Public Health Grant
Steve Brine Excerpts(5 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Today I am publishing the public health allocations to local authorities in England for 2019-20, based on the 2015 spending review profile.
Through the public health grant and the pilot of 100% retained business rate funding for local authorities in Greater Manchester, we are spending £3.134 billion on public health in 2019-20. We will be spending in excess of £16 billion on public health over the five years of the 2015 spending review until 2020, in addition to what the NHS spends on preventative interventions such as immunisation and screening.
The 2019-20 grant will continue to be subject to conditions, including a ring-fence requiring local authorities to use the grant exclusively for public health activity.
Full details of the public health grants to local authorities can be found on gov.uk and have been deposited in the Libraries of both Houses. This information will be communicated to local authorities in a local authority circular.
[HCWS1221]
Draft Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019
Steve Brine Excerpts(5 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I beg to move,
That the Committee has considered the draft Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019.
It is nice to see you, Mr Sharma.
The draft regulations are made under powers in the European Union (Withdrawal) Act 2018 to make the necessary amendments to the UK’s Blood Safety and Quality Regulations 2005. The instrument will correct those regulations to ensure that the UK is prepared in the unlikely event that it leaves the EU without a deal on 29 March next year.
The UK regulations set out the safety and quality requirements that cover all steps in the blood transfusion process from donation, collection, testing, processing and storage to distribution. The short shelf life of such products means that an uninterrupted process of donation and processing is needed to ensure that the UK has a safe continuity of supply for blood and blood components. Patients rely on the treatments every day, and many people would not be alive today if it were not for the generosity of blood donors—I want to place that on the record.
As a responsible Government, we have been preparing for all scenarios, including that we leave the EU without a deal in March. The draft statutory instrument will ensure that the regulatory regime for blood safety and quality continues to function effectively after exit day. It is important to make the changes for the continued donation and processing of blood and blood components such as plasma and platelets to facilitate a wide range of essential and often life-saving treatment. In addition, the donated plasma is a component of blood that can be used to manufacture medicinal products such as clotting factors and immunoglobulins.
To be clear, the instrument is limited to the necessary technical amendments to ensure that legislation is operative on EU exit day. It confers powers—from the EU Commission to the Secretary of State—to make the technical changes. However, no policy changes are made through the draft regulations, and at this point we have no intention of making any. I commend the regulations to the Committee.
Steve Brine
The hon. Member for Washington and Sunderland West, my shadow from the Labour party, talked about regulation 8. Each blood establishment will be responsible for the labelling, storage and so on of blood. There is no change; the only change to regulation 8 is from “European Union” to “third country”, which of course is what we would become in the event that that happened. We have made sure that the UK blood establishments have capacity for labelling.
The hon. Lady also asked about patient safety. The statutory instrument will ensure that the existing high standards of safety and quality of blood and blood components is continued. There is no increased risk to patient safety.
The hon. Lady and the hon. Member for Eltham both talked about supply. The draft regulations will not affect the supply of blood or blood components in the UK. As the hon. Member for Central Ayrshire from the Scottish National party said, the UK is largely self-sufficient in blood and blood components. We do not routinely import or export blood components.
One exception to that is blood plasma—we import about 6.5% of our total blood plasma units from the EU, as has been said, as a safety measure against BSE for people born after 1996. We are putting contingency plans in place to ensure a continuing safe supply after 29 March. NHS Blood and Transplant will be stockpiling plasma centrally to ensure continuity of supply.
The hon. Member for Central Ayrshire is absolutely right about the importance of that in ongoing medicine and in keeping people safe, which is why I feel confident in saying that there will be no adverse impact on patient safety as a result. That involves fast-tracking shipments at ports and alternative routes being prepared, while partners stockpile alternative medicinal products and consumables.
The hon. Member for Washington and Sunderland West talked about regulatory benchmarks. She is absolutely right to say that that is our work—we have been a member state for 40 years, and we have no intention of diverging from that, because we wrote most of it. One of the reasons why, through this SI, we are updating the powers to give the Secretary of State power to amend the regulations is so that, on exit day—if that happens as we hope it will not happen—we would be in exactly the same place.
Obviously, if the ongoing review in the European Union 27 of the future of blood and blood component products decides to make changes, we would also be in the position of being nimble enough to make changes ourselves to ensure that we stay close to them in a regulatory benchmark way. My views on EU exit are well known, but I do not think anyone voted in order to diverge from our closest partners on blood supply.
Gibraltar is making its own EU exit legislation. The Gibraltar Government have been closely engaged with the Department, and we with them. Gibraltar meets the same standards as the UK, and I see no reason for that not to continue.
On the devolved Administrations, because blood is a devolved competence, the SI confers the EU Commission’s regulation-making powers on to the Secretary of State and on the relevant DAs, with the devolved Administration’s consent. We are engaging with the blood establishments, the Medicines and Healthcare products Regulatory Agency and the DAs to ensure that there is day-one operability for blood safety and quality legislation.
Scotland, Wales and Northern Ireland—dealing with the civil service in the latter—have provided their consent for this instrument, and they have been closely involved in its development over the past six months. I place on record my thanks to those in Scotland and Wales, and the civil servants in Northern Ireland, who have worked well and closely with us to ensure that this is done safely and sensibly.
In answer to a point made by the hon. Member for Eltham, we will go all out to ensure that we do not need the draft regulations. Dare I say it? The best way to avoid no deal is to have a deal, and Members will get the opportunity to agree one when we come back in the new year.
Question put and agreed to.
Independent Breast Screening Review
Steve Brine Excerpts(5 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
The independent breast screening review was announced on 2 May to look into a serious incident in the breast screening programme in England, which resulted in hundreds of thousands of women aged between 68 and 71 not being invited to their final breast screening. I would like to apologise for the distress and suffering caused by this incident.
The review concluded that the policy on the upper age limit for breast screening had been ambiguous since the outset of the programme in 1988. A new specification, issued in November 2013 by the Department of Health and NHS England (NHSE), attempted to clarify how the upper age limit should be defined. However, the specification inadvertently changed the policy, which resulted in a discrepancy between the specification and the IT systems in use, and was not consistently implemented by the breast screening units. This was the source of the incident, which first became apparent in January 2018. The impact of the change in policy was not fully understood at this time.
