Beer Duty

Debate between Jane Ellison and Jim Shannon

Tuesday 7th March 2017 Westminster Hall

[Jane Ellison]

I suspect that is a debate for another time. It is certainly a debate in which I took part in my previous role. If the hon. Lady will forgive me, I will stick to the topic of the debate, lest we get drawn into minimum unit pricing, as it is a complex issue.

My hon. Friend the Member for Faversham and Mid Kent (Helen Whately) spoke about the long history of the brewing industry in her constituency. She is another strong advocate for the brewing industry, and she rightly mentioned beer exports, which were worth £531 million in 2015, up 10% on the previous year. I reassure her that no duty is payable on exported alcohol, so the link between duty cuts and exports is not a direct one, although I take her point about general confidence within the industry.

The issue of high-strength alcohol has been challenged. I think the House is unanimous in wanting to tackle excessive alcohol consumption and the related health harms associated with the strongest products. The question is how we do that, but the point has been well made and the Government are of course reflecting on that.

I hope I have covered most of the points raised. I have not been able to respond to the whole thrust of the debate, although more will be said tomorrow in the Budget. The debate has been a valuable opportunity to discuss the issues, and it has been interesting to see so much common ground.

[Jim Shannon]

In my contribution I talked about alcopops—I know that might be a separate issue—and the advantage that high-street supermarkets have over the pubs. Do the Government intend to address that imbalance, the unfair advantage that high streets have over pubs, and the control of the alcohol that is sold?

[Jane Ellison]

Again, that is perhaps for a wider debate, but, as I recollect from my time as Public Health Minister, the industry was rightly praised for the extent to which it stepped up to address issues with certain products. A lot of alcopop products have been phased out by some producers who decided to change their portfolio. One or two speakers referred to the bigger chains and the fact that they have tried to shift their portfolios as they recognise the challenges that certain products pose, especially for younger drinkers. It is worth putting on the record a recognition of the industry’s actions in that regard, although there is always the challenge to do more.

I hope that I have been able to reassure Members on some issues. In opening the debate, my hon. Friend the Member for St Austell and Newquay said that the industry wanted to make sure it was not overlooked, and I can reassure him that it is not. Its voice is rightly heard loud and clear across the House and within Government. We have regular meetings and dealings with the industry and we listen very carefully to all the points made.

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 22nd March 2016 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

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

[Jane Ellison]

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

Infected Blood

Debate between Jane Ellison and Jim Shannon

Thursday 21st January 2016 Commons Chamber

[Jane Ellison]

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

[Jim Shannon (Strangford) (DUP)]

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

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

[Jane Ellison]

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

Victims of Contaminated Blood: Support

Debate between Jane Ellison and Jim Shannon

Wednesday 16th December 2015 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

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

[Jane Ellison]

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

Alcohol Harm and Older People

Debate between Jane Ellison and Jim Shannon

Thursday 15th October 2015 Commons Chamber

[Jane Ellison]

I will come on to matters relevant to that, but I will also say more about a possible opportunity for a wider debate on this important issue a bit further down the line.

It is important to consider what can be done through secondary care. About 139 district general hospitals already offer some level of specialist alcohol service. I saw for myself such specialist work when I visited Blackpool in 2014. One team told me about how it took the opportunity of people being admitted for something related to alcohol to talk to them about their drinking. They described, with huge understatement, as a “teachable moment” the time when someone is in hospital having suffered, either through a disease or an accident, an unfortunate effect from alcohol. They are right: the idea of talking to people at the moment when they are most receptive is vital.

We would like to have similar alcohol care teams in every hospital to take such opportunities to identify the problem and provide brief advice to patients, as well as medical management. That is again based on the evidence that higher-risk and increasing-risk drinkers who receive brief advice are twice as likely to have moderated their drinking six to 12 months after an intervention—a quick response—compared with drinkers who get no intervention. We want greater use of such really good opportunities. It is not costly or, indeed, lengthy; it is about timeliness.

There are means for people to monitor and manage their own alcohol intake. Technology is increasingly deployed to good effect in a number of areas of personal health monitoring, and alcohol intake is no different. Apps such as the one developed by Drinkaware, which my hon. Friend mentioned, can help people to track how much they are drinking, what it costs them and even the number of calories. We know that personal estimates of weekly drinking are not always as accurate as keeping a log. That is quite well documented, so individuals may find apps and tracking mechanisms particularly helpful.

The Big Lottery Fund, in partnership with the support charity Addaction, is investing £25 million in an alcohol-related harm prevention and awareness programme for the over-50s. Rethink Good Health is a UK-wide programme aimed at those aged 50 and over. My hon. Friend very thoughtfully explored some of the reasons why people may find themselves in such a situation in later life. We would recognise from our constituency case load and perhaps from our social circles how life events can take a toll on health and lead to people drinking more. She mentioned some of them, but I would highlight how such problems can be a driver, and sometimes a product, of loneliness and isolation.

As the House will know, Dame Sally Davies, the chief medical officer, is overseeing a review of the lower-risk alcohol guidelines to ensure that they are founded on the best science. We want the guidelines to help people at all stages of life to make informed choices about their drinking. The guidelines development group, made up of independent experts, has been tasked with developing the guidelines for UK chief medical officers to consider. The group has researched and is developing a proposal on the guidelines, including a UK-wide approach for guidance on alcohol and pregnancy. We expect to consult on that.

I know that that is an issue, and that there are worries about people receiving different advice, so let me say a word about the consistency of health messages. As I have said before at the Dispatch Box, where the evidence base is not completely certain—leading experts to reach slightly different conclusions—there will be a certain level of debate. I appreciate that that can be extremely challenging for the public and that there is a role for trying to provide clarity, but guidance must always be based on the best evidence base.

[Jim Shannon]

The Minister knows that Members of this House, myself in particular, have the utmost respect for her and her position, for what she does and for the guidance she gives. However, the very possibility of uncertainty poses an important question for us. The message must go out from the Minister and from us as elected representatives that during pregnancy, there must be no alcohol at all. That has to be evidence-based, as she said, but there should be the same message so that there is no uncertainty.

[Jane Ellison]

The UK chief medical officers are extremely alive to that challenge and it is something to which they have given considerable thought. Perhaps we will return to it when the guidelines are consulted on. I assure the hon. Gentleman that I have had that conversation and that I have been at pains to emphasise how regularly the issue comes up in Parliament. I know that it is being addressed and that it will be talked about when we consult on the new guidelines.

It is clear that there is more that all of us can do. We have to recognise the contribution that not just individuals, but businesses, communities and local government can make to help people better understand the risks associated with alcohol. I agree with my hon. Friend the Member for Congleton that we need to do more. We are working to ensure that there is a better understanding of the risks.

