Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 29th October 2019 Commons Chamber

[Caroline Dinenage]

I simply say to the hon. Lady that people over the age of 60 qualify for free prescriptions.

[Julie Cooper (Burnley) (Lab)]

Too many patients cut back on their prescribed medicines or go without them altogether because they simply cannot afford to pay prescription charges. Research by University College London indicates that this non-adherence to prescribing regimes costs the NHS £500 million more in complex treatments and hospitalisation. Prescription charges are a tax on sickness that disproportionately burdens those who have chronic illnesses and those on low incomes. Does the Minister agree that it is high time we brought an end to these charges, which fly in the face of the principle of an NHS free at the point of delivery?

[Caroline Dinenage]

I suppose I should probably have declared an interest in this issue, because I am severely asthmatic and I do not get free prescriptions, but then again I do not think I should. There is a prescription exemption system designed specifically to assist people who are most likely to need support in paying for prescriptions: people on low incomes or in full-time education; the over-60s; people living with many long-term conditions; and people with an increased risk of illness, such as pregnant women. That is why 89% of prescriptions are dispensed without charge.

Health Visitors (England)

Julie Cooper Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve with you in the Chair, Mr Bone. I thank the hon. Member for East Worthing and Shoreham (Tim Loughton) for bringing this important subject before us, and for the sterling work that he does chairing the all-party parliamentary group for conception to age two—the first 1,001 days.

We have had some really interesting speeches, and I thank all Members who have spoken for some very convincing contributions that have outlined very clearly the massive contribution that health visitors make to communities and to individual families, covering all sorts of services—from basics such as the transition to parenthood, particularly helping new parents, to support with breastfeeding and weaning, and encouraging the full take-up of immunisations. It has been pointed out that we have a very poor record on that. Health visitors also support the mental health of parents who might be feeling vulnerable in their new role; advise on a host of minor ailments from which children might suffer; ensure readiness for school; check that developmental changes are happening at the appropriate stage; and help to pick up early any special needs and problems.

The hon. Member for East Worthing and Shoreham talked about the importance of safeguarding and the cost—not just the cost to the family, but the financial cost of services when it does not happen. Health visitors, as registered nurses with additional midwifery, community and public expertise, play a tremendous role. I do not think that there is any disagreement in the Chamber about the contribution that they make. Praise for them among health professionals is widespread. The president of the Royal College of Paediatrics and Child Health has said:

“Health visitors act as a frontline defence against multiple child health problems”.

The Children’s Commissioner for England said:

“Health visitors are an essential part of the country's support structure for young children and their parents”.

My daughter Anna became a new parent six months ago today. Ahead of the debate, I asked her what she thought of her health visitor. She said:

“We loved our HV. We didn’t have consistent midwifery care—a different midwife every week before and after Nora was born—but we had one HV who first visited me before Nora was born and told me she would be my health visitor throughout the early stages of me becoming a mum. We found her especially helpful when Nora started struggling”

with feeding. Anna also said of her health visitor that

“we’d been discharged by the midwife and didn’t want to bother the GP. She was just a phone call away or would pop to see us.”

I am grateful to the hon. Member for Liverpool, Wavertree (Luciana Berger) for what she said about the benefit she had from health visitors. There is no disagreement about their value, and I put on the record my thanks to health visitors across the country for the sterling work that they do in times of considerable difficulty and challenge. They are very much a British phenomenon. We are the envy of the world, having health visitors—and with good reason. We all know that there is nothing more important than giving children the best possible start in life.

Bearing all that in mind, it is distressing to hear that the number of health visitors is falling so drastically. We are going backwards and it is extremely worrying. The Minister may point to the fact that David Cameron increased the number of health visitors, but that is old news, and the picture now is very different. In 2015, there were 10,300 health visitors; by 2017, that number had fallen to 8,244. The reality is that every month the numbers fall. None of that is really surprising considering that, in late 2015, public health and the commissioning of health visitors became the responsibility of local authorities. That transfer of responsibility was accompanied by a budget reduction of 6.2% and the requirement to cut year on year until 2020. Funding for health visitors is not ring-fenced, so is it any wonder that cash strapped authorities are commissioning fewer and fewer?

I raised my concerns about this last year with the former Health Minister, the hon. Member for Thurrock (Jackie Doyle-Price). She said:

“health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating…There has been a decline…which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.”—[Official Report, 23 July 2019; Vol. 663, c. 1204.]

I totally agree. That was said last year, and the Government have failed to act and the numbers have continued to fall.

The numbers of children have not fallen, though, and it is therefore important to recognise the increased workload of the remaining health visitors. My hon. Friends the Members for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Lincoln (Karen Lee) all raised the falling numbers, and pointed to the fact that the Institute of Health Visiting current caseload identification exceeds safe levels. The recommended maximum caseload for health visitors is 250. The Care Quality Commission reports that the average is 500 and, in the London Borough of Hounslow, the average number—not the highest—is 829 per health visitor. That is obviously affecting their ability to deliver a quality service, and it is now true that the proportion of six-to-eight-week reviews completed for newborn children ranges from 90% in some areas to only 10% in others. It seems that vital workforce planning is a thing of the past, and our children and communities are paying the price.

In the widest sense, that approach is so short-sighted. No health professional is better placed than a health visitor to support parents and children in those vital early years. The early intervention of a well-qualified, accessible health professional can be the difference between children thriving and not. For every child who does not thrive, there is a cost, not just to the family but to wider society. There is a wealth of evidence to demonstrate the high impact that health visitors have in key areas.

[Mr Peter Bone (in the Chair)]

Order. I am sorry to interrupt the shadow Minister, but there is a guideline of five minutes for shadow Ministers in these debates, with 10 minutes for the Minister. We are cutting into her time, so I hope the shadow Minister has finished her speech.

