Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

I completely agree with my hon. Friend. It seems to me to be inherent in the nature of therapy that people go into it willingly. The idea that we could frogmarch them into therapy against their will simply would not work. We could end up with a dangerous and costly tick-box exercise that achieved nothing, so there is no plan to introduce compulsion to access therapy.

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

I listened carefully to what the Minister said in answer to the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), but will he confirm that there is no truth to reports that the Government are considering plans that would mean that people with mental illness would have their benefits stopped if they refused treatment? Rather than people refusing treatment, are not the increasing shortage of beds and ever longer treatment delays under this Government the real reasons why people are not receiving the help that they desperately need?

[Norman Lamb]

I can confirm, as I already have done, that there is no truth in the rumour. Indeed, in August we anticipate publishing the start of trial programmes to bring together IAPT—improving access to psychological therapies—with Jobcentre Plus. The idea of ensuring that people who are out of work and have mental health problems get access to psychological therapies is incredibly important, and I am very excited about the pilots that we will launch in August.

Organ Transplants

Luciana Berger Excerpts

Tuesday 8th July 2014 Westminster Hall

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

It is always a pleasure to serve under your chairmanship, Mrs Osborne.

I thank the hon. Member for Strangford (Jim Shannon) for a debate on such an important issue. In his opening remarks, he alluded to others who have encouraged him, so I thank them, too, and the Backbench Business Committee for granting the debate. I thank all hon. Members who have contributed; they have shared their personal connection and the case studies of their affected constituents. Our discussion today is most timely, given that we are in the midst of national transplant week.

Sixty years ago this year, the world’s first successful kidney transplant was performed by Dr Joseph Murray in Boston, Massachusetts. Dr Murray broke new ground when he and his team transplanted a kidney from Ronald Herrick to his dying twin brother, Richard, which saved his life. Today, kidneys are the organ most commonly transplanted, with about 2,000 transplants each year in the UK.

Organ donation is without doubt one of the great success stories of the latter half of the 20th century. This debate and national transplant week provide the opportunity to celebrate such fantastic achievements, to debate the challenges facing organ transplantation and to increase awareness of organ donation. It is welcome to see so many hon. Members showing their support for the campaign.

Over the past century, organ transplantation has overcome some major technical limitations to become the success that it is today. Breakthroughs include developing surgical techniques to manage the immune response and devising preservation solutions to enable prolonged periods of ex vivo storage. The results of organ transplantation continue to improve as a consequence of such innovations and of improvements in peri-operative and post-operative management.

Major progress has been made with the infrastructure and organisation of organ donation, which has led to a significant increase in donation rates. I am extremely proud of the fact that, in 2001, the previous Government said that we would double the number of donors from 8 million to 16 million by 2010; we achieved that a year early, in 2009. The 19.7 million of us on the NHS organ donor register are testament to the changes made at every level—from hospitals to the critical care and emergency department staff committed to donation. Most of all, there is the generosity of donors and their families.

Despite all those astounding achievements, many challenges persist, most notably the shortage of suitable donor organs. We know that the number of potential donors is declining because people are living longer and fewer are dying in hospitals in circumstances where they could donate. Every year in the UK, about 1,200 people die after death has been diagnosed on neurological criteria, with a further 3,000 people dying after the withdrawal of treatment in circumstances where donation is possible.

The hon. Member for Romsey and Southampton North (Caroline Nokes) highlighted the particular challenge of finding suitable child and infant donors. That makes it more critical than ever to increase the pool of willing donors and to encourage more people to join the NHS organ donor register, which includes engaging with parents to consider the gift of life at a time of child death tragedy.