This is an issue to which we will return. The publication of the new alcohol guidelines will provide a moment in the national debate when we can look at it closely with the public, experts, health professionals and industry. That will be a stimulus to fresh thinking, more public education and debate. Those in Parliament who have a particular interest in the issue will want to participate in that important debate. However, change will not happen overnight. I know that the hon. Members who are here will agree that raising awareness of the issue is key. We have an evidence base to show that, in some cases, raising awareness with individuals is the most important thing we can do to help them.

This debate has been an important opportunity to revisit these important issues. We will return to them in more detail in the coming months. That will be a great opportunity to reflect not just on the good progress that we have seen among younger people, but on the work that we are yet to do.

Question put and agreed to.

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 7th July 2015 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

A recent study suggests that the NHS is starting diabetics on insulin much later than in other countries. What will the Department do to address that issue?

[Jane Ellison]

I thank the hon. Gentleman for his interest in this important subject. As he knows, we are looking at care right across the diabetes pathway, with a view to building on the first ever at-scale national diabetes prevention programme. I will take up the issue he raises and look at it in the context of all the other aspects of diabetes care we are examining.

Health and Social Care

Debate between Jane Ellison and Jim Shannon

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

It is a very important part of cancer care, and something we have debated often in this House. I have seen for myself while on visits just how important the services that wrap around clinical care are.

Let me turn to an issue that we hope to give particular focus to in this Parliament: the need to tackle obesity. It is appropriate that I do so just after an intervention on cancer, because we are understanding more and more about the links between obesity and cancer in later life. They are frightening and shocking. We want to tackle issues such as childhood obesity fiercely in this Parliament. The biggest link between obesity and ill health, however, is that between obesity and type 2 diabetes. If not properly managed, type 2 diabetes can have devastating consequences, including loss of eyesight and limb amputations.

[Jim Shannon]

In my contribution I asked about legal highs. Perhaps the Minister could give some idea of what will happen with those.

[Jane Ellison]

The relevant Bill is being brought forward by another Department, but I noted that the hon. Gentleman welcomed it and am sure that we will return to that.

The start of a new Parliament provides an opportunity to take a serious and thoughtful look at how we tackle a big issue such as obesity. As I said during Health questions earlier today, there are no silver bullets; it will require effort on a global, national and local scale. We are working up our plans for that and will announce them in due course, but they will involve everyone. All parts of Government, local government, industry and individual families will need to move the dial on such a big issue in a way that has not been done in the developed world. There will be interest right across the House in tackling it, particularly the link with diabetes. I note that the right hon. Member for Leicester East (Keith Vaz), who has so often championed the issue in the House, is in his place.

The NHS is coping well with unprecedented pressures. That achievement has been possible only through the hard work of doctors, nurses and health professionals, together with our commitment to invest in the NHS, but a strong NHS needs a strong economy. It is only by having a long-term economic plan that we can increase the NHS budget by £8 billion in real terms over this Parliament. The public got that, even if the Labour party did not. However, there is much more to do. I hope that the era of scaremongering and running down the NHS is over—[Interruption.] Sadly, I am beginning to think it is not. I really hope that we can make a new start. One of the saddest conversations I had during the election—I am sure that this could be echoed by many colleagues on the Government side of the House, particularly new Members—was with an elderly constituent who had been informed very seriously by a Labour canvasser that the NHS was going to be sold to an American company. That was absolutely shocking.

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 2nd June 2015 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

With almost 82,000 people living with diabetes in Northern Ireland over the age of 17, does the Minister agree that this ticking time bomb needs more research into better treatments? One way of doing that would be to ensure that there is sufficient funding for Queen’s University in Belfast, in the hope of providing a superior treatment for the many who are affected and living with that disease.

[Jane Ellison]

The hon. Gentleman is right to draw attention to the important role of research. We will leave no stone unturned in looking at all aspects of the treatment or prevention of diabetes. The issue of research is something I recently discussed with the chief medical officer. I will draw to her attention the point he makes. As he knows, although health is a devolved matter we always make a point of sharing all research right across our United Kingdom.

Breast Cancer

Debate between Jane Ellison and Jim Shannon

Tuesday 25th November 2014 Commons Chamber

[Jane Ellison]

I certainly pay tribute to all those who are trying to drive awareness of this issue. There are a number of very important campaigns. Prevention is so important; for example, it was good that it was right at the heart of the recent NHS “Five Year Forward View”. There is a lot more to do, and I have recently had discussions with some of the breast cancer charities about how we use their reach and undoubted public credibility, which is enormous, to raise awareness more about some of the things that people can do on the prevention front, as well as about their important work on care and drugs. I join my hon. Friend in paying tribute to those campaigners.

The NHS is treating more people with cancer than ever, as I have said. Survival rates for breast cancer are improving, with more than 85% of women with breast cancer in England and Wales now living for more than five years. The work that all the charities have done in that regard is really important. They have all made significant contributions, but we know that more needs to be done, and that is the focus of this debate. We need to catch breast cancers earlier, and to avoid the risk of secondary breast cancers. We also need to improve the detection and treatment of secondary breast cancer, as my right hon. Friend has highlighted.

My right hon. Friend spoke very movingly about pain and its management. I am sure that we all agree that our NHS doctors and nurses do everything that they can to alleviate pain. In fact, it was good to see from the 2014 cancer patient experience survey that only 1% of patients reported that they did not think that hospital staff did everything they could to control their pain. Indeed, 86% of patients—the highest level in the four surveys so far—reported that staff did everything they could to control their pain. She is right to say that referral to specialist palliative care services can provide more by way of effective pain relief. The NHS must do what it can to ensure that women with secondary breast cancer have access to the right services. She is also right to highlight the room for improvement on that.

On the patient experience for women with secondary breast cancer, the results of the 2014 cancer patient experience survey show improvements in many areas, with 89% of all patients reporting that their care was either excellent or very good. As my right hon. Friend said, there are two specific references to secondary breast cancer in the NICE quality standard. The first states that people who develop it should

“have their treatment and care discussed by the multidisciplinary team”,

and the second states that people with recurrent or advanced breast cancer

“have access to a ‘key worker’, who is a clinical nurse specialist whose role is to provide continuity of care and support”—

she mentioned that—

“offer referral to psychological services if required and liaise with other healthcare professionals, including the GP and specialist palliative care services.”

NICE clinical guidelines represent best practice, and we expect commissioners and clinicians to take them into account when making decisions, including on the provision of cancer nurse specialists. On the whole, breast cancer patients reported a more positive experience than many other cancer patients, and 93% were given the name of a clinical nurse specialist. My right hon. Friend is right to highlight the fact that we are not doing as well for patients with secondary cancer or a recurrence of cancer—those patients reported a worse experience and were less likely to have a clinical nurse specialist. NHS England is working with NHS Improving Quality, Macmillan Cancer Support and strategic clinical networks to improve the cancer patient experience and spread good practice across hospitals providing cancer care. That includes support from a clinical nurse specialist for those with secondary breast cancer.

