Cervical Cancer Screening

Baroness Berger Excerpts

Thursday 1st May 2014 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) and the other hon. Members who supported the application for this debate to ensure that the House can discuss such an important issue. I also thank hon. Members for their thoughtful contributions throughout the debate, which are a testament to how much the case of Sophie Jones has moved Members on both sides of the House. Not only across this House, but across the country people have reacted with shock and sadness at the death of a young woman that might have been prevented. We need only consider the number of people who signed the petition calling for the Government to look again at cervical cancer screening to appreciate the depth of feeling surrounding this issue. As we heard, 321,956 people signed it, which is more than three times the number required for it to be considered for a debate in this House. As my hon. Friend the Member for Liverpool, Walton said, that is the largest number for any of these petitions.

I would like to take this opportunity to pay tribute to Sophie Jones’s family and friends for their courage, spirit and strength in driving forward this campaign and for their determination to ensure that what happened to Sophie does not happen to another young woman. I am speaking in this debate not just as shadow public health Minister, but as a constituency MP representing Liverpool, Wavertree. My constituency is close to that of my hon. Friend the Member for Wirral South (Alison McGovern), where Sophie Jones lived, and this tragic case has affected people right across Merseyside. I have heard from a number of constituents who have read about Sophie’s story and were very keen for me to participate in this debate.

I was very privileged to meet Sophie’s family with my hon. Friend the Member for Wirral South and hear from them about what a remarkable young woman Sophie was. She was active, well-liked and so positive, and I was so moved hearing about her bravery and positive outlook, even as her cancer took hold—it really is a true inspiration to us all. I am glad that the House has had the opportunity to hear about Sophie’s case, to examine policy on cervical cancer screening and to debate ways in which we can do so much more to ensure that such a tragedy does not happen again.

Cervical cancer is the most common cancer in women under 35 in the UK and although deaths from cervical cancer have plummeted over the past 30 years, about 970 women died from it in 2011 in the UK—that is more than two women every day. Cervical cancer is not normally associated with younger women—as we have heard from a number of hon. Members, it is extremely rare in under-25s. There were 47 cases in women aged under 25 in England in 2011, which was less than 2% of all cases. The House has heard today many good reasons why routine cancer screening is offered when women turn 25. I will not go through them in detail but I will touch on them briefly.

We have heard today, including from my hon. Friend the Member for Liverpool, Walton, about evidence showing that screening all women under the age of 25 can lead to some harmful investigations and treatments. I listened to what the hon. Member for Cheltenham (Martin Horwood) said and I will be interested to hear the Minister’s response and whether she believes that that evidence needs to be reviewed. I am grateful for the opportunity I have had to speak to experts in this field, including at the Liverpool women’s hospital, in preparation for today’s debate. I have heard that there are problems involved in screening under-25s and that young women often undergo natural and harmless changes in the cervix that a smear test would identify as abnormalities. Screening young women would involve putting these women through further tests and investigations they would not otherwise have gone through when, in most cases, the abnormalities would have sorted themselves out without any need for treatment. I understand that the decision for routine cervical screening to begin at 25 was taken after a thorough review of the evidence by expert clinicians and scientists. That decision was reviewed in 2009 by the Advisory Committee on Cervical Screening, which at the time voted unanimously to keep the age at which screening starts at 25, reaffirming the earlier conclusion that the harms of screening women under 25 outweighed the benefits.

The point in the cases of Sophie Jones and of all the other people we have heard about today is that there is heartbreaking proof that, though rare, cervical cancer in the under-25s can happen. We must get better at spotting the signs of the disease and diagnosing it earlier.

I wish to cover three main areas for improvement to which I hope the Minister will respond. First, we must increase awareness of the symptoms not just among women so that they can spot the signs and go to their doctor at an early stage, but among doctors and nurses so that they understand that young women can develop cervical cancer. Secondly, we must ensure that once cancer is diagnosed, women are swiftly referred for treatment. Finally, we must do more to prevent cervical cancer from happening in the first place. We can do that by ensuring high levels of coverage among girls of the human papillomavirus vaccination programme and that eligible women attend their cervical screening appointment.

The cervical screening programme is highly effective at detecting early stages of cancer or pre-cancer, but it is not the best tool for diagnosing cervical cancer once symptoms are apparent, as they were in the case of Sophie. We know that detecting cancer early can make a real difference. The earlier that cervical cancer is diagnosed, the better the outcomes are likely to be. As we heard from the chair of the all-party group on cancer, the hon. Member for Basildon and Billericay (Mr Baron), it is so important that women are made aware of the signs and symptoms of the disease.

I echo the point made by my hon. Friend the Member for Wirral South; it was refreshing to hear a man—my hon. Friend the Member for Liverpool, Walton—listing the different symptoms experienced by women. I will not read them out again, but encouraging women to visit their GP if they have any concern or are showing any of the symptoms is such a simple message that could make a really big difference. Men, as fathers, partners and siblings, can also play a part, by being aware of the symptoms.

The tragedy in Sophie’s case was that she did visit the doctor on a number of occasions, but tragically was not diagnosed accurately. The Government must do more to ensure that GPs are getting the support and the training they need to help them identify cancer signs and symptoms, and that needs to be done during initial training and ongoing professional development. Clinical commissioning groups have a role to play, too. Crucially, we must make doctors aware that, although rare, young women can suffer from cervical cancer.

As much as these improvements at the first point of contact are needed, they are not enough if, once cancer is suspected, people are not seen quickly enough by specialists. We have heard from Members about how important early diagnosis and treatment are. NHS England’s figures on cancer targets for the last three months of 2013 reveal that 4,500 people waited more than two months for treatment after an urgent GP referral, which was in breach of the Government’s own target. That is not good enough, and the Government must urgently get to grips with the failing.

If we are to win the battle against cervical cancer, we must do everything possible to prevent it from occurring in the first place. I am proud of the fact that it was the previous Government who, in 2008, introduced the HPV vaccine, which immunises teenage girls against the majority of the high-risk strains of HPV that are associated with cervical cancer. My hon. Friend the Member for Liverpool, Walton highlighted the very high risks connected with the HPV virus and cervical cancer. All 12 and 13-year-old girls are now being offered the vaccine through their secondary schools. From September 2012 to September 2013, 86.1% of 12 to 13-year-old girls in England went on to receive all three doses of the vaccine. There is room for improvement here, and the Government must do more to encourage girls aged 12 and 13 to participate in the HPV vaccination programme.

As my hon. Friend the Member for West Ham (Lyn Brown) outlined in her contribution, the HPV vaccination alone will not prevent every case of cervical cancer. Alongside the HPV vaccine, the best preventative measure is for eligible women to attend their routine cervical screening appointment. We know that cervical screening saves around 5,000 lives every year in the UK, but, despite that, around 3.7 million women are currently overdue for a smear test. Shockingly, that has increased to 11% since 2009-10.

One challenge is around access to GPs. A YouGov survey for Jo’s Cervical Cancer Trust found that of the women of screening age who have missed or delayed appointments, almost a third of them said that it was hard to book a screening at a convenient time, and 35% said that if GP surgery opening times had been more flexible it would have encouraged them to attend their appointments. As my hon. Friend the Member for Wirral South said, we should do all that we can to encourage and provide the opportunity for women to take up their invitation for a smear test.

I wish to finish by coming back to Sophie and her family. As Sophie's mother, Peri Cawley, said:

“If we can do something to make sure this doesn’t happen to someone else, then Sophie's death will not have been in vain.”

The petition under discussion had hundreds of thousands of signatures, which shows that people across the country support that goal. As today’s debate has shown, Members of this House are clear about what needs to be done. We must increase awareness of the symptoms among not just women, but men and all GPs to ensure that they understand that younger women can develop cervical cancer and are able to spot the signs. We must also ensure that we do more to prevent cervical cancer from occurring in the first place by encouraging girls to have the HPV vaccine and women to attend their cervical screening appointments. We now look to the Government to take the action that is needed to make progress on those counts and to ensure that there is no repeat of the tragedy that happened to Sophie Jones. I look forward to the Minister’s response.

Tobacco Products (Standardised Packaging)

Baroness Berger Excerpts

Thursday 3rd April 2014 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank the Minister for an hour’s advance notice of her statement. May I take this opportunity to put on record my thanks to Sir Cyril Chantler and his team for their excellent review? I welcomed some of what the Minister said, but I want to probe her on several issues.

We know that the cost to the NHS of treating diseases caused by smoking is approximately £2.7 billion a year. One in two long-term smokers die prematurely due to smoking-related diseases, and two thirds of adult smokers took up smoking as children. As Sir Cyril says, if we can reduce that figure by even 2%, 4,000 fewer children will take up smoking each year. For that reason, I strongly welcome the fact that Sir Cyril’s review confirms what public health experts have been arguing for some time: standardised packaging makes cigarettes less attractive to young people and could help to save lives.

Sir Cyril’s remit was to consider whether standardised packaging would lead to a decrease in tobacco consumption. Does not the Minister accept that his conclusion is clear that

“standardised packaging would serve to reduce the rate of children taking up smoking”

and could lead to an “important reduction” of uptake and prevalence, and have a “positive impact” on public health? Of course, that is something that all the previous evidence reviews have already shown. Indeed, Sir Cyril says:

“my overall findings are not dissimilar to those of previous reviews.”

