Oral Answers to Questions

Jim Fitzpatrick Excerpts

Tuesday 29th October 2019 Commons Chamber

[Caroline Dinenage]

My hon. Friend hits the nail on the head. We are absolutely committed to the principle of an NHS that is free at the point of use, but the NHS has, under successive Governments, commissioned care from the private sector to ensure that patients receive the treatment that they need as quickly, safely and near to home as possible. All NHS healthcare, irrespective of how it is provided, must be of the highest possible quality and improve outcomes.

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

When the Government published their action plan on hearing loss in 2015, it was widely welcomed across the deaf community, as well as in the House, but there is now just a sense in the deaf community that NHS England’s commitment to the action plan is somehow waning. Will the Minister confirm that the Government are still fully committed to the action plan and will also encourage NHS England to carry on?

British Sign Language Users: Access to NHS Services

Jim Fitzpatrick Excerpts

Wednesday 15th May 2019 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you in the Chair, Ms Ryan. I am delighted to follow my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell). I congratulate her on securing this important debate and commend her both for her role as a champion for deaf and hard-of-hearing citizens and for her excellent opening speech. I also thank the House authorities and technicians, and the interpreters—the signers—for their ongoing efforts to ensure that our proceedings are accessible to deaf and hard-of-hearing people. Having spoken recently to senior members of staff, I know that a number of initiatives are being explored, and I look forward to some really positive news very soon.

I am grateful to Action on Hearing Loss for its briefing, and to SignHealth. Action on Hearing Loss offers some top tips for GPs to improve access, such as providing a range of methods for people who are deaf to contact the surgery, providing deaf awareness training for practice staff, and ensuring that people who have hearing loss leave feedback about the quality of their care. It lists troubling statistics about the experience of deaf people at their local health centres. Some 57% of people who are deaf said they felt unclear about their health advice because a sign language interpreter was unavailable for their appointment. Only one in 10 deaf people surveyed had been asked about their communication needs, and two fifths said that staff at their GP surgery still call their name out when it is their turn to be seen. Those numbers indicate a serious lack of attention to deaf people’s needs. You probably know, Ms Ryan, that NHS England has set out an accessible information standard—a clear approach for improving the accessibility of NHS and adult social care services for people with disabilities and sensory loss. Will the Minister comment on how the standard could be better enforced among GP practices in England?

Other recommendations made by Action on Hearing Loss include: introducing loop systems in all GP surgeries; making BSL interpreters available, and allowing for extended appointments when they are needed; and making sure that staff have a good knowledge of the communication needs of people who are deaf or have hearing loss by annotating their medical records and files appropriately.

Action on Hearing Loss quotes from a recent NHS England study, which found that

“deaf people’s health is poorer than that of the general population, with probable under diagnosis and under treatment of chronic conditions putting them at risk of preventable ill health.”

When it comes to mental health, the picture for deaf people is not encouraging. SignHealth reports that deaf people experience significant difficulty in accessing mental health services. Deaf people are twice as likely to experience mental health problems, but their access to help in British Sign Language is extremely poor or non-existent. Deaf people continue to suffer from mental ill health in disproportionate numbers and, sadly, suicide is becoming more of a concern. SignHealth reports that several high-profile deaf men have died by suicide in the past few weeks. Clearly, deaf access to NHS services is a life-or-death issue that needs to be treated with the utmost urgency.

In conclusion, easily solvable problems continue to inhibit deaf people from accessing health care. As my hon. Friend the Member for Newcastle upon Tyne North pointed out, when deaf people want to see their GP, many have to walk to their surgery to make an appointment because there is often no other way for them to do so. When deaf people see their doctor, 80% want to use sign language but only 30% are given the chance to do so. Of the deaf people surveyed, 70% had not been to their GP recently although they had wanted to go, mainly because no interpreter was offered.

On behalf of Action on Hearing Loss and SignHealth, and as chair of the all-party parliamentary group on deafness, I will ask the Minister some questions. It is the first chance I have had to welcome her to her place; I wish her well in all her endeavours. Will the Department for Health and Social Care commit to monitoring performance against the accessible information standard? Will the Department publish performance results? Will the Department commit to providing funding to help with the standards requirements? Finally, will the Minister make representations to the Minister for Disabled People about looking again at the steps that can be taken to improve the market for BSL interpretation?

I am grateful for the opportunity to speak today and to help to represent the views of the deaf community. I hope the Minister can agree to their requests, and that we will start to see a positive change in the physical and mental health of deaf people in England. I look forward to the responses from the Front-Bench spokespeople, especially from the Minister.

--- Later in debate ---

[Julie Cooper (Burnley) (Lab)]

Thank you, Ms Ryan, for your chairmanship of today’s important debate on an essential issue for our times. I thank my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) for securing this debate and for her passionate speech and obvious commitment to acting on behalf of her own constituents and deaf people everywhere. She has inspired me to audit the provision in my constituency to see what I can do to make things easier for the deaf. I want to say how pleased I am to see Parliament facilitating sign language and subtitles here today. I spoke to the Minister ahead of the debate and we agreed that it would be wonderful if such provision could be made available in every debate in this place.

[Jim Fitzpatrick]

I alluded to the fact that a lot of progress has been made behind the scenes. The authorities are working very hard to see whether provision can be made, as it is in other Parliaments around the world. The Independent Parliamentary Standards Authority gives financial support for tuition for MPs who want to learn BSL, so perhaps we can make colleagues more aware that that facility is available also.

[Julie Cooper]

That information is helpful. I am sure that a number of Members would like to take advantage of that and learn more, and perhaps make a commitment to becoming signers.

As my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) reminded us, two thirds of people with hearing loss have left their GP surgery feeling unclear about the health advice that has been provided. The scale of the problem is that there are 11 million people living with hearing loss. That is one in six of the population. The charity Action on Hearing Loss estimates that by 2035 15.6 million people will have some sort of impairment. It is time we took that seriously and focused our attention on solutions. It beggars belief that 40% of deaf people say that staff at their medical healthcare provider have called out their name to announce that it was their turn to be seen by a healthcare professional. It is hard to believe, but it happens all the time.

We have also heard about difficulty in making telephone applications. The Secretary of State is focusing on technology, and perhaps he might want to look at the request for an app to make emergency appointments for a deaf person. The Minister could advise him about it. Other issues include the fact that in trying to communicate on the telephone there is obviously no one to sign, and no opportunity to lip read. There can sometimes be difficulties with reading documents, because often when someone’s first language is sign language they fall behind with their reading level, which adds to the difficulties.

Those communication barriers mean that many people rely on friends and family members when navigating NHS services. We have heard about the challenges that someone experiencing hearing loss or deafness has in dealing with life in general, but none can be more important than those arising over health matters. When deaf people are forced to rely on family members, their independence is clearly compromised. Their confidence is undermined and their right to confidentiality is taken away. It is estimated that communication difficulties experienced by people with hearing loss cost the NHS an extra £76 million a year in additional, unnecessary GP visits. Those barriers may also deter some patients from seeking medical advice and attention, which could lead to their having more serious conditions and more expensive treatments—so the situation is not cost-effective, either.

Last year there was a BBC broadcast showing some distressing experiences of deaf people who were undergoing complex medical treatments for serious conditions, with no one to explain properly what was happening. The reporter concluded that deaf people were being left behind by the NHS and described a moving scene in which a patient undergoing complex investigations in connection with cancer treatment was absolutely terrified. There was no one there for them to talk to, although they felt extremely unwell and totally frightened. The hon. Member for Strangford (Jim Shannon) touched on that very point, which is a powerful one, about empathising—putting ourselves in the place of a deaf person and thinking what it might be like for them, given that such procedures can be frightening even when we are able to ask “What is that for?”, “How long will this go on?” and “What happens next?”

The issue could easily be addressed by the provision of trained interpreters with a full working knowledge of British Sign Language. BSL is a visual-gestural language that is the first or preferred language of many deaf people and has its own grammar and principles, which differ from English. The provision of British Sign Language interpreters would surely facilitate a kinder, more efficient, more cost-effective service. Members have mentioned that where such a service is provided it is done in a limited fashion. Someone who is in for five hours of medical treatment will be given an interpreter for only two; or the interpreter will not be there when they awaken after an anaesthetic. Clearly that is not good enough. My hon. Friend the Member for Poplar and Limehouse talked about the mental health issues that deaf people face disproportionately. Is it any wonder, given the isolation forced on them?

The whole issue relies on the recognition that for many deaf people sign language is their first language. English is often their second language, so providing a British Sign Language interpreter is as important as providing an interpreter for a speaker of a foreign language. Surely the Government must recognise that access to a BSL interpreter should be not an optional extra but a fundamental right. More than that, not only is the lack of qualified British Sign Language interpreters discriminatory; it is putting the health and, in some cases, the lives of deaf people at risk.

Those who suffer with deafness or hearing impairment have a legal right to support. Since August 2016 all organisations that provide NHS care and/or publicly funded adult social care have been legally required to follow the accessible information standard. The standard sets out a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients with a disability, impairment or sensory loss. In addition, the Equality Act 2010—landmark legislation introduced by the last Labour Government—made provision for equality in all public services and made a specific demand for service providers to make reasonable adjustment to avoid substantial disadvantage. Offering the services of an interpreter is cited as an example. The failure to provide support and British Sign Language interpreters is not just undesirable: it is a breach of the law.

We understand that the Minister who is responding to the debate cannot tackle all the issues on her own, but if she has been as moved as the rest of us by some of the speeches we have heard, we ask her to offer a lead. We want her to liaise with her colleagues in the Department for Education and the Department for Work and Pensions, and to talk to the Minister for Disabled People, Health and Work about taking the issue forward to ensure that the communication needs of all those who are deaf or who have some hearing loss are assessed and that, where necessary, a qualified BSL interpreter is always available.

