Children’s Wellbeing and Mental Health: Schools

Jo Churchill Excerpts

Tuesday 10th January 2017 Westminster Hall

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under you chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb), with whom I share a mental health trust, which we are both glad to see is out of special measures. I congratulate the staff on that, but there is much more work to do. I concur with other Members who have said that prevention is better than cure. There could be no more opportune time for this debate, which comes a day after the Prime Minister highlighted mental health, and particularly children’s mental health, as a problem. We have been talking the talk, not walking the walk, for quite long enough.

Why have I chosen to speak today? Mental health is one of my top three surgery priorities. Week after week, in surgery after surgery, I see families whose lives are breaking down because of waiting times. Very often, it is not only the child at the centre. Often Mum has given up work, so there is an economic impact; Dad has stopped doing overtime, so there is a further economic impact; and the siblings do not quite get the activities that they used to, because everybody is focused on the child who has the problem at that time.

I have four children; the last left school last year. Like my hon. Friend the Member for Taunton Deane (Rebecca Pow), I have been somewhat horrified over the past 10 years, as they have travelled through their teenage years, to see how their contemporaries have struggled with mental health and to see the help that has been available for them. As a governor some 10 years ago, the fact that some of my children would be sent hundreds of miles away, when we know that closeness to the family gives better outcomes in the long term, filled me with horror. We really need to drill down into the issue of tier 4 beds and the local availability of child and adolescent mental health services.

As governors and teachers, we instigated sessions with parents on eating disorders and resilience. The World Health Organisation’s whole-school approach is the right one, but we actually need a whole-system approach of teacher training, actual connectivity and knowing where the services are. School-based counselling is excellent, but as the right hon. Member for North Norfolk said, we need to ensure that the funds are there at the right time. Like my hon. Friend the Member for Taunton Deane, I welcome fairer funding, but the fairer funding formula for Suffolk still leaves us short of the national average, so for us it will make a slight difference but not enough. Suffolk’s population is rural, and delivering issues rurally causes problems. It is much harder for us, with a sparse population in which more than 40% are scattered around, to deliver those scattered services.

Why do only 25% to 40% of children and young people currently receive input? Some 50% of lifelong mental health illnesses develop before the age of 14, and 75% before the age of 25. Young people with mental health problems use other coping strategies: self-harm is one that is familiar to me, unfortunately, and they are four times more likely to turn to alcohol. All these are destructive. They are 20 times more likely to go to prison, as we have heard. Tragically, they are six times more likely to die before the age of 30.

One in seven adults has a common mental disorder. If we capture these problems earlier on, we will be doing ourselves and the country a great service, saving people’s lives and building resilience within their families. I was glad to hear the Prime Minister placing importance on mental health, but at the schools and colleges I go to, particularly my sixth-form college, the pastoral care teams reckon they spend up to 70% of their time on mental health issues. I have talked to teachers in the primary sector, who are seeing issues earlier and earlier. We need that teacher training and we need that funding.

How do we improve? We must build resilience, both personally and emotionally. We must focus on young women, who are three times more likely to experience common mental disorders than young men. However, our young men have less ability to express themselves and we see greater suicide numbers in young men, so we need a comprehensive approach. I encourage schools to reach out. Like my hon. Friend the Member for Taunton Deane, I support volunteering and using green spaces. The Green Light Trust does a great deal locally; Westgate Community Primary School does the daily mile. Exercise and sport improve outcomes, because children are within a team—research backs that up. Reducing the hours children spend in front of a screen, ensuring they eat together—all these things are part of resilience building.

When things go wrong, we do not want to medicalise, but we do not want to wait. People need services locally, and we need our children not to be sent all over the country. We have to look at the provision of funding and the allocation of resources. The lack of the family unit locally undermines short and long-term recovery.

I pay tribute to the fantastic work of the Prince’s Trust, of the Duke and Duchess of Cambridge and of Heads Together, which aims to destigmatise and shine a light on the area. That is to be welcomed. I will not give the statistics about body image and coping with work for young people, because we have already heard them, but we need to understand where the money goes. When I spoke to my local mental health trust recently, I discovered that some £363,000 went to eating disorders, but that there was no more money for any additional services. That worries me.

I ask the Minister the following questions. Young people’s mental health needs prioritising. How do we scrutinise those who commission those services? I welcome the £67 million investment in digital connectivity, but many of my constituents do not have access, and there is a broader issue with telecare and prescriptions. How are we locking into the Department for Culture, Media and Sport and the Department for Communities and Local Government to ensure that the fourth utility is there? Will she assure me that rural areas will be fairly treated? As in everything, we sit in the lower quartile both for education and for health, and that is not a good combination. How can we ensure that cuts in community care and local government support, which often give support services the money they are looking for, are considered effectively? Many trained professionals have moved out from children’s services into adult services. We need to capture that skill and bring it back.

It was my birthday when “Future in mind” was announced. I want to understand how we will properly evaluate whether the money that was announced yesterday—most welcomely—and the money announced in “Future in mind” is being spent where we need it to be spent, so that we can understand what is working. I was also glad to hear the Secretary of State for Health announce that sustainability and transformation plans will not be passed without mental health being high on the agenda.

Many have said that the journey to better mental health starts with a conversation, so I hope that this is our conversation and that by 2020 there will be shorter waiting times and talking therapies in every region, and particularly for my young people.

Accelerated Access Review

Jo Churchill Excerpts

Tuesday 13th December 2016 Westminster Hall

[Ian Austin]

The hon. Gentleman is completely right to say that Orkambi could reduce hospital admissions, and could shorten the amount of time people spend in hospital when they have been admitted.

In its statement, NICE referred directly to the trust’s proposal as a potential solution to the shortage of long-term data. With the NICE process exhausted and seven months wasted, we hoped that the way would be clear for direct negotiations between the drug manufacturer Vertex and NHS England, which would allow for a speedy resolution to the situation. However, Department of Health officials then demanded that the drug be put through a rapid review process, which, at 16 weeks, is anything but.That process is based on exactly the same criteria that had just seen Orkambi denied to those who need it. Vertex has declined to enter the process, because of the certainty that it will come to nothing.

New data published in October at the North American cystic fibrosis conference, which my right hon. Friend the Member for Leigh (Andy Burnham) mentioned, are based on 96 weeks of trials and show that Orkambi slows the decline in lung health by up to 42%. That is comparable with the 47% slow in decline caused by the transformational treatment Kalydeco, which is widely available in the UK for a less common mutation of cystic fibrosis. Those data were unavailable to NICE but clearly illustrate that drugs such as Orkambi need the chance to prove their worth in the long term. That also underlines the fact that we now have a situation where people with cystic fibrosis face discrimination by genotype, because they are being denied the same level of treatment that people with a different genetic mutation of cystic fibrosis receive.

Twelve months after licensing, negotiations are at a standstill. I understand that Vertex is keen to offer a substantial discount, but for commercial reasons would need to do so confidentially. It would like to take up the trust’s offer of monitoring the effectiveness of Orkambi for a trial period. That could build on the American data and allow NHS England to conduct final negotiations based on an accurate reflection of the drug’s effectiveness.

[Jo Churchill (Bury St Edmunds) (Con)]

I would like to thank the hon. Gentleman for securing such an important debate. One of the beauties of cystic fibrosis data is that they capture 99% of all people with the disease, so could truly be used as an exemplar. The accelerated access review calls for accurate monitoring via data, and this offers an ideal chance to do that.

[Ian Austin]

The hon. Lady is completely correct. It is good that she is here in the Chamber, making these important points.

Vertex is also keen to explore flexible reimbursement schemes, which would allow the NHS to manage the overall budget impact of the treatment. However, the inflexible current system insists that any offer has to be made public, rejects the trust’s solutions and offers no scope for flexible reimbursement schemes. That brings me to the accelerated access review, which was commissioned to speed up access to innovative new drugs and treatments such as Orkambi. The review was finally published in October, after a long delay, and recommends that NICE reviews its processes. It calls directly for the current system to change, to include more emphasis on the confidential commercial arrangements, flexible reimbursement arrangements and collection of real-world data that I and other Members have referred to. Those recommendations could be the key to reaching a deal that delivers Orkambi to those desperate to receive it.

When the review was commissioned last year by the Minister’s predecessor, the hon. Member for Mid Norfolk (George Freeman), he spoke of how accelerating the uptake of transformational technologies in the 21st century would attract investment in research and innovation to help us earn the prosperity we need as an advanced economy. When the review was published in October, NHS England’s chief executive, Simon Stevens, said that creating headroom for faster and wider uptake of important new patient treatments would create opportunities for the UK’s globally successful life sciences sector. The failure to deliver Orkambi undermines that vision.

We have a rigid and inflexible system, and warnings that it is not fit for purpose have been ignored throughout the process. Instead of embracing the opportunity for an innovative solution, we have been offered further negotiations based on criteria that have already failed once. That is a waste of time and taxpayers’ money and sends completely the wrong signal to a global life sciences industry currently questioning future investments here in the UK. Hugh Taylor, the review’s chair, set out the need for commitment and collaboration across Government, the NHS and the life sciences industry to make the review’s proposals a reality.

The review sets out criteria for transformational treatments that should be fast-tracked for access. Orkambi meets those criteria. It presents the perfect opportunity to put many of the review’s proposals to the test, to illustrate the commitment and collaboration needed and to demonstrate how we can come together and adapt in the light of new information. It is predicted that 95% of people with cystic fibrosis could benefit from a personalised medicine within five years. Coming up with a solution for Orkambi—one that makes sense to the NHS as well as reflecting the investment that goes into these treatments—will give us a genuine opportunity to beat this condition.

