—across CAMHS, psychological therapies, dementia, primary care and crisis services to improve the integration of service partners, with a clear focus on involving voluntary sector and social enterprise groups. I am sure that that is mirrored in other parts of London.

The hon. Lady raised the challenges facing LGBT people. The National Institute for Mental Health in England carried out a review that showed that LGB people are at greater risk of suicidal behaviour and self-harm, as others have said, and that the risk of suicide is four times more likely in gay and bisexual men, while the risk of depression and anxiety is one and half times higher in LGB people. I was interested to hear what she said—it mirrors my experience—highlighting the concerns of young gay people from BME communities. I have experienced that too as a constituency MP. Interestingly, some of those people said that the worst prejudice they experienced was from within their community. In that regard, London’s diversity also poses us a challenge sometimes. We as constituency MPs, and in other roles we have in our communities, must try as much as possible to stand up to and challenge that when we acknowledge London’s diversity.

West London mental health trust has a specialised gender dysphoria service, the largest in the country, which is accessed following GP referral to general mental health services with a question as to whether the patient has gender dysphoria. The total annual value of that service is £9.9 million. The London Lesbian and Gay Switchboard provides national information and a listening service over the phone and by e-mail and instant messaging. The helpline operates from 10 am to 11 pm, seven days a week, 52 weeks a year. It is based in London but takes calls from the whole of the UK. I thank all local LGBT support groups. They do such a great job. I look forward to spending this evening with the Wandsworth LGBT forum at one of its film nights. We will watch a new film that addresses issues of particular concern. That organisation provides a great service in my community. I am sure other people have the same experience.

As we have heard, mental health crisis care is crucial. The first national crisis care concordat was published in February last year to improve service responses to people in mental health crisis, and in particular to keep people in mental distress, who have committed no crime, out of police cells. NHS England has signed up to the mental health crisis concordat and is in active partnership in London with the police, the ambulance service, the mental health trusts, CCGs, local government and the voluntary sector, as we would expect. Huge progress has been made in London in reducing the number of people taken to police cells for assessment after they have been detained under section 136 of the Mental Health Act. I am pleased to tell the House that this number has reduced from several hundred a year to less than 20. That is a very welcome process.

Interesting contributions were made by Members on both sides of the House about the conversations we have had with our local police agencies. I, too, had an interesting experience when I went out with two very impressive young officers as part of my rapid response unit locally. They showed great understanding of the challenges they met. It was nice that that was acknowledged in all parts of the House, while also recognising the very considerable concern that the hon. Member for Islington North raised about deaths in custody.

[Jeremy Corbyn]

I am sorry that I was out for a couple of minutes during the Minister’s concluding remarks. The point about deaths in custody is essentially about the powers of investigation—the powers of inquiry. In my experience, too often it is left to the randomness of whether there is a family and community support network or not. If there is not one, absolutely nothing happens; if there is one, something might happen. I am sure the Minister is aware of this, and I would be grateful if she would have a good look at the INQUEST report on this subject. Perhaps her Department might like to study it and come up with some proposals in relation to its very sensible suggestions.

[Jane Ellison]

I will of course bring that report to the attention of the right Minister in our Department, and the hon. Gentleman is correct to highlight it.

I want to give a note of assurance on street triage, which was mentioned by my hon. Friend the Member for Hendon. The DOH has funded nine street triage pilots, with police and mental health professionals working together to support people in crisis. In the areas where the pilots are operating, the number of people being detained under section 136 has dropped by an average of 20%. There are some encouraging results.

On the points made only by the hon. Member for Islington North, we are obviously concerned about the reports of high levels of physical restraint. Restraint should only ever be used as a last resort, and we think that the transfer of police custody health to the NHS and commissioning to a standard specification, together with liaison and diversion services being available in every police station, will help to improve that situation and the care and advice available to people in police custody.

I am proud of the Government’s record on mental health, but we have always acknowledged that there is more to be done, and I would not want to suggest any complacency on the part of Government on this vital issue. I will certainly draw to the attention of my DOH colleague the Minister of State who has responsibility for care, all the issues raised by Members on both sides of the House in this very thoughtful debate. I end by thanking all the people in our constituencies—whether within the NHS, the voluntary sector or all the community groups that Members have acknowledged—who provide care to those experiencing mental ill health. We are grateful to them all for what they do to keep Londoners well.

Improving Cancer Outcomes

Jane Ellison Excerpts

Thursday 5th February 2015 Commons Chamber

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

It is a pleasure and an honour to respond to an excellent debate in which we have heard distinguished contributions from both sides. This is the sixth debate in six months I have responded to on cancer, which demonstrates the House’s interest in this important subject. I congratulate the all-party groups on cancer, not only on securing this debate, but on everything they have achieved—I will touch on that at the end of my remarks. I sometimes think that with the expertise we have between us, and given the number of times some of us have met in these debates, were we not to be returned to this place, we could take our cancer awareness roadshow around Britain and do some good for the nation in another way.

I shall try to respond to as many points as possible, and in some areas, I can update the House. However, I want to rattle through as many of the detailed points as possible, and I am sure that the shadow Minister, who I like very much, will forgive me if I do not counter his reiteration of the Opposition’s policy position with a detailed exposition of the Government’s. I will say only three things. First, I shall respond mostly to the Back-Bench contributions. Secondly, I do not recognise his figures on reduced spend, although I understand where they are derived from. Thirdly, when the NHS is bringing together its own strategy on cancer, I would question why we would want to come forward with another strategy. As the hon. Gentleman and others have argued, there is a remarkable degree of consensus about what needs to be done, and that is the area we need to focus on.

Obviously, improving cancer outcomes is a major priority for the Government. As the annual report on our outcomes strategy showed in December, we estimate that we will save an extra 12,000 lives a year by 2015, more than double the ambition of 5,000. That figure of 12,000 lives is the best estimate based on a projection using the latest survival estimates and assuming incidence is constant, which I think responds to points made in the debate. I am sure that my hon. Friend the Member for Basildon and Billericay (Mr Baron) will be interested to see the detailed breakdown of how that figure is derived in the annexe to the fourth annual report on the cancer outcomes strategy.

Clearly that figure represents a great achievement by the NHS and it is good news for the thousands of people affected by cancer. Yesterday was world cancer day. A number of Members have referred to the one in two figure. I emphasise that, in the bylines to that headline, it made the point that that was only if lifestyle factors for many people were not adjusted. In fact, chances are considerably better if we could make some of those lifestyle changes. That was alluded to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who as usual made a distinguished contribution. I know that he could not stay for the winding-up speeches.

My hon. Friend the Member for Salisbury (John Glen) made well a point about prevention. Were it not unparliamentary, I might have run up the green Benches to embrace him when I heard his argument in favour of tobacco control and standardised packaging. I could not agree with him more. It was absolutely excellent. The “Five Year Forward View”, which many Members have talked about, is the NHS’s vision of its future strategy. It was brilliant to see prevention right at the heart of that strategy; there is an entire chapter about it. Picking up the point made by my hon. Friend the Member for Salisbury, I have discussed this issue with all the major charities over the past six months and asked them to bring their considerable reach and influence to bear and to talk as much about prevention, given their authority on treatments and drugs. That is an ongoing conversation and we have seen some evidence of that. My hon. Friend is right to remind us that 80,000 people a year die in England as a result of tobacco. If only the women in the 1970s who started smoking knew what we know today; it is now two weeks since lung cancer took over from breast cancer as the biggest killer of women. We continue with our tobacco control measures with enthusiasm. We have a good record.

Of course we want to match the best in Europe, and there has been some discussion about that. We accept that cancer survival in England has historically lagged behind the best performing countries in Europe and the world. However, none of those international comparisons of cancer survival includes patients diagnosed after 2007. I delved into this matter in anticipation of the debate. We always cite the figures, but the reality is that because of the time lag, the five-year survival rates are essentially the gold standard—the benchmark against which the international comparisons are made. Therefore, because of the time lag in the five-year survival rates, we are not in a position to know exactly how we are doing compared with other nations.

However, I take the points made often and well by my hon. Friend the Member for Basildon and Billericay about the one-year survival data. It is inaccurate at the moment to use those figures based on patients diagnosed before 2007 as a measure of current performance in the system. The next best estimate of international benchmarks will be in 2017-18. Until then we will look at issues such as projection.

[Mr Baron]

May I seek clarity on that? Is my hon. Friend saying that the 2007 figures are pertinent to the five-year survival rate figures? What we have been focusing on is the one-year figure as a means of driving forward earlier diagnoses, because it is largely at the one-year point that we are losing thousands of lives.

[Jane Ellison]

I completely understand that point, which is well made. We will not have the next best international benchmark until 2017-18, but my hon. Friend is absolutely right that that does not mean that we are without proxy benchmarking and real benchmarking in the interim. He is right to draw attention to the one-year survival rates. I was trying to give a sense of the international picture and of comparisons.

On how further to improve cancer outcomes, I am sure all Members will be delighted that on 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services, to consider the vital survival rates and to improve them, saving thousands more lives. The taskforce has been set up to produce a new cross-system national cancer strategy, bringing all the strands together, as so many Members wanted. This is a strategy—by the NHS for the NHS—to take us through the next five years to 2020, building on NHS England’s own vision for improving cancer outcomes, as set out in the “Five Year Forward View”.