Did not the Government’s own systematic review in 2012, which Sir Cyril describes as “extensive” and “authoritative”, conclude that standardised packaging is less appealing than branded packaging, makes health warnings more prominent and refutes the utter falsehood that some brands are healthier than others? All the royal colleges and health experts are united on this and the majority of responses to the Government’s consultation favoured such an approach, so does the Minister finally accept that there is an overwhelming body of evidence in favour of standardised packaging and that there can be no excuse for further delay?

You will know, Mr Speaker, that Labour has long been calling for the immediate introduction of standardised packaging. For every step that we took in government, the tobacco industry adopted a new approach. After we banned advertising, tobacco manufacturers developed increasingly sophisticated marketing devices for their packaging. In the words of Simon Clark of the tobacco-funded lobby group FOREST and the “Hands Off Our Packs!” campaign:

“It’s like showing them a picture of a Lamborghini and a beaten up Ford Escort and saying, ‘Which one do you prefer?’”

When my right hon. Friend the Member for Leigh (Andy Burnham) was Health Secretary, he was clear that the next front in the fight against tobacco should be packaging. The question is why have we had to wait so long? More than 70,000 children will have taken up smoking since the Minister announced the review, and today she has announced yet another consultation. The Government have already had a consultation that reported less than a year ago. What does the hon. Lady expect to change? Let me remind her of the words of the Health Minister in the other place, Earl Howe, who said:

“we will definitely introduce the regulations should the case be made and should we be persuaded of the case that Sir Cyril presents. I hope that I have been clear about that.”—[Official Report, House of Lords, 29 January 2014; Vol. 751, c. 1251.]

Why is the Minister now kicking the matter into the long grass? How many more children will take up smoking before this Government make a decision? Does the Minister not accept that it was the clear will of both Houses of Parliament to proceed with standardised packaging, and is this not yet another example of how her Government are caving in to vested interests and standing up for the wrong people?

[Jane Ellison]

The hon. Lady’s response serves to illustrate the difference between opposition and government. I agree that Sir Cyril has produced a compelling report; I recommended it to the House and urged everybody to take the opportunity to read it. He has made a compelling case on the public health evidence, but to make robust policy in this area it is essential that we follow a careful process. That means we have to look at everything in the round, and we have to give everybody who has a stake in the decision an opportunity to make their case. That is what we will proceed to do. I have drawn the House’s attention in the past to the fact that the Australian Government are still engaged in litigation in this area. We need to proceed in a sensible way, but I could not have given the House a clearer indication of the fact that we are moving at the pace dictated by a sensible and robust policy approach. That is the requirement for making good policy.

I am glad the hon. Lady drew attention to Sir Cyril’s review of the evidence from the Stirling review. He did more than just look at the Stirling review; he commissioned independent academic review of its methodology and concluded that it was robust. That is part of his review. As I said, I urge Members to look at that.

Members will have heard the hon. Lady’s response. I can only say to her that at every stage we have proceeded in a sensible, measured but clear way. We took the regulation-making powers in the Children and Families Act 2014, for which there was a large parliamentary majority. We will publish draft regulations alongside the final short consultation to look at the wider issues, and we will then move as swiftly as possible to a final decision based on all those elements. That gives the House a clear sense of our direction of travel. I want to make sure that, whatever decision the Government finally take, it is robust and one that everyone can have confidence in.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 1st April 2014 Commons Chamber

[Norman Lamb]

My hon. Friend raises an incredibly important point. One thing that I am very proud of is that under this Government 80,000 more people a year are getting access to psychological therapies through the improving access to psychological therapies programme—something we that should be very proud of. We have also done some joint work with the Department for Work and Pensions on how we can link up IAPT much more effectively with Jobcentre Plus to get people back to work, rather than paying them benefits.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The Minister was right to point out that from today people who use mental health services are supposed to be able to choose where they get their treatment. However, the payment mechanisms still are not in place and the guidance has not been issued. Is it not the case that the only choice for many teenagers is whether to be treated on an adult ward or travel hours to the nearest bed? The Health and Social Care Act 2012 was meant to deliver parity of esteem. The Minister is not a commentator or a bystander. I listened to his answers a moment ago. Can he explain what has gone so wrong and how he intends to fix it?

[Norman Lamb]

I agree that I am not a bystander. That is why I have acted to introduce choice for mental health patients for the first time—something that the Labour Government completely failed to do. Perhaps the hon. Lady could explain to the House why on earth they would leave out mental health patients from the legal right of choice. It is extraordinary. This Government are taking decisive action to ensure that there is real parity—real equality—in the way that mental health patients are treated.

Cancer Treatment and Prevention

Baroness Berger Excerpts

Tuesday 11th March 2014 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship again this morning, Mr Gray. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing the debate, and thank her for sharing her personal connection with its subject.

Every two minutes someone in the UK is diagnosed with cancer, and more than one in three people in the UK will at some time develop some form of cancer. One in four of them, sadly, will die of it. Cancer touches every community, without exception. Its reach is wide and its impact devastating. We have won many important victories in our battle against cancer, but there is a long way to go to ensure we are diagnosing it earlier, treating it more effectively, and preventing it in the first place. Many hon. Members have focused on those things in the debate, and I want to discuss them.

Detecting cancer early can make a real difference. When cancer is diagnosed at an early stage, the treatment is often simpler and the outcome is more likely to be positive. The hon. Member for Strangford (Jim Shannon) shared some startling statistics about the impact of early detection on ovarian cancer survival. Developments in cancer screening and increasing efforts to promote public awareness, such as the Be Clear on Cancer campaigns, are welcome. On Saturday, I saw the great work being done by those campaigns when I joined a team at a shopping centre in Liverpool to raise awareness of ovarian cancer in women.

Encouraging people to visit their GP sooner rather than later if they have any symptoms of concern is a simple message that can make a big difference. However, we have further to go to ensure that GPs are getting the training and support that they need to help them identify cancer signs and symptoms. Several hon. Members have raised concerns this morning about the amount of training of that kind that GPs receive. I hope that the Minister will respond on that issue in particular. I share the alarm expressed by the hon. Member for Basildon and Billericay (Mr Baron) about the fact that too many cancers are detected in accident and emergency.

Improvements at the first point of contact are not enough if, once cancer is suspected, people are not seen quickly enough by a specialist. Before Christmas there was concern at the news that in as many as half of cases the Government are missing their target for 95% of people with suspected cancer to be seen by a specialist within two weeks. It was right that Labour introduced the two-week cancer guarantee. We also left plans in place to speed up diagnosis, but unfortunately it appears that focus has drifted a bit from that important part of the fight against cancer. I am keen to hear the Minister’s comments on what further steps the Government are taking to improve early diagnosis.

If cancer is diagnosed, people need to feel safe in the knowledge that they are going to receive the most effective treatment possible, as quickly as possible. Many hon. Members expressed concern about that this morning. The hon. Member for Basildon and Billericay said that if we reached the average European survival rates we would save an additional 5,000 lives. I think that we can do better than that. Despite improvements in survival and mortality in recent decades, cancer outcomes in England remain poor when compared with the best outcomes across Europe. The hon. Members for Mid Derbyshire and for Lancaster and Fleetwood (Eric Ollerenshaw) mentioned the Cancer Drugs Fund and raised the question of its future, and I share their concern.

In more than 90% of cases when cancers are cured, it is as a result of surgery or radiotherapy. That is where our focus and resources should be directed. I welcome the Government’s recent focus on radiotherapy, and, in particular, on access to intensity-modulated radiation therapy. Last week I visited the Clatterbridge cancer centre in Merseyside, which treats 26,000 new patients every year, and saw how cutting-edge treatments are positively affecting patients’ lives.

Last week, however, we heard that the Prime Minister’s pledge that, from April 2013, all cancer patients would receive the advanced radiotherapy treatment they need, where it is clinically appropriate and cost-effective, has not been met. A less than glowing report published by Cancer Research and NHS England last week said that

“more needs to be done”

to achieve the Prime Minister’s guarantee. The report describes how momentum has been lost during the transition resulting from the NHS reorganisation in England, and it identifies a number of challenges on which I hope the Minister will comment.

One concern is that ageing equipment is preventing centres from keeping pace with innovation and providing advanced techniques. Another key concern is about deficiencies in the numbers of staff in crucial positions such as physicists, therapeutic radiographers and clinical oncologists. When I visited Clatterbridge last week, I heard first hand from the management how they are struggling to get physicists in the hospital.

There is also concern about the shortfall in radiotherapy work force capacity across the services, which impinges on the ability to deliver advanced techniques and innovate. On the number of radiotherapy treatments administered per 1,000 patients, we are well off the pace compared with other parts of Europe. While advances are being made, the pace at which innovations have been adopted across the NHS has been inconsistent. In Liverpool, cancer mortality rates are twice that of parts of London. Clearly, we still need to do much more about inequalities in access and outcomes for cancer patents. I hope that the Minister, in her response, will share with the House the Government’s plans in that regard.

