Breast Cancer

Sharon Hodgson Excerpts

Thursday 18th October 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank my hon. Friend the Member for Crewe and Nantwich (Laura Smith) for leading this timely debate during Breast Cancer Awareness Month and for her excellent speech. It is timely because it is on the same day as Baroness Jowell’s moving memorial service, which I attended prior to this debate. I will say more about why that is relevant later.

I also thank other hon. Members for their excellent contributions—the hon. Members for Bexhill and Battle (Huw Merriman), for Strangford (Jim Shannon) and for Central Ayrshire (Dr Whitford), and my hon. Friend the Member for Lincoln (Karen Lee). I also thank the amazing campaigners, ambassadors and charities, especially Breast Cancer Now and Breast Cancer Care, for their unswerving support to us as politicians campaigning on the issue, but more importantly to the women, men and families who are living with breast cancer, before, during and after treatment.

As we have heard so movingly today, so many of us, especially those here today, have had our lives touched by breast cancer. I lost my mother-in-law to breast cancer 21 years ago—I have spoken about this before—and that is what inspired me to join the all-party parliamentary group on breast cancer when I became an MP. As the hon. Member for Bexhill and Battle so astutely spotted, I served as co-chair of the group, with the Minister and the hon. Member for Central Ayrshire, and I still serve as the vice-chair. That shows how close breast cancer is to the heart of the health spokespersons of each party and how important it is to work in a cross-party, collaborative way on such an important issue.

More women are surviving breast cancer than ever before. Around 95% of women will survive for one year and more than 80% survive for five years or more. However, the UK still lags behind countries such as Sweden, Portugal, Malta, Germany and France. It is clear that more must be done. Many different issues have been mentioned, but I will specifically talk about breast screening, the workforce and prevention, which others have touched on.

We all know how important early diagnosis is to improving the chances of survival. Breast cancer screening has a huge part to play in this, yet uptake is the lowest it has been in ten years, with stark variations across the country. According to Breast Cancer Now, increasing breast screening uptake from the current decade low of 71.1% to the 80% standard set for breast screening units could prevent over 1,200 breast cancer deaths per annual cohort of eligible women. Will the Government be taking steps to increase breast cancer screening, so that over 1,200 breast cancers deaths can be prevented each year?

The Prime Minister’s commitment as part of the NHS long-term plan to see three out of four cancers detected at an early stage by 2028 included a plan to make screening programmes more accessible and easier to use. Can the Minister elaborate on those plans? Will they include outreach services to groups who are less likely to attend screenings, such as those from certain demographic groups or those with learning disabilities?

Earlier this year it was announced that there had been a serious breast screening invitation error, which meant that over 10 years more than 174,000 women did not receive an invitation to their final breast screening appointment. A review into this error is expected to be published next month. Can the Minister provide an update on that review and is it expected to report on time?

Every year over 55,000 people in the UK are diagnosed with breast cancer, but the failure to address those increasing numbers means that, according to Breast Cancer Now, the number of breast cancer deaths is set to rise within four years. That is why pressure on the workforce needs to be addressed as a matter of urgency. Demand on the breast imaging and diagnostic workforce is set to increase over the next 10 years. We already have a workforce crisis with growing demand, but the problem is only going to get worse if it is left unaddressed. For every three breast radiologists who retire over the next five years, only two are expected to replace them. What plans do the Government have to deal with the growing pressure on an overstretched workforce?

Leaving the EU could also have an impact on our NHS workforce: 5.6% of the NHS workforce in England are from the EU. Changes to immigration rules may exacerbate existing workforce problems for breast cancer patients, particularly among the nursing workforce. Can the Minister provide any clear guarantees to EU citizens working in our NHS? What steps is his Department taking to ensure that the UK continues to attract nurses from the EU?

The current cancer strategy for England includes a recommendation that all patients diagnosed with cancer are supported by a clinical nurse specialist, but this support is not widely available. We heard from my hon. Friend the Member for Lincoln how devastating that is and what it means in reality, when she talked about her experience with her daughter. That support is not available to the majority of the 35,000 people in the UK living with secondary breast cancer. Nearly 72% of hospital organisations in England, Scotland and Wales do not have a dedicated secondary breast cancer clinical nurse specialist. I share Breast Cancer Care’s belief that incurable should not mean unsupported. Does the Minister share that belief and what steps will he take to close the stark disparities and support between primary and secondary breast cancer patients?

[Dr Whitford]

The hon. Lady has recognised the comment I made earlier, that our patients all have the support of a cancer nurse specialist, but they do not have a title of secondary nurse specialist. That is something that requires looking into in more detail, so that we can identify places where there really is no support versus places where support is linear, and the decision has been made to follow patients through their whole journey rather than make a decision on a title.

[Mrs Hodgson]

That is an important point and the model that is used in Scotland should perhaps be looked at. I took on board the hon. Lady’s point, when she said that patients who are assigned a secondary breast cancer nurse know what that might mean, whereas if it were someone who had been with the patient on their whole journey, that would be a different experience.

[Dr Whitford]

It varies in Scotland. We are a huge and rural country, so we will have some areas where there is a cancer nurse specialist and, for example, islands where there is someone who has the training to act in that role. In Glasgow and Edinburgh there may well be nurses who are different. It was a decision that we took as a team, as we felt it would be hard on the patients to suddenly move to someone new. It is also hard to sustain the nurse, if they are only ever involved in that part of the journey and do not have other days when they see patients get discharged, be well or be diagnosed.

[Mrs Hodgson]

The challenge to the Minister is whether improvements to the breast cancer workforce will include recruiting and training additional secondary breast cancer nurses, clinical nurse specialists—whatever we may decide to call them—so that patients have the vital support they need and no one has to witness their loved ones suffering in agony, with only over-the-counter painkillers to ease the pain, as my hon. Friend the Member for Lincoln so bravely testified to earlier.

[Karen Lee]

Does my hon. Friend agree that the withdrawal of nursing bursaries cannot fail to have impacted on the numbers of nurses training? There are figures out today—I have been on the radio this morning. I think there has been more than a 30% drop in the number of people training to be nurses since the nursing bursary was withdrawn. That cannot fail to have had an impact. It impacts on radiographers as well, because they train for three years, then for another year after that to do mammograms. Does she agree that those bursaries absolutely must be reinstated?

[Mrs Hodgson]

Yes, I agree. Obviously, that is why it is in our manifesto that we would reinstate those nursing bursaries. I would urge the Government to look at this closely, especially in light of Brexit, and what might happen post Brexit, with regard to the EU workforce, as I already mentioned.

Finally, I will move on to prevention. It is a challenge to us all to live healthier lives. I do not stand here saying I am doing a very good job, but we know that regularly drinking alcohol, as the hon. Member for Central Ayrshire mentioned earlier, and being overweight or obese, can increase the risk of developing breast cancer—and most cancers—as can smoking and lack of exercise. Regular physical exercise and reducing all the above can reduce the risk. Researchers estimated that 23% of breast cancers are preventable through lifestyle changes. That means there were approximately 10,600 preventable cases in 2016. Turning that into money, approximately £102 million in treatment costs could have been saved in 2016 if all those cases had been prevented. I know that may not be completely achievable, but since 2015, public health budgets have been cut by 3.9% a year until 2020-21. Has the Minister made any assessment of the effect that cuts to public health budgets have had on the incidence of breast cancer, and will he commit, as much as he can, to an increase in public health funding to help to prevent more cases of breast cancer? I know that might be above his pay grade; he is not the Chancellor—yet.