Picking up a point made by my hon. Friend the Member for Salisbury, many of the major charities involved in the taskforce have told me that much of it is about working smarter. It is not necessarily to be measured purely by spending more. I thought my hon. Friend made a very thoughtful contribution on that topic. The taskforce is an expression of our ambition for outcomes. It has been set up in partnership with the cancer community and other health system leaders, and it is chaired by Dr Harpal Kumar, chief executive of Cancer Research UK. It met for the first time on 27 January. The new strategy will set a clear direction covering the whole cancer pathway from prevention to end-of-life care; a statement of intent will be produced by March 2015; and the new strategy will then be published in the summer.

I have always been keen in responding to these debates to emphasise the need for the NHS and all others intending to improve cancer outcomes to come together and interact effectively with Parliament. That is vital. The expertise is here in the all-party group, so I am pleased that the cancer taskforce yesterday sent a call for evidence to the various all-party groups—on pancreatic cancer, brain tumours, breast cancer, ovarian cancer and cancer generally. I of course encourage colleagues to submit evidence to the taskforce. After the debate, I will speak to the chairman and of course draw his attention to the quality of the inputs into this debate.

Turning to deal with early diagnosis, I shall not reiterate all the points made about the importance of tackling late diagnosis. We have heard some important illustrations of just how crucial this can be. We have invested over £450 million to achieve earlier diagnosis. As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working jointly with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly.

The new approaches include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms such as tiredness—a big issue for pancreatic cancer, so it is important to work on this; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. So many Members have spoken in today’s and other debates about the wearying journeys and the debilitating effects that multiple tests on multiple occasions can exert on their constituents—another important area to look at. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17.

Briefly, all Members will need to debate and bring more into the open in the coming years the inevitable tension between the concentration of expertise to carry out early diagnosis, particularly in rarer cancers and those with more difficult symptoms, and the understandable desire that Members and members of the public have to have facilities closer to people. There is a tension, and we will inevitably have to debate it. I think it was the hon. Member for Heywood and Middleton (Liz McInnes) who made the point about the number of rare cancers that GPs see. The issue has been teased out in these debates before, but in reality the number of common cancers seen by the average GP is very few, while the number of rare cancers they see is very few indeed.

[John Glen]

Does the Minister acknowledge that there is a difference between urban and rural in this context? While those who represent rural constituencies understand the need to aggregate services to get the specialism, we are also concerned about access. Is this not a careful judgment to be made?

[Jane Ellison]

I entirely agree; I think there is a balance to be struck. One of the issues that was discussed at about the time of the launch of the “Five Year Forward View”, by the NHS among others, was that of moving consultant expertise from secondary to primary settings. There are a number of ways of looking at that. I urge Members to feed the points that they have raised to the taskforce, because it is exactly that kind of new way of looking at things that we want to capture in its work.

Since 2010-11, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns to raise awareness of signs and symptoms of specific cancer types, and to encourage people with such symptoms to visit their GPs. Decisions on further Be Clear on Cancer activity will be made during 2015, and will be based on all the available evidence relating to the effectiveness of the campaigns. I will argue strongly for their continuation, because I think that the case for them has been conclusively made. Many have been very successful, and they are evidence-based, which I think is important. The Department will continue to work with Public Health England, NHS England and all the relevant experts and stakeholders to keep the campaigns under review.

Let me briefly update the House on the ovarian cancer campaign, which was mentioned by the hon. Member for Washington and Sunderland West (Mrs Hodgson), and for which she is a long-standing and doughty champion. I recently lost a dear friend to ovarian cancer, so the issue is very close to my heart. Public Health England ran an ovarian pilot campaign in the North West television region between February and March last year, which, as the hon. Lady said, focused particularly on awareness of bloating as a symptom of ovarian cancer. Public Health England is waiting for the full evaluation results of the campaign, but we expect the interim report to be shared with the charities later this month. Public Health England has also agreed to meet them. A decision on how to proceed will then be made, at a national level.

A draft policy proposal for BRCA gene testing is among those on which NHS England’s clinical priorities advisory group is awaiting consultation. That consultation will probably take place following a 90-day public consultation on the decision-making framework. I understand that NHS England will soon consult on the lowering of the threshold for BRCA1 and BRCA2 testing in line with guidance from the National Institute for Health and Care Excellence.

Let me now briefly touch on the point made by the hon. Member for Heywood and Middleton, from whose health expertise we benefited earlier in the week during another debate. In May last year, before the hon. Lady entered the House, we had a very good debate about cervical cancer and screening following a tragic case involving a young woman in Liverpool. She may find it interesting to read the report of that debate, in which Members described cases similar to that of the young woman to whom she referred.

If people have gynaecological symptoms that make them alarmed enough to visit their GPs, they should be referred for diagnostic tests. Smear tests are screening tests, not diagnostic tests. In fact, the best clinical guidance is that if there are gynaecological symptoms, a smear test will only delay possible diagnosis. I think it important to send young women the message that if they are worried about gynaecological symptoms, they should seek a diagnostic test rather than a smear test.

My hon. Friend the Member for Castle Point (Rebecca Harris) raised the important issue of brain tumours. I can update her on the work that has been done. Representatives of the Brain Tumour Charity recently met representatives of Public Health England, and the meeting went very well. The charity is to give a presentation to the school nursing partnership in March. It is also going to contact the NHS England’s national clinical director for cancer to see how it can contribute to work on early diagnosis. Other actions were agreed on, but I understand that that particular piece of work is proceeding well.

As we know, screening is an important way of detecting cancer early, and under this Government there has been a £170 million expansion and modernisation of cancer screening programmes. They are reviewed regularly, and I am always happy to tell Members how further information can be submitted to the UK National Screening Committee.

On cancer waiting times, the NHS is treating more cancer patients than ever and survival rates are improving. In the last 12 months, nearly 560,000 more patients were referred with suspected cancer than in 2009-10, an increase of 60%. In 2013-14, almost 35,000 more patients were treated for cancer than in 2009-10, an increase of 15%.

Most waiting times standards are being maintained despite the growing numbers, although we are aware of the dip in the 62-day pathway standard in the last three quarters. Of course it is vital that all patients fighting cancer should have high-quality, compassionate care and we expect every part of the NHS to deliver against those national standards. Therefore, the NHS is looking urgently at any dips in local performance to ensure that all patients can get access to cancer treatment as quickly as possible. It has a specific waiting times taskforce looking at that.

Radiotherapy has long been championed by the hon. Member for Easington (Grahame M. Morris). Radiotherapy can be a helpful treatment for some patients. His points about its success rate when used at the appropriate time were well made. As part of its recent announcement, NHS England also committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy, stereotactic ablative radiotherapy, or SABR, to which he referred. That new investment is in addition to NHS England’s pledge to fund up to £6 million over the next five years to cover the NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK. Those are for pancreatic cancer, lung cancer, biliary tract cancer and prostate cancer.

I can confirm that we are investing £250 million in two proton beam therapy centres. One is at UCLH—I saw the foundations being built when I visited the hospital recently; it was exciting to see that centre being built—and the other is at the Christie in Manchester, so that patients can be treated in the UK. As Members will be aware, patients are currently referred abroad

On the cancer patient experience and the cancer patient experience survey, nothing could more amply demonstrate the importance of putting cancer patients’ experience at the heart of treatment and of the NHS response than the speech by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). It was impossible to remain unmoved by it. It could not have more aptly underlined the importance of taking patients’ experience into account. Therefore, I was pleased to see that the results of the 2014 cancer patient experience survey, published in September, show some improvement on many of the scores since the previous survey—89% of patients reported that their care was either excellent or very good.

Following the 2014 survey, NHS Improving Quality is launching a pioneering project that pairs highly rated cancer trusts with trusts that have potential to improve. That “buddying” programme will involve up to 12 trusts and will be directed at clinical and managerial staff so that we can continue to use that survey to drive improvements.

As to the future of the survey, on which there has been some discussion, my hon. Friend the Member for Basildon and Billericay mentioned the new tendering of the contract, which NHS England is taking forward. For those reasons, it is unlikely that there will be a survey report in 2015. I know that that will be a disappointment to him, but it is very much the intention to run a survey this year for publication next year. NHS England is working with a range of stakeholders, including cancer charities, to ensure that that survey is even more effective.

[Mr Baron]

I can probably accept that there may be good reasons for the delay, but perhaps even more importantly, will the Minister do what she can to ensure that the results of that survey, when it is eventually brought forward, are followed through for the benefit of patients? Too often, they are not and different CCGs are doing different things with the results.

[Jane Ellison]

Absolutely. That is the purpose of the buddying programme. There is now a more formalised process to ensure that those that are not doing so well are “buddied up” with those that are doing very well.

I want to make a few more points in response to hon. Members’ comments. My hon. Friend rightly brought up the issue of CCG accountability and how we hold CCGs to account. I congratulate the APPG and his personal campaign to make sure we get the one-year cancer survival rates added to NHS England’s delivery dashboard from April this year. Where the evidence from the delivery dashboard is that local providers are not meeting the standards, that will be challenged by NHS England. I think there is still work to do to understand how we can do that most effectively. I know the APPG will also be giving thought to that. I encourage all local authorities, health and wellbeing boards and Members to be part of that challenge process. I also refer them to the work of the chief inspector of general practice, Professor Steve Field, in that regard, because that is an important part of his work, too.

I can confirm that work is ongoing with regard to free social care at the end of life. The hon. Member for Easington asked about that. That work is ongoing, but the Minister with responsibility for care will be able to expand on that.

