Alcohol Strategy

Sarah Wollaston Excerpts

Tuesday 7th February 2012 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

How far should the state step in to regulate the free market and alcohol? If a jumbo jet fully laden with passengers crashed over Britain every fortnight, drastic action would be taken, and that is what we are talking about—22,000 people die every year in Britain as a result of alcohol. The Office for National Statistics cites the figure of 8,790, but that excludes all the accidental deaths, the homicides, the impulsive suicides and the many victims of road traffic accidents. Alcohol is linked to more than 60 medical conditions, including many cancers.

Some will argue that this is all about personal responsibility and that we should resist the interference of the nanny state, but how can the 705,000 children who live with an alcohol-dependent parent exercise personal responsibility? We have a blind spot when it comes to the destructive effect of alcohol. Yesterday, I spoke to Stephen Otter, the chief constable of Devon and Cornwall police, who told me that the statistics for 2004-05 showed that about a third of violent crime in Devon and Cornwall was related to alcohol. Since then, the statistics have followed a steadily upward path and alcohol is now related to about half of such crime. The trend is increasing, so how do the victims of violent crime feel when we say that we should leave this to the market?

What about taxpayers? The cost of the epidemic is out of control. It is at least £20 billion, but if we look at the finer details of the impact on productivity, we will see that the evidence given to the Health Committee when it looked at this issue showed that the cost could be as high as £55 billion. At a time when the NHS has to make efficiency savings of £20 billion over the next four years, is it right that we are flushing down the drain at least £20 billion a year on alcohol?

The Secretary of State talks frequently about outcomes, so I would like to give some that I think he should look at. Forty per cent. to 70% of all accident and emergency admissions are related to alcohol. The impact on health inequalities is undeniable. The difference between the poorest and the wealthiest neighbourhoods in terms of average life expectancy is about seven years, and early deaths from alcohol-related liver disease are a significant contributor to that. Almost one in four deaths in young people is directly caused by alcohol. That means that every week 12 young people are losing their lives, which is a far higher figure than the number who die as a result of knife crime.

Positive outcomes could be achieved from a reduction in teenage pregnancies, as well as in educational failure and its impact and sexually transmitted diseases. The state has a duty to protect young people and take action. On personal responsibility, harmful drinking does not just affect the individual; it has a knock-on effect on all those around them when they leave a destructive trail in their wake.

If it were possible to solve this problem just through education and gentleman’s agreements with the drinks industry and supermarkets, I would say that we should go that way, but that approach has clearly failed. The fact is that when alcohol is too cheap, people die. That was as true in the 18th century with its gin craze as it is today. This, however, is a general debate on what should be in the alcohol strategy, so I do not want to dwell too long on pricing. Suffice it to say that without action on pricing, I am afraid that nothing else will be as effective as it could be. Alcohol is no ordinary commodity and we should not treat it just through market forces.

[Philip Davies (Shipley) (Con)]

My hon. Friend appears to be making a coherent argument for banning alcohol altogether. I am concerned that she is like the anti-smoking lobby, which tries to come up with different things to restrict smoking in order to hide its real agenda, which is to abolish smoking altogether. If she thinks that alcohol is such a bad thing and that it does so much damage, why not have the courage of her convictions, follow her argument through and say that alcohol should be banned altogether?

[Dr Wollaston]

There is a simple reply to that question—it would not work. We have seen that clearly from the efforts at prohibition in the States. I myself enjoy a drink, as I am sure do most Members present. Everyone might like a drink, but nobody likes a drunk, and that is what this is about. It is not about stopping people drinking, but about asking at what point the state should step in to address the real harm. There is a balance to be achieved. I am not suggesting for one moment that my proposals will stop people drinking, and I would not want them to do so. I just want to do something about 22,000 people dying every year in this country.

I propose that we act on price and address availability, marketing, education and labelling, and that we take action on offending behaviour. We should also change the drink-drive limit. Crucially, if we are to put all those measures in place, we also need to help people who already have a problem, which means better screening and treatment in the health service for hazardous, harmful and dependent drinkers. It is also time to send a clear message that we have had enough of drunken antisocial behaviour and violent crime.

On availability—I will try to be brief, because I know that lots of Members want to speak—I welcome the consultation on dealing with the problem of late-night drinking. It is absolutely right that communities should have a greater say in the licensing hours, and I welcome the return from 3 am back to midnight and the idea that those who supply late-night alcohol should contribute to the clean-up cost. Will the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), go further and address whether supermarkets should face greater penalties? The problem for late-night premises and clubs is that their customers are already drunk when they arrive, having pre-loaded on very cheap alcohol. It is crucial that supermarkets should contribute to the clean-up cost.

On marketing, we currently spend £800 million a year on alcohol marketing, which dwarfs the budget given to the Drinkaware Trust, which is industry controlled. There is clear evidence that marketing encourages not only drinking earlier, but children to drink more when they do. Although it is encouraging that fewer children overall are drinking, we should still remember that, after the Isle of Man and Denmark, we are the country with the highest levels of binge drinking and drunkenness in our schoolchildren. The problem is that the current controls are complex and easily circumvented. There is an off-the-peg solution that is compatible with European Union law, namely to introduce similar measures to those in France under the Loi Évin. Rather than having a set of complicated measures saying what we cannot do, we would set out clearly where alcohol can be marketed and everything else would not be allowed. If we want to protect children, why do we allow alcohol advertising before screenings of 15-cetificate films? It is also confusing that, while we say that alcohol cannot be associated with youth culture or sporting success, we allow alcohol-related sponsorship of the FA cup and events such as T in the park. We need to protect children.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does the hon. Lady agree that it is no coincidence that, between 1992 and 1996, when the advertising budget for alcohol products marketed at young people rose from £150 million to £250 million, the number of schoolchildren drinking alcohol doubled?

