Dental Charges

Steve Brine Excerpts

Monday 11th March 2019 Written Statements

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

Dental charges remain an important contribution to the overall cost of the NHS budget. We have taken the decision to uplift dental charges for those who can afford it, through a 5% increase this year.

This means that the dental charge payable for a band 1 course of treatment will rise by £1.10 in 2019-20, from £21.60 to £22.70. The dental charge for a band 2 course of treatment will increase by £3.00 in 2019-20, from £59.10 to £62.10. The charge for a band 3 course of treatment will increase by £12.80 in 2019-20, from £256.50 to £269.30.

The uplift continues with the aim of finding an appropriate balance between the costs paid by service users and those met by the NHS through the contributions of taxpayers.

Those who qualify for free dental treatment will remain entirely exempt from charges. Those under the age of 18, those under the age of 19 and in full-time education, pregnant women or those who have had a baby in the previous 12 months, and those on qualifying low income benefits will not be impacted by these changes.

Even those not entitled to exemption from dental charges, but who are on low incomes, are eligible to receive full or partial help with dental charges through the NHS low income scheme.

This policy will allow us to continue to protect the most vulnerable through exemptions and the NHS low income scheme. We therefore consider that the proposed uplifts in charges are fair and proportionate and will support NHS front-line services.

Details of the revised charges for 2019-20 can be found in the table below;

DRAFT GENERAL FOOD HYGIENE (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT CONTAMINANTS IN FOOD (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT SPECIFIC FOOD HYGIENE (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019 DRAFT GENERAL FOOD LAW (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019

Steve Brine Excerpts

Tuesday 5th March 2019 General Committees

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

I beg to move,

That the Committee has considered the draft General Food Hygiene (Amendment) (EU Exit) Regulations 2019.

[The Chair]

With this it will be convenient to discuss the draft Contaminants in Food (Amendment) (EU Exit) Regulations 2019, the draft Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019 and the draft General Food Law (Amendment etc.) (EU Exit) Regulations 2019.

[Steve Brine]

If one has to be in a Delegated Legislation Committee at 8.55 on a Tuesday morning, this room is a good result. Happy Tuesday.

It is a pleasure to see you in the Chair, Ms McDonagh. The instruments, which all concern food and feed safety, food hygiene and food contaminants, are made under the powers in the European Union (Withdrawal) Act 2018. They make necessary amendments to the overarching food regulations so that we can continue to protect public health from risks that may arise in connection with the consumption of food. The instruments correct deficiencies in the regulations to ensure that the UK is prepared to leave the EU without a deal on exit day. The instruments are limited to necessary technical amendments—the legislation does not allow for anything else—to ensure that the regulations are operative on EU exit day. No policy changes are made through the instruments.

As Members know, the Government have negotiated a deal with the EU and are in the process of taking it through Parliament. The deal is designed to ensure a smooth and orderly exit from the EU. As a responsible Government, we have been preparing for all scenarios, including the outcome that we leave the EU without a withdrawal agreement. We are committed to ensuring that our regulatory controls function effectively after exit day in the event of no deal, ensuring that public health continues to be protected, which is my priority. It is for that scenario that the instruments have been laid before the House.

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I am grateful for the opportunity to intervene on the Minister, and it is a pleasure to see under you in the Chair this morning, Ms McDonagh. Can the Minister reinforce and clarify what he is saying? Is he saying that if there is a deal next week, the regulations will not be necessary, and that if there is no deal next week, and in the event of no deal, the regulations will be necessary for the protection of public safety?

[Steve Brine]

Yes. The regulations transpose into domestic law the good public health requirements that we are part of as a member state. If we agree a deal or a withdrawal agreement next week that is subsequently legislated for, everything that we currently enjoy as a member state will roll over during the transition period. If we then negotiate a future trade deal that incorporates all those undertakings, the regulations will not be necessary, but it is about putting the necessary regulations in place to ensure a seamless bridge between membership and being a third country to protect public health, which is what I am interested in.

The instruments will ensure that UK domestic legislation that directly implements applicable EU regulations continues to function effectively after exit day. The proposed amendments are critical to ensuring minimal disruption to general food and feed law, food hygiene and controls on contaminants if we do not reach a deal. The regulations on general food and feed law, food hygiene and controls on contaminants are key to ensuring the safety of food and thereby public health. Consumers in the UK will benefit from a high standard of food and feed safety and quality. The Government are committed to ensuring that the high standards are maintained.

The main changes are that the instruments will transfer responsibilities incumbent on the European Commission to Ministers in England, Wales, Scotland, and the devolved authority in Northern Ireland. They also transfer to the relevant food safety authority the responsibilities currently incumbent on the European Food Safety Authority, the body that provides scientific advice on food safety to the European Commission, the European Parliament and EU member states. That authority will be the Food Standards Agency in England, Wales and Northern Ireland, and Food Standards Scotland north of the border.

Let me take the regulations in turn, because they start very general and get more specific. The General Food Law (Amendment etc.) (EU Exit) Regulations 2019 ensure that Regulation (EC) 178/2002, which lays down fundamental principles underpinning food law, basic food and feed business requirements, as well as describing certain functions carried out by EU institutions, will function effectively on exit day. The regulation states that food placed on the market must be safe to eat, and it provides for other fundamental food and feed safety and hygiene requirements, including presentation, traceability—we must be able to look one step back and one step forward in the supply chain—the enforcement of regulations, and open and transparent public consultation during the preparation, evaluation and revision of food law. I used the word “presentation”, which is to ensure that we do not mislead consumers. Members may remember that a few years ago there were a lot of concerned constituents because of press coverage about horse meat being sold as certain other meats, and these regulations will ensure that food is what it says on the tin.

The General Food Hygiene (Amendment) (EU Exit) Regulations 2019 ensure that Regulation (EC) 852/2004, which contains basic food hygiene requirements for all food businesses, will function effectively on exit day. It sets out the general requirements for the hygienic production of foodstuffs by all food business operators, through the provision of effective and proportionate controls throughout the food chain to the final consumer. Its farm-to-fork scope covers basic hygiene requirements for food businesses, as well as hygiene requirements relevant for the primary production sector.

[Caroline Flint (Don Valley) (Lab)]

It is a pleasure to serve under your chairmanship, Ms McDonagh. As a former public health Minister, I am interested to hear what the Minister says about this issue, and I feel reassured that as we leave the European Union there is no question of the UK falling behind on food safety standards. In many respects, while being a member of the EU we have been at the forefront of pushing higher standards—in fact, we probably have higher standards than a number of EU member states. Will the Minister say a little more to reassure the public? There have been some wild scare stories out there about how Sodom and Gomorrah will somehow arrive if we leave the EU, and that there will be lightning bolts from the sky, earthquakes, and we will fall off a cliff edge and no longer be able to buy a portion of fish and chips without worrying about our public health.

[Steve Brine]

I thank one of my esteemed predecessors for that point. When we had a referendum on our membership of the EU, we heard talk of “take back control”. Ultimately, that was about many things—it was about sovereignty, the economy and trade, but I do not think it was about weakening the public food standards that our constituents expect. When I delved into this area of policy as part of my portfolio for these statutory instruments, I realised how much heavy lifting goes on in the European Commission to protect that food security, which we benefited from as a member state. I also realised—the right hon. Lady made the point well—how much we have shaped that. The idea that when we are a third country we will want to diverge from those standards is for the birds. If anything, I want us to increase food safety standards, and the idea that leaving the European Union will leave us as a country, and our constituents and the public exposed, is indeed “Project Fear”, and people should be more responsible in the way they use such language. I thank the right hon. Lady for her point.

Regulation (EC) 852/2004 contains a key requirement that food businesses—except primary producers—must put in place food safety procedures based on the principles of the internationally recognized hazard analysis critical control point procedures. That means that each food business must assess hazards to food safety, and put in place steps to ensure they are controlled, thus ensuring the high level of consumer protection that we all expect.

The Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019 relate to Regulation (EC) 853/2004, which covers specific hygiene rules for products of animal origin, and Regulation (EC) 854/2004, which relates to the organisation of official controls for products of animal origin. Let me unpack that. We are talking about meat, fish, dairy and eggs. Regulation (EC) 853/2004, for instance, is the regulation by which we determine what kind of wash we might use on certain products. Our standards, as a member state, say—just to give an example that somebody might be interested in—how we wash chicken after it has been killed. Currently, we wash with drink-water. We will continue to wash with drink-water and the standards that we transpose protect that safety standard, which exists for a reason, and long may that continue. That regulation is about the processing stage—cutting plant standards and standards relating to the wash, for instance.

Regulation (EC) 854/2004, which relates to the specific food hygiene regulations, concerns vet involvement. When I have been to cutting plants, I have seen vets’ involvement at the pre-kill stage, to ensure that the animals have no sign of disease, and at the post-kill phase—which is not to be done after breakfast, I would suggest—to check the carcasses and ensure that there are no signs of ill health. These specific hygiene rules set out the requirements and the specific health standards for establishments on land, or at sea, for the slaughtering process, as I have said, and for the storing or transporting of products of animal origin.

The fourth and final set of regulations in this esteemed grouping, the Contaminants in Food (Amendment) (EU Exit) Regulations 2019, will ensure that the provisions in the three main pieces of EU contaminants legislation continue to function effectively after exit day. These are Council Regulation (EEC) No. 315/93 and Commission Regulation (EC) No. 1881/2006, which is the main one, which sets maximum levels for certain contaminants in foodstuffs. For instance, lead in offal is a possible concern, and that regulation ensures that the maximum level of certain contaminants in that foodstuff is not exceeded.

Finally, Commission Regulation (EC) No. 124/2009 sets maximum levels for the presence of coccidiostats or histomonostats—easy for me to say—in food resulting from the unavoidable carryover of those substances in non-target feed, while associated regulations relate to appropriate methods of sampling and analysis.