On health and inequalities, I could not agree more with all hon. Members who made the point that tackling health inequalities is inextricable from tackling cancer effectively. I visited the constituency of the hon. Member for Nottingham North (Mr Allen) recently. The figures for how many cancers are diagnosed through the emergency route have been put on the record in this debate—around 22%. He told me that in his constituency 40% of lung cancers are diagnosed in A and E, and they have very poor outcomes. That brought that point home to me extremely clearly.

Sean Duffy, the national clinical director, is passionate about the treatment and care of older people affected by cancer. That can play a very significant role in improving our overall outcomes. I know that is something he wants to focus on through his call to action, as well as looking at lower socio-economic groups and some black and minority ethnic groups. A recent Be Clear on Cancer campaign on prostate cancer took place in six London boroughs and focused on black men and their particular susceptibility to that cancer.

On rarer cancers, I have touched on some of the work that is going on, but I am pleased that Cancer Research UK’s new strategy launched last year set out how it would increase research in key areas such as early diagnosis, and again that work will feed into the taskforce.

On research, I will not go into detail, but I invite my hon. Friend the Member for Castle Point to contact me at the Department of Health with regard to research on brain cancer. I was recently able to supply some very detailed figures to the all-party group on pancreatic cancer from the chief medical officer, and I would be very happy to supply them in her area of interest.

Lastly, let me give some reassurance on access to data. Transparency is a key theme for this Government. We have rightly put huge amounts of data into the public domain. It is a frustration that the data availability issue to which my hon. Friend the Member for Basildon and Billericay referred has been hard to resolve. Last year some concerns were raised about the legitimacy of the release of patient data to a range of organisations. When these concerns were raised, Public Health England did absolutely the right thing and suspended the release of data while it conducted a full review. This review is now complete. Public Health England and the Health and Social Care Information Centre have also clarified the legal basis of data transfer between the organisations and a letter of authority has just been issued by the departmental sponsors to remove any ambiguity. Data should now begin flowing more quickly.

I would like to thank all those who have contributed to this debate and to so many other debates we have had in the House on this vital subject. I strongly believe there is a great deal of consensus about what needs to happen. We need to continue to challenge the system, and I am delighted that Parliament continues to challenge Ministers in this regard. The new NHS England independent cancer taskforce is leading the way in partnership working and will make a real difference.

If this is the last general debate we have on cancer in this Parliament, may I say thank you to the various APPGs and the people who speak for them, and give them the following assurance? I can tell them that, although it may not always seem like it, in the 18 months or so that I have been a Minister their work has made a difference, and I do know of things that have happened because APPGs and individual Members championed them in this place. If that does not give them the heart and encouragement to keep going and to come back in the new Parliament and champion these issues further, I do not know what will. I congratulate them on their efforts today, and on other days and throughout the year, on this highly important topic that matters so much to all our constituents.

Radiotherapy Services (North East Hertfordshire)

Jane Ellison Excerpts

Wednesday 4th February 2015 Westminster Hall

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

I congratulate my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) on securing this debate on, as he pointed out, a very apt day: world cancer day. I am still getting used to the idea of the MPs’ road trip that he appears to be planning for himself, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and my hon. Friend the Member for Stevenage (Stephen McPartland). I will come on to address the issue of access, but that certainly sounds like an offer that no one could refuse.

[Stephen McPartland]

NHS England has refused us on several occasions. We keep pushing, so we would be grateful if the Minister could persuade it to accept the offer to embark on our road trip.

[Jane Ellison]

I will certainly draw NHS England’s attention to the force with which the invitation was put in this debate.

Let me say a few words about the bigger picture on cancer before we go into the detail in the contribution by my hon. and learned Friend the Member for North East Hertfordshire. The Government are committed to improving cancer outcomes and matching the best in Europe. As Members are aware, we do not match the best in Europe; we were certainly lagging behind some important countries when the Government came to office in 2010.

The 2011 strategy, which was backed by £750 million, set the ambition of saving an additional 5,000 lives a year. We believe that we are on track to save an additional 12,000 lives a year, far exceeding that ambition. Much of the focus has been on early diagnosis and awareness. Given the clear interest in cancer that Members have expressed by being here, I hope that they will join me in welcoming the announcement of NHS England’s cancer taskforce, which is charged with designing a new cancer strategy for the NHS to take us through to 2020.

I thought Members might be interested in the statistics for East and North Hertfordshire NHS Trust over the last 12 months. Some 2,881 more patients with suspected cancers were seen than in 2010—a 49% increase. In addition, 239 more patients were treated for cancer than in 2009-10—an 11% increase. Local NHS staff, to whom I pay tribute, are therefore doing a good job of seeing more people.

[Sir Oliver Heald]

I am grateful to the Minister for giving way on that important point. About half of the patients require radiotherapy, so the numbers on that journey are getting higher and higher, and there surely comes a point when we can have our satellite.

[Jane Ellison]

Indeed, and I will address some of the issues my hon. and learned Friend raised, but let me say a quick word on radiotherapy more generally. The Government have set about improving these services. NHS England will be investing an additional £15 million in stereotactic ablative radiotherapy on top of the £6 million already committed. That will benefit about 750 patients a year. There is also a £23 million radiotherapy innovation fund, which has resulted in the doubling of intensity-modulated radiotherapy activity. In addition, we are investing £250 million in building two new proton beam therapy centres. A lot of investment is therefore being made in some very up-to-date and important technology.

Let me turn to local health matters. First, I congratulate my hon. and learned Friend the Member for North East Hertfordshire, my right hon. Friend the Member for North East Bedfordshire and my hon. Friend the Member for Stevenage, who are all known as doughty champions of their local health services. It is particularly good to see the latter, who champions health matters with great vigour in this place.

I am aware of the issues that have been raised. Regardless of the part of the country we live in, we would all expect patients to have ready access to radiotherapy services as part of patient care. Obviously, radiotherapy is a specialised service. It is commissioned directly by NHS England. Fortunately, it is not needed by the majority of NHS patients, but it is vital to those who do need it. The smaller number of patients involved means that the health service needs to think carefully about access—locating units to provide the maximum benefit closest to the highest possible number of people. I will go on to talk about the implications for expertise.

Such decisions are made locally, and are best made locally, by clinical leaders who have the full benefit of local knowledge. However, it is right, of course, to bring concerns to Parliament and to give Ministers a chance to understand what is happening in the local health economy, so that we are aware of the issues and can discuss them, where necessary. Decisions on where to locate specialist services need careful consideration. The issue is of particular note to those who represent more rural constituencies. Patients who live some distance from treatment centres—not only those providing radiotherapy—can, unfortunately, face repeated, long and tiring journeys. I realise that the seats of my hon. Friend the Member for Stevenage and my hon. and learned Friend the Member for North East Hertfordshire are not necessarily rural, but those are factors in parts of our country. My hon. and learned Friend gave us examples of the anxieties that long, tiring journeys bring, alongside the already stressful situation of being treated for cancer.

Interest in where radiotherapy services are located is understandably heightened by the NHS England review of stereotactic radiotherapy and stereotactic radio surgery services, which is being undertaken at a national level. For the benefit of Members, let me explain that those services involve a type of external beam radiotherapy treatment currently commissioned by NHS England for the treatment of patients with a wide range of cranial cancers. That consultation closed recently, on 26 January, and as part of the review, NHS England found

“an unmet need in the provision of treatment, with services distributed unevenly across the country.”

The proposed changes to the way in which stereotactic radio surgery and radiotherapy services are commissioned in England was looked at in the public consultation. Proposals include consideration of the location of services provided in the interests of ensuring equity of access, and the results are being reviewed by NHS England.

My hon. and learned Friend will be aware that NHS England has also carried out a separate, high-level exercise to assess capacity and demand for external beam radiotherapy more generally at a national level to give it a sense of the national picture. A further phase of work is proposed to take place locally, as there will be some specific local issues of which commissioners and providers will need to take account. That process is due to begin in late March.

Accessibility is characterised by an assurance that all patients are offered the most appropriate and effective treatment for their cancer. The latest research suggests that about 40% of all cancer patients should receive radiotherapy, complementing earlier recommendations made by the National Radiotherapy Advisory Group that aim to boost cancer survival through increasing access to that therapy, delivered as part of a treatment with curative intent. The England average access rate was 33% in 2007, and 38.8% in the most recent figures, which demonstrates real progress. I know, however, that there is further to go, as my hon. and learned Friend made clear in his speech.

NHS England has told me that the radiotherapy clinical reference group, which supports it in commissioning radiotherapy, is of the view that all patients should be offered equitable access to specialist radiotherapy care and treatment. The clinical reference group plans to build on the assessment of radiotherapy demand and capacity for England by considering aspects such as innovative treatments, the stock of equipment and how needs differ across areas. That national overview will enable commissioners to ensure that the right services are in the right places to meet future demand, including innovative forms of radiotherapy. Such improvements might well mean that, in future, patients need fewer episodes of treatment, so the problem of repeated tiring journeys would at least be reduced. I think we would all welcome that.

Access to radiotherapy treatment locally is a matter for NHS England to lead on. The decisions on the introduction of satellite radiotherapy centres will need to involve the local providers—in this case, East and North Hertfordshire NHS Trust—and NHS England as commissioners. As my hon. and learned Friend said, his closest radiotherapy services are the excellent services at the Mount Vernon hospital, and there are also services at Addenbrooke’s hospital in Cambridge. NHS England will continue to review the need for additional radiotherapy facilities outside those centres, if such facilities would benefit sufficient numbers of patients, be economically viable and enhance the existing care pathways.

