Vaping

Martyn Day Excerpts

Wednesday 1st November 2017 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I thank the hon. Member for Dartford (Gareth Johnson) for securing this debate on nicotine vapour products. I fully agree with him about their potential to save thousands of lives. We should always bear that in mind. I am grateful that he clarified the point about the public perception of the safety of vaping versus traditional cigarettes. We need to get that important message out there, especially given that some of the briefings we have seen show that people think it is as dangerous. Clearly, it is not.

I also agree that we need a fact-based approach, and that a lot more research needs to be done. I am grateful to the hon. Member for Ipswich (Sandy Martin) for mentioning some of the studies, and I look forward to seeing their results. The hon. Member for Dartford mentioned one of the most interesting dilemmas, which relates to the rules on advertising and the anomalies. How do we accurately advertise the benefits of this product to the people who would benefit from it—the 7 million smokers who are not vaping—without making it attractive and sexy to people who do not smoke at all? Finding that balance will be challenging, and I do not envy anyone who has to come up with the regulations that deal with that problem.

The positive case in favour of vaping has been well made today. Most of the harm caused by cigarettes and other smoked tobacco products comes not from the nicotine but from the smoke, which contains a huge number of carcinogens. I am very grateful to the Royal College of Physicians for its work in estimating that the hazard from long-term vapour inhalation is about 5% that of the harm of smoking. We need to get the message out to smokers that vaping is much safer. More than one quarter of all cancer deaths can be attributed directly to smoking. Smoking is associated with 10,000 deaths and about 128,000 hospital admissions each year in Scotland alone. It costs the Scottish NHS more than £300 million to treat smoking-related illnesses. It does not take a genius to work out that it is in the interest of our public purse to encourage people on to smoking cessation products.

A statistic that I have seen—I have forgotten which briefing it was in; it may have been by the Independent British Vape Trade Association, but I apologise if I have misattributed it—states that for each person we can persuade to stop smoking, we will save about £74,000 in public health benefits. That would have a huge impact, so we need to take it very seriously.

Smoking is, without any doubt, the primary preventable cause of ill health and premature death, which is why the Scottish Government are taking radical action to attempt to stub it out. We aim to create a tobacco-free generation by 2034. Smoking rates, especially among young people, are at record lows across Scotland.

We also share the view of the Royal College of Physicians and ASH that e-cigarettes should be regulated to encourage their use as a means of stopping smoking but to discourage their use by non-smokers. That is very much the dilemma that we have with advertising.

In Scotland, we know that e-cigarettes are almost certainly safer than cigarettes and have a role to play in helping people to quit smoking, but I certainly do not believe that children or young people should have access to them. A public consultation paper, “A Consultation on Electronic Cigarettes and Strengthening Tobacco Control in Scotland”, was launched in October 2014, following which the Scottish Government introduced the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016. The Act had cross-party support, although a number of concerns were raised during debates in the Scottish Parliament. Among other measures, it banned the sale of NVPs to under-18s, made it illegal to buy NVPs for under-18s and required all shops to have an age verification policy. That is key to preventing a new generation of people from using nicotine-based products.

In Scotland, there has been record investment in NHS smoking cessation services. We know they have a cost benefit for every pound we spend. My area is served by two NHS trusts: Forth Valley and Lothian. This issue falls under devolved competences, so it is worth pointing out that neither trust outwardly endorses e-cigarettes, unlike some stop-smoking services elsewhere.

Although I have been unable to ascertain accurate local figures, ASH states that there are 3 million vapers across the UK, half of whom have given up smoking, and that about 97% of all vapers are either current smokers or ex-smokers. The information available suggests that vaping is not currently a gateway to tobacco products and that it helps people to stop smoking, so it is genuinely a positive measure.

Vaping also helps to reduce second-hand smoke, as the hon. Member for Gordon (Colin Clark) has said. In Scotland, the number of children affected by second-hand smoke in the home has reduced from 11% to 6%. I do not know what proportion of that reduction was caused by NVP products and what proportion was caused by the “Take it right outside” campaign, but both have clearly contributed to it.

There is clearly a role for vaping to play in helping people to stop smoking. Despite my thick throat—I have managed not to cough today—I have never smoked in my life, but I have many friends who have done so. Looking back over the years since the smoking ban was introduced in Scotland in 2006—I thought it was a birthday present for me, as it was introduced on my birthday, 26 March—I can see that it has certainly improved the lives of many people. I have friends who gave up largely due to that event. Some managed to stop through sheer willpower—a minority, I have to say—while others struggled and used different cessation products. Vaping is probably the most popular method in my social circle. It certainly makes a real difference.

Vaping is significantly less harmful than continuing to smoke. Harm reduction is not as good as cessation, but it is way better than smoking. Realistically, given how addictive nicotine products are, that may be the best we can expect for many people. I believe that vaping can lead to a serious reduction in smoking. I welcome this debate, and I thank the hon. Member for Dartford for securing it.

Tobacco Control Plan

Martyn Day Excerpts

Thursday 19th October 2017 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the right hon. Member for Rother Valley (Sir Kevin Barron) for securing this important debate on the tobacco control plan for England. I congratulate him on his work over the years and, as a testament to that, on the general consensus today.

Scotland has its own strong tobacco control strategy. The Scottish Government have implemented and overseen a number of progressive actions on smoking, and I am grateful to the hon. Member for Stirling (Stephen Kerr) for listing many of them, which shows the strength of the consensus in the Chamber to which I referred. Record investment in NHS Scotland on smoking cessation services has helped hundreds of thousands of people to quit smoking, and our aim is to create a tobacco-free generation by 2034. Last year, the Scottish Parliament celebrated the 10-year anniversary of the smoking ban and welcomed comments from the World Health Organisation praising our excellent example of global public health leadership.

