World Antibiotics Awareness Week

Jeremy Lefroy Excerpts

Thursday 16th November 2017 Westminster Hall

[Jeremy Lefroy (Stafford) (Con)]

It is a great honour to follow my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) and my hon. Friend the Member for York Outer (Julian Sturdy) in this extremely important debate. As my right hon. Friend said, this issue is both important and urgent; it is not something that we can put off.

I declare my interests as a trustee of the Liverpool School of Tropical Medicine, which does research in this area, and as chair of the all-party parliamentary group on malaria and neglected tropical diseases, the significance of which I shall come to in a moment.

Both previous speakers outlined the importance of this subject. The O’Neill report said that we are looking at the possibility of 10 million deaths a year and the loss to global GDP. However, I do not want to dwell on that, because I want to talk about how we can make progress. We have to make progress because at the moment it is too slow. As the chief medical officer, Professor Dame Sally Davies, has said, we do not have time. “The Drugs Don’t Work”, to quote the title of her book.

There are four areas in which we need to make some progress. I do not claim any innovation in this. I listened to a lecture on the issue just last week and these were the four areas set out; I am just repeating what I have heard. The four areas are public education, drug discovery, the involvement of drug companies, and financial mechanisms such as advance market commitments. I shall take them in turn.

First, on public education, it is extremely important that we work together, that we bring the public with us. This country has had a great record over the years in preserving antibiotics for the most essential use, at least in relation to human health. My right hon. Friend described the problems in the animal health sector, but in the area of human health, we have preserved antibiotics. Compared with most countries in the world, we are extremely prudent in our use: doctors do not prescribe them unless they are really needed.

We can do more, however. We can involve the public—citizens—in the search for new antibiotics. I was introduced last week to a great scheme called Swab and Send, which can be looked up on the internet and which is run out of the Liverpool School of Tropical Medicine now. For a small amount—I think it is £30—people get five swab kits. They are encouraged to send in dust samples or whatever; they are encouraged to swab anywhere in their house where they think interesting cultures might be building up and to send the samples in to be tested in laboratories. I saw some of the results. Young people, children and adults all around the country are sending swabs to Liverpool for them to be tested and cultured to see whether potential new antibiotics can come out of that. The reason for doing it is that, just as with the fortuitous discovery of penicillin, we have, potentially, the answer—it could even lie somewhere in a corner of this room. We do not know, but let us get citizens involved in sending those samples in from all over the country and, indeed, the world and get them tested. We have an army of volunteer scientists and researchers out there who are able to help us to discover the next generation of antibiotics.

The second area is drug discovery. We have heard that it has been extremely difficult to make progress in drug discovery, for a number of reasons. I believe that the last major development was 30 years ago, so we have not had a new antibiotic for 30 years. The problem is that antibiotics are cheap. When drugs are cheap but developing them is expensive—it takes years, we have heard 15 years, and the cost can be in the hundreds of millions of pounds —it is simply not commercially possible for drug companies to engage in this kind of research and development. It needs a combination of public finance and private development and initiative.

At this point, I want to reflect on what has happened in relation to malaria, which I know a little about, over the last 16 or 17 years. The Medicines for Malaria Venture is a fine example of how we can have international co-operation. It supports pharmaceutical companies to develop new medicines for malaria that would not be able to be produced commercially. Seventeen years ago, in 2000, as I know myself having contracted the disease a number of times, the efficacy of standard treatments for malaria was poor, or they were pretty toxic. Resistance to chloroquine, which was the main drug, was high everywhere. Sulfadoxine-pyrimethamine, or SP, which had replaced chloroquine as the main drug in a number of places, was also becoming less effective. New drugs, based on the Artemisia annua plant, were emerging, but much more work needed to be done on them. Drugs were available, but they were not particularly well developed, and because they were single therapies, not combination therapies, there was the great risk that resistance to them would occur very quickly.

The Medicines for Malaria Venture was set up with the specific aim of working with companies to bring potential drugs through research and development to the market. I am proud to say that, since 1999, the United Kingdom has been the second largest provider of funding to that excellent organisation after the Bill & Melinda Gates Foundation, which has funded more than half the total expenditure since then, which is something like $1 billion.

What have we seen as a result of the $1 billion of expenditure over 17 years? We have seen a transformation. In 2000, there were 10 products around and being worked on: six at the research stage and four at the translational stage. There was none at the product development stage and none on the market. Where are we now, 17 years later? There are 21 in research, nine at the translational stage, seven at the product development stage and 10 on the market. That is a huge return on investment. Obviously, it was not just the investment of the $1 billion or so with MMV; it was also investment by private companies working alongside MMV that put a lot of their own money into it.

