NHS Blood Cancer Care

Sharon Hodgson Excerpts

Wednesday 17th January 2018 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a genuine pleasure to serve under your chairmanship, Mr Wilson, and I congratulate the hon. Member for Crawley (Henry Smith) on his good fortune in securing this debate just before the launch of the report by the all-party group on blood cancer, which will take place afterwards. That was very opportune and well done. He made an informative and heartfelt opening speech, and I am sure that he can secure no finer legacy in memory of his mother than what he is achieving in Parliament today. I am sure his whole family are proud of him.

As we have heard throughout this debate, blood cancer is the third biggest cancer killer in the UK, and the fifth most common cancer, with more than 230,000 people living with the disease. For those people and their families—some of whom are here today or watching the debate—action is needed to improve the treatment and support on offer. That includes some of my own constituents who contacted me prior to this debate, and it is for them that we are here today. There is much that we can do to improve treatment and support, as so eloquently put by the hon. Member for Crawley, and others who have spoken today, including my hon. Friend the Member for Coventry North East (Colleen Fletcher), and the hon. Members for Gordon (Colin Clark), for Strangford (Jim Shannon), and for Central Ayrshire (Dr Whitford), who all made excellent speeches.

Blood cancer patients need to see their GP many more times before being referred to hospital than those with other cancers. Indeed, 35% of blood cancer patients had to see their GP three or more times before being referred, compared with only 6% of those with breast cancer, and 23% of those with all other tumour types. Such figures must be the fire beneath that spurs us on to do more, otherwise we will be failing the 230,000 people who live with this disease. Today I want to pick up on three key issues: first, patient experiences, and specifically the “watch and wait” principles of treatment and support; secondly, the improvements needed in research and access to treatments; and finally I will discuss post-stem cell transplant care. 

Each year, 5,000 people with slow-growing blood cancers do not start treatment straight away, but instead are placed on a regime called watch and wait. That means that patients are monitored until they reach a point where treatment must start. It can take many years for that to happen, which can add much pressure to a patient’s life, including the psychological struggles that they might face. That is understandable: it must be excruciatingly difficult for someone to live with a cancer, including a blood-borne one, yet not receive any treatment, even though they know they have the disease. 

To help fully understand this struggle, I want to read from a case study that was sent to me by Bloodwise, and written by the blogger who writes the “Diary of a ‘Fake’ Cancer Patient”. It states:

“About a month after diagnosis, I went to pieces and sat in front of my consultant panicking, crying and generally not coping.”

Reading the full case study is harrowing but heart-warming at the same time. That may sound peculiar, but it shows the scale of the struggle that blood cancer patients face under “watch and wait”, and also that when support is offered they can lead as normal a life as possible, and have the support to cope with the disease and the situation in which they find themselves. That is why Labour supports calls for tailored psychological support for patients who are on watch and wait, and it would be welcome if the Minister addressed that point when he replies to the debate.

It would be of great interest to hear from the Minister whether the Government plan to look at the perceived pitfall in the cancer strategy regarding the recovery package, and the failures to take into consideration the unique characteristics of blood cancer, as well as the use of terms such as “beyond cancer” and “post-treatment”, which can be alienating to blood cancer patients. As we know, blood cancers are very different to solid tumour cancers, and that determines the kind of treatment on offer to patients. For blood cancer patients, treatment is not about surgery or radiotherapy; it is about drugs to help to fight their cancer, and importantly, about access to said drugs. It is therefore crucial that innovation and the development of new drugs is encouraged to help improve patient outcomes. The Government must continue to commit to ongoing research to help save lives, and capitalise on our world-leading position as blood cancer research pioneers.

Lots of this work already happens, including charitable investment and collaboration between public bodies. One such example is IMPACT—a £4 million clinical trials programme that is jointly funded by Anthony Nolan, Leuka, and NHS Blood and Transplant services. By 2020, this exciting and much welcomed project will have established 12 clinical trials involving approximately 1,500 patients. It will play an invaluable role in achieving the vision set out in the Government’s life sciences industrial strategy and—most importantly—it will help to save lives. It is of utmost importance that the Government continue their commitment to this work.

We must also consider how the cancer drugs fund works, and how the temporary collection of data to make appraisal decisions can, for some rare blood cancers, lead to insufficiency in collecting robust data, and therefore to negative appraisals for drugs. I have raised concerns in the past about the way we appraise drugs—indeed, I worked with the hon. Member for Central Ayrshire when we were both co-chairs of the all-party group on breast cancer, and we carried out work on some breast cancer drugs, including Kadcyla. It is therefore disappointing, yet not surprising, that we find similar situations when it comes to blood cancer drugs with, for example, the drug ibrutinib being given to patients with mantle cell lymphoma. That drug received a negative appraisal, and later a positive one. That causes unnecessary distress and anxiety for patients, and it is important that such problems are addressed. I hope that the Minister will give us some steer on when the Government plan to rectify these matters.

Finally, I will touch briefly on the need for support for those living post transplant, and the care that should be on offer to them. It is estimated that by 2020 more than 16,000 people will be living post transplant, and they will therefore be more exposed to physical and psychological effects, such as graft versus host disease, depression and prolonged duress stress disorder. Although stem cell transplants can save a person’s life—that is fantastic—it is important that when someone’s life is saved, they can live it to its fullest. Sadly, only 54% of those who need psychological support actually receive it. That is down to the commissioning of post-transplant services not working for all patients, especially at the 100-day cut-off after a transplant, when responsibility for services moves from NHS England to CCGs, and therefore leads to gaps in the care and support provided. Is the Minister aware of that, and will he commit to looking at how that gap can be filled so that patients receive the best post-transplant support possible?

This debate has been incredibly important, and I am sure it has given the Minister a lot to think about. I hope that when he gets back to his office, he will look at this issue in depth and read the APPG’s report following its launch today—I am looking forward to that—so that all the 230,000 people living with blood cancer can be confident that the Government are doing their utmost to give them the best chance of living.

