Ovarian Cancer: Diagnosis and Treatment
Steve Brine Excerpts(5 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
It is a pleasure to see you in the Chair, Mr Bone. I, too, congratulate my hon. Friend the Member for North East Derbyshire (Lee Rowley) on securing the debate. As vice-chair of the all-party parliamentary group on ovarian cancer, the subject means a great deal to him. We also heard more about why it means a lot to him. I place on record my thanks to the all-party group and to the excellent ovarian charities. Target Ovarian Cancer is the biggest, but others work tirelessly in that space, such as Ovacome.
Watching my hon. Friend brought back memories of sitting in that exact chair as one of the vice-chairs of the all-party parliamentary group on ovarian cancer almost exactly seven years ago, in October 2011. I was talking about ovarian cancer, which has also had an impact on my family, although sadly not with the outcome that my hon. Friend currently has. I described it as a “silent national scandal”, which was then trending—quite something in 2011. I was also present for the 2014 debate that he remembers, which was the last time the subject was specifically debated in the House. It was a pleasure to hear him today; he reminded me of me—but I put on record the warning that this is where I have ended up.
I was pleased to meet with the hon. Member for Washington and Sunderland West (Mrs Hodgson) and Target Ovarian Cancer a couple of weeks ago to discuss the all-party group’s report, as the hon. Lady said. As she knows, I take the all-party groups very seriously. I have the report here—this is my coffee table copy in the Department of Health and Social Care, and anybody who knows my office knows that what is on the coffee table is what counts. It is an excellent report with many important recommendations and I will return to it a lot in my remarks. I have already committed to responding fully to it and the hon. Lady knows that I will do that.
I am responding to my third cancer debate in the House in less than two weeks, which demonstrates that improving cancer diagnosis and treatment is a priority for right hon. and hon. Members, as it is for me as the Minister with responsibility for cancer, the Government, the Prime Minister and the Opposition. In this job, I am fortunate to see first hand the superb work being done by our NHS staff and by our many partners and charities across the cancer community in implementing the 96 recommendations in the cancer strategy for England.
We are three years into that work and cancer survival rates have never been higher, as has been said. About 7,000 people are alive today who would not have been had mortality rates stayed the same as before Cancer Research UK and Harpal, who led the work, published the strategy. As I make clear every time I respond to a cancer debate, however, I know that we must do more and that people want us to do more, because we still lose 12,000 women a year to breast cancer and far too many women to ovarian cancer. We must do better. Despite the huge strides that I have mentioned, and the best-ever survival rates, ovarian cancer survival rates in the UK are among the lowest in Europe with fewer than half of all women diagnosed surviving five years or more, so there is much that we need to do.
Mr Marcus Jones (Nuneaton) (Con)
The Minister has mentioned the success rates in dealing with cases of ovarian cancer in our country compared with some of our European partners. Can he set out what we can learn from them in improving outcomes for women in this country?
Steve Brine
I will certainly cover that. Put bluntly, as I will come on to in a second, and as almost all hon. Members have mentioned, it is about early detection. That has an impact because, as the former chair of the all-party parliamentary group on cancer, my hon. Friend the Member for Basildon and Billericay (Mr Baron), has said many times, early diagnosis is cancer’s “magic key”. We have that magic key in some cancers in this country. We do very well in breast cancer, where the early-stage survival rates are well over the 75% target that the Prime Minister set out at the party conference earlier this month, but it is true that we do not yet have the magic key in enough cancers. I will come on to what we need to do.
I was pleased when the Prime Minister announced the ambitious package of measures for cancer care and treatment earlier this month, which will be at the heart of our long-term plan for the NHS. It will be backed up by the new funding that was announced in the summer and confirmed in yesterday’s Budget. We will overhaul screening programmes, provide new investment in state-of-the-art technology to boost our research and innovation capability and, critically, transform how we diagnose cancers earlier. As I have said, our ambition is to diagnose 75% of all cancers at an early stage, which will result in an estimated 55,000 more people surviving cancer for five years in England each year from 2028.
All hon. Members have mentioned early diagnosis, and many have mentioned some stats—or the same stats. The important one for me is that a quarter of women with ovarian cancer are diagnosed through an emergency presentation. When I first became an MP, I remember going to meetings with the all-party parliamentary group on ovarian cancer and the all-party parliamentary group on cancer, where I was shown the stats for my constituency of the number of people who presented in the emergency department with cancer. That really frightened and shocked me—it still does—and along with my personal history, it was one of the reasons I wanted to get involved in health and cancer when I joined the House.
Of that quarter of women with ovarian cancer who are diagnosed through an emergency presentation, just 45% survive for a year or more. That is no surprise—if someone is diagnosed in an emergency department, they have exhibited more outward symptoms, so they are at a later stage and their survival rate is lower. The survival rate is more than 80% when women are diagnosed following a GP referral, so it is crystal clear where improvements are urgently required. That is why early diagnosis is a key strategic priority in the cancer strategy. As has been said, it allows for more options for treatment and, crucially, the earlier a cancer is diagnosed, the more likely it is that doctors will be able to provide successful treatment or operate on the “bunch of grapes”—that is a good analogy, which I have heard before.
My hon. Friend the Member for North East Derbyshire talked about the multidisciplinary diagnostic centres. NHS England and the Department are testing new innovative ways of diagnosing cancer earlier. As regular attendees of cancer debates will know, I never tire of praising the accelerate, co-ordinate, evaluate—ACE—centres, which are the multidisciplinary diagnostic centres for patients with vague or non-specific symptoms. As the hon. Member for Washington and Sunderland West said, they are being piloted across 10 sites in the country. They offer patients a range of tests on the same day—a point that has been made by several hon. Members—with rapid access to results.
The centres are magnificent. I visited the ACE centre at the Churchill Hospital in Oxford earlier this year. I met the practitioners who work there, the commissioning group and the GPs who are involved in it. GPs are tremendously, and rightly, excited about the centres. They will make a huge step-change improvement in early diagnosis, particularly for cancers such as ovarian cancer, where symptoms can be vague and can appear less serious at first. The plan is for that innovation to address the delay that the hon. Member for Washington and Sunderland West and other hon. Members spoke about, so instead of a GP having to refer for one test and wait for the results, then refer for the next test and wait for an appointment, the ACE centres will allow for a snappy, quicker turnaround. They could be a game-changer and could unearth the magic key when it comes to ovarian cancer.