I am sure people will benefit from the review’s proposals in the years to come, but that must not be at the cost of Orkambi, which is available now. Many people with cystic fibrosis, as well as their families and carers, such as my constituents Carly Jeavons and Samantha Carrier, are watching this debate. Many of them are forced to spend weeks and months of each year in hospital, and most of all they want a chance to be able to do the everyday things we all take for granted, such as raising a family, planning a holiday or breathing without struggling. They have already endured needless delays, and as time goes on those delays present an obstacle to investment in future treatments to beat cystic fibrosis. That is not the vision set out by the accelerated access review.

Social Care Funding

Jo Churchill Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

The hon. Lady made two points, both of which I agree with. The first was that in Scotland there has been a 9% reduction in delayed transfers of care. It is also true that in England many parts of our system, particularly those that have integrated most quickly, have achieved reductions of that size and more. She is right that the STPs are part of the process of re-engineering the system. Adult social care and the integration of adult social care are a big part of that and we need to ensure that we deliver.

[Jo Churchill (Bury St Edmunds) (Con)]

Does the Minister agree that better integration could be driven by better patient data, which could help to show us where quality practices exist and how to spread best practice?

[David Mowat]

I do agree. I had a discussion with the Care Quality Commission on the dataset that is reported, and I hope that over the next months and years we can improve how we do that.

Cancer Strategy

Jo Churchill Excerpts

Thursday 8th December 2016 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

I am most grateful to you, Mr Deputy Speaker, for calling me to speak in this important debate.

I listened with great interest to the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) talking about his experiences of smoking. I gave up smoking before a flight with a parliamentary delegation coming back from Bahrain nearly 15 years ago, and I have never looked back. One of the drivers that made me give up smoking was a conversation with the then Member for Manchester, Withington—I would call him an hon. Friend, but he was an Opposition Member—who is now Lord Bradley. Like the hon. Member for Poplar and Limehouse, I remember smoking in the House. I remember lighting up in a Standing Committee and being reprimanded, but we could smoke in the Library Room C then. I offered the then Member for Manchester, Withington a cigarette in the Tea Room—we could smoke anywhere then, as well as in the Smoking Room—and he said, “David, no thanks. I’ve got an emphysema hospital in my constituency.” That really hit home.

The hon. Member for Scunthorpe (Nic Dakin) is nodding. May I pay tribute to him? He was at the Britain against Cancer conference on Tuesday, which I attended as an officer of the all-party group on cancer. He has served on that group for much longer than I have, and he chaired the meeting in the absence of my hon. Friend the Member for Basildon and Billericay (Mr Baron). Other hon. Members have paid tribute to my hon. Friend, and of course to his wife, who is undergoing treatment at the moment. I want to say what a great job my hon. Friend has done to drive this agenda on the Conservative Benches. It just shows that if you follow something you believe in in this House, you can get dramatic results.

As a politician, I often think that we should be able to sum up something, such as a very wordy report, in just a phrase or a sentence. That may be because of my background in advertising many years ago. Those dramatic results were clearly illustrated by Simons Stevens, when he said that in 1999, 60% of cancer patients survived, but in 2014, the figure was 70%. We went over some of those figures, which I thought were truly remarkable and really very encouraging.

I want to focus on something else that Simon Stevens said, which the hon. Member for Scunthorpe has mentioned. He announced £200 million of funding at the conference:

“The £200m fund has been set up to encourage local areas to find new and innovative ways to diagnose cancer earlier, improve the care for those living with cancer and ensure each cancer patient gets the right care for them.”

That includes aftercare treatment. What do we do when a patient has had chemotherapy and then there is nothing else—they have not been given any other options, so they feel depressed and unhappy?

That is where my main experience in this House comes in, as I have worked on integrated healthcare—holistic medicine, I suppose—with the all-party parliamentary group on integrated healthcare for nearly 30 years. I have been an officer of the group for nearly 25 years, and have chaired it for quite a while. It feels almost as if our time has come. It has now been clearly recognised that part of the cancer package should be a wide range of support. We can see that all over the country. I was at LOROS last week, which is where very ill people in Leicestershire go for their last few days. A range of different therapies were being offered there. That is happening not just in my constituency but in many others.

I return to the conference mentioned by the hon. Member for Scunthorpe—[Interruption.] I see he has now been promoted to the Front Bench. That is the great thing about the Opposition—the Front-Bench team changes so quickly that we can never be sure where any hon. Members are. I remember that when I was a young Member the advice I was given was always to sit in the same place in the House so that the Speaker knew where you were. In that case, it is a wonder that any Opposition Members get called at all, because they are always moving around the Benches. The hon. Member for Scunthorpe has clearly been promoted this afternoon, so congratulations.

One battle I have had over the years has been with the medical establishment about what should be included in treatments on the health service. It has been an ongoing battle against vested interests in the medical establishment who do not want to see money leaking from their own particular silos. That is down to scarce resources. One of the most interesting stalls at the Britain against Cancer conference on Tuesday was about cancer detection dogs. Even I gasped when I saw it—my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who has also had experience of cancer and has contributed so much in her short time in this House to addressing cancer problems, is nodding and smiling. Just as we have dogs in this House—I will not say when or where they go—to detect things that may have been placed here by people who do not particularly agree with what we do, so it is possible to use dogs to detect cancer. If that is possible, I suspect that the authorities in the health service have not run double-blind placebo-controlled trials to establish whether it works. It works on the basis of experience, because the dogs are trained to detect by smell when people have developed cancer.

On the great battleground with the orthodox proponents of orthodox medicine, the battle line has in recent years been drawn on something called evidence-based medicine. We are told that in the health service medicine should always be evidence-based, and nothing should be used unless it meets that criterion. I had a look at that, and got the Library to look the papers up. It goes back to 1992 and a statement by Professor Sackett that various other academics then ran with—there was a Professor Guyatt also. But when saying how important evidence-based medicine was, Professor Sackett also said:

“Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

It is hardly a secret that we were discussing Brexit in the House yesterday and that we have been very much involved in the whole debate since the summer—and for many of us, a long time before that. One problem in healthcare in relation to the EU has been the imposition of directives on the UK that have negatively impacted support services in healthcare. The traditional herbal medicines directive requires Chinese medical practitioners to show 30 years’ usage of a particular medicine in the UK, or 15 years under other circumstances, and bans a whole range of complex preparations freely available, and produced to very high standards in modern factories, in the People’s Republic of China.

Before I came to the Chamber this afternoon, I was at a Chinese medical clinic. I practise what I preach and have acupuncture once a month. I take Chinese herbal medicine and I think it has kept me away from antibiotics, steroids and other drugs for a good few years. I talked to practitioners about what they are able to do for cancer patients. There is a very long list of types of cancer that can be treated using traditional Chinese herbal medicine: cervical cancer, Non-Hodgkin lymphoma, HIV, colon cancer, head and neck cancer, breast cancer and prostate cancer. The list goes on.

I believe that several of my constituents are alive today because they have used Chinese medicine. It strengthens one’s immune system and is very effective after cancer treatment. It deals with particular symptoms. I asked the practitioner this afternoon what conditions she would expect to be able to alleviate using Chinese herbal medicine and acupuncture. She said: tiredness, lack of energy, fevers, headaches, hypertension, dry skin, seizures and involuntary muscular twitching.

We have to broaden the scope of services available on the health service to help to meet patient demand. I hope the £200 million fund will mean a further widening of the scope of services available. My hon. Friend the Minister, who is new to his post, could do a lot worse than contact the head of the Professional Standards Authority, Harry Cayton. Harry Cayton’s organisation oversees the regulation of 23 different health organisations, including about 20,000 providers. If we go to the trouble of regulating different therapies, or having oversight of that regulation, why on earth do we not use it? What is the point of having a statutory regulator that checks the oversight when we do not actually use its services? That is a great mistake.

My hon. Friend the Minister could do a lot worse than go around the country and look at some of the practices that help cancer patients in remission. One of the best is the award-winning Velindre cancer centre in south Wales. Each year, it sees over 5,000 new referrals and about 50,000 new out-patient appointments. It employs over 670 staff and has an annual budget of over £49 million. The money for that service, which is widely used by doctors, comes not from the Department but from charitable donations. At that centre, they use reflexology, reiki healing, which I have studied over the years, aromatherapy, and breathing and relaxation techniques, and they have spectacular results.

Another wonderful clinic that my hon. Friend would do well to visit—it is a few stops on the District line from here, in Fulham—is the Breast Cancer Haven. It offers a range of therapies to combat stress, and I have attended its sessions. It is wonderful to see people suffering from breast and other cancers being given hope that chemotherapy is not the end of the road and that there is something out there to support them.

Another wonderful organisation of which my hon. Friend should be aware, and which was at the cancer conference on Tuesday, is Penny Brohn UK, the living well with cancer organisation. It has worked hard to produce a report on the long-term impact of its living well course, and the results from the five-year follow-up show a high approval rating among patients. The figures are staggering: 97% of patients reported making positive lifestyle changes after the course; 75% said they had maintained the positive changes for four to five years or were still maintaining them; and 85% said the living well course had enabled them to self-manage their health more effectively.

My hon. Friend, being well aware of Government policy, will know that patient choice is, according to the Health Secretary in the last Parliament, at the heart of the health service. If we are to give patients choice, we have to give them the provision to choose from. I was a member of the Health Committee for the whole of the last Parliament—I chaired it for a while when Stephen Dorrell stood down, before my hon. Friend the Member for Totnes (Dr Wollaston) took over—as well as a member of the Science and Technology Committee, both of which looked at the complex problems of polypharmacy and polymorbidity, which is jargon for too many people taking too many drugs and nobody really knowing what those drugs do. We need to reduce that.