Junk Food Advertising and Childhood Obesity

Sharon Hodgson Excerpts

Tuesday 16th January 2018 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Dorries. I thank the hon. Member for Erewash (Maggie Throup) for securing this important debate, and for sharing her knowledge in her passionate speech. I also thank the other hon. Members who have spoken this morning for their eloquent speeches: my hon. Friend the Member for Reading East (Matt Rodda), the hon. Members for South West Bedfordshire (Andrew Selous), for Strangford (Jim Shannon) and for Angus (Kirstene Hair), my hon. Friend the Member for Bristol East (Kerry McCarthy) and the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), who spoke for the Scottish National party.

The UK has one of the worst obesity rates in Europe, with almost two in every three people either overweight or obese. I am, as hon. Members can see, one of those two. I am back on a strict diet post-new year, with no sugar or alcohol for the foreseeable future—if any hon. Members see me with either or both in my hand, please take them off me—and I hope that by August there will be a lot less of me.

I commend the honesty of the hon. Member for Strangford. I have been on a similar journey to him healthwise, and I hope to share his success weightwise. It is hard though—if it were easy, nobody would be overweight. We have not all got metabolisms as good as a horse, as the hon. Member for South West Bedfordshire attests to. However, I started life as a skinny kid and was a slim teenager. I am proud to say that I was a size 10 when I got married, but I still ended up overweight as time went by. Therefore, I worry greatly when I see the stats, as I know we all do, for this country’s children.

As we have heard this morning, a pattern now emerges at a very early age. In 2016-17, almost a quarter of reception children aged between three and four were overweight or obese. In the same year, for pupils in year 6, it was more than a third. An obese child is five times more likely to grow up into an obese adult. I did not start as an obese child, and hon. Members can see where I got to, so it is important that the Government do all they can to ensure that child obesity rates are reduced as a matter of urgency.

As we know, obesity is linked with several health issues: lung and liver disease, heart attacks, strokes, seven or more types of cancer, and type 2 diabetes, all of which could be prevented with healthy eating and a healthy lifestyle. According to Cancer Research UK, continued eating and drinking patterns—alcohol is also a major factor in cancer—could lead to being overweight and obese and could cause an additional 670,000 cases of cancer in the UK over the next 20 years. Diabetes UK also warns that there are now 12.3 million people at an increased risk of developing type 2 diabetes. If overweight and obesity levels were to be reduced, three in five cases of type 2 diabetes could be prevented or delayed.

Obesity comes at a high financial cost too. Obesity and its related health problems cost the NHS in England an estimated £5.1 billion a year, projected to reach £9.7 billion by 2050, if the Government and the people themselves fail to take any action—as we have heard in the debate, people need to take action for themselves. That is why this debate is so important. If we do not do anything about obesity today, the children of tomorrow are the ones who will suffer.

There are many ways to address obesity. No one intervention is a silver bullet, but it is the Opposition’s belief that action on advertising and marketing can make serious inroads.

Ten years ago, Ofcom’s restrictions on junk food advertising came into effect, but over that decade, our viewing habits have changed, as we have discussed. At that time, the Ofcom report said:

“Advertisements of high fat, salt and sugar products should not be shown in or around programmes specifically made for children...For the avoidance of doubt this measure will remove all HFSS advertising from dedicated children's channels”.

Ten years on, as we all know, that is incredibly outdated and out of touch with the way children watch TV. Children are likely to watch TV with their family or watch programmes that are not on specific children’s channels, such as “The X Factor”, “Britain’s Got Talent”, “Hollyoaks” and other programmes.

A report by the University of Liverpool found that 59% of food and drink adverts shown during family viewing time were for high fat, salt and sugar products and would have been banned from children’s TV. The same report also found that, in the worst case, children were bombarded with nine junk food adverts in just a 30-minute period and that adverts for fruit and vegetables made up only 1% of food and drink adverts shown during that family viewing time. Ofcom’s restrictions on junk food advertising are therefore totally obsolete and in need of a serious update to protect children from the bombardment of junk food advertising from multinational companies.

Many of the charities and organisations that provided me with briefings for this debate called for junk food advertising to be restricted until the 9 pm watershed on all channels, which was something I was pleased to commit to in the 2017 Labour party manifesto and am proud to remain committed to. I hope that the Minister will hear the calls today from hon. Members across the House and will see why an update of the restrictions is necessary.

Children must of course also be protected from other forms of advertising, such as billboard and bus shelter adverts, as well as subtle advertising in films and in made-for-purpose games, which are so prevalent there is a name for them—advergames. “Newsnight” last night noted that there are major concerns with the regulations around confectionary firms and their marketing to children. There seems to be a loophole in the law with regard to advergames, which needs to be closed.

There are also genuine games that are very popular with children although they are not aimed at them, such as Candy Crush—I have to admit to having tried that one myself—which embed advertising in the game and have been shown to drive children's food choices. Sponsorship has also been shown to have a huge impact on brand awareness and purchasing decisions among children. Products high in fat, salt and sugar are often found to sponsor sporting events or teams of which children are a key part of the audience. For example, Cadbury is the official snack partner of the premier league.

The current restrictions do not encapsulate those areas, and in our digital world it is important that our restrictions advance to protect children. Will the Minister commit to holding a cross-Departmental meeting with colleagues in the Department for Digital, Culture, Media and Sport to discuss the urgency of addressing junk food marketing to children across those forums?

Not only do we watch TV and use the internet differently, but we also shop differently. Our sedentary lifestyles mean that we now rush into supermarkets trying to buy the quickest or cheapest products. As soon as we walk through the door, we are tempted with promotions, such as buy one get one free or three-for-two offers. Such discounts make up for more than half of all food sold in the UK, a higher proportion than in any other country in western Europe. We all love a bargain, but research has shown that 76% of purchases were unplanned and decided on in store, which shows the power of such promotions.

That trend is increasingly prevalent among families from poorer backgrounds who are not able to afford more expensive, nutritious and healthier food, or lack the skill to cook it. It is therefore no wonder that children aged five from poorer backgrounds are twice as likely to be obese, and that those aged 11 are three times as likely to be obese. Following what the hon. Member for South West Bedfordshire said, we also need affordable, healthy and nutritious products available on promotion to change habits.

I am sure the Minister will uphold the Government’s pledge to tackle childhood obesity, but their efforts are dwarfed by multinational corporations’ spending on junk food advertising. In 2016, the 18 highest-spending crisps, confectionary and sugary drinks brands together spent more than £143 million advertising their products. I recently met an advertising executive who has turned gamekeeper since having a damascene conversion—he now campaigns against added sugar and obesity. He told me how much effort multinational corps put into marketing specifically to children. It is not accidental, but a deliberate, well-thought-through and lucrative strategy.