The APPG’s report says that we should roll out ACE centres nationwide, so I am delighted, as I know the hon. Member for Washington and Sunderland West is, that the Prime Minister recently committed to doing just that, as part of our long-term plan. I do not get excited easily, Mr Bone, as you well know, but I am excited about the ACE centres and they are potentially transformative.
I turn now to early diagnosis in primary care. Other support measures are necessary to ensure that more cancers are caught in primary care. The NICE guidelines for suspected cancer referral recommend safety netting for those people who are at higher risk of cancer but who do not meet the referral criteria. Both Cancer Research UK and Macmillan have produced additional advice and support for GPs to implement those guidelines, including the safety netting that I have just mentioned, over the last few years.
I was blown away to meet Macmillan GPs at Britain Against Cancer earlier this year. They are an excellent innovation and have an awful lot to give, but they are few in number. I am very interested in them and I talk to Macmillan about the potential use of Macmillan GPs in helping to transfer specialist knowledge of cancer to wider general practitioners. I always say of GPs that they are not dissimilar to MPs when we hold our surgeries, in that almost everyone who comes to our surgeries is more of an expert on the subject that they have come about than we are, because we are general practitioners. So GPs get a hard rap, but they are general practitioners and that is the area of the profession that they have chosen to go into.
We need to support GPs better through diagnosing cancer, from our targeted lung cancer screening in the lorries in car parks in the north-west—we trialled that approach in Manchester and it has been very successful—to the ACE centres that I have mentioned. That is all aimed at supporting the NHS, especially GPs, to identify cancer earlier.
The shadow Minister asked about the review of the referral pathway. As she knows, the implementation of the faster diagnosis standard requires trusts to review and speed up diagnosis pathways for suspected cancers. NHS England and NHS Improvement are working closely together to emphasise the key principles for improvement that we need in this area, which include ensuring that the most value is derived from each appointment. The standard is being measured for a year from April 2019 to April 2020, when it comes into place. That will ensure that patients are told that they have a cancer diagnosis or an all-clear within a maximum of 28 days of being urgently referred by their GP for suspected cancer. As I always say, 28 days is not a target; it is a maximum. When someone has a cancer worry, 28 minutes can seem like a lifetime, and such things always seem to come on a Friday night, when the weekend lies ahead. Twenty-eight days is our new target, but it is certainly not what we aim for; we aim to do better than that.
We heard from several Members—including the hon. Member for Strangford (Jim Shannon) and the shadow Minister—about Be Clear on Cancer. That campaign is one of the great successes of public policy in recent years. The APPG’s report also recommends, as the hon. Lady said, running a Be Clear on Cancer campaign to raise awareness of ovarian cancer symptoms. However, she is experienced and smart enough in this area to know that Be Clear on Cancer cannot focus specifically on a cancer type, such as breast cancer; it is about clusters. That is where we have found it to be most successful.
Public Health England, for which I have ministerial responsibility, takes a number of factors into account when deciding which campaigns to develop; of course, there is healthy competition in this space and unfortunately there is always more demand than supply. One of the main criteria in deciding which campaigns to run with is the scope to save lives through early diagnosis; that measure is what I will judge that work against.
Campaigns can be effective only if the cancer has a clear early sign or symptom that the general public can act upon if it should emerge. Being honest, even blunt, that is part of the challenge here, as has already been said and for the reasons that have already been given. So the regional Be Clear on Cancer pilot for ovarian cancer took place in the north-west of England in February and March 2014—a while ago now—with this simple key message:
“Feeling bloated, most days, for three weeks or more could be a sign of ovarian cancer. Tell your doctor.”
PHE is currently undertaking new data analysis and research to determine Be Clear on Cancer campaigns for next year, which is 2019-20. At this time, no decisions have been made, and I will take the bid from today’s debate very strongly. The outcomes from the regional pilot—and a pilot that focused on a range of abdominal symptoms such as diarrhoea, bloating and discomfort, which can be indicative of a number of cancers, including ovarian cancer—will of course be taken strongly into consideration, and that is where I think we will head with this work.
However, let me clear that PHE and NHS England have had a very clear steer from me that I want to run the campaign on lower abdominal symptoms as soon as practicably possible. We have to make sure that the operational capability is in place across the NHS, because the worst thing that we could do is create a demand without being able to meet it. That is a rather boring, practical reality, but it is a reality. I reiterated this point to the APPG recently when we met and I will of course keep Members updated; I know they follow these matters very closely.
The hon. Member for Strangford also asked about genetic testing and its role in identifying the increased risk of ovarian cancer. One area where England is very much at the cutting edge of cancer diagnosis is in the creation of the new national genomic testing network, which will be delivered through seven new genomic laboratory hubs, as we call them. They will give patients access to state-of-the-art tests that can diagnose their disease or help to inform their treatment. So the genomic lab hubs will do three things: provide consistent and equitable access to genomic tests, which is very important, as it will ensure there is a level playing field; operate to common national standards, specifications and protocols; and deliver the single national genomic testing directory, which will cover the use of all the genomic technology, from the single gene to the whole-genome sequencing for cancer and for rare and inherited disease.
The labs are in a period of transition, to embed fully the new infrastructure and the new national genomic test directory. I hope that this transition will ensure the safe roll-out of the service without disrupting clinical care. Patients will continue to receive the testing they need to inform their clinical care, and the new national test directory will also include the BRCA testing for women with ovarian cancer in line with NICE guidance, which the hon. Gentleman rightly mentioned.
While I am talking about the hon. Gentleman, or “the hon. Member for Westminster Hall” as I like to call him, I note that he also touched on screening programmes, as did the Opposition spokesperson and my hon. Friend the Member for North East Derbyshire. The UK National Screening Committee is awaiting the updated results of the UK trial of ovarian screening, which is the UK collaborative trial of ovarian cancer screening, as it is known. The secretariat is in contact with the researchers and the committee will review the findings as soon as they are published.