As many Members have said, market research carried out by NHS Blood and Transplant highlights that, although 51% of the population definitely want to donate their organs and 31% said that they would consider it, only 31% have actually signed the register. Twenty years on from the launch of the NHS organ donor register, people may sign up in many ways, such as through an online form, a 24-hour donor line, a text message, the GP or even a driving licence application. I did so when I signed up for my Boots advantage card. Surely even more mechanisms could be used to sign people up—the hon. Member for Strangford mentioned a debate we had on the issue only a few weeks ago, when I suggested supermarket cards. What more could we be doing to encourage people, particularly young people?

A current campaign, led by the Anthony Nolan trust, goes into schools to encourage 16 to 18-year-olds to consider signing up to the bone marrow register. What more could we be doing across all schools?

[Jason McCartney]

The hon. Lady has just raised the campaign by the Anthony Nolan bone marrow trust—it is called Register and Be a Lifesaver. As the hon. Member for Stretford and Urmston (Kate Green) pointed out, there is still an issue when it comes to different ethnic backgrounds. As the bone marrow register has been mentioned, I want to point out that northern Europeans have a 90% chance of finding a bone marrow donor, but that figure falls to just 40% for people from black, Asian and minority ethnic backgrounds.

[Luciana Berger]

I was just about to come to the specific challenges of regional differences and of people from different communities having access to organs. To finish my point about the important campaign by the Anthony Nolan trust, as part of that campaign the organisation wrote to all MPs to encourage us to write to schools in our constituencies to inform them about the opportunity to have the Anthony Nolan trust come in and inform 16 to 18-year-olds about the chance to be a life saver. I want to put on the record that I strongly encourage other Members to write that letter if they have not already done so—I sent mine off only last week—because it is something that we can do as MPs to encourage people locally to get involved.

In response to the hon. Gentleman’s point about specific communities, the challenge, as we have heard from a number of Members, is not simply getting more sign-ups to the register but targeting specific communities and areas that we know are losing out from the stark inequalities in our system. In the north-west, for example, where my constituency is situated, patients are waiting longest for a transplant and we have the highest death rate among those who are waiting: 62.2% of patients in the north-west wait more than six months for a transplant, compared with an average for England of 47.3%. Some 23.2% of patients in the north-west have waited more than 18 months for a lung transplant, compared with an average for England of 15.8%. We need to take regional differences into account.

Many Members have referred to lung donation. My hon. Friend the Member for Bristol East (Kerry McCarthy) referred to the zonal lung allocation system, an important issue that I will focus on in more detail. The Cystic Fibrosis Trust has raised legitimate concerns about that system and is concerned about equity in lung allocation.

Currently the allocation of lungs to transplant centres operates on a rota system. When a donor becomes available, the organs are offered to the closest transplant centre if a matching recipient has been identified. If no suitable candidate is found, the organs are then offered to the next centre, as per the pre-agreed rota. The likelihood of getting a lung transplant and the time frame for the procedure will therefore vary according to where an individual is listed. A donated organ will not currently always reach the candidate most in need anywhere in the country. Will the Minister give her view on the zonal lung allocation system? Does she have any plans to develop a more needs-based system?

It is not just where someone lives that can affect their chance of having a transplant operation if they need one. People from BAME communities are up to three times more likely to need a transplant than others, yet, because organ matching is likely to be closer when the ethnicity of the donor and the recipient are the same, they have to wait much longer. For example, on average a person from a BAME community will wait a whole year longer for a kidney transplant than other patients.

The #Spit4Mum campaign to find suitable stem cell donors for a woman called Sharon Berger—I am not related to her—highlighted the specific challenge of finding suitable donors for members of the Ashkenazi Jewish community. I am a member of that community and I have done my bit to contribute to that specific campaign. But we know that there are many different ethnic minority communities that struggle to find donors of organs and stem cells.

Such inequalities are not acceptable. We cannot accept that some of our citizens will be far more likely to die than others because of where they live or their ethnic background. Will the Minister address that point specifically and outline what concerted action the Government will be taking to tackle it?

