Self Care Week

Kevin Barron Excerpts

Tuesday 22nd November 2016 Westminster Hall

[Sir Kevin Barron (Rother Valley) (Lab)]

I beg to move,

That this House has considered Self Care Week 2016.

It is a pleasure to serve under your chairmanship, Mr Walker. I am delighted to have secured this debate, timed to take place just after Self Care Week. As co-chair of the all-party parliamentary group on primary care and public health, I have taken an interest in self-care for some years. Self-care is essential for healthy living, and self-care certainly does not mean no care. Self-care is also essential for the future sustainability of the NHS.

There are two reasons why the Department of Health established Self Care Week in 2009, which is a national awareness week to support people to better look after their physical health and mental wellbeing. The Minister was not in office when the NHS was grappling with reforms and reorganisation in 2010, but at that time the Self Care Forum, a charity that aims to further the reach of self-care and embed it in everyday life, was asked to take over the organisation of Self Care Week. Since then, it has gone from strength to strength, with growing numbers of local and regional health organisations running events and activities across the country to support and educate people in their health.

The theme for the 2016 Self Care Week was improving people’s health literacy. According to the Royal College of General Practitioners, 60% of working-age adults find health information too complex to understand. That worrying statistic shows that there is an urgent need to empower people in their health and improve health literacy across the population. When people play a more collaborative role in managing their health and care, they are less likely to use emergency hospital services and more likely to stick to their treatment plans and to take medicines correctly. Those who are more involved are less anxious, more satisfied, less likely to complain and tend to enjoy better outcomes and a better quality of life than those who are less involved. It is awful jargon, but it is true, that person-centred care is good for healthcare professionals, too. As patient engagement increases, staff performance and morale sees a corresponding increase.

Earlier this year, the all-party group on primary care and public health carried out an inquiry into the NHS’s five-year forward view. We looked specifically at behaviour change information and signposting and concluded that poor health literacy was harming the nation’s health and contributing to the pressures on the national health service. In other words, the NHS is failing to harness the potential of patients to improve and maintain their own health.

To address that, we recommended that comprehensive health education should be included in the national curriculum to improve the health literacy of children, who are future health service users. That health education should go beyond the usual sex, relationships and drug education programmes and include, for example, information on the national health service, its history and structure and the right way to access services.

It is important that the elderly do not think that self-care ends when they move into a care home. They must be able to maintain their independence and live life to the full. A main component of that is ensuring that they are able to buy personal goods. I was therefore disappointed when I was contacted by a constituent who was concerned about the treatment of his mother-in-law in relation to the personal expenses allowance that people in nursing homes get. That allowance has not been raised at all, which means that, due to inflation, people have less money to spend. In an email to me, he said:

“Recently, as you will be aware, her annual pension and pension credit increased by 2.9% in line with inflation. However, the PEA remained at £24.90 per week. So in effect her increase in Pension and Pension Credit from Central Government was passed straight through to the Local Government and she has received zero increase. No doubt her personal items such as underwear, clothes, shoes sweets etc. will increase in cost this year leaving her actually worse off for the increase.”

It seems I have dropped this on the Minister—that was not my intention, but it is an opportune time to bring the case to his attention—but will he explain now or later why the personal expenses allowance was not raised in line with inflation or even further?

Health education needs to continue throughout life, particularly at key stages such as when people start university, have their first child or retire. That would help people to understand which parts of the NHS they should use based on their health needs and whether they need to access health services or could self-treat safely at home.

It may be an opportune time to mention this. I am one of the three Rotherham MPs and we have a scheme called social prescribing, which is contracted and paid for by the Rotherham clinical commissioning group. I understand that the team from the Rotherham social prescribing service, who I spoke to at a community function last Friday night, have spent some time with the Secretary of State, who has seen exactly what they do. They are helping people with long-term health conditions to use a wide variety of services and take part in activities provided by voluntary organisations and community groups; 1,600 different community groups are playing a part.

People do not always need medicines. Medicines play a part in people’s life where the health service does not engage, and we would not expect it to do so, but the scheme is about preventing people from going into the healthcare system. I know a lot is changing now in the plans being laid down at local level, which are advancing in Rotherham as well, but something like social prescribing is a good way of involving other people—not just the health service—in helping to ensure that people avoid, if at all possible, going into the health service.

Last week, the Proprietary Association of Great Britain—the trade association that represents the consumer health industry—published new research that found that 92% of people agree that it is important to take responsibility for their own health to ease the burden on the national health service. Despite that, 46% still visit their GP or accident and emergency with self-treatable conditions. Its research also found that 47% of people would not visit a pharmacist first for advice on a self-treatable condition, with 18% claiming that that is because they do not think pharmacists are as qualified as doctors or A&Es.

It is clear that more needs to be done to educate people about the expertise of pharmacists—at this stage, I should say that I chair the all-party pharmacy group. My experience of the fitness of pharmacists to look after people without the need to bother doctors was not in this country. Many years ago, I was on holiday with my three young children in Spain. One of them fell ill and I asked the hotel staff how we could contact a doctor. They said, “Just go up the road to the pharmacist.” I went up to the pharmacist and it was extraordinary: we came away with the right medicines, which cured the condition pretty quickly and the holiday carried on.

I try to keep healthy myself, but that was the first time I had seen the expertise that pharmacists have and how they could help us. Pharmacists are expert health professionals who have a front-line role to play in giving people information and empowering them to take responsibility for their own health. I am sure the Minister agrees with that, as we have talked about pharmacies and the current situation with the pharmacy budget. He will be pleased to know that I will not bring that up today, but we have talked a lot about it. Better signposting to the pharmacy is necessary when we consider that 57 million people go to their GP and 3.7 million people go to A&E for ailments that only a few generations ago would have been safely treated at home with advice and medicines from a pharmacy.

Cambridgeshire and Peterborough clinical commissioning group reported in March that, over the Easter period, people visited A&E with splinters, broken nails, paper cuts and hiccups. I am certain that that is not particular to Cambridgeshire and Peterborough, and that we would hear similar reports from A&E departments up and down the country. I know that about 50 people came along to my own CCG in Rotherham last year because they had toothache. I have no doubt that those people will have passed a local pharmacy where they could have bought some reasonably cheap pharmaceutical products to get rid of the toothache in the short term, and so not clog up the A&E.

People are clearly confused about when and how to use the NHS and need help in knowing where to go. I know that work is being done to improve the non-emergency helpline, NHS 111, which is important. Every day NHS 111 sends to GPs and to A&E people who could just go to a pharmacy without waiting and without an appointment to get the help that they need. We need to make sure that people receive a consistent message about self-care, whether they look at NHS Choices online, call NHS 111, visit a GP or speak to a pharmacist.

I know other hon. Members want to speak, so I will sum up by saying that more has to be done to address the escalating demand on the national health service, to combat the general confusion about where to go in the system and to improve people’s ability to look after their own and their family’s health. Excellent though it is, Self Care Week alone is not enough, as I suggested earlier. The local activities and events taking place during Self Care Week are definitely part of the solution to empowering people and addressing the demand on the national health service, but a bigger, more co-ordinated programme of work is essential if we are to move the self-care agenda along quicker.

Our all-party parliamentary group concluded earlier this year that we need a national strategy for self-help, led by a Government Minister and a national director to ensure implementation. It should be designed to co-ordinate policies across Government Departments and throughout the NHS and public health at the national and local level. It should be designed to empower people and should lead to a self-care culture and a behaviour change, so that people know not to go to A&E or to a general practitioner with their splinters, understand what steps to take to avoid serious conditions and know how to avoid hospital emergencies by managing long-term conditions. We would all agree that that is essential, but it does not happen very often. More than 70% of national health service expenditure in this country is on people with long-term conditions. People normally have more than one, of course, which sometimes seems difficult to grasp.