It is possible that, as a result of those discussions, it will be found that more radiotherapy services are needed, but the optimum location will be determined by a number of criteria, including the impact on nearby trusts and existing cancer pathways—in other words, in trying to balance out one lack of access, we would not want to cause a problem elsewhere. Such decisions need to be looked at in the round in the local health economy. However, my hon. and learned Friend made good points about access, and I will ensure that those are underlined.

I understand that in 2009-10 there was a capacity review of radiotherapy provision for the Mount Vernon cancer network. That concluded that although the capacity to meet future demand up to 2016 could be met by the current providers, increasing access to the north of the network was an objective that needed looking at. My hon. and learned Friend underlined that point.

[Sir Oliver Heald]

It is remarkable that the county of Hertfordshire, which has 1.2 million people, does not have radiotherapy facilities at all. Does my hon. Friend agree that the urgency of the matter is changed by the fact that the whole county—or at least most of it—has to go all the way down to London? That is a rather old-fashioned approach. I do not know whether she is prepared to ensure that my remarks, and the support of my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and my hon. Friend the Member for Stevenage (Stephen McPartland), are relayed to NHS England.

[Jane Ellison]

I will certainly do that. I make a point of drawing the attention of the relevant clinical leaders to our debates, and to the strength of feeling expressed by Members on behalf of their constituents. I am of course happy to do that.

The siting of a satellite unit at either the Luton and Dunstable hospital or the Lister hospital in Stevenage was considered in the previous review, but given that the system already had sufficient capacity to meet future requirements, the report acknowledged that any satellite development would need to be planned as part of existing capacity, not additional capacity. In other words, services would have to transfer.

Any review should include an assessment of the best fit, to ensure that if a radiotherapy satellite service is a preferred solution, it is located in the right place. I understand all the points made about location and the county not having such a facility, but equally, looking purely at the geography and the county boundaries might not always lead one to completely the right conclusion. That point was, however, important and has been well underlined today. The unit has to be located in the right place, so that there is capacity, and so that the preferred location offers cost-effective treatment to a sufficiently large number of patients. That is the important point: the number of patients.

I understand, too, that my hon. and learned Friend is not talking about using old equipment, but looking at the location of new equipment. Furthermore, sometimes there is concern about involving what might be called the “penny packet” approach, scattering specialist services thinly to achieve better access. One of the challenges with that approach, however, is that while it can often make sense to people on the face of things—“Of course we want those services there”—there is always the caution about staff not getting the benefit of mutual support, and expertise in particular can become diluted. That approach might also make it sometimes more difficult to manage demand, as one unit might become overwhelmed while others are underworked.

Those factors need to be taken into account, and I underline the expertise one in particular. We all want our constituents to be seen by people who treat sufficient specialist health problems to be really expert in them. We want those experts to see enough patients to know what they are doing when they see something. Concentration of expertise is important in many areas of health and has been much focused on.

[Sir Oliver Heald]

I am suggesting a Mount Vernon operation—that it provides the service in the Lister. Mount Vernon would have two fewer machines, which we would have in the Lister. In that way, we hope that the expertise would be as good as it always has been, but people would not have to do the long journeys.

[Jane Ellison]

I completely understand that point. I expect local clinical leadership to understand the expertise and staffing available. All those factors will be taken in the round and looked at, because the work is specialist. I would expect the NHS to look at things such as his suggestion about the new machines at Mount Vernon. I will of course write, drawing attention to the particular concerns of my hon. and learned Friend and of my hon. Friend the Member for Stevenage about access and the travel distances. They, however, would in turn expect the local NHS to look at issues such as the distribution of expertise to ensure that the continuity of expertise was available.

[Stephen McPartland]

I am grateful to the Minister, who is being generous in giving way. The local Lister hospital in Stevenage is part of the same trust as Mount Vernon. The chief executive and the cancer surgeons of the local hospital support the concept of a satellite radiotherapy unit, so the local NHS supports having such a unit in Stevenage, or nearby in Hertfordshire. The issue we have is with NHS England getting on and commissioning it. The problem is that we cannot understand how the NHS is getting travel times of 45 minutes.

[Jane Ellison]

I have certainly picked up from the debate the importance of the issue of travel times. I will make a particular point of drawing that to NHS England’s attention.

It is always heartening to hear that colleagues are so engaged with their local health leaders as to be working together on such things. I am sure that that will all be fed into the process of making a decision. That will have to look at the implications for the whole cancer pathway, and all the other patients who receive services as part of the cancer network.

My hon. and learned Friend the Member for North East Hertfordshire, my right hon. Friend the Member for North East Bedfordshire and my hon. Friend the Member for Stevenage are hoping to meet the local NHS, as they detailed. Again, it sounds as if all the right people will be at that meeting. I strongly encourage colleagues to continue such meetings. Such a high level of engagement with local clinical leaders can only be to the benefit of their constituents. They will want to get the best and safest services for their constituents.

I congratulate my hon. and learned Friend the Member for North East Hertfordshire, who was supported by other right hon. and hon. Friends, on the debate and on their interest in the issue, which they are championing on behalf of their constituents. It is great to hear that they have the local newspaper, The Comet, involved, because it is always good for local newspapers to be involved in health campaigns, drawing attention to and explaining the issues to their readership. It sounds like a real commitment to fighting cancer in their part of the country. I commend them. I will draw the debate to the attention of those who will be interested, including NHS England. I am happy to continue to liaise with Members, and to hear how they get on with their discussions and the eventual outcome of the local review.

Question put and agreed to.

Human Fertilisation and Embryology

Jane Ellison Excerpts

Tuesday 3rd February 2015 Commons Chamber

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

I beg to move,

That the draft Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015, which were laid before this House on 17 December 2014, be approved.

Mitochondria are present in almost every cell in the body and produce the energy we need to function. This is why they are often referred to as “the battery pack” of the cell. Unhealthy mitochondria can cause severe medical disorders, known as mitochondrial disease, for which there is no cure. The techniques provided for by these regulations offer the only hope for some women who carry the disease to have healthy, genetically related children who will not suffer from the devastating and often fatal consequences of serious mitochondrial disease.

First, I would like to bring the House up to date with the process followed since the principle of mitochondrial donation was first debated by Parliament during the passage of the Human Fertilisation and Embryology Act 2008 in 2007-08. There has been much consideration of this issue in this Parliament. Over the last five years, there has been extensive engagement and consultation with the public on this issue, including an ethical assessment by the Nuffield Council on Bioethics in 2012; a public dialogue and consultation exercise carried out by the Human Fertilisation and Embryology Authority in 2012-13; and a public consultation on draft regulations carried out by the Department of Health in 2014.

There have been three reports on the safety and efficacy of mitochondrial donation techniques by an expert panel convened by the HFEA which were published in 2011, 2013 and 2014. The expert panel members were selected for their broad-ranging scientific and clinical expertise, and for having no direct or commercial interest in the outcome of the review. Indeed, Professor Frances Flinter, a genetics consultant who works with affected families, has said:

“There has been more scientific review of this proposed process than any other medical technology.”

[Robert Flello (Stoke-on-Trent South) (Lab)]

The Minister says that there is no point in further review, but the safety tests recommended by the HFEA in its three reports have not yet been completed, written up or peer reviewed. Does that sound like a completed analysis?

[Jane Ellison]

I will come to that point in my remarks.

There has been much parliamentary scrutiny of the proposals, including three parliamentary debates and over 200 parliamentary questions in both Houses. As part of this parliamentary scrutiny, the Science and Technology Committee held an evidence session on mitochondrial donation in October last year. Following the hearing, the Chair, the hon. Member for Ellesmere Port and Neston (Andrew Miller) who I see in his place, wrote to me on behalf of the Committee, expressing the opinion that there was sufficient information for Parliament to make an informed decision, and urging the Government to bring forward regulations. Given the extensive scrutiny in this Parliament, I believe it is right to allow this Parliament to decide whether to take the next step for mitochondrial donation, which can progress only with these regulations.

The two proposed techniques, maternal spindle transfer and pro-nuclear transfer, are covered by the regulations. They are about replacing the battery pack that contains a small number of unhealthy genes with a healthy battery pack. Mitochondrial DNA is just 0.054% of our overall DNA and none of our nuclear DNA, which determines our personal characteristics and traits and is not altered by mitochondrial donation.

I would like to take this opportunity to pay tribute to the scientists at Newcastle university, who have led the world in the development of the new techniques—an area where Britain is at the forefront of life sciences.

[Robert Flello]

The Minister is extremely generous with her time. She says that these scientists are leading the way, but is she not aware of the work done in China over a decade ago in exactly this area? It was clearly pioneering, and it led to the Chinese Government outlawing the use of these techniques because of the appalling, tragic outcomes.

[Jane Ellison]

I am aware of that work, which has been the subject of extensive parliamentary questions. The expert panel considered all of those issues, including that piece of work, during the course of their deliberations.

[Mr David Burrowes (Enfield, Southgate) (Con)]

Does the Minister acknowledge that scientists broadly accept that the procedures are nuclear cell transfer? That is what regulations 4 and 7 make clear. That means that nuclear DNA in the egg is explicitly altered. Therefore one has to agree that an honest, clear definition of what we are dealing with is genetic modification.

[Jane Ellison]

No, I cannot accept that description. I recognise that my hon. Friend has objections to the procedure, but I do not recognise his description. Nuclear DNA is not affected; mitochondrial DNA is different.