Many Members on both sides have raised their concerns about what more we can do to support families in honouring the wishes of their loved ones. It is very difficult when someone passes away, but we know that in 2011-12, 125 families overruled an individual’s intention as recorded on the NHS organ donor register to become an organ donor. Many people do not realise that if they have not made their donation decision clear, their family could be asked to agree to a donation taking place. Nobody wants to leave their family with such a burden, so it is vital that we encourage and support families in having those conversations earlier. The theme of the current national transplant week is “Spell it out”. Will the Minister outline what she is doing to promote that message further? There is a great disparity between those people who sign up and share their intentions with their families and those who do not, and there can then be issues with vetoing.

I will touch briefly on the issue of the opt-out or presumed consent system, which was raised both by my hon. Friend the Member for Bridgend (Mrs Moon) and by the hon. Member for Montgomeryshire (Glyn Davies). There are many obvious advantages to the system. I return to the point I made earlier: there is a gap between the 51% of the population who definitely want to donate their organs, the 31% who would encourage it and the 31% who have actually signed the register. The system will be introduced in Wales in 2015. Any change in legislation will need to take into account the impact of the system in Wales and must have the backing of the public. What consideration is the Minister giving to learning from the introduction of the system in Wales and to introducing a similar system in England?

[Sandra Osborne (in the Chair)]

Order. I am sorry to interrupt the hon. Lady, but I ask her to be mindful of the fact that the Minister has many points to answer in the debate.

[Luciana Berger]

My hon. Friend the Member for Bristol East referred to the international comparison that suggests that there is room for improvement in ensuring that we are making the most of donor organs. The Cystic Fibrosis Trust has pointed out that a large number of donor lungs are never used, despite consent from the next of kin. Lungs from fewer than 25% of brain-dead donors are utilised in clinical transplantation. The need for suitable organs must be balanced against possible risks to the recipient, such as transplanting an organ that does not work properly or transmitting a serious disease from donor to recipient. However, I echo the concerns raised by my hon. Friend the Member for Stretford and Urmston (Kate Green) on donor lungs: there are clinically viable lungs within the 75% that are not used and more can be done to address the issue.

Anxiety over the likely function of an organ largely explains why it is only in a minority of cases that all possible solid organs are used. The Government strategy for organ donation and transplantation, published last year, highlighted that sometimes actions that could be taken to improve the function of a retrievable organ are not taken and the organ is declined. On other occasions, organs declined on the grounds of poor function should have been accepted and implanted. What steps are the Government taking to ensure that we are using as many donor organs as possible? I also echo and reinforce the points made and questions raised about supporting patients who are waiting for organs to ensure that, when the time comes, they are psychologically prepared.

This issue is important to all Members, across the political divide. Anyone in this room could one day need an organ donation or have a loved one who does. We are making progress but we must maintain our momentum. I welcome the Government strategy for organ donation and transplantation set out last year. I am happy to work with the Minister and do all I can to promote efforts to improve organ donation and transplantation, to ensure that anyone who needs an organ transplant has one. I look forward to the Minister’s response.

Organ Donation Register

Luciana Berger Excerpts

Tuesday 17th June 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Burton (Andrew Griffiths) for calling a debate on such an important issue, and for his passionate reflections on organ donation and on the fact that the chance of life for one person can often come at a time of trauma for another family. There were also emotional and personal contributions from the hon. Members for Strangford (Jim Shannon), for Montgomeryshire (Glyn Davies) and for Foyle (Mark Durkan).

Organ donation is surely one of the great success stories of the latter half of the 20th century, not just for science, but for humanity. It is a precious thing: there can be few greater achievements than to have given life to those who were on the verge of death. Fewer than 5,000 people each year die in circumstances in which they are able to become a donor. Despite the sadness of the moment, the act of organ donation can become a major comfort to bereaved families as time passes.

There have been major improvements to the infrastructure and organisation of organ donation over the past few years. Those improvements have been reflected in donation rates, which have increased significantly. I am extremely proud of the fact that in 2001 the previous Labour Government said that we would double the number of donors from 8 million to 16 million by 2010, and achieved that target a year early, by 2009. That was thanks to an enormous effort from large numbers of people.