Not everything that we want to achieve can be done in isolation, however. A good example of something that required UK-wide co-operation was the introduction of standardised packaging for tobacco products. However, I want to focus on another area that requires co-ordination across the jurisdictions of the UK, and indeed of Europe and the world: the illicit tobacco trade. I press the Minister to report on progress to secure a Europe-wide traceability system, which is still being discussed at the European Commission, and to confirm that the UK Government will rapidly ratify the illicit trade protocol, the first subsidiary treaty under the WHO framework convention on tobacco control.

Illicit tobacco undermines public health policy because it makes tobacco products available at a low price and often in branded packaging. It damages public revenue because it reduces the take from tobacco taxation. Figures from Her Majesty’s Revenue and Customs for 2015-16 estimated that the illicit market share in the UK for cigarettes was 13%, with the figure for hand-rolling tobacco 32%. The tobacco tax gap in that period was estimated at £2.4 billion, so clearly the illicit trade undermines our tobacco control strategy.

The involvement of the major tobacco manufacturers in the illicit trade is a major concern. Their involvement is evidenced by the fact that their genuine products—not counterfeit ones, or so-called cheap whites—form the largest share of the illicit market. The Scottish Government have committed to continue to support strong national and local alliances to tackle illicit tobacco. In 2009, the enhanced tobacco sales enforcement programme was introduced to enable the Scottish Government and trading standards officers throughout Scotland to work with Her Majesty’s Revenue and Customs to tackle the availability of illicit cigarettes and their sale to people under 18.

As we all know, there is an open border between England and Scotland, and if the amount of illicit tobacco rises in England, it will affect Scotland, as well as Wales and Northern Ireland. Scotland needs a commitment from the UK Government that they will ensure that local authorities in England are adequately resourced to conduct the fight against the illicit trade. At present, that is absolutely not what we appear to have.

[Bob Blackman]

The hon. Gentleman makes a powerful point. Does he concede that the tobacco companies themselves deliberately overproduce products for certain countries, knowing that they will be brought into the UK by illicit means and sold as illicit products? The tobacco companies themselves have a key role in this.

[Martyn Day]

The hon. Gentleman makes a good point. The tobacco companies are indeed the villains in this scenario.

For the last 20 years, the UK has had an effective and well-resourced anti-smuggling strategy, and HMRC’s tax gap estimates have fallen by about a half since the peak in 2000, but there is every reason to fear that that success is under serious threat and that the progressive reductions in the market share of illicit tobacco may soon go into reverse. That is already suggested by recent small upticks in HMRC’s figures.

There is a specific problem for local authorities. Figures from the Chartered Trading Standards Institute published at the end of last year showed that the total budget for trading standards across Great Britain had fallen from £213 million in 2009 to only £124 million in 2016, and that the number of trading standards staff had fallen by more than half. That means that the chance of catching someone selling illicit tobacco or supplying it to an unscrupulous retailer or local consumers is significantly reduced. Information from local enforcement action can be used to help to track the supply chain, and less information means less tracking and intelligence, which cannot be in the interests of either public health or the public finances.

I urge the UK Government to make rapid further progress at the European and international level. The EU’s revised tobacco products directive establishes a new traceability system for all tobacco packaging, and that requires a coding system that can be accessed by enforcement officers to give information about the movement of products through the supply chain from manufacturer to retailer—this addresses the point made by the hon. Member for Harrow East (Bob Blackman). The system also requires security features to prevent tampering and ensure that products are genuine.

The European Commission has been carrying out consultations and research on the system’s specifications. While I consider its current proposals to be largely constructive and sensible, there are tobacco industry systems that the manufacturers are desperate to see states adopt to implement the directive requirements. The coding system developed by the four major manufacturers is known as Codentify, although it has now been hived off to a nominally independent company. In my opinion, it does not fulfil the requirement for independence in the protocol to eliminate illicit trade in tobacco products. That protocol explicitly requires Governments to take responsibility for control measures, rather than relying on industry self-regulation, which has clearly failed to deliver in the past. I therefore ask the Minister to confirm that the UK Government intend to participate in the European traceability system, and also to state clearly that they will work to ensure that its specifications include robust requirements for independence from the tobacco industry. The industry must not control the traceability system, either directly or indirectly through proxies.

A global tracking and tracing system is offered by the World Health Organisation’s illicit trade protocol, which was rightly negotiated as the first subsidiary treaty under the framework convention on tobacco control. The EU system will have to be consistent with the protocol, but it is obvious that a working global system would be even more effective than one that is confined to the EU. The protocol also contains other important provisions on control of the tobacco supply chain, including the requirement for manufacturers to conduct due diligence with their customers and to keep proper records of their transactions.

The UK Government have stated that they will become a party to the protocol on numerous occasions, including in their new tobacco control plan, and I welcome those statements, but they are yet to do so. I ask the Minister to give a clear commitment that the UK Government will move rapidly to ratify the protocol. A date for ratification would be excellent. It certainly needs to happen before 10 July 2018, which is the deadline if the UK is to be able to participate in the first meeting of the parties in October 2018 in Geneva.

Like others who have spoken, I welcome the tobacco control plan for England. It is not perfect, but it does represent a real commitment to tackling the smoking epidemic. I trust that it will also strengthen continuing co-operation with the Scottish Government, as well as the Welsh and Northern Ireland Governments, in addressing this No. 1 public health priority. However, the approach still needs to be strengthened and supplemented, and action against illicit trade is at the top of my “to do” list.

I very much hope that the Minister will be able to make the commitments that I have called for today, along with other Members on both sides of the House, and I look forward to the arrival of the first truly smoke-free generation throughout the United Kingdom.