[Julie Cooper]

May I make a couple of final points?

[Mr Peter Bone (in the Chair)]

Of course—very quickly.

[Julie Cooper]

Today, the Minister has heard an appreciation of the contribution of health visitors. We look to her to address the question of future provision, and outline how she is going to turn around the decline in numbers.

Baby Loss Awareness Week

Julie Cooper Excerpts

Tuesday 8th October 2019 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

It is a privilege to have the opportunity to speak in this debate, which marks the 18th UK Baby Loss Awareness Week and the fourth debate in this place on the subject. I join the Minister in hoping that this will continue to be an annual event, as this is a really important subject on which we need to focus. I also welcome her comments on efforts to focus on prevention, to share examples of good practice and to learn from mistakes. I also want to put on record my thanks to midwives and obstetricians across the country, who do so much to deliver safe babies.

As a mum and a grandma, I can say that anyone who has ever known the joy of conceiving and giving birth to a child and the joy of watching that child grow and thrive knows how precious it is, and the very thought of losing that is something too painful even to contemplate. The fact is that, every single day, there are 650 miscarriages in the UK, which means that every single day, 650 women and their partners and families experience the most devastating loss. Every day in the UK, nine babies are stillborn, which means that 3,168 mums-to-be a year never get to keep the child that they have carried and loved for nine months. For every 1,000 babies born, between two and three will die before they are 28 days old. That is the equivalent of 2,131 babies every year. Somehow those parents have to find a way to go on. Baby Loss Awareness Week is about raising awareness of their suffering, and it is so important. It is also about finding ways to provide support and about highlighting the need for good care following a bereavement or miscarriage.

This week, bereaved parents and their families and friends will unite with each other and others across the world to commemorate the lives of babies who died during pregnancy, at or soon after birth and in infancy. I want to pay tribute to members of the Baby Loss Awareness Alliance. There are too many to mention individually, but those incredible charities and organisations are working together for change and tangible improvements in policy, research, bereavement care and support for anyone affected by the death of a baby at any stage. I want to thank them for the work that they do, and for reminding us that, first and foremost, this week is about remembrance.

The campaign to break the silence is crucial because miscarriage, stillbirth and infant death must not somehow become a guilty secret never to be told. The memories are painful, but precious, and the sharing of experiences with others is important. Many parents affected describe feelings of isolation, extreme sadness, anger and sometimes guilt. They need their experience to be listened to and acknowledged, because a loss of life matters and will always matter.

This week is also about raising awareness about pregnancy and baby loss in the UK and, crucially, it is a call for action. I want to commend the excellent “Out of Sight, Out of Mind” report published today. It is a call for mental health care for bereaved parents. Too often, they fall through the gaps in provision. The report illustrates a system that is at best insensitive and at worst totally inadequate. It is really hard to believe that anyone could ever think that it was appropriate for psychological support to be offered to a parent who has lost a baby on a neonatal ward with other people’s babies present. I was staggered to read also in the report of a bereaved parent turned away from bereavement counselling because they had not lost a loved one. We must do better.

A survey carried out this year found that 60% of bereaved parents felt they needed specialist psychological support for their mental health, but were not able to access it on the NHS. It has long been recognised that women who experience a stillbirth or neonatal death are four times more likely to have depression and seven times more likely to have post-traumatic stress disorder, yet currently, while there are pockets of good practice, provision is too often inadequate and reliant on a postcode lottery, and parents in need are falling through the gaps. This report is a call for the UK Government to act to ensure that all parents who experience pregnancy and baby loss and who need specialist psychological support can access it at a time and place that is right for them—free of charge, wherever they live.

I thank Members on both sides of the House who have on other occasions shared their very personal and painful experiences of loss. I also recognise the sterling work of the all-party parliamentary group on baby loss. Finally, but by no means least, I thank my hon. Friend the Member for Swansea East (Carolyn Harris) for her powerful campaign that led to the establishment of the children’s funeral fund.

I hope that Members on both sides of the House can together acknowledge today that we have heard the call for action and that, most importantly, we guarantee that we will act. In 2020, I want to be standing here and thanking the Government for their achievements in this field.

Draft Human Medicines and Medical Devices (Amendment etc.) (EU Exit) Regulations 2019

Julie Cooper Excerpts

Monday 7th October 2019 General Committees

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the Minister for outlining the detailed changes in the new regulations and for underlining their importance.

The regulations certainly are important, given that we are only 24 days away from a potential no-deal Brexit. A parliamentary majority has three times voted to oppose the UK crashing out of the EU with no deal. Hon. Members, including me and others on the Opposition side of the House, did not do so on a whim or as part of some political game, but because all the evidence, including the Government’s impact assessment, makes it clear that leaving the European Union without a deal would be catastrophic for the UK in general.

Indeed, no area gives greater concern than the provision of medicines and medical devices. There can surely be no issue more important than ensuring that patients have timely access to the safest and most effective medicines and medical devices. Some 60% of prescription and over-the-counter medicines supplied in the UK come from or via the EU. It is vital for patients that that access is uninterrupted, so it is exceptionally worrying that the Government’s Yellowhammer papers warn that medical supplies could be delayed for up to six months.

The British Medical Association is worried about the provision of medicines and medical devices in the event of a no-deal Brexit. It has urged the Government to consider that:

“Many medicines, including life-saving agents for cancer diagnosis and therapy, cannot be stockpiled and for those that can, stockpiles could run out”;

that such delays can lead to fatalities; and that

“No responsible government should take that risk.”

Can the Minister respond to that point and outline some of the specific contingency plans that the Government have put in place for medical supplies that cannot be stockpiled, such as radioisotopes used in the treatment of cancer patients? What guarantees can she give that radioisotopes will continue to be imported into the UK without delay in the event of no deal? What further contingency steps has the NHS taken to ensure that radioisotopes will be supplied uninterrupted to hospitals across the UK?

