Lung Cancer Screening
Maggie Throup Excerpts(10 months ago)
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Steve Barclay
Clearly, the earlier we detect cancer, the less pressure it puts on the workforce. There is much more work involved in the treatment of a later cancer than of an earlier cancer. That is why we are investing in our community diagnostic programme, with 108 community diagnostic centres already open and delivering 4 million additional tests and scans. As part of the wider £8 billion investment in our electives recovery, over £5 billion is going into that capital programme. Yes, the workforce plan is a key part of that, but so is getting the CT scanners and the other equipment in place. That is exactly what our community diagnostic programme is doing, and it is being furthered by our screening programme through announcements such as this.
Maggie Throup (Erewash) (Con)
Alongside the new lung screening programme, which I welcome, will my right hon. Friend now commit to implementing in full the recommendations made by Dr Javed Khan in his review, so that we can finally stub out the No. 1 cause of preventable cancer and end the suffering for smokers who develop cancer and for their loved ones? Our late colleague requested that we be bold. In taking forward the Khan review in full, I am sure we would be fulfilling his wishes.
Steve Barclay
My hon. Friend is quite right to highlight the significance of smoking as a cause of cancer. We have a number of measures, including the programme to move 1 million smokers on to vaping, the financial incentives to encourage pregnant women not to smoke, the tougher enforcement and the consideration of inserts for packaging. The Government are taking a range of measures to address the very important issue that my hon. Friend rightly raises.
Ultra-processed Food
Maggie Throup Excerpts(10 months, 1 week ago)
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Maggie Throup (Erewash) (Con)
It is a pleasure to serve under your chairmanship, Dr Huq. I could not miss the opportunity to progress my argument about the importance of tackling obesity, and today’s debate, which was so aptly brought to this Chamber by my hon. Friend the Member for Stourbridge (Suzanne Webb), provides just that opportunity to discuss the ultra-processed food that has an impact on everybody’s diets.
I welcome the premise that if we want a wealthy nation, we need a healthy nation, as I am sure everybody in this room would agree. Obesity and related conditions, such as type 2 diabetes, are the most prominent health impacts of poor diets, which are driven by high levels of consumption of products that are highly processed and contain unhealthy levels of fat, salt and sugar. The term “ultra-processed foods” comes from the NOVA food classification system, which was originally developed by researchers in Brazil. Ultra-processed foods typically have five or more ingredients and, as we have heard, tend to include many additives and ingredients that are not typically used in home cooking, such as preservatives, emulsifiers, sweeteners, and artificial colours and flavours. Such foods generally have a long shelf life. This is how I define the term: if there is a word that someone cannot pronounce when they look at the contents list on a package, the food is ultra-processed.
The vast majority of ultra-processed foods are high in fat, salt and sugar—HFSS, which is the well-established term to refer to foods that negatively impact on people’s health. It has been known for decades that products high in fat, salt and sugar have a negative impact on the health of the nation, and the nutrient profiling model underpins the existing and planned legislation to improve the food system. That includes now-delayed measures to protect children from seeing junk food adverts on TV and online, and to prevent two-for-one offers. My plea to the Minister today is: can we look at the timescales again? They are far too distant in the future and, as I say, the health and wealth of our nation is far too important.
A recent report by the Obesity Health Alliance argued that obesity is the new smoking. That comparison was reinforced by the announcement of £40 million to pilot ways to make the newest and most effective obesity drugs accessible for eligible patients. There is acceptance that obesity is a disease and should be treated with drugs, in the same way that lung disease is treated with drugs. Following that argument through, immense effort has gone into stopping smoking measures and reducing exposure to cigarettes, so immense effort should now be put into reducing everyone’s exposure to foods that are more likely to cause obesity—that is, ultra-processed foods.
The health and economic impacts of obesity are devastating. Obesity is a force multiplier on fatty liver disease, cardiovascular disease, stroke, type 2 diabetes and cancer, which puts ever-increasing pressure on the NHS. The combined cost of obesity to the Treasury—that is, through the NHS, the Department for Work and Pensions and the economy as a whole—is predicted to reach £58 billion a year, and I fear that that is probably a very conservative projection. Those who are obese cost the NHS twice as much as those who are not, and it has been estimated that those who are obese take four extra sick days a year, which equates to 37 million sick days across the UK working population. Those stats are clearly very concerning, and there needs to be a collective effort to tackle this widespread problem. If action is not taken now, we will embed ill health and low productivity in generations to come.
A few weeks ago, BBC’s “Panorama” highlighted just how harmful ultra-processed foods are and how they contribute massively to diet-related ill health. However, as we have heard, they are among the most profitable foods that companies can make. This may sound unlikely, but there is willingness among food manufacturers to reformulate their products. However, they want a level playing field. We have a proven model in the soft drinks industry levy, so let us use that as a basis for the reformulation of ultra-processed food and provide manufacturers with a level playing field, because no company is willing to step out of line and lead the way. If consumption of ultra-processed food continues at the current rate and the obesity rate continues to rise, our nation will be economically poorer and very unhealthy.
I will be bold and state my belief that this country is addicted to ultra-processed foods, similar to the way it was addicted to smoking in past decades. We tackled smoking addiction by intervention; it is now time to tackle ultra-processed food addiction by intervention, too.