The three contaminants regulations protect consumers by ensuring that they are safeguarded from the adverse effects of exposure to contaminants that may be present in food. Chemical contaminants may be present in food from the environment or as a result of growing conditions, which is perfectly natural; it is part of the natural evolution and the natural supply chain. The legislation sets out maximum limits for those certain contaminants in food and provides a clear legal basis on which enforcement action—by local authorities, by trading standards officers or by ports’ health officers—may be taken, where necessary, to protect consumers by facilitating the removal of unsafe food from the food chain.

There are a couple of other points to make. The first is about the impact on industry. I am clear that these instruments do not introduce any changes for food businesses in how they are regulated and how they are run, nor do they introduce extra burdens. These instruments just provide continuity for businesses and the protection of consumers’ interests, and ensure that enforcement of the regulations can continue in the same way—I gave three examples of that. These changes will ensure that a robust system of controls will underpin UK businesses’ ability to trade both domestically and internationally.

It is also important to note that, as with many of the statutory instruments that I have been involved with—in fact, as with all of them—the devolved Administrations have provided their consent for these SIs. We have engaged positively with the devolved Administrations throughout the development of these instruments. That ongoing engagement has been very warmly welcomed, and I place on the record my thanks to all the officials and Ministers who we have worked with.

In conclusion, these instruments are necessary to ensure that our food safety and hygiene legislation continues to work effectively after exit day. I urge right hon. and hon. Members to support the amendments proposed in these four instruments, to ensure the continuation of effective food and feed safety, and public health controls, which our constituents rightly expect. I commend the regulations to the Committee.

--- Later in debate ---

[Steve Brine]

I shall work in reverse and begin with the comments of the hon. Member for Poplar and Limehouse, who is a good man. He may not have been a public health Minister, but if he had been, he would have been a very good one. We have engaged with certain issues many times in Westminster Hall and I know exactly where he would place his focus if he were in my job. Hey, he might be one day—who knows?

To begin with the point about transposition, the simple answers is yes. As I said, the European Union (Withdrawal) Act 2018 allows us only to do the housekeeping. That is effectively what these constant fun Tuesday mornings about. They are about the housekeeping and transposing regulations into domestic law. I cannot imagine why anyone would oppose them, because it would be to oppose the status quo, which, I think everyone agrees, keeps the public safe.

There were lots of questions from my dear friend and shadow, the hon. Member for Washington and Sunderland West. She started where she always does, and I shall start where I always do, with the withdrawal agreement. Let us remember, we are not discussing a deal, or a future trade deal, but a withdrawal agreement—a divorce, if you like. Yes, there is no withdrawal agreement yet, and there are 24 days, but the hon. Lady knows what I am going to say. She has a golden chance next week, on or before next Wednesday, to change that.

As to scrutiny, we have spent quite a lot of time in Committee sittings scrutinising SIs together, and in some ways it has been an interesting spring cleaning process, has it not? We have delved into some regulations that I suspect have not been discussed in this place for a long time. The hon. Lady rightly says that we cannot get this wrong, because we have to bear in mind consumer confidence always. That is why we are so keen to get things right.

The hon. Lady raised the issue of relaxation, but that would not happen under the present process, because, as I said to the hon. Member for Poplar and Limehouse, this is a process of transposition. Any relaxation—or indeed increase—of rules in the area in question would be subject to discussion, consultation and approval by this place. That is when we finally find out what “take back control” means.

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

This follows on a little from what the Minister has been saying, but I understand that rates of food poisoning in the US are 10 times those of the UK, and the death rates from food poisoning are also much higher. Whatever happens next week, will the Minister assure us that any trade deals negotiated with the US and elsewhere will involve the same standards of food safety that we require now?

[Steve Brine]

What I can do is repeat the words of the Prime Minister and the Secretary of State for Environment, Food and Rural Affairs, who have said that there will be no diminution of food safety standards in pursuit of trade deals with the US or anywhere else; and even if such changes were proposed, Parliament would have the final say. Hon. Members can read the paper that was set out last week, on how the Government would conduct future trade negotiations and engage with Parliament. I think we know where Parliament would stand on the matter of diminution of food standards.

[Debbie Abrahams]

rose—

[Steve Brine]

I am happy to give way to the hon. Lady a second time, but then I must make progress.

[Debbie Abrahams]

The Minister is always very kind. Can I assume, then, that he and his Secretary of State have sent a letter to the US ambassador, giving short shrift about our agricultural farming methods?

[Steve Brine]

I do not think that we have sent a letter. I am not sure that it would be my place to do so anyway, but the British Government have been crystal clear that we do not expect any degradation of food standards in pursuit of a future trade deal. That has been said by the Prime Minister, down to those at my lowly rank.

To go back to what the hon. Member for Washington and Sunderland West said about maintaining high standards of food safety, leaving the EU does not change our top priority, which is to ensure that UK food remains safe, and that the label says what it is. The Food Standards Agency is working very hard to ensure that high standards of food safety are maintained. We are committed to having a robust regulatory regime in place from day one that will mean that businesses can continue as normal. That is why we are transposing the legislation word for word.

The hon. Lady talked about RASFF, the rapid alert system for food and feed, to which the UK is a major contributor. RASFF facilitates vital food and feed safety data sharing. It is clearly of mutual benefit to the UK and our EU partners to share food and feed safety information quickly, so securing continued access to, and participation in, the system after leaving the EU is one of our top food safety priorities. We continue to press for full access to that vital data-sharing system in our negotiations with the EU. Even as a third country, the UK will continue to receive information from the EU as required by EU law—it is worth putting that on the record—where a food or feed subject to notification under the rapid alert system has been dispatched from the EU to the UK. However, not having full RASFF access would mean less data than is currently available, which may affect UK timely communications on food safety issues.

With regard to actions that we will take to mitigate the loss of full access, the FSA has been building on proven mechanisms, such as the monitoring of key data sources and a new strategic surveillance programme, to enhance its capability and capacity to respond effectively to any food-borne contamination or outbreak incident that occurs in the UK, for the protection of our consumers. In terms of other international engagement, the FSA is implementing an enhanced programme of bilateral engagement and surveillance that focuses on the exchange of information on risks to the food chain. It is engaging with competent food safety authorities across Europe and worldwide, building on its strong reputation and established contacts to develop a mutually supportive approach to information sharing on food safety incidents.

There is no getting away from the fact that we have decided to leave, and are leaving, the EU. We therefore will leave some of its processes, one of which is the RASFF. However, as I have said, we will do our utmost to secure continued access to it—we were, of course, a huge contributor to establishing it in the first place. If we cannot, some of the mitigations that I have outlined will be important.

The hon. Member for Washington and Sunderland West asked about the FSA. Her Majesty’s Treasury has made significant extra funding available to the FSA to increase staff, for instance, some of whom are in the room. The FSA’s resource has expanded to ensure that it can undertake the assessment and the risk exercise, to ensure food safety. In answer to a direct question, I am satisfied that it has the new resources that it needs.

The hon. Lady asked about the additional burden on industry for enforcement. We do not expect any additional enforcement burdens. The law and the regulations remain exactly the same, which is why I addressed the transposition point first in my response. She also mentioned the need for clarity on the transition period for businesses to implement any changes. As I have said, the transition period will involve the continuation of the existing standards, so businesses will not need to adapt to any extensive changes.

I was asked whether we will fund local authorities for additional burdens. We are providing support to enforcement officers in local authorities to allow them to continue to enforce the legislation. However, no policy changes are being made in practice. For labelling changes domestically, the transition period will be considered. We may talk about such statutory instruments in future happy moments, but today’s legislation is not about the labelling of products. Of course, we will have a whole new freedom once we leave the European Union in terms of labelling. I have talked about that in other policy areas—around obesity, for instance, with traffic light labelling.

The hon. Lady talked about 60 minutes of familiarisation not being realistic. Were there substantial changes, I suppose that that would not be realistic, no matter how fast one reads. However, businesses will need little familiarisation time, for the reasons that I have said.

Finally, the spokesperson for the Scottish National party, the hon. Member for Motherwell and Wishaw, talked about the importance of Scottish food exports. They are indeed very important to the country, including within the UK single market. That is why there is some level of consistency, and why we expect to have convergence across the four nations of the UK. That is very important for the internal market, and for Scottish food exports to the EU. I know what I would do if I represented a seat in Scotland and the Scottish food industry: I would ensure that we have a smooth and safe transition out of the EU at the end of March. There will be a golden opportunity for the hon. Lady to do that next week.

Resolved,

That the Committee has considered the draft General Food Hygiene (Amendment) (EU Exit) Regulations 2019.

Draft Contaminants in Food (amendment) (EU Exit) regulations 2019

Resolved,

That the Committee has considered the draft Contaminants in Food (Amendment) (EU Exit) Regulations 2019.—(Steve Brine.)

Draft specific Food Hygiene (amendment Etc.) (EU Exit) regulations 2019

Resolved,

That the Committee has considered the draft Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019.—(Steve Brine.)

Draft General Food Law (amendment Etc.) (EU Exit) regulations 2019

Resolved,

That the Committee has considered the draft General Food Law (Amendment etc.) (EU Exit) Regulations 2019.—(Steve Brine.)

Draft Nutrition (Amendment etc.) (EU Exit) Regulations 2019

Steve Brine Excerpts

Thursday 28th February 2019 General Committees

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

I beg to move,

That the Committee has considered the draft Nutrition (Amendment etc.) (EU Exit) Regulations 2019.

It is a pleasure to see you in the Chair, Mr Evans. I hope we can get through this Committee without talk of avocado—that will seem so random in Hansard, but I enjoyed it.

The people of the United Kingdom currently benefit from world-leading standards of safety and quality for nutrition and the regulation thereof. Our intention is that those high standards be retained and built upon following our exit from the European Union. The Department of Health and Social Care has prepared this statutory instrument to ensure that those high standards are maintained and that the UK possesses a functioning body of nutrition-related legislation that will uphold consumer protection standards and continue to safeguard our public health.

The SI covers a discrete aspect of nutrition legislation that is currently governed by EU law. It includes, first, the health and nutrition claims that food manufacturers can make for the foods they produce and sell to our constituents; secondly, the vitamin and mineral substances permitted for use in the food supplements that so many of our constituents take; thirdly, the vitamins and minerals that can voluntarily be added to fortify foods, such as breakfast cereals or soft drinks; and fourthly, the content of foods for specific groups such as young children, foods that are used for special medical purposes such as by people recovering from an illness, and total diet replacement foods for weight control purposes.