The hon. Gentleman was absolutely right to talk about the workforce. On page eight of its report, the APPG outlines the importance of sonographers. There will be increased emphasis on diagnosing cancers earlier, but we will not be able to find the magic key without those people who do the searching, who are our NHS workforce. So we must ensure that we have the right workforce in the right place to deliver that frontline care and meet the Prime Minister’s ambition.
Last December, Health Education England published its first ever cancer workforce plan, committing to the expansion of capacity and skills. HEE will follow that plan up with a longer term strategy that will be aligned with the NHS long-term plan, which seems sensible to me, and that will look at workforce needs beyond 2021. We have to look at a very long landscape when it comes to the NHS workforce. I will not pre-empt that plan, but I can assure hon. Members that it will set out how we will ensure that a sustainable cancer workforce are in place to deliver on the ambitions that we have set out.
My hon. Friend the Member for North East Derbyshire talked about the cancer dashboard. The APPG report, which of course he was involved in drafting, also recommends including ovarian cancer data within the dashboard. The dashboard was first published in May 2016 as a tool to help the cancer alliances, the commissioners and the providers in the acute trusts to quickly and easily identify the priority areas for improvement, and to enable easy tracking of progress towards our national ambitions.
PHE is working with NHS England’s cancer programme team on the next phase of the dashboard development, and that will be informed by the needs of the key stakeholders and the cancer charities, with which I hold a regular roundtable; some of those charities’ staff are here in the Gallery today. It is no secret that hon. Members know that I am frustrated about the cancer dashboard. I am impatient about most things, as my private office will sadly attest, and I am incredibly impatient about the dashboard being limited to the top four cancers. I want to see it expanded and I intend to see it expanded: NHSE and PHE have a very clear direction from me that I will be watching their work and I expect to see it producing what I and other Members in this House want.
The hon. Member for Washington and Sunderland West spoke about surgery and the mixed picture around the country. I do not want to short-change her by not giving her the detailed answer I want to provide to her good point, so I will look into it and write to her and the other Members who have been in the debate today. We obviously must diagnose early, as that gives us better and less radical treatment options, but for some surgery is a sad reality. We must ensure that the NHS is good at not only sharing best practice but implementing it, and that is as true in surgery as anywhere else.
I pay tribute to the hard work and professionalism of our dedicated cancer workforce, and to the Members who care so passionately about the subject and have brought it to the House today. Ultimately, it is our workforce who will determine the success of the cancer strategy and the long-term plan for the NHS. We can only set the direction and the ambition and ensure that the resources are in place, and I believe that I am doing that, as Minister for cancer.
I am excited by the huge potential for the next 10 years of cancer diagnosis, treatment and support. We have fully established the 19 cancer alliances. We have backed them with the funding they need to transform services, and will go on doing that, to ensure that the NHS long-term plan can be delivered on the ground through the alliances, with cancer at its heart. The plan can turbo-charge all that we have achieved through the cancer strategy. I have said before, and I will say again, that I want the alliances to be much more open and accountable and much more approachable, especially by Members of Parliament in England, who should be able to call them to account much more than they do. I suspect that many Members here have the chief executive of their local trust on speed dial; I hazard a guess that they do not have the leader of their cancer alliance there also, and that should change.
It was interesting to get the Scottish perspective from my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont). We would like to see the ambition in England matched across the whole United Kingdom and we absolutely stand ready, as always, to work with Scottish Members and the Scottish Government. If there is anything we can do to help share that ambition, we will do it.
NHS England, Public Health England and I, with the tireless support of our cancer community—team cancer as I always call it—are committed to making a reality the ambitions that the Prime Minister has set out. That will ensure, as I said in this place not two weeks ago, that we continue to make huge leaps forward over the next 10 years to a future where cancer has no future.
Oral Answers to Questions
Steve Brine Excerpts(5 years, 6 months ago)
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Mary Robinson (Cheadle) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
This June we published chapter 2 of the childhood obesity plan, which built on the world-leading measures we introduced in 2016 and included bold plans to halve childhood obesity by 2030. Our consultations on banning energy drinks and on calorie labelling are now open. Later this year we will be consulting on promotion and marketing restrictions, including suggestions of a 9 pm watershed.
Peter Aldous
The feedback that I receive locally in Waveney is that childhood obesity needs to be tackled by Government Departments, clinical commissioning groups, medical centres and councils working together, whether in schools or by encouraging breastfeeding and the preparation of weaning foods. Can the Minister confirm that he is pursuing such a multi-agency approach?
Steve Brine
I can, and the plan covers many Departments, which was why I recently announced the trailblazer programme to support innovative local action with local authorities. That has the commitment of key policy teams across many Departments to support participating councils to harness the potential of what they can do and learn from others.
Mary Robinson
One in five children in Greater Manchester are classified as overweight or obese, but Prospect Vale Primary School in Heald Green is just one of the schools in my constituency that are getting on and getting moving through the Daily Mile campaign. Will the Minister join me in welcoming that initiative, which brings daily fun and fitness into schools? As more and more adults use wristbands to help them to get fit, what consideration is being given to the use of technology, such as in the UK Fit Kids programme?
Steve Brine
Like my hon. Friend, I pay tribute to Prospect Vale. I have many similar examples in Winchester. We absolutely recognise the importance of physical activity in tackling obesity, which is why as part of chapter 2 we are promoting a new national ambition for all primary schools in England to adopt an active mile initiative.
John Cryer (Leyton and Wanstead) (Lab)
So further to the Minister’s previous answer, why did the Government abolish school sport partnerships?
Steve Brine
This Government are investing heavily in school sports through the school sport premium. For instance, the money raised from the soft drinks industry levy—the sugar tax—is going directly to supporting schools’ investment in sports, for instance through the Daily Mile campaign, which has just been mentioned.
Alison Thewliss (Glasgow Central) (SNP)
Scotland’s diet and healthy weight delivery plan contains specific recognition that breastfeeding can be a means of preventing obesity. Will Ministers engage with the all-party group on infant feeding and inequalities to see what more can be done in England through early breastfeeding to prevent children from becoming obese later on in life?
