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.

NHS 70th Anniversary

Sharon Hodgson Excerpts

Wednesday 16th May 2018 Westminster Hall

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

Mr Hosie, it is a pleasure to serve under your chairmanship this morning in this very important debate.

I start by thanking my hon. Friend the Member for Blaenau Gwent (Nick Smith) for securing the debate and for his excellent speech. He is rightly proud of his roots in his wonderful constituency and the connection that it holds with Nye Bevan and the founding of the NHS. I am sure that he and his constituents will enjoy the 70th anniversary celebrations, and I look forward to hearing all about them.

I would also like to thank the other hon. Members who spoke this morning for their thoughtful contributions to the debate—the hon. Members for Ayr, Carrick and Cumnock (Bill Grant), for Henley (John Howell), for Caithness, Sutherland and Easter Ross (Jamie Stone) and for Airdrie and Shotts (Neil Gray), who speaks for the Scottish National party, and my hon. Friends the Members for Coatbridge, Chryston and Bellshill (Hugh Gaffney), for York Central (Rachael Maskell) and for Bristol South (Karin Smyth).

This is the first speech that I am giving on the 70th birthday celebrations of the NHS, and it is a genuine honour and privilege to be able to do so here today as the shadow Minister for public health. On 5 July, 70 years ago, the Health Secretary, Aneurin Bevan, was handed the keys to Park Hospital in Manchester, now known as Trafford General Hospital, and launched our national health service. I have my own little photocopied memento of a leaflet distributed before that launch—I wish I had a better copy, but I treasure this one. It says:

“Your new National Health Service begins on 5th July. What is it? How do you get it?

It will provide you with all medical, dental, and nursing care. Everyone—rich or poor, man, woman or child—can use it or any part of it.”

It went on to say:

“But it is not a ‘charity’. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.”

The crux of it for our citizens was that they would no longer have to make that awful decision—the choice between debt or, in some unfortunate cases, death. Everyone would now receive healthcare publicly provided and free at the point of use.

I have got my own family anecdote which, as we have the time, I am going to share with you all this morning. I am sure we have all got these family anecdotes. Mine involves my Aunty Ella and my mam. My Aunty Ella was born before the start of world war two and my mam was born in 1945—so you can see straightaway that there is going to be a great anecdote here.

Now, I do not know why—they must just have been unlucky—but in both of their childhoods they suffered from pneumonia. Pre the NHS, when it was my Aunty Ella who had pneumonia, my nana had to go to the doctor’s surgery every morning, where he would hold out his hand, and into his hand she would place a coin—a shilling or whatever. Then she would hold out her hand and into her hand he would place a tablet—obviously, penicillin or some form of medicine. Then she would go home and give it to my Aunty Ella. This went on nearly a week.

My nana was very poor, working class, and she says that in those days, in order to get the money to get that tablet, she would pay a visit to the pawn shop on her way, and pawn whatever was valuable to her at that moment. It tended to be sheets, or a son’s suit or her husband’s suit. She did that in order to get the tablet.

Now fast forward to when my mam, who was born in ’45, got pneumonia, after the health service came in in ’48. My nana did not have to pawn anything; she did not have to go to the doctor’s surgery at all, because a district nurse knocked on the door every day and went upstairs to where my mam was lying in bed with pneumonia, gave her an injection and left. No pawning of sheets, no handing over of money, no stress—that was the difference. Therefore, all of us—I do believe that it is all of us—are committed to those founding principles. We on the Opposition side of the House especially, will continue to fight against the privatisation of our NHS for those reasons.

To quote a phrase often falsely attributed, I now understand, to Bevan, but one I repeat because it rings true no matter who said it:

“The NHS will last as long as there are folk with the faith to fight for it.”

I am pleased to say that 70 years on, there are still plenty of people with the faith left to fight for it. I hope that we will all—though maybe not us personally—be celebrating our NHS for 70 years more, and 70 years after that, and so on. It changed the lives of people then and it is still changing the lives of people today.

Bevan had huge ambitions, but he never would have imagined all those years ago the successes we have had in medicine because of the development of the NHS. I will talk about a few of them now. In 1952, Francis Crick, a British scientist, and James Watson, an American student, made one of the most important scientific breakthroughs of the 20th century, when they discovered the molecular structure of DNA. The discovery helped revolutionise medical treatments in the NHS and elsewhere, improving prevention and treatment of disease. For example, we know now that a BRCA gene mutation can cause a number of cancers in both men and women, who now have the option to have preventive surgery in order to reduce their risk of developing cancer.

In 1954, Sir Richard Doll, a British scientist, published a study in The British Medical Journal co-written with Sir Austin Bradford Hill, which established the link between smoking and lung cancer. That very important study has since led to increased smoking cessation policies from successive Governments, including the ban on smoking in public spaces by the Labour Government in 2006 and the current Government’s—and the Minister’s—tobacco control plan. Smoking prevalence is decreasing across the country, and I am pleased to say that smoking rates in the north-east are declining faster than the national average, thanks in no small part to support from programmes such as Fresh North East, which has seen around 165,000 people quit smoking since 2005.

In 1958, vaccinations for polio and diphtheria were launched, to reduce deaths from both diseases. I am pleased to say both those terrible diseases have now been eradicated from the UK. Others, such as TB and MMR vaccinations, have now become a key part of NHS prevention work. We were in this Chamber just two weeks ago debating the extension of the HPV vaccination to boys after its successful roll-out to girls in order to prevent cancers caused by that virus. Bevan could never have imagined such developments—or maybe he did, such was his vision.

In 1960, doctors at the Royal Infirmary of Edinburgh completed the UK’s first kidney transplant, using a set of 49-year-old twins. Incidentally—perhaps it was the pneumonia—my Aunty Ella, who I have mentioned once already, went on to have kidney failure; and just a decade after the first transplant in Edinburgh, she became one of the first to receive a kidney transplant in Newcastle Freeman Hospital. That helped her live long enough not only to see her own children grow up, but to see her first grandchildren born. In 1968, a team of 18 doctors and nurses at the National Heart Hospital in London, led by surgeon Donald Ross, carried out the first heart transplant in this country. There are now more than 50,000 people living with a functioning transplant thanks to organ donation and transplantation in the UK, giving them more time to spend and treasure with their families.