Now, therefore, we have not only a good range of very effective drugs available globally that have saved millions of lives—one estimate is 6 million; it is possibly more than that—but a very healthy pipeline: 30 drugs at the research and translational stages and another seven at the product development stage. That is exactly what we need to see for antibiotics, and not just in the future but now. There we have a model. It may not be exactly the right model for antibiotics, but it is a model. That shows that it can work and not just in relation to malaria drugs; we have seen it work in relation to drugs for so-called neglected tropical diseases. An equivalent organisation is bringing forward drugs in that area. We have seen it with vaccines. The world has come together to produce better vaccines or more vaccines to cover more diseases through the Global Alliance for Vaccines and Immunisation.

We therefore have models for drug discovery, but we need to ensure that they involve the drug companies. This cannot be done just by the public sector. The drug companies have enormous expertise and great researchers; they just need the incentive to work on the development of new antibiotics to a much greater extent. We are not talking about doing one or two; we are talking about looking at dozens and dozens. That is why it needs a co-ordinated and global approach. I think the drug companies are willing. They are out there, they are able to do it and they want to do it; they just need a bit of co-ordination and incentive—a bit of a push—and also the public encouragement that comes from knowing that this is something that we all want to do and that will benefit the entire world.

We need to look at how that finance could be introduced. I have talked about advance market commitments. That is the possibility that has been suggested to me. It has been done before. Just over a decade ago, advance market commitments were developed for vaccines. We have vaccines available around the world now, inoculating children and preventing them from getting debilitating or killer diseases, because of the commitment made by our Government in 2005-06 and other Governments, with again the UK taking the lead. That is an area in which we have expertise and have already shown commitment. Therefore, it is absolutely right, as my hon. Friend the Member for York Outer and my right hon. Friend the Member for Chipping Barnet have said, that the UK should be taking a lead in this. At this time, when perhaps our global position is changing, what could be better than showing global leadership in an area that is of great benefit to all humanity and showing that global Britain is a reality, not just a form of words?

Just a few words on how advance market commitments work. In the case of vaccines—there is no reason why it could not work in the same way for antibiotics—there is an agreement for money to subsidise the purchase of a future drug at a given price, so that people know that they are going to sell that drug at a certain price, which means that they can invest in the research and development. That gives manufacturers the incentive to invest not only in that R and D, but in capacity. We need to build that capacity. Clearly, in the case of vaccines, that was enormous because vaccine plants are extremely expensive; in the case of antibiotics, the expense would be less, but nevertheless significant. Then there is the agreement that, once a fixed amount of sales, in terms of numbers or value, has been reached, the manufacturer is contractually obliged to sell the drugs affordably in the markets or to license the technology. Let us be frank: these drugs are not going to make large sums of money for people. They have to be available at prices that everybody in the world, whether they get them through a health system or purchase them individually, can afford.

[Theresa Villiers]

Listening to my hon. Friend’s speech, it occurs to me that, in other areas of medical research, we see a hugely positive impact from the charitable sector. Should we be trying to read across the lessons from other areas of medical research and to get these fantastically successful charities involved in raising money for AMR research?

[Jeremy Lefroy]

My right hon. Friend is absolutely right. I referred earlier to the involvement of the Bill & Melinda Gates Foundation in the setting up of MMV, but there are so many other medical charities putting millions and sometimes tens of millions of dollars into these areas. That is the beauty of partnerships such as MMV, the Drugs for Neglected Diseases initiative and other partnerships: they take money from the commercial sector, charities, non-governmental organisations and from Government and everybody is working together—they are not in competition with each other over relatively scarce resources. The partnerships are using the benefits, in the case of companies, of their researchers and facilities; in the case of foundations, of their contacts, ability to deploy drugs on the ground and funding; and in the case of Governments, of the substantial funding that they can put in.

I want to conclude by saying that this is not pie in the sky—this is something we can do. We have proven in the case of malaria and other diseases that we can achieve tremendous results. We know there is a will. We know Government have a will. We know there is a will in other countries. It just needs a lot more urgency and more co-ordination. If the UK, through the Department of Health, and as my hon. Friend the Member for York Outer has said, through the co-ordination of the various Departments, were to take this by the scruff of the neck, we would have something by which the UK could again show world leadership not just in words, but in actions. I look forward to hearing from the Minister the plans that we have in that area.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

In a rare and welcome twist for a Westminster Hall debate, I think I will have time to cover pretty much all the points that colleagues have raised.

Let me congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on successfully securing this debate in World Antibiotics Awareness Week. As everyone has said, it gives us a great opportunity to draw attention to an important issue—or the important issue. On the way in, I said to my right hon. Friend the Member for Chipping Barnet (Theresa Villiers), “I didn’t know you were interested in this subject,” and she said, “This is a critical issue.” It has come on to her radar, so she has come to speak—brilliantly, I thought—in today’s debate. Say to many Members across the House, “We have a debate on AMR this afternoon,” and they would ask what that is. I do not think that will be the case for much longer, nor should it be, and I thank everyone for their contributions. Raising awareness of the importance of preserving antibiotics through their appropriate use and preventing infections in both humans and animals is part of the challenge.

