End of Life Care
John Glen Excerpts(8 years, 4 months ago)
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John Glen (Salisbury) (Con)
It is a great pleasure to make a modest contribution to the debate. When I speak on matters to do with the NHS, the emphasis always seems to be on more resources, greater transparency, greater accountability and greater universal provision of reliable quality. Everything is important in the NHS—everything is a priority—but the resources are not infinite.
End-of-life care is a painful and emotive subject that is difficult to get right. As has been mentioned, about half a million—I think the actual figure was 470,000—people died in this country in 2014. They died in different circumstances, with wide variations in their experiences of what the NHS was able to offer. In my constituency, I acknowledge not only an excellent hospital and a number of GPs, but a high level of respect in our community for Salisbury hospice. One of the challenges is to arrive at a settlement that makes clear where the boundaries of responsibility lie between funding from the NHS and the charity element. Clearly, there is a massive amount of good will, but that must not be abused.
The national director at Hospice UK has said:
“The things that make a better death are so simple. It’s basic knowledge about good pain control and conversations with people about the things that matter”.
That goes to the heart of what is required. It will be about resources, to some extent. It will be about transparency, and greater reliability and sufficiency of provision. But it will also be about us, as leaders in our communities, being able to speak about our constituents’ experience of dying. Just as we put great emphasis on the provision of wills to ensure that people’s estates are in good shape, we need to ask people what choices they want to make about the way in which they are looked after and cared for in their last days. We need to ensure that people have greater awareness and make more informed choices so that we can make a better estimate of how to allocate resources and better integrate the different elements in our society.
One challenge that has frustrated me concerns free social care at the end of life. The Select Committee recommends in its excellent report that
“the Government clarify the eligibility criteria for the NHS Continuing Healthcare Fast Track Pathway”.
Some of my constituents have waited far too long to have such matters resolved; for example, I raised the situation of the Vaughans last week in business questions. Ambiguity and long delays in sorting things out cause enormous distress to families who are trying to make sensible provision.
I recognise the great emphasis that is placed on dying at home, and the tragedy that almost half—47%—of the 470,000 people who died in 2014 died in hospital, although the latest survey shows that only 3% of people who stated a preference wanted to die in hospital. By any measure, that is a failure of society, Governments and us all in not delivering what people want. That is not efficient for public services—it is more expensive—but it is also really unpleasant for the families involved when they cannot deliver what their loved ones want.
I hope that the Government will be able to give real and costed responses to the report and to all the various groups that have commented on the need for greater clarity about the Government’s intentions. Our constituents need that, and we need to do more to ensure that this does not become a taboo subject, but one on which there is greater engagement, so that we can secure better outcomes for those who are dying and for their families.
Sugary Drinks Tax
John Glen Excerpts(8 years, 7 months ago)
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Helen Jones
I am not sure which of these defenders of the Government to take first. I will take the hon. Member for Kingston and Surbiton (James Berry).
Helen Jones
Yes, the hon. Gentleman is right that we need much clearer labelling. As I will come on to say, the proposal in the petition is one avenue for tackling the problem, but not the only one and not a silver bullet.
I will take the intervention of the hon. Member for Salisbury (John Glen), but then I will make some progress.
John Glen
I am extremely grateful to the hon. Lady. She is making a powerful case, of which I am somewhat persuaded. However, does she not feel that it would be best if the Government were given an opportunity to develop the responsibility deal and to do a lot more to change public attitudes and consumption patterns before a sugar tax, the effects of which are not yet fully known, is implemented?
Helen Jones
The public health responsibility deal has had a fair trial over the past five years. The House of Lords Science and Technology Committee said of it that
“the current Public Health Responsibility Deal pledge on obesity is not a proportionate response to the scale of the problem.”
The reason for that, as the British Medical Association has pointed out, is that the deal does not set targets for individual food and drink products, or a timescale in which changes have to be made. That is why I have come to believe that there is a great deal of merit in what the petitioners are asking for, as one method among a whole lot of ways to tackle the problem.
A tax on sugary drinks would probably have to be at the level of 10% to 20% to make a change in behaviour, apparently—Public Health England suggests that range. There is evidence from Mexico and France that at that level, people’s behaviour starts to change and they start to choose sugar-free alternatives. However, that has to be part of a whole-Government effort to reduce obesity, which has to begin in schools.
Much work has been done on improving school meals, setting better nutritional standards for them and removing vending machines from schools. The problem is that those things do not apply to academies and free schools, and as more schools become academies we are putting more children at risk of poor nutrition. We should not tolerate that. It is good that food and nutritional education is compulsory at key stage 3, but we need to look at how that operates. Much more investment in equipment is needed. Schools need to be outward-facing and need to encourage local people to visit them to talk to children about food and how it is grown. The best schools do that, but often the curriculum is not appropriate for all children.
In my entire school career I did a term and a half of cookery, because it was considered that those who were academically inclined did not need to learn how to cook. The only thing I can remember being taught is how to make rock buns, something that I have not indulged in before or since. Another example is that my son specialised in Indian cooking. It was supposed to be brought home for the evening meal, but anyone who suggests that has never met a teenage boy. That was interesting, but expensive. What most of us need to know when we first set out in the world is how to eat healthily on a restricted budget. That is the sort of thing that we need to look at with our children.
In fact, all public institutions should be promoting healthy eating. Dare I suggest that we start with some of the vending machines in this place, so that I do not walk down the corridors thinking, “Get thee behind me, Satan”, every time I pass machines full of chocolate and fizzy drinks? That needs to be done in hospitals as well—there have been a number of articles about that recently.
I challenge people to walk into the foyer of many hospitals. There are machines selling chocolate and fizzy drinks, and the outlets often sell cake and biscuits quite cheaply but overcharge for a piece of fruit. If someone wanders in to buy a paper, they will be offered a big, discounted chocolate bar at the till. That makes it much harder for people to resist temptation. Of course, that is difficult to do, but the message that hospitals are giving their patients, staff and visitors is, “Don’t do as we say; do as we do.” The Government urgently need to negotiate with trusts and with NHS England to see how the issue can be remedied. It is nonsense to take an income from those sorts of outlets in one part of the hospital and then to deal with the effects of poor diet in another.
Dr Wollaston
In an ideal world, I agree, it would be nice not to have to do any of that, but I return to the point about whether the Government also have a responsibility for the health of the nation’s children. Should the Government step back? Should any of us feel that it is acceptable to condemn one in four—a quarter—of the most disadvantaged children in Britain to a lifetime of ill health? If we can do something simply to nudge people a different way, should we not consider the possibilities, and ask how different those children’s life chances could be? As I said, such a tax would not be regressive because there is always an easier, untaxed alternative. We are talking not about telling people that they cannot have a product that they enjoy but about nudging them to choose a healthier one.
There is an interesting phenomenon whereby education, for example, is sometimes taken up by the people in society who are already healthier, which can inadvertently end up widening the health inequality gap. We should target measures to help those who are suffering the most harm. As for this being regressive, look at who is suffering the most harm. Is my right hon. Friend happy with the situation as it stands?
John Glen
Does not that point also suggest that the distribution of education interventions is not being focused in the right way? The Government could do significantly more to improve support, advice and education to allow that group of people who consume too much to make informed choices before going down the route of a tax.
Dr Wollaston
I ask my hon. Friend to look later in our report, where we set out some of the evidence on delivering education and advice. I am afraid that it does not provide the solution that he imagines it will, but I encourage him to read the report. I wish education alone could solve the problem, but it will not, and it tends to be short-lived. The scale of the problem demands our attention.
A tax would not be regressive because there would always be an alternative. No one is thinking of introducing a sugar tax of the type that sometimes people imagine when they hear “sugar tax”, which is one that would apply to the bag of sugar that they buy off the shelf or to biscuits, cakes and sweets. We are not suggesting that, because it is difficult to reformulate those products as entirely sugar-free alternatives. We are considering only products with an easy alternative. Why did we choose sugary drinks? Look at the data in our report, particularly on teenagers’ diets. A third of their entire sugar intake comes from sugar-sweetened drinks. In other words, there is an easy win here, through which we can help to take calories out of children’s diets, but no one is suggesting that that is the entire answer.
Paul Flynn (Newport West) (Lab)
It is a great pleasure to speak in this debate and to follow the two marvellous opening speeches. It is a shame that the right hon. Member for Cities of London and Westminster (Mark Field) has now gone after intervening so often—I think he intervened seven times—and then complaining that there was no debate. Now he has deserted us to spend more time with his prejudices.
This is a debate of great importance. I will not go into detail about what generation I was part of, but there were certainly no sugary drinks when I was a child. There was a lot of water—we had that in abundance—but, being a child of the war, I had the benefit of a system of rationing whereby the amount of food was carefully controlled. We were probably the healthiest generation there has ever been, because we were quite rightly denied the damaging drinks that children often have now.
I want to make just one point, which is about who comes first in the Government’s thinking. Where does public opinion come? Where does the health of children come? We all know the misery that is felt by overweight children, and how they suffer mockery at school. It is extremely damaging for them. There is no question but that we have to do all we can to avoid obesity as far as possible. We can do something about it, but a number of decisions taken by the Government have been extremely worrying, and one of them is this—turning down the idea of a sugar tax.