While subsequent advice provided to the then Secretary of State, my right hon. Friend the Member for South West Surrey (Mr Hunt), was based on an incomplete understanding of what had happened, we welcome the review’s conclusions that the former Secretary of State was correct, based on the information provided, to inform the House of the breast screening incident. The review makes clear that the number of women affected by this incident is significantly lower than previously estimated. Based on the review’s conclusions, Public Health England’s (PHE) current estimate of the number of women who may have had their lives shortened is zero to 34. We agree with the recommendation that PHE progresses as quickly and as sensitively as possible the clinical review with the NHS of all women who may have suffered harm.
The protection of the public’s health has been, and remains, the paramount consideration when responding to this incident. Although PHE was slow to develop a clear understanding of the incident and its causes, we reiterate the review’s praise of the operational response. We would like to put on the record our tremendous gratitude to PHE and the dedicated NHS staff in breast screening centres across England who worked tirelessly to manage significant additional demand and pool capacity across centres to ensure that additional appointments were made available and offered to all women who wanted one.
We agree that there is an urgent need to clarify how we define the upper age limit for breast screening. We will commission the UK National Screening Committee (UKNSC) to provide advice as soon as possible on the scientific evidence to support a precise definition of age. On the basis of the committee’s advice, we will ensure that a new, fit for purpose specification for our national breast screening service is agreed and is reflected in the programme’s delivery. DHSC will work with NHSE and PHE to ensure that the management of local breast screening units, quality assurance of the service they provide, and the national breast screening programme performance indicator are consistent with the new service specification.
We agree it is vital to ensure clarity in roles and responsibilities within each of the national cancer screening programmes, and in accountability arrangements for how these services are commissioned and delivered. We welcome the report’s reference to the comprehensive review of cancer screening programmes by Professor Sir Mike Richards that was recently announced by NHSE. Terms of reference will be published once we have had an opportunity to fully reflect on the review’s recommendations.
We also need to ensure that our current systems adequately support effective delivery and we acknowledge the review’s criticisms that the current national breast screening system (NBSS) is outdated. We welcome the review’s conclusion that the introduction of breast screening select by PHE in 2016 was a step forward. I can confirm that Government have already committed an initial £1.8 million to design a replacement for NBSS.
We will continue to monitor closely all screening IT systems to ensure they are robust and operating as they should. A series of fail-safes to ensure the monitoring of the use of “call and recall” systems within breast screening offices has already been put in place, together with additional national assurance to ensure that these fail-safes are being used effectively.
The AgeX trial will continue as planned. The trial will provide significant new evidence on screening women under 50 and over 70 that simply is not available now, providing the evidence needed to make decisions about the age range for breast screening.
It is essential that we take all necessary actions to learn from the mistakes made. We will consider the review’s report and its recommendations in detail over the coming weeks and will provide a substantive response in the new year. I would like to record my thanks to the co-chairs of the review for their thorough report.
[HCWS1175]
Clinical Negligence Indemnity Cover
Steve Brine Excerpts(5 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Today, the Department of Health and Social Care is launching a consultation seeking the public’s views on the regulation of clinical negligence indemnity cover. All regulated healthcare professionals are required to hold appropriate clinical negligence cover for the risks of their practice, covering the costs of defending clinical negligence claims and damages awarded to patients. This is a condition of registration in the UK for all regulated healthcare professionals, and in the case of medical practitioners, a condition of licence under s.44C of the Medical Act 1983.
The current state-backed clinical negligence scheme for trusts provides cover for professionals working in NHS trusts, and it is anticipated that a future state-backed scheme will provide clinical negligence indemnity cover for NHS general practice in England. The Secretary of State announced his intention to develop the scheme in a written ministerial statement on 12 October 2017, Official Report, column 27WS. The Welsh Government are also planning to introduce a state-backed scheme for general practice indemnity.
Regulated healthcare professionals who are not covered by state-backed indemnity schemes are indemnified either through membership of a discretionary indemnity provider, such as a medical defence organisation, or by holding contracts of insurance with commercial insurers. Discretionary indemnity providers are not subject to financial conduct or prudential regulation.
The consultation will consider whether regulated healthcare professionals who will not be covered by any state-backed scheme should continue to be permitted to hold unregulated discretionary indemnity cover.
The Government’s objectives are to ensure patients’ access to appropriate compensation in the unfortunate event of them suffering physical injury as a result of clinical negligence, and that healthcare professionals hold stable and sufficient cover enabling the costs of legitimate claims to be met. This will provide regulated healthcare professionals with greater clarity and confidence about the security and terms of their cover.
The consultation will be open for 12 weeks. Following consideration of responses to this consultation, if the Government are minded to introduce regulation, the Department will consult on the options for such regulation. I will inform the House of the Government’s response to the consultation when it is completed.
[HCWS1150]
Health: Branded Medicines Pricing
Steve Brine Excerpts(5 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
My hon. Friend the Parliamentary Under-Secretary of State for Health (Lords) (Lord O’Shaughnessy) has made the following written statement:
Further to my written ministerial statement of Friday 23 November, I am pleased to announce that final agreement has been reached on the 2019 voluntary scheme for branded medicines pricing and access between the Department of Health and Social Care, on behalf of the UK Government representing the Governments of Scotland, Wales and Northern Ireland, and the Association of the British Pharmaceutical Industry.
The scheme terms are detailed in the documentation for the agreement, a copy of which has been deposited in the Library of the House. The 2019 voluntary scheme has now been agreed by all parties, and will commence on 1 January 2019 for a period of five years.
[HCWS1144]
Health Technology Assessment Charges
Steve Brine Excerpts(5 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Mr Speaker, you are remarkable for sitting here for all this time. I share the admiration for you, if not your football team after Sunday afternoon. Less said about that the better. I cannot even believe I have raised it. I know that you will have been there and will have enjoyed it. I just have to take my hat off to the 4-2 score. The return leg will come.
