Tattoo Artists, Body Piercers and Cosmetic Clinics: Licensing

Debate between Jim Shannon and Steve Brine

Tuesday 28th November 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

Earlier this year it was announced that Wales was set to become the first UK nation to introduce mandatory national licensing for what we call special procedures: tattoo artists and those working in body piercing, semi-permanent makeup, acupuncture and electrolysis. The licensing regime in Wales is being introduced under part 4 of the Public Health (Wales) Act 2017. Happily, section 180 of the Health and Care Act 2022, passed by this place, gave the Secretary of State the power to introduce a licensing regime in England. I am really glad that we are now doing that and that our Government are taking the issue seriously.

In this very short debate, I am keen to hear from the Minister what the Government are doing to speed up the introduction of that regime in England, something that the Health and Social Care Committee, which I chair, called for when it published a report on body image back in 2022. I want to mention my hon. Friends the Members for Bosworth (Dr Evans) and for Sevenoaks (Laura Trott), who did good work on that regard when they were on that Committee.

As we are all well aware, non-surgical cosmetic procedures such as Botox, dermal fillers, chemical peels and aesthetic procedures such as tattooing and body piercing are soaring in popularity. The beauty industry is valued at an estimated £3.6 billion in the UK. That boom has been fuelled by sales on social media and in beauty shops on the high street. However, while these procedures are popular, they carry risks that must be managed to protect both those who undergo the procedures and those who provide them.

At present, healthcare professionals such as doctors, nurses and dentists who carry out non-surgical cosmetic procedures must be trained and insured as part of the requirements laid down by their own regulatory bodies or Royal Colleges. However, there is no set training for beauty therapists and other non-professionals, something that is a cause for concern and an issue that many respected practitioners have campaigned on for some time. It is, after all, in their interests; as the sector has boomed, there has been a rise in people being physically and mentally harmed by poorly performed procedures. The aesthetics sector has been described to us by some, in part, as the “wild west”, which clearly is not ideal for anyone, patient or practitioner.

Further to that, a survey carried out by the British Association of Aesthetic Plastic Surgeons found that 69% of its surgeons have seen patients with complications following temporary fillers. Again, that outlines the need for the licensing scheme to be introduced and enforced. An estimated 900,000 Botox injections are carried out in the UK each year, with 3,000 complaints registered in 2022. The public need to be educated on the risks; they cannot assume that someone who is carrying out an aesthetic treatment is trained. It goes without saying that people should take the time to find a reputable, insured and qualified practitioner, if they decide that such treatments are for them.

To my mind, the licensing scheme is an important step towards better outcomes for the industry and consumers and, I hope, towards removing rogue practitioners from the industry. Practitioners must have adequate training to deal with complications and to minimise them in the first place. For instance, if a blood vessel is blocked while a patient is undergoing a procedure, it could easily block the blood supply to their eye. I was contacted with the horror story of one woman who was unable to open her eyes for 16 weeks following botox treatment.

Wales opened its 12-week consultation on its licensing scheme in January of this year. The scheme aims to reduce infections, eliminate poor working practices and create a central public register for licensed practitioners and approved business premises. That is important as the industry continues to increase in popularity. The Welsh chief medical officer said at the time that he was

“very pleased that these impending changes have been widely welcomed by practitioners in Wales, with many already volunteering to meet the new standards.”

One tattoo shop owner who has been working with the Welsh Government on the new qualifications said—this was widely reported—that:

“The increase in quality of tattoos in the last decade has been exponential so the hygiene needs to be raised. This is all positive for the industry and helps shake the image of it being dark and shady. It’s reassuring for those getting tattooed as well.”

I obviously very much agree with that statement, which shows why we need further legislation—or regulation off the back of legislation—in England to protect both clients and practitioners. In answer to a written question earlier this month, the Welsh Government confirmed that the aim is for their statutory licensing scheme to come into force in the summer of 2024, when it will initially apply to the four special procedures specified in their 2017 Act: electrolysis, body piercing, tattooing and acupuncture.

As I say, I was pleased when the Health and Care Act 2022 introduced powers for the Secretary of State to establish a mandatory licensing scheme in England, following calls for greater regulation of non-surgical cosmetic treatments—not least from my Select Committee. It is important that the scheme is introduced sooner rather than later, which we emphasised in our report on body image.

It was positive when the consultation in England finally opened at the beginning of September this year with pretty much the same intentions as the Welsh piece of work. However, concerns have been raised with me by those in the industry that the consultation in England has been far too heavily biased towards medical input rather than input from those in the cosmetics industry, which makes up a large part of the sector. As part of our body image inquiry in 2022, the Health and Social Care Committee recommended that the introduction of licensing for non-surgical cosmetic procedures be made a priority and introduced by July this year. The Committee also suggested that a safety taskforce be set up to bring stakeholders together, but I understand that the Government decided not to follow that route. The National Hair and Beauty Federation says that it is concerned that the Government have not reached out to an adequately broad range of stakeholders. Why have the Government not pursued the route recommended by the Select Committee?

In the pre-consultation phase, it was felt that more medical organisations than beauty organisations were consulted, which the NHBF has suggested caused a bias towards the medical sector. That is creating concern that routes into aesthetics via the beauty sector will therefore be restricted, which will have obvious consequences for many legitimate and reputable businesses. It also creates the risk that the new regulatory regime may drive some practices into the underground market rather than increase quality and standards across the industry, which is what we are aiming to see. The NHBF also said in September that it had written to the Government twice this year regarding the new licensing scheme but was yet to receive a response. Maybe that has been updated since.

When implementing mandatory licensing, we need to ensure that we establish a framework that demands a higher standard of care and proficiency from all practitioners. Further to that, another issue that needs to be addressed by the national scheme is procedures carried out in tattoo and piercing studios in England, which are currently subject to regulation by local councils. As there is no national scheme, we currently lack the reassurance needed. Practitioners need to contact the local council where their premises are based to get a tattoo, piercing or electrolysis licence. They must then register both themselves and the premises with the local council. However, registration is a fairly simple process, there is no requirement for the provision of proof of qualifications, and local authorities have few powers to refuse a registration. The current licence with local authorities covers tattooing, semi-permanent skin colouring, cosmetic piercing, electrolysis and acupuncture.

Local councils do, it must be said, conduct regular inspections of premises to ensure that they are compliant with health and safety laws, and there is a requirement for every tattoo artist to be licensed by their local council. To remind the House, tattooing without a licence or tattoo certificate is illegal. However, the fact that licensing is determined by local councils in England means it differs on what standards must be met across the country by those who apply. For example, some councils demand that all practitioners have access to their own sink, while others are happy for shared sinks, which risks cross contamination—posing a health risk. A new compulsory licensing scheme would ensure that both clients and practitioners are adequately protected, and practitioners would have to abide by the same rules across England.

The purpose of registration with councils is to protect the public from the transmission of blood-borne viruses such as HIV, hepatitis B, hep C and other infections, and to ensure that the health and safety regulations are followed. I think a national licensing scheme would increase this protection. As I have already set out, although section 180 of the Health and Care Act enables the Secretary of State to establish a licensing scheme, it is yet to be fully enacted. The consultation process closed a month ago today, and the advances to implement this hugely important scheme have been slow in England. When does the Minister think the Government will respond to the consultation?