[Jim Shannon]

The Minister is good in debates such as this and we always appreciate her response. One thing that is not always mentioned is the work done by pharmaceutical companies and their investigations to find and perfect new drugs to combat cancer. Current TV programmes often show people saying, “We’re almost there” when speaking about a cure for cancer—well, we are halfway there anyway. Together with pharmaceutical companies, universities such as Queen’s university in Belfast do fantastic work to find new drugs to address cancer and many other things. Sometimes that point is missed in debates such as this, so perhaps this is an occasion to get that on the record.

[Jane Ellison]

I pay tribute to the hon. Gentleman who is always present in health debates and makes an important contribution. If he were to secure a debate on research and clinical trials, I would be delighted to respond. He is right to say that that topic is sometimes a bit unsung, and it is enormously hope-giving for people to hear what is in the pipeline. He is right to highlight that issue, and perhaps we could explore it in a bit more detail on another occasion.

I alluded earlier to work that is taking place to bring everybody up to the best standard. That includes pairing highly rated cancer trusts with those that have potential to improve, regional events for commissioners to consider how patient experience survey results inform commissioning decisions, and the publication of guidance on using survey data to drive improvement. The survey is used in very hands-on ways, and in previous debates I have been impressed at the extent to which data are used right at the front line to say, “This is what really good looks like”, or to highlight where services can be improved by reference to those who are doing things well.

The need to improve is recognised by the NHS. In his forward to the 2014 survey report, Sean Duffy, NHS England’s national clinical director for cancer, recognised the importance of clinical nurse specialists and the need to be particularly sensitive to the needs of patients with a recurrence of cancer. We all recognise the picture that my right hon. Friend painted of people telling others of their diagnosis and what they say and the enormity of the news they are trying to convey not really being understood. Sean Duffy also highlighted the need for sensitivity when the cancer has not responded to treatment as had been hoped.

I understand that NHS England has no plans to discontinue the cancer patient experience survey. I have drawn on it a number of times when responding to debates, and it has been extremely valuable to front-line clinicians for understanding where excellence is being practised. I am keen and have stressed to NHS England on a number of occasions how much Members of the House appreciate the survey and feel that it informs our debates and the knowledge of our constituents.

The survey is overseen by the cancer patient experience advisory group, chaired by Neil Churchill, NHS England’s director of patient experience. Suggestions for amendments or additions to the survey can be addressed to that group. I will obviously draw this debate to the attention of NHS England, and the all-party group on breast cancer will continue to engage with it on ways that the survey could be improved or amended.



My right hon. Friend mentioned the need to improve detection and treatment of people with secondary breast cancer. We need to have good data about those affected. As she said, in the 2011 cancer outcomes strategy we committed to pilot the collection of data about metastatic disease, which had previously not been recorded. In March 2012, a report on the pilot data collection project was published. The pilot programme included data from 15 units and enabled the National Cancer Intelligence Network to identify deficits in the information recorded for those patients. Lessons learned from the pilot have now been applied to a country-wide programme. Since April 2012, all breast units have been required to submit information on all patients diagnosed with a new recurrence or with metastatic disease through the cancer waiting times process.

Analysis of the cancer waiting times data, based on referrals to hospital between 1 April 2012 and March 2013, shows that 7,176 patients were diagnosed or treated for recurrent breast cancer in England. However, we know we need to improve the quality of the data to ensure that we are getting the full picture. There are significant discrepancies between trusts and the analysis will need to be updated with more recent cancer waiting times data to ensure that the figures are robust. The NCIN, Macmillan and the Public Health England knowledge and intelligence teams are working collaboratively on a system to detect patients with recurrent breast cancer by looking at treatment patterns. Results from that collaborative work should be available in 2015. I know it is a source of frustration that they have not been available to date, but that work is at least ongoing. I will pursue that point further with Public Health England after the debate. We have regular meetings. I will of course raise the issue and ensure we keep the House up to date.

On the national peer review programme, I would like to assure my right hon. Friend that NHS England is currently reviewing the national cancer peer review programme with a view to considering how its success might be extended into other new areas of specialised commissioning. Regardless of the outcome of the review, cancer peer review will continue to play a critical part in any broader peer review programme the NHS might introduce. Further details will be published shortly as part of the wider review into specialist commissioning.

The clinical commissioning group outcomes indicator set is not designed for use as an accountability tool. For that, NHS England uses the CCG assurance delivery dashboard—I apologise for the jargon, which, unfortunately, is a feature of these debates—to hold CCGs to account. “Everyone Counts: Planning for Patients 2014/15-2018/19” was used by NHS England to identify the relevant indicators for reporting in the CCG dashboard. In addition, as new data have come on line throughout 2013-14, as well as feedback received on the indicators that are currently being used, NHS England has reviewed whether there is potential to make improvements in 2014-15. The cancer indicators used in the CCG assurance dashboard are based on cancer waiting times. NHS England is continually looking to improve the delivery dashboard. I know the all-party group will continue to engage with that process, as will the charity that supports it and the other charities.

As well as improving patient experience, we want to ensure that women are informed about the risks of metastatic disease so it can be diagnosed early. NHS England breast cancer clinical reference group is determined to ensure that everything possible is done to reduce the risk of secondary breast cancer. It is preparing a service specification for the provision of breast cancer services in England. NHS England knows that the information currently given to patients on the risk of secondary breast cancer is variable and frequently inadequate. That was brought to life for all of us in the Chamber by the deeply moving extracts from the comments of sufferers that were read out by my right hon. Friend. I do not think that any of us could have been unaffected by them. The clinical reference group’s service specification will require that all patients should have an end of primary treatment consultation, which will include advice on signs and symptoms that might indicate secondary breast cancer. That information needs to be delivered together with an holistic needs assessment as part of a recovery package. The evidence that this has been done will have to be recorded in the records of every breast cancer patient.

Touching briefly on research, the National Institute for Health Research is enabling patients to take part in trials of new treatments for metastatic breast cancer through its clinical research network.

As we all know, early diagnosis is key. Alongside the work to increase awareness, the Government have committed £450 million to achieve earlier diagnosis and the associated improved cancer survival rates. On breast cancer specifically, in February and March, we ran a Be Clear on Cancer campaign to increase awareness of breast cancer in women over 70. The proportion of women spontaneously mentioning breast cancer rose significantly, as did confidence in people’s knowledge of signs and symptoms of breast cancer. The campaign was well recognised, with many agreeing that the advertising would prompt them to talk to somebody close to them about the symptoms to watch out for. As well as increasing awareness, the campaign appears to have resulted in a large increase in referrals to secondary care in the target age group. The analysis, although only interim, suggests a significant increase in the number of women over 70 self-referring for breast screening. We are encouraged by that.