I am disappointed that only you, Mr Speaker, my Parliamentary Private Secretary, the Whip and my hon. Friend the Member for Newton Abbot (Anne Marie Morris), who introduced the debate, and I are here. An Adjournment debate without the hon. Member for Strangford (Jim Shannon) is a rare thing. I can only feel that he will come running in at any time.
I have been asked to reply to the debate on behalf of the Under-Secretary of State for Health, Lord O’Shaughnessy, who sits in the other place and has responsibility for this policy area. I take a keen interest in it, as he knows. My hon. Friend the Member for Newton Abbot has a keen interest in this matter, both on behalf of her constituents and in her capacity as chair of the all-party group on access to medicines and medical devices, which I know she chairs with aplomb.
The main thrust of my hon. Friend’s remarks was about the charging process the NICE has proposed, but let me reiterate to the House that the Government are committed to ensuring that patients can benefit from rapid, consistent access to effective new treatments. It is always important to say that in these debates. NICE plays a key role in this aim, through its technology appraisal and highly specialised technologies programmes. Through both programmes, NICE produces authoritative evidence-based guidance on whether drugs and other treatments should be funded by our NHS. Where NICE recommends a treatment as value for money, the NHS is required to make funding available, so that the treatment can be provided when it is clinically appropriate for a patient. That is reflected in the NHS constitution as a right to NICE-approved treatments, as it should be. Since it was established, NICE has recommended around 80% of the drugs that it has assessed. Many thousands of our constituents have benefited from access to effective new treatments as a direct result of its guidance.
Over almost 20 years, NICE has gained a firm reputation as a world leader in its field, and I was pleased to hear my hon. Friend talk about us wanting more NICE. When I travel around—at the G20 last month, for instance—and talk to fellow Ministers, they are always respectful about and look with some envy at what NICE achieves as an organisation. If we did not have it, we would have to invent it, so it is crucial that the methods and processes for making recommendations continue to evolve and develop to meet new challenges. I totally take my hon. Friend’s point about the NICE methodology review next year. These issues will be talked about within that process, of course.
My hon. Friend talked at length about charging. We think it extremely important that we have a system such as NICE in place to ensure that the NHS spends its money—public money, our constituents’ money—in the most effective way possible. It is critical that NICE’s work operates on a sustainable footing in a way that enables it to continue to be responsive to developments in the all-important—I completely agree with what my hon. Friend said—life sciences sector.
To date, NICE’s technology appraisal and highly specialised technology programmes have been funded through the resources that it receives from Government. However, in common with all Government bodies, it is right that NICE considers how to operate with maximum efficiency, as well as who stands to benefit from the services that it provides. My hon. Friend is absolutely right to talk about the robustness of how it spends money and looking at efficiencies across the board. As she rightly points out, that is why it will be doing its methodology review and why it does that regularly. It is also essential for us that NICE continues to be able to respond to continuous change in the global life sciences market—it is a global market, of course—whether with the ever-growing movement towards personalised medicine or an increasing number of medical devices and digital products.
For that reason, the Government and NICE believe that the most appropriate and sustainable method for NICE’s appraisal programmes in future is for NICE to charge the companies that benefit directly from its recommendations. This is not without comment and controversy, as we have heard this evening, but it also has support. To this end, the Government carried out a public consultation between 10 August and 14 September on proposed changes to regulations that would enable NICE to charge companies for the cost of making technology appraisal and HST recommendations. The consultation followed extensive engagement by NICE with the life sciences industry on a possible charging model. During that engagement, NICE heard clearly from companies that it would be important to ensure that there was some mechanism for minimising the impact of charges on small companies—my hon. Friend rightly referred to that—wanting the NHS to invest in their innovative and effective new products.
The Government are committed to ensuring that there is appropriate support for small businesses—I do not know whether my hon. Friend saw my speech before the debate, but she seemed to know a lot of what was in it—and she is right that this was reflected in the Government’s recent consultation that proposed a small discount for small companies and provision for small companies to pay by instalments. That was in there, too. We are especially keen in the response to pitch this right as we move from the consultation to the Government response. That is probably as much as I can say about that, but I repeat: we are keen to pitch that right for small companies and have listened to responses, including from my hon. Friend, to that consultation. It also gave a clear commitment to reviewing the charging mechanisms over time to ensure that they are fit for purpose and respond to developments in the life sciences sector.
We received 78 responses to the consultation from a range of audiences, including the life sciences sector, the NHS, patient groups and professional groups, as well as my hon. Friend through the all-party group. A range of issues were raised in response to the consultation, such as NICE’s impartiality and the impact on drugs for rare diseases, as well as potential impacts on small companies. I was over the road at the Britain Against Cancer conference today talking, for instance, to Cancer52, which represents people with rarer cancers, so that is very important to me as the cancer Minister.
It would not be appropriate for me to pre-empt the Government’s response to the consultation, and I do not intend to do that this morning, but I can assure the House that the Government have been carefully considering all the issues raised and agree that any charging mechanism must include appropriate support for the small companies, while protecting the impartiality and benefit of NICE’s work to patients and, as my hon. Friend rightly says, the global nature of this business and the great opportunities in this sector from Brexit.
We will publish our response to the consultation very shortly. The Under-Secretary of State for Health, Lord O’Shaughnessy, has invited my hon. Friend to meet to go through these proposals in detail and discuss her response to the consultation. As chance would have it, I understand that the appointment went in the diary today—just before today’s debate. Who would have thought it? That is happening this Thursday.
Anne Marie Morris
Would it be right to say that the consultation assumed there would be a charging mechanism and that it was not about whether but about how?
Steve Brine
Yes, the consultation was about how, but we are listening very carefully to the “how”.