Our battle against cancer will not be won with treatment alone. As the title of the debate suggests, we also need to look at prevention. More than half of all cancers could be prevented if people adopted healthy lifestyle choices such as stopping smoking, eating a healthy diet and exercising. I will focus on each of those in turn.

On smoking, great progress has been made in the past decade, but a quarter of cancer deaths are still linked to tobacco and smoking is by some margin the largest single cause of cancer in the UK. About 20% of our population smoke. That is down from 27% in 2000, but that figure is still too high. For every 1% decline in smoking prevalence, we could prevent about 3,000 deaths. Last month, Parliament voted in favour of an amendment to make Labour’s proposal of a ban on smoking in cars with children in them a reality. That great step forward will protect children and, ultimately, create a shift in smokers’ behaviour.

We are glad that the Government have agreed to standardised packaging; we look forward to Sir Cyril Chantler’s review. We are also pleased that the Government adopted our proposal to ban proxy purchasing of cigarettes. However, we must maintain momentum and ensure that those three victories are not pursued in isolation, but are part of a much bigger ambition. I hope that the Minister will share what more her Department is doing to reduce the number of smokers and smoking-related deaths, specifically in relation to the cancers that we are discussing.

Obesity is the second area for prevention and some of my biggest concerns are about the Government’s approach to tackling that. The voluntary responsibility deal stands little chance of delivering the fundamental change needed to improve our national diet. We need action that will impact on the whole population rather than the current piecemeal scheme that works on a product-by-product basis.

I was concerned to hear in the press reports relating to the World Health Organisation’s position on reducing our consumption of sugar, which leads to obesity. If what we read was correct, the view was that the Government might ignore that expert guidance. I hope that the Minister will respond to that and outline specifically what her Department is doing to tackle the obesity crisis in order to reduce cancer prevalence, because so many cancers are connected to obesity. On physical activity, to secure significant improvements in tackling the main causes of cancer, we need to see a fundamental shift in our nation’s behaviour.

[Jim Shannon]

To step back one sentence to the hon. Lady’s comments on better diet, and the need to have that at an early stage, many education authorities across the United Kingdom—they are doing this in Northern Ireland—are trying in schools to address children’s diets and the relationship of that to their parents and their family budget. Does she feel that education and health can play a joint role to help get the diet right at an early stage, which would prepare children for adult life?

[Luciana Berger]

The hon. Gentleman makes an important point about the role of education. A real intergenerational role can be played in education. If we educate our students and young people, they can play a role in informing and educating their parents and grandparents too. Some work has been done on that, but more can be done. I am concerned that when children start school, about 10% are obese or overweight, yet when they get to year 6, about a third are obese or overweight. That is a shocking statistic that we need to address urgently. I am working with my colleagues who shadow education on that and I hope that the Government are looking at what more can be done to affect the lifestyle and food choices of our young people to give them the best chances in life. A child with obesity will live on average nine or 10 years less than a child who is not obese, which is of serious concern and I thank the hon. Gentleman for making his point.

Labour is putting physical activity at the core of its public health policy. The easiest lifestyle change to make is moving from inactivity to activity and, once achieved, people can begin to feel better about themselves and more in control, and can then make better choices on smoking, drinking and eating, yet more than two thirds of our population fail to meet the minimum recommended levels of physical activity a week. I am concerned about the Government’s cuts, which have led to a reduction in local leisure services, which I have seen locally. The end of free swimming, for example, serves only to create further barriers to participation in physical activity. I would be interested to hear from the Minister on what the Government plan to do about that.

On prevention, the hon. Member for Mole Valley (Sir Paul Beresford) raised some important questions on vaccinations, specifically the HPV vaccination. I hope that the Minister will respond to those points.

Undoubtedly our national fight against cancer is going in the right direction, but is that enough? I do not think that it is. We have had a thorough debate this morning, with interesting and varied contributions. Collectively, we have touched on what needs to happen. We need earlier diagnosis, swifter access to the most effective treatment and an even stronger focus on prevention. We need bold, ambitious and concerted action on all three counts to ensure that we win not just the battle, but the war. I look forward to the Minister’s reply.

Children and Families Bill

Baroness Berger Excerpts

Monday 10th February 2014 Commons Chamber

[Jane Ellison]

I want to make a bit of progress because I sense that a lively debate will follow my speech, so I want to leave time for that.

The Government—and all Members—are clear that children should not be exposed to second-hand smoke, which can be particularly harmful to young children, and we know that young people often have little choice about being in places where they are exposed to smoke. Nevertheless, there are obviously many ways of trying to achieve that aim, which takes me on to the point about education raised by my hon. Friend the Member for Brighton, Kemptown (Simon Kirby).

We need smokers to protect children not only in the family car, but in any enclosed environment, including the home. Many argue that legislation is the answer, and we will debate that today, but social marketing campaigns to help smokers and parents to understand the risks of second-hand smoke and strongly to encourage voluntary behaviour change are also vital. We would all like to think that the vast majority of parents would not knowingly risk the health of their children. In the event that legislation is introduced to stop smoking in cars carrying children, we should measure its success not by the number of enforcement actions, but by the reduction in exposure to second-hand smoke.

As I have said, the Government will listen carefully to what Parliament has to say about the important principle of whether we should have the power to legislate to prevent smoking in cars when children are present. We will then consider what needs to happen next, which is why, if hon. Members will forgive me, I am not able to talk in great detail about some of the points that they have raised—they are questions for the next stage, once the will of Parliament has been expressed. However, in any event, I have asked Public Health England to continue its work on behaviour change in this area, including through social marketing campaigns. I have asked it to carry out targeted work with local authorities and public health directors in places where we know that there are problems. When Parliament’s will is known and we can assess the maximum impact that can be achieved through education, we will consider putting in place wider public information campaigns.

Arguments about effective enforcement were well rehearsed during the passage of this Bill and the consideration of private Members’ Bills on this matter, including that promoted by the hon. Member for Stockton North (Alex Cunningham). I look forward to hearing the debate on smoking in cars with children present and to finding out the will of the House on the principle of the Lords amendment. I also hope that the House will support our proposals on other aspects of tobacco control: the regulation-making powers on standardised packaging; and measures on the age of sale for electronic cigarettes and the proxy purchasing of tobacco.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Today the House has the opportunity to vote for a number of measures that will protect children, help to transform attitudes and improve our nation’s public health. I am proud to speak in favour of all the amendments in the group, with the exception of amendments (a) to (c) to Lords amendment 124, and I hope that hon. Members from all parties will support the Lords amendments in the Lobby.

It is worth remembering that when the Bill left the House, it did not contain any of the tobacco measures before us today. Those provisions are a credit to those in the other place who successfully argued for them, for which I commend them. The package of measures was passed with a great deal of agreement in the other place, so I hope that we can preserve that consensus in this House.

While I shall focus my remarks chiefly on smoking in cars carrying children, let me first speak to the other measures in the group. I welcome Lords amendment 124, which deals with the standardised packaging of tobacco products. It must be said that the Government have taken a rather long and winding route to get to here, with a few sharp turns along the way. As we heard from the Minister, the Lords amendment is only an enabling provision, because while it gives Ministers the power to introduce standardised packaging, we have no 100% assurance that that will happen. It is no secret that the Opposition would prefer more immediate action, but it is good that we finally see legislation in black and white. Labour Members sincerely hope that, once Sir Cyril has reported, Ministers will do the right thing and use the power. Will the Minister update us on when Sir Cyril will report? Will she guarantee that if he does recommend standardised packaging for tobacco products, secondary legislation will be brought forward before the general election?

[Mrs Main]

I shall keep my intervention brief because many hon. Members wish to speak and we do not have much time. The Minister and the hon. Lady have talked about smoking in cars, but Lords amendment 125 refers to smoking in a “private vehicle”, which means that it will cover any vehicle, including motorised homes. We need to be absolutely clear that any vehicle will be affected, not just cars.

[Luciana Berger]

I shall come on to talk about measures on vehicles that were introduced in the 2006 Act. Lords amendment 125 refers specifically to private vehicles.

I also welcome Lords amendments 122 and 123, which deal with nicotine-containing products. I agree with the Minister that it is sensible to prohibit the sale of e-cigarettes to under-18s. E-cigarettes can help smokers who are trying to quit, but they should not be available to children, especially when there are so many question marks about the long-term health effects of nicotine and when concern has been expressed that e-cigs might act as gateway products that could lead some young people to take up tobacco smoking.

I am especially pleased to support Lords amendment 121, on proxy purchasing, which will prevent adults from buying cigarettes on behalf of children. Labour proposed that policy by tabling amendments in the other place last year. It is already illegal to buy alcohol on behalf of under-age children, so it does not make sense that the same offence does not apply to tobacco products given that, if they are used as directed, they kill half of all lifetime smokers. I am glad that the Government now agree with us, but I hope that the Minister will be able to share with hon. Members the Government’s rationale for introducing a maximum fine of £2,500, given that the equivalent penalty for the alcohol offence is £5,000.