[Chris Stephens (Glasgow South West) (SNP)]

Can the Minister confirm that infant formula will be covered by the statutory instrument? How would he respond to the concern that many of us have about the fact that standards are currently set by the European Food Safety Authority, whereas other places, such as the US, have lower standards?

[Steve Brine]

I will come on to directly address the hon. Gentleman’s point about the replacement for the European Food Safety Authority; I thank him for raising that point. I mentioned foods for young children, which obviously addresses the other point that he made.

The instrument deals with an important area of legislation. Many thriving businesses operate in this space and employ many of our citizens. I reassure those citizens that our overarching aim is that businesses and other interested stakeholders seeking to submit applications, scientific dossiers, relevant files or notifications currently governed by the nutrition legislation amended by this instrument are not burdened with additional regulations or significant changes to the processes. Overall, our policy intention is to mirror the existing regulatory system and processes already in place as closely as possible, and the SI makes all the provisions necessary to do exactly that.

The amendments made by these regulations are primarily technical in nature. They include changing EU-specific references to ensure that they are effective in the UK after EU exit day, and transferring legislative functions from the European Commission to the appropriate UK authority. The amendments also ensure that all relevant EU lists, registers and annexes apply effectively from exit day, enabling continuity for businesses and maintaining the high standards already in place at EU level. Following exit day, any changes made at EU level will not apply in the UK, because clearly we will then be a third country.

One important change made by the SI is the transfer of functions from the European Food Safety Authority, which has already been referred to, to an appropriate expert committee in the UK. For nutrition and health claims, a new UK nutrition and health claims committee would assume responsibility for providing scientific advice to the four UK Administrations on any new claims made about products marketed within the UK’s borders. That committee would operate in a similar way and to similar timescales as the current EFSA process, providing further continuity to business. I am pleased to confirm to the Committee that the process for recruiting specialist members is well under way: high-calibre applications were received, interviews took place earlier this month, and the committee is ready to come into effect if required. We will announce its members shortly.

Regarding the devolved Administrations, the SI allows for the relevant Commission powers to be transferred to the Secretary of State here in England, Scottish Ministers, Welsh Ministers and, in Northern Ireland, the Department of Health in Stormont, thereby making provision for each of the Administrations to make their own legislation. In addition, if consent is provided by the devolved Administrations, the SI gives the Secretary of State the power to make legislation for the whole of the UK where that is appropriate and agreed to.

The devolved Administrations have been involved with the drafting of the regulations at every stage. I want to state on record that I am grateful for their continued collaborative approach in this area, helping to make sure that this policy continues to operate at the same high standards after our exit from the EU as it does now, as expected by Members of this House, by me and, most importantly, by the British public.

[Martin Whitfield (East Lothian) (Lab)]

The regulations specifically require the consent of the devolved authorities for the regulations to be made across the UK by the Secretary of State. As MP for East Lothian, may I welcome that explicit statement, which is perhaps lacking in some other instruments?

[Steve Brine]

Yes, you may.

[Mr Robert Goodwill (Scarborough and Whitby) (Con)]

The Minister has not referred specifically to kava kava, a foodstuff that can have similar effects to alcohol and that was banned by the United Kingdom in 2003 because of the effects it can have on the liver. Under EU regulations, we could not ban the transit of kava kava. Once we have left the EU can we actually ban its transit? Many people are worried that these goods can be bought online and the transit of kava kava may be intercepted as it passes through the UK.

[Steve Brine]

I cannot say that I am familiar with kava kava, but because we are closely aligning in this area, everything that we have agreed to thus far would be transferred. After exit day, as I said, nothing new would be transferred, but it would then be for the body I mentioned that is being set up and members appointed to it, through accountability to me, to the Secretary of State and to this sovereign Parliament, to make any changes that it deemed were appropriate. I have a funny feeling that my right hon. Friend might return to this subject after exit day, and he would be entitled to do that. I dare say it would be one of the benefits of taking back control.

As the statutory instrument proposes no significant changes to the current regulatory regime, we estimate that there will be no significant impact on the public sector. Regarding the impact on industry, we have consulted with industry and other interested groups through our public consultation, which ran in December. Our analysis of the consultation showed that overall respondents were supportive of the proposals, but more detail was sought on how they might work in practice. We published our consultation response on Monday 25 February. We are confident that the guidance, which my Department is due to publish shortly, will provide all the additional details that respondents requested. I will ensure that, after publication, it is copied to members of the Committee, who I am sure will retain an interest in this matter after we leave Committee Room 9 today. Respondents should be reassured that our guidance is currently being tested with stakeholders to ensure that it is fit for purpose, and exposes industry and other affected parties to minimal procedural changes.

The British public and food manufacturers will not lose out in any way from the amendments contained in this statutory instrument as a result of Britain leaving the European Union. I believe it is important to stress again that the amendments will provide continuity for businesses and ensure that the exceptional standards of safety and quality for nutrition regulation already in place will continue long after our exit from the EU. I have said time and again publicly and before the Select Committee, and I will repeat again now, that there is nothing about us leaving the European Union that in our view will degrade our capability or responsibility to the British public in this area. I am not sure I can be clearer about that. I commend the regulations to the Committee.

--- Later in debate ---

[Steve Brine]

I am sorry to hear the hon. Member for Glasgow South West say that he will vote against the instrument. I do not think it is a terrible piece of legislation at all. It is sensible legislation that aligns us with the European Union after exit day, as is our intention.

The hon. Member for Washington and Sunderland West said that it is disturbing that we are still preparing for no deal. Well, it would be more disturbing if we were not. Bluntly, the House has an opportunity on or before 12 March to see that no deal does not happen. If it decides to decline that opportunity, it has another opportunity after 12 March to see that it does not happen. Last night’s votes in the House may have given an indication as to what that would be, but I could not possibly comment. The hon. Lady probably has the votes app on her phone as much as I do. In terms of who started this, well—

[The Chair]

Order. Can I say that I am finishing it?

[Steve Brine]

Maybe it is set in stone. Members can work out what I mean by that.

The hon. Lady asked lots of different questions. About the impact on business, we appreciate that there may be an additional administrative burden on companies that would have to submit claims to the UK and the EU if they wish to make the claim in both areas, but our intention is that procedures for submitting claims in the UK will closely follow those already in place for the EU. We have been in that family for some 40 plus years.

Leaving the European Union is a complex process, to put it mildly. It is not just about trade deals, reciprocal healthcare and citizens’ rights. It is about complex supply chains at every level of business, and there is a complex supply chain around nutrition regulation. It would be an act of foolishness on our part to diverge too far and we do not intend to do that. We estimate that the application paperwork should take only 30 minutes to complete, and rightly so.

In terms of future divergence with the EU, we will make sure that we continue to review the situation to make sure we stick to regulatory alignment with the EU, as deemed appropriate by the Government and ultimately by this House, which holds the Government to account. I am content, as is the Government, that the SI maintains regulatory standards and nutrition policy in a no-deal scenario, and therefore an impact assessment is not required. I have already said that businesses will have to spend a short time on administration.

We completed an equalities impact assessment. We found that the measures set out in the instrument do not have an impact on any of the protected characteristics as defined in the Equality Act 2010.

The hon. Lady asked why the consultation period was just 10 days. To be factual, it was not. It was 11 days—[Laughter.] That is #factualnews. A consultation’s duration is generally determined by the proposals it contains, and in this case we are proposing to mirror the existing regulatory regime as closely as possible, ensuring minimal disruption to business. With that in mind, we consider the consultation period to be entirely appropriate and in line with Cabinet Office consultation principles.

We received 31 responses to the consultation—a case of quality over quantity. We are pleased that they included responses from a broad spectrum of groups, including manufacturers, trade bodies, members of public and one local authority. The response was supportive of the proposals to mirror the existing regulatory framework, as I have already said. We are working with the Department for Business, Energy and Industrial Strategy’s business insight group—now there is a catchy title—to sight the industry on proposed guidance and to obtain its feedback.

Infants are deliberately not mentioned in the SI, because the issue does not apply on exit day. Our current policy intention is to make domestic legislation that is consistent with regulation 609/2013. That includes requirements for foods for special medical purposes developed to satisfy the nutritional needs of infants and for infant and follow-on formula, which are important. The Department will issue further advice on that once the EU exit position is clarified, which clearly is yet to happen.

I was asked whether the UK will continue to be a member of EFSA after we leave the EU. I have said no. The nature of our future relationship with EFSA will be subject to negotiation with the EU, and that is not just in terms of the withdrawal agreement. The SI provides for the appropriate expert committee—I appreciate that the acronym is not ideal—to assume EFSA’s functions in a no-deal scenario, which will guarantee certainty.

The hon. Member for Glasgow South West asked what will happen in relation to products banned in the EU after exit day. As I said in my opening remarks, products that EFSA approves after exit day will be for it to approve for the remaining member states. In terms of the relationship between our new committee and EFSA, we have a long tradition of close scientific collaboration with EFSA in this country. We value it greatly and very much hope and intend that to continue in the future. If EFSA makes a decision on a product, it would be most unlikely that our new committee, whatever it is called, would not take notice of that. We want to continue close regulatory alignment in this policy area so that the public have confidence and so that, returning to my first point, businesses do not face an undue burden in getting products covered in both areas.

Public Health England is in the process of recruiting specialist members for the UKNHCC, including the chair. The recruitment was open and transparent: it was advertised on gov.uk from 8 November to new year’s eve; high-calibre applications were received and the shortlisted candidates were interviewed last week. The committee is ready to come into effect if required. I do not have the names here, but I know that recommendations for appointments to the committee have been shared with the devolved Administrations. They have confirmed that they are content with the calibre and experience of the recommended individuals. Appointment letters will be issued shortly; once accepted, they will be published. I have already said I will publish that to members of the Committee.