It seems to me that these issues are plain to everybody. We need to tackle them and to shape the national health service around long-term conditions, and not let the national health service shape us on how we should present to it. That needs radical thinking but, the Minister will be pleased to know, not legislation. I sat on a Committee back in 2010-11 that was suspended for a while because of the turmoil over the national health service reorganisation that was happening at the time, which is the last thing we want now. However, we want people in the health service and elsewhere to recognise that things ought to change and can change, and that legislation is not needed for that to happen. We need to make sure that we see a population that is able to self-care for life.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship, Mr Walker. I welcome this important debate and the fact that it has been secured during Self Care Week—

[Sir Kevin Barron]

Just after it.

[Mrs Hodgson]

Just after Self Care Week. I commend my right hon. Friend the Member for Rother Valley (Sir Kevin Barron) for securing this debate and for his excellent speech, which shows his deep knowledge of and passion for all matters relating to the health of our nation, especially with regard to preventive health measures. I thank him for that.

This debate is especially important, as it is the first time we have had a dedicated debate on self-care in a very long time. We heard an excellent contribution from the hon. Member for Linlithgow and East Falkirk (Martyn Day). Before we hear from the Minister, I want to look at the issue of self-care and the wider picture of preventive measures through the lens of the cultural shift in the NHS away from care and repair to prevention and wellbeing promotion. I will also look at how aspects of current Government policy, such as the cuts to public health funding—I know I keep banging on about that, but it is important—is detrimental to our shared vision for an improved NHS and to achieving a healthier nation.

When NHS England’s “Five Year Forward View” was published just over two years ago, we were promised a radical upgrade in prevention and public health. That belief in reshaping the approach of the NHS and our health services away from a sickness alleviation service towards a wellbeing service that promotes healthier lifestyles choices, improved wellbeing and the prevention of ill health through behavioural change is supported across the NHS and in wider society.

That shift is paramount when we see the NHS in a state of crisis, with longer A&E waiting times and GP appointments becoming harder and harder to come by. One in four patients wait at least a week to see their GP. My husband had to wait three weeks to see the GP because it was not an emergency, but he thought it was an emergency; sometimes we do not know, and it is up to the doctor to decide what is important and what is not.

Some parts of the NHS are at crisis point. That is not a party political point at all; it is supported by health organisations such as the Nuffield Trust and the Health Foundation, which professed this time last year that the NHS was at risk of a “catastrophic collapse”. If the worrying trends in waiting times that I have described are ever to be reversed and we are to save the NHS, we need to have a wholesale rethink about the way we approach health policy. Prevention must be the key, and self-care should be a central part of that reconsidered approach.

Self-care is about empowering people and patients to maintain their own health through informed lifestyle choices, better awareness of symptoms and better awareness of when it is important to seek professional advice—for example, for possible cancer symptoms, where early diagnosis is absolutely crucial and a matter of life and death—and when an ailment can be treated by someone themselves in the appropriate manner by talking to their community pharmacist, as my right hon. Friend the Member for Rother Valley described on the occasion of a family holiday. With improved confidence, people can take control of their own health or long-term conditions much better and make decisions that are far better for the NHS.

It is completely understandable that when we are unsure about the cause of symptoms or the best course of treatment or care, our first port of call is the NHS. However, being more aware of how we can treat ourselves and having preventive practices in place that reduce the prevalence of ill health will help go some way towards pulling the NHS back from the brink. The NHS is a trusted bastion, but sadly we are seeing more and more people accessing NHS services when there is no need and when a chat to one of our excellent community pharmacists would have sufficed—for example, in the cases we have heard about today of splinters, paper cuts, hiccups or broken nails. A bit of common sense is all that is needed, certainly not a trip to A&E.

In 2014, A&E departments across the country dealt with 3.7 million visits for self-treatable conditions such as those mentioned today, as well as the common cold, flu or muscle pain, combined with 52 million visits to the GP for similar conditions. It is no wonder people cannot get an appointment when some people are going to see their GP for that sort of thing. That has an estimated cost to the NHS of more than £10 billion over the past five years, which is not a small or insignificant amount of money.

Self-care is a crucial preventive measure that must be developed further to ensure that the NHS is as resilient as possible and can respond in more effective and meaningful ways to the nation’s health. With all that in mind, it is deeply worrying that the vision set out in the “Five Year Forward View” has progressed little or not at all. That is seen most clearly through the Making Every Contact Count initiative, which aims to make NHS staff members an important part of boosting awareness of healthy living, rather than only administering healthcare to the sick. It is a fantastic initiative. In theory, that strategy can go far in addressing issues around lifestyle choices such as smoking, drugs, diet and alcohol consumption by just adding a one or two-minute conversation when a healthcare professional already has someone in front of them.

It is worrying that the progress and roll-out of that scheme is patchy, despite there being lots of good practice across the country, such as the social prescribing service in Rotherham that my right hon. Friend talked about. Where such system change is flourishing and showing that it can support a reduction in pressures on NHS services such as A&E and GP practices, it should be encouraged, and the roll-out should be far more substantial.

I hope the Minister can give us some reassurance on three key asks for the Make Every Contact Count initiative: first, that we see progress made on the scheme in the new year, as promised by Professor Fenton from Public Health England during the second oral evidence session for the APPG on primary care and public health inquiry; secondly, that best practice is made more readily available to improve provision across the country through the Self Care Forum’s database of best practice; and thirdly, that he commits to ensuring CCGs prioritise implementation of the scheme in their local areas and that training is provided for staff, to equip them to provide consistent self-care messaging.

It should not go without saying that there are examples across the country that show the innovative and positive impacts of improving self-care, such as a scheme in my own neck of the woods in South Tyneside—the neighbouring borough to my own—where a borough-wide conversation has been developed that shifts away from asking, “How can I help you?” and instead asks, “How can I help you to help yourself?”

Those initiatives need funding and encouraging from Government to succeed. However, what we are currently seeing has been described as a frustrating and perverse approach to preventive measures, with cuts to public health funding of £200 million in last year’s Budget, along with an average real-terms cut of 3.9% each year to 2021, announced in last year’s autumn statement. Hopefully tomorrow we will see our new Chancellor go some way to rectifying and reversing that; we can live in hope, unless the Minister has some insight into what the Chancellor will announce. We will keep our fingers crossed.

The Minister is well aware of my opinion on those cuts, because we discuss them every time we meet, and the need to rethink the whole approach, but it is not only me saying this. Only recently, the Health Committee, chaired by the hon. Member for Totnes (Dr Wollaston)—who I am sure would have been here today if not for the health debate coming up in the Chamber very soon—uncovered serious concerns about the finances and funding of the NHS and public health. In a letter to the Health Secretary in October, the Committee said:

“All the indicators suggest that demand is continuing to grow and that we need to go further on prevention”.

I could not agree more. These cuts are a false economy and are exacerbating the situation within our health services. We are seeing funding directed to our crisis-ridden A&E departments, which are having to crisis-manage failures that could have been addressed a lot sooner.

The Minister needs fully to understand that to make cuts to one part of our health service without considering the impact on other parts is leading us down the road to rack and ruin. To give him some understanding of the cuts, I suggest that he look at the Health Committee report “Public health post-2013”. The Select Committee does good work, but the Chair is not here to hear me highlight all this work. The report that I have just mentioned highlights research by the Association of Directors of Public Health, which found that local authorities are planning deep cuts to public health services due to the cuts coming from central Government to local authorities. It shows a marked rise for 2016-17 compared with 2015-16.

The Government need to have a wholesale rethink of the funding of the NHS and public health services that sees a redirection to prevention, which will go some way towards addressing many of the problems in our health service that are now being documented weekly. I hope that the Minister takes some time in his response to consider the points that I have raised in relation to public health funding and how current actions are failing the vision of the five year forward view and the health of our nation. Self-care needs properly to be funded and supported to be innovative, so that we ensure that the continuing crisis facing the NHS can be reversed. We cannot continue as we are, because our NHS is too precious to let it fail. The health of the nation needs to be protected, where possible, to enable people to lead long, happy and fulfilling lives.