The recommendations from the organ donation taskforce in 2008 set in train many of the reforms that NHS Blood and Transplant has made. It laid the path for many of the improvements we have seen, such as, for example, the creation of a network of specialist organ donation nurses—already referred to in our debate—who support families in considering organ donation at a difficult time.

As we have heard, over 20 million of us are on the NHS organ donor register. Again, that is testament to the changes that have been made at every level in hospitals, to the commitment of critical care and emergency department staff to donation, and most of all to the generosity of the donors and their families.

We cannot be complacent, however. As we have heard in the debate, we have lower registration rates than some of our European neighbours, and too many people still die while waiting for a donation—three people every day, which is three too many.

We need to raise awareness, and hon. Members have been right to emphasise the need to raise more awareness of the importance of joining the register and supporting our families and friends when they do so. This year marks 20 years since the NHS organ donor register was launched, and there are now many ways in which people can sign up. There is an online form and a 24-hour donor line. People can register through a text message, at their GP’s surgery, or when they apply for their driving licence. I signed up through my Boots advantage card. Yet we still have more to do. Are there any more ways in which we can ask people to sign up? Boots advantage cards are disproportionately owned by women. There are ways in which we can target men; many supermarkets have cards. Should we be thinking about that? I would welcome the Minister’s thoughts on the different ways in which we can encourage people to sign up.

We know from market research carried out by NHS Blood and Transplant that 51% of the population definitely want to donate their organs, and 31% would consider it. Only 31%, however, have actually signed the organ donor register. The question of how to bridge that gap is vital. As MPs, we will all have received e-mails telling us that national transplant week runs from 7 to 13 July, and that is a great opportunity for us all to raise the profile of the issue. Will the Minister share with us the Department’s plans to mark national transplant week and encourage more people to sign up to the register?

As the hon. Member for Burton mentioned, we need to get more people on the register from specific communities. The challenge is not only getting more sign-ups to the register, but targeting specific communities and areas that we know are losing out from the stark inequalities in the system. My constituency is in Liverpool, in the north-west, where patients are waiting the longest for a transplant. We also have the highest death rates among those waiting. In the north-west, 62.2% of patients waited more than six months for a transplant, whereas the average for England is 47.3%; and 23.2% of patients waited more than 18 months for a lung transplant, whereas the average for England is 15.8%. Those long waits are themselves concerning, but where some people are waiting longer than others for a life-saving operation purely because of where they live, it is something we need to address urgently.

It is not just where someone lives that can affect their chance of getting a transplant operation. As we have heard, people from black, Asian and minority ethnic communities are up to three times more likely to need a transplant than others, yet because organ matching is likely to be closer when the ethnicity of the donor and recipient are the same, they have to wait much longer. On average, a person from a BAME community will wait a year longer for a kidney transplant than a white patient. Many die while waiting for an organ to become available, and the Government must urgently tackle that situation.

The debate this morning has centred on organ donation, although Members have referred to bone marrow donation, which is an important area for us to reflect on, and an area where we should look at lessons that we can learn. More than 90% of white patients in need of a bone marrow transplant find a match, but for the BAME population the matching rates can be as low as 40%, which is a difference of 50 percentage points. We need to look at that. I am of Ashkenazi Jewish descent, and I joined the bone marrow register because I know how hard it is for people from my community to find a donor.

A number of campaigns have led to a massive increase in the number of people joining that register. The Berger family—no relation to me—led the campaign #Spit4Mum. A woman called Sharon Berger had a very rare blood disease. She was of Ashkenazi Jewish descent, but she needed to find a match in a hurry. Her children, Jonni and Caroline, started the #Spit4Mum campaign, which has raised awareness among all BAME communities and had a high press profile. There was a 1,700% increase in Jewish people joining the bone marrow register in the year that they ran that campaign. We need to see that happening in all communities right across the country, and it needs to extend to organs as well.