Let me turn to Lords amendment 125 and the question of protecting children from adults smoking in cars. I pay tribute to everyone who has campaigned for such a measure, especially the British Lung Foundation and my hon. Friend the Member for Stockton North (Alex Cunningham). I also applaud my noble Friend Lord Hunt of Kings Heath, who tabled the original amendment. Since that amendment was successfully passed, the Government have laid out how that Labour proposal could be written into law. In the final analysis, the decision before the House comes down to a simple question: if we know beyond doubt that passive smoking in an enclosed space can do serious harm to a person’s health and that hundreds of thousands of children are being subjected to passive smoking in a car every single week, and if we know from our experience of similar laws passed in this country and others that legislation can have a major impact by changing behaviour and improving public health, should we act and do something, or stand by and do nothing? We say that we cannot afford not to act.

[Tim Loughton]

By that same token, does the hon. Lady concede that we should criminalise pregnant women who smoke, on the basis that their child is in an even more confined space than a car?

[Luciana Berger]

We are considering a specific provision, but if the hon. Gentleman wants to bring forward further measures, I am sure that the House would wish to debate them. We are talking about children who do not have a choice when travelling in a car.

We all know the dangers of passive smoking, but the reality is that its worst consequences are inflicted predominantly on the very youngest in our society. Children are especially vulnerable to the dangers because they have smaller lungs and faster breathing rates than adults.

[Mr David Winnick (Walsall North) (Lab)]

While it is easy for opponents to make a mockery of the suggestion —no doubt we will hear a great deal more of that this evening—has not the House of Commons a responsibility to do everything possible to protect children from the effects of smoking? If the proposal can work, it is at least worth a try.

[Luciana Berger]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We are up against time and a lot of Members want to speak, so I would be grateful if we could move on as quickly as possible.

[Luciana Berger]

I thank my hon. Friend for his intervention. He raises a point that I am seeking to make in my contribution: we have an opportunity to do something, so I hope that Members will support the Lords amendment in the Lobby tonight.

Bronchitis, asthma, meningitis, glue ear, the common cold and reduced lung function are just some of the many respiratory illnesses that can be suffered by children as a result of passive smoking.

[Sir Gerald Howarth (Aldershot) (Con)]

If smoking is so damaging to children’s health, surely the logic of the hon. Lady’s argument is that we should ban smoking in people’s homes.

[Luciana Berger]

I thank the hon. Gentleman for that intervention. I will talk later about the toxicity of smoke in an enclosed vehicle, because many studies have shown that children are susceptible to passive smoke in the back of a car in a way that they are not in a building or in the home.

Each year around 300,000 GP appointments are attended as a direct result of children suffering from illnesses linked to passive smoking, 10,000 have to be admitted to hospital and, according to a 2010 report by the Royal College of Physicians, roughly 40 families lose infants to sudden cot deaths. If the health and tragic human costs were not justification enough, it is estimated that treating children for the effects of passive smoking costs our NHS some £23 million every single year.

[Mark Tami (Alyn and Deeside) (Lab)]

Will my hon. Friend give way?

[Luciana Berger]

I will give way one more time.

[Mark Tami]

I am old enough to remember when it used to be okay to smoke on underground trains and on planes. Does my hon. Friend agree that society has moved on and that this proposal is just part of that?

[Luciana Berger]

I thank my hon. Friend for that contribution. I will mention some of the comments that children have made about that and outline why young people feel so strongly about this important measure.

A significant proportion of the effects of passive smoking felt by children are linked to passive smoking in a car, not least because—this relates to the intervention made by the hon. Member for St Albans (Mrs Main)—tobacco smoke in a small, enclosed car can create levels of pollution that are up to 35 times greater than the level deemed safe by the World Health Organisation. A single cigarette in a car can create concentrations of smoke up to 11 times greater than those in a smoky pub of old.

We are not talking about a small number of cases. Many people have contacted me in recent days, some of them suffering from many of the conditions I have mentioned, including asthma, to say that they wish a ban had been introduced when they were children. Other people have said in recent weeks, “Surely no adult smokes in a car with children.” Unfortunately, according to the British Lung Foundation, nearly half a million children are exposed to potentially toxic levels of smoke in cars every single week. That number is based on children aged between 11 and 15. If we take babies, infants and primary school children into account as well, the number is likely to be even higher. According to a study by SmokeFree Sports in Liverpool, the area I represent, around a quarter of nine and 10-year-olds reported being exposed to smoking in cars.

That brings me to the crux of my argument about why the proposal is justified. This is about children, who often do not have a choice about how they travel and cannot speak out. In 2010, a third of children surveyed said that they were too frightened or embarrassed to ask an adult not to smoke with them in the car. If we want to protect future generations from the dangers of smoking, we need a comprehensive approach.

I agree with the Minister when she says that we need better education and that we have to improve public awareness. Adults and parents have a duty to act responsibly, but we know from experience that when education is accompanied by legislation, it can help bring about profound changes in behaviour. That is why we already have laws on what people can and cannot do in cars, from not using mobile phones at the wheel to compulsory use of car seats for children under the age of five. It is why our existing smoke-free legislation already makes it illegal to smoke in the workplace or in public vehicles. The proposal to protect children from smoking in cars would build on that precedent.

[Several hon. Members]

rose—

[Luciana Berger]

I am not going to take any more interventions, because many Members have prepared speeches and wish to contribute to the debate.

The proposal has the overwhelming support of royal colleges, health experts and leading authorities on public health from across our country. In the past week alone, 700 doctors have written to the British Medical Journal in support of a ban on smoking in cars with children. YouGov polls have shown that the measure enjoys the support of up to 80% of the public. It also has the support of the Liverpool Schools’ Parliament, which voted for such a ban unanimously. Many colleagues who have visited schools in recent days have encountered similar enthusiasm from young people.

To those who say that this law would be unenforceable, unworkable or a dreadful infringement of civil liberty, let me offer this thought: 38 years ago this month this House debated a law that would make a certain behaviour in a car illegal, and Government Members were granted a free vote. There was general agreement about health and safety, but Members raised concerns about whether it would be enforceable or a step too far. One Member said that it was a mark of the fact that

“as a society we are becoming over-governed and over-regulated.”—[Official Report, 1 March 1976; Vol. 906, c. 1006.]

Despite that, the proposal passed that night with a convincing majority and eventually became law. More than 30 years on, no one is arguing that we should repeal the law that made it compulsory to wear a seat belt. In the same way, few people would argue that we should bring back smoking in enclosed public spaces or on the London underground. In the meantime, the proportion of motorists wearing a seat belt has risen from around 25% to over 90%. It shows just how powerful the effect can be when Parliament unites and sends a signal. We have such an opportunity before us today. This is a matter of child protection, not adult choice.

Members across the House will be familiar with the words of the great liberal philosopher John Stuart Mill. He prized liberty above all else, but even he accepted that a civilized society should exert influence over an individual in order to prevent harm to others. This is a simple and straightforward measure that would make a world of difference to hundreds of thousands of children across our country, reducing the misery inflicted by passive smoking, saving millions of pounds for our NHS and protecting children who do not have a choice and do not have a voice, and who in 20 years’ time, I am sure, will wonder how it was ever allowed in the first place. I sincerely hope that Members on both sides of the House will support the measure today.

[Philip Davies (Shipley) (Con)]

I have no quibble at all with the hon. Member for Liverpool, Wavertree (Luciana Berger), who represents the smug, patronising excesses of new Labour. They think that the only reason they came into Parliament was to ban everybody else from doing all the things that they happen not to like. What perturbs me is that Conservative Ministers appear not to have grasped the concept, even though they claim to be Conservatives, that we can disapprove of something without banning it. This is just another in the long line of triumphs for the nanny state.

I will not give way because I want to rattle through what I have to say in order to give other Members an opportunity to speak. I believe that parents are much better placed to decide what is best for their children than the state is. If we want to encourage parents to take responsibility for their children, we have to give them that responsibility. We will never get parents to do that if the Government say, “Don’t worry about taking responsibility for your children, because we will make all the relevant decisions for you. You don’t have to worry about anything.” That is not something we should be encouraging.

The Conservative party used to believe in the rights of private property, and that people could do as they pleased in their own private property. Their private vehicle is their own private property. If people wish to smoke in a car with children, that is a decision for them to take. As Conservatives, we should not interfere with that.

Members have talked about small and confined places and about restricting the proposal to private vehicles, so why not caravans? I know that Labour Members are not going to ask their friends in the Gypsy community to stop smoking in caravans, so we will never have the prospect of that happening. What is the difference between a caravan and a small car? What is the difference between a small, confined flat and an open-top car? Why is it worse for people to smoke in an open-top car than in a confined flat or a caravan? Why is one much more of a danger to health than the other? This in no way reflects the fact that most car journeys are very short. Why do Labour Members think it is an absolute outrage and terribly dangerous for somebody’s child if they smoke in a two-minute car journey but absolutely fine for them to smoke for hour after hour in a caravan that is, in many cases, just as much of a confined space? The whole thing is absolute nonsense.

NHS

Baroness Berger Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

I am about to answer, if the right hon. Gentleman will be a little bit patient. The Act does not change the procurement requirements under which PCTs operated. It does not change the locus of the Competition Commission or the OFT under the Enterprise Act.