There is a crisis in this country with antimicrobial and antibiotic resistance—we are not getting new antibiotics into the pipeline—and part of the problem is that we are trying to create new drugs while also trying to reduce antibiotic use. There is a range of other therapies that can help patients stay away from antibiotics. I will not get called to order, Madam Deputy Speaker; I know that this is a cancer debate, but a lot of alternative therapies—I will get to the H word, homeopathy, in a minute—offer options at a time when mainstream medicine is running out of solutions.

I have always championed the cause of homeopathy in this House, and I want to relate that strictly to cancer this afternoon. Homeopaths do not claim to cure cancer, but my goodness they can assist people who have had cancer and who are in remission by helping them to adjust their moods and to deal with anxiety and sleeplessness. It is a great tragedy that a tiny number of people, whom I regard at best as foolish and at worst as wicked, are trying to erase the tiny sum of money—£500 million—spent on homeopathy in the health service. Without looking at the benefits, they argue that it is a waste of money.

We have seen the pressure on institutions at Liverpool and elsewhere. What could be more stupid than to attack a medical system that is widely used in France, that voters went for in Switzerland, and that is used across the world, including in India and Brazil? What is the problem here?

I was in Toulouse to look at British Aerospace work recently, and I found a homeopathic chemist right in the middle of the main square there. Some 90% of pregnant women in France use homeopathy. The Minister must not be bludgeoned by the tiny number of people who use legal threats and resist it. Simon Stevens is now coming up with new money for aftercare for cancer, so we need to look out of the box and consider new possibilities. We are not even looking at some possibilities that are orthodox.

As I said, I am an officer of the cancer group, and I chaired a meeting the other day to hear anxious and anguished professors of medicine from this country talking about a new mainstream treatment called Target for breast cancer. Target is about putting a small device the size of a tangerine on the end of a cricket stump into an incision in the chest. The chemotherapy treats the tumour and not all the other organs in the chest. The professors saw this as a great breakthrough. It was invented in Britain, and it is widely available in Europe. How come NICE has only given it draft clearance? What is going on? Professors of medicine are saying that this is hugely important, yet we are not actually dealing with it.

[Jo Churchill (Bury St Edmunds) (Con)]

On that particular point about targeted interoperable radiotherapy, I too have spoken to these professors, and I understand where they are in the clearance process. I find it a little bit concerning when there is a lack of money in the system. Is my hon. Friend aware that there are half a dozen machines around the country that could deliver that targeted therapy? Perhaps we need to look at what we should do first—whether it is purchasing the machines or giving the clearance in full.

[David Tredinnick]

My hon. Friend makes her point very well. In his excellent presentation, Simon Stevens talked about bringing new equipment onstream for radiography, I believe. [Interruption.] Yes, my hon. Friend was there, and she confirms this. I certainly agree with what she said, and we need to wake up to what is being invented in Britain and used across the world.

I shall conclude shortly, in case anyone else is hoping to catch your eye, Madam Deputy Speaker. I want to finish with a couple of other points. There are other treatments out there, to which people turn in desperation when they reach the end of their conventional treatments. One of them is called oxygen therapy, and broadly speaking it means getting more oxygen than is normally received, from a container. It is not a very expensive treatment, and the information I am getting is that it produces spectacular results when it comes to energising people and improving their sense of self-worth and wellbeing.

My final point is one that I find amazing. In the great cancer hospitals and clinics of this country, diet is seen as a sideline. In some of these institutions, the diet is, frankly, appalling, but I am not going to name of any of them this afternoon. Like most colleagues, I have a big enough postbag already and I do not want to hear the defence. Anyone attending a big clinic in America, such as the Mayo Clinic, can say goodbye to dairy and sugar, and hello to more juices. The Haven in Fulham certainly uses a lot of raw juices and raw vegetables. Diet is absolutely fundamental. When I worked in the computer industry, we used to say “Garbage in; garbage out”—and the same applies to humans. Our outputs as a being—[Interruption.] The hon. Member for Scunthorpe (Nic Dakin) does me the honour of laughing, but it is true. Diet is such a soft ball to hit, is it not? We are spending millions of pounds on all these expensive treatments, but what about telling people to cut back on sugar? Well, there we are.

I have tried to address some of the issues following the landmark speech at a landmark conference on Tuesday. For the first time, we have seen a lot of money set aside for developing aftercare for patients and improving services around mainstream medicine.

My hon. Friend the Minister has a great opportunity to make his mark in the House. His Department is, I believe, the fourth largest employer in the world. I think the Red Army comes top and McDonald’s second; I expect another burger provider comes third; and my hon. Friend is presiding over part of an organisation that comes fourth. His brief gives him enormous opportunities to improve the quality of life of cancer patients in this country, and by the time he has finished, there should not be just an increase in the cancer survival rate from 60% to70%—his target should be 80%.

Madam Deputy Speaker, I rest my case.

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[Bob Blackman]

When the change in law came through, a number of people objected to it, saying that it would not be enforceable. I remember back to my childhood when both of my parents were smoking in the car in front of me. It was difficult then as a child to say, “Please, will you not smoke, because I do not like it?” It was just easier to open the window. I do not want children to go through that. It is right and important that we changed the law in that way, as we know that second-hand smoke is a key killer of young lungs. It was a significant development—and a development that people did not think would happen. People did not think that we could introduce this change and get it through both Chambers, but I am delighted to say that we did it and that it was the right thing to do.

[Jo Churchill]

I thank my hon. Friend for providing such a powerful case. I could not agree with him more. To my way of thinking, banning smoking would do me, but we probably cannot go that far. Does he agree that the broader point of health economics is also important? Lung cancer is not the only issue. There is also emphysema, pulmonary disease and so on. If we sort out the tobacco issue, we could make much broader savings across the health service.

[Bob Blackman]

There are aspects of that with which I agree. The reality is that tobacco is the only product in the world, which, if used in the way that was intended, will kill us. Therefore, controlling it is vital.

We know as well that those with complex medical needs have the highest smoking rates. I am talking about people who are unemployed, who have mental health conditions, and who are in prison. I am also talking about the people whom I am championing at the moment—the homeless. All of them are much more likely to smoke than others, and they are also more likely to have the most health problems as a direct result. It is quite clear that the most disadvantaged members of society are more likely to smoke and therefore suffer cancer and other health-related problems as a result. Clearly, we need to take action. Quitting smoking reduces the likelihood of having cancer. It is also key that lungs can recover if one gives up smoking. We must encourage people to give up smoking and, more importantly, to try to prevent young people from ever starting. The hon. Member for Strangford (Jim Shannon) told us what happened to him as a five-year-old. I would not advocate that as a shock treatment. None the less, it is quite clear that stopping people starting to smoke is the best way forward, rather than trying to get them to give up later in life.

The recent report “Smoking Still Kills”, which was endorsed by no fewer than 129 organisations, recommended that, as a target, we should reduce adult smoking to less than 13% by 2020 and to 5% by 2035. I take the point made by my hon. Friend the Member for Bury St Edmunds (Jo Churchill): that is not ambitious enough. We should be going for a smoke-free Britain, or, rather, a smoke-free United Kingdom. I must get my phraseology correct.

To achieve that target, we need mass media campaigns, which the Department of Health has ceased. We need stop-smoking services to be encouraged, promoted and funded across the UK, and local authorities should enforce the necessary activities and to do their job. We know that mass media campaigns are extremely effective and cost- effective in prompting people to stop smoking and in discouraging young people from starting. In 2009 we had funding of just under £25 million for anti-smoking campaigns, but by 2015—last year—that had been reduced to £5.3 million. That is a false economy.

If we had much better funding for mass media campaigns, I am sure we could reduce the incidence of smoking far more. Equally, we know that stop-smoking services across the UK have been highly effective in reducing smoking rates. Smokers are up to four times more likely to quit if they have support from specialist groups and smoking services, compared to quitting cold. The hon. Member for Poplar and Limehouse referred to when he gave up smoking, and he can remember the time and the date when he did so. Most people who have smoked in their adult lives have difficulty giving up and they need help and support. We should ensure that that is available.

The sad fact is that right across the UK smoking cessation services are either having their funding reduced or being closed altogether. That is extremely regrettable. I suggested to the Chancellor that by putting just 5p on a packet of 20 cigarettes and using that money to fund smoking cessation services we could provide all the money that is needed to continue smoking cessation services across the United Kingdom. That, to me, would be a very sensible investment indeed.

Funding for trading standards has fallen from £213 million in 2010 to £124 million now; the teams have been cut to the bone and the number of staff working in trading standards has been reduced radically. That means fewer local controls to target illicit tobacco in the way we should, to prevent some very nasty products from being used by people across the United Kingdom. That is a retrograde step. We need to invest in those services to make sure that we deliver better health outcomes.

We desperately need a new tobacco control plan and programme so that we can see the radical targets that are needed and the investment required across the United Kingdom. We should be setting out our stall—we want a smoke-free United Kingdom not by 2035 or beyond, but by 2020 or 2025. We can achieve it with the right programme. The key point is that if we deliver this plan, we will cut the rate of cancer deaths and the number of people suffering from cancer, which will reduce the burden on the national health service and allow us to take that money from the health service to use on the more difficult cancers that colleagues have mentioned. Those cancers are difficult to spot, difficult to treat and need specialist drugs and specialist treatments.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

I, too, thank the Backbench Business Committee for allowing this debate. I also thank the hon. Member for Scunthorpe (Nic Dakin) for the way he introduced it, which has allowed us to conduct it in the tone that we have.

