Tobacco Control Plan

Martyn Day Excerpts

Thursday 13th October 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Brady. I thank the hon. Member for Stockton North (Alex Cunningham) for bringing forward this interesting debate. I should say that I have never smoked a cigarette in my life, so if I start coughing, as I have been doing throughout the week, that is purely down to a bug that I have picked up.

When the Scottish Parliament brought in its smoking ban in 2006, I thought it was a birthday present, because it was brought in on 26 March, which is my birthday. Since 2007 my party has been in power in Scotland, where we do things a little bit differently. However, there are many parallels on this issue. The latest figures from Scotland show that tobacco use is associated with more than 10,000 deaths and about 128,000 hospital admissions every single year. It costs the NHS in Scotland £400 million to treat smoking-related illness, which highlights the scale of the problem across the UK.

The Scottish Government have implemented and overseen a number of progressive actions on smoking: increasing the age for tobacco sales from 16 to 18 in 2007; the overhaul of tobacco sale and display law, including legislation to ban automatic tobacco vending machines and a ban on the display of tobacco and smoking-related products in shops; the establishment of the first tobacco retail register in the UK in 2011; and the passing of a Bill in December 2015 to ban smoking in cars when children are present. Record investment in NHS smoking cessation services has helped hundreds of thousands of people to attempt to quit smoking.

This year, the Scottish Parliament celebrated the 10th anniversary of the ban on smoking in public and welcomed comments from the World Health Organisation, which praised the Scottish Government’s

“excellent example of global public health leadership”

for implementing its framework convention on tobacco control. In 2013, the Scottish Government published a tobacco control strategy setting out bold new actions that will work towards creating a tobacco-free generation of Scots by 2034. I hear that in the Humber there are more plans in advance of that, although I think our problem may be slightly larger. Key actions in the plan include setting the target date of 2034 for reducing smoking prevalence to 5% and eliminating it in children; a pilot of the schools-based programme ASSIST—“A Stop Smoking in Schools Trial”; and a national marketing campaign on the dangers of second-hand smoke in cars and other enclosed spaces. I echo the comments on the need for a UK-wide national campaign and media advertising.

Although the Scottish Government have long made clear their aspiration for a tobacco-free Scotland, the strategy sets the date by which we hope to realise the ambition. It is not about banning tobacco in Scotland, though if we were to discover it today we would never licence it. I remember as a child listening to the Bob Newhart radio sketches—some may remember them—and he had one about Nutty Walt and the discovery of tobacco. That was only about the crazy tobacco scene and did not even go into the ludicrous health aspects. Nor is the strategy about stigmatising those who wish to smoke. The focus is on doing all we can to encourage children and young people to choose not to smoke.

In September, the Scottish Government welcomed figures that showed that children’s exposure to second-hand smoke in the home reduced from 11% to 6% from 2014 to 2015, which I think sets us in the right direction. Health inequality is a key theme running through the Scottish National Party’s tobacco control strategy, with explicit recognition that current smoking patterns have a hugely disproportionate impact on Scotland’s most deprived communities. That is no different from anywhere else in the UK or, as we have heard from so many speakers, throughout the world.

Scotland has a proud record on tobacco control. We believe the UK Government need to get their finger out and commit to publishing their promised new tobacco control plan for England. I am a great believer that we can learn from each other and pinch good practice whenever we see it, so a good tobacco control plan for England may well help us in Scotland by exposing a few other ideas and strategies that perhaps we have not considered or pushed as firmly.

[Ms Karen Buck in the Chair]

[Alex Cunningham]

The hon. Gentleman has outlined a great catalogue of activities north of the border, in my own homeland. I appreciate that, but what new, big ideas are there north of the border that could contribute to the plan of colleagues in England?

[Martyn Day]

I thank the hon. Gentleman for that question. I have mentioned some of the key points that we are targeting, and stopping children smoking is the key aspect. The title of the strategy we are working on is “Creating a Tobacco-Free Generation”. That is important. The point has been alluded to by other speakers that stopping people smoking is more important than reducing it, although reduction is important for those who smoke because of the impact on deaths and on the health service.

We encourage the UK Government not to keep the House waiting but to fulfil their promise to publish their new plan. If they are stuck for ideas, they are welcome to look at Scotland’s 2013 plan.

European Medicines Agency

Martyn Day Excerpts

Wednesday 12th October 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank the hon. Member for Cambridge (Daniel Zeichner) for initiating this very important debate.