As my hon. Friend said, Members have expressed concern that the introduction of the charging mechanism will make us a less attractive country in which to invest. We are committed to ensuring that the UK is an attractive environment for the life sciences sector. Sir John Bell’s life sciences industrial strategy published last year set out the sector’s vision for how we will do that, and we fully support the strategy’s vision. We have committed £500 million of Government money, and that has been backed by significant investment from 25 different organisations across the sector. Strong progress has been made on that sector deal, therefore, and one year on we are working with partners to agree the second sector deal with the new measures to secure our lead in the areas of global opportunity.
Anne Marie Morris
I thank the Minister for answering my last intervention so honestly. Given that the last consultation was not about the “whether” but about the “how”, may I ask if there was ever a consultation on whether this was the most appropriate way to ensure better value and more money for NICE to develop more medicines more efficiently?
Steve Brine
Not to the best of my knowledge, but this will of course continue through the NICE review process next year, and I have no doubt that my hon. Friend will be able to discuss this at great length with Lord O’Shaughnessy on Thursday.
I stress that the Government share the views that we have heard today about the vital importance of NICE’s work and about protecting the UK’s place in this important sector, which a lot of people work in and which—more importantly—a lot of patients rely on. That is why we want to ensure that NICE can continue to develop its recommendations with the same authority, transparency and impartiality that have been the backbone of what is a world-leading organisation with a world-class reputation.
Question put and agreed to.
HIV and World AIDS Day
Steve Brine Excerpts(5 years, 12 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
That was an unexpected but lovely thing for the hon. Member for Kensington (Emma Dent Coad) to say at the end of her speech. I believe “Give HIV the finger” is the expression that the hon. Member for Bristol West (Thangam Debbonaire) was looking for. Wow! Madam Deputy Speaker, you have just taken over in the Chair, and you have missed a treat. I suggest that you watch it back later. Let me, as it says in my brief, congratulate the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) on securing the debate. Obviously, I share his passion for the topic, but I did not know what he was going to say until we spoke just before the debate, and even then I did not know how he was going to say it and the extent to which he was going to put so much of the personal into it.
The turnout of the hon. Gentleman’s friends and colleagues around him for his speech was a testament to its power and to how much they obviously think of him. Clapping is not right in the Chamber, but even I did clap after his speech. I do not like to clap in the Chamber or in church, but I have done one of them. The look on his face when his colleagues were all standing up and clapping him was wonderful. If I had thought to do so, I would have stood up and taken a photo for him, because it will be a nice moment for him. [Interruption.] No, Madam Deputy Speaker, you are not at all happy about that. I have gone too far. Edit that bit out, Hansard.
It was an incredible speech and it was a very brave thing to do. Following the debate that had just taken place on education—we were here for the winding-up speeches—which got a little political at times, the Adjournment debate has once again shown that it is Parliament’s best kept secret. It is where all the good things go on, and this was certainly a good thing.
As the hon. Gentleman reminded us, World AIDS Day is 30 years old this year. We had a wonderful reception in Speaker’s House on Tuesday night, with the Terrence Higgins Trust, and some really good friends were there. It is the second time I have done that now. As I said then, this week and Saturday will be about remembering loved ones who lost their challenge against and their battle to HIV. However, it will be a celebration, as he said. I note that he said that he will be at the Brighton AIDS memorial at the weekend, and I wish him well with that, as I do everybody who will be with him from his constituency and, I am sure, from much further afield. This is also a chance to say to say how much has changed since the late ’80s.
Eddie Hughes (Walsall North) (Con)
I just want to say briefly how fortunate I feel I am to have been walking past the Chamber, seen that there was this debate and taken the opportunity to come in. My first wife was a nurse, and I remember when she came home from work—I think 27 years ago—having just treated her first AIDS case, and we were both scared. Since then, the treatment of it and the understanding and appreciation of it in society have changed so dramatically. I realise now, having heard the speech of the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), that there is still some way to go for those who are hesitant about telling new friends and acquaintances, but it felt like a genuine privilege to have been here to hear him speak, so I thank him very much.
Steve Brine
I thank my hon. Friend for his intervention.
As I was saying, much has changed since the late ’80s: health needs are different; we have better drugs and better diagnostic tools; and, as has been said, attitudes towards HIV and AIDS are totally different and totally transformed.
The hon. Member for Kensington mentioned Princess Diana—the original one, as opposed to the new one—and that incredible moment. I will repeat what I said the other night in Speaker’s House. I was in secondary school at that time, and I remember that powerful image being broadcast. I was only a teenager at the time, and little did I know that I would one day be the public health Minister talking about these issues. It was one of those images that is really seared into our national conscience. What a great loss that lady is to so many social causes, as well as of course to her family. It was an incredible image.
As the hon. Member for Brighton, Kemptown has said, today, it is not about dying of AIDS, but about living with HIV. I would go further, however, because it is about more than that, is it not? It is not really “living with”; it is just “living”. I am also very privileged to be the cancer Minister, and how many times cancer patients say to me—my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), knows this, because people very often used to say this to us when we ran the all-party group on breast cancer together—that, “I am not my cancer. It is just something that I do and something that I have as well.” Happily, HIV is now just part of the hon. Gentleman: I am sure he would rather it was not, but it is not just something he lives with; it is something that he lives.
A big public health display in the foyer of the Department of Health and Social Care currently shows all the different public health campaigns over the years. The terrifying tombstone image is obviously something that we have, rightly, moved on from, but it is still an incredible part of our public health campaign history. Back then, the Government made the bold move to run a major public information campaign on HIV—“Don’t die of ignorance”—and we piloted needle exchange schemes, introduced HIV testing and raised the prospect with the public. If we consider the HIV epidemic in this country, we can be proud of the record of Governments of all parties over many years.
As figures released today show, the UK has met the UNAIDS 90-90-90 target—yes!—and it is one of the first countries in the world to do so. Members from across the House are proud of that, and the latest report from Public Health England showed that in 2017 an estimated 92% of people living with HIV in the UK were diagnosed, 98% of those were on treatment and 97% of those on treatment were unable to pass on their infection. That is a major achievement that we should be proud of. More importantly, those who work in our health service and have done so for years—like the partner of my hon. Friend the Member for Walsall North (Eddie Hughes)—should be even more proud.