I came to this place after a journey with this disease, but I have been amazed since I have been here. The hon. Member for Bristol West (Thangam Debbonaire) has fought the disease and now sits back in her place, and very welcome that is. The news about the hon. Member for Blyth Valley (Mr Campbell), too, is welcome. I have heard my hon. Friend the Member for Lichfield (Michael Fabricant) talk about his journey with the disease. My best wishes go to my hon. Friend the Member for Grantham and Stamford (Nick Boles), who is on the journey at the moment. It is unusual not to see my hon. Friend the Member for Basildon and Billericay (Mr Baron) in the Chamber, and my thoughts and prayers go out to him and his wife at this time.

Cancer is interesting: you don’t pick it, it picks you. We have heard from many Members that some cancers are preventable, but there are over 200 cancers. The debate often gets channelled towards rare diseases or prolific diseases such as breast cancer, prostate cancer or lung cancer—one of the big four. However, the debate we have had today is very broad, and I welcome that.

My hon. Friend the Member for Bosworth (David Tredinnick) said we are doing better, which we are, but we could do even better, and I would like to return to the issue of research, which was brought up by my hon. Friend the Member for Castle Point (Rebecca Harris), to see how we might do better there.

I welcome the commitment to the strategy. Implemented, it could be transformational, which is why I hope we will hear about better implementation. The “Five Year Forward View” shows that funding for cancer services will go up by 9%, reaching £13 billion by 2020-21.

As we have heard, one in two of us will suffer from cancer by the end of this Parliament, and 2.5 million people in this country are living with the disease. A question the strategy does not necessarily address properly is how we will care for those people. How will we deal with the survivors affected by it—625,000 people will be, as was mentioned earlier—who will carry forward some form of disability or hardship from having the disease? How will we deal with palliative care? Have the sustainability and transformation plans looked into palliative care and how we can address the needs of people who are looking towards the end of their lives?

I would also like to highlight teenage cancers, although it is usually breast cancer that I talk about in this place. I have a young friend for whom a year on means something different. She wrote to me on Sunday, after I said I was talking in this debate. I thought of her because, on 11 December last year, young Emily was diagnosed with cancer.

She said:

“Last year in December I was diagnosed with ALL Leukaemia. It was a very scary time for me and my family. But something that makes going to hospital that little bit nicer is how lovely the nurses are.

However, there were a lot of horrid bits during the start of treatment, such as hair loss and sickness.

Although, I still have two years to go of treatment to go on treatment, it is a lot less intense now I am in maintenance. The majority of chemo is in tablet form at home, one hospital visit a month and the HORRID, HORRID steroids, also once a month for five days!

I know that the steroids work as one of the main chemo therapy treatment - but they make me put on weight, feel emotional for no reason and sometimes cross and angry at my mum, who is my absolute rock and is always there for me, so that makes me feel very sad!

If I could change anything about the chemo it would definitely be; to not feel sick and not take steroids!”

Emily is a year on in her journey. I am sure I can speak for everybody in wishing her lots of success for a great journey.

One of the best things we can do for young people is to educate them. Education is a theme that has come out of this debate. I will not go over the comments by my hon. Friend the Member for Harrow East (Bob Blackman) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) about smoking, which they discussed so well, but merely say that education in that regard is important. Nor will I go over education around food and nutrition, which, as we have heard, is worked on by the Penny Brohn institute and The Haven.

The hon. Member for Strangford (Jim Shannon) mentioned diet. Every oncologist I have ever had through all three of my journeys has spoken about the need to look after oneself through a good diet, keeping fit and exercise. We do our young people a disservice if we do not help them to lead better and healthier lives. I want to understand how the Minister is looking across Departments to make sure that this is addressed in the policies of the Department for Communities and Local Government and the Department for Transport through cycle paths, trim trails, and right across the piece so that we can all lead healthier lives.

I am pleased that the industry is responding by reducing adverts for children and so on, and I would like this to go further, but parents have a huge part to play in their children’s lives. We have a huge part to play in our own lives with regard to what we eat and how we make choices about whether we smoke or have that extra beer or extra pie. There is some self-responsibility involved. If the Minister will do his bit by helping to educate people a little more through public health information, I am sure that we will step up to the mark and do our bit as well.

I welcome the setting up of cancer alliances and the appointment of Cally Palmer, the excellent head of the cancer taskforce. Early diagnosis is fundamental, as the hon. Member for Scunthorpe pointed out, because it gives us better outcomes, but the Government must set out, with NHS England, how funding will be strategically allocated. For example, will we be able to use mobile diagnostics and molecular diagnostics? I note my interest as chair of the all-party parliamentary group on personalised medicine, and vice-chair of the cancer APPG and the breast cancer APPG. If we could see who would benefit from the use of drugs, we would stop waste. For example, only 20% of women with breast cancer would benefit from Herceptin. Will the Minister address the point about the use of innovative technologies raised by my hon. Friend the Member for Castle Point?

How can we utilise the workforce in a more strategic approach? Macmillan, Cancer Research UK and 20 other organisations have developed eight principles on this. We need a workforce that is fit for the future, with people who understand the changing landscape that we are dealing with. I welcome the £130 million put into radiotherapy machines, but I would like to know that we have the radiographers who can work those machines and optimise their use.

More of us survive living with and beyond cancer, but metastatic cancer, in particular, is a type that we need to learn more about. That brings me on to the use of data. The Teenage Cancer Trust would welcome clinical trials with young people. There is a lack of data on metastatic breast cancer.

[Rebecca Harris]

My mother-in-law passed away from secondary metastatic breast cancer after opportunities to diagnose her were missed. It has been brought to my attention that we do not keep very good records or data on metastasized breast cancer. The cancer pathway does not provide a specialist nurse for those with breast cancer, and we do not seem to provide a specialist nurse for those with metastasized breast cancer, either.

[Jo Churchill]

I agree with my hon. Friend. People who are diagnosed with metastatic cancers—not only of the breast, but across the piece—feel like they are dropping through the cracks. They do not necessarily get a clinical nurse specialist, so that is another area for the specialist workforce to address. We need to make sure that we catch people on the journey, because it may be iterative. People may feel fit and well, but then find that they have to use the services again, so our approach needs to be flexible.

My hon. Friend has mentioned the importance of the ecosystem of research, hospitals and patients. My hon. Friend the Member for Crawley works hard with the Bloodwise charity, which is truly emblematic of an empowering organisation that works with the patient, clinician and researcher to help drive understanding. That is one way of giving UK plc a huge advantage. The hon. Member for Strangford has said that we need to look at the ecosystem, which is not just about cancer treatment at the end, but about researchers, universities, those brilliant students and staff whom we welcome from Europe and everyone in the pharmaceutical industry and charities working collaboratively to get the best outcome possible. That is how we will start to rise up the table and be as good as Sweden and other countries whose patients have truly fantastic outcomes.

Timely interventions can help recovery. I want to understand how recovery packages are being rolled out, because the issue of the workforce is critical.

The hon. Member for Bosworth (David Tredinnick) has mentioned alternative therapies, which can be useful, but this is a space in which charities can help people. Only this week, the Countryside Alliance Foundation took women who have received treatment fly-fishing. They find that the experience of being outside, doing something physical and enjoying nature gives them a huge sense of wellbeing. Personally, I do not think that it is a question of either/or; it is a question of joining them together.

Finally, I know that this is not the Minister’s area, but I would like him to take it back with him. I welcome the cancer drugs fund, but I am worried about those who benefit from combined treatments. Melanoma Focus has said that people on combined treatments may be disadvantaged, because not all of them will have access to the cancer drugs fund. I hope that the fund will be flexible and that the matter will be addressed.

National Health Service Funding

Jo Churchill Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jo Churchill (Bury St Edmunds) (Con)]

I want to start by saying a huge thank you to everybody in our hospitals, our GP surgeries and our care homes. Listening to the debate, one might be under the impression that brilliant things are not going on, but nine out of 10 people in A&E benefit from being seen within four-hours. This discussion therefore needs to be balanced. I have heard that there are problems up and down the country, but the West Suffolk hospital in my constituency has just been rated as outstanding not for its buildings or anything peripheral, but for its care. That is the most important thing we can ask anyone to give.

The hon. Member for Tooting (Dr Allin-Khan) said that things were better under Labour. I was diagnosed with my second and third cancers when Labour was in government. The radiotherapy machines were under a sheet and not working because of a lack of staff. This problem has been coming down the track for ages. We do not do anybody a service if we deny that it is a problem and that it is looming.

GPs in Suffolk are under pressure. I talk to them regularly. I engage with social care, which is struggling. It is about the service, as my hon. Friend the Member for Calder Valley (Craig Whittaker) said, but we should remember that every patient is a person—a daughter, a mum, a dad. For the five year forward view, we listened and we came to the table with the money. Demand has outstripped us, and we need to look at streamlining services. Having one pot of money will help us to understand the blockages in the system to which so many people, including my hon. Friend the Member for Henley (John Howell), alluded. We can then look to unblock the system. It is ridiculous to have people on delayed discharge because we cannot get them into the community, and then for GPs to send to A&E people who cannot get into the hospital to be treated. We all know the problem; let us look at the solutions.

Prevention is also an issue. The motion today is about far more than cash. The year 1948 is a long time ago and the system has always been a mix of private and public. It is stronger today, but there are 1.4 million in its workforce.

I said thank you earlier. I would especially like to thank junior doctors, many of whom speak to me on a regular basis. They tell me that just a little thank you from people for the hard work they do would make a difference in their daily lives, so I ask for that. Some 92% of the pot of money goes to the acute sector. Our GPs, who we are expecting to do more, receive 8%. Working together would help us to look at what funds are needed for social care.