--- Later in debate ---

[Sir Kevin Barron]

The hon. Member for Linlithgow and East Falkirk (Martyn Day) and my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) mentioned groups in their areas that help people with long-term conditions, and those are a resource that we should use. My hon. Friend spoke about prevention, and that is right; we need it. The need for the NHS and taxpayers’ money will never stop if we cannot turn around the health of the nation. Population health is something we must attend to.

As for the minor ailment scheme that the hon. Member for Linlithgow and East Falkirk described, we have one in my area; I hope that they will be rolled out nationally. However, I wonder how many people know that really they should go to the pharmacist. Pharmacies are open all the time—at the weekend as well—but people drive past them to the A&E. We need to look at that issue.

The Minister spoke about health education and there is no doubt in my mind about it: as a Rotherham MP I know about the problems caused by not having good sex education and, more importantly, personal relationship education in our system. We have it now, having gone through the awful child sexual exploitation experience of practically two decades in Rotherham. It seems to me that it is also important to have continuing health education, including educating people about the system and where to engage with it.

On sustainability and transformation, on Friday morning this week the Rotherham MPs will have a meeting with the lead person on the issue from South Yorkshire, Sir Andrew Cash. On 16 December we will visit a pilot scheme running in the constituency of my hon. Friend the Member for Rotherham (Sarah Champion). There is a group of 30 patients and two or three GP surgeries who are working with other health professionals in the acute and primary sectors, and other organisations such as Voluntary Action Rotherham, which runs social prescribing. They are going to run a pilot to see how well it is possible to look after people and improve population health.

I do not want to get dragged too far on to this point, but the Minister talked about referring people with long-term conditions to football teams. I hope that is not a slight on Rotherham United, which is at the bottom of the championship at the moment, some eight points adrift, as it were. I have been a supporter for nearly 60 years and will continue to be one, but I think now and again one or two of them might have some problems that need sorting out—with the pharmacist or others.

We have had a short but good debate, in which we recognised that self-care and preventive healthcare will be crucial to the future of the nation and its people.

Question put and agreed to.

Resolved,

That this House has considered Self Care Week 2016.

Community Pharmacies

Kevin Barron Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I should say that I am chair of the all-party pharmacy group. I am sure that many of my colleagues will today talk about the savings and services that community pharmacies provide to the national health service. Although that is an important point, it is also essential that we highlight the good that they provide to patients. They do so much more than just deliver prescriptions to people. Let me just highlight the scale of their operations. Some 11,800 community pharmacies dispensed more than 1 billion prescription items in 2015.

Community pharmacists are well prepared to adapt to many different problems with which they are presented. They help people to give up smoking, alter their diets, become healthier and manage their cholesterol. Effectively, they are on the frontline as far as the health of the public is concerned.

[Anna Turley]

My right hon. Friend makes an extremely important point. Pharmacies are right at the heart of their communities. As has already been mentioned today, access to those services is vital. In some areas—such as our two constituencies—bus services are being cut and people are finding it increasingly difficult to access services. It is nonsense for the Minister to say that it is a matter of seconds between pharmacies. Will my right hon. Friend comment on how important access to pharmacies is to our communities?

[Kevin Barron]

It is very important, and the mechanism that has been put in place will not solve everything. We may get Boots in Gatwick airport supporting it, but there is the potential that others may drop off the line because they are just outside the geographical area. We need to look at that.

Let me turn to population health. This cannot be done by central distribution centres or a pharmacy based miles away, as they have no link with the locality. I am pleased that the idea of major companies getting involved in prescribing has been dropped. Pharmacists know their customers well and are familiar with their medications and, consequently, the customers feel confident in asking them for their advice.

The Government’s figures show that the £170 million cut could force up to 3,000 community pharmacies—one in four across the country—to close their doors to the public, so people would have to travel a lot further to their pharmacist and not have the local connection that I mentioned previously. Community pharmacy is the gateway to health for some 1.6 million patients each day. If anything, that is something we need to get a grip on.

A core component of current pharmacy services supports the public to stay well, live healthier lives and self-care. Pharmacists play a central role in the management of long-term conditions. They carry out medicines use reviews, for example. We must remember that more than 70% of expenditure on our national health service at both primary and acute level is spent on people with long-term conditions. There could not be a better gateway for those people to get the assistance they need to manage those conditions than through local pharmacies.

[Nic Dakin (Scunthorpe) (Lab)]

My right hon. Friend is right. Community pharmacies are at the heart of the gateway. Does he agree that there is a danger that the proposed cuts might end up costing more money than they save?

--- Later in debate ---

[Kevin Barron]

That is a danger. We do not know what is going to happen.

Community pharmacies attract patients who will not access health care anywhere else. People greatly value the fact that they do not need an appointment at a pharmacy. The long opening hours, too, are appealing. People from deprived populations who may not access conventional NHS services do access community pharmacies, which helps to improve the health of the local population and to reduce health inequalities.

I know that there is some weighting of the figures in relation to the assessment scheme. We need to see how that will work. I hope that we will take it into account that where there are higher levels of deprivation, large numbers of pharmacies might not be inconsistent with need.

I was contacted by a pharmacist in my constituency to highlight two examples from the past week that showed the vital role of a local community pharmacy. In the first example, a 34-year-old lady with epilepsy had run out of her essential medication, owing to a visit lasting longer than she had anticipated. She went along to the local walk-in centre but was denied a supply because of the lack of prescription evidence. As we all know, records are not as joined-up as they should be. The lady then visited her local pharmacy, which, thanks to local record access, was able to determine that her request was genuine and gave her a short-term supply. A lengthy and stressful visit to A&E was therefore avoided and the risk of potentially harmful seizures was averted as well.

In the second example, the pharmacist described spending 45 minutes with the parents of a one-year-old late on Wednesday evening, helping to administer soluble prednisolone for severe croup. The fact that the pharmacist was able to spend that time with the family got the job done, and again an A&E visit was avoided.

The difficulty in collecting such examples is that so many pharmacists see this simply as what they do, rather than as great examples of care for patients. They do not moan about it, worry about whether they get paid to do it or pass the buck; they just deal with the situation and improve patient care for the individual in front of them.

As well as providing extra services, community pharmacies are taking on more of the clinical roles that have traditionally been undertaken by doctors, such as the management of asthma and diabetes and blood pressure testing. That should be welcomed, as it reduces the pressure on GPs. It is usually so much easier for people to visit their local pharmacy for these services than to wait at their GP’s surgery. Because of the greater amount of time that they can spend with each patient, community pharmacists can respond to patients’ symptoms and advise on medicines that have been prescribed or are for sale in pharmacies.

The public support for local pharmacies and the services that they provide is huge. I was one of a number of Members from both sides of the House who presented a petition to No.10 a few weeks ago that now has some 2.2 million signatures. It is the biggest health petition that we have ever had here in the UK.

I shall finish with a quote from a pharmacist in Rotherham, who said, “I do what I do to make a positive difference to patients’ health and wellbeing every single day. How many things would I be able to pick up post-cuts? Probably not as many, as we will have to cut back on staff and I won’t have as much patient-facing time.” The all-party group will be looking at the proposals. I do not say that we should move away from a dispensing model, but we need reassurance that any move will not affect our community pharmacies and patients’ needs.

Community Pharmacy in 2016-17 and Beyond

Kevin Barron Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[David Mowat]

I will not say much more because of time constraints, but I thank my right hon. Friend for his comments. He is right to remind the House that this sector is quite concentrated towards public companies. That is not to say there are not some individual pharmacists that will be affected, but about 25% of pharmacies are owned by two or three public companies.