Recently we had a debate in the House on a sensible Bill, which was supported by the hon. Member for Central Ayrshire (Dr Whitford), a Scottish National party Member. She is a breast cancer surgeon, and she made a splendid, well-informed speech in support of the Off-patent Drugs Bill, which would have been greatly beneficial to people in need of drugs, as it would have made them cheaper, and also to the health service. Members of all parties spoke in the debate, but the only voice for the party of Government was the Minister’s, and we know that the pharmaceutical industry—big pharma—has the Government in a throat hold. It is big pharma that decides what happens.
I believe it is the same with “big sugar”—that the Government are excessively influenced by the commercial interests of the sugar industry. They are also influenced by other industries—the alcohol industry is very powerful. We recall that at the time of the 2010 election there was an impassioned plea by the future Prime Minister. He said he knew what the next scandal in Britain was going to be: it was going to be a lobbying scandal. He knew about lobbying, of course, because he was a lobbyist himself. He knew about the influence of lobbyists—the odd word here, the invitation to a reception there, getting someone on side by inviting them to a seminar in the Alps, or in Bermuda. That is the way they work. Are the Government listening to the financial concerns of the greedy lobbyists, or to the pleas for a more rational, healthy policy?
Paul Flynn
We have had a—[Interruption.] Exactly, and I thank my hon. Friend the Member for Swansea West (Geraint Davies) for saying so. I respect my hon. Friend. We had a little exchange in Welsh about who made the remark in question. I find the story most unlikely, and I would like to check on it.
The Conservative Government have abused their position repeatedly to attack the achievements of the health service in Wales. In one week, the Daily Mail had the Welsh health service as its No. 1 story for four days running. There is no way, by news standards or by the value of the stories, that that was justified. I am proud of the achievements of the health service in Wales, and I am glad that today is the day when the presumed organ consent system begins. Wales is leading Britain on that matter, and there is much other pioneering work being done by the Labour party and the Labour Government in Wales.
Unfortunately, the Tory Government like to use the Welsh health service as a stick with which to beat the Labour party. That is irresponsible and dangerous, because one of the most important things is that people should have faith in their own health service. It is an important part of therapy and confidence: when people go into hospital, they are of course nervous and concerned, and when they read these lying stories about political—
John Mc Nally
I could not agree more. That is one of the biggest problems. People drink lots of sugar, which gets them high quickly, but they then come down and go into a never-ending cycle of having to drink it again. It is an extremely worrying state of affairs for everybody, so I totally agree with the hon. Lady.
I believe that raising tax on sugary drinks would be an effective means of reducing childhood obesity. I thank all the MPs here, and I hope they all agree that Jamie Oliver should be applauded for setting up this petition and making use of his profile and that of the charity Sustain. I, for one, echo his concerns about the health and welfare of our future generations, and I share his belief that
“we can shift the dial on the epidemic of childhood obesity.”
I thank the right hon. Member for Leicester East (Keith Vaz), who is no longer in his place, for his diligent work in pursuing better public health awareness for the people of this country.
It is commonly known that sugar-sweetened drinks are associated with a higher risk of weight gain than similarly calorific solid food. Evidence indicates that there is a link between the habitual excess consumption of sugar, type 2 diabetes, and weight gain. A large study of European adults showed that there is a 22% increase in diabetes incidence associated with the habitual consumption of one daily serving of sugar-sweetened drinks. Sugar-sweetened drinks contribute a significant amount of sugar to children’s diets. A reduction in their consumption would, in my view, significantly lower the intake of sugar and therefore reduce obesity and the associated detrimental effects on personal health.
According to statistics released in 2014, 64% of adults in the UK are overweight or obese, which cannot be good for anybody. I am sure my hon. Friend the Member for Central Ayrshire (Dr Whitford) will talk about that fact later. International comparisons indicate that the UK has above-average levels of overweight and obese adults. The cost of our obese population is not just felt in the increased risk of a range of serious diseases, including type 2 diabetes, hypertension, heart disease and some cancers; there is also an economic cost. It is estimated that obesity costs the NHS up to £600 million in Scotland alone, and the McKinsey Global Institute estimates that the cost to the UK is equivalent to 3% of gross domestic product. The Scottish Government await the outcome of the Cochrane review on that issue.
Worryingly, for the majority of adults, obesity starts in childhood. Evidence shows that being obese in childhood increases the risk of becoming an obese adult. If we do not encourage adults and children to reduce their sugar intake, the economic costs and the cost to the NHS will continue to be a significant burden. Perhaps that is where a bit of libertarian paternalism is needed. As was said earlier, it is possible and legitimate to nudge people.
John Mc Nally
The hon. Gentleman is right. Once again, it is the poorest who do not know how to make such choices. I hope to come on to that point later.
Although I welcome the proposal to increase tax on sugary drinks and agree with the rationale behind it, I am slightly cautious about it, simply because the body of evidence on this subject does not robustly demonstrate the effect it would have in isolation on rates of obesity and type 2 diabetes. I feel strongly that a raft of measures should be developed to reduce sugar intake and obesity. Taxation of this kind is an important tool in shifting the population’s dietary patterns. Educational messages alone simply will not achieve the reduction that we need, so fiscal and reformulation measures need to be introduced. We MPs can help to nudge that decision. We should improve the decision-making process to allow the choosers whom the hon. Gentleman mentioned to make better choices for their own welfare.
In conjunction with a sugar tax, we require legislation on the reformulation of foods to reduce overall calorie intake. If that is not possible, the industry should be compelled to reduce portion sizes—although not of Mars bars. We also need to introduce marketing restrictions on unhealthy foods to restrict the marketing of foods that are high in salt, sugar and fat to children. Restrictions should be applied most stringently to TV and online advertising, as evidence suggests that under-16s are strongly affected by advertising through those mediums.
We must improve our confused labelling system. We should continue to support a consistent front-of-pack labelling system and should extend caloric labelling, such as the traffic-light system, to all food and drink. Arguably, it is most crucial for the Government to invest more heavily in active travel by dedicating a national budget to walking and cycling; I am absolutely with the hon. Member for Warrington North on that.
The obesity epidemic is not going away. If anything, it will get worse for successive generations unless the Government take action. Implementing and evaluating a sugar tax as part of a childhood obesity strategy would be one step towards improving the health of our nation. I urge the Government to take heed of the petition and implement such a tax.
Finally, I holidayed in Cornwall this year, so I appreciate what the hon. Member for St Austell and Newquay (Steve Double) said about weight—such is the quality of the food in Cornwall.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Thank you, Mr McCabe. I am actually Dr Whitford; Eilidh Whiteford—my hon. Friend the Member for Banff and Buchan (Dr Whiteford)—is the other one, whom I always get mixed up with.
Like the hon. Member for St Austell and Newquay (Steve Double), I am clearly not skinny. I was not overweight as a child; it was the usual comfort eating later on, middle age, lack of exercise and all the rest of it. I know what it is like to move through a world where everything shouts “eat me” all the time. We live in a totally obesogenic environment. The idea that it is easy to resist things is simply not true. Everything is geared towards making people eat unhealthily. We spend a little more than £600 million on obesity prevention, but £256 billion is spent on advertising unhealthy foods. It is David and Goliath. It is difficult for people to make the right choices.
Obviously the debate is about the sugar tax, but as Members have said, the issue goes much wider than that. The hon. Member for Totnes (Dr Wollaston), who is the chair of the Health Committee, talked about the sheer scale of the problem. One third of children leaving school are obese or overweight and a quarter are obese—that is the reason for the differing figures mentioned earlier. It is predicted that 70% of the population will be overweight or obese by the mid-2030s. That is an astronomical number. Our health service will not cope with all the directly obesity-related problems such as type 2 diabetes, cancers and heart disease. We have heard figures about the cost of that from other members of the Health Committee, but it is estimated that the societal costs are £27 billion. We all know someone who was overweight or obese as a child, and we know about the bullying, exclusion and self-contempt that occurs and the impact that that has on schooling, and therefore on jobs, which leads to another generation of deprivation. People say that a tax might be regressive, but it would be no more so than duty on cigarettes or alcohol. It is important to see it in that light.
We have discussed evidence from Mexico, which we heard in the Committee, but other countries such as Norway, Hungary and Finland have taken the same approach. Although not all the evidence has been peer-reviewed, published and assessed, all the details of the national experiments point in the same direction. Cochrane reviews coming up in the next year to 18 months will be able to put that information in a solid position based on experiments and data. At that point it will not be possible to ignore the issue, but we need to be thinking now about our options and what we will do.
Although this is a debate about sugar tax, the Health Committee made nine recommendations. Sugar tax is the one that the media are interested in, because it catches the light, but it is part of a whole package and a sugar tax is not even in our top three recommendations. The first is about promotions, because 40% of food bought in our shops is on promotion, and that is heavily weighted towards unhealthy foods. We need to look to rebalance that. One Member who has scuttled off said that we would come up with other rules such as getting rid of discounting, or we would suggest portion control—darn tootin’ we will!