Moving people through the system is tricky. With an ageing population and comorbidity, 70% of the health budget is spent on long-term conditions. Some 22.4 million people visited A&E last year—up 600,000. I applaud the doctors who are beginning to say, “Do you know what? You can do the odd thing at home. You don’t always have to come and see us.” We need to be more responsible for our own health.

It is important that we look at new ideas. My hon. Friend the Member for South West Wiltshire (Dr Murrison) mentioned in The Telegraph the other day that we should perhaps look at the triple lock. Today, Stephen Dalton, interim chief executive of the NHS, talked about using the private sector more slickly. The provision of care relief for patients could be moved around so that home services are sorted. We need to consider community diagnostics. We need to be able to talk about these new ideas. Let us think about the future.

A young medic told me on Friday how much a 10-hour operation involving nine professionals cost. People need to understand what things cost. A young clinician said to me only yesterday that when somebody does not attend they should be asked to pay. They are sent a text, and there has to be more responsibility.

In this country, where a diabetes crisis is looming, 66% of people are obese; one third drink too much; and 20% smoke too much. We have to decide what we want out of this overburdened system and what we want to put in. As the hon. Member for Strangford (Jim Shannon) mentioned, the NHS spends around £85 million on paracetamol, yet it can be bought for just 16p. Should we be investing money in different places? If we treasure the NHS, we should treasure ourselves and its resources. The rise in cancer diagnoses is linked to obesity. Some £3.5 billion is spent on treating alcohol-related illnesses. The system is in crisis, but we have ways of addressing it. I do not want this to be a blame game. We have recruited more doctors and nurses, but now we need to step up, talk about the problems and develop a streamlined system.

Health Service Medical Supplies (Costs) Bill

Jo Churchill Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Dr Whitford]

That is an area that needs to be looked at. A narrow definition that covers only blades and swabs and that does not take into account our hugely expensive infrastructure would not make sense. When we buy those kinds of machines in Scotland, we tend to consider central procurement and assessment, which opens up the potential for massive savings. A lot more work will have to be done in Committee and then in regulation to make the process function in the way that everyone wants it to function.

We need something much more radical. That aspiration may not happen with this Bill, so it will have to come later. Patients in the UK face a delay of about five years to access new medicines. If we compare cancer survival rates, we will see that we are often ahead when it comes to patients with early disease. We are one of the earliest nations doing population screening for breast cancer. However, we start to fall behind when it comes to people with more aggressive or advanced disease. I think that that is where our poorer outcomes and survival rates by comparison with European countries come from, because it is palpable on the ground. Part of that is sometimes the eye-watering initial prices of new drugs. Yes, we can set methods to try to control that, but a lot of those drugs do not get through the system introduced by the National Institute for Health and Care Excellence because they are expensive. In my interactions with some of the major pharmaceutical players since I have been in the House, I have discovered an appetite for a different way of doing it. Prices could be much lower but there could be a guaranteed number of patients before a drug became generic. We might need to look at risk sharing, because at the beginning we often do not know whether a drug will really be as good as it is cracked up to be. If the price starts, like some cancer drugs, at £100,000, we will struggle to get it through any of our pricing systems.

Something else we have to deal with is the question of how we expect pharmaceutical companies to make a profit on drugs that we never intend to use. We need new antibiotics, but any brand-new class of antibiotics—we have not had such a class for 30 years—will have to be left on the shelf. The existing system will simply not fund research for such a drug. While the Bill tidies up some of the issues that we face now, we need to do much more blue-skies thinking on equipment, drugs and the way in which we develop different things. Otherwise we will have interminable debates, such as those in which I have participated in Westminster Hall: in one debate, we say that we want more research on, for example, brain tumours, but the next week we have a debate on the fact that we cannot access a brand new drug that has been developed by the pharmaceutical industry in the UK.

[Jo Churchill (Bury St Edmunds) (Con)]

The hon. Lady is making an informed and impassioned speech. Does she agree that we are entering a new landscape, and some drugs that have been discovered can be used for multiple treatments for different cancers, or even for other diseases? We therefore need an even more flexible approach so that we can benefit from those drugs and optimise patient outcomes.

[Dr Whitford]

Absolutely. We have entered the realms of using immunotherapies such as Herceptin for cancer. Equally, in the mid-2000s, people went to court to try to access that drug, which halves the risk of metastatic disease—and we end up spending much more on patients with that stage of the disease. We give Sofosbuvir in Scotland for hepatitis C because it is almost curative, so we have fewer new hepatitis C patients. We need a much more rounded way of looking at the costs and benefits of new drugs. The genetic drugs that we are likely to use in future will be even more eye-wateringly expensive, but then again, they may have a bigger impact.

The Bill tidies up loopholes, but I have concerns about the involvement of the devolved Administrations in the design of the schemes, access to data and ensuring that the funding for PPRS, which we use for our new drugs fund, is maintained. There is a call for us to do something much bigger and much more blue skies in future.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to follow my hon. Friend the Member for Erewash (Maggie Throup).

We all know the background and I will not waste everybody’s time by going over it again. We know about the ageing population and about bearing down on the costs, to which my hon. Friend the Member for Salisbury (John Glen) and the right hon. Member for North Norfolk (Norman Lamb) alluded earlier. We know that advances in science are going faster than we can legislate. One of my local clinical commissioning groups, Ipswich and East Suffolk, suffered an exorbitant increase in Epanutin capsules two years ago and had to find another £600,000 in six months. Looking at drugs more widely, as my hon. Friend the Member for South Suffolk (James Cartlidge) mentioned earlier, not prescribing paracetamol in that particular CCG would save £1 million a year.

The measures in the Bill aim to manage the cost of drugs. The measure on efficient data collection, so that we start to have good decision making based on evidence, is also most welcome. Last autumn, the Secretary of State consulted publicly on how to address the problem of excessively priced unbranded generic medicines, and the industry and others fed back. They were glad of the dialogue. As I said, drug costs are unsustainable. A saving of some £90 million per health area was identified. My own CCG area could save £1 million per annum from unused repeat prescriptions. Nationally, it would mean that more than 12,000 more community nurses could be employed. We need to start making these decisions about where we want to be spending our money. With the pressure on social care, something alluded to by the right hon. Member for North Norfolk, these are decisions we are going to have to make as a Government and as patients.

The current system allows for some to be inside and others to be outside the system. That limits its robustness. It is for this reason that I support the Bill wholeheartedly. The system does not target those who do not play fair and we need to stamp down on them. It is better patient outcomes that I am passionate about. We all play a part, including the pharma industry, due in no small part to the unique infrastructure in this country. This industry is important to us. As my right hon. Friend the Member for Chelmsford (Sir Simon Burns), my hon. Friend the Member for South West Bedfordshire (Andrew Selous) and my right hon. Friend the Member for Cities of London and Westminster (Mark Field) have all alluded to, we need to be supportive of those companies that work positively for patients and engage in trying to find solutions. Indeed, the Association of the British Pharmaceutical Industry supports the Government increasing their powers where market failure has occurred. There is a balance to be had to ensure that new drugs are developed.

That brings me to the matter of repurposed and off-label drugs, those that have another use than that for which they were originally formulated, for example Everolimus, Rituximab, Cycloserine, Viagra and Thalidomide. As the hon. Member for Wolverhampton South West (Rob Marris) said, Thalidomide was originally developed for morning sickness. Lately, it has been found to be very beneficial for the treatment of some cancers and skin conditions. We need to understand new uses for approved drugs for the speediest of transitions from bench to bedside. As they have not gone through new trials, we need to be mindful that they are not new drugs; and just because the target is, for example, prostate cancer and not breast cancer, these drugs should still be costed accordingly.

[Dr Philippa Whitford]

I wonder whether the hon. Lady remembers the time we spent in the House last November debating the Off-patent Drugs Bill. I flagged up the concern that a doctor prescribing a drug with a licence for a use takes precedence over an off-patent drug that may actually be the same. With the sort of gaming we have seen, there is a real concern that drug companies will tweak a drug in the slightest manner and then start selling it to the NHS at hundreds and thousands of pounds, when in actual fact an off-patent drug would do the same job. That has still not been dealt with.

[Jo Churchill]

I thank the hon. Lady for making the point so succinctly. I am also grateful to the Secretary of State for his clarification and the comments that have been made about the medical technologies industry, which I believe needs looking at. I would be grateful if we could know whether the savings made are likely to be reinvested in patients, particularly given my position as chair of the all-party group on personalised medicine, and in the latest medicines and treatments.

The Bill is designed to stop individuals making vast sums of money and taking advantage of a loophole. I back the Government’s aim of value for money and fair prices for optimum patient outcomes. I am heartened by the cross-party support for the Bill and look forward to it making positive progress.

European Medicines Agency

Jo Churchill Excerpts

Wednesday 12th October 2016 Westminster Hall

[Jim Shannon]

I thank the hon. Lady for her intervention and the knowledge she brings to this Chamber and the House. I hope that we can improve on what she refers to when we get into the Brexit negotiations, and through our negotiations outside Europe when article 50 is triggered next year.

Let us work together to allow the EMA and the MHRA to come to an arrangement to continue what has been a great partnership to date and has achieved many results. According to the Financial Times, the EMA outsources up to a third of its work to the MHRA, and that work is responsible for a third of the MHRA’s income. A report in The BMJ states that that work makes the UK an attractive location to carry out clinical trials. The hon. Lady outlined that in her intervention, and I know that the Minister will respond and the shadow Front-Bench spokesman will add his comments.