While we are correcting some facts, the right hon. Gentleman may be interested to know—as would my hon. Friend the Member for Taunton Deane (Mr Browne), but he is no longer in the Chamber—that we have the figures for the number of people admitted to the NHS with scurvy in 2011-12 and in 2012-13. In 2011-12, the number of admissions not just to A and E departments but in total—[Interruption.] Yes, including A and E departments. In 2011-12, eight people were admitted—[Interruption.] This was the right hon. Gentleman’s big argument about why A and E departments are under so much pressure. In 2012-13, 18 people were admitted. With the greatest respect, I think that the right hon. Gentleman is building his house on sand.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

We have figures for 2010-11, because they were included in the answer to a parliamentary question that I asked just before Christmas. The Minister of State, who is present, replied that they were not the total figures, because the Department had the hospital admission figures but did not have the figures for primary care admissions.

[Mr Hunt]

With the greatest respect, what we heard earlier from the right hon. Member for Leigh was a big argument about a massive growth of pressure on A and E departments that had been caused by, among other things, scurvy, and we found that the total number of admissions was 18. I think that that says a great deal.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

This debate has laid bare the stark reality of the Government’s blinkered approach to the NHS. They are utterly complacent, hopelessly out of touch, and in complete denial not only about the scale of the crisis in A and E, but about how their changes to competition rules are making things even worse. They have nothing to offer patients and our hard-working doctors and nurses who tirelessly serve the NHS every single day, except smoke and mirrors to try to disguise the real causes.

The Government have come to the House today celebrating “the strong performance”—it is in their amendment—of A and E. We have previously heard the Secretary of State insisting that the NHS is getting better. Almost 1 million patients have waited longer than four hours in the last year and Ministers are asking for a pat on the back. In the last 12 months, trolley waits are up; delayed discharges are up; 18-week waits are up; median and mean waiting times are up; emergency admissions are up; cancelled elective operations are up; cancelled urgent operations are up; and we have even seen patients being ferried to A and E in the back of police cars because no ambulances are available. It is not getting better, it is getting worse.

If Ministers will not listen to us, perhaps they will listen to the experts and those on the front line. Today, the Foundation Trust Network has said that

“pressure on the emergency care system is growing”.

Ministers like to forget about the confusion and disorder that they have inflicted upon the NHS through their £3 billion top-down reorganisation, but they should acknowledge it. My hon. Friend the Member for Walsall South (Valerie Vaz) referred to it in detail, and it is the same top-down reorganisation that the Prime Minister promised would never happen on his watch.

Let me remind the House of the warnings the Government were given at the time. In December, Dr Clifford Mann, president of the College of Emergency Medicine, revealed that he advised Ministers more than two years ago of a growing crisis in A and E. But his words were unheeded, leaving him and his colleagues feeling like

“John the Baptist crying in the wilderness.”

Dr Mann warned that the Health and Social Care Act 2012 would take up

“a lot of time and resources from the medical royal colleges and other organisations.”

He added that it

“tied us all up in knots”—

and created—

“a lot of decision-making paralysis and stasis in the system”.

While Dr Mann was warning of dangerously low staffing levels, spending on expensive locum doctors in A and E has rocketed by 60% in the past three years.

The issue here is that too few doctors are picking emergency medicine in the final stages of their training, and who could blame them? It might take six years to train a doctor, but it only takes a second for the Government’s A and E crisis to deter a junior doctor from going into emergency medicine.

The disruption the College of Emergency Medicine talks about is the disruption that the care Minister and his fellow Liberal Democrats allowed to happen when they nodded through the Health and Social Care Act, but we hear reports that his party is preparing to disown the NHS reorganisation and pretend it had nothing to do with them.

The right hon. Member for Sutton and Cheam (Paul Burstow) has admitted today that he got it wrong on competition. Why does the care Minister not own up and admit that he got this wrong, and that he should have listened to his own supporters and hundreds of thousands of people across the country who pleaded with him not to go through with it?

The human cost of that mistake is clear for all to see. We can see it in the sheer number of people coming through the doors of A and E. As my right hon. Friend the shadow Health Secretary pointed out at the beginning of this debate, attendances at A and E rose by 16,000 in the last three years of the Labour Government. In the first three years of this Government, they have rocketed by 633,000. Ministers may be pleased that the NHS is still standing after being subjected to this level of pressure, but the question they should ask is, why are so many more people coming to A and E in the first place?

[Mr Jeremy Browne]

The hon. Lady mentioned the figure of 633,000 extra people presenting to A and E. In his opening speech, the shadow Health Secretary attributed a proportion of that number to people who had scurvy or rickets, as he tried to paint a Dickensian picture of national squalor. Now that she has had a few hours to check, can she tell me how many of those 633,000 people were diagnosed in A and E with either scurvy or rickets?

[Luciana Berger]

The hon. Gentleman may not have been here when we had the response from the Health Secretary. I will come on to the very points the hon. Gentleman raises in my speech, and I look forward to going through all the big issues we have with malnutrition in this country.

I echo the comments made by my right hon. Friend the shadow Secretary of State about the sneering we have heard from Government Members this afternoon regarding some very serious issues. Any case of scurvy in 21st-century Britain is shameful.

My hon. Friend the Member for Stretford and Urmston (Kate Green) talked about the catalogue of coincidences that have led to so many more people going to A and E in the first place. I refer back to the increase of 16,000 in the last three years of the Labour Government, and of 633,000 in the first three years of this Government. Why is that? A quarter of walk-in centres have closed. NHS Direct was abolished. The guarantee of a GP appointment in 48 hours was scrapped, and extended GP opening hours were cut. As my hon. Friends the Members for Easington (Grahame M. Morris) and for Worsley and Eccles South (Barbara Keeley) said, £1.8 billion has been hacked from social care budgets, with thousands of people losing their care packages.

[Angie Bray (Ealing Central and Acton) (Con)]

Is the hon. Lady prepared to admit, just a teensy bit, that some of the added numbers going to A and E, which I agree are putting a lot of pressure on the departments, are partly to do with the change in GP contracts introduced by the Labour Government? That is driving people to A and E, because no GPs are working the hours that would allow people to be seen.

[Luciana Berger]

I just do not know what to say to that because it is so ridiculous. There was an increase of 16,000 in the last three years of the Labour Government, which has rocketed to 633,000 in the first three years of this Government. The gap in those figures is tremendous. The GP contract happened in 2004. When have we seen crises in A and E? Not under the Labour Government, but under this Government—the Tory-Liberal Democrat Government.

What else has happened under this Government? We have seen the Health Secretary handing back £2.2 billion of underspend to the Treasury, 2,300 managers receiving six-figure pay outs and £1.4 billion siphoned off to pay for redundancies. My right hon. Friend the Member for Leigh also raise the issue of the amount of money NHS trusts are now having to spend on expensive legal fees as a result of competition, introduced through the Health and Social Care Act. That goes to show that when it comes to our NHS, this Government know the cost of everything but the value of nothing.

As the hon. Member for Stafford (Jeremy Lefroy) said, our elderly population is growing, but half a million fewer older people are receiving support compared to 10 years ago. That means more older people going to A and E because they cannot receive the care they need at home, and more older people stuck in hospital beds because there is no safe place to discharge them to.

[Margot James]

Will the hon. Lady give way?

[Luciana Berger]

I am not giving way because I have only three minutes left.

As my right hon. Friend the Member for Leigh said earlier, the CQC recently reported that in the last year, more than half a million pensioners were admitted as an emergency to hospital with potentially avoidable conditions. There is another reason for that: it is now harder, not easier, to get a GP appointment under this Government. The Royal College of General Practitioners says that it will soon become the norm for people to wait a week or longer to see their GP. Just this week, I was contacted by a constituent whose partner was suffering from chest pains. They contacted the GP but could not get an appointment for eight days.

This is what patients are having to endure right across the country, and it is being made even harder by the cost of living crisis hitting families all over Britain. People are having to eat less, and less healthily, and more than half a million people are being forced to turn to food banks. As my hon. Friend the Member for Worsley and Eccles South described so poignantly, carers are having to make the choice between heating and eating. GPs are now asking patients when they last had a meal. It is no coincidence that, as food bank use has exploded, so have cases of malnutrition. There has been a 42% increase in malnutrition cases, and in 2012-13 more than 5,000 people were thus diagnosed in English hospitals. I share the view of my hon. Friend the Member for Stretford and Urmston that that is a disgrace in 21st-century Britain.

Doctors are now treating diseases we thought had all but disappeared. It is not just scurvy; rickets and vitamin deficiency are also on the rise. The Government have already given us the longest fall in living standards since the 1870s; we now have the Victorian diseases to match. They should be ashamed of every single case of these 19th-century diseases returning to 21st-century Britain.

That is not all. With energy bills up by £300 and more children living in fuel poverty, is it any wonder that episodes of hypothermia have jumped by 40% in the past three years? We have seen a 29% increase in the number of excess winter deaths—31,000 deaths that by definition were entirely preventable—while new figures this week show a dramatic increase in the number of older people being admitted to A and E for cold-related illnesses. Furthermore, there have been 145,000 more cases of over-75s being treated in hospital for respiratory or circulatory diseases, compared with 2009-10.