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)
It is a pleasure to serve under your chairmanship, Dr Huq. I am particularly grateful to my hon. Friend the Member for Stourbridge (Suzanne Webb) for securing this debate, which is timely and deals with an incredibly important issue, which I am very interested in. I recently met Dr Van Tulleken and the Scientific Advisory Committee on Nutrition, and we are working on this at pace, so I welcome the debate.
One of the great challenges with ultra-processed food is defining what it is. The most commonly used definition, as we have heard, is the NOVA definition, which includes foods that are clearly less healthy, such as sugary drinks, confectionery, salty snacks, cakes and other products that are high in calories, saturated fat, salt and sugar. A diet high in those things increases the risk of excess weight gain and obesity. We are committed to tackling obesity, and have a programme of measures to do that. We have introduced calorie labelling in cafés and restaurants, and since last October we have introduced location restrictions on less healthy foods to reduce pester power. An advertising watershed will be introduced in 2025. That requires numerous steps, and we are taking them.
For children and young people, we are spending £150 million a year on healthy food schemes, such as school fruit and veg and nursery milk, through our Healthy Start scheme. We are also putting in £330 million a year for school sport and the PE premium. In addition, there is a £300-million youth investment fund in facilities to encourage an active lifestyle, and we are spending about £20 million a year on the national child measurement programme, which aims to nip problems in the bud. Only a few weeks ago, the Prime Minister made an announcement on funding a £40-million start in the use of new weight loss drugs for those living with obesity.
Neil O'Brien
Yes. We are working with food businesses and we have set out direct measures to further progress reformulation, which is crucial to helping people to make healthy choices. The soft drinks industry levy decreased the amount of sugar in soft drinks by 46% between 2015 and 2020, and the voluntary sugar reduction programme has delivered a nearly 15% reduction in average sugar levels in breakfast cereals and a 13.5% reduction in yoghurts and fromage frais. Together, these policies are expected to accrue health benefits of about £60 billion, producing savings for the NHS.
Although a significant amount of work has been published, there is no universally agreed definition of ultra-processed food; nor is there an evidenced position. We do have definitions of products that are high in fat, salt and sugar, and that is the basis on which we regulate and control those foods. The Scientific Advisory Committee on Nutrition provides the Government with robust, independent advice on the science and the underpinning evidence base. SACN is clear that there is evidence that a diet high in calories, fat, salt and sugar is bad for people’s health. The question then is what ultra-processing adds to that impact. Is it something about the ease of eating these foods, or what it does to someone’s physiology? Are the products in some way addictive, or is it something else entirely?
Some people say, “Why don’t you just adopt the NOVA definition?” but the breadth of the NOVA definition is such that it includes foods that our current dietary guidelines encourage as part of a healthier diet. Shop-bought wholemeal bread, baked beans, or wholegrain breakfast cereals such as bran flakes and Weetabix would be captured by it, so clearly there is work to do to reach the right definition. Some of the foods that I have mentioned can make a positive contribution to nutrient intakes: for example, fortified breakfast cereals or bread and pasta made from fortified wheat flours are the largest source of dietary iron in all age and sex groups and provide, on average, between a third to a half of our calcium intake.
Defining the problem is not completely straightforward. To make progress so that we can start to regulate or do anything else, we need to have a clear definition. However, even though how to define these things is not totally obvious, that does not mean that there is not a problem, that we will not take action, or that we cannot find a solution. We all know it when we see it—I particularly admired the definition of my hon. Friend the Member for Erewash (Maggie Throup) that having an unpronounce-able ingredient is a pretty good sign—but we need to be precise and follow the scientific evidence.
That is why SACN is carrying out the scoping review of the evidence on processed foods and health, which includes reviewing existing processed food classifications and the ability to apply NOVA to UK diets and our national diet and nutrition survey. SACN aims to publish its initial assessment this summer, so we are moving quickly. We are also in touch with other countries in the same position, and I know that France and Canada are doing similar work. As part of the review, SACN will consider whether there is sufficient evidence to undertake a full risk assessment. Only after an in-depth risk assessment and the identification of robust supporting evidence would we consider updates to Government dietary advice.
The Eatwell Guide, which most Members present will know about, summarises dietary recommendations and shows how much of what we eat overall should come from different food groups to achieve a healthy, balanced diet. It recommends that we consume less often, and in smaller amounts, food and drinks that are high in saturated fat, salt or free sugars. Foods such as crisps, biscuits, cakes, ice cream and sugary drinks are all shown outside the main Eatwell Guide image to highlight that they are not necessary. Those foods also meet the NOVA definition of ultra-processed foods.
The Eatwell Guide and associated messaging is promoted through a range of channels, including the NHS and gov.uk websites, and the Government’s national social marketing campaigns, such as Better Health. We know from our national diet and nutrition survey that most people in the UK are not meeting the dietary recommendations depicted in the Eatwell Guide. Aligning diets more closely with existing dietary recommendations will deliver considerable population health benefits and healthcare savings.
Obviously, one of the things that we are doing to achieve those benefits is supporting people with the cost of living so that they can afford to do it. Support for the cost of living, which we have provided through both energy price support and direct measures for poorer households, has been worth £3,300 for the average household over last year and this year—one of the most generous support packages anywhere in Europe. We are absolutely conscious of the challenges around the cost of food at the moment, caused by the Russian invasion of Ukraine.
