Cervical Cancer Smear Tests

Sharon Hodgson Excerpts

Monday 28th January 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Roger. I begin by thanking my hon. Friend the Member for Warrington North (Helen Jones) for introducing this debate on behalf of the Petitions Committee. I, too, pay tribute to Natasha Sale, who started this important petition. As others have said, it is so sad that she did not live to see this debate take place. Her family, I am sure, are very proud of her.

I thank all hon. Members who have spoken in the debate: the hon. Member for Henley (John Howell), and my hon. Friends the Members for Rotherham (Sarah Champion), for Darlington (Jenny Chapman), for City of Chester (Christian Matheson), and for Kingston upon Hull West and Hessle (Emma Hardy), whose speech was excellent and we will not forget any time soon. I thank the hon. Members for Livingston (Hannah Bardell), and for Lanark and Hamilton East (Angela Crawley), who spoke on behalf of the SNP. It has been an excellent debate with very good contributions and lots of sharing. I am a classic oversharer, but I will try to resist the urge. Finally, I thank the 167,000 people who have signed the petition so far.

This is a very timely debate, because Cervical Cancer Prevention Week concluded only yesterday. The age to start screening is a very emotive issue. Every year in the UK, more than 3,000 women are diagnosed with cervical cancer. As we have heard, 15% of those women are under 30. Last year, 12 of those under 30 died from cervical cancer. The number of cervical cancer deaths has fallen in recent years, but it remains the most common cancer in women aged 35 and under. That is why I welcomed preventive measures such as the introduction of the HPV vaccination, which was offered to adolescent girls in secondary school.

My daughter was one of the first to receive the vaccination when she was 13. I was very pleased to give that permission; I would not have hesitated for a second to give it, although as my hon. Friend the Member for Warrington North said, a number of people do not give permission. That is very concerning; genuine concerns will have led them to that decision, but we must do what we can to allay their fears. We heard about the catch-up programme at the time, to ensure that all girls up to the age of 18 were vaccinated.

At that time, I looked extensively into this policy area, following a campaign by Washington constituent, Claire Walker Everett, and her family. Claire led the campaign before her untimely death at the age of 23 in 2008, and her family continued it for some time afterwards. I called for a further catch-up programme to address what I called the “seven-year gap”, so that women between 18 and 25 could be vaccinated until they were eligible for smear tests. I said that the gap would close each year until almost all under-25s had been vaccinated, as is now the case. That was 10 years ago, so that gap has closed. Many of those first vaccinated are approaching 25 and are eligible for a smear test, so we should have a whole generation of young women and girls who mostly have been vaccinated against the HPV virus, to help protect them from cervical cancer.

The vaccination programme has been very successful on the whole, with a high national uptake of around 85%. However, I have previously raised with the Minister the significant regional differences in the uptake of the HPV vaccination, which need to be addressed. The lowest uptake for the two doses is in Stockton-on-Tees, at 48.3%; the highest uptake is in East Renfrewshire, at 95.6%. That is curious, and flies in the face of the screening statistics cited by hon. Members, which show that the north-east reached higher rates than others. Perhaps the differences are in pockets rather than whole regions.

I therefore ask the Minister what steps he is taking to investigate and address the regional inequalities in HPV vaccinations and screening. How do the Government ensure that the HPV vaccinations are taken up by the vast majority of girls? Otherwise, the reassurance of my earlier statement that a whole generation of women and girls approaching 25 have been vaccinated falls short in certain areas, which is extremely concerning. Cervical smear tests are available to women aged 25 to 64, yet cervical screening is at a 21-year low. Last year, it was discovered that more than 40,000 women had missed out on crucial information about cervical screening appointments and test results. Has the Minister made any assessment of the impact that has had on uptake? Can the Minister give assurances that this issue has been solved?

According to Jo’s Cervical Cancer Trust, which I commend for its tireless work and campaigning, one in four women across the UK do not attend cervical screenings. That proportion increases to one in three among those aged 25 to 29, when they are first eligible for screening, and to one in two in some of the most deprived regions in the UK. That decline can be for a host of reasons, such as fear or embarrassment.

I pay tribute to TV shows that show the medical equipment involved in a smear test; the “Victoria Derbyshire” show even showed a smear test live on the show on Friday, in an attempt to address those reasons. There was no wincing or obvious cries of pain, so it will have been reassuring to someone who has not had one, although I am sure some viewers complained that it was not suitable daytime viewing. Aside from doing more of that, will the Minister tell me what steps he is taking to increase take-up? Additionally, what steps is he taking to educate women on the need for cervical smears and what the tests are for? I understand that some women believe that a cervical smear will also detect ovarian cancer—as he knows, that is not the case.

As I mentioned, most women under the age of 25 have received the HPV vaccination, giving them excellent protection from the HPV virus. That means that the reason that once may have existed to lower the screening age no longer does. However, I say again, that reason falls down in low take-up areas. Additionally, I worry that lowering the eligibility age for a cervical smear test to 18 would cause additional problems and worries for young patients, as my hon. Friend the Member for Warrington North detailed so well in her excellent speech. False positives are more likely in younger women, as they often undergo natural and harmless changes in the cervix that a smear test would identify as cervical abnormalities. In most cases, those abnormalities resolve themselves without any need for treatment.