Will the Minister demonstrate today that she understands the problem, which amounts to discrimination on the basis of disability? Will she listen, as I did, to the examples of good practice from Scotland, Finland, New Zealand and Hungary? If they can get it right, I am sure it is not beyond us to take some action.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Ms Ryan. I will begin with the observation that I was wondering how to include square sausage in my speech. I do not think it will fit in anywhere, but I am very much looking forward to speaking to the hon. Member for Falkirk (John Mc Nally) and finding out more.

I thank the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for securing the time for this important debate. I know that she has wanted to raise the matter for some time. As last week was Deaf Awareness Week, the debate could not be more timely. What a pleasure it is that we have two interpreters here today; we welcome them. I know that Mr Speaker is committed to making Parliament accessible to all. It was great to see that one of the senior Clerks was present just now. Let us hope that she takes what was happening back to the Speaker. I am sure that the shadow Minister, the hon. Member for Burnley (Julie Cooper), and I can speak to the House authorities about the possibility of a pilot in Westminster Hall. We have discussed whether we might ask even a team of interpreters to interpret busy sittings in the main Chamber—I do not think that some interventions deserve interpretation anyway, but this is an important issue, and it is wonderful that we have subtitling and interpreters here today.

Ensuring fair and equitable access to public services, including but not limited to the NHS, is of critical importance to disabled people. I thank the hon. Member for Newcastle upon Tyne North for all the efforts that she has made in her constituency to use BSL to be more accessible to her constituents. I will definitely reflect on that with my team. I also want to thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for his careful stewardship of the all-party parliamentary group on deafness, and for the group’s work. It has done a lot of work to raise awareness and improve the way that we support people with hearing loss or deafness.

I shall attempt to answer several points raised by hon. Members, but I hope they will bear with me if I do not answer them all, in which case I will write to them. I am afraid there was nothing on the Department’s website about Deaf Awareness Week, but if I am still in post next year, I and the Minister for Care, who was due to respond to this debate, will ensure that that is no longer the case. NHS England highlighted Deaf Awareness Week on social media, including advice on how the NHS can help the one in six people who are estimated to have hearing loss. On Twitter, the NHS Business Services Authority published a video highlighting how its technology team have been learning BSL to support deaf colleagues.

The Government consider that current legislation is sufficient—I will speak more about that issue—but the challenges raised by hon. Members today mean that I will look carefully at what more we can do to communicate obligations under existing legislation to individual NHS trusts. The issue of BSL as a language is probably a matter for the Department for Digital, Culture, Media and Sport rather than the Department of Health and Social Care, but all Departments have a responsibility to create inclusive communities. I will take away the comments made by hon. Members and discuss them with ministerial colleagues in other Departments.

The hon. Member for Newcastle upon Tyne North brought up a distressing example of the gentleman in Essex, and mentioned issues of deafness and mental health—of course, we are thinking about mental health this week. The Government are committed to that issue, and addressing mental health is at the heart of the long-term plan. We are investing £2 billion over five years to improve mental health services, and NHS England commissioned specialist mental health services for deaf people, including in-patient and outreach services. The hon. Lady and the shadow Minister asked me to ask NHS England to look at health services for deaf people, and I am happy to raise those points and look at what the Care Quality Commission is doing. The hon. Member for Poplar and Limehouse set me several challenges, and I will attempt to address the performance results later in my remarks. If I do not, I will be happy to talk to him after this debate or hold a meeting, and I would also be happy to speak to the Minister for Disabled People.

I was asked how we can help more people to know about British Sign Language—indeed, the hon. Gentleman mentioned that his grandchildren are learning it at school. The Department for Education has confirmed that it will begin working with experts to develop subject content for a British Sign Language GCSE, and that will be assessed against the rigorous subject content criteria that apply to all GCSEs. Ofqual will also need to consider the proposal against its assessment criteria. Schools have asked for a period of stability to provide them with a chance to embed the extensive reforms to GCSEs and A-levels, and in March last year, the Education Secretary confirmed that the Government will not introduce further reforms to GCSEs or A-levels beyond those committed to during this Parliament. However, if a British Sign Language GCSE can be developed in line with GCSE requirements, the Government will consider making an exception to their rule on stability, and introducing it this Parliament, and I hope hon. Members will be encouraged by that.

As hon. Members have said, British Sign Language is the primary form of communication for many deaf people and fundamental to the way that they communicate with their families and loved ones. I thank everybody—interpreters, teachers and users of BSL—for their work, which helps people with hearing impairments to lead fulfilling lives in our communities. About 24,000 people in the country have BSL as their first language, and it is essential that they can communicate with NHS staff and services to access the best possible healthcare.

This Government are committed to a truly world-class health service that must be equally available to all. People must be able to communicate their needs and access the information, advice and support that they need to complement the hands-on work of health professionals. Some people may need additional support or to be supported in a different way. We must take proactive steps to provide support for reasonable adjustments —hon. Members highlighted examples of where that is perhaps not happening, and I will take note of that.

Let me focus on the robust framework that we have in place to ensure that reasonable adjustments are made to permit access to NHS services for those with hearing impairments and those who use BSL. Existing equality legislation means that employers, service providers and public bodies must provide services in BSL when it is reasonable for them to do so. That was underpinned by the Equality Act 2010, which places a duty on all public bodies to make reasonable adjustments so that disabled people are not put at a disadvantage compared with those who live without a disability. Commissioners of NHS services must pay due regard to the needs of their population, including those living with a disability, when planning and commissioning services.

Service providers must consider what disabled people who use their services might need and make reasonable adjustments accordingly. That includes, where appropriate, access to BSL services. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 further expand on how the NHS should implement the Equality Act and make reasonable adjustments. Such provisions help to ensure that people are treated at all times with the dignity and respect that they deserve. A key part of that is the accessible information standard, which is essential for an effective high-quality health service. It was introduced in 2015 and clarifies what health and care services must do under the Equality Act to make reasonable adjustments so that people with additional communication needs are not put at a disadvantage.

All organisations that provide NHS care or publicly funded adult social care are required to comply with the accessible information standard, which sets out how patients and service users—including carers, where appropriate—should receive information in a way that is accessible to them. The Care Quality Commission, which monitors how the standard is put into place, specifically highlights that that includes users of British Sign Language. One wonderful example of that is the fact that BSL users can use the NHS 111 BSL language service, which provides telephone advice on when to seek further medical help, advises on medication use and provides tips on self-care. BSL users can download an app that enables them to connect to an interpreter via a webcam, and the interpreter then relays the conversation to the 111 adviser. Such technology is a great passion of the Secretary of State, and I will take away the comments that have been raised about that during the debate.

For standards and duties to be effective, compliance must be monitored and action taken where needed. When it inspects a service, the CQC uses five steps to identify whether it is complying with the accessible information standard to ensure that people with disabilities can access health and care services. Those five steps focus on how services identify and assess needs and how they are planned, how services clearly record identified needs, what steps are in place as part of the assessment and care planning service, and how services flag information and communication needs and their records, given that the method used must make it possible for all staff to be quickly made aware of and work to meet those needs. Finally, the CQC assesses whether services meet an individual’s needs, ensuring that people receive information in a way that they understand. That might mean arranging communication support if people need it, and it could include access to a BSL interpreter or lip reader, or using a hearing aid.

Organisations are required to publish an accessible communications policy and establish a complaints process. It is important that organisations support users to provide feedback and help to improve those services. In 2017, NHS England led a post-implementation review of the accessible information standard, which provided an invaluable opportunity to assess its impact and ensure that it remains fit for purpose. Following the review, a revised specification was issued. Although there were no substantive amendments, there were changes to the definition of some terms, and clarification of requirements regarding the Mental Capacity Act 2005 and data sharing. The review showed that there was widespread support for the aims of the standard and that patients and carers were clear that receiving accessible information is essential if they are to receive high-quality, safe care.

More generally, there is an action plan on hearing loss, which sets out key objectives including prevention, early diagnosis, maximising independence—a point the hon. Member for Newcastle upon Tyne North made—and enabling people to take part in everyday activities, such as gaining access to work. There is already a commissioning framework published as part of the action plan, and a joint strategic needs assessment for local authorities and NHS commissioners is expected this summer.

The National Institute for Health and Care Excellence published “Hearing loss in adults: assessment and management” in June 2018, which will form the basis of developing a quality standard for adult onset hearing loss that clinical commissioning groups can use to support commissioning. The action plan on hearing loss consortium is led by NHS England, which works with stakeholders across a system to tackle this important issue and galvanise action, given the rising prevalence of hearing loss.

[Jim Fitzpatrick]

I commend the framework document and the action plan published last year; the Department of Health got a lot of plaudits for putting in place a plan to ensure that that which everyone has been raising is delivered on the ground. I would be very grateful for reports on how well the Department is doing, on cross-government support, and on progress in the NHS, because what is on paper is very good and got huge support from the deaf and hard-of-hearing community last year.

[Seema Kennedy]

I thank the hon. Gentleman for his comments. Once plans are put in place, it is important that we monitor them, assess them and review them. I am happy to ensure that the Department keeps lines of communication open with the hon. Gentleman and his group on this matter.

I hope that I have provided some reassurance that there is a robust legislative framework, standards that enact it and a monitoring regime in place. This debate has highlighted where we can sponsor greater responsiveness—I appreciate the important point that the hon. Gentleman in particular made about the market for interpreters. I take these concerns very seriously and I am committed to communicating with colleagues across Government. I will finish by thanking the hon. Member for Newcastle upon Tyne North for highlighting such an important issue.

Draft Food and Feed (Chernobyl and Fukushima Restrictions) (EU Exit) Regulations 2019 Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Jim Fitzpatrick Excerpts

Thursday 14th March 2019 General Committees

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I am looking forward to the Minister’s responses to the questions raised by my hon. Friend the Member for Washington and Sunderland West. I want to make a specific reference to Chernobyl and radiation, which will take me less than a couple of minutes.

For the first responders at Chernobyl, 1986 was a year of gruelling radiation poisoning that for ever changed their lives, along with the very fabric of their DNA. With little protection from radiation other than makeshift lead suits, 28 firemen and employees died in the weeks following the event. Radiation was so strong that the skin peeled off their bodies. The Chernobyl firefighters’ eyes turned from brown to blue.