In addition, Public Health England is funding the biggest randomised control trial in the world and extending the NHS breast screening programme to women in the 47 to 49 age group and the 71 to 73 age group. As the trial is studying the effects of screening on breast cancer mortality rates over time, the results will not be known until the early 2020s, but it is an important and extensive study.

To conclude, I thank my right hon. Friend once again for bringing this debate to the House, the manner in which she introduced it and her important work on this subject throughout her parliamentary career, and I thank my other hon. Friends who have supported her and who also take a great interest in this subject. She is right to point out that fundamentally there is a message hope: so great is our progress that we can now compare of where we want to be with secondary breast cancer with where we increasingly are with breast cancer. However, she also rightly reminds us that more progress needs to be made.

I shall draw this debate to the attention of the national clinical director, Sean Duffy, and make him aware of the concern expressed in the House on this subject. I reassure my right hon. Friend of the Government’s commitment to reducing the incidence of secondary breast cancer and to improving outcomes for everyone diagnosed with this terrible disease. I offer a message of hope and improvement to all of them.

Question put and agreed to.

Transient Ischaemic Attacks

Debate between Jane Ellison and Jim Shannon

Wednesday 5th November 2014 Westminster Hall

[Jane Ellison]

I note the hon. Lady’s comments.

Turning to the Act FAST campaign, when people have a TIA, getting medical attention quickly is key, as the hon. Lady said. Ensuring that the general public are familiar with the signs and symptoms is important. Public Health England continues to run the highly impactful Act FAST stroke awareness campaign, which covers similar signs to those of a TIA—I note that she is right to draw the distinctions—and the simple message to call 999 if such signs are witnessed. The campaign was run again in March this year, and new adverts feature an Afro-Caribbean man to underline the fact that people from some ethnic groups, whether south Asian, African or Caribbean, are at higher risk of TIA and stroke than others. PHE plans to run the adverts again later in the financial year. Over the summer, the Stroke Association also ran a campaign to raise awareness of TIA, “Not just a funny turn”. It was welcome and many of us saw it.

The hon. Lady also referred to front-line staff and to raising awareness of signs and symptoms. Act FAST and the Stroke Association’s campaign were aimed at public and professionals alike to ensure that everyone acts swiftly. PHE plans to run its adverts, which do not only face the public, again before April 2015.

In addition, NHS England has produced a resource for clinical commissioning groups, to support them in setting and delivering on the level of our ambition to reduce premature mortality. TIAs form an important part of that. The resource includes information on the most high-impact interventions that CCGs can consider commissioning to reduce premature mortality, and TIAs fit into that description. One such intervention is to increase the proportion of patients suffering a TIA treated within 24 hours from 71% to 100%. Let us recognise that TIAs sit right at the core of all the resources being distributed to our front-line staff and produced by NHS England.

NHS England has also been working with the 111 service to ensure that the protocols and triaging systems on the phone lines are used to identify as many people with stroke and TIAs as possible. We recognise that there is more to do and that such work is ongoing.

On getting patients the treatment that they need, quite a lot of work is under way in many parts of the country to reorganise services. That involves reconfiguring care for patients with TIAs as well as acute strokes. For example, in Birmingham and the black country, Warwickshire, Surrey and Sussex standards for TIA care have been set and services are being redesigned to ensure that patients with high-risk TIA can be seen and managed within 24 hours.

The reorganisation of vascular surgery services into a smaller number of higher-volume units is also improving the efficiency of the provision of surgery for TIA. There have been huge improvements in TIA patients’ access to neurovascular clinics in recent years. That is important because, as the hon. Lady said, we know that the risk of stroke in the first four weeks after a TIA can be as high as 20%. It is vital that people are seen urgently and their symptoms investigated, and that a management plan is put in place.

The hon. Lady said that services can be inconsistent. We want to ensure that we work towards making all services as good as the best, but part of that work is to define what the best standards are and to disseminate best practice. I will talk about some of the ways in which that is done.

The 2012 national clinical guidelines for stroke recommend that patients who have had a TIA are seen, investigated and treated in a neurovascular clinic within one week. A few years ago, such clinics were relatively unusual and waiting times could run to weeks or months. Information from the latest Sentinel stroke national audit programme organisational audit published in 2012 shows a picture of real improvement. According to the audit, 100% of trusts in England, Wales and Northern Ireland now have a TIA or neurovascular clinic, with a median of 20 clinics held in each four-week period. There has been a really big improvement in access to those clinics.

The same audit also said that there are very few areas of the country where a high-risk TIA patient would need to wait more than a week, and that over half of high-risk in-patients could be seen the same day, seven days a week. We are waiting for an update of that audit, which is due to be published quite soon. I hope to see further improvement.

In the mini-exchange I had with the hon. Lady at the beginning of my contribution, we touched on best practice. The strategic clinical networks are important for that. They bring together clinicians from across health care settings and the wider health and care system in 12 geographic areas. The SCNs share best practice and promote initiatives on their core service areas, which include cardiovascular disease. The networks hold regular meetings to enable communication and information sharing. As an MP for a London constituency, I saw the benefit of bringing that clinical excellence to bear in the reorganisation of stroke services in London. Such work is ongoing, to make sure that best practice is disseminated around the country.

[Jim Shannon]

One problem I am aware of—I suspect the hon. Member for Warrington North (Helen Jones) is as well—is that TIAs pass in two or three minutes and there is no real understanding of what is happening among friends, relatives or others who are close by when they occur. The hon. Lady is trying to push for raising the level of awareness, and I am sure the Minister would wish to achieve that as well. How can we better achieve that within the Act FAST campaign? That was what I was hoping the Minister would set out.

[Jane Ellison]

I am happy to put that issue on the agenda for my next meeting with Public Health England, which puts together such campaigns. We all wish to raise awareness of the symptoms of a lot of different conditions, but one has to be realistic about how many public information campaigns we can run and how those can be organised. However, I am happy to have that discussion with Public Health England, because we are pleased with the way in which the Act FAST campaign has been received. There is clearly something to build on. I also know that the Stroke Association feels strongly about the issue. I am happy to discuss it and perhaps feed back in due course.

Hon. Members might be interested to know that the National Institute for Health Research has recently funded research on TIAs to look at the pathways taken by patients, from symptom onset to specialist assessment. That research found that factors contributing to delay included incorrect interpretation of symptoms and failure to involve the emergency services. The research is something else we can build on in order to understand what needs to be put in place so that we can do better.

Work is under way, and I am happy to look at what has been said today about public information. However, we have made a really good start. The picture for stroke care is also really improving. Sometimes I respond to debates on issues where we have not seen improvements of the kind that I set out on specialist clinics and surgery. We can see some real momentum, so it is case of building on that and on awareness of symptoms. I pay tribute to the work of the Stroke Association and its report. I saw the “Not just a funny turn” campaign over the summer, which I thought was well judged and was put across well. It did a good job of attracting publicity to stroke and TIA, so I congratulate the association on the campaign.