Treating false positives as cancer can damage the neck of the womb, which can cause a woman to give birth prematurely in any future pregnancies. In women under 25, therefore, the risk is deemed to outweigh the benefit. However, as my hon. Friend said, women should be provided with that information, to make judgments for themselves. Wider education should start in school; my hon. Friend the Member for Kingston upon Hull West and Hessle called for that to start as early as possible, to tackle the fear and embarrassment as soon as possible. I also believe that much more research should be done on the age so a decision can be made that is best for all women.

Cervical cancer is very rare in women under 25, with under three cases per 100,000 women. However, every such case is an awful ordeal for the woman and her family, and sometimes it becomes a tragedy, as it did in the case of Natasha Sale. That was also true for Claire Walker Everett from Washington in my constituency, who died at 23 and whose case first brought this issue to my attention, and more recently for Amber Rose Cliff from the neighbouring Sunderland Central constituency, who died in 2017 at the age of 25. If a young woman has abnormal bleeding or symptoms that she is concerned about, she should be taken seriously by her GP and offered a smear test as soon as possible as part of the health investigations into what is causing her symptoms.

I believe that is part of current guidance and best practice, but we have heard clearly that that guidance is not always followed. That was the case in the short life of Amber Rose Cliff. Between the ages of 18 and 21, she went to the doctor around 30 times, complaining of worrying symptoms and asking for a smear test, only to be told 30 times that she was too young and sent away. When she was 21, her mum paid for her to have a smear test privately. The results were devastating. It was cancer, and the cancer had spread. She died just four years later, aged 25. Young women should not be excluded from a valuable screening service just because of their age if they have symptoms, as Amber obviously did. GPs should be aware of cervical cancer symptoms and know that they should refer young patients who present with such symptoms for smear tests as part of wider investigations.

With all I have said in mind, I conclude that the age for cervical smear tests should remain at 25, on the condition that further research and debate is conducted and tests are offered to those under 25 who present with symptoms. The Government must also ensure that preventive measures such as the HPV vaccination are taken up as fully as possible, and that women who are eligible for a cervical smear test attend their appointments when they are invited or as soon as possible thereafter. I know the Minister cannot drag them all there personally, but I look forward to his response.

Appropriate ME Treatment

Sharon Hodgson Excerpts

Thursday 24th January 2019 Commons Chamber

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

I start by thanking the hon. Members for Glasgow North West (Carol Monaghan) and for Cheltenham (Alex Chalk) and the right hon. Member for Loughborough (Nicky Morgan) for securing this important debate. I thank all hon. Members who spoke; it was great that so many did so. Due to time, I shall not list them all.

I thank the charities—MEAction, Action for ME, the ME Association, the M.E. Trust and ME North East—and all the patients who have been in touch with me to share their thoughts, feelings and experiences of living with ME. The ME Association estimates that approximately 250,000 people in Britain are affected by ME; we have heard plenty of moving stories about those individuals today. However, an article published in the British Medical Journal in July 2018 reported that 90% of cases are thought to go undiagnosed, and that people with ME are substantially undercounted, underdiagnosed and undertreated. As we have heard, patients are often passed from pillar to post with dismissals and misdiagnoses, and sometimes left waiting over a year for a diagnosis. I am sure the Minister does not need me to tell him that that does not meet NICE guidelines of diagnosis within four months of the onset of symptoms. The Government should therefore do more, and considering that they are not doing much for patients with ME at the moment, I do not think that that is too much to ask.

The Government do not fund research and clinical care for people with ME at the rate they do for other serious prevalent diseases. As we have heard, the average spent on research for a person living with ME is just £1 a year. According to Action for ME, that represents just 0.02% of all active grants given by the mainstream UK funding agencies. I am therefore concerned that the Government recently confirmed in a written answer that ME research funding is lower now than it was even in 2013-14.

Current treatments of graded exercise therapy and cognitive behaviour therapy have been found to be harmful to patients with ME, and continue the narrative of disbelief and neglect of them, which we have heard about from a number of hon. Members. NICE has already recognised that its guidelines are outdated, and that patients do not receive the full picture on recommended treatments. NICE is updating its clinical guidance on the diagnosis and management of ME, but that is not expected to be published until October 2020. Patients and their families have already waited long enough, so will the Minister work with patients, charities, researchers and NICE to ensure that treatment and care for ME is appropriate?

We have heard today why funding for biomedical research into ME is so desperately needed. According to MEAction, the only year in which the Medical Research Council invested any meaningful sum in biomedical research was 2012, when £1.5 million of funds were ring-fenced. However, no funds have been allocated for biomedical ME research since then.

In the Westminster Hall debate in June last year, I called on the Government to consider funding research, because it is long overdue. Will the Minister commit to doing that today, or will the Government continue to leave it up to the charity sector to do so? Projects such as Invest in ME Research, which has four PhD students researching ME, have been financially supported by patients and their families via crowdfunding in excess of £870,000. That is fantastic, but it should not be left to patients to crowdfund research. More funding for research will enhance healthcare professionals and clinicians’ understanding of ME, which will improve the patient experience and debunk the myths of ME being a primarily psychological condition, as we have heard about today. Clinicians must have access to up-to-date research and information so that they can give patients the best possible care and advice.

In some areas, however, that is not the case, as Jennifer Elliot, the CEO of ME North East, has brought to my attention. Jennifer told me of the diminished services available to patients with ME in the north-east region. There are no services at all for young people with ME in the entire north-east. Adult services in Sunderland are closed to patients altogether, and have been for some months, with no date for them to be reinstated. For 20 years, ME North East has been doing all it can to help and support ME patients but, with a severe lack of funding, it is now at crisis point. I am sure that other regions have similar stories, as we have heard today, so will the Minister please consider the loss of services in his response? Will he ensure that the services are reinstated and supported financially by the Government?