Eighteen months ago, the Government launched their much-depleted childhood obesity plan, which left much to be desired. Will the Minister update us on the current situation of the childhood obesity plan? Will he commit to looking beyond it and going further by introducing the initiatives that have been suggested today, such as a 9 pm watershed on junk food marketing, which were sadly dropped from the original plan?

All of the arguments we have heard this morning point to the fact that essential Government action is needed to ensure that our children grow up in a healthy environment so they can be fighting fit for the future. I hope the Minister will take these suggestions back to his Department and think about how they can be implemented into a serious drive to reduce childhood obesity over the next 10 years. Childhood obesity must be addressed. We cannot have a soft-touch approach. We must do this for future generations of children, and make a promise to them that they can be some of the healthiest children in the world.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 19th December 2017 Commons Chamber

[Steve Brine]

Happy Christmas to St Helens as well. I agree that we need to work together. The Healthy Start programme, for which I am responsible, provides a nutritional safety net to hundreds of thousands of pregnant women and families with children under four. There is a slight increase in cases being reported in recent years. In part, that is due to much better diagnosis and detection. Some 1.1 million children get free school meals in England, and the Government are investing £26 million in breakfast clubs. Only last week, Kellogg’s was here with its breakfast club awards—an excellent innovation.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

That being said, it is disgraceful that under this Government’s watch we have seen a 54% increase in children admitted to hospital with malnutrition. Instead of seeing malnutrition rising, we really should be eradicating it. As the festive period is upon us and it is the season for good will and giving, will the Minister give this House an assurance that he will seriously address this matter to ensure that no child in this country ever experiences malnutrition?

[Steve Brine]

Of course we want no child in our country to experience malnutrition. I mentioned the Healthy Start scheme and the breakfast clubs. Healthy Start is an excellent programme run by Public Health England that encourages a healthy diet among hundreds of thousands of families with children under four. It is exactly that which is helping us to tackle this issue.

Hormone Pregnancy Tests

Sharon Hodgson Excerpts

Thursday 14th December 2017 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I congratulate the right hon. Member for Hemel Hempstead (Sir Mike Penning), who opened the debate so powerfully, and my hon. Friend the Member for Bolton South East (Yasmin Qureshi), who has been a strident campaigner on this issue for more than six years and knew all about it before it had even reached my consciousness. She gave an excellent, if rather too short, speech. I thank all other Members for their passionate and thoughtful contributions; because of the time constraints, I hope they will please forgive me for not naming them all. Ultimately, thanks must go, as others have said, to Marie Lyon, the chair of the Association for Children Damaged by Hormone Pregnancy Tests. I am sure that I speak for all of us in the House today when I say that she has the utmost respect and admiration of Members from across the House.

I want to touch on not only the science that was used to come to the conclusions in the review, but what is missing and what should have been considered before any conclusions were drawn. I will then highlight why this is a matter of injustice and why it is important that answers are found, so that we can finally conclude this sad chapter.

The main sticking point of the review’s conclusions is that the expert working group found that the science did not support a causal association between HPTs during pregnancy and adverse outcomes. My focus will be on the science used and the historical documentation that we are aware of, but which seems not to have been considered—we heard about some of it in the excellent speech by the right hon. Member for Kingston and Surbiton (Sir Edward Davey). I will not deviate into the important argument about “possible” and “causal”, as that was covered comprehensively by other Members, including the right hon. Member for Hemel Hempstead.

I must make it clear from the outset that I am no scientist—I am sure that Members are aware of that—and my speech is not a critique of the integrity and expertise of the specialists involved. However, the conclusions arrived at in the report and the conversations I have had with many of those who have been involved in the campaign show a need for us to be critical of what was concluded by the expert working group. That is our duty as Members of Parliament, especially when it comes to what is such an important matter for so many women and their families, and also because a great deal of public funds were invested in the review over the past few years.

In the report’s consideration of the scientific detail regarding HPTs, it is argued that there are inconsistencies in the conclusions drawn from the evidence used. Take, for example, the fact that of the 15 studies that looked at heart defects, 11 favoured a link, and of five studies into limb reduction, all found a link, yet those studies were deemed to show “insufficient evidence” of the drug’s harm. Even information I requested recently and got just this week from the Medicines and Healthcare Products Regulatory Agency in the lead up to this debate is at odds with the conclusions of the review, including graphs that plot birth defects against the availability of HPTs. Even to my untrained eye, they show a possible link. In one graph on all malformations, it is clear that birth defects increased during the period in which HPTs were on the market, and shortly afterwards. They began to decrease soon after HPTs were taken off the market.

Further, in the briefing I received, the MHRA said that for every 100 babies born in the general population, around two to four are expected to have a birth defect, which means that 14,000 babies a year would be expected to be born with a birth defect. That is just generally. Using those figures, the MHRA concluded that for the more than 1 million women who took HPTs, as many as 19,000 babies would be born with a birth defect, irrespective of any additional risk from HPTs. Yet let us compare Primodos to thalidomide, for instance. More than 30 million thalidomide prescriptions saw 600 children affected in the UK, which is a rate—I have had help with these numbers —of 0.002%. Some 1.2 million Primodos prescriptions were sold and 800 children were affected, which is a rate of 0.06%. That shows a much higher prevalence caused by Primodos compared with thalidomide. It also shows how little meaning a comparison of HPT adverse reactions has against today’s prevalence of birth defects in the general population, and it is hardly a defence of disproving a link.

As I have said, I am no scientific professional, but I believe that the red flags that arise when reading what the evidence says and what conclusions were drawn from it are not ones that only an expert in this field would see. This reflects the arguments that were raised last week by Dr Neil Vargesson—that the report does not provide definitive evidence that the drug was safe. As others have said, the only conclusion that can be drawn is that a link cannot be ruled out.

That leads me on to my next point, which is to touch briefly on the historical perspective and cover-up of the evidence. We have got to use that word—it is the only word we can use—as this is something that should have been considered by the expert working group.