In 1988, breast cancer screening was introduced, offering mammograms to women over 50. We have now increased the number of women who are eligible for breast screening. That helps with early diagnosis and survival rates, which are now at 78% for 10 years or more—excellent figures. None of this would have happened if it were not for our NHS and the everyday heroes that work within it. The NHS is the UK’s largest employer, with over 1.5 million staff from all over the world and more than 350 different careers. Those people are kind, caring and passionate about their patients. They just want to get on and do their job, but sadly, they are finding this more and more difficult, with funding cuts and thousands of unfilled vacancies, when more and more is expected of them.

We on the Opposition side of the House do not take our NHS or the workforce for granted, and neither should the Government. It has to be said that for the last eight years, the NHS has been in crisis. We have ever-growing waiting lists, patients waiting on trolleys in overcrowded hospitals, and people being told not to go to A&E unless it is an absolute emergency. Earlier this year, the Prime Minister announced a funding plan to mark the 70th anniversary of the NHS. I hope the Minister will inform the House how much of that funding will go to improving and establishing public health services. There is a huge funding gap within the NHS, but with the right public health services we can help people to live healthier lives and support them in their endeavour to do so, which, in turn, will save money.

It is estimated by the King’s Fund that since local authorities became responsible for public health budgets in 2015, on a like-for-like basis, public health spending has fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16 and there are further real-term cuts to come, averaging 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse in adults—cut by more than £22 million compared with just last year—and smoking cessation services—cut by almost £16 million. Spending to tackle obesity has also fallen, by 18.5% between 2015-16 and 2016-17, again with further cuts in the pipeline in the years to come. These are vital services for local communities, which would benefit their health and life expectancy, but sadly, they continue to be cut due to lack of funding.

As my hon. Friend the Member for Blaenau Gwent said in his excellent opening speech, an ounce of prevention is better than a pound of cure—a line that I will certainly be stealing for future speeches—and that is why, 70 years on, we must focus on public health initiatives. That is why I am so pleased that he made today’s debate about public health, rather than its just being on the 70th anniversary generally. Not only can such initiatives help people live healthier lives, but they will save the NHS—and, in turn, the Treasury—money. I think the technical term for that is a no-brainer.

In closing, I will return to Bevan’s wise words. He said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

This Government have the means to make people in this country some of the healthiest in the world. I hope that they will take those means and ensure that vital public health services are provided to society to do just that.

[Karin Smyth]

My hon. Friend is making an excellent speech, as usual. Does she agree that one of the issues with devolution, and some of the experimentation we have seen, is the separation of knowledge between the health service and providers of our public services, particularly in England? We can learn from the experience that has been gained, particularly in Wales, where there is much more integration between those areas, and transfer the learning about public health that has come into local authorities, so that they understand the need to work better with local health services.

[Mrs Hodgson]

Absolutely. That point had not been covered, so I am pleased that my hon. Friend has made it. There is best practice in Wales, and even in Scotland—we are always hearing in these debates about some of the wonderful things going on in Scotland, aren’t we, Minister? We should learn from where there is best practice. Where good things are happening, that knowledge should be spread across the NHS, especially if it will lead to better public health and, in turn, save money.

I was just coming to the end of my contribution. I just wanted to say that we want to go on to see more successes, such as the ones I listed earlier, over the next 70 years. I am sure we will. With medical technology and science the way they are, we probably cannot even imagine the sorts of advances that we will see. I hope those will all be within the publicly funded national health service that we are all so proud of, for many years to come.

Fortified Flour

Sharon Hodgson Excerpts

Wednesday 16th May 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hanson; I think it is the first time I have had such a pleasure.

I thank my hon. Friend the Member for Pontypridd (Owen Smith) for securing the debate and for his eloquent speech. As always, he showed his knowledge and passion on this important topic. I also thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks for the Scottish National party and mentioned that the Scottish Government have looked at this policy and, as I understand the situation, concluded that it was impossible to bring in fortified flour on a Scotland-only basis because of the fluid nature of the UK food industry and the very fluid nature of flour. I therefore think it is definitely time that the UK Government looked at this issue again.

I thank the right hon. Member for Belfast North (Nigel Dodds) for his brave and personal speech, and I thank my hon. Friend the Member for Newport East (Jessica Morden) and the hon. Members for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) and for Strangford (Jim Shannon) for their excellent contributions to the debate. Finally, I add my thanks to my hon. Friend the Member for Redcar (Anna Turley), who raised this matter last week during Health and Social Care questions.

As we have heard, this issue has been on the table for decades now, and it is only right that it continues to be brought up at every possible opportunity. The UK Government continue their policy of voluntary folic acid supplementation for women of childbearing age, despite the evidence and the fact that the latest National Diet and Nutrition Survey states that 91% of women of childbearing age have a red blood cell folate level below the level estimated to lower the risk of NTDs. I therefore ask the Minister what he is doing to encourage women of childbearing age to take folic acid supplements. Additionally, what steps is his Department taking to ensure that women of childbearing age even know that they should take those supplements?

Incidentally, this was something that I was aware of when I was having my children 25 years ago. We think things have moved on, but my young researcher in my office said that she only found out about it when she was researching for this speech. So, the message is not out there—not everybody knows this information. The voluntary approach means that, more often than not, those who do not need the supplements will take them, whilst those most at risk will miss out. Young mothers and those from the most socioeconomically deprived areas are least likely to take supplements. What steps are the Government taking to ensure that these groups of women are included and reached?

I am sure that it will not come as a surprise to the Minister that as many as 40% of pregnancies are unplanned, and that means that many women will not have been taking supplements during the crucial phase, just before or just after conception. It therefore makes sense for flour to be fortified with folic acid, to ensure that women get the nutrients that they need in order to reduce the risk of NTDs. That already happens in over 80 countries worldwide, including the United States, Canada and Australia.

Currently, no countries in the European Union fortify their flour with folic acid. However, there is no legislation preventing any of them from doing so. Given the UK’s research on this matter, I believe that they are waiting for us to lead the way, and as we have heard, I believe Scotland is probably doing just that. Why are the Government not therefore taking the opportunity to lead the way and reduce NTDs, not only in the UK but, in turn, across Europe? I understand and sympathise with concerns about adverse effects that this may have on the population. However, there really is no evidence to suggest that from other countries that have fortified their flour with folic acid for many years.

I also note the response of the Parliamentary Under Secretary of State for Mental Health and Inequalities from Health and Social Care questions last week:

“We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems”.—[Official Report, 8 May 2018; Vol. 640, c. 537.]