We need to realise what we are fighting, because we are talking about something deeply shocking and very dangerous. The argument is that people who are less well off save money if they can buy one for £1 or two for £1.50. However, the evidence we heard is that, if that means they buy two packets of biscuits, one will not be put in the cupboard for next week; both will get eaten this week, and the same mum or dad will be back the following week to shop for another packet of biscuits. Therefore they have not only eaten far more unhealthy food and sugar but spent more money. Promotions of unhealthy foods in multi-buys are not helping anyone.
We also see a change in portion sizes. Packets are getting bigger, and there is the bottomless cup at McDonald’s or wherever. There is the end of the aisle, the pester power and the stuff at the till. Every mum and dad out shopping at the supermarket with their wain—that is Scottish for child—will know what it is like: they can see the light at the end of the tunnel, then their child hangs out of the trolley and grabs something. They may put it in their mouth, which means the mum or dad is obliged to pay for it. Some supermarkets have been good at taking that opportunity away, but not all of them. My local supermarket still has sweets right at the till.
Promotions have a big impact and should be tackled. So should marketing, because of the sheer scale of the budgets for and against obesity. It is not just about asking for advertising to be put after 9 o’clock; it is particularly about what is emerging on the internet in social media and advergames, as the hon. Member for Totnes mentioned. Things keep wriggling around, so we need a strategy broad enough to cover that.
Reformulation is almost the holy grail. We have seen its success with salt, but it took a long time. We have taken about 40% of the salt out of the British diet, and by and large people have not noticed. However, we do not have 10 years to do that. Reformulation is also much harder to do with sugar, because it has an impact on the structure and texture of food, but we need to get on with it. The reason why we are spending so much time talking about sugary drinks is because, as the hon. Lady said, they are one product where reformulation is easy: we can replace sugar with sweeteners.
We also need to reformulate to drive down sweeteners. We need to reset our sweet tooth—we have all seen someone washing down a big slab of sticky cake with a diet soft drink—because the craving remains. Even those who choose diet soft drinks will find that their craving for sugar remains, so when they cook they will add more sugar and they will eat more cake and biscuits. Sweeteners can really help us to speed up the removal of sugar, but we still need them to be on a downward journey. That must be done with industry, which has done a lot. Many soft drink manufacturers provide a choice, so if a sugar tax is introduced, hopefully that should nudge people across to less sugary drinks, as the hon. Member for Totnes said. It would be ideal if there was no tax collected at all, because that would suggest that the policy was working. At the moment, however, the traditional product is still absolutely packed with sugar.
John Glen
The hon. Lady is speaking with her customary authority on the subject. Does she agree that the industry has the potential to go a lot further so that we can make more progress before a sugar tax, which has attracted all the attention, is instituted? It is a matter of providing choices, and a lot of consumer power could be harnessed to help us make that progress.
Dr Whitford
As the hon. Member for Totnes mentioned, the people who make such choices tend to be those who are more oriented towards a healthy diet anyway. It is about trying to teach people in the mire of deprivation, and often in the mire of despair, who smoke more, use more alcohol and take more sugar. They are the very people who are hit by all our measures to try to bring about health improvement.
All the industries are making efforts, but they are afraid of being out there on their own and seeing their competitors mopping up their business. That is why we need regulation. In our inquiry, that came out from the retailers in particular, who said they wanted a level playing field. Whether it is through a sugar tax or regulation, they want to feel that everyone has to move forward.
We also need leadership. The Food Standards Agency was important in leading on salt reformulation, so we need to work out who will be the leader on this, because we need a focused project to get not just sugar but fat and calorific intake out of our diet. As has been mentioned, there are also hidden sugars, particularly in tomato products such as baked beans, tomato sauces and bolognese sauces in which it is easy to hide sugar. When we start to look at that, we see that it is quite scary.
That is where labelling and education comes in. The traffic light system has been helpful for a broad range of foods. When we are looking for a sandwich in a rush, we can spot the green and amber on the label as opposed to the red and red. However, that will not help with sugary drinks, which get a red light and two green lights because they do not contain salt and fat. Therefore, someone who picks that up might think, “Two greens— that must be quite good.” That is why the labelling of teaspoons of sugar is important. The industry could be applauded as it took every single teaspoon of sugar out of a drink.
We have heard talk about the nanny state and people having the freedom to do what they like, but as a doctor for 33 years I heard that about seatbelts and crash helmets. People want to feel the wind in their hair, but they do not look so good if they have come off their bike. We talk about the challenge of cigarettes and alcohol, and sugar is the same. All Governments have a responsibility to look at the report and all the measures it suggests, and to bring them in as a full package, because we need to tackle this, and we need to start now.
Antibiotics (Primary Care)
John Glen Excerpts(8 years, 7 months ago)
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Maggie Throup
My hon. Friend is right. That is what we need to make clear. People often do not understand that the causes of those illnesses are quite different.
My local clinical commissioning group, Erewash CCG, is working hard to empower patients to take responsibility for their health, very much along the lines of the antibiotic guardians idea. As part of the initiative, it wants patients to learn to recognise when it is right to visit the GP and when it is right to seek alternative advice, such as that of a pharmacist.
I want to come back to where I began: the little device that performs the C-reactive protein point-of-care test. I can tell that hon. Members are wondering what C-reactive point-of-care testing is. A point-of-care test is a diagnostic test that is quick and easy to perform. It can be used during a patient consultation or completed while the patient waits. It allows for immediate diagnosis and treatment choice. Such point-of-care tests are designed to be used by people who are not laboratory scientists.
A C-reactive protein point-of-care test is a blood test that measures the amount of protein called C-reactive protein in a person’s blood, using just a drop of blood from the finger. Evidence shows that the test can deliver significant benefits when used in the primary care setting. It is used in the primary care setting in several European countries and has been shown to reduce unnecessary antibiotic prescribing by empowering GPs to make informed decisions.
John Glen (Salisbury) (Con)
My hon. Friend is making a powerful case for how innovation in the NHS can be the key to securing significant savings and a change in the culture of antibiotic use among the general public. Does she agree that it is about time NHS England moved quickly and decisively to empower people to change their behaviour in respect of managing their own health?
Maggie Throup
I completely agree with my hon. Friend. That is exactly why I secured this debate. We need to move quickly because this is a ticking timebomb that we must address sooner rather than later.
Point-of-care testing can reassure patients that they do not need antibiotics and will recover without them. There is evidence that C-reactive protein point-of-care testing could reduce the number of antibiotic prescriptions issued in primary care for acute respiratory tract infections by up to 42%. That represents millions of prescriptions every year. It has been calculated that using C-reactive protein point-of-care tests in primary care has the potential to save £56 million a year in prescription and dispensing costs. At the same time, C-reactive protein point-of-care testing could make a significant contribution to the UK’s antimicrobial resistance strategy.
I am sure that all hon. Members will have visited a GP with a cough and a cold and feeling pretty bad, and thinking that a short course of antibiotics is just what is needed to get rid of the bugs. They expect to leave the GP’s surgery with a prescription for antibiotics and already start to feel better. The problem with that scenario is that there is a high probability that those antibiotics will be useless, because the cold is not a bacterial infection, but a viral or self-limiting infection that antibiotics will not touch. The consequences are far reaching. First, the drugs will have been ingested unnecessarily, and it is likely that antibiotics will have increased antimicrobial resistance in the population. Secondly, a prescription will have been issued unnecessarily, which is a wasted cost to the NHS.
Let us consider an alternative. The hon. Member will still visit their GP with a cough and a cold and feeling pretty bad, but now by using just a drop of blood from their finger, a C-reactive protein point-of-care test can be carried out and will give an almost instant result. If the level of the protein is low to medium, no antibiotics are needed. The hon. Member will leave the GP’s surgery without a prescription, but knowing that they will start to feel better without one. If the level of the protein is high, a prescription for antibiotics can be issued. Such a simple measure is better for the patient, does not add to the ticking timebomb of antimicrobial resistance, saves the need for a prescription, and saves the NHS millions of pounds. I am sure hon. Members will be asking why it is not happening already.
Such a simple test can also be used for more complex cases than coughs and colds. With the life-limiting condition idiopathic pulmonary fibrosis, GPs find it hard to differentiate between the ongoing condition and an underlying infection. An underlying infection, which could be tested by using the C-reactive protein point-of-care test, may require hospitalisation, but the ongoing condition would not. In such instances, it is not just about whether to prescribe antibiotics; it is about whether a hospital bed and all the resources alongside it are needed. Surely a low-cost, point-of-care test is worth its weight in gold given that scenario.
Despite recent reforms, the NHS still works in silos and is inflexible when it comes to funding a test that originally would be carried out in the hospital laboratory. The majority of testing required by primary care is done by block contract through the local hospital, and additional testing is seen as a cost burden on the GP—that was the barrier I hit more than 20 years ago.
Today, C-reactive protein is included as a recommended area of best practice within the National Institute for Health and Care Excellence clinical guidelines for pneumonia, which state that
“clinicians should consider a point-of-care C-reactive protein test for patients presenting with lower respiratory tract infection in primary care”.
