Oral Answers to Questions

Debate between Philippa Whitford and Jackie Doyle-Price

Tuesday 26th March 2019 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend will know that this has to be reviewed independently, but the Secretary of State does have duties to consider inequalities in all his work.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, wish to pay tribute to the hon. Member for Winchester (Steve Brine), who I sparred with many times in Westminster Hall. We might not have agreed on how to go about it, but he was clearly passionate about improving health.

The Secretary of State’s vision for NHS England includes video links to GPs, diagnostic phone apps and healthy people undergoing gene tests for a few hundred pounds. Considering his own experience of such a gene test, does he not recognise that this just increases access for the well-off, will drive demand in the system and will actually widen health inequalities?

[Jackie Doyle-Price]

I do not accept that at all. Apart from anything else, we are seeing younger generations be more technologically savvy. We are taking advantage of that technological innovation to spread good health prevention and to help people look after themselves.

[Mr Speaker]

I call Dr Philippa Whitford.

Health Inequalities

Debate between Philippa Whitford and Jackie Doyle-Price

Wednesday 20th March 2019 Westminster Hall

[Jackie Doyle-Price]

We have a number of inter-ministerial groups looking at particular areas of inequality, such as rough sleeping and the first 1,001 days. The hon. Member for Central Ayrshire (Dr Whitford) spoke about the importance of early intervention; if we could get that right, that would be a real way of addressing inequality. My short answer to the question asked by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) is that we pick up public health in a number of ways, but my priorities are the first 1,001 days and particular pinch points where there are real inequalities. We will continue to look at those areas, not least because supporting those individuals is not just better for them, but makes financial sense. If we can tackle some of these issues earlier, not only do individuals live longer and healthier lives, but there is a reduced cost for the health system.

[Dr Whitford]

Many of us have spoken about the fact that poverty drives ill health. Can the Minister tell us whether any discussion is taking place between the Department and the Department for Work and Pensions about the impact of welfare changes over the past few years, and how to tackle them?

[Jackie Doyle-Price]

I have been in close consultation about that issue with the recently departed Minister of State for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton). She has really challenged the DWP to look after people who are vulnerable, and put in place safeguarding policies for them, so I confirm to the hon. Member for Central Ayrshire that that discussion is taking place.

My hon. Friend the Member for St Ives (Derek Thomas) raised the issue of dementia. Clearly, dementia has a big impact on the number of years in which people can enjoy a healthy life, and we must get that right. For that reason, we have introduced the ageing society grand challenge, which is focused on narrowing those inequalities. My hon. Friend is right that we must have better integration with social care; there have been a lot of moves towards better integration between local authorities and the NHS, and that must continue.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) referred to public health cuts. We have tackled those through the NHS forward plan, and have said that this is an area in which we expect the NHS to focus and work collaboratively with local government, specifically highlighting health visitors and the wider public health agenda. My answer to the hon. Lady’s point is “watch this space”, but we recognise that we spend less if we spend wisely, which has to be about getting the system to work better.

[Derek Thomas]

rose—

[Dr Whitford]

rose—

[Jackie Doyle-Price]

I have limited time, and I would like to get through this.

We have made it clear that the long-term plan will be focused on reducing inequalities. The hon. Member for Strangford (Jim Shannon) mentioned people with learning disabilities and autism, and I can tell him that those people are a real priority for me. When we consider inequality, the life expectancy of people with those conditions is massively less than it ought to be, and we need to fix that. This year we expect all local health systems to set out how they will reduce health inequalities by 2023-24 and by 2028-29. Through that, we are targeting specific areas. NHS England will highlight areas in which it can do specialist commissioning. One example is people who are rough sleepers, who have low levels of life expectancy.