As well as paying tribute to the scientists at Newcastle university, I want to pay tribute to the Lily Foundation, a charity founded by families who have lost their children to serious mitochondrial disease, and who have shown us the human suffering behind this scientific advance. Many right hon. and hon. Members, like me, have constituents who are affected, and I am sure that some Members will talk about such families in their own speeches.

[Steve Baker (Wycombe) (Con)]

Does the Minister accept that a person born as a result of a mitochondrial replacement would not pass on mitochondrial disease to their successors? In other words, the germ line would have been modified so that the mitochondrial disease had stopped with their parents. It seems to me that if she accepts that the germ line has been modified, what she said a few moments ago cannot possibly be right.

[Jane Ellison]

We have made it clear that the removal of the faulty mitochondria will be passed on to the next generation. That is exactly what we have been describing, but I do not accept my hon. Friend’s description of it as genetic modification. It has to be said that there is no universally agreed definition of genetic modification, but for the purposes of these regulations, we have used a working definition and it involves not altering the nuclear DNA.

[Fiona Bruce (Congleton) (Con)]

rose—

[Jane Ellison]

I know my hon. Friend is going to make her own contribution. If she will forgive me, I want to outline for the benefit of Members less familiar with the regulations their detailed content.

Turning to that detail, the regulations are made under the powers in the Human Fertilisation and Embryology Act 1990. They were added to in 2008 to permit mitochondrial donation to prevent the transmission of serious mitochondrial disease, anticipating the advancement of science to this point. Regulations 3 to 5 set out the circumstances for mitochondrial donation techniques using eggs; regulations 6 to 8 set out the circumstances for mitochondrial donation using embryos. They would allow the use of the two techniques that have been subjected to extensive UK-wide review and consultation: maternal spindle transfer and pro-nuclear transfer.

Regulations 11 to 15 and 19 set out the information that can be provided about a mitochondrial donor to any child born from the donation and information to that donor. Regulations 16 and 17 set out special provisions around consent that were identified through the public consultation process. These regulations apply UK-wide, and the devolved Administrations have been kept informed of development and progress.

[Fiona Bruce]

Does the Minister consider that the Government’s own regulator, the HFEA, was wrong to state, in a consultation document that “PNT involves genetically modifying a human embryo”?

[Jane Ellison]

I shall deal shortly with the regulatory regime that the HFEA would introduce. However, that and many other points have already been examined in great detail and responded to in great detail in parliamentary answers, to which I refer my hon. Friend.

[Richard Fuller (Bedford) (Con)]

It is clear to many of us who have spoken to our constituents that this procedure will make a huge difference to individual families. There is, in a sense, an ethical gateway to the framework that will allow the scientists and medical experts to move forward. Can my hon. Friend tell us why there appear to be a number of people who, for ethical and religious reasons, are quite close to agreeing with the Government but have not quite agreed yet, and have asked for more time?

[Jane Ellison]

I think that those Members may speak for themselves during the debate. No one would deny that this is ground-breaking science—it is—but there have been three expert panel reviews. What I am trying to demonstrate in my speech is that we have taken all the necessary rigorous steps towards the point at which Parliament can make an informed decision. I think it important to distinguish things that are knowable and on which Parliament can make that informed decision, and things that can only be known when we take the next step, which involves making the regulations. I hope that that is helpful.

[Several hon. Members]

rose—

[Jane Ellison]

I want to make a little progress, but I may take another intervention later. I am conscious that many Members wish to speak.

There has been much discussion of the safety of mitochondrial donation techniques. As I have said, three reports have been produced by the HFEA-convened expert panel during the current Parliament. On each occasion, the panel has concluded that there is nothing to indicate that the two donation techniques are unsafe. Although the panel has recommended that further experiments should be conducted, it expects such research to support the conclusions that it has reached so far.

In public discussion, there has been some misunderstanding of the term “critical”, which was used by the expert panel. That is helpfully clarified in the HFEA’s introductory briefing note, which has been endorsed by the panel and which makes it clear that the experiments could take place before or after the approval of regulations by Parliament. The chief medical officer sent a copy of the briefing note to all Members yesterday.

[Sir William Cash (Stone) (Con)]

Is my hon. Friend aware that there are profound legal reasons for believing that the regulations are ultra vires in respect of the primary Act—the Human Fertilisation and Embryology Act 2008—and are also in breach of the clinical trials arrangements that are set out in the European Union clinical trials directive? Does she understand that that allegation has been made, and what is her response?

[Jane Ellison]

The clinical trials directive applies only to medicines. It does not apply to embryology, so it is not relevant in this case.

[Mr Brian H. Donohoe (Central Ayrshire) (Lab)]

rose—

[Dr William McCrea (South Antrim) (DUP)]

rose—

[Jane Ellison]

I am sorry. I know that many Members wish to intervene, but I am trying to leave time for Back-Bench contributions.

If the regulations are passed by Parliament, the HFEA will introduce a robust regulatory process, as it has in other areas of fertility treatment. The regulations would also establish important safeguards through the HFEA’s own licensing procedures. Before licences could be issued to providers of mitochondrial donation, they would have to demonstrate that they could carry out the procedure safely and effectively. Each provider would need to be licensed, and treatment for each patient would be approved on a case-by-case basis. Decisions would be based on the scientific evidence and advice that were submitted to the licensing committee. The HFEA is highly respected across the globe as a model for the regulation of fertility and embryology treatments and research. Many other countries do not have such a framework.

I recognise that some Members disagree in principle with mitochondrial donation, and I respect their point of view, although I do not share it. To those who do not disagree in principle I have sought to demonstrate—as we have sought to demonstrate over the years of expert panel reviews and further consideration—that all reasonable and rigorous steps have been followed to reach the point at which Parliament can be asked to make an informed decision about whether to allow these techniques to be licensed on a case-by-case basis. It is a bold step for Parliament to take, but it is a considered and informed step.

This is world-leading science within a highly respected regulatory regime, and for the families affected it is a light at the end of a very dark tunnel. I commend the regulations to the House.

--- Later in debate ---

[Steve Baker]

Prevention certainly is better than cure, but the question is: at what risk? I simply accept that on the earliest stages of human life there is a space for conscience; we will have different beliefs, some of which will be religious, and it is a matter of conscience. There are noble reasons for disagreeing about that stage and about what is and is not legitimate risk taking with human beings.

The second point I wish to make is that in the course of this conversation there seems to have been what, at best, I could describe as semantic sophistry as to whether or not this process is genetic modification. As always, there is space for debate about the definition of terms, but the germ line is to be modified if these techniques go ahead. The Minister has stated that plainly—

[Jane Ellison]

indicated assent.

[Steve Baker]

She nods, and I am grateful. If the germ line is to be modified, to me this is genetic modification. I heard the hon. Member for Cambridge (Dr Huppert) give a clear explanation of the separate origins, and he understands the science better than I do. But for me the key thing is not so much where these parts of the DNA identity of a person came from, but where they are now. Each one of us has our own particular DNA identity. This procedure changes only a tiny part of it, but, having changed it, we cannot know what the consequences will be. I know that families will be affected by the decision, but I have to say, with great sorrow, that, when it comes to human beings, this degree of uncertainty cannot be borne by my conscience and I shall be voting against the regulations.

--- Later in debate ---

[Jane Ellison]

I will try to touch on some of the points raised in this high-quality debate, in which views have been expressed on all sides of the argument. I will deal first with the technical questions. I really cannot add to the excellent explanation that the hon. Member for Heywood and Middleton (Liz McInnes) gave of the Zhang et al study from China. She was precisely right and explained it very well.

In answer to an earlier question, we are satisfied that regulations are necessary and that they are not ultra vires. The clinical trials directive is not relevant in this context. It is part of a suite of EU measures that set out common rules across Europe to ensure the free movement of safe medicines in the EU. Mitochondrial donation is not a medicine, so those provisions do not apply. The follow-up assessment of the treatment’s efficacy is part of good clinical practice.

[Sir William Cash]

Will my hon. Friend give way?

[Jane Ellison]

I am afraid that I cannot, because my role now is to respond to the points that have already been made.

On international support, Britain does not stand alone, as some Members have suggested. The Department of Health has recently received a lot of correspondence from researchers and scientists in Germany, France, the Netherlands, Sweden, Japan, Hong Kong and two states in Australia, all indicating support for UK advances on mitochondrial donation. It is also important to note that nobody is saying that scientists are of one voice or one mind on the issue, but the House should note that the overall weight of international scientific opinion is very much in favour of these techniques, and they have been looked at exhaustively.

Following the point made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I have today spoken to the right reverend Prelate the Bishop of Carlisle, who speaks for the Church of England on ethical matters in the other place, and with the Rev. Dr Brendan McCarthy, the Church’s national adviser on medical ethics, and they have told me that I can confirm that the Church is not opposed in principle to mitochondrial donation.

We have discussed germ-line therapy, with Members disputing definitions of genetic modification. The HFEA agrees that these techniques are germ-line therapy, but it has also agreed with the Government’s working definition that mitochondrial donation is not genetic modification; but I accept that others will have a different view, because there is no international or universally accepted definition.

With regard to the techniques being successfully performed in non-human primates, I can confirm that maternal spindle transfer is a technique developed in the US that has been performed successfully in non-human primates. Lord Brennan’s comments on the regulations were made to the Joint Committee on Statutory Instruments, which did not draw any special attention to his remarks. In answer to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), the regulations will not prevent mitochondrial disease caused by faults in nuclear DNA; the techniques make no alteration to nuclear DNA.