I hope that what I have said will reassure the hon. Member for Warrington North that the Government and the NHS both recognise that it is vital to ensure that people who have had a TIA receive the right treatment and care to help them to recover. I have not touched on the issue of psychological support, which was the subject of our debate last year, at which time there were encouraging signs. I will write to her about how those have been built upon over the past year and whether we have continued to make progress.

The picture is improving, but we recognise that there is more work to do. I congratulate the hon. Lady on keeping this issue very much at the forefront of Parliament’s attention. As ever, I congratulate the hon. Member for Strangford (Jim Shannon) for contributing to this debate on health in the way in which he always does. We are all keen to see the best possible services for people to ensure that TIA care is of the highest quality and that we minimise the number of people who go on to suffer a stroke.

Question put and agreed to.

Melbourne Declaration on Diabetes

Debate between Jane Ellison and Jim Shannon

Wednesday 18th June 2014 Westminster Hall

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

Thank you, Dr McCrea. I am aware that some colleagues who would normally be with us for a debate on this important topic have been speaking in the main Chamber. No doubt they will catch up with the debate online, at some point. I thank my hon. Friend the Member for Torbay (Mr Sanders), who opened the debate, and all those who have spoken. It has been another thoughtful debate on a topic that is very important, as he said. I congratulate him on his recent election as the first president of the Global Parliamentary Champions for Diabetes Forum. I am not sure whether he modestly did not mention that, but I give him credit for it. It is a tribute to his effective championing of the issue, and the global initiative is important.

As my hon. Friend said, we must not underestimate the global threat posed by diabetes. Other hon. Members have mentioned the numbers involved; the International Diabetes Federation estimates that by 2035 there will be 600 million people with diabetes worldwide, which is about one in 10 of the planet’s population. I think that the hon. Member for Strangford (Jim Shannon) described that as a ticking time bomb, but the debate has drawn out the fact that for the most part we do not have to accept that as inevitable. There are things that we can do, and it is right that we are beginning to talk about the issue as a global community, in global health terms.

In the UK, 3 million people are affected by diabetes. It is estimated that by 2025 the figure will be 4 million if we do not make progress. We estimate that around 850,000 people have undiagnosed type 2 diabetes. Diabetes is a priority for the Government. We have set clear objectives for the NHS and Public Health England to do more on prevention and to improve the care and management of people with diabetes. I accept that there is a challenge about the need for a national action plan. I have had meetings with Diabetes UK and it is one of the things mentioned in its briefing. We have set up clear objectives for the NHS and Public Health England and we ask them to deliver against those, so my contention is that we do indeed have a national plan, but that we may be carrying it out within a slightly different framework from the one advocated. The degree of priority we give it, and the importance that the Government accord to ensuring that the health and care system work together at all levels to give people with diabetes the care and support they need, should not be underestimated.

I hope that while I have been the Public Health Minister I have reassured colleagues about the personal priority that I give to the issue of diabetes. Indeed, my first public outing, slightly terrifyingly, was to speak to a meeting organised by my hon. Friend the Member for Torbay. Almost certainly, everyone in the room knew more than I did about the subject, but I attended to show, very early in my ministerial role, how important the issue was to me.

I have met the national clinical director. I try to have reasonably regular meetings with him, because the issue is such an important one. I have a continuing relationship with the all-party group on diabetes and the other diabetes campaigning groups and Members in the House. With respect to type 1 diabetes, I met my and other Members’ constituents at the JDRF event, which I have attended several times. It is always humbling to meet those fantastic young people who have learned very young to manage and live with a difficult condition.

What is NHS England doing to improve the management and care of people with diabetes? As I mentioned, I have several times met Professor Jonathan Valabhji, the NHS England national clinical director for obesity and diabetes. He has been generous with his time in attending parliamentary events, and is a great supporter of the work of groups and Members in the House. He regularly attends events focused on diabetes and is focused very much on improving outcomes for people with all types of diabetes.

Earlier this year “Action for Diabetes” was published, which describes the actions that NHS England is taking to improve diabetes care. It covers many areas, some of which have been highlighted during the debate, including developing GP contracts and incentives; working with primary care services to trial and roll out case-finding; and decision-support tools to help to detect and diagnose diabetes earlier. A national conversation is also going on about obesity and taking care of one’s own health. Hon. Members have touched on that with regard to the prevention of type 2. Every member of the public is a part of that conversation. We did not talk much about individuals during the debate, but I think we would all agree that we need constantly to emphasise personal responsibility in relation to preventable or avoidable type 2.

I sometimes worry—I talked about this with the head of Diabetes UK shortly after becoming a Minister—that, because few deaths are recorded as being due to diabetes, rather than its complications, there may be a slightly more relaxed attitude among people who think they might develop diabetes, which they would never in a million years have towards a disease such as cancer, which they would immediately identify as a threat. Through debates such as today’s, and the work that we all do, we can emphasise the fact that, although people may not know many people who can be said to have died of diabetes, they will know many whose diabetes contributed to premature death or a long period of ill health. There is more work for us to do, to get that message out. That is how we can empower people to help themselves.

[Jim Shannon]

The Minister could not have said a truer word, because many people see diabetes as a disease that they can manage—one that is not too bad. However, she is right: the complications are far reaching and can lead to consequences that are final. In my speech I talked about education, because people must manage the condition themselves, but they need to know what they have to manage. That is my point: some people need the information reinforced, with the seriousness that the Minister expressed.

[Jane Ellison]

That is right. We need to make sure of that. People cannot be empowered without information. We also know, having a duty to address health inequalities, that some people and groups in the community find things much harder. I was taken by some of what the shadow Minister, the hon. Member for Copeland (Mr Reed), said about deploying technology more. Work is going on, but I agree with him that we could go further faster with that, to find ways to empower people who may not have a good sense of what to do to take care of their health, and who find it harder than others to obtain the available advice. We must work harder to reach them and I shall talk about NHS health checks in relation to that.

As to the commissioning of integrated care, NHS England is working with other organisations to help to promote services that are integrated around patients’ needs across all settings. There has been much emphasis on that. That body is implementing what it calls a customer service platform to allow patients with diabetes to self-manage, through booking their own appointments, managing their prescriptions, monitoring the care they have received and being able to view their personal health records. That picks up on some of the shadow spokesman’s points.

NHS England has also produced a sample service specification for the management of type 1 and type 2 diabetes that is based on National Institute for Health and Care Excellence standards. It provides a model for commissioning integrated care for those with diabetes, and also highlights the specific needs of those with type 1 diabetes, where they differ from the needs of those with type 2. If the current trial of the service specification is successful, it will be offered as a tool that all clinical commissioning groups can choose to use to deliver high-quality care. That is therefore an important piece of work in progress.