One such example was in 1975, when the UK regulator knew of a potential five-to-one risk that the drug could cause deformities, but that evidence was apparently later destroyed. This is a running theme—I do not have time to go into it all—through the chronology of this scandal. We see multiple examples of suppressed information regarding the adverse effects and delayed notification of those effects to medical professionals who administered the drugs.

It is also deeply concerning that this drug came into the market in 1958, with no studies on its effects at all until 1963. Five years passed before it even underwent teratogenic testing. It was still officially in circulation until 1975, but we are aware of cases of its use up until 1978. All the evidence uncovered should have been considered as part of the review. The question is: why was it not?

With any scandal such as this, it is important that those affected have the trust and confidence of any review or inquiry undertaken. In this instance, that has not been the case. The victims feel that the review has muddied the waters even more and that their views have been ignored. I have been told many harrowing stories, many of which we have heard today, and how, time and again, they have been ignored. These women did not ask to be given HPTs. Nor were they ever made aware of the effects that they could have on them or their unborn baby. They were just given them—sometimes out of a supply in a drawer on the doctor’s desk. There were no warnings, no explanations, no discussions.

A great injustice has been inflicted on these women. It is up to this House to put pressure on the Government of the day, here and now, in a fully cross-party, non-partisan way, to make things right. It is paramount that a judge-led public inquiry be conducted—one that is independent and can fully examine all the materials and documentation available and insist that all information be made public, including that which has been withheld so far. I hope that this debate helps us to take that one step further to achieving that.

In closing, may I quote the hon. Member for Mid Norfolk (George Freeman), the then Minister for Life Sciences? In October 2014, when he instigated this review, he said that the review would

“shed light on the issue and bring the all-important closure in an era of transparency”.—[Official Report, 23 October 2014; Vol. 586, c. 1143.]

Let this debate and the following actions by the Minister ensure that what was promised in 2014 is actually achieved.

Autism Community: Mental Health and Suicide

Sharon Hodgson Excerpts

Thursday 30th November 2017 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and others on securing this important debate and on her excellent opening speech. I thank Autistica, the National Autistic Society and Ambitious about Autism for the important work that they do and the support that they provide for people living with autism.

This is our second debate on autism since our return from the summer recess and it is good that it has been so constructive. I also thank all other hon. Members here for their excellent and passionate speeches. The hon. Members for Berwick-upon-Tweed (Mrs Trevelyan), for Bexhill and Battle (Huw Merriman) and for North Ayrshire and Arran (Patricia Gibson), and my hon. Friends the Members for Bristol West (Thangam Debbonaire), for Blaydon (Liz Twist) and for North Durham (Mr Jones), all spoke movingly, often from personal family experience or about constituents. This debate may have been short, but it has none the less been very powerful.

It is important to say that autism is not a mental health condition: it is possible to have both autism and good mental health, but that is not always the case, as we have heard. Between 70% and 80% of autistic people develop mental health problems such as anxiety and depression, and four out of 10 children with autism have at least two mental health problems.

Adults with autism who do not have a learning disability are nine times more likely to die by suicide than the general population; those with a learning disability are still twice as likely to take their own lives. Clearly, more needs to be done to support the mental health needs of people living with autism. Reducing the health inequalities experienced by people living with autism is a priority for the NHS mandate for 2017-18, and that is welcome. Mental ill health is a major contributory factor to health inequality for people with autism. Ensuring access to appropriate mental health care is important in the fight to tackle these disparities.

However, there are too often significant barriers to accessing the right treatment. In a debate in September, we talked about waiting times for autism diagnosis—it is a scandal that those can be as long as 125 weeks. Accessing a diagnosis is the first step towards securing the support that people living with autism need, and that is also true for mental health support. We are pleased that data on autism diagnosis waiting times is going to be collected and published from April 2018; hopefully, it will help to drive an improvement in this area.

Today, I want to focus on how mental health services can be improved for people living with autism. Last week, my hon. Friend the Member for Stockton South (Dr Williams) told the Health Committee about T, a young boy with autism. As we heard from the hon. Member for East Kilbride, Strathaven and Lesmahagow, T was rejected four times for treatment by child and adolescent mental health services, despite reporting suicidal thoughts and having a family history of suicide. He was rejected because he had not yet attempted to take his own life.

The Children’s Commissioner for England confirmed concerns about the issue when she stated to the Health Committee that this type of situation was now “the norm” within children’s mental health services. That is worrying generally for children’s wellbeing, but for those living with autism it is particularly so, for a number of reasons. Experiences of suicide are different in the autism community from those in the wider population; relying on certain behaviours and expectations of what someone in need of support will look like can be dangerous.

As the Children’s Commissioner put it, children with mental health problems will become adults with mental health problems very soon. We cannot continue to miss opportunities to intervene early. That means, sadly, that T’s experience is just one of many. The five year forward view for mental health recommended that NHS England develop autism-specific mental health care pathways, but there is currently no information on the timetable, the scope of the pathway or who will be leading the issue. The pathway should cover children, young people and adults on the autism spectrum. It should take into account the fact that mental health conditions can present themselves in different ways for people with autism and it should recognise that mental health treatment may need to be tailored for people with autism. I hope the Minister will reflect on that in her response. Will she tell the House when and how the pathways will be developed?

Early intervention and prevention should form the basis of our mental health services. However, too often specific issues make it difficult for people with autism to access that early support that is so vital. The first point of call for many people experiencing mental health problems is their GP; for many people with autism that can be difficult, as GP surgeries are often not autism-friendly. This is how one autistic adult described their experience:

“When anxiety is really bad I start to feel a panic attack at the prospect of just having to step out of my front door. So having to go to the GP is like having to climb Everest.”

It is important that GPs understand that every autistic person is different, and that each person may need some adjustments to be made before he or she can feel comfortable about attending the local GP’s surgery. For example, some autistic people may be hypersensitive to sound and light and may therefore need an appointment at a quieter time of day, while others may be hyposensitive and benefit from a more stimulating environment. GPs may also need to tailor the way in which they communicate with patients—for instance, using clear language, or finding ways of communicating with somebody who does not speak. To do that, GPs must be able to access detailed and accurate records about their patients’ needs. Currently GPs often do not record much information about their autistic patients, and may not even record that a person is autistic at all.