Finally, we must ensure that the stigma of ME is tackled. Funding and research will help, but it cannot be right that, as found last year, more than one in five families caring for a child with ME have been referred for child protection proceedings due to school absences and a lack of understanding by the school, as we have heard. I am pleased that the vast majority of those accusations are dismissed in less than a year, but the added stress and burden to families with children suffering with ME can be overwhelming. We therefore need more funding for research, so that we can understand, care for and treat ME, and break down the stigma.

Diabetes

Sharon Hodgson Excerpts

Wednesday 9th January 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship this morning, Mr Robertson.

I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes) for securing this important debate, especially after the excesses of Christmas—in which I am sure we all indulged, which is relevant to the topic we are discussing—and for his characteristically informative, entertaining and articulate opening speech. I also thank all right hon. and hon. Members who have taken part: my right hon. Friend the Member for Knowsley (Mr Howarth), the hon. Member for South West Bedfordshire (Andrew Selous), who is co-chair of all-party parliamentary group on obesity and does excellent work in this area, and the hon. Members for Rochford and Southend East (James Duddridge) and for Linlithgow and East Falkirk (Martyn Day). They made excellent contributions.

As we have heard—I will repeat these facts because they are worth saying again—there are 4.6 million people living with diabetes. Over the last 20 years, the number of people diagnosed has more than doubled. Every day, around 700 people—one person every two minutes—are diagnosed with diabetes, which is really quite shocking. Diabetes UK estimates that if nothing changes, more than 5 million people will have diabetes in the UK by 2025. That is why this debate is so important, and I am pleased to be here to discuss treatment, remission and prevention.

I start with treatment and care. Once a patient has been diagnosed, it is crucial that they get the right treatment and care for them. Technology can play a role in that, particularly for people with type 1 diabetes. New technologies mean that patients can be treated and monitored, which can help to reduce diabetes-related complications in the long term. However, access to those technologies is subject to a postcode lottery, as are many other things. I have heard of huge variation of availability and use across the country. I was pleased to see the Government commit to making life-changing flash glucose monitors available for patients with type 1 diabetes by April 2019. Will the Minster please also ensure that basic technologies, such as test strips and meters, are available to all patients who clinically need them across the country? We cannot just say that everyone with type 2 diabetes would clinically need them—although I have bought myself one and they are good for monitoring—but if people need them clinically, they should be available, not subject to a postcode lottery.

Such technology can be redundant if patients do not know how to use it, or do not know enough about their condition and how to manage it. That is why educational courses, such as the one that the hon. Member for Rochford and Southend East said he attended after his diagnosis, should be widely available, to give patients the knowledge, skills, support and independence to look after their own health. I was pleased to see that get a mention in the long-term plan earlier this week. Can the Minister please elaborate on when he expects the

“structured education and digital self-management tools”

to be expanded?

It is crucial that patients know about their diabetes and the health risks associated with it. According to Diabetes UK, there are over 160 lower-limb amputations every week in England that are a direct result of diabetes. As someone with type 2 diabetes, I find that really scary. Four out of five of those cases could have been prevented. Local foot care teams help to prevent thousands of amputations each year, but diabetes-related amputation is now at an all-time high. Does the Minister have any strategy to reverse that trend?

Finally on treatment and care, one person in six occupying a hospital bed has diabetes; at some sites it is as many as one in four. The majority of patients with diabetes are admitted for treatment of a different condition, but while in hospital their diabetes should not be in ignored. When diabetes is not adequately cared for in hospitals, harm can result from the in-patient stay. Acute or long-term conditions can develop further, adding further costs to the NHS and complications for the patients.

The long-term plan includes a welcome commitment to introducing diabetes in-patient specialist nursing teams to improve recovery and to reduce lengths of stay and readmission rates. Will the Minister indicate when he expects that to begin? Will he also assure us that those teams will be available in all hospitals across the country?

On remission, as we have heard, my hon. Friend the Member for West Bromwich East (Tom Watson) has been very vocal about his own transformation—it has been huge—and the remission of his diabetes owing to exercise and changes in his diet. He has done a fantastic job, as we have all acknowledged, and I wish him all the best. Diet changes, when I stick to them, have also helped me in my management of my diabetes. When I have totally cut out sugar and reduced all carbs, as the hon. Member for Rochford and Southend East said helped him, that has made a massive difference. While there is currently no evidence that diabetes can be completely cured, even by changes to diet and lifestyle—I am told that once someone is diabetic they always will be—people can take steps to control, reduce or even reverse symptoms of diabetes, and to put their diabetes into remission.

As we heard from the hon. Member for Linlithgow and East Falkirk, research and trials by Professor Roy Taylor of Newcastle University—I am very proud that a north-east university is leading the way on this—have found that a low-calorie diet of 800 calories a day, which is low but manageable, can actually reverse diabetes, which was recently listed by MadeAtUni as one of the UK’s 100 best breakthroughs in health. That is certainly an area that needs to be explored further. However, not everyone can make those changes on their own, and patients must have access to medical support and dietary advice if they wish to try. The NHS has confirmed that it will pilot diabetes remission services in England and Scotland. Some places are already rolling out the service informally. For example, I know that some GPs in Tyneside are piloting this model. Will the Minister please tell us when expects those pilots to begin?