Even as we focus on the cost of living, we are still very much focused on obesity, because it accounts for a significant cost to the NHS and the economy. That is what we are doing with our existing programme on obesity and healthy eating. We know that there is more to do, and we will do more. Our major conditions strategy has a call for evidence that runs until 27 June, seeking people’s views on how the healthcare system can support people to lead healthier lives, including supporting them to achieve and maintain a healthy weight. We know that diet has an important impact on health. My hon. Friend the Member for Stourbridge has raised important concerns about ultra-processed foods, which we are looking at.
Our existing policies support less consumption of many of the foods that would be classified as ultra-processed because they are high in fat, salt and sugar. We know that they are a problem, and that is why we regulate in the way we do. It is vital that we take a considered and robust approach to the emerging evidence on what ultra-processing is doing. That is what we are doing, and we will not hesitate to take action if the evidence suggests that it is needed.
Obesity and Fatty Liver Disease
Maggie Throup Excerpts(10 months, 3 weeks ago)
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Maggie Throup (Erewash) (Con)
It is a pleasure to serve under your chairmanship, Mr Hollobone, and to participate in this extremely important debate. I congratulate the hon. Member for Caerphilly (Wayne David) on securing the debate, which is timely because it coincides with International NASH Day. International NASH Day aims to raise awareness of fatty liver disease and non-alcoholic steatohepatitis, which affects more than 115 million people globally. Up to one in five people in the UK have non-alcoholic fatty liver disease, and almost 12% of the population have NASH. I am sure it comes as no great surprise to anyone, as the clue is in the name, that one of the key causes of non-alcoholic fatty liver disease is obesity.
The need to tackle obesity as a priority was first identified by the Government in the early 1990s in the “Health of the Nation” White Paper. In the three decades since then, there have been policies such as the soft drinks industry levy, the pilot of the “Better Health: Rewards” scheme in Wolverhampton, restrictions on product placement and calories on menus, which have been introduced effectively with the aim of reducing obesity. I am particularly proud that many of those measures were introduced or reinforced during my time as public health Minister. However, despite those policies being implemented successfully, the obesity rate continues to increase, so more needs to be done.
A recent report by the Obesity Health Alliance argued that obesity is the new smoking. That comparison was reinforced yesterday by the announcement of £40 million to pilot ways to make the newest and most effective obesity drugs accessible to eligible patients. That is an acceptance that obesity is a disease and should be treated with drugs, in the same way that lung disease is treated with drugs. Following that argument through, immense effort has gone into stopping smoking measures and reducing exposure to cigarettes, so immense effort should now be put into reducing everyone’s exposure to foods that are more likely to cause obesity—that is, ultra-processed foods. The delayed 9 pm watershed and action on two-for-one offers will do just that.
Research by the Obesity Health Alliance shows that 72% of people believe a 9 pm watershed on junk food adverts should be brought in during popular family TV shows. The measure has public support, so why hold back? When will the Minister’s Department introduce those important measures? Provisions are on the statute book, so let us just get on with it.
Statistics provided by the House of Commons Library highlight how obesity is steadily getting out of control in England. Since 1993, the proportion of adults in England who are overweight or obese has risen from 52.9% to 64.3%, and the proportion who are obese has risen from 14.9% to 28%. It is no surprise that the UK has the third highest obesity rate in Europe. Furthermore, the alarming rate of child obesity is of real concern. Data from the national child measurement programme outlines that in England, 10.1% of reception-aged children —aged four to five—were obese in 2021-22 and a further 12.1% were overweight. At ages 10 to 11—in year 6—23.4% were obese and 14.1% were overweight. Obesity prevalence is highest among the most deprived groups in society: children in deprived parts of the country are twice as likely to be obese than their peers in more affluent areas.
The health and economic impacts of obesity are devastating. Obesity is a force multiplier on fatty liver disease, cardiovascular disease, stroke, type 2 diabetes and cancer, and that, of course, puts ever-increasing pressure on the NHS. The combined cost of obesity to the Treasury—that is, to the NHS, the Department for Work and Pensions, and the economy as a whole—is projected to be £58 billion a year. I feel, however, that that could be a conservative projection, as there are many factors that have not been taken into consideration.
Those who are obese cost the NHS twice as much as those who are not. It has been estimated that those who are obese take four extra sick days a year, which equates to 37 million sick days across the UK working population. Those stats are clearly very concerning, and there needs to be a collective effort to tackle this widespread problem. If action is not taken now, we will embed ill health and low productivity into generations to come.
Non-alcoholic fatty liver disease is triggered by a build-up of fat in the liver, and as its name suggests, it is usually caused by obesity. Early-stage non-alcoholic fatty liver disease does not usually cause any harm. However, if left untreated, it can lead to serious liver damage, including cirrhosis. Some 90% of liver diseases are preventable, and in the UK, the most common causes of cirrhosis are excessive alcohol consumption, hepatitis and NAFLD.
What can we do to avert this public health crisis? As individuals, we can all take measures to help us to avert the risk of NAFLD—simple measures including eating a balanced and healthy diet, and in particular, not eating ultra-processed foods. Additionally, we can all increase our activity levels, as the hon. Member for Caerphilly indicated. It has been estimated that if those who are overweight or obese lost just 2.5 kg—5½ lb for people of my generation—that could save the NHS £105 million over the next 15 years. I am sure that most people would want to lose more than just 5½ lb, and doing so would save the NHS even more money—5½ lb, or 2.5 kg for the younger ones in the room, is not a lot.