Many others who survived the acute radiation poisoning returned from the clean-up site with a wealth of ongoing health problems from which they never recovered, including Leonid Petrovich Telyatnikov, who was the officer in charge of the Chernobyl firefighters. I had the privilege of meeting him when he came to London shortly afterwards to brief fire brigade managers and senior safety representatives in the UK on nuclear hazards, radiation and fighting in such instances. He survived for some years before succumbing to cancer, which was attributed to his experience at Chernobyl. I want to place on record the heroism of the first responders who dealt with Chernobyl. The House rightly recognises their heroism at regular intervals. As the SI deals with Chernobyl, it would be inappropriate for me not to put that on the record.

Draft Food and Feed (Chernobyl and Fukushima Restrictions) (Amendment) (EU Exit) Regulations 2019 Draft Food and Feed (Maximum Permitted Levels of Radioactive Contamination) (Amendment) (EU Exit) Regulations 2019

Jim Fitzpatrick Excerpts

Thursday 14th March 2019 General Committees

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I am looking forward to the Minister’s responses to the questions raised by my hon. Friend the Member for Washington and Sunderland West. I want to make a specific reference to Chernobyl and radiation, which will take me less than a couple of minutes.

For the first responders at Chernobyl, 1986 was a year of gruelling radiation poisoning that for ever changed their lives, along with the very fabric of their DNA. With little protection from radiation other than makeshift lead suits, 28 firemen and employees died in the weeks following the event. Radiation was so strong that the skin peeled off their bodies. The Chernobyl firefighters’ eyes turned from brown to blue.

Many others who survived the acute radiation poisoning returned from the clean-up site with a wealth of ongoing health problems from which they never recovered, including Leonid Petrovich Telyatnikov, who was the officer in charge of the Chernobyl firefighters. I had the privilege of meeting him when he came to London shortly afterwards to brief fire brigade managers and senior safety representatives in the UK on nuclear hazards, radiation and fighting in such instances. He survived for some years before succumbing to cancer, which was attributed to his experience at Chernobyl. I want to place on record the heroism of the first responders who dealt with Chernobyl. The House rightly recognises their heroism at regular intervals. As the SI deals with Chernobyl, it would be inappropriate for me not to put that on the record.

DRAFT GENERAL FOOD HYGIENE (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT CONTAMINANTS IN FOOD (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT SPECIFIC FOOD HYGIENE (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019 DRAFT GENERAL FOOD LAW (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019

Jim Fitzpatrick Excerpts

Tuesday 5th March 2019 General Committees

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I am grateful for the opportunity to intervene on the Minister, and it is a pleasure to see under you in the Chair this morning, Ms McDonagh. Can the Minister reinforce and clarify what he is saying? Is he saying that if there is a deal next week, the regulations will not be necessary, and that if there is no deal next week, and in the event of no deal, the regulations will be necessary for the protection of public safety?

[Steve Brine]

Yes. The regulations transpose into domestic law the good public health requirements that we are part of as a member state. If we agree a deal or a withdrawal agreement next week that is subsequently legislated for, everything that we currently enjoy as a member state will roll over during the transition period. If we then negotiate a future trade deal that incorporates all those undertakings, the regulations will not be necessary, but it is about putting the necessary regulations in place to ensure a seamless bridge between membership and being a third country to protect public health, which is what I am interested in.

The instruments will ensure that UK domestic legislation that directly implements applicable EU regulations continues to function effectively after exit day. The proposed amendments are critical to ensuring minimal disruption to general food and feed law, food hygiene and controls on contaminants if we do not reach a deal. The regulations on general food and feed law, food hygiene and controls on contaminants are key to ensuring the safety of food and thereby public health. Consumers in the UK will benefit from a high standard of food and feed safety and quality. The Government are committed to ensuring that the high standards are maintained.

The main changes are that the instruments will transfer responsibilities incumbent on the European Commission to Ministers in England, Wales, Scotland, and the devolved authority in Northern Ireland. They also transfer to the relevant food safety authority the responsibilities currently incumbent on the European Food Safety Authority, the body that provides scientific advice on food safety to the European Commission, the European Parliament and EU member states. That authority will be the Food Standards Agency in England, Wales and Northern Ireland, and Food Standards Scotland north of the border.

Let me take the regulations in turn, because they start very general and get more specific. The General Food Law (Amendment etc.) (EU Exit) Regulations 2019 ensure that Regulation (EC) 178/2002, which lays down fundamental principles underpinning food law, basic food and feed business requirements, as well as describing certain functions carried out by EU institutions, will function effectively on exit day. The regulation states that food placed on the market must be safe to eat, and it provides for other fundamental food and feed safety and hygiene requirements, including presentation, traceability—we must be able to look one step back and one step forward in the supply chain—the enforcement of regulations, and open and transparent public consultation during the preparation, evaluation and revision of food law. I used the word “presentation”, which is to ensure that we do not mislead consumers. Members may remember that a few years ago there were a lot of concerned constituents because of press coverage about horse meat being sold as certain other meats, and these regulations will ensure that food is what it says on the tin.

The General Food Hygiene (Amendment) (EU Exit) Regulations 2019 ensure that Regulation (EC) 852/2004, which contains basic food hygiene requirements for all food businesses, will function effectively on exit day. It sets out the general requirements for the hygienic production of foodstuffs by all food business operators, through the provision of effective and proportionate controls throughout the food chain to the final consumer. Its farm-to-fork scope covers basic hygiene requirements for food businesses, as well as hygiene requirements relevant for the primary production sector.

--- Later in debate ---

[Jim Fitzpatrick]

It is a pleasure to follow the hon. Member for Motherwell and Wishaw. Unlike my right hon. Friend the Member for Don Valley—or, for that matter, the Minister—I was not a public health Minister. However, I was the Minister of State at the Department for Environment, Food and Rural Affairs responsible for food. Food security in all its aspects—continuity of supply, quality, safety and sustainability—was absolutely critical to the Department. That was very much the case for producers, suppliers and retailers big and small, as the hon. Member for Motherwell and Wishaw mentioned.

I am grateful to my hon. Friend the Member for Washington and Sunderland West, the shadow Minister, for raising her questions with the Minister. As I mentioned in my brief intervention earlier, I oppose no deal and I do not think that there is a majority for it in the House. Therefore, I do not think that the regulations will have to apply. However, the Government must make contingency plans, and perhaps the Minister can reassure us that, in line with what my hon. Friend said, the regulations are a straight transposition of the existing arrangements and regulations that apply to the British food industry.

I would be reassured by that, and I am grateful to my hon. Friend the shadow Minister for indicating that we will not oppose the regulations. I would find it difficult to oppose them, on the public safety and health basis that she outlined. I look forward to getting that reassurance from the Minister, as well as some reinforcement of the points he made in his opening remarks.

Cancer Workforce and Early Diagnosis

Jim Fitzpatrick Excerpts

Tuesday 8th January 2019 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I beg to move,

That this House has considered early diagnosis and the cancer workforce in the NHS long-term plan.

It is a pleasure to see you presiding over our business this morning, Mr Howarth. I wish everyone a happy new year. I thank the Backbench Business Committee for supporting the bid of a number of colleagues for this debate, and the Chairman of Ways and Means for allowing it. I was lucky enough to be chosen as the chief sponsor, but I recognise the support of other Members in this Chamber. I will try to keep my remarks to 10 minutes or thereabouts.

I am grateful for the many briefings we have had—we have had briefings from the House of Commons Library, Barts Health NHS Trust, Cancer Research UK, Breast Cancer Care, the Fire Brigades Union, Macmillan Cancer Support, Breast Cancer Now, the Royal College of Pathologists, Maggie’s, the British Lung Foundation, the Royal College of Physicians, CLIC Sargent and the Royal College of Nurses. I have had more briefings from interested parties on this debate than on any other in my 21 years here. Interestingly, they virtually all agreed on two basic points. First, they welcomed the fact that the Government have addressed their issues in the 10-year review and, secondly, they welcomed the new investment but asked for more detail about staff training, recruitment and retention.

Running through most of the briefings I received were questions about the publication of the NHS long-term plan, which was promised by the end of 2018. In very timely fashion, the Government published it yesterday. It has focused the debate but not eliminated the need for it.

I want to highlight some of the issues raised in the briefings. The Royal College of Pathologists cited disturbing statistics. Notably, just 3% of services reported that they have enough staff to meet clinical needs, and more than three quarters of departments reported vacancies for consultants. The royal college emphasised the need for early diagnosis and called for increased investment in pathology services, particularly in the recruitment and training of pathologists and scientists. It said that histopathologists should be listed on the shortage occupation list as there is a shortfall in that speciality. The Migration Advisory Committee currently includes no pathology specialities on the shortage occupation list. Placing histopathology on that list would help overseas qualified pathologists to obtain a visa to work in the UK.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I lost my mother to bowel cancer last year, and I have been campaigning to reduce the bowel cancer screening age to 50. I understand from my campaign and the debates I have had that it is important that we get the pathology capacity right. Otherwise the reduction in the screening age will not work. Does my hon. Friend agree?

[Jim Fitzpatrick]

I certainly do. I am sorry to hear about the fatality in my hon. Friend’s family. I am sure the Minister will talk about staff and I will come to it later in my speech. Without staff in diagnosis and pathology services, the reduction in the screening age will be pointless.

The Royal College of Pathologists identified a growing demand for pathology services and predicted a 28% shortfall in staff by 2010. Cancer Research UK said, as we all know, that the earlier a cancer is diagnosed, the more likely it is that it will be treated successfully. The Labour Government’s initiative to reduce the time between an urgent GP referral to seeing a cancer consultant to two weeks was a success in ensuring swifter treatment, but 2018 was the first year in which that target was not met. I would be grateful if the Minister told us how the Government expect to address that slippage.