On prevention, 12.3 million people are now at an increased risk of developing type 2 diabetes. Of course, not all of those will go on to develop diabetes, but such a high number of people at risk is deeply concerning. Type 2 diabetes has several risk factors, but as the hon. Member for South West Bedfordshire highlighted, being overweight or obese accounts for as much as 80% to 85% of someone’s overall risk of developing the condition.

Almost two in every three people in the UK are either overweight or obese. I am obviously one of the two at the moment. I strive and hope to be like the hon. Member for Rochford and Southend East, who said he is now the one out of those three. I congratulate him on that. I am back on a diet and cutting out sugar and carbs again and trying my best. However, if it was easy, nobody would be overweight. It is hard, and Christmas is not the best time to try to diet. This is why the nudge theories introduced by Public Health England are very welcome, along with proper traffic light food labelling and the “Eatwell plate”, for example.

However, we have to acknowledge that our society has become increasingly obesogenic and sedentary, and we have to address that as soon as possible, starting with the next generation in particular. In that regard, the Government launched the second childhood obesity plan last year, which I hope will help to tackle this problem if they implement all the policies within it and do not only consult on them. Clear calorie labelling and introducing a 9 pm watershed for adverts for food and drink that are high in fat, salt and sugar are two steps that the Opposition would introduce if in government, to help to reduce the high level of obesity in this country.

However, it is not all about diet, as Baroness Tanni Grey-Thompson is always telling me, but about exercise, too. Inactive children become inactive adults, which increases their risk of long-term conditions. According to ukactive, only 50% of seven-year-olds meet recommended physical activity guidelines. We therefore need to make sure that children have the space and resources to participate in sports, activities and play, which will benefit them in a host of ways, not just their health.

Nor should we forget the over-55s—or anybody, actually. According to ukactive, a total of £80.5 million could be achieved in NHS and healthcare savings on diabetes if one third of inactive over-55s were supported to be active over the next 10 years. The Secretary of State says that prevention is better than cure, and I think that that figure alone shows that it is.

The long-term plan committed

“to fund a doubling of the NHS Diabetes Prevention Programme over the next five years, including a new digital option to widen patient choice and target inequality.”

That must target people from black, Asian and minority ethnic groups, who are six times more likely to develop type 2 diabetes. We must ensure that any prevention programme reaches those communities as a matter of urgency.

To conclude, people with diabetes are sadly at greater risk of serious but largely preventable complications. For example, they are twice as likely to have a heart attack or a stroke. For those of us here who suffer from diabetes, that is a sobering fact. We must ensure that their diabetes is properly managed and cared for, so as to avoid those serious complications. What the Government do next as part of the long-term plan will be beneficial to those with diabetes, and I know that patients, campaigners and all of us here will keep a close eye on developments.

Cancer Workforce and Early Diagnosis

Sharon Hodgson Excerpts

Tuesday 8th January 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Howarth. In case anyone wonders why I am shivering a bit, I have to say it is a bit cold in here.

[Mr George Howarth (in the Chair)]

But it is a very warm atmosphere.

[Mrs Hodgson]

Oh, good—we do try.

I start by congratulating my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate and on his excellent speech. I wonder whether he has a crystal ball and knew something that we did not; I am sure if he does, it will be much in demand, because we have an important vote next week and somebody might want to have a borrow. I thank all the other hon. Members who have spoken this morning—the hon. Members for Westmorland and Lonsdale (Tim Farron), for Eastbourne (Stephen Lloyd), for Strangford (Jim Shannon) and for Central Ayrshire (Dr Whitford), and my hon. Friends the Members for Easington (Grahame Morris), for Bristol West (Thangam Debbonaire), for Scunthorpe (Nic Dakin) and for Enfield, Southgate (Bambos Charalambous)—for their excellent contributions to the debate.

As we know, the long-term plan was launched yesterday. We had waited several months for it to be published, but I am pleased that, after a few setbacks and delays, we now have it and are able to move forward. I was also pleased to see that cancer is a key priority in the plan; I am sure the Minister played a large part in that. Cancer is important, but it is an emotive issue. One in two of us will face a cancer diagnosis in our lifetime, which is a sobering thought, and many of us in this Chamber will know someone who has been affected by cancer. Some of us, I know, have been affected by cancer individually, and no doubt some of us will have lost someone to cancer.

What led me initially to join the all-party parliamentary group on breast cancer as a new MP was losing my mother-in-law to breast cancer over 20 years ago. I notice that in this debate there is a gathering of former co-chairs of the all-party parliamentary group on breast cancer, as well as the current co-chairs of that group and the current chair of the all-party parliamentary group on cancer. Once this subject takes hold and catches our interest, it stays with us for the whole of our parliamentary career—as it should, because it is so important.

It is estimated that by 2035, one person every minute will be diagnosed with cancer. That is why cancer diagnosis, treatment and care and their workforces should play an important role in our NHS now and in the future. The Prime Minister set out in her conference speech last September the Government’s ambition to see three in four cancer patients diagnosed at an early stage within the next decade. Currently, just more than half of the people diagnosed with cancer are diagnosed early in England, so the Government have a long way to go to achieve that welcome ambition.