Contaminated Blood

Martyn Day Excerpts

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

We obviously want to hear from as many of the affected people as possible, and we will reflect on their representations. If they want to be very clear and blunt about the role of the Department of Health, we need to hear those representations so that we can make the best decision about who takes forward the inquiry.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I thank the hon. Member for Kingston upon Hull North (Diana Johnson) for asking this urgent question and pay tribute to her for continuously pushing on this important subject to ensure that we get justice for those so tragically affected. The inquiry must get the right answers, and it must command the confidence of those affected. Will the Minister confirm when a decision will be made as to which Department will lead on the establishment of the inquiry? Does she think it is right for the Department of Health to lead it? Will she confirm that the inquiry will include the families and victims, so that it is sensitive to what they want to know? Will the Government ensure that the inquiry will have to look at all matters, including documents, patient records and things that were altered and hidden, and that the things hidden behind public interest barriers will be opened up, so that light can be shed on this matter, as was the case with Hillsborough?

[Jackie Doyle-Price]

To be clear, the Department of Health is the sponsoring Department for the inquiry, which will be entirely independent. It is yet to be determined who will oversee it. Clearly, having made the statement and expressed our intention to hold an inquiry, we need to consult to make sure that that inquiry reflects on and answers the hon. Gentleman’s questions. Central to that will be the need for it to be seen to be transparent, open and fully independent. Once it is established, the inquiry will be entirely removed from the Department of Health. That should be enough to inspire confidence, provided we get the consultation right so that we get the remit right.

NHS Shared Business Services

Martyn Day Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

Absolutely. There is a short-term and long-term lesson. The short-term point is that it is unlikely this would happen again because it was paper correspondence, and we are increasingly moving all the transfer of correspondence to electronic systems. The longer-term point is exactly that—[Interruption.] An Opposition Member mentions cyber-attacks; they are absolutely right to do so, because of course we have different risks. This clearly indicates that we need better checks in place, so that when we trust an independent contractor with very important work, we know that the job is actually being done, and that did not happen in this case.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The NAO’s findings are deeply concerning for the families of patients caught up in this chaotic shambles. For those involved and the wider public, this will only deepen their mistrust and misgivings in how the Tories are running the NHS; we can be grateful that they are not in charge in Scotland. Surely it is simply astonishing that a company partly owned by the Department of Health failed to deliver 500,000 NHS letters, many of which contained information critical to patient care. Not only were 1,700 people potentially at risk of harm, but thousands of others were put at risk. Was this SBS contract properly scrutinised by the Secretary of State? Was patient care or cost-cutting at the forefront of that decision? Why did he publish a vague written statement in July 2016 when he actually knew what was going on four months earlier?

[Mr Speaker]

Splendid—the hon. Gentleman was within his time. He gets an additional brownie point.

HIV Treatment

Martyn Day Excerpts

Wednesday 29th March 2017 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mrs Main, and to take part in today’s debate. I am grateful to the hon. Member for Finchley and Golders Green (Mike Freer) for securing the debate, and for his detailed and informative speech, as well as for the work of the all-party group on HIV and AIDS in producing an excellent report, “The HIV puzzle”. The report notes, on the basis of evidence from charities, civil society groups and the pharmaceutical industry, significant upheaval to HIV and sexual health services since the Health and Social Care Act 2012 was implemented.

The findings of the report are very worrying. A joined up, multi-sector approach to support and care for those at risk of or living with HIV is crucial to its prevention. The UK Government should reflect seriously on how they can improve HIV services in the light of that body of evidence. The report is concerned with HIV services in England, but its findings will be of interest throughout the UK. Communicable diseases do not, after all, recognise administrative or national borders. The report recognises:

“In Scotland sexual health sits under Blood Borne Viruses in the health system, which Dr Gordon Scott argues makes it easier to set priorities.”

In that spirit, and given that the issue is devolved, I hope that the comments of a Scottish Member about HIV in Scotland will also be of interest to Members from other parts of the UK.

There were 6,095 new diagnoses of HIV across the UK in 2015, and 300 of those were in Scotland. The latest figures for NHS Lothian, which covers the West Lothian part of my constituency, tell us that there are 1,589 people diagnosed and living with HIV, and that 70 of those were diagnosed in the past year. At the other side of the country, Glasgow has experienced its biggest rise in HIV infection for three decades. The issue will affect every community in the country. We all have our challenges, especially when we consider that it is estimated that about 13% of people may be undiagnosed, with all the consequent risks of onward transmission, as well as the impact on those people of being unable to get access to care and treatment.

Lifetime treatment costs the NHS between £280,000 and £360,000 per patient—a not insignificant amount. Prevention of HIV infection remains a priority for the Scottish Government. There is no room for complacency on communicable diseases such as HIV. We continue to provide funding to NHS boards for HIV prevention, as well as supporting organisations such as HIV Scotland, with £270,000 in funding this year. There is of course no one-size-fits-all approach to HIV prevention. That is why in Scotland we are providing Waverley Care with £45,000 in funding this year for its HIV prevention and support work with African communities.

A joined-up approach to HIV care is vital to ensuring that infected people can get the care they need to live life as independently as possible. The Scottish Government’s sexual health and blood-borne virus framework 2015 to 2020 is continuing to build on achievements made under the original framework document of 2011. The HIV Testing Kits and Services Revocation (Scotland) Regulations 2014 lifted the ban on the sale of instant-result testing kits in Scotland. In the light of that change, and following leadership on the issue by HIV Scotland, a subgroup of the executive leads group published a questions and good practice document on instant-result self-testing in March 2014. The good practice document was the first of its kind in the world and has since been recognised internationally as an example of good practice by the World Health Organisation.

All NHS boards in Scotland have protocols in place in relation to HIV post-exposure prophylaxis—PrEP—for sexual and non-sexual exposures. The framework makes clear the importance of a multi-agency approach to sexual health and blood-borne viruses. Truly delivering on the framework outcomes in the long term will require the involvement of patients and service users, NHS boards, local authorities, the third sector, academics, the media and, indeed, the general public. The integration of health and social care in Scotland is one of the most significant reforms since the establishment of the NHS. We are the only UK nation to have legislated to put NHS boards and local authorities under statutory duties to work together. That is helping to tackle priorities in the framework to work towards as joined-up an approach as possible to caring for people with long-term conditions and disabilities, such as HIV.