Lord O’Neill has been rightly lauded and much mentioned this afternoon for his review of AMR, which was published last year. I agree that it is an excellent and accessible piece of work. The former Chancellor of the Exchequer, George Osborne, and David Cameron deserve great credit for having the foresight to ask him to do it. His review said that, by 2050, an estimated 10 million deaths a year could be caused globally by AMR if no action is taken. In comparison, cancer causes 8.2 million deaths per year—I am also the cancer Minister for England —and diabetes causes 1.5 million, to put that in context.

AMR is part of the Darwinian process of natural selection, as microbes adapt following exposure to antimicrobials. The problem is greatly amplified by the inappropriate use of antimicrobials—in particular, antibiotics. All Members who have spoken today mentioned public education. It was one of the four points made by my hon. Friend the Member for Stafford (Jeremy Lefroy). While he spoke, I googled Swab and Send—I was listening at the same time; I can multitask, contrary to popular belief—which looks absolutely excellent. I look forward to finding out a bit more about Dr Adam Roberts’ project; he has done excellent work.

If any Members or constituents wish to find out more about the science of AMR, I heartily recommend the new “Superbugs” exhibition at the Science Museum in London. It explains both what AMR is and how we are using science to tackle it. The exhibition is an excellent example of the cross-sectoral collaboration that has enabled the UK to take such a leading role in tackling AMR.

While I am on the subject of science museums, may I give a shameless plug to my constituency—this does not happen often for a Minister? Public awareness is critical and that was a key point in the O’Neill report. A few weeks ago, I went to the Winchester Science Centre, which has just launched a new partnership with the University of Southampton. It has a brilliant new exhibit on AMR called, “The most dangerous game in the world”, which gives children—it is mostly children who visit the centre—the chance to understand what AMR is. They play an interactive game to try to understand the threat it poses to us and what we are doing to tackle it. Through the Association for Science and Discovery Centres—there are science centres all around the country; some will be in the constituencies of Members here today—we have the chance to raise the profile of the public education role that is needed for AMR. I suggest that raising awareness among our young people would be a brilliant place to start.

This debate is timely as it follows the publication last week of the all-party group’s antibiotics report, which was mentioned by my hon. Friend the Member for York Outer. The report made recommendations for us and others to consider in our development of future action plans to combat AMR. I thank the group for the report. Its recommendations will be useful as we develop the refreshed UK AMR strategy and the new action plan; the current one comes to the end of its five-year life at the end of 2018. In addition, the UK strategy makes the commitment to assess the effectiveness of the implementation plan at the end of the five-year period. The policy innovation research unit at the London School of Hygiene and Tropical Medicine is undertaking a full evaluation of the current UK five-year strategy, looking at the evidence underpinning the key mechanisms of change across human and animal health sectors. Its work will further inform the development of the refreshed strategy.

It is World Antibiotics Awareness Week and European Antibiotics Awareness Day is on Saturday 18 November. The two events take a “one health” approach, with human and veterinary health professionals working closely to give a unified message on the subject. They provide opportunities to engage with healthcare professionals and the public on AMR and what we can all do to help to address it. As part of World Antibiotics Awareness Week, letters are sent from the chief professional officers for England and other national leaders inviting colleagues who are working in the NHS, local authorities, universities and professional organisations to support activities for the week. Links are provided to a wealth of AMR-related resources.

Our chief medical officer, the much mentioned—rightly so—Professor Dame Sally Davies, works closely with her opposite numbers in Edinburgh, Cardiff and Belfast. She falls within my responsibility and I see her regularly. We always talk about this, and her book, “The Drugs Don’t Work”, which was mentioned by my hon. Friend the Member for Stafford, is a brilliant piece of work. I recommend it to anybody with an interest in the subject.

The national Keep Antibiotics Working campaign was launched across the country last month by Public Health England, for which I have ministerial responsibility, to raise awareness of AMR and, using TV, radio and social media advertising, to reduce demand for antibiotics by the public. I hope that Members have seen, heard and watched that campaign.

In addition, the antibiotic guardian scheme, which was mentioned by the hon. Member for Glasgow North (Patrick Grady), was launched in 2014, providing brilliant tools for healthcare professionals to raise awareness. That has now signed up more than 50,000 individuals, of whom I am one—people pledge personally to commit themselves to use antibiotics more prudently. When I signed up I did not see in the drop-down options a dram of whisky, but why not? The people behind that website are probably listening or watching, so surely it is only a matter of time.