There are four key priorities that must be addressed in the new licensing scheme to make sure that there is adequate protection for practitioners and clients. The first is the design and implementation of the national licensing scheme for all premises, as well as practitioners of non-surgical cosmetic procedures, to ensure that those who practise invasive procedures are competent and safe for members of the public—our constituents. Secondly, all practitioners must hold the correct insurance to provide these procedures. Thirdly, there needs to be official guidance on the training and qualification expectation of all practitioners, such as the knowledge and application of infection controls and first aid training should things go wrong. Fourthly and finally, we need a system that effectively records adverse incidents and public awareness raising so that all cases that go wrong can be tracked. I think such a system would dramatically improve safety standards. It would also ensure that members of the public are better equipped, as they would have better tools and knowledge surrounding the procedures and the practitioner that they were using.

The Government did assure the Joint Council for Cosmetic Practitioners, the British Beauty Council and the Chartered Institute of Environmental Health that they were committed to the licensing of the non-surgical aesthetics sector in England, so I ask the Minister when we can expect to see further action, following the consultation that I have mentioned.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this debate forward. My council, Ards and North Down Borough Council, has a policy in relation to piercings specifically. It has initiated a piercing guidelines policy to make both piercers and those who get piercings aware of the guidelines and policies that, in its word, “must” be followed. Does he agree that there could be more discussion of providing this information—in local schools, for example—because many people who get piercings are under 18 years of age, and are often naive to the guidelines and hygiene policies that piercers must follow? Educate them early: does the hon. Gentleman agree?

[Steve Brine]

We have enough debates in this House about some of the things that we teach in schools, and I can but imagine some of the responses we would get to this, but in my view education can never be a bad thing. There is nothing wrong with tattooing and piercings. It is not my personal choice—I do not know about the hon. Member for Strangford (Jim Shannon)—but if people are going to do it, I think they should go with their eyes, or any other part of themselves, wide open; and that is why the hon. Gentleman’s point on education is well made. [Interruption.] Did that amuse you, Mr Deputy Speaker?

In closing, would it be possible for the Minister to outline the timeline, even in rough terms, for the introduction of the licensing scheme? Finally, I understand that it is complicated and a bit like peeling an onion—the more you take, the more you find—could the Government outline which procedures will fall under the new licensing scheme? On that, I will close; I look forward to hearing from the Minister.

Universal Infant Free School Meals

Debate between Jim Shannon and Steve Brine

Tuesday 25th April 2023 Westminster Hall

[Steve Brine (Winchester) (Con)]

I beg to move,

That this House has considered universal infant free school meals.

It is good to see you in the headteacher’s chair, Mr Gray. In my time in the House, I have seen many innovative ways of speaking in a debate, but the mover of one debate speaking on the following one, as the hon. Member for Glasgow North (Patrick Grady) has just done, is a new one, even on me.

There are lots of debates around on universal infant free school meals, and lots of things that could be meant by that phrase. A number of the briefings I have been sent ahead of today’s debate back up that view. There is the campaign being pushed by Jamie Oliver and others on extending the free school meal entitlement to all children. There is the ongoing debate on school holiday food for those eligible for free school meals during term time. On that issue, I want to recognise how responsive and welcome Ministers have been, getting help to my constituents where it is most needed. I place on the record my thanks to them for that.

Today’s debate, however, is not about either of those areas, important though they are. I want to focus on the pressure being felt by headteachers across my constituency, and, I am sure, elsewhere, when it comes to meeting the cost of what is supposed to be a universal entitlement to free school meals for infant-aged children. Put simply, there is a gap between the funding received and the cost of putting good-quality food on the school table. There is an inevitable impact on school budgets, which make up the shortfall. Heads began to raise that issue with me late last year. We will come on to some figures for Winchester in a moment.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this issue this forward. He is absolutely right. There is pressure on headmasters. There is pressure coming from parents, who are having difficulty providing meals for their children at school, and school uniforms. On support for parents, including through the universal provision of school meals, does he agree that the least we could do for all those working parents who are struggling to make ends meet is to help them, and help headmasters as well?

[Steve Brine]

Yes, headmasters and headmistresses are in a very difficult position; I will quote some of them shortly.

Representatives of UK wholesalers have contacted me to express concern about the fact that because of food inflation, rising energy bills and increased labour costs, they are fulfilling their public sector food contracts, but at a loss. I think there was broad welcome for the Government’s recent decision to increase the funding for universal infant free school meals by 7p per pupil, but that rise remains well behind the rise in food inflation, which is running at 20% for wholesalers, according to the Federation of Wholesale Distributors.

Education Route Map: Covid-19

Debate between Jim Shannon and Steve Brine

Thursday 25th February 2021 Commons Chamber

[Steve Brine (Winchester) (Con)]

Thank you, Madam Deputy Speaker. I hope that my right hon. Friend the Member for Harlow (Robert Halfon) can at least hear this. Hopefully we can get him back to “open” the debate, after it has already been opened. We made the application to the Backbench Business Committee together, along with the hon. Member for Twickenham (Munira Wilson). Of course, when we made the application, the Prime Minister’s national road map of Monday had not been announced, and we were very much pushing for a national educational route map out of covid-19 for schools and colleges, as is the title of the debate. We are, of course, all delighted that the Prime Minister made an announcement on Monday and that all schools will return, or at least be able to return, for all pupils from 8 March.

My right hon. Friend the Member for Harlow leads the Education Committee with aplomb, and I would not try to take his place, but I know what he will want to cover in this debate, including the practicality issues around testing. He will also be majoring on issues around the catch-up fund and the announcement by the Secretary of State in his statement this morning about exams for this year’s cohort. Hopefully he will get his chance to make that pitch at some point during today’s debate.

Obviously, I greatly welcome the announcement about 8 March; I have called for this to happen many times in the House, as have so many colleagues across all Benches. As I said on Monday, it is absolutely the right decision. As a constituency MP for almost 11 years, I have never seen such concern and anxiety from parents and grandparents for the current state of mind and state of education of their children as I have seen in recent months. They are beyond worried about the impact of this dreadful pandemic on their children. That is what led me to push as hard as I did for schools to return. That is not to say that I am a “let it rip” merchant in any state of the term, whether that be in the wider economy or in schools. Of course we have to have a cautious, irreversible, balanced and data-driven release from lockdown, and we have to have—exactly—a cautious, irreversible data-driven return of our schools and colleges. I believe that that is what the Government are trying to set out.

There is no point in pretending—the Prime Minister made this very clear on Monday—that there will not be an impact on cases, on hospitalisations and even on deaths as a result of lifting restrictions on our economy. Anybody who seeks, after the 8 March, to say, “Well, this is the consequence that wasn’t admitted to by the Government at the time” would be disingenuous, to put it mildly.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Steve Brine]

Yes, I will briefly, but I do not want to mess with the timings from Madam Deputy Speaker.

HIV Commission

Debate between Jim Shannon and Steve Brine

Tuesday 1st December 2020 Commons Chamber

[Steve Brine]

I most certainly would. As a Health Minister I travelled around the world to G7 and G20 meetings. The NHS and what we do within it, as the Health Secretary has said many times, is so well respected around the world that we often set the tone and the lead. Yes, this is a plan for England, but I hope it will work across the devolved nations of the UK. I hope that we will set the standard around the world, as we have in so many areas of public health policy, so that others will then follow. I take the hon. Gentleman’s point exactly.