We need to do more to promote early diagnosis and raise awareness of the different causes of liver disease. It would be remiss of me, as chair of the all-party parliamentary group for diagnostics, not to mention the possible impact of community diagnostic centres. Community diagnostic centres provide a quick and easy way to access checks, tests and scans, providing routes to early diagnosis. The recent announcement by the Department of Health and Social Care that fibroscan services will be made available in 100 community diagnostic centres is welcome. It could result in thousands of people being made aware of the poor condition of their liver, which could still be reversible.
Despite that positive news, I would like to see an expansion of liver testing in areas where obesity levels are higher and the risk of fatty liver disease is more extreme. Lives are saved when diseases are caught early. I am interested to hear the Minister’s comments regarding the expansion of fibroscan services to all CDCs. My own local integrated care system in Derbyshire is currently categorised as green, indicating that an effective pathway is in place for the early detection and management of liver disease. Will the Minister therefore look at emerging good practice throughout the country and emerging good practice pathways at the ICS level, with a view to establishing a national pathology pathway to accelerate early diagnosis? Government policy towards obesity over the last 30 years has mainly been focused on individual responsibility, rather than mandatory policy, but we can all see that that is not working.
Monday night’s BBC “Panorama” highlighted just how harmful ultra-processed foods are, and how they contribute massively to diet-related ill health. However, they are among the most profitable foods that companies can make. I know that this may sound unlikely, but there is a willingness among food manufacturers to reformulate; however, as the hon. Member for Caerphilly said, they want a level playing field. Sadly, no company is willing to step out of line and lead the way, yet if the consumption of ultra-processed foods continues at the current rate and the obesity rate continues to rise, our nation will be economically poorer and very unhealthy. To be bold, I believe this country is addicted to ultra-processed foods, similar to the way it was addicted to smoking in past decades. We tackled smoking addiction by intervention; it is now time to tackle ultra-processed food addiction by intervention too.
To conclude my remarks, this debate has undoubtedly helped to raise awareness of the problem of obesity and the detrimental impact it has on people’s health, including liver disease, as well as the economy and the NHS. Clearly, more needs to be done to tackle the health inequalities of obesity and improve early diagnosis of fatty liver disease. The Government need to be bold and brave for the sake of the individual, the NHS and the economy.
Will Quince
The hon. Gentleman raises a good point; I totally agree. As further details are published, he will see the current criteria for accessing those drugs. The reality is that more and more are coming on stream, and they will be part of our arsenal and one of our tools to help people tackle obesity and make healthier life choices.
What do we also know about the drugs? Well, we know that they are effective. However, they are effective only for as long as someone takes them, unless they change their lifestyle and behaviour. Anything we do in relation to drugs must be alongside an education piece, and supporting and empowering people to make healthier life choices. Ultimately, and ideally, we do not want people to be on drugs for the rest of their lives where it is not necessary. We want the drugs to be a tool and enabler to help and support them to get to a place where they can manage their own weight. That might be difficult for some people and they may struggle to do so, and for others it may not. It is just a helping hand; the hon. Gentleman is right.
As hon. Members made their contributions, I scribbled down the actions—just in my own mind—that the Government have taken over the past few years, such as calorie labels on food in supermarkets. I know that that made such a difference, because when I am looking, I make active choices. I look at the traffic light system, I look at the calories, and I look at the amount of salt and sugar in these products; and doing so enables me to make healthier choices. That is important. There is the calorie labelling on food sold in large businesses, including restaurants, cafés and takeaways, which came into force back in April—not uncontroversially.
Maggie Throup
My hon. Friend is right that there is a lot more information there for people to make informed decisions on, but there are also hidden contents that people are not being informed about, such as the ultra-processed foods. Products may be labelled as low in fat, but they have other products in them to ensure that they will taste okay and still be low in fat. We need to not just look more at the overall messaging on packaging, but ensure that we reduce some other items in the products that are causing the obesity crisis.
Will Quince
My hon. Friend is absolutely right; we are constantly learning more. At the moment, I do not think there is a definition of an “ultra-processed food”. There has been a lot of work. We are learning more and more about the issue and it has recently exploded into the public domain. We need to ensure that more people are aware of and being educated about what is actually in their food, and that they are looking at labels. If we go back 20 years, we were all very much alive to E numbers —does everyone remember E numbers?—which no one looked at before. Now, we often look over the back of the packaging to see the number of E numbers in our products. The more that the public are educated and informed so that they can look out for these things, the better. My hon. Friend the Member for Harborough will be happy to discuss this further with my hon. Friend the Member for Erewash. I know that ultra-processed foods are an issue about which the public are concerned, and we certainly have more to do on food labelling.
Oral Answers to Questions
Maggie Throup Excerpts(10 months, 3 weeks ago)
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Steve Barclay
I pay tribute to my hon. Friend, who has long championed this issue. Indeed, he secured an amendment to the Health and Care Act as part of that campaign. We will be fulfilling our obligation by including an objective on cancer outcomes when we publish the next mandate to NHS England, and I hope he will see that as a welcome step.