In August, the National Institute for Health and Care Excellence recommended that GPs keep a set of local autism registers similar to those kept for people with learning disabilities, asthma and diabetes. Will the Minister tell us when she expects the NICE recommendations on autism GP registers to be adopted, and whether NHS England will work to ensure that the data gathered is used to inform better commissioning of autism and mental health services?

We have heard powerful accounts today from Members on both sides of the House about what happens when we get mental health treatment wrong. It is all too easy for people with autism to receive inappropriate mental health treatment, or to be blocked altogether from access to treatment. As the Government review the Mental Health Act 1983, it is important that they consider everything that has been raised in today’s debate and ensure that autistic people are supported. The shocking suicide statistics and testimonies from Members today show starkly how crucial it is that more is done on the issue, and the power is in the Minister’s hands. I hope that she has listened and will act.

Drug Addiction

Sharon Hodgson Excerpts

Wednesday 22nd November 2017 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gapes.

Let me start by thanking the hon. Member for South Thanet (Craig Mackinlay) for securing this important debate, and for his excellent opening speech, which laid out all the human and associated monetary costs that drug addiction costs society and indeed the Exchequer. His figures are even greater than the ones I will be citing in my contribution, which is perhaps because he included all classes of drugs. I will only be citing figures for class A drugs, but that shows the enormity of the costs that we are dealing with today.

While there is a very important debate going on in the main Chamber, it is welcome to see the number of MPs here today to discuss this important issue. We have had many excellent contributions to the debate, including from the right hon. Member for North Norfolk (Norman Lamb), the hon. Members for Reigate (Crispin Blunt), for Inverclyde (Ronnie Cowan) and for Henley (John Howell), and the hon. Member for Glasgow East (David Linden), who is the Scottish National party spokesperson; he made a pertinent and moving speech, and I commend him for that. They all made strong and thought-provoking speeches, and we have had some excellent interventions. I thank all Members for taking the time to set out their positions and thoughts on drug addiction and the costs to society.

As we have heard, drug addiction is one of the most deeply concerning issues we face today. Drug addiction, in its many guises, can blight communities and the lives of so many people, which is why it is vital that policy is developed to significantly reduce the harm that addiction can inflict on individuals and communities. According to Home Office figures, the number of people taking drugs has fallen significantly over the past decade. That is to be welcomed. Reducing the number of people taking drugs is a step in the right direction to not only improve the health of the nation but reduce crime and pressures on our public services.

Sadly, if we scratch the surface, we unveil more uncomfortable truths that the Government must face. In 2016, there were a total of 2,593 drug misuse deaths involving illegal drugs—the highest number since comparable records began in 1993. That trend in avoidable deaths is reflected across both genders. However, for men the drug misuse mortality rate has jumped sharply over the last three years and reached a new peak of 67.1 deaths per million people—another high since records began in 1993. The female rate is less pronounced but is also at an all-time high.

Across Europe, it is estimated that a total of 8,441 deaths occurred due to drug overdose in 2015, mainly from heroin or other opioids. Here in the UK, we come out on top with the highest percentage of those deaths, at 31%. That is absolutely damning, especially when the Advisory Council on the Misuse of Drugs stated in a report last year that England alone saw an increase of 58% in opioid deaths between 2012 and 2015. Much of that is put down to ageing users of heroin and opioids, which gives rise to the question: what are the Government doing to address the often complex social care needs of drug addicts?

It is not only the deaths that occur from drug misuse and addiction that are concerning, but the costs to society in general, as we heard from the hon. Member for South Thanet. In terms of monetary costs, it is estimated that class A drugs such as heroin and crack cocaine cost us £15.4 billion a year, which is £44,231 per problematic user. Broken down, that figure is roughly £13.86 billion on social and economic costs, £535 million on drug arrests and £488 million on the NHS dealing with mortality and morbidity and providing acute treatment and support for mental health and behavioural disorders associated with drug misuse. As I said, that is just for class A drugs. When we include all classes of drugs, the sums increase substantially, as has been set out in detail.

[Mary Glindon (North Tyneside) (Lab)]

Does my hon. Friend agree with the drugs, alcohol and justice cross-party parliamentary group that, to reduce alcohol and drugs-related deaths and illnesses, a co-ordinated harm reduction strategy needs to be prioritised?

[Mrs Hodgson]

Yes, I do agree.

It is no wonder, when we go off all these figures, that earlier this year the UK was deemed the overdose capital of Europe and is now seen internationally as having serious shortcomings when it comes to addressing addiction and drug misuse. What are the Government going to do to address these problems? I am sure the Minister will cite the recent publication of the drugs strategy in the summer. As he will know, Opposition Members welcomed the strategy, but it left us wanting. There is much to be welcomed in it, but it is clear that what was announced has not moved us on any further from what was happening in 2010 and now works within a seriously reduced financial envelope due to short-sighted cuts to public health budgets.

The Minister knows all too well that public health budgets have been decimated, with an estimated £800 million expected to be siphoned out of local budgets by 2021. That has meant drug rehabilitation services being closed and budgets to tackle drug abuse cut, all against a backdrop of an NHS under significant pressure. Labour’s analysis of figures published by the Department for Communities and Local Government shows that this year we will see 106 councils reduce drug treatment and prevention budgets by a total of £28.4 million; 95 councils reduce alcohol treatment and prevention, at a total of £6.5 million; and 70 local authorities reduce drug and alcohol services for children, at a total of £8.3 million. That works out at a total reduction of £43.3 million imposed by the Minister’s Government on a whole host of services created to prevent and treat addiction problems. Those figures are unavoidable and shameful. We should be putting greater emphasis on the radical upgrade in public health and prevention promised in the “Five Year Forward View” in 2014.

The Minister cannot come before us today and honestly say that his Government are improving services and seriously addressing this issue when they are overseeing such significant cuts that are rolling back provision on addiction services. It is not just me or Labour making that case, but the likes of the chief executive of Collective Voices, Paul Hayes, who said earlier this year:

“The more we disinvest in treatment, as we are doing at the moment, the more we will put increasing numbers of people at risk of early avoidable deaths.”

The Minister has the power to go back to his Department and ensure that these avoidable deaths are avoided and the unnecessary losses of life halted.