[Jim Shannon (Strangford) (DUP)]

First, I congratulate the hon. Gentleman on securing the debate. I just want to add my support for the HIV Commission project. I spoke to him beforehand. It is important that we put on record the hard work that has been done by so many people, including by those in my constituency. The Elim Church’s missions have helped to address HIV in Swaziland. Over the years I have known them and what they have done, they have been instrumental—it is a wonderful thing—in assisting the Swazi Government to reduce the number of adults who have HIV from 50% to 27%. A programme of education and medical support has helped. Does he agree that what they have done in Swaziland could enable us, through the House of Commons, to deliver that to the rest of the world as well?

[Steve Brine]

Yes. The faith element is very important. We have done very well on driving down the numbers, but we have to do even better, and it will get harder as we get closer to the goal. Reverend Steve Chalke, a Baptist minister and the founder of the Oasis Charitable Trust, was one of our commissioners. He provided a very important element and the hon. Gentleman’s point is very valid.

Why do I say that this is scientifically possible? A HIV diagnosis is a notification of a serious condition, but these days, thank goodness, it is not the death sentence it once was and many understand it to be. An end is therefore in sight. Treatment has come such a long way. People on the right treatment have their viral load suppressed, meaning that they cannot pass on HIV. That, frankly, was a game changer. Overwhelmingly, people in England and the UK now know their HIV status. Of the 106,000 people with HIV in our country today, 94% know they are HIV positive, 98% are on treatment, and nearly all are virally suppressed and therefore cannot pass it on.

In addition, we have a wonder drug, PrEP— pre-exposure prophylaxis—which is taken by people who are HIV negative. It stops transmission during sexual intercourse. The PrEP impact trial data comes out in the new year, but we know already that it is a massive success—I hope I am proved right in that assertion. The Secretary of State made the drug readily available, free on the NHS—that was important. That took a little longer than it might have done but, legal challenges notwithstanding, let us not dwell on old ground. Let us ensure that all communities that can benefit from it know about its virtues and its availability.

If we are to get the benefits of PrEP to all who need it, HIV testing is needed in GP surgeries, pharmacies—I refer the House to my entry in the Register of Members’ Financial Interests—termination clinics, gender clinics and much more besides. Then, PrEP prescribing powers need to be given to each of those bodies. Again, it can be done—we need the will to do it. I commend the PrEP Protects campaign, focusing on black African women and men. If we can get take-up in other communities as there has been with gay and bisexual men, we will be changing lives and saving money. So thank you to the Terrence Higgins Trust, the National AIDS Trust, I Want PrEP Now, who lobbied me heavily as a Minister, and PrEPster for their amazing campaigns on the issue.

Schools in Winchester

Debate between Jim Shannon and Steve Brine

Wednesday 3rd July 2019 Commons Chamber

[Steve Brine]

Ahead of this debate, I asked constituency heads for their thoughts on their school’s current funding position and whether they had had to make any reductions in teaching or other staff for the current 2019-20 financial year. I wanted to get a view on the teachers’ pension scheme, which the Minister will know is the source of much concern in the profession. I wanted to get from the heads themselves the current view, and it is fair to say I certainly got that.

There is an understanding across the board among schools in my Winchester constituency that per-pupil funding has risen, but there is also frustration at the reduction in the lump sum in Hampshire to bring it in line with the national funding formula, which was a decision taken by the schools forum a few years back. The truth is that has created winners and losers, depending on the size of the school, a point to which I will return. Concern is unanimous within the schools about the rising cost base, including the unpopular apprenticeship levy. I would therefore welcome comments from the Minister on what procurement help the Department can offer to help schools meet the challenge of rising costs.

Three of my secondary schools have told me that they have regrettably made staffing reductions in the past two years. Several told me about support workers, librarians and business managers not being replaced and about increasing science and maths class sizes. Kings’ School, which is ranked excellent, increased its intake by 24 pupils this year without increasing the number of classes, so tutor groups now have 30 pupils instead of 28. That increase in numbers has understandably undermined trust between the Winchester schools, putting something that we have called the Winchester schools teaching alliance in a fragile position and leading one secondary school to pull out of it altogether.

Several heads made the point that they have had no choice but to cut back on continuing professional development in recent years, which is inevitably going to hit staff recruitment and retention—if it is not hitting it already—in Winchester and central Hampshire, which is already an expensive part of the world to live in.

[Jim Shannon (Strangford) (DUP)]

I sought the hon. Gentleman’s permission to intervene and talked to him about the matter that he is bringing to the House. Does he agree that the Government need to refocus on the point of the schooling system, which is to educate children, prepare them to reach their potential and help them to find a job that makes the most of what they have? Instead, there is a fixation on micro-management, which ignores our duty to ensure that schools are funded correctly and given enough to operate to an acceptable standard.

[Steve Brine]

The hon. Gentleman and I have danced in this Chamber many times during Adjournment debates—usually with me at the Dispatch Box—so it is good to see him in his place. I agree with some of what he says, but I do not think that schools are micro-managed by this Government. The Government have a focus on rigour for some of the key outcomes, and the Schools Minister has been absolutely laser-focused on that, as he should be. A good school looks at the whole person, and my schools in Winchester do that, but they are finding that a challenge right now, and I will come on to the reasons why.

Finally on funding, I have my fair share of small rural primaries in Winchester, and the fair funding formula has not been good news for them all. For obvious reasons, the schools forum decision that I mentioned earlier has not created winners out of schools with a small role. Compton All Saints’ Church of England Primary School tells me that the new formula has left it operating with about £20,000 less than in previous years. That, as the Minister will appreciate, makes a massive difference in a school with only four classes.

As the Minister will know, the Government have now published their response to the recent consultation on funding the changes to the teachers’ pension scheme employer contribution rate. This welcome announcement confirms that the Government will fund all state-funded schools, further education and sixth-form colleges and adult community learning providers to cover their increased costs from September 2019, when the rate for employer contributions is due to increase to 23.6%.

The letter to me from the Secretary of State for Education, dated April 2019, said the grant will be accompanied by a “supplementary fund” to which schools facing unusually high pension costs—typically, I suppose, where a school faces a shortfall between its grant allocation and its actual increase in pension costs—will be able to apply for additional support. Ministers said they planned to announce details of how schools can apply to the supplementary fund in the autumn of this year, so will the Minister please update us on progress?

More generally, the message I got is obviously one of relief that the TPS employer contribution has been fully funded for 2019, but schools need a lot more certainty—I am sure the Minister hears this a lot on his travels, and I know that he travels a lot—if they are to plan properly. Rolling one-year settlements are just not good enough.

One of my schools tells me that it is part way through a four-year deficit recovery plan and that it aims to balance in 2020-21, but the great known unknown in its projections is staff costs. Governing bodies urgently need to take a long view of financial planning, and I urge the Minister in that respect.

Other themes running through the responses centre on help for children with additional needs and for parent teacher associations, and I am sure we have all engaged with PTAs in our constituencies. I hear that PTAs in my patch—I know that other people hear this, too—are increasingly being asked to step up for major capital projects in the absence of any chance that schools in my constituency will be eligible for external funds.

Will the Minister touch on what resource schools in places like Winchester can tap into when they need to make capital improvements to their site? I understand there is a capital maintenance grant, but Hampshire County Council tells me that its calculated liabilities—in other words, what needs doing—are currently around £370 million, whereas the grant received this year is around £18 million, which is obviously a big gap.

I am very concerned by what I am hearing about children with special educational needs or additional needs, a subject about which you and I care passionately, Mr Speaker. If I am honest, this is the issue that brings together all the pressures, funding and otherwise, being communicated to me by headteachers in my constituency and by the local education authority.

