Tobacco Control Plan

Debate between Norman Lamb and Baroness Blackwood of North Oxford

Thursday 13th October 2016 Westminster Hall

[Norman Lamb]

On the adequacy of public health budgets, does the Minister think it is rational in any way to increase in real terms the budget for the NHS while reducing in real terms the budget for public health?

[Nicola Blackwood]

Prevention is a core part of the NHS five year forward view and should be embedded in NHS funding, public health funding and social care funding, as the right hon. Gentleman has stated. We are looking for the STPs to show a joined-up plan for how prevention, acute delivery services and social care will work together. PHE can and does advise and support local councils to tailor their services effectively, but we need to see how we can improve that. The local tobacco control profiles are one way in which we are doing that, but we must ensure that we see some of that work implemented.

At national level, to help drive a reduction in variation, the Government are committed to publishing the new tobacco control plan that all Members have mentioned, which has tackling inequalities at its heart. The plan will build on our success so far and will include renewed national ambitions. We have to maintain the proactive, comprehensive and non-partisan approach we have seen so far. The UK is recognised as a world leader in tobacco control strategy, and we intend to maintain that. However, I am afraid that on this occasion I will not be able to match my predecessor by announcing the date of publication. [Hon. Members: “Oh!”] I know; I feel inadequate.

My hon. Friend the Member for Harrow East is right in identifying my desire to ensure that the plan is evidence-led. It is reasonable for a new Government to want to check that the plan offers the best possible strategy, based on evidence. On something as important as a tobacco control plan, which is a golden moment, we have to ensure that we do not publish the plan until we get it right. It has been valuable to have the opportunity to listen to and engage with this debate, so that I can hear from colleagues as expert and engaged as those present before going forward. I assure all Members that the Government see the issue as a matter of urgency and are pressing forward with the plan as quickly as possible. I will certainly take away the suggestion from the hon. Member for Stockton North about incorporating respiratory health monitoring into the NHS health check.

I would like to go through a few of the points that we have discussed before I finish. As I have highlighted, it is right to turn our focus to population groups in which smoking prevalence remains higher than elsewhere. In particular, we must turn our attention to reducing health inequalities in populations who already suffer from poorer health and social outcomes, such as those in routine or manual occupations or those who suffer from mental health conditions.

As my hon. Friend the Member for Totnes said, improving maternity outcomes and giving children the best start in life is an important priority for this Government, and supporting pregnant women to quit smoking will be an important factor in working towards that. We all know that smoking during pregnancy increases the risk of stillbirth, as the shadow Minister said, and of problems for a child after birth. We also know that babies born to mothers who smoke are more likely to be born underdeveloped and in poor health. Tackling that was a priority under the previous tobacco control plan, during the period of which smoking prevalence among that group fell by three percentage points, but more can be done to reduce it further and, most importantly, to tackle the variation I mentioned. We will look at that.

Alongside limiting babies’ exposure to smoke during and after pregnancy, we must continue to work to end the cycle of children taking up smoking in the first place. As the percentage of 15-year-olds who regularly smoke has fallen to 8% and continues to fall, we must press our advantage and work towards our first smokeless generation. That would be something that we could genuinely be proud of. Restricting access to tobacco remains key, and we will want to maintain the enforcement of measures mentioned today, such as age of sale laws. Evidence shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Continuing to support adults to quit is therefore vital to ending the cycle of children taking up smoking and must remain a key part of tobacco control in the future.

In order to achieve our ambitions for the population groups I have mentioned, and to reduce smoking prevalence across all populations to even lower rates, we have to continue to draw on the things that we know work. This is an area in which we have a strong evidence base, and that work will include continuing a programme of evidence-based marketing campaigns such as Stoptober and monitoring the evidence base for e-cigarettes.

Finally, the right hon. Member for North Norfolk is right to say that tobacco use is a global issue and an international priority. Our new tobacco control plan will need to reflect that. As a world leader on tobacco control, the UK will continue to work closely with others to reduce the burden that smoking places on individuals, families and economies across the globe. As he said, we are investing official development assistance funds over five years to strengthen the implementation of the WHO’s framework convention on tobacco control. The project will be delivered by the WHO, and through it, we will share the UK’s experience in tobacco control to support low and middle-income countries to put effective measures in place to stop people using tobacco. That will happen through capacity sharing. We will carefully monitor the progress of that initiative to ensure that it delivers results, using very effective evaluation measures. I am happy to have further discussions about that with the right hon. Gentleman, if he would find that helpful.