The Government’s failure to seriously get to grips with the issue of drug addiction and the sad outcomes associated with it is shaming us across the world. Yasmin Batliwala, chair of the Westminster Drug Project, was recently reported as saying:

“We once had services that led the way.”

She went on:

“We now need to do a lot to catch up with countries in the developing world that are doing a lot more for their service users. The sign of a civilised society is how it cares for its most vulnerable.”

The Minister needs to acknowledge that his Government are overseeing such a negative and backwards approach to prevention, instead of taking radical steps to address and prevent drug addiction.

It is high time this Government seriously came to terms with the actions they have taken over the last few years on public health and rethink their short-sighted approach. Otherwise, we will see the figures that I quoted at the beginning of my speech become ever worse under their watch. The people who struggle and battle with addiction deserve and need our support, not just for them, to improve their lives, but for the rest of society, so that we can finally ensure that no one’s life is blighted by drug addiction.

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

It is a pleasure to serve under your chairmanship, Mr Gapes. Thank you for protecting my 10 minutes at the end of the debate. I congratulate my hon. Friend the Member for South Thanet (Craig Mackinlay) on securing the debate.

It has been noticeable that there is complete consensus among those who have contributed today about the horror and damage that drug abuse causes for individuals and wider society. Nobody, quite properly, has stood up here to say anything other than that. However, there is a noticeable difference in approach as to how to deal with some of these challenges. It is impressive that we had a consistent line from the right hon. Member for North Norfolk (Norman Lamb), my hon. Friend the Member for Reigate (Crispin Blunt) and the hon. Member for Inverclyde (Ronnie Cowan). They all called for a particular approach that the Government do not support. I shall focus most of my remarks on what the Government are actually doing.

The hon. Member for Washington and Sunderland West (Mrs Hodgson), who speaks for the Opposition, was quick to criticise the support provided to drug abusers and she called for more action, but she did not come up with a single example that I could detect of what more could be done—[Interruption]—to provide any greater action, in response to the drug strategy that we published in July. I appreciate that she expressed some welcome for that strategy, but she did not indicate anything else that she said was missing that we should introduce.

[Mrs Hodgson]

We could always take over in government.

[Mike Gapes (in the Chair)]

Order.

Draft Greater Manchester Combined Authority (Public Health Functions) Order 2017

Sharon Hodgson Excerpts

Monday 20th November 2017 General Committees

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms McDonagh. I thank the Minister for setting out the draft order in such detail. Let me say at the outset that the Opposition welcome it and do not oppose it, so I do not think we will be here much longer. I think everyone will be happy about that. [Hon. Members: “Hear, hear!”] How to win friends and influence people.

Over the years, there has been much movement in Manchester towards a new style of local government, with a combined authority and now a metro Mayor, and it makes sense for public health duties to be undertaken by that new local government structure. I, for one, have no doubt that the former right hon. Member for Leigh, Andy Burnham, will do excellent work alongside his combined authority colleagues to champion the improvement of public health in communities across Greater Manchester.

We have already seen visionary planning and passion with the creation of plans to improve the health and quality of life of people in Manchester, but I cannot miss an opportunity to remind the Minister of his responsibilities on public health—responsibilities that I know he takes seriously. He knows that severe cuts to public health budgets—there is expected to be an £800 million cut over the five years leading up to 2021—are having serious ramifications for public health services across the country, including in Manchester. The placement of duties on a new body as part of the new landscape of local government is to be welcomed, but the funding to provide for those duties must not be ignored and left out of the picture. The Government must get to grips with the wider public health agenda and not let it be sidelined in any way.

Question put and agreed to.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

Such issues are much in people’s minds at the moment, and the hon. Lady makes an important point, so I will take that away with me and come back to her with some thoughts once I have looked into it carefully.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Further to the Secretary of State’s response to the question of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), I feel that the Secretary of State is not being clear with the House. Will the extra money that Simon Stevens asked for be in the Budget or not?

[Mr Hunt]

I am afraid that the hon. Lady will have to wait until the Chancellor delivers his Budget. There are huge financial pressures on the NHS. We inherited a financial recession but, if she looks at this Government’s record she will see that, unlike her party, we refused to cut spending on the NHS; we are now increasing it.

--- Later in debate ---

[Mr Speaker]

It is always useful to have a bit of additional information, for which the House is grateful.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Under this Government we have seen lung disease admissions to A&E rise at double the rate of general admissions. That is even more concerning when the bulk of lung disease admissions happen over the winter months, when A&E departments are already under significant pressure. Will the Minister commit today to introducing a lung disease strategy to ensure that we can reverse these worrying trends and this pressure on people’s lives and on our NHS?

[Steve Brine]

The meeting was in Milan, Mr Speaker, but we do not mention football in relation to Italy or Milan any more. I hear it is a touchy subject. [Interruption.] Very topical.

There is no plan for a new national strategy or taskforce, but we work closely with charities like the British Lung Foundation. We have to remain committed to implementing the NHS outcomes framework for 2016-17. As the Secretary of State said, we are better prepared for winter than we have been before, and the hon. Member for Washington and Sunderland West (Mrs Hodgson) is right to raise that point.

Vaping

Sharon Hodgson Excerpts

Wednesday 1st November 2017 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship, Mr Howarth. I thank the hon. Member for Dartford (Gareth Johnson) for securing this debate. It is timely and important, especially because we have just seen the end of Stoptober, which vaping played a role in advertising. I thank all hon. Members for their thoughtful contributions, and I welcome the array of views and opinions they conveyed. It is clear that there is strong interest in the House in this topic. Although we are small in number here, the quality of the contributions made up for that.

E-cigarettes have been around since the mid-2000s, but in recent years we have seen them boom. Recent figures estimate that 2.9 million adults now use e-cigarettes, compared with only 700,000 in 2012. That increase is expected to grow as more people turn to e-cigarettes to reduce their tobacco consumption or to quit tobacco completely.

The interest in e-cigarettes can also be seen in the rapid growth in availability of such products and the advertising around them. In 2014, it was estimated that there were 460 brands and more than 7,500 flavour solutions. The BMJ highlighted that the advertising and promotion of the products had grown from £1.7 million in 2010 to £13.1 million in 2012—if we had the figures for 2017, they would obviously be a lot higher.