I am getting a consistent message from heads that they are seeing a marked increase in the needs of children, especially with regard to social, emotional and mental health. As one head put it to me:

“Schools seem to be having to cope with increased levels of violent behaviour—not because the children are naughty but because we are unable to provide for their needs. Special school places are at a premium and children who need this specialist and therapeutic provision are having to be ‘held’ in mainstream school. This not only means their own needs are not being met—but also disrupts the learning of others. Teachers find working in this environment stressful and I have experienced good staff leaving because of it.”

This familiar view has been expressed to me by several of my headteachers.

Funding pressures at local authority level, for which I appreciate the Minister and the Department for Education are not responsible, have left social care and children’s services under pressure, and schools are increasingly finding themselves plugging the gap. Teachers are becoming involved as lead professionals in supporting families and home life.

Teachers have always done much more than teaching, of course, but right now it feels like they are expected to be housing officers, mental health professionals and even nutritionists to boot. I have spoken warmly of the teachers at my schools, and they are resourceful people, but that is pushing it. As one headteacher in Winchester put it to me recently, a small group of pupils are taking a very large slice of support and time, which obviously is then having an impact on the other children, but it is also having an impact on the children with less complex education, health and care plans, who then miss out as a result.

I thought that IDACI—the income deprivation affecting children index—on the proportion of people under the age of 16 who live in low-income households could be a place to turn, but sadly it is not, because my constituency will always fall short of that measure, even though there are pockets of deprivation in Winchester; these are nothing special just because they have a fantastic view of the south downs or the city of Winchester from the playground. If we add in how stretched child and adolescent mental health services are and how stretched the supporting families programme is in my area, we have a perfect storm, which says clearly that we need so much more support in our schools, to stand with these often highly vulnerable children and their families.

Clearly, we as a country are at a crossroads in our political life at this time. As we pause for breath before the new Prime Minister takes office later this month, I make this plea to my right hon. Friends the Members for Uxbridge and South Ruislip (Boris Johnson) and for South West Surrey (Mr Hunt), as well as to the outgoing occupant of No. 10, who I know will hear these words acutely. When I was a Minister at the Department of Health and Social Care, as I was until recently, I was fortunate to work alongside two Secretaries of State as we landed a very healthy long-term financial settlement for the NHS and subsequently a long-term plan for how it would deliver the improved outcomes we wanted to see across the acute sector, public health and all the things I am passionate about. We clearly need a long-term plan for schools, backed by significant new investment—the first bit may be easier than the second—just as we did for the NHS.

As the Minister knows, I have long been a member and supporter of the f40 campaign group and we have had some success. I pay tribute to the Minister because I know that he has personally done a huge amount with f40 and to push the fairer funding agenda within government, during a time of difficult financial constraint. It is a fact that over the two years 2018-19 and 2019-20, per-pupil funding in Hampshire is going up by £167, which represents 4% compared with the national average of 3.2%, and when changes in pupil numbers are taken into account, total funding rises in my county by £42.5 million. But when the dedicated schools grant for 2019-20 is divided by the number of students in Hampshire, each pupil is worth £5,523, which is the fourth lowest figure in England.

Although we have received an additional £6 million over two years in high needs block funding, we clearly cannot keep up with demand. Let me give an example. In 2014, there were 5,500 pupils with a statement across Hampshire, but in 2019 there are 8,300 pupils with EHCPs. It does not take a genius to work out that this has led to a big deficit—a £10 million in-year deficit at the LEA. I know from independent studies that the UK is a high spender on state primary and secondary education by international standards, and real spending per pupil is half as much again higher than it was in 2000, during the so-called Blair years of plenty, but we still have all that I have set out in this debate and schools facing very real financial constraints, which I know, from his letter in April, that the Secretary of State and the Minister do not duck.

The long-term plan for schools must be part of a properly funded settlement that recognises the reductions in lump sum that have done so much to aid the current situation, enters into a new long-term deal with the profession on pay and pensions and, like the NHS long-term plan, takes seriously the wider services in society, such as CAMHS and social services, because when they fall down they significantly affect our schools.

I would say, with the benefit of my experience in the Department of Health and Social Care, that we did bring in a long-term settlement for the NHS and we did bring forward a long-term plan for the NHS, but we did not, at the same time, bring forward the people plan of the workforce or a funded public health settlement. That weakened the NHS long-term plan, and those two elements are now playing catch-up. We must not make that mistake again with a new long-term plan for schools.

We have much to celebrate in my constituency. I have given many figures in support of that and tried to be balanced in the way I have presented the schools in Winchester. We have strong leadership at the LEA, and I have given some stats relating to that, and very strong leadership in the schools themselves. Generally, we have a well-engaged parent body. However, there are signs for me, as a constituency MP for nearly a decade, that suggest we need change. I have set out some of that this evening, particularly in respect of the acute challenge that we face on high needs.

Above all, we need that long-term plan. We need a long-term financial settlement for schools in Winchester and throughout the country. I would be grateful if the excellent Minister and the rest of his team at the Department left a note to that effect when, or if—although I hope not—they leave office in a few weeks’ time.

Oral Answers to Questions

Debate between Jim Shannon and Steve Brine

Tuesday 15th January 2019 Commons Chamber

[Steve Brine]

I am glad that my hon. Friend mentions CRUK, which has launched a powerful new marketing campaign that Members will see around Westminster and in the media over the rest of this month. We will launch the consultation on further advertising that was in chapter 2 of the child obesity plan, including the 9 pm watershed, very shortly. We are working hard to ensure that the remaining consultations announced in the second chapter are right. I want to get them right and, when they are ready and we are satisfied that they are the right tools to do the job that we want to face this enormous challenge, we will publish them.

[Jim Shannon (Strangford) (DUP)]

With recent Northern Ireland figures showing that at least 25% of young people and 40% of teens are classed as overweight or obese, will the Minister outline what cross-departmental discussions have taken place on the strategies to improve the health of young people through co-ordination and interaction with parents and the provision of healthy eating schemes?

[Steve Brine]

Of course, health is devolved, but we talk to our opposite numbers all the time, as do our officials. Our north star ambition to halve child obesity by 2030 is right and it is shared and matched by our colleagues in Scotland, and we look to our colleagues in Northern Ireland to do the same. Any advice and support that they want from our world-leading plan is more than on offer.

Leaving the EU: Tobacco Products and Public Health

Debate between Jim Shannon and Steve Brine

Monday 7th January 2019 Commons Chamber

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

Happy new year, Mr Deputy Speaker.

I beg to move,

That the draft Tobacco Products and Nicotine Inhaling Products (Amendment etc.) (EU Exit) Regulations 2018, which were laid before this House on 1 November, be approved.

Smoking causes 78,000 deaths a year in England, accounting for 16% of all deaths annually. The United Kingdom is a global leader in tobacco control and the Government are committed to ensuring that we remain so after we leave the European Union. As hon. Members know, the Government have negotiated a deal with the EU and are in the process of taking it through Parliament. As has been much discussed, the deal is designed to secure a smooth and orderly exit from the EU. At the same time, it is of course the job of a responsible Government—I am pleased to say that the shadow Leader of the House is listening intently—to prepare for all possible scenarios. We are committed to ensuring that our legislation and policy function effectively in the event of no deal. It is for this scenario that these regulations have been laid. If the UK reaches a deal with the EU, the Department will revoke or amend this instrument to reflect that agreement.