The debate is also timely in that the Government are due to publish shortly the third annual progress report on implementation of the UK five-year AMR strategy. The report will set out the range of activity that went on through 2016—we look at the year before—to implement the strategy and points to the reduction in antimicrobial use in 2015 throughout the UK. Data for England in 2016, published just last month, show a continuing reduction in antimicrobial use in humans. Significantly, the annual sales data for antimicrobial use in animals, published last month, show a 27% drop in the use of antibiotics in food-producing animals since 2014. That meets the Government commitment two years ahead of target.

At this point I want to touch on colistin, which my hon. Friend the Member for York Outer referred to. Sales of colistin decreased by 83%—below the maximum target recommended by the European Medicines Agency—during the lifetime of the plan so far. On whether a review is looking into colistin use, I am not aware of any specific review, but its use is highly restricted and controlled now; it has dropped by 83%, as I said, and we continue to monitor it extremely closely, I am sure he will be pleased to hear.

This is just the beginning; our work is by no means complete. Last month, Responsible Use of Medicines in Agriculture launched a set of sector-specific reduction targets that we aim to and will deliver by 2020. The Government have also set challenging ambitions to halve the number of healthcare-associated gram-negative bloodstream infections and the inappropriate use of antimicrobials in humans by 2020-21. Gram-negative infections are growing in incidence. Gram-negative bacteria are more resistant to antibiotics and are increasingly resistant to most available antibiotics.

E.coli infections, for example, make up the bulk of the healthcare-associated gram-negative bloodstream infections we aim to reduce. A report published by Public Health England last month revealed that four in 10 patients with an E. coli bloodstream infection in England cannot be treated with the antibiotic most commonly used in hospitals; that relates to a point made by the hon. Member for Burnley (Julie Cooper). In 2017-18 we aim for a 10% reduction in all E.coli infections. Just two days ago, on Tuesday, the Secretary of State hosted an event with over 200 frontline staff from primary and secondary care to share good examples of actions to tackle such infections—I am sure that colleagues from Lancashire were there—and to develop improvement plans for 2018.

The consumption of antibiotics is a major driver of the development of antibiotic resistance. We have implemented a range of initiatives to help prescribers to improve their use of antibiotics, including the provision of guidance and tool kits and the use of behavioural change initiatives and financial incentives. AMR local indicators are provided in the Public Health England Fingertips portal, bringing together local information on prescribing and infection rates to allow local teams to benchmark their performance against others in similar areas so they can develop strategies for improvement that are appropriate for their local circumstances.

That gives me a chance to touch on the point made by my right hon. Friend the Member for Chipping Barnet, who mentioned sustainability and transformation partnerships. We absolutely expect AMR to be included, and it was included in the planning guidance for developing STPs. Take-up in local areas has been limited, but I suggest that MPs apply pressure to their local STPs by encouraging the STP leads to consider AMR. For the record, STPs that are in my good books—the apples of my eye—are Cheshire, Wider Devon and the Black Country. If Members wish, they can refer their STP leads to those as places to look for good practice that are involving AMR in their planning.

Most Members who have spoken have touched on new drugs; my hon. Friend the Member for Stafford certainly did so at great length. Although preventing infections and protecting the antibiotics that we have are the first two pillars of any approach to tackling AMR, the third is promoting the development of new drugs and alternative treatments. However, as has been said, no new treatments have been brought to market for many years. We fully support action to address this market failure through market incentives such as market entry rewards, championed by the O’Neill review, and other solutions, and we welcome the commitment made this year by G20 leaders to consider how such solutions could be implemented regionally and internationally. My hon. Friend’s ideas are welcome, and he is dead right in calling for a co-ordinated approach and for us to give them a bit of a push, to use the expression that he used.

[Jeremy Lefroy]

My hon. Friend’s commitment to the subject shines through; it is great to see his leadership. I gently suggest that although global work and co-operation are extremely important and will, in the end, produce the kind of results that we need, we could take a step ourselves as the United Kingdom. The amount of money required to start something like, for instance, the Medicines for Malaria Venture is not great, particularly if it comes from a combination involving Government. The UK has provided 20% of the funding, as I said, alongside the Gates foundation. Sometimes it takes quite a time to get the world to work together. Perhaps we could consider doing something ourselves with as many co-operators as we can, and getting it going right now. As my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) said, we could consider using the official development assistance budget, because this is for the benefit of everybody in the world, and it certainly is for poverty reduction.

[Steve Brine]

My hon. Friend is quite right. I have made a note and passed it back to the team. There are many pulls, of course, on the UK aid budget—that is a topical subject about which he knows far more than I do—but I will definitely take away that point and speak to our colleague, the new Secretary of State.