Given the importance of the legislation, one has to wonder why it is not in place at this late hour. I have a sense of déjà vu because, as the Minister said, it was only in March that the Human Medicines (Amendment etc.) (EU Exit) Regulations 2019 and the Medical Devices (Amendment etc.) (EU Exit) Regulations 2019 were debated. At that time, my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) put on the record our grave concerns about the widespread and totally inappropriate use of secondary legislation for such important and potentially controversial matters. Secondary legislation is not fit for this purpose, not least because it does not provide the opportunity for detailed scrutiny.

Back in March, my hon. Friend the former shadow Minister warned that the process was not robust and that rushing through the legislation with inadequate scrutiny would lead to mistakes and omissions. Here we are today, required, according to the Government’s accompanying explanatory notes,

“to correct drafting defects and omissions in the Human Medicines (Amendment etc.) (EU Exit) Regulations 2019 (S.I. 2019/775) and the Medical Devices (Amendment etc.) (EU Exit) Regulations 2019 (S.I. 2019/791).”

My hon. Friend was absolutely right. The situation is extremely worrying. It begs the question of how many more omissions and defects in this regulation are yet to be revealed.

I know everyone on both sides of the House is keen to ensure that all aspects of retained EU law in relation to human medicines and medical devices operate effectively and are not deficient after exit day as a result of the UK’s withdrawal from the EU. The stakes are high, and this legislation will have far-reaching effects on the multi-billion-pound pharmaceutical industry, medical device companies, wholesalers and all those in the supply chain. If we do not retain a close working relationship with the countries of the EU that closely emulates the one that we have enjoyed for many years through the European Medicines Agency, opportunities for research, innovation and access will be restricted. Most importantly, this could have a devastating effect on our NHS, potentially affecting the lives of millions of patients.

We support the Government’s desire to give the UK protection in all these areas, so we will not oppose this SI, but we want to put on the record our grave concerns about the way they have gone about this. We are appalled by the Government’s late attention to this most serious of matters. The Government have known since 2016 that there were risks, and for much of the past three years they have taken no action. We are horrified by the shambolic process that has led us at this late stage to be addressing omissions.

These regulations go beyond technical corrections and the correction of key acronyms; they clearly make substantive amendments and raise more questions than they answer. Let us look at some of the specific corrections. I hope that the Minister can clarify some important points.

There is provision here for a mechanism for companies affected by proposed decisions of the licensing authority in relation to orphan medicines to have those decisions reviewed by the Commission on Human Medicines. The question is how long that process will take. Where the criteria are satisfied, how long will it take for supplies to be sanctioned? How will timely supplies be guaranteed? What protections will be in place to protect patients in the UK from fake medicines?

In relation to the treatment of rare diseases, can the Minister clarify what provision she has made to support UK patients who rely on the European Research Network for the diagnosis and treatment of their rare diseases, if a no-deal Brexit leads to our expulsion from the network? What will the Government do to ensure that the UK can continue to participate in EU-wide clinical trials in the event of a no-deal Brexit?

The changes to the regulations allow for the introduction of a transitional period relating to the system for pharmacovigilance. Effective pharmacovigilance must be at the heart of the new arrangements, ensuring the health and safety of patients and, crucially, increasing the benefits of medicines. I understand that businesses will need time to comply with the new regulations, but what protections will be in place for patient safety during this interim period?

What estimate has the Minister made of the cost to the industry of establishing the presence of a qualified person responsible for pharmacovigilance for those companies that do not already have a UK presence? That will inevitably involve costs for establishing premises, familiarisation and administration to ensure compliance with the new legal requirements. Does she intend to ensure that the Government meet those costs? While answering that point, perhaps she could also take this opportunity to advise on the planned provision for extra resources that will be needed by the Medicines and Healthcare Products Regulatory Agency to enable it to carry out its extensive new responsibilities.

The new regulations deal with the very important matter of medicines for children. These are not mere technical changes. The regulations introduce paediatric investigation plans. Can the Minister explain exactly what these will entail and how long the process will take? Will it lead to delays in supplying medicines and medical devices? Will additional training for staff be required? What extra resources will the process require and where are those resources coming from? Will it mean any delay in the development or availability of medicines?

[The Chair]

Order. I am sorry to interrupt the hon. Lady. I know that this room is not ideal for a Committee, but officials are not supposed to pass notes directly to a Minister.

[Julie Cooper]

These points all prompt a question: why are these changes not accompanied by a new impact assessment? Our constituents will be listening to this debate and fearing that these changes will lead to poor or delayed supplies. They will be worried, and they are right to be. For some people this will be a matter of life or death. This is not “Project Fear”; this is a genuine fear that patients will be put at risk. The BMA has said:

“Disruption resulting from the UK crashing out of the EU without a deal on 1 November will cause ‘irreparable harm’ to the NHS and catastrophically exacerbate the challenges posed by a winter pressures crisis.”

It went on to say:

“We are not ‘the doubters, the doomsters or the gloomsters’ the Prime Minister described on the steps of Downing Street. Nor is this ‘Project Fear’. We are doctors who day in and day out provide care for patients in the face of challenges that will only be made worse by a ‘no deal’ Brexit in the critical winter months following 31st October. We have a duty to speak out about matters that can harm patient care and we will continue to highlight the dangers Brexit presents in the weeks and months ahead.”

We will not oppose these regulations today, but we will record our grave concerns and seek answers to the specific questions that have been put. I agree with the medical professionals, and for the sake of the health and wellbeing of the citizens of the UK I urge the Minister to join me in heeding their warning, and I urge the Prime Minister to avoid a no-deal Brexit and instead work on constructive transitional arrangements in the context of an organised exit.