As we know, the European Medicines Agency is a decentralised agency of the European Union, employing about 890 people and located at Canary Wharf in London, which makes it the biggest EU operation in the UK. As we have heard, its staff is multinational; only 7% are from the UK, but all now face the prospect of a painful and uncertain period that almost inevitably will lead to relocation. It is inconceivable to me that an EU institution would not be located within the EU, although that will be decided by the member states at some point after the UK has left. Given that it took seven years to establish the organisation and given the possible further complication of its recent 25-year lease for its headquarters, who knows how long it may take to disentangle?

Of course, it is not just the staff who face the prospect of an expensive move. There are likely to be repercussions for the public purse and implications for medicine regulation. We know that currently more than one third —almost 40%, in fact—of EU drug approvals are outsourced to the Medicines and Healthcare Products Regulatory Agency, which clearly places significant reliance on that business for its income. Consequently, there will be a financial gap for the UK. I would be interested to hear from the Minister how the Government plan to plug that gap.

The complications are not just financial; there may well be implications for how medicines are regulated. We seem to be looking at a hard Brexit. If the UK does not become a member of the European economic area, marketing authorisations will be required from the MHRA for the UK. I am in no doubt that the implications of that will be less efficiency and possibly longer processes for obtaining authorisations in the EU and the UK, 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 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 that is currently carried out by the EMA, he said: “Certainly not.” Considerable investment and recruitment would be required to re-establish it as a stand-alone national regulator.

The EMA is central to the harmonised approach to medicines regulation. Losing this mechanism would have huge implications for the way in which drugs and medicines are tested and marketed, with concerns already expressed by many in the pharmaceutical industry that leaving the EU will result in the UK losing out on some trials that might otherwise benefit patients, as we will no longer be part of that harmonised procedure. The pharma industry argues that the UK is involved in about 40% of all adult rare disease trials in the EU at present, but that would be undermined by a change of status. Some in the pharma industry argue that that would in itself reduce the importance of this country in the eyes of the global drug companies. Being outside the EU would mean that the UK was not part of the harmonised procedure and so might lose out on some trials that might otherwise benefit patients. Officials at the National Eczema Society say that they have been informed by two US companies that trials of new treatments will not take place in the UK in the event of Brexit.

Across the UK, the pharmaceutical industry will be dealt a hammer blow through the loss of the European Medicines Agency, which is crucial for attracting foreign investment. It is clear that international pharma companies like to be close to their regulators. Until now, the EMA has been an attraction for companies to locate their European headquarters in the UK. The Japanese Government recently published a report detailing consequences if requirements from UK-EU negotiations are not delivered. Many Japanese pharmaceutical companies operate in London because of the EMA’s location in London. The Japanese Government have said that the appeal of London as an environment for the development of pharmaceuticals would be lost, which could lead to a shift in the flow of research and development funds and personnel elsewhere.

Thanks to a reckless gamble with our membership of the EU, the UK now faces the prospect of losing being part of the EMA, which not only will mean patients losing out on pioneering and beneficial medical trials, but will leave a disastrous trail when the inevitable happens and it seeks to have its headquarters in the EU.

Blood Cancers

Martyn Day Excerpts

Thursday 7th July 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Walker. I thank the hon. Members for Strangford (Jim Shannon) and for Crawley (Henry Smith) for securing this informative and timely debate. Although I might have sleepless nights at the thought that one in two people will receive a cancer diagnosis, I thank them both for driving home that point to the wider populace.

There can be little doubt that a cancer diagnosis is a daunting prospect for those affected and their families, which is why it is vital that we support them throughout their journey from detection through to aftercare. Many heartfelt examples and experiences have been detailed in today’s debate, and it is clear that the support that individuals require can vary greatly. One size does not fit all, so we need a system that considers the problems from all angles. I agree wholeheartedly with the hon. Member for Strangford that everyone should be offered tailored support.

I am grateful to the hon. Member for Erewash (Maggie Throup)—I hope I have pronounced it correctly—for her explanation that we should refer to all the diseases as blood cancers. As a layman, I found it helpful. There are 130 of them, all with complex names, and having done some research for this debate, I found the names confusing. It is a good approach. Her argument about the strong need for more clinical research should be taken on board.

I was grateful to hear from the hon. Member for Coventry North East (Colleen Fletcher) about her personal circumstances. I am glad that her husband has had a positive outcome. The regional variations are somewhat disappointing; a lot more can be done. I thank the hon. Member for Crawley for his submission and for securing this debate. He drove home the fact that blood cancers are the third biggest cancer killer, and spoke about the difficulties caused by small sample sizes in providing adequate data for drug assessments. That is an important point.