[Dr Wollaston]

That is a valuable point and clear evidence that marketing encourages children to drink, to start drinking younger and to drink more when they do. We should protect young people—that is an absolute duty of the state.

On education, the most important point is clear labelling. The drinks industry has made some progress, but if it does not meet its targets the issue should be mandated so that people can be clear about how many units they are drinking and receive advice on the sensible limits.

[Susan Elan Jones (Clwyd South) (Lab)]

The hon. Lady is making a powerful case and she can rest assured that most Members present do not think that she is anything like Eliot Ness. On her point about labelling, many of us were rather disappointed that more was not done on the subject of food labelling. Is there a case for us to do what is done in New York state in terms of food labelling, where an outlet that has more than two branches labels the calorie intake? That gives people a choice and also provides information.

[Dr Wollaston]

That is an excellent point, and I thank the hon. Lady for making it. Certainly, many young women drinkers would be deterred if they realised what the calorie content is for some of the popular alcohol mixer drinks. That might help to stem the rise in vodka mixer drinking among young women.

[John Pugh (Southport) (LD)]

Is the hon. Lady aware that there is a problem with EU legislation in terms of putting the calorific amount on the bottle?

[Dr Wollaston]

I thank the hon. Gentleman for making that point. EU legislation is getting in the way of an awful lot of the measures I would like to be introduced.

Returning to why education should not be in the hands of the drinks industry, I would like to draw hon. Members’ attention to a problem that arose when the Drinkaware Trust introduced its safe drinking recommendations. It presented those recommendations not as a safe upper limit but a recommended daily amount, as if it were marketing them as a vitamin intake. There is a clear conflict of interest in having the drinks industry controlling education. Although I welcome much of the Drinkaware Trust’s work, I do not see the need for the drinks industry to be on the board and would like the Minister to comment on that if possible. Following the report of the Select Committee on Science and Technology, the clear message should be that people should take at least two alcohol-free days a week to protect themselves.

Turning to the health service, relatively few hospitals have a dedicated alcohol service. It is a shame that only 5.7% of dependent or harmful drinkers are able to access treatment compared with 67% of dependent or harmful drug users. There is a clear case for changing that. One third of people who are admitted to hospital with acute liver disease die immediately, and the mortality rate for that has remained unchanged for 15 years. They die without being able to be aware that they even had a problem in the first place.

I would like to make the case for having much better services for screening and early intervention because such an approach works. Some 12% of people who are given brief advice and are informed that they are developing harmful or hazardous drinking traits will significantly cut down or stop drinking. Such a scheme is highly cost-effective, and I would like it to be rolled out, particularly in casualty departments. All hospitals should have a seven-day acute nurse specialist to give brief advice and intervention. That approach should be rolled out further to GP surgeries through the quality and outcomes framework and should also be available in community pharmacies, so that we can let people have clear information and advice. As I say, we should do that, principally, because such a scheme is evidence based and works.

Regarding people who already have a problem, it is time for all hospitals to have a dedicated alcohol specialist team and an assertive outreach team, particularly to help those revolving-door patients who come in and out of hospital repeatedly. They often have complex mental health needs and issues surrounding homelessness. Again, such an approach has a very strong evidence base and is cost-effective.

The law and order challenge for our police force is vast. May I pay tribute to the people who are at the sharp end of all this? Police officers, street pastors, casualty workers and ambulance staff bear the brunt of the problem. The police are making progress. I pay tribute to Devon and Cornwall police for their work. In my area, people who are picked up by the police can choose between a fixed penalty notice of £80 or attending a course run by Druglink. For those people who attend those courses, there is only a 2% offending rate. That is an example of something very positive that we should be moving forward with.

We should also carefully consider what has been happening in South Dakota in the USA, where they have introduced mandatory breath testing for those convicted of an alcohol-related offence. That has significantly reduced the prison population and has had an effect on domestic violence rates. It would be sensible to at least pilot that in this country to establish whether such a model could work here.

There is a strong case for reducing the drink-drive limit from 80 mg per 100 ml of blood to 50 mg, if for no other reason than for the sake of the 380 people who are killed every year on our roads and the more than 11,900 who are injured. Of course, we also need to give the police greater powers to breath test people.

What about the industry’s role? There is a role for industry in reducing product strength and I welcome those who have already taken action along that line. Crucially, business models should be changed, so that they are based on quality not quantity. The opinion is that that is what has had the greatest effect on the continent, where there have been significant falls in drinking levels because of the move away from drinking vast quantities of plonk towards drinking smaller quantities of quality product. That is something we could do here. I would like to see further work on the use of responsible locations in supermarket aisles and, as I have said, further progress on labelling.

I repeat that it is not the place or the responsibility of the drinks industry to define public health policy. There is a clear conflict of interest. It is time for us to follow an evidence-based approach built on medical advice and for there to be far less involvement with the drinks industry in dictating policy.

I have already been fortunate to lead a debate on alcohol taxation, so I will not repeat the points I made then. I hope that other hon. Members will give us advice on why the introduction of minimum pricing is compatible with EU legislation. I know that the hon. Member for Brighton, Pavilion (Caroline Lucas) will do so. The fact that price influences behaviour is, beyond doubt, completely undeniable. There has recently been further evidence from British Columbia about the impact of minimum pricing, based on 20 years of experience. There has also been evidence from Scotland, where the change in pricing policies, particularly those inhibiting multi-buys, have caused a 14% fall in beer sales. I will conclude and allow other Members to contribute by saying that there is no such thing as a cheap drink, but we are all paying a very heavy price.