That recommendation was made by the NICE guideline development group and based on antibiotic prescription rates, mortality, hospital admission rates, and quality-of-life outcomes. Antibiotic prescription rates were felt by the guideline development group to be the most relevant direct outcome influencing that recommendation.
Junior Doctors’ Contracts
John Glen Excerpts(8 years, 8 months ago)
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Dr Andrew Murrison (South West Wiltshire) (Con)
I declare my interest as a doctor, and a veteran of truly awful rotas of the 1980s, involving one in two very often—that is every other weekend, every other night on duty, as well as a normal working day, which I would not recommend to either patients or practitioners. Thankfully, they are a thing of the past.
I welcome very much the Health Secretary’s statement today and the guarantees that he has given. On that basis, I am more than happy to support the Government this evening. However, I would say that we need to insist on evidence-based policy making. It is important to understand the difference between a causal effect and an association. My worry is that perhaps the Front Bench has been more influenced by Euclidean theorem than a proper understanding of statistics. My reading of the Freemantle paper and Professor Sutton’s remarks lead me to conclude that no causal link has been established between doctors’ rostering and excess weekend deaths. If we are serious about reducing weekend deaths, and reducing the difference in health outcomes between this country and countries with which we could reasonably be compared, which I know that my colleagues on the Front Bench are, we need to properly understand what are the drivers of those differences, and I do not think that junior doctors’ hours are a principal driver in the problem that we are trying to address today.
I think it is also right to appreciate that we are heavily dependent on the good will of all doctors—consultant grades and junior doctors. Most doctors that I know work well beyond their contracted hours—I know I certainly used to when I was in hospital medicine—and in dealing with them and in communicating with them, we need to keep that in mind and not take that good will for granted.
I very much regret the BMA action, and I very much regret the ballot on 5 November on strike action. The last time such action was taken was in 2012 on, ironically, the subject of pensions. It ended ignominiously and the only outcome was a reduction in the esteem in which the public held the medical profession. I would urge the BMA, armed with the assurances we have had today, to think again. I say “ironically” because, of course, the proposals, as I understand them to be, would increase core hours, which are pensionable—out-of-hours are not—and I have yet to see the BMA make any comment on that, or indeed reflect it in its pay calculator. Maybe a belated understanding of that has meant that it has chosen to take it down.
In trying to reduce weekend deaths and in trying to reduce that gap between our health outcomes in this country and those in the rest of Europe, we need to be focused much more broadly than on junior doctors’ hours. I know the Health Secretary is trying to work out how we can best configure the health service of the future. It is a dynamic thing; it never is fixed in one place. In my opinion, part of that means looking at our NHS estate all the time to make sure that we are getting the best from our assets. In my opinion, it means concentrating our specialist services in larger, regional and sub-regional centres. Those centres find it much easier to roster junior doctors and to concentrate expertise in one place. I am talking about stroke, heart attack and upper gastrointestinal bleeding—all things where we do less well in this country than in countries with which we should be comparable.
John Glen (Salisbury) (Con)
I am grateful to my hon. Friend and parliamentary neighbour for giving way. Does he agree that in the rural communities in south Wiltshire that we both represent, there does need to be a certain minimum proximity in order for patients to be able to access their hospital with confidence?
Dr Murrison
I agree with that, which is where networks come into our national health service, and making sure that we have specialist centres that can deliver the right outcomes for people, and that there are protocols to ensure that ambulance services take people to the right place at the right time, so that they can receive the treatment they need. What we cannot do is continue with the current situation, in which our constituents can expect lower life expectancy and health in later life than, say, French or German patients. That is not sustainable and it is not right. It means looking again at how we configure our national health service. It may mean some difficult decisions in some parts of our NHS, but that should not be a barrier to making sure that we do it right.
What I would say to my right hon. and hon. Friends on the Front Bench is that this is not really about junior doctors; this is about consultant grades, who deliver the therapeutics and diagnostics in relation to upper GI bleeds, heart attacks and strokes. They are now, in our new NHS of the 21st century, at the coalface of delivery in a way that they previously were not. So, if I may say so, I would like a greater focus on consultant grades, perhaps at the expense of some of our junior doctors who are the principal subject of our debate today.
NHS: Financial Performance
John Glen Excerpts(8 years, 8 months ago)
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Ben Gummer
Across the country, trusts are struggling under the load of poorly negotiated PFI contracts. It is worth remembering that when the Labour party speaks about all the money it put into the NHS, a large part of it was borrowed via PFI—that part which was not borrowed as part of Government debt. The important point about PFI is to try to address each contract in turn. The Department is looking at this on an ongoing basis, not only as it concerns old contracts but in the letting of new ones.
John Glen (Salisbury) (Con)
Salisbury hospital enjoys an excellent reputation across the constituency. On a recent visit, having completed a number of easily found cost reduction programmes, the management expressed their determination to continue with patient-level costing service by service and to pursue electronic patient records reform. They asked me to raise their concern about obtaining visas for specialist scientists at the hospital and the need to have a better joined-up service between primary, secondary and tertiary elements of the NHS.
Ben Gummer
I thank my hon. Friend for bringing the attention of the House to innovation at a local level. This kind of innovation, which will allow us to transform the service into an even better NHS in the years to come, is being repeated in many trusts across the country. If I may, I will reply to him by letter on the specific issue of scientists after I have investigated the points he has made.
Oral Answers to Questions
John Glen Excerpts(8 years, 11 months ago)
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The Minister for Community and Social Care (Alistair Burt)
The withdrawal of the minimum practice income guarantee was announced in 2013 because it was unfair. In fact, more practices will benefit from its removal than will lose from it. As for those that will lose, NHS England is already in contact with people about transitional care support. The practices that the hon. Gentleman mentioned have received some of that support, and I understand that the conversations are continuing.
John Glen (Salisbury) (Con)
T5. Following my fourth Adjournment debate on the future of Public Health England at Porton Down two weeks ago, I remain concerned about value for money for the taxpayer. Will the Minister confirm that she has assessed the full value of the life sciences work at Porton Down to the United Kingdom economy, and that she remains committed to maximising the site’s potential regardless of the outcome?
Jane Ellison
I congratulate my hon. Friend on securing so many Adjournment debates. Our most recent debate took place only a couple of weeks ago. He is right to continue to remind us of the contribution that the Porton Down site makes to the UK economy. I can assure him that the outline business case has been and is being scrutinised by Ministers, and that that includes an economic assessment. However, as I have said on previous occasions when we have debated the matter, Public Health England will remain committed to the site even if research staff are relocated.
Public Health England: Porton Down
John Glen Excerpts(9 years ago)
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John Glen (Salisbury) (Con)
The first debate I secured as a Member of Parliament was five years ago on Monday, and it was on the future of the Public Health England site at Porton Down in my constituency. I did not imagine then that the first debate I would secure in the 2015 Parliament would also be on the future of that critical site, but I can think of no issue of greater significance to my constituency.
Porton Down is known across the world for the work that Public Health England and the Defence Science and Technology Laboratory do there. It would not be right to open this debate without first paying tribute to all the staff for the work they have done to tackle Ebola in Sierra Leone in recent months. It has been truly humbling to hear the stories of my constituents, who have travelled at great risk and put themselves on the front line in the fight against Ebola. Their expertise has been vital to the people of Sierra Leone, and it is testament to the UK’s reputation for excellence in infectious disease research. I welcome the recent decision to award a medal for their commitment and dedication, which I know a number of my constituents will be very pleased to receive.
It is almost seven years since the Department of Health authorised Public Health England, then the Health Protection Agency, to develop an outline business case for the refurbishment of the facilities at Porton Down. That was after the Science and Technology Committee found the category 4 containment laboratory facilities at Porton Down
“to be in need of significant investment given their age”.
It recommended in 2008 that
“the Department of Health consider the redevelopment of the HPA’s Porton Down site as a priority”.
Project Chrysalis, the proposal for that multi-million pound redevelopment, was put forward shortly after the Committee’s report was published. In January 2010, a former GlaxoSmithKline site where Public Health England could consolidate its assets in one place was proposed as the preferred option, and a business case was put to the Department of Health just six months later. That was rejected—rightly, in my opinion—after scrutiny and further work were commissioned, but not as part of Project Chrysalis. Instead, Public Health England began putting together the case for a single science hub programme, which some might argue was a clear signal of an intention at an early stage to centralise before the business case work had even concluded.
The new outline business case was finalised in July 2014, and recommended that the facilities at Porton, Whitechapel and Colindale should move to a single campus in Harlow. The PHE board asked for a decision to be made by September 2014. I would like to take the opportunity to ask the Minister why, if the outline business case is so rock solid, it has still not been signed off nine months after Public Health England wanted it to be and 11 months after it was submitted.
There are certainly doubts remaining among many of my constituents about the decision, for a number of reasons. First, co-location in Harlow was recommended as, according to Public Health England’s officials, it
“offers the best value to the taxpayer and delivers the lowest cost over the 60 year life of the programme”.
PHE also stated in its publicly disclosed annexe, however, that
“the differences in cost between the options are relatively small”.