There is always a challenge for any of us in making sure that the rest are as good as the best. Occasionally when we talk about the challenges of our current health infrastructure I worry about the assumption that there is a model out there, somewhere, that would absolutely guarantee the delivery of completely consistent care in a given area, across the country. In a country such as ours it is not possible to give such a top-down guarantee. Yes, we must find a way to drive care from the top, with a clear sense of direction from the strategy and mandate that we have given the NHS and Public Health England, but we must also put the tools in the hands of the clinicians, as I have been discussing. Most importantly, we must empower individuals and patients to know what they can expect and to demand good care. Nevertheless, I genuinely do not think that we could devise any system in which we could just issue a notice from the centre to say exactly how care will be delivered consistently across the country. We must find other ways to do it.

--- Later in debate ---

[Jane Ellison]

I agree. The Government, NHS England and Public Health England are all looking at how we drive that consistency. How do we drive consistent excellence? What tools can we use to do that?

Perhaps it would be helpful if I gave an example. Public Health England is developing a tool to drive improvements in diabetes care and iron out variation. It will be launched later this year, and although I am not able to give much detail now, I am sure that my hon. Friend the Member for Torbay will be interested when it is launched. It will provide a clear picture of how diabetes care and outcomes vary across the country and among practices, which will support decisions on how to make improvements.

The Government have made transparency of data a real priority, and being very transparent about what is being delivered and identifying variation is one of the ways in which we can drive the rest to be as good as the best. I suppose I am trying to explain that, although I could send out a memo tomorrow outlining my national diktat on diabetes, that is not how we drive change. It is crunchy, it is detailed and it is about getting to that local variation and ensuring that we drive up standards in every way possible. That is one of the tools we are developing, but there are others as well.

[Jim Shannon]

In my speech, I called for a strategy that was not just regional but UK-wide, and I hope the Minister can respond to that. Other Members have spoken about the need for an English strategy, but there must also be one for Wales, one for Scotland and one for Northern Ireland. All four must work together so that we can address the issue together. The Melbourne initiative is very much worldwide, so although people refer to England, we must go further. What are the Government doing to initiate a UK-wide strategy?

[Jane Ellison]

As the hon. Gentleman knows, health is a devolved matter. That is not to say that I am not at all interested in what is going on in Northern Ireland—far from it—but it is nevertheless a devolved matter. As I have said to him in other debates, there is clearly an awful lot that we can learn from each other. People can learn from everything that I report to the House on innovation and the progress that we make in England, as well as, indeed, things that other Health Ministers report from other parts of the United Kingdom. Nevertheless, I currently have no plan for a UK-wide strategy because health is a devolved matter.

[Jim Shannon]

Will the Minister give way?

[Jane Ellison]

If the hon. Gentleman does not mind, I am going to make some progress.

Of course, the fact that health is a devolved matter does not mean that we cannot find areas of joint working, and the Melbourne declaration shows us the way forward on that. That is probably where we end up—the fact that it is devolved does not mean that we cannot share learning and knowledge, learn from one another’s initiatives, or operate in that global context.

--- Later in debate ---

[Jim Shannon]

I hope that the Minister will accept that I am not being argumentative, but we had a UK-wide strategy until 2013—last year—so we have shown that we can work together. All I am asking really is: why do we not initiate a similar plan to what was there before 2013—a 10-year plan that started in 2003—and have the four regions work together? That is exactly what the Melbourne initiative is about, and we could do it because we have done it before.

[Jane Ellison]

I will reflect on the hon. Gentleman’s comments and perhaps we will discuss the idea again.

[Jim Shannon]

Thank you.

[Jane Ellison]

I want to discuss another area in which we can make a difference by empowering patients. Colleagues might be interested to hear about the patient experience of diabetes services survey, part of the national diabetes audit, in which I know there is always great interest in the House—we regularly answer a number of parliamentary questions about it. The survey measures the health care experiences of people with diabetes in England and Wales. It collects information online from people with diabetes by asking questions about their care using a short, validated questionnaire, and it is being tested.

Any diabetes service in England and Wales should be able to use the survey to get feedback from patients. We want to publish the first results this month or this summer. That is going to be an interesting extra tool in the box, not only to help to drive excellence and drive out variation, but to empower local services to understand at a local level what is going on and how satisfied their patients are with the service being provided. That can lead only to upward pressure to improve services, not least from patients.

Let me talk a little about the NHS health check programme. Alongside the work being done by NHS England to improve the management and care of people with diabetes, the Government are working on prevention and earlier detection, which all Members mentioned. We are continuing to roll out the NHS health check programme, which identifies those aged between 40 and 74 who are at risk of diabetes and other vascular diseases and helps them to reduce that risk. More than 15 million people are currently eligible for an NHS health check. Our economic modelling has shown that the programme has the potential to prevent more than 4,000 people a year from developing diabetes and to detect at least 20,000 cases of diabetes or kidney disease earlier. It is all about helping people to better manage and improve their quality of life.

In the past year, almost 3 million NHS health check offers were made and almost 1.5 million appointments were taken up, during a time of great change across the health system. We are now looking to challenge the system to go further and faster and to continue to increase the number of people who participate in the programme. I have been out and about and seen some great local initiatives. I visited an NHS health check team in Southwark and witnessed the important conversations they were starting with people in their local area.

Another example is Bolton, where health trainers have worked with 134 people identified as being at risk of diabetes through the NHS health check. The health trainers have supported people to make lifestyle changes such as eating more healthily and increasing physical activity levels, and they have helped almost half the group to return their glycaemic level to normal. That is really good evidence of effective intervention.

In Tower Hamlets, where more than 50% of the population are from ethnic minority groups, the prevalence of type 2 diabetes has been growing rapidly. To help to combat that, Tower Hamlets has incorporated the health check programme into its managed practice network scheme. I have talked to staff about that and heard about how they are approaching it. Tower Hamlets has worked hard to ensure that all diabetic patients have a care plan, and that focus has resulted in a 70% increase between 2009 and 2012. There has also been a lot of focus on the take-up of retinal screening for people with diabetes, and, again, there has been a significant rise.

We are seeing that such local interventions can really work. I firmly believe that a localist approach is important in some of these areas, because there is no one-size-fits-all approach that we can devise in Westminster that will work for every community. Such local innovations are important. I constantly challenge myself to think about how we can ensure that we spread the word about some of this great local action. We have started initiatives in that regard, but Parliament has a great role to play, and I encourage Members to tell us of effective local initiatives, so that we can spread the word.