Labour Members welcome e-cigarettes as part of our drive towards a smoke-free society and because of the role they can play in the smoking cessation landscape. What remains important, however, is that e-cigarettes are regulated correctly to ensure that the health of our country is improved, not diminished—which, at the end of the day, is our main goal when it comes to smoking cessation. I will also use my contribution to this debate as an opportunity to further discuss smoking cessation, which is a crucial aspect of the debate around vaping, and the importance of continually looking at this market as we move towards a smoke-free society.

Smoking cessation is crucial. It improves the health of individuals and our nation significantly, and reduces the prevalence of cancer, lung disease and COPD—chronic obstructive pulmonary disease—diseases which we know are all too persistent. If smokers quit smoking when diagnosed with lung cancer, it is estimated that even at that late stage they will live nearly a year longer than if they continued to smoke. For those living with COPD, smoking cessation is the only treatment that can prevent the progression of the disease in smokers. It is also the most cost-effective one. The cost per QALY, or quality-adjusted life year, for smoking cessation in COPD patients is around £2,000, compared with between £7,000 and up to £187,000 per QALY for drugs to control the symptoms of COPD. The National Institute for Health and Care Excellence, NICE, has estimated that for every £1 invested in specialist stop smoking services, a return of £2.37 will be generated in savings on smoking-related diseases and in ending loss of productivity.

I hope that such issues will be addressed as the Government implement their recently published tobacco control plan, and it is welcome that e-cigarettes have been included as part of that work. E-cigarettes, however, must never be seen as a silver bullet to achieve our vision of a smoke-free society. E-cigarettes are a crucial player in the cessation landscape, but they are not the only player. It is important that we maintain the position set out by research and evidence from the World Health Organisation and in the tobacco control plan that nicotine replacement therapy is four times more effective when prescribed by a doctor and monitored than when simply bought over the counter, which is how e-cigarettes are acquired.

It is important that smoking cessation is a wide-ranging package that reduces smoking in society. Sadly, however, I have to say that the Government’s actions are undermining that approach. As the King’s Fund and the Royal Society for Public Health have identified, public health cuts will reach £800 million in the five years to 2021 and, in 2017-18, spending on tobacco control services faces cuts of 30%. That is concerning, because ASH has identified that a growing number of local authorities no longer have a specialist stop smoking service accessible to all smokers.

Even across the wider health service, it is clear that there are failures to implement NICE guidance on smoking cessation. An audit by the British Thoracic Society of 146 hospitals found that 27% of hospital patients were not even asked if they smoked, and provision of NRT and other smoking cessation treatments in hospitals was classed as poor. Is the Minister aware of that and is he ensuring that action is taken?

What is the Minister doing to address those genuine concerns? I would also welcome knowing his thoughts on promoting vaping and other smoking cessation treatments for in-patients during their stay in hospital, which is championed by Professor John Britton and chimes well with the position set out in the tobacco control plan:

“Promote links to ‘stop smoking’ services across the health and care system and full implementation of all relevant NICE guidelines by 2022”—

I am sure the Minister knows the quote well, as he published the plan, which I am pleased about.

That all shows the serious concerns within the smoking cessation landscape, and the worries for its future and for our move towards a smoke-free society. It is important to include vaping as part of the landscape, but it cannot detract from the other treatments available, which we cannot allow to wither on the vine because something new and shiny has come along. That is partly because the evidence for the impact of e-cigarettes on our health is still not definitive. Public Health England’s review of vaping products showed that they were 95% less harmful than tobacco products—which is excellent—because of the lack of carbon monoxide being inhaled and the reduction in the many other health implications that come with smoking tobacco, but that does not mean there are not concerns or split opinions over the health, harm and safety of such products.

It is paramount that such views are continually looked at and that we review our positions on the products regularly. That is why it is welcome that Public Health England will publish its update on vaping research and evidence by the end of this year. Will the Minister also outline plans to evaluate heat not burn? Although not vaping, such products are something else on the market seen as a way of limiting and reducing harm from smoking. The impact of those devices needs further research.

[Gareth Johnson]

I did not mention the available heat-not-burn products simply because I could not find any independent information on whether they were beneficial for health or still dangerous. I would be grateful if the hon. Lady enlarged on any information that she has found out about those products, because I found it difficult to find anything.

[Mrs Hodgson]

I do not think that I know much more than the hon. Gentleman, which is why I mentioned heat not burn. I have asked some questions about it because some independent research is needed. The manufacturers of heat-not-burn products have done their own research and make quite strong claims that although they are still tobacco products, they are far less harmful, but we need independent research to back that up before anyone can substantiate the claims. Will the Minister update us on when research into vaping and perhaps heat not burn will be happening?

As we come to the end of the year, the Minister will be aware that if we see any delays in publishing reports or plans, I will of course be on his case. I welcome the Science and Technology Committee also looking into this matter, and I will keep a close eye on the developments of that inquiry while looking forward to its findings. It is important that we take a pragmatic approach to e-cigarettes, which is reflected in Public Health England’s 2016 statement, which had the support of 12 health charities:

“We all agree that e-cigarettes are significantly less harmful than smoking…but we must continue to study the long term effects.”

The Opposition agree, as it is clear from the evidence so far that e-cigarettes are far less harmful than tobacco smoking, but the evidence remains inconclusive. That is why monitoring must be maintained to ensure that we fully understand the impact of such products in the short and long term.

The Minister has had a lot to think about during this short debate, and I am sure that in his response he will address each and every one of the points made. I implore him in that response to remember the wider smoking cessation landscape and how important it is to ensure that vaping is included as part of that wider package, which is sustainable and effective in reducing smoking in society and thereby improving the health of the nation.

Tobacco Control Plan

Sharon Hodgson Excerpts

Thursday 19th October 2017 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I thank my right hon. Friend the Member for Rother Valley (Sir Kevin Barron) for securing the debate. He is a long-standing campaigner on the issue of tobacco and its effects on society, and it is good to see that he is continuing his campaign. He made an insightful and thought-provoking contribution.