That relationship, which has been proven to work, does not have to die because the EMA may—I emphasise “may”—move its headquarters. Work must be undertaken to underline the fact that although we will not be in the EU, we will remain the best in Europe at this type of clinical work. We have many things to be thankful for in our experience of it. We all understand the red tape in Europe, and I find it very hard to believe that the only reason why the work was outsourced to the MHRA was the location of the EMA.

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I want to return to the point made by the hon. Members for Cambridge (Daniel Zeichner) and for Central Ayrshire (Dr Whitford). The Government need to be aware of the connectivity between the university sector, the clinical trials sector, the pharmaceutical sector and beyond, and of the importance of where the EMA sits in that. I would be grateful for an assurance from the Minister that we are putting everything we can into ensuring that the situation is sorted effectively and quickly.

[Jim Shannon]

I thank the hon. Lady for her intervention and for the knowledge she brings to these debates. She is right in saying that we want a continuation of the good work with universities. Queen’s University Belfast has a partnership with pharmaceutical companies throughout the world, doing clinical trials and marvellous work, as do many other universities across the whole United Kingdom of Great Britain and Northern Ireland. We could do that even better, and we should be doing so.

It was because of the quality of service and the tendering process that we showed that this was the best place for the work to be carried out, and that will remain so no matter where the EMA locates its headquarters. I cannot blame the Republic of Ireland and other countries for putting down a marker that their country could be the home of the EMA when it is time for it to move. If this were an opportunity for business in my constituency, I would also be highlighting our ability to take the business on board. However, panic stations need not be manned tomorrow, because those countries are hoping that an opportunity will arise when we leave in the not-too-distant future.

It is clear that countries that are members of the EEA are covered by the EMA and have access to the centralised marketing authorisation procedure. That is important, as it may mean that the UK could continue to have that procedure after leaving the EU, but it will depend on the negotiations and the UK’s resulting position in the single market. If the UK did not become a member of the EEA, pharmaceutical companies would need to apply separately for marketing authorisations from the MHRA for a medicine they wished to supply in the UK. That will be covered the negotiations.

We must have faith in the negotiations and in those who have been tasked with the job. Let us support the Ministers who have been given that job and encourage them to move forward. I hope they will read the Hansard report of this debate. We are not in the main Chamber, but the contributions made here are important in formulating policy and moving forward.

I have been contacted by Muscular Dystrophy UK, which has asked me to ask some questions of those who will enter the negotiations so that they are recorded in Hansard. I am happy to do so. Will the Government ensure that there is a parallel approval system for new treatments, so that after the UK exits the EU, EMA approvals that are granted apply to the UK at the same time? Will the Government increase the capacity of the MHRA and the National Institute for Health and Care Excellence so that the regulatory and approval processes are faster and can cope with the growing number of emerging treatments for rare diseases in forthcoming years? It is important to underline the issue of rare diseases—I think every hon. Member in the Chamber today has spoken about it at some point. We are all aware of the need for medicines, investigations and work to find new medicines to heal people better.

Those questions need to be considered, and a constructive approach that accepts there will be a change and seeks to influence the way the change takes place is the best way forward as we begin to work on the details that will shape our new position in Europe outside the EU. Let us focus on that.

I am nothing if not a realist, and my decision to support Brexit was not made on a whim or through emotion. It was made after thoughtful consideration that on the whole, we can do better for our country than the way things stand. That will come about through massive change and an overhaul of systems, and this is one of the changes that must happen. The onus is now on the Government, and particularly the team that is working on the negotiations, to ensure that we address the matter and gain the best possible outcome. I thank the hon. Member for Cambridge for giving us the chance to make a contribution to finding the way forward and highlighting the work that must be done to ensure that our MHRA, and indeed our system for clinical trials, continues to encourage work to be carried out here. We need to cement partnerships so that we can make the United Kingdom of Great Britain and Northern Ireland a better place for pharmaceutical companies.

Comparative Healthcare Economics/NHS Finance

Jo Churchill Excerpts

Tuesday 7th June 2016 Commons Chamber

[Dr Murrison]

I think the hon. Gentleman and I are on the same side of the Brexit debate, and I certainly would welcome the extra money that would be spent on the NHS in the event that we leave the European Union, so fingers crossed for 23 June.

The Health Consumer Powerhouse report highlights poor accessibility and an “autocratic top-down management culture” here, in contrast to top-performing Holland’s removal of what Health Consumer Powerhouse calls “healthcare amateurs”—that is to say, politicians and bureaucrats—from decision making. Unhappily, that sounds rather familiar. Earlier this year, Dame Julie Moore slated fellow senior NHS managers for “gross incompetence” and poor leadership.

The question is, what, apart from its management, accounts for the UK’s lacklustre ranking? Despite the UK’s innovative cancer drugs fund, Health Consumer Powerhouse found, for example, relatively poor availability of the latest oncology interventions and therapeutics, including radiotherapy. Sadly, that rings true, and we remember the high-profile case of Ashya King, the five-year-old with medulloblastoma, who was taken by his parents in 2014 from Southampton general hospital to Spain and then the Czech Republic for proton beam therapy, which was not available here.

The much-vaunted Commonwealth Fund report that some use to claim that the NHS is super-efficient and effective actually contains just one element that deals directly with health outcomes—a composite of deaths amenable to medical care, of infant mortality and of life expectancy at 60, it puts the UK 10th out of 11, the US being bottom. Tenth out of 11 sophisticated healthcare economies is not where I want the UK to be, and not where the Minister wants the UK to be either. The British public would expect us to be doing rather better against a raft of healthcare outcomes where the UK is firmly in the wake of our immediate northern-European neighbours France, Germany, Holland, Belgium and Denmark.

Can we explain why UK healthcare outcomes are not as good as those of peer group nations through differences in the level of healthcare funding? We can expect an opinion from the House of Lords, which last week set up a Select Committee under Lord Patel to examine the sustainability of the NHS—that is, the “what next?” question. I would be very surprised if it did not conclude that the answer is to bring spend up to the level enjoyed in countries such as France, Germany and Holland. After all, closing the gap with the EU15 in health spending as a proportion of GDP was a goal explicitly set in 2000. However, Conservative Members tend to be somewhat wary of making spend a proxy for outcome. It is not enough just to write big cheques and consider the job done. Can we do better with what we have? There are apologists for our low spending on health who cite the supposed efficiency of the NHS, but simply asserting that the NHS is more efficient than health services in other countries does not make it true.

I do not know what is in the Minister’s speaking notes, but there is a very good chance that he will use the New York-based Commonwealth Fund analysis on comparative healthcare to support a contention that the NHS is very efficient and thus ameliorates the relatively low UK spend on healthcare. The report’s methodology rewards close examination. I am sure he will have read it thoroughly, but if not, I commend it to him. In my opinion, its methodology renders the sorts of deductions that have been made unsafe. The only reliable element of the analysis that is used to claim that the NHS is relatively efficient is the percentage of national expenditure spent on administration and insurance, meaning that the UK comes in at fifth out of 11. Given that the nature of our system means that insurance and transactional costs are very low, that is hardly something to crow about. Other markers of efficiency rely on patient and practitioner surveys and include items such as time spent filling out financial transaction forms. UK-relevant metrics, such as rehospitalisation rates, were found to be comparatively poor. I conclude that it would be unsafe to make claims about the relative efficiency of the NHS based on contestable reports like that of New York’s Commonwealth Fund.

Let us suppose for one moment that the NHS is fairly efficient—not very efficient, because Carter and others suggest that that would be unwise, but fairly efficient. Indeed, I have no reason to suppose that it is institutionally profligate. If it is fairly efficient, we will not be able to squeeze many more efficiencies from it beyond the Stevens assumptions, but we will still be left with relatively poor outcomes and still needing to know “what next?” Simon Stevens still believes that we can squeeze £22 billion in efficiencies from the NHS. Much of this, presumably, is predicated on productivity gains that are contingent on holding down salaries and wages—a challenge if incomes in the economy rise. This is what I think he means by “strong performance”—strong indeed, because the implied productivity gains of 2.4% are well in excess of anything that has been achieved by the NHS historically and well beyond expectations for the wider economy. It also depends on sustained spending on social services and public and preventive health. Both, in the event, have been impacted by cuts to local government funding—cuts that I supported and accept were entirely necessary to repair the public finances, but cuts nevertheless.

So “what next?” will inevitably mean a step change in input—in money—if not by the end of the five year forward view period, then without doubt during the next decade and beyond. Here again, it is instructive to look across the channel, where we find some good news for Ministers. The Office for National Statistics has just tweaked its approach to health accounting to comply more closely with that of the OECD, and obligingly, this increases the UK’s spend on public and private healthcare combined from 8.7% of GDP to 9.9%. Most of this is due to re-badging a slice of publicly funded social care as healthcare spend. Of course, none of this accountancy changes by one penny the amount spent on care, but it impacts on the international spending league table. It means that we overtake southern European countries such as Spain, Portugal, Italy and Greece. However, we still lag well behind Germany, France and the Netherlands—my chosen basket of similar European countries.

So what next? Data from the Kings Fund and the Institute for Fiscal Studies suggest that income tax must rise by at least 3p in the pound simply to offset the fall in NHS spending as a proportion of GDP predicted over the rest of the decade. But all that will do is arrest the UK’s relative downward trajectory towards being the sick man of Europe. To bring spend up to the EU15 average would now involve an 8p increase. That eye-watering sum may be toned down a little bit by the new Office for National Statistics method for calculating healthcare spend, but probably not greatly if the comparison we actually want to make is with our closest European neighbours France, Germany and the Netherlands.