This instrument will ensure that the UK domestic legislation that implements the two main pieces of EU tobacco legislation—the tobacco products directive and the tobacco advertising directive—continue to function effectively after exit day at the end of March. The instrument also amends and revokes some EU tertiary legislation that will no longer apply to the UK after our withdrawal. The amendments and revocations are being made under the European Union (Withdrawal) Act 2018 and are necessary in order to correct deficiencies in the UK and EU legislation in the event of no deal. The primary purpose of this instrument is to ensure that tobacco control legislation continues to function effectively after exit day. These proposed amendments are critical to ensure that there is minimal disruption to tobacco control if we do not reach a deal with the European Union.

This instrument introduces three main changes. First, in the event of no deal, the UK will need to develop its own domestic notification systems for companies that wish to sell tobacco products and e-cigarettes on the UK market. The notification process is essential for ensuring that companies are complying with legislation on product standards. Public Health England and the Medicines and Healthcare Products Regulatory Agency have already commenced work to ensure that domestic notification systems are in place and functional by exit day.

Secondly, in the event of no deal, the UK will not hold copyright to the EU library of picture warnings for tobacco products. Requiring the industry to continue to use these pictures would breach copyright law. Picture warnings are a key part of tobacco control, and it is therefore extremely important that we continue to require the inclusion of graphic picture warnings on tobacco products. The UK has therefore recently signed an agreement with the Australian Government to obtain their picture warnings free of cost—who knew, Madam Deputy Speaker? This agreement covers all copyright issues. I am very grateful to the Australian Government for their assistance in this matter. Action on Smoking and Health supports the proposals on notification systems and on the picture warnings as

“pragmatic and practical, minimising the amount of additional work involved if there were to be a no deal Brexit.”

Thirdly, this instrument proposes a transfer of powers. Currently, the Commission holds a range of powers under the tobacco products directive that enable it to respond to emerging threats, changing safety and quality standards, and technological advances. This instrument transfers these powers from the Commission to the Secretary of State. It should be noted that all powers in this category relate to technical, scientific and administrative adjustments that may be necessary to respond to changing circumstances in this space.

This instrument will have some impact on the tobacco and e-cigarette industry—there is no getting away from that. My Department ran a short technical consultation in October to seek feedback on the practical issues that will affect the industry in a no-deal situation. It focused on picture warnings and the notification process that I have outlined. We received 32 responses and have welcomed practical feedback on the issues highlighted in the consultation. Tobacco control stakeholders expressed support for the continued use of picture warnings as an effective way of stopping people smoking. They also showed support for the proposals to amend the notification system for e-cigarette and tobacco products as a means of harm reduction. The tobacco industry raised concerns around the timing of implementation and cost, primarily in relation to the changes to picture warnings. The Department has consulted with external experts who confirmed that the timescale for industry to implement these changes would be difficult but certainly manageable. To support industry with these changes, the Department intends to publish detailed guidance later this month.

Let me say a word on the devolved Administrations. It is important to note that the DAs have provided their consent for the elements of the instrument that are considered to be devolved. Furthermore, we have engaged positively with them throughout the development of this instrument. This ongoing engagement has been warmly welcomed. I want to place that on the record for our friends in the devolved Administrations.

In conclusion—

[Jim Shannon (Strangford) (DUP)]

Will the Minister give way?

[Steve Brine]

In conclusion, Madam Deputy Speaker, taking my lead from your look—Members will have a chance to contribute—this instrument constitutes a necessary measure to ensure that our tobacco control regulations continue to work effectively after exit day. I should, however, emphasise that, due to the instrument being made under the withdrawal Act, the scope of the amendments in the instrument is limited to achieving that objective. Therefore, at an appropriate point in the future, the Department will review where the UK’s exit from the EU offers us opportunities to reappraise current regulation to ensure that we continue to protect the nation’s health. That is timely on this day of all days, when we have published our long-term plan.

I urge Members to support the instrument, to ensure the continuation of effective tobacco control and harm reduction. I commend the regulations to the House.

Oral Answers to Questions

Debate between Jim Shannon and Steve Brine

Tuesday 27th November 2018 Commons Chamber

[Steve Brine]

The hon. Lady—my shadow Minister—knows that I have a great deal of respect for her. She mentioned smoking; smoking rates in England are at their lowest ever levels. We hear spending commitment after spending commitment from the Labour Government; it is like the arsonist turning up at the scene of a fire. I will take very seriously, as I am sure will the Treasury, her bid towards the spending review discussions, but yes, prevention is better than cure and it will be at the heart of the long-term plan.

[Jim Shannon (Strangford) (DUP)]

4. What steps he is taking to support people to lead healthier lives.

Oral Answers to Questions

Debate between Jim Shannon and Steve Brine

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

My hon. Friend makes a good point, which he made in last week’s debate. Public Health England and NHS England will continue to work with local areas in our constituencies to promote evidence-based ways of identifying and supporting pregnant smokers to quit. The overall ambitions in the tobacco control plan, which I published a year ago last week, will touch the general population, which of course includes the partners of pregnant women.

[Jim Shannon (Strangford) (DUP)]

Has the Department carried out investigations into the effects of vaping during pregnancy? If so, what are the results?

[Steve Brine]

Vaping and e-cigarettes were part of the Stoptober campaign that we ran last October through Public Health England. I am often criticised for not promoting vaping enough, and I am sometimes criticised for promoting it too much, which possibly gives me a steer. The advice is clear that the best thing to do, whether someone is pregnant or otherwise, is not to smoke.

Childhood Obesity Strategy: Chapter 2

Debate between Jim Shannon and Steve Brine

Monday 25th June 2018 Commons Chamber

[Steve Brine]

Especially tennis, Mr Speaker. I know my hon. Friend is keen on social prescribing, as am I. I recently signed an accord between National Parks England and Public Health England to use the brilliant natural resource of our national parks. They are clearly part of the social prescribing mix that we increasingly see across our country, and I want to see more of it. She is right to raise that.

[Jim Shannon (Strangford) (DUP)]

I, too, thank the Minister for his statement. With 25% of children overweight in Northern Ireland, will he confirm how he intends to work cross-departmentally there in the absence of a working devolved Assembly? We need a strategy that works for all of the United Kingdom of Great Britain and Northern Ireland.

[Steve Brine]

Yes. Some of the measures in this strategy relate to reserved matters, such as the advertising proposals that I have spoken about. I have been speaking to my officials, who are already talking to officials in Stormont and will be helping them to develop their own plans. I know they have been very interested in what we are doing, and I hope they can copy and follow some of this locally.

Acquired Brain Injury

Debate between Jim Shannon and Steve Brine

Monday 18th June 2018 Commons Chamber

[Steve Brine]

I thank my hon. Friend, who has professional experience of the criminal justice system. I shall come to his point in a moment, but I thank him for putting it on the record. Sometimes it is a difficult subject to talk about, but it is very relevant.

[Jim Shannon (Strangford) (DUP)]

This debate is important to me personally; many years ago my brother had a serious brain injury as a result of racing motorbikes. That made an independent, single-minded person into someone who depended very much on others; it took him from being a person with his own business and social connections to being someone who could not co-ordinate more than one thing at a time.

I look forward to some comfort in the Minister’s response, which I know we will get. We need not only help for the person in an institution; they need to be taken home and given a semblance of order in their lives and what quality of life is possible. Does the Minister accept that families need help to take on that job for someone whom they love and want to help?

HPV Vaccination for Boys

Debate between Jim Shannon and Steve Brine

Wednesday 2nd May 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Henry, I think for the first time. I congratulate my hon. Friend the Member for North Thanet (Sir Roger Gale) on securing the debate and bringing this important subject to the House. He was in the Chair the last time I was in Westminster Hall, which was just yesterday. I am surprised that so few Members are present for the debate. As the shadow Minister suggested, perhaps matters elsewhere in the House and outside are occupying their minds.