Finally, guidance is being developed and tested with industry to ensure that it is fit for purpose, is closely aligned and clearly communicates to business any changes in the process that would occur in a no-deal scenario. That guidance will be published shortly—certainly before exit day, which we still hope will be 29 March.

[Mrs Hodgson]

On a point of clarity on the lack of mention of infants, I heard what the Minister said, but there is a lack of clarity on whether there will be a gap between the situation in the EU and the regulations here. Will that gap exist? Will there still be a difference? I know he is sort of saying that he cannot say what the position will be at the moment, but will he seek to ensure that there is no gap?

[Steve Brine]

Not only will I seek to ensure that there is no gap, but I will very much take that as feedback from Her Majesty’s Opposition on the regulations and ensure that it is fed through to the new committee as it is formed. I understand the concerns expressed by the hon. Lady and the Scottish National party spokesman in that regard.

Question put.

Dental Health: Older People

Steve Brine Excerpts

Wednesday 27th February 2019 Commons Chamber

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

I realise that a debate on older people’s dental health is merely of passing interest to you, Mr Deputy Speaker, as you are many years from it being of direct interest, but I hope you enjoy my response.

I congratulate my good friend, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), on securing time for this debate and on setting out his case so clearly. I will do my best to answer his points in the time available. As he knows, I will write to him on anything I do not answer.

Oral health has improved significantly over the 40 years that I have been alive. At the start of the NHS—it is worth noting this incredible statistic—40% of the population had no natural teeth. The figure is now—answers on a postcard—6%. These massive improvements are to be celebrated but, of course, with improvements come new challenges.

As we are all aware, older people—we categorise those aged over 65 as older people for the purpose of this conversation—make up an increasingly large proportion of the population. By 2032, we project there will be 13.5 million people aged 65 and over in our country. Older people are retaining far more teeth, often heavily filled, than previous generations. As people age, so do their fillings and all the other bits of their bodies, and ongoing restorative work is needed.

Many older people live independently and are in full charge of their oral health, as are working-age adults, but we recognise that frail older people—those with additional needs, often living in care homes or supported to remain at home, as my hon. Friend set out—can face real barriers to accessing the appropriate care and support they need to maintain good oral and dental health.

My hon. Friend set out some of the reasons why good oral health is an essential part of active ageing. We know that poor oral health can affect an individual’s ability to eat, which can lead to an acute episode and an encounter with the tertiary sector, or even to speak and socialise. Obviously, poor oral health hits their confidence and then it spirals. For older adults who are frail, good oral health is particularly important to maintaining hydration and the ability to eat comfortably and easily, which helps them to stay healthy and independent for as long as possible, and even to stay well in a care home setting.

As we set out in our 2017 manifesto, we are committed to improving the nation’s oral health, from children right the way through to older people. The NHS long-term plan, published last month, set out our plans specifically to ensure that individuals in care homes are supported to have good oral health. My hon. Friend raised that point.

The long-term plan national implementation framework, due to be published later this spring, and the national implementation plan, due to be published this autumn, will provide further information on how the LTP will be implemented, but I will now turn to the five specific issues raised by my hon. Friend.

[Andrew Selous]

The Royal College of Surgeons obviously raised concerns about people who use domiciliary care agencies. While there is still time, will it be possible for the NHS long-term plan to address that issue, too, so that we look after all older people whatever type of care they receive, not just those in care homes?

[Steve Brine]

I will touch on that, but I take my hon. Friend’s point. I will make sure it is flagged up in writing as a note from me, the Minister, to the relevant officials as a response to this debate.

In 2016, the National Institute for Health and Care Excellence published its “Oral health in care homes” report, which was an important piece of work. As we know, it set out a number of recommendations for care homes to help maintain and improve oral health and ensure timely access to dental treatment for their residents. In dental health, as in every other part of health, prevention is better than cure.

I completely agree that we expect care homes to follow NICE guidance and NICE recommendations in this area, as in every other. Alongside the importance of appropriately trained staff, my hon. Friend makes an important point about the role regulators can play in this area.

The Care Quality Commission is responsible for this area, as it is for many other areas of policy, and it is currently looking in depth at oral health for older people in residential care settings, and much needed that is, too. So last autumn, the CQC’s dental inspection teams joined adult social care inspectors on visits to about 100 care homes to gain a better understanding of the oral health care support for residents. I know that the CQC intends to publish the findings later this year. I have asked to be kept updated on the progress of this work and to have early sight of its findings. I will update the House and my hon. Friend in particular on this, given his interest and the fact he is a member of the Health and Social Care Committee. I will make sure the rest of the Committee are aware of this as well.

We should also recognise and highlight the ongoing work of NHS England and Public Health England, which I sponsor within my portfolio, to improve the oral health of vulnerable older people. As is referred to in the long-term plan, NHS England considers oral health for older people, particularly those in care homes who may be vulnerable, an important issue. I have asked also to be kept updated on progress as NHS England takes forward action on this and other areas highlighted in the plan.

Public Health England has published “Commissioning better oral health for vulnerable older people”—a snappy title—which is designed to support commissioners of services to improve the oral health of vulnerable older adults so that they can lead a healthy, long and meaningful life outside the acute sector. My hon. Friend highlighted the Mouth Care Matters programme, which, as he says, is a local training initiative from Health Education England offering support and training in oral healthcare for the elderly and for hospital staff looking after patients who may need help with mouth care. I know the programme has been very successful locally in Kent, Surrey and Sussex. Decisions on whether to extend the training more widely are for HEE, but I would hope the success of the programme to date means that HEE is able to take it forward to new areas in the longer term, including to his county. I cannot give the nationwide answer that he asked for in his speech, but I suggest that the early signs are positive.

On access to dental services currently, NHS England is legally responsible for commissioning services to meet local identified need, and that includes the commissioning of domiciliary care services, where appropriate. However, it is important to say that where residents can, the care home and the local NHS work together, often very successfully, to ensure that dental services are provided in the most appropriate setting for those residents, whether that is within the care home itself or in a dental practice, or provided by the community dental service. Often people in care home settings will enjoy the trip out to the dentist; it is part of their socialisation and their routine, and we should not overlook that.

I note my hon. Friend’s concerns about the availability of oral health data, particularly for the older age groups. I agree that the adult dental health survey is an important tool for understanding oral health changes over time. I can reassure him that although there is not yet a date set for the next survey, no decision has been taken to discontinue this important source of information. I take this debate as a bit of a nudge to ask more questions about this. If my hon. Friend looks at my track record, for example, on the cancer patient experience survey, which I was clear was an important tool to give me information about cancer patients’ experience, he will see that I place value on such patient health surveys. In the shorter term, I agree that the regularly published NHS dental statistics on numbers of people seeing an NHS dentist could provide more helpful information by analysing the data by age. I am going to ask my officials to work with NHS England and NHS Digital to pursue this further, and I will ensure that my hon. Friend is kept informed on that point.

My hon. Friend made a point about the social care Green Paper, which remains very much a priority but is not yet in reach. The Green Paper will cover a range of issues that are common to all adults with care and support needs, and will bring forward proposals to ensure that we have a social care system in which people know that the care they receive will help them to maintain their independence and wellbeing, and that we have a social care system that we can be proud of. We will publish the document shortly, and it will set out proposals to reform the adult care system. I take the points made by my hon. Friend about the importance of including dental and oral health in the Green Paper. I will make sure that a copy of this remarks is sent to the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage).

In the remaining few minutes, I wish to touch on the prevention Green Paper. We set out our prevention strategy last year, and it is one of the Secretary of State’s three priorities. We are now in the process of developing the prevention Green Paper, which is an exciting piece of work with which to be involved. It will be called “Prevention is better than cure” and will do exactly what it says on the tin. I will engage with key dental stakeholders—including the British Dental Association, Mr Deputy Speaker, so there is no need to tweet me—in the coming weeks. I look forward to those engagements.

In conclusion, although I am disappointed not to have heard from the hon. Member for Strangford (Jim Shannon) during my speech, I know he has already intervened, and I am pleased that we have had the opportunity to discuss these issues. I think this is the first time I have responded to an Adjournment debate on this subject, and I have responded to quite a few. I hope I have been able to demonstrate the Government’s commitment to improving oral health. Of course there is more to do, and that commitment absolutely includes work on the oral health of older people in care homes, as set out in the long-term plan, and in domiciliary care settings. Our plans to engage in the coming weeks with key dental stakeholders on the development of the prevention Green Paper are honest and sincerely meant. I will continue to watch the work of the CQC and the outputs of its report with interest, and I will follow up on the dental survey so that we have the key data we need to improve services for the people we are here for—our constituents.

Question put and agreed to.

Foods Standards Agency: Contingencies Fund Cash Advance

Steve Brine Excerpts

Monday 25th February 2019 Written Statements

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

The Food Standards Agency (FSA) is seeking an advance from the Contingencies Fund to meet its cash funding obligations relating to preparation work for EU exit. This work has been ongoing throughout this financial year to ensure day one readiness ensuring food safety, supply and security.

Parliamentary approval for additional resources of £11,000,000 and capital of £3,000,000 will be sought in a supplementary estimate for the Food Standards Agency. Pending that approval, urgent expenditure estimated at £10,000,000 will be met by repayable cash advances from the Contingencies Fund.

The advance will be repaid upon Royal Assent of the Supply and Appropriation (Anticipation and Adjustments) Bill.

[HCWS1354]

NHS Prescription Charges

Steve Brine Excerpts

Thursday 21st February 2019 Written Statements

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

My right hon. Friend the Parliamentary Under-Secretary of State (Baroness Blackwood) has made the following written statement:

Regulations will shortly be laid before Parliament to increase certain national health service charges in England from 1 April 2019.

In the 2015 spending review, the Government committed to support the five year forward view with £10 billion investment in real terms by 2020-21 to fund frontline NHS services. Alongside this, the Government expect the NHS to deliver £22 billion of efficiency savings to secure the best value from NHS resources and primary care must play its part.