Cancer Research UK added that it expects new cancer cases to reach 500,000 a year by 2035—right now, it is 350,000. With more cases and more thorough screening measures, our NHS will need more diagnostic and treatment staff. Cancer Research UK highlighted that the promise to produce a workforce implementation plan after the 2019 spending review leaves the status of Health Education England’s upcoming cancer workforce plan unclear. Will the Minister give us more information about how the two initiatives relate to each other?

Macmillan said that it recognises and welcomes the focus on cancer in the NHS long-term plan, including the Prime Minister’s commitment radically to improve early diagnosis. However, it has concerns that the long-term plan will not adequately address the immediate and long-term pressures facing the NHS cancer workforce. It also asked when the workforce implementation plan can be expected this year. I note that the Health Secretary said yesterday that he expects Baroness Dido Harding to report to him by the end of March. I would be grateful therefore if the Minister can confirm that we can expect the publication of the workforce implementation plan by summer this year.

Breast Cancer Now made the point that only 18% of breast cancer screening units are adequately resourced with radiography staff, in line with breast screening uptake in its area. My area of north-east London is covered by Barts Health NHS Trust, the NHS North East London Commissioning Alliance and the East London Health and Care Partnership. Many of the points made by the national charities are apparent locally. Those bodies have made their concerns clear. They have raised the basic issue that cancer outcomes in north-east London are among the poorest in London and the country, and that presentation via the emergency route remains high and is clearly associated with advanced cancer and low one-year survival rates.

In my borough of Tower Hamlets, the one-year survival index of people diagnosed with cancer is 4% lower than the England average, and diagnosis through the emergency route remains high. The local NHS trust has plans to attack that problem with a new early diagnosis centre, which is due to open in December; the introduction of multi-diagnostic clinics, which were first introduced in Denmark and were supported here in the pilot phase by Cancer Research UK; and new faecal immunochemical testing for colorectal cancer in primary care from April this year. It plans a health and wellbeing school spread across the whole of north-east London, based on the principle of making every contact count. It is raising population awareness and screening initiatives, including placing staff to promote screening in GP practices, promoting text reminders for cervical cancer screening, video competitions for schools to promote vaccinations, prostate cancer targets, breast and bowel cancer target ads on Muslim TV channels, and the reintroduction of bowel screening reminder calling and other initiatives.

The North East London NHS Foundation Trust conclusions are relatively simple. The workforce is a key factor in delivering a faster diagnosis standard, expected by 2020 and beyond; earlier diagnosis of cancer needs a resilient and sustainable radiology, endoscopy and pathology workforce; the high cost of living, the lack of affordable housing and the disparity in salaries across London are barriers to recruitment; and there is a need to look at technology such as artificial intelligence and digital pathology, and innovations in careers.

CLIC Sargent raised the problem of diagnosing child cancer and said, worryingly, that more than half of young people diagnosed visited their GP with their parents at least three times before their cancer was diagnosed. That is of particular concern.

Breast Cancer Care also raised the workforce plan, and asked how the commitments of the current cancer strategy and the ambitions of the long-term plan will be met. The Royal College of Physicians told me that, in London in 2018, 27% of physician consultant posts advertised were not filled, and that across the UK a total 45% of advertised consultant posts went unfilled due to a lack of suitable applicants.

The British Lung Foundation made two key points: that early diagnosis is essential because almost half of lung cancers are diagnosed at stage 4 when survival rates are very poor; and that there is an urgent need to train and employ more NHS staff to diagnose lung cancer earlier. The Royal College of Nursing stated that in England there are nearly 41,000 vacant registered nursing posts in the NHS. It predicts that the number will increase to almost 48,000 by 2023 if the Government do not take action.

The Commons Library briefings said that the cancer workforce plan devised in 2017 recommended that action be taken to ensure that enough staff with the right skills are trained to deliver the cancer strategy by 2021. In November last year, the highly respected Professor Sir Mike Richards—NHS England’s cancer director—announced that cancer screening would be overhauled as part of the long-term plan. He also announced a review team to assess current screening programmes and a report is due this summer. I ask the Minister whether that timetable might coincide with the publication of the Government’s workforce plan. The Library stated that there is no measure of the total NHS cancer workforce. Will the Minister comment on that anomaly?

I would be grateful if the Minister addresses the fundamental issue raised in all the briefings: how the workforce implementation plan fits in with the strategy, and when it can be expected. I look forward to his response. He is highly regarded in his post. I look forward to the responses from the hon. Member for Central Ayrshire (Dr Whitford), the Scottish National party spokesperson, and from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Health Minister, and to other colleagues’ contributions.

[Several hon. Members rose—]

--- Later in debate ---

[Jim Fitzpatrick]

I am grateful to all colleagues for their contributions, which were pertinent, personal, knowledgeable and clinical. I thank the Front-Bench spokespeople for their contributions. The Minister knows that we all want the same things—success for the Government’s programme, better and earlier diagnoses, adequate and professional staff and better survival rates. We are here to help him.

Motion lapsed (Standing Order No. 10(6)).

Deafness and Hearing Loss

Jim Fitzpatrick Excerpts

Thursday 30th November 2017 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I beg to move,

That this House has considered deafness and hearing loss.

It is a pleasure to see you in the Chair, Mr McCabe. I am even more pleased to see that our debate is being interpreted into sign language, which I believe is a parliamentary first; we may be making history, which is great for all of us who are here to participate. I am grateful to the Backbench Business Committee for the opportunity to introduce the debate, and am very pleased that so many colleagues have been able to join us to contribute to this important discussion. It is good to see the Minister in his place, even though the subject is not exactly in his brief, and I look forward to hearing the winding-up speeches from him and from the Opposition spokespersons.

I place on the record my thanks to the UK Council on Deafness, Action on Hearing Loss, the National Deaf Children’s Society, Deaf Plus, the Adult Cochlear Implant Action Group and Brian Lamb, DeaflympicsGB, Access Bedford, the network Three and the House of Commons Library for their assistance in preparing for the debate. That is a long list, but given that 11 million people across the UK are living with hearing loss, it could have been much longer. The UK Council on Deafness, for example, represents 43 deafness or hearing loss organisations and has produced a collective briefing. I should also declare that I wear two hearing aids of my own and am chair of the all-party group on deafness.

There are too many issues for me to raise personally and it would be unfair not to share the time available as equitably as possible among hon. Members present, so the bulk of my speech, which I have timed at 13 and a half minutes, will focus on three key issues: Access to Work, legal recognition of British Sign Language and the implementation of the national action plan on hearing loss. First, however, I would like to put down a brief marker on several other issues that I do not have time to raise in detail.

I secured an Adjournment debate on cochlear implants in March, in which the then Minister David Mowat advised me that the National Institute for Health and Care Excellence would consult on new proposals by the end of the summer. We are still awaiting that consultation, so any information from the Minister would be very welcome.

Requests to improve paediatric audiology services across the country by accrediting them through the IQIPS —improving quality in physiological services—programme have been made for some time. I would welcome an update on any progress on voluntary accreditation or, if that has proved unsatisfactory, on whether the Government have given more thought to making it compulsory.

On Deaflympics, any information from the Minister about discussions between his Department and the Department for Digital, Culture, Media and Sport on support for our deaf athletes would be very welcome.

On early years intervention, the first three and a half years are critical for the development of listening and spoken language. I would be grateful for any update from the Minister on Government thinking about ensuring that auditory-verbal is put on the patient pathway as a follow-up to the newborn hearing screening.

Finally, I have some positive news about telecommunication services: the briefing from Three shared how it provides services for its deaf or hard-of-hearing customers. I also have some good news from Deaf Plus, whose BSL advice line was shortlisted this week for a national Helplines Partnership award. Well done!

Let me return to my three key issues, beginning with Access to Work. One person in six in the UK—or approximately 11 million people—is living with some form of hearing loss, and estimates show that nearly 90,000 use British Sign Language as their first language. The Government’s Access to Work scheme provides grants to disabled people to enable them to have equal participation in the workforce. It has revolutionised the career opportunities of deaf people, shattering the glass ceiling that had limited them to manual jobs. It has been largely due to Access to Work that deaf people have progressed as far as their talent allows: there are now deaf chief executive officers, deaf Ministry of Justice intermediaries and deaf theatre directors, among other senior professionals.

In March 2015, however, the then Minister for Disabled People, the right hon. Member for Forest of Dean (Mr Harper), announced that the Government would impose a cap. The cap means that the scheme no longer properly supports those deaf and disabled people for whom support costs are more expensive. For deaf people who are self-employed or entrepreneurs, there is no employer to make up the difference between the award and the need. In a recent written answer, the Department for Work and Pensions indicated that it was unable to state the number of people still in receipt of awards above the cap.

The UK Council on Deafness conducted its own survey to establish the impact of the cap on deaf people. It received 87 responses, including 60 from those who will be capped in April 2018—a high response rate, given that fewer than 200 people were identified in the equality assessment as potentially in that situation. Deaf people tell us that they are already avoiding applying for work in professional, managerial and senior roles that will be capped. The cap on Access to Work awards risks imposing a glass ceiling for deaf and disabled people in their work. Some 46% said that they would not apply for promotions, 20% said they had not applied because they were worried, and 44% said that they would stay with their current employer for as long as possible because they were worried about a new employer.

Will the Government look again at the evidence opposing the cap on Access to Work awards? Do the Government accept that the cap on Access to Work grants is set too low? The Secretary of State amended it from £42,100 to £43,000 in his statement today, but that is still too low. If the Government will not remove the cap, will they consider raising it to a level that provides deaf people with more of the support they need? Finally, have the Government considered that they may inadvertently have created legitimate financial grounds on which employers can discriminate against job applicants who use BSL? I recognise that those are questions mainly for the DWP, but if the Minister cannot respond to them today, I would be grateful if he ensured they were passed on to the appropriate quarter. In answer to my question in the Chamber about an hour ago, the Secretary of State said that the Government were still looking at evidence. I hope that means that the door is still open, because increasing the threshold by £1,000 clearly does not cut it.