However, the modelling undertaken by Food Standards Scotland in 2017 indicated that fortification at the recommended levels, with a capping of voluntary fortification and supplements, can achieve the reductions in NTD risk without increasing the number of people consuming the upper recommended limit. Has the Minister made any assessment of that finding, and could he stipulate where his advice is from? Finally, has the Minister’s Department made any assessment in the last five years of the benefits of fortifying flour with folic acid?

From this afternoon’s debate it is clear that there are benefits to the mandatory fortification of flour with folic acid. I really do hope that the Minister will take all of this away with him today back to his Department and reconsider this policy—unless, of course, he is going to announce that he is going to fortify flour forthwith.

[David Hanson (in the Chair)]

I call the Minister, Steve Brine.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Hunt]

I have spoken to my hon. Friend about this matter, and he speaks powerfully about the community interest in this particular transaction. We have listened carefully to what he has said, and will continue to do so before a decision is made.

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

This August marks two years since the world’s first childhood obesity plan was published, but the Government’s plan, at just 13 pages, left a lot to be desired. More than 5.5 million children in this country are now officially classed as overweight or obese, with 140,000 classed as morbidly obese, as the hon. Member for South West Bedfordshire (Andrew Selous) mentioned. This is now an epidemic. Will the Secretary of State confirm whether the Government’s second childhood obesity plan—due this summer, we have heard—will include meaningful policies such as restricting junk food advertising and the sale of energy drinks to children?

[Mr Hunt]

I agree with the hon. Lady that we need to do more, because this is a very serious issue. I think that she is being slightly unfair on our first initiative. The sugary drinks tax has been responsible for 45 million kg of sugar being removed from the market, which is enormously important for children. There is more to be done and I hope that we will be able to announce plans soon.

HPV Vaccination for Boys

Sharon Hodgson Excerpts

Wednesday 2nd May 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Henry. I thank the hon. Member for North Thanet (Sir Roger Gale) for securing this important and long-awaited debate, and for speaking with such knowledge and passion. I also thank the hon. Members for Henley (John Howell), for Worthing West (Sir Peter Bottomley) and for West Dunbartonshire (Martin Docherty-Hughes) for their contributions. Although we are few in number, due in no small part to the local elections, that has been more than made up for by quality.

As we have already heard, 70% to 80% of sexually active women and men will acquire HPV at some point in their lives. Most healthy people will be able to clear the infection out of their system and will never know that they had been infected, but 3% to 10% of cases lead to serious health conditions. HPV is a major cause of cancers in men and women, and accounts for 4.8% of the estimated 12.7 million new cancer cases occurring annually among men and women worldwide.

HPV is linked to nearly all cervical cancers, 70% to 75% of vaginal cancers, 29% of vulvar cancers, 50% of penile cancer and 85% to 90% of anal cancers in both sexes. HPV can also cause genital warts, as we have heard, which is the most common sexually transmitted disease caused by the virus in both sexes. Why, then, do we vaccinate only girls, when men and women can be infected?

Since 2008, girls aged between 11 and 13 in the UK have been offered the HPV vaccination. My daughter was in the first cohort. As a parent, I was a bit anxious when the new vaccination was rolled out, but I need not have been. The vaccination programme has been mostly successful, with a high uptake of about 85% nationally, and it has made an important contribution to reducing the burden of infection among young women in the UK.

However, there are significant regional differences in the uptake of the vaccination, with the lowest level of uptake of two doses at 48.3% in my region, in Stockton-on-Tees, compared with the highest level of uptake in East Renfrewshire at 95.6%, which is astonishingly high. What steps will the Minister take to address those regional inequalities in the vaccine uptake? How does he expect a herd immunity philosophy to apply in areas such as Stockton in the north-east, where uptake is so low?

It is clear from the ever-growing evidence that it is time to extend the HPV vaccination to boys. The Joint Committee on Vaccination and Immunisation believes that the high uptake in girls protects enough males and makes it cost-ineffective to vaccinate boys too, but that short-sighted view protects only heterosexual men who come into sexual contact with a woman who has been vaccinated, and leaves out a significant proportion of the population. Despite the high uptake among young girls, a heterosexual man still has a one in seven chance of meeting an unvaccinated woman in a sexual encounter.

Men who have sex with men are also unprotected by a girls-only vaccination programme. They are 20 times more likely than heterosexual men to develop anal cancer, but the men who have sex with men—MSM—programme being piloted in England will not be sufficient to protect that population.

Between 2009 and 2014, the median age of the first presentation of men who have sex with men to sexual health services in England was 32 years old. They are therefore likely to have been having sex for many years before they attend a sexual health clinic. A recent study of men who have sex with men attending a London sexual health clinic found that 45% had a current HPV infection of a type that could cause cancer or genital warts, which suggests that a significant proportion of them will have already been infected before they are offered the HPV vaccination. Offering the vaccine in a sexual health clinic is too little, too late for men who have sex with men.

In addition, as we know, sexual health services are at a tipping point after demand for them increased by one quarter in the past five years, but at the same time, spending on them was cut year on year. Offering the vaccination in a sexual health clinic adds to the ever-growing demand on those services, but still excludes a significant proportion of the population and is far too late for some men.

The optimum age for the HPV vaccination to work is around 12 or 13 years old, when boys are unlikely to attend a sexual health clinic or may not be aware of, or willing to declare, their sexual orientation. The only solution to the problem is to offer the vaccine to both girls and boys while they are still at school and not sexually active. That will protect girls and boys from preventable disease.

HPV Action estimates that more than 2,000 new cases of HPV-related cancers are diagnosed each year in men in the UK. Like me, the Minister is passionate about reducing the incidence of cancer in this country. Extending the HPV vaccination programme to boys would be a step forward in doing that.

In response to a written question earlier this year, the Minister stated that the Government do not have an estimate of the number of boys and men each year who are left unprotected against HPV because of a lack of direct or herd immunity. However, HPV Action estimates that, with each year that passes, another cohort of almost 400,000 boys is left unvaccinated and potentially at risk of HPV infection and the diseases it causes. As the briefing I received from the Terrence Higgins Trust says:

“When we have a vaccine that can provide effective protection against such illnesses, it is unacceptable to maintain that vaccinating only one half of the population is sufficient to stop preventable ill health.”

HPV is not gender specific, so the vaccination programme should not be gender-specific either.