Professor George Griffin estimated in his review of the single science hub work in 2012 that the difference amounted to 2.6% over 68 years, which I maintain is disputable given the complexities associated with modelling over such a long period. The resultant cost to the taxpayer might well be marginally smaller, but it is important to remember that the costs to my constituents will not be. The fact remains that they are being asked to uproot their lives and transplant to Harlow. For many of them, Salisbury has been their home for years. It is where their children go to school and where their family responsibilities lie.
Increasingly the trend in science is not to co-locate assets on single sites, but to harness the power of technology to work across larger areas. Centralisation remains an approach that the private sector left behind, in many cases a long time ago, in recognition that smaller specialist sites can be more effective. The direction of travel towards greater use of genomics and big data reinforces the argument for smaller entities such as Porton to continue to leverage global partnerships. I was previously told by Public Health England that it favoured the single hub model because of the approach taken at the Francis Crick Institute, but this is not a co-location of one entity’s assets; six distinctly different players all operate across multiple sites themselves and, in many ways, will continue to do so.
Secondly, the unwillingness to grasp the potential opportunities at Porton or fully to engage in a conversation about them is disappointing. Public Health England says that
“the Harlow campus has the potential to become a campus with an international reputation for public health science”.
Porton Down already has an international reputation. It has 250 external partnerships across the world and is supported by $55 million of investment from the US Government. It already partners more international universities than universities in the UK, eight US Government agencies, five international health bodies and nine global pharmaceutical companies.
Public Health England has not yet articulated publicly precisely how being in Harlow will improve on that. How many new commercial partnerships does it believe will be generated from the site? What will be the impact on Public Health England’s revenue streams? Have those factors even been modelled thoroughly as part of the business case? I have long been concerned that the outline business case focuses too narrowly on Public Health England’s objectives as an organisation and the benefits it allegedly accrues from centralisation, not the wider opportunities for UK life science industries.
Thirdly, centralising in Harlow flies in the face of the Government’s agenda to promote more prosperous regional economies. The Chancellor said:
“The south-west contains some of Britain’s greatest economic strengths. It should be as central to our nation’s future prosperity as any other part of these islands”.
He said that it
“already has a strong reputation for life sciences”,
and even asked the chief scientific adviser and the chief medical officer to
“explore the potential for new proposals for investment in life sciences in the south west”.
In the light of that ongoing work, will the Minister assure me that the chief scientific adviser has been consulted about the single science hub, given its implications for the entire south-west?
I appreciate that not all of Public Health England would move to Harlow, should the business case be approved, and that Porton would retain the manufacturing facilities. I also recognise that Public Health England management have given an assurance that they will not be abandoning those remaining facilities, and that they are meeting representatives of Wiltshire Council on Friday to examine how Public Health England can facilitate the optimal exploitation of opportunities that will derive from a new science park, which this Government have supported, right on its doorstep. However, it is unacceptable to assume that that would be appropriate consolation for the loss of the remaining facilities and capabilities, and I remain concerned that, if the Porton site were cannibalised in that manner, the temptation to examine commercial opportunities for those remaining facilities would be high.
Indeed, I understand from a letter that was recently sent by the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), to an interested party on 10 June that Public Health England is
“continuing to investigate commercial opportunities for its activities at Porton”.
I have long been an advocate for greater capitalisation on the commercial potential at Porton, but I would like assurances that the vaccine manufacturing facilities will be treated with the respect they deserve and not simply sold off to provide a quick win to allow the Government to balance the equation. This is not just a vaccine factory, and any proposal to maximise its potential needs to recognise its value to the south Wiltshire and regional life science economy.
More importantly, how do these concurrent agendas best serve the interests of my constituents? Can the Minister reassure me that individual Government Departments are not operating on different agendas? It seems to me that any discussions about commercialisation in advance of a decision on the outline business case would be premature and potentially misaligned.
Fourthly, the opportunity to consider the more effective use of existing public sector assets has still not been fully considered. The Defence Science and Technology Laboratory, located on the same site, has existing synergies with Public Health England and the two organisations work together closely. DSTL also has category 4 containment facilities which were refurbished relatively recently and are considered to be of the highest standard. Indeed, it has spare capacity in its facilities, and when the size of refurbished labs at the Public Health England site was being discussed, the decision was taken to request a smaller facility on the basis that DSTL would be expected to provide back-up capacity in an emergency. Professor George Griffin also told the Science and Technology Committee in 2008 that
“the Ministry of Defence has a facility at Porton…there is spare capacity there, we know, and we would be able to use that if necessary”.
However, I have been told that there are conceivable emergency scenarios in which DSTL and PHE would need to occupy the entire space at the same time, resulting in a conflict of interest with severe implications for national security. Those scenarios have never been articulated—they may well be considered above my pay grade—but I would ask the Minister to put on record that the DSTL collaboration option has been fully explored with DSTL management and examined independently, and that the security concerns about the laboratories proved irresolvable.
DSTL and PHE have an important collaboration that benefits from their physical proximity. They are treated as the “Porton campus” by the regulator, enabling pathogenic samples to be transferred between the two sites without the need for additional licensing. Both are licensed for animal work, and I understand that PHE manages some of the sensitive resources occasionally used by DSTL. They can currently be safely transported at minimal risk, but a move to Harlow would completely remove that capability.
Fifthly, I again take the opportunity to emphasise that Porton Down is embedded in the Salisbury community. We support its staff and recognise the sensitive nature of the vital work they carry out. Porton’s relatively isolated location makes it an ideal secure site. Harlow remains untested, and rebuilding the relationship and acceptance of the sensitive work that Public Health England does will take valuable time and effort. As many of my constituents tell me, it is simply common sense to keep that work where it is, not move it to a more densely populated suburban area.
Finally, I reiterate that this is not just a conversation about keeping jobs in my constituency; it is a debate about what is best for our life science industry and the partners that depend on Porton’s expertise. I said in my previous Adjournment debate that my primary concern is that the decision is motivated by a desire to tidy up different entities within the PHE organisation on to a single site, when the advantages of co-location are notional, uncosted and unproven. Until I am permitted to see the full business case, my concerns will remain about the logic that is being used.
I appreciate that this is a decision that will have significant implications for our national security and I have always stressed it is imperative that we get it right. However, the Department of Health was informed in 2008 that the category 4 labs at Porton were
“built over 50 years ago and refurbishment and upgrading work is becoming increasingly difficult.”
In my debate five years ago this week, the then Minister with responsibility for public health, my right hon. Friend the Member for Guildford (Anne Milton), told the House:
“The site is 60 years old, the building structures are in a poor state of repair and the laboratories clearly do not meet modern safety standards, so something must be done.”—[Official Report, 22 June 2010; Vol. 512, c. 273.]
I believed her, yet five years later nothing has been done. The facilities are deteriorating and my constituents have lived in the shadow of this decision for five years, not knowing if they will be moving to Harlow, although we have had the positive news of a science park, which will, I hope, open in the next year or so. I will persist in my questioning on this matter, because, frankly, some of my questions have gone unanswered.
When I last met the PHE leadership team in November, I was told by the most senior official that he was the boss and he would decide how any re-examination of Porton’s potential would be evaluated, but I have heard nothing from him for six months. I have a responsibility to my constituents to seek assurance that the decisions that will have an impact on their lives are being made on the basis of rigorous analysis of the facts. I urge the Minister to finally clarify for my constituents, one way or the other, where their future lies. We owe the staff based at Porton Down that much.
Improving Cancer Outcomes
John Glen Excerpts(9 years, 4 months ago)
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John Glen (Salisbury) (Con)
It is a great pleasure to contribute to this important debate, because so many of our constituents are eager for us to grasp the underlying issues relating to cancer, to explore how to deal with the inadequate service they sometimes receive, and to address some of the challenges we will face in future. As has been mentioned, Cancer Research UK said this week that one in two people will be diagnosed with cancer. As we heard in the moving testimony from my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), sometimes that diagnosis comes out of the blue; it is random and unrelated to previous medical history. We need to recognise that, but we also need to look at the public health challenges. I will therefore focus my remarks on two points: first, the important role that public health has to play; and secondly, how we can ensure that patients have access to timely diagnostic procedures, regardless of where they live.
Four in 10 cancers are thought to be preventable, which is why it is crucial that we view prevention as one of the best cures and work relentlessly to pursue what is required to reduce the number of people who suffer from cancer. We need to work at changing attitudes to prevention across the population, and keep pressing the message that cancer is not always a disease of chance. The 2011 strategy rightly placed an emphasis on that and on delivering a “whole society” approach. In my constituency, NHS nurses run an excellent annual fair to raise awareness of the link between cancer and factors such as smoking, diet and lifestyle. That proactive initiative by a group of local nurses offers a targeted solution. It is combined with clear national campaigns, such as the successful Be Clear on Cancer campaign, which enable us to reach as many people as possible.