In general employment terms, there are hurdles to getting into work for people with hearing loss anyway. In a YouGov survey commissioned by Action on Hearing Loss, 35% of business leaders stated that they did not feel confident about their business employing a person with hearing loss, while 57% agreed that there is a lack of available support or advice for employers about employing people with hearing loss. Access to Work is still the DWP’s best-kept secret: 63% of the business leaders polled had never heard of it.

Let me move on to British Sign Language. BSL is the first or preferred language of more than 80,000 deaf people in the UK, and more than 150,000 people use it at home. In 1987, the British Deaf Association launched a call for the legal recognition of BSL, and in 2003, following extensive lobbying, BSL was officially recognised as a language in its own right by the DWP.

In 2009, the UK Government ratified the United Nations Convention on the Rights of Persons with Disabilities, which states that Governments must uphold rights by

“Accepting and facilitating the use of sign languages…in official interactions”

and by

“Recognizing and promoting the use of sign languages.”

Despite formal recognition by the UK Government that BSL is a language in its own right, there has been no further progress towards establishing a legal status for BSL.

In the devolved Administrations, the situation is different. In 2012, a consultation for a British Sign Language Act in Scotland was initiated, culminating in the passing of the British Sign Language (Scotland) Act 2015. In 2017, the Scottish Government published their first BSL national plan. In 2016, a sign language framework consultation was launched in Northern Ireland. Despite those developments, however, there is still no pathway in place for legal recognition of BSL across the UK. With such legal recognition of BSL would come the rights of deaf people, and the benefits for deaf people and for wider society would be far-reaching.

On education, deaf children are 42% less likely to achieve five or more GCSEs at grade C or above than their hearing peers, but there is no reason a deaf child should do any worse than a hearing child. On health, 70% of deaf people who have not been to a GP recently wanted to go but did not, mainly because there was no interpreter available. Deaf people who have been told that they might have high blood pressure are three times more likely than everyone else not to have it under control. Deaf people are almost twice as likely as others to experience mental health issues, which can be exacerbated by social exclusion. A health economics study showed that eliminating poor diagnosis could save the NHS £30 million annually—and it is worth noting that 90% of deaf children are born into hearing families.

The call to Government is that the deaf community want them to acknowledge the benefits of legal recognition of BSL and commit to establishing a UK-wide sign language framework consultation for a UK-wide sign language Act. The British Deaf Association is asking for this consultation process to be led by an appropriate Department whose remit covers language. However, that is another major obstacle and it prompts a question for the Minister: which Department and which Minister lead on BSL? I have been writing for some time to try to find out. I even tabled a parliamentary question to the Cabinet Office and the answer that question elicited was that

“all Government departments have a responsibility to create inclusive communications. This does not mean promoting BSL as an activity in itself but it does mean identifying and meeting the communication needs of the audiences we are targeting”.

I am sorry, Minister, but that answer is nowhere near clear enough and I think it demonstrates why BSL is stranded. No Department is responsible for it; no Minister is responsible for it; there is no champion in Government who is responsible for it; there is no advocacy for it; and there is no progress on it.

Finally on BSL, there is the case for a British Sign Language GCSE. Although BSL is a recognised language within the UK, a GCSE that can be taught in schools is not available. A GCSE on BSL has already been piloted and is largely ready to go, but the Department for Education is declining to give it the go-ahead. There is a principle of fairness and justice here. BSL is an official language in the UK that is used by tens of thousands of people. Not allowing BSL to be taught as a GCSE implies that it has a lower status and importance than other subjects, and that could even be seen as discriminatory against deaf people. Also, we do not have enough deaf interpreters. Judging by the briefings that we have all received, I think that there are 800 to 900 registered deaf interpreters, which is clearly inadequate to deal with more than 100,000 people.

The last of the three issues that I will raise today is the implementation of the action plan on hearing loss. When the Department of Health and NHS England published that plan in March 2015, it was widely welcomed. This cross-Government plan not only recognised hearing loss as a major public health issue, but highlighted the major impacts of hearing loss. It also committed the Government to improving services for everyone living with hearing loss. In addition, it set out the need to reduce variation in the provision of services, through the development of guidelines by NICE on adult-onset hearing loss.

The action plan set out five key objectives in the following areas: earlier diagnosis; good prevention; integrated services; increased independence and ageing; and good learning outcomes. There was wide support for the plan. As part of the implementation, NHS England published its new national commissioning framework for hearing loss services in July 2016. It is essential that information about that framework is properly disseminated by NHS England and that the framework is fully adopted by clinical commissioning groups. To help with that dissemination, in September, NHS England published its “What Works Guides—Action Plan on Hearing Loss”, which provides advice to commissioners and providers on supporting people with hearing loss in a variety of different settings.

NHS England is also set to publish guidance imminently, setting out the need for health and wellbeing boards to consider people with hearing loss when they are commissioning services, as well as considering its data tool. In this case, the requests made of Government would be fairly straightforward to meet, because the frameworks are in place.

The UK Council on Deafness is asking the Government to work with NHS England, commissioners and professional bodies for medical professionals to raise the importance of early diagnosis of hearing loss; produce an analysis of the case for hearing screening, potentially adding it to the NHS health check that is provided to people in England aged between 40 and 70; and raise the importance of promoting the commissioning framework through NHS England. The framework provides a clear alternative to the decommissioning of hearing aids, and CCGs should be aware of it when designing and commissioning local services.

It is fair to say that on the three major issues I have raised today the Government have a mixed report card. On Access to Work, the Government started very positively, then faltered and now could be going backwards. We need the response of the Secretary of State for Work and Pensions to my question in the main Chamber today on the need to continue to look at the evidence to make serious progress, because the evidence, as I hope I have laid out, is very much there.

On BSL, the Government never really got started. That is not just the Minister’s Government; that is “the British Government”, a phrase that covers both sides of the Chamber. We are still stalled on BSL and there is no sign of an ignition switch to start us moving again. We need a champion of BSL in Government.

On the action plan, the Government started well and maintained progress, but they need to move through the gears now to ensure that that progress continues and secures the promised outcomes. We only need more of the same, because the start in this area was welcomed by the whole deaf and hearing loss community.

Finally, this is an important debate and I am grateful that so many colleagues have managed to be here to participate. I am also grateful for the opportunity to open the debate and I look forward to the contributions that will follow.

--- Later in debate ---

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I begin by echoing the tribute paid to my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this debate. As we have heard, there are a number of dimensions and aspects to deafness, but I want to focus on one issue: the criteria for receiving cochlear implants under the NHS. My argument today is simple: the criteria should be reviewed so that it is easier to get an implant. That would transform the lives of those who need this technology, and improve the lives of their families and loved ones. It would be a prudent investment, because it would obviate the need for more expenditure further down the line as a consequence of people not receiving the implants they desperately need.

I will tell the story of my constituent, Lamina Lloyd. Until last year, Lamina had a flourishing career as the manager of a local citizens advice bureau. However, Lamina has Meniere’s disease, which has resulted in progressive hearing loss—so much so that last year she had to give up work. She has two children who themselves have additional needs. She can no longer hear her children, who have to act as her ears. She describes her family as having gone from being an outdoor family to one that rarely leaves the house. Lamina is an intelligent, capable person, but hearing loss has meant the end of her career, a diminishment in the quality of her family life, and increasing isolation.

To try to alleviate her condition, Lamina wears the most powerful hearing aids available, turned up to maximum volume, but they make little difference and give her frequent ear infections and headaches from their feedback and squealing noises. She can no longer hear music or follow conversations, yet she has been in a battle—that is the only word for it—for the past two years to try to get a cochlear implant. She falls just 5 dB short, which is no more than a whisper, of the 90 dB hearing loss threshold for consideration for an implant. That threshold is one of the strictest in the western world. It is estimated that only 5% of those who could benefit from the technology get access to it in the UK.

Lamina describes her condition as being too deaf to hear, yet not deaf enough to get the help that could make a huge difference to her life. Her hearing has deteriorated even further in recent months, and she has an appointment to be assessed at the Queen Elizabeth Hospital in Birmingham in two weeks’ time, but she and many others in her position have serious reservations about how the assessments are made. The Bamford-Kowal-Bench test uses short sentences in lab conditions. It does not replicate normal conversation or real-world conditions. Lamina and many others feel that that tool is not fit for the purpose of properly measuring hearing ability and hearing loss.

Even if Lamina is approved for an implant, why has it taken so long? Why do we put people and their families through such pain before giving them the help that could be life changing? My hon. Friend the Member for Poplar and Limehouse raised those issues in an Adjournment debate earlier this year, and briefly at the beginning of his speech today. He was told earlier this year that the National Institute for Health and Care Excellence was launching a consultation on the relevant guidelines. That has not happened. The guidelines have been in place since 2009, but technology and costs have moved on a great deal since then.

I wish to ask the Minister a few questions. If he cannot respond to them all today, I would be very happy for him to consult with colleagues and write to me, and other Members participating in the debate, with a more considered response. First, why has the NICE consultation, which we were promised would be launched this summer, not yet been launched, and when will it be? Secondly, does he agree that Lamina’s case and many similar cases around the country show that there is an overwhelming argument for revising those criteria?

Thirdly, whatever hearing loss threshold is picked, does the Minister agree that the hearing loss test needs to be done in real-world conditions that approximate to how people actually live their lives and conduct conversations, and so on? Fourthly, and perhaps most fundamentally, why does it take so long for people to get an implant? Why is it such a battle? The NHS is there for those who need it; it should not be an organisation that people have to battle with to get the treatment that they need. Had my constituent been helped earlier, she might still be in a job. She would not need to rely on the state for financial support, and her family would not have had to go through the huge difficulties that they have all been through together over the last couple of years.

It is time for a step change in the urgency with which the issue of cochlear implants is treated. The guidelines must be revised. NICE needs to move on that soon, so that the suffering of my constituent Lamina Lloyd, and the many people around the country who are in a similar position, can be alleviated.

[Jim Fitzpatrick]

On a point of order, Mr McCabe. I asked my staff to monitor the transmission of the sign language. It is not being broadcast; the cameras do not meet the interpreters. Westminster Hall debates do not have subtitles, unlike in the main Chamber. Obviously I would very much appreciate it if you took that matter back to the Panel of Chairs and discussed it in due course.