This year therefore, we have increased the prescription charge by 20 pence from £8.80 to £9 for each medicine or appliance dispensed. To ensure that those with the greatest need, and who are not already exempt from the charge, are protected, we have frozen the cost of the prescription pre-payment certificates (PPC) for another year. The 3 month PPC remains at £29.10 and the cost of the annual PPC will stay at £104. Taken together, this means prescription charge income is expected to rise broadly in line with inflation. Charges for wigs and fabric supports will also be increased in line with inflation. Details of the revised charges for 2019-20 can be found in the table below:

Sunbed Use: Health Implications

Steve Brine Excerpts

Wednesday 13th February 2019 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Hosie. I thank my hon. Friend the Member for Mid Derbyshire (Mrs Latham) very much. We use the term “hon. Friend” a lot in this place, but she knows that she is my very good friend as well as my hon. Friend. Well done to her for securing the debate.

I was interested to hear the word search statistic from my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson). It was very interesting, but not at all surprising. The hon. Lady and I spend a lot of time in Westminster Hall, but this is not an issue that we have covered before, although we have obviously covered cancer a lot. This issue affects so many people’s lives. We heard from my good and hon. Friend about how it has impacted on her family and, as the hon. Member for Washington and Sunderland West said, it was very good to hear that she herself has managed to deal with it successfully.

I do not know about other hon. Members, but sunbeds feel very 1980s to me. As someone who was at secondary school in the 1980s, I thought that they had been left behind there, because we do not hear much about them these days, but it occurs to me that there is a large sunbed salon in my constituency of Winchester. There is a reason why the 1980s came into my mind. Hon. Members may remember an episode of “Only Fools and Horses” called “Tea for Three”. The infamous character Trigger has a niece whom Del and Rodney remember from her much younger years and who comes to stay with Trigger for a period. The niece, Lisa, is now 25 and—well, let’s just say that she has matured into a very attractive young lady. Del and Rodney set out to impress her, both thinking that they have a chance. I remember the episode well, and the reason why it is relevant to the debate is that Rodney decides to lie on the sunbed in the flat at Nelson Mandela House to improve his look for young Lisa and falls asleep. Del then turns up the dial, and Rodney spends the rest of the episode with a bright red face—in many ways. It is interesting that tanning was portrayed in that sitcom as a technique to attract the ladies. It backfired, as everything seemed to, on poor Rodney, but it was interesting how it was used and it explains why I connect sunbeds with the 1980s. As we have heard today, however, sunbeds and their impact are very much current phenomena.

As my hon. Friend is keenly aware, there are huge health consequences from exposure to both natural and artificial ultraviolet radiation. The most significant is of course skin cancer, which we have talked about, but there are other impacts, such as sunburn, which is very unpleasant and uncomfortable, accelerated skin ageing—the “prune” factor that we have discussed—eye inflammation, which my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) mentioned, and temporary immunosuppression. Importantly, though, there are measures that we all know we can take to reduce the impact of exposure to UV radiation from the sun, such as using sunscreen and seeking shade. Equally, there are many precautions that should be taken when using sunbeds, such as only using a staffed facility that provides guidance to users and limiting regular use of a sunbed. I will come on to those two points. Younger people who use sunbeds are at greater risk, which is why in 2011, regulations were introduced banning the use of sunbeds by under-18s in England and Wales, as we have heard.

Melanoma skin cancer is one of the most common cancers in the UK today. About 15,500 new cases of melanoma are diagnosed each year and more than 2,000 people die every year in the UK from melanoma. In recent years, skin cancer has become much more common in the UK, which is thought to be the result of increased exposure to intense sunlight on holidays abroad. Many people these days can afford foreign holidays, which come with much fun but also many dangers. It is worth noting that more than one quarter of skin cancer cases are diagnosed in people under 50, which is unusually early compared with most other types of cancer. Cancer Research UK estimates that 86% of skin cancers are preventable. I often say in Westminster Hall debates—my shadow will have heard me say this many times—that two thirds of cancers are down to bad luck and one third of cancers are preventable. When we consider the high percentage of skin cancers that are preventable, we realise that this is an area where we can move the dial in the prevention space. That is why I am interested in today’s debate and so grateful to my hon. Friend the Member for Mid Derbyshire for initiating it.

My hon. Friend referred to the many people who would not have skin cancer if they had not used sunbeds. It is difficult to be certain about how many cases of skin cancer are due to sunbed use, as most people will also have had natural exposure to UV from the sun. Obviously, there are a few people who have skin conditions that mean that they must remain 100% covered up or who do not go outside, for other health reasons. It is vital—my hon. Friend made this point very well, as did others—that the public are fully aware of the risk from their overall exposure to UV and how to minimise the risks.

We have not mentioned vitamin D much in this debate. Vitamin D is a hormone that is very important in musculoskeletal health, and vitamin D synthesis is triggered in the skin through exposure to UVB, including from sunbeds. However, we do not advise people to use sunbeds to enhance vitamin D levels, because any beneficial effect of increased vitamin D synthesis is outweighed by the adverse effects that we have heard about in the debate. We recommend alternative sources of vitamin D, such as dietary supplements.

Public Health England, for which I am responsible, discourages the use of sunbeds for cosmetic tanning, and rightly so. Those individuals who have very fair skin, who burn easily in the sun—I think of the hon. Member for Linlithgow and East Falkirk (Martyn Day) when I say that, and it certainly applies to me—or who have had skin cancer previously would be at increased risk and obviously are advised not to use a sunbed. This is the point that the hon. Member for Rhondda (Chris Bryant) made about the race that we are and the part of the world in which we live.

The Be Clear on Cancer campaigns, which Public Health England leads on behalf of the Government, are designed to raise the public’s awareness of specific cancer symptoms, encourage people with those symptoms to go to the doctor, and promote the diagnosis of cancer at an early stage. We are about to roll out the next iteration of the Be Clear on Cancer campaign, about cervical cancer, on which there was a big debate in this Chamber last month, and we have had the campaign on breast cancer in the past. It is fair to say that there is no shortage of applications for the next iteration of Be Clear on Cancer. And often we are limited in what we can do in those campaigns in relation to the impact that people would then be driven into the health service. However, one of the things that I will take away from this debate is that it would be well worth my placing on the radar of the Be Clear on Cancer team melanoma and skin cancers generally for the campaign as we roll it forward. That will hopefully be one positive outcome from the debate.

It is critical—it is important that Health Ministers say this at the Dispatch Box—that people are aware of their skin. They need to be skin aware—in the same way as so many women have, hopefully, been trained to be breast aware—and to seek advice from their GP if they notice any changes, particularly in terms of moles that itch, bleed or change shape. I remember being taught that as a youngster and I wonder whether the younger generation are still as aware of that health message, but Be Clear on Cancer is something that we can look to with hope.

Let me touch on regulation. The Sunbeds (Regulation) Act 2010 came into force in April 2011 in England and Wales, as has been mentioned, to prohibit under-18s from using sunbeds. Restrictions on sunbed use by under-18s also apply in Scotland and in Northern Ireland. Guidance has been provided to support local authorities’ authorised officers in successfully implementing the Act, by providing information on the duties of businesses and how to carry out inspections. The local environmental health departments in England are responsible for monitoring and inspecting sunbed salons everywhere, except those situated in local authority leisure centres, which are regulated by the Health and Safety Executive. It is worth making that distinction.

My hon. Friend the Member for Mid Derbyshire talked about banning sunbeds. Should they be banned? A range of options to minimise the adverse effects of sunbeds has been considered. Public Health England has contributed to the most recent World Health Organisation review, published in 2017, on the public health interventions to manage sunbeds. Banning sunbeds was one option under consideration, but the adverse impacts need to be considered carefully to avoid unintended consequences, such as increased use of home machines—like Del and Rodney had—with more harmful impacts.

We have to be aware of the unintended consequences. One of the unintended consequences of banning the use of commercial sunbeds by under-18s was the opening of a market for home hire of second-hand sunbed equipment and sunbed parties—believe it or not. I have been to many parties in my time, but I have yet to be invited to a sunbed party. The mind boggles—it is probably best to leave it there. My swimming trunks have not had an outing for years, but that is probably for the best. It is vital to equip people with the information to avoid the risks of over-exposure to UV radiation. In this way, we empower individuals to protect themselves from UV sources.

Before I address prevention, diagnosis and treatment, I will respond directly to my hon. Friend’s suggestion that sunbeds should be banned. I think we need to look at the regulations again, as the shadow Minister mentioned. They have not been changed for a number of years. My hon. Friend has brought this issue to this Chamber with great force, intelligence and evidence. Now is a good time because we have published the prevention strategy and we are working on a Green Paper on prevention. I am interested in any and every idea that is related to prevention.

As a Minister, I am often given papers by officials, and stuff to look at and sign off. However, in this process of preparing the Green Paper on prevention I can say to my officials, “I want real blue-sky thinking here. I want you to look out into academia, to see where the really interesting and cutting-edge work is going on around prevention and future prevention.” This Green Paper process is really open-minded and based on open-source planning. If we look at the evidence and think that banning the commercial use of sunbeds, while taking into account the possible unintended consequences, could be part of prevention, I will not rule it out. I absolutely do not rule that out.

Wherever possible, the aim is to prevent skin cancer from developing in the first place. I met Melanoma UK at the Britain Against Cancer conference just before Christmas. It has a fantastic team, who I am sure have been very helpful to my hon. Friend ahead of today’s debate. I am proud to say that Public Health England and Melanoma UK have had great success in raising awareness of the risks, and the actions to take to reduce the risk of exposure to the sun and the use of sunbeds. The Health and Safety Executive plays a vital role in raising awareness through leaflets and posters, reflecting its guidance for tanning salons and their customers about the safe operation of sunbeds. My hon. Friend used many quotes from people who are engaged in this issue. One interesting quote was from the lady who runs a salon and said that she wants people to feel good about coming into her business, and that sending people away with a potentially life-threatening condition is not a good look for any business. That was an important point.