Ministers cannot resolve the crisis in our NHS. They know what is happening and that their policies are stoking the crisis, but they will not admit it. Only Labour can preserve, protect and progress our NHS. Our approach focuses on the patient, and it champions integration and collaboration, not competition, fragmentation and profit. We want a public, integrated NHS free at the point of use, and a whole-person approach that combines physical, mental and social care and helps to take the pressure off A and E. That is the principle behind our motion today, and I urge Members on both sides of the House to support it.

Early Childhood Development

Baroness Berger Excerpts

Thursday 30th January 2014 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I commend and congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing this debate. I also congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas), my right hon. Friend the Member for Birkenhead (Mr Field) and the right hon. Member for Sutton and Cheam (Paul Burstow) on their work in developing this manifesto and promoting the ideas within it. This debate has been constructive and well-informed. Many excellent points have been made that will resonate strongly with those on both sides of this Chamber.

When the first national health service hospital opened its doors in 1948, it was conceived as part of an all-encompassing system of social security, supporting everyone in our society from cradle to grave. Only in recent years, more than 60 years on, have we have come to understand just how much that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a life a newborn baby will enjoy.

We must do everything we can to give all babies born in Britain today the best possible start in life. That was underlined earlier this week in an open letter to The Times from 23 of the UK’s leading child health experts. They warned that, for the first time since the Victorian age, it is predicted that living standards for children will be lower than for their parents and that child mortality is still stubbornly higher in Britain than in other western European countries. They called for a greater focus on younger generations. We have heard some powerful and encouraging contributions to that debate today; I want to build on what other hon. Members have said and focus on some of the challenges that we must address. I want to focus on early intervention, maternal support and care, and general help for all mums and dads. That is by no means a comprehensive list of what I would like to cover, but it is most fitting for the debate.

All hon. Members who spoke referred to the importance of early intervention. The maxim that prevention is better than cure is one of the most enduring in public health. As the “The 1001 Critical Days” manifesto details, more than a quarter of all babies in the UK are estimated to be living in complex family situations that present heightened risks to their well-being. The sad reality is that babies are far more likely to suffer from abuse and neglect, and up to seven times more likely to die in distressing circumstances, than older children.

We have a duty to reach out to families in difficult circumstances and to maximise opportunities for them to access support. Not only is it the right thing to do, but it is the best thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early-years intervention can yield a return on investment as high as 6% to 10%. If it is done in the right way, early intervention can save money, save lives and improve the well-being of parents and children.

An example is the pioneering work by Manchester city council and its partners. They have created a scheme in which midwives, outreach workers and health visitors work together to identify at the earliest opportunity the families most in need. It is an inspiring project, with which my hon. Friend the Member for Manchester Central (Lucy Powell), the shadow Minister with responsibility for children and child care, has been closely associated. We heard from the hon. Member for South Northamptonshire about how the programme is making a difference when it comes to registering a child’s birth.

Under the scheme, every new mother is visited eight times from about 12 weeks before the birth of their child until just before the child’s fifth birthday. Crucially, all the professionals who are supporting those mothers hold joint fortnightly meetings and can let each other know if a parent needs additional help. Their work is integrated and intelligence is shared between organisations —a very strong theme in the “The 1001 Critical Days” manifesto. It is a world away from some of the haphazard experiences of the past. Hon. Members may have heard the anecdote about how health visitors in the past would wait by the nappy aisle in supermarkets to identify expectant mothers; we must do more to encourage close working and data-sharing, so that that is no longer necessary.

[Mr Sheerman]

I totally support the work of the 1,001 group. All the work done—certainly during my chairmanship of the Select Committee on Children, Schools and Families—indicates that early intervention is vital. It is also vital that such intervention is regular, persistent and delivered by highly skilled, well-trained people. The problem is that that is expensive.

[Luciana Berger]

My hon. Friend makes knowledgeable points that, given his experience on the Children, Schools and Families Committee, he is well placed to make. The example that I shared with the House—this is separate from the 1,001 days manifesto—shows that there are many activities going on around the country to address some of the issues, but the challenge is that the activity is not happening everywhere. We need to lead from best-case examples, which is why data sharing is so vital to make a difference. Will the Minister comment on what steps the Government are taking to encourage these activities to happen throughout the country?

I am also keen for the Minister to address the point made by my hon. Friend the Member for Rotherham (Sarah Champion), who is no longer in her place. She mentioned the early intervention grant, which has funded many of the programmes that we are discussing. When the fund was first introduced, it totalled nearly £3 billion, but by 2015 it will have almost halved to around £1.5 billion. We have had contributions this afternoon about Sure Start centres, many of which have relied on the funding of the early intervention grant, and it is a blow that 576 such centres have had to close their doors since the last election. The hon. Member for East Hampshire (Damian Hinds) commented that he did not know what Sure Start was for—

[Damian Hinds]

To be clear, I did not say that—

[Mr Mike Weir (in the Chair)]

Order.

[Luciana Berger]

I will give way to the hon. Gentleman.

[Damian Hinds]

To be clear, I was talking about what happened when I was on the Education Committee, the successor Committee to the one chaired by the hon. Member for Huddersfield (Mr Sheerman). When we asked people what the purpose of Sure Start was, we got different answers, even from practitioners in the field.

[Luciana Berger]

I thank the hon. Gentleman for his clarification. I apologise if I misrepresented his words.

[Mr Sheerman]

I, too, found that fascinating. When we first started looking at Sure Start children’s centres, they were concentrated in the 500 wards with the greatest poverty. We soon realised that more families in poverty were outside those 500, so we had to change the policy totally.

[Luciana Berger]

The point that I wanted to make about Sure Start, as a result of what has been said by both Government and Opposition Members, is that it is widely acknowledged that the centres have made a real difference to families. I have Sure Start centres in my constituency; Liverpool city council has gone out of its way to do everything possible to keep all centres throughout the city open—it has had to remodel and look at a hub-and-spokes model, given that we will have experienced cuts of 54% by 2016-17—all because of the centres’ importance to communities.

In one of the most deprived wards in my constituency, the Sure Start centre is giving vital support to parents in the most deprived households. It is providing meal packets for £1—fresh food with recipes—to encourage parents to cook for their children. That is making a real difference to those children’s nutrition, in particular in their early years. In another, more affluent, part of my constituency, the children’s centre is tailoring its services to the need in that area, because this ward has a high incidence of multiple births. That Sure Start centre is providing a vital support service for mothers who have twins and triplets—for parents contending with the challenges presented by a multiple birth.

Those centres are making a real difference in my constituency. Their staff—including Liz Parsons, a manager in the Picton Sure Start centre, to name just one person—provide vital hands-on support to parents, often first-time parents or parents with lots of children. The centres provide support, including parenting support, to many families in my constituency.

[Damian Hinds]

Like the hon. Lady, I pay tribute to the staff in the Sure Start centres in my constituency; they do a fantastic job. We all know that there are fantastic Sure Start children’s centres out there, but it is also worth dwelling on the fact that at the macro level we may not quite have cracked the formula. If we compare the millennium cohort study with the previous one, for the children who have been alive throughout the Sure Start period, the gap between the rich and the poor has not been narrowed at age five.

[Luciana Berger]

Towards the end of my contribution, I shall reflect on the hon. Gentleman’s points about social mobility. He commented that the gap between rich and poor might not have changed. Nevertheless, Sure Start centres have provided vital services to parents and families who might not have contended with that specific issue, but have dealt with a lot of other ones that we have discussed.

In the debate, we have not touched on health visitors, who are integral to this issue. It is welcome that the Government are committed to increasing the number of health visitors. The latest figures from the Health and Social Care Information Centre, however, show that there are 1,234 more health visitors than in April 2010, but that is less than a third of the way towards the Prime Minister’s target of 4,200 new health visitors by April 2015. With the deadline looming, will the Minister please offer some words of assurance about meeting the target?

[Andrea Leadsom]

I have talked to a lot of health visitors, and there is a concern that by letting speed be the only target, we might pile a lot of new health visitors into the system but diminish our ratio of experienced health visitors to inexperienced ones, and those trying to support new health visitors will struggle. Generally speaking, my feedback from health visitors is that they are happy that the rate of new arrivals is not as rapid as the hon. Lady might like.

[Luciana Berger]

I listened to the hon. Lady’s point about the speed of introduction, but reflecting on the experience in my area of Liverpool, the work load on our health visitors is such that they cannot provide the best service possible, because they are so swamped by the amount of visits that they have to do. I contend that there is a challenge in the work load on health visitors. Will the Minister share with us what steps her Department is taking to meet the target?

On maternal support, in particular during the months of pregnancy, with births in the UK at a 40-year high, prioritising maternity services has never been more urgent. Around 10 stillbirths happen in Britain every day, and we have one of the highest stillbirth rates: according to The Lancet, Britain is ranked 33rd out of 35 countries with similar income levels. The charity Sands has linked that to maternity care, issues to do with inappropriate risk assessments for potential mothers and low uptake of perinatal services. Given that neonatal mortality and stillbirth have been indicated as areas for improvement in the NHS mandate to 2015, will the Minister please share with us what activities her Department will undertake to lower the stillbirth rate in England?