Evidence generated in late 2014 and early 2015 indicates that the HIV infection is being transmitted among a small population of highly chaotic, vulnerable and often homeless people who inject drugs. These transmissions reinforce the importance of prevention work with such populations. The Scottish Government are working with health boards, schools and the police service to ensure that vulnerable groups can get the right support to prevent and treat infection. The framework update includes commitments on development of care services with local authorities; tackling social stigma through education; encouraging HIV testing to be regarded as routine; and NHS boards and partners offering testing to vulnerable groups using innovative approaches such as delivering testing in the communities themselves.

The Scottish Government are also considering the recommendations of an independent review of PrEP. The European Medicines Agency has granted a licence for Truvada as PrEP for HIV in adults at high risk. The Scottish Government’s chief pharmaceutical officer has written to its manufacturer to ask it to make a submission to the Scottish Medicines Consortium. The Scottish Government’s position is that all medicines must be licensed before they can be made routinely available on the NHS, but we recognise that some people are already buying PrEP drugs privately in Scotland. It is important that people who are doing so receive appropriate advice from and are monitored by clinicians. The executive leads network for the sexual health and blood-borne virus framework is considering the findings of the PrEP short life working group, which considered a range of issues associated with the use of PrEP. I look forward to hearing about the outcomes.

In conclusion, I commend the work of the APPG and its report on this issue. There are undoubtedly lessons for us all within it.

Rare Diseases Strategy

Martyn Day Excerpts

Tuesday 28th March 2017 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship today, Mr Pritchard, and I am grateful to the hon. Member for Bath (Ben Howlett) for securing the debate, for his informative speech and indeed for the work that he has undertaken with the all-party group.

As we have heard, rare disease affects considerably more people than we would at first imagine, with over 3 million people across the UK likely to suffer from a rare disease at some point in their lives. The Scottish Government’s implementation plan for rare diseases in Scotland recognises this fact in its title: “It’s Not Rare to Have a Rare Disease”.

My own constituency has had, as I am sure every other constituency has had, several fairly high-profile rare disease cases. These cases attract media attention and affect entire communities, not just the family directly affected; often, communities have to raise funds to help with treatments and raise awareness. Such a case was that of Kirsty Reid from Whitburn. In 2015, after being diagnosed with pseudomyxoma peritonei—it is one of those conditions where the acronym, PMP, is slightly easier to say—Kirsty raised over £7,000 to help others diagnosed with the rare condition, which affects only two people per million.

We also have a charity called Shavon’s Journey, which was set up in 2012 following the death of Shavon Morton from Grangemouth after a long fight with aplastic anaemia, a condition in which bone marrow does not produce sufficient new cells to replenish blood cells. I could go on with other examples, but I think we all get the point— rare diseases touch the lives of many, and therefore the importance of raising awareness, and of improving diagnosis and ultimately the services and treatments to sufferers, cannot be overstated.

[Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP)]

I thank my hon. Friend for giving way and I congratulate the hon. Member for Bath (Ben Howlett) on securing this debate. The Teddington Trust, which is jointly run by one of my constituents, supports people living with xeroderma pigmentosum, who lack the DNA repair mechanism necessary to repair damage caused to the skin by exposure to ultraviolet sunlight. Does my hon. Friend join me in commending the work of the Teddington Trust and the work of many other rare disease charities in supporting those living with rare diseases and keeping rare diseases on the political agenda?

[Martyn Day]

I do indeed join my hon. Friend in commending the work of so many good charities and organisations in this field.

The Scottish Government’s implementation plan, which I have mentioned, sets out the Scottish approach to delivering the UK strategy commitments. Key to the plan is recognising the importance of timely and accurate diagnosis, and allowing treatments to start as soon as possible. The Scottish Government have substantially increased access to new medicines, particularly for cancer, due to reforms and investment in recent years, which has led to a marked increase in uptake of orphan, ultra-orphan and end-of-life medicines.

Last year, the Scottish Government launched a review of the way drugs are assessed for NHS use, which was led by the former NHS Fife medical director, Dr Brian Montgomery. His review looked at how changes made to the Scottish Medicines Consortium process in 2014 had affected access to medicines for rare and end-of-life conditions. The review’s recommendations set out how the process for appraising medicines can be made more open, transparent and robust, and the Scottish Government have committed to implement all 28 of its recommendations, such as a new approval pathway, outwith the standard SMC process, for these high-cost medicines for very rare conditions.

The Scottish Government’s peer-approved clinical system, or PACS, has helped to give patients and clinicians a better say in which new medicines are approved by the SMC for use in NHS Scotland, particularly those used for rare or life-limiting conditions. PACS was first piloted in Glasgow in 2015 and has been successfully rolled out across Scotland, and a second tier of PACS will now be introduced to replace and build on the existing individual patient treatment request system. A new national appeals process will be introduced through this new tier of PACS, which will include consideration of equity of access with other parts of the UK as a material part of the decision-making process.

It is also perhaps worth saying at this point that the Scottish Government are happy to work with the National Institute for Health and Care Excellence, and indeed with any other countries, to improve access to medicines in Scotland and to obtain a fair price from the pharmaceutical industry. I emphasise that last point, because we now need the pharmaceutical companies to do their bit by bringing forward fairer prices for new medicines, so that access can be as wide as possible.

Finally, we know that the Health Secretary has said that he does not expect the UK to remain within the European Medicines Agency, which raises a number of concerns about potential delays in new drugs reaching patients in the UK. Sir Alasdair Breckenridge, who was the chairman of the UK’s drug regulator—the Medicines and Healthcare Products Regulatory Agency—for almost a decade, said last month:

“The UK market compared to the European market of course is small and they may decide not to come to the United Kingdom. So therefore there will be delay in getting new drugs—important new drugs, anti-cancer drugs, anti-infective drugs—for patients in the UK.”