A tan may give you a so-called healthy glow. The hon. Member for Ayr, Carrick and Cumnock pointed to the magazines and the media image: people always have that healthy glow. However, I have never thought of a good tan as a healthy glow. The National Institute for Health and Care Excellence guidance, published in February 2016, is clear that there is no healthy way to tan. The idea that there is such a thing as a healthy tan, as my hon. Friend said in her opening remarks, is a myth. Any tan can increase your risk of developing skin cancer, whether through natural or artificial UV, and getting a tan does very little to protect your skin from the harmful effects of the sun, which is my hon. Friend’s fundamental point.

NICE, NHS England and cancer charities, including Cancer Research UK and Macmillan, are all clear that if you want browner-looking skin, fake tan is the way to go. It is much safer to use a fake tan product on your skin than to sunbathe or use a sunbed. As the expression goes, “Fake it, don’t bake it”. I think that is what they say in the Department of Health and Social Care these days. I do not know whether you are aware of that, Mr Hosie.

I hope that I have covered a lot of the points that have been raised. I hope that I have demonstrated the Government’s commitment—my commitment—to improving outcomes for people in this country living with skin cancer, and the many more who are at real risk of developing this disease. The Government’s ambitions outlined in the long-term plan for the NHS, the Secretary of State’s prevention strategy, and the Green Paper will ensure that we strive to do even better over the next decade. In conclusion, I agree completely with the hon. Member for Linlithgow and East Falkirk that, while we learn a lot in this place, there is a lot of repetition in many of the debates, but that this debate has not been one of those.

Mental Capacity (Amendment) Bill [Lords]

Steve Brine Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Chris Bryant]

Yes. The Government have effectively already said that, but to be really nasty, we should have had the code before today, in all honesty, even if it was only in draft form, so that we would be able to see what we are really talking about, and I would then not have been talking about these amendments.

I want to bring my remarks to a close as soon as I can. We need to build in an incentive to make sure that there is proper neurorehabilitation provision for people with acquired brain injuries. All too often, patients and carers in this field feel as though they are being processed. That is not because health clinicians are nastily minded, but because people sometimes end up having to deal with so many different departments that they feel as though they are being pushed from pillar to post. That is why it is really important that the Government strike the right note when it comes to the next stage of introducing the code.

Amendment 1 simply says that

“the Secretary of State must lay before Parliament a report on”

the “likely effects” of the Bill on ABI before it comes into effect. Amendment 2 requires the “relevant person”, who could be somebody managing a care home, to consider

“the effects of any treatment undergone by the cared-for person, including prescription brain injury rehabilitation therapy”

in addition to the length of time since the assessment was originally made. Amendment 3 would mean that an authorisation that was not renewed would lapse after 12 months, after a time specified in the original authorisation, or, as I would like it to be,

“at the end of a period of prescription brain injury rehabilitation therapy”.

I think that is key to making sure that there is an incentive to ensure that therapy is provided. Amendment 4 refers to the renewal of an authorisation and requires the responsible body to take into account

“any treatment to be undergone by the cared-for person, including prescription brain injury rehabilitation therapy”.

I do not think that any of those amendments would do the Bill any harm—no harm at all—and I am feeling a bit more grumpy with the Minister than I was yesterday when I met her, so who knows? We might end up voting on them.

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

It is good to see the hon. Gentleman on his feet, but I hate to see him grumpy. He will have my response to his all-party group next week. I promised him a recommendation by recommendation response to his report, the launch of which I attended, and he will have it next week.

[Chris Bryant]

I am very happy with this Minister, but the other Minister—

[Steve Brine]

She’s nicer than me.

[Chris Bryant]

That is true, but she has to prove her mettle on this. I do not mean that in a nasty way; I simply mean that we want some changes.

Prostate Cancer

Steve Brine Excerpts

Wednesday 6th February 2019 Commons Chamber

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

It is always a pleasure to see you in the Chair, Madam Deputy Speaker. Here we are again and for once we are not in a rush. It will be dark outside before we finish. I congratulate my hon. Friend the Member for North Dorset (Simon Hoare) on securing today’s important debate. He entertained us and educated us, and he set out his stall very well.

Let us start with a positive: cancer survival in this country has never been better. Survival rates are at their best ever, having improved every year since 2010. That is a hard-fought success, and we should celebrate it. Among men, prostate cancer is the most common cancer in the UK and the second most common cause of cancer deaths. However, prostate cancer survival has tripled in the past 40 years, with 85% of men surviving for five or more years.

It is worth stating at the outset—some people who are watching may not be familiar with this subject—that the prostate is found only in men. It produces some of the fluid in semen and is found below the bladder. It is about the size of a walnut and surrounds the urethra, the tube that carries urine from the bladder. The causes of prostate cancer are not that well known. The strongest risk factor is age, but about 5% to 10% of prostate cancer is thought to be due to family history. Black men, whether of black African or black Caribbean origin, are more likely to develop prostate cancer than white men. One in four will get the disease, as opposed to one in eight of all men. Asian and oriental men have the lowest chance of developing prostate cancer, which is interesting—we should always look at this sort of data when looking at prevention. I will come on to that point.

The way that prostate cancer develops is not fully understood. It is not a single disease, but a spectrum of diseases ranging from slow-growing tumours that may not cause any symptoms and may not shorten life at all to very aggressive tumours that can kill. We should remember that. As I said, the strongest risk factor is age, but younger people get it, too. I have a school friend who has recently contracted and beaten—I will come on to the use of language in a moment—prostate cancer. He may even be watching today’s debate; he may be mowing the lawn, who knows? We wish him well.

My hon. Friend raised some very good points in his speech, and I should be able to touch on them all. This is a timely debate for all the reasons he set out, but also because it was World Cancer Day on Monday. It was great to see Cancer Research UK light up the Palace of Westminster in pink and blue.

My hon. Friend’s point about language was very interesting. He may have seen a poll by Macmillan that came out last month. It showed how many people with cancer are fed up with the language of war. We often say “cancer stricken” or “victim”. We often call a person’s cancer diagnosis a “war” or a “battle”. We say that they “lost their battle” or “lost their fight” when they pass away. It is no surprise that articles in the media and posts on social networks were found to be the worst offenders. My advice is to be real and honest. Macmillan has launched the “Right there with you” campaign to highlight the challenges posed by a cancer diagnosis and the support that is available. As we all know, Macmillan does fantastic work, including in this House. I urge people to take a look at its campaign.

My hon. Friend also touched on the all-party group on male cancers, formed by my hon. Friend the Member for Lewes (Maria Caulfield) who is a former nurse. It had one of its first gatherings this week. Orchid, the male cancer charity, will provide the secretariat for the group. It is not that well known as a charity, but it is growing fast. I met the charity at Britain against Cancer a couple of years ago, and it is now part of my cancer roundtable work here in the House every quarter. I pay tribute to its works and to the all-party group. I had a good conversation in the Lobby with my hon. Friend last night. We are going to do an awful lot together. The group is very important. If it did not exist, it would need to be invented, and I congratulate her on inventing it.

My hon. Friend the Member for North Dorset raised early diagnosis, so let us deal with that. The biggest weapon we have in successfully treating cancer is early diagnosis. I have said many times, as did the former chair of the all-party group on cancer, that it is the magic key or magic bullet. That is true, but there are many cancers where early diagnosis is all but impossible. We do not see presentation of symptoms until it is very late and then it becomes incredibly difficult. They will be a big challenge for the cancer ambition that I will come on to talk about in a moment.

As my hon. Friend and others said, we men are notorious for not visiting the doctor at the first sign of a concerning symptom. I think that that is changing, but anything that can raise awareness of prostate cancer, where early diagnosis is indeed the magic key, is to be welcomed. I pay tribute to public figures such as Stephen Fry and Bill Turnbull from “BBC News” for speaking out so honestly about their own prostate cancer diagnosis. They provided an invaluable public service in raising the profile and awareness of the disease, giving some men the vital nudge they need to see their GP if they think something is not right. For some men, it can be a quick burst of symptoms that come on very quickly. They can go to a doctor, are seen and treated and have surgery in a very short space of time. For others, it can be a very slow burn.

I hope that the work that Stephen Fry, Bill Turnbull and others have done will have an impact similar to 10 years ago when the TV personality Jade Goody, following her cervical cancer diagnosis from which tragically she died, spoke out about how vital it was for women to attend their smear tests. We had an excellent debate in Westminster Hall last week on Natasha’s Army—there is that word again. Natasha was a 31-year-old mother from Newton Abbott who died of cervical cancer, leaving four young children just before Christmas. Natasha’s Army are her friends and family who campaign on awareness and smear tests. That is so important. The work Jade Goody did led to a huge uptake in screening, enabling the NHS to detect and treat more cancers early. I hope that, as more people talk about prostate cancer, something similar can happen.

[Nick Smith]

I join the Minister in congratulating people like Stephen Fry and the grassroots movements on doing such a good job in talking about the importance of early diagnosis. The hon. Member for North Dorset talked about the important PSA test. The Minister may not have the figures available, but if he does could he let us know the proportion of men over 50 who have had the test? That would be an interesting indicator as to what is going on.

[Steve Brine]

I do not have that figure with me today, but I will write to Members attending the debate and I will tweet it @BrineMinister—but enough of the advert.

Early diagnosis and the NHS long-term plan is where I want to turn next. Straight after the Christmas recess, we launched the NHS long-term plan, which is a seismic piece of work. I would be the first to say, along with many other people working clinically in the field, that we cannot rely solely on the celebrity cases that I mentioned to improve early diagnosis. The long-term plan included a comprehensive package of measures that will be rolled out across the country, with the aim of securing the Prime Minister’s promise, which my hon. Friend the Member for North Dorset spoke about, from party conference back in the autumn: that three quarters of all cancers will be detected at an early stage—stage 1 and stage 2, when they are most beatable—by 2028. The plan will provide new investment in state-of-the-art technology to transform the process of diagnosis and boost research and innovation, with the aim of ensuring that 55,000 more people are surviving cancer for five years in England every year from 2028.

That ambition refers to all cancers, including prostate. When we came out with that ambition, a number of people, in the breast cancer community, for instance, said, “But what about us? We are already above 75%”, and some said, in relation to the rarer and less survivable cancers, “What about us?” It is very important for me to restate at the Dispatch Box that this ambition does refer to all cancers—not just those that afflict men or women, old or young, or that are easily treatable or more difficult and less survivable. We are clear that to achieve the five-year survival ambition, we have to improve outcomes for all cancers, and we will.