This is not a new philosophy. In fact, 14 countries are already vaccinating boys against HPV, or they will be soon. They include Australia, Austria, Bermuda, Brazil, Canada, Croatia, the Czech Republic, Israel, Italy, New Zealand, Norway, Serbia, Switzerland and the US. Compared with their international peers, therefore, boys in the UK are at risk of being disadvantaged.

This is an opportunity for us to play a leading role globally in the elimination of cancer caused by HPV, but we are at risk of letting that opportunity slip away. Since 2013, the JCVI has been reviewing whether to extend the HPV immunisation programme to boys. However, the publication of a final decision has been deferred twice. The thousands of boys who go unvaccinated each year cannot afford to wait any longer and the JCVI must make a decision this year, preferably when they meet next month. I therefore urge the Minister to work with the JCVI as it comes to make its decision, so that both genders can be protected from these preventable diseases.

--- Later in debate ---

[Steve Brine]

Those people are nearer to my hon. Friend than he knows, and they will have heard his point.

In his opening remarks, my hon. Friend the Member for North Thanet asked the JCVI to take the long view, and I hope that I can reassure him somewhat on that point. Some examples of what the JCVI is taking into account in its considerations include: the projected future number of HPV cancers resulting from the current incidence of HPV infection; the potential savings as a result of preventing future cancers, which a number of Members have mentioned; the potential savings from preventing genital warts; and, crucially for my hon. Friend’s point, the long-term impact of HPV infection up to 100 years into the future, which will outlive even him.

The JCVI’s interim advice indicated that to vaccinate boys would be

“highly unlikely to be cost-effective in the UK, where uptake in adolescent girls is consistently high”.

It is true that the UK has achieved high uptake for the girls HPV immunisation programme for the past 10 years. In 2016-17, 83.1% of girls completed the current two-dose course, including the daughter of the hon. Member for Washington and Sunderland West. I have two young children—one of each—and of course those of us who are parents want what is best for our children. Somehow arguments about cost-effectiveness do not feel right. Cost-effectiveness is important, however, because it is about how to fairly, consistently and robustly assess which interventions and treatments should be funded in what we must remember is a publicly funded health system. We need to deliver value for money for the taxpayer and deliver the most health benefit possible to all patients. That is our system.

[Mrs Hodgson]

I take on board what the Minister is saying for areas where uptake is high but, as I cited earlier, there are parts of the country where uptake is nowhere near high enough, such as Stockton, where it is 48%. How does that work? How does that argument stand up for those parts of the country?

[Steve Brine]

The hon. Lady makes a very good point. I was hoping to have a note to respond on that specific point about regional inequalities, but I will have to write to her. Perhaps it is something we can discuss offline. That very good point has not been raised with me recently, but I will take it away and follow it up.

My hon. Friend the Member for North Thanet did not mention discrimination and equality, but other Members certainly did. I accept that equality needs consideration in this case, and I confirm that the Department is carrying out an equality analysis. That cannot be completed until we have received the JCVI’s final advice and we know what it is advising and why, but I can confirm that officials will make contact with key organisations such as HPV Action—I met members of it recently at a roundtable I held on cost-effectiveness methodology for immunisation programmes and procurement, and I know that some of them are here today—as they progress the equality analysis to ensure that such views are taken into account. I confirm that the equality analysis will be published, and I will make the House aware when it is.

There have been a number of threats of judicial review related to equality and sex discrimination in relation to HPV vaccination. I do not think it would be appropriate to say more at this stage, but the House will have heard those two commitments.

[Mrs Hodgson]

On the equality point and the herd immunity point, may I raise the issue of men who have sex with men and the fact that their first presentation at a sexual health clinic could be at the age of 32? Again, there is no way for there to be herd immunity or even for us to extend the vaccination, as we have done in the pilot, to men who have sex with men. There will still be huge numbers of people not covered. Does the Minister agree, and what is he going to do about that?

[Steve Brine]

The hon. Lady makes her point, and it is not one that I miss, I assure her. That issue forms part of the ongoing deliberations. She has made that point twice, and it is a good point.

I know there are concerns, to put it mildly. My hon. Friend the Member for North Thanet set out the timeline of how long it is taking the JCVI to finalise its advice. However, the consultation raised some important, complex issues around the cost-effectiveness model, and it would be remiss of the JCVI not to ask for those issues to be addressed before it puts the matter on its agenda and makes its final decision. I appreciate that my hon. Friend and other Members want the advice quickly—believe me, so do I—but I cannot advocate asking the JCVI to cut corners, which would call into question the quality and robustness of its advice and undermine an internationally respected organisation. The JCVI will get its advice on boys to me as soon as it can, and I am certainly expecting it this year. As soon as I have it, we will turn it around as quickly as we can.

I am totally committed to our world-leading vaccination programme. It is an area where this country leads the world. I am as keen as my hon. Friend and other Members present to hear the JCVI’s final advice on HPV vaccination for boys as soon as possible. The JCVI has helped successive generations of Ministers and, as my hon. Friend said, it will help those who come after me—there will be many, and maybe sooner than we think. It has helped Ministers make decisions that are fair and justifiable, and we need to allow it to complete its advice without too many distractions that could slow it down even further, which no one wants.

We have heard an impassioned case for an HPV vaccination programme for boys from, among others, the hon. Member for Washington and Sunderland West, for whom I have so much respect. As my hon. Friend the Member for Worthing West (Sir Peter Bottomley) suggested, I will send a transcript of the debate to the JCVI to ensure that in the unlikely event there are any issues it was not aware of, that can be reflected in its final advice. It is listening to the debate today. For the reasons I gave at the start of my remarks, I cannot give the House an indication of when exactly a decision will be made, or what that decision might be—trust me, I would love to—but I can say that I will prioritise consideration of the JCVI’s final advice as soon as I receive it.

Surgical Mesh

Sharon Hodgson Excerpts

Thursday 19th April 2018 Commons Chamber

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

I thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and for her passionate speech. Like me, she has been shocked and horrified by the stories we have heard from men and women who have had their lives turned upside down because of surgical mesh. I also thank my hon. Friend the Member for Pontypridd (Owen Smith), who spoke with such passion and knowledge. He was campaigning with the all-party group on surgical mesh implants long before I even came across it, and I am grateful for his contribution and continued leadership.