Research on the NHS health check programme carried out by Imperial college London and Queen Mary university of London is under way. That research will improve our understanding of who is taking up the opportunity, their risk of cardiovascular disease and the incidence of diseases such as diabetes in those groups. When that work comes back, it will help us to understand how we can make those interventions count more.

We have already talked a little about obesity and sedentary lifestyles. Physical activity is a big priority of this Government, and I have had a couple of meetings in the past couple of days alone on the cross-Government action we are taking to try to hardwire physical activity into all aspects of life. We have a long way to go yet because, for too long, physical activity was left in a silo marked “health” when it is more important than that. We know that all parts of local and national Government need to address inactivity; that is one of the factors that can help to prevent diabetes.

I also want briefly to address the responsibility deal. The Government have been working with business—the hon. Member for Strangford mentioned this—on its responsibility to consider calorie reduction and clearer labelling of food. We are starting to see calories and other contents displayed on the packaging of many more foods, as we roll out consistent food labelling on a voluntary basis across the country.

The Change4Life social marketing campaign, which is one of Public Health England’s flagship programmes, is encouraging individuals to make simple changes, and it is trying to work with people in the way that the shadow Minister mentioned. The campaign is trying to talk to people in language that makes it straightforward and easy for them to understand the good choices they can make for the health of both themselves and their family.

The national child measurement programme’s findings on childhood obesity are encouraging. We know that far too many people are overweight and obese, but we are seeing signs of encouragement. In 2012, childhood obesity rates fell for the first time since 1998, so we must not despair over the actions we have all taken and advocated over many years. We are beginning to see that such action can have an effect, but we must never underestimate how far we have to go.

In 2013, the global burden of disease study showed that the UK has the lowest rates of early death due to diabetes of the 19 wealthy countries included in the analysis. The last data on diabetes care showed a 60% completion rate for all eight care processes recommended by the National Institute for Health and Care Excellence, which is a five percentage point improvement on 2010. We see progress, but we know there is much more to do. The Melbourne declaration is a timely reminder of the serious threat posed by the disease across the world, as well as here in the UK. I assure the House and my hon. Friend the Member for Torbay, who led this debate and leads the all-party group in such an exemplary way, that diabetes is a priority on which we continue to work hard. We are pleased to see progress, but we do not underestimate how much more there is to do. Such debates are welcome opportunities to keep the issue firmly on Parliament’s radar.

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

We will certainly look at that, but I emphasise that all those things are important as part of the conversation between area teams and CCGs. I remind the House that the CCG outcome indicators set for 2014-15 include a range of important indicators for cancer, including one-year survival for all cancers, one-year survival for breast, lung and colorectal cancers combined, cancers diagnosed via emergency routes, and cancers diagnosed at an early stage—something I know my hon. Friend has, quite rightly, championed consistently in this House.

[Jim Shannon (Strangford) (DUP)]

Does the Minister agree that the inclusion of more innovative drugs in the NHS medicine cabinet is essential for improvements in one-year cancer survival rates? Does she also agree that information shared between the devolved Assemblies, such as the Northern Ireland Assembly, is a vital part of that process of improvement?

[Jane Ellison]

We want people in England to have the best cancer outcomes, and to bring those outcomes up to the best in Europe. We know we are not there yet, but we have done a range of things to try to make that happen, including putting a lot of money into early diagnostics. In my area of public health there are award-winning public campaigns such as Be Clear on Cancer, and I know that the cancer drugs fund has been appreciated by many people. I hear what the hon. Gentleman says about the Northern Ireland example.

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

My hon. Friend is right to highlight this important nutritional need for women who are planning to get pregnant or are pregnant. He and I are meeting soon to discuss fortification as a policy area. I urge all GPs and health services to take every opportunity to highlight to women this important nutritional requirement.

[Jim Shannon (Strangford) (DUP)]

Last week at Queen’s university in Belfast, a significant breakthrough for ovarian and breast cancer means that women who might otherwise opt for an oophorectomy can still have children. Does the Minister agree that money spent on cancer research can increase quality of life and life expectancy? What help will Government give to cancer research at Queen’s university in Belfast?

[Jane Ellison]

The hon. Gentleman is right that research is vital, and a great deal of it is going on in this area. I recently met the all-party group on ovarian cancer to update it on that research, and I will be happy to update him after questions. He has mentioned before how research applies across our United Kingdom. As he knows, whatever we learn through research in England is always shared across the different countries.

Pancreatic Cancer

Debate between Jane Ellison and Jim Shannon

Tuesday 4th March 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and leading it in the knowledgeable and able way that he has led other debates on this important subject. I will do my best to respond to his specific points, but there may be some that I will need to respond to after the debate.

It goes without saying that cancer is a terrible disease, and my hon. Friend spoke movingly of his experience, but all hon. Members know ways in which it has touched them and their families and friends. I pay tribute to the work that he and colleagues in the all-party parliamentary group on pancreatic cancer have done to raise awareness of the disease. Its excellent report, “Time to Change the Story”, does much to counter common misconceptions about the disease.

My hon. Friend drew the House’s attention again to the particularly poor outcome for people who get the disease and the challenges in diagnosis. If we could match the best survival rates in Europe we could save an additional 75 lives a year. Clearly, if we exceeded those survival rates, more people would be saved.

Before I tackle my hon. Friend’s specific point about Abraxane, it is worth giving the context of other work that the Government are doing to support earlier diagnosis. We committed more than £450 million in funding over the four years to 2014-15. Sadly, there is currently no easy way of detecting pancreatic cancer and it can be particularly difficult for GPs to detect and diagnose it, especially in its early stages. However, to try to address the situation, the Department helped to fund a six-month pilot with Macmillan Cancer Support of a cancer decision support tool for GPs to help them to identify patients whom they might not otherwise refer urgently for this suspected cancer. Evaluation of the pilot is under way, and if it is found to be helpful, we will work with NHS England actively to promote its use. That tool was highlighted at a recent parliamentary event that some hon. Members might have attended.

We need to do more about earlier diagnosis and public awareness of the symptoms, which are often limited. As is often the way, I suspect that the recent “Coronation Street” story line has done more than many public health campaigns could have done to raise awareness. Yet again, well done to our broadcasters for covering some difficult issues and providing through Hayley’s sad story some important health education. It has reached many people, and we thank them for that.

On Abraxane, I am obviously aware of Pancreatic Cancer UK’s Two More Months campaign, and I congratulate my hon. Friend on this particularly well-timed debate. I am fully sympathetic to his points. As he says, two more months can mean so much to those who are affected by this cancer, and he gave some moving examples. We do not associate the disease with younger people. Sufferers are predominantly older but, as he illustrated, many people suffer at a younger age. I thank those who contributed to the report details of loved ones they have lost. My hon. Friend bears witness to his own loss, which we feel keenly with him.