As I said, early diagnosis is key. Early diagnosis of prostate cancer is challenging, in truth, because the symptoms are similar to those of an enlarged prostate and very often, there can be no symptoms at all. As has been said, the most common method of identifying an increased risk of localised prostate cancer is the prostate specific antigen test. However, that is not perfect. The House will have seen press reports a year or so ago stating that a raised PSA level is not necessarily a sign of prostate cancer, and that a low PSA level is not necessarily a sign of it not being there either. That is not entirely helpful, but we must always remember in these debates—and I am not a doctor, as is clear—that medicine is not an exact science. I thought that story was a good example of that.

A raised PSA level can indicate prostate cancer, but in some cases it can miss indicating a cancer. It can also suggest a cancer when there is not one, or identify slow-growing tumours that may never cause any symptoms for a man or shorten his natural lifespan. This can all be very difficult in primary care. My hon. Friend talked about GPs, and there is a clue in the name. I sometimes get a lot of flak for saying this, but general practitioners are so called for a reason—they are general practitioners—and we should remember the devilish job that general practitioners have, given the huge variety in what comes through their door.

The prostate cancer risk management programme—the PCRMP; we love our acronyms in the health service—was established so that men considering a PSA test are given information about the benefits, limitations, which I have touched on, and associated risks. It supports GPs in giving and discussing information with their male patients. A pack of materials is available for primary care to help men to make an informed choice about the PSA test, which includes a leaflet that they can take away to discuss with partners. There is also an evidence booklet and summary sheet for GPs. These are all widely available online.

As I said, there are pros and cons of having a PSA test, but it is so important that men arm themselves with as much information as they can and speak to their GP or practice nurse, including when they go for their NHS health checks—I will be going for one of those at the end of this month. I know that it is hard to believe that I am old enough to be called for one, but they phoned me yesterday, so I have been booked in.

As has been said, men over 50 have the right to be given a PSA test free on the NHS once they have discussed the advantages and disadvantages with their GP. The PCRMP makes that very clear to GPs, and, having discussed the pros and cons, no one over 50 should be told “No”, as we have heard today. I will find those figures—I agree that they will be very interesting.

[Simon Hoare]

I am very grateful that the Minister is setting this out in his customary detail. In a circumstance in which all those conversations have taken place, if the patient says, “Thank you doctor, I hear what you say, but I am entitled to have this test, and I want to have this test done,” will the Minister confirm that GPs are obliged to make the referral, rather than saying, “Well, I’ve heard what you said, but I am your doctor and I am not going to let you have it done”?

[Steve Brine]

We do not often use the term, “No decision about me, without me” any more, but I always remember the former Health Secretary—now Lord Lansley—using that a lot, and that is still very true. A patient over that age has every right to request a PSA test, and certainly even more so if they believe that they have symptoms. I would be very concerned about a GP refusing it—I think it would be extremely unlikely for one to do so in such instances—but any patient has the right of travel. Every patient has the right to change GP if they are not satisfied with the relationship that they have. If my hon. Friend did know of an instance of that, I would be very interested to hear about it—as, I suspect, would the Royal College of General Practitioners —but I would be very surprised.

I want to touch on screening, which we talk about a lot at the moment, and I will come on to why. Because of the limitations of the PSA test, there is currently no national screening programme for prostate cancer. In 2016, Prostate Cancer UK, which has been rightly lauded this afternoon, began work to help to develop tests that could form part of a national screening programme. This would potentially involve better blood tests, which are currently in development, combined with more advanced scanning. It is hoping to make that happen in the next five years—nothing happens quickly in this space unfortunately—and I am sure that we all welcome their efforts.

Members will be aware—I have spoken about this quite a lot in the House recently; we have had a number of cancer debates since Christmas—that Sir Mike Richards is leading a review for the Secretary of State of our current screening programmes. As part of that—I met Sir Mike last month—we will consider how we can make screening smarter, targeting those most at risk. We expect that Sir Mike’s work will have positive implications for future programmes. He is an incredibly experienced and respected figure in this space, and I hope that his work will enable us to roll screening out faster when the evidence base is there to support it. I am very hopeful and ambitious about that work, as I know Sir Mike is.

Let us talk about public awareness campaigns, which my hon. Friend mentioned in opening the debate. The Government have to do all that they can to raise awareness of prostate cancer and target high-risk groups, while recognising that there are limitations on how much the public will listen to public health messages from Ministers at the Dispatch Box—I know that it is hard to believe that people do not take this all to heart, but they do not, so we work with our partners.

In 2014, along with Public Health England, we worked on the phenomenally successful “Be Clear on Cancer” campaign, which has had a number of iterations, on prostate cancer in black men. The campaign messaging included:

“1 in 4 black men will get prostate cancer”,

which was one of its tag lines. It urged black men over 45 who were concerned about their risk of prostate cancer to visit their GPs. The campaign evaluation showed that it had stimulated new conversations about prostate cancer among families and the black community. Public Health England has made all the materials developed for the campaign available online, so that groups and other organisations can use them locally if they wish. They are very striking and powerful, and we believe that they were very successful.

We also welcome the work that Prostate Cancer UK is doing with the Football Association to raise awareness through their “relegate prostate cancer” campaign. It is fronted by high-profile celebrity football figures, including the England football manager, Gareth Southgate, and includes the slogan:

“One man dies every 45 minutes of prostate cancer”.

Anyone who can stay awake for “Match of the Day” on a Saturday night—thank goodness for the repeat on a Sunday morning—will see very many people, including the pundits and the managers interviewed afterwards, wearing the badge that I am wearing today. Members will be very familiar with that badge, which demonstrates the widespread support that Prostate Cancer UK has in continuing to raise awareness of this disease.

Let me turn to research, as I come to a conclusion. Research has played a crucial part in the advances that we have made in cancer survival over the past four decades. More than 15 years ago, the Department identified the need for further research into prostate cancer, and we have since worked closely with Cancer Research UK—it was here this morning; I was pleased to pop into its drop-in—Prostate Cancer UK, the Medical Research Council and others, through the National Cancer Research Institute, which is a strategic partnership of the major UK funders of cancer research. NCRI spend specifically on prostate cancer research increased from £17.1 million in 2011-12 to £26.5 million in 2015-16.

[Mary Glindon]

On research, does the Minister think that those who are diagnosed with cancer should be encouraged to take part in clinical trials that aid research and help us to find ways to halt or even cure these horrendous diseases? I think this is underplayed and that we should encourage as many people as possible to help with research by themselves getting involved in trials.

[Steve Brine]

I am happy to agree with the hon. Lady. In her work on brain cancer, the late Baroness Jowell made the point about stimulating new research projects, and that work has been incredibly successful, including subsequent to her death. She also spoke a lot about clinical trials. Anybody diagnosed with a cancer for which there is no significant treatment would want to load the gun with the trial bullet, but there are challenges there. There is only so much that one can do, and there is a toxicity issue with moving from trial to trial that patients do not always fully appreciate, but in consultation with one’s oncologist and physician absolutely it has a critical role to play. Without trials, we would not have any of the treatments we have today, so I thank the hon. Lady for raising that point.

My hon. Friend the Member for North Dorset said that women’s cancers, such as breast cancer and the gynaecological cancers, perhaps get more Government attention. I have to disagree. Last April, the Prime Minister pledged £75 million towards clinical trials for prostate cancer, which will focus on improving early diagnosis and survival rates as well as exploring options for different treatments for men affected by the disease. We expect 40,000 men to be recruited to new research projects with this cash boost. I hope this demonstrates our ongoing commitment to male cancers as well as female cancers.

I am the first guy to hold the post of Public Health Minister in a long time, possibly ever, and it is true that there is a lot of focus on female cancers, but I am determined to raise the bar for men’s health generally, but for male cancers in particular, which is why I was pleased to mention the all-party group earlier.

Alongside the £75 million for research, in 2016-17 the NIHR clinical research network recruited patients to over 90 trials—the hon. Member for North Tyneside (Mary Glindon) raised the point about trials—and other studies on prostate cancer, so there are a lot of trials in this area. The NIHR biomedical research centre at The Royal Marsden here in London and the Institute of Cancer Research also have a five-year £3.1 million prostate cancer research theme.

I started by saying that we do not know everything about prostate cancer. We hope to see these projects deliver more personalised diagnosis, treatment and care of men with prostate cancer through better understanding of the molecular and genetic pathways that determine the non-uniform nature of prostate cancer. The prostate testing for cancer and treatment—ProtecT—trial was the largest publicly funded clinical trial ever to take place in the UK. NIHR funding to date is £40million, which is quite a significant sum.

I agree with what my hon. Friend said about the workforce. The NHS is nothing without the 1.3 million staff on whom patients depend day and night, and for no group is that more true than for cancer patients. We will not achieve our cancer ambitions without an increased cancer workforce, which is why the Secretary of State has commissioned Baroness Dido Harding, working closely with Sir David Behan, who used to lead the Care Quality Commission, to lead a number of programmes to engage with key NHS stakeholders to develop a detailed workforce implementation plan. Baroness Harding and Sir David will present initial recommendations to the Department in March, and these will consider detailed proposals for growing the workforce rapidly alongside the implementation of the NHS long-term plan, including that early diagnosis of cancer target I mentioned.

In connection with that, my hon. Friend mentioned cancer nurse specialists. Health Education England is working to expand the number of cancer nurse specialists and to develop their competencies and routes into training. This will mean every cancer patient having access to a CNS or other support worker by 2021, which I think he will agree is a very good thing.

I have covered today just some of the many initiatives the Government are undertaking in our significant efforts to tackle prostate cancer for many of our constituents, including my friend. I hope I have given the House some information today and a promise of some more. The Government remain totally committed to maintaining and improving cancer survival rates. Prostate cancer is the second-biggest cancer killer among men and is right at the top of our list of priorities.