He is not alone in saying that; David Jefferys, vice-president of Japanese drugs firm Eisai, has also warned that UK patients could face delays of up to two years. I would be grateful if the Minister could advise in his response to the debate how these dire warnings can be prevented from becoming a reality.

O’Neill Review

Martyn Day Excerpts

Tuesday 7th March 2017 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Streeter, and to take part in this important debate, which has been well informed and highly consensual. I am grateful to the hon. Member for Thirsk and Malton (Kevin Hollinrake) for securing it. This issue is one of the greatest global health challenges facing our generation. I agree thoroughly that it is potentially devastating and that it is already happening.

[Mr Philip Hollobone in the Chair]

Worldwide, antimicrobial resistance currently kills an estimated 700,000 people annually, and approximately 70% of known bacteria have developed resistance to one or more antimicrobials. The O’Neill review sends a clear and stark warning to us all that we must act for the sake of our economy and, more importantly, our health. Lord O’Neill estimates that by 2050, 10 million people globally could die each year because antibiotics are losing their power to tackle common infections, and that a quarter of those deaths will be caused by tuberculosis, whose attributes make TB bacteria more likely to develop resistance. It is worth noting that the O’Neill review final recommendations highlighted that

“tackling TB and drug-resistant TB must be at the heart of any global action against AMR.”

It is also projected that antimicrobial resistance could cut global GDP by 3.5% in the same time period, which amounts to $100 trillion. I am not even sure how many zeroes that is, but it is a frightening sum. Action is needed at a local, national and global level to improve knowledge and understanding of antimicrobial resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and therapies.

To those ends, the Scottish National party-led Scottish Government are taking their role seriously. Last March, the Scottish Government announced a £4.2 million research grant to investigate the prevention and control of healthcare-associated infections, as well as to research new ways of using existing antibiotics more effectively and efficiently. Scottish Government funding was provided to a consortium of researchers led by the University of Glasgow, working with other Scottish universities, to establish a new Scottish Healthcare Associated Infection Prevention Institute.

Antibiotics are not only critical for treating bacterial infections, they are a cornerstone of routine healthcare, as they prevent infections following surgery and cancer chemotherapy. In Scotland, more than 80% of antibiotic use is within primary care. Overuse and inappropriate use of antibiotics can unnecessarily increase the development of AMR. As limited new antibiotics are under development, it is vital that health professionals and the public work together to optimise how antibiotics are used to preserve their effectiveness for future generations.

Some progress is being made. The latest Scottish figures for 2015 show a 2.4% fall in one year in the number of antibiotics prescribed in primary care, a reduction of 84,490 items compared with 2014. As per the recommendations of the UK five-year antimicrobial resistance strategy, a Scottish “One Health” report will be published in 2017. The report will contain antimicrobial use and resistance data for humans, animals and the environment, in line with the aims of the global “One Health” approach, which spans people, animals, agriculture and the wider environment. There is little doubt that a present and serious challenge faces us; what is less clear is how best to tackle it.

It seems to me that we have two principal problems, both of which have been covered by hon. Members who have spoken in the debate. First, pharmaceutical companies do not have a financial incentive to develop new antibiotics. Even if a company invests in developing a new antibiotic, it needs to be held back until we are resistant to other antibiotics. However, while the antibiotic is being held back, the time on its patent is still ticking down, meaning that the company has less time to recoup the money that it has invested developing it. Therefore, the SNP would like the UK to accelerate its leading role in developing solutions to incentivise the development and management of new antibiotics, promote re-investment in antibiotics and appropriate use and reduce the risks for both payer and investor. I look forward to any comments that the Minister might have on that aspect.

Our second major problem is the use of antibiotics in livestock, which we then consume via the food chain. The evidence suggests that the amount of antimicrobials used in food production internationally is at least the same as in humans, and in some places is higher. For example, in the US, more than 70% of antibiotics that are medically important for humans are used in animals. This form of antimicrobial usage is likely to rise as a result of economic growth, increasing wealth and food consumption in the emerging world.

When properly used, antibiotics are essential for treating infections in animals, but excessive and inappropriate use of the drugs may be a problem. It is therefore important that we play our part in working towards the O’Neill recommendation of

“a global target to reduce antibiotic use in food production to an agreed level per kilogram of livestock and fish, along with restrictions on the use of antibiotics important for human health.”

The SNP encourages everyone to play their part in reducing the unnecessary use of antibiotics, raising awareness and pledging to be an antibiotic guardian. I have not yet followed the example of my hon. Friend the Member for Glasgow North (Patrick Grady) and registered, but now that I know it is easy to do, I will do it today.

In November 2015, Scotland’s Health Secretary, Shona Robison, said that the rise of drug-resistant infections is an issue that must be tackled in Scotland and around the world. Marking European antibiotic awareness day, Robison also pledged to be an antibiotic guardian, in a scheme run by a joint UK initiative to encourage everyone to become an antibiotic guardian by making a personal pledge. As part of European antibiotic awareness day, the Scottish Antimicrobial Prescribing Group, alongside UK partners, launched a target of 100,000 people signing up to become antibiotic guardians, including one in 10 prescribers and one in 100 other healthcare professionals.

Inevitably, any solution will have to be multi-factorial and involve a large range of stakeholders including Governments, non-governmental organisations, industry, the pharma, food and agriculture sectors, academia, research, health professionals and the public at large. If we become completely resistant to antibiotics, operations and procedures currently considered routine will become a lot more dangerous. The medical profession in Britain has become a lot better at not prescribing antibiotics unnecessarily. We must maintain that stance, develop it further and encourage others to follow.

My final plea to the Minister is not to allow UK contributions to international efforts to tackle AMR to become diminished. I seriously hope that the issue does not become a casualty of any post-Brexit isolationism.