As my hon. Friend the Member for North Thanet mentioned, our expert group, the Joint Committee on Vaccination and Immunisation, is considering this matter, and it is important that I do not pre-empt its final advice, as he rightly said. That does make the timing of the debate challenging, but I will respond as fully as I can and give as much context as possible.

I will first set out some of the context. In 2008—before I was even a Member of the House—on the advice of the JCVI, an HPV vaccination programme for girls was introduced. The primary objective was to protect against cervical cancer. As the hon. Member for Washington and Sunderland West (Mrs Hodgson) kindly said, my mission in life—not just in my job—is to challenge and beat that dreadful disease. While I am on the subject, I pay tribute to Jo’s Cervical Cancer Trust and the brilliant Rob Music, who leads it—I know that the hon. Lady knows them well. The trust’s work in this area over many years, including with me as Minister, has been truly transformative for many women’s lives.

The HPV vaccine that is used in the UK offers protection against the two types of HPV that are responsible for about 70% of cervical cancers, and since the introduction of our vaccination programme the number of young women infected with HPV has fallen dramatically. Protection is expected to be long-term, eventually saving hundreds of lives each year, which I am sure we all agree is very welcome. Today, however, our focus is on boys and men.

[Jim Shannon (Strangford) (DUP)]

Is the Minister aware of the paper on this subject by Dr Gillian Prue of Queen’s University Belfast? Dr Prue’s six recommendations are very similar to what the hon. Member for North Thanet (Sir Roger Gale) and others have put forward today. They include: first, that both men and women should be vaccinated against HPV-related diseases; and secondly, and more importantly, that the significant human cost of HPV-related diseases should be the primary consideration for including boys in vaccination programmes. If the Minister has not been made aware of the paper, I am happy to furnish him with the copy. Its recommendations are integral to moving forward on the issue.

[Steve Brine]

Not wishing to mislead the House, my honest answer is that I am not aware of that paper. Whether my officials are aware of it is another matter—I will ask them. I know that the hon. Gentleman will not be shy about putting a copy in my hand after the debate.

The good news is that HPV vaccination of girls also provides some—I emphasise “some”—indirect protection for boys. When the vaccination uptake rates are high, as they are in England, there are fewer HPV infections in heterosexual males, because the spread of HPV infection between girls and boys is reduced. There is evidence to back that up; it is not just words. For instance, diagnosis of first-episode genital warts in young heterosexual men between the ages of 15 and 17 declined by 62% between 2009 and 2016. That suggests that there is some—again, I emphasise “some”—herd protection from the existing HPV vaccination programme. However, that is not the start of the story, and neither is it the end, and I have to put it on the record that nobody in Government has ever said that it was. Nevertheless, I take the points that have been made today about herd immunity; it is only part of the story.

Of course, it will take much longer to see the impact that the girls programme has on HPV-related cancers, but we should not wait for those results before considering whether more needs to be done now for boys. As my hon. Friend the Member for North Thanet said, this is a slow-burn problem.

GP Recruitment and Retention

Debate between Jim Shannon and Steve Brine

Wednesday 28th March 2018 Westminster Hall

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

It is a pleasure to see you on your throne this afternoon, Mrs Moon.

I have a lot of time and respect for my shadow, the hon. Member for Burnley (Julie Cooper), but what a counsel of despair that was. As the sun comes out after a day of rain in London, let me see if I can bring some sunshine to our proceedings.

I congratulate the hon. Member for Houghton and Sunderland South (Bridget Phillipson) on securing the debate. She spoke passionately, as always, about her constituents and her area. The hon. Member for Strangford (Jim Shannon) said that we are often in here together and share many of the same subjects. That is true but, to be fair, he is in here even more than I am.

I note the Prime Minister’s announcement yesterday that she intends to bring forward a long-term plan for the NHS with the Secretary of State, Ministers and our partners. That will build on our record of extra funding for the national health service in England year on year since 2010, to deliver a NHS that is fit for the future. I agree with the shadow Minister that this is about the wider NHS, and that we cannot see primary care in isolation. We are able to do what we have done for the past eight years because of the state of the economy, which we have got into a better place. When the economy fails, the NHS catches a cold or much worse, which is important.

[Jim Shannon]

rose—

[Steve Brine]

I will not give way at the moment.

As everybody has said, we recognise the importance of general practice as the heart not only of our NHS, but in many ways of the country. It is as much about prevention before people get into the NHS as it is a gateway to it. That point was made well by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the SNP. As others have kindly said, I am absolutely committed to ensuring that the NHS has the resources, workforce and Government backing to make it fit for the future.

As the hon. Lady said, it is a great success that we are living longer, but an ageing population and more people living with long-term conditions, or so-called comorbidities, means that general practice will become more important than ever in keeping well and living independently for longer. On Friday, I spent a morning sitting and observing—lucky patients—a general practitioner in Hampshire, not in but near my constituency. I watched him do his morning surgery. It was a brilliant thing to do as the Minister with responsibility for primary care, but I would recommend it to any Member who has that relationship with GPs in their area. By sitting and watching, it is possible to see what comes through the door and the pleasures of general practice, which is not dissimilar to the surgeries we hold as MPs.

The number of people over the ages of 60 and 85 is set to increase by about 25% between 2016 and 2030, and the number of people living with long-term conditions is increasing. In 2017, almost 40% of over-60s had at least one long-term condition. I am sure we can all think of people in our families who are in that position—I certainly can. We recognise that that places general practitioners in England under more pressure than ever before, and are taking comprehensive action to ensure that general practice can meet the demand.

The NHS set out its own plan for general practice in the general practice forward view. We have backed that with additional investment of £2.4 billion a year by 2020-21, from £9.6 billion in 2015-16 to more than £12 billion by 2020-21. That is a 14% increase in real terms. That is not made up—those are genuine figures, on the record. As has been said, we have also announced our ambition to grow the medical workforce to create an extra 5,000 doctors in general practice by 2020, as part of a wider increase to the total workforce in general practice of 10,000. We recognise that that is an ambitious target—it is double the growth rate of previous years—but it shows our commitment to growing a strong and sustainable general practice for the future.

This debate is about recruitment and retention, so let me break those down. NHS England, which we work with—it is approaching its fifth birthday—and Health Education England are working together with the profession to increase the GP workforce. That includes measures to boost recruitment, address the reasons why GPs are leaving the profession and encourage GPs to return to practice. We recognise that GPs are under more pressure than ever, but we want them to remain within the NHS and are supporting them to do so.

The hon. Member for Stroud (Dr Drew) made the point about recruiting and then following through. As I said at oral questions last week, there are things we can do, but there are things the profession can do too. If doctors in general practice are a counsel of despair, it is little wonder that people do not want to follow them. There are some good, positive voices in general practice, ably led by Helen Stokes-Lampard, who leads the Royal College of General Practitioners. She is a brilliant example of the cup being half full. That kind of positivity is very important—it is a partnership.

Neuroblastoma

Debate between Jim Shannon and Steve Brine

Tuesday 23rd January 2018 Commons Chamber

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

I congratulate my hon. Friend and parliamentary office neighbour, the Member for Spelthorne (Kwasi Kwarteng), on securing this debate on such an important issue.