That point fits neatly into where I was going next. Although it will take time to develop an appropriate global model on the pull incentives, we are making significant progress on the push side. The UK has committed £50 million over the next five years to the global AMR innovation fund, which has been discussed in the House many times. The first tranche of £10 million will fund a bilateral UK-China AMR research collaboration, which we expect to open next spring.

At the same time, we are working with pharmaceutical companies through the joint Government-industry working group. A number of Members have said that this cannot all be left to the public sector, and it absolutely cannot. Through the working group, we are seeking to develop a NICE health technology assessment-based reimbursement model—another snappy title. As my hon. Friend the Member for Stafford said, that means that we would pay for antibiotics based on their value. A team at York University—I know that this will be of great interest to my hon. Friend the Member for York Outer—is working on the evaluation process and will report back to me in the spring. We will then decide on and announce the next steps. I hope that that is useful to Members.

To return to international issues, last week I attended the G7 in Milan—the presidency is held by Italy this year—to discuss international health matters. AMR was one of the three key items that we discussed, which shows the importance of taking a “one health” approach. It was a meeting with many challenging conversations as we attempted to produce a communiqué, which we did in the end, but I can report that the AMR discussion was not one of them. All attendees—the seven Governments, international bodies such as the World Health Organisation and other non-governmental organisations—were in complete alignment that AMR is an urgent global issue and the problems that it raises cannot be solved by individual countries. There was unanimity.

This was the third time that AMR had been prioritised on the G7 agenda, which shows our continued dedication to tackling it and the importance of countries working together. I had an interesting bilateral conversation with the Health Minister from Canada, which will assume the presidency next year in January. I urged her to keep the issue at the forefront of her mind; I hope that that went in. Each country needs to take action to tackle AMR, but we are obviously stronger together.

Our chief medical officer, to refer to Sally again, works tirelessly to raise the profile of AMR in the WHO and international circles. She travels far more than I, and ensures its place not just as a health and agricultural issue but as a political and financial one; a number of Members have mentioned the fiscal cost of AMR. The United Nations declaration secured in September last year made it clear that we will not be able to deliver the sustainable development goals if we do not tackle AMR. As a number of Members have been kind enough to mention, we have been at the forefront of shaping action on AMR through proactive engagement, and Dame Sally has an awfully big role to play in that.

Indeed, at the G7, the OECD recognised and acknowledged that the UK is leading the way in providing experience on how to tackle AMR. Although many challenges will come as a result of our decision to leave the European Union, in this area, as in so many others, we lead the world, and it is very much in the world’s interest to continue working closely with us and benefiting from our experience. The bottom line is: why wouldn’t they?

I will also mention the Japanese, who are passionate about tackling AMR and with whom I had conversations around the G7. I was pleased to learn that they are as dedicated as we are to addressing AMR. This week, our chief medical officer attended an AMR conference that they hosted in Tokyo with other Asian countries. I understand it went well and look forward to getting a formal readout when she returns.

Good global surveillance is essential to provide a co-ordinated global response, as underlined by last week’s G7 discussions. For that reason, we support low and middle-income countries through our £265 million Fleming fund to improve their surveillance capacity and capability. UK official development assistance will improve in-country laboratory capacity for AMR surveillance through a “one health” approach. It has already supported 31 countries worldwide to develop AMR national action plans that follow on closely from what we have done.

Many hon. Members have mentioned that a cross-Government approach is needed in Whitehall. That goes without saying. The officials advising me today are from the Department of Health and from the Department for Environment, Food and Rural Affairs. We work closely with officials and Ministers across Departments. AMR is a global problem that will not be addressed in the lifetime of any single strategy. Although the UK has led the way and made significant progress at home and overseas, this is a long-term, serious and urgent problem. I welcome initiatives such as World Antibiotics Awareness Week that enable us to continue to discuss the issue, give us a media hook to hang it on, keep it high on the agenda for professionals across all sectors and, vitally, keep it in the minds of members of the public.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Dunne]

The hon. Gentleman is looking for answers about social care. The Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has responsibility for social care, has made it clear that a paper will be published in due course. I am afraid that the hon. Gentleman will just have to be a bit more patient.

[Jeremy Lefroy (Stafford) (Con)]

Earlier, my right hon. Friend the Secretary of State made a welcome statement about the contribution of EU citizens to the health and social care sector. Will the Minister kindly advise us on what is being done at a trust level to support overseas workers, both from the EU and elsewhere, to ensure that they feel welcome and are encouraged to stay here as long as possible?

[Mr Dunne]

I am grateful to my hon. Friend for giving me the opportunity to reaffirm the commitment of the NHS, from the centre through to every organisation for which EU citizens are working, that these people are welcome here. My right hon. Friend the Secretary of State for Exiting the European Union yesterday made it very clear that we are looking to have a simple, straightforward and cheap means for those who are here at the point of departure to be able to register to stay here. We want to encourage all those who are working for our NHS, wherever they come from, to continue doing so.