Early diagnosis improves the likelihood of survival, as we all know. For example, if bowel cancer is diagnosed at an early stage, nine in 10 people will survive, but if it is diagnosed late, at stage 4, only one in 10 will survive. Early diagnosis also increases the likelihood of responding well to treatment. Target Ovarian Cancer, which I am proud to say I am the chair of the all-party parliamentary group for, found that as many as one in every five women in England are too ill to treat by the time they receive their ovarian cancer diagnosis. Awareness and screening programmes are crucial to early diagnosis, but breast screening uptake, for example, is the lowest it has been in 10 years, with stark variations across the country. The percentage of women taking up their screening invitation within six months fell from 71.1% in 2016-17 to 70.5% in 2017-18. Some might say that is only 0.6%, but analysis by Breast Cancer Now has found that upward of 1,200 additional deaths could be prevented per annual cohort of eligible women if we were to increase screening uptake to the current target of 80% for individual breast cancer screening units. With 500,000 people projected to be diagnosed with cancer in 2035, it is clear that we must do more to ensure that cancer is diagnosed early so that it can be treated effectively.

The long-term plan, as I am sure everyone has read and the Minister will be aware, says:

“We will build on work to raise greater awareness of symptoms of cancer, lower the threshold for referral by GPs, accelerate access to diagnosis and treatment and maximise the number of cancers that we identify through screening. This includes the use of personalised and risk stratified screening and beginning to test the family members of cancer patients where they are at increased risk of cancer.”

That is all great, but the Government cannot make those improvements without improving the workforce, and they must not be complacent about the role our NHS workforce have to play in this. As we all know, that workforce do a wonderful job every day, treating, caring for and supporting us and our loved ones, as those who have witnessed it at first hand will attest. Unfortunately, the cancer workforce is at breaking point and already struggles to keep up with increasing demand. There are chronic staff shortages across the NHS, with vacancies for 102,000 staff, including nearly 41,000 nurses. As anyone who has ever worked somewhere with staff shortages will know, the pressure that places on an individual is huge. I cannot imagine what it is like for the NHS staff who work day in, day out under those pressures, when so much depends on their being able to do their job properly.

Cancer Research UK has pointed to chronic shortages in the diagnostic workforce, with more than one in 10 positions unfilled nationally. According to Breast Cancer Now, for every three breast radiologists who retire over the next five years, only two are expected to replace them. I know that others have already stated a lot of these facts, but they are worth stating twice. There is a similar problem with breast cancer clinical nurse specialists; Breast Cancer Care states that they are an ageing part of the workforce, with 45% of breast cancer clinical nurse specialists aged 50 or above. The Royal College of Radiologists has warned of a shortage of cancer doctors, with 5% of clinical oncologist posts vacant during the course of last year, up from a 3% vacancy rate in 2015. The Royal College of Nursing also warns that in England there are nearly 41,000 vacant registered nursing posts, and it predicts a dangerous increase to almost 48,000 by 2023 if the Government fail to take urgent action now.

The Government must take the issue of the cancer workforce incredibly seriously, as nearly every person who has spoken so far in the debate has said. Will the Minister provide a progress report on Health Education England’s cancer workforce plan, which was published just over a year ago? Additionally, will he please provide us with a date for when he expects the second workforce plan to be published? As others have said, “soon” is not good enough. The NHS long-term plan makes it clear that the funding available for additional investment in the workforce, in the form of training, education and continuing professional development through the Health Education England budget, has yet to be set by the Government. Can the Minister assure us that any workforce plan will be properly funded, so that the workforce gap can be filled as a matter of urgency?

The NHS long-term plan says:

“We will complete the £130 million upgrade of radiotherapy machines across England and commission the NHS new state-of-the-art Proton Beam facilities in London and Manchester”,

but staff will need to be trained on both how to use those new facilities and how to read the results. Education and training must be high on the agenda for the second workforce plan, including the reinstatement of the training bursary, removing any financial burdens and barriers so that we can recruit the nurses that we need for the future. It also means offering further training opportunities once qualified, so that staff can keep up to date with technological advances.

Our NHS should be the most attractive employer in the country, but without the financial backing and support from the Government we are failing to recruit and retain our hard-working NHS staff. Of course, as the Secretary of State continues to say, prevention is better than cure, but £96 million has been cut from public health budgets this financial year.

[Mr George Howarth (in the Chair)]

Order. I call the Minister.

Leaving the EU: Tobacco Products and Public Health

Sharon Hodgson Excerpts

Monday 7th January 2019 Commons Chamber

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

It is a pleasure to be here on the first day back to discuss these interesting and colourfully illustrated amendment regulations on tobacco products and nicotine inhaling products, not tucked away in a Committee Room but on the Floor of the House.

As I have said previously on EU exit secondary legislation, I still strongly hope that we leave with a deal and that all these SIs will have been for naught. I understand that, as a matter of contingency planning, it is only right that we discuss these changes as a just-in-case measure. However, I have to say again that if a no-deal scenario was ruled out once and for all, none of this would be necessary, saving vital taxpayers’ money that could have been better spent elsewhere. As I understand it, these no-deal SIs run to around 900, so that be a substantial sum of money. But here we are. The Minister has already set out what these regulations mean, so I will not repeat any of that.

Smoking rates have declined. However, it is estimated that around 6.1 million adults in the UK still smoke. I hope that they were listening to your comments, Madam Deputy Speaker, and that we all show those awful images to as many people—young and old—as possible, because it is never too late to quit. Hospital admissions attributable to smoking increased by 2% in 2016-17 compared with the previous year, and last year we also saw a small increase in the number of women smoking during pregnancy.