--- Later in debate ---

[Philip Davies]

I will not give way, because plenty of other people want to speak and time is pressing. I will happily debate with the hon. Gentleman in the Tea Room or at some other point, although I am the only one arguing from this perspective, I suspect.

The Centre for Economics and Business Research conducted research on minimum pricing and concluded that the heaviest drinkers are the least responsive to higher prices. For example, at a minimum unit price of 40p, the CEBR found that harmful drinkers, which the policy is supposed to be targeting, would reduce their weekly consumption by only 1.7 units per week, which at the end of the day is less than one pint of weak beer. A report by Sheffield university found that a minimum price of 45p per unit would trigger a 6% fall in overall alcohol consumption and 60 fewer deaths in the first year alone. Yet the Government figures for 2009-10 show that overall alcohol consumption fell by 7%, while alcohol-related deaths rose by 36. Clearly, there is no link between the two.

Minimum pricing treats all drinkers the same, and penalises—financially and practically—the overwhelming majority of adults, all those people who drink alcohol responsibly and in a socially acceptable way, causing harm neither to themselves nor to others. The people who would be most penalised by minimum pricing are those who are already on tight budgets, such as pensioners, people on fixed incomes or those in low-paid jobs. I simply cannot understand how hon. Members, in a time of economic austerity, are prepared to force some of their poorest constituents to pay more for alcohol, when they know full well that the overwhelming majority of those constituents drink alcohol responsibly and in moderation. If hon. Members want to tackle binge drinking and alcoholism, they should focus their efforts on binge drinkers and alcoholics, not on everyone in the country, which would be unjustifiable.

The Institute for Fiscal Studies produced a report on minimum pricing that found that poorer households, compared with richer households, on average pay less for a unit of off-sale alcohol. For example, households with an income of less than £10,000 a year pay 39.8p per unit, while those on a household income of more than £70,000 pay 49.3p per unit on average. As a result, a minimum price of 40p or 45p per unit would have a larger impact on poorer households and virtually no impact on richer ones.

[Dr Wollaston]

Does my hon. Friend accept that our poorest constituents are paying the price for harmful drinking and that we should consider the effect of alcohol on health inequalities? Furthermore, the Sheffield study showed that minimum pricing at 50p per unit would only add an extra £12 a year to the cost for moderate drinkers.

[Philip Davies]

I do not accept that for two reasons. First, people should be free to spend their own money as they so wish, without having to obtain the permission of my hon. Friend before they decide how to live their life, in particular if no one else is affected; it is their responsibility. Secondly, the one thing that I have learned about alcoholism is that alcoholics will go to any lengths to get the alcohol they need; if we increase the price of alcohol, all that will happen is that they will give over a bigger proportion of their money to buying alcohol, leaving them less money to spend on other things—it will not change their behaviour at all.

I want to touch on advertising, but not for long. I opposed the ten-minute rule Bill of my hon. Friend the Member for Totnes on advertising. I used to work in marketing, for my sins, and I want to stress its purpose: it is about brand awareness and increased market share. When Cadbury sponsored “Coronation Street”, does anyone really believe that at the moment the Cadbury advert appeared at the start of the programme everyone leapt off their seat, switched off the TV set and dashed to the nearest newsagent to buy a bar of Dairy Milk? Of course not. All that Cadbury hoped was that, next time people went into the newsagent, they would buy a bar of Cadbury’s Dairy Milk rather than a Kit Kat. That is the whole point of marketing.

If we curb alcohol advertising, more than £80 million of revenue for the broadcasting industry would be jeopardised, leading to a direct loss in programme making in this country. It would also wreak havoc on sporting events, and I expect that the Department of Health would prefer to encourage as much sporting activity as possible. We already have a robust system of advertising regulation in this country, administered by the Advertising Standards Authority and in this case the Portman Group, endorsed by Ofcom. We hear that so many young people are made aware of alcohol by advertising, but lots of young children know about car advertising and yet it does not mean that they go straight out and start driving a car, merely because they are aware of the advertising.

I worry where this will stop. Will my hon. Friend the Member for Totnes return to the House in a few months’ time and urge us to ban the advertising of cream cakes, pizzas, chocolate, fish and chips or curry, because they are all bad for us if eaten to excess? This is a slippery slope, and certainly not one that I am prepared to support.

Breast Implants

Sarah Wollaston Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

I completely understand the right hon. Lady’s point, but this activity is not unregulated. For example, the Care Quality Commission is responsible for the registration of providers, and for ensuring that they meet essential standards of safety and quality. However, for precisely the reasons cited by the right hon. Lady, I am asking Sir Bruce Keogh’s group to consider wider issues relating to the regulation of cosmetic surgery and cosmetic interventions.

The registry to which the right hon. Lady referred was discontinued in 2004 because a substantial number of women were not consenting to the addition of their names to the register. I believe that, given the positive experience that has followed the establishment of the National Joint Registry, we can reassure women that their data can be entered without prejudicing their patient confidentiality.