I absolutely agreed with what the right hon. Member for Rother Valley (Sir Kevin Barron) said about social prescribing. How we deliver health services depends not only on medicalised professions and clinical support; when tackling inequality, a lot of the wrap-around and de-medicalised support can deliver better health outcomes. I am very excited to hear about what is happening in Rotherham, so I might pay a visit next time I go to see my mum. That would be quite nice.

Turning to the specific points made by my hon. Friend the Member for Telford about her local trust and the impact on inequalities, she has clearly articulated the issues that she is concerned about. The decision is clearly a local one, but it is within the gift of the council to make an appeal to the Secretary of State, and I gather from my hon. Friend’s comments that that will happen. I obviously cannot prejudge the outcome of that case, but I assure her that when it arrives on the Secretary of State’s desk, he will consider it impartially. She has articulated the concerns from her constituents’ perspective extremely well.

I am under no illusion about the fact that tackling inequality requires commitment and leadership, energy and focus, and national and local accountability. Let us look at the plans that come from clinical commissioning groups later this year and interrogate them to make sure that they will tackle inequality. We will make sure that we stand fully behind them to ensure that they deliver.

Draft Human Medicines (Amendment etc.) (EU Exit) Regulations 2019 Draft Medical Devices (Amendment etc.) (EU Exit) Regulations 2019

Debate between Philippa Whitford and Jackie Doyle-Price

Wednesday 6th March 2019 General Committees

[Jackie Doyle-Price]

I thank the hon. Members for Ellesmere Port and Neston and for Central Ayrshire for their probing questions. They have both made compelling arguments. I recognise their concerns about scrutiny, but we are where we are. The Government have to make provision for a no-deal scenario, even though we remain determined to leave the EU on 29 March with a deal. None the less, we need to put these statutory instruments in place to deal with the event that that does not happen. Both hon. Members asked probing questions, and I shall try to address all of them. I am sure I will miss some, but I promise to write to them both with full answers to the points they have raised.

Overall, there are concerns about the costs to businesses, patients and taxpayers, all of which need to be addressed. However, I should be up front about this. Clearly, there will be a cost to business. One reason why Margaret Thatcher was such a big believer in the single market was that a single-market regime would reduce costs to business. Therefore, unilaterally leaving the single market will increase costs. We need to be frank and honest about that. We also need to be frank and honest that some of those costs will be passed on to taxpayers and patients. That is a given, but it underlines why we are determined to leave with a deal and minimise any disruption, recognising that we want to make the best out of this scenario for Great Britain.

Some issues were also raised about resources and personnel in respect of the MHRA, which I will come on to. I appreciate that hon. Members feel that they have not had sufficient opportunity to scrutinise this. However, I can assure the Committee that the proposals have been taken forward by MHRA in full consultation with business with a desire to minimise disruption and additional cost, and with a full view to planning to ensure that MHRA is equipped to deal with it. Much of the machinery is in place, given MHRA’s role in being such a key player within the EMA.

As I mentioned in my opening remarks, the Government’s approach has been to minimise burdens on business while enabling the most robust action for the UK to protect public health. As I have said, I acknowledge that that will place costs on business. The hon. Member for Central Ayrshire explained the disproportionality of EMA costs with regard to what might be replicated with the MHRA. She is absolutely right about that. I can tell her that the fees have been developed based on existing processes. For example, the targeted assessment fee is based on the existing MHRA incoming mutual recognition fee. Furthermore, the MHRA regularly reviews its fee levels and will continue to do so. There is a commitment from the MHRA to review the overall system of fees to the industry following exit with no deal so that we can maintain that they are fair and proportionate to business.

[Dr Whitford]

Obviously, the MHRA uses a trading fund now and must basically wash its own face financially. Will the Government provide more direct funding to the MHRA or is it envisaged that all of the costs will still be recouped from fees?

[Jackie Doyle-Price]

On day one of exit under this scenario, the MHRA will, as the hon. Lady says, continue to wash its own face. As to what might materialise subsequently, that would be subject to further discussion. I would not rule out anything at this stage. We are trying to ensure that the business can continue as usual on 30 March if we leave without a deal, but—let us set this in stone—that is if that is the result on 30 March. If we end up in that scenario, we will of course want to make sure that we have got things working effectively. It is also true that we will have to see how relationships work in practice. We can already see that some market practices are preparing for a no deal; others are not. We have said what we are prepared to do to recognise what has happened and what is licensed and goes through the regulatory system in Europe. We are being quite open about accepting that.

The hon. Lady mentioned batch testing, for example. We cannot be sure the same will happen in Europe. We will have to monitor how that works out in practice before setting in stone what the future regulatory regime will be. I come back to my original point: this is for day one of exit to keep the show on the road.

[Dr Whitford]

The Minister talks about preparing for a no deal, but as the EMA does not have associate membership, most of what is being put in place will be required, deal or no deal.

[Jackie Doyle-Price]

That is right. As I have said, we are seeing that some parts of industry are preparing for that scenario on the basis that there will be no associate membership. Having left in that scenario, if we look broadly at how the MHRA discharges its functions and how it is funded, at this stage we are looking at it continuing as usual and washing its own face. The hon. Lady mentioned that we could use some of the Brexit dividend to meet the cost. All of that is completely wide open at this stage. This measure is really just to keep the show on the road.

We have put some expectations down in terms of review. Most of the commitments we have made are to review all of the operations within two years. As for any conclusions we reach, we will come back to Parliament to institute any change if that is what we wish to do, but that would be done very much in consultation with industry and in a transparent way, recognising that all Opposition Members are not entirely satisfied. Clearly, we will go back to business as usual when it comes to scrutiny of these matters. Again, I cannot say often enough that I do not want that eventuality to materialise. It is my determination that we leave with a deal.

There was a reference to the impact on SMEs. The MHRA is taking steps to ensure that the burden on them is minimised. It will look at things such as fee waivers for some products to encourage further research and innovation. Again, that recognises the real concern about that.

[Jackie Doyle-Price]

I trust the MHRA to manage its own finances and take a proportionate view as to what is an appropriate fee, because it has the day-to-day contact with businesses. Overall, it will still be expected to settle its budget on the basis of the fee income that it incurs. That still gives it the freedom to do that, if that is in the sector’s strategic interest.

We have responded to some of the representations made by business about the potential additional costs. One reason that we introduced the responsible person for import assurance procedure was to minimise, as effectively as possible, the burden on the trading of the wholesale sector. Again, that recognises that where things have been checked and have gone through an appropriate European regulatory procedure, we should be satisfied that that is good enough for us. I am confident that that pragmatic approach will be repeated as the MHRA takes the matter forward.

Several points were made about the MHRA’s ability to take on new roles. The UK already has substantial capacity and expertise to regulate and evaluate the safety of our medicines and medical devices. The MHRA has real expertise in many areas, including pharmaco- vigilance and clinical trials regulation, which provides benefits to patients across the EU. I am confident that the EU will want to retain access to that expertise. That also shows that the MHRA has the expertise and human resources to discharge those roles. It has 30 years of experience as a lead regulator, it has led on the registration of more than 3,500 medicines, and it is globally recognised for its expertise. None the less, it will manage the demands on its service and I have every confidence in its ability to do so.

The hon. Member for Ellesmere Port and Neston raised the issues of continued access to medicines and of reviewing the fees. The statutory instrument provides continuity for patients and businesses by providing for existing EU licences to be automatically converted into UK licences, which should give continued access to medicines and will be done at no cost to industry. It also puts in place a new licensing route that will allow the MHRA to accept the same information from companies that apply for an EMA licence and that will allow the UK to grant a licence in the same timeframe as one would be received today.

Effectively, we will follow and replicate what the EMA does. There has been much talk of the UK being rule takers and hon. Members might suggest that there is no change here. That recognises, however, that we are in a global marketplace for medicines and that we all want to have access to the best medicines. In practice, there is much shadowing and sharing of expertise in this area. That raises a question that we do not have time to debate this afternoon, but there is much to be gained from international co-operation in this area.

Obviously, we want to make sure that the UK remains an attractive market for new medicines and for innovation. As I said earlier, we will review the fees set out in the SI within two years to make sure that they remain competitive and fit for purpose, and that they deliver the objectives that we want to achieve through the regulatory system.

The hon. Gentleman laid down a challenge; he said that the regulations go beyond a simple technical implementation of the directives into UK law and raise new powers for the Secretary of State. Clearly, the regulations are made under section 8 of the European Union (Withdrawal) Act 2018, which gives Ministers powers, where appropriate, to take additional powers. However, the changes are the minimum necessary to maintain continuity while protecting the health of UK patients while we are outside the EU, although clearly there is concern about issues of supply, as the hon. Member for Central Ayrshire mentioned.

We do not anticipate needing to use the Henry VIII power. We are confident that the regime that we have set out will ensure continuity of supply. However, in the event that that did not happen, provision would be needed. The power is a safeguard to be used in the case of serious shortages. I would not choose to describe it as a Henry VIII power, but I recognise the right of Opposition Members to do so. It is limited to temporarily modifying the effects of the human medicines regulations, for a limited time or purpose. As has been mentioned, the statutory instrument would use the negative procedure, but it could obviously be annulled. However, it would be used only where existing processes had been exhausted.

The hon. Member for Ellesmere Port and Neston raised the question whether any particular medicines would be at risk, and also mentioned prices in that regard—a concern that I think the hon. Member for Central Ayrshire will share. Clearly the MHRA consulted on the issue, and that informed its analysis. Any potential increase in medicine prices will depend on the extent to which costs are passed on to the consumer; but we shall bear the matter in mind, with regard to future medicines price negotiations. It is something that we shall have to keep an eye on at this stage. It is difficult to quantify. None the less, we have made clear commitments to the public about what they can expect, and about ensuring a continuous supply of medicines, and we shall have to find ways to deliver on those commitments.

[Dr Whitford]

Is the Minister aware that the Royal College of Radiologists has now produced emergency guidance to nuclear medicine departments, simply because the UK Government did not, on the potential threat of shortage of radionuclides and radiopharmaceuticals, both for scanning and for cancer treatment?

--- Later in debate ---

[Jackie Doyle-Price]

I was not aware of that, but I encourage everyone to participate in the dialogue, because in such an event the whole system would need to be ready. I shall perhaps come back to the hon. Lady on that specific point because, although much of our no-deal preparation is happening within the confines of Whitehall, it is not all being shared publicly.

I emphasise that there have been massive conversations with industry, including those in the life sciences industry—and with charities—about the changes, to make sure that everyone is prepared.

[Dr Whitford]

The Minister says that preparation is happening in Whitehall that is not being shared with the public, but we are talking about the president of the Royal College of Radiologists. The people who actually deliver scans have not had any guidance from the Government. That is not scaremongering. They have to be ready for something that could happen in a few weeks. They are talking about delaying patients, planning light weeks, and when the molybdenum will arrive, because those things cannot be stockpiled. Why has there not been guidance to the NHS about how to prepare to deal with shortages of radionuclides?

[Jackie Doyle-Price]

My understanding is that those conversations have been taking place. However, the hon. Lady is right that the very nature of those products, which cannot be stockpiled, has brought complications. I fully expect the president to be involved in those conversations. I do not have that knowledge to hand now, but I will write to her afterwards, to give her some reassurance.

We had two waves of consultations on the draft instruments. For the last, in October, we issued a consultation that received 170 responses, through which we ended up with the proposals before us. Again, these are subject to further consultation with the industry.

It is obviously a priority for us to make sure that Britain remains a competitive location for life sciences companies, and we are committed to maintaining our renowned strength in science and research. Since the referendum, we have seen many signs of the industry’s continued confidence in the UK. In 2017, we received the highest level of life science investment in Europe, and were second globally only to the US. That illustrates the confidence in our regulatory system, which is why we are confident that the MHRA is well up to the task given to it by the draft statutory instruments.

The hon. Member for Ellesmere Port and Neston gave an impressive illustration of what he described as the confusion regarding the various dates at which parts of the draft regulations will come into effect and the complexity of some of the references within them, and he posed legitimate questions on how business would understand and prepare for them. However, as I say, we have produced detailed guidance to support everyone in interpreting the draft instruments, and the MHRA does not expect anyone to navigate this alone and will be there to give advice. That support is partly reflected in the length of time that businesses will have to prepare for and implement these measures. We will ensure that that dialogue continues.

The hon. Gentleman also raised questions about market access and legal accountability, and whether we will have sufficient people to discharge that role for the industry. We believe that those skills are already in place, bearing in mind that a lot of companies will already have to fulfil these functions with the EMA, particularly when exporting. We do not anticipate that this change will be disproportionately onerous on business. However, we have given the industry 21 months to implement that aspect. To make sure that only genuinely qualified people undertake that role, anyone who vouches for a medicine that is then potentially harmful to patients faces a maximum two years’ imprisonment. The sector has sufficient integrity to engage only properly qualified people; to do otherwise would be foolhardy.

Questions were asked about the degree to which UK consumers could be protected from false medicines. To reassure Committee members, the falsified medicines directive, implemented in 2013, will remain in UK law, even in the event of a no-deal exit. We will make sure that we continue to apply the same protections as before. We obviously want to retain a close working partnership with the EU on medicines regulation, and I think that we will be able to share expertise and information on such issues over and above any potential mutual recognition of regulations. We will all benefit from that information sharing. Issues were also raised about the wholesale sector. We will obviously continue to ensure that the MHRA keeps a good eye on that and makes sure that that regulatory regime is fit for purpose.

Turning to some of the comments about the devices, we will continue to recognise the CE mark on medical devices. It is also fair to say that the existing regulatory regime has perhaps been seen as rather liberal in its approach—the hon. Member for Central Ayrshire alluded to this when she referred to mesh—and it has been subject to some revision at EU level. Certainly, we want to follow what is happening with that review and consider whether there are any further improvements we would wish to make to that CE mark system.

To those colleagues who thought that leaving the EU might lead to a bonfire of regulation, I say that, clearly, when it comes to medical devices, some of which remain within the body for a length of time, we should not stint in our approach to the protection of patients. Patient safety should be the primary objective, notwithstanding the importance of maintaining a competitive marketplace. Patient safety is crucial.

There are estimated to be around 600,000 medical devices available on the EU market, many of which have not been produced in the UK or approved by UK-notified bodies. It would be quite a big undertaking for the MHRA to license those products, but we will increase our market surveillance by requiring all new devices being placed on the UK market to be registered with the MHRA after exit day by the manufacturer or a UK responsible person, in accordance with the transitional timetable. Our emphasis is patient safety first and foremost, while doing our best to improve access to the market. We will require, as the hon. Member for Ellesmere Port and Neston said, all overseas manufacturers to register those products here with the MHRA themselves.

We have also had some discussion about the RP-I. That is a new role; the hon. Gentleman asked how many will be required and where we will find them. We are giving the industry a two-year transition period, to give it the opportunity to register those persons with the MHRA, and it will depend on the number of wholesalers who intend to import products from the EEA. We are satisfied on the basis of the discussions we have had with the industry that that two-year implementation period is appropriate, and there has been consultation on exactly what sorts of skills those persons should have, with the intention that they should fill the regulatory gap caused by our removal from the EMA, but without putting undue burdens on the industry.

Exiting the European Union (Medicines)

Debate between Philippa Whitford and Jackie Doyle-Price

Tuesday 19th February 2019 Commons Chamber

[Jackie Doyle-Price]

I appreciate the hon. Gentleman’s point. Perhaps I can reassure him by emphasising that the UK is committed to establishing a far-reaching science and innovation pact with the EU to facilitate the exchange of research and ideas, so we continue to maintain the competitiveness to which he refers.

In bringing forward these proposals, we have been determined to establish our pattern of regulation from outside the EU if need be, but as much as possible we wish to continue with business as usual. We will continue to engage with the sector to maintain competitiveness, because we fully appreciate the value of the life sciences sector to our economy.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Paragraphs 7.6 and 7.7 of the explanatory notes highlight that the EU makes information public and transparent. They talk about the MHRA doing that, but they do not mention that the MHRA would be publishing data within the upcoming EU system.

[Jackie Doyle-Price]

The regulations are determined to facilitate transfer with not only EU bodies, but internationally. We fully recognise that in bringing forward the regulations we are operating in an international landscape. The regulations are designed to facilitate that co-operation, as well as to establish the MHRA as the lead regulator. It is worth noting that, within the current system, the MHRA is the lead. In terms of the regulation we are transposing, rather less is coming to the MHRA given the existing ownership it has in this field.

--- Later in debate ---

[Jackie Doyle-Price]

I thank all hon. Members who have participated in this debate, which has demonstrated how vital it is that we make sure the legislative underpinning of clinical trials continues safely, as the hon. Member for Washington and Sunderland West (Mrs Hodgson) outlined in her opening comments. That is by far our biggest priority: we need to continue business as usual, and to value our important pharmaceutical and life sciences sector and guarantee people’s safety.

I will try to address some of the points made today. The hon. Lady mentioned the clinical trials regulation and what it would mean in terms of adoption by the UK if it was implemented after March 2019. We expect the clinical trials regulation to be implemented in late 2020, and the MHRA, the National Institute for Health Research and the NHS have been working towards the implementation of that regulation since it was agreed in 2014. The withdrawal agreement Bill will give effect to the implementation period in domestic law and will allow EU regulations to continue to apply directly in the UK for this time-limited period. If the clinical trials regulation comes into force during the implementation period, as it is currently expected to, we would expect to apply that to the UK. If however we leave without a deal—this is why we have these regulations—the CTR will not be in force in the EU at that time so will not be incorporated into UK law on exit day; however, we intend to align, where possible, with the CTR without delay when it does come into force, subject of course to the usual parliamentary approvals. But that alignment will happen after 29 March 2019.

The two key elements of the regulation that are outside the UK’s control and that this instrument does not therefore cover are the use of the shared central IT portal, as mentioned by the hon. Member for Central Ayrshire (Dr Whitford), and participation in the single assessment model, both of which will require negotiated UK-EU agreement regarding UK involvement post-Brexit. This reiterates the wish expressed by the hon. Lady and shared by me that it would be far preferable if we can leave the EU with a deal. Sadly, experience tells us that these things always go to the wire, but let us hope we get a resolution sooner rather than later.

The hon. Lady also mentioned patient safety. Currently a sponsor can report a suspected unexpected serious adverse reaction—SUSAR—during the course of a clinical trial through the EU database. Similarly, all SUSARs originating outside the UK where the sponsor has an ongoing trial in the UK involving the same medical products currently must be entered on the EU database, and we will clearly need to find a way of entering that so we can share such information and have arrangements for holding it on the MHRA database.

[Dr Whitford]

Does that mean that that ability is not there if the UK leaves without a deal, for April of this year?

[Jackie Doyle-Price]

Being brutally honest with the hon. Lady, and perhaps more honest than some are in this debate, I do not think we can dictate terms to our EU partners; I think we can look forward to having constructive working arrangements with them and it is in all our interests to do so, but ultimately we would have to seek agreement about this. At this stage this SI can only really cover the things that are in the gift of this Government, and a lot will rest on good co-operation after the event, which again means it would be much more preferable to leave with a deal.

Austerity: Life Expectancy

Debate between Philippa Whitford and Jackie Doyle-Price

Wednesday 18th April 2018 Westminster Hall

[Jackie Doyle-Price]

The right hon. Gentleman knows that we have made tackling that a priority. It is too early to draw any conclusions. It is the case that poverty is a big source of inequality, but we need to do more work before drawing conclusions. Having developed the evidence, we will act. There is a reason that we have developed a national maternity safety strategy. There is a reason we are focusing resource on the perinatal phase, because we recognise it is critical. We will also continue to spend money on the healthy living supplements to give children a better start in life and to tackle some of those inequalities.

[Dr Whitford]

The Minister accepts in her speech that poverty is a big driver of these changes and talks about doing more, but we expect that over the next few years another quarter of a million children will be driven into child poverty. It is not a matter of doing more. In fact, the policies at the moment are making the situation worse.

[Jackie Doyle-Price]

I do not accept that. The real issue for us as a Government is being able to make those interventions that address the sources of inequality. It is about giving practical steps, which I will come to in more detail.

The hon. Member for Sheffield, Heeley referred to the article in The BMJ by Hiam and Dorling about the spike in mortality and winter deaths. She was absolutely right to highlight that. We must pay attention to emerging studies. However, using the total number of deaths can be misleading and needs to be put in the broader context. It does not take account of the ageing population and the fluctuations in population numbers. We use the age-standardised mortality rate as the accepted measure, which looks broadly stable. Clearly this is not something we should be complacent about, and we should continue to keep a very close eye on trends in those numbers.

I mentioned people with learning disabilities living for 20 years less than the rest of us. It is good that that figure has come down since 2000. Their life expectancy has risen by seven years since the millennium. We must encourage that direction of travel by supporting them to live full, healthy and independent lives. That goes to show that having better health is not just an issue for the NHS and health services, but is about having more support to get people into work and to help them to live in the community. We need to use every interface with the state to achieve that.

If we take a lifestyle approach to securing the best possible health outcomes and tackling inequalities, an individual’s start in life is the beginning of that. We are focusing on pregnancy through early years and into old age to ensure that every child gets the best start and journey through the rest of their life. Public Health England is leading programmes to ensure that women are fit during pregnancy. It is leading programmes to ensure that children are ready to learn at two and ready for school at five. We want to continue to support smoke-free pregnancy, which leads to better health for children. Central to that is local commissioning driving best-quality service and interventions as appropriate.

We are obviously very concerned about childhood obesity. If we do not tackle it, it will set people up for poor life expectancy in the longer term. It is worrying to see the number of children entering school at the age of five who are already obese. We need to leave no stone unturned to achieve early intervention. Broader public education about the impact of sugar is helping, but there is much more we can do to encourage people to adopt healthier lifestyles.

--- Later in debate ---

[Jackie Doyle-Price]

I cannot give the hon. Lady that information now, but I will write to her.

Alcohol is a source of poor health outcomes, so we are also doing much to tackle that. I am in dialogue with Members on both sides of the House about supporting the children of alcoholic parents, recognising that they are a particular need group. I thank those hon. Members who have been associated with that.

[Dr Whitford]

With Scotland having been the first place to ban smoking in public places, and now moving forward with minimum unit pricing for alcohol, will this Government consider following that lead for England to tackle alcohol?

[Jackie Doyle-Price]

I am grateful for that point, which consideration is being given to in the Department. There are any number of tools that we could use to tackle alcohol. Probably the most important thing is to give the message that unsafe drinking is bad for the health. It is always interesting to learn from Scotland’s experience, and we will keep an eye on that.

Tobacco is a major cause of poor health. It is worth noting how much progress we have made over decades to reduce the prevalence of smoking. That should lead to better health outcomes, but that has yet to be seen.