Those figures are not surprising when coupled with the fact that £96 million has been cut from the public health budget this financial year alone, adding up to £800 million by 2021. That means cuts to vital public health services, which both the Minister and I are passionate about, including smoking cessation services. The Government must reverse these public health budget cuts if they are serious about reducing smoking rates. It is a shame that today the Secretary of State missed yet another opportunity to do that, in his statement on the NHS 10-year plan. There was no reversal or any new money that I could see for smoking cessation services or public health services. He did, however, maintain that prevention was at the forefront of the Department’s forward view, which was welcome. If that is the case, the high standards for the safety and quality of tobacco and nicotine products must be maintained or even improved if the UK leaves the EU without a deal.

With that in mind, I have a few questions about the regulations. Will they have any impact on the current advice on e-cigarettes? Will the Government be undertaking a review of e-cigarette regulations to ensure that they are fit for purpose and encourage their use by smokers to quit smoking, while also discouraging uptake by young people? More generally, will the amendments allow for regular reviews and updates of the health warnings?

That brings me to the picture warnings on cigarette packets—anyone who wants to see the new ones can find them at the back of the draft regulations. They replace a number of unappealing photographs that we currently use with new photographs, which are under copyright by either the Commonwealth of Australia or Professor Laurence J. Walsh of the University of Queensland. I am sure that this is a short-term fix, but could the Minister please elaborate, and provide some clarity, on what agreement has been reached with the Australian Government, or indeed with Professor Walsh, on using the photographs? In what form was the agreement made, what does it cover, and how and to what extent does it affect the rights of the copyright owners? What payment, if any, will the Australian Government or Professor Walsh be entitled to as a result? What conditions and constraints will there be on UK businesses using these photographs? What about current packaging that uses the old images? I hope that some contingency has been made for those to continue to be sold.

I am under the impression that these photographs are still being evaluated by the Australian Government. If they are found not to be fit for purpose in Australia, will the Minister take that to mean that they are not fit for purpose in the UK either? I know that the Government will be publishing detailed guidance on the picture warnings and the notification process this month, but it may be beneficial to businesses if the Minister could please give a better idea of when they can expect to receive the guidance?

Finally, do the Government have any plans to use UK-sourced or commissioned photographs? Surely we have some comparable images of our own, taken by doctors or researchers, that we could use? If not, are plans in place to acquire some? The legislation also introduces a fee-making power for characterising flavours and emissions on nicotine and tobacco products. Will the Government be using that power immediately, and what impact will it have on businesses?

Unfortunately, smoking is still prevalent in our country, which is why we must ensure that tobacco and nicotine products meet the highest safety and quality standards. If the worst happens and we do leave the EU without a deal, we must ensure that these standards are upheld, so the Opposition will support the regulations today, in the hope that they will not be needed.

Draft Human Fertilisation and Embryology (Amendment) (EU Exit) Regulations 2019 Draft Quality and Safety of Organs Intended for Transplantation (Amendment) (EU Exit) Regulations 2019 Draft Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019

Sharon Hodgson Excerpts

Wednesday 19th December 2018 General Committees

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

It is a pleasure to serve under your chairmanship, Mr Stringer, and to be in this room to discuss these draft regulations.

It concerns me that we have to have contingency plans in place in the event of a no-deal Brexit. I certainly hope that all of us in this room would prefer us to leave with a deal, so that we can have an element of certainty. However, in lieu of any certainty, I understand and acknowledge that the draft regulations are very much needed and are the next option. I am sure that the public will also be concerned. What assurances can the Minister give patients, who will inevitably be concerned about these contingency plans? Will she give assurances that the draft regulations will retain—and in some cases even improve—patient safety?

I understand that the draft regulations will come into effect on 30 March 2019 in the event of a no-deal Brexit. However, these changes must be effectively communicated to the affected agencies in a timely manner. Do the Government have a deadline for doing that? The draft Human Tissue (Quality and Safety for Human Application) regulations include a six-month transition period, with provisions to ensure that imports may continue while licences and agreements are put in place. Can the Minister please elaborate on what those provisions will consist of?

The draft regulations must not affect the safety, quality or supply of organs, tissue or cells. We know how the healthcare system depends on there being a constant supply of those, so it is crucial that there is no interruption in that. Hopefully, the draft regulations will not be needed—but if they are, I hope that all these issues will have been considered by the Government.

Draft Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019

Sharon Hodgson Excerpts

Wednesday 19th December 2018 General Committees

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

It is a pleasure to serve under your chairmanship, Mr Sharma, and to be in Committee on another SI. We were at it this morning and yesterday, if not with this Minister, with his colleague. A few in the room, such as his Parliamentary Private Secretary and our team’s PPS, are seemingly doing both, or all, stints. We were at it yesterday as well. I understand that a few SIs are going on across the Committee Rooms at the moment.

As I said this morning, I would prefer that we did not have to do any SIs because we are leaving with a deal and do not have to worry about no deal. As a matter of contingency planning, however, it is only right to be in Committee to discuss the changes as a just-in-case measure.

Having said that, people will be rightly concerned that we are even having to make contingency plans in the event that we have a no-deal Brexit, so what assurances will the Minister give patients, in particular those with rare diseases who receive important blood and blood components? Will the Minister give assurances that the changes will not affect the safety, quality or supply of blood and blood components in the UK, and that the standards we enjoy now will be maintained? The UK has set the regulatory benchmark for the EU, so it is important that that is not impaired post Brexit.

I understand that regulation 8 means that a UK establishment, rather than an EU establishment, will be responsible for labelling, recording and storing blood from the EU. Will the Minister confirm that the UK has the capacity to label, record and store blood, and which UK establishment will be responsible?

I hope the amendments will not be needed in the end, but I appreciate that the Government have to make them and are keen to get it right. I therefore hope the Minister will consider everything that has been mentioned and will give us assurances.