[Ms Dorries]

I will not comment on the hon. Lady’s opening comments about a no-deal exit, because obviously we are where we are, we all stood on a manifesto to honour the result of the referendum, and it is not my position to comment on a no-deal exit.

I will answer the hon. Lady’s more specific points. It is important to make the point that at any one time in the UK there is a shortage of over a hundred medicines, and that has absolutely nothing to do with Brexit, as I am sure she knows. It can be to do with fires in factories, or a downturn in supply from abroad. At any one time there are shortages, and any shortages today have nothing to do with Brexit.

[Julie Cooper]

I absolutely agree with what the Minister has just said. I have personal experience of pharmaceutical provision in the UK and I know that what she has just said is true. However, does she not agree that exiting the EU with no deal will exacerbate existing problems?

[Ms Dorries]

The hon. Lady will not be surprised to know that I do not agree, because I believe—I cannot guarantee, but I believe—that all efforts are being made and all arrangements are in place to ensure a supply of drugs into the UK. Under just-in-time arrangements, drug companies would have a stockpile of a week’s supply, but now all drug companies have stockpiled six weeks’ worth of medications to be used in the UK, and I do not envisage a shortage of any drug that is required.[Official Report, 14 October 2019, Vol. 666, c. 1MC.] Obviously, I cannot guarantee that—that cannot be done—but every effort has been made by every Department and every official and in every negotiation with drug suppliers and pharmaceutical companies to ensure that they have a six-week supply ready for a no-deal Brexit. We do not see any problem with that.

The hon. Lady referred to drugs with short shelf lives, which cannot be stockpiled. In that instance, arrangements have been made for those drugs to be air freighted into the UK. She mentioned isotopes in particular. They cannot be stockpiled, but they will be airlifted into the UK, so we will see absolutely no shortage of isotopes either. I am sure that we can provide further information on that, but I hope that, now that hon. Members are aware that drugs that have no shelf life will be airlifted, we will not hear those stories. What worries me, and what worries many people, is the public perception when they hear stories that there will be no isotopes because they cannot be stockpiled. We must take our responsibilities very seriously here.

[Julie Cooper]

I can assure the Minister that I take my responsibilities in this very seriously. I know that many hon. Members here do too—including her, I am sure. But this is not just a case of political to-ing and fro-ing, trying to create a sense of panic in the community about this. When the medical professions are leading the voices of concern, surely the Government should be listening to their worries.

[Ms Dorries]

I assure the hon. Lady that we do, and I hope that they will see today’s debate and be reassured that there will be no shortage of drugs with short shelf lives, because they can be airlifted in.

The hon. Lady also asked how we can be confident that there are no more mistakes. I think she is referring to the grammatical errors and various technical errors that occurred in the previous SI, which was 700 pages long and very technical in its content. Those issues were not identified at the time by any party or any individual, but they have now been identified. The amendments that this new SI makes to the previous SI are minimal and include updates to the underlying EU regulations that have been brought forward since the original SI was finalised.

This particular SI has also undergone legal checking and been scrutinised by the Joint Committee on Statutory Instruments and the Secondary Legislation Scrutiny Committee, and we are confident that it will ensure that these regulations operate effectively after exit day. If the hon. Lady does not feel that she has had enough detail, we will provide anything in writing as a back-up.

The hon. Lady asked what paediatric investigation plans mean. This SI does not introduce paediatric investigation plans; they are already required by EU legislation. The previous no-deal SI simply transferred functions relating to those plans from the EU to the MHRA. She also asked why there was no impact assessment. There are no new policies in this SI, so there is no need for a further impact assessment. The MHRA ran a four-week public consultation and published an impact assessment on the previous SI. This SI ensures that the policies implemented are in line with the consultation and the responses to it.

On the protection of patients, the hon. Lady asked about an interim period relating to a transitional period for a pharmacovigilance system. The new proposed transitional period is for the pharmacovigilance system master file, which will be held in the UK. Companies will be required to operate a pharmacovigilance system from exit day. The master file is in the description of the pharmacovigilance system and the amending SI, which includes statutory contributions associated with a temporary exemption, to ensure supervisory capability of the companies, the QPPV and the MHRA.[Official Report, 14 October 2019, Vol. 666, c. 1MC.] I think that she also mentioned the safety aspects. Each pharmaceutical company will be required to have safety staff in the UK in line with this.

The hon. Lady asked whether new and innovative medicines would be delayed in the UK under a no-deal scenario. The MHRA intends to provide free scientific advice for UK-based small and medium-sized enterprises and has introduced a new targeted assessment procedure to authorise medicines as soon as possible following an EMA-positive opinion. In addition, it will often accelerate an assessment route to enable licensing more quickly than in the EU. The MHRA would monitor application volumes in a no-deal scenario.

I thank the hon. Lady for her valuable contribution to the debate. As promised, we will get back to her with further information in writing if she requires it. I am confident, as was the case in March, that we have a shared intention to protect and improve the safety of patients using medicines and medical devices, while enabling their access to the most innovative treatments.

Our regulator, the Medicines and Healthcare Products Regulatory Agency, has more than 30 years’ experience as a leading regulator in the EU. That expertise and experience is globally recognised and respected, and we want to ensure that continues, to the benefit of all UK patients. It is with that at the forefront of our minds that the UK’s plans for the regulation of medicines and medical devices in a no-deal scenario have been developed.

Question put and agreed to.

Artificial Intelligence in Healthcare

Julie Cooper Excerpts

Thursday 5th September 2019 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank the hon. Member for Crawley (Henry Smith) for securing this debate on a very important subject. I welcome the Minister to her place. I, too, am very pleased to be talking about something other than Brexit. I thank all hon. Members for their informed contributions, and I pay tribute to the hon. Members for North East Derbyshire (Lee Rowley) and for Strangford (Jim Shannon) for sharing their personal family experiences. As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) said, that always adds poignancy to debates and keeps us rooted in reality. I thank the APPG on heart and circulatory diseases for its excellent report, “Putting patients at the heart of artificial intelligence”, which I thoroughly enjoyed reading. I learned a great deal from it.