We cannot accept that some of our citizens will be far more likely to die than others because of where they live or their ethnic background. Will the Minister address that point specifically and outline what concerted action the Government are taking to tackle it? In particular, what will the Government do to improve the diversity of the organ donation specialist nurses? Another Member raised that issue.

We need to ensure that the wishes of those on the register are granted, and we must do more to support families in that. In 2011-12, 125 families overruled the individual’s intention, as recorded on the NHS organ donor register, to become an organ donor. Of course, that is understandable. The decision to allow their loved one’s organs to be used is incredibly tough for a family to make when they are in the throes of grief. We know, however, that many family members were unaware that it was what their loved one wanted and found it difficult to come to terms with such a decision at such an awful time of loss. That is why it is vital that we encourage and support families in having conversations about organ donation. Family consent rates have been static at around 55% to 60% over recent years, but that shoots up to 95% when those family discussions take place. NHS Blood and Transplant is taking steps to address that, so I would welcome an update from the Minister on its progress.

Finally, I want to touch on the opt-out or presumed consent system. We have heard some Members’ positions on that, but if more Members had been in the debate, we might have heard a wider variety of views. Some professional groups, including the British Medical Association, consider the system to be the most effective solution in addressing the shortage of organ donors. The system has advantages. To return to an earlier point, there is a gap between the 51% of the population who definitely want to donate their organs and the 31% who have actually signed the register. We would, however, have to consider carefully the safeguards the system would need and continue to review the evidence from countries that already have it in place. Wales will be introducing the system later this year. Any change in legislation would need to have the backing of the public. Whether we agree with assumed consent or not, I hope we can all agree that it is time we started a major public debate about how we can best tackle the shortage of organ donors in this country. What steps is the Minister taking to start that national conversation?

In conclusion, this issue transcends party politics and is important to all Members. We are making progress, but we need to maintain our momentum. I welcome the Government’s strategy for organ donation, which was laid out last year. Its first goal is as follows:

“action by society and individuals will mean that the UK’s organ donation record is among the best in the world and people donate when and if they can.”

I would be very happy to work with the Minister to continue to build awareness of the importance of joining the organ donor register, and to work towards achieving that critical goal.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 10th June 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question, and it is a legitimate one. A lot of work is being undertaken by NHS England and the national clinical director Geraldine Strathdee, a highly regarded individual, to strengthen the quality of commissioning of mental health services. It falls short in many areas at the moment and it is essential that it is improved.

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

Ministers say that they are committed to parity of esteem between mental and physical health, yet we have already learned from an NHS England report that three quarters of children with anxiety or a diagnosable depression are not receiving the treatment they need. This is plainly unacceptable. It would not happen to children presenting with a broken arm or asthma, so can the Minister please tell the House when he will translate his rhetoric into reality?

Care Homes

Luciana Berger Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

My hon. Friend makes a really important point. In ensuring that we have decent, civilised standards of care for older people, but also for people with learning disabilities and others in vulnerable positions, it cannot be any one party on its own that achieves that objective. It is a challenge for the whole of society, and we must recognise that. Government have their part to play in setting very clear standards and making it absolutely clear that where these standards are not met there are consequences. Through the integration pioneers that we have around the country, we are demonstrating that with better collaboration between statutory services and families, wider communities and neighbours, we can achieve better care for people. The state cannot do this on its own. It has a crucial role to play, but this is a challenge for the whole of society.

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

I think the whole country was appalled last night when the BBC’s “Panorama” programme exposed the neglect and abuse of vulnerable older people at the hands of their carers. When older people and their families take a decision to move into residential care, they must be assured of high standards. Poor care must be stamped out and those responsible properly held to account.