Prevention is one of my passions, and one of the Secretary of State’s priorities. We do not yet have a cure for HIV, which is why prevention is so important. Our efforts to prevent HIV and AIDS have been highly successful, and much has been said about the international dimension, which I will touch on. The UK is a world leader in efforts to end the AIDS epidemic, including through our major investment in the global fund. Our largest investments are through multilateral organisations such as the Global Fund to Fight AIDS, UNAIDS and Unitaid, given their greater reach and scale. I met Lelio from Unitaid at the G20 in Argentina last month, and it is doing such good things with the investment that we announced in Amsterdam, to which the hon. Member for Cardiff South and Penarth (Stephen Doughty) referred. I work closely with my hon. Friends in the Department for International Development and the Foreign Office, and these three Departments are very tight and work closely together on this issue.
Excellent initiatives such as the MenStar Coalition aim to get more young men tested and on to life-saving HIV treatment to protect them and their partners. There is the Elton John AIDS Foundation and other partners, and MenStar is rolling out a self-testing campaign in east Africa. The UK is the second largest donor to Unitaid—a charity that does so much work against stigma—and provides an annual contribution of around €60 million as part of our 20-year funding commitment.
There has been much talk about the domestic situation, and NHS England launched the world’s largest pre-exposure prophylaxis—PrEP—trial last year. To be honest, I had never heard of that until I became a health Minister—why would I have?—but once officials had explained it to me, it did not take me long to think that it sounded like a real no-brainer. I know that many people are eagerly awaiting the results of the trial. I am one of them, and my officials know of my impatience, which is legendary in our Department. It is crucial to have the right information to address the major questions and effectively implement the PrEP trial on a larger scale.
The point about savings was well made and not lost on me. I am not in a position to make a policy promise at the Dispatch Box today, but on the point about places made by the hon. Members for Brighton, Kemptown and for Cardiff South and Penarth, I say only that I am listening closely and they should continue those discussions with me—I know they will. The Department met members of the all-party group on HIV and AIDS to discuss these issues, and they should continue those discussions with me. We are listening. Many of the public health challenges we face today require different approaches and fresh thinking if we are to make progress. Indeed, in the past few years many innovative ways to tackle HIV have emerged, including HIV testing options such as self-sampling and home testing services, which I know are very popular.
I would like to mention the HIV prevention innovation fund, which I am very proud of. Innovative community-led interventions have had a significant role to play in limiting the HIV epidemic in England, so we set up the HIV prevention innovation fund in 2015 to support voluntary sector organisations. The fund has supported many projects since it started. I announced them at an event here in the House last year—the hon. Member for Cardiff South and Penarth, who chairs the all-party group, was present. In 2017, we awarded just under £600,000 to 12 projects. I am very pleased to say that we are running the fund again this year. The principle of the fund is something we are carrying over into other areas of policy, because it has been so successful. I want to see us do more of that.
This year we celebrated the 70th birthday of the NHS. I have already mentioned the incredible staff who work across the service. England has an outstanding record of achievements in HIV treatment and care. I want to take this opportunity to recognise and thank everyone for doing that. Care for people with HIV is now highly effective, and increasing numbers of people are living with HIV into older age with normal life expectancy. Antiretroviral therapy has transformed the outlook for people living with HIV, from what used to be a tragic death sentence to a very manageable long-term condition, as we heard so eloquently this afternoon.
Our policy is to make sure that HIV testing is as accessible as possible, in particular to those at increased risk. It is therefore very important that testing is available in a range of clinical and community settings—hence why the innovation fund and its programmes are important. Over the years, local authorities, which are now public health authorities up and down the land, have introduced innovations and improvements of their own, in particular on testing. We know it is working. Testing activity at sexual health services, which we know are under great pressure—we do not deny that for one moment—continues to increase and HIV diagnoses have fallen. HIV testing in sexual health services has increased 15%, from 1.07 million tests in 2013 to 1.24 million in 2017. Most significantly, we have seen a 28% drop in new HIV diagnoses between 2015 and 2017. That is encouraging and good, but we must not be complacent. I assure the House that we are not complacent and we want to continue to maintain this progress.
The hon. Gentleman mentioned the prevention strategy. That was a very top line document. I had a meeting this afternoon to discuss the prevention Green Paper, which will follow next year. I can assure him that the long-term plan, which will follow before that, will absolutely have sexual health and HIV in it. I am being very ambitious with officials on that. I know that he will rightly hold us to account and I thank him for giving me a chance to say that.
I want to touch on education and awareness. Education around HIV and how it is transmitted remains absolutely critical, as the hon. Member for Brighton, Kemptown said in his opening remarks. I am pleased to say that schools will be required to teach relationship and sex education from September 2020. The Government announced that relatively recently. I have been very involved in that in relation to the cancer brief, because I am very keen for schools to responsibly teach cancer awareness to young people. At secondary schools, there will be clear and accurate teaching about sexual matters, including factual knowledge around sex, sexual health—including HIV—and sexuality. The schools Minister was sitting next to me throughout his speech. He wanted me to pass on his congratulations to the hon. Gentleman on his speech.
Testing is the only way to be certain of HIV status. Last week was National HIV Testing Week and the Secretary of State took part. This flagship campaign promotes regular testing among the most at-risk population groups and aims to reduce the rates of late diagnosis or of those remaining undiagnosed. Sadly, stigma remains a significant factor in why people do not test for HIV. I understand that. This can mean that HIV goes untreated and can then be transmitted. It is vital that we continue to break down the stigma, normalise testing and support those most at risk of infection.
I want to mention the “Can’t Pass It On” campaign. Whoever is doing the marketing for the Terrence Higgins Trust is doing a very good job—I know it works with a very good agency. As I said at the reception the other night, I was on the tube the other day with my daughter, who spotted some advertising or branding for testing week. She asked me what it was, because it caught her eye, and I was able to explain it to her. She is only 11. If more parents did that for their children and relatives, it would help to break down that stigma. The trust’s website has a very good page on the “Can’t Pass It On” campaign that includes different people’s stories, and I have a funny feeling that before we leave the Chamber, “Lloyd’s story” will be on it, with a clip from today in Parliament. I will certainly be clipping it off the Parliament TV website and tweeting it out through the Department of Health’s social media account.