This is a fascinating debate. When Charles Babbage created the difference engine in the 19th century, he could not have envisaged where modern computing would take us. We are living in a brave new world. We are in the midst of a technological revolution that is already massively transforming our lives. Artificial intelligence is already widely used at our airports and in our homes. Virtual care assistants are being trialled, and driverless cars will soon be a common sight on our roads. It would be strange therefore if we did not take full advantage of the contribution that AI can make to healthcare.

There are many different types of AI. I am not a scientist and do not understand all the complexities of AI—although I can text—but I do understand that it involves a computer equipped with a sophisticated algorithm capable of analysing thousands of sets of data. A computer learns patterns from the data and is able to make predictions based on it. The more data the computer has, the smarter it gets. Tasks that require extraordinary attention to detail, such as radiography, diagnosis, robot-assisted surgery, administration and many others, can be transformed using AI. The prospects are exciting. The ability to deliver early and speedy diagnosis and to develop personalised treatment plans is welcome in a health service besieged by unprecedented demand, long waiting lists and staff shortages.

AI is a game changer for the NHS and healthcare in general. The UK has the potential to be the world leader in digital-assisted healthcare. In our lifetimes, there will come a point when conditions like cancers and strokes can be pre-detected instantly from simple scans, enabling the patient to get the very best early intervention treatment. Only this week, researchers at Oxford University reported that they have developed artificial intelligence that will be able to detect, from a scan of an apparently healthy individual, heart attacks that are 10 years away.

We must be careful, however, in enabling this revolution. Technology is a double-edged sword, and for every monster it destroys, it has the potential to create one in its place, as my hon. Friend the Member for Cambridge (Daniel Zeichner) reminded us. We must be grounded in reality. It is easy to get excited about a vision, but we must keep bringing ourselves back to what it means to real people, and what the potential dangers are. We must proceed with caution. Above all, we must ensure that AI is not something that is done to patients. We must proceed with an engaged and well-informed population. Legislation and regulation must keep pace with scientific innovation. No one wants to see unnecessary regulation. I note the points made by the hon. Member for North East Derbyshire.

It is absolutely vital, however, that the regulation is adequate and keeps pace. Above all, we must protect patient safety. We must act sensibly and legislate robustly, with proper scientific input to ensure that changes are to the benefit and not the detriment of patients. Patients must be kept at the heart of the changes and we must retain their trust, which, as other hon. Members have said, is hard to gain but easily lost.

If patients are to trust and fully embrace this revolutionary transformation of care, they need full explanations and to understand what is involved. People need to understand, for example, that artificial intelligence will not replace their GP with a robot, but will mean that a GP session may be recorded and transcribed by computer, which then produces a diagnosis. We need to pay special attention to the needs of the vulnerable, elderly and, in particular, the mentally ill. We must make it plain to patients that AI is not and never will be a replacement for human health professionals. It should always be clear that AI is not a means of providing health services on the cheap, but a way of enhancing diagnosis and treatments to assist, not replace, well-qualified health professionals.

There are obvious implications for data protection and the misuse of data. Although ideas such as allowing Amazon’s Alexa to use NHS 111 information to guide patients to the most effective non-emergency treatment are beneficial, the idea of inadvertently letting such companies have unfettered access to patient records, which they could use for other unconnected purposes, is clearly unacceptable.

We must ensure that patients know that our laws protect them from predatory companies. All data used in the NHS—even if through third-party contractors—must stay within the NHS. If we are to embrace this revolution, it must be patient-focused and not a market-centred approach. AI must improve life outcomes and not be used to sell diet pills in the name of healthcare. Patients and medical professionals must be properly educated in what AI will mean for them, and both should be involved as much as possible in the design process.

Artificial intelligence can bring many benefits, but its use in healthcare brings significant challenges. We have nothing to fear from embracing it, as long as all provision is properly regulated in a way that protects patients without stifling continued innovation—there is a fine balance. The key is to ensure that health professionals are involved in every stage of development and, most importantly of all, that the NHS ensures that patients are fully informed and engaged.

The APPG concluded:

“Meaningful, early and proactive engagement on how AI is used in healthcare is essential for effective implementation and sustainability.”

That is well put and I agree. Unless patients are fully engaged, AI will just not progress in the way that it could and opportunities will be lost. I hope that the Minister will outline the Government’s plans for implementing the report’s recommendations. Will she reassure us that the NHS will lead on this with all its resources, ensuring that patients are at the heart of this exciting new technology, and that all patients, irrespective of their socioeconomic background or personal ability to access technology, will be able to benefit?

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Matt Hancock]

I have been working hard with the Chancellor of the Exchequer to ensure that we can resolve this important issue. The hon. Gentleman will have seen the consultation document that we put out yesterday to resolve the problem. The consultation is open and asks open questions about the best way to fix it. I am absolutely determined that we will fix it to remove some of the unintended consequences of changes in pension tax law. It is a pity, though, that the SNP spokesman did not stand up to accept that the proposal mentioned by my hon. Friend the Member for Angus (Kirstene Hair), which would discriminate against people from outside of Scotland, is wrong and should be withdrawn.

[Julie Cooper (Burnley) (Lab)]

The Secretary of State is in denial. There is a crisis in GP retention. In fact, there are now 1,200 fewer fully qualified permanent GPs than there were in 2010. Because of this, patients are waiting longer than ever to get a GP appointment. He has promised, as he did again today, to address this, but it is a fact that the situation is getting worse, with a pension system that is effectively charging GPs to work extra hours. Does he really believe that this is the best way to retain GPs in the NHS? Does he have a detailed plan, and can he explain how he is going to sort out this mess?