It is really important, in the seconds remaining, to point out to those Members who have said that we are rushing, and that it is open season on all these things, that that is not true. It is defined in primary legislation that the regulations can apply only to serious mitochondrial disease. There is no slippery slope. I looked back at the debates in the House on IVF all those years ago, when some were worried about a slippery slope, and all the safeguards are still in place more than two decades later. I think we can give the House confidence that we have considered this very carefully and that there is enough information. As I have said before, this is a bold step for Parliament to make, but it is a considered and informed one. We have world-leading science set in a well respected regulatory regime. For many families affected, this is indeed the light at the end of a dark tunnel. I commend the regulations to the House.

Question put.

Blood Safety (Variant Creutzfeldt-Jakob Disease)

Jane Ellison Excerpts

Thursday 29th January 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir David. Sadly, I have been left with less time than any of the other hon. Members who have spoken in the debate to respond to the questions put to me, but I will do my best.

[Sir David Amess (in the Chair)]

Order. The debate goes on until 4.30 pm.

[Jane Ellison]

Marvellous. My mistake. In that case, I have plenty of time.

In case there is anything I cannot cover in my remarks, I should point out that we have already committed to write to the Committee with a further update before the end of the Session. There are issues where we will have more to report, and I will focus on a couple of specifics today.

Let me start by thanking the Committee for the opportunity to look at the issue again. May I also apologise for the fact that I am holding my notes so far away from me? I have left my glasses at home.

[Frank Dobson]

Would you like to try mine?

[Jane Ellison]

Let’s see how I get on, although I thank the right hon. Gentleman for that kind offer.

First, let me reiterate—I said this in the evidence sessions, but perhaps we did not stress it enough in responding to the Committee—that there is no hint of complacency over the issue on the part of the Government, the Department of Health, me, the chief medical officer or anyone else, although I understand why that question mark is in the title. I would hate for my optimism about our perhaps being in a better place than we were to be characterised in any sense as complacency or as not wanting to keep this area under careful review.

In that respect, I want, like other contributors to the debate, to mention the number of cases. We have had one UK case of vCJD since 2010. The UK’s annual mortality rate per million for all forms of CJD from 1993 to 2012 was 1.1, which, I am pleased to say, is lower than that in France, Spain, Germany and Italy. On secondary transmissions, there is no evidence of any person-to-person transmissions via blood since 1999, as was said in the debate. There is also no evidence of any person-to-person transmissions via surgery or dentistry. However, I accept that the fact that there is no evidence does not mean there is no challenge.

On Government funding, the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger), referred to the ring-fenced budget. The Department of Health has provided more than £95 million for CJD studies since 2001. It is funding 18 CJD-related research projects with total investment of about £45.5 million. In 2011, it was estimated that about £500 million had been spent on prion-related research.

Professor Collinge has been mentioned. His advocates are here in the form of hon. and right hon. Members who are familiar with the work done by him and his unit. The Department of Health has provided more than £16 million of research funding to the National Prion Clinic, led by Professor Collinge, since 1996. The Medical Research Council continues to provide £6 million annually to fund the MRC prion unit, which is led, again, by Professor Collinge. Members have said that that has been said before, but it is important to stress that it is the context in which the Committee’s report was written.

There was perhaps a slight lack of generosity in the way some contributions to the debate characterised the attitude of the Department and the Government, and I want, therefore, to make two general points about science. I rather disagree with the point made by the right hon. Member for Holborn and St Pancras (Frank Dobson) that if we have spent an awful lot on theoretical research, it follows that we must always seek to apply it. It would be slightly dangerous always to adopt that principle, because that would make the funders of research far more risk-averse. If there was an obligation to put into practice every piece of research one had backed, there would be an inclination to back away from the more risky pieces of research and to back only the winners. That is just a comment on the principle; it does not necessarily relate to this issue.

The second point I hope colleagues would concede is that there is surely a difference between having one set of scientists look at something and then another set of scientists look at it and reach different conclusions and recommendations, and being in any sense complacent. A lot of different people with great scientific knowledge have advised Ministers over the years and have sometimes come to different conclusions or made different recommendations. It is important to stress that in all the ways in which we have responded to the report we have been guided by some very senior scientists. I want to put that on the record.

[Frank Dobson]

Will the Minister confirm that none of the scientific advisers has advised her or any other Minister that the John Collinge treatment proposals would not work or ought not to be tested?

[Jane Ellison]

I will say a few words about some aspects of the Collinge work later, but I want to focus on giving an update on some of the work on the assays.

[Sir Paul Beresford]

In the early days of research, a number of different tests were brought forward. To my knowledge, all have fallen by the wayside bar one. Have any of the 18 research projects come up with tests that look fruitful?

[Jane Ellison]

I will come on to talk about the assay in some detail.

[Andrew Miller]

I find the Minister’s remarks somewhat surprising. As I said in my opening remarks, the Government response alluded to unspecified “technical issues” that they would refer to the relevant advisory committee, but that committee had already recommended that the study should go ahead.

[Jane Ellison]

I will update the Select Committee further. We have already committed to submit an additional piece of work before the end of the Session.

I will say a few words about the work undertaken so far. The chief medical officer and I gave evidence to the Committee last April. The report was published in the summer and the Government response in October. In that response, the Government committed to responding with a further update report to the Committee. I subsequently received a letter from the Committee with more than 20 further questions, to which I responded in November. The Select Committee then held a legacy hearing on 3 December at which Professor David Walker, the deputy chief medical officer, and I gave further evidence.

I am extremely grateful to all members of the Committee who have put the issue on Parliament’s agenda and maintained a close interest in it, something that has been clear to me in the relatively short time I have been in post. I will write to members of the Committee, as we have undertaken to do, before the end of March with further updates on some work. That will include an update on the CQC issues that have been raised, which I will not give an update on today.

Let me focus on the potential use of the vCJD blood test. In the response, we made a commitment on that, so I can focus largely on it today. There is the potential to use a prototype variant CJD blood assay, developed by Professor Collinge and his team. He leads the relevant unit, and as hon. Members might know, the MRC is concluding its latest quinquennial review of that unit.

I am pleased to report that—along with two of my Public Health England officials, Professor Noel Gill and Dr Katy Sinka—Professor Marc Turner and Dr Lorna Williamson, the medical directors of, respectively, the Scottish and the English national blood services, met Professor Collinge and his team in October 2014 to discuss the potential use of the prototype assay. At the meeting on 13 November 2014 of the transmissible spongiform encephalopathy sub-group of the Advisory Committee on Dangerous Pathogens, Professors Turner and Gill presented a paper on the possibility of using the assay to carry out an anonymised blood prevalence survey for asymptomatic vCJD, as recommended by the Select Committee.

Members might recall that the ACDP is the independent scientific advisory committee that provides the Government with authoritative advice on all forms of TSE, including all forms of CJD. During the presentation to the sub-group, the professors asked three specific questions. I will update Members on those questions and the ACDP’s responses.

First, with a view to the ability of the assay to detect sub-clinical vCJD infection in otherwise healthy individuals, the ACDP was asked if it had confidence in three qualities of the assay. The first was sensitivity, which is the ability of the assay to give true positive results; in this case, that is the true number of asymptomatic cases that the test could identify in any population. The second was specificity, which is the ability of the assay to give true negative results; in this case, that is the true number of unaffected individuals that the test would identify in any population. The third was reproducibility, which is the ability of the assay to be reliably and repeatedly reproduced outside the centre in which it was developed.

Basically, that process would be to find out whether the assay could be used to identify people with asymptomatic infection, and those who showed no clinical signs of vCJD but who would be presumed at some stage to be potentially infective and/or go on to develop clinical symptoms. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) said that symptoms could develop over a very long period.

The ACDP’s sub-group discussed the issue and agreed that the answer to the first question had to be no, because it has seen no published data on the assay when used in any human or animal samples from individuals without clinically diagnosed disease. Members might recall the February 2011 paper in The Lancet that first gave detailed information on this assay. That paper provided evidence that the assay can give, in seven out of 10 cases, a positive result in blood samples taken from patients with known and clinically diagnosed vCJD. Unfortunately, however, that is not what we need if we are looking for evidence of vCJD in those with no clinical signs. There is no published evidence that provides assurance that the assay, if used in the general population, would give true positive results in those who might be carrying the infection but are asymptomatic.

If a test for this very rare disease—it has been noted that we have had only 14 new cases in the UK since 2005, and only one was after 2010—is used in presumed healthy individuals, it is essential that it is accurate. We have no evidence that the MRC assay can identify vCJD infection in an asymptomatic individual. Those in Westminster Hall with a keen interest in science will understand that undertaking a test of large numbers of individuals when we do not know what a test result means—either for those individuals or, as in this case, for the development of effective public health measures—is not the best use of limited resources.

The second question that the ACDP was asked—

[Sir Paul Beresford]

Of course, the results would be anonymised, so the effect on individuals would not be apparent.

[Jane Ellison]

Let me move through the second question; I will be very happy to pick up on any further things in my additional response to the Committee.

The second question that the ACDP was asked was whether it would replace its current UK prevalence estimate of 1:2,000, which is based on data generated by a blood study using the MRC Prion Unit assay. In response to that second question, the ACDP also agreed that the answer to the question—whether to replace the current prevalence estimate—was no. It gave that answer because it is uncertain as to what the blood assay would measure in a general population. Even in the event that a prevalence result lower than the current 1:2,000 figure were found, the precautionary principle, which the Select Committee rightly emphasised in its report, would still apply and the 1:2,000 figure would continue to be used.