[Steve McCabe (in the Chair)]

I understand that the sign language is being filmed today, and when the debate is re-broadcast it will appear in a box, as is normal in other TV transmissions. Obviously this is an early stage. I will report back on how the whole debate goes and any points that Members raise, but I understand that the arrangements for today are that when the debate is re-broadcast, the sign language will appear.

[Jim Fitzpatrick]

I am grateful for that clarification, Mr McCabe.

--- Later in debate ---

[Jim Fitzpatrick]

The right hon. Gentleman makes the same points that we have all made. Access to Work is a great scheme. It works. As I understand it, the logic for the cap is that there is only so much money in the pot—that is always the case for Governments—and therefore its purpose is to try to spread what is available as widely as possible. But for people with fantastic talent who could be advocates and champions for the deaf community by becoming chief executives and leaders of their professions and so on, the glass ceiling has been reinforced, because they can now get only £43,000. This is not a criticism—well, it is in some respects—but we need to ensure that the evidence is looked at regularly.

[Sir Mike Penning]

Governments need to be kicked and beaten up when they get things wrong and praised when they get things right. I was proud that a Conservative Government brought in Access to Work, which is massively important. There will always be examples of abuse in the system and so on, but that does not give the Government carte blanche to say, “No, the only way this can work is with a cap,” particularly if the evidence does not show that a cap will work. The Minister will have looked twice when he came into the Chamber and realised what this debate would mostly be about, which is not his responsibility but the DWP’s. I am more than happy to go across to my old Department and sit with my old officials and explain to them exactly where the evidence is in their cupboards.

Let me touch briefly on two other areas, and then on one thing that has not been touched on at all. I do not understand why, in the 21st century, a recognised language is not recognised in the House or across the country. I really do not understand why, all these years after I made a point of order in the main Chamber in 2005 to complain that a hearing loop was not available for my constituents when they were in the House—even when it was installed, it did not work properly—this is the first time a debate has been signed for our constituents. People will always go on about how that must cost more money. The cost is minimal compared with the benefit to our constituents of being part of the democratic process.

[Sir Mike Penning]

The things I do for everybody in this House. It was genuinely embarrassing. I remember it vividly. I said to the Speaker, Michael Martin, “My constituents have come to see this world heritage site and their Parliament at work. I took them on a tour, and frankly they got hardly any benefit apart from visuals, because they couldn’t understand or hear a word I was saying.” I seem to remember that there was the comment, from a sedentary position, “Well, they didn’t miss very much,” but I was trying to get across a point. This is the mother of Parliaments, and as we have heard from colleagues, we are way behind the loop again. I am sorry to use that terrible pun, but we are really behind. I hope that we will have a lurch forward. I have noticed all the Clerks coming in, and have heard that the Speaker will be reported to, and all that, and that is great, but it is absolutely useless unless someone actually does something. Then we can move on. I know this is a trial, but signing should be transmitted live.

Secondly, there should be a GCSE. I find it fascinating: we can see all the different courses that our young people do in schools and colleges, yet they are excluded in this way. If people do not want any more GCSEs, we could drop one of the ones that would not get used anywhere near as much as this. It would make people aware. In my constituency, people who are not deaf or hard of hearing have said to me that they want to be able to communicate like this; they want to do these courses as well. They want to have a GCSE, so that they can chat away with their mates in that sort of way. That is a simple thing, and I cannot see huge cost implications, so it should be moved on, as we have heard this afternoon.

Finally, I will touch on people whose hearing has been impaired by industrial injuries. That has not been mentioned at all in the debate, but not because people think it should not be. It is just one of those issues. People cannot see this type of industrial injury. It is not like the industrial injuries that my hon. Friend the Member for Poplar and Limehouse and I saw in our former jobs as firemen. There is something very wrong about how we measure industrial injuries, and hearing impairment industrial injuries in particular. So many people who have a hearing impairment do not admit it to themselves, their wives and their loved ones, even though their wives and loved ones are probably aware that there is an issue. They certainly do not talk about it to their employer or previous employers.

I can talk about this, because my eardrum is perforated. I did not know about that until I started to miss conversations that I thought I should be picking up. You just do not think there is something wrong. However, when I was a Minister at the Ministry of Defence, I had to have a medical before I was allowed to go into operational fields, and it was obvious that I had a perforated eardrum. It was almost certainly from live firing when I was in the armed forces—the specialists told me that—although it was not picked up then. That is not so important to me, but where industrial injuries are common, it is massively important that there be a level playing field on decibel levels. Completely different levels are used for hearing damage in the armed forces and what I call civvy street, and that cannot be right.

We must encourage people to come forward, not so much so that they can get compensation, but because, as we heard earlier, if we can pick this up earlier, it saves the state and everyone a lot of money, and also makes life much better for that person, who can start to accept the disability that they have and continue to live a happy life.

[Ms Karen Buck in the Chair]

[Jim Fitzpatrick]

When I had the hearing test that identified my audiological loss, as the right hon. Gentleman will know, the printout showed whether it was down to age or genetics, or whether it was industrial. Mine was at least partly industrial. I was told by my clinicians, “Your hearing loss is above the threshold for applying for industrial injury compensation.” I never did, because I had a great job here, so I did not have to, and it was not a matter of money. I have always felt a bit difficult about saying, “Well, I should have gone down as a statistic.” I am sure that, as the right hon. Gentleman says, there are a lot of us out there who have not registered and do not appear in the statistics. The base statistics are only of the people who absolutely needed to make sure that they registered.

--- Later in debate ---

[Jim Fitzpatrick]

The early statistics said that for every £1 spent on Access to Work, the Treasury got a cost-benefit analysis plus of £1.34 or £1.50. A lot of the people the hon. Gentleman describes are senior professionals, chief executives and so on, who will be on a 40% rate of tax, so it is an investment that will give the Treasury more money back than the basic rate of tax does.

[Tommy Sheppard]

I could not agree more. If somebody is in work and gets support through the scheme, not only are they earning money and paying tax, but the people who support them earn money and pay tax as well. There are all sorts of ways in which this makes sense. My key point is that given the small number of people affected, is the cap really worth it? Would it not be better to not have the cap, and assess the situation later? It is expensive because of the nature of the support that people need in this part of the programme if they are deaf and a BSL user. It is expensive because that support is undertaken by hard-working professional people such as the signers here today, who have trained very hard for the job that they do.

Perhaps in the future developments in audio technology and computer graphics will be such that we will get an app on our smartphone that will turn speech into sign in a way that works, but who knows? That is for the future. For now, we need professional human beings to be able to provide the service. We should accept as a society that for the limited number of people affected, the money is a price worth paying. We could perhaps look at other ways, rather than the cap and restricting the services provided, to reduce costs.

I want to finish by talking about Parliament and some of the things that we might be able to do here. It is wonderful that we have our proceedings signed today. I do not know why we do not have a signer standing beside the Speaker’s Chair and filmed for all the proceedings in our Parliament. When we think of the amount of money we spend in this place, the number of staff that we have, the amount we spend on maintenance and the amount we are going to spend on refurbishment, it is not such a big price to make sure that during the 30 hours a week or whatever when the Chamber is in operation and debating, there is a signer there, signing for the people in the Chamber, and, more importantly, for the people who watch live online or wish to check back on proceedings.

Another thing that we could do has to do with the scheme in Parliament, which Members may be aware of—I have not taken advantage of it yet, but I am sure others have—to get tuition in a foreign language. Why do not we add BSL to that? Why does not each MP have an opportunity to learn that as part of our professional development as Members of Parliament, so that we are better able to communicate with our constituents, and more aware of the technological needs?

My central point, which I will stress as I end, is that it is impossible to overestimate the importance of a legislative framework, because of the sense of purpose it creates for civil society and statutory agencies, and the sense of worth, I suppose, that it gives to people who are looking to us to respond to their needs.

--- Later in debate ---

[Jim Fitzpatrick]

I am grateful for the opportunity to sum up, Ms Buck. Invariably, the Member who sums up such debates says, “We have had a good discussion.” Not only is that the case today, but this has been an exceptional debate, and I thank everybody who has contributed. There has been a personal theme, but even those who did not raise a personal experience clearly have a grasp of the importance of the subject to their constituents. If any hon. Members are not on the all-party group mailing list, they are now, but I suspect everybody already is.

The hon. Member for Milton Keynes South (Iain Stewart) put his finger on the big issue. As others mentioned, this is a cross-departmental matter, so we need a champion. I will return to that in due course. My right hon. Friend the Member for Wolverhampton South East (Mr McFadden) spoke about cochlear implants and NICE. The Minister says that the work is now back in hand; it will be nine months late, but hopefully it is coming.

The hon. Member for Rochester and Strood (Kelly Tolhurst), as the Minister said, covered her mum’s story powerfully, bringing a tear to my eye. If she saw me wiping it, it is because it was such a great explanation of an individual’s difficulty, told with clear personal commitment. She made a point about how important it is for organisations such as Auditory Verbal to get to children born deaf within the first three and a half years, when their brains can still learn to speak; after that, it is far too late. That is why the pathway is so important.

The hon. Member for Eastbourne (Stephen Lloyd) also spoke powerfully about his personal experience. I was not sure whether he was making a bid to come back as the chair of the all-party parliamentary group; he will need to wait for the annual general meeting, but he is a great vice-chairman, and I will be pleased to see him there. The hon. Member for Waveney (Peter Aldous) and the right hon. Member for Hemel Hempstead (Sir Mike Penning) both called me their hon. Friend; that does not do me any favours on this side of the House, but I know what it means. We have done a lot of good work on a number of Committees, especially on fire, and we are friends. That tells people outside the House that although we might not often be in the same Division Lobby, we have friends across the Chamber and we work together when there is a common purpose. That is really important.