[Matt Hancock]

I think it is worth starting with a few facts. One fact is that I published a detailed plan yesterday, on which we are consulting, to tackle the pension issue. The other two facts that are worth noting, and that the House will want to know about, are the following. First, there is a record number of GPs in training—3,473. Secondly, the overall number of GPs is rising, with, as of March 2019, 300 more doctors working in general practice than a year earlier. I want to see that number continue to rise.

Drug Treatment Services

Julie Cooper Excerpts

Tuesday 16th July 2019 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I begin by thanking my hon. Friend the Member for Manchester, Withington (Jeff Smith) for bringing this debate on this very important subject. As we have already said, the debate is timely, as we hear today that 1,187 people died drug-related deaths in Scotland last year, an increase of 27%. I can say from personal experience of delivering services to drug users in a community pharmacy in my constituency that the problem is not confined to Scotland.

The problem is not new, but there is no doubt that cuts to budgets for addiction support services in recent years have made the situation worse. The cuts to public health budgets that have had an impact on this are downright irresponsible. There have been numerous calls over the years for us to take steps to address the problem, but instead, we prefer to speak about getting tougher in tackling the trade in illegal drugs. Meanwhile, police chiefs are on record as saying that there is no way that police will ever stop addicts buying from dealers, but still we continue to chase drug addicts like criminals.

While other countries move increasingly to a public health approach to drug use, the instinct in the UK is to criminalise addicts. It is worth noting that in Portugal, where drug use has been decriminalised, there has been a steep fall in the number of drug-related deaths and even in the number of drug users. It is time for an intelligent approach here in the UK, an approach that stops drug dealers preying on vulnerable addicts and that recognises that drug addicts are not alien beings, but people in our communities in need of help, not a criminal record.

Drug addicts have families and children who need and love them. My hon. Friend the Member for Glasgow North East (Mr Sweeney) spoke movingly of his constituent Chelsea, reminding us of the humanity in all this. In the first instance, addicts need support to stay alive, to safely manage their addiction, to overcome it and to recover their lives.

So what can the Government do? The Advisory Council on the Misuse of Drugs has clearly said that maintaining funding of drug treatment services is essential to preventing drug-related death and drug-driven crime in communities. It has also said that if resources are spread too thinly, the effectiveness of drug treatment will suffer, leading to drug-related deaths and drug-driven crime. As a first step, I hope the Minister can tell us that her Government will restore funding to addiction support services, but I also hope she will go much further and consider new ways of tackling the problem to save lives.

Both supervised consumption rooms and heroin-assisted treatments are possible ways to effect some positive changes. Supervised consumption rooms reduce the risk of disease transmission, prevent overdose and also present an opportunity to refer users to appropriate addiction services. Heroin-assisted treatment allows for the provision of pharmacological heroin to dependent individuals who have not responded to other treatments, and involves patients receiving heroin in a clinical setting from a doctor under strict controls.

That has many benefits. It reduces the use of street heroin, which can be of dubious quality and variable strength. It takes away the need for criminal drug dealers, who are preying on vulnerable people and profiting from their addictions. It gets addicts into treatment. It stops desperate addicts resorting to criminal activity to fund their addiction. It improves access to recovery services, HIV treatments and services to address adverse life circumstances. As the police remind us, it also stops drug-taking in open spaces in the community and protects the wider public from contact with used needles.

Both those services reduce pressure on other services in the NHS, police and justice systems, protect the wider public from contaminated needles and ultimately save public money. Cuts to those services are short-sighted in the extreme. Those initiatives are supported by the British Medical Association, and it is a fact that other countries are doing better than us because they have implemented those programmes.

I say to the Minister that we need urgent action. We need mandatory commissioning of drug and alcohol treatment services. We need to amend the Misuse of Drugs Act to enable an innovative, health-focused approach to tackling this problem. We need a Government with the courage and the compassion to act to save lives.

--- Later in debate ---

[Seema Kennedy]

I will come on to that. However, health is a devolved matter. Any death is a tragedy, but the figures are really worrying. I understand that the Scottish Government have appointed Professor Catriona Matheson to head up a drug deaths taskforce, to look at the main causes of death and to examine how to save lives.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) raised the question where responsibility for public health should sit. Clearly, he thinks its sitting with local authorities is not right, but that is a broader question of public health commissioning that I do not know if we can get into here. However, he has a wealth of experience in this, and I will take away some of the points that he raised.

[Julie Cooper]

Does the Minister agree that, while we can argue about who should be responsible, as long as public health is the responsibility of local authorities, cutting their budgets is irresponsible?

[Seema Kennedy]

I will come on to funding.

My hon. Friend the Member for Reigate (Crispin Blunt) takes great interest in this issue. He spoke about the legislative framework for drugs, which is a matter for the Home Office. As I said, I will talk to ministerial colleagues about that. The Government are putting together a formal response to the report on custody-community transitions, with input from many Departments, including the Department for Work and Pensions, the Ministry of Justice and the Home Office. I think we have until the end of the summer to issue that response.

Local authorities will want to increase the provision of naloxone to people who are not in treatment, perhaps through outreach workers, hostels or needle and syringe programmes. Public Health England is working alongside the National Police Chiefs’ Council and Her Majesty’s Prison and Probation Service and recently updated its advice and guidance on naloxone availability in prisons. The problem with drug testing kits is that not all of them are entirely accurate, which might give people false reassurance. More sophisticated testing has been available at some festivals in one pilot, but again this is a matter for the Home Office.