In conclusion, I congratulate the hon. Gentleman again on introducing this timely and vital debate, and I wish him and everybody well for Saturday who will be marking World AIDS Day, whether they be remembering and celebrating private, not yet able to do so publicly, and those who, like him, are able to do so publicly. They are all part of the story, and our best wishes and love go to them all. We look forward to brighter futures in this policy area, as we work towards what I am determined will be zero stigma and zero transmissions.
Madam Deputy Speaker (Dame Eleanor Laing)
Would it not be wonderful if more people paid attention to the work done in the House in such debates—this excellent, positive, meaningful, emotive and successful debate this afternoon? If only.
Question put and agreed to.
Oral Answers to Questions
Steve Brine Excerpts(5 years, 12 months ago)
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Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
In the year to June 2017, the NHS spent approximately £569 million on prescriptions for medicines that could be bought over the counter from a pharmacy or supermarket. That is why, following public consultation earlier this year, NHS England issued guidance to reduce the routine prescribing of some medicines for minor, short-term ailments, including head lice treatment.
Emma Hardy
Yesterday, I met people from the charity Community Hygiene Concern, which provides cheap, reusable and effective bug-busting kits for less than £5. However, because of these NHS prescription guidance changes, these kits are no longer available, which threatens an epidemic of head lice in our schools. Surely head lice should not be considered a minor ailment. Will the Minister please write to Simon Stevens to encourage him to meet me and Community Hygiene Concern to look at this issue again?
Steve Brine
I have been itching all morning while thinking about this answer. I do not believe there is an epidemic because of NHS England’s actions. Clinical experts in the NHS advise that head lice can be safely and effectively treated by wet combing; I have very recent personal experience of doing this, as I am sure do many parents in this House. Chemical treatment is recommended only in exceptional circumstances. I had not heard of the charity the hon. Lady mentions, but as we discussed before questions, I am happy to facilitate that interaction.
Michael Fabricant (Lichfield) (Con)
In France, where head lice are more common per capita than in the UK, people make good use of pharmacies, because it costs money to visit a general practitioner and because the state promotes the role of pharmacies. May I therefore ask the Minister why do we not advertise that we should be using pharmacies more often than not, instead of going to a GP?
Steve Brine
I do not know whether my hon. Friend is familiar with wet combing his hair.
Steve Brine
Only with his gel. He is absolutely right that, as the Secretary of State just said, community pharmacies are experts in so many minor health matters, and Pharmacy First can absolutely be used when it comes to head lice as well.
Mike Amesbury (Weaver Vale) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
We have had lots; it is just that none come with any idea of how that might be paid for. The Government have a strong track record on public health. Local authorities in England have received more than £16 billion in ring-fenced public health grants over the current spending period. Decisions on future funding for that area of spending are of course for the next spending review.
Mike Amesbury
On current projections, over £800 million will have been cut from public health budgets by 2021, £2 million of which has been cut from vital services in my constituency relating to sexual health, and to tackle obesity and smoking. Will the Minister guarantee that the new NHS long-term plan will reverse the cuts to public health budgets?
Steve Brine
I know that Opposition Members like to pretend that the past eight and a half years did not have to happen, but there is a reason why they had to happen—the economy was crashed—and eight and a half years is not a long time to clear up the mess of the last Government. But we are very clear, as the hon. Gentleman should know, that a focus on prevention will be central to the long-term plan. He mentions child obesity—[Interruption.] Opposition Members may wish to listen. The public health grant remains ring-fenced and protected for use exclusively on improving health, but local government spending on health is not just about the public health grant. The Government spend money on many other things, including around the child obesity plan and vaccinations, and that is all around prevention and public health.
Mr Philip Hollobone (Kettering) (Con)
As local government is reorganised in Northamptonshire ahead of May 2020, will the Minister consider whether it may not be appropriate in all cases for local councils to manage public health budgets, and whether in some cases it might make sense for the NHS to regain control?
Steve Brine
There are active discussions going on between my right hon. Friends the Health Secretary and the Secretary of State for Housing, Communities and Local Government about this, but the bottom line is that Parliament legislated through the Health and Social Care Act 2012 for local authorities up and down the country in England to be public health authorities. We believe that they are well placed to make these spending decisions with the ring-fenced grant—£16 billion —that we have given them.
Tim Farron (Westmorland and Lonsdale) (LD)
The underfunding of public health in Cumbria means that the NHS spends only 75p per child per year on preventive mental health care. Added to that, over three quarters of young people with eating disorders are not seen within the target time of a month, and in the event that they are seen, there is no specialist one-to-one eating disorder service to see them, despite the Government promising three years ago that there would be. Will the Minister meet me and our local NHS so that we can get a better deal for our young people on all three of these points?
Steve Brine
The hon. Gentleman will remember, of course, that £1 billion extra was put into mental health in the Budget last month, but I would absolutely be interested to hear from him. There are very good things going on up and down the country in local authorities with the ring-fenced £16 billion that we have given them. We are very interested to hear about where there are good examples of things going on, and the long-term future discussions around them will take in the spending review, as I have said.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
The Secretary of State claims that prevention is one of his top three priorities, yet this year alone the Government have slashed public health budgets by £96 million. That includes cuts to smoking cessation services, sexual health services, obesity and addiction services and many more. This affects the most vulnerable in our society, so will the Minister do the right thing today and cut the rhetoric, commit to reversing these damaging cuts to public health, and put funding in the long-term plan?
Steve Brine
The hon. Lady—my shadow Minister—knows that I have a great deal of respect for her. She mentioned smoking; smoking rates in England are at their lowest ever levels. We hear spending commitment after spending commitment from the Labour Government; it is like the arsonist turning up at the scene of a fire. I will take very seriously, as I am sure will the Treasury, her bid towards the spending review discussions, but yes, prevention is better than cure and it will be at the heart of the long-term plan.