[Kevin Barron (Rother Valley) (Lab)]

I should declare my interest as chairman of the all-party group on pharmacy. I do not want to speculate about closures, as that has been done already, but if we get to a point where it might make sense for pharmacies to merge in different communities, my understanding is that the regulations are not yet in place for that. Is that true, and, if that is needed, when will it happen?

Community Pharmacies

Kevin Barron Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

As I said, we are recruiting an additional 2,000 pharmacists into general practice by 2020. We will also link community pharmacists into the NHS 111 system in a way that has never been done in England, so that repeat prescriptions will go direct to pharmacists and not to out-of-hours GPs. By 2018, pharmacists will receive additional payment for looking after minor ailments.

[Kevin Barron (Rother Valley) (Lab)]

I declare an interest as the chair of the all-party pharmacy group. In February this year, the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said there would be an impact assessment. In answer to a parliamentary question I tabled last week and the Minister answered, you also said that an impact assessment will be published, so that it would inform the final decision. Can the Minister tell us when that will be published? Will it be shared with representatives of community pharmacists?

[Mr Speaker]

I did not say anything about any impact assessment, but the Minister might have done for all I know. I have a feeling we are about to learn about it.

Tobacco Control Plan

Kevin Barron Excerpts

Thursday 13th October 2016 Westminster Hall

[Kevin Barron (Rother Valley) (Lab)]

I declare an interest: I speak as a vice-chairman of the all-party group on smoking and health, the secretariat of which is supported by Action on Smoking and Health, a national charity.

I echo the thanks expressed by my hon. Friend the Member for Stockton North (Alex Cunningham) to the previous public health Minister, the hon. Member for Battersea (Jane Ellison), for all the work she did and her commitment to support for tobacco control. I welcome the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), to her new post; I hope that we can work together on this important issue. The previous four public health Ministers, under either the current Administration or the coalition Government, have worked very well with the all-party group and other Members who want to see progress on this issue. I also welcome my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) to her new role as shadow public health Minister. She is going to have to get used to seeing us, as she is going to be in here quite regularly.

It was in December that I last spoke in Westminster Hall on tobacco control. I was highlighting the fact that the tobacco control plan for England, “Healthy Lives, Healthy People”, was soon to expire, and that a new plan to ensure sustained funding for tobacco control was needed. I rise today for the same purpose. England has now gone 10 months without a comprehensive strategy on tobacco control. The House was assured that a new plan would be published in the summer. I know that some political summers lapse into the autumn, but I stand here in October wondering whether this summer is going to lapse into the spring. I hope that is not the case. The Government have since stated that a publication date will be decided in due course.

I am proud that tobacco control is no longer a partisan issue but enjoys the benefits of support from all parties in this House and in the other place. However, Parliament cannot act alone. We need a Government strategy to ensure that in this period of austerity tobacco control does not slip off the agenda and that local authorities continue to see it as a crucial part of their work. The hon. Member for Totnes (Dr Wollaston) referred to Manchester in her speech. It was deeply worrying to hear what she said, because I have no doubt that, although Manchester is a much bigger place, its socioeconomic profile will be like that of my own borough of Rotherham, where, sadly, a lot of people participate in smoking.

My hon. Friend the Member for Stockton North commented on the impact of smoking in his constituency; my constituency, Rother Valley, is similarly hit by the burden of smoking. Approximately 13,660 people in Rother Valley smoke, and across the three borough constituencies of Rotherham nearly 1,500 people died prematurely from smoking between 2012 and 2014. We know the national figure and I have to say, as I have always said in similar debates, that if we were losing our fellow citizens on such a scale from any other cause—whether it was an intervention in a war or anything else—we would be much more concerned than we seem to be about people tragically dying so prematurely.

Smoking has such a dreadful impact on communities. Surveys of smokers show that around two thirds want to quit smoking and that that desire to quit is the same across population groups. However, only around a third of smokers make a quit attempt each year, and the number of people accessing NHS stop smoking services is declining. A new plan is needed to set out continued support for those people by encouraging them to make quit attempts and to access services that can offer support. Smokers are four times more likely to quit with the help of the expert support provided by stop smoking services, but a new plan is needed to guarantee funding for such services, which are currently under threat.

I have been contacted on this issue by Teresa Roche, Rotherham’s director of public health, and Councillor David Roche, Rotherham Council’s cabinet member responsible for this subject. I do not think they are related, but somebody in my office once asked whether they were. I am not too sure at this stage, but the next time I meet them I shall find out. They are part of the ambitious plan in Yorkshire and the Humber to inspire a generation free from tobacco by 2025. However, their work requires funding. I ask that that be addressed in the strategy, when it is published. The percentage of adults who smoke is falling, but the fall has been even better among teenagers and young children. Back in 1993-94, I introduced a private Member’s Bill against the advertising and promotion of tobacco. At that time, the levels of smoking among both the adult and teenage populations were far higher. Work to discourage smoking is working, and it is saving lives.

International evidence shows that funding for tobacco control activities is crucial. Members who attended the debate in December may recall me describing the situation in New York, where smoking rates declined consistently until 2010, when funding for tobacco control was cut. Smoking prevalence then began to increase until 2014, when funding was reinstated and smoking rates began to decline once more. That is one example of the well-known fact that tobacco control needs sustained funding in order to be effective. As was said earlier, after the change of Government in 2010, the removal of social marketing in the national media was clearly followed by a decline in the number of people stopping smoking. There is a direct correlation.

Funding is needed not only to secure the future of stop smoking services, but for mass media campaigns to encourage smokers to quit. We must keep them up. I understand that this year the Stoptober campaign has moved online, utilising resources such as Facebook Messenger—something on which I have to say I am no expert—to support people who are attempting to quit.

[Alex Cunningham]

It is all very well having online services, but people need to have access to those services. I know that everybody thinks every kid from a poor home has a smartphone, but that is not true. If they do not have access to IT services, they cannot benefit from the services my right hon. Friend is describing.

[Kevin Barron]

I accept that entirely. We hear all the time about people getting online to claim their benefits or whatever else, but it is quite clear that not everybody has access. Nevertheless, we are in the 21st century now and we have moved on a little. We can now sit in this Chamber using our phones for things that would have required an office 20 years ago, so we must remember that things are moving on. I do agree with my hon. Friend, though.

The Stoptober campaign will be delivered at a fraction of the cost by using new media. I await with anticipation the evaluation of its effectiveness compared with previous campaigns that have used a broader range of outlets, including TV and print media. Effective tobacco control needs to be comprehensive, encompassing all these activities to support smokers and to promote systems-wide action to dissuade people from taking up smoking.

Quitting smoking is incredibly difficult. As we have heard, electronic cigarettes are now used by over 2.5 million people in the UK; some people estimate that the figure is 2.8 million. They give smokers access to a significantly less harmful source of nicotine and help individuals to give up tobacco. Evidence from the Royal College of Physicians—I should say here that I am an honorary fellow of that body, before it gets into the newspapers. There is no payment for that. None the less, I ought to say that I use my personal experience in these matters. Evidence from the royal college and from Public Health England shows that vaping is around 95% less harmful than smoking cigarettes.

Two new publications have further supported the argument that electronic cigarettes can make it easier to quit smoking without posing significant health risks. The first is a systematic review of the evidence from the Cochrane Tobacco Addiction Group. Such reviews are generally considered to be authoritative summaries of the current scientific evidence. The results show that electronic cigarettes containing nicotine significantly increased the chance of quitting smoking, while not showing any adverse health effects within two years of use. I know that there are some people outside who say, “We’ve got to see what this is like over decades to make sure they are perfectly safe”. I am afraid that we would have to wait decades to be able to see that. What we should concentrate on is the scientific evidence that we have available since the introduction of electronic cigarettes and make judgments on that.