Steve Brine
Yes, and I am a big supporter of breastfeeding—I have supported it a lot in my constituency, and we engage regularly with the sector. I will be interested in any proposals that the hon. Lady has.
Damien Moore (Southport) (Con)
Grahame Morris (Easington) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Yes, we are fully committed to ensuring that the most innovative cancer treatments are available to patients on the NHS. Since 2016, the radiotherapy modernisation programme has seen £130 million of new investment to ensure that all new equipment is capable of delivering advanced radiotherapy.
Grahame Morris
I thank the Minister for that reply. May I point out how effective advanced radiotherapy is against many cancers affecting the soft tissue? I must declare an interest as a beneficiary of the treatment myself. The latest NHS research shows that treating prostate cancer with 20 treatments of advanced radiotherapy is far better for patient outcomes and would save the NHS more than £20 million a year, but the current tariffs system disincentives trusts from saving this money, as their income is based on the number of treatments. Will the Minister meet me and representatives of the all-party group on radiotherapy to discuss how we might address this anomaly and improve treatments?
Steve Brine
It is good to see the hon. Gentleman in his place and looking so well—I am glad we looked after him well. He is absolutely right that access to advanced radiotherapy treatments is critical, as is getting them against the key standard. I would be very pleased to meet his all-party group and discuss its manifesto for radiotherapy.
Michael Fabricant (Lichfield) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
We continue to make good progress against our 2013 AMR strategy ambitions. According to the latest figures, since 2013, antibiotic prescriptions dispensed by GPs have decreased by 13%, and sales of antibiotics for use in food-producing animals dropped by 27%.
Michael Fabricant
That is encouraging to hear because antimicrobial resistance is caused by the excessive and inappropriate use of antibiotics. Given that we have a Matt Hancock app, should not we have a similar app to try to educate people about when it is appropriate and not appropriate to use antibiotics?
Steve Brine
I will look at what can be added to the Matt Hancock app—there is always room for more.
As luck would have it, today Public Health England has launched its latest “Keep Antibiotics Working” national public awareness campaign, which aims to educate the public about the risks of AMR and urges them always to take the advice of their healthcare professionals on antibiotics and, when necessary, to challenge them.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
AMR poses a grave threat to health. Professor Dame Sally Davies, the chief medical officer, told our Health and Social Care Committee inquiry that if action is not taken to address this
“growing threat, modern medicine will be lost.”
Will the Secretary of State and Ministers heed that warning and ensure that AMR is prioritised?
Steve Brine
Absolutely. The UK is a global leader in tackling AMR and we are currently working on the refresh of our strategy. I was at the G20 earlier this month, where Dame Sally Davies, the chief medical officer for England, showed world leadership and led an exercise with world leaders to strengthen understanding by showing how developed countries would tackle an outbreak.
Diana Johnson (Kingston upon Hull North) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
This Government have a strong track record on public health. Local authorities in England are supported by ring-fenced public health grants of more than £16 billion over the current spending review period. Decisions on future funding are, of course, for the next spending review.
Diana Johnson
Substance misuse services are due to be slashed by £34 million owing to cuts imposed by central Government. In Hull, and I am sure in many other parts of the country, there is a growing blight on our streets caused by Spice and other substances. How is it in any way helpful to communities, frontline police or the NHS for the Government to cut services that help people deal with their addictions?
Steve Brine
As I said, we are spending £16 billion of our constituents’ money during this spending review period on public health grants. Decisions about where we go in future are of course not a matter for me but for the Chancellor in the spending review. This House decided in the Health and Social Care Act 2012 to make every upper tier local authority a public health authority. We believe that it is right for local authorities to make those decisions, with the funding that we give them.
Dr Paul Williams (Stockton South) (Lab)
How many health visitors have been lost since 2015? How will the Minister ensure that important investments are made at the start of life to reduce health inequalities?
Steve Brine
As I suspect the hon. Gentleman knows, I do not have that figure at my fingertips, but I will provide it to him. Health visitors are a critical part of the puzzle, and local authorities are well aware of that, as are Ministers.
Huw Merriman (Bexhill and Battle) (Con)
James Duddridge (Rochford and Southend East) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
We certainly will. I do not wish to pre-empt what the long-term plan will say, but it is an excellent opportunity for us to look at how the NHS can best support people who have or are at risk of developing diabetes, and that includes transformation funding beyond next spring and how technology can be used to help people better manage that long-term condition.
Mike Amesbury (Weaver Vale) (Lab)
Mr Marcus Fysh (Yeovil) (Con)
Steve Brine
We are continuing to review the advice from our expert advisory groups on safe levels of folate intake, but, continuing our tradition of announcing things to the House first, I want to inform the House today that we are going to issue a public consultation, as of now, on adding folic acid to flour.
Toby Perkins (Chesterfield) (Lab)
The service from the East Midlands Ambulance Service NHS Trust has been a considerable disappointment for many of my constituents in recent months. When I met them about the service, they told me that on a huge number of occasions they have ambulances sat waiting outside accident and emergency departments, rather than getting to the next call. What more can the Government do to make sure we get these A&Es cleared?
Bob Blackman (Harrow East) (Con)
Steve Brine
As my hon. Friend, the chair of the all-party group on smoking and health, knows, those groups are key to delivering our tobacco control plan. We are not complacent at all; the delivery plan that was published in June sets out the actions that different agencies will take to deliver the five-year plan, and that absolutely includes mentor cessation services.
Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)
I very much welcome news of the consultation on the mandatory fortification of flour with folic acid, but are the Government consulting on whether it should happen or on how it should happen?
Steve Brine
We will be taking evidence, including from the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, which is meeting as we speak, to look at the safe upper limit of folate levels. I am particularly keen to get that right, but I am convinced that the evidence shows overwhelmingly that this is something we should be doing.
Sir Nicholas Soames (Mid Sussex) (Con)
Bill Esterson (Sefton Central) (Lab)
Foetal alcohol spectrum disorders mean permanent brain damage. In the United States, studies show that one in 20 children are affected. So when will this Government carry out their own prevalence study, so that we can confirm the extent of this entirely preventable disability in the UK?