Maggie Throup (Erewash) (Con)
To improve cancer waiting times and outcomes, and learning from the success of the covid vaccine roll-out where hard-to-reach cohorts were vaccinated in everyday settings such as shopping centres and football stadiums, will my right hon. Friend look at locating more community diagnostic centres away from formal clinical settings in hospitals and taking them out into the community?
Steve Barclay
This is an innovative and exciting development, thinking about how we offer services in different ways and bring those services to patients much more locally. The community diagnostic centres are a huge step forward in that, but we should also be looking at our engagement with employers, at how we use more tests at home and at the successes we have had, for example, with some of the screening programmes in order to offer more services closer to patients.
Steve Barclay
The hon. Gentleman is recycling this question almost as often as he recycles the non-dom funding. As I said at the last Health and Social Care Question Time, it is like the 1p on income tax that the Lib Dems used to promise, which was applied to every scheme going.
We touched on this issue at the last Question Time, and indeed at the one before: we have a commitment to a long-term workforce plan. The Chancellor made that commitment in the autumn statement, but it is a complex piece of work that NHS England is working on. It is important that we get the reforms in that plan right, and that is what we are committed to doing.
Maggie Throup (Erewash) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
We are still committed to reducing the advertising of unhealthy food, including the junk food watershed that will be implemented in 2025. Ahead of that, we are taking action on obesity across the board, including the sugar tax, which has cut the average sugar content of affected drinks by 46%, the calorie labelling that we have on out-of-home food in cafés and restaurants, and the location restrictions on less healthy food that are coming in from October.
Recovering Access to Primary Care
Maggie Throup Excerpts(11 months, 3 weeks ago)
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Steve Barclay
First, I thank the hon. Member for recognising, constructively, that this is a step in the right direction. As the quotes from the sector show, many working within pharmacy welcome it. As I said a moment ago, there are 20,000 more pharmacists than in 2010. The additional funding, including—directly to her question—for prescribing, will make the business model more viable and therefore support the workforce within the pharmacy sector.
We are working on IT as part of the recovery plan. There is a big read-across into the NHS app and how we better empower patients both to access their own medical records and to find the right services, including by being directed from the NHS app to pharmacies.
Maggie Throup (Erewash) (Con)
I welcome today’s announcement, which will undoubtedly widen access to primary care services. However, will my right hon. Friend consider investing in point-of-care diagnostic testing in pharmacies and GP surgeries, to speed up the diagnostic pathway and help to reduce NHS waiting times?
Steve Barclay
My hon. Friend raises a great point. I am extremely keen on how we can improve diagnostic testing and make it more accessible. As she knows from her time in the Department, early treatment is more effective and more cost-effective. Looking at more home testing, more testing at pharmacies and more work with employers to accelerate early detection is a win for patient outcomes and for delivering care in a more affordable way.
Oral Answers
Maggie Throup Excerpts(1 year ago)
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Maggie Throup (Erewash) (Con)
Building on the novel approach to clinical trials that was so successful for the covid-19 vaccines, what more is the Department doing to capture that success and the willingness of volunteers to come forward, as well as to streamline processes across participating bodies for clinical trials of future medicines?
Urgent and Emergency Care Recovery Plan
Maggie Throup Excerpts(1 year, 2 months ago)
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Steve Barclay
This statement is focused on urgent and emergency care. At Health oral questions and on other occasions, we often discuss the wider capital programme and the increased funding we are putting into that programme. Part of that is about outcomes and how we get more from that investment in capital. That is why through the NHS estate we are starting to standardise our builds, starting with the Hospital 2.0 programme. We will be rolling that out more widely through the estate. I am not familiar with the specific issues at the hon. Member’s local site, but I am happy to look at them after the statement.
Maggie Throup (Erewash) (Con)
I welcome this recovery plan and my right hon. Friend’s comments on the role community hospitals have to play in future. The 16-bed Hopewell ward at Ilkeston Community Hospital was re-opened ahead of this season to ease pressures, but it is due to be decommissioned in the spring. To aid with more efficient planning, will he work with my local community health trust and ICB to ensure that these beds form part of the extra beds for next winter and, more importantly, become permanent—rather than this ad hoc approach we have had until now?
Steve Barclay
Again, decisions on the estate are principally for the ICBs, but I am happy to look at any individual proposals my hon. Friend has on how we get more flow into the system, and that is about putting more capacity into the community.
Oral Answers to Questions
Maggie Throup Excerpts(1 year, 3 months ago)
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Neil O’Brien
In Derby and Derbyshire, for example, there are 495 more doctors and other patient-facing staff than in 2019. Step 1 is to have more clinicians, which we are doing through that investment. The hon. Member raises a point about Carr-Hill and the funding formula underlying general practice. There is actually heavy weighting for deprivation, and the point he raises is partly driven by the fact that older people tend not to live in the most deprived areas, and younger people tend to live in high IMD—index of multiple deprivation—areas. That is the reason for the statistic he used. Funding is rightly driven by health need, which is also heavily driven by age. We are looking at this issue, but the interpretation he is putting on it—that there is not a large weighting for deprivation—is not quite right.
Maggie Throup (Erewash) (Con)
In south Derbyshire there are now 133 more full-time equivalent clinical staff in general practice than in 2015. That includes nurses, physios and clinical pharmacists. What more is my hon. Friend doing to encourage more people to book an appointment with the most appropriate healthcare professional, rather than simply defaulting to booking a GP appointment?