The second publication has already been mentioned by the hon. Member for Totnes (Dr Wollaston). A number of newspapers have picked up on the researchers’ estimate that in 2015 electronic cigarettes helped an additional 18,000 people to quit smoking. That illustrates how electronic cigarettes have the potential to be a huge public health innovation. There is growing consensus, including charities such as the British Lung Foundation, Cancer Research UK and the Royal College of Physicians, that electronic cigarettes are a very useful tool for smoking cessation.

We all know that smoking is responsible for approximately 96,000 premature deaths across the UK, which is more than the number of deaths caused by the next six biggest causes of preventable deaths in the UK, including obesity, alcohol and illegal drugs. Electronic cigarettes have amazing potential to reduce that burden of death and disease. The Tobacco and Related Products Regulations 2016, which came into effect in May, aim to maximise the benefits from these products within a properly regulated framework. There is a clear role for electronic cigarettes as a form of tobacco harm reduction, but regulation is needed to ensure manufacturing quality and to dissuade non-smokers, including young people and children, from taking up vaping. In the UK, there is no significant evidence that non-smokers are taking up vaping, or that electronic cigarettes are acting as a gateway to smoking. However, it is proportionate to the risks posed by nicotine in any form that these products are regulated.

I wish that people would get over the fact that some of the owners of the companies that make these products happen to be tobacco companies. I do not think anyone has battled more against tobacco in this House than I have for two decades now. However, tobacco companies grow tobacco; tobacco contains nicotine; and nicotine is addictive. It is 90% safer to take nicotine through vaping than through a cigarette, and I wish that people out there who listen to these debates would recognise that fact and stop knocking on about who owns the companies that make these products. The quality of people’s lives is improving in taking people off this drug, which prematurely ends the life of 50% of people who smoke cigarettes. That is what we should concentrate on.

Before the summer recess, on 4 July, Lord Prior announced in a debate in the other place that those regulations would be reviewed within five years to ensure that they were fulfilling the aims of supporting smokers to quit, preventing uptake among non-smokers and young people, and providing appropriate regulation of products containing nicotine, including a route to medicinal licensing. Although I understand that that might be affected by Brexit, I would be grateful if the Minister could confirm that that is still the plan. I know that Brexit is something that nobody knows about, other than it is Brexit at this stage, but these are crucial, potentially life-saving things for many of our citizens and this is an issue that we need to address.

Lord Prior also committed to commissioning Public Health England to update its evidence report on e-cigarettes annually until the end of this Parliament, and to include within that its quit smoking campaign’s consistent messaging about the safety of e-cigarettes. Can the Minister tell us when Public Health England’s review and updating of the evidence for 2016 will be published, and what message about electronic cigarettes has been included in the Stoptober campaign? The one that was published by Public Health England and others in August 2015 about e-cigarettes was truly ground-breaking in showing how people with a nicotine addiction can help to save themselves from dying prematurely by using these products. Do not get me wrong, Minister and Members of this House—I would like to see people off nicotine all together, but that is a difficult thing to achieve, as we all know. We have been debating this issue for years and years, but more than 2.5 million people have voluntarily gone on to this safer system of dealing with their addiction. If we can use that to get them off the addiction all together, we should do so.

We all know that quitting smoking is one of the hardest things a person can do and we have a duty to support these people in any way we can, not only for their own personal health and well-being but for the health and economic well-being of society as a whole. A new tobacco control plan is urgently needed to make sure there is the funding and momentum to ensure that we are successful in making smoking history for our children.

--- Later in debate ---

[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to serve under your chairmanship, Mr Brady, and to follow the hon. Member for Harrow East (Bob Blackman). I find myself in agreement with everything he said. Anyone who has come here hoping to see violent disagreement and robust debate will be disappointed, because we all agree about the importance of this issue.

The hon. Gentleman talked clearly about the nature of this lethal product, which, as we have heard, kills 96,000 people a year across the UK. He also touched on the issue of the developing world. It is anticipated that 8 million people across our world will die from smoking in 2030, and that 80% of them will be in low or middle-income countries that do not have strategies to tackle the problem. Companies based in this country are selling this lethal product to the developing world and killing so many people. We need to be clear that that is shameful.

Many hon. Members, including the hon. Member for Totnes (Dr Wollaston) and the hon. Member for Stockton North (Alex Cunningham)—I congratulate him on all the work he has done and on leading this debate—have talked about the inequalities that are associated with smoking tobacco, including wealth and income inequalities. Smoking hits people from low-income communities much harder than others. As Members have said, smoking is about half of the reason for the difference in life expectancy between the richest and the poorest in our country.

I want to talk about another inequality, which the hon. Member for Harrow East touched on at the end of his contribution: the impact on people with mental ill health. A substantial part of the reason why such people, particularly those with severe and enduring mental ill health, die 15 to 20 years earlier than others is higher smoking rates. Here’s the thing: we have been very successful in this country—I will come back to this in a moment—at reducing the smoking rate. Public health strategies have worked effectively, although we all recognise that there is much further to go. But as the smoking rate has come down in the population as a whole, it has remained stubbornly high among those with severe and enduring mental ill health; there has been hardly any shift at all. That has been a failure of public health strategies.

Back in 2013, when the smoking rate across the population was 21%, it was 40% among those with severe and enduring mental ill health, 60% among those with psychosis, and 70% among people in in-patient care. We can start to see why those people end up dying so much earlier than everyone else. That amounts to a neglect of those people’s need for support in combating this highly addictive product, and it makes me absolutely driven—as is everyone else in the Chamber—to do more to combat the problem.

Let me come back to the successes of smoking cessation strategies. I join other hon. Members in congratulating the hon. Member for Battersea (Jane Ellison) on her work. The hon. Member for Harrow East was right; there are Government Members who take a different view. I remember hearing the hon. Member for Battersea speaking and wanting to tell her to watch her back, because there were quite a few Members behind her who took a different view. She was brave in standing her ground, particularly in pursuing the plain packaging policy. The right hon. Member for Rother Valley (Kevin Barron) has a plain packet in his pocket. The previous Government were in my view a coalition Government, not a Conservative-led Government; the Liberal Democrats played our part in important strategies such as plain packaging and ending smoking in cars with children on board, which will have a big impact on saving people’s lives.

It is imperative that the new strategy is published and becomes operational. Given the leadership role that we have played for so many years, it is important that we go to the meeting in India in November and demonstrate our continued leadership. If there is any way for the strategy to be published before that meeting, and for it to include a focus on how we will use the fund that has been established for combating smoking in developing countries, I urge the Minister to do everything possible to ensure that that happens.

Let me speak a little more about what the tobacco control plan needs to include. I come back to what I said about mental health, which the plan needs to address directly. I do not know whether the Minister has seen the iterations of the plan, which we hope will be published soon, but I hope very much that it will address directly the failure of public health strategies to reduce smoking among people with mental ill health. The plan needs to focus on the recommendations of the report “The Stolen Years”, which was published by ASH and produced in collaboration with the Royal College of Psychiatrists, and its ambitious targets for reducing smoking among people with mental ill health. We can no longer fail to confront the failure of past strategies in that respect. Interestingly, that report highlights the therapeutic benefits of stopping smoking for people with mental ill health, not only for their physical health but for their mental health. Ironically, many people with mental ill health smoke because they see it as an escape from the pain that they are suffering and a way of coping with stress, yet smoking increases stress and the risk of aggression, particularly in in-patient services.

[Kevin Barron]

I went to the launch of that report. Some 70% of people who are discharged from mental health secure units smoke, yet we have in our midst a product—e-cigarettes—that could have been designed to be put into such institutions, some of which are now putting e-cigarettes on their shopping lists. That would allow people to satisfy their addiction without creating secondary smoke and the many ailments that occur when people smoke. Does the right hon. Gentleman agree that we need more leadership to ensure that e-cigarettes can be used in institutions where, for control reasons, it is difficult to keep the customer satisfied, as it were?