Thirdly, given its negative answers to the first two questions, the ACDP was asked what further data it would need to develop confidence in the outcome of any study using the assay. In summary, it suggested that in the first instance the assay developers work with the National Institute for Biological Standards and Control, and with others, to show that the assay can be used to identify asymptomatic infection, and with the blood services to develop the throughput of the assay. If that work progresses successfully, the ACDP will, of course, look again at the issue and we will take its advice on any potential use of the assay.

I turn briefly to the RelyOn issue, as it has been raised. RelyOn is the protein removal soak developed by DuPont, which Members have discussed. Members will recall that this technology has been fully considered by the Rapid Review Panel, which assesses new products that may be of value to the NHS in improving infection control, on two occasions.

Although the RRP raised specific points on the application of the product in practice—my hon. Friend the Member for Mole Valley well described the challenges around it being a soak—it considered that it would be a

“useful addition to available decontamination products”

if it could be correctly formulated. Obviously, it is for the developers to make a commercial decision to market the product, although I have noted what has been said about where DuPont is with that. It is not within the remit of the RRP to influence procurement and the uptake of products in the NHS, but we would always be willing to discuss with manufacturers the potential for adoption of all effective technologies.

The Minister for life sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), takes seriously the ensuring of rapid access to innovative therapies. It is a large part of his portfolio, and that is why he launched the major review of the pathways for the development, assessment and adoption of innovative medicines and medical technology. That very much goes to the point made on whether the process can be speeded up to make it more easily usable.

The review will consider how to speed up access for NHS patients to cost-effective new diagnostics, medicines and devices. It will set out short and long-term options for action by the Government and relevant bodies, including the National Institute for Health and Care Excellence, the Medicines and Healthcare products Regulatory Agency and NHS England. That will make a major contribution to the policy debate and may well answer some of the points made on this piece of technology.

[Sir Paul Beresford]

I thank the Minister and apologise for being persistent. DuPont undertook the work because it thought there was a market. When the Department backed away from the market and it became apparent that, if developed, the product was not going to be put through as a requirement, perhaps through the Care Quality Commission, DuPont stopped. There was no market and no interest, so it stopped the project.

[Jane Ellison]

I understand the point. We have debated it before, and it was explored in the meeting with him and Professor Collinge. As I said, the Department was happy to discuss the potential for adoption with manufacturers, but the hurdle was the Rapid Review Panel’s rating. That work is ongoing and has moved on in the past year or so. The new Minister for life sciences acknowledged that there are sometimes challenges around the adoption and the speed with which large organisations can adopt these things, and I am happy to keep Members updated on that work.

There is a well established process whereby the Rapid Review Panel assesses potentially useful products. Those achieving a level 1 rating are suggested as suitable for NHS use. It was acknowledged by the DuPont representative on 5 March that RelyOn had reached only the level 2 rating and more work was needed. It would be unfair on the manufacturers of other level 2-rated products to change unilaterally the RRP processes for one product. As it stands, it is not formulated in a way that could be used in standard NHS decontamination processes.

In my remarks, I have offered a potential route forward and an assurance that the area is being carefully looked at by my colleague the Minister for life sciences. He is looking not only at soaks, but devices, other diagnostics and other medicines. I am happy to draw to his attention the view of the Committee and other Members that this product might be an example of where adoption has been delayed or held up.

We have undertaken to give the Committee a detailed update before the end of March on the other points that have been raised. I thank the Committee again for bringing this subject for debate. I am glad I have had another chance to put before Members some of the recent and ongoing developments and to commit to continuing to use our extensive research strategies. I stress, particularly to the Chair of the Committee, how seriously this Government and successive Governments have taken the subject. It was interesting to hear some of the history from the right hon. Member for Holborn and St Pancras. We will update Members shortly.

Thank you, Sir David, for giving me the opportunity and reminding me that I had time available to respond in a little more detail than I thought I could. I thank you, the Committee and Members who have attended the debate.

NHS (Government Spending)

Jane Ellison Excerpts

Wednesday 28th January 2015 Commons Chamber

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

It is a pleasure to follow the hon. Member for Leicester West (Liz Kendall). In truth, I think we have heard a great deal more consensus about the future of our health services than the Opposition sometimes like to pretend. It has been obvious that Members in all parts of the House care passionately about their local services. They have spoken up clearly on behalf of local staff who are working so hard through this winter. I thank all hon. Members for their contributions.

All Members speaking up for their constituencies are doing so because they care about their local health services. They also accept the challenge that the NHS and the whole health service in England is facing but is collectively rising to meet. Hard-working NHS staff do not need to hear the endless politically driven scaremongering that we hear all too often from Opposition Members. That was highlighted by my hon. Friend the Member for Daventry (Chris Heaton-Harris) and by many colleagues who have come here with scaremongering leaflets from their constituencies saying the very opposite of what is true. Far too much of that is going on. It must be absolutely demoralising for staff who are working hard in the face of winter pressures.

Despite the huge financial pressures we were faced with when we came to office, such as the need to reduce the deficit we inherited, which was, as Members have said, the worst peacetime—

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

I will make some progress; the hon. Gentleman has made a contribution.

Not only has NHS funding in England been protected; it has risen in every year of this Parliament. That is an indisputable fact that flies in the face of the Opposition’s financial scaremongering. As a result of the additional £2 billion funding for 2015-16 the Chancellor announced in the autumn statement, funding in 2015-16 will be £16 billion higher in cash terms than in 2010-11. Those are the facts. That equates to an increase of £6.8 billion in real terms. That additional investment is a down-payment on the NHS’s own plan, which was set out in the “Five Year Forward View”. The chief executive of NHS England, Simon Stevens, has said that the autumn statement gives the NHS what it needs for next year.

Winter is always challenging for the NHS. This year, it comes on top of a significant increase in A and E attendances, which have been higher than in any year since 2010. On average, 3,000 more patients each day are being seen and treated in under four hours than under Labour. As my hon. Friend the Member for Stourbridge (Margot James) set out clearly in going back over the past few years, the additional funding the Government have put in emphasises the priority we place on the NHS. That makes utter nonsense of the claim that we are going back to 1930s levels of funding. That is ludicrous, and Opposition Members parroting that because they have been told to insults the intelligence of every Member of the House. It is nonsense.

[Helen Goodman]

The OBR says that the Government’s plans involve cutting 1 million public service workers. Will the Minister say from the Dispatch Box which 1 million public service jobs are going to be cut?

[Jane Ellison]

I remind all Opposition Members of their predictions about employment at the beginning of this Parliament. If any of them wants to remind us of those, they can be my guest.

We recognise the significant and continuing pressure on services in the short term and the need to invest in new ways of providing care for the future.

This Government have put more performance data in the public domain and have put an unprecedented emphasis on transparency. Indeed, some of the statistics Members quote in these debates are in the public domain only because the Government have put such an emphasis on transparency. Transparency is one of the key drivers of safety in our system.

As public health Minister, I welcome the focus on prevention in the “Five Year Forward View”. I think this is common ground across the parties. Prevention has to be a key part of the NHS’s plans. When we keep people healthy and out of hospital, it is a win for them and a win for the NHS. Mention has been made of the national diabetes prevention programme. We will be the first country in the world to implement such a programme at scale to help prevent the onset of the disease and reduce demand on the NHS. Investing in the NHS with a focus on prevention is one of the keys to a sustainable footing for the NHS in the long term.

Thanks to the work of NHS staff and the funding protection provided by the Government, the NHS is treating more patients than ever. Again, that flies in the face of all the dire threats about its peril. There are 9,000 more doctors and 3,300 more nurses. The additional funding announced by the Chancellor in the autumn statement will enable the NHS to continue to meet the rapidly rising demand in the short term, while making investments in new services and facilities to transform care for patients and ensure that the NHS is sustainable in the long term.

[Barbara Keeley]

The Minister mentioned an increase in the number of nurses, but there is no increase in the number of district nurses, of whom we have lost thousands. Week in, week out, the Health Committee keeps being told how serious that is for all aspects of care in the community.

[Jane Ellison]

I am sure that, like me, the hon. Lady will welcome the 589 new nurses in her trust.

The more sensible Opposition Front Benchers have made it clear in interviews that the link between reform and investment is important. I want to pay tribute to the NHS, which is well on track to make up to £20 billion of efficiency savings to be reinvested in front-line care. For example, the NHS is securing savings of £2 billion a year as a result of the drive to tackle waste and improve procurement. Tough decisions were taken at the beginning of this Parliament to protect the NHS budget—against the advice of the Labour party—that have allowed us to strengthen family doctoring and reform out-of-hospital care. We all agree that integrating health and social care is important, and that is exactly why the Government have the £5 billion better care fund. It is an area on which—despite what Opposition Members say—there is significant consensus. They should support that fund instead of, as I recall, inviting us to put it on pause.

We have heard about how Labour plans to raise more money for the NHS, but in 2015-16 it would raise nothing. The Government are already consulting on a tobacco levy. The tax on family homes, by the Opposition’s own admission, would not start until 2016-17 and has already been spent three times—paying down the deficit, funding the NHS, getting rid of the 10p rate. As a London MP, I have to say that the chance of the homes tax surviving Labour’s London mayoral candidate race is minimal, given the ire raining down on it from Labour MPs in London. On top of that, Labour plans to spend an extra £5 billion, including more than £2 billion on committing equal resources to physical and mental health and more than £1 billion on GP access—it just does not stack up.