Finally, I could not close without paying tribute to Prostate Cancer UK, led by Angela Culhane, and the work it does on research and early diagnosis and in supporting men with prostate cancer and reassuring them that they are not alone and that there is often a way out. As cancer Minister, I have been told many times by cancer patients that the cliff edge of an all clear is every bit as bad as the original diagnosis. Owing to our successes, people are living much longer and perfectly normal and full lives after cancer, but we need to support them better, so I pay tribute to the work of Prostate Cancer UK. Its work is invaluable, as is that of all those members of staff who make the NHS what it is. I thank everybody for taking part in today’s debate.

Question put and agreed to.

Orkambi

Steve Brine Excerpts

Monday 4th February 2019 Commons Chamber

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

It is a pleasure to see you in the Chair for the Adjournment debate, Mr Speaker. My hon. Friend the Member for North Herefordshire (Bill Wiggin) and all Members who have contributed to the debate, some of whom I recognise from previous debates, have spoken on behalf of constituents from the heart as usual, regardless of political persuasion, with one voice. That is good to hear. I had a school here this morning, and the students asked me what the biggest misconception about this place is. I said that we get on far more than we do not, even at the moment. If they tune in this evening, they might see that happen. Adjournment debates are always a good example of that, in my experience—and as Public Health Minister, I have significant experience of the Adjournment debate, as does my poor Parliamentary Private Secretary.

Everyone has been speaking without political bias and with one voice, and that voice wants patients to benefit from effective treatments for cystic fibrosis. So do I, and the Government wholeheartedly share that view. We have urged Vertex to accept the fair offer that NHS England has made to the company, which would guarantee immediate access for NHS patients to all Vertex’s cystic fibrosis treatments. I hope that the pleas we have heard from my hon. Friend and other Members once again this evening will go some way to persuade Vertex—I agree that it will be listening intently—to consider NHS England’s fair and best offer.

[Mr Ivan Lewis (Bury South) (Ind)]

rose—

[Ian Austin (Dudley North) (Lab)]

rose—

[Steve Brine]

I will give way once—and that is it—to the hon. Gentleman who rose first.

[Mr Lewis]

I thank the Minister for giving way, and I congratulate the hon. Member for North Herefordshire (Bill Wiggin) on securing this Adjournment debate. We have been debating this in this place for months, and the fact is that our constituents and patients still do not have access to Orkambi. May I say to the Minister that it is time that Ministers themselves took over these negotiations and responsibility for sitting face to face with and eyeballing the company so that our constituents get the justice they deserve? These negotiations between NHS England and the drug company have got us nowhere, despite the efforts of right hon. and hon. Members in this House. Will Ministers now directly get their hands dirty, roll up their sleeves, participate in these negotiations and bring this matter to a conclusion on behalf of our constituents?

[Steve Brine]

Okay, the hon. Gentleman has got his press release with his intervention. Perhaps I should go back on what I said at the start. All he has done is to take away time, on what is a very complex issue, from my trying to set out a response to my hon. Friend’s Adjournment debate.

My hon. Friend has called on the Government to consider making use of the legal provision in UK patent law of Crown use licensing to break, as he rightly puts it, the current “deadlock”. As the hon. Member for Bury South (Mr Lewis) said, in a reasonable part of his intervention, it is a deadlock and it has been going on for some time. I commend my hon. Friend’s efforts in raising this. Indeed, it is right that we consider every possibility. Every effort must be made to ensure that effective medicines are made widely available to cystic fibrosis patients. There is no doubt and no debate about that.

I can assure my hon. Friend that we, too, have considered this option. Indeed, I have received initial advice on Crown use licensing. While the use of these mechanisms is not our preference, we are looking at all options. Crown use licensing is complicated, and it would not represent a quick solution to ensuring patient access to Orkambi. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) mentioned that in her intervention and, sadly, she is right.

The UK is one of a limited number of countries that actively protects the role of intellectual property in medicines development in international forums. We believe, however, that there is a balance to be struck between providing incentives to create and commercialise new medicines and ensuring that they remain affordable to the taxpayer—our constituents.

The 2019 voluntary scheme for branded medicines pricing and access, alongside the statutory scheme for branded medicines, are two mechanisms that are in place for ensuring branded medicines are affordable to the NHS. The 2019 scheme provides for flexible commercial arrangements between companies and NHS England—in other words, the customer in this scenario.

In theory, Crown use licensing could be utilised with respect to Orkambi. However, in the past Crown use has only really been intended or designed to deal with emergencies, where a particular patented product is not available in the UK at all. Crown use has not historically been intended to circumvent commercial agreements or to create a mechanism for the production of medicines at a lower price.

The relevant legislation on Crown use states that compensation would need to be provided to the original patent holder—in this case, Vertex, and that would stick in the throat of many of us—which would need to take into account any loss of profit from not being awarded a contract to supply the patented medicine. Unless an agreement could be reached with Vertex, it would be for a court to decide on an amount in this instance. This would of course need to be paid from the public purse. If a Crown use licence were issued, then there would be a subsequent, critical question about how the medicine would be produced and authorised as the usual licensing requirements would apply, with approval required by the Medicines and Healthcare Products Regulatory Agency.

Vertex has protections in the form of both data and marketing exclusivity for Orkambi, and it will continue to have these for a number of years. As such, unless another manufacturer conducted its own clinical trials, there are no realistic alternatives at this time to produce it and the NHS does not hold such a capacity. Using this route, it could take several—many—years before the drug was available on the market, and it would, in all likelihood, be very expensive for another manufacturer. The total length of time and cost of manufacturing and licensing—plus the compensation to the patent holder and a potential appeals process through the courts, which seems inevitable everywhere we turn these days—could be potentially significant.

We also do not know what impact Crown use would have on the other medicines that Vertex supplies to the NHS or the pipeline of products that it is developing. We should remember—and my hon. Friend reminded us of this in his opening speech—that around 50% of people with CF would benefit from Orkambi; in other words, 50% would not.

Crown use could have the effect of putting patients at a disadvantage, jeopardising access to future medicines and potentially setting a precedent of issuing further licences at very high cost.

[Ian Austin]

Will the Minister give way?

[Steve Brine]

Just because I cannot resist the hon. Gentleman, I will give way to him.

[Ian Austin]

I am grateful to the Minister for giving way. He is setting out all the arguments against Crown use licensing. I agree with the point that he has made in the past—that Vertex needs to show flexibility on this—but I think we all think that the Government also need to show flexibility and to think carefully about whether the NICE guidelines work when evaluating these new, precision medicines. What we would all like to hear from him tonight is what he proposes to do, and what the Government are going to do, to break this deadlock and bring these negotiations to a conclusion.

[Steve Brine]

In response to the hon. Gentleman and to one of the other interventions about compromise and meeting in the middle—there is lots of talk about compromise at the moment—I suggest that the £500 million offer is a pretty good first step from the Government. I suggest that that is a pretty good attempt to meet in the middle. That is our constituents’ money.

[Mr Hepburn]

Will the Minister give way?

[Steve Brine]

I will not.

The hon. Member for Dudley North (Ian Austin) talked about breaking the impasse and breaking the deadlock. I said in response to the point from my hon. Friend about Crown use that I have not closed the door on it tonight. I am not trying to put obstacles in the way. I have been asked a question at the Dispatch Box about the practical realities of making this policy move, and I am setting out for the House’s benefit—on the record for everybody listening and for Members—the practicalities.

My hon. Friend talked about use of similar mechanisms by other countries. It is always interesting to understand what other countries are doing and what they are considering and implementing in their health services—there is much that we can learn from each other. However, I cannot comment on the circumstances that would prompt another country to take these steps; other countries have different health systems, and they do not have NICE. We have said—the hon. Member for Dudley North touched on this in his intervention—that we are looking to review the NICE processes, but we should also remember that NICE is respected around the world. If we did not have NICE, we would probably have to invent NICE—that is the truth for Ministers in this Government, as it would have been for Ministers in the previous Government.

I understand the sense of frustration in this Chamber.

[Mr Hepburn]

Will the Minister give way?

[Steve Brine]

I said I would not.

I think the House gets a minuscule sense of my frustration about the situation. I want this sorted. I have constituents who contact me about this too. I am sure the key question we are all thinking about is, where does this leave us now? I suppose that is the point of the intervention that the hon. Member for Dudley North made. I just want to be clear that we are still taking a very close interest in this matter.

The reason I responded so robustly to the earlier intervention about Ministers getting their hands dirty is that I do not think that is particularly helpful. Ministers are not the customer here; NHS England is the customer, Vertex is the seller and NICE is involved. Ultimately, we have made a very, very generous offer to this company, and I think that it should look again, and look long and hard, at its moral obligations as much as anything else, as somebody mentioned in their intervention.

Of course I recognise the impact that these protracted discussions are having on the daughter of my hon. Friend’s constituent. I heard the lady on the “Today” programme this morning on Radio 4, and it breaks our hearts to hear these stories. Of course we want this sorted. For many of the patients who suffer from this debilitating disease, including constituents of my own, it is extremely disappointing that Vertex rejected the final offer made by NHS England, as well as rejecting the opportunity for NICE to appraise its new medicines.

I have talked about the £500 million over five years; it is the largest ever commitment of this kind in the 70-year history of the NHS—it is not insignificant. It is a huge sum of money and of course NHS England must also fund other drugs for other distressing diseases. My hon. Friend made reference to that. I do not often get asked to come and answer Adjournment debates about spending less on precision drugs for other conditions. There are many, many other drugs that demand our funds. Vertex must re-engage with the NICE appraisal process. We understand the frustration of the CF community. However, it has been made crystal clear to Vertex that its drugs need to be priced responsibly and that any reassessment of Orkambi’s effectiveness must be carried out by NICE’s established process.

The position of Vertex is unreasonable. It is unacceptable to us, to patients and to our constituents. I know that other countries also worry for their patients because of Vertex’s unfair pricing of this drug, so let me put on record once again that Vertex should and must take up the very generous offer that NHS England has made. That offer will improve the lives of eligible cystic fibrosis patients and their families. For all the reasons I have set out, it is far and away the quickest and simplest way to resolve this matter.

Question put and agreed to.