[Norman Lamb]

I completely agree. If we want to focus effort where it is most needed and where smoking rates are highest, we should focus on those very mental health institutions. As well as making vaping available for people who need help to give up smoking, we need to do much more to focus on training staff in such institutions so that they know the importance of smoking cessation being one of the objectives in the care of individuals there, because of its potential therapeutic benefit.

I should also mention the move towards smoke-free in-patient settings, a strategy that I supported as Minister and that I am pleased is continuing. Guidance was published by Public Health England and NHS England in June 2015, and that strategy is having a beneficial effect on the environment in in-patient settings by reducing aggression and stress and improving physical and mental health. I encourage the Government to keep pursuing that objective.

On electronic cigarettes and vaping, although I was a committed remainer in the EU referendum debate, the tobacco products directive is flawed, because it takes an inappropriately tough approach to electronic cigarettes. I therefore hope that the Government will review that directive regularly. One of the potential benefits of leaving the EU—there are not many, in my view—is that we will gain the ability to differentiate more between the effective regulation on tobacco in that directive and the regulation on electronic cigarettes, and do much more to recognise the evidence that already exists, as the right hon. Gentleman has made clear, on the benefits of electronic cigarettes.

I will end by saying something about public health funding. The hon. Member for Totnes made the point clearly, and I totally share her view. The Health Committee has pointed out that the £8 billion or £10 billion that we keep being told will be given to the NHS by 2020 is actually nearer £4.5 billion. Extra money is being found for front-line NHS services partly by cutting other parts of the Department of Health budget, including, distressingly, public health and health education. As she said, that is completely counterproductive. When NHS finances get tight, crisis management takes over. The hon. Member for Stockton North made the point that CCGs are focusing on propping up established traditional services—the repair services, as it were—and in so doing, tragically, are cutting the prevention services that prevent people from ending up needing care in the first place. That is so counterproductive. A new settlement for the NHS and the care system, which I keep calling for, must recognise the imperative to invest more in prevention and public health, particularly given that there is so much evidence that that has a beneficial effect.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship again, Ms Buck. I start by paying tribute to my hon. Friend the Member for Stockton North (Alex Cunningham) and to the Backbench Business Committee for allowing him and others to secure this important debate. As we all know, he has done much during his time in Parliament to address the sale and use of tobacco products, not only in his own constituency, just up the road from my own, but across the country. That includes his excellent work with my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) to bring forward the ban on smoking in cars with children. I commend him for his tireless campaigning and commitment to this hugely important area of public health policy.

I thank right hon. and hon. Members who have taken part in the debate. I pay tribute in particular to the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, for the support and expertise she brings to the debate. Her predecessor plus one or two, my right hon. Friend the Member for Rother Valley (Kevin Barron), also has a huge wealth of expertise and knowledge across the whole health brief. In my new role, I will certainly be calling on him a fair bit—I hope that he is prepared and willing for that to happen. I also want to commend the other right hon. and hon. Members who spoke today: the hon. Member for Harrow East (Bob Blackman), the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke on behalf of the SNP.

I wish to say a few words to the public health Minister. This is our second outing together and I have had this role for only four days, so I think this will be a regular thing. I am definitely looking forward to keeping a close eye on her work at the Department of Health and to debating across the Chamber. I am sure we will do that on many important issues facing our country’s health. If the tireless work of my predecessor, the hon. Member for Denton and Reddish (Andrew Gwynne), is anything to go by, that will be often—surely he has his own seat in here with his name on it because he was in here so much. That is a daunting prospect.

Today we are debating the important topic of tobacco products. It is crucial that the message is put across to the Government that more can and should be done to ensure that we all lead healthier lives. The control of the sale and use of tobacco is an important public health matter not only for those individuals who use it but for all around them.

During Labour’s time in office, we recognised that fact, which is why we did a lot to address smoking in society, most famously with the introduction of the ban on smoking in public places. The ban brought in a culture change in our society. When we used to walk into any indoor public space, it was the norm to be met with a cloud of stale tobacco smoke, whereas now all of us—especially children and families—can enjoy ourselves freely without having to breathe in second-hand smoke or have the overhang of smoke in the air.

The Tory-led coalition Government came into power and brought in their own tobacco control plan, and it was welcome that it achieved so much over its lifetime, including the prohibition of point-of-sale displays in shops; the introduction of standardised packaging for tobacco products; and the national ambitions on reducing smoking, which were all met. However, when the plan ceased at the end of last year, it was vital that the Government published a new plan in a timely manner to build on the work of previous Governments. Sadly, nearly a year on, the Government have failed to come forth with such a plan, despite the promise and a commitment to do so last December.

Last month, the Health Minister in the House of Lords failed to commit to a final date for publication. We were expecting to have sight of that plan over the summer; we are now hopeful that we will see it during the Indian summer. Changes in Government meant the plan was put on hold. The delay is not too dissimilar in some ways to the constant delay to the childhood obesity plan—although at least that was rushed out over the summer.

A change in ministerial personnel should not be an excuse for delaying such an important intervention in the health of our society, especially when the new Prime Minister stood on the steps of No. 10 Downing Street in the summer and committed her Government to

“fighting against the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others.”

We were led to assume that was going to be the driving force of the Prime Minister’s Government, and I hope it is, but the rhetoric has not yet translated into reality when it comes to this serious public health issue facing our country.

The Government have faced a vocal chorus from charities and organisations, including the British Medical Association, Action on Smoking and Health and the British Lung Foundation, which have all called on the Government to get their act together and publish the new plan. In that regard I also commend the work of Fresh, which my hon. Friend the Member for Stockton North mentioned, which does such sterling work in the region with the highest smoking rates and some of the worst health outcomes.

The Minister and her officials at the Department of Health are being told loud and clear to get on with the job at hand and to answer the crucial question that has come out of today’s debate: what is the delay? I hope she will shed some light on that important question in her response and—finally—tell us when we can expect the new tobacco control plan.

I want to set the scene on why it is so important we have a new plan, on top of what has already been said today, by looking at the facts and figures on smoking, including the variation of smoking habits among certain groups of society—especially children, young people and pregnant women. The smoking rate in England is 19%, but that varies from region to region. It is highest in the north-east, where it reaches 19.9%, and lowest, at 16.6%, in the south-east. Those are regional figures. When looking at the figures borough by borough, my local authority of Sunderland does not fare well at all, with 23% of the population smoking. That is much higher than even the highest of the regional averages.

Looking at smokers based on their socioeconomic status, it is clear that the less well-off in society are more likely to smoke. I am not going to go into all of the reasons for that. We just have to accept that it is where we are—but what can we do about it? Smoking rates among those in the professional and managerial socioeconomic group are less than half the rate of those in routine and manual socioeconomic groups, at 12% and 28% respectively. When the net income of a family and their smoking expenditure are both taken into consideration across England, 1.4 million, or 27%, of the households with a smoker fall below the poverty line. If those costs were returned to the families, it is estimated that approximately 769,900 adults and 324,550 dependent children would be lifted out of poverty.

That is a striking statistic, especially given the study published only a few weeks ago that showed that 250,000 children will be pushed into poverty during the lifetime of this Parliament due to the Government’s policies. Getting it right on smoking could totally negate that impact, so it is definitely something worth looking at. The stats show we must do more to address the cycle of health inequality, which spans generations and continues the awful situation in which there are huge life expectancy gaps between the rich and poor, as we have clearly heard today. If the Government want to change that, one way would be to step up and continue the work of reducing smoking in society.

If those figures do not spur the Minister on to bring forward the new tobacco control plan, hopefully looking at the issue of smoking among our children and young people will. It is welcome that smoking among children and young people fell to an all-time low of 6% under the last tobacco control plan, as we have heard, but it remains an issue when two thirds of adult smokers report taking up the habit before the age of 18, with 80% saying it was before 20. That is compounded when children who live with parents or siblings who smoke are three times more likely to take up the habit than children from non-smoking households. It is also estimated that 23,000 young people in England and Wales start smoking by the age of 15 due to exposure to smoking in the home.