Hon. Members talked about the international evidence that drug consumption rooms can be effective at addressing public nuisance issues and health risks for users and for the wider public, but there is a risk that such facilities would be introduced at the expense of other more relevant, evidence-based drug services for local areas. There is currently no legal framework for the provision of drug consumption rooms, but we support a range of evidence-based approaches to reducing health-related harms. Again, we are committed to widening the availability of naloxone to prevent drug-related deaths. I acknowledge the strength of feeling on drug consumption rooms in the House.

Acquired Brain Injury

Julie Cooper Excerpts

Tuesday 2nd July 2019 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank all Members who have contributed to the debate, particularly those who have shared their personal experiences and those of their constituents, as well as their expertise in various areas. I pay tribute to my hon. Friend the Member for Rhondda (Chris Bryant) for securing yet another debate on this important subject. No cause could have a greater champion. He challenged Members in the previous debate on this subject to learn how to pronounce the name of his constituency properly. Well, I can assure my hon. Friend that I will try my best to do better today. I also pay tribute to all the members of the APPG for the excellent work that they do in raising awareness of this really important subject.

We are here again today debating the subject because of the scale of the problem: currently, 1.3 million people in the UK live with an acquired brain injury. Every 90 seconds someone is admitted to hospital with such a brain injury. We have considered the human cost of acquired brain injury in this debate and we have also heard of the financial cost. In the previous debate the Minister said that it cost the UK economy £1 billion, but the APPG reports that the truer figure is £15 billion, alongside the human cost.

Consideration of this subject is not new. The Health Committee has been reporting on the issue since the turn of the century, furnishing Parliament with a raft of recommendations, many of which have never been implemented, so it really is time for change. Last year the APPG set out a range of recommendations for the kind of support and rehabilitation that must be made available. As the term suggests, acquired brain injury applies to injury caused to the brain after birth, and it can happen to anyone at any time. It is usually caused by a trauma to the head but can be the result of substance abuse, and the Alcohol Health Alliance has reported on the growing incidence of alcohol-related brain injury. My hon. Friend the Member for Sefton Central (Bill Esterson) talked about the effect on unborn infants of foetal alcohol syndrome.

All Members have constituents who have lived with the consequences of ABI. A brain injury can happen in an instant, but its effects can be devastating and lead to lifelong challenges. My hon. Friend the Member for Rhondda mentioned that the condition is often not visible, and that sufferers can appear to be drunk. There is a tremendous lack of understanding in the community. The right hon. Member for South Holland and The Deepings (Sir John Hayes) talked about the fact that it is difficult to detect, medically, socially and culturally. There is a total lack of understanding.

Owing to improvements in medical procedures and acute care, more people than ever before survive following an injury to the brain. That is of course really welcome, but it brings with it a responsibility for Government Departments to support those affected, which is crucially all about quality of life. It is cruel to save lives without following up with support and rehabilitation. As my hon. Friend the Member for Newport West (Ruth Jones) said, sharing her expertise, not providing vital support services is where the NHS is at its weakest. My hon. Friend the Member for Darlington (Jenny Chapman) talked movingly about the experience of Nicola and her family, and the failure to get the support and help that they clearly needed to get them through.

Early and continued access to specialist rehabilitation has been shown to optimise the chances of recovery and to be extremely cost-effective. As is the case for many health conditions, however, the number of available beds across the UK is inadequate, and service provision is variable. Consequently, long-term outcomes for brain injury survivors are compromised, with many describing being passed from pillar to post. It is particularly distressing to hear the experiences of children, as my hon. Friends the Members for Blaydon (Liz Twist) and for Nottingham South (Lilian Greenwood) mentioned.

It is clear that a national review of neuro-rehabilitation is required, with particular reference to the service provision for children, to ensure that provision is adequate and consistent throughout the UK. Members have described current provision as a lottery. All affected individuals should be given a rehabilitation prescription and a well-defined pathway to recovery. I ask the Minister again to focus on that, because NR can help to avoid or minimise disability and optimise recovery. Early access is critical, and substantial evidence demonstrates that NR is both clinically effective and cost-effective.

Will the Minister ensure that every individual with an acquired brain injury gets an NR prescription and has their individual needs specified in a care pathway? Will she ensure that all health professionals in the community in primary and secondary care are trained to recognise the symptoms of acquired brain injury? I asked for those commitments from her the last time we debated the subject. She has demonstrated that she is listening, which we all appreciate, but can she ensure that the Government up their game and act on those precise commitments?

This is not just a matter for the Department of Health and Social Care, of course. In September 2018, the APPG’s report called for reform in all areas and Departments. It should be an issue for the Department for Education, because 24% of children have some sort of brain injury, compared with 1% who have autism. That has clear implications for teacher training, and it is essential that special educational needs and disability specialists are appropriately trained to recognise the signs. It is also a matter for the Ministry of Justice, as ABI can often lead to criminal behaviour. My hon. Friend the Member for Rhondda has regularly raised the issue of female prisoners who have been found to have brain injuries caused by exposure to domestic violence. All benefits assessors in the Department for Work and Pensions should be trained to understand the problems that affect individuals with ABI. Excessive bureaucracy and form-filling can be a nightmare for many vulnerable claimants, but for someone with an acquired brain injury it can present an insurmountable barrier, leading to sanctions and additional hardship.

As was mentioned in the previous debate, there is a lack of awareness among those involved in contact sports such as football and rugby. Government and professional clinical bodies must work collaboratively to improve health professionals’ knowledge of concussion management. In defence, we must work to ensure that acquired brain injury among veterans is fully recognised and that the appropriate support is made available. The Minister committed to pass on concerns to colleagues in other Departments, and I hope that she will be able to report back on their responses.

We have heard over and over again about the human cost of acquired brain injury. Frankly, it also makes no financial sense not to put the right care plans in place and deliver the support that individuals and their families need. I urge the Government to implement the recommendations of the APPG in full, and to raise their game across Departments to ensure that the people we have heard about today truly get the support they need.