I thank all Members who have spoken in this excellent debate: the hon. Members for Totnes (Dr Wollaston), for Congleton (Fiona Bruce) and for Glasgow North (Patrick Grady); the right hon. Member for New Forest East (Dr Lewis); my hon. Friend the Member for Peterborough (Fiona Onasanya); the hon. Members for East Renfrewshire (Paul Masterton), for Belfast South (Emma Little Pengelly), for Thirsk and Malton (Kevin Hollinrake), for Glasgow North West (Carol Monaghan) and for Torbay (Kevin Foster); and my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous). The hon. Member for Central Ayrshire (Dr Whitford) spoke for the Scottish National party with such knowledge, and it was a privilege to be in the Chamber to hear her speech. I thank them all for their thoughtful contributions, and I thank their constituents who have allowed their experiences to be shared with us today. It has been distressing to hear their stories and I sympathise with anyone affected by surgical mesh.

Finally, I thank Kath Sansom, who leads the Sling the Mesh campaign, and who I know is watching from the Gallery, for all her hard work in uniting the women affected by vaginal mesh implants and raising awareness of the tragic impact that they have had on so many lives. I thank everyone who is part of that campaign for everything that they do to raise awareness and support women.

After the Westminster Hall debate in October last year, and the media coverage that followed, more women came forward as victims when they realised that the mesh was causing their additional health problems. I am very sorry to say that my 73-year-old mam was one of them. She likes to watch my debates and speeches, as do all our mams, I am sure. When she was at mine one Saturday, while I made lunch, I sat her down to watch some of the speeches that I had made that week. There she was with my iPad: I put on the Westminster Hall debate, it started to play, and I said, “I’m so pleased you haven’t had anything like this done.”

You see, Madam Deputy Speaker, over the past four to five years my mam has been back and forward to the doctors with loads of health issues, from IBS to constant urinary infections, and from stabbing pains in her groin to pain walking and trouble sleeping because of pain and twitching in her legs—and more. It has been never-ending. She said, “I’ve turned 70 and I’m falling to pieces.” She has had cameras everywhere, which is not always pleasant and can be very uncomfortable, but all to no avail. No diagnosis or solution has ever been found. With that background knowledge, the House can imagine my horror when she said, “Oh, no, I just had some tape put in to stop the leaking when I coughed and sneezed!” I had no idea that she had had that done.

As the hon. Member for Torbay said, sometimes women—even your mam—do not like to talk about these things. When I asked her why she had never mentioned it, she said, “Oh, it was quick—I was in and out on the same day. And you’re always so busy, so I just didn’t mention it.” It had not even occurred to her that there could be a connection between what she had been going through for the past four or five years and this procedure that she had had done five years earlier.

As the House can imagine, I went into panic mode, because although we are talking about mesh today, surgeons use many different names for it—tape, ribbon and sling are the more patient-friendly ones. I am also told that they now like to use the phrase “Don’t worry—it’s not the mesh that they talk about in the media.” Surgeons must be absolutely clear with their patients what treatment they are about to receive and address any concerns that they might have, instead of talking about the success of the majority or dismissing those concerns outright.

After the sudden realisation, all my mam’s symptoms over the years suddenly began to make sense and could be attributed directly to the mesh. I am pleased to say that, thanks to the help of the fabulous Kath Sansom, my mam is now armed with all the facts and arguments to take to her GP and surgeon. She has done that and is on the long road to getting reversal surgery, if that is the best option for her. She has also had to come to terms with the fact that she may never be the same again, with the associated guilt that she agreed to the procedure. She trusted the medical profession to do her no harm.

My mam is lucky at the moment, compared with some of the other cases we have heard about today, which she recognises. A Sling the Mesh survey found that more than 78% of patients have pain when walking and sitting; 69% of women have pain that prevented intercourse; more than 60% of patients suffer with anxiety and depression because of the mesh and the symptoms that it causes; and almost 54% suffer with nerve damage. I have seen the piles of medication and medical equipment that some women have to use on a daily basis to try to live a life with a bit of dignity. Before the mesh, these were fit, healthy and, in some cases, young women, as we have heard. Now they need assistance to do simple things such as tie their shoe laces, pick up their children, or even use the toilet. Some have lost their sex lives, their marriage or their job. This is a tragedy for these women and their families. The effects of mesh have been so unbearable that, I am sad to say, some women have tried to end their own lives. Innovative and effective treatments should not do this to patients, and the Government must not stand idly by while women suffer in pain like this. The Opposition continually urge NHS England and NICE to act immediately to update the guidance before 2019—as we have all said—and to suspend the use of vaginal mesh.

The Government’s “Retrospective Review for Vaginal Prolapse and Stress Urinary Incontinence using Tape or Mesh”, published just two days ago, is a first step in understanding the sheer scale of the number of women affected by this scandal. Unfortunately, the effects of mesh are hidden within the document—it takes a bit of a numbers expert to be able to work their way through it. So hidden and complex is the review that, on Tuesday, the Minister in the other place announced that he was giving his expert a month to work it out. I will be waiting with bated breath for that analysis.

It is clear that the review fails to show up all the women who have been treated with mesh in the UK. It shows only the number of women treated in England on the NHS, meaning that patients treated in Wales, Scotland and Northern Ireland, and patients treated privately in England, were not included. The audit does not include the sheer number of women who have gone back and forward to their GP for pain relief or antibiotics but who have not yet been referred to a consultant, or even those women who have not yet even made the connection and considered that mesh could be the problem, as was the case with my mam. Why were those women missed out? What is the Minister doing to ensure that their concerns are heard and that they are counted in the numbers?

When the audit was announced, I called for a suspension of the use of mesh while it was carried out. As the hon. Members for Totnes and for Glasgow North West and others have mentioned in their contributions, medical devices do not undergo any clinical trials or rigorous evaluation in this country. If ever there were a case to prove that that needs to change, it is surgical mesh.

As I have said, and as the hon. Member for Glasgow North West mentioned, if this were a car, an aircraft or even a washing machine or a dryer that was malfunctioning and causing life-changing harm in 10% to 15% of cases, its use would be stopped and the product recalled immediately while the problem was investigated. It would not even need to be as high as that, or even the 1% to 3% that was referred to—just a handful of incidents triggers a recall.

The suspension did not happen, so will the Minister please tell the House in her response how many women have had a mesh implant while the audit took place? Does she know how many women since March 2017 have been treated with a mesh implant or had mesh removed, as the audit went up to only March 2017—a year ago? These newly mesh-implanted women may not have any symptoms now, or if they do they will not necessarily realise that the mesh is to blame, but they may do so in a few years’ time.