In closing, I will touch on secondary breast cancer. More than half of women are given no information about the signs and symptoms of breast cancer returning. Will the Minister look into ensuring that all patients are advised at the end of their primary breast cancer treatment about lifestyle and symptoms, so that where possible all cases of incurable secondary breast cancer can be prevented? I know that, like me, the Minister is incredibly passionate about breast cancer and that he will take much if not all of what he has heard today back to his Department to work on, so that he can achieve the best future for breast cancer.

On the day of Dame Tessa Jowell’s memorial, I will end by quoting from her magnificent last speech in the House of Lords in January this year, when she said:

“In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”

She said that she hoped the debate would give hope to other cancer patients,

“so that we can live well together with cancer—not just dying of it”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]

Perhaps her most precious legacy will be not only Sure Start and the Olympics, as wonderful as they are, but a better future for everyone with any form of cancer.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Thank you for chairing our session today, Mr McCabe. I add my congratulations to the hon. Member for Lincoln (Karen Lee) on securing the debate and the hon. Member for Crewe and Nantwich (Laura Smith) on leading us off today. Breast cancer sadly affects so many of us so personally. It is always a privilege to respond to any debate in this House, especially on cancer and more especially on breast cancer, and this has been a constructive, small and perfectly formed debate.

It is always a pleasure to follow my shadow Minister and friend, the hon. Member for Washington and Sunderland West (Mrs Hodgson); I think this is the first time that a debate has been led by all three chairs of the same all-party parliamentary group, speaking for their respective parties. It was important to us when we chaired the group that we had the three main parties in the chair. The third chair was then held by the Liberal Democrats—remember them?—[Laughter.] Stop it. When the hon. Member for Central Ayrshire (Dr Whitford) joined the House, it was a real pleasure that she came on board and took that seat.

I will start by saying, “Happy BCAM!” There is much to celebrate, as hon. Members have said, and it is Breast Cancer Awareness Month, or BCAM for short. I pay tribute to all the people who are here, the survivors—survivorship is very important—and to all the people who have gone. Macmillan Cancer Support ran a heartfelt campaign earlier this year on the idea that “A mum with cancer is still a mum”, which was one of the best pieces of advertising I have seen in the health space for a long time. The reason I say, “Happy BCAM!” is that the people who have gone were still mums, daughters and sisters, even while they were going through their challenges. That is very important. Even children who lose their battle with cancer after being on this earth for a matter of days leave an indelible mark, because they were here for a few days. It is important to me that we always remember that, and I always do.

The title of today’s debate on the Order Paper is “Future of breast cancer”. The hon. Member for Washington and Sunderland West said to me once in one of our group meetings, “You will be cancer Minister one day.” If she could predict something else great for me, that would be excellent.

[Mrs Hodgson]

Chancellor.

[Steve Brine]

Oh yes; the hon. Lady has already said Chancellor today. I am not sure about that one.

As the cancer Minister, I want a future where there is no breast cancer. The hon. Member for Strangford (Jim Shannon) mentioned that, and I think all hon. Members who have contributed this afternoon would like to see a future where there was no breast cancer. One day, perhaps—but the statistics show that we are making good progress. That is why I said that there are things to celebrate. We are ensuring that more people than ever survive breast cancer. As has been said, 10-year survival rates have almost doubled, from around 40% to nearly 80%, in the last 40 years.

I hope I do not need to say it, but cancer is a huge priority—the priority—for me. The Prime Minister chose to make it a central point of her party conference speech this month, and there was a reason for that; it is a huge priority for her and for her Government. Survival rates have never been higher, and they have been increasing year on year. Of course the Prime Minister celebrates that, but it is also why she announced a very ambitious package of measures for cancer care and treatment, showing that cancer will be absolutely central to the long-term plan for the NHS, which she has challenged NHS England to write before the end of this year and of which I will say more later. We are committed to investing an extra £20 billion a year in our NHS. The investment will build on the success we have already achieved through the implementation of the cancer strategy for England. I pay tribute to Harpal Kumar and those at Cancer Research UK who put that strategy together. We will build on that legacy and take it forward into the long-term plan.

In opening the debate, the hon. Member for Crewe and Nantwich raised a number of good points. She talked about secondary breast cancer data collection—a number of people did so, but she raised it first. She is right that the robust and timely collection and sharing of data is vital for improvements in breast cancer services. If we do not measure it, we do not know, and if we do not know, we cannot act. The National Cancer Regulation and Analysis Service, or NCRAS, collects data on all cancers diagnosed in England, with the data collection specified by the cancer outcomes and services dataset. That data collection of secondary breast cancers was mandated as part of the COSD for diagnoses from April 2013 onwards.

I remember, with my shadow Minister, taking a delegation to see Prime Minister David Cameron in No. 10 to talk about that exact issue just before Christmas; I remember our photo by the tree. It is good that that happened, but it is evident, comparing the collected data with sources in academic literature, that a large proportion of cases are still not being reported in the COSD. That is of great frustration to me. NCRAS continues to work with NHS trusts to improve the completion of the data, and we have redesigned aspects of the COSD to allow more relevant information on occurrence to be captured, but I do not for one minute shirk the fact that there is more to do in this area, and I assure the House and colleagues that I will constantly redouble my efforts in that regard.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

Yes, he will. I am pleased to say that prevention is one of the Secretary of State’s three key priorities. The HPV vaccine is a key prevention measure, while one of the drivers behind the child obesity plan was Cancer Research UK’s very clear advice that being overweight was one of the big risk factors, alongside diabetes, in cancer. Yes, prevention is always better than cure.

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

I welcome the Government’s acceptance of the JCVI’s recommendation to extend the vaccination programme to adolescent boys, but the Minister will know that there are huge regional differences in the take-up of the vaccination among girls. What steps will he take to tackle these regional differences before and during the roll-out to boys?

[Steve Brine]

The shadow Minister is absolutely right to raise this issue, which she also raised with me in the Westminster Hall debate on the same subject introduced by my hon. Friend the Member for North Thanet (Sir Roger Gale), who has done a lot in this area. I have already spoken to Public Health England about this in respect of the girls’ programme, and I will be speaking to it again now that we have announced the boys’ programme, because the equality of doing the dual programme must be matched by the equality of its taking place in her constituency as much as in mine in Hampshire.

Tobacco Control Plan

Sharon Hodgson Excerpts

Thursday 19th July 2018 Commons Chamber

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

It is a pleasure to be here to speak about the tobacco control plan, which celebrated its first anniversary only yesterday, as the Minister said. We are here to discuss the progress of the plan so far in reaching the Government’s goal of a smoke-free generation by 2022. I start by thanking the Government for allowing time for this debate to take place after all the drama and commotion of this week. As the Minister said, my first outing as shadow Minister for public health was in a debate on this issue, and thanks to him, we have the new, updated tobacco control plan that we are debating today. I know that it holds a very special place in both our hearts and, like him, I look forward to the debate.

The Opposition welcomed the plan and its ambitious goals, but we remain concerned about how they will be achieved by 2022. It is true that smoking is now thankfully at an all-time low, but the Government must not be complacent—I know that the Minister is not—and must not quit when it comes to measures that reduce smoking rates.

There are still 7.3 million adult smokers in the UK but, shockingly, smoking is an addiction of childhood, with the vast majority of smokers starting to smoke before the age of 18. Between 2014 and 2016, more than 127,000 children aged between just 11 and 15 started to smoke in the UK. According to a recent study by the Society for Research on Nicotine & Tobacco, this amounts to 350 young people starting smoking each day. That is equivalent to 17 classrooms of secondary school children starting to smoke every day. The Government therefore have a huge challenge on their hands—as we all do in Parliament—to tackle smoking in childhood and to reduce the rate of children smoking to 3% or less.