It is a privilege to be cancer Minister—I hear some of the worst and some of the best. We know that cancer is a disease that will affect most of us, either directly or indirectly, at some point. I suspect it will affect everybody in the House tonight. That is particularly true, and somewhat inevitable, as the population ages, but it is especially heartbreaking, is it not, when cancer afflicts children and teenagers, as it has his constituent Alfie? I have young children myself, and I cannot help but think about that.

Neuroblastoma is an uncommon cancer—there are about 95 cases in the whole of the UK each year—but it has one of the lowest survival rates of all the childhood cancers, and that is why raising awareness of it is vital and why I thank my hon. Friend for bringing it to the attention of the House. As he says, it is always a privilege to speak here and to raise issues on behalf of constituents.

I will come in a minute to how we are prioritising investment, which is so important, in research and improving access to drugs for cancer, particularly those that are less survivable. First I would like to pay tribute to the Bradley Lowery Foundation—my hon. Friend mentioned Bradley—which is providing fantastic support to Alfie’s family, for which I thank it. As a football fan myself—okay, I am a Spurs fan—I saw several times how Bradley’s smile lit up many football grounds, including his own in Sunderland, before he sadly lost his own battle against neuroblastoma, as my hon. Friend said. His legacy is the tremendous awareness of this rare cancer that he raised in his short life. He encouraged a huge amount of fundraising for treatment and research that will help so many children. I often think, whether we live for 100 years or 100 minutes, we all in some way change the world we are born into, and that is certainly true of Bradley’s life.

In England, we want something that is very difficult but quite simple to convey: we want to have access to the best cancer services in the world, especially for children and young people who have to face this disease so early in their lives. That is why the Government—this Prime Minister, the previous Prime Minister, the Secretary of State and I—have prioritised cancer services. Since 2010, we have seen year-on-year increases in the number of people surviving. At the end of last year, this country had its best survival figures ever, which is of course something to be pleased about, but just one person who is battling cancer will not feel like that.

We know that there is a huge amount more to be done. NHS England is leading the health and care system in implementing every one of the 96 cancer strategy’s recommendations with the aim of achieving our ambition to save a further 30,000 lives a year by 2020—although if we can do more, we should. NHS England has committed some £600 million to support the delivery of the strategy. No one will hear me speak about cancer without mentioning early diagnosis, which is the most crucial factor that we know of in successfully treating neuroblastoma or any other cancer.

In 2016, some £200 million was made available to the new cancer alliances, challenging them to encourage innovative ways in which to diagnose cancer earlier and to improve the care for those living with cancer. That is so important. Members will have seen the television campaign by Cancer Research UK, which includes the words “A mum with cancer is still a mum.” Many people are battling cancer, but they are still living their lives. It is always important to say that. The funds are also intended to ensure that all cancer patients receive the care that is right for them, and we are rolling out one-stop shops throughout the country. We have invested some £130 million in upgrading and replacing radiotherapy equipment, to ensure that patients have the best and latest equipment regardless of where they live.

Cancer services for children and young people, including the treatment of neuroblastoma, are specially commissioned by NHS England. Neuroblastoma is often treated with radiotherapy. In 2013, a £23 million fund was used to improve access to intensity modulated radiotherapy, a precise form of radiotherapy that can be directed more accurately at cancers and allows a higher dose of radio- therapy to be given with, hopefully, fewer side effects. That is particularly important to very young children, who may have weaker immune systems and who are less resilient to more invasive treatments.

[Jim Shannon]

I thank the Minister for his endeavours. It is always a pleasure to listen to his response to any constituency issue. In England, responsibility clearly lies with him, but is there any possibility of discussions with the regional Governments with a view to joint working, whatever their role might be? I think of young Oscar Knox in Northern Ireland, and that is really my reason for making the suggestion.

[Steve Brine]

I am glad that the hon. Gentleman is here. He raised the same point last week during the Westminster Hall debate on blood cancers, to which I responded. As he had to leave before I did so, I will repeat what I said then. Obviously, once devolved government returns to Stormont and there is a Health Minister in the Northern Ireland Executive, I shall be happy to meet him or her, and I am sure that the hon. Gentleman would like to be involved in that meeting. We shall then be able to talk about some of the successes that we have had in England and some of the things that I am sure we can learn from Northern Ireland.

An even more precise form of radiotherapy that can be used in neuroblastoma treatment is proton beam therapy. It sounds like something out of the future, and in many ways it is, but the future is coming. In 2012, the Government provided some £250 million for the building of two PBT centres in England, at University College Hospital here in the capital and at the Christie cancer centre in Manchester. I had the privilege of visiting the Christie last year—I happened to be there in the autumn, for some reason—to see its new PBT facilities, which are incredible and which will be providing treatment for patients later this year. As a result, the NHS will no longer need to send young patients to the United States—which has caused great upheaval to patients and their families, has had an impact on patient outcomes and has, of course, involved huge expense to the families and the NHS—for this cutting-edge treatment.

My hon. Friend the Member for Spelthorne spoke about guidance from the National Institute for Health and Clinical Excellence. We want the very best new innovative treatments, such as the promising antibody therapy we have heard about today, to be available on the NHS. NICE is the independent body that provides guidance on whether drugs and other treatments represent a clinically effective and cost-effective use of resources in the NHS—a publicly funded health system. I am advised that NICE is currently considering two antibody-based treatments for neuroblastoma. It is appraising Dinutuximab-beta for use in high-risk neuroblastoma, but the appraisal has been delayed as NICE awaits additional evidence from the drug company. Final guidance on the use of any drug can be issued only after careful consideration of all the available evidence and extensive engagement with stakeholders. That has to be the right approach, however frustrating it is. Another drug used in the treatment of high-risk neuroblastoma is dinutuximab or Unituxin. NICE’S appraisal of this drug, which is in the same family as Dinutuximab-beta but is distinctly different, has also been suspended as demand for the drug in the United States has exceeded expectations and is outstripping the company’s ability to meet global need.

I stress that just because drugs are not routinely available to patients on the NHS that does not preclude their use. Clinicians can make a case on a patient’s behalf for exceptional funding if they believe a particular treatment would deliver the best clinical outcomes. I understand that Alfie’s consultant is looking at doing that. Individual funding requests made by a supporting clinician are always a potential route for access to treatments that are not currently commissioned by the NHS. NHS England is not aware of any IFR in Alfie’s case, but I will be happy to make it so, working with my hon. Friend, following tonight’s debate.

Despite the strides we have made in increasing overall cancer survival rates, we recognise that there are some cancers where progress has been far too slow. That is why our focus for these cancers is on research and innovation, and ensuring that proven innovations, once they are discovered, are adopted swiftly across the health service in England. I am pleased to say that the Government are fully supportive of the Less Survivable Cancers Taskforce, which I launched last summer here in the House, specifically to address the survivability gap between the least and the most survivable cancers. I met the taskforce just before Christmas to discuss how we can work together to raise awareness of the symptoms of cancer and how we can ensure that less survivable cancers have better access to research funding. That is a promising workstream. The taskforce is a cutting-edge group and I look forward to working with it.

Cancer Research UK is also funding research to better understand childhood cancers such as neuroblastoma. In September 2016, the Government announced the largest ever investment in health research infrastructure—£816 million over five years from April 2017 for 20 National Institute for Health Research biomedical research centres in England. That was a big step, and I am sure hon. Members recall the Prime Minister’s announcement. That includes £61.5 million in the biomedical research centre at the Royal Marsden Hospital here in London and the Institute of Cancer Research. The NIHR spent £137 million on cancer research in 2016-17—an increase from just over £100 million in 2010-11. That investment in cancer research is of huge importance and constitutes the largest in a disease area.