Since the Westminster Hall debate last year, the audit and the wider medicines and medical devices safety review, patients who have been treated with surgical mesh—not specifically vaginal mesh—have come to feel that their experiences and concerns are not being considered by the Government. Obviously, I include men in that category. The majority of hernia mesh operations are successful. However, complications can leave patients in chronic pain, which patients were not warned about.

According to NHS data, 10% of people who have had hernia mesh fitted go back to their clinician at some point after their surgery. The former surgeon Peter Jones says that the risks of using hernia mesh are so bad that he himself would not take the risk. Will the Minister respond to the concerns of patients who have been harmed by surgical mesh and elaborate specifically on what the Government are doing to review the harm caused by all surgical mesh—not just vaginal mesh?

Let me repeat my calls to the Government once again: the use of surgical mesh must be suspended and NICE must bring forward its review. A simple, quick and cheap operation has turned far too many patients’ lives upside down. We must stop playing Russian roulette with these patients’ lives. It really is time to sling the mesh.

Cancer Treatment

Sharon Hodgson Excerpts

Thursday 19th April 2018 Commons Chamber

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

It is a genuine pleasure to be speaking in this debate on behalf of the Opposition. Indeed, I am speaking in this Chamber for the second time today. Both debates have been on very important issues.

I thank my hon. Friend the Member for Croydon Central (Sarah Jones) for securing the debate, and for her very moving and emotional speech. I also want to thank the other hon. Members who have spoken in this excellent debate: the right hon. Member for Old Bexley and Sidcup (James Brokenshire), my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), the hon. Member for Mid Norfolk (George Freeman), my hon. Friend the Member for Croydon North (Mr Reed), the hon. Member for Congleton (Fiona Bruce), my hon. Friend the Member for Hove (Peter Kyle), the hon. Member for Torbay (Kevin Foster), my hon. Friend the Member for Lewisham East (Heidi Alexander), the hon. Member for Redditch (Rachel Maclean), my hon. Friends the Members for Hampstead and Kilburn (Tulip Siddiq) and for Ilford North (Wes Streeting), my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh), who moved us all to tears, the hon. Member for Strangford (Jim Shannon), my right hon. Friend the Member for Don Valley (Caroline Flint) and the hon. Member for Glasgow East (David Linden). They all made excellent contributions. Members throughout the House have been visibly moved by the moving testimonies we have heard.

As has been said, no one in the House or in the country escapes being touched at some time in their life by cancer. I lost my mother-in-law to breast cancer 21 years ago. That was one of the reasons why I joined the all-party group on breast cancer and work with it to this day. I thank the Secretary of State for being here. I am very pleased to see him back in place. I know that Tessa and others will be very grateful for his attendance, and for the personal and moving tribute he gave earlier. I also thank the shadow Secretary of State, who also made a personal tribute to Tessa.

I pay enormous tribute to our very good friend and colleague from the other place, Tessa, for her bravery and determination, and for the outstanding speech she gave in the other place. That was another occasion when people were visibly moved to tears, not just in the other place but across the country as it ran on the news all day. She is as much an inspiration now as she has always been throughout her political career. In 1997, as we have heard, she became the first Public Health Minister—she is a predecessor of the Minister who will be responding today. With the then Secretary of State for Education, Lord Blunkett, she set out to build Sure Start, the early years programme of which she should be immensely proud. It has transformed the lives of tens of thousands of children across the country and been a lifeline for parents, some of whom have said that without it they do not think they would even be here today.

I am enormously proud to have played, in a very small way, a part in continuing the fight for early years provision over 20 years on. When I became shadow Children’s Minister, Tessa’s personal support, advice and guidance were invaluable in helping me fight to protect the legacy she had built. I remember one particular conversation when she said that she had told her officials that she wanted to walk into a Sure Start children’s centre and be able to smell the babies, so she would know the centres were being used and that lives were being changed.

Tessa’s optimism and ambition have affected us all over the years, especially in the run-up to, and in the aftermath of, the 2012 London Olympics, which, as we heard in detail, she secured as Secretary of State for Culture, Media and Sport. Even since her diagnosis, Tessa continues to inspire us all with her hard work and determination. I wish her all the love in the world, and I really look forward to joining her a little later with her friends and family for a get-together.

As Tessa said in the other place:

“Today…is not about politics but about patients”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1169.]

I know from my work over many years chairing or co-chairing two cancer all-party groups that we can and do work together when it comes to tackling cancer. The Minister and I co-chaired the all-party group on breast cancer, along with the former hon. Member for Mid Dorset and North Poole, Dame Annette Brooke. I am still vice-chair of that all-party group, and I pay tribute to my fellow officers for continuing their hard work in the group to raise awareness in Parliament of breast cancer.

I also chair the all-party group on ovarian cancer. Observant Members may have noticed that there is always some cancer campaign going on, and last month it was Ovarian Cancer Awareness Month. For the first time, the all-party group hosted a drop-in photo call, challenging MPs and peers to be a “teal hero”. This included wearing a superhero mask and a cape—I do not know whether the Minister came along and managed to get caught—to raise awareness among our constituents of the signs and symptoms of ovarian cancer. I am sad to say that my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), who lost his mum to ovarian cancer when he was a teenager, came along and, complete with a superhero pose, pipped me to the post for “best picture”. I hope that colleagues will join me again next year—I will be looking out for the Minister. Although it was fun, it was for a very important purpose: to raise awareness of the symptoms of ovarian cancer.

Finally in this regard, I pay tribute to the hon. Member for Basildon and Billericay (Mr Baron) for his sterling work as chair of the all-party group on cancer, which regularly unites all the cancer charities and all-party groups in debates and in work throughout the year, and most notably at the Britain Against Cancer conference every December. All-party groups and the many other cancer groups are the perfect example of how cancer is not about politics. I believe that we have seen that exemplified in its best form in the House today, and that in future we can put our politics aside for Tessa and for all cancer patients and truly fight cancer together.

Around 11,400 people were diagnosed with a brain or related tumour in 2015 in the UK. That includes the approximately 470 children under the age of 15 who are diagnosed with a brain or related tumour in Britain each year. I also commend HeadSmart for the work that it does to raise awareness of the symptoms of brain tumours in children. Brain tumours are the largest single cause of death from cancer in adults under the age of 40, and the most common type of solid tumour in children.