I become very weary when Ministers bring forward sensible measures for dealing with some of the drivers of cancer, only to hear an outbreak of great ideological proportions about what we should be doing. It is undoubtedly critical that we continue the vital research into new treatments, but we must also remember that reducing the prevalence of smoking in the UK by just 1% could prevent 3,000 cases of cancer a year. I therefore welcome the decision to introduce standardised tobacco packaging, at a time when around 600 children start smoking every year. I welcome that on the basis of evidence and as a pragmatic decision, but I also want to challenge the assumption that somehow everyone has a free choice about whether to start smoking. I think there are many communities, in my constituency and up and down the land, where peer pressure to start smoking plays a crucial role. If there is anything we can do to reduce the attractiveness of smoking—which we know is so addictive and distinct from other health pressures—we should get on and do it.
Next, I want to highlight the crucial role of GPs. They are the gateway to wider diagnostic and treatment services, and we need to invest in them. We must invigorate their leadership and role in guiding patients to healthier lifestyles and earlier diagnosis, and therefore to earlier treatment and better outcomes. In 2011, as part of the cancer outcomes strategy, the Government provided £450 million of funding to help GPs access diagnostic tests earlier. The benefit of this investment is clear and will save about 12,000 extra lives every year. However, there are significant inequalities in referrals for diagnostic tests. There is a ninefold variation across GP practices in referring patients for the CA 125 test to identify ovarian cancer, and a fivefold variation in referrals for the PSA test used to identify prostate cancer. I visited a group of GPs in my constituency who were somewhat frustrated when they read the comments of the Secretary of State about wide disparities in diagnostic rates. However, this is not about criticising GPs but about recognising that we have unacceptable differences across the nation. NHS England has proposals to enable patients to self-refer for tests, and to establish multi-disciplinary diagnostic centres that allow patients to have several tests done at once. Those are welcome steps, as is the commitment from the Chancellor in the autumn statement to increase the proportion of funding allocated to GPs.
I pay tribute to the work done by charities across the UK to raise awareness and funds for research—in effect, to carry out life-saving interventions to ensure that even when forms of cancer are very rare, the best possible treatment is accessed. I know from my own modest experience—last week I was a blood stem cell donor—that Delete Blood Cancer UK, the Anthony Nolan Trust, and Love Hope Strength do an enormous amount of work to find matches for patients with blood cancer. On 17 March, we will hold another recruitment event in the House to get more people registered. I commend that to all Members present and to all colleagues. Only half the people in this country who have blood cancer find a match, so we can make a small contribution in that way.
I will conclude by focusing on a concern that I have deep inside me whenever we have a debate on the NHS. The fundamental dynamic is one where the supply of treatments and new procedures is ever growing, people are living longer and longer, and demand will increase. Everything we talk about relies on more money going into the NHS, whether that is more transparency, greater awareness of what cancer rates exist across the country in one year, or how we can differentiate the quality of outcomes for 85-year-olds and 65-year-olds. Wherever we know that inequalities and differences exist, there will be yet more pressure to fund more services and more work. We can try to counter this through bigger public health campaigns and greater awareness of how to live—how not to eat, smoke or drink too much—but we also need to be honest about what the NHS can tolerate in this never-ending dynamic of increased supply of services, increased demand, and increased expectations. The right hon. Member for Sutton and Cheam (Paul Burstow) talked about our coalition partner’s commitment to put up £8 billion, and he welcomed the fact that there will be £2 billion more from April.
Paul Burstow
The hon. Gentleman is making the important point that we must debate the resourcing of the national health service. I made the point that removing inexplicable and unfair variation in access to early treatment for cancer will not cost more, but will save money.
John Glen
Absolutely, and I was going to come on to that. My fundamental point is that we must change the appetite of the nation for the NHS. Yes, we want it to be there when random events take place, but we must also recognise that if we are to promote better health, everyone in this country has a responsibility as individual citizens to reduce the demands on it. Unless we do that, every five-year forward view will imply further and further increases. We need to be realistic about the fact that, unless we make real changes, we as a country will be presented with profound challenges.
Mr Baron
My hon. Friend is making a thoughtful and powerful point, but may I push back very gently? For me, the most transformational improvement we could make would be to put the one-year figures up in lights, as I said earlier. That will not cost money; it is about our sense of priorities, as he is fully aware. When we consider that we spend almost as much money per head of population on our health care system as many continental countries, but are still 5,000 lives behind the average—let alone 10,000 lives behind the best—there are still vast improvements to be made within existing resources, and those improvements would save money.
John Glen
I absolutely take that point, but I am challenging the fact that it is extremely demanding to deliver structural changes to how we provide the volume of services in a national system. For 18 months, I went through the experience of dealing with Naomi House, which provides palliative care for children and serves Hampshire, Berkshire and Wiltshire. I met four Ministers and the Prime Minister, but we still did not get a concession on bringing forward guidance on the use of tariffs by local authorities supporting palliative care for children. It was a case of being told that there would be a review, which would happen this year, next year or whenever. Because of my great frustration that delivering this change demands such effort, I doubt that continuing with the NHS as it is now will ever satisfy people. We must be more nimble in dealing with such challenges.
The other outstanding issue relates to the use of data. My hon. Friend the Member for Basildon and Billericay (Mr Baron) rightly pointed to the need for more awareness of data transparency so that we can target resources more effectively. I hope that he is right about the sufficiency of the resources that every party in the House will no doubt pledge in the run-up to the general election. However, when we have a lot of data, we need to be able to process and deal with it, and ensure that we use it to guide resource allocation decisions. I resist strongly all the voices saying that we need to be extremely cautious about using data. Unless we can aggregate data on health outcomes in different dimensions, and use them to drive the reallocation and refocusing of resources, we will not deal with inequalities.
I have probably said enough, but I want to thank my hon. Friend who has given us all something to aim for by championing cancer issues. I once again commend the recruitment event pushed by my local paper in Salisbury, the Salisbury Journal, to make us the place with the highest number of people on the register of Delete Blood Cancer UK. Will the Minister reflect on the key point about the sufficiency of resources and the challenges that the NHS faces and give us an honest answer, as I know she will? It is really important that people outside Parliament know that Members understand the challenges involved in the vital area of how to tackle cancer.
Jane Ellison
I completely understand that point, which is well made. We will not have the next best international benchmark until 2017-18, but my hon. Friend is absolutely right that that does not mean that we are without proxy benchmarking and real benchmarking in the interim. He is right to draw attention to the one-year survival rates. I was trying to give a sense of the international picture and of comparisons.
On how further to improve cancer outcomes, I am sure all Members will be delighted that on 11 January, NHS England announced a new independent cancer taskforce to develop a five-year action plan for cancer services, to consider the vital survival rates and to improve them, saving thousands more lives. The taskforce has been set up to produce a new cross-system national cancer strategy, bringing all the strands together, as so many Members wanted. This is a strategy—by the NHS for the NHS—to take us through the next five years to 2020, building on NHS England’s own vision for improving cancer outcomes, as set out in the “Five Year Forward View”.
Picking up a point made by my hon. Friend the Member for Salisbury, many of the major charities involved in the taskforce have told me that much of it is about working smarter. It is not necessarily to be measured purely by spending more. I thought my hon. Friend made a very thoughtful contribution on that topic. The taskforce is an expression of our ambition for outcomes. It has been set up in partnership with the cancer community and other health system leaders, and it is chaired by Dr Harpal Kumar, chief executive of Cancer Research UK. It met for the first time on 27 January. The new strategy will set a clear direction covering the whole cancer pathway from prevention to end-of-life care; a statement of intent will be produced by March 2015; and the new strategy will then be published in the summer.
I have always been keen in responding to these debates to emphasise the need for the NHS and all others intending to improve cancer outcomes to come together and interact effectively with Parliament. That is vital. The expertise is here in the all-party group, so I am pleased that the cancer taskforce yesterday sent a call for evidence to the various all-party groups—on pancreatic cancer, brain tumours, breast cancer, ovarian cancer and cancer generally. I of course encourage colleagues to submit evidence to the taskforce. After the debate, I will speak to the chairman and of course draw his attention to the quality of the inputs into this debate.
Turning to deal with early diagnosis, I shall not reiterate all the points made about the importance of tackling late diagnosis. We have heard some important illustrations of just how crucial this can be. We have invested over £450 million to achieve earlier diagnosis. As part of the recent taskforce announcement, NHS England also launched a major early diagnosis programme, working jointly with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly.
The new approaches include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms such as tiredness—a big issue for pancreatic cancer, so it is important to work on this; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day. So many Members have spoken in today’s and other debates about the wearying journeys and the debilitating effects that multiple tests on multiple occasions can exert on their constituents—another important area to look at. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17.
Briefly, all Members will need to debate and bring more into the open in the coming years the inevitable tension between the concentration of expertise to carry out early diagnosis, particularly in rarer cancers and those with more difficult symptoms, and the understandable desire that Members and members of the public have to have facilities closer to people. There is a tension, and we will inevitably have to debate it. I think it was the hon. Member for Heywood and Middleton (Liz McInnes) who made the point about the number of rare cancers that GPs see. The issue has been teased out in these debates before, but in reality the number of common cancers seen by the average GP is very few, while the number of rare cancers they see is very few indeed.
John Glen
Does the Minister acknowledge that there is a difference between urban and rural in this context? While those who represent rural constituencies understand the need to aggregate services to get the specialism, we are also concerned about access. Is this not a careful judgment to be made?