Steve Brine
Public Health England collects some data on foetal alcohol syndrome, but we recognise that the data do not reflect the range of FASD. These disorders are difficult to diagnose, which is why we are engaging experts and those affected to explore what more could be done to improve our understanding.
Anna Soubry (Broxtowe) (Con)
I thank the Secretary of State for the extra £5 million for East Midlands ambulance service and for the £4.5 million extra for Nottingham University Hospitals Trust, which will mean at least 150 more beds this winter, all of which will help with winter planning, but does he agree that it behoves us all to play our own part in keeping fit and healthy and to use the NHS services responsibly?
Tom Pursglove (Corby) (Con)
I am extremely concerned about the case of Logan, a young boy in my constituency who requires round-the-clock care and the handling of his case by Corby clinical commissioning group. I have written to the Minister raising concerns about this case, but is he willing to meet me and Logan’s parents, Darren and Wendy, to talk about how this could perhaps be resolved and to apply any pressure that he can, because, as a family, they should be making memories at the moment, not battling local NHS bureaucracy?
Mr Ben Bradshaw (Exeter) (Lab)
Is it true that the Secretary of State is now so worried about the supply of vital medicines in the event of a no deal or a hard Brexit that he has asked the pharmaceutical industry to extend the period of stockpiling from six weeks to 20 weeks?
Kevin Hollinrake (Thirsk and Malton) (Con)
Will my hon. Friend, the Minister with responsibility for antimicrobial resistance, consider a 10% levy on antibiotics? If such a levy were applied globally, it would raise £3 billion a year, which is the amount specified in the O’Neill review to fund research into this area properly.
Steve Brine
I thank my hon. Friend for his consistent work in this area. Stimulating the pipeline for new antimicrobials and alternative treatments is a complex matter. I can assure him that we continue to work with our international partners—I mentioned the G20 earlier —and that absolutely involves market entry awards, which, as he knows, is a global problem that requires a similar solution.
Owen Smith (Pontypridd) (Lab)
Every week in this country, two children are born with spina bifida or anencephaly, and I am delighted that the Minister has just announced the consultation on the fortification of flour, which could stop 70% of those birth defects. Can he tell the House how quickly he hopes to bring about the conclusion of the consultation?
Steve Brine
Let me just pay tribute to the hon. Gentleman for the work that he has done, bringing this matter to the fore and really pushing it forward. The answer is as soon as possible. I also want to make sure that I can involve the other agencies. Public Health England will be very important in this, because, of course, not every woman eats bread and therefore takes the flour supplement.
Craig Tracey (North Warwickshire) (Con)
I am sure that the Minister is aware that October is breast cancer awareness month. I welcome the ambition that the Prime Minister set out at the party conference for 75% early-stage diagnosis. There is some concern that, as breast cancer is already above that, there is no ambition left for it to do even better. Can he assure me and the breast cancer community that that is not the case?
Steve Brine
That is certainly not the case. We had a very good debate on breast cancer last week. It is BCAM still this month for another week. The 75% was a target, a new national ambition. It most certainly is not the limit of our ambition.
Stephanie Peacock (Barnsley East) (Lab)
Will the Government write off the debts of Yorkshire hospitals so that extra money invested can go into patient care?
Eleanor Smith (Wolverhampton South West) (Lab)
I have a constituent who has Turner syndrome, a female-only genetic disorder that affects one in every 2,000 baby girls. Owing to this, she has to take several medications every day of her life, and this is mounting up as she gets older. She works so she is not on any benefits and has to pay for her medications herself. Will the Minister consider exempting those who suffer from lifelong conditions such as Turner syndrome from paying for their prescriptions? Surely, it cannot be right that people in England should be treated differently from those in Scotland, Wales and Northern Ireland, where such prescription charges have been abolished.
Steve Brine
I would be very happy to meet the hon. Lady to discuss her constituent’s case.
Sir Kevin Barron (Rother Valley) (Lab)
Will the Minister tell me whether the withdrawal of funding for the Healthy Futures programme in the north-west and Public Health Action in the south-west is likely to help or hinder us meeting the smoking cessation targets in the tobacco control programme?
Steve Brine
This comes back to the matter of public health budgets—£16 billion during the current spending review period, with local authorities best placed to make local decisions on what is needed in their local area. That is the same in the right hon. Gentleman’s area as it is in mine.
James Frith (Bury North) (Lab)
Last month, the Mayor of Greater Manchester adopted the five recommendations of my report, “Living Well and Dying Well”, which seeks to include hospice care provision more formally in our NHS and social care planning. Will the Minister meet me and representatives of our hospices to see how we might best make use of these brilliant community health assets?
Paediatric Cancers of the Central Nervous System
Steve Brine Excerpts(5 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I, too, wish we were not here, but let me congratulate my friend the hon. Member for Ogmore (Chris Elmore) on securing this evening’s debate. I commend him on his support and the incredible tribute he gave to Cian and Cian’s family this evening, and on the way he has handled the debate. For those who know him, in both the Government and the Opposition, it is rather typical of the man.
From what we have heard this evening, it is clear that Cian was a very special little boy who touched many people in his short life. I have seen his “Cian’s Kicking Cancer” campaign online, including the picture of him with his hands out in front of the No. 10 Downing Street door—it is a lovely photo—and I pay tribute to the determination of Cian’s parents to raise awareness of paediatric cancers. The way that they have been supported by their local MP is brilliant.
As the cancer Minister, I all too often hear of the devastation that this terrible disease can bring to people and their families, but nothing is as heartbreaking as when a child is affected. I said last week in the breast cancer debate that a life lived long or a life lived short is still a life lived, and I passionately believe that a life lived, short or long, still leaves an indelible mark on this world and still changes this world forever, even in a small way. From what the hon. Gentleman has told the House this evening, there is no question but that Cian has left his mark and changed the world a little bit. We will do our best to honour that and see whether we can change it a bit more.