In Scotland, of course, health issues are devolved, so unlike many hon. Members here today, I see only a tiny number of such cases in my casework, as they go to MSPs instead. Our experience in Scotland is also a little different. The Scottish Government are implementing a £100 million new cancer plan to improve prevention, early diagnosis and treatment, and have reformed how the Scottish Medicines Consortium assesses drugs in order to give patients better access to treatments that can give them longer and better quality lives.

Basically, we have combined our cancer drugs fund with our rare diseases drugs fund and simply called it the new drugs fund. The amount in the fund has been quadrupled, which is a significant factor. That approach will serve as a blueprint for all cancer services in Scotland, improving the prevention, detection, diagnosis, treatment and aftercare of those affected by the disease.

Other initiatives include a £50 million fund over the next five years to improve radiotherapy equipment and support radiotherapy training, ensuring that everyone who would benefit from it has access to advanced radiotherapy, and £9 million over five years to support access to health and social care services during and after treatment, such as link workers to provide support in the most deprived communities. We will also invest £5 million over the next five years in reducing inequalities in screening. There are many such examples, and we can learn from one another’s good practices in the different parts of the United Kingdom.

In Scotland, the Scottish Medicines Consortium considers drugs as NICE does, including worldwide evidence, and works up each drug in detail. The balance for us seems to be slightly more on effectiveness than on cost, although cost obviously remains a factor in all matters. Our impression is that, for NICE, cost would sometimes be a bigger component. Both organisations consider cost-effectiveness; as we all know, there is not an infinite pot of money.

In conclusion, although no system will ever produce a favourable result for every individual, more can always be done and we can always learn lessons from each other’s systems. In that light, I suggest that Ministers consider giving NICE the power to change its decision-making process and consider new medicines more flexibly.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 5th July 2016 Commons Chamber

[Jane Ellison]

As I have said, it was our Prime Minister who commissioned the independent O’Neill review, showing astonishing foresight, and that review is now galvanising the discussion. I was at the World Health Assembly in Geneva in May, and the review was the talk of Geneva. Lord O’Neill presented it to many delegations from around the world and we now need to move forward. As well as working on human health, we are also looking to work with animal health organisations, as we take forward the very important recommendations on prescribing and the use of antibiotics as growth stimulators.

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

3. If he will make an assessment of the potential effect of the UK leaving the EU on the availability of NHS services for (a) EU nationals living, studying and working in the UK and (b) UK citizens abroad.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Before I start, the House will want to mark an important milestone, which is that this year, alongside Arnold Schwarzenegger, Brian May, Camilla Parker Bowles and Meat Loaf, the NHS is 68 years old, and its birthday is, in fact, today. I know that we will all want to wish the NHS and all who work there a very happy birthday.

As long as the UK is subject to EU law, current arrangements remain in place. As we move to a new relationship with Europe, our guiding principle will be to get the best possible deal for British citizens who live and work in, and who visit, EU countries. An EU unit will be set up in the Cabinet Office and will report to the Cabinet, and my Department will feed into its work.

[Martyn Day]

I am aware that nothing will change for the next two years, but what is the Secretary of State’s proposal for reciprocity of access to healthcare within the EU, and does he envisage the £500 NHS immigration health surcharge applying to EU nationals already living in the UK?

[Mr Hunt]

The health surcharge that this Government have instituted for people on long-term visas to come and work and live in the UK is the right thing to do, because it is important that everyone makes a fair contribution to the cost of NHS services. In terms of future arrangements for EU nationals in the UK, that would obviously be subject to the negotiations that now happen, and a very important part of those negotiations will be access to the EU health systems for British citizens currently living in EU countries.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

My hon. Friend raises an important point. NHS England is currently unable to take final decisions on this year’s new treatments, including this particular drug, until the courts have decided whether pre-exposure prophylaxis HIV prevention should compete with other candidate drugs. She makes an important point about timeliness, and that is why I am leading an accelerated access review to speed up the way in which such decisions are taken.

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

T4. In March, the Scottish Government made a commitment to substantially increase the financial support for the victims of contaminated blood. Initially, that will have to be administered through the current system, but the Department of Health appears to be dragging its feet. Will the Secretary of State explain the cause of the hold-up and say how he plans to expedite these payments to people with life-threatening illnesses?

[Jane Ellison]

No one is dragging their feet and we are trying to get this matter sorted out. I have had a number of discussions with the Cabinet Secretary for Health and Sport, Shona Robison, most recently last Thursday. We are working together to facilitate the increased payments, using the current scheme administrator. We want the payments to be made as quickly as possible to people who were infected in Scotland and across the UK. Officials in the Department of Health and officials in Scotland are working closely together to expedite the matter.