Between 2013 and 2016, the rate of decline in smoking among young people slowed down and the proportion of 15-year-old regular smokers had fallen from 8% to 7% but, at this rate, we will fail to achieve the ambition for England of 3% by 2022. The Minister mentioned in his opening remarks that we really will need to accelerate our progress when it comes to the number of children taking up smoking. Tackling this issue will be the first step to achieving a generation that is not only smoke-free, but healthier.

Smoking remains the leading cause of preventable premature death, such as from cancer or lung disease, and accounts for around 100,000 deaths each year in the UK. Each of those deaths could have been prevented. In 2015-16, there were approximately 474,000 smoking-related hospital admissions, with smokers also seeing their GPs 35% more often than non-smokers. In 2017, 22% of hospital admissions for respiratory problems were directly attributed to smoking. In 2015-16, smoking-related respiratory diseases cost NHS England £167.4 million in adult secondary care costs. I am sure that the Minister agrees with me that an ounce of prevention is better than a pound of cure.

The National Institute for Health and Care Excellence estimates that every £1 invested in smoking cessation generates £2.37 in benefits. However, according to the King’s Fund, spending on smoking cessation services in 2017-18 was reduced by almost £16 million compared with figures for 2013-14. Furthermore, the Health Foundation has found that next year just £95 million will be spent on smoking and tobacco control services, which is 45% less than in 2014-15. Has the Minister made any assessment of the impact that those cuts will have on local smoking cessation services?

A study conducted by Action on Smoking and Health—ASH—and Cancer Research UK found that in 2017 budgets for stop smoking services were reduced in half of the local authorities in England, following reductions in 59% of authorities in 2016 and 39% in 2015. It is a wonder that there are any smoking cessation services left at all. What that means on the ground is that smokers who want to quit do not have access to the services that they need, and smokers who may need an extra push to seek help to quit are not getting that push.

Given that local smoking cessation services are on their knees, how does the Minister’s Department expect to reach the goal of reducing smoking rates to 12% by 2022? The Government’s own plan acknowledges that

“local stop smoking services continue to offer smokers the best chance of quitting”,

but cuts in local authorities’ funding have led to unacceptable variations in the quality and quantity of services available to the public. In my region of the north-east, the current smoking rate is 16.2%, which is down from 17.2% in 2016. That represents the biggest fall in smoking in England. It means that smoking rates in the north-east have fallen by more than 44% since 2005, when 29% of adults in the region smoked, and that there are about a quarter of a million fewer smokers.

It has to be said that that decline in smoking rates is due to the excellent programme Fresh north-east. I know that the Minister has commended the programme before, and no doubt he will take the opportunity to do so again. Its vision is to make smoking history and to reduce smoking prevalence in the north-east to 5% by 2025.

[Steve Brine]

I am happy to place on record my thanks for the work of Fresh north-east, whose representatives I have met. It is a good example of what I was talking about—local systems working together. It is not just about what local authorities commission and the state provides. Fresh north-east is a coalition consisting of the public sector and the third sector.

[Mrs Hodgson]

That is important, especially when, as the Minister has acknowledged, we are in such straitened times when it comes to local authority budgets. I am sure that Fresh north-east will be very grateful for what he has said.

Sadly, other areas are not as lucky. They do not have a Fresh north-east; if only they did. Stop smoking services are roughly 300% more effective than quitting by going cold turkey, but in some places the specialist services are being decommissioned altogether. For example, in Blackpool, smoking prevalence is 22.5%, while the average for England is 15.5%, yet Blackpool Council recently decommissioned its specialist smoking cessation service, citing a number of factors including public sector budget cuts.

That example leads me to my next point. Between 2012 and 2014, the healthy life expectancy for newborn baby boys in England was the lowest in Blackpool at 55 years. Again, the shortest life expectancy among men was in Blackpool too, at 74.7 years. Interestingly, in 2014, Blackpool had the highest smoking prevalence at 26.9%. Wokingham had the lowest smoking prevalence at 9.8%, but the highest healthy life expectancy of 70.5 years. That is a 15.5 year difference between healthy life expectancies, and while there will be several factors in play in these figures, it is clear that smoking is one of the largest causes of health inequalities in England.

Some 26% of routine and manual workers now smoke, compared with 10% of those in managerial and professional jobs. This has slightly increased rather than decreased the inequality from 2016. Some 28% of adults with no formal qualifications are current smokers compared with only 8% of those with a degree. It is these people—manual workers or those from low socioeconomic backgrounds—who suffer the most when the Government cut spending to public health services. I therefore ask the Minister what steps his Department is taking to ensure that these people are reached by local smoking cessation services. What assessment has the Minister made of the impact that smoking rates have on widening health inequalities, and how does he intend to address them?

Finally, I move on to smoking in pregnancy. The Government’s ambition to reduce smoking in pregnancy to 6% or less by 2022 is laudable. In 2015-16 the rate was 10.6%. However, new data published recently showed that the rate of smoking during pregnancy in 2017-18 had increased slightly, to 10.8%. It is therefore deeply concerning that the Smoking in Pregnancy Challenge Group, which I recently met, has warned that this ambition is unlikely to be met unless urgent action is taken.

In 2010, 19,000 babies were born with a low birth weight because their mothers had smoked during pregnancy. Up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy. In addition, many other children will be three times more likely to take up smoking in later life because they live in smoking households. If we are going to have a smoke-free generation in the future, the Government must take urgent action to ensure that rates of smoking in pregnancy fall. We must not forget that it will be those very babies who will become the smoke-free generation that we all hope to see.

The current target is to reduce smoking in pregnancy to 6% or less by 2022. If that is achieved, it could mean around 30,000 fewer women smoking during pregnancy, leading to between 45 and 73 fewer stillborn babies, 11 to 25 fewer neonatal deaths, seven to 11 fewer sudden infant deaths, 482 to 796 fewer pre-term babies, and 1,455 to 2,407 fewer babies born at a low birth weight. That is something to aim for, but it will only happen if the Government take urgent steps to reduce the number of women smoking during pregnancy.

[Bob Blackman]

On behalf of the all-party group on smoking and health, I thank the hon. Lady for speaking at the launch of our recent report. Does she agree that we must encourage not only pregnant women to give up, but their partners, too, so that pregnant women no longer have to face the challenge of not only being deprived of smoking, but of seeing their partner smoke in front of them? This should be a partnership for both parties.

[Mrs Hodgson]

That is a very pertinent point. We all know the damage of passive smoking. It is all well and good if the mother gives up smoking—that will definitely help her and the baby during pregnancy—but if smoking is still going on in the household, the children will still be growing up in an environment of passive smoking. I thank the hon. Gentleman for making that important point and for his excellent work as chair of the all-party group.

I welcomed what the Minister said about tackling smoking in pregnancy, but will he also tell us how he will target work to encourage younger women and women from more disadvantaged backgrounds to give up smoking during pregnancy? Teenage mothers are nearly four times as likely to smoke before or during pregnancy than those aged 35 and over. Young mothers are less likely to quit before or during pregnancy, and only 38% of mothers under the age of 20 did so, compared with 58% of mothers aged 35 or above. It is clear that the Government need to tackle smoking in pregnancy, and smoking in childhood, as a matter of urgency to achieve their ambition of a smoke-free generation.