Healthcare: North Staffordshire

Jeremy Lefroy Excerpts

Monday 23rd October 2017 Commons Chamber

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

At the heart of every community is a hospital, and a hospital such as north Staffordshire’s Royal Stoke is one that has many potential problems. As a result of previous occurrences, the trust has grown in size, and at the end of 2017-18, the hospital was predicted to have a deficit of £119 million. We know that the NHS is one of the things we are proudest of in our country, but we also know that it is one of the things in our country where spending squeezes have been greatest.

It was announced earlier this year that £29 million would be saved in-year by the hospital as part of the cost improvement programme. This hospital has one of the highest entry rates at accident and emergency, and it is also one of the places at which people routinely present themselves out of frustration at not being able to get a doctor’s appointment locally. The figure of £29 million in-year savings was increased in March to a target of £50 million, and further savings were projected for 2018-19 and 2019-20 of £35 million each, taking the total savings of the hospital to well in excess of £120 million.

After serious work, the hospital is now suggesting that it will be able to end the year with a deficit of £68.9 million. However, the deficit is dependent on two other funding arrangements that have yet to materialise relating to the County Hospital in the constituency of the hon. Member for Stafford (Jeremy Lefroy), and I am grateful to him for being in the Chamber. NHS England has promised £14.9 million towards the transitional fund to help Royal Stoke with the demands placed on it by the County Hospital and to help the people of Stafford to maintain the hospital that they want and so richly deserve, and a further £9.9 million was promised from the Department of Health, but that money has not materialised. That bill of about £25 million is one the University Hospitals of North Midlands NHS Trust needs and would like to have in order to secure the provision of health services for north Staffordshire.

[Jeremy Lefroy (Stafford) (Con)]

I congratulate the hon. Gentleman on securing this debate. I absolutely agree with him that the work Royal Stoke has done to bring stability to County Hospital, Stafford, has been of great benefit to my constituents and the people of the whole of my part of Staffordshire. It is therefore absolutely vital that the trust and Royal Stoke should not suffer from having undertaken this very important work.

[Gareth Snell]

The hon. Gentleman is absolutely right. The trust in north Staffordshire should not suffer, and nor should his constituents in Stafford, who quite rightly want to have the hospital they have with the services it is providing, including an A&E service that is vital to relieving pressure in Royal Stoke A&E at peak times.

As I have said, the cost improvement programme in-year saving was raised to £50 million in March. Having already found itself with a £25 million hole, because money had not materialised from NHS England and the Department of Health, the trust decided to up the cost improvement programme savings by a further £10 million. That means the hospital is required to find £60 million in this financial year, on top of all the savings that are being made through the capped expenditure programme.

The hospital is aware of things it can do to help to alleviate its problem. For instance, it is investing £2 million in creating 45 additional beds to alleviate waiting times in A&E by taking out excess space in corridors and smaller bathrooms to use for beds. We would all agree that we do not want them to be in such a position, but it is taking that risk and making that investment to try to improve the health service in Stoke-on-Trent and in north Staffordshire.

I pay tribute to Paula Clark, the chief executive of the trust, who has worked tirelessly with the former chair of the trust, John MacDonald, to try to overcome the problems the hospital has faced, not least the reputational issues that came with some of the incorrect information circulated under the—

Surgical Mesh Implants

Jeremy Lefroy Excerpts

Wednesday 18th October 2017 Westminster Hall

[Emma Hardy]

We should be looking into that. I thank my hon. Friend for making that excellent point.

Recently in America, a woman was awarded damages of $57 million in relation to mesh implant surgery, and more than 800 women are currently taking legal action in the UK. Yet so far the Government have sat on the fence on this issue, acknowledging in answers to parliamentary questions from the hon. Member for East Renfrewshire (Paul Masterton) and my hon. Friends the Members for Bristol South (Karin Smyth) and for Ellesmere Port and Neston (Justin Madders) that it is a problem, but completely failing to create a robust system to ensure that all complications are accurately recorded.

The surgeon Robert Bendavid has argued for longer studies on the women who have had mesh fitted, because in short-term studies the data are not capturing the level of risk. Many of the women who have written to Sling the Mesh have reported difficulties three years after having the mesh fitted. The Department does not even have accurate data to show just how many mesh removals have taken place as a result of surgery complications. We must have a proper framework for building an evidence base to determine exactly how widespread this problem is.

The guidelines from the National Institute for Health and Care Excellence do not provide any information on mesh-removal surgery procedures. I accept the argument for clinical freedom for surgeons and that there are difficulties in testing objects that go into our bodies, but that makes the case for thorough and effective follow-up even more important. There is an ethical duty for surgeons to write and record where there have been complications, so will the Minister commit today to ensuring that all mesh procedures are properly recorded? Will she commit to the mandatory reporting of all complications, and will she commit to raising awareness of this condition?