We came to government with a long-term economic plan to reduce the deficit and build a stronger economy, with a commitment to protect and safeguard the NHS. We have kept that important promise on the NHS and we kept our promise on the success of our economic plan. We recognise that the NHS still faces significant challenges, both short and long term, as the hon. Member for Leicester West (Liz Kendall) laid out—rising demand, an ageing population and growing expectations—but it is only through sticking to our long-term economic plan that we are able to put the investment in. We are making a down-payment of £2 billion on the NHS’s five-year forward view and we fully support the long-term vision for the NHS, by the NHS—by the most senior and experienced clinicians in our country. The Government have committed to put more resources in now and in the future to give all our constituents a better service, free at the point of use and fit for the future.

Question put.

Standardised Packaging (Tobacco Products)

Jane Ellison Excerpts

Wednesday 21st January 2015 Commons Chamber

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

I am pleased to have the opportunity to respond to this important debate and I congratulate the hon. Member for Glasgow North (Ann McKechin) on securing it.

As other Members have said, tobacco use remains one of our most significant public health challenges and reducing smoking rates is a key public health priority for this Government. The burden of smoking places enormous strain on the NHS and holds us back in the battle against cancer. This is why the Government have committed to and delivered on a comprehensive set of tobacco control measures, which include a ban on smoking in cars with children present, making it illegal for adults to buy tobacco products on behalf of children, outlawing displaying tobacco in shops and working to introduce age of sale requirements for e-cigarettes. Standardised packaging is part of this strategy and I am grateful for tonight’s opportunity to provide the House with an update on this policy.

It is important to acknowledge the enormous progress that has been made so far. Smoking rates in England are at their lowest level since records began. Today, around 18% of adults are smokers, down from around half of adults in the 1970s. Almost 2 million fewer people in England are smokers compared with a decade ago. Assuming that the downward trend of the past years continues, that equates to around 15,000 smoking-related deaths avoided during the course of this Parliament.

We know that most smokers start young, and we want our children to grow up free from the burden of disease that tobacco inflicts. The very good news is that the rates of regular smoking by children in England are also falling, with 8% of 15-year-olds smoking now compared with 15% in 2009, achieving the target set out in our tobacco control plan two years early. However, around 8 million people in England still smoke, so there is no room for complacency. The hon. Member for Glasgow North is right to draw attention to regional differences in smoking rates—including in her own area, where more than one in four people smokes. I think that she will agree with me that there is a concerning link between those rates and deprivation.

I wish to pick up on what the hon. Lady said about prevarication and delay. I have always been clear about the need to follow a robust process and ensure that all issues relevant to the introduction of standardised packaging are properly considered. That includes the implications for illicit trade, as my hon. Friend the Member for Hornchurch and Upminster (Dame Angela Watkinson) mentioned, as well as the legal issues.

[Nick de Bois (Enfield North) (Con)]

Will my hon. Friend give way on that point?

[Jane Ellison]

I am afraid that I am really short of time.

[Nick de Bois]

Just a brief question.

[Jane Ellison]

I am very sorry, but I have been left very short of time.

The challenges that the tobacco industry is likely to bring to the regulations have also been carefully considered. It is vital that all stakeholders are heard and all evidence is carefully considered and evaluated. Ministers must ensure that that is done as thoroughly as possible so that any decision taken is solidly based on the available evidence.

Over the past few weeks and months, the Department of Health has carefully considered all responses to the most recent consultation and taken into account all the information and evidence on the public health implications as well as the wider issues, including the legal ones. I commend my officials, who have worked tirelessly to provide me and my ministerial colleagues with essential and valuable advice with which to make a decision.

As the House has already heard, I asked Sir Cyril Chantler, an eminent paediatrician, to undertake an independent review of whether the introduction of standardised packaging is likely to have an effect on public health, in particular in relation to children. I would like to thank him again for delivering such a thorough report.

Sir Cyril’s report concludes that, if standardised packaging were introduced, it would very likely have a positive impact on public health and that the health benefits would include health benefits for children. Following the publication of his report, we also held a final short consultation in summer 2014, seeking new and additional information, relevant to the policy, that had arisen since the last consultation.

Earlier this month, the chief medical officer and chief scientific adviser, Professor Dame Sally Davies, provided me with her review of the evidence and also of the criticisms of the Chantler review that have been put forward by the tobacco industry. Dame Sally has made it clear that she

“does not believe there is evidence to show that the process or the conclusions of the Chantler review are flawed and there is now accumulating evidence to support the conclusions of the review.”

It is her view that the evidence does support the introduction of standardised packaging.

There have been particular concerns that standardised packaging would increase illicit trade. In his review, Sir Cyril addresses those concerns and concludes:

“I am not convinced by the tobacco industry’s argument that standardised packaging would increase the illicit market, especially in counterfeit cigarettes.”

Her Majesty’s Revenue and Customs has also undertaken a detailed assessment of the potential impact of standardised packaging on the illicit market. It concluded:

“We have seen no evidence to suggest the introduction of standardised packaging will have a significant impact on the overall size of the illicit market or prompt a step-change in the activity of organised crime groups.”

The assessment is expected to be published in full soon.

We are also giving careful consideration to any and all potential legal challenges that may be brought against the Government as a result of introducing standardised packaging. As the hon. Lady knows, litigation by the tobacco industry is always a risk when introducing tobacco control legislation.

The Government are committed to reducing the numbers of young people taking up smoking and to helping smokers who are trying to quit. Our comprehensive approach to tobacco control is working. Fewer people than ever now smoke and cancer survival rates are at record highs. However, we cannot be complacent. We all know the damage that smoking does to health. Tobacco causes over 80,000 deaths a year, and around 600 children in the UK start smoking every day, as the hon. Member for Glasgow North said in her opening remarks.

The Government are completely committed to protecting children from the harm that tobacco causes. That is why I am announcing today that we will be bringing forward legislation for standardised packaging before the end of this Parliament. A consultant respiratory physician told me last year that he is confident that the introduction of standardised packaging will end up saving more lives than he would be able to in his entire career.

I thank all the people who have campaigned for this policy and all those who have contributed to the consultations—the 2012 consultation and the 2014 consultation. I hope that the thousands of other clinicians who have written to me, and to colleagues, over the past weeks and months will welcome this important progress. I want to reassure the House that I will provide further details about the introduction of the policy in due course.

Legislation—even new laws on packaging—will not solve all the problems relating to tobacco. Effective tobacco control depends not just on Government action; local authorities also have a key role, which is why we gave local government responsibility for public health. It is best placed to take forward local plans, based on local circumstances. We see a wide variation between the levels of smoking in our nation—during pregnancy and among young people—and we see that the policy of local action has been vindicated. Local authorities, supported by Public Health England, can advise on effective local action and share experience of what works.

Standardised packaging has the potential for huge public health benefits, but we must not forget that other measures will also contribute to reducing smoking rates. I remind the hon. Member for Glasgow North that Sir Cyril Chantler’s report advises that any policy of standardised packaging must be seen in the round as part of a comprehensive policy of tobacco control measures, and that is how I see the potential for standardised packaging working in this country. Effective tobacco control depends on taking a multifaceted approach, and that is what we are doing.

Only this morning, I was speaking to a number of local government leaders and hearing their reflections, and I know that many local authorities as well as health charities have also addressed the Government on this subject. Legislation to end tobacco displays has already been implemented for large shops such as supermarkets, as I mentioned. All other shops selling tobacco, including corner shops, will need to end their displays of tobacco on 6 April. The display of tobacco products in shops can promote smoking by young people and undermine the resolve of adult smokers trying to quit—and we know how many adult smokers are trying to quit.

While I have the Floor, I can give the House an update on smoking in cars. We laid the regulations to end smoking in private vehicles carrying children on 17 December 2014. The regulations have been considered by the scrutiny Committees, and I expect that we shall have a date for the debate soon. The regulations make it an offence to smoke in a vehicle if a child is present, and for a driver to fail to stop someone smoking in such situations. They provide for the police to be able to enforce against these offences and, if approved by Parliament, the regulations will come into force on 1 October 2015—again, as part of a comprehensive tobacco control strategy. We will also continue social marketing work in this area, with Public Health England running campaigns to raise awareness of the health harms and of the new offences. It is not my desire that people should be fined as a result of ignorance, and I want to ensure that as many people as possible are aware of the new policy.

As I mentioned earlier, we have also introduced legislation to make it illegal for an adult to buy or attempt to buy tobacco for anyone under the age of 18. Through regulations we plan to extend the scope of this offence to cover e-cigarettes. The Department is currently consulting on those draft regulations to introduce age-of-sale requirements for electronic cigarettes, as we already have for tobacco, and that consultation will close on 28 January.

I thank colleagues who have attended the debate, many of whom have expressed strong views about this policy. All of those views have been extremely carefully considered. The hon. Member for Glasgow North referred to the desire to make UK-wide legislation. I can confirm that I will be speaking to my ministerial colleagues in the devolved Administrations and I hope they will follow us to make this a UK-wide measure.

We will bring the regulations before Parliament in this Parliament. Should Parliament support the measure, we will be bringing the prospect of this country’s first smoke-free generation one decisive step closer. I thank the House for its attention tonight and colleagues for all their input into this policy making. I commend the policy to the House.

Question put and agreed to.