The Minister and his Department have a huge challenge on their hands if they are to meet the ambitious targets set out in the tobacco control plan. I still welcome the plan as the right thing to do, as I am sure the Minister does. Anything that is worth doing is going to be hard. We have four years to go before the target date, and the Minister must now look at how the Government can properly fund smoking cessation services to drive down smoking rates and support those who need extra help to stop smoking. I look forward to the remainder of the debate and the Minister’s closing remarks.

--- Later in debate ---

[Mrs Hodgson]

With the leave of the House, I would like to start my closing remarks by thanking the hon. Member for Harrow East (Bob Blackman) and my hon. Friend the Member for Stockton North (Alex Cunningham), the chair and vice-chair of the very influential and active all-party parliamentary group on smoking and health, for their excellent speeches today and their leadership on this issue. I also thank my right hon. Friend the Member for Rother Valley (Sir Kevin Barron). As we know, he has campaigned in this House for decades on this issue. I thank the hon. Member for Linlithgow and East Falkirk (Martyn Day), who speaks for the Scottish National party, and, last but by no means least, the hon. Member for Strangford (Jim Shannon). It has been an excellent debate.

I will begin by touching on e-cigarettes, which I mentioned in my opening remarks and several hon. Members mentioned in the debate. For the first time, e-cigarettes were mentioned in the updated tobacco control plan, with the aim of maximising the availability of safer alternatives to smoking. There has been a significant increase in e-cigarette usage since the publication of the previous 2011 strategy. There were 700,000 e-cigarette users in 2012. That figure rose to 2.8 million by 2016. In 2016, Office for National Statistics data found that 470,000 people were using e-cigarettes as an aid to stop smoking, while an estimated 2 million had used the products and had stopped smoking completely. I am therefore pleased that Public Health England’s Stoptober campaign now includes e-cigarettes as a smoking cessation aid and that e-cigarettes have been found to be about 95% less harmful than smoking. We should encourage people to use smoking cessation aids, such as e-cigarettes, to help them to stop smoking, while keeping a watchful eye on any negative health outcomes, if there are any.

Earlier this year, I joined the Minister, Action on Smoking and Health, Fresh North East and a host of NHS professionals to launch the NHS Smokefree Pledge. During my speech at the launch, I said that smoking cessation should become a central theme of healthcare staff’s engagement with patients, making every contact count to help people to quit smoking. Has the Minister made any assessment of the success of this pledge so far and will the Government make any further assessment of how many people have quit smoking because of the NHS Smokefree Pledge?

While the proportion of adults who have never smoked cigarettes has increased over the past 30 years, from 25% of men and 49% of women in 1974 to 56% and 63% respectively in 2016, we must ensure that that steady increase continues. However, the deaths attributable to smoking continue. Of the 115,000 lung disease deaths each year, up to 58,500 are attributable to smoking. This includes 86% of all lung cancer deaths and 77% of all chronic obstructive pulmonary disease deaths. The UK currently has one of the highest premature mortality rates from lung diseases in Europe. Smokers are almost twice as likely to have a heart attack compared with people who have never smoked and about half of all regular smokers will eventually be killed by their habit. This is unacceptable.

The Government have a duty to ensure that their citizens are healthy, which means properly funded public health services and implementing policies that encourage healthier lifestyles. Will the Minister tell the House if further funding will be granted to local authorities to deliver public health services such as smoking cessation? I truly believe that the ambitions in the tobacco control plan cannot be achieved without adequate funding. I know that like me, he is truly passionate about reducing smoking rates and rightly passionate about achieving a smoke-free generation, so I look forward to his response.

Universal Health Coverage

Sharon Hodgson Excerpts

Thursday 5th July 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe, on this historic day—the 70th anniversary of the founding of the NHS. I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate and for his passionate speech. I also thank my hon. Friend the Member for Hampstead and Kilburn (Tulip Siddiq) and the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) for their contributions. Finally, I thank the Backbench Business Committee for granting time for this debate, especially on the NHS’s 70th birthday.

It is an honour to be here to speak about our NHS and the example it has set for the rest of the world. When introducing the National Health Service Bill to the House of Commons, Bevan said:

“I believe it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering…It will be a great contribution towards the wellbeing of the common people of Great Britain.”—[Official Report, 30 April 1946; Vol. 422, c. 63.]

Seventy years on, those words still ring true in the UK. That is why the Labour party will always defend our NHS from Government funding cuts and from ever-increasing marketisation, which opens the door to unwanted privatisation. We remain committed to defending our NHS so that it continues to be the fairest and best healthcare system in the entire world. While we celebrate today, however, it is easy to forget that across the world, as we heard from the hon. Member for Strangford, some of the poorest and most vulnerable people are being denied the basic right to health services that we enjoy and indeed take for granted.

In December 2017 the World Health Organisation reported that at least half of the world’s population did not have access to essential health services. It also found that 800 million people spent at least 10% of their household budget on health expenses for themselves, a sick child or other family member, and that for almost 100 million people, the expenses associated with healthcare meant that they were forced to live in poverty.

That widespread lack of access to healthcare contributes to the global epidemic of vaccine-preventable diseases, widespread malnutrition and other health-related problems. Following on from the hon. Gentleman, I shall add some examples to the debate. Globally, 2.6 million children died in the first month of life in 2016, largely due to lack of quality care at birth or skilled care and treatment after birth. More than 20% of births throughout the world still take place without the presence of a skilled birth attendant, and in sub-Saharan Africa that figure rises to more than 40%.

Pneumonia is now the biggest infectious killer of children, claiming nearly 1 million lives each year, or two children every minute. Pneumonia is preventable and treatable; that so many children are dying because of it is shameful. Globally, only 4% of HIV-positive people who inject drugs have access to HIV treatment, and that also increases the risk of HIV transmission among those who use drugs. Behind such awful statistics are tragic human stories of unnecessary loss and suffering. When we invest in health, we invest in people, no matter where they are in the world.

Universal health coverage means that everyone can receive the healthcare services that they need without the worry of suffering financial hardship. It can therefore protect countries from epidemics, reduce poverty and the risk of hunger, create jobs—as we know, the NHS is the biggest employer in the country—drive economic growth and enhance gender equality. Given the world-class reputation of our NHS, the UK Government have a huge part to play in encouraging other countries to establish universal health coverage, and we should be proud that we have such a prestigious role in leading the way on health.

I am pleased that the Government are committed to delivering the UN’s sustainable development goals, which include universal health coverage. Indeed, we should all be committed to ensuring that people live healthy lives, no matter where they live. Will the Minister tell us whether his Department has worked with other Governments from around the world to promote universal healthcare coverage? Which countries has he worked with on that?

Public Health England has developed a global health strategy to look into building public health capacity, particularly in low and middle-income countries, as well as sharing excellence by working in partnership and building on the UK’s strengths. Does the Department of Health have any plans to develop a global health strategy with a specific focus on universal healthcare coverage? Does the Department have regular conversations with Public Health England and colleagues in the Department for International Development to discuss universal healthcare coverage and how to promote it around the world?

Seventy years ago everyone in the UK was granted access to free healthcare, regardless of how much they earned or where they lived. Sadly, millions around the world are still missing out on access to such a basic human right, and people are dying because of it. It should be the ambition of us all on this special day to ensure that that right is enjoyed by everyone around the world. I support the Government on any aims that they might have to do that.

Child Migration Programmes (Child Abuse)

Sharon Hodgson Excerpts

Tuesday 3rd July 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Wigan (Lisa Nandy) for securing this very important but long-awaited debate, for her excellent speech and for her campaigning on this issue for many years.