Jane Ellison
I entirely agree; I think there is a balance to be struck. One of the issues that was discussed at about the time of the launch of the “Five Year Forward View”, by the NHS among others, was that of moving consultant expertise from secondary to primary settings. There are a number of ways of looking at that. I urge Members to feed the points that they have raised to the taskforce, because it is exactly that kind of new way of looking at things that we want to capture in its work.
Since 2010-11, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns to raise awareness of signs and symptoms of specific cancer types, and to encourage people with such symptoms to visit their GPs. Decisions on further Be Clear on Cancer activity will be made during 2015, and will be based on all the available evidence relating to the effectiveness of the campaigns. I will argue strongly for their continuation, because I think that the case for them has been conclusively made. Many have been very successful, and they are evidence-based, which I think is important. The Department will continue to work with Public Health England, NHS England and all the relevant experts and stakeholders to keep the campaigns under review.
Let me briefly update the House on the ovarian cancer campaign, which was mentioned by the hon. Member for Washington and Sunderland West (Mrs Hodgson), and for which she is a long-standing and doughty champion. I recently lost a dear friend to ovarian cancer, so the issue is very close to my heart. Public Health England ran an ovarian pilot campaign in the North West television region between February and March last year, which, as the hon. Lady said, focused particularly on awareness of bloating as a symptom of ovarian cancer. Public Health England is waiting for the full evaluation results of the campaign, but we expect the interim report to be shared with the charities later this month. Public Health England has also agreed to meet them. A decision on how to proceed will then be made, at a national level.
A draft policy proposal for BRCA gene testing is among those on which NHS England’s clinical priorities advisory group is awaiting consultation. That consultation will probably take place following a 90-day public consultation on the decision-making framework. I understand that NHS England will soon consult on the lowering of the threshold for BRCA1 and BRCA2 testing in line with guidance from the National Institute for Health and Care Excellence.
Let me now briefly touch on the point made by the hon. Member for Heywood and Middleton, from whose health expertise we benefited earlier in the week during another debate. In May last year, before the hon. Lady entered the House, we had a very good debate about cervical cancer and screening following a tragic case involving a young woman in Liverpool. She may find it interesting to read the report of that debate, in which Members described cases similar to that of the young woman to whom she referred.
If people have gynaecological symptoms that make them alarmed enough to visit their GPs, they should be referred for diagnostic tests. Smear tests are screening tests, not diagnostic tests. In fact, the best clinical guidance is that if there are gynaecological symptoms, a smear test will only delay possible diagnosis. I think it important to send young women the message that if they are worried about gynaecological symptoms, they should seek a diagnostic test rather than a smear test.
My hon. Friend the Member for Castle Point (Rebecca Harris) raised the important issue of brain tumours. I can update her on the work that has been done. Representatives of the Brain Tumour Charity recently met representatives of Public Health England, and the meeting went very well. The charity is to give a presentation to the school nursing partnership in March. It is also going to contact the NHS England’s national clinical director for cancer to see how it can contribute to work on early diagnosis. Other actions were agreed on, but I understand that that particular piece of work is proceeding well.
As we know, screening is an important way of detecting cancer early, and under this Government there has been a £170 million expansion and modernisation of cancer screening programmes. They are reviewed regularly, and I am always happy to tell Members how further information can be submitted to the UK National Screening Committee.
On cancer waiting times, the NHS is treating more cancer patients than ever and survival rates are improving. In the last 12 months, nearly 560,000 more patients were referred with suspected cancer than in 2009-10, an increase of 60%. In 2013-14, almost 35,000 more patients were treated for cancer than in 2009-10, an increase of 15%.
Most waiting times standards are being maintained despite the growing numbers, although we are aware of the dip in the 62-day pathway standard in the last three quarters. Of course it is vital that all patients fighting cancer should have high-quality, compassionate care and we expect every part of the NHS to deliver against those national standards. Therefore, the NHS is looking urgently at any dips in local performance to ensure that all patients can get access to cancer treatment as quickly as possible. It has a specific waiting times taskforce looking at that.
Radiotherapy has long been championed by the hon. Member for Easington (Grahame M. Morris). Radiotherapy can be a helpful treatment for some patients. His points about its success rate when used at the appropriate time were well made. As part of its recent announcement, NHS England also committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy, stereotactic ablative radiotherapy, or SABR, to which he referred. That new investment is in addition to NHS England’s pledge to fund up to £6 million over the next five years to cover the NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK. Those are for pancreatic cancer, lung cancer, biliary tract cancer and prostate cancer.
I can confirm that we are investing £250 million in two proton beam therapy centres. One is at UCLH—I saw the foundations being built when I visited the hospital recently; it was exciting to see that centre being built—and the other is at the Christie in Manchester, so that patients can be treated in the UK. As Members will be aware, patients are currently referred abroad
On the cancer patient experience and the cancer patient experience survey, nothing could more amply demonstrate the importance of putting cancer patients’ experience at the heart of treatment and of the NHS response than the speech by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). It was impossible to remain unmoved by it. It could not have more aptly underlined the importance of taking patients’ experience into account. Therefore, I was pleased to see that the results of the 2014 cancer patient experience survey, published in September, show some improvement on many of the scores since the previous survey—89% of patients reported that their care was either excellent or very good.
Following the 2014 survey, NHS Improving Quality is launching a pioneering project that pairs highly rated cancer trusts with trusts that have potential to improve. That “buddying” programme will involve up to 12 trusts and will be directed at clinical and managerial staff so that we can continue to use that survey to drive improvements.
As to the future of the survey, on which there has been some discussion, my hon. Friend the Member for Basildon and Billericay mentioned the new tendering of the contract, which NHS England is taking forward. For those reasons, it is unlikely that there will be a survey report in 2015. I know that that will be a disappointment to him, but it is very much the intention to run a survey this year for publication next year. NHS England is working with a range of stakeholders, including cancer charities, to ensure that that survey is even more effective.
NHS Services (Access)
John Glen Excerpts(9 years, 8 months ago)
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Mr Hunt
I will make some progress.
The right hon. Gentleman said that the reforms have made it harder to access NHS services. The opposite is true. Scrapping the primary care trusts and strategic health authorities meant the introduction of clinical leadership, which he wants to abolish, and allowed the NHS to hire 6,100 more doctors and 3,300 more nurses. Those members of staff are helping the NHS to do 850,000 more operations every single year compared with when he was in office. How can he possibly stand before the House and say that access to NHS services is getting worse, when nearly 1 million more people are getting operations every year compared with when he was Health Secretary?
John Glen (Salisbury) (Con)
What is more, the evidence from Labour’s last years in office shows that the number of managers was increasing at three times the recruitment rate for nurses. What does that say about Labour’s priorities in office?
Mr Hunt
My hon. Friend is absolutely right. That is why the management pay bill doubled under Labour and why we took the difficult decision, which the Opposition bitterly opposed, to get rid of 19,000 administrators and managers so that we could recruit the extra doctors and nurses. I notice that Opposition Front Benchers are very quiet on that point because they cannot answer the simple question of how they would pay for those extra doctors and nurses if the Health and Social Care Act 2012 was reversed. [Interruption.] Ah! They would pay for the extra doctors and nurses by bringing in new taxes that the country is not paying at the moment.
The right hon. Gentleman talked about structural reforms. We ought to discuss the structural reforms that he chose not to talk about, such as making the Care Quality Commission independent, with new chief inspectors for hospitals, adult social care and general practice. He tried to vote down that legislation in this House. So far—[Interruption.] I know that this is uncomfortable for Labour Members, but they should listen, because the new inspection regime has put 18 hospitals into special measures. Five of them have been turned around completely and have exited special measures, and important improvements are being made at the others.
The motion talks about Government mistakes, so will the right hon. Gentleman finally accept the catastrophic mistakes that he made as Health Secretary, such as failing to sort out the problems at those hospitals, even though there were warning signs at every single one of them? Does he accept that because Labour ignored those warning signs, patients were harmed and lives lost? Will he finally apologise to the relatives of patients at Mid Staffs whom he made wait outside in the cold because he refused to meet them and hear their concerns? Will he make that apology now? He has not apologised and it is clear that he does not want to do so today.
The right hon. Gentleman talked about A and E. Just as when he was Health Secretary, there have been weeks when the target has not been met. What he did not tell the House is that, thanks to our reforms, we have 800 more A and E doctors than four years ago and nearly 2,000 more people are being treated within four hours every single day than when he was Health Secretary.
As the motion refers to Government mistakes, perhaps the right hon. Gentleman might like to acknowledge some of his own mistakes on A and E, such as the 2004 GP contract that removed personal responsibility for patients from GPs, making it more likely that people would end up in A and E, or the failure over 13 years to integrate the health and social care systems, meaning that many vulnerable older people continue to end up in A and E unnecessarily—something that we are putting right through the Better Care programme.
When the right hon. Gentleman spoke about NHS performance, he talked repeatedly about missed targets. That is a really important issue and is perhaps the biggest dividing line between his approach to the NHS and mine. Of course targets matter in any large organisation, but not targets at any cost. That is why the Government have been careful to ensure that in the new inspection regime, waiting time targets are assessed not on their own, but alongside the quality and safety of care.