I listened to my hon. Friend’s request that the recently licensed drug Abraxane should be made available from the cancer drugs fund. As he says, in the light of new evidence from the manufacturer, NHS England’s cancer drugs fund expert clinical panel is reviewing its earlier decision not to add it to its national list. One criterion in the scoring tool used by the panel is evidence of a drug’s impact on quality of life, which is what my hon. Friend spoke about. While I cannot in any way pre-empt the panel’s decision, I can fully understand how important this will be to people with pancreatic cancer. I will ensure that NHS England is made aware of tonight’s debate and the very good attendance. As the hon. Member for Scunthorpe (Nic Dakin) said, that reflects the impatience of parliamentarians, on behalf of their constituents, to see progress on this issue, which we seem to have been stuck on for so long. I undertake to do that immediately in the morning to ensure that the information is with the panel ahead of its deliberations.

My hon. Friend will be aware that Abraxane has not yet been assessed by the National Institute for Health and Clinical Excellence. Partly because of these situations, we established the cancer drugs fund to ensure that cancer patients in England have better access to life-extending or life-improving drugs that are not routinely funded by the NHS. He may also be aware that Novartis’s drug Afinitor is included on the national list for the cancer drugs fund, alongside two other treatments for treating pancreatic and neuro-endocrine carcinomas. More than 44,000 patients have benefited from the cancer drugs fund since October 2010, and we have recently announced an extension to funding for the scheme.

Looking further ahead, NICE is appraising Abraxane for untreated metastatic pancreatic cancer and expects to publish its guidance to the NHS in January 2015. That may seem a long way away, but, as been mentioned, this reflects the robust, evidence-based technology appraisal programme that NICE provides to ensure that clinical effectiveness and cost-effectiveness is taken into account when we look at drugs and treatments. The Government believe that clinically appropriate drugs should be routinely available to NHS patients, and we remain committed to the rapid uptake of NICE-recommended drugs in the NHS.

My hon. Friend referred to recent decisions on cancer drugs made by NICE. I am sure he appreciates that there will naturally be fluctuations in the proportions of drugs recommended by NICE each year, so a more accurate picture can be gained from looking at all NICE decisions on cancer drugs to date. That shows that almost two thirds of its decisions on cancer drugs have recommended their use for all or some of the eligible patient population. Far from making appraisals tougher, the most significant change to NICE technology appraisal methods in recent years has been to introduce greater flexibility in the appraisal of potentially life-extending treatments for patients at the end of their lives, and that has helped NICE to recommend a number of new cancer drugs for use on the NHS. That speaks directly to the extremely pertinent points that my hon. Friend made about how someone who has had such a diagnosis will see an extra two months in the context of the end of life, given that the progress of the disease can be very rapid from the point of certain diagnosis.

[Jim Shannon]

Will the Minister give way?

[Jane Ellison]

Yes, very briefly.

[Jim Shannon]

In an earlier intervention I asked about a UK-wide strategy. Has the Minister considered that for all the regions?

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 25th February 2014 Commons Chamber

[Jane Ellison]

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

[Jim Shannon (Strangford) (DUP)]

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

[Jane Ellison]

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

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 14th January 2014 Commons Chamber

[Jane Ellison]

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

[Jim Shannon (Strangford) (DUP)]

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

[Jane Ellison]

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

Podiatry Services

Debate between Jane Ellison and Jim Shannon

Wednesday 4th December 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Corby (Andy Sawford) on securing this important debate. He is right to say that podiatry might not be at the more glamorous end of the health service, but of course it is important. I had a very good meeting with Diabetes UK within the first few weeks of taking on my new job as the Public Health Minister. Many of the points that he has raised were stressed, particularly the link with diabetes and with unnecessary and avoidable amputations. Being unglamorous does not mean that it is not important. I think we can agree about that.

The Government know that receiving personal care that is responsive to people’s needs is absolutely essential, and the service that podiatrists provide to local communities is vital in helping people to maintain their mobility, independence and well-being. We know that many other good things flow from maintaining mobility and independence.

Healthy feet allow people to be active and to exercise, which, as we know, has numerous benefits: maintaining better weight, improving muscle and bone strength, and keeping people’s emotional and mental health in a good place. There has been a lot of discussion about the isolation and loneliness of some older people, and the more active they can be, the less likely it is that they will be isolated and lonely.

With the elderly being the fastest-growing age group in Britain, increasing pressure is being put on health care, which will be reflected in the demand for podiatry care. Ensuring people have got healthy feet, preventing falls in older people, and proper and regular foot care can alert us to the early signs of other, more serious health issues, which is obviously important in people with diabetes.

Diabetes, arthritis and blood circulation problems are of particular concern, and they are big priorities for all parts of the NHS. Sometimes people are concerned that individual services or conditions are not always specifically named, but NHS England has very clear direction, through the NHS mandate, about looking after long-term conditions and older people, and podiatry is a key component of that mandate.

[Jim Shannon]

Will the Minister ensure that podiatry home visits continue for people—probably those in rural locations—who are unable to access the surgeries?

[Jane Ellison]

Access is an important factor. The hon. Gentleman is right to highlight the fact that improving and maintaining access is important.

Sometimes education is about making sure that people understand when to seek help and what the warning signs are. Podiatry is an important component of early alert work, as well as an important provision for older people and for people with long-term conditions. In situations in which services need to be changed, the NHS commitment is to make sure decisions are made in a clear and transparent way, so that patients and the public can understand how services are planned and delivered.

Through the mandate, NHS England is responsible for services and for working with local clinical commissioning groups to ensure that their services are based on the needs of the local population within the resources available—the hon. Member for Corby acknowledged the constraints—and there has to be evidenced-based best practice.

An important part of the reforms was to establish CCGs at the level at which commissioning decisions are informed. They are closer to their local communities and can respond to local needs, but they have access to good advice through NHS England, clinical senates and local professional networks. That commissioning process also takes into account the local authority’s views, with regard to the joint strategic needs assessment and, of course, the local health and well-being strategy, so these decisions do not exist in a vacuum: they are taken within a framework, all of which is geared towards local services responding to the needs of local people.

Of course, a big part of that—it is something I am always keen to stress—is the engagement with local democratically elected representatives. I am really pleased that the hon. Gentleman is so engaged with this issue. Whenever I have the chance to talk to people from any part of the health service in the course of my work, I stress the need to keep local councillors and local MPs closely informed and to work with them in making these key decisions, because I know that we are often the early warning signal when people have concerns. Like the hon. Gentleman, I have had people come to my surgery about these issues and that has been an early alert about when people might have concerns. It also allows us to respond to concerns that perhaps arise sometimes when a misunderstanding of a decision is causing undue alarm.

Oral Answers to Questions

Debate between Jane Ellison and Jim Shannon

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

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

[Jim Shannon (Strangford) (DUP)]

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

[Jane Ellison]

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