I pay special tribute to Dr Margaret Humphreys for bringing this terrible issue into the public domain back in 1987—more than 30 years ago—and for her work and campaigning ever since with the Child Migrants Trust. Having been let down, it has to be said, by successive Governments, her work has changed the lives of so many families for the better. The bonds that families have made, having been reunited, are irreplaceable and she has played a huge part in that. I know that they all thank her deeply.

I also thank the hon. Members for Henley (John Howell) and for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) for taking part in the debate.

I pay tribute to those who have been affected by the child migration programmes and echo the words of the former Prime Minister, Gordon Brown, who in 2010 said:

“To all those former child migrants and their families...we are truly sorry.”—[Official Report, 24 February 2010; Vol. 506, c. 301.]

The stories we have heard in the debate and over the years have been incredibly moving and heartbreaking. It is inconceivable that over several decades more than 130,000 British children, some as young as three years old, were deported from UK children’s homes and their families without consent, and sometimes even without their parent’s knowledge. That was despite concerns being raised about how those children were being treated not only while abroad but on their journey, including, as we have heard, physical, emotional and sexual abuse. They were also completely dehumanised by having their names and birth dates changed, and even by having any records they had destroyed.

These children did not have regular access to basics such as food, water, shoes and underwear. It is important to remember that they were just children and they had done absolutely nothing wrong to find themselves in that position. They were taken away from their homes to a foreign country where all around them were strangers, and almost all were perpetrators. It is no wonder they were intimidated and scared even to speak out about how they were being treated. My heart truly aches for those victims, and I am sure the Minister’s does too.

It is now time for the Government to take action. There have been many opportunities for successive Governments to take action over the years, but sadly they have all been missed. In March this year, when the report of the independent inquiry into child sexual abuse was published, the Government had another opportunity to take action. Four months on, the Government risk missing yet another opportunity to make a change.

It is thought that about 2,000 former child migrants are still alive today, but they cannot afford to wait much longer. The report recommended that financial redress payments should start being made within 12 months, so the Government have only eight months left to take action. When will they publish a formal response to the report? Will the Minister ensure that that is done before the summer recess?

As has been mentioned, many of these children had their records destroyed, so how will the Government ensure that everyone who was affected receives justice and recognition? Similar to the Windrush scandal, we cannot allow victims to go without justice just because they do not have the documents to prove it, especially when those documents were destroyed by the parties involved on an industrial scale.

The victims have suffered for too long at the hands of successive Governments who made the choice to turn a blind eye. The last Labour Government recognised the victims and apologised to them, but will this Government take steps to grant financial compensation to victims and their families, as recommended by the recent inquiry report? Will they take steps to ensure that siblings and other family members who were separated because of the programme are reunited here in Great Britain?

Gordon Brown said in 2010 that

“successive governments have failed in a duty of care”.

These victims have been let down all their lives. The Government now have the power to address those decades of failure, and I hope they do so very soon.

Phenylketonuria: Treatment and Support

Sharon Hodgson Excerpts

Tuesday 26th June 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my hon. Friend the Member for Blaydon (Liz Twist) for securing this important debate, for her excellent speech and for all her campaigning on the issue. I also thank all the Members who have spoken this morning. There has been a good number. I thank the hon. Member for East Renfrewshire (Paul Masterton), my hon. Friend the Member for Portsmouth South (Stephen Morgan), the hon. Member for Waveney (Peter Aldous), my hon. Friend the Member for Dudley North (Ian Austin), the hon. Members for Chelmsford (Vicky Ford), for Dwyfor Meirionnydd (Liz Saville Roberts), and for Strangford (Jim Shannon), my hon. Friends the Members for Warrington South (Faisal Rashid), for Hornsey and Wood Green (Catherine West), and for Derby North (Chris Williamson) and the hon. Member for Linlithgow and East Falkirk (Martyn Day) for their excellent contributions to this important debate.

I also thank the all-party parliamentary group on phenylketonuria, which is more commonly known as PKU. I understand the group was only recently set up by my hon. Friend the Member for Blaydon and others. It is already providing an invaluable forum for PKU to be discussed. Finally, I thank the National Society for PKU for the help and support it provides to sufferers of PKU, for its sponsorship of medical research into PKU and for the work it does with medical professionals in the UK. Just last week, it held a particularly informative event in Parliament sponsored by my hon. Friend. I attended it, and I know it will have been helpful in spreading awareness of this extremely serious disease. I found it very useful, and I know other Members did, too.

I had not heard of PKU. It is a rare metabolic disease that causes an inability to break down the amino acid phenylalanine, which can then build up in the blood and brain. Left untreated, PKU causes severe intellectual disability, seizures and behavioural problems. Damage caused by the disease is, tragically, irreversible. That makes early diagnosis and treatment essential. The only treatment available on the NHS for PKU is an extremely restrictive diet. A PKU diet involves avoiding most forms of protein, and taking a special protein replacement—as we have heard, it does not taste as good as what it replaces—to avoid malnutrition. I would like to briefly highlight a number of the problems with the treatment.

First, it is extremely restrictive. Only a small number of foods can be eaten without severe limitation. It is easy to think that almost all food allergies and requirements are catered for in the modern supermarket these days, but with PKU that is not the case. Some of the necessary food replacements are available only by prescription. For some sufferers, the nature of the diet can have a detrimental impact on their social lives, particularly for younger people, as we have heard from a number of Members. Sadly, a high number of PKU patients also suffer from eating disorders and other mental health problems because of it. The NSPKU recommends that all people with PKU should automatically have follow-up appointments with an integrated specialist metabolic physical dietician, along with support from a psychologist and support worker. Is that something the Minister agrees with? Are the Government looking into providing that kind of support?

The second problem with the current available treatment is that it places a huge amount of pressure on those who care for children with PKU. In order to administer the necessary diet, a significant amount of measuring and preparation is required. As we heard at the event last week, dietary care takes on average 19 hours a week according to a recent study.

[Catherine West]

Is the shadow Minister aware that nearly 60% of mothers who care for their children with PKU have some kind of other psychological stress associated with this type of lifestyle?

[Mrs Hodgson]

I was not aware of that fact, but it is hardly surprising when we realise how complicated the diet is. As the child grows, the calculations have to be changed. As we know, children’s sizes change every week, so it is a constant battle to try to get it right, and it is not surprising that that figure is so high.

As the consequences of a child with PKU consuming the wrong type of food are so severe, it is easy to see how much stress a carer can go through in ensuring not only that they are preparing the right food but that a child follows the diet, particularly when away from home, as we have heard, or in school. With that in mind, I want to know whether the Minister believes that patient-centred care should be extended to school support, psychological support and counselling in order to relieve some of the pressure on carers.

When we consider the fact that the consequences of failing to adhere to the necessary diet are so extreme, one would imagine that all treatments that could improve outcomes would be available. Sadly, as we have heard, that is not the case. As has been discussed this morning, a non-dietary treatment for PKU does exist, yet it is not available to patients here in England. Kuvan is a licensed medicine that comes in the form of a simple tablet. In some 20% to 30% of people with PKU, taking Kuvan considerably increases the amount of protein that they can eat each day while maintaining a safe phenylalanine level. Indeed, some patients are able to stop or decrease the use of specially manufactured prescription foods while taking the drug. For those people, having access to Kuvan would literally change their lives and in some cases it would allow them to come off their restricted diet.

Unfortunately, the treatment is not currently commissioned by the NHS, except in a very small number of cases and for women during pregnancy. That is despite its having been licensed in the USA since 2007 and in the EU since 2008. It is used by thousands of patients across Europe and around the world. We heard the full list from the hon. Member for Chelmsford, but I will simply mention such countries as Ukraine, Estonia and Turkey by way of example. Many patients who suffer from PKU will rightly ask why, if the treatment is available there, it is not here?

