Contaminated Blood

Rebecca Pow Excerpts

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

We are really looking to settle that question in this consultation. One decision that needs to be taken is exactly what shape the inquiry should take. Clearly, we would normally do this through a statutory inquiry, which would have the powers to which the hon. Lady referred, but equally, Members of the House have made representations that we should have a Hillsborough-style inquiry, which, by definition, would be more fleet of foot. One reason why we are pushing forward with this consultation is to get exactly that feedback, so that we put together an inquiry that inspires confidence among those who have been campaigning for this for so long.

[Rebecca Pow (Taunton Deane) (Con)]

Far from being negative, the Government should be applauded for their very swift action—recently, not in the past. They are listening and have already committed extra compensation, sorted out the complex system that we had before, and announced an inquiry. Can the Minister give an assurance, particularly to my constituents, that the right Department will be chosen, because we do have to give them confidence that we will not all be here again discussing this? We have the chance to sort it out now.

[Jackie Doyle-Price]

The purpose of the consultation is to allow people to make their points about which Department should be chosen to oversee the inquiry, and then we will respond accordingly. All I can say is: please encourage people to participate in this consultation.

Contaminated Blood

Rebecca Pow Excerpts

Tuesday 11th July 2017 Commons Chamber

[Kevin Hollinrake]

My hon. Friend is absolutely right. These terrible diseases have so many tragic implications. Through no fault of their own, people did not know that the treatments would have an adverse impact on their health.

Helen was infected in the 1980s, but it was only when she moved to my constituency in 2006 and registered with a new GP that she was diagnosed with hepatitis and its associated difficulties. She has had many consequent health problems, including four strokes, diabetes and rheumatoid osteoporosis. It has had a huge impact on her life. She calls her health a “ticking time bomb”. She had to relocate back from France after trying to set up a new life there with her husband and two children.

I have spoken to both of those constituents today. It is incredible how lightly they seem to carry their burdens. They have moved on from the principal issue, which was compensation, and what they want now is a public inquiry to get to the bottom of this. It is about getting answers. I am not saying that compensation is not important—it is hugely important, particularly for their spouses and children—but today they want answers.

[Rebecca Pow (Taunton Deane) (Con)]

My hon. Friend is making a very good case. Does he agree that, while we welcome the Government’s inquiry and the funding given so far, transparency should be at its core? That is what it is all about.

[Kevin Hollinrake]

I absolutely agree. The Minister may confirm at the end of the debate, if he gets the chance, that the Government have released all the relevant documents in their possession. It is absolutely right that there should be full transparency and that key witnesses who were involved in this tragedy should be interviewed.

One of the biggest outstanding questions is: what was known? Helen told me that, despite the fact that she did not find out until 20 years after she was infected, the hospital had known for years. That is a tragic set of circumstances.

Richard sent me a passage that he found during his research. As early as 1975, Dr Joseph Garrett Allen, then professor of surgery at Stanford University in California, wrote to Dr William Maycock, then head of the transfusion service in the UK, to warn him of the severe dangers of using US-pooled plasma sourced from paid skid-row donors and prisoners. He said that the situation was extraordinarily hazardous.

My constituents want answers to the following questions. What was known about the risks? Was Parliament informed about the change from self-sufficiency to imported products? What was found out and why were the products not withdrawn? Was it a cover-up or negligence? Did clinicians take a paternalist approach or was it simply incompetence?

I welcome the fact that this Government have done more than any other on compensation and transparency. I welcome the public inquiry and hope I can play my part in making sure that my constituents, their loved ones and everyone else affected by this terrible tragedy get answers.

--- Later in debate ---

[Rebecca Pow (Taunton Deane) (Con)]

I welcome you, Madam Deputy Speaker, as this is the first time I have spoken with you in the Chair.

I am pleased to follow the hon. Member for Hammersmith (Andy Slaughter). The case he mentioned is almost unreal, and few of us could believe it to be true if we had not lived through this issue ourselves. I pay tribute to all the campaigners up and down the country who have worked so hard to get this issue on the agenda—in particular the hon. Member for Kingston upon Hull North (Diana Johnson), but also many Members from across the House. This shows us pulling together and how Parliament should work. It has taken a long time, but we can make a difference. I hope this really will make a difference to those victims who have suffered, and that today’s announcement will change people’s lives once the public inquiry gets going. I would very much like to thank the Prime Minister and the Government for listening and for responding over this tragic affair.

When I became MP for Taunton Deane, one of the first people who came to see me, who does not want to be named, visited my surgery to tell me the desperate story of how his whole life had been blighted by being treated—inadvertently—with infected blood, as in so many other examples that we have heard today. I was quite naive. I had never engaged with anybody in that situation before, and I was deeply shocked by his account of all that he had gone through for his whole life. Being given infected blood had plagued and blighted his life. He was ill, of course, but also his quality of life was affected. One of the effects that resonated most with me was that it affected his relationship with his son—he did not have the time to spend with him. We all take for granted that we can leave our children an inheritance, even if it is not very much—some money for a car or a share of a house. My constituent was distraught and felt he had not done justice to his son because his illness meant that he had a problem holding down jobs. Not only was he suffering from the blight of the illness, but he carried that guilt with him.

My constituent raised two practical concerns with me about the system. First, he felt that the level of financial support was not sufficient to enable him to feel secure and he was constantly struggling. Secondly, the scheme that administered his payment—the Macfarlane Trust, which other hon. Members have mentioned—did not work effectively and as a result did not adequately support those it was designed to help.

I have spoken on this issue several times in the Chamber and in Westminster Hall, as well as privately to the Department of Health. I was pleased to hear that the Government had listened to our voices and it is welcome that this autumn a new single scheme will be introduced, with additional funding of £125 million, to replace the complicated system of five different support schemes. The devil will be in the detail, but I know that the Government will take into consideration all the comments from the consultation. I hope that that will iron out some of the problems that so many people have struggled with and make life better for the victims.

I am also pleased with the moves that the Government have made on transparency—another issue that hon. Members have mentioned. I appreciate the serious concerns about how this has been handled in the past, but I know that Ministers are keen from now on to make all information readily available. That has been promised in the inquiry announced today.

[Antoinette Sandbach (Eddisbury) (Con)]

I am grateful to my hon. Friend for giving way because I, too, have a constituent who has been infected by contaminated blood since the 1960s. He will be delighted with the public inquiry, because he wants to know why it happened and how he can gain access to proper compensation. Transparency is vital in this case.

[Rebecca Pow]

I thank my hon. Friend for that intervention and I could not agree more. Transparency should be the nub of the inquiry, because it is important for my constituent and for all those who have had their lives changed forever through no fault of their own. We must remember that they have not brought it on themselves.

I thank the Government for listening and giving the issue the attention it deserves. I also thank them for more than doubling the Department’s annual spend in this area. Let us make sure that the funding gets to the people who really need it. I thank the Government for announcing the inquiry as I will be able to give my constituent a glimmer of hope both that the Prime Minister has understood the issues and called for the inquiry, and that we will get the inquiry right. Public inquiries are rare events and we need to make sure this one works. New evidence will emerge, and I urge that all relevant and commercially sensitive documents are made available. With the right framework, progress can be made and—I hope—the right thing done at last. I urge the Minister to ensure above all that the inquiry does not drag on too long. For those who have suffered for too long already, time is of the essence.

Oral Answers to Questions

Rebecca Pow Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

Let me tell the hon. Gentleman what extra money is going into the NHS: three years ago, £1.8 billion, which was not asked for by Labour; two years ago, £3.8 billion, which is nearly £1 billion more than Labour was promising; and this year, £1.3 billion. That is a lot of extra money. Why is it going in? Because, under this Government, we have created nearly 3 million jobs, and that strong economy is funding an improving NHS.

[Rebecca Pow (Taunton Deane) (Con)]

3. What steps he is taking to increase the number of dermatologists in the NHS.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Health Education England is responsible for meeting the workforce requirements of the NHS in England. The number of dermatologists in the NHS continues to grow, with 18% more consultants and 13% more doctors in training since May 2010. HEE’s latest workforce plan shows a 2% increase in funded training places for dermatologists compared with the previous year. Dermatology remains a popular choice for doctors, and it typically enjoys 100% fill rates.

[Rebecca Pow]

I am pleased to say that, through a combined approach by the clinical commissioning group and Musgrove Park hospital in my constituency of Taunton Deane, it has been possible to prevent the long-term closure of the dermatology department and to put in place an interim service, with a full service reopening in 2018. Given the seriousness of the conditions of people coming through this department—including an increasing number of cases of skin cancer—will my right hon. Friend give further assurances about how we can ensure there is a sufficient supply of specialists in this area?

[Mr Dunne]

I know that my hon. Friend has campaigned actively to ensure that dermatology services at Musgrove Park hospital in her constituency have been retained following a consultant retirement, which prompted the temporary arrangements. I am pleased that, since the beginning of April, Somerset CCG has successfully commissioned regular dermatology clinics at Musgrove Park using specialists from Bristol, with a view to restoring a full service from next April. We recognise the important service that dermatology clinics provide and are committed to encouraging that specialty in Somerset and nationally.

Oral Answers to Questions

Rebecca Pow Excerpts

Tuesday 21st March 2017 Commons Chamber

The Secretary of State was asked—

[Rebecca Pow (Taunton Deane) (Con)]

1. What steps he plans to take to increase the number of opportunities for domestic students to study medicine.

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

We are funding 1,500 additional medical school places each year to ensure that the NHS can continue to deliver safe, compassionate and effective care well into the future. Around 500 places will be made available in September 2018, and the remaining 1,000 places by September 2019.

[Rebecca Pow]

In Taunton Deane, we are desperately short of trained health professionals, from dermatologists to nurses, but one of the worst shortages is of GPs, with some practices not even able to get locums. I know Ministers are working on this, but could my right hon. Friend update me on what the Department is doing to encourage more medical students to become GPs? It is hard to believe they do not want to come to Somerset, but what are we doing to encourage them?

[Mr Hunt]

There is no greater champion for Somerset than my hon. Friend. What I would say to her is what I would say to all medical students, which is that general practice is going to be the biggest area of expansion in the NHS over the coming years; in fact, we are planning to have the biggest increase in GPs in the history of the NHS.

O’Neill Review

Rebecca Pow Excerpts

Tuesday 7th March 2017 Westminster Hall

[Kevin Hollinrake]

The right hon. Gentleman is right. Some 50% of prescriptions are needless, and diagnostics would mean that a lot of drugs were no longer prescribed.

We talk glibly about tens of thousands of deaths—Stalin once said, “One death is a tragedy; a million is a statistic” —but the reality is that these are our partners, our brothers, our sisters and our children, so we must act.

[Rebecca Pow (Taunton Deane) (Con)]

My hon. Friend is making a powerful point, but is not the key to find new antibiotics? Is he aware that several antibiotics originated from organisms in soil? That is how penicillin was found, and the first lead on a new antibiotic was recently found in soil. Does he agree that protecting our soil is key to our future? Given how much soil is being eroded and degraded, the Government should treat that as an important issue.

[Kevin Hollinrake]

My hon. Friend is a fantastic champion of the natural environment, and she makes a very good point.

The World Health Organisation has stated that antimicrobial resistance is

“one of the greatest challenges for public health”

and that the problem is increasing and we are

“fast running out of…options.”

Antibiotic resistance is just one form of antimicrobial resistance—others concern viral and fungal infections—but my focus is antibiotics, which the public more readily understand and should have real concerns about. Bacteria undergo an eternal battle for survival, and natural resistance occurs as a result of bacteria fighting that battle, but when we use antibiotics—particularly when we overuse them—that natural resistance accelerates significantly and becomes super-charged, and we end up with many more antibiotic-resistant bacteria.

Children’s Wellbeing and Mental Health: Schools

Rebecca Pow Excerpts

Tuesday 10th January 2017 Westminster Hall

[Rebecca Pow (Taunton Deane) (Con)]

I am delighted to serve under your chairmanship, Mr Nuttall. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate, which is so important and timely, and I am pleased to be able to speak in it. I noticed last week that the debate was going to take place and I started to prepare my comments then, but of course, in the light of the Prime Minister’s excellent and welcome speech yesterday, I have had to change them somewhat.

I think it is pretty much agreed across the House that we need to put more emphasis on mental health, putting it on a par with physical health, as we have heard. We also need to do much more work on removing the stigma that seems to be attached to mental ill health, especially among young people. Another universally agreed principle is that prevention, or at least early intervention, is much better than cure. Obviously, that is where the school environment can really come into its own, and where I truly believe we need to focus a lot more effort.

To be positive for a moment, many Members from across the House have worked on bringing to the Government’s attention the fact that we needed a fairer funding formula for our schools. I am delighted that that is happening, and particularly that rural areas, such as mine in Somerset, will receive a much fairer share of funding per student. Although that will not solve mental health problems, it will alleviate the situation for many schools. They will have slightly more money to go around, which may mean that they have money to pay for consultants, advisers and specialist services, should they need them, for mental health. That is just one small thing, but if there is better education across the board, that has to be better for children growing up.

We know that a vast amount of mental health problems begin at school age, with 50% of lifetime diagnosable illnesses beginning at the age of 14, so it makes perfect sense to start dealing with those at that young age. I want to point out some positive initiatives that we could learn from and that perhaps should be copied on a wider scale. One is community engagement and involving young people in activities so that they really feel part of something. To give an example, I was very proud to go to the recent Somerset elections to the Youth Parliament in my constituency, where I was really taken by the assuredness of the students. Not only were they having great fun, but how well they conducted themselves, and how interested they were in life! I got talking to the chap who runs that—Jeff Brown from Somerset County Council—who said, “You should see the state that some of these children come to me in, when they are quite young—about age 11—and how this involvement, engagement and working together has really changed and helped them.” He also said that many of them had mental health issues, so if we could encourage children to get involved in such areas, it would be very helpful. Obviously, that means that we have to keep giving funding to organisations such as the Youth Parliament.

Another area that I am especially interested in, given my gardening and environmental background, is schools that are running gardening and outdoor projects to involve children in activities out of the classroom. I recently went to North Town Primary School in Taunton Deane; it has an excellent, innovative gardening set-up for a primary school. It is really involving children and giving them an outside interest—especially those who, perhaps, are not so academic—in growing and in watching the seasons change, watching nature and watching wildlife. The Royal Horticultural Society has many statistics to prove that that has a really beneficial impact on people’s mental health, and anything that any schools can do to get involved in such projects is worth while and to be encouraged.

Similarly, the Somerset Wildlife Trust, of which I am a vice-president—I am very proud to work with it—does an awful lot of work with local primary and secondary schools, enabling children to connect more with nature and the outside. According to national wildlife trusts’ statistics, 93% of schools said that outdoor learning improves people’s social skills, and 90% of children said that they feel happier and healthier when they are doing these activities outside. Interestingly, 79% of teachers in the surveys that they did said that outdoor learning had a real impact on their teaching practice, so I think there are real lessons to be learned there. Those are all excellent examples of what has already been done.

When I met the people from YoungMinds, they stressed the importance of placing wellbeing and all the activities that I have mentioned alongside academic learning. Again, I welcome what the Prime Minister said, and I was especially pleased to see that a review will be done of child and adolescent mental health services; I hope that it will begin swiftly.

Now for my negative bit: in the south-west, young people’s mental health is a significant issue. I am sure that all Members could give examples; I have many from my casework. People come to me with heart-rending stories exactly like the one that the right hon. Member for North Norfolk told about his daughter. I could list handfuls of people who are affected, including my children’s school friends, my son’s sports mates—guys with aspirations—and neighbours’ children. It is absolutely shocking how many people we can think of offhand. It is not only awful for the child; it puts so much pressure on families, especially if they must go long distances for treatment. It is awful for the child and awful for the parents, but it is also difficult for other siblings to carry on a normal life, and for parents to bring up all their children. I do not know if the right hon. Member for North Norfolk has other children, but I know that the impact makes things difficult for siblings. This is a serious issue, and this House and the Minister need to deal with it.

I welcome the introduction of mental health first aid training in schools, but will the Minister liaise with the Department for Education on an issue relating to the budget cuts for sixth-form colleges? In Taunton Deane, we have an outstanding sixth-form college called Richard Huish College, which has just been shortlisted to be The Times Educational Supplement’s sixth-form college of the year. I wish the college well in that, but when I spoke to its principal, he told me that the school had had to cut all its enrichment courses: sport, drama, music. He was at pains to stress that we need to send the message that we should not expect children to excel only at academic things such as maths and English. Obviously, those are important, but there are other ways for children to show that they are good at something, and for us to celebrate what they do. He pointed out that it is often the children who do not get such opportunities, or who think that they are not good at anything, who fall into a trap and start on a downward spiral. That is how we end up with a spike in mental illness. I urge the Minister to go along to the Department for Education and see whether we can have a bit of joined-up thinking.

I am delighted by the renewed focus on children’s mental health, especially as children spend a third of their time in school. Much good is already being done, as I have pointed out, and I would like to see some of those models copied, especially the ones relating to outdoor activities, the environment and even sport. Some schools run a daily mile; I believe that started in Scotland. Pupils go outside at a set time every day with their schoolteachers, in whatever they are wearing, and run a mile. They might get a bit sweaty, which I believe the girls do not like terribly—

[David Rutley (Macclesfield) (Con)]

My daughter does.

[Rebecca Pow]

—although my hon. Friend’s daughter does. What a terrific idea. If everybody does it, nobody worries about what they look like. It is simple and cheap; it does not cost a penny. I will also throw in that on Radio 4 this morning, we heard about shared family meals. There is so much benefit in things like that.

To conclude, I stress that the long-term benefits of addressing mental health issues at an early age will be to everybody’s advantage. I applaud the Government for what they are doing, but it is just the start—the building blocks or foundations on which I hope we will build a better future, in which we do not have to debate this issue.

Social Care Funding

Rebecca Pow Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

Today is not the day on which to announce a royal commission on the funding of care in the future, but I do agree that it is important that we put care funding on to a better structural footing for the future. The right hon. Gentleman is right to say that.

[Rebecca Pow (Taunton Deane) (Con)]

I applaud the Government’s commitment to £10 billion to the NHS by 2020, but does my hon. Friend agree that social care and healthcare must be better integrated across the whole country? Somerset County Council’s sustainability and transformation plan has that at its heart. It is a good model. Does my hon. Friend agree that such models should be copied, but that councils must be given the tools?

[David Mowat]

The STP for Somerset is excellent in that regard and my hon. Friend is right to raise it. She is also right to emphasise again the integration of health and social care, which is the holy grail of this. Those councils and health systems that do it best are making a huge difference.

Contaminated Blood and Blood Products

Rebecca Pow Excerpts

Thursday 24th November 2016 Commons Chamber

[Diana Johnson]

That leads me to my next point, which is on the Scottish proposals. As we have heard, they offer a better settlement, particularly for the bereaved, who are guaranteed 75% of their partner’s previous entitlement in addition to continued access to the Scottish discretionary scheme. That gives them much-needed security in a way that the proposed English scheme does not. I ask the Minister to look again at adopting the Scottish model and at providing more guarantees on non-discretionary support for widows and widowers.

My fourth point is about support for primary beneficiaries, which was raised in an intervention. The APPG asks the Government to look again at some groups of primary beneficiaries who need better support than is proposed under the English scheme. I received an email this morning from someone who contracted hepatitis B through contaminated blood products. Under the scheme, they are not eligible for any help, but they have obviously suffered and are suffering still. I hope that the Minister is willing to look at a very small group of people who are not covered.

The APPG believes that if more assistance were provided in the form of non-discretionary, ongoing payments, it would reduce the need for discretionary support and allay a great deal of our constituents’ worries. I urge the Department of Health to consider the contrast with the support announced in the Scottish scheme and whether more non-discretionary, ongoing payments could be made.

[Rebecca Pow (Taunton Deane) (Con)]

I applaud the hon. Lady for bringing the debate to the House. Although I recognise that the new payments scheme is an improvement, I want to speak up for one of my constituents, who does not want to be named. He is among the 256 out of the 1,250 haemophiliacs who were infected with multiple viruses—those who were co-infected. Their lives have been devastated—absolutely blighted—and they feel that they are not being fairly treated under the new arrangement. Will she expand on whether we can help those people a little bit more?

[Diana Johnson]

I will come on to the ways in which I think the funding that the Government have put together could be used more effectively to assist more people who have been affected by receiving contaminated blood, including the hon. Lady’s constituent.

I will talk a little about the overall funding of the new scheme. There is much that the Government could do to improve the scheme without any additional cost to the public purse. Even if the Scottish proposals, particularly those for widows and primary beneficiaries, were adopted in England, they would fall within the budget that has been allocated for every year save 2016-17. That is set out in an analysis conducted by the Haemophilia Society, which was presented to the Department of Health at last week’s meeting. I hope officials will consider that carefully.

Any need for additional funding could easily be met from two identifiable sources. I think the £230 million from the sale of our 80% stake in Plasma Resources UK should be made available, as should any reserves left in the accounts of the three discretionary charities when they are closed in 2017. Further, I ask the Minister to promise that any money that is not spent on beneficiaries in each year will be rolled over to support beneficiaries in the next year. At last week’s meeting at the Department of Health, it appeared from what officials told us that any unspent money would have to be given back to the Treasury. That would be a gross act of betrayal towards those affected.

In conclusion, unless the Department of Health accepts that its new scheme still has substantial issues that need to be addressed, the new support scheme will not command the full confidence of the people it needs to satisfy. Indeed, in some crucial respects it will be worse than the system it replaces.

The APPG still believes that people should have the option of a lump sum payment as part of any new scheme, to give them the opportunity to decide for themselves what is best for them—either a regular payment or a one-off lump sum payment.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate and on all the fine work she has done on the all-party group in keeping this issue in the public eye and in the ministerial eye. I associate myself with many of the points and comments she made. She set out clearly what needs to happen now to resolve the problem, so I shall not repeat what she said.

I would like to highlight the cases of a couple of my constituents who have suffered from the terrible effects of this scandal. I spoke again this week to one of my constituents, Helen Wilcox, who contracted hepatitis C following a blood transfusion at the age of 17, 40 years ago. She told me that she had received some terribly bad news—that her illness had progressed to cirrhosis of the liver. She is currently undergoing tests and biopsies to find out how long she has left to live. I ask Members to imagine the sort of strain her family has had to live with all these years, knowing that her condition would probably get worse, yet hoping that it would not.

Mrs Wilcox has had four strokes and suffers from rheumatoid arthritis and osteoarthritis. She takes 35 tablets a day and can barely get out of bed. Understandably, she says she has no life. She does not go out and she cannot make plans. She barely has the energy to bring up her children, and she had to give up her job 10 years ago. I am sure that the Minister will agree that she and her family deserve the certainty and clarity of a decent settlement in keeping with the pain and suffering she has endured.

Mrs Wilcox is not on her own. Many other Members will have similar stories from their constituencies. Another victim in my own constituency is Richard Warwick, who was multiply infected with HIV and hepatitis C as well as hep B by the NHS. His life has been ruined through no fault of his own. Of the 30 pupils in his class in the special school he attended, only four remain alive today. In fact, of the 1,200 victims who are co-infected, only 280 are still alive. Richard has campaigned long and hard for a fair deal for victims such as himself. One of the most heart-breaking and emotional meetings I have ever had as a Member of Parliament was when I spoke to Mr and Mrs Warwick, who told me about the impacts that has had on their lives and their terribly difficult decision not to have a family because of the health implications that would potentially have for their children.

I welcome the point made by the Haemophilia Society that the new payment scheme is an improvement on proposals in the original January consultation. I think it makes complete sense to have one single scheme rather than multiple schemes, and I am pleased that more money has been identified to pay the victims. On behalf of my constituents and others like them, however, I ask the Minister to ensure that no one is worse off under the new system, including those who are in receipt of discretionary payments. I ask, too, for greater clarity about payments made to the families of victims after they have passed away.

[Rebecca Pow]

My hon. Friend is giving an emotional speech, and it is hard to listen to these cases. I am not going to go into the details of the constituent I speak for, but I will speak up for the idea of the lump sum payment for the co-infected, because they have even more strains than others. As my hon. Friend says, there are fewer and fewer of them and it is up to us to try to make their lives as good as we possibly can.

[Kevin Hollinrake]

My hon. Friend makes a good point, echoing the comment of the chair of the all-party group that there should be an option to take an ongoing payment or a lump sum.

Of course, the victims have lived with their illnesses for decades and now they want to ensure that their families are compensated for the losses they endured because of that. Mr Warwick also had to give up his job many years ago. When his employers discovered that he was infected with HIV, he was asked to leave. That meant his wife became the main breadwinner, although she could only work part-time as the rest of her time was devoted to his care. Given that she may be near to or at retirement age, it may be difficult for her to find a full-time job. Mr Warwick tells me that more than anything he wants to be able to put his mind at rest by knowing that Mrs Warwick will continue to receive monthly payments throughout her lifetime.

I urge the Minister to think about the terrible impact this injustice has had on Helen Wilcox, Richard Warwick and their families—and many others like them—and to offer them greater clarity and a fair settlement, so that they can have peace of mind this Christmas.

Reducing Health Inequality

Rebecca Pow Excerpts

Thursday 24th November 2016 Commons Chamber

[Maggie Throup (Erewash) (Con)]

It is a great pleasure to follow the very thoughtful speech of the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson).

Today’s subject, reducing health inequalities, is very far reaching. I will focus on obesity, as I chair the all-party parliamentary group on obesity, and also sit on the Health Committee and was involved in producing the report that my hon. Friend the Member for Totnes (Dr Wollaston) has alluded to.

I make no apology for talking about obesity again in the Chamber. Alongside terrorism and antimicrobial resistance, it poses a major threat to our nation. More than one in five children are overweight or obese before they start primary school; that figure rises to more than one in three as they start secondary school. Our children—our future generations—are at risk of developing serious health conditions such as type 2 diabetes, heart disease and cancer. Recent data have shown the continuing and widening inequality gap in the overweight, obese and excess weight categories for reception and year 6 children. Some 60% of the most deprived boys aged five to 11 are predicted to be overweight or obese by 2020, compared with a predicted 16% of boys in the most affluent group— 60% versus 16%. Overall, 36% of the most deprived children are predicted to be overweight or obese by 2020 compared with just 19% of the most affluent.

Those vast inequalities must be tackled, and, as the Health Committee inquiry into childhood obesity stated, we need to take “brave and bold” action. Every study around at the moment shows that higher obesity rates are linked to deprivation. Critically, the national child measurement programme showed that the gap between areas less affected and those where childhood obesity is more prevalent is growing. That cannot and should not be ignored. We need to see it as a wake-up call, highlighting the fact that many of our young people could face a future riddled with the complications of obesity—as I have said, those include diabetes, heart disease and cancer—as well as the immense strain we risk putting on our public services and the potential emotional impact on our population. Medics are reporting cases of type 2 diabetes in children. That is shocking and frightening, as until recently it was thought of as a disease only of the older population. It is a reminder, yet again, that action is needed to prevent a public health calamity.

I will focus now on the overall impact of obesity in adults. It is important we provide parents with every tool possible to make sure they can be great role models when it comes to what we eat and our lifestyles.

[Rebecca Pow (Taunton Deane) (Con)]

I am sure that my hon. Friend is aware that last week Tesco announced significant changes to the amount of sugar in its drinks. It did so off its own back. What are her views about how such pressure from the supermarkets could influence outcomes for our children?

[Maggie Throup]

My hon. Friend makes a good point. It is not just Tesco that has done that; so have Waitrose and Morrisons, to name just two—I am sure there are many more. It is really good that major retailers have taken on board the severity of the challenge faced both by us as a nation and globally. Parents need to be role models, as do retailers. Sometimes they are not quite the role models that they should be, but we need every bit of help we can get.

It is not just childhood obesity that is linked to social class and to different levels of deprivation; adult obesity is, as well. The highest prevalence of excess weight for both men and women is found among low socioeconomic groups. If current trends continue, almost half of women from the lowest income quintile are predicted to be obese in 2035.

Obesity is the single biggest preventable cause of cancer after smoking. The Government acknowledge the importance of early cancer diagnosis, and dedicated NHS staff at all levels are committed to delivering that, so surely every preventive measure that can be put in place, must be. As previously noted, as well as cancer, obesity leads to a greater risk of type 2 diabetes and heart disease. Those conditions are all life-changing and life-limiting.

I am sure people now understand that there is a link between obesity and diabetes, but, sadly, I fear that many think they can just take a pill to keep diabetes under control. Sadly, for far too many diabetes sufferers, that is not the case. The consequences are vast, with many diabetes patients needing lower limb amputation and suffering kidney disease, heart disease and sight loss—as I said, it is life-limiting and life-changing. Action needs to be taken now to turn around what I believe has become an obesity epidemic.

Everything I have talked about should prompt a reconsideration and review of the Department of Health’s childhood obesity plan. Although the Government were leading the world in producing the plan for action, when it was published, many, myself included, said that it was quite a let-down. I stand by that view. There simply was not enough detail in that 13-page document. It was aspirational, rather than a focused plan of action; it ignored the recommendations of Public Health England, which were endorsed by the Health Committee; and it did not set firm timescales for turning the tide on childhood obesity.

The plan we have is insufficient for the scale of the task we have to tackle. That does not mean starting all over again, however; it means that we need to do more. We need clear actions and timescales. I acknowledge that there is a fine balance between a nanny state, business co-operation, and parental and personal responsibility, but I am sure it is not impossible to find that common ground. Yes, it is the responsibility of parents to ensure their children eat healthily, are physically active and learn good habits that will last a lifetime, but time and again that has proven insufficient by itself. Parents need more help and the current childhood obesity plan cannot and will not give them what they need.

It would also be a mistake to think the answer lies in burdensome regulation of business, namely the food and drink sector. Demonising that sector is both unhelpful and unfair. As we have discussed, some producers, manufacturers and retailers have already taken great strides in reformulating products and encouraging healthier consumer behaviour. We must commend them and welcome those actions. Evidence suggests that the least affluent households in the UK have higher absolute exposure to junk food advertising than the most affluent households. Interventions such as reducing the promotion of junk food, or the soft drinks industry levy, are likely to have a positive impact on reducing health inequalities by delivering change across the population and consequently delivering disproportionate benefit to the most deprived communities.

Just as the current plan does not help parents, however, it likewise does nothing for business, which would be better served by clear goals for reformulation, advertising and labelling, and timeframes in which those must be achieved. Both publicly and privately, many businesses in the sector note that they would be better served by clearer, more far-reaching Government recommendations that at least gave them a measure of certainty for the future.

We may well be horrified by the national child measurement programme figures and other data we read on an almost daily basis now. Just this week, Cancer Research UK revealed that teenagers drink almost a bathtub full of sugary drinks on average a year—I hope that a visual representation will shock some teenagers into changing their habits rather than suffering the consequences.

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[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I follow previous speakers in this debate with a certain trepidation. I hope that I can live up to their mark. I congratulate the shadow spokesperson, the hon. Member for Washington and Sunderland West (Mrs Hodgson), with whom I have worked closely on issues around basketball. I should also draw the House’s attention to my entry in the Register of Members’ Financial Interests. I also congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate. As a fellow Devon MP, she might know something about the issues I want to talk about—it would be helpful to have a conversation with her afterwards.

In my constituency, there is an 11-year life expectancy difference between the north-east of my patch, where the professionals live, and the south-west, in Devonport, which is best known for its dockyard. Last week, I chaired a supper in Plymouth with health practitioners and academics on the subject of iron-deficiency anaemia in Devon. I will not pretend to be a medical expert—as hon. Members can probably tell, that is something that rather bypassed me—but it is a condition where the body has a low red blood cell count, resulting in less oxygen getting to organs and tissues. It can have serious consequences and often leads to more admissions to hospital or a deterioration in health.

The condition is a result of poverty—especially, but not exclusively, among the over-75s. I was horrified to learn that Plymouth is top of the national list of iron deficiency. The rates of iron-deficiency anaemia are four times the national average. In the Northern, Eastern and Western Devon area, which includes Plymouth, there were 1,530 in-patients with IDA in 2014, a 19% increase on 2013, following a steady rise over the previous few years. I understand that in 2014 this amounted to an avoidable cost to the local health economy of just over £1 million.

I want to focus on NHS England’s desire to close three GP surgeries in my constituency by next March. I fear that this action will serve to put greater pressure on the principal acute hospital at Derriford, in the constituency of my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer). I am told that the reason why NHS England is considering the closures is the size of the GP practices. I understand there is a Nuffield report that says that that should not be the only thing taken into account. The Cumberland GP practice has 1,800 patients, Hyde Park has 2,800 and St Barnabas 1,700. They are considered by NHS England to be unsustainable and too small, despite the fact that they are growing practices. I have mentioned some of these issues before, but I have no problem repeating them. I was told that closing the practices is not down to saving money, but is about delivering better value for money. However, before I speak about those issues, let me put my constituency in some context.

Plymouth, Sutton and Devonport runs from the A38 down to sea, and from the River Plym to the River Tamar. It is home to one of the largest universities in the country, with more than 27,000 students, thousands of whom live in the city centre. It is a naval and Royal Marines Commando garrison city, as the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), for whom I was previously a Parliamentary Secretary, knows only too well. Before the November recess, the Ministry of Defence sadly confirmed that it would be releasing Stonehouse Royal Marines barracks and announced that the Citadel, which is where 29 Commando is based, would be released back to the Crown Estate. Fortunately for Plymouth, the MOD also announced that the Royal Marines and their families would be transferred from Chivenor, in the north of Devon; Arbroath, up in Scotland; and Taunton, just up the M5. While the city’s population is growing, this announcement will almost certainly put even greater pressure on our schools, our hospitals at Derriford and Mount Gould, and our GP practices.

Although Plymouth has a global reputation for marine science and engineering research, it is a low-wage, low-skills economy. It is an inner city—something pretty unique for a Conservative to represent, if I might say so. Indeed, I do not have a single piece of countryside in my constituency, unless we include the Ponderosa pony sanctuary, which is a rather muddy field. In the run-up to the 2010 general election, when I won the seat on the third attempt, the Conservative party pledged to do something about healthcare in deprived inner cities. We have started to make good our word, and in 2014 my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—one of the Minister’s predecessors —came to Devonport to open the Cumberland GP practice, which is now very much under threat. Other facilities on the Cumberland campus include a minor injuries unit, the Devonport health centre and a pharmacy.

The Cumberland GP practice was set up by Plymouth Community Healthcare—now Livewell Southwest—and the Peninsula medical school. There was, and is, a desperate need to provide a tailor-made alternative service to the existing GP practice—then the Marlborough Street practice, now the Devonport health centre—for this deprived Devonport community and a need to look after drug users and the city’s homeless in hostels such as the neighbouring Salvation Army hostel. The practice also offers practical placements to students at the Plymouth medical school. Until earlier this year, it was funded by Livewell Southwest, a social enterprise, which found it too expensive to maintain.

Despite Devonport’s real deprivation, NHS England did not want to get involved in providing a contract to the Cumberland GP practice, which has consequently been operating without a formal contract and is managed by Access Health Care. I understand that in the past the neighbouring Devonport health practice has not been interested in offering facilities to homeless people and drug users—it may change its mind, though. Indeed, I understand that some of the Cumberland practice’s patients were not keen to transfer back to the Devonport centre, which is where they came from in the first place.

NHS England’s reason for putting the Cumberland GP practice under threat is because it considers it to be too small and to be operating in unsuitable, cramped premises. Unless we are careful, we could put more pressure on Derriford’s acute emergency unit, which is already under enormous pressure.

I became aware of NHS England’s proposals for these three GP practices in August, during the summer recess, when NHS England no doubt expected me and other MPs to be away on parliamentary trips or taking a holiday—hard luck; I was there! I immediately put together a series of meetings with the city councillor director of public health, the leader of the council, the cabinet member for adult social care, people from NHS England, the dean of the medical school and Dr Richard Ayres, who runs the Cumberland GP practice. At that meeting, I suggested that the Cumberland GP practice should share the Devonport health centre’s brand-new building, which has space and operates as a federation, sharing the receptionists and backroom staff. This was supported by everybody present. Indeed, the city council’s health and wellbeing board also supported it, following an inquiry that recommended measures to allow the Cumberland GP practice to continue.

However, I understand that Devonport health care might not be willing to do that, so it appears that the Devonport community might be deprived of a second GP practice and patients will have no choice over which doctor they go to. The Northern, Eastern and Western Devon CCG is looking at ways to try to keep the Cumberland GP practice open, but it needs space in the short term while it considers alternative locations. I have also received representations from patients at both the Hyde Park and St Barnabas surgeries.

At Hyde Park, although Dr Stephen Warren is keen to continue as a GP, following a heart attack, he has transferred the ownership of his practice to Access Health Care because he no longer wishes to deal with the backroom tasks of administration, which is part of running a practice. He argues that his and his partner’s growing 2,800-patient practice—the Cumberland is growing as well—has attracted outstanding reviews, and that he would not be able to inform his patients where he was going if he relocated to another practice. He also thinks that some patients like to have a relationship with an individual doctor whom they can see speedily rather than having to wait weeks. It is rather like having one’s own personal bank manager, which I feel is quite important.

The St Barnabas surgery, which is also run by Access Health Care, was set up in a new development next to a residential care home for the elderly where patients do not have to walk very far to get to it. In all three cases, NHS England, for supposedly technical reasons, gave patients only 24 hours’ notice of its initial engagement. I must say, frankly, that I found the public consultation process utterly appalling. I wrote to NHS England asking it to give more time to engage with local communities, and I am grateful that it bothered to listen.

Recently, at my weekly constituency surgery, I was asked to write to NHS England to ask whether it had engaged with other GP surgeries and with Derriford hospital, and whether it had consulted them, because some GPs will have to accommodate more patients. That is a very big issue.

There are wider issues in all of this, too. At the moment, the commissioners in Northern, Eastern and Western Devon spend a higher amount of money in eastern Devon than in the more deprived western locality. The Government’s success regime is keen to correct that, so that resources are focused on deprived communities such as Devonport.

[Rebecca Pow]

I wish to make an observation. Given the detail that my hon. Friend has gone into and how he seems to be representing his community in these deprived areas, I wish to observe how very fortunate they are to have this Conservative MP in that inner-city area.

[Oliver Colvile]

It is generous of my hon. Friend to say that, and I shall try to intervene on similar lines later! [Interruption.] I also observe that there have been no mentions of hedgehogs in this debate.

Finally, as the Minister may know, I am the Government’s pharmacy champion, and the Government are reviewing the role of pharmacy to take pressure off our GPs and major acute hospitals such as the Derriford. Much has been made of the 6% cut, but there has been very little publicity of the £19 million that will be made available through the Government’s pharmacy access fund. My hon. Friend might like to use her winding-up speech to give us a little more information about all this, and to explain how the Department of Health will provide the resources for pharmacies to take pressure off GPs by delivering flu jabs, opticians, mental health services, anti-smoking measures and a nationwide minor ailment facility. If she cannot do that now, perhaps she would like to write to me about it.

Plymouth’s health service is under real pressure. Like the rest of the country, the town does not have enough GPs. Parts of my constituency are very deprived and we need to do something about the 11-year life expectancy difference. The Government must ensure that resources follow health needs. We also need to make much more use of pharmacies. As my hon. Friend the Minister knows, I am the Government’s pharmacy champion, so may I ask how we will ensure that pharmacies have funding, and how they will be able to operate?

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[Rebecca Pow (Taunton Deane) (Con)]

I am very pleased to follow the hon. Member for Bradford South (Judith Cummins), who gave such a shocking account of oral and dental health. I am also delighted to follow my hon. Friend the Member for Totnes (Dr Wollaston). I commend her for raising this important issue and for so ably highlighting the impacts and causes of health inequality.

I want to focus on an area my hon. Friend did not mention, and to bring it to the Minister’s attention: natural and green solutions to help to reduce and prevent the disparity and inequality in health outcomes. I am not suggesting that the things I am going to mention are the only solutions, but I really believe that our natural environment has an important and often underestimated role to play in our health and wellbeing. Health inequality can cost up to £70 billion a year, with those below the wealthiest levels in society suffering the greatest degrees of inequality. Many of my colleagues have expanded on that point today. I have a particularly deprived area in my constituency called Halcon, which is among the 4% most deprived parts of the country. Many of the factors being described today apply to that part of Taunton Deane.

Interestingly, people living in deprived areas are 10 times less likely to live in the greenest areas. That seems more than a coincidence. There must be a link. In fact, I can tell the Minister that research shows that disadvantaged people who have greater access to green spaces are likely to have better health outcomes. A good-quality natural and built environment can have a significant positive impact on mental and physical health. Not only that, but some of the solutions that I am going to mention can be cost-effective. I know that the idea of cost savings will always make a Minister’s eyes light up. Many people are beginning to realise the important link between health and wellbeing and the natural environment, and I am heartened that many service providers are already thinking about that and putting people in place to deal with it. For example, the Somerset Wildlife Trust, of which I am very proud to be a vice-president, has appointed Jolyon Chesworth as its first health and wellbeing manager. That is heartening, and I shall watch with interest to see how that role develops and what the trust will do to highlight this issue.

The natural world can have a really positive impact on mental health. I am a firm believer in the therapeutic power of a brisk walk in the beautiful Somerset countryside. Maybe we can stretch that to include Devon.

[Oliver Colvile]

Does my hon. Friend agree that one of the great problems is that mental health care has been a Cinderella service in the NHS for far too long? Does she also agree that the Government are trying to do something about that?

[Rebecca Pow]

My hon. Friend is right; it has been a Cinderella service.

The solutions that I am outlining are free. I am giving the House ideas for free therapy, because nature is free. It is a beautiful thing, and it really does have power. What could be more relaxing than a walk up to the Wellington monument on the Blackdown hills in my constituency? Hundreds of thousands of people go up there, including lots of people with disabilities, because it is easy to get to and it is all flat. Those walks to the monument are really beneficial. I know that it is not quite relevant to the debate, Mr Deputy Speaker, but the Government raised my spirits yesterday by announcing that they were giving £1 million to the Wellington monument’s restoration project from the LIBOR fund. That will have loads of spin-offs for the public, and health and wellbeing will be part of that. We are going to build a big community project to encourage more people to go up there.

When I was looking for somewhere to live in London—obviously, I have to stay up here during the week—one of my criteria for the flat was that I had to be able to see a tree from my window, and I can. I could not live without one.

[Dr Wollaston]

I congratulate my hon. Friend on the points that she is making. There are good data to back up what she is saying. Public Health England estimates that an inactive person is likely to spend 37% more time in hospital than someone who is active, and that inactive people are 5.5% more likely to visit their doctor. There is a good evidence base for what she is saying.

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[Rebecca Pow]

That is absolutely true, and I shall give the House a few more statistics as I go on. I am not making this up. This is not wishy-washy; it is actually coming into our psyche.

[Oliver Colvile]

May I encourage my hon. Friend, when she is in London, to take a boat from Chelsea Harbour down to Greenwich? She will see the magnificent layout of trees that occurs beautifully in the west, although there seem to be fewer of them in east London.

[Rebecca Pow]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I do not want us to get into a forestry debate. I admire this love-in for the south-west, but I think we need to get back to health.

[Rebecca Pow]

I did actually go out on a boat up the Thames this morning with Greenpeace to look at the issue of microplastics in water, and we also saw some trees. Trees are important and serve a good purpose in taking in air pollution, which has an effect on health; we have a lot of asthma in our cities. If we plant more trees, we will help to combat all that.

It has been demonstrated that mental health can be aided through contact with nature. As a keen gardener, I can vouch that getting one’s hands in the soil, watching things grow, planting seeds and watching the seasons change definitely does lift the spirits and is a pick-me-up.

[Maggie Throup]

My hon. Friend makes a good point that brisk walks are not the only thing that can help health. Last Friday, I was helping some young children at Chaucer Junior School to plant bulbs in the school’s grounds. We were getting exercise out in the fresh air in an area that is quite built up and urban, which must be a good thing for their future health.

[Rebecca Pow]

My hon. Friend is absolutely right. Many schools run gardening groups. There is so much to take from gardening, and it can also help the unemployed and other groups. Gardening is physical activity, but watching things grow out of the soil is so beneficial. In fact, Royal Horticultural Society research shows that 90% of UK adults say that just looking at a garden makes them feel better. Doing something in a garden is better, but one can also just look. There were data recently about watching birds on a bird table or hedgehogs. If someone has the chance to watch a hedgehog, that could make them incredibly happy because they are so rare now. I got terribly excited when I recently saw one eating my cat’s food.

[Alison Thewliss]

I do not want to rain on the hon. Lady’s garden as such, but does she agree that there can be a negative impact on someone’s mental health if their surroundings are not good? Some 60% of people in Glasgow live within 500 metres of vacant or derelict land, which can negatively affect their mental health.

[Rebecca Pow]

That is such a good point. We need to be doing something with derelict land as communities. The Woodland Trust has some great data saying that, if someone lives 500 metres from a wood, their health will be better because not only can they go into it, but they can look at it and enjoy it. The mental health charity Mind produced a report called “Feel better outside, feel better inside” that advocates the benefits of ecotherapy. Ecotherapy improves mental and physical wellbeing and boosts people’s skills and confidence to get back into work by taking part in gardening, farming, growing food, exercise and conservation work. Some 69% of people who took part in such projects definitely saw a significant increase in their mental wellbeing and 62% thought that their overall health was improved. The projects helped 254 people find full-time work, which saves the nation money because they no longer need support.

In my constituency, a job agency called Prospects has a contract to get the long-term unemployed back to work. It does gardening with groups of people, but it also does forest walks. I have been out with them in the Neroche forest, which contains a lot of ancient woodland. It definitely helps people not only to engage in nature, but by giving them confidence because they are talking to each other and getting out in a different atmosphere—not an office. Many of those people then have the confidence to apply for jobs and get back into work. There is a clear case for having the prescription of access to green space in the armoury of traditional medical treatments to deal with a range of mental health issues.

We also have physical health to consider. The great outdoors is a vastly underutilised tool, in the wider sense. Many of my colleagues have been talking about obesity and the outdoors can play an important part in our fight against it. Obesity, particularly childhood obesity, currently costs the Government £16 billion, and those living in deprived areas are twice as likely to be obese.

With that in mind, I advocate that consideration be given to green prescriptions. The Local Government Association has recently called on the UK to implement a similar model to that used in New Zealand, where eight out of 10 GPs have been issuing green prescriptions to patients, with 72% of them noticing a change in their health. The LGA is encouraging GPs to write down moderate physical activity goals for their patients, including things such as walks in the park and all-family classes that they can go to. A number of GPs are already using these schemes on Dartmoor and Exmoor, and in one pilot people are being encouraged to visit the national parks, which are beautiful, on their doorstep and free to enter. I am recommending all these things. Councillor Izzi Seccombe, chairman of the LGA’s health and wellbeing board, said that writing such a formal prescription encourages many more people to get out and do the activity. If the doctor says that people must take a pill, they take it, so if the doctor says that they must go out for a walk in the wood, people might do it.

A great many initiatives are already taking place, such as NHS Forest, which aims to improve the health, wellbeing and recovery times of patients and staff by increasing access to NHS gardens—the locations on the doorsteps of the hospitals. As part of the Health and Social Care Act 2012, a statutory duty was placed on local authorities to create health and wellbeing boards. However, the Health Committee has reported that those were not working very successfully and have few powers. Perhaps the Minister might examine that, as they could start to make a big difference in moving this agenda forward.

There was a proposal in 2015 for a nature and wellbeing Act, which was much discussed and debated. That sought to put nature at the heart of all the decisions we make about health, education, the economy, flood resilience and so on. Perhaps, Minister, we could re-examine some of the ideas in there, because some of them are very good. We know that there are links between access to green space and health. It seems a no-brainer to me—if we can improve access to green space and look into the idea of beginning to prescribe these green treatments, we could really make a difference to health and health inequalities.

That would be much easier if we had all the data and we could prove these benefits with those data. Help is at hand, because the Wildlife Trust has commissioned a piece of work; it has commissioned the school of biological sciences at the University of Essex to gather just such data. Once we have some solid facts, we can really move forward. I would like to think that the Minister will consider some of these ideas. When the Cabinet Minister for tackling health inequality is put in place, as was recommended by my hon. Friend the Member for Totnes—or perhaps the Prime Minister could lead on this, as recommended by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson)—we might be able to add my green points to the agenda and really move forward to a healthier society.

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[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

I join colleagues across the House in congratulating the hon. Member for Totnes (Dr Wollaston) and her Committee on their work in this area and on securing this debate. She brings a calm and clear knowledge to every health debate. We really do need a long-term vision in this area and I know that she, like me, wants to see that, whatever party is in government.

I speak today both as an MP for a constituency with large gaps in health, wellbeing and life expectancy, which are very much determined by place of birth, early years experience and poverty, and as Chair of the Public Accounts Committee, which in this year alone has published 10 reports on the national health service, some of which shine a light on this debate. Our reports show the huge pressures on the national health budget and the huge increases in demand on that budget. To take diabetes as an example, 4.8% of the population is currently diabetic, but that is set to rise to 8.8% in the next few years.

It is my role and the role of my Committee to look at funding. Specifically, our role is to look at the economy, effectiveness and efficiency with which the Government spend taxpayers’ money, so I will talk first about how we spend the money that is allocated to our health service and how that is key to tackling health inequalities. I will then turn to how we look at the impact of decisions, both in the health service and in other parts of Government, on health inequalities—what we in the Committee call “cost shunting”.

NHS budget spending is in the region of £110 billion a year. The Government are keen endlessly to remind us that they have injected £10 billion into the NHS over the six-year period to about 2016. At the same time, we see an ageing population, a large and increasing demand, including for specialised services, and a health service squeezed at each step of the journey. My Committee has heard evidence on general practice, specialised services such as diabetes and neurology, acute trusts and social care, all of which has shown the impact on the budget. That has all been caught up in what, sadly, has been a rather childish debate over headline figures and often very subtle changes in language from the Government about who is to blame. Ministers have moved from the mantra, “We’ve injected an extra £10 billion”, to saying, “The NHS has been given what it asked for”, as though they were scolding a naughty child, and, “We will manage this within the NHS”, as the Chancellor said yesterday when I asked him why he had not considered the NHS budget in the autumn statement.

In today’s Daily Mail there is an exhortation—this is quoting sources close to or in Government—that the NHS simply needs to manage its resources better and cannot endlessly be given more money. I am Chair of the Public Accounts Committee. This is taxpayers’ money. I do not think we should endlessly pour money into any Department without demanding quite a lot of it, and I am clear that there are always efficiencies to be found in a system so large and with such a large overall budget. Every pound saved is a pound to spend on something else. That is the key point. Every pound saved in the Department of Health budget can be spent on other things and ought to be spent on public health in particular. I will come on to that.

As I have highlighted, there are many pressures on the NHS budget. With all these discussions and figures being bandied around, we need to take a closer look. In 2015-16, the Department’s budget was projected to have a £2.45 billion deficit. The measures used in the last financial year to balance the budget were extraordinary and one-offs and led to an unprecedented three-and-a-half-page explanatory note from the Comptroller and Auditor General alerting all of us, particularly the Department, to his concerns that those were not replicable, long term or sustainable. He reiterated that point in a Committee hearing only a few weeks ago.

I will not spend too long on the budget figures—the debate needs to move on—but I will touch briefly on the overall figures this year for acute trusts alone. From April to September, trusts overspent by £648 million and the deficit for the first six months forecast to the year end is £669 million. This trend was increased largely because of the decision in 2011 to allow for 4% efficiency savings across the NHS by the then Chancellor of the Exchequer. Everybody in the system knew that that was not realistic on a long-term basis. People knew that there would be a problem with the budget two or more years out from the crisis in the budget settlement in the last financial year, yet there is no openness in discussing how we spend money in the NHS, what we spend it on and what we focus on.

That brings me to public health. Too often, public health budgets are raided to deal with day-to-day crises and money is taken out of NHS education. The plans for service transformation are not necessarily a bad thing, but the danger is, if they are done in the wrong climate and with the wrong tone, that they are seen as an excuse for cuts. They can be so much better for patients, especially if focused on preventive work and the more efficient spending of taxpayers’ money, but too often they will be driven by financial pressures. A lot of pressure was put on finance directors of acute trusts in particular at the end of the last financial year. Many were encouraged, for example, to move capital funding into the resources side of their budget in order to balance the books—a short-term measure that can lead to underinvestment in facilities that, if invested in, can actually save money and improve the patient experience.

This short-term, year-on-year, or even spending review period planning will not tackle health inequalities effectively. We need a longer-term approach. We need to prevent more ill health and treat fewer patients. As others have highlighted, the age of death is increasing—we have an ageing population—but the age of disability remains broadly similar. Public Health England released a report towards the end of 2015 highlighting some of these figures. The cost of treating illness and disease arising from health inequalities has been estimated at around £5.5 billion a year, and then there is the issue of cost shunting, which is a big concern.

If we do not tackle these things, it will not just be individual patients or their families who suffer, or the taxpayer funding these services; there is a wider impact on society. Productivity losses are estimated at between £31 billion and £33 billion per annum. Lost taxes and higher welfare payments cost in the region of £28 billion to £32 billion per annum.

To go back to what the hon. Member for Totnes said about smoking, if we tackle tobacco issues in my neighbouring borough of Newham alone, that would save about £61 million per annum. That would make a big contribution to the local health budget in east London. If we replicated that across just east London, just think what we could contribute to the NHS budget.

About 1.3% of workdays a week are lost to sickness in London alone, which is lower than in many parts of the country. All these things contribute to our productivity gap and have a big effect, so if we are to do what the Chancellor said yesterday and ensure that our workers produce in four days what they now produce in five, we need workers who are well and can work until the increased retirement age that is demanded. It is quite shocking that the hon. Member for Glasgow East (Natalie McGarry) and other colleagues from Glasgow represent a city where people will die before the age at which they qualify for their state pension. There are certainly many people in my constituency who face that, although they are not the average. That is a sign of the failure of preventive work to tackle health inequalities at the right point.

When it comes to joining up Government, we need to look not just at the silos in various parts of the health budget, but at ensuring a healthier wider society. Let us take, on the one hand, the land disposals that the Government are undertaking to provide public land to build new homes. My Committee has looked at that a great deal, although I will not divert the House today too much. In my area we have St Leonard’s hospital, the site of a former workhouse in Hackney. When the most recent reorganisation of the NHS took place in 2011, the site was moved to the central PropCo, the property company that the NHS holds centrally to manage its estate. We therefore no longer have local control of what to do on that site. Given the state of homelessness locally, if we could provide families with more good-quality homes on that site that were not overcrowded, we would do more for public health and health inequalities than a lot of the fiddling around we do over whether a service should be based here or there and all the treatment work we are doing.

Departments are now taking account of other “strategic objectives”, as they put it, in land disposals, but that is still ill-defined. My Committee will continue to push on this matter because from the perspective of my constituency, where we have extraordinarily high house prices, if we can release land and provide homes for key workers, that would contribute to the outcomes of those Departments. I am determined that the Government are clearer in their outcomes, because in constituencies such as Taunton Deane—or perhaps not, as the hon. Member for Taunton Deane (Rebecca Pow) highlighted—the need might be for green space or other facilities that would improve or promote health. However, if we do not have a wider view of what we are doing with our public assets, there is a danger that we will just sell to the highest bidder and lose the chance for several generations, because once land is gone, it is gone.

Finally on this issue, it is important to touch on the increasing challenge of homelessness, particularly in London and in my constituency. London households in temporary accommodation now account for around three in four of all such households in England. That is not a surprise, given increasing house prices and rents, and the impact of the benefit cap, which means that people cannot now rent a three or four-bedroom home on housing benefit anywhere in London or the south-east of England. I have people coming to see me now who even five years ago, and certainly 10 years ago, would not have come to me about their housing. They were managing okay, they were living in the private sector, they were paying their rent and they were working.

Now, one woman who came to see me had lost her job because she had been ill. She had hoped to go back to work. She had a good job with professional prospects, although not a well-paid job. She became ill and her rent went up, so she fell notionally into arrears while she was trying to find another home, as her rent was no longer covered because of the housing benefit cap. She tried to find somewhere in Hackney and the neighbouring six boroughs but could find nowhere, until eventually a landlord said he would take her in on benefits. However, because of the complexities in how housing benefit is allocated, he would not take her unless he had a guarantee a month before she moved in that she would be able to receive housing benefit. However, the system does not allow for that. As a result, a woman whose health was challenged anyway was suffering mental health issues through no fault of her own.

My constituent was of course very concerned, anxious and depressed about what was going to happen in her situation, and she is just one of many. This is the worst situation I have experienced in over 20 years as an elected member at local or national level. The stress of poor, uncertain and overcrowded housing has a huge impact on health. If someone is homeless, it increases by one and a half times the likelihood of their having a physical health problem, and it makes them 1.8% more likely to have a mental health problem, although it seems to me from my experience of speaking to people face to face that those figures are underestimates. Perhaps they mask the temporary housing problem, compared with the reality of what I am seeing. This has a huge impact, focused, yes, on the absolutely poorest, but also on people such as the woman I mentioned—people who have just hit a bit of a rocky patch in their life, where something has gone wrong and caused a spiral downwards towards homelessness.

There are so many hidden households in my constituency —families living on the sofa in the living room. It could sometimes be a family of an adult and two children in that situation while another family is living in the bedroom. For various reasons, they do not qualify for council housing, or they are on the waiting list—a bit of a misnomer when people wait a lifetime for a council property. Sometimes they cannot afford, on their income, to rent privately and they have no other options.

Temporary accommodation is now costing Hackney council about £35 million a year. I commend the Hackney Gazette, which has done a lot to highlight the conditions in temporary accommodation hostels in my borough and across London. We have the Homelessness Reduction Bill, which is passing through Parliament, but that is only part of the picture. Saying that councils must accept people who are homeless is fine, but unless we have the homes available to provide to those people at an affordable level, we will not solve this problem.

[Rebecca Pow]

I believe that the Government provided £10 million yesterday for homes, particularly in London, so things are being done and they are on the move. I just wanted to put that on the record.

[Meg Hillier]

The hon. Lady pre-empts my next point. I welcome the fact that the Government have begun to make some moves on housing, particularly taking away the “pay to stay” provisions. I am making sure that all my local housing associations are not going to buy into this on a voluntary basis—I hope they would not in London. The autumn statement freed up housing associations to use Government money for affordable housing as defined locally, rather than as set nationally. The idea that in my constituency affordable would be 80% of private rents is nonsense; it is well out of the range even of people who are well above the minimum wage. Most young people in Hackney share a home, because they could never afford to rent somewhere privately and they certainly cannot get on the housing ladder. It is going to take a generation to solve this housing problem, so although I welcome what the Government have done, much more could have been in their six years of office.

I am pleased that we now have a Housing Minister who is a London MP and who understands London issues. We London Members often speak about housing here, and it is as though we are in a different world from others. However, we have this very big problem of homelessness, overcrowding and excessive use of temporary accommodation.

Let me finish with a story that should never be true in our world. It is a story of a woman who was living with her toddler and her husband in a hostel because she was waiting to get some council housing. Even three years ago, I used to say, “Hold on and hang on in there for six months, and we’ll find a home for you.” Nowadays, it is increasingly a year or 18 months. The woman went into hospital to give birth and had to come back, with her new-born baby, her toddler and her husband, to that one room in the hostel. The people living in that hostel are among the most vulnerable—not an ideal environment in which to bring children home. Many people with a lot of problems are crowded into one place, without the support they need. This is not, I am sure, what any Member wants to see. We must tackle the issue, because the health problems that that spins off for the next generation of children are immense. I add a plea from my local constituency perspective as well as from my national perspective as Chair of the Public Accounts Committee—tackling homelessness is a vital issue to tackling health inequalities.

Coeliac Disease and Prescriptions

Rebecca Pow Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Jones]

It can. There is some anecdotal evidence about the connection between coeliac disease and mental health. The hon. Gentleman raises an interesting point.

This situation is creating considerable uncertainty for those who rely on access to gluten-free staples on prescription, and it is the vulnerable who are most adversely affected. Individuals with the disease are not eating gluten-free food out of choice or because it is some type of fad or Hollywood diet. They do so because they have to. It is people on fixed incomes or on benefits who receive free prescriptions and those whose households rely on deliveries from community pharmacies who will suffer most if prescriptions are withdrawn.

A number of people have written to me ahead of this debate, and I would like to draw Members’ attention to their cases. Patricia said:

“The diet I and many others follow is not a fad. It is necessary as it will affect my health and wellbeing if not followed, and might actually result in my admission to hospital—an extra strain on the NHS.”

[Rebecca Pow (Taunton Deane) (Con)]

Will the hon. Gentleman consider students in this category? Many of them are on low budgets. They might be tempted not to buy the right food and then end up being sick and in the NHS, costing the state more money.

[Mr Jones]

That is the main point. What some CCGs are doing is a false economy, because one hospital admission will cost more than the annual cost of prescriptions for an individual who adheres to a gluten-free diet.

Another person living with coeliac disease, Janice, who is a constituent of mine, wrote to me saying:

“I strongly believe that these plans will cause more expense to the government when coeliac patients can’t afford shop priced gluten-free foods and don’t stick to their diet and end up with cancer of the bowels”,

as well as other conditions. She went on:

“I am a pensioner and find it increasingly hard to afford luxuries like biscuits and cakes. If I have to add gluten free bread, pasta and cereals to my shopping list this will cause more stress. I cannot have any form of gluten, even in small doses, as I am violently ill.”

As well as a failure to consider the evidence before making decisions to withdraw gluten-free prescriptions, there is also evidence of a lack of public consultation by CCGs. Coeliac UK has been doing a good job of holding CCGs to account. One example it provided is of Trevor, who told Coeliac UK that he has never received confirmation in writing that the policy had changed; he was informed only when Coeliac UK told him. He was diagnosed 10 years ago and has only ever had bread on prescription. He is unable to work and has ongoing medical problems. His nearest shop is a Co-op, which does not stock gluten-free products, and the nearest shop that does is some six miles away. That creates problems for people such as him.

The CCGs that have already removed access to prescriptions for gluten-free products have not outlined or implemented policies that offer alternatives to safeguard patients, such as access to specialist dietary or nutritional advice. When a coeliac patient is taken out of a CCG’s responsibility because their gluten-free food prescription has been withdrawn, that CCG can no longer monitor them or determine the changed policy’s impact on that patient’s health. This is an important factor, and I am concerned that it has not been taken into account by a number of CCGs.

In areas where gluten-free products are not prescribed, there is now no opportunity to encourage dietary adherence nor a prevention strategy for long-term management of people with coeliac disease. Effectively, patients who suffer the condition in these areas will be offered no support by the NHS. Although CCGs are engaged with local authorities and wellbeing boards to explore alternatives, none has yet been put in place.

The NHS has a good track record of involving the public in consultation, but the lack of consultation on the decision to withdraw prescriptions for gluten-free products is a disgrace, added to the fact that charities such as Coeliac UK are not consulted before such decisions are made.

--- Later in debate ---

[David Mowat]

That is an interesting idea, which I will consider, but I am not briefed to talk about it. The position of most Members on this issue is very clear from the tone of this debate and the points being made, and we will respond to that.

[Rebecca Pow]

Will the Minister give way?

[Liz McInnes (Heywood and Middleton) (Lab)]

Will the Minister give way?

[David Mowat]

First to my hon. Friend, and then to the hon. Lady.

[Rebecca Pow]

This is highly relevant. I, too, have been contacted by constituents who have suggested this voucher idea—that the bona fide coeliacs get the staples and so many vouchers a month, not for all their products, but for the bread, pasta and absolute staples.

[Liz McInnes]

Is the Minister aware that the annual cost per diagnosed patient of prescribing gluten-free food is £180 per year? Weigh that up against the cost of avoiding infertility, bowel cancer and osteoporosis. What is the obvious conclusion for any NHS professional?