Neil O’Brien
That is an excellent question. As well as having an extra 495 staff across Derby and Derbyshire, it is crucial that we use them effectively by having good triage. That is why we are getting NHS England to financially support GPs to move over to better appointment systems. That is not just better phone systems, but better triage.
Maria Caulfield
Can I just reassure the hon. Lady that we take sexual health services very seriously? Local authorities in England have received more than £3 billion from Government to support those services. We have produced a number of plans to improve sexual and reproductive health, from the HIV action plan in 2021 to the women’s health strategy, which focuses on sexual health as well.
Maggie Throup (Erewash) (Con)
The all-party group for diagnostics will hold its inaugural meeting on 8 February, and plans to conduct a short inquiry with the aim of providing a blueprint for how community diagnostic centres should operate in the longer term. As part of the inquiry, will my right hon. Friend commit to meeting members of the group to discuss what more the Government can do to maximise the role of diagnostics in addressing the pressures on the NHS?
Steve Barclay
I am very happy to give my hon. Friend that commitment. She is absolutely right to highlight the centrality of diagnostics and its importance in our overall plan to get elective numbers down.
NHS: Long-term Strategy
Maggie Throup Excerpts(1 year, 3 months ago)
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Maggie Throup (Erewash) (Con)
I begin by paying tribute to the hardworking staff of our NHS, including those working across Erewash, whether at Ilkeston Community Hospital, in our GP practices or pharmacies, and those who work in the care sector.
On the creation of the national health service in 1948, the public information leaflet sent to every household in the country stated:
“Everyone—rich or poor, man, woman or child—can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as tax payers, and it will relieve your money worries in time of illness.”
At that time, average life expectancy for men and women was 66 and 70 respectively. Alongside heart disease and cancer, people were still dying in large numbers from what today are preventable diseases such as tuberculosis, polio, measles and diphtheria—all now preventable through vaccines.
Countless lives have been saved by the NHS since its inception, which is in no small part thanks to the increasing use of diagnostic testing. Often overlooked as the less sexy side of medicine, the field of diagnostics is so much more than a blood pressure check, X-ray or computerised tomography scan. A simple blood test provides a multitude of clinical information, leading to the diagnosis of complex medical conditions. More and more in-vitro diagnostic tests are available in a rapid format, giving almost instant results close to the patient. I am sure all Members in the Chamber today will have used a diagnostic test recently in the form of a lateral flow test for covid. Indeed, we will all have seen the benefits of such devices, which are a useful and invaluable tool that help to prevent serious illness and disease by diagnosing conditions at an early stage, allowing for timely treatment and helping to prevent more serious illnesses.
We are, however, yet to capitalise on the full potential of diagnostics as a way of relieving pressure in the NHS system, and helping to reduce the backlog—one of the Prime Minister’s top priorities. For example, the British In Vitro Diagnostics Association estimates that at least 3% of Accident and Emergency admissions are for chest pain symptoms. A simple but sensitive blood test for cardiac troponin can be used to rapidly diagnose or rule out a heart attack in patients attending A&E with chest pains, allowing for either early discharge or admission for further treatment. That could potentially save billions of pounds and is better for the patient, but it requires changes to well established protocols within the department, and links with the hospital laboratory. I am sure that is the type of change the Secretary of State was referring to when he spoke about productivity. This is about the productivity of procedures and processes that fully match the technology available today, rather than that available 74 years ago. I therefore seek the Minister’s assurance that in-vitro and in-vivo diagnostics will be given the recognition they justifiably deserve in all forward planning by her Department, as an effective way of reducing pressures on our NHS and social care services.
I believe this debate should be framed within a wider global context, and not localised just to issues affecting the NHS in the UK. The Guardian newspaper—a favourite of the Labour party—recently highlighted that in France more than 6 million people, including 600,000 with chronic illnesses, do not have a regular GP, and 30% of the population does not have adequate access to health services. There are similar pictures in Germany, Spain—I could go on. This is a Europe-wide problem, and not a unique crisis in the NHS as Opposition Members would like the public to believe.
I believe the onus is also on us as individuals to use our precious resources appropriately. I hear from my local GPs that people are seeing them who have had a cough for just four hours, as opposed to four weeks, and that people phone 111 instead of 999, or 999 instead of 111. People turn up at A&E when they could have got great advice from their local pharmacy, and others do not appreciate that some of their lifestyle choices will have a huge negative impact on their health. There is still a lot of work to be done on simple and effective public messaging. We must all make our own contribution—both financial and from the perspective of personal responsibility—to ensure that the NHS remains viable because, like any form of insurance, although we may not need it today, we might well need it tomorrow.
Cancer Services
Maggie Throup Excerpts(1 year, 4 months ago)
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Steve Brine
Indeed. The reason why we had Dame Cally and Professor Peter Johnson, who is the national clinical director for cancer, into the Select Committee a couple of weeks ago is that the NHS has set itself a deadline of next spring—it was this spring—to get back to the 62-day wait. I have everything I have crossed that they can get there, but they need to make it happen. I know they are relentlessly focused on that, and the Minister is relentlessly focused on that, but we have got to help them get there.