There are, of course, challenges to brain tumour research that limit progress in developing innovative treatments. As we have heard, brain tumour research in the UK has been grossly underfunded, with just 1% of the national spend on cancer research being allocated to this devastating disease. That is why the recent announcement that £45 million would be invested in brain tumour research was so very welcome. I hope that some of the funding will be used to create opportunities for collaboration so that research and data can be shared around the world, because there are real and concerning gaps in the research workforce, both at a senior level and in the number of junior researchers entering the field.

There is also insufficient infrastructure for brain research, and the research community is fragmented, with no clear hubs of excellence and limited opportunities for collaboration. We need to address those challenges for the sake of patients and their families so that we can improve the lives of those living with a brain tumour. One way to do that is to ensure that all brain tumour patients are invited to participate in clinical trials, which can lead to significant improvements in survival and quality of life for future patients diagnosed with a brain tumour. However, despite the clear correlation between greater research and improved outcomes, only 3% of people with a brain tumour take part in a clinical trial. That compares with 7% across all cancers, so what steps is the Minister taking to ensure that brain tumour patients are entered into clinical trials?

In June 2017, the Brain Tumour Charity conducted a survey that found that 97% of those with a brain tumour said that they would be happy to share their medical data to help to accelerate research. As we have heard, Tessa has made the historic decision to be the first patient to consent to sharing her data in the hope that her cancer journey can contribute to new cures that alleviate future suffering. Let me again take the opportunity to commend her for her selflessness. I know that where she leads, others will naturally follow.

For Tessa, the Olympic legacy and Sure Start are just two of many legacies to be proud of, but I think that this legacy will be even greater in its reach and importance. For that, we once again thank you, Tessa.

Austerity: Life Expectancy

Sharon Hodgson Excerpts

Wednesday 18th April 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) for securing this important debate and for her excellent and well-informed speech. It is of great interest—not only to me, but to the public, who I am sure will be listening closely to the Minister’s response today. I also want to thank the hon. Members for South West Bedfordshire (Andrew Selous) and for Witney (Robert Courts), my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), for their thoughtful and passionate speeches, even though I do not necessarily agree with all the things that were said.

As we heard, life expectancy has always gradually increased. Between 1920 and 2010, it increased from 55 to 78 years for men and from 59 to 82 years for women. However, the improvement began to stall in 2011 when the coalition Government came in. That cannot be just a coincidence. Since then, for the first time in over a century, the health of people in England and Wales has stopped improving, and has flat-lined ever since.

I must emphasise that researchers do not believe that we have reached peak life expectancy. The Nordic countries, Japan and Hong Kong all have life expectancies greater than ours and they continue to increase, so why is life expectancy flat-lining in the UK? Why is Britain being left behind and fast becoming the sick man of Europe? I know that the hon. Member for South West Bedfordshire said that that was not the case, but academic research by Danny Dorling, published in November 2017, which I have here, said:

“Life expectancy for women in the UK is now lower than in Austria, Belgium, Cyprus, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden, and Switzerland. Often it is much lower. Men…do little better.”

I think the hon. Gentleman needs to check his facts.

The life expectancy gap between the richest and poorest in this country is nothing less than shameful. According to the Institute of Health Equity, the longest life expectancy in the country is, not surprisingly, in the richest borough: Kensington and Chelsea. Men in Kensington and Chelsea can expect to live to 83 and women to 86. Unsurprisingly, you will find the lowest life expectancy in my part of it: the north and Scotland. In Glasgow, life expectancy for men is 73 and in West Dunbartonshire it is 79 for women—10 years of difference for men and seven years for women. The difference within the richest borough, Kensington and Chelsea, is even more stark. Despite living in the richest borough in the country, the most disadvantaged within it can expect to live 14 years less than their most advantaged counterparts. Does the Minister agree that this is completely unacceptable?

The north-south divide remains as relevant as ever when we look at healthy life expectancy—the years that people can expect to live a healthy life. In the south-east, the healthy life expectancy is 65.9 years for men and 66.6 years for women. However, people can expect a shorter healthy life expectancy in the north-east, where men have a healthy life expectancy of 59.7 years and women 59.8 years. That is significantly lower than the England average. Looking after those people during that unhealthy part of life means a huge cost to the NHS. It also means that the inequality gap in healthy life expectancy at birth between the south-east and the north-east is 6.2 years for men and 6.8 years for women.

What will the Minister do to address the life expectancy and healthy life expectancy gap between the rich and poor, and the north and south? It is simply unacceptable that the least advantaged in our society bear the brunt of this Government’s policies—wherever they live. Austerity is not a choice. It is a political ideology, which harms the poorest and the most vulnerable in our communities.

[James Cartlidge (South Suffolk) (Con)]

Rubbish!

[Mrs Hodgson]

It is not rubbish. Professor Sir Michael Marmot warned:

“If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too”.

Sadly, we have seen this across the board. Despite the growing pressure on our health and social care service, the Government are responsible for spending cuts across our NHS, social care and public health services. While demand continues to increase, the Government have taken away vital funding, which could close the life expectancy gap.

Since local authorities became responsible for public health budgets in 2015, it is estimated by the King’s Fund that, on a like-for-like basis, public health spending will have fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16. Further real-term cuts are to come, averaging between 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse among adults of more than £22 million compared with last year and smoking cessation services cut by almost £16 million. Spending to tackle obesity, which the hon. Member for South West Bedfordshire mentioned as a cause of shorter life expectancy, has also fallen by 18.5% between 2015-16 and 2016-17 and further cuts are in the pipeline. These are vital services for local communities and could benefit their health and lifestyle, but sadly they continue to be cut due to lack of funding.

How does the Minister expect to close the life expectancy gap without investing properly in vital public health services? An ounce of prevention is better than a pound of cure. The Government must invest in public health and prevention services, as that could play a significant role in closing the life expectancy gap that we are discussing.

When the Prime Minister made her first speech on the steps of Downing Street—the Minister is nodding, because she knows the quote—she said:

“if you are born poor, you will die on average nine years earlier than others.”

We were all pleased that the Prime Minister highlighted that issue, but I have been left disappointed with her Government’s lack of response to tackle it. We on this side of the House are committed to ensuring that our health and care system is properly funded, so that all children are given the best possible start in life and older people are treated with the respect and dignity that they deserve. I hope that the Minister will clearly outline what the Government will do to close the life expectancy gap.