Raising awareness is not just about raising awareness among the general public. Women are telling us that they are going back to their doctors and surgeons after surgery and being met with blank faces when they describe the complications that they are experiencing. It seems that without adequate research and awareness of the risks of mesh surgery, patients are not receiving the support and aftercare that they need. Although we welcome the resource guide that has been developed to provide GPs with more information about the risks of transvaginal mesh implants, more must be done to encourage dialogue on this issue between GPs and their patients.

Building an evidence base is not the only issue. Many people, most notably the Sling the Mesh campaign, have raised concerns about the fact that previous reviews, especially in England, of surgical mesh have focused solely on the procedural failures of mesh surgery and not looked into the safety of the product itself. That is in line with the findings of a report issued by the EU’s Scientific Committee on Emerging and Newly Identified Health Risks, which said that when assessing the risk associated with mesh application, it is important to consider the overall surface area of material used, the product design and the properties of the material used.

I completely agree with my hon. Friend the Member for Pontypridd (Owen Smith), the chair of the all-party parliamentary group on surgical mesh implants—he was of great help to me in preparing this speech—when he says that the fact that many companies have already taken their mesh product off the market should tell us that something is not right with these devices. We have to go to the core of the issue and investigate the fundamental safety of the products. Will the Minister commit to doing all she can to ensure that any future reviews of mesh products look at product safety as well as procedural issues?

[Jeremy Lefroy (Stafford) (Con)]

I congratulate the hon. Lady on securing the debate. Does she agree that the Health and Social Care (Safety and Quality) Act 2015 —legislation passed by this House two years ago—is relevant? It says:

“The Secretary of State must by regulations impose requirements that the Secretary of State considers necessary to secure that services provided in the carrying on of regulated activities cause no avoidable harm to the persons for whom the services are provided.”

Adult Social Care Funding

Jeremy Lefroy Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

Mr Speaker, I have no advance knowledge of the future career prospects of my hon. Friend the Member for Christchurch (Mr Chope), but I am sure it is only a matter of time before he becomes a Dorset knight.

I do not agree with the hon. Member for Colne Valley (Thelma Walker), whom I welcome to her place. I do not think that what the sector needs right now is nationalisation. I would gently say once again that public ownership is not the answer to every challenge in our public services.

[Jeremy Lefroy (Stafford) (Con)]

When visiting a constituent at home last week, I discovered that he has had dozens of carers. Many of them have delivered excellent care, but he was really concerned about the sheer number of different carers that he had had. What does my hon. Friend have to say about proposals or plans to ensure that people receive consistent care from as few carers as possible, which benefits both the patients and the carers?

[Steve Brine]

As ever, my hon. Friend is on the money. Across primary care, the named GP policy is a huge step forward, and that idea is absolutely something we should aim for in this sector. That may come out during the consultation later this year, and I feel certain that my hon. Friend will respond to that consultation.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Dunne]

The hon. Gentleman is right to point out that the more mature workforce, particularly people resuming careers later in life—perhaps, in the case of women, after they have had children—is an important source of experienced professionals, and we need to do more than we have been doing to try to encourage such people to return to the workforce.

[Jeremy Lefroy (Stafford) (Con)]

7. What steps he has to secure the future of accident and emergency departments.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Last year our A&Es saw 1,800 more people every day within the four-hour target than they did in 2010. We also have nearly 1,500 more emergency care doctors and over 600 more emergency care consultants.

[Jeremy Lefroy]

A&E departments and associated acute care services at district hospitals such as Stafford and Burton are a critical part of the regional emergency infrastructure, enabling the large city-based departments to deal with major trauma specialist cases as well as day-to-day emergencies. Will my right hon. Friend ensure that that vital emergency infrastructure is protected, enhanced and funded?

[Mr Hunt]

I absolutely agree with my hon. Friend that an emergency care network that works well for his constituents is essential. As he fully understands, that will mean relying on a network of hospitals. I recognise the concern at his own local hospital, for which he campaigns extremely vigorously, and I assure him that I shall be watching very carefully what happens there.

NHS Shared Business Services

Jeremy Lefroy Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

I did not come to that conclusion. The hon. Lady is right, as a doctor, to say that patients’ trust in the way we hold their records is very important. In this case, the correspondence concerning patients was not forwarded, but it was not lost either. It was held securely, so no patient data were put at risk, but it should have been forwarded to another part of the NHS, and it was not; it was effectively stockpiled. That is what caused the concerns. We have been going through the high-priority cases. So far, the vast majority of cases have had two clinical reviews, and the ones we are still concerned about are having a third clinical review. We are taking this extremely seriously.