Draft Nursing and Midwifery (Amendment) Order 2017

Martyn Day Excerpts

Wednesday 22nd February 2017 General Committees

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank the Minister for his clear and concise explanation of the order. I will not oppose the order and, indeed, I welcome the changes in general because I believe that they strengthen public protection and bring midwifery regulation into line with that for other healthcare professionals.

Alcohol Harm

Martyn Day Excerpts

Thursday 2nd February 2017 Westminster Hall

[Patricia Gibson]

There is indeed a bigger picture. Laws do not necessarily change attitudes, but what they do over time is change a culture. They send out a clear signal. The point was made earlier that when people are out and using a car, they tend not to drink. They are more likely not to drink at all due to the reduction in the drink-driving limit. It has also been a great educator for people who are out drinking and not driving, but who might be driving the following day. They decide, “I had better not drink tonight, because I might still be over the limit tomorrow when I get in my car.” We know that many of the people who have been pulled over, had their blood alcohol level tested and been found to be over the drink-driving limit were simply not aware of it, because it was from the previous evening; they had not considered that they might still be over the limit.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

On that point, does my hon. Friend agree that the lower drink-driving limit has been particularly effective with younger drivers?

[Patricia Gibson]

Indeed. Our younger drivers are the most likely to be inexperienced. They are therefore not willing to risk it, after all the blood, sweat and tears to pass their test. The limit is helping to reduce the alcohol intake of young people for a whole variety of reasons.

Alcohol is killing too many people in our communities prematurely—I do not think anyone in the Chamber would dispute that. It is splitting up too many families. Its pervasive, insidious influence is the context in which too many of our children grow up. It is costing our NHS billions. It is exacerbating mental health challenges for too many people. It is rendering too many people economically inactive.

Alcoholism is a disease and, as with any disease, we need to find the cure. One silver bullet will not cure the disease. We need minimum unit pricing. We need all our high streets and neighbourhoods to look at how they can support and contribute to good health. There must be a presumption against an over-concentration of outlets selling alcohol, preying on our socially disadvantaged communities. All those things combined can make a difference, because they tackle price, availability and consumption. A serious problem and disease such as alcohol addiction or misuse requires a serious, bold solution. I urge the UK and Welsh Governments to look at the measures and the determination of the SNP Government in Scotland to tackle the issue head-on. It is one of the most serious health challenges of our time.

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Ms Buck, and to take part in this important debate. I congratulate the Backbench Business Committee on securing it and I praise the hon. Member for Congleton (Fiona Bruce) for leading it. She mentioned that we have as many as three all-party parliamentary groups relating to alcohol. I had not realised that, but it reminded me of a lyric from an old country and western song:

“One drink is one too many and a thousand not enough”,

which highlights the problem that many have—apologies for the corny remarks.

I am grateful for the hon. Lady’s points. Although they relate to the English and Welsh alcohol strategy, they will strike a chord north of the border in Scotland. Many of the points are totally applicable and I agree with much of what she said, particularly with regard to minimum unit pricing and drink-driving limits.

It will come as no surprise to anyone that Scotland has a long-standing and problematic relationship with alcohol. The damage that misuse causes is indeed stark. It causes harm to individuals’ health, employment and relationships, as well as to community wellbeing and public safety. Then we have the financial burden on the economy through costs to the NHS, police and emergency services, and lost productivity to businesses. Many points that illustrate that have been highlighted today by various speakers.

The hon. Member for Congleton advised us that 70% to 80% of accident and emergency admissions at weekends are alcohol-related, and that 80% of police officers have been assaulted by drinkers, which is absolutely shocking. The hon. Member for Luton North (Kelvin Hopkins) gave us a wonderful summary of the lifetime damage to babies and the costs that obviously creates through foetal alcohol spectrum disorders. He also highlighted the drink-driving statistics, which paint a totally frightening scenario.

The hon. Member for Sefton Central (Bill Esterson) included the risks to young women who drink. He highlighted the 40% of the prison population with FASD and the 41% of women who drink during pregnancy. Again, that is truly shocking in this day and age, given the knowledge we now have. My hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) reminded us that not every cost can be measured, which is entirely true. I am an ex-banker and I always think in terms of numbers and statistics, but it is the human tragedy that is more important. The problem falls disproportionately on the sections of society with the fewest benefits, and the most disadvantaged are at the greatest risk. In fact, the simple horror story is that alcohol is 60% less expensive than it was in the 1980s. Some things have not kept pace.

The right hon. Member for Birmingham, Hodge Hill (Liam Byrne) gave a powerful personal account that dealt with the psychology of the issue. One of the inspirational points that he made was that we can change things for the next generation. That is a message we must all take away from the debate. The hon. Member for St Helens South and Whiston (Marie Rimmer) highlighted the many avoidable conditions related to alcohol—they could so easily be prevented—and the need to improve health professionals’ knowledge. I fully agree on that; there is great consensus in the Chamber today.

You will have noticed, Ms Buck, that I am male, Scottish and a Member of Parliament, which must be three of the worst demographics for alcohol harm, so perhaps I should confess that I finished a bottle of whisky last night, and when it comes to enjoying occasional refreshment I am certainly not teetotal. However, perhaps I should clarify that I opened the bottle in June 2015—I hope that I will be seen as an example of moderation, not excess. Sadly, not everyone’s experience with alcohol is moderate. Excessive consumption has been responsible for many issues in society, including, at worst, the rates of alcohol-related deaths. Scotland’s figures have shown higher death rates for males over the past 20 years than the other UK nations. The 2014 figures put that at 31.2 deaths per 100,000 compared with the English rate of 18.1.

[Kelvin Hopkins]

Another horrifying statistic is that Russia’s population has been in fairly serious decline in recent years, and the major factor in that is alcohol consumption, which is epidemic.

[Martyn Day]

I thank the hon. Gentleman for making that point.