So, if we accept that big fistfuls of money are needed, the question becomes, “How are we to get it?” The Labour party does not know. It has yet to say how much it thinks the NHS budget should be, despite every encouragement from me and others to do so. All we know is that the party opposed the Stevens uplift at the general election. Maybe the unaccustomed reticence about pledging money from the party of fiscal incontinence is an indication of the sheer scale of the spending challenge that even Labour has perceived in a rare lucid moment.

Although I have every confidence in my right hon. Friend the Chancellor, a precipitous growth in the economy seems unlikely, and further borrowing should not be an option. In fact, half the £350 million per week that we send to the EU—a figure, net of rebate and subsidy, that I personally rely on—would, by my reckoning, halve the difference. I fervently hope that it will be in play after 23 June, but it would still leave a gap. How will that gap be closed? It is said that if we want a social healthcare system, we must choose between Bismarck and Beveridge. For my part, I cannot see how the transaction costs implicit in insurance-based models or large-scale schemes of co-payment would improve productivity or efficiency in our NHS—this despite the fact that the UK healthcare economy is distinguished from others by the small scale of its private provision.

For me, the Bismarck versus Beveridge debate is pretty much settled. However, I would expect a commission to examine all possible funding streams, drawing on experience from other countries. I would expect it to look closer to home at incentives that can be given to encourage subscription to mutuals, such as the Benenden Healthcare Society, formed in 1905 by and for Post Office workers, whose headquarters in York I visited recently.

But affirming that the great bulk of healthcare in the UK should continue to be funded through general taxation does not just mean more of the same. A variable hypothecated tax would be an easier sell to the public than a general tax hike. Treasury officials, or course, hate hypothecation, but the Treasury has been softening its approach in recent years and we are now, of course, wedded to the far less economically literate practice of hypothecated spend as a proportion of GDP for selected areas of public expenditure. Despite the Treasury’s reluctance, if we are talking about several pence in the pound to bring UK health spending up to the average of neighbouring similar countries, we have to find a politically acceptable and publicly palatable way of doing so. Either way, gathering a consensus on this most sensitive and complex of public policy areas, using a vehicle on a spectrum from royal commission to non-departmental public body, surely makes sense. As a model, may I suggest the influential Pensions Commission, chaired by Adair Turner, during the last Labour Government?

If the NHS is the closest we have to a national religion, its critical friends are often seen as heretics. We saw that even at the height of the Mid Staffs scandal. How, then, are we to uphold this rallying point for national morality, decency and righteousness with the more prosaic imperatives to save and lengthen life, make sick people better, prevent ill health and match health outcomes in comparable countries? I hope that the Minister will agree that the proposal for a commission and associated national conversation—made by me and others in this House, in the other place and elsewhere—has merit. I warmly congratulate Ministers on successfully arguing the NHS’s corner at a time of austerity. However, I urge the Government to give serious thought to establishing a commission that will examine how we can properly and sustainably fund healthcare and close the widening gap that exists between us and our European neighbours.

[Jo Churchill (Bury St Edmunds) (Con)]

I do not think that a commission is the right way to go, but does my hon. Friend agree that we sit on a new horizon, with molecular diagnostics, personalised medicine and so on, and that it is really important that we take a broader look at what our healthcare needs will be in future and how we can embrace more self-responsibility and new techniques for ensuring good patient outcomes? I said in this place in 2010 that we were lagging behind; sadly, we still are.

[Dr Murrison]

My hon. Friend is absolutely right: we are lagging behind. I hope that in the course of my remarks I have made it very clear that we are lagging behind countries with which we can reasonably be compared, particularly Germany, France and the Netherlands. The challenge is to bring our spend up to that level and to anticipate new developments and technologies. We should welcome that, because it will extend our lives and it will make us healthier for longer, but we do have to decide where the money will come from. Since the sums, I fear, will be so great, I believe that a commission would be a reasonable way to approach this matter and to have the conversation with the public about how the money will be raised.

The sands are fast running through the five year forward view hourglass. I believe it is time for Ministers to consider, “what next?”

World Autism Awareness Week

Jo Churchill Excerpts

Thursday 28th April 2016 Commons Chamber

[Brendan O'Hara (Argyll and Bute) (SNP)]

I pass on my sincere thanks to the Chair for indulging me by calling me so early in the debate. I have to return home to attend to urgent constituency business this afternoon. I also congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing this very important debate.

As we have heard, autism is a spectrum condition, meaning that no two autistic people display the same characteristics. Some people with autism live relatively independent lives, while others, at the other end of the spectrum, might need a lifetime of specialist care and support. That demands that every single person living with autism be treated as an individual and that society affords each individual the respect and dignity they deserve. I have no doubt that we, as a society, aim to do that, but the question is: do we actually do it?

I recently met the National Autistic Society at the launch of its “Too Much Information” campaign, designed to help people recognise autistic behaviour and better understand how they should respond to it. It is an excellent report. It sometimes makes for uncomfortable reading, but I commend it to all Members. In it, the society published figures from a wide-ranging survey it had commissioned to look at public attitudes towards those living with autism. Its findings suggest that we, as a society, have a long way to go in affording people living with autism the respect and dignity they deserve.

Although almost every person in the United Kingdom had heard of, or was aware of, autism, only a fraction actually recognised what it meant. There is a chasm between public awareness and public understanding of autism. It is this lack of public understanding that causes great distress for those living with the condition and their families. The right hon. Lady has given us some of the findings, but they are worth repeating: 87% of parents had experienced people stopping and staring at their children while they were displaying autistic behaviour and 74% had experienced public expressions of disapproval at their children displaying autistic behaviour. Importantly, the NAS also spoke to people living with autism, and what it discovered was pretty depressing: 84% of people living with autism felt they were judged by the rest of society as being “strange”.

[Jo Churchill (Bury St Edmunds) (Con)]

Would the hon. Gentleman agree that that reaction to people in our society with autism and their families leads to a fear of going out, as my constituent Maureen said, which, particularly for autistic children transitioning into adulthood, can in turn lead to social isolation for them and often their primary carer, which is not adequately recognised across the piece?

[Brendan O'Hara]

The hon. Lady is absolutely correct, and it is something I will touch on in a moment.

Nearly 70% of people living with autism believe that the public see them as antisocial and almost one third have been asked to leave a public place for displaying behaviour associated with their condition. As a result, as the hon. Lady just alluded to, four in every five people living with autism in the UK feel isolated from society and half do not go out for fear of how people will react to their condition. As I said, those statistics make for pretty depressing reading and should force us all to look at our behaviour and question what we are doing, as a community, to our fellow citizens that makes them prefer social isolation to the way they are treated by the public, ourselves included.

It is not all bad news, however, as the NAS report also contains some good news. Its research shows that with greater knowledge and better understanding, the general public will behave with much greater empathy towards autistic people.

Digital Records in the NHS

Jo Churchill Excerpts

Thursday 28th April 2016 Westminster Hall

[Jo Churchill (Bury St Edmunds) (Con)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I, too, congratulate my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) on bringing this debate to the Chamber.

For me, data hold the key. As we move into new medical landscapes, comprehensive data sets hold vast possibilities for research and care, and we should harness and optimise their potential benefits, as my hon. Friend the Member for Twickenham (Dr Mathias) alluded to. I have been working with individuals, charities, researchers and clinicians to try to understand how to put patients at the centre of everything that is done with and for them.

Recent research by charities into patient responses shows that patients are keen for their data to be used. As my hon. Friend the Member for The Cotswolds mentioned, Data4Health was launched earlier this year. At its launch, we heard from a patient, Graham, whom my hon. Friend also mentioned. Graham was backed by a clinician, a researcher and a charity, and he spoke about his journey with leukaemia and how research had helped him get the most effective treatment. We also heard from the mother of the youngest patient to be diagnosed using cutting-edge genomics about how we are moving forward. What got those patients to a diagnosis and the correct care was a true understanding of their diseases. Data are a precious gift and we must take care to ensure that everything we do with them is in the patient’s best interest.

If we can speed up data sharing in something as simple as immunisation programmes, for example, it will be more effective. Vaccination coverage is necessary to ensure success, and at the moment data collection is, as a doctor described it to me, clunky in many areas. We still have paper records. Only recently we saw how integrated patient data might have saved a young child’s life. Patient safety and good data are therefore real and ever-present issues.

[Geoffrey Clifton-Brown]

My hon. Friend is extremely knowledgeable in this area. Is she aware of the campaign for the new-generation Bexsero meningitis B vaccine, which was developed by genomics? The NHS was the first health service in the world to allow two-month-old babies to receive that vaccine. The collection of data and the effectiveness of vaccines and drugs can put the NHS at the forefront of what is happening in the world.

--- Later in debate ---

[Jo Churchill]

Indeed, and there is a larger point than that: we also lead the world in life sciences, innovation and technology. The NHS is a critical resource; with patients’ permission, we have the ability not only to create great health for our nation, but to save money for our NHS and produce wealth for our economy. There is nothing not to like in that virtuous circle.

How much better would things be for people who go into hospital if the ambulance staff and paramedics who took them there could view their medication and understand their personal situation more fully, and therefore respond more appropriately and not waste precious time? As a doctor said to me, that is particularly important in caring for patients out of hours. Ringing other hospitals is sometimes not an option. Side effects can be worse for some patients than others, and we need to know why in order to target effective treatment. That would avoid waste and reduce the cost for individuals, their families and the system. My hon. Friend alluded to health economics studies that show potential savings ranging from as little as £16 billion to as much as £66 billion if data were deployed properly. We must grab this opportunity. The NHS needs to find cost savings, and we have an opportunity to drive the innovation that would deliver such savings.