Diabetes-related Complications

Martyn Day Excerpts

Tuesday 7th June 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Dewsbury (Paula Sherriff) on bringing forward this timely debate. It is encouraging to hear such consensus across the Chamber today. She gave an informed and comprehensive presentation, and I was grateful to hear it. I speak, obviously, as a Scottish Member, and many things are devolved there, but the scale of the problem is remarkably similar in Scotland; 10% of our NHS budget is likewise devoted to treatment of preventable diabetes-related conditions, and those costs continue to rise, as has been noted for England.

I was somewhat shocked by the figure for the number of deaths, which I had not considered before. I am sure that that will strike many people. We think of the life-affecting changes that people go through, and the fact that lives are shortened, but not necessarily of the resulting deaths. The hon. Member for South Down (Ms Ritchie) summed things up in her short comment about the need for early intervention; she hit the nail on the head. That, undoubtedly, is what we need. I was impressed, also, by the remarks of the hon. Member for St Ives (Derek Thomas). I thank him for the figures he gave about the one in five heart and stroke-related admissions to hospital, and for what he said about costs, adaptations that are required, and effect on quality of life. It is important to consider those things together. One of the few optimistic comments that I have taken from the debate is the statistic that four in five amputations are avoidable. I hope that that message will get out to people.

I have not been diagnosed as diabetic, but my lifestyle is somewhat appalling, and perhaps I should get myself checked. Obviously people of both genders should be checked, but perhaps males in particular should take more care. Maybe there are lessons for other people. I was somewhat cheered by the comments of the hon. Member for Islwyn (Chris Evans). It made me slightly more optimistic to hear about the 40.2 inch waistline. I thought, “I’m a bit below that.” However, it does not fully mitigate the diet. I think perhaps that there are many others who will not consider 40.2 inches as a particularly large waistline. When we think about the connection to obesity, which is important, we tend not to think of ourselves as obese even when there is an issue. Several years ago, I was 6 inches bigger than I am now: I did not think I was large at the time. My mother, of course, always commented that I was, and she was probably proved correct. If those figures got through to the wider public they might think, “Yes, that does affect me”—or whoever they know who is in that position. It is important that people see that.

We can probably agree that diabetes is the fastest growing health threat of our time. That is certainly how it appears. The Scottish National party is committed to ensuring that in Scotland people with diabetes have access to the best possible care, and it aims to reduce the risks of complications. There have been a number of reports, an action plan in 2010 and an improvement plan in 2014. The statistics are very similar to those we have heard. One in 16 people has diabetes—diagnosed or undiagnosed. Since 2008 we have seen a 25% increase in the number of Scots with the condition, which accounts for 5.2% of the population. That is largely in line with figures from England and Wales. However, a more frightening aspect of the Scottish dimension is the fact that a further 500,000 are at high risk of developing type 2, and a further 1.1 million are at an increased risk as a result of their waist circumference. I am grateful that I now have a set of statistics to put that in perspective. That figure represents one in five adults, which seems typical, going by figures for elsewhere in the UK. Of course, the connection with obesity cannot be underlined strongly enough. Similarly, 80% of our NHS spending on diabetes is invested in treating avoidable complications—amounting to the same 10% of the budget.

One of the keys to avoiding manageable complications through diabetes is, as has been said, early prevention. Approximately 80% of complications in Scotland are estimated to be preventable, or can be significantly delayed through early detection, good care and access to appropriate self-management. That involves reaching the people who are at risk and supporting them in knowing the risks of poor diet and low levels of physical activity. Among the positive things that are happening are volunteer groups, including the Diabetes UK West Lothian group in my area, which supports people living with the condition through several different schemes. It has NHS support through St. John’s hospital in Livingston. Exercise groups are provided, and they include a session of seated exercise for people who have limited mobility. There is also a GP referral service entitling people to free or heavily discounted memberships at Xcite West Lothian gyms. Again, that is probably not well enough known about in my area and it could be taken up more. That is all part of the push to support people, and to further prevent complications arising from diabetes.

There is much we can agree on, and much good practice, as well as many frightening statistics out there.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 10th May 2016 Commons Chamber

[Carol Monaghan (Glasgow North West) (SNP)]

7. What assessment he has made of the potential effect of his proposals to reform the NHS bursary on future levels of recruitment into the medical professions.