Although Kuvan is available to women during pregnancy, it can be difficult to get hold of. Tragically, some women with PKU avoid having children altogether owing to fear of the risks to the foetus associated with high levels of phenylalanine. I understand that NHS England has recently referred Kuvan to NICE after it went through its internal clinical panel. Can the Minister explain why there has been such a delay in commissioning Kuvan, and when we can expect it to be available to all patients? Indeed, I understand that it was under the appraisal process in NHS England for seven years.

Access to Kuvan is not the only PKU treatment that has been impeded by the structure of the NHS. For sufferers of PKU, there is a significant risk of variable outcomes and health inequalities, exacerbated by lack of access to special protein replacements and manufactured low-protein foods. Many PKU patients have reported difficulties in accessing the prescriptions they rely on, and some clinical commissioning groups have been found to actively restrict funding for PKU products. Has the Minister had any conversations with Public Health England and the CCGs to ensure that people with PKU have easy access to prescription-only foods and amino acid supplements?

As a parent who watched her children have the heel prick test as babies, I had no idea how important that test was. I had not heard of PKU back then and I thought the test was just a little test in which they check the hips and prick the heel. I can only imagine how it must feel to be the one out of 10,000 parents who receive a life-changing diagnosis for their child, only to find out that their life and the health of their child will be harder than they need to be because of what can only be described as rationing by their CCG and NHS England.

[Catherine West]

Does my hon. Friend the shadow Minister agree with me that it is a disgrace that it takes a court case to get the NHS, NICE and all the other bodies to respond, even when they have heard about the difficult times that families have? Does she agree that a family should not have to take the Government to court to get the treatment that their child needs?

[Mrs Hodgson]

I absolutely agree. It is shocking. I want to end by saying to all the campaigners here and across the country that I hope we have shown in this debate today that we are listening. All their campaigning has not been in vain. It has led to us having an amazing champion in my hon. Friend the Member for Blaydon, and it has led to this well-attended debate today. The Minister has heard all the powerful speeches. He is a compassionate man, so they cannot fail to have had an impact on him. I look forward to his response. This is his opportunity to give hope to thousands of people. Let us hope that he does so.

ME: Treatment and Research

Sharon Hodgson Excerpts

Thursday 21st June 2018 Westminster Hall

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

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

I thank the hon. Member for Glasgow North West (Carol Monaghan) for her excellent speech setting the scene today and for securing this important debate, and I thank the Backbench Business Committee for granting the time for it. I also thank all hon. Members who contributed. A great number of them did so: the right hon. Member for Kingston and Surbiton (Sir Edward Davey), the hon. Members for Mid Dorset and North Poole (Michael Tomlinson), for Cheltenham (Alex Chalk), for Strangford (Jim Shannon), for Stirling (Stephen Kerr), for Luton North (Kelvin Hopkins) and for Paisley and Renfrewshire North (Gavin Newlands), and my hon. Friends the Members for Stroud (Dr Drew), for Bristol East (Kerry McCarthy), for Heywood and Middleton (Liz McInnes), for Plymouth, Sutton and Devonport (Luke Pollard) and for Ealing North (Stephen Pound) all made excellent and moving speeches. I thank the many other Members who made excellent interventions. The packed Public Gallery and the number of Members attending and speaking in the debate on a Thursday afternoon shows the strength of feeling on the subject not only in Parliament but in the nation as a whole—more should be done to help people with ME. They should get the help, recognition, support and treatment that they deserve and need.

I thank MEAction, Action for ME, the ME Association and the ME Trust for the detailed brief that they sent me, and ME North East and especially the Sunderland and South Tyneside ME support group including Professor Malcolm Hooper—I first met him way back in 2010 on this very issue—for all the work that they do to campaign for better care, support and recognition for people living with ME. We have heard today in great and moving detail from numerous Members sharing tragic and very personal stories from their constituents, whom we thank for allowing their stories to be told.

ME is a neurological disease, or a disease of the central nervous system, but that does not begin to explain how devastating it can be to have to live with it—or die from it, as happened so tragically to 21-year-old Merryn Crofts. I thank my hon. Friend the Member for Heywood and Middleton, who was her MP, and the hon. Member for Glasgow North West for sharing her story with us in some detail—I especially thank her family for allowing that—and helping to make the case so strongly in the debate.

ME affects an estimated 250,000 adults and children in the UK and about 17 million people worldwide. Despite the fact that so many people are affected by ME, it is little understood in the medical world, leaving patients feeling dismissed, neglected and stigmatised further by their condition. That can be no surprise, as no significant research has been done into the condition, as we have heard. ME receives far less research funding than other neurological conditions of similar prevalence or disease burden. The answer to a written question from the hon. Member for Glasgow North West revealed that the average research spend per person living with ME is only about £1 a year, as she said. Also, the majority of that research spending does not even come from Government; it comes from the charity sector.

Does the Minister think that research into this condition should be left entirely up to the charity sector? The ME charity sector in the UK does a fantastic job of researching the condition. For example, the UK ME/CFS Biobank is a vital part of the ME research infrastructure and has achieved an international reputation. All the start-up costs for the ME Biobank were funded by the charity sector, and ongoing costs are met by the ME Association’s Ramsay Research Fund. Do the Government have any plans to contribute to that research?

Patients with ME feel that they have been let down time and again as research such as the PACE trial—which, sensibly, we heard about—has been found to be seriously flawed. In fact, Jonathan Edwards, emeritus professor of medicine, said that the PACE trial would be a great example

“in an undergraduate textbook as an object lesson in how not to design a trial”.

In addition, a petition signed by more than 12,000 individuals —mostly patients, but also more than 90 scientists and clinicians—and more than 50 patient groups worldwide has demanded a retraction of the results of that trial. Does the Minister agree that ME patients deserve a trial that they can trust not to dismiss their condition or recommend treatments that could make it worse? Do the Government have any plans to fund a proactive and co-ordinated piece of research on ME that patients can trust?

Given the lack of medical research into ME, healthcare professionals are, unsurprisingly, not sufficiently trained in diagnosing the condition, as hon. Members have told us today. According to several ME charities, coverage of ME in many medical textbooks remains inadequate and can be misleading or even non-existent. The chief medical officer’s report and the NICE guidelines on ME set out clear timeline markers for making an early and accurate diagnosis. Both recommend that adults should normally have had the diagnosis confirmed within four months of onset of symptoms, or within three months for children and young people. However, standard medical tests often find nothing wrong, which leads many doctors initially to dismiss ME as psychological.

In 2016 a patient survey by the ME Association indicated that only a small number of patients were receiving a positive diagnosis within six months of onset. Further experiences from the charity sector suggest that a majority of patients have to wait for more than a year, and a significant number for many years, before they receive a diagnosis. That means that patients are being dismissed and stigmatised further and, more importantly, are not then receiving the care and support that they need. Does the Minister have any plans to create a care pathway for people with ME to ensure that patients are given access to the care and treatment they require in a timely manner?

In addition, has the Minister made any assessment of the effects that ME, and the delay in diagnosis of it, have on women in particular? I find it incredibly illuminating that 75% of patients with ME are women. That leads me to believe that there is an issue of women’s pain being dismissed and not taken seriously by healthcare professionals. Will the Minister consider that issue in his response?