[Kevin Barron]

My hon. Friend uses the statistics very well. Do they not defeat the myth that smoking is an adult habit?

[Mrs Hodgson]

They certainly do. The situation on children smoking is quite stark. The earlier children start smoking, the more serious the consequences are for their health. Children who take up smoking are two to six times more susceptible to coughs and increased phlegm, wheeziness and shortness of breath than those who do not smoke. It can also impact their lung growth, which can impair lung function and increase the risk of chronic obstructive pulmonary disease in later life. As we heard from my hon. Friend the Member for Stockton North, 25,000 people a year die from COPD. Surely we do not want any child in this country to die in that way. The prevalence of these conditions among smokers shows it is paramount that we seriously tackle smoking among our children and young people. We do not want to see the children of today being the COPD sufferers of the future, as well as having those other conditions.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Stockton North (Alex Cunningham), my hon. Friend the Member for Portsmouth South (Mrs Drummond) and the right hon. Member for North Norfolk (Norman Lamb) on securing the debate, and the Backbench Business Committee on allowing it. The importance of the debate is shown by the fact that we have the Chair and former Chair of the Health Committee and a former Health Minister present, as well as our newly appointed shadow Minister, whom I welcome here today; there was not much chance to do so in Health Question Time.

As hon. Members have made clear, despite the continuing decline in prevalence, smoking remains the largest single cause of preventable and premature death in this country, with approximately 17% of deaths annually caused by smoking. I want to be clear from the outset that the Government remain committed to reducing the number of people who smoke by stopping them before they start. We have a clear track record in reducing the harms caused by tobacco, which has already been mentioned.

We have made good progress through a comprehensive package of measures, many of which were brought about by my predecessor, my hon. Friend the Member for Battersea (Jane Ellison), with a lot of support from the all-party group on smoking and health; I thank its many members who are here today. We have introduced standardised packaging and the ban on displaying tobacco in small shops. We have maintained a high duty rate on cigarettes and hand-rolled tobacco, and we have ended smoking in cars with children in them. Such measures have played a part in ensuring that the public are protected from the harms of tobacco. We now see that 80% of people support the smoke-free places legislation, which shows a change in culture and attitude.

We have also continued to support people to quit smoking, with Public Health England running media campaigns such as Stoptober. As the Minister responsible for public health and innovation, I am pleased to see the innovative use of digital tools such as the Stoptober app and social media messaging, which have allowed campaigns to reach out to groups in which smoking rates remain high and target them more effectively. That approach has proved extremely successful and was responsible for 130,000 people successfully quitting for 28 days in Stoptober in 2015.

I have heard the concerns about the lack of use of mass media, and I will look at the evaluation of Stoptober and see whether there has been any impact. That strategy has been used so that we can have a more focused targeting of high prevalence areas and groups by using the most efficient social media channels, but we will examine the evidence to see how effective that has been. As today is so close to the halfway mark for those attempting to quit during the campaign, I take this opportunity to wish them all the best in reaching 28 days smoke-free. I want to tell them not to give up.

As the former Chair of the Health Committee, the right hon. Member for Rother Valley (Kevin Barron), said, it is notable that one of the most significant disruptions to smoking in recent years has had nothing to do with Government intervention. We have seen considerable take-up of e-cigarettes in the UK, and we know that almost half of the 2.8 million current users are no longer smoking tobacco. We need to continue to embrace developments that have the potential to reduce the burden of disease caused by tobacco use. However, we need to recognise that the use of such products is not risk-free. We need a regulatory framework that minimises risks to users and targets the promotion of products at existing smokers and not at children. I have heard the comments made today about e-cigarettes.

[Kevin Barron]

Will e-cigarettes, or vaping, be in the new tobacco strategy?

[Nicola Blackwood]

I am looking closely at PHE’s expert independent review. I have asked officials to examine that closely, and they are updating the review of the evidence each year. I do not have a date for this year—I know the right hon. Gentleman asked for it—but I will write to him when I find out exactly when that will come forward.

Our approach has been comprehensive and has seen smoking prevalence fall in all age groups for both men and women. As various Members have said, adult smoking prevalence in England is now just under 17%, the lowest rate since records began, and we should take a moment to be proud of that. However, as others have said, we cannot be complacent. Smoking continues to be one of the largest causes of social and health inequalities in this country. It accounts for approximately half of the difference in life expectancy whereby, as the Prime Minister said, those on the lowest incomes die an average of nine years earlier than others. The Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), said it so well: it has an even greater impact on healthy life expectancy, which we also need to focus on.

At national level, smoking prevalence is declining year on year. There remain significant regional and demographic variations—an issue raised by the hon. Member for Stockton North, the shadow Minister and others—with the prevalence in some population groups, such as those with mental health conditions, at more than twice the national average. That point was particularly raised by my hon. Friend the Member for Harrow East (Bob Blackman) and the former Health Minister, the right hon. Member for North Norfolk. I shall certainly look at the report that was mentioned, “The Stolen Years”.

Regional variation means that rates of smoking during pregnancy can range from anywhere between 2% in some areas to 27% in others. That is another issue that we must focus on. Given the wide variation in smoking rates across the UK, it remains crucial that local councils have the flexibility to consider how best to respond to the unique needs of their local population and tackle groups in which prevalence remains high.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 5th July 2016 Commons Chamber

[Alistair Burt]

The hon. Gentleman is right to praise the role pharmacies play and right to identify that we must do all we can to ensure that those who are most vulnerable retain the excellent access they currently have. The national formula on access proposal will be used to identify those pharmacies that are most geographically important for patient access, taking into account isolation criteria based on travel times and distances, and population sizes and needs. Both deprivation and isolation will be covered in the access formula.

[Kevin Barron (Rother Valley) (Lab)]

Given that the access scheme could potentially alter the situation for community pharmacies, will the Minister consider more money than was originally proposed for community pharmacy budgets to stop any shock from the cuts we are expecting later this financial year?

[Alistair Burt]

There are no changes to the funding issues announced when the review of pharmacies started on 15 December. As my right hon. Friend the Secretary of State said, we are hoping to make an announcement on pharmacy when we can. I am aware that pharmacy is waiting for that.

Budget for Community Pharmacies

Kevin Barron Excerpts

Tuesday 24th May 2016 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

Does my hon. Friend agree that the petition that went to Downing Street today was not just about 1.8 million people being concerned about their local pharmacy? Those 1.8 million people are also taxpayers who feel that this efficiency drive is going to have a negative effect on what they believe to be an important part of their communities.

[Michael Dugher]

My right hon. Friend makes an interesting point. I have seen the cuts to community pharmacies described as a Treasury-led process. A lot of people are paying their taxes, including the 1.8 million who have already signed the petition. I pay tribute to my right hon. Friend for the leadership he has shown as chair of the all-party parliamentary pharmacy group.

This is not a clear, well-thought-through strategy. It is a reckless leap into the unknown, and it is the NHS, patients and every community in the country that will pay the price. For those of us who were here during the last Parliament, this is painfully reminiscent of the process involved in the passing of the Health and Social Care Act 2012, with the Government making things up as they go along and ending up in a situation where things are worse for the NHS and more money is once again wasted.

I implore the Minister to listen to Members from both sides of the House and from the other place who have voiced their real and sincere concerns. I urge the Government carefully to consider the overwhelming body of evidence from our healthcare professionals who do so much to serve our local communities and our NHS. The Government must now listen to the unprecedented 1.8 million people who have signed the petition, which states:

“We, the undersigned, believe that local pharmacies are a vital frontline health service and part of the fabric of communities across England. Under new Government proposals, many pharmacies could be forced to close—depriving people of accessible medicines, advice and other valuable support from trusted professionals. It would also put more pressure on GPs and hospital services. In the interests of patient care, we urge the Prime Minister and the Health Secretary to abandon plans that put pharmacy services at risk.”