Public Health England Hub Programme and Porton Down
John Glen Excerpts(9 years, 9 months ago)
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John Glen (Salisbury) (Con)
May I say what a pleasure it is to serve under your chairmanship for the first time, Mr Robertson?
I have called this debate on the back of two similar debates in June 2010 and September 2013, several questions in the House, the lobbying of Ministers and meetings with officials over the past four years. Today, I urge the Minister critically to appraise the recommendations that she and her ministerial colleagues have received from the board of Public Health England to move significant elements of the PHE facility at Porton Down to a new site in Essex.
The UK Government have had capabilities at Porton Down for more than a century, which have evolved into a unique asset overseen by PHE. The facility is recognised around the world for its role in responding to some of the gravest threats facing mankind today. Indeed, several of my constituents have been deployed abroad to support the international response to the Ebola crisis, which is widely reported in the media.
However, it is well known that the facilities at Porton Down have been in need of a substantial upgrade to remain fit for purpose. Until 2009, the board of the Health Protection Agency, PHE’s predecessor organisation, felt that its objectives would be best achieved by expanding and redeveloping the existing site at Porton. The PHE board has submitted three different business cases—in June 2010, April 2012 and, after a two-year gap, in 2014 —as it has sought to justify its intention to create a single science hub in Harlow. The PHE board has submitted the outline business case to Ministers, and the preferred option is to collocate its assets on a new campus in Harlow modelled on the USA’s Centers for Disease Control and Prevention in Atlanta. The latest publicly available analysis from Professor George Griffin’s 2012 due diligence report disclosed that the Harlow option would produce a mere 2.6% cost saving for the Treasury compared with redevelopment with Porton, over a 68-year time frame.
I want to use the debate to highlight the risks associated with relocating such a sensitive facility. PHE’s primary mandate is to
“protect and improve the nation’s health and wellbeing”.
Some of the work done at PHE Porton, especially translational research into taking products from the workbench to commercial markets, arguably does not fit comfortably in that mission statement. Consequently, I am led to believe that the business case does not fully assess the potential of a redeveloped site at Porton to drive growth in the UK life sciences sector. The Government clearly view that sector as important to the UK economy, given that they selected one of our colleagues to become Minister with responsibility for life sciences in the July reshuffle. I emphasise the critical importance of translational research and urge the Minister to be the one who finally unleashes PHE’s full potential at Porton in that area.
Public Health England Porton is on course to generate £65 million in external revenues this year; it receives just £8 million in funding from the Department of Health. PHE Porton is operating in an increasingly competitive global environment where outcomes are harder to achieve, and it is doing so very successfully. Understandably, PHE’s primary mandate is not about seizing commercial opportunities, and the translational research capability at Porton has arguably never been fully realised, and its potential never fully exploited, as a consequence.
One of the key arguments for relocating to Essex is that Harlow is ideally sited between London and Cambridge, which would allow PHE to establish links with companies and research institutions based there. My fear, however, is that that argument is flawed because the team at Porton has never been disadvantaged by its current location. As the useful document from the Porton life sciences group sets out, the team at Porton currently works with more than 250 partners across the world, including more than 130 universities, the US Government, five international health agencies, nine global pharmaceutical companies and more than 60 small and medium-sized enterprises. The list includes more than 30 entities currently based in London or Cambridge.
In 2012, the Boston Consulting Group carried out a comprehensive study of the drivers of research productivity in 420 life science companies. The study found that location was not a key factor and that accumulated research expertise was twice as significant. PHE Porton has some 3,750 years of scientific acumen relating to infectious disease in its ranks. Almost half of those individuals are operating above PhD level. PHE argues that new staff can easily be moved or recruited to Harlow and that it is a desirable place to work, but the fact remains that, when the staff at Porton were last surveyed, just 7%, or one in 14, were inclined and prepared to move.
I find it perplexing that in the modern age, when the Government are increasingly looking beyond geographical borders for commercial opportunities, when digital by default is the preferred option and when the Government are actively seeking to disperse their functions outside the south-east, Ministers could accept a plan that flies in the face of those aspirations. The entire business case is dependent on the premise that an organisation will be more effective if its staff and resources are in one location, but across PHE employees perform a wide range of functions, many of which have little day-to-day operational co-dependency.
The idea that a physical hub will result in “water cooler conversations” leading to improved research outcomes is, at best, highly questionable. The private sector left that mindset and approach long ago in favour of more effective use of technology and flexible working practices. The outline business case also makes the assumption that existing partnerships will be able to continue operating effectively throughout at least a 10-year transition period.
I want to imagine a different scenario in which Porton is finally given the operational freedom to capitalise fully and extend its current external research relationships, as I have consistently suggested in debates in the House over the past four years. Other Departments have recognised the potential of what exists at Porton. On the same day that Public Health England’s board made public its recommendation to move to Harlow, the Department for Business, Innovation and Skills announced an investment of several million pounds to establish a new science park at Porton, which was supported by the local authority, Wiltshire council, and the local enterprise partnership. The science park will be next door to Public Health England and the Defence Science and Technology Laboratory. The Department of Health’s first spin-off company emerged from PHE Porton, and one of the reasons why the science park was conceived was to provide space for similar likely companies in the future.
Imagine if the ambition of the universities of Oxford and Southampton to create a second corridor of excellence to rival Cambridge and London could be fostered. The regional life sciences industry proposed to create a new national centre for translational vaccinology, which the Medical Research Council could not support further because of the uncertainty around PHE at Porton Down. The project is not some blue-sky ambition proposed at the last moment, either. There are signed expressions of interest from two multinational pharmaceutical companies and SMEs across the region. It is not a new project but one that has developed from existing working relationships. The university of Southampton, for example, is involved in more than 30 projects with PHE Porton, such as the one awarded $1.4 million by the US National Institute of Health last month to continue its groundbreaking work on tuberculosis treatments.
I will now discuss PHE Porton’s one geographical partnership that depends on physical location. The Defence Science and Technology Laboratory is currently located immediately adjacent to PHE, and there is a natural synergy in the work that the two organisations do and the security arrangements that they share. I am told that staff have worked particularly closely in emergencies. They have a close historical connection, their staff share a number of unique competencies and both organisations retain a significant proportion of the UK’s containment level 4 laboratories.
Although I understand that greater collaboration with DSTL has nominally been considered as part of the single science hub programme, I seek reassurance that that option has been fully evaluated, particularly in light of what I know to be the willingness of DSTL’s management to embrace the programme. It has been known since 2008 that there is spare capacity in DSTL’s high containment facilities, as Professor Griffin told the Select Committee on Innovation, Universities, Science and Skills. He reported in 2012 that it is important that the relationship is preserved:
“A move to Harlow would not prevent collaboration with DSTL but it would be more difficult, particularly since outside the UK ‘Porton Down’ is perceived as being managed more under common control than it really is and this carries considerable brand value.”
I emphasise that point. When the Prime Minister said that our laboratories had confirmed that there were chemical weapons in Syria, he referred not to DSTL or PHE labs but to our labs at Porton Down. The media reports on samples of Ebola being sent to “our experts at Porton.” Porton has a global reputation built up over several decades, which Harlow will need to work hard even to establish.
Although I fully concede the need to do what is best for the national public health interest as a whole, my concern is that the translational research function and the complex relationships and revenue generation activities that have been built up over many years will be put at serious risk if the outline business case is accepted as is. Given the pace of technological change, the notion of a single science hub might become redundant, too. Earlier this week I met my hon. Friend the Member for Mid Norfolk (George Freeman), the new Minister with responsibility for life sciences, and he is a great believer in the power of genome sequencing to revolutionise care in the NHS. He will know that the direction of travel undermines the case for physical collaborations as more laboratory-based diagnostic work is replaced by computer-based modelling.
Before approving the plan, I ask the Minister to be sure that the business case contains a rigorous analysis of the issues of transitioning and recruiting teams of world-class scientists and that the security concerns about sensitive work, which we hear nothing about, are not optimistically handled in the business case. Please be sure that the economic value associated with 10-year contracts with the US Government and other external parties will not be seriously jeopardised during an extended, uncertain transitional period in which facilities at both Porton and Harlow will need to co-exist.
Perhaps more importantly, I urge the Minister to recognise that, although translational science may not be core to the entity that is currently Public Health England, it is certainly core to the UK’s life sciences industry. Please be sure that the outline business case demonstrates conclusively that the commercial opportunities for PHE will be significantly improved by relocating to Harlow and that the anticipated gains clearly outweigh the opportunity to create a new world-leading corridor of translational vaccinology in the south-west at Porton.
I stand here today, for the third time in an Adjournment debate since I was elected in 2010, not because I want to articulate a narrow “keep the jobs in my constituency at all costs” argument. My primary concern is that this decision is motivated by a misjudged desire to tidy up different entities within the PHE organisation into a single site, when the day-to-day functional synergies of the different components of PHE are not significant, the advantages of co-location are notional, uncosted and unproven and most of all, sadly, the risks to the life science sector and the international Porton Down brand are so significant that they render the recommendation to proceed with the Harlow option even more questionable.