Stroke Services

Debate between Jim Shannon and Steve Brine

Tuesday 5th December 2017 Commons Chamber

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

What a pleasure it is to see you, Madam Deputy Speaker; it has been a while. I knew that my hon. Friend the Member for Southend West (Sir David Amess) would get in a mention of Southend becoming a city. I was only disappointed that it did not happen earlier in his speech, but he managed it in the very last line. I will show great diplomacy and leave that matter to the Ministers responsible. I congratulate him on securing another Adjournment debate—we have done this before—which is on stroke services this time. As ever, he set out his case brilliantly and with such passion. He gives newer parliamentarians a real lesson in how to handle debates in this House.

As my hon. Friend said and as so many of us know, stroke is a devastating disease for patients and their families. He is right that there are currently 1.2 million stroke survivors in the UK, with more than 1,350 in my hon. Friend’s constituency alone. The hon. Member for Strangford (Jim Shannon), who is in his place as always at these debates, is absolutely right that stroke is predominantly a condition that affects older people. But it does affect younger people. I have met people of my age and younger who have been affected by stroke. Obviously, it is clinically debilitating, but it also comes as a great shock to their friends and families, who are taken aback by this happening to young people.

So many NHS staff work in multidisciplinary teams on stroke, and I pay tribute to them. There are nurses, consultants and speech and language therapists—the speechies, one of whom I am married to, so I will get brownie points for this—as well as physios, occupational therapists and specialist nurses, who all do so much when somebody suffers a stroke. The Stroke Association, which has already been mentioned, is an absolutely first-rate charity and a real partner for the Government. I also commend my hon. Friend the Member for Southend West for his strong work in driving improvements to stroke services both nationally and within his constituency. I know that he has taken a long interest in health matters, including stroke, as an MP. I reiterate his comments about the high-quality service provided by Southend stroke unit—more on that in a moment.

My hon. Friend will no doubt agree—he said this of course—that, in general, stroke services across the country are performing really well. Let me just reiterate some of the figures. Thirty-day mortality has dropped from 30% in 1998 to just over 13% in 2015-16—a huge improvement. The percentage of patients scanned within one hour of arriving at hospital, which is so critical, has increased from 42% in 2013-14 to over 51% in just three years, and the percentage scanned within 12 hours has increased from 85% to 94% in the same period.

There are many public health campaigns that we remember throughout the years, but the Act FAST campaign that public health campaigners and the Stroke Association have done is something we see and do not forget, and that, of course, was the intention.

Excellent progress has been made in the treatment of stroke over recent years. It is important that this programme continues and that the gains are built on, especially given the demographic changes we know are coming down the track with our much talked off and much publicised obesity challenge and our ageing population. That is why we published the cardiovascular disease outcomes strategy in 2013.

There is ongoing work in virtually all parts of the country to organise acute stroke care to ensure that all stroke patients have access to high-quality specialist care, regardless of where they live or what time of day or week they have their event. Although the national stroke strategy comes to an end shortly, as my hon. Friend said, NHS England continues to lead an effective programme of work on prevention and treatment. We are continuing to work closely together to improve acute treatment through the centralisation of care in centres that can provide the highest level of care and treatment at all times of the day and night.

Decisions on whether the strategy should be renewed are, of course, a matter for NHS England, but in liaison with Ministers. My understanding is that NHS England does not have current plans to renew it in the same form, but it is a subject that I, as the relatively new Minister, encouraged, of course, by my hon. Friend’s debate, plan to discuss with NHS England early in the new year. I would welcome my hon. Friend’s involvement —and that of other Members—if he wishes to feed into that.

[Jim Shannon]

I thank the Minister for his comprehensive response. One thing that is sometimes overlooked is research and development—the work that is done by universities in conjunction with health groups to try to find better ways of caring for people with strokes. Does he have any information on how critical that is to the whole care package that is given to those who have had strokes?

[Steve Brine]

I echo the hon. Gentleman’s sentiment that that work is critical. I mentioned the Act FAST campaign, which was a heavily evidenced public health campaign showing that the quicker we act after the event, the better the outcome, so he is absolutely right to highlight that issue. However, I am conscious of time, so I am going to press on.

My hon. Friend rightly spoke about mechanical thrombectomy, which he called a game-changer, and he is absolutely right. To continue and build on our stroke service success and to address the costs associated with stroke in England, which was one of my hon. Friend’s first asks, it is imperative that we keep identifying and developing innovative treatments and cutting-edge procedures.

In mechanical thrombectomy, or MT as we shall know it, we have an innovation that we believe can significantly improve patient outcomes, and my hon. Friend spoke about that. In April this year, NHS England announced that it will commission mechanical thrombectomy so that it can become more widely available for patients who have certain types of acute ischaemic stroke, which is a severe form of the condition. My understanding is that work by NHS England is now under way to assess the readiness of 24 neuroscience centres across the country. It is expected that the treatment will start to be phased in later this year and early next year, with an estimated 1,000 patients set to benefit across the first year of introduction. Overall, this will benefit an estimated 8,000 stroke patients a year and save millions of pounds in long-term health and social care costs—my hon. Friend was absolutely right to point out the rising costs to NHS England around this condition.

As the clinical director for stroke at NHS England has said, we are committed to fast-tracking new and effective treatments that will deliver long-term benefits for patients. For me, this treatment is just one example of many that we believe have the potential to tangibly improve patient care and to address rising costs.

Hormone Pregnancy Tests

Debate between Jim Shannon and Steve Brine

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

All I said is that there were checks to be made to ensure that the report was as readable and as accessible as possible. We are confident in the report, and we are not going to sweep it away and forget about it and move on to the next story; we will implement the recommendations.

[Jim Shannon (Strangford) (DUP)]

Will the Minister outline what support is on offer to those who took Primodos and were traumatised by stillbirth when it was not possible to carry out genetic testing because the baby had died and the remains were gone? We understand the Minister’s compassion, but where is the redress for the still-grieving parents? Where is their support? Where is their help?

[Steve Brine]

I repeat that we cannot turn the clock back. The conclusions of any review, no matter how it is done, cannot take away from the suffering of families and constituents. I repeat that the review of the evidence by the expert working group was comprehensive, independent and scientific. We are confident in the report and in the review process, and we will now get on with implementing the recommendations.

Adult Social Care Funding

Debate between Jim Shannon and Steve Brine

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

Although I am not specifically the Minister with responsibility for care, I am the public health Minister and the primary care Minister. We have brought those two subjects together because we want to see a healthy population across the board. I am pleased that my hon. Friend has mentioned the Commission on Loneliness. It was probably set up before she entered this House; it was started by the late Member Jo Cox, who did some really good work that is rightly being taken forward in this Parliament.

[Jim Shannon (Strangford) (DUP)]

Carers in Northern Ireland who provide for elderly and disabled loved ones save the NHS some £4.6 billion, and that figure rises to £132 billion across the whole of the United Kingdom. How does the Minister intend to ease the pressure on them by funding more respite places, to allow families to have the much-needed breaks that enable them to carry on caring in the long term?

[Steve Brine]

I will look into that. The hon. Gentleman makes an important point. I am sure that Members across the House take part in carers week events every year. I certainly do that in my constituency. It is at those events that we meet not only the staff who work in the system but the people who, day in and day out, do not have the life that they would like to have because they have caring responsibilities. We also meet young carers who do incredible work. The hon. Gentleman is right, and we should all say a clear thank you to those people for the work that they do.