Every day, at least 12 children and young people are told that they have cancer. When they are born—I have children myself—we all imagine bright futures for our children and the things that we want them to do, but cancer robs many children of that future and the opportunity to fulfil their potential. As the hon. Gentleman said, it is relatively rare in young children, but that is absolutely no consolation to the parents of a child with cancer. It can even be worse to know that and inevitably leads to questions such as, “Why me? Why my child? They haven’t made any lifestyle choices.” Cancer is indiscriminately cruel, and that is one of those awful truths that we face in life.
It is great that we have so much time for this debate. I know that there has been a bit of knockabout that the business finished early again this evening, but I genuinely believe that there is a reason why that happened, and we are going to make the most of it. I start by reassuring the House and those watching that cancer absolutely is a priority for me—I think most people know that—and for this Government.
I happened to be in the Tea Room before coming into this debate and the Prime Minister popped in after her marathon stint on her statement this afternoon. She asked me what I was working on and I said that I was doing this debate tonight. We spoke about how remarkable the way in which the House comes together in these debates is and how there is a concentrated audience for such debates. I know that the hon. Gentleman has put out on social media networks, as I am sure many others have, the fact that this debate is happening tonight, and I know, many people will be watching, so let us be clear: fighting cancer is absolutely central, as the Prime Minister said in her conference speech, to our long-term plan for the national health service in England—I have to say “in England”, because I am an English Health Minister, and the English cancer Minister. It will build on the progress already achieved in the cancer strategy and will set out how we will achieve our ambition that some 55,000 more people in England will survive cancer for five years each year from 2028.
I am absolutely committed to ensuring that our plan transforms outcomes for children with cancer over the next 10 years. The fantastic work being done by NHS cancer doctors and nurses, as well as the invaluable support that we get from our incredible cancer community, is helping us to achieve our vision of transforming cancer services for children and young people.
As I have said, childhood cancers are mercifully rare, but 1,600 children under 15 are still diagnosed each year in the UK. Central nervous system cancers are estimated to account for 25%, with 400 children diagnosed each year. Brain cancers alone account for more than 100 CNS cancers, making each cancer extremely rare.
It is true that survival for children’s cancer has gone up over the past decade, with five-year survival for children’s CNS cancers at 75%—that is how we measure it, but, of course, if people develop a cancer in their 70s, a five-year survival rate is a more significant achievement than for those who develop a cancer when they are under five. The survival rates have gone up, but there is not an ounce of complacency in me; we will and must keep working hard to go further and faster.
Treatment of CNS cancers varies depending on several factors—age, the tumour growth rate and the location and size of the tumour—but, as the hon. Gentleman said, it will usually involve a combination of surgery, chemotherapy and radiotherapy, depending on the clinical need. To ensure that patients have access to the latest, most cutting-edge technology wherever they live, we have invested heavily—some £130 million—to modernise NHS radiotherapy equipment. Over the past two years, 73 trusts have had their older linear accelerators, as they are known, upgraded or replaced, and that is an important thing that we have done—[Interruption.] Cheltenham is one of them, says my Parliamentary Private Secretary, my hon. Friend the Member for Cheltenham (Alex Chalk)—who says that PPSs do not speak in the House? He sits there diligently day in, day out, so why not?
The hon. Member for Ogmore mentioned proton beam therapy and I want to touch on that. In the past few years, there has been an increase in the use of PBT—for those who do not know, it is an advanced form of radiotherapy—for treating children with CNS tumours. It uses high-energy proton beams to treat the cancer much more precisely. These targeted doses of treatment have less impact on surrounding healthy tissue and fewer side-effects. In childhood cancers, that is critically important—the hon. Gentleman mentioned side-effects of treatment with regard to fertility, for instance.
Until now, PBT for children has been commissioned from overseas. We have sent children to America and to Germany. That is why we have invested £250 million to provide PBT services in England. I am delighted that the first NHS centre, at the Christie in Manchester, is scheduled to begin treating patients this autumn. A second facility is due to open at University College London Hospitals in London in 2020. I had the pleasure of visiting the Christie shortly after delivery of the giant ProBeam proton system, which is a significant engineering feat. The scale and complexity of the technology is truly breath-taking, and I am tremendously excited that we will shortly be providing PBT on the NHS in England, sparing patients the upheaval, discomfort and cost—I will come on to that—of travelling abroad for treatment.
Although survival rates for CNS cancers have been improving, some children will unfortunately suffer relapse, as we heard in Cian’s case, and treatment options can sadly be limited, even for palliative care. That is why NHS England is reviewing whether additional radiotherapy treatments, such as stereotactic radiosurgery and stereotactic radiotherapy—there is a difference—would be suitable for these patients. I am following that work closely, as I am interested in and excited by its potential.
This month, NHS England published the draft national genomic test directory for cancer, setting out how whole-genome sequencing for paediatric brain tumours and other genetic tests are now being considered for CNS cancers. I hope that introducing those tests will support better tumour identification and more targeted treatments for CNS cancers in children, and give hope to many others.
Perhaps the most exciting development in our efforts to treat childhood cancers successfully is the increasing availability of personalised treatments such as CAR-T therapy, about which there is understandably a lot of excitement in the medical community. With the introduction of more personalised and targeted treatments and different treatment options for children with CNS cancers, NHS England is reviewing how best to ensure that children receive the available treatment and from the relevant clinical team, now and in the future. We expect the availability of more personalised treatments to be a real game-changer for childhood cancers. The work is still in its early stages, and it will involve clinicians, service providers and charities as it progresses, but I will of course update the all-party group, which I will come to in a moment, as it develops.
Research, which the hon. Gentleman mentioned, is a crucial part of the fight against brain tumours. In May, we announced £40 million over five years for brain tumour research through the National Institute for Health Research, as part of the late Tessa Jowell’s brain cancer mission, which includes research for children with brain cancer. I only met Baroness Jowell once, unfortunately, but I was left in no doubt about what she wanted me to do—her legendary determination was very much in evidence. I very much enjoyed meeting her and Jess, her daughter, who is carrying on much of the work.
The hon. Gentleman talked about research projects. Baroness Jowell’s mission is about stimulating quality research projects—a point that the late baroness was able to nail as soon as she started to look into it. Although the NIHR spent £137 million on cancer research in 2016-17—the largest ever investment in a disease area—it does not allocate funding for specific disease areas. It does not have a basket for each disease area. Spending has to be driven, therefore, by scientific potential and the number and scale of quality funding applications.