[Ian Paisley (in the Chair)]

Before I call the Minister, I thank all hon. Members for complying so obediently with the timing that I requested.

 Orkambi and Cystic Fibrosis

Sharon Hodgson Excerpts

Monday 19th March 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the hon. Member for Sutton and Cheam (Paul Scully) for his excellent opening speech, and I thank the 114,000 people who signed the online petition to enable us to debate it. As we have heard, the petition received more than 107,000 signatures in just 11 days—probably a record for such a petition—which shows how important Orkambi is to people with cystic fibrosis and their families.

I also thank my hon. Friend the Member for Dudley North (Ian Austin) for his sterling campaigning on this issue over a number of years, for his passionate speech and for organising the excellent roundtable in Parliament. I was unable to attend the roundtable, but a member of my staff took extensive notes and briefed me fully. I also thank all hon. Members who spoke in the debate. I was going to list them all, but so far there have been 23, and with me and the Minister that will make 25, so I will save everyone from the roll-call. Indeed, at the start of the debate it was standing room only, which shows the strength of feeling on this issue across the House. We have heard very moving accounts about family members and constituents, and that alone should be more than enough to make the case for Orkambi to be made available on the NHS as soon as possible. Finally, I thank the Cystic Fibrosis Trust for its continued “Stopping the Clock” campaign and for all the work that it does to support people with cystic fibrosis.

As we have heard, cystic fibrosis affects about 10,400 children and adults in the UK today. It affects one in 2,500 people, and one in 25 of us carries the gene that causes it. It is a life-shortening genetic condition, with the median survival for an individual with cystic fibrosis currently at just 47 years. Patients with cystic fibrosis therefore have to spend three to five hours every day on aggressive and indiscrete physiotherapy, and need nebulised treatments and strong antibiotics just to keep well. The medicines tackle the symptoms of cystic fibrosis rather than the root cause. That is why new precision medicines such as Orkambi will change cystic fibrosis care for the better.

Kalydeco is the first precision medicine used in this country for people with cystic fibrosis. It has transformed the lives of those receiving it. Patients report no longer needing a tank of oxygen to support their breathing, and greater health stability, so that they can plan their lives more securely. Some are taken off the transplant waiting list, as their clinical status improves dramatically. However, it works for only one in 20 people with cystic fibrosis. In comparison, Orkambi works for eight in 20 people. About 50% of individuals with cystic fibrosis in the UK have the genetic mutation that Orkambi tackles, so the approval of Orkambi for use on the NHS could benefit about 5,200 people living with cystic fibrosis.

Orkambi has been shown to slow decline in lung function by 42% and cut the number of infections requiring hospitalisation by 61%. It gives patients not only more control over their lives but a greater quality of life. Orkambi is available for patients in nine other countries: Austria, Denmark, France, Germany, Luxembourg, the Netherlands, Italy, Greece and the United States. Yet here in the UK, NICE has deemed it to be cost-ineffective, and at least two and a half years after being approved for use it is still not available for cystic fibrosis patients on the NHS. I welcome reports that, after over a year of waiting, dialogue between the drug company Vertex, NHS England and NICE has reopened, and that last month Vertex announced it had proposed a new portfolio approach to the Government on the funding of Orkambi.

I would be grateful if the Minister would elaborate on that in his response and tell us whether the Government are considering the offer seriously. I understand that some hon. Members may have had an update email from Vertex this morning, although I did not; there may be news on that front. I would also appreciate it if the Minister would acknowledge that, given the example of Orkambi, more needs to be done to change how drugs for rare long-term conditions are assessed by NICE. The longer patients go without those precision drugs, the longer they go on suffering irreversible lung damage. That is why we need urgent change.

[Mr Sweeney]

Many hon. Members have referred to the Scottish Medicines Consortium. Of course, healthcare in Scotland is a devolved issue but the issues are the same: there is still a two-year wait to get the matter through. Does my hon. Friend agree that there is a need for a closer working relationship between NICE and the SMC? Perhaps sometimes, with collective bargaining, a deal on price could be reached sooner.

[Mrs Hodgson]

Absolutely, I agree. I do a lot of work, as the Minister does and has done in the past, on access to cancer drugs. The same can be said in that context—that it is a postcode lottery not just within nations but between the nations, and that it need not be. The issue could be explored further.

NICE considers all the different benefits that a treatment could give, including living longer, but also having a better quality of life. That is hard to establish for some rare long-term conditions such as cystic fibrosis, making it hard for drugs to meet NICE’S requirements. There is a need for high-quality data on treatments, so that an accurate quality-adjusted life year model can be created. However, that is very difficult to achieve in short trials, particularly for rare long-term diseases such as cystic fibrosis, where “powering” a trial with enough patients is very difficult. People with long-term conditions often score their quality of life more highly than people who have developed acute conditions after being well, often because of differences of perception. If, during trials, people score their quality of life as high prior to treatment, subsequent quality-adjusted life year gains are lower.

The cost of developing a treatment for a rare disease is also high. Understanding the condition, developing an effective treatment and running the required trials in a small population is expensive. Treatments often have no competitors, so there is dampening of market forces, with negative consequences for the consumer or payer. NICE found that Orkambi was important and effective, but that the cost was too high. Vertex must therefore work as a matter of urgency to bring down the cost of Orkambi, so that thousands of cystic fibrosis patients can benefit from the drug on the NHS. The Opposition are committed to ensuring that all NHS patients get fast access to the most effective new drugs and treatments.

In response to the online petition, the Government responded:

“We want patients to benefit from clinically and cost effective treatments.”

What steps are they taking to bring that about? NICE’S guidance on Orkambi is scheduled to be reviewed in July 2019. Will the Government work with Vertex, NICE and NHS England to ensure that the review is brought forward so that thousands of patients can benefit much sooner from the drug on the NHS? It is clear from today’s debate that we need more and better treatments for cystic fibrosis in the UK. Last year, half of all people who died with cystic fibrosis were under the age of 31. It is unacceptable that while pharmaceutical companies, NHS England and NICE barter, people’s lives are at stake. The Government must therefore take responsibility for negotiating an agreement as soon as possible. I hope that the Minister will take on what he has heard today. I hope he will acknowledge how important it is to find a solution that guarantees that the current situation affecting the pipeline of treatments for cystic fibrosis will never happen again, and that thousands of patients will get access to the most effective drugs and treatments as soon as possible.