The Government must now think again.

Junior Doctors: Industrial Action

Kevin Barron Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

We will do everything in our power to ensure that patients are protected. We have a very robust assurance programme, conducted by NHS Improvement and NHS Employers. We will do everything we can to ensure both that the number of elective operations cancelled is as low as possible, consistent with the needs of safety, and that emergency cover is provided. Withdrawing the number of doctors that the BMA will withdraw in this action means that there is an increased risk of patient harm, and I am afraid that the BMA and its members need to consider that very carefully in the weeks ahead.

[Kevin Barron (Rother Valley) (Lab)]

It is clear that the Government are in a very difficult position, hence the Minister’s attack on Opposition Front and Back Benchers. I have to say that, from my experience of nine years on the General Medical Council, I do not recognise the various descriptions of the doctors’ profession that the Government have given over the past few weeks, including as being radicalised. We all know that this dispute should and will be settled not by imposition but by negotiations around a table. It seems to me that instead of using, at the Dispatch Box and elsewhere, rhetoric that has fired this up, Ministers would do much better to react to what the BMA said yesterday, which is that it wants

“to end this dispute through talks”.

Why do the Government not get on with it, keep us out of it and just do what people expect them to do?

[Mr Speaker]

Before the Minister replies, may I remind the House that this is an urgent question, not a debate under Standing Order No. 24 or a series of speeches? There seems to be predilection among colleagues to preface whatever question they ultimately arrive at with an essay first. A number of Members say, “Oh, I have to say this.” No, Members do not have to say anything; they have to ask a question, preferably briefly. That is all we want to hear.

NHS: Learning from Mistakes

Kevin Barron Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his question. He and I have talked many times and thought very hard about how we can learn lessons from the air industry. He is one of the people who came to me first to say that if we want to set up an equivalent to the air accidents investigation branch, we need to give people in the healthcare world the same legal protections that others have when they are speaking to that branch, and that is at heart of the statement that I have made to the House today.

The point about safe space is very, very important. This is not about people getting off scot free if they make a terrible mistake. There is no extra protection here for anyone who breaks the law, commits gross negligence or does something utterly irresponsible. Patients still have those protections. What they gain is the comfort that we will get to the truth and learn from mistakes much more quickly. Every single patient and bereaved family says that the most important thing is not money, but making sure that the system learns from what went wrong. We will ensure that we construct the safe space concept, and I do not rule out extending that beyond the investigations of the healthcare safety investigation branch.

[Kevin Barron (Rother Valley) (Lab)]

In welcoming the statement, may I say that, in my experience on the General Medical Council and on the Health Committee, the biggest cloud that hangs over the culture of non-reporting in the national health service is litigation? Last year it cost the British taxpayer £1.1 billion, £395 million of which went on legal costs alone. Should we not be looking at a no-fault liability scheme inside the national health service so that we can really encourage cultural change?

[Mr Hunt]

The right hon. Gentleman is absolutely right that the fear of litigation has a very pernicious effect, which we see across the NHS. Litigation is a huge drag on costs and we are reforming how it works. We have looked at what happens in other countries. In Sweden, for example, the creation of a no-blame culture has had the dramatic impact of reducing maternity and neo-natal injury. I hope that today’s statement is a step towards that, but we will consider other reforms to the litigation process as well.

Community Pharmacies

Kevin Barron Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for St Ives (Derek Thomas) on securing this debate.

I am the chair of the all-party group on pharmacy in Parliament and I have been for more than five years. I have a keen interest in public health and lifestyle issues, and I have quite enjoyed chairing the group. After the letter of 17 December, the all-party group—three Members of this House and one from the other place—met the Minister, on 13 January. We had what I described afterwards as “straightforward talking” about the letter—a letter that posed more questions about the future of pharmacy than it gave answers. The Minister was straightforward, and he said that one issue was that, in October of this year—so just for the second half of the financial year—£170 million will be taken out of the community pharmacy budget. That leaves a number of questions to be answered, including that of what will happen in a full financial year.

The Government make great claims about putting an extra £8 billion into the national health service, but the truth is that that £170 million, which is part of the £22 billion of efficiency savings, is being taken out of the NHS, so it is hardly new money. It is not the £8 billion—that comes in a few years’ time. We are talking here about major cuts to vital services.

Since the publication of that letter, it has become clear that as many as 3,000 community pharmacies could close in England alone—a quarter of them. How would that happen? Would it be by stealth, which is suggested in the letter and in the consultation currently coming out of the Department, or is there some sort of plan? We have seen in the letter, and in others, that if there is a 10-minute walk between pharmacies, that might be looked into, but there seems to be no plan whatsoever.

What we have to accept—I put to this to the Minister in that meeting on 13 January—is that pharmacists do not work for the national health service, yet more than 90% of community pharmacies’ income comes from the NHS. The idea that we could change that mechanism and close community pharmacies is outrageous. The pharmacists may not work for the national health service, but their income depends massively on it—I wish it did not.

For many years I have been promoting lifestyle issues and the idea of pharmacists getting paid for doing things other than just turning scrips over, but that is how it works at the moment and there needs to be some serious talking. What happens if someone who has a 10-year lease on a property they took over to run the local pharmacy is forced out of business? All those questions remain unanswered, yet there is the threat of up to 3,000 pharmacies in England closing.

[Rachael Maskell]

I am following the argument that my right hon. Friend is putting forward. Does he agree that, instead of cutting services, we should be looking at opportunities for community pharmacies to extend healthcare further into their communities? It should be about investment at this time, particularly in prevention, which is all about saving money further down the line.

[Kevin Barron]

I agree with my hon. Friend. That is one of the reasons I took over as chair of the all-party group more than five years ago. I believe that our pharmaceutical services should be taking that route of travel.

It would help if the Government provided details of how they will ensure access to pharmacy services in remote or deprived communities. If the market will drive closures, there will be chaos, and something substantial needs to be in place.

[Mr George Howarth (Knowsley) (Lab)]

My right hon. Friend makes a powerful case. He mentioned the market. Does he agree that one difficulty that smaller independent pharmacies, such as John Davey in my constituency, have is that unlike the big chains they are unable to negotiate favourable deals on the drugs they dispense and, therefore, they are already at a disadvantage in market terms? Before the Government go any further with the programme they need to address that important issue.

[Kevin Barron]

I do not disagree with my right hon. Friend. I will not use the name of the company, but I can go into the store of one of the major chains, which is not in my constituency but not far away, and it takes me a minute to walk to the prescription counter, whereas in most of the pharmacies in my constituency I can get there in two or three seconds. We must recognise that, at constituency level, we are not comparing like with like.

Another thing is that key payments for pharmacies will be phased out, and there might be a drive towards a commoditised medicine supply service with an increased focus on warehouse dispensing and online services. Again, the possibility of added value in a local pharmacy regarding lifestyle issues potentially goes out of the window, and we really need to look at that. I have no direct experience, but I am told that they have that in the United States.

As well as dispensing medicines, community pharmacy teams help people to stay well and out of GP surgeries, to get the most benefit from their medicines and to manage their health conditions. The NHS spends £2 billion a year on GP consultations for conditions that pharmacy teams could treat. Community pharmacy can and should do more. A national community pharmacy minor ailments service could save the national health service some £1 billion a year. In some of the pharmacies in my constituency, there is already a minor ailments service. I understand that the Government recently changed their mind about developing such a service at a national level, and I would like to know why. Such a service makes great sense to me. It keeps pressure off not only GP surgeries but the local A&E.

In 2014-15, pharmacies delivered more than 3.17 million medicines use reviews, to increase people’s understanding and help them to take their medicines correctly. We get a lot more from our pharmacies than their just turning scrips over. Our communities and our constituencies need that, and if there are to be any changes, they should be carried out in a sensible and planned way, and not in the chaotic way of some of the suggestions of recent weeks.