Draft Human Fertilisation and Emryology Act 2008 (Remedial) Order 2018 Draft Human Fertilisation and Emryology (Parental Orders) Regulations 2018

Sharon Hodgson Excerpts

Tuesday 18th December 2018 General Committees

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

It is indeed a pleasure to serve under your chairmanship, Mr Evans. The Minister and I shared a phone conversation about this issue earlier this year; I believe it was sometime in the summer. I told her then that I would support the Government in this change and I remain committed to that today. I know that the Government have been keen to get this right. It is a shame that it has taken so long for the measure to be brought forward. Sadly, Brexit seems to get in the way of everything at the moment.

In May 2016, as we have heard, the High Court ruled that the inability of a single person to obtain a parental order was incompatible with the European convention on human rights. The Government rightly confirmed in December 2016 that they would lay a remedial order before Parliament, but with the referendum and then a general election and Brexit business in-between, we are now only just getting to debate the revised draft of the remedial order.

I understand that a draft remedial order was tabled in November 2017, but that the Joint Committee on Human Rights said that a blanket ban on a person

“who is in a couple getting a single parental order is clumsy and inflexible, as well as discriminatory”,

and, in relation to the requirement for a single person still married or in a civil partnership to prove that a separation from a partner was permanent, that that would be

“difficult or impossible to prove to the Courts”.

The Government’s revised remedial order has addressed the JCHR’s concerns, and it has advised that there are now no reasons why this order should not be agreed by both Houses of Parliament. However, I would like to place a couple of questions on the record, which I hope the Minister will be able to address when she concludes the debate.

First, when will single people be able to apply for a parental order? As the Minister will be aware, many people have already been waiting years for the legislation to come forward and so will be very eager to start a family of their own. Can she provide an update on what this will mean for surrogacy and adoption legislation? I know that the Law Commission is looking into the matter as part of a three-year review, but I am sure that if the Minister could please update us on it as soon as possible, that would be helpful to families and campaigners.

Has the Department made any assessment of unintended consequences to the way parental orders operate as a result of these measures? Applications for parental orders can be made six weeks after the birth of a child and are made to the Children and Family Court Advisory and Support Service—CAFCASS—for a court fee of £215. Has the Government made any recent assessment of the cost of the court fee and any accessibility issues that it may cause?

The Minister recently said:

“The order will allow a six-month period where an existing sole applicant can retrospectively apply for a parental order for a child born through surrogacy.”—[Official Report, 19 July 2018; Vol. 645, c. 38WS.]

Currently, applications can be made six weeks after birth. Why has a six-month period been chosen for retrospective applications, and has any assessment been made of the impact that that could have on the surrogate mother, parents and child?

As I have said, I support the Government in making these changes, so I am happy to end my remarks there.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 27th November 2018 Commons Chamber

[Steve Brine]

The hon. Gentleman will remember, of course, that £1 billion extra was put into mental health in the Budget last month, but I would absolutely be interested to hear from him. There are very good things going on up and down the country in local authorities with the ring-fenced £16 billion that we have given them. We are very interested to hear about where there are good examples of things going on, and the long-term future discussions around them will take in the spending review, as I have said.

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

The Secretary of State claims that prevention is one of his top three priorities, yet this year alone the Government have slashed public health budgets by £96 million. That includes cuts to smoking cessation services, sexual health services, obesity and addiction services and many more. This affects the most vulnerable in our society, so will the Minister do the right thing today and cut the rhetoric, commit to reversing these damaging cuts to public health, and put funding in the long-term plan?

[Steve Brine]

The hon. Lady—my shadow Minister—knows that I have a great deal of respect for her. She mentioned smoking; smoking rates in England are at their lowest ever levels. We hear spending commitment after spending commitment from the Labour Government; it is like the arsonist turning up at the scene of a fire. I will take very seriously, as I am sure will the Treasury, her bid towards the spending review discussions, but yes, prevention is better than cure and it will be at the heart of the long-term plan.

Ovarian Cancer: Diagnosis and Treatment

Sharon Hodgson Excerpts

Tuesday 30th October 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the hon. Member for North East Derbyshire (Lee Rowley) for securing this very important debate and for his vice- chairmanship of the all-party parliamentary group on ovarian cancer, which I am extremely proud to chair. We work very well together. Indeed, earlier this year he and I shared the chairing responsibilities for two oral evidence sessions as part of the preparation for publication of our report entitled “Diagnosing ovarian cancer sooner: what more can be done?” to mark World Ovarian Cancer Day 2018. I thank him for that also.

The hon. Gentleman made an excellent and extremely moving opening speech. He shared many examples of women’s lived experiences of this awful disease, including his own experience with his mum Linda. I have no doubt she will be proudly watching him lead this debate. We are all MPs—that’s for sure—but we are also real people with lived experiences and families. Sharing those personal experiences can improve the debate, as it has done today. I thank the hon. Members for Strangford (Jim Shannon), for Berwickshire, Roxburgh and Selkirk (John Lamont) and for Lanark and Hamilton East (Angela Crawley) for their contributions to this important debate. We have also had some excellent interventions.

Many of the key statistics around this awful disease have been covered so far in this excellent debate, but if something is worth saying once, it is worth saying twice. Over 7,000 women are diagnosed with ovarian cancer every year in the UK, but sadly survival rates are among the lowest in Europe. Less than half of women diagnosed with ovarian cancer survive five years or more. Tragically, 4,000 women in the UK die each year because of this awful disease. Although progress has been made in diagnosing and treating ovarian cancer, there is still much more to be done and I want to highlight some ways the Government can do that.