The baroness was very pithy and understood immediately that we needed to stimulate the market in brain tumour research to enable quality research proposals to come forward. After that, the clinical research network, which is recruiting for or setting up more than 700 cancer trials and studies, including studies into childhood cancers and brain tumours, can press forward and do its work. Funding for paediatric cancer research is critical.
The hon. Gentleman also talked about international research. I absolutely agree that international collaboration is key for successful research on rare diseases such as CNS and childhood cancers. The Prime Minister has made it very clear that we want to work closely with Europe in science and research and that the UK is committed to establishing a far-reaching science and innovation pact with the EU, facilitating the exchange of ideas and researchers and enabling the UK to continue to participate in key programmes alongside our EU partners. Whatever “take back control” meant—one day I will be told—it did not mean that we are not to work with our EU partners in such areas. I am determined that it will not mean that, as are the Government. The Chancellor has also made it clear that he will guarantee EU structural and investment funding and underwrite payments for competitive EU research awards through the Horizon 2020 underwrite guarantee, which is a very important project.
The hon. Gentleman mentioned the Eliminate Cancer Initiative, which the late Baroness Jowell made sure I was acutely aware of. Its tagline “Making cancer non-lethal for the next generation” is really neat, and we certainly support it. It has huge global potential and reach. As he mentioned, given my international health brief, I travel to talk to Ministers from around the world. I was at the G20 earlier this month. The G20 and G7 have Health Minister meetings, as they should do; I certainly hope they will when we have the chair. I would like to see international research collaboration, specifically on cancer, on one of the G20 or G7 agendas. The hon. Gentleman’s point was well made. I will take it up with my officials so that, as we lobby for the chair of the next meetings, we talk about that. It would be an interesting piece of work that we as fellow Ministers could do. I know that people think that sometimes these international meetings are talking shops, and of course there is an element of that, but actually an awful lot of good stuff goes on and an awful lot of other agencies—the OECD, the World Bank, the EU—are part of those meetings. If Ministers decide that this is part of our agenda, that will make a difference and move the dial.
Several Members have talked about awareness of childhood cancers and I thank the hon. Gentleman for what he said about the all-party group on children, teenagers, and young adults with cancer. I am pleased to see my friend the hon. Member for Bristol West (Thangam Debbonaire) in her place. I welcome the establishment of that all-party group on the specific needs of children and young people with cancer. It is an excellent all-party group—several of its members are or were here. I was delighted to give evidence to its patient experience inquiry earlier this year. She had some of her patient advocates there, who asked great questions as well, and I commend it for an excellent report. I do not have to do this for all-party groups—I do for Select Committees—but I have undertaken that the Department will respond line by line to its report. I will definitely do that. It is not ready yet, but it will happen.
One of the all-party group’s recommendations was on signs and symptoms, which I will come on to, and another was on the cost of travel. The hon. Member for Alyn and Deeside (Mark Tami) mentioned the CLIC Sargent report that highlighted the financial impact of travel on the families of young cancer patients. It is a really good piece of work. I assure hon. Members that the Government are working to review the service specifications for children and young people with cancer. This will help us to consider how some aspects of the patients pathway might be provided more locally to reduce the travel burden for patients and their families. There is the other element: sometimes that cannot be done and people have to travel for treatment. The NHS cannot do everything brilliantly everywhere—clearly, specialisms are sometimes needed. That is why we have the healthcare travel costs scheme, which is part of the NHS low income scheme. It allows for patients’ travel costs to be reimbursed if they are in receipt of a qualifying benefit or are on a low income. The scheme helped some 337,000 applicants to receive financial help with their NHS treatment. I am very interested in the recommendations of the all-party group on that and I assure its members that I am taking great note of them.
Dr Caroline Johnson
I am pleased to learn that my hon. Friend takes such an interest in reports from all-party parliamentary groups. Will he undertake to look equally carefully at the report that will be produced tomorrow by the all-party parliamentary group for children who need palliative care, known as Together for Short Lives, which I co-chair with the hon. Member for Newcastle upon Tyne North (Catherine McKinnell)? It looks at how we provide palliative care for children with cancer and other life-limiting and life-threatening conditions.
Steve Brine
I will now take an intervention from the hon. Member for Ilford North (Wes Streeting).
Wes Streeting
I am grateful to the Minister for his thoughtful response to the debate. Will he and the Department look carefully at the issue of access to experimental treatment and financial support, and also the issue of control? One of the conversations that I had with Tessa was about how she had to wrest back control over her own choice in relation to risk and access to experimental treatment.
It would be hard enough for adults to make such choices for themselves, but parents are having to make those difficult choices, too. Some parents feel that they are making the best decisions for their children in turning down the opportunity of access to experimental treatment on the basis of an assessment of the risk and the impact on the life that they have left, while others choose to access such treatment in the interests of their children. While there are challenges in respect of the governance and, perhaps, some of the ethics of those arrangements, we must put a bit more trust and faith in parents. When they choose to access experimental treatment, even if the Department will not fund access to the treatment itself, it might be able, reasonably and ethically, to provide more support than it currently provides in respect of the associated costs of, for instance, travel, accommodation and subsistence.
Steve Brine
I will look into that. The late Baroness and I talked about exactly that subject. I do not think it is so much about ethics; I think that this must be clinically led. There is a great deal of debate in the clinical cancer community about the toxicity of concurrent treatments. However, I take the hon. Gentleman’s point about the costs, and the importance of supporting parents who must make decisions which are hard enough when people are making them for themselves.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) mentioned an all-party parliamentary group of which I was a member before I was a Minister. I take all-party parliamentary groups so seriously because I used to lead loads of them. I spent hours writing reports, and, dare I say, I wish that they were sometimes taken as seriously as I take such reports.