There is sufficient evidence to show a clear link between levels of consumption and of harm. My hon. Friend the Member for North Ayrshire and Arran has already given several examples. It is particularly worrying that retail sales data show that sales in Scotland are higher than in England and Wales—they were 20% higher in 2014—particularly for low-cost spirits. It might surprise Members to hear that since 2008 vodka has outsold blended whisky by about 20% in Scotland. In 2015, 10.8 litres of pure alcohol was sold per adult in Scotland, which is equivalent to 41 bottles of vodka, 116 bottles of wine or 476 pints of beer. When I consider my consumption rates, or those of my friends and family, many of whom take less than I do, the average means that there are people out there consuming a phenomenal amount of drink. On average, alcohol misuse causes about 670 hospital admissions and 22 deaths a week, and it is costing Scotland £3.6 billion each year, or £900 for every adult in the country. How much better that would be spent on other aspects of the NHS.

I served for 13 years on the West Lothian licensing board and in that role learned a lot about the licensed trade and alcohol issues within many of the communities that I now represent in Parliament. One of the more encouraging developments that I saw during those years was the Best Bar None award scheme, which is a great example of partnership working. It has operated in West Lothian since 2008 and has 20 accredited venues, with the Glenmavis Tavern in Bathgate nationally winning overall best bar at the awards in 2015. Best Bar None is administered by the Scottish Business Resilience Centre, whose remit is to create a secure Scotland for business to flourish in. It promotes responsibly managed licensed premises in Scotland, with the aim of partner agencies working together with licensed premises to create safer and more welcoming city and town centre environments. The crux is that it is also about changing Scotland’s relationship with alcohol—something that I believe can be achieved only by working together as a society.

The Scottish alcohol strategy, published in 2009, recognises that a whole-population approach is needed to reduce alcohol harm. Harry Burns, who was the chief medical officer of the Scottish Government at the time, said:

“Every one of us must ask frankly, whether we are part of the problem and whether we are going to be part of the solution.”

I wholeheartedly agree with that comment. The approach is correct, and indeed we have encouraging signs that it is working. Scotland had the steepest fall in alcohol-related deaths between 2004 and 2014. The rate fell from a staggering 47.7 per 100,000 to the current 31.2. Significantly, the fall in death rates over the period was greatest among the lowest income groups, which helped with some of the country’s inequality issues.

A measure that has been particularly effective is the multi-buy discount ban, which has accounted for a 2.6% reduction in consumption, as my hon. Friend the Member for North Ayrshire and Arran has pointed out. In December 2014 the drink-drive limit was reduced from 80 mg to 50 mg, bringing Scotland into line with the majority of European and Commonwealth countries. There is international evidence that lower limits are effective in preventing alcohol-related road accidents.

Controlling availability through licensing has also been a feature of the Scottish strategy. There is a presumption against granting 24-hour licences to on-trade premises, and off-sales are allowed only between 10 am and 10 pm. There are also strict controls for displays and marketing materials, which are limited to single designated areas in supermarkets and shops. I agree with the point made by the right hon. Member for Birmingham, Hodge Hill about sports advertising, and the UK Government should take that on board. We have seen the effectiveness of limiting marketing in supermarkets; cutting it out of people’s bedrooms would have a massive effect. Scottish licensing legislation puts the objective of protecting and improving public health into the mix, and licensing boards may consider that when making decisions. My understanding is that there is no such public health objective in England and Wales. That is something that UK Ministers might want to consider.

Several hon. Members have mentioned the fact that pricing to reduce affordability is a key component of tackling alcohol harm. I believe that taxation is a means of doing that, but it does not deal with the reality that the availability and relative affordability of the cheapest and strongest drinks is at the heart of the problem. Minimum unit pricing is a more effective tool in targeting those cheap, high-strength products that are excessively consumed by heavy drinkers.

As my hon. Friend the Member for North Ayrshire and Arran informed us, evidence from Canada suggests that there is a direct link between changes in minimum price and changes in consumption. It is estimated that a 10% increase in minimum price might be associated with a 32% reduction in wholly alcohol-attributable deaths. That is significant, and it is an approach worth taking. As we heard, using updated modelling from the University of Sheffield, it was estimated that a minimum unit price of 50p would result in 121 fewer deaths and a fall in hospital admissions of about 2,000 per annum in Scotland. Significantly, 51% of off-sales are sold for less than 50p per unit—some for as little as 18p.

The Scottish Government will ensure that a minimum price policy is implemented as soon as possible. The policy had overwhelming support in the Scottish Parliament and it has twice been approved by the Scottish courts. The Court of Session’s Inner House granted the Scotch Whisky Association and its partners permission to appeal to the United Kingdom Supreme Court in December 2016. The appeal will be heard in 2017.

In conclusion, our nations have a long history with alcohol, and somewhere along the way things have got out of hand for many in our society—often those from the most disadvantaged areas. There is much that can be done, and we must all take responsibility. There are many reasons why we need to take action, including the impact on police workloads and the weekend A&E admissions, all fuelled by alcohol. Perhaps the most important reason is premature death—20 years earlier than the average for a heavy drinker—and its impact on families and communities. Tackling that issue alone would greatly help reduce inequality in society.

Breast Cancer Drugs

Martyn Day Excerpts

Thursday 26th January 2017 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to take part in today’s important debate and I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) for securing it. I am grateful to her for her contribution and the cases that she used to illustrate it. She eloquently put a human face to the problem.

The debate about access to Kadcyla and other breast cancer drugs is of immense interest to the public on both sides of the border. Breast cancer is the most common cancer, which was shown by the many individual constituency cases cited by hon. Members of all parties today.

As has been said, Kadcyla is an effective life-extending treatment, which gives some women with incurable secondary breast cancer up to nine months longer than the alternatives, and has fewer side effects and a cost of around £90,000 per patient. In Scotland, Kadcyla has never been available on the NHS.