I was extremely grateful to the Minister for meeting with me recently to discuss the key recommendations from the APPG’s report, which I just mentioned, and I will raise some of them now. Diagnosis is one of the key ways that women with ovarian cancer are often let down. Many women report experiencing delays in diagnosis. An astonishingly high proportion, 45%, say that it took three months or even longer to receive a diagnosis after first approaching their GP with symptoms. As we have heard, symptom awareness is one of the key things we must address. This is most concerning because we know the significant impact early diagnosis can have on chances of survival. Nine in 10 women who receive an early diagnosis of ovarian cancer can survive for five years or more, compared with less than five in 100 women who are diagnosed at a very late stage.

I want to share a story, as a few hon. Members have. My constituent Gail wrote to me ahead of this debate telling me the experience of her younger sister, who has stage 3 ovarian cancer that has spread to her stomach lining. Although she is currently responding to treatment, it took a long time to get the diagnosis in the first place. At one point, she was being incorrectly treated for rheumatoid arthritis. That changed only when she developed blood clots in her legs, which led the hospital to look for cancer. We can only imagine the added distress that this kind of delay can cause in an already extremely difficult experience.

As a result of her sister’s diagnosis, Gail underwent genetic testing and discovered that she had the BRCA2 gene, which, as we know, gives her a high predisposition to ovarian and breast cancer. My constituent underwent elective surgery at the start of the year to remove her ovaries and fallopian tubes, and is awaiting the next step with regard to the breast cancer risk. This case shows how important it is that patients are diagnosed as soon as possible, not only for themselves, but for their family members who may have to undergo further testing.

On early diagnosis, will the Minister support a review of the referral pathway for ovarian cancer, particularly in relation to the introduction of the shortened pathway that we have seen in Scotland, so that, as the hon. Member for North East Derbyshire also requested, the CA125 blood tests and ultrasound tests can be done at the same time, rather than sequentially, as they are now? What steps has the Department taken to ensure that NICE guidelines, which say that women should be offered BRCA testing at diagnosis, are adhered to? Ovarian Cancer Action found that 30% of women are not being offered this testing. I know that the new multidisciplinary diagnostic centres will also help with early diagnosis, but they are in the pilot stage and limited to 10 sites. Will the Minister confirm whether there are plans for more centres, so that everyone can have access to those services regardless of where they live?

As we know, the four key symptoms of ovarian cancer are a bloated tummy, needing to urinate more often or urgently, experiencing tummy pain and always feeling full. Anyone newly experiencing those symptoms 12 times a month or more is advised to see their GP. However, awareness of these symptoms is worryingly low. According to Target Ovarian Cancer, just 20% of women can name bloating as a symptom and only 3% can name feeling full or loss of appetite. Awareness campaigns run by Public Health England have been shown to be highly effective. The one currently running focuses on blood in urine. Considering that we know how important it is that those with ovarian cancer are diagnosed quickly, it would be helpful to know whether Public Health England has any plans to run a Be Clear on Cancer campaign that focuses on either ovarian cancer or a cluster of symptoms for a range of cancers, including ovarian.

I recently attended Ovarian Cancer Action’s research grant award ceremony, where I heard about some of the incredible work being funded across the UK. The innovation and determination of some of the projects is truly astonishing. One project—it is hard to describe, but I will give it a go anyway—had a huge number of examples of DNA that needed going through on an individual basis and labelling. Due to the sheer quantity of data that needed sifting, those in charge of the programme invented a Tinder-style app—I know it sounds unusual—that enabled people to quickly categorise the different examples of DNA by swiping left or right. That information was then fed back into the research team’s data, to build up a comprehensive body of data.

Another project that received funding was that of Dr Jonathan Krell and Dr James Flanagan of the Ovarian Cancer Action Research Centre. They are investigating how changes to our genes can play a big part in the risk of developing cancer, including assessing how feasible it would be to implement a new genetic testing model that identifies and supports families at risk of ovarian cancer because of an inherited BRCA1 or BRCA2 gene mutation. With that in mind, does the Minister’s Department have any plans to increase Government funding into medical research for the early detection, diagnosis and prevention of ovarian cancer?

Finally, I want to cover the issue of surgery. As the Minister knows, surgery for ovarian cancer is widely considered one of the biggest factors in survival rates. Surgery for ovarian cancer is extremely difficult. Someone I know well who had the surgery once described it to me as being like trying to remove a bunch of grapes, and if any of the grapes was punctured or broke that would cause huge internal damage by spreading the cancer. Although there are a number of surgical centres of excellence across the UK, there are many women who do not have access to them and are being operated on by general surgeons—no generalist will ever be as good as a specialist. Through no fault of their own, those women will have a lower chance of survival than those who receive the specialist surgery. What assurances can the Minister give that steps are being taken to ensure that all women with ovarian cancer have access to a specialist surgeon and that the regional variation can be brought to an end?

Before I conclude I want to pay tribute to some of the incredible organisations and campaigners that I have had the pleasure of working with on this issue over the years. They work tirelessly not only to combat the disease, but to provide support and comfort to those who have it. They include Ovarian Cancer Action, the Eve Appeal and Target Ovarian Cancer, which also does much to support the work of the APPG on ovarian cancer in its role as the secretariat to the group. I look forward to hearing from the Minister about the ways in which the Government can support the work of those great charities and campaigners, and support the thousands of women across the country who sadly suffer from this disease.