It is in all-party parliamentary groups that a lot of good work goes on in the House. Opposition Members, who are not in government at this time, have a huge role to play in moving the dial. The smart Ministers are the ones who say that they do not know everything. The lines that the civil service gives them are often great, but they are not the be-all and end-all. I see APPGs as a brilliant and rich vein of knowledge for me, and I learn a lot from them. So yes, I will look out for my hon. Friend’s work in Together for Short Lives.
My constituency contains one of the best children’s hospice trusts, Naomi House and Jacksplace. My heart goes out to the child hospice movement and my respect for it is ample, and what Together for Short Lives does to represent that movement is incredible.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
There is also a fabulous children’s hospice in Stoke-on-Trent, the Donna Louise Trust, which goes above and beyond its remit to support not just children with life-limiting conditions, but their families. Most children’s hospices depend almost 100% on charitable giving and fundraising to undertake such work. Should not we, as a society, be considering that, and should not the state have a role in helping to provide the service when it is needed?
Steve Brine
There is a role for the state, but the hospice trust in my constituency told me many times that the last thing it wanted was to be 100% reliant on the state. It does not want to be an arm of the state; it enjoys its charitable status. I remember taking delegations from Naomi House, and from the sector, to meet David Cameron when he was Prime Minister, and I think that we could do a lot better in relation to the specialised commissioning of these services. It is still too confusing and too confused, and still too patchy from clinical commissioning group to clinical commissioning group. We are determined to do better in that regard.
Before I went off on a tangent, I was talking about awareness of childhood cancers, which a number of Members mentioned. We must improve awareness of cancer, full stop. I am very proud of Be Clear on Cancer’s “blood in pee” campaign, which is part of my brief. However, as someone who has young children, I know that the challenge is striking the balance between educating children about the warning signs of cancer and frightening them about a risk that is relatively low at their age. My motto would be that the best must not be the enemy of the good.
A number of Members will know about the work of the Teenage Cancer Trust and CoppaFeel! The hon. Member for Bristol West certainly does, because of the work that she has done in relation to breast cancer. Coppafeel!—I still think that that is the best name for a charity that I have heard since I have been doing this job—is run by Kris Hallenga, a brilliantly brave young lady who has terminal breast cancer. It ran a superb cancer awareness campaign in schools, about which I have talked to secondary schools in my constituency. It is sensitive and evidence-based, and pitched very appropriately.
I recently took both those charities to discuss their campaigns with the Minister for School Standards, my right hon. Friend the Member for Bognor Regis and Littlehampton (Nick Gibb). As the House will know from a statement made by the Secretary of State before the summer recess, the Department for Education will be consulting on its health education guidance until 7 November. I encourage charities, all-party parliamentary groups and parents to put forward their views on how we might go further to educate children about cancer. That is critical if we are serious about prevention, which we are.
Let me end by putting on record my tribute to the NHS doctors, nurses, support staff and charities, and our colleagues in the wider cancer community—Team Cancer, as I call it—who work so tirelessly every day to ensure that our constituents, and thousands of children like Cian, benefit from the support and the expertise that give them a chance of recovery and a full life. They are true heroes. They are the ones who will oversee the potential for huge progress in the next 10 years on the cancer diagnosis, treatment and support that we hope to see.
Chris Elmore
I am extremely grateful to the Minister for giving way again—we are in the unusual position of having lots of time, as he has pointed out. I am not sure whether this is in order, but I want to thank him most sincerely for the open way in which he has spoken and responded to Cian’s story, and for the commitments he has given this evening, which will be welcomed across the House and by Cian’s family, particularly the commitment to respond to the all-party parliamentary group and the international commitment on the G7 and the G20. I am enormously grateful, as I know every cancer sufferer and every family member of a cancer sufferer will be. I pay tribute to him, in a rare moment of affection and thanks in this House, which often resembles a bear pit more than anything else, because he clearly has an enormous commitment to the cause that is cancer.
Steve Brine
That is a very nice thing to say. I thank the hon. Gentleman.
In closing, we think that the NHS long-term plan, with cancer right at its heart and with the new north star ambition on early diagnosis and 75% early stage detection, will turbo-charge all that we have already achieved. We are on track to achieve that through the cancer strategy. Last Thursday, in the Westminster Hall debate on breast cancer, I said that I want to see a future where cancer has no future. Maybe I am naive and ambitious, but I want to reiterate that today, because I think that we could achieve that. If we are ever to achieve that goal, I sincerely hope that we can begin by first eradicating all childhood cancers, because many people are relying on us.
Breast Cancer
Steve Brine Excerpts(5 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Thank you for chairing our session today, Mr McCabe. I add my congratulations to the hon. Member for Lincoln (Karen Lee) on securing the debate and the hon. Member for Crewe and Nantwich (Laura Smith) on leading us off today. Breast cancer sadly affects so many of us so personally. It is always a privilege to respond to any debate in this House, especially on cancer and more especially on breast cancer, and this has been a constructive, small and perfectly formed debate.
It is always a pleasure to follow my shadow Minister and friend, the hon. Member for Washington and Sunderland West (Mrs Hodgson); I think this is the first time that a debate has been led by all three chairs of the same all-party parliamentary group, speaking for their respective parties. It was important to us when we chaired the group that we had the three main parties in the chair. The third chair was then held by the Liberal Democrats—remember them?—[Laughter.] Stop it. When the hon. Member for Central Ayrshire (Dr Whitford) joined the House, it was a real pleasure that she came on board and took that seat.
I will start by saying, “Happy BCAM!” There is much to celebrate, as hon. Members have said, and it is Breast Cancer Awareness Month, or BCAM for short. I pay tribute to all the people who are here, the survivors—survivorship is very important—and to all the people who have gone. Macmillan Cancer Support ran a heartfelt campaign earlier this year on the idea that “A mum with cancer is still a mum”, which was one of the best pieces of advertising I have seen in the health space for a long time. The reason I say, “Happy BCAM!” is that the people who have gone were still mums, daughters and sisters, even while they were going through their challenges. That is very important. Even children who lose their battle with cancer after being on this earth for a matter of days leave an indelible mark, because they were here for a few days. It is important to me that we always remember that, and I always do.
The title of today’s debate on the Order Paper is “Future of breast cancer”. The hon. Member for Washington and Sunderland West said to me once in one of