Jim Shannon (Strangford) (DUP)
Luke Hall (Thornbury and Yate) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
In June we published chapter 2 of our child obesity plan, which built on the world-leading measures we introduced in 2016, including bold new measures to halve child obesity by 2030.
Luke Hall
Will the Minister join me in welcoming the launch this week of South Gloucestershire Council’s Reach programme? It is an evidence-based service for obese and overweight children aged between four and 16 in South Gloucestershire and their families, aimed at improving the wellbeing of young people and building their esteem, and raising issues of weight gain between and among families.
Steve Brine
I certainly will; we need a collective effort to achieve the national ambition of halving child obesity by 2030, and that means we need local initiatives such as the Reach programme to support families and help them make positive lifestyle choices. I pass on my congratulations to South Gloucestershire Council on its programme.
Chris Evans (Islwyn) (Lab/Co-op)
Steve Brine
Through our work on parity of esteem for physical and mental health, we take eating disorders very seriously. That is not directly related to the child obesity plan, but we are absolutely determined to tackle weight challenges at either end of the scale, because I know that they affect a lot of people.
Nic Dakin (Scunthorpe) (Lab)
Obesity is now one of the biggest risks to health and a significant cause of cancer and other conditions. Is it not time to look at restricting the advertising of junk food up to 9 o’clock?
Steve Brine
I have a lot of time for the hon. Gentleman and do a lot of work with him. He knows that we published proposals in the child obesity plan to launch a consultation on a pre-9 pm watershed ban, and we will be bringing that forward before the end of the year as promised.
Robert Halfon (Harlow) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
No child or young person with cancer should be unable to access the treatment they need because of the cost of travelling to hospital. Through the healthcare travel costs scheme, which is part of the NHS low income scheme, parents in receipt of a qualifying benefit or on a low income can claim for the reimbursement of travel costs for their children’s treatment. To date, the scheme has helped some 337,000 people.
Robert Halfon
CLIC Sargent, the charity for children with cancer, has shown that families in my constituency with children with cancer can face a 54-mile round trip to get to their nearest treatment location, which can cost them up to £161.58 a month. Families are incurring thousands of pounds of debt paying for parking and driving their children to their cancer treatment. Does my hon. Friend acknowledge that only 6% of parents of children with cancer are reported as having received financial help from the NHS healthcare travel costs assistance scheme? Does he recognise that the scheme is not designed to meet the needs of children and young people who need highly specialised treatment—
Steve Brine
Yes, we do recognise that there is a challenge there. I gave evidence to the all-party parliamentary group on children, teenagers and young adults with cancer, and I have a copy of the “Listen Up” report here. CLIC Sargent is part of the secretariat for that group. We are looking at this issue through the long-term plan, and I look forward to meeting my right hon. Friend along with CLIC Sargent in the next few weeks as planned.
Helen Jones (Warrington North) (Lab)
Access to services is very important for those in the poorest areas of my constituency. Warrington Hospital has been losing services over time, but it has now sought to become a cancer hub for north Cheshire. Will the Minister ensure that, in the case of such applications, access to services for the poorest people is considered along with other factors?
Steve Brine
Yes, we are interested in access to services for all people, wherever they are on the income scheme. The hon. Lady is right to raise that issue. We need to do better on cancer diagnosis, so I would be interested to hear more about the cancer hub that she mentions.
Nick Smith (Blaenau Gwent) (Lab)
David Tredinnick (Bosworth) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
The NHS long-term plan, backed by the extra investment by 2023 and confirmed by the Chancellor in the Budget, will set out a sustainable vision for the NHS to make strides towards it being the safest, highest-quality healthcare system anywhere in the world, learning from everywhere and anywhere in the world over the next 10 years.
David Tredinnick
According to the flyer for the post-launch party, the integrated care systems will be considered. Will the Minister make sure that he looks at the use of homeopathy by French pharmacists, the three quarters of a million doctors using traditional healthcare in the Ayush Ministry in India and the 55,000 state hospitals using acupuncture in the People’s Republic of China?
Steve Brine
The NHS should always look to learn from the best healthcare systems and practices anywhere in the world provided they are backed by evidence.
Kevin Hollinrake (Thirsk and Malton) (Con)
Everyone in this place has lost someone close to them to the terrible and terrifying disease that is cancer. How will the NHS 10-year plan help to improve detection rates?
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
The Prime Minister will set out our ambition that three quarters of all cancers will be diagnosed early, up from just half today. Our cancer survival figures are our best ever, but we do not have world-class outcomes yet, as we must and want to. That is why early diagnosis will be absolutely at the heart of the NHS long-term plan—for instance, in radically overhauling the screening programmes that the Secretary of State mentioned earlier.
Mr Speaker
I do slightly worry about the staying power of some colleagues. I will not say who, because it would be unkind, but there was a Member I was about to call who has beetled out of the Chamber. People have got to be a bit patient.
Steve Brine
Yes, I can. I feel very passionately about stroke and the impact that it has on people’s lives and the health service. We are working very closely with the Stroke Association to develop the new national plan for stroke in England as part of the long-term plan. That plan will build on the success of the Department’s stroke strategy, which ended last month, and look at how we can improve stroke care across the pathway. It will also, critically, include prevention so that we can protect more people from stroke in the first place.
Stephanie Peacock (Barnsley East) (Lab)
Despite the Government’s reassurances on the new NHS pay deal, it has left one of my constituents actually taking less money home at the end of the month and being required to pay money back. When I wrote to the Department, the Minister had the audacity to simply respond with a generic factsheet. Does he think this acceptable, and if not, will he give a meaningful reply to my constituent, who has done 30 years in the NHS?
Steve Brine
My hon. Friend is spot on, as always. Just last week, I spent time with the heads of all 19 cancer alliances in England, which are doing so much to deliver the strategy on the ground, including his Thames Valley cancer alliance, led by Bruno Holthof of Churchill Hospital in Oxford. The alliance was clear that we need more people across the board in “team cancer”, as I call it, and that is right. We especially need more radiographers, and we are working through that with Health Education England in the beyond 2021 plan.