The findings of a National Audit Office review late last year are also of concern. It found that more than half of birthing units are not meeting staffing guidelines; that more than one in 10 had to close for a fortnight or more last year; and that 28%, or nearly a third, were forced to turn away mums-to-be at the door between last April and September because of a lack of space or a shortage of midwives. We can all understand how stressful that must be for women towards the end of their pregnancy.

[Mr David Amess in the Chair]

I thank my hon. Friend the Member for East Lothian (Fiona O'Donnell) for raising the important issue of premature babies and for sharing her personal experience of having premature twins and of the importance of the neonatal care received by her sons. A parent in a similar position who had to work might struggle to balance that with visiting the hospital and developing a bond with the babies.

We all have friends or family, or know people who have been expectant mums—some people in the room have been expectant mums—so we know that a skilled midwife can make all the difference between a smooth pregnancy and a stressful one. It is deeply concerning, therefore, that the NAO has highlighted that there is a shortfall of 2,300 midwives. The hon. Member for South Northamptonshire highlighted the increase in midwives’ work loads. The Royal College of Midwives has also calculated that the gap between the number of midwives we have and the number that the NHS in England needs will not be closed until 2026.

Before the previous election, the Prime Minister promised that there would be 3,000 new midwives during this Parliament. Again, regretfully, that target is some way short of being delivered. I am aware that there are many midwives in training, but the high drop-out rate and impending retirements could mean that we face significant shortages for some time to come. We would appreciate any reassurance that the Minister can provide on that matter.

Will the Minister also comment on the training that midwives receive? We have heard from a number of Members about the importance of maternal mental health. Mental ill health is one the biggest risks to a pregnancy, with one in 10 mothers suffering a mental illness before or after birth. Last November, I asked the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), what proportion of midwives were trained to provide expectant mothers with mental health support. Unfortunately, he was not able to provide a figure, but I am sure that both he and the Minister agree that we need more midwives who are confident in providing that kind of support.

We also need more specialist mother and baby mental health units. It has been estimated that as much as 50% of the UK lacks any kind of specialist perinatal mental health service. There are only 17 mother and baby mental health units across England, and they are geographically disparate. There are just two in Scotland and one in Wales, and none in Northern Ireland. As both the hon. Member for South Northamptonshire and my hon. Friend the Member for East Lothian said, it is a postcode lottery.

The hon. Member for South Northamptonshire talked about the 1% of mothers who might experience a psychotic episode. That could lead to mothers being hospitalised two or three hours’ drive away from their loved ones. It could also mean that they are separated from their babies. That is good for neither the mother’s well-being nor her newborn child’s development.

I thank all those Members who have raised the importance of support for parenting. A number of Members thanked Home-Start for the work that it has done and the way in which it so helpfully supports parents. We have also heard about specific challenges on early intervention, maternal support and maternity care. However, we know that the challenge of improving early years development reaches far beyond those specific issues. The hon. Member for East Hampshire raised the issue of social mobility, for example; many social determinants extend well beyond the reach of the Department of Health. The hon. Member for South Northamptonshire suggested that the issue could be looked into more widely, perhaps at Cabinet level, and I take that point on board.

Both my hon. Friend the Member for East Lothian and the hon. Member for East Hampshire raised the issue of the importance of digital networks and social networks. They are indeed important, and I welcome the work done by Mumsnet and Netmums, but I would like to put on record the challenges there are for many mums who do not have access to the internet, or perhaps do not know how to use computers. Although digital networks are important and can help to support parents—both mums and dads—one issue that we need to look at further, which is far beyond the reach of the Department of Health, is access to the internet and to broadband, particularly for people living in rural areas. There is also the issue of being able to afford that internet access: people might not want to have to go to a public library to connect and reach out about specific personal issues. We should be thinking about those matters.

There are other issues that we should address, which again reach far wider than the remit of the Department of Health. For example, there is the problem of parents who are struggling with the cost of living, and those who are working all hours and do not have the time to be with their children because they are working all day. We must establish genuine parity of esteem between mental and physical health, across the board. We have to protect babies and children from specific dangers—just yesterday in the House of Lords, for example, there was a debate about protecting children and babies from smoke in cars. There is no better investment that we can make as a society than in our children.

[Dame Tessa Jowell (Dulwich and West Norwood) (Lab)]

I pay tribute to the hon. Member for South Northamptonshire (Andrea Leadsom), with whom I have had the pleasure of collaborating on the all-party group on conception to age two—the first 1,001 days. Does my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) agree that there is an increasing amount of scientific evidence on early childhood that shows the value of intervention in the first 1,000 days? Will she join me in commending the campaign to see early childhood represented in the new millennium development goals in 2015, which will benefit tiny children and their mothers, not only in this country but around the world?

[Luciana Berger]

I thank my right hon. Friend for her important contribution to this debate. She has summed up many of the earlier speeches on the importance of this issue and how vital early intervention is. Right at the start of the debate, we heard about the science relating to the difference in brain development of children who get that care, love and affection in early life, and those who do not. As we heard, that care is vital to the development of a child over their entire lifetime. I echo her remarks on the millennium development goals. This issue is important not only for us in the UK but further afield, right across the world. I support her call for early intervention to be included in the 2015 goals.

[Andrea Leadsom]

I pay tribute to the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell) for all her work on promoting early years development in the post-millennium development goals. I did not touch on that today, but she has played an enormous role. I can report that UNICEF has asked us to speak at the UN on the importance of the earliest years and how early intervention can support children, not just in this country but around the world. It is fantastic that she has been able to pop into the debate, and I commend her for all that she is doing.

[Luciana Berger]

I thank the hon. Lady for her intervention. I will now seek to conclude.

[Mr Sheerman]

My hon. Friend briefly alluded to smoking and children’s exposure to smoking in cars. There was good news this morning from the Government: there will be a free vote on the issue. Back in the mists of time, my very first private Member’s Bill was on banning children from being carried unrestrained in cars. There was a tremendous backlash against that Bill in certain parts of the House; people said that it breached human and individual rights. We won that battle, and I hope that we can win the next one. It is wrong that a child, who has no choice, has to go in a smoky environment and breathe in dreadful fumes that can affect their health for the rest of their life.

[Luciana Berger]

My hon. Friend’s intervention has given me the opportunity to expand on this serious political issue, with which we are engaging in the House at the moment. He rightly points out the opposition there was to rules on wearing seat belts. The discussions on that issue are relevant to our discussions about banning smoking in cars when children are present. When we had no rules on wearing seat belts, only 25% of the population wore one; since the introduction of the rules, more than 90% of the population wear a seat belt, and that has made a massive contribution to safe car travel.

It is worth noting that there is overwhelming public support for banning smoking in cars when children are present. Around 80% of the public think that we should deal with the issue, and it will be interesting to see what happens in the vote. It is also worth putting on record that when there was a vote on a private Member’s Bill on the issue in 2011, 22 MPs from the coalition supported it, including a current Health Minister. I welcome the free vote, and I hope that we are successful when the proposal comes before the House on, I believe, 10 February.

To conclude, a broad, holistic approach will ultimately make the difference for children, and for future generations.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Jeremy Hunt]

Yes, we are looking at that closely, with the Minister responsible for paediatric services doing so particularly closely. In principle, we support what my hon. Friend is trying to achieve with that document and we welcome its contribution to the debate.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Last week, we heard shocking revelations about the reasons behind the Government’s U-turn on minimum unit alcohol pricing. In particular, researchers at Sheffield university have confirmed that they were asked by government not to publish a report that would have undermined the Government’s decision to shelve minimum unit pricing. Why were Ministers so keen to suppress the report? Will the Secretary of State please tell us why some of our country’s leading public health experts are accusing Ministers of deplorable practices and of dancing to the tune of the drinks industry?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

On the hon. Lady’s substantive point, the reports for the British Medical Journal investigation, which I read in full, did not say that at all and in fact confirm that that was not asked, so what she says is not quite right.

On the wider point, over the past two weeks we have heard a succession of attacks from the hon. Lady and the Opposition about dealings with industry and business. This Government have set out to work in partnership across business and industry, with public health experts and local authorities, to tackle some of these really big public health issues. It is simply incredible that the Labour party believes that these big issues can be taken seriously without engaging with business. Instead of demonising businesses, let us hear some praise for those such as Lidl, which yesterday announced that sweets would be removed from all its checkouts across the country, in response to its customers—a voice that is too little heard by the Labour party.

Hospices (Children and Young People)

Baroness Berger Excerpts

Wednesday 18th December 2013 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I begin by congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this debate on a topic about which he is clearly passionate. I pay tribute to him and to all the members of the all-party parliamentary group on hospice and palliative care for the work that they have done to bring this important issue to the fore.

As we have heard, there are 49 children’s hospices across the UK, which all do fantastic work for young people and their loved ones. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, much of the hospice movement is supported by volunteers and millions of pounds of charitable donations. Many hon. Members from both sides of the House made passionate representations on behalf of their local hospices and the holistic care that they provide. Hon. Members have raised many powerful points, and I hope to touch on several of them. I want to focus on three points covered in the debate. First, I will set out the full scale of the care crisis facing young people with complex health and care needs; secondly, I will explain why that is an issue not simply for individual families but for society at large; and thirdly, I will touch on some of the areas that need attention to make life better for those young people, particularly those receiving palliative care.