Living with Dementia

Julie Cooper Excerpts

Tuesday 25th June 2019 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for securing today’s debate and for her excellent work on the all-party parliamentary group on dementia, championing awareness of dementia and support for those affected. I also thank Members present, particularly the hon. Members for North Ayrshire and Arran (Patricia Gibson) and for Chichester (Gillian Keegan), who have shared very personal stories about how they and their families have been affected. I pay tribute to carers, both paid and unpaid, who do so much to make life bearable for those who are suffering—I apologise for saying “suffering”, but personal experience teaches me that that is the reality.

Dementia is a life-changing disability that affects millions of people in the UK. Some 850,000 people in the UK have been diagnosed with dementia, including more than 1,000 people in my constituency of Burnley. More than 24 million people have a friend or family member who lives with dementia, and that figure is increasing all the time. Alzheimer’s Research UK estimates that one in three people born in the UK this year will develop dementia in later life, and as the hon. Member for Witney (Robert Courts) has reminded us, this is not just a feature of old age; people of all ages can suffer.

Dementia has a huge human cost. My grandmother suffered with dementia—she did suffer—and, regrettably, the support that was needed was not available to my family. Dementia also has a huge impact on resources: each year, the total cost of dementia to the UK is £26 billion, and that cost is expected to more than double in the next 25 years. Given the scale of the issue, it is fitting that Members from all parts of the House have raised their voices today to call for action.

Members have made it abundantly clear that action is needed in three main areas. First, prevention is crucial: The Lancet reports that 30% of cases of dementia could be avoided through an increased understanding of risk factors and the implementation of basic lifestyle changes. It is imperative that the Government lead on enhancing awareness among the general public, and on celebrating dementia-friendly projects and looking at other processes. I am grateful to my hon. Friend the Member for Vale of Clwyd (Chris Ruane) for reminding us of the impact that mindfulness can have on preventing the development of dementia.

In the area of research, it is clear that dementia is the poor relation; as my hon. Friend the Member for Cambridge (Daniel Zeichner) has so expertly reminded us, dementia is decades behind other conditions. Alzheimer’s Research UK has asked, very reasonably, that the Government commit to investing an amount equal to just 1% of the total societal cost of dementia into research. After all, the UK has some of the best scientists in this field, although there are simply not enough of them; they are outnumbered four to one by cancer specialists. The 2015 challenge on dementia, which has been mentioned, was most welcome but does not go far enough, and I look forward to hearing how the Minister might take that forward.

While prevention measures and research to achieve early diagnosis and future treatment are still so inadequate, it is vital that those who are diagnosed with dementia are given access to a comprehensive package of support. That is not just a job for the authorities: we have heard many Members describe pockets of really good practice in their constituencies, and I pay tribute to those who are delivering on the ground. However, there is no doubt that Government cuts to social care funding amounting to £7 billion since 2010 have taken their toll—nowhere more so than in the area of social care for those who suffer with dementia.

We often hear talk of the so-called dementia penalty, which is not surprising, as those affected by dementia regularly pick up two thirds of all care costs. Dementia patients often require more specialised and more expensive care. The associated costs can be as high as £500,000, and they almost always exceed £100,000. It is clear that patients with dementia are treated differently from patients with other conditions and disabilities. The failure to fund care adequately is placing additional pressure on NHS resources: last year, there were 70,000 avoidable hospital admissions for people diagnosed with dementia. That causes unnecessary suffering for patients and their families and is hugely wasteful of NHS resources.

What can be done to right this wrong? The recommendations of the all-party group on dementia could be implemented without delay. Dementia must be fully recognised as a disability, with sufferers afforded the same rights, protections and dignities as any other disabled person. Local authorities and health providers need to collaborate to offer a package of support that is both comprehensive and accessible; as my hon. Friend the Member for Bradford South (Judith Cummins) has stressed, it is no good having help available if that help is difficult to access. The eagerly anticipated social care Green Paper must fully address the needs of those living with dementia. The UK Parliament must lead by example, becoming the first dementia-friendly Parliament and actively promoting and supporting dementia-friendly communities everywhere. All members of health and wellbeing boards should be obliged to become Dementia Friends. Most crucially, the Government’s plans for the NHS and care workforce must properly reflect the needs of people with dementia.

The situation is urgent, and now is the time for the Government to listen. As part of the comprehensive spending review, the Government must introduce a dedicated £2.4 billion dementia fund to cover the additional costs of delivering dementia specialist care, and end the inequity between dementia and other diseases that currently leaves affected families facing astronomical care costs. That fund would enable timely access to an integrated package of support and help to facilitate specialist training for all care workers, equipping them to deliver high-quality dementia care.

Will the Minister commit today to addressing the long-term needs of dementia sufferers in the social care Green Paper and in the NHS and social workforce strategy? Will she commit to increasing research into the development of new treatments? Will she go beyond warm words and ensure that those with dementia are not forgotten in the comprehensive spending review? Will she support the establishment of a dedicated dementia fund to give people the support they are desperately crying out for?

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 18th June 2019 Commons Chamber

[Seema Kennedy]

We recognise the importance of community pharmacies. Pharmacists are specialists who have a great role in primary care, which is why they are highlighted in the NHS long-term plan.

[Julie Cooper (Burnley) (Lab)]

Since 2014, 5.6 million penalty charge notices have been issued, including a staggering 1.7 million to people who are entitled to free prescriptions. FP10 prescription forms and the criteria for eligibility for free prescriptions are far from straightforward. Some people in receipt of universal credit are eligible for free prescriptions and some are not—and, by the way, universal credit is not mentioned at all on the form. Those claiming exemption on grounds of low income can see their eligibility change from one month to the next. Is it any wonder that some patients tick their box? What steps are the Government taking to sort out this chaotic system that is too often treating vulnerable people like criminals?