It is therefore clear that more training is required, not only for healthcare professionals but for welfare assessors. A survey by Action for ME found that 79% of survey respondents disagreed with the statement that their assessor had sufficient expertise of their condition to conduct an assessment effectively and appropriately. Symptoms of ME can fluctuate so much and are often invisible, as we have heard, so the condition is difficult to manage for patients and, it has to be said, difficult for welfare assessors to detect.

A patient may perform well during a welfare assessment, but an assessor will not see how long patients rested in order to perform tasks during the assessment, or how long it took for them to recover afterwards. As we know, the onerous and ill-conceived assessment process can result in not only an inaccurate award, but an exacerbation of ME symptoms, which can result in a long-term deterioration of the individual’s health. Has the Minister had any conversations with his ministerial colleagues in the Department for Work and Pensions on that matter?

From this excellent debate, it is clear that the majority of issues that arise from ME do so because the condition is so little understood. The Government should consider funding research into ME to further our understanding of the condition. The hope is that that would, in time, improve perceptions of ME and improve the routes to diagnosis, care and treatment.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 19th June 2018 Commons Chamber

[Jackie Doyle-Price]

I could not have put that better myself—[Laughter.] Opposition Members can laugh, but the Government firmly believe that work is good for people’s health. We are committed to getting 1 million more people with disabilities into work so that we actually treat them as assets, and we are encouraging them to be more independent and to take control of their own lives. The only way to achieve that is by having a strong economy.

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

When the coalition Government came into office in 2010, life expectancy began to stall for the first time in over a century. This, coupled with eight years of funding cuts, means that there are grossly disproportionate health inequalities across the country. For example, according to Northern Health Science Alliance, people in the north are 20% more likely to die early than people in the south. Is not it a failure of the Government’s funding deal for the NHS that it comes with no public health money to tackle these astonishing regional health inequalities?

[Jackie Doyle-Price]

No, it is not. Labour Members like to draw attention to north-south divides and so on, but the issues about health inequalities are much more complex than how money is spent and where. Within my constituency, for example, there are differences of 10 years in life expectancy depending on the particular locality. We need a much more multi-layered approach to tackling inequality, and that is what this Government will have.

Acquired Brain Injury

Sharon Hodgson Excerpts

Monday 18th June 2018 Commons Chamber

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

Thank you, Madam Deputy Speaker. That is now in Hansard. I am sure the Minister will enjoy it in the months and years to come.

It is an honour to speak in this very important debate, and I thank the Government for allowing the time for it. I pay tribute to my hon. Friend the Member for Rhondda (Chris Bryant) for calling for it and for his tenacity in ensuring it went ahead, against all the odds, when we all doubted it would and even though we are very pushed for time. I thank the all-party group on acquired brain injury and the right hon. Member for South Holland and The Deepings (Mr Hayes) for all their work and for their excellent campaign for better support and recognition for people living with ABI. I join the Minister in praising the work of the late and great Baroness Jowell. I, too, will never forget her last appearance in this Chamber in the Under Gallery.

Last month, along with colleagues from across the House, I was pleased to attend the rally for people with acquired brain injury at which they, along with their families, friends and carers, talked about their conditions and the services available to them. As we have heard, 1.3 million people in the UK live with the consequences of ABI, and each year approximately half a million patients attend UK emergency departments for traumatic brain injury. That is nearly 1,500 patients with traumatic brain injury attending A&E departments in the UK each day; one every minute. Brain injury can happen to anyone at any time, and all Members will have constituents living with the consequences of an ABI.

Despite the fact that so many people are living with ABI, it is little understood, which is why I am so pleased that the time has been allowed to discuss it in this place this evening. A brain injury can happen in an instant, but its effects can be devastating and last a lifetime. Thankfully, due to excellent advances in emergency and acute medicine, more and more children, young people and adults now survive and live with an ABI, but this brings its own challenges. As ever more people survive an ABI, further pressure is put on the vital services that people require.

For example, many individuals with an ABI require early and continued access to neuro-rehabilitation to optimise their recovery. The United Kingdom Acquired Brain Injury Forum says that the average cost of the initial rehabilitation programme is offset by savings in the cost of ongoing care within just 16 months and that this leads to an average saving over a lifetime in care costs of £1,475,760. That is a huge amount of money. Neuro-rehabilitation is therefore one of the most cost-effective services the NHS provides and one of the few services in medicine that result in long-term decreased costs to the economy. However, as is the case for many health conditions, the number of available beds across the UK is inadequate, service provision is variable and consequently long-term outcomes for brain injury survivors are compromised. What plans do the Government have to address those issues and improve the lives of patients living with an ABI? The UKABIF recommends a review of neuro-rehabilitation to ensure that service provision is adequate and consistent throughout the UK. Does the Minister agree that that is needed?

Many children and young people with an ABI are in education, and therefore the majority will receive most of their rehabilitation at school. Yet among education professionals there is a lack of awareness and understanding of ABI, its consequences, and its impact on learning. A pupil with an ABI may also require extra support when transitioning between primary, secondary and further education. What discussions has the Minister had with his colleagues in the Department for Education to ensure that children with an ABI receive the support that they need throughout their journey through the education system? Will he discuss with them the inclusion of ABI in the code of practice for special educational needs co-ordinators?

Brain injuries can be difficult to detect for people who are not already aware of them, which is why all education professionals should have a minimum level of awareness and understanding of ABI. In fact, that requirement goes beyond education and into everyday life. People living with ABI are discriminated against because of the general lack of understanding of their condition. For example, earlier this year Grace Currie was escorted out of a pub on a Saturday night because the bouncers believed that she was “too drunk”. In fact, Grace, who had suffered life-changing injuries after being hit by a car in 2010, had had just one drink. The incident must have been extremely upsetting and embarrassing for Grace, and I am sure that it really knocked her confidence.

Sadly, such encounters are not rare, and the level of misunderstanding of brain injuries is high among the general public, including assessors for employment and support allowance and personal independence payments. A study conducted by Headway found that 71% and 60% of respondents felt that assessors for ESA and PIP, respectively, did not have an understanding of brain injury. Further, assessors were widely reported to lack empathy and patience, resulting in a stressful and even traumatic experience for many brain injury survivors. Many respondents also said that their medical evidence was not taken into consideration, and that the assessment location and environment were not suitable for them, despite requests made in advance. Consequently, a strong sense of frustration and anxiety was reported by brain injury survivors and their carers about the failure to recognise or respect their needs throughout the application process. Has the Minster had any discussions with his colleagues in the Department for Work and Pensions about that issue? Will he look into those concerns with his colleagues, and ensure that they are properly addressed?

Living with a brain injury is difficult enough for people without their having to struggle to explain and prove their disability to anyone who lacks understanding of the condition. Each brain injury is different, which is why it is so important to raise awareness of ABIs. However, it is also important to recognise that such injuries affect not just the people directly concerned, but their families and friends. Headway aimed to highlight that during brain injury week last month for its “you, me, and brain injury” campaign. Headway found that 69% of brain injury survivors reported breakdowns in their friendships after the injury, and that 28% of relationships ended after an ABI. However, it is not all doom and gloom: 47% of survivors reported improvements in their relationships with family members. It was clear from Headway’s study that a little bit of understanding and time really can go a long way. That is the kind of service that is provided by its 127 groups and branches across the country.