As we have heard, more than 40,000 children and young people in England have palliative care needs. That includes children suffering from curable and chronic conditions, children with severe disabilities, and children and young people nearing the end of their life. That represents a 30% jump over the past 10 years. There has been a particularly marked increase in the number of 16 to 19-year-olds requiring palliative care, as we have heard from several hon. Members, to around 4,000 young people, which accounts for roughly 10% of young people under the age of 19 with complex care needs. That is in many ways a positive sign, because it demonstrates the great advances made in science and medical technology, and the fact that they have resulted in people living longer.

Cancer accounts for around 14% of young people diagnosed. Cancer Research UK figures show that five-year survival rates for teenagers and young adults have risen significantly across all cancers across the past 25 years. In the late 1980s, less than three quarters of young men lived longer than five years after having cancer, but the rate is now better than eight in 10. For girls and young women, the five-year survival rate now stands at 84%. There has been a particular improvement in leukaemia; the survival rate has jumped from less than 50% to more than 60%.

We are moving in the right direction, but as we have heard from hon. Members today, that presents a particular challenge, because more young people live beyond the reach of children’s care and transition into social care. Too many young people who receive care from children’s services turn 16, 17 or 18 and then fall off a cliff during the transition to adult social and health care. The right hon. Member for Chelmsford (Mr Burns) and the hon. Member for Pudsey highlighted the specific challenges facing young adults, and we heard an emotive quote from Lucy Watts, who summed up the situation well. Much more needs to be done to make the transition work better. Some of my constituents who have accessed wonderful services at the Alder Hey children’s hospital struggle when the health professionals and familiar surroundings that they have been accustomed to for so long change—a point that my hon. Friend the Member for Rotherham (Sarah Champion) articulated. Many families are shocked by the reduced support that they receive in many aspects of adult social care after they have made that switch.

Transition is a hugely stressful process, and in most cases families are moving from dealing with a single, comprehensive agency to managing several different agencies with up to four points of contact. It is easy for gaps to emerge in that fragmented process. Many conditions reach crisis point in late adolescence, so it is all the more important that young people and their families receive responses from care and health agencies in an appropriate, sensitive and timely fashion. There are too many instances of people having to endure the agony of being put on hold, or waiting for a reply to an e-mail, when their loved one has an urgent care need.

That is all in the context of a crisis in adult social care. Since 2010, £1.8 billion has been cut from council budgets for adult social care, and we await the impact of the local authority settlements which have been released today. That means that fewer people receive help with paying for their care and more people face increased charges for vital services that help them to get up and get washed, dressed, fed and helped to bed at the end of the day.

Let me make a brief comment on the wider costs to society. Demand for care is growing at a time when resources are being reduced. The costs to society of a bad care transition—whether those costs take the form of greater illness, negative social and educational outcomes, or possible early death—are far greater than the cost of putting in place adequate resources to ensure a good transition. I welcome some of the modest measures that the Government—[Interruption.]

[Sandra Osborne (in the Chair)]

Order. The sitting is suspended for a Division for a minimum of 10 minutes.

--- Later in debate ---

On resuming—

[Luciana Berger]

Before the Division, I was sharing with the House my welcome for some of the modest measures the Government put forward in the Care Bill, which the House debated on Monday. It represents a small step towards a better social care system, and builds on the Labour Government’s work to provide stronger rights for carers and improved access to information and advice.

Let me conclude by looking at some areas that still require attention, and with a few questions for the Minister. I praise the many charities working in the sector, particularly Marie Curie Cancer Care, which has a hospice not too far from my constituency, and Together for Short Lives, the leading UK charity for children with life-threatening and life-limiting conditions. Their joint “Don’t let me down” report, published last year, set out sensible and important proposals, a number of which the Government adopted, but four areas of concern remain.

First, we need a much more joined-up approach to commissioning health and social care services for children with palliative care needs. Currently, we have a split: NHS England commissions specialist care, and local authorities manage social care. That fragmentation means that the very high variation in access to and quality of services, depending on where people live, will continue. I would be grateful if the Minister told us the Government’s assessment of that postcode lottery, and what they are doing to address the disparity.

Secondly, children and young people need to be consulted, so that their care caters for them and their needs. There is a particular role for health and wellbeing boards in that. More than half the health and wellbeing boards have explicitly examined care for terminally ill adults, according to the National Council for Palliative Care. The likelihood, however, is that far fewer will have engaged with children and young people on the same scale. I would welcome a response from the Minister on that specific point. Thirdly, the different agencies that provide hospice and palliative care to children and young people need to talk to one another much more. Local authorities are unable to share data. What solutions are Government considering to address that problem? Fourthly, a solution needs to be found to enable all the information and records about a young person’s needs to travel with them. Too many young people have to tell their story all over again when they need to access a new service, or when they are transitioning.

The debate this afternoon has been positive and constructive. On this side of the House, we are ready to work with the Government to improve outcomes for young people and children who need hospice and palliative care. We hope to deliver an integrated, whole-person approach to health and social care. Whole-person care is about meeting the needs, whether physical, mental or social, of people of all ages, so that they are able to live an independent and dignified life. That is ultimately what the future of health and social care needs to look like, with world-class hospice and palliative care front and centre. That is what we are committed to delivering, so that we can help those who need it most.

Tobacco Packaging

Baroness Berger Excerpts

Thursday 28th November 2013 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Government’s policy on standardised packaging of tobacco products.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

In accordance with the notice I gave the House yesterday afternoon, this morning I made a written statement announcing that Sir Cyril Chantler will carry out an independent review of the evidence on the impact of standardised tobacco packaging on public health.

Tobacco use, especially among children, remains one of our most significant public health challenges. Each year in England more than 300,000 children under the age of 16 try smoking for the first time. Most adults who smoke started before they were 18 years of age. As a result, we must do all we can to stop young people from taking up smoking in the first place, if we are to reduce smoking rates.

We have listened to the strong views expressed on both sides of the House, including when we debated standardised packaging in a Back-Bench business debate earlier this month, to which I responded. Many Members then told me that the evidence base for standardised packaging continued to grow and urged the Government to take action. Similarly strong views have been expressed in the other place. As a result, I believe the time is right to seek an independent view on whether the introduction of standardised packaging would be likely to have an effect on public health. In particular, I want to know the likely impact on young people.

I have asked Sir Cyril to undertake a focused review, reporting in March next year. It will be entirely independent, with an independent secretariat, and he is free to draw evidence from whatever sources he considers necessary and appropriate. It will be up to him to determine how he undertakes the review, and he will set that out in more detail in due course. As the House will know, Sir Cyril has confirmed that he has no links with the tobacco industry. The review is not a public consultation. The Government ran a full public consultation in 2012 and the responses will be available in full for the review. To maximise transparency, the Department will also publish the substantive responses received as soon as possible.

The Government will also take advantage of the opportunity offered in another place by tabling an amendment to the Children and Families Bill to provide for a regulation-making power. If, on receiving Sir Cyril’s review, the Government decide to proceed, that will allow standardised tobacco packaging to be introduced without delay. The Government have been consistent in their desire to take an evidence-based approach to public health, and we will introduce standardised tobacco packaging if, following the review and consideration of the wider issues raised, we are satisfied that there are sufficient grounds to proceed.

--- Later in debate ---

[Luciana Berger]

We have seen plenty of U-turns over the past three years, but only a Government as shambolic as this one could U-turn on a U-turn. It is not so much that they have lost their way on public health—they are running around in circles.

Will the Minister answer a straight question: does she support standardised packaging for cigarettes—yes or no? In the week running up to this being debated in the other place, does she honestly expect us to believe that this has nothing to do with the fact that the Government are on the brink of a humiliating defeat?

The Minister says that we need another review, but the Government have already had a review and the evidence is clear for all to see. Did that not already find that standardised packaging made cigarettes less attractive to young people and health warnings more effective, and did it not refute the utter falsehood that some brands are safer than others? All the royal colleges and health experts are united behind the case for standardised packaging—I commend everyone who has campaigned for this measure—but is it not the case that if the lobbying Bill goes through in its current form, it will prevent charities such as Cancer Research UK from ever raising such issues in an election year?

Is not the Prime Minister more interested in listening to Lynton Crosby and the vested interests of big tobacco than cancer charities and health experts? What further evidence does the Minister need? What do Ministers know now that they did not already know when they U-turned on this before the summer recess? Why are the Government delaying this still further? Some 79,230 children will have taken up smoking in the 139 days since the Government U-turned on standardised packaging in July, and about 70,000 more will have had their first cigarette by the time the review reports next March. We should be legislating now, not delaying.

[Jane Ellison]

I thought that was a rather disappointing and naive response. This is a complex area of public health policy, and it is important to follow a clear process and to follow the evidence. The hon. Lady might not believe me, but perhaps she will believe the right hon. Member for Leigh (Andy Burnham), who in November 2009, when he was Health Secretary, wrote:

“we would need…convincing evidence showing the health benefits of this policy before it would be acceptable”.