First, I want to press the Minister on the specific case at Oban House. He will be aware that concerns were first raised about the home by whistleblowers back in 2012. What action was taken to address those concerns, and were they brought to the attention of Ministers? In its latest inspection in February, the Care Quality Commission reported that the home had too few staff and that some residents waited too long for staff to answer their calls. Will the Minister set out precisely what action was taken after those failures were highlighted back in February?

The Minister will be aware that following the awful abuse exposed by “Panorama”, a number of staff have been suspended, and HC-One has said it will increase staffing levels and improve training at the care home. However, is he fully satisfied that the safety and well-being of residents at Oban House is not still at risk?

This case raises serious questions about not only the inspection of care homes but the role of local councils. Councils and local authorities, which are much closer to care homes, should have a strong role in monitoring and driving up care standards. They should be the first safety net. Was it not a major error, therefore, to remove in the Care Bill the CQC’s powers to check that local councils are commissioning care services properly?

Care home bosses who fail to ensure that their residents are treated properly must face tough consequences. I heard what the Minister said about holding those bosses to account. My hon. Friend the Member for Blaenau Gwent (Nick Smith), as he outlined, proposed an amendment to the Care Bill to introduce a new criminal offence so that negligent care home owners can be fined or sent to jail. Is it not disappointing that the Government voted against that amendment?

In the first three years of this Parliament, social care budgets have been slashed by £1.8 billion. Yesterday, the growing abuse of zero-hours contracts, particularly in the care sectors, was revealed. Does the Minister accept that we will never get the standard of care that we aspire to from a social care system that has been cut to the bone? Should the coalition not revisit its brutal cuts to social care, which make such a situation more, not less, likely to occur?

This shocking case is yet another reminder that the time has come for a radical rethink of how we care for older people. These abuses must stop. How many more “Panorama” programmes exposing appalling cases such as at Oban House must we see before proper action is taken? Today, the Government must explain how they plan to prevent older people facing further abuse and indignity.

[Norman Lamb]

I thank the hon. Lady for those questions. I completely agree that unacceptable practices, and abuse and neglect, must be stamped out. I hope she is pleased that the Government are taking action to ensure that we can prosecute care providers who have allowed unacceptable practices. When I came into my job and had to respond to the scandal at Winterbourne View, the question I asked officials was, “What has happened to the company? How has it been held to account?” I was told that the Care Quality Commission could not prosecute because it had to serve a notice first, and if the company complied with the notice, nothing could be done.

A flawed regulatory regime was established when the CQC came into being. We are changing that so that providers of care can be prosecuted if they fail to meet fundamental standards of care. [Interruption.] I am answering the question. That is precisely what we are doing. The hon. Lady mentioned the issue of corporate accountability and corporate neglect, and that is exactly what we are addressing: we are giving the CQC the power to prosecute when there is corporate neglect.

We are also going further by introducing a fit-and-proper-person test so that every director of every care company will have to demonstrate that they are a fit and proper person. That should already be the case, but this is the first time it has happened. We are also introducing proper standards of training for all staff.

On the care home concerned, I hope it will be helpful if I write to the hon. Lady setting out the whole sequence of events and the entire timeline of the steps taken by the CQC. I commit to doing that in the next few days so that she will have the full picture.

We have made sure that the CQC is independent—we have strengthened its independence. We are introducing a far more robust inspection regime and we are addressing a problem. When the CQC was introduced by the Labour Government, the design of the inspection system was for generalist inspectors who might inspect hospitals one week and care homes the next. We are introducing specialist inspections. When inspectors go into a care home, they will talk to relatives, residents and staff, to get a much fuller picture of what is going on. Care homes will then be rated on their standards of care, so everyone will know what their local provider’s standards are.

I hope the hon. Lady will feel that real, substantial steps are being taken to address unacceptable standards of care and to ensure that people are properly held to account when bad things happen.

Cervical Cancer Screening

Luciana 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)

Luciana 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

Luciana 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

Luciana 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

Luciana 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.