My hon. Friend the Member for Bristol East (Kerry McCarthy) spoke about IQIPS and accreditation. The right hon. Member for Hemel Hempstead, with his experience as Minister of State on Access to Work, is a powerful ally. The hon. Member for Edinburgh East (Tommy Sheppard), who just left to catch his train, talked about money being available for BSL lessons here. That ought to be the case, and I am sure that it is the case; we just need to explore it. He made a point by signing, reminding me that so much of sign language is common sense, such as “book”. He used the sign for “Scotland”, which is bagpipes. That tickles me every time I see it. He made a clear point about the power of legislation.

My hon. Friend the Member for Erith and Thamesmead (Teresa Pearce) told a story about Jacob and crowdfunding. It was powerful, as was the personal story told by my hon. Friend the Member for Blaydon (Liz Twist). My hon. Friend the Member for West Lancashire (Rosie Cooper) told her stories about having BSL as her first language, and the Access to Work issues. She spoke about Liverpool minicoms, and her dad, of whom she is clearly and rightly very proud. I am sure that it touched everybody in the room.

The politics came from the three Front-Bench speakers; the place went back to normal when they started talking. I mean no disrespect at all; they deal with things from a political point of view. Judging by their speeches, the hon. Member for Linlithgow and East Falkirk (Martyn Day), my hon. Friend the Member for Burnley (Julie Cooper) and the Minister clearly understand the issues, and we are grateful for that.

Finally, we need a champion in Government. BSL needs a champion in Government. At some point, a Department or a Secretary of State will have to say to a Minister, “You’re the person for the job.” Then we can all go support that person and get a better hearing in Government. This has been a powerful debate. I am grateful to both signers for being here—[Hon. Members: “Hear, hear!”]—and to the House authorities for facilitating that. I hope that this is the first of many opportunities and becomes the norm. I am grateful for the opportunity to say these few words in closing.

[Ms Karen Buck (in the Chair)]

On behalf of us all, I thank the two signers, Sally Macreavy and Richard Law. We greatly appreciate their work.

Question put and agreed to.

Resolved,

That this House has considered deafness and hearing loss.

Cochlear Implantation

Jim Fitzpatrick Excerpts

Friday 24th March 2017 Commons Chamber

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I am grateful for the opportunity to raise the question of the funding and assessment of cochlear implantation, and I do so as chair of the all-party group on deafness. I am pleased to see the Health Minister in his place; I know he has this issue on his radar.

The starting point is a petition calling for a review of the tests for implants approved by the National Institute for Health and Care Excellence. I have been contacted by my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) and my hon. Friend the Member for Rotherham (Sarah Champion) on behalf of their constituents Lamina Lloyd and Diane Matthews respectively.

Both constituents fall foul of the Bamford-Kowal-Bench test—the BKB test. It is this aspect that concerns them and their MPs, and they want it reviewed and changed. I will come back to that later, as well as to the case of Robert Gee, a constituent of the hon. Member for Daventry (Chris Heaton-Harris), who I am pleased to see in his place on the Treasury Bench. I want to register my appreciation for Action on Hearing Loss, the Action Group for Adult Cochlear Implantation, Professor Chris Raine and the Ear Foundation for their assistance with briefings for this debate.

I shall start with papers sent to me by the Ear Foundation. Sue Archbold writes:

“I was at the World Health Organisation in Geneva for the meeting on World Hearing Day, 3rd March...with WHO for the first time confirming that cochlear implants and hearing aids are cost-effective and should be made more widely available globally”.

The WHO has produced two documents: “Global costs of unaddressed hearing loss and cost-effectiveness of interventions” and “Action for hearing loss”. I am sure the officials at the Department will have brought them to the Minister’s attention.

Professor Chris Raine, who I believe is one of the UK’s leading clinicians in this field, emailed me and wrote:

“CIs”—

cochlear implants—

“are funded for health and NICE only look at this aspect. What needs to be addressed is, value for the taxpayer. For example, in education: children with CIs are now going into the mainstream sector which results in a significant saving of education funding of special classes. We have a generation now going through higher education, and this means better employment prospects and more people paying more tax. Adults who go deaf can expect better health outcomes with CIs. Deafness is associated with illness and unemployment. Also, studies in the USA and France have shown improvement and reduction in dementia in the elderly. We are spending £13 billion on dementia.”

Professor Raine concludes with the recommendation that

“we need adult hearing screening”.

The Ear Foundation has produced a document, “Improving access to cochlear implantation: Change lives and save society money”, written by Brian Lamb OBE, Sue Archbold, PhD, and Ciaran O’Neill, PhD. It recommends, for instance,

“That NICE urgently conducts a formal review of its current guidance on cochlear implants”,

and that the review

“considers lowering the current audiological threshold for candidacy…That any cost benefit analysis done…ensures…real world benefits are taken into account”,

including those relating to social care. It also states:

“A screen for candidacy for cochlear implants should be built into routine audiological appointments.”

Action on Hearing Loss writes:

“More adults could benefit from cochlear implantation than are currently doing so. NICE…should review and update its current guidance on cochlear implantation”.

It also writes:

“74% of children who could benefit from cochlear implantation aged 0-3 have received them, increasing to 94%, by the time they reach 17 years of age. The comparable figure for adults who have severe or profound hearing loss is only around 5%.”

I am sure that the Minister is aware of that.

“Research is also currently underway to see whether the BKB…sentence test… could be excluding adults who could benefit.”

The document recommends a review of guidelines, as well as the raising of awareness of cochlear implantation among the public and NHS organisations and professionals.

Brian Lamb also writes, this time on behalf of the Adult Cochlear Implant Action Group:

“Hearing loss is one of the most challenging health and social issues facing the UK...Those with hearing loss have higher rates of unemployment and underemployment.”

Hearing loss is associated with the risk of developing dementia:

“Those with severe hearing loss are at five times the risk of developing dementia as those with normal hearing”.

I remind the Minister again of the billions that we are spending on dementia.

“In older age people with hearing loss are at greater risk of social isolation and reduced mental well-being”.

Yet we have never had better solutions to address hearing loss.

The ACIAG states:

“Hearing aids can make a huge difference to the majority of people, but for those who are severely or profoundly deaf cochlear implantation offers the main way of hearing spoken language again. We now have world-leading technology in cochlear implants to address hearing loss, but many more people could benefit from this transformative technology than currently do.”

It also states:

“There are an estimated 100,000 people with a profound hearing loss and 360,000 with a severe hearing loss who might benefit from implantation at any one time. Yet”

—as I said earlier—

“only 5% receive CIs.

The UK currently has one of the most restrictive tests across the whole of Europe...In this country it is not until the hearing loss is over 90 dB that people qualify, while in Europe the majority of clinics use a measure between 75-80 dB.

We also use a word test, the BKB test, which is no longer fit for purpose according to a recent review by experts in the field who concluded, ‘use of this measure... alone to assess hearing function has become inappropriate as the assessment is not suitable for use with the diverse range of implant candidates today’.

The guidelines have been in place since 2009 and not reviewed since 2011.

The Action Plan on Hearing Loss, published by DoH”

—the Department of Health—

“and NHS England in 2015, made clear that there should be ‘timely access to specialist services when required, including assessment for cochlear implants’.”

That action plan was widely welcomed when it was published, and I, along with others, commended the Department, officials and Ministers at the time, but much of it seems to be being ignored by a number of clinical commissioning groups. Indeed, some are following policies that contradict the plan. The ACIAG requests more research on the links between hearing loss and dementia, and mental health issues. In conclusion, it writes:

“The NHS has been a leader on cochlear implant technology and helped transform many people’s lives. The NICE guidance was welcome when originally produced in 2009, but we are now falling behind the access available in many developed countries. It is our health and social care services which will pay the cost of not intervening early for those who could benefit.”

I wear two hearing aids, primarily because of damage to my ears sustained while I was in the fire service, although I am sure that age has now added to the problem. I am one of the 11 million people in the UK—one in six of the population—who suffer from hearing loss. Despite the annoyance I cause friends and family by asking them to repeat things, the use I make of the House of Commons loop system, and the assistance I seek here from the sound engineers and technicians, who are always very helpful, I still rely on my hearing aids because they work for me, despite sometimes having limitations. However, I have listed the problems for people suffering profound hearing loss, which are much more serious. We can do something about this; we have the technology, and it is not a matter of costs, because it should save money. It should save the NHS and the taxpayer money, as well as allowing profound hearing loss sufferers to live more complete and productive lives.

In conclusion, I return to the emails from the constituents of my colleagues. One of them writes:

“Lamina passes the pure tone threshold for a cochlear implant, but had to take a speech recognition test in what she regarded as a ridiculously false atmosphere of a soundproof booth with very simplistic sentences in an environment totally different from real conversation or the normal outside world. She is, in her own words, too deaf to hear, but not deaf enough for an implant.”

Robert Gee, the constituent of the hon. Member for Daventry, writes similarly, but gives more details of what 70 dB actually is. He says:

“Now just to give you some benchmarks: 60 dB equates to the volume of conversation in a restaurant. 70 dB is twice that volume (busy traffic). 80 dB is 4 times that volume (an alarm). And 90 dB is 8 times (factory machinery etc).”

He then refers to the sentence comprehension test:

“A candidate qualifies if they can only hear (with hearing aid fitted) and repeat less than 50% of the sentences which are played over speakers. The problem with this test is that it is conducted in a soundproof booth with the sentences played at 70 dB...double the volume level of standard conversation. This test does not represent reality at all.”

I give the last word to Mrs Diane Matthews, who started the petition to ask NICE for a review. She writes:

“I started a petition for NICE to revise their cochlear implant tests after refusal again for a CI in January this year...The tests are in a soundproof room at a sound intensity of 70 dB. Whilst I understand there has to be set parameters, this does not mirror the real world. There should be a test with background noise and the sentences should be comparable with adult conversation...A CI is life-changing and whilst it’s not a cure, it’s the best option. To know there is something to help and be denied is heart-breaking when you want to work and contribute to society.”

I hope that NICE will accept the requests from individual patients, professional clinicians and campaign organisations, and I hope that the Minister in his response can articulate something in the way of support, or at least acceptance and understanding that there is a major issue out there, and obviously write to NICE directly as well.