Headway Wearside, whose representatives I met recently at the rally in Parliament, provides information, support and social activities for brain injury survivors, and works with the local community, relevant professionals and organisations to promote understanding of ABI. I spoke to Neil and Jimmy, who use the Headway Wearside service, and was touched when they explained that Headway had brought them together as a community, and they had formed friendships that they never expected to form. Headway Wearside does not just teach new skills, but helps people to form and develop friendships at a time when doing so might otherwise be hard. When I met with Neil and Jimmy we feared that this service might soon be lost, and I am pleased to say that it has been extended to June 2019, and I hope it will be extended still further so that patients can have access to this life-changing service. I pay tribute to Headway Wearside and all the work it does for the local community, and I will continue to support it so that this vital service can continue to support its 4,000 patients.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

My wife suffered exactly this problem in 1999. The eldest of my three children was sitting her exams—her highers—at school, and while that school and the education system in general supported them fantastically well, there is the issue of supporting the children, quite apart from supporting the sufferer of an injury like this. Will the hon. Lady elaborate on how we might increase the support and help for families caught up in such situations? My children got through it, but it was touch and go, and I remember these events without much happiness.

[Mrs Hodgson]

I thank the hon. Gentleman for sharing such a personal anecdote from his own experience. It demonstrates why it is important that we support the Headways across the country that are giving this vital support to families in the position his family was in, and he is right to mention the children of people with acquired brain injuries; they must not be forgotten in all of this.

Unfortunately, not every patient with an ABI will have access to a service like Headway Wearside. If the Minister is to take away one thing from this debate, I urge him to recognise the need for services such as Headway Wearside and the other 126 across the country, so that the more than 1 million people living with a brain injury can access the support they need and deserve.

[Several hon. Members rose—]

Hepatitis C

Sharon Hodgson Excerpts

Tuesday 12th June 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter. I thank the hon. Member for Southend West (Sir David Amess) for securing this important debate and for the work that he has done as co-chair of the all-party group on liver health for many years, as well as for his excellent opening speech today. My hon. Friend the Member for Ealing, Southall (Mr Sharma), a vice-chair of the all-party group, is not in his place today, but I pay tribute to him for the work that he has done to raise awareness of this issue. I thank the hon. Members for Strangford (Jim Shannon) and for Central Ayrshire (Dr Whitford) for their excellent contributions and I thank the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) for his interventions.

Finally, I thank Professor Steve Ryder, whom I met earlier this year, for his expert briefing and for the obvious passion that he has for eradicating hepatitis C in this country as soon as possible. I also pay tribute to the Hepatitis C Trust and the Hepatitis C Coalition for the work that they do.

I welcome NHS England’s ambitious commitment earlier this year to eliminate hepatitis C by 2025, five years ahead of the World Health Organisation’s target. Healthcare professionals and experts are confident that hepatitis C can be eliminated, notwithstanding everything we have heard today about the cap on the treatment. Today is the first time I have heard about that, but I am sure the Minister will respond to the issue in his remarks soon. I remain concerned about some of the challenges that need to be faced by 2025 if the target is to be achieved.

Hepatitis C, as we have heard, is a hidden disease with patients experiencing few or no obvious symptoms for many years, but its long-term effects can cause severe liver damage if it goes untreated. Across the UK, around 214,000 people are infected with hepatitis C, but I understand that 40% to 50% remain undiagnosed. That huge percentage of people going undiagnosed is one of the biggest challenges to eliminating this virus—we cannot treat people if we do not know who they are. As Professor Paul Klapper and Pam Vallely of Manchester University ask in an article published this year,

“how do we identify those who are infected so that they can be guided into treatment and care?”

As I, and many others, have mentioned today, hepatitis C is a hidden disease. People may be completely unaware that they are living with the virus, and at risk of unknowingly passing it on to those around them. Although awareness of hepatitis C is gradually improving, low awareness and stigma remain a challenge to ensuring that as many people as possible are tested, diagnosed and treated.

Levels of stigma and poor awareness are particularly high among at-risk groups, such as former or current drug users, or those who do not access conventional healthcare facilities, possibly because of fear of being challenged or stigmatised. How will the Government ensure that those at-risk groups are reached—not only for testing but for continued treatment? Again, this is where the cap will come into things; as more people come forward and are diagnosed, we must be able to treat them.

People need continued support throughout their treatment to ensure that they complete the course of medicine—if they do not, it is just a waste of time and money. Will the Government provide extra support to at-risk groups to ensure that that happens? An effective way of raising awareness and breaking down the stigma of hepatitis C is to introduce peer-to-peer messaging programmes for at-risk groups. Such a provision could be increased in settings such as drug services and prisons, and would mean that there will already be an understanding and relationship between the two parties. Has the Minister made any assessment of the role that a peer-to-peer programme might have in achieving the goal of eliminating hepatitis C by 2025?

Although at-risk groups make up a huge proportion of those living with hepatitis C, people who do not consider themselves to be at risk also pose a challenge to the 2025 target. As we have heard, Anita Roddick from The Body Shop was one of those who would not have been in an at-risk group, and she would have had no way of knowing that she was infected with hepatitis C. The excellent all-party group on liver health stated that

“A high-profile, Government-backed awareness campaign should be considered, and awareness messaging should be targeted through novel channels at those who may not consider themselves to be ‘at risk’.”

Do the Government have any plans to support Public Health England in raising awareness of hepatitis C among the wider general public, and what format might that campaign take?

Crucially, awareness among primary care professionals should be increased through targeted testing initiatives in primary care, with additional resources and support for primary care workers. If we are to eliminate hepatitis C, we must seize the opportunity when people are already having blood taken—tests for HIV for example, or when bloods are taken in A&E—and test them for hepatitis C. Testing should become routine in substance misuse services, sexual health clinics and prisons, and it must also increase in primary care and community settings, such as hostels, daycentres and police custody. The prevalence of hepatitis C among the prison population is four times that of the population as a whole. If the amount of people tested increases, we will be closer to identifying the 40% to 50% of infected people who are living with it unknowingly, and we will be one step closer to eliminating the virus.

A big step in recent years has been the development of a new class of drugs—direct-acting antivirals or DAAs—that has revolutionised the treatment of hepatitis C. The drugs no longer carry the toxicity or side effects of previous treatments, and the short treatment courses effectively cure the infection in a high percentage of cases. Once patients are diagnosed, however, it is crucial that they are treated immediately, because the time between diagnosis and starting treatment poses the greatest risk of patients dropping out of the care pathway.

For example, a prisoner who is diagnosed and treated while in prison but who is then released might not continue with the treatment and could be at risk of infecting others, as well as of not being cured. What mechanisms will the Government put in place to ensure that those who begin their treatment can finish it, regardless of any change in circumstances? Quicker referrals are also needed to simplify the process of linking people into care. Currently, some secondary care services will only accept referrals for treatment from GPs. The all-party group on liver health recommends that referrals for hepatitis C treatment should be accepted from any service where someone might receive a test and be diagnosed. Has the Minister made any assessment of that recommendation?

Finally, I move on to prevention. If we are to eliminate hepatitis C—we all want that to happen—we must ensure that the number of new infections falls. Substance misuse services and sexual health clinics have a crucial role in that, but their funding has consistently been cut by the Government. The King’s Fund estimates that spending on tackling drug misuse in adults has been cut by more than £22 million compared with last year, and funding for sexual health services has been cut by £30 million compared with last year. What role do the Government expect such services to play in the elimination of hepatitis C, given such finite funding and resources? Those services provide not only a testing service, but an educational one that could help reduce reinfection rates—a further challenge to the elimination of this virus.

I am sure the Minister will agree that serious challenges lie ahead in meeting our ambition to eradicate hepatitis C by 2025. All those challenges need to be addressed—not only to meet NHS England’s target, but to ensure that this potential public health crisis is averted. I look forward to hearing the Minister’s response on how the Government plan to tackle those challenges in the months and years ahead.