The Scottish Medicines Consortium, which makes its decisions independently of Ministers and Parliament, decided in October 2014 not to approve Kadcyla for routine use in Scotland. After considering all the available evidence, it felt that the health benefits were not sufficient in relation to the treatment’s cost. Patients have, therefore, been able to access the drug only in exceptional circumstances through individual patient treatment requests—IPTRs. It is estimated that more than 100 women in Scotland could benefit from Kadcyla annually.

A Kadcyla discount has been offered by the pharmaceutical company Roche and it recently wrote to Scottish Government officials about a patient access scheme. Roche has now resubmitted its application to the SMC, so that it can be considered for routine use in the NHS across Scotland. That is currently being assessed—

[Kirsten Oswald (East Renfrewshire) (SNP)]

Will my hon. Friend join me in hoping for a positive outcome in relation to Kadcyla for our constituents who are affected by secondary breast cancer, to whom this debate means so much?

[Martyn Day]

I thank my hon. Friend for that point and I join her in hoping for a positive outcome. We expect a decision to be made in March with an announcement on 10 April.

The SNP Scottish Government have substantially increased access to new medicines, particularly for cancer, with plenty of reforms and investment in recent years. The Scottish Government will build on recent reforms and make further improvements, in collaboration with patients and NHS staff, by accepting the recommendations of Dr Brian Montgomery’s review. Shona Robison, Cabinet Secretary for Health, Wellbeing and Sport, has announced that the Scottish Government will take forward all 28 of the review’s recommendations. Dr Montgomery was tasked to examine how changes made to the Scottish Medicines Consortium process in 2014 affected access to medicines for rare and end-of-life conditions. His recommendations set out how the process for appraising medicines could be made more open, transparent and robust.

Among the Montgomery recommendations—the House need not worry; I will not list all 28 of them—is to give the SMC an additional decision option of an interim recommendation for use subject to ongoing evaluation, which will allow collection of more data on a medicine’s real-world effectiveness. Another is the introduction of managed access agreements, under which medicine would be provided at a discounted price for a period of time, again to collect real-world data on its effectiveness. Another recommendation is to make greater use of national procurement in NHS National Services Scotland— NSS—to lead negotiations on cost with the pharma industry to get the fairest price possible. Better capturing of patient outcome data in the real world is vital to enable us to determine whether medicines are bringing the expected level of benefits to patients.

Beyond the recommendations of the review, Ms Robison has also announced improvements to the processes for non-routine access to medicines on an individual case-by-case basis. The peer approved clinical system or PACS, piloted in Glasgow in 2015 to handle applications for ultra-orphan medicines, has been successfully rolled out across Scotland. A second tier of PACS will now be introduced to replace and build upon the existing individual patient treatment request system. A new national appeals process will be introduced through the new tier of PACS, and that will include consideration of equity of access with other parts of the UK as a material part of its decision-making process.

In November Gregor McNie, Cancer Research UK’s senior public affairs manager in Scotland, said:

“SMC does a difficult but necessary job to assess whether new cancer drugs should be made available on the NHS. Following the SMC reforms, we’ve been pleased to see a significant increase in the availability of cancer drugs in Scotland and we support the review’s recommendations to make further progress.”

Breast Cancer NOW has said that

“Scottish Government reforms give fresh hope for a medicines system that will put patients and their families first.”

It also said:

“Scotland’s approach to reform is a useful example to the rest of the UK about ways in which the system can be improved.”

[Kirsten Oswald]

I thank my hon. Friend for his words about the flexibility of approach and the need to continue to keep pushing forward to ensure that we allow access to as many of these drugs as possible for the people who are in such need. Will he join me in commending the Scottish Government and the SMC for that approach, and in hoping that it will continue and make a difference?

[Martyn Day]

I do indeed join my hon. Friend in those comments.

A new and ambitious Scottish cancer strategy, launched in 2016, aims to stop anyone dying from breast cancer by 2050, and breast cancer is of course a priority in the Scottish Government’s Detect Cancer Early initiative. We need to do many things to move forward in that direction.

No debate seems complete these days without reference to Brexit, and this issue is no exception. The Health Secretary has stated that the UK will not be in the European Medicines Agency. If so, there could be implications for the way in which medicines are regulated, and marketing authorisations will be required from the Medicines and Healthcare Products Regulatory Agency for the UK. I am in no doubt that the implications will be less efficiency and possibly longer processes for obtaining authorisations, resulting—I fear—in innovative drugs taking longer to reach patients. Some industry leaders predict delays in the region of 150 days, based on the examples of Switzerland and Canada.

According to a piece that appeared last year in the Financial Times, when Sir Michael Rawlins, chair of the MHRA, was asked whether it would be able to take on all the extra work registering new drugs and medical devices currently carried out by the EMA, he said, “Certainly not”. It seems that considerable investment and recruitment will be required to re-establish it as a stand-alone national regulator. I am keen to hear from the Minister how delayed drug access for UK patients will be avoided.

[Mr Baker]

I have listened carefully to the hon. Gentleman, and of course he raises a perfectly reasonable concern, but the campaign director of Vote Leave had, as one of his particular bugbears, the costs associated with the clinical trials directive and its prejudicial effect on innovation in medicines. I hope that the Government can find a better way through than the previous system and that, in leaving the EU, we will not only solve the problem of the EMA but have a better regulatory system afterwards.

[Martyn Day]

I thank the hon. Gentleman for his intervention, and I look forward to hearing the outcome.

In conclusion, with regards to Kadcyla, I hope the company’s resubmission to the Scottish Medicines Consortium is at a fair price to allow it to be considered for approval for use in the NHS in Scotland. It would give people across Scotland the opportunity to benefit from more treatment options and could give them precious extra time with their families and loved ones. The Scottish Government, the SMC and the NHS have worked hard to reform access to new medicines, but we now need pharmaceutical companies to do their bit by bringing forward much fairer prices for new medicines, so that access is as wide as possible for the people of Scotland. Cost-effectiveness is a key marker in ensuring that drugs are routinely available in the NHS, and I take the opportunity to emphasise that point to the pharmaceutical industry in general.