We have a solution. It is at worst cost-neutral, and in reality offers huge cost benefits both in productivity and economically, and in human wellbeing. I am looking forward to hearing the Minister’s response.

Draft Nursing and Midwifery (Amendment) Order 2017

Jim Fitzpatrick Excerpts

Wednesday 22nd February 2017 General Committees

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Paisley. I rise to seek reinforcement of the reassurances already articulated by the Minister and to echo some of the questions raised by my hon. Friend the Member for Ellesmere Port and Neston, the shadow Minister. I should point out that, as MP for Poplar, the historic location for the BBC flagship drama, “Call the Midwife”, it would be remiss of me not to speak, having been placed on this Committee. Indeed, my Whips Office or the Speaker’s office have demonstrated a sense of humour by placing me on this Committee and making it an obligation to make a contribution to this debate.

In Poplar, we still have several nuns’ residences. I have met constituents who were delivered by the nuns and midwives in Poplar in the ‘40s, ‘50s and ‘60s. Although the BBC series is a historical drama, it is still relevant in east London today.

I must confess I was slightly confused by the two briefings I received: one from the Royal College of Midwives and the other from the Nursing and Midwifery Council. On first reading, I thought one was in favour and one was opposed, but further and closer inspection demonstrated that that is not entirely the case. The RCM raised a couple of questions, as my hon. Friend has already explained. He said that it was concerned about the removal of the additional tier of regulation for midwives, which includes the supportive supervision at a regional level, the removal of the midwifery voice on the NMC in the new replacement structure, and the fact that the new systems will be non-statutory, which will make their existence in the long term potentially more fragile. The RCM seeks reassurance from the Government that the new systems will be enforced, particularly in the long term.

The NMC was much more supportive of the Government’s proposals. The briefing from Kerry Racher, the senior parliamentary officer of the NMC, indicated that the NMC forcefully welcomed many of the changes that the Government propose, and indeed advocated them. It quotes a number of reasons why it supports the changes. It says that they are changes that were requested following a number of critical incidents; the Minister referred to Morecambe Bay.

The NMC has long maintained that the legislation is out of date, which the Minister referred to a lot in his remarks. It has worked closely with the Department of Health to bring forward these changes and it welcomes the Secretary of State’s announcement that the Government would accept all the recommendations in Dr Kirkup’s report into Morecambe Bay. Finally, it says:

“The changes to midwifery regulation will strengthen public protection.”

In conclusion, I would welcome additional reassurance from the Minister because the two perspectives do not seem irreconcilable. I am reassured that my hon. Friend has indicated that the Opposition will not oppose these changes. I am grateful, Mr Paisley, for the opportunity to make these brief remarks.

Cancer Strategy

Jim Fitzpatrick Excerpts

Thursday 8th December 2016 Commons Chamber

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to follow the hon. Member for Crawley (Henry Smith), who has made a very strong case on blood cancers. I am sure that the Minister was listening and I suspect that he will respond positively.

I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on opening the debate. I also congratulate him and his colleague on the all-party parliamentary group on cancer, the hon. Member for Basildon and Billericay (Mr Baron), on securing it. I echo the hon. Member for Crawley in wishing the hon. Gentleman’s wife and family well in the treatment that they are undertaking.

I had not intended to speak in this debate, but I have received briefings from Action on Smoking and Health and from Cancer Research UK, as well as a copy of the British Lung Foundation’s expert working group report on lung cancer, and I thought that it would be appropriate to reinforce some of the points that they make. I checked that there was no massive pressure on time and that I would be able to make those points were I to catch your eye, Mr Deputy Speaker, so I am grateful to you for calling me.

I thank Deborah Arnott from ASH and Lucy Absolom for their briefings, which I found very helpful. I should point out that I have had four basal cell carcinomas removed from my face. Fortunately, the biopsy on all of them found that they were benign, but my consultant dermatologist has recommended that I wear a hat to protect my Scottish features from the southern sun and the ultraviolet rays, which are even more worrying. Being married to a doctor, I always take very careful notice of any clinical advice that I am given, to avoid the risk of being criticised for not listening to those who are more intelligent and better qualified than me. I thank the good doctors at the Aberfeldy health centre and the dermatology department of the Royal London hospital for their assistance in protecting me.

I will start with the bad news. All three of the briefings that I have received have many positive things to say about the Government’s cancer strategy. I also think that, on the whole, my hon. Friend the Member for Scunthorpe was positive in his opening remarks. There are clearly some questions to be asked, and I will do so, but the briefings are more supportive than critical of what the Government and the clinicians of NHS England are trying to achieve.

The ASH briefing begins:

“The UK’s Cancer Strategy…for England 2015-2020 recommends the publication of a new Tobacco Control Plan within 12 months as a key element of its first strategic priority, a radical upgrade in prevention and public health. If this target had been met a new Plan would have been published in July 2016. However six months on, and a year since the last Tobacco Control Plan expired, there is still no new Plan.”

That is a major criticism in the briefings. ASH goes on to say:

“The previous Tobacco Control Plan achieved its ambitions to reduce smoking rates: adults fell from 21.2% to below 18.5%, 15 year olds from 15% to below 12% and among pregnant women from 14% to 11% or less. The Government must publish a new plan to build on this progress.”

I apologise to the Minister if the plan has been published, but my hon. Friend clearly suggested that it has not, so when will it be published? We would be grateful if the Minister gave us any encouragement that it is due sometime soon. The data show how successful the previous plan was at cutting the number of smokers and, consequently, reducing the exposure of non-smokers, especially children, to second-hand smoke.

I should own up to being an ex-smoker. I started in my early teens, and I gave up at 21.35 hours on 4 November 1980. The fact that I remember the minute does not indicate that I miss it at all. I remember it because it was during a “Panorama” programme that highlighted the legs of a chap who was, it became apparent later, in a wheelchair. The poor gentleman had suffered thrombosis in both legs and had had amputations on both legs. The camera eventually got to his face, and we could see that he was still smoking cigarettes. My then wife was pregnant at the time, and giving up smoking seemed a very sensible thing to do. I had tried to do so 18 months previously, when I gave up for six months. However, I burned my hand badly in a fire, and the first thing I asked as I was being taken to hospital—after six months off cigarettes—was, “Will somebody give me a cigarette?” It took me 18 months to get back off them, but I managed to quit.

When I joined the London fire brigade, two thirds of firemen—as it was in those days—smoked. This is only anecdotal, but 23 years later two thirds of fire fighters did not smoke. That demonstrates the change in attitudes to health and fitness within the service, and it reflects a similar change in attitudes in society towards smoking. All the positive policies that have been introduced, such as no smoking in public buildings, demonstrate that we live in a society that is completely different from 30 or 40 years ago.

On a new plan for tobacco control, which we hope will be published shortly, I would be grateful if the Minister shared his thoughts ahead of publication on what targets we might expect from 2020 onwards for reducing adult smoking numbers, what budget might be set aside for mass media campaigns and what support might be available for stop-smoking services. Those services reduce health inequalities, because most of the people who access them are from more deprived communities. That will help many of my constituents, appropriately. The last plan clearly worked, and we need a new one.

Cancer Research UK’s briefing states:

“If the strategy is implemented in full then it is estimated that 30,000 more lives could be saved per year by 2020. 11,000 of those lives will be saved through improvements to early diagnosis.”

That is one of the strong points that my hon. Friend the Member for Scunthorpe made. Cancer Research UK stated that it had not seen the progress needed on the plan. On prevention, it states:

“4 in 10 cancers are preventable. We need a radical upgrade in prevention to ensure the future sustainability of the NHS and reduce cancer incidence.”

Cancer Research UK wants the Government to publish the tobacco control strategy without further delay, as does ASH, and it wants the Government to extend existing junk food TV marketing restrictions to the 9 pm watershed to reduce children’s exposure to marketing by more than half. The briefing states that

“urgent action needs to be taken to ensure the NHS cancer workforce is adequately equipped to deal with rising demand and improving care…We welcome the commitment to increase the spend on diagnostics by up to an additional £300 million by 2020, but need clarity over how this is being allocated and used in local areas to improve earlier diagnosis. In addition, the national Diagnostic Capacity Funding must also be continued.”

Those points were also raised by my hon. Friend. The briefing states:

“Cancer waiting times targets are being consistently missed…suggesting there are still thousands of people not having the tests they need on time.”

As I have said, Cancer Research UK has also made a lot of positive comments. On governance and the progress made on implementation so far, the charity states:

“We welcome the appointment of Cally Palmer as National Cancer Director and Chris Harrison as National Clinical Director for Cancer…We welcome the establishment of the Cancer Alliances across the country…We welcome the priority that has been given to earlier diagnosis in the first year and the commitment to invest more.”

Cancer Research UK welcomes NHS England’s proposed investment of £130 million for over 100 replacements or upgrades of radiotherapy machines over the next two years in hospitals in England. It says:

“Replacing the machines will mean that more patients can access the innovative radiotherapy which plays a vital role in curing cancer, slowing the growth of tumours and improving quality of life for cancer patients.”

Its final question is about the Government’s commitment of £300 million by 2020 to improve diagnostic capacity, which was also raised by my hon. Friend. It asks for

“clarification on how this money is being allocated and used in local areas and how its impact is being evaluated.”

As I said at the beginning, not only are not all the comments from respected organisations critical of the Government’s policy, but they are actually complimentary about their policy and approach, apart from for the absence of a tobacco control plan. That key absence has been highlighted by all the charities and research organisations concerned. I want to reinforce the point to the Minister that there have been lots of positive comments, because this is not just the Opposition being critical of the Government. There are lots of great and positive stories, but there is that one absence.

As my hon. Friend said, and as I have said on behalf of Cancer Research UK and ASH, we want the Minister to answer a number of questions. If he is not in a position to do so today, it would be very welcome if he asked his officials to write to those of us involved in this debate in due course with additional information. I look forward to hearing the comments of the shadow Minister, my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), and of the Minister in response to this debate.