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

10. What assessment he has made of the potential effect of his proposals to reform the NHS bursary on future levels of recruitment into the medical professions.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The reform to the NHS bursary will lift the cap currently placed on university places for nurses, midwives and allied health professions. Universities will be able to train up to 10,000 extra students by the end of this Parliament. This increase in UK graduates will reduce NHS reliance on expensive agency staff and staff from overseas.

--- Later in debate ---

[Ben Gummer]

The NHS benefits enormously from mature students entering the service, and that is why we have already said that we will be looking at offering second-degree bursaries in the scheme. The consultation is clear: it asks a number of open questions, inviting responses from nurses and nurse trainees about how best to support mature students. We will be looking at those carefully as we formulate our conclusions.

[Martyn Day]

With the increased cost of training as a nurse and a 1% pay freeze throughout this Parliament, how does the Secretary of State plan to recruit and retain sufficient nurses in permanent posts in the short term, so that patient care and staff wellbeing are not negatively affected?

[Ben Gummer]

South of the border we have been able over the past six years to increase the number of nurses, both in training and in the service, which has been made possible by the stronger economy and the stewardship of the NHS, in such contrast to the developing picture in Scotland. We are able to expand the numbers in training by up to 10,000 between now and 2020 as a result of that innovative policy, and that is why it should also be adopted in Scotland.

Oral Answers to Questions

Martyn Day Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

My hon. Friend is absolutely right. There has been a 54% reduction in the use of police cells for mental health cases in the past three years. This is being improved by work of the local crisis care concordat. My right hon. Friend the Home Secretary will later this year introduce legislation to prevent children and young people from being held in police cells at all, but the use of police cells has gone down dramatically because of the use of the crisis care concordat. We will continue that process.

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

T9. Yesterday, the Minister’s offer to junior doctors had still not dealt with the important issue of weekend working and appropriate compensation. As a result, doctors in England will be forced to strike and the Minister will have damaged the patient safety he claims to value. Instead of attacking consultants and junior doctors, will he follow the example of the Scottish Government and work with the medical profession to help the NHS face the challenges of increased demands and private finance initiative-induced deficits?

[Mr Speaker]

Project, man, project! We wish to hear the full gist of what the hon. Gentleman has to say to the House.

Cystic Fibrosis

Martyn Day Excerpts

Tuesday 8th December 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Edward. I applaud the hon. Member for Dudley North (Ian Austin) for bringing this timely debate. If any fact highlights the importance of this, it is that the median survival age is just 28. That really highlights the issue. If that does not focus minds on the need to do something, nothing will. He also touched on quality of life. We must remember that it is not just about statistics and medical reports. It is about the life of not just the sufferer, but the families involved. I am grateful to be able to take part in the debate.

The hon. Gentleman also mentioned issues relating to NICE, its assessments and medicines. I am obviously a Scottish Member, and things are slightly different in Scotland, so I was grateful that Members mentioned the differences. One thing we have is the Scottish Medicines Consortium, which assesses medicines a bit quicker, putting them through the peer-approved clinical system. That is a good practice, which the Minister should perhaps look at. Having said that, we are also still waiting for the assessment of Orkambi, and we hope to have it around April, so there is still a delay in getting things through for everyone.

The right hon. Member for Chesham and Amersham (Mrs Gillan) made some good points. I was interested to hear about muscular dystrophy, which is not an issue I know much about, although the situations people face are obviously very similar. She highlighted the impact on families and the importance for children and young people. When we hear people’s life expectancy, that really highlights just how devastating this issue is.

The hon. Member for York Central (Rachael Maskell) made interesting points about therapeutic measures. Her key message was about providing hope, and I share her view on that. I hope that this Government and all the Governments in the devolved Assemblies take on board the message that we should not be nervous about costs. That message needs to go out from here very strongly.

The hon. Member for Strangford (Jim Shannon) highlighted the different and positive practices in Northern Ireland, which, again, I find interesting. I am sure there are things we can learn from each other’s areas. One positive in Scotland is that the Scottish Government have the UK-leading new medicines fund, which, in May, more than doubled the support it provides, from £40 million to £90 million. That will affect all rare diseases, including cystic fibrosis. There are therefore things we can do, and there is good practice we can demonstrate and lead the way on.

Another thing we did in Scotland was to abolish prescription charges. Before we did that, two thirds of all paid-for prescriptions were for long-term conditions. That was another financial impact on the families we are talking about, who already have enough difficulties.

With those comments, I look forward to hearing the Minister’s view. I hope we have sent a strong message to not only the Government here, but the Governments in our devolved Assemblies.