[Jeremy Lefroy (Stafford) (Con)]

The Secretary of State mentioned Mid Staffordshire and patient safety, which is absolutely critical, but may I point out that the County hospital in Stafford now has an excellent record? It is currently seeing 27 patients in A&E with a waiting time of not much more than one hour, according to the app that I have on my phone. Will he confirm that the situation has been transformed because of the fantastic work of the staff in that hospital?

O’Neill Review

Jeremy Lefroy Excerpts

Tuesday 7th March 2017 Westminster Hall

[Jeremy Lefroy (Stafford) (Con)]

I declare an interest as a member of the board of the Liverpool School of Tropical Medicine. Indeed, I talked to Dr Adam Roberts who is a senior lecturer in antimicrobial chemotherapy and resistance there; he gave me some pointers to the things that he believes are extremely important in this work. I will touch on four of them.

The first thing, as others have mentioned, is to revitalise drug discovery. We are not talking about one or two drugs but 10, 20 or 30 new drugs. That is the scale of what is needed, particularly in the area of anti-Gram- negatives, because there is the least resistance to those drugs at the moment.

The second point, which has been made, is that the pharmaceutical industry as a whole should be involved. My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) rightly said that many treatments, such as more intense chemotherapies, rely on the availability of good antibiotics so that patients do not suffer when their resistance levels are lower. Why should those companies not contribute to the development of antibiotics, if they are not doing so already? As we said, that is challenging commercially. Perhaps we could even look at a tax on those drugs to pay for antibiotics or some other way of raising revenue from those that do not participate.

Thirdly, a public education campaign, which has been mentioned, would help people recognise that antibiotics are not to be taken at every opportunity and that we should consider who is using them, particularly in meat production. I believe that one or two major companies in the United States have already started using meat reared without antibiotics, which I welcome. The fourth area, which has also been mentioned, is regulation of the sale of antibiotics online. It is a major loophole that must be closed, and the United Kingdom can play a role.

Finally, I draw a parallel with malaria, which the hon. Member for Glasgow North (Patrick Grady) mentioned. As a result of the development of rapid diagnostic tests for malaria, the use of the very effective anti-malarials has declined, because people no longer see anti-malarials as the only treatment that can be provided when their child gets a fever. Consequently, although resistance exists, it has become less of a problem in some places. Also, initiatives such as the Medicines for Malaria Venture have created a much stronger pipeline of anti-malarial drugs through co-operation among the pharmaceutical industry, charities such as the Gates Foundation, the United Kingdom and other Governments and the Global Fund to fight malaria, HIV/AIDS and tuberculosis. Such co-operation is critical.

NHS Shared Business Services

Jeremy Lefroy Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

I would like to reflect on the hon. Gentleman’s question in a bit more detail rather than giving an instant answer, because, to date, no one has brought to my notice particular issues about staff safety, but that is always something we take extremely seriously. We are aware of the extra administrative pressure on staff caused by needing to go through records where there is a higher risk of harm to patients—indeed, we have given GP surgeries extra resources to cover that additional time—but I will look into the issue the hon. Gentleman raises.

[Jeremy Lefroy (Stafford) (Con)]

Since at least 2015, it has been a statutory requirement to use a unique and consistent identifier on health and social care records. Given that that would, as the hon. Member for Central Ayrshire (Dr Whitford) said, help with putting data electronically on health and social care systems, will the Secretary of State update the House on the issue?

[Mr Hunt]

I am very happy to do so. Clearly, when we are all able to access our health records electronically, there are potentially huge benefits for patients. In particular, people with long-term conditions who use the NHS a lot would be able to take more control of what happens and also to spot mistakes, which sometimes happen in medical records—that is one of the big findings from the US, where people have had more widespread access to electronic records for longer. The issue is the security with which people access those records online, and we are looking very closely at the systems used by banks, for example. Those are pretty robust, but we are looking at whether we can have systems that are even more robust, because it is very important that patients have confidence that only they and those they give permission to can access those records.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

With the greatest respect, I do not think it is passing the buck to put £1.3 billion more into the NHS this year than the hon. Gentleman was proposing at the last election. A lot of actions are being taken in Cheshire and Merseyside; a local accident and emergency delivery board was set up, which is doing very important work, and the emergency care improvement programme is working very well at his local trust.

[Jeremy Lefroy (Stafford) (Con)]

There is great pressure on emergency services throughout Staffordshire at the moment. There would be even more without the accident and emergency centres in Stafford and Burton, yet the sustainability and transformation plan proposes to reduce one of them, so there will only be two left in the county. Will the Secretary of State speak to the authors of the STP to make it clear that this is totally unacceptable given the current situation?

[Mr Hunt]

No one fights harder and more eloquently than my hon. Friend for the needs of the people of Stafford. I always look with concern at proposals to change emergency services given the huge pressures that exist, so I shall happily look at the plan as he suggests.