I also thank other Members who have made excellent speeches on this important issue, including the hon. Member for Chippenham (Michelle Donelan), my hon. Friend the Member for Ipswich (Sandy Martin), the hon. Member for Harrow East (Bob Blackman), my hon. Friend the Member for Stockton South (Dr Williams), the hon. Member for Colchester (Will Quince), my hon. Friend the Member for North Tyneside (Mary Glindon), and the hon. Members for Witney (Robert Courts), for Eastleigh (Mims Davies) and for Stirling (Stephen Kerr).

I welcome the fact that the debate is taking place during Stoptober. It is nearly a year since our last debate on the tobacco control plan, which—this may interest some Members—marked my first outing as shadow Minister for public health. While the Minister I shadow has now changed—it is now the hon. Member for Winchester (Steve Brine)—the most significant change since our last debate is that, thanks to him, we finally have a new, updated tobacco control plan, which we were all very pleased to see. It is welcome that, after a long-drawn-out 18-month delay, we now have a plan that will take us a step further towards creating a smoke-free society.

Labour Members have welcomed the plan and its ambitious and noble goals, but we remain concerned about how it will be effectively implemented and achieved, especially given the short-sighted cuts in public health budgets, which my hon. Friend the Member for Stockton South highlighted knowledgeably in his excellent speech. As we know, the previous plan was extremely successful and reduced smoking rates from 20.2% to 15.5% but, as we have heard from every speaker today, it remains the case that smoking is still a serious issue in our society in terms of both its financial and human cost. Smoking and its related health problems cost our already financially strapped NHS more than £2.5 billion each year. If we were to seriously address smoking in society, we could reduce that financial cost and direct the money towards improving our NHS and ensuring that we have a healthy society.

It is estimated that 200 people a day die from smoking-related illnesses. In 2015, 79,100 people aged just 35 or over died because of smoking. It is not just adults who are affected, but babies and children. In 2010, as a result of pregnant women smoking, 19,000 babies were born with a low birth weight and an increased chance of taking up smoking later in their lives. As we heard in the excellent speech made by the hon. Member for Colchester, last week was Baby Loss Awareness Week. The hon. Gentleman is co-chair of the all-party parliamentary group on baby loss, of which I am proud to be an officer. It is estimated that up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year are attributed to smoking during pregnancy. Those saddening and distressing figures show exactly why we are here today to debate this issue and to ensure that the tobacco control plan is as effective as possible so that we can achieve a smoke-free society, and, in particular, support women during pregnancy.

We also know that smoking rates remain persistently high, especially among people with mental health issues, as my right hon. Friend the Member for Rother Valley mentioned. The plan sets out various recommendations relating to mental health, including improving support for smokers with mental health conditions and training for mental health staff to help to reduce smoking among that group, but I should like to hear from the Minister exactly what measures have been taken on the basis of those recommendations.

It is equally worrying that, as a number of Members have pointed out, the level of smoking remains high among those who are unemployed or members of lower socioeconomic groups, especially given the estimate that tobacco was 27% less affordable in 2016 than it was in 2006. There are a host of reasons for that, including the tax on tobacco products. I agree with the hon. Member for Chippenham that we should never seek to reduce that tax, for all the reasons that she gave, but it is deeply worrying that those groups, for whom poverty is rife, are not being sufficiently helped to quit smoking. During last year’s debate, I cited figures that showed that if smoking were reduced among those living in poverty and the costs of smoking to them were reinvested, we could make serious progress towards the eradication of poverty. Will the Minister give us an idea of what consideration he has given to the idea that reducing smoking could be a vehicle for ending poverty in society?

There is a clear drive in the plan for action on smoking cessation to be taken at a more local level. We do not disagree with that; in fact, we welcome it. We all agree that a “one size fits all” approach does not work, because of the geographical variations when it comes to smoking in our society. In my own region of the north-east of England, smoking rates are 25% higher than those in the south-west, and it is therefore unsurprising that the prevalence of lung cancer in the north-east is close to double that in the south-west. This is why it is important for us to do more at a local level to reduce smoking. However, I must urge the Minister—I know that he takes these matters very seriously—to bear in mind that “localising” action does not mean abdicating responsibility at a national level.

The Prime Minister’s driving mission on the steps of Downing Street in the summer of 2016 was to call out the burning injustices of inequality in our society, but we have yet to see that come to fruition—as we know, the Prime Minister has been a bit busy with Brexit. I know that the Minister is also passionate about the burning injustice of health inequality, because we have worked together on many health issues over the years. I know that he understands the importance of improving public health as a mechanism of prevention, and reducing the burden on our NHS by addressing the issues at source. However, the Department in which he is now a Minister has overseen some of the deepest cuts in public health services in recent years. I am sure the Minister knows the figures for these significant cuts, but for the benefit of the House, I will quote statistics used by the Royal Society for Public Health, meaning that I know they are accurate. It says that the total cuts mean that there will be £800 million less in public health budgets between now and 2020-21, which must have a significant impact on smoking cessation rates.

A study conducted by Action on Smoking and Health and funded by Cancer Research UK found serious budget cuts to smoking cessation services, with a growing number of authorities admitting they no longer have a specialist stop smoking service that is accessible to all smokers. This must be paired with the damaging analysis of Department for Communities and Local Government figures on local government spending by the King’s Fund, which found that wider tobacco control faced cuts of more than 30%. If the tobacco control plan is to be truly successful, as I know the Minister wishes, it cannot be pushed for in isolation from the cuts to public health budgets. The two are inextricably linked and cannot be dealt with in silos.

The Minister must go away and look into this matter and the effect it will have on the outcome set out in the TCP. Now that we have a blueprint in front of us, which we are all grateful for, it is time to ensure it is achieved completely—not partially and not just in bits, but completely.

The Minister has been given much to think about during this excellent debate, and I hope that, in his relatively new role, he will be the champion needed to improve smoking cessation and reduce the prevalence of smoking in our society. Now is the time not for simple, warm words, but rather for concrete, defining action that drives forward this agenda.

There are many actions to take, but I know the Minister has a true passion for health improvement and prevention. He cannot allow the power he now has at his fingertips to be squandered when it comes to implementing this plan. I say again that the plan, as good as it is, cannot be seen in isolation from other Government actions and policies. Ensuring that the right funding is in place to fulfil the plan’s vision and ending the disastrous cuts to public health budgets is the only way we can truly see the plan’s vision realised.