Ruth George (High Peak) (Lab)
Today’s report on the amount of police time spent dealing with emergency mental health cases without support from mental health professionals is echoed by police in my constituency, who say that it takes up almost 40% of their time. Will the Government recognise that this crisis should not be dealt with by police officers, far less in cells, and sort it out?
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
Will the Minister support Plymouth’s Peninsula Dental School in training more dentists and encourage use of the underspend in the south-west dental spending pool?
Steve Brine
Yes. I would be interested to hear more about anything that can increase access to dentistry in the hon. Gentleman’s part of the world.
James Cartlidge (South Suffolk) (Con)
Next year marks 10 years since the passing of the Autism Act. What more can the Government do to support people who suffer from autism?
Branded Medicines Pricing
Steve Brine Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
My hon. Friend the Parliamentary Under Secretary of State for Health (Lords) (Lord O'Shaughnessy) has made the following written statement:
I am pleased to inform Parliament that agreement has been reached on a heads of agreement for a new voluntary scheme for branded medicines pricing and access. The voluntary scheme is an agreement between the Department of Health and Social Care, on behalf of the four UK Governments, and the pharmaceutical industry, represented by the Association of the British Pharmaceutical Industry (ABPI).
This is an important milestone in the ongoing negotiations. If all proposals in the heads of agreement are agreed in a full scheme document, then the new voluntary scheme will operate for five years starting from 1 January 2019. The current voluntary scheme, the 2014 Pharmaceutical Price Regulation Scheme, will end on 31 December 2018.
The new voluntary scheme is expected to benefit patients, the NHS and the life sciences industry through delivery of its overarching objectives of improving patient access to medicines, innovation and affordability. If final agreement is reached on the proposals set out in the heads of agreement, patients will benefit from faster adoption of clinically and cost-effective medicines so they have access to the best available treatment. The deal is expected to deliver a benefit of £930 million next year, to be reinvested into the NHS. The proposals also demonstrate the Government’s commitment to innovation through measures to improve uptake of transformative new medicines, to support small businesses through improved exemptions from the cost control mechanism and targeted case management of commercial discussions with NHS England, and to provide greater commercial flexibility for companies that offer the best value new medicines. In addition, the new voluntary scheme would deliver better value for the NHS by ensuring the branded medicines spend remains within affordable limits through an overall cap on growth on NHS branded medicines sales.
Taken together, the new voluntary scheme is expected to support the Government’s commitment to ensuring the UK remains an attractive hub for our world-leading life sciences sector, a central part of the Government’s industrial strategy.
A summary of the heads of agreement has been placed in the Library. Further information will be provided as the negotiations progress.
[HCWS1108]
National Cervical Screening Programme Incident
Steve Brine Excerpts(6 years ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I am today informing the House of a serious incident relating to the ‘call and recall’ process administered by Primary Care Support England (PCSE), a service provided by Capita on behalf of NHS England as part of the national cervical cancer screening programme.
The NHS cervical cancer screening programme saves an estimated 5,000 lives a year by detecting abnormalities of the cervix early and referring women for effective treatment. It is offered to women aged 25 to 49 every three years and those aged 50 to 64 every five years.
On 17 October, NHS England and Public Health England were informed by Capita that a number of cervical screening invitation and reminder letters had not been sent to women inviting them to make a routine cervical screening appointment. Following further urgent investigation of this incident since then, I can now confirm that between January and June 2018, 43,220 women did not receive one or other of these letters and, in a very small minority of cases, neither the invitation nor reminder. In addition, Capita has also informed us that, between January and October 2018, a further 4,508 women were not sent letters informing them of the result of their cervical screening.
In light of this, NHS England declared this as a serious incident and set up a clinically-led multiagency incident panel including PCSE, Public Health England and NHS Digital on 23 October 2018 to assess any risk or harm to the women affected. The panel has put in place actions to assess and mitigate any risk as well as care and support where needed. Daily audits are now in place to ensure all women’s files are accounted for, and the panel is looking closely with Capita at how parts of the process could be automated to reduce errors.
Capita has confirmed that this incident was caused by files from their call and recall operations team not being correctly sent and uploaded to Capita’s print and despatch service between January and October 2018. Capita has accepted full responsibility for this incident and has apologised for it.
For the majority of the 4,508 women who did not receive their result letter, their result was normal. However, 182 women had a result that required a follow-up test (colposcopy) and 252 women needed an early repeat screening test. In most instances, where the screening result requires further tests or treatments, the laboratory will usually refer the woman directly to a colposcopy clinic independently of the woman receiving her result letter from Capita. For women needing early repeat testing, their GP routinely follows up these tests. However, to make sure all women needing a colposcopy or an early repeat test are being managed correctly, every woman’s screening record is being checked to ensure they have been referred appropriately. No harm has been identified to date.
Capita has made a public apology and has written to all the women who did not receive invitation or reminder letters and to those who did not get their normal result letter. Letters and apologies are being sent to all women who have not been referred for colposcopy or who have not had the required follow up screening test. In addition, the GPs of women affected have been informed so they can offer support to their patients.
The results of the screening and further tests on all women affected by this incident will be monitored over time to ensure any impact is followed up.
In addition to reviewing the checks in place around file transfer and checking the number of files processed, sent, printed and dispatched, Capita has produced a briefing for staff and proposed additional automation to the process to remove manual steps that may have contributed to this incident.
Our priority is patient safety and we will be assembling a clinical board that will provide oversight for the cervical screening call and recall service. This will ensure that every part of the process has an in-depth review.
NHS England is also undertaking an independent expert review of its screening programmes.
The Government continue to closely monitor the performance of all our suppliers and to implement improvement plans where necessary. Officials are working with Capita to ensure that the process recommendations and lessons learned from this issue are applied to similar services across Capita's public sector contracts.
Incidents of this type not only are unacceptable in terms of the impact they have on the women affected, but undermine public confidence in our screening programmes as a whole.
[HCWS1086]