We can be proud of the progress that successive Governments have made on helping people to quit smoking, preventing them from starting in the first place and creating an environment that de-normalises smoking. With prevalence rates at an all-time low, there is no question that good work has been done, but as the issues raised in this debate clearly show, there is more work to be done. The Government are committed to doing that work as a matter of urgency. I will take away the comments made today, which are incredibly helpful to me as a new Minister, and I will ensure that as we finalise the new tobacco control plan—

Psychosis: Early Intervention

Debate between Norman Lamb and Baroness Blackwood of North Oxford

Wednesday 7th September 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship for my first outing as a Minister, Sir Roger, and I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate. He has rightly pointed out that many areas of our mental health services are not yet meeting the standards that patients and their families deserve and have a right to expect, and he is absolutely right to say that improving access and waiting times for early intervention in psychosis must be a top priority among those. I assure him that both I and the Government share his determination and sense of urgency in such matters.

I think we can agree that for far too long as a nation we tolerated poor mental health services in this country, and we all know the terrible price that some have had to pay for our collective failure to step in earlier. That time is now over and we are in the process of creating a mental health service that we can be proud of—one in which, no matter where someone lives, they will be able to access the services they need when they need them, and just as importantly, one that people feel safe and confident using.

But we have to be honest about this, or we will get discouraged and lose momentum: it is not going to happen overnight. Although there are already some areas of outstanding practice that we should be encouraged by, we are, in general, coming from a low base, and only a sustained effort over the next few years is going to bring about the change that we are all demanding.

For that reason, I would like personally to thank the right hon. Member for North Norfolk for his pivotal role in securing parity of esteem and for supporting the introduction of the first waiting time standards for mental health services. With the previous Prime Minister, the Health Secretary and my predecessor, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the right hon. Gentleman has set us on the road to better mental health services. Now we have to follow it through, no matter how bumpy the journey may become at times. I hope that he will meet me and give the benefit of his advice, because I suspect I am going to need it.

I would also like to thank everybody who has contributed to today’s debate. Some have given moving accounts of personal experiences or those of family members or friends. Others have taken the opportunity to raise difficult constituency cases. I know that all here today are committed to keeping mental health at the top of our agenda as the Government shape their new programme.

That brings me on to the challenges of the early intervention pathway for psychosis, which is designed to deliver the improvements to psychosis care that are urgently needed, as the right hon. Gentleman so clearly laid out. He pointed out that psychosis is more common than people realise: it affects one in 2,000 people in England in any given year. We know that the early intervention in psychosis programme is crucial in ensuring that mental health services maximise their opportunity to intervene at the earliest possible moment to prevent patients from relapsing, so that they are less likely to be admitted to hospital and have less severe symptoms. As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) so expertly described, such services are recognised as the best model for helping young people to recover from the first episode of psychosis. They have the potential not only to save the NHS tens of millions of pounds but to reduce the serious impact of psychosis on those patients’ lives and those of their families and carers.

The hon. Member for Strangford (Jim Shannon) asked about funding. When waiting times for mental health were introduced for the first time, they were backed by £120 million of investment. In addition, we have invested £33 million in developing EIP services. Further funding for early intervention in psychosis was announced in NHS England’s “Five Year Forward View for Mental Health” implementation plan earlier this year. That funding is designed to support delivery of the target to ensure that 60% of people who experience their first episode of psychosis receive treatment with a NICE concordant package of care within two weeks of referral by 2021.

[Norman Lamb]

I am encouraged by what the Minister is saying. I assume that the money she has talked about that will be allocated is part of the baseline that CCGs will receive and not a separate allocation. The question is how she ensures that CCGs actually spend the money as intended.

[Nicola Blackwood]

As the right hon. Gentleman is aware, this work is in its early stages. He is right that services are working hard to develop this process. NHS England has set out in its implementation plan how the services will need to grow and improve to meet the new standards. In particular, it has noted that the current block contract arrangements can result in poor transparency on spend per patient, as he has seen with his freedom of information request.

NHS England has been looking at alternative funding models that will link an element of payment to achievement of quality and outcomes, including the EIP access and waiting time standard. When there are variations in spend, we will need to consider the reasons for that and ensure that necessary action is taken to address any impact on the quality of care available. I hope that reassures the right hon. Gentleman.

In addition, the Royal College of Psychiatrists College Centre for Quality Improvement has been commissioned to undertake continued assessment and quality improvement work. This will be through a quality improvement network, supported by an annual self-assessment that will be independently validated and scored. All early intervention in psychosis services are going to be expected to participate. The first results will be published in April 2017, but any earlier results will be published before that. It is intended to provide a transparent assessment of services across England. This will give us a clear picture of service provision and enable us to target areas where additional development will be required, so that we can ensure that the standard is met and that people receive the care they need.

The right hon. Gentleman also mentioned the important issue of age caps. The most likely age for a first episode of psychosis to occur is between 14 and 35, as has been pointed out.