That applies across the piece. I have just come from a debate on autism in the main Chamber, and one of the key points that was raised there was that health data are not adequate to link things up so that young children can have effective and timely diagnosis. As my hon. Friend mentioned, we had a powerful debate on meningitis in the House a few days ago, and we would benefit from data on that disease too. We also had a powerful and moving debate on brain tumours recently. Data on such issues should be linked, because the patient is an individual and how they respond to a drug or combinations of drugs is important.

Only this morning I spoke to Mike Burrows of the wonderful Salford lung study, in which a drug is put into a real-world environment and connected with databases so that all of a patient’s health needs can be tracked. The study looks at real life and can cope with all the different variables to see the effects that a drug might have on people. As we move into an environment in which co-morbidities are ever present in our ageing population, we can immediately see how someone who takes a drug for one condition and thereby receives a benefit for another will have their health enhanced.

GlaxoSmithKline is about to produce the results of that study, which will be interesting, but Mike said to me that it has been a winner for the local health service, and that is what is important. The GPs who have been involved have seen the benefits. The hardware alluded to by my hon. Friend the Member for Twickenham, which is so often lacking in the system, has been invested in and now, with the integration of the NHS and social care, we have the ability to optimise care for the patient, which is important. The Salford study covers a quarter of a million people, and the learning from it will be rolled out across the broader Manchester landscape as devolution takes place.

The Minister is in a unique position to see data as a solution. On many challenging issues in this data-rich system, we are information-poor. Variations lead to inconsistencies. He can implement the recommendations of the accelerated access review, spearheading how we can best put to use the lessons from large-scale studies such as the Salford study, the Birmingham study mentioned by my hon. Friend the Member for The Cotswolds and studies from right across London.

There is also much to be learned from some of the devolved areas. I have spoken at length about that with the hon. Member for Central Ayrshire (Dr Whitford), who is the Scottish National party’s lead on health. We have a lot of medical expertise to harness in my party and right across the House, so that we can concentrate minds and ensure that we take the right direction of travel.

Work is going on across the Richmond group and in the pharmaceutical industry. In this place, my hon. Friend the Member for Bath (Ben Howlett), who chairs the all-party group on rare, genetic and undiagnosed conditions, my hon. Friend the Member for North West Hampshire (Kit Malthouse), who chairs the all-party group on life sciences, and I, as chair of the all-party group on personalised medicine, are discussing how we can best develop a combined piece of work in this area, because collaborative approaches always give us the best results. There is a plethora of data in the system, but, as Chris Carrigan of the National Cancer Intelligence Network says, we must harness data effectively.

In this country we have some of the best science in the world. The areas of informatics and genomics will be game changers, allowing us to develop drugs in as little as five months instead of years. We need responsive systems. It is unlikely, if not impossible, that our clinicians will be able to keep up with cutting-edge research without the use of electronics. Last year, a multidisciplinary group looked at data sharing in genetics and concluded that the current arrangements are unsatisfactory.

If we understand why drugs work better on certain groups or in distinct geographical areas, they can be targeted effectively. That is particularly the case in the area of rare diseases. A young constituent of mine who has a condition called tuberous sclerosis and those who suffer from other conditions such as Duchenne muscular dystrophy, lupus or rare cancers are in cohorts that are too small to prove efficacy. If there are only a few suffers of such conditions throughout the country, the transferral of knowledge is difficult unless information is held centrally, but the data provide the key.

[Geoffrey Clifton-Brown]

I would not have intervened on my hon. Friend if we did not have plenty of time. She has developed the interesting theme of the benefit of the life sciences to our economy. She then explained how the better use of data can speed up the development of drugs. By doing that effectively at a time when global drugs companies are looking at where it is best to locate themselves, the NHS could encourage more of them to come to the United Kingdom to develop drugs. Would that not be a huge benefit?

[Jo Churchill]

It would. That is also part of the complex environment covered by the accelerated access review, the early access scheme that my hon. Friend mentioned and so on.

We now know what the landscape for the cancer drugs fund looks like going forward. I started my journey to this place on a personal note, speaking about personalised medicine as a campaigner back in 2010 after my second bout of cancer. My dream is that anybody will be able to have my data to learn what will prevent any of my four daughters from developing any of the cancers that I unfortunately have had in my lifetime. We need to take hold of patients’ ability to gift such data. Alongside that gift, we must drive an industry where we have the ability, the innovation, the technology and—quite frankly—the brains we need. Everybody comes here for our life sciences, to lead the world in that area, and we should grab that opportunity.

As I said, the cohorts are too small to prove efficacy. Unless we hold information in a central place, that creates a problem. As has been said, confidentiality is crucial. Strict safeguards and strong governance are a given, as my hon. Friend said. Confidentiality for participants involved in clinical research is well established, but most data are either aggregated or pseudonymised.

Speaking personally, if my data, particularly on cancer, can make one other person’s journey better than mine, it is a gift. I have spoken to Graham Silk about that, and he agrees, as do the many people I have campaigned with. As Christina and Les say, being the first to gift data makes someone feel that they have done something really special. Even if it gives someone with a complex disease to a small amount of additional time, we have given someone else a very special gift.

It is important that the risks are moderated, but we must also consider the benefits and what we can win. Many patient groups show involvement rates of getting on for 100% when people know that their information will go to others. My hon. Friend mentioned the cystic fibrosis group, which has an involvement rate of 98%. We need strong leadership to draw the strands together, a common understanding and a national agreement to optimise sharing in a safe, transparent and trustworthy way.

The risks and benefits of sharing data have to be explored, but those who talk only of the risks will miss the benefits. I would like to see a chief clinical informatics officer. I look to the Minister to lay out his vision for standardising, resourcing and futureproofing the system; drawing together the ongoing work; and achieving the momentum needed for greater data sharing to improve both the health and the wealth of our nation.

--- Later in debate ---

[Stephen Metcalfe]

My hon. Friend is very kind and generous, as always. I congratulate him on securing this important debate.

As I said, I am just sitting in for someone in the hope that at some point I might need to be released into the wild and they will cover for me. However, one thing I have found in my time in Parliament is that there is a huge crossover. One area in which I am very interested and actively involved in Parliament is science and technology. In the previous Parliament, I sat on the Select Committee on Science and Technology. In this Parliament, I chair the Parliamentary and Scientific Committee, which, for those who do not know—this is a bit of a plug for it—is the oldest all-party parliamentary group, established in 1939 to help with the war effort, to bring Parliament and science together and to look at things such as how we can improve the public’s health and food security and what we can do to improve our defences. It strikes me that we are talking about things I looked at when I was a member of the Science and Technology Committee, particularly the use of big data and the use of stratified and individual, personalised medicines. This has been quite an eye-opener for me, and I am grateful to my hon. Friend.

My hon. Friend is entirely right that huge amounts of data are now being generated across all services, especially the health service, with more and more advances in what we can test for and how data are stored. The effective use of IT is important not only in storing data—obviously, we must store data accurately and associate them with the correct patient records—but in making them accessible to others in future and in ensuring that their integrity is maintained. It will also allow clinicians who are perhaps viewing those data from a different angle and not fully understanding where they were collected to understand their use.

My hon. Friend spoke of his constituent, Les, who is an inspiration—I am sure that is why my hon. Friend used him as an example—and of the Empower: Data4Health campaign to promote the better use of data, which would have wide benefits. The use of state-of-the-art IT and the analysis of data can be of huge benefit to the wider patient body. Data can be used to spot trends, patterns or crossover between certain circumstances, particularly in those with rare conditions. My hon. Friend brought that up in the case of Christina, who suffers from a rare cancer. She does not know why she is especially prone to that, but feels that by finding other sufferers, clinicians may be able to spot patterns and therefore be able to develop appropriate treatments or preventive measures.

It is only by examining huge databases for the smallest anomalies that we can start to have a real impact on people with such rare conditions. Where there is only a small sample of people, it is very difficult to put them together and analyse them as a whole, particularly with the barriers and the silo mentality that exist across many of our public health services. People are fearful of sharing data or do not even know that the data exist. Anything we can do to break that down, so that we can take a helicopter view—I think that is the current phrase—to see patterns must be good. The example that my hon. Friend gave showed what could be achieved through better use and analysis of data. On my behalf and the Minister’s—I have no authority to speak for the Minister; I am speaking entirely as a Back Bencher— I wish Christina well for the future.

As I have said, the future for individualised and stratified medicine is very bright, but it is only one part. That is why the data aspect is very important. Some think that the changes we will experience as a society in the next 30 years will be equal to those we have experienced as a society over the past 300 years, whether in transport, education, or the way we interact as nations. The greatest changes will probably be experienced in the healthcare system. I truly believe we are on the cusp of a major breakthrough, and the collection, analysis and use of data from a much wider base than has ever previously been available will play a huge part in that.

[Jo Churchill]

I would like to say what a sterling job my hon. Friend is doing; I agree with everything I have heard so far. Does he agree that there is a big opportunity to drill down and understand more about health inequalities, which are so important in our society? When the average life expectancy in certain areas is so much more than in other areas, the use of collective data to drill down on health equalities and understand why things happen and the concomitant effect on certain diseases is really important.

[Stephen Metcalfe]

I thank my hon. Friend for those remarks; she is absolutely right. We have been talking about people suffering with rare conditions and about putting them together and spotting patterns, but tackling health inequality by comparing data from different parts of the country and by comparing, perhaps, people’s longer term histories is equally important. It may also help policy makers to find a way of developing a geographically stratified approach to tackling some of these health inequalities. Just moving on slightly, I think that part of why clinical commissioning groups were established was that they would allow doctors and clinicians locally to identify what was in the interests of the people they represented. Of course, using data to do that is vital, so I could not agree with my hon. Friend more.