The Committee also heard about the challenges facing surgery and radiotherapy services, which makes it rather timely that the hon. Gentleman intervened on me at that point, as I suspect he will speak about it later. Professor Pat Price, who he and I are going to meet early in the new year, is a consultant oncologist at Imperial College in London. She told us that radiotherapy services were lacking staff and machines to be able to deliver the best possible care and that services were struggling to deliver the level of activity needed to catch up with the cancer backlog. I will let the hon. Gentleman expand on that a bit later. Professor Mike Griffin, professor of surgery at Newcastle University, also highlighted workforce shortages as a significant barrier to effective cancer surgery, but he also told us about the organisation of services. Because cancer surgery is often co-located within general, acute and emergency care, it can be subject to delay because of capacity shortage, and that was a particular problem during covid in some places, but not everywhere.
My trust, Hampshire Hospitals, did a brilliant job to keep cancer surgery on track at all times by doing it offsite. I pay tribute to Alex Whitfield and her team at Hampshire Hospitals for the way they organised with Sarum Road private hospital in particular to ensure that patients continued to get their cancer treatment. Professor Griffin called for more ringfenced hubs to be developed so that cancer surgery can continue even when there are severe pressures on acute care, and I hope the Minister refers to that when she winds up.
Growing the workforce, investing over the long term in machines and IT and reorganising services to create more cancer surgery hubs are all in the Government’s gift, which is why we recommended that they consider those actions in developing the 10-year plan. Without a wider focus on removing the barriers to the NHS delivering the best possible cancer treatments, the potential gains of earlier diagnosis might not be realised. Given the number of people presenting with suspected cancer at the moment—it is good that they are presenting, and many of them will turn out not to have cancer— if it is found that they do have it, we need to move on that. That is why treatment is the other side of the same coin.
Just as further progress on early diagnosis will depend on research and innovation to develop new tests, improving cancer treatments will require new and more advanced techniques to be developed and implemented by the NHS. We found in the Committee report that the UK is a genuine world leader in research. There are unique aspects to the NHS that make it an effective partner for research organisations. We also heard that there are significant barriers to researchers accessing the data they need for quick and equitable patient recruitment to clinical trials and for staff having the time they need to take part in research. The Government have set out several steps they are taking to improve access to data and improve flexibility for staff wanting to take part in research, and that is welcome, but research by Cancer Research UK has found that the UK’s recovery from the pandemic in clinical trials continues to be outpaced by other comparable countries.
NHS England told us that supporting clinical research into cancer is not its responsibility, so it is clear that a wider effort is needed to make sure that cancer research taking place in the NHS is well supported and aligned with the priorities for cancer services. That is another reason why the plan is important.
Finally, we heard that there is significant variation in outcomes for people diagnosed with cancer, depending in part on the type of cancer they are diagnosed with, but also demographic factors. The Government told us that they would be addressing these differences through the levelling-up White Paper, but also through the health disparities White Paper, by addressing issues such as smoking and obesity, which are more prevalent in our more deprived communities.
On that, there is a story in today’s press which suggests that Britain has the biggest increase in early onset diabetes in the western world. That is a huge concern. I am not suggesting that diabetes is cancer; I am saying that we have many suggested actions to reduce obesity around junk food advertising and stuff that follows on from the sugar tax. Much of that has still not been implemented. Rumours abound—there are always rumours around here—that the Government are seeking to delay junk food advertising restrictions until 2025. I hope that is wrong. I invite the Minister to respond to that when she winds up and, if not, to take that away.
Maggie Throup
I agree 100% with his concerns about the potential watering down of the much-needed anti-obesity measures. Does he agree that it is important that we reflect what the public want? The public are in agreement with banning advertising on TV for particular foods that cause obesity. If we want to keep the public on our side, surely we have to follow their wishes, as well.
Steve Brine
I think that is right. The public are clear on this. I get that there are different views across this House and that there are those who disagree with much of the work that my hon. Friend and I did in government to push some of those measures on preventing obesity. I could agree with them, but then we would both be wrong. At the end of the day, obesity is a driver of diabetes, and obesity is a driver of certain cancers. We must take that seriously. Next year, the Select Committee will be doing a huge piece of work on prevention, and we will be returning to that. I hope that Ministers are aware of that.
The recognition of the importance of health in the levelling-up White Paper is welcome, but without specific actions to address health disparities, this agenda will be at risk, so it is vital that the Government take up the prevention agenda again to stop people developing cancer in the first place. I hope the Minister will have some good news for us on that front, and I recommend that she returns to the prevention Green Paper that we published back in 2019, which contains lots of helpful ideas in that respect.
Maggie Throup (Erewash) (Con)
It is a pleasure to follow the hon. Member for Easington (Grahame Morris), who speaks with much knowledge and personal experience, which makes a huge difference. I welcome the report of the Health and Social Care Committee on cancer services, and the subsequent response from the Government. I commend all Select Committee members involved in producing that excellent report and I have every confidence that more quality reports will be produced on this subject and many others under the leadership of my hon. Friend the Member for Winchester (Steve Brine).
I am grateful for the opportunity to discuss the report further. I will focus on community diagnostic centres and the role of diagnostics more generally in supporting cancer services. With 91 community diagnostic centres already open, a further 19 announced yesterday and 40 more to come before March 2025, this is definitely a good news story. I am delighted to have a community diagnostic centre in my constituency at Ilkeston Community Hospital. It opened a year ago. In its first eight months, it delivered more than 6,500 tests, checks and scans. To date, across all the community diagnostic centres that have opened, 2.4 million tests, checks and scans have been carried out. That is excellent news, but not the full story.
The success of the upcoming 10-year cancer plan—we hope that it is upcoming and has not been shelved—as well as tackling the backlog, elective recovery plans and levelling up, depends heavily on diagnostics. Diagnostics, whether in vivo or in vitro, are crucial to the overwhelming majority of patient pathways and are central to health outcomes. I know that the royal colleges, specifically the Royal College of Radiologists, and many other organisations support investment in improving cancer services across England and, at the same time, addressing historic postcode lotteries created over recent decades.
Community diagnostic centres have an important role to play in this, but they bring their own problems. There are already existing chronic workforce shortages and ageing equipment that prevent cancer diagnosis and improvements in cancer care. There is a shortfall of 30%—1,453—full-time equivalent clinical radiologists and a 17%—148—shortfall of clinical oncologists. Those shortfalls vary in severity for each region, but I take a particular interest in the east midlands, where my constituency is. The east midlands has the same shortfall of clinical radiologists as the national average, which is 30%, but the shortfall in clinical oncologists is above the national average, at 28%, while 19% of clinical radiologists and 18% of clinical oncologists are forecast to retire in the next five years, adding even further pressure on a workforce already struggling to meet demand.
A global study has found that a treatment delay of four weeks, which could be caused by a workforce shortage, is associated with a 6% to 13% increase in the risk of death, and that worries me as it could have a detrimental impact on the outcomes for cancer patients across Erewash, however hard those in post work. If we are to improve cancer services in England, we must invest in clinical radiology and clinical oncology training places to ensure that there are enough clinicians throughout a cancer patient’s pathway. I know there is competition for clinicians across all disciplines, but, if we are to improve outcomes for our cancer patients, we need to attract radiologists and oncologists.
I pay tribute to everyone involved in this aspect of medicine, whatever their role, and of course our NHS workforce across all disciplines. I include all the amazing people, whether healthcare professionals or volunteers, at my local hospice, Treetops Hospice Care, who each day make the end of life a better experience for so many of my constituents—a huge thank you to everybody.
I have mentioned that one of the other barriers to community diagnostic centres reaching their full potential is the lack of investment in equipment in the existing system. The UK has fewer scanners than most comparable countries in the OECD: it has 8.8 CT scanners per million of the population while France has 18.2 and Germany has 35.1; it has 7.4 MRI scanners per million of the population, while France has 15.4 and Germany has 34.7. Industry surveys have shown that one in 10 CT scanners and nearly a third of MRI scanners in UK hospitals are over 10 years old, and 10 years is usually the age at which this equipment can be considered obsolete and must be replaced.
In June, the Royal College of Radiologists surveyed a representative sample of its members in England about equipment needs, revealing that 49% of clinical radiologists and 21% of clinical oncologists said they do not have the equipment they need to deliver a safe and effective service for patients in their department or cancer centre. Only 32% of clinical radiologists and 54% of clinical oncologists said their equipment is fit for purpose, with the rest saying it is substandard or only acceptable to some extent. There must be a comprehensive audit of all diagnostic equipment across England so that investment is made in the right equipment where it is needed most.
I have some questions for the Minister, for whom I have great respect. I know just how much she cares about getting it right for patients. First, are clinical radiology and clinical oncology training places being invested in to ensure there are enough clinicians throughout a cancer patient’s pathway and, if so, will that investment include both the 50% of trainee costs covered by Health Education England and the other expenses incurred by trusts? When it comes to equipment, are community diagnostic centres taking the investment preference over and above the replacement of obsolete diagnostic equipment in hospitals, and will an audit of all diagnostic equipment be carried out? Of course, as has been mentioned, one of the elephants in the room—or, more correctly, in the Chamber—is: how do we help to prevent people from getting cancer in the first place?
Across the UK, there are huge health disparities. When heat map after heat map is laid over the UK —whether for high smoking rates, high levels of obesity, high rates of cardiovascular disease, high rates of cancer, excess alcohol consumption or poorer health outcomes—they all show that the same areas are affected detrimentally. Therefore, we need to consider how we are going to achieve the Government’s targets to become smoke-free by 2030 and to halve childhood obesity by 2030. Perhaps, after the festive season, there can be a fresh look at measures to tackle excess alcohol, because alcohol, smoking and obesity are all markers of and can all cause cancer. If we are serious about tackling cancer, we need to be serious about preventing it as well, and it is never too late. We are always excited to hear about new therapies that have been proved to be effective, but surely we need to get as excited about preventing cancer in the first place, so my final question for the Minister is: when can we expect the health disparities White Paper to be published?
There are many innovations to harness across all diagnostics, while community diagnostic centres, genomics and AI have a role to play, as do many more innovations, but until the unprecedented challenges—including the huge workforce pressures, out-of-date equipment and preventive measures continuing to be watered down—are addressed, cancer diagnosis and treatment will never reach their true potential. The Government state in their response to the Select Committee’s report that
“the Government’s forthcoming 10 Year Cancer Plan will set a new vision for how we will lead the world in cancer care, including ensuring we have the right workforce in place.”
That is an admirable ambition, and we all want the Government to succeed. Indeed, they must succeed, as this will be transformational for the life chances of my constituents in Erewash and those of the whole nation. As my hon. Friend the Member for Winchester has said, I look forward to reading the Government’s 10-year cancer plan very soon.