I should make it clear that as yet we have no evidence demonstrating any significant difference between the rupture and leakage rates of PIP breast implants and those of other implants. Last June the American Food and Drug Administration published the findings of a study of normal implants, two of which had a 10% to 13% rupture rate over a 10-year period. It is important to appreciate that implants in themselves pose a distinct risk of rupture and leakage.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the clear commitment to putting women’s health needs first in this context, but is not the heart of the problem the obvious conflict of interests for private clinics when it comes to the provision of long-term safety statistics? Will my right hon. Friend ensure that any future system allows women to self-report to the registry—albeit with a follow-up from specialists for confirmation purposes—so that we can have a complete picture of the long-term complications caused by devices of this kind?

[Mr Lansley]

My hon. Friend is right. When Sir Bruce and his colleagues are considering the establishment of a wider registry, they will consider not only the possibility of self-registration but the possibility of making clinical professionals responsible for the publication of such data. The responsibility should not rest solely on providers or manufacturers.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

It is precisely because the Prime Minister and I listen to nurses that we met them and made it clear that we will support best practice. The hon. Gentleman and his colleagues should support nurse leadership on the wards. Nurses can see—through best practice, if they talk to patients about their experience every hour—that they can deliver better care. We will support nurses to deliver better care; he should support us in doing so.

[Dr Sarah Wollaston (Totnes) (Con)]

I know the Secretary of State cares deeply about outcomes in health. Will he add his support to the campaign for a minimum price for alcohol in England and Wales?

[Mr Lansley]

The Government will shortly publish our alcohol strategy, which will set out how we hope to deliver continuing success in the reduction of alcohol consumption and abuse.

Life Sciences

Sarah Wollaston Excerpts

Monday 5th December 2011 Commons Chamber

[Mr Lansley]

I understand the right hon. Gentleman’s point, but the ethical approach is for everyone to have access to the latest and best available treatments through the NHS. That is the principle that we apply, but we should be aware that, although we offer people the right to opt out, we have seen—for example, in relation to the general practice research database, where patients have the equivalent right to opt out, and in two pilots conducted on the proposals that we have announced—that the rate of opt out is 0.1%.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the Secretary of State’s statement, as this strategy will reduce the delay between discovery and dispensing and, undoubtedly, bring great benefits to patients and to our pharmaceutical industry, but in return will he ask the industry to go further and publish negative trial data, as well as positive trial data, as a gesture to improve the quality of research data?

[Mr Lansley]

I am grateful to my hon. Friend for that point. The industry has done quite a lot in recent years in publishing more data, including data that do not necessarily support the positive case that it is looking for, because all of us, and especially those working in the field, learn a great deal and, sometimes, as much from clinical trials that produce a negative result as we do from those that produce a positive result. So, I will certainly take her point away, explore it with my colleagues and write to her if we can take further steps in that direction.

Obesity

Sarah Wollaston Excerpts

Wednesday 9th November 2011 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the hon. Member for East Londonderry (Mr Campbell) for securing this important debate. I do not want to repeat his message about the economic cost of the problem, but I would say, having been a general practitioner for 18 years, that once someone becomes obese, it is extraordinarily difficult to regain their normal weight in the long term.

I would like the Minister to consider the following points. We need to focus on better identification of those who are most at risk, particularly children, and to target action on those high-risk children. A nudge will just not go far enough, and it is time for more of a bit of a shove. We need particularly to look at the role of liquid calories in obesity among children. I ask the National Institute for Health and Clinical Excellence to update its guidance and review the evidence.

Nearly two thirds of adults are overweight or obese, but they do not start out that way. Around one in five four to five-year-olds are overweight or obese, but by the time they reach 11, that figure will have risen to one in three.

[The Minister of State, Department of Health (Mr Simon Burns)]

On the point about NICE, may I give my hon. Friend a reassurance that might be helpful at this stage in her contribution? As she may know, NICE has recently consulted on whether now is the right time to review its original guidance. As a result of that consultation, it will be making a decision later this month.

[Dr Wollaston]

I thank the Minister for that helpful response and look forward to hearing the outcome of that.

Children at primary school and in the early years before they have reached school are among the really high-risk groups. Some 85% of obese children go on to become obese adults, whereas only 12% of normal weight children become obese adults, so it makes sense to focus on that group of children, but that can happen only if we have better early identification. We should introduce annual measurements of weight and height, so that we can see when children are starting to slip towards obesity. We should target our resources much better on that group.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Years ago, parents with chubby children would be told, “It’s puppy fat and they will grow out of it.” There is still that idea around among otherwise bright and responsible parents. We need to press the point that chubby children grow into chubby adults.

[Dr Wollaston]

I absolutely agree with the hon. Lady. We need to be much clearer with parents that their children are at risk and that being overweight is not something that they will grow out of.

We should be much more creative about how we target help to high-risk children. Why not allow all those children to have free healthy school lunches? As poverty and deprivation have such strong links with obesity, considering that high-risk group is particularly appropriate if we are to address the Marmot agenda. Unfortunately, families on tight budgets are much more likely to be pushed towards unhealthy and cheaper choices. If we want to nudge them in the right direction, we must recognise the role that price plays in the choices that they make. We should look at the role of loss leaders. We urgently need a change in what supermarkets offer so that loss leaders are redirected towards healthy rather than unhealthy products.

Why not incentivise exercise in those high-risk families with vouchers for success and free access to good-quality sports facilities? We should incentivise a whole-family approach to cooking skills because cooking is a fun activity. An effective way forward would be to make such a service free and readily available to whole families.

On liquid calories, a survey conducted by the British Dental Association and Ipsos-MORI showed that 47% of children’s fluid intake is in the form of sugary and carbonated drinks. That means that one in five children is consuming 500 calories or more a day just in the form of sugary drinks and 73%—nearly three-quarters of children—are consuming more than 200 calories a day. It is a staggering number of calories that children are consuming.

If we look at adults, we will see that there is a particular issue with alcohol. The chief medical officer has already highlighted that around 10% of an adult’s calorie intake can be through alcohol. What we should understand from that is the role that discounting plays. I have mentioned that before. It really does not matter how disciplined the rational part of our brain tries to be—the irrational and impulsive side will continue to be irrational and impulsive. It is not helpful to see heavily discounted products in super-sized multi-buy packs piled high at the check-outs in supermarkets. If we want to move “nudge” towards “shove”, we should regulate how supermarkets market their products. I do not suggest that the whole answer to obesity lies in regulating supermarkets. I realise that there is a complex interplay between over-supply, pricing, culture, marketing, poor consumer choices and human nature. There is also the interplay between genetic predisposition and a lack of exercise. However, it is unlikely that our current strategy will go far enough in this regard. If we are going to do something about the £5 billion a year that this problem is costing us—the figure is predicted to rise to £10 billion a year by 2050—I suggest and hope that the Minister takes a strong line and abandons the idea of giving the problem a little nudge, in favour of giving it an almighty shove.

--- Later in debate ---

[Dr Poulter]

Yes, certainly. There is an issue about how physicians prescribe effectively. Statins are an effective way of controlling cholesterol, and there is good evidence that they benefit people with heart disease and high cholesterol and that they increase life expectancy. There has been a lot of research, and I believe that it has been shown that statins may have beneficial effects in reducing the risk of breast cancer, although the Minister will correct me if I am wrong.

The right hon. Gentleman touches on the wider point that the emphasis in this debate needs to be on effective community-led interventions that tackle obesity and health care, and my hon. Friend the Member for North Swindon (Justin Tomlinson) discussed that very effectively. However, we need to ask how we will make those community health care measures effective.

The Government are setting up health and wellbeing boards, which are a very useful part of their health care reforms, because they will, for the first time, bring together different organisations in a meaningful way. Local councils in certain towns may run good community initiatives that connect GPs with leisure centres, exercise and sport, and some schools may encourage sport and physical activity in an effective way or have good links with local sports clubs. However, that does not often happen in a co-ordinated way across whole counties or, indeed, across the country. Health and wellbeing boards will help to bring together different organisations to address key public health problems, and obesity is a key public health challenge in all our constituencies.

As part of the health care reforms, the health and wellbeing boards will be able to address issues such as obesity. For example, if we know that there is an issue with teenage pregnancy or obesity in certain schools or among certain schoolchildren in my constituency, targeted interventions can be put in place in a much more community-focused way by getting the local authority together with health care representatives at a much more strategic level. That must be a good thing, because it allows much more targeted interventions.

The second thing I want briefly to discuss—I do not want to speak for much longer—is nudge theory. My hon. Friend the Member for Totnes has a slightly different view of it. I have more faith in nudge theory than she does, and I say that because we have had debates about agriculture—some of the Opposition Members here today were present—in which we discussed the need for corporate firms and supermarkets to show greater corporate responsibility on issues such as food labelling. We have now seen active movement from some supermarkets on honest food labelling. For example, we talk about food in a store being labelled British only if it is actually farmed in Britain, and not if it is merely processed or sliced here. We are beginning to see such initiatives come through, with supermarkets supporting British farmers. Morrisons is a good example of a supermarket where the British food stamp actually means something, and that allows consumers to make an informed choice. Supermarkets are therefore able to show corporate responsibility when they are asked to do so, although things are not entirely perfect, as we all know.

In a similar vein, the Government have introduced a public health responsibility deal, and it is a good initiative. Almost 200 different companies have signed up to the deal, including supermarkets such as Asda, the Co-op, Morrisons, Marks and Spencer, Sainsbury’s, Tesco, Waitrose and many others. Fast-food outlets such as McDonald’s, Pizza Hut and KFC have pledged to remove trans fats and introduce calorie labelling as a result of this initiative. Those are all pleasing and beneficial steps in the right direction.

[Dr Wollaston]

Does my hon. Friend share my concern, however, that organisations such as Asda, which have signed up to the new responsibility deal, are in some ways undermining it by offering hugely discounted alcohol products?

[Dr Poulter]

There are areas of obvious concern, where supermarkets can go further. As I said earlier, when we were talking about the agricultural sector, even though several supermarkets are backing honest food labelling, and showing responsibility in food labelling and calorie counting to tackle obesity, it is right to highlight the areas in which they need to show greater corporate responsibility. Cut-price alcohol is one of those, and we will continue to monitor it carefully in our work on the Select Committee on Health, and as physicians. My hon. Friend makes a good point.

In preparing for the debate, although I do not normally take an active interest in children’s TV, I found out about an Icelandic TV show called “LazyTown”—the Minister may want to expand on the subject a little later. The show is watched by children all over the world, and we have it in Great Britain as well. There is a healthy sports superhero character, called Sportacus, who motivates children to eat healthily and be active. In Iceland several “LazyTown” initiatives have been run in partnership with the Government and the private sector. For example, children between four and seven years old were sent an energy contract, which they and their parents signed, in which they were rewarded for eating healthily, going to bed early and being active. In one supermarket chain, all the fruit and vegetables were branded “sports candy”, which is the “LazyTown” name for fruit and vegetables. That led to a 22% increase in sales at that supermarket, and improved health and reduced obesity levels in Iceland.

The fact that Iceland’s child obesity levels have started to fall as a result of initiatives of that kind is good evidence in support of such corporate responsibility. Those initiatives are designed to support supermarkets coming together with Government, to make effective use of the nudge theory of improving behaviour, and they can work—and have worked. For that reason, we must support what the Government are doing, because there is evidence that it can work. It is a good thing and the evidence from Iceland is that we need to do what works, with children and communities.

I understand, and I am sure that the Minister will confirm, that the Department of Health has set up a partnership with “LazyTown” and is interested in expanding that initiative in the United Kingdom. We need more such approaches. The reason supermarkets sign up to such deals and initiatives is that it is good not just for the children, who become healthier and less obese, but for the supermarket and its brand image. Supermarkets see that working with corporate responsibility—we see it in our constituencies with Tesco schools vouchers—can enhance their image and custom, and do real good, for example, by reducing obesity levels.

I have greater faith in the nudge theory than my hon. Friend the Member for Totnes, and we need to allow similar initiatives to take root in the future. What has been done in the past has not worked very well; obesity levels have been going up. We have good evidence, from examples of corporate responsibility, that things can be tackled, so let us give nudge theory a chance. Let us also look to those health and wellbeing boards to provide community-based interventions that will work. If we do not do something, things will get worse, and the boards are a good way to address the problem.

Ovarian Cancer

Sarah Wollaston Excerpts

Wednesday 12th October 2011 Westminster Hall

[Fiona Mactaggart (Slough) (Lab)]

I should start this speech by telling the House that I should be dead, because only two out of every five women with ovarian cancer survive beyond four years and my cancer was diagnosed eight years ago, at the start of 2003. I remember the dates well. Throughout that autumn term, I had been on a very serious diet. As hon. Members know, I need to do that, and I was completely unaware that the loss of appetite that was caused by my cancer was being helpful to my dieting. At the end of that autumn term, I went to see my GP about symptoms that actually were irrelevant to the cancer, but she is a very insightful woman. She took a very careful history from me and did a CA 125 test. This was about December. She referred me and I did the CA 125 test. I remember the dates fairly well because it was just before I went away for a Christmas holiday. The level was elevated. Of course, I had no idea how significant that was. I cannot remember what it was at that point—45 or something like that. I said, “Is that serious?” She said, “Well, yes.” I did not quite work out how serious it was, but she had referred me to a specialist. I came back from my Christmas holiday and had an intravaginal ultrasound in January. I went to see the doctor about the results and was told on, I think, 15 January that I was going to have a hysterectomy in an operation that might be related to cancer on 14 February—not a date one forgets.

Although I was late detecting the symptoms and, indeed, the symptoms that I went to see my GP about were not symptoms caused by my cancer, it was a very short time before I had an intervention. In fact, it was quicker than that. It was this time of day on a Wednesday. The day before, we had lost, by just three votes, a cross-party vote on an 80% elected House of Lords. Those three votes were hon. Gentlemen who had had too good a dinner. I was trying to do press and so on about the House of Lords vote. I was trying to get across the point that a majority of the House of Commons thought that we should have an 80% elected House of Lords, but some hon. Members went in the wrong door because they cannot manage when they do not have Whips telling them where to go. Those calls were interrupted by a telephone call from St Thomas’ hospital, which said, “We have a cancellation. Can you come in today?” I burst into tears. Then I went to the Army & Navy Stores and bought a nightie and a pair of slippers and set off to St Thomas’ hospital.

As can be imagined, I arrived at the hospital not with my head in the place where a cancer patient needs it to be, but still trying to sort everything out, because although I had known that I was to have the operation, it was originally to take place about two weeks after the House of Lords vote that I was working towards. So I arrived all shouty and dictating things, putting out press releases, bellowing into a phone and so on. I was put in my bed and was still shouting down the phone, but then this woman came up to me, took my hand and put it in a bowl. I was on the phone and I said to her, “What are you doing?” She said, “I’m giving you a manicure.” I said, “Why?” She said, “I’m a volunteer. I come into the women’s ward in St Thomas’ hospital on a Wednesday and give women manicures.” I have told the Minister that story because that volunteer helped me through the experience, as I stopped being an MP and started facing being a patient. I strongly urge the Minister to recognise how powerful such roles, which do not look clinically essential, are in the care of people. That is my first message.

My second message is that my story tells us how good the NHS can be—how fast it can respond. In my case, it was eight to 10 weeks between first going to the GP—and not reporting the right symptoms—and having an operation. One cannot ask for better than that. I know that a big reason for it was the targets that we had set, because when I was told when my operation would take place, the consultant said to me, “Oh, I’m bumping up against the date.” I therefore urge the Minister both to look after the role of volunteers and voluntary organisations and to retain those targets that put pressure on the system to help people like me to live.

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on initiating this important debate. Does the hon. Member for Slough (Fiona Mactaggart) agree that although it is wonderful that she had such rapid access to treatment, such access to diagnosis is not uniformly available throughout the country? My experience is that it is difficult for general practitioners to gain rapid access to ultrasound scans, which was a crucial factor in the hon. Lady’s diagnosis. Equally, access to CA 125 measurements, although included in the NICE draft guidelines, which is welcome, is not uniformly available to GPs throughout the country.

[Fiona Mactaggart]

The fact that those things are not accessible is condemning women to die. It is very simple, and they are not complicated tests. I have had an awful lot of CA 125 tests because women have a lot before and a lot afterwards to see what is happening to the markers in their blood. It is a very simple test and certainly should be available in primary care so that GPs can do it quickly and reassure themselves and their patients. It was thanks to Ovacome that I began to realise how important knowing one’s CA 125 level is. Until I started reading the educative materials produced by voluntary organisations, I did not know that.

I want to say one thing about all the voluntary help available to people with cancer. It is very confusing. People never really know who does the thing that they need—who provides the help. Today, the question might be, “Should I wear a wig, or are they all horrible and uncomfortable?” The answer is yes, by the way. It might be, “Do I need someone to hold my hand and explain what’s wrong with me?” People do not know these things. I wish that somehow all the wonderful charities could get together and have one doorway through which the patient goes and can say, “This is what my life’s like. I can’t afford to park at the hospital” or “The wig that I got is itching” or “Is my reaction to chemotherapy appropriate? Do other people have it?” Who are the right people to help? People in this situation never know who the right people are, so one thing that I wish the Department of Health would do is find some way of resourcing those organisations to provide a better entry to their services for people with cancer.

However, I want to focus on diagnosis and helping people to detect their symptoms early. I did not detect mine particularly early; indeed, it was my GP who detected them, not me. Many hon. Members have written to the Minister, and at the annual general meeting of the all-party group in July we considered the response that he had sent us. Frankly, to me, it seems that the message is not getting through. The work being done to improve early diagnosis of cancer, particularly awareness, will not make a difference to the women who have ovarian cancer. I am very glad to receive an account of the work being done on breast, lung and bowel cancer, but frankly it is a bit insensitive. Someone who is concerned about ovarian cancer will see all those wonderful information campaigns on other cancers, but none of them applies to the symptoms of ovarian cancer. That will not do, and it particularly will not do when ovarian cancer is such a killer.

In the letter to the all-party group, the Minister said that

“future activity will depend on the success of the Be Clear on Cancer campaigns”.

His Department has since announced that following the success of the regional pilot campaign for bowel cancer, it will be rolled out nationally. Now that we know that those awareness campaigns work, when will we have a commitment to work on ovarian cancer? We have extended the work to include stomach, oesophageal, bladder and kidney cancer. Why not ovarian cancer? It was not until long after I had had a hysterectomy, chemotherapy and so on that I realised which of the symptoms that I had had were clues to my cancer. We really must help people to know that they are at risk. Ovarian cancer is the fourth most common cause of cancer death in women. Is it just because it affects women that we are not seeing action? If men had it too, we might be doing better, although, of course, we have a good history on breast cancer.

I worry that ovarian cancer is being put in the “too difficult” box, and it is not acceptable to do that with the most fatal gynaecological cancer. Ovarian cancer kills four times as many women as cervical cancer, for which we have a national screening programme. Is it not time that we put in place a national screening programme for ovarian cancer and gave GPs and others proper access to diagnostic tests that will save thousands of women’s lives? It is not acceptable that so many women die of this cancer when we know how to stop it, and I urge the Minister quickly to put in train action to deal with this issue.

Health and Social Care (Re-committed) Bill

Sarah Wollaston Excerpts

Wednesday 7th September 2011 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Will my hon. Friend give way?

[Nadine Dorries]

No, I should like to continue. [Hon. Members: “Give way!”] I will give way once more and then not until I have finished the next section.

[Dr Wollaston]

My hon. Friend has twice quoted the Royal College of Psychiatrists and asserted that there is a much higher rate of mental illness after termination of pregnancy, but the RCP has made it clear—any Member can look online at the draft of its very comprehensive evidence review—that we have to compare like with like. In other words, we have to make a comparison with rates of mental illness after unwanted pregnancy. Looking at the rates after unwanted pregnancy, we see that there is no difference between the rate of mental illness after termination of pregnancy and live birth. Indeed, the biggest predictor of mental ill health after a termination of pregnancy is whether somebody was suffering with problems beforehand.

[Nadine Dorries]

The hon. Lady makes the assumption that I want women to continue with unwanted pregnancies. That is not the case. I have made the point that abortion is here to stay for any woman who wants an abortion. The amendment simply proposes that any woman who feels that she wants or needs counselling can be offered it—that is all. I find it very difficult to understand why the hon. Lady would feel that anybody in a crisis pregnancy should not be offered counselling. Why should they not?

--- Later in debate ---

[Owen Smith]

I will not dispute that there may be occasions when it will be appropriate for the CCG to meet in private, but that is not what the Minister said. My point was to do with the tone and the misrepresentation that has been systematically applied by those on the Government Benches. That is the difference.

[Dr Wollaston]

rose—

--- Later in debate ---

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

I speak in support of amendment 1169, which seeks to strengthen the Secretary of State’s duty to reduce health inequalities. As presented in clause 3, the Secretary of State’s duty is insufficient to tackle the health inequalities in our society. The clause lacks strength, invites the Secretary of State to disregard its meaning and changes little in the way in which health inequalities will be tackled in the future. By supporting amendment 1169 we can ensure that the Secretary of State can be regularly and properly held to account for his duty to tackle health inequalities across England.

Tackling health inequalities is vital because this is, in many cases, a matter of life and death. The World Health Organisation’s Commission on Social Determinants of Health has said:

“Social justice…affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.”

In our own country, Bevan’s dream for the NHS was for a service in which:

“No longer will wealth be an advantage nor poverty a disadvantage.”

Yet, despite the great strides that have been made there is much more to do, and the link between poverty and poor health remains.

[Dr Wollaston]

Will the hon. Lady give way?

[Rushanara Ali]

As there is not much time left, I would like to proceed in order to allow other colleagues to speak.

That link can be seen as clearly in London as anywhere else. According to the London health inequalities strategy,

“for men, life expectancy at ward level ranges from 71 years in Tottenham Green ward in Haringey to 88 years in Queen’s Gate ward in Kensington and Chelsea—a span of seventeen years”.

Despite the progress made nationally, in the borough of Tower Hamlets, in which my constituency sits, the rate of heart disease or stroke before the age of 75 is more than twice that of a more affluent area such as Surrey, and early cancer rates are nearly 50% higher.

We know that with the right resources and leadership it is possible to reduce health inequalities. In the past 10 years, the rates of early death from cancer and from heart disease and stroke have fallen in my constituency, but they remain worse than those in other parts of the country. That is why it is vital for the Secretary of State to continue the focus on tackling health inequalities, for us to look at the cross-cutting issues affecting health and for there to be co-ordination across government, led by the Health Secretary.

Tackling health inequalities was central and integral to Labour’s policy making in government. I urge this Government to think again, to recognise the vital importance of continuing that commitment and to make sure that there is genuine accountability for reducing health inequalities.

I was saddened to see last month that the Government plan to reduce the funding allocated to tackling health inequalities by altering the weighting given to inequalities in the weighted capitation formula from 15% to 10%. That will lead to a reduction in funding of £20 million over the next three years in Tower Hamlets—

--- Later in debate ---

[Dr Wollaston]

The hon. Member for Bethnal Green and Bow (Rushanara Ali) spoke of health inequalities in her constituency. Perhaps she should look at the King’s Fund’s annual review of NHS performance between 1997 and 2010, which

“identified the lack of progress in reducing health inequalities as the most significant health policy failure of the last decade.”

Opposition Members should bear that in mind when they talk of a two-tier health service, because they fail to focus on outcomes and they fail to focus on inequalities.

I welcome the duty of the Secretary of State, the NHS commissioning board and clinical commissioning groups to have regard to reducing health inequalities. Let us see something done about that scandal. I also welcome the work of the NHS Future Forum in setting out the central dilemma surrounding the role of the Secretary of State. The NHS should be freed from day-to-day political interference, but it must also be clear that the Secretary of State retains ultimate responsibility.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the hon. Lady give way?

[Dr Wollaston]

I will not, because so many Members are waiting to speak.

There has been real scaremongering about, in particular, the difference between the duty to provide and the duty to secure provision, but I believe that the wording simply reflects the reality. The key issue is the line between the ability to step in if things go wrong, and the very real need for politicians to step back and let clinicians and patients take control.

I shall cut my speech short because I have been asked to be brief, but let me end by saying that, for three clear reasons, I would not be supporting the Bill if I thought that it would lead to the privatisation of the NHS. [Hon. Members: “Have you read it?”] I assure Members that I have read it in great detail.

Let me give those three clear reasons. First, clinicians will be in charge of commissioning. Secondly, the public will be able to see what clinicians are doing. Thirdly, neither clinicians nor the public will allow privatisation to happen. They do not want it to happen, and neither do Members of this House.

PCTs and foundation trusts did not meet in public, but they will do so in future, and it is the public and patients who will ensure that the NHS is safe in the hands of the Conservatives and the Liberal Democrats.

[Mr Deputy Speaker (Mr Nigel Evans)]

That is the length of speech that we like.

Reform of Social Care

Sarah Wollaston Excerpts

Monday 4th July 2011 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I understand the need for the timetable to allow for adequate consultation, but Andrew Dilnot’s excellent report draws attention to several areas including a lack of transparency, a lack of information available to families making decisions about care homes and, in particular, a lack of portability, which results in many patients being trapped and unable to move closer to loved ones. Does the Secretary of State feel that he could expedite any of the report’s recommendations to allow such proposals to receive more detailed consideration?

[Mr Lansley]

I entirely understand my hon. Friend’s point. In the course of the engagement during the latter part of this year, some of those issues will certainly come to the fore. My colleagues and I felt that it was better for us not to cherry-pick Andrew Dilnot’s report now, but rather for us to give people an opportunity to comment on the recommendations in full. That will, however, take place over the space of weeks rather than many months.

NHS Future Forum

Sarah Wollaston Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

It has not damaged patient care. The right hon. Gentleman should not denigrate the NHS. In May 2010, at the last election, patients waiting to be admitted to hospital waited 8.4 weeks for their treatment; on the latest figures, that went down to 7.9 weeks. Out-patient waiting times for May 2010 were 4.3 weeks on average; that went down to 3.7 weeks, and that in the midst of rising demand on the NHS and continuously improving performance.

[Dr Sarah Wollaston (Totnes) (Con)]

This is clear evidence of a listening Government. Does the Secretary of State agree that what the NHS now needs is consensus across all political parties, and for everybody to put their money where their mouth is and support the NHS and these changes as we move forward?

[Mr Lansley]

I am grateful to my hon. Friend, who makes a very good point. The Future Forum made the point that what people across the NHS want now is the certainty of knowing what the policy is and to move forward to make that happen.

Winterbourne View Care Home

Sarah Wollaston Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

In my public statements and in my statement today, I have made it clear that the spotlight needs to be shone just as clearly on the provider organisation in this case, and not just on the CQC. That will be my continued intention as we pursue this matter to its conclusion.

[Dr Sarah Wollaston (Totnes) (Con)]

Will the Minister address the question of how long these vulnerable people were filmed being abused, because that simply would not have been tolerated if they were children?

[Paul Burstow]

My hon. Friend makes an important point. I do not know the answer to the question of how long the people were filmed before the whistle was blown again by “Panorama”. However, it is an important point that will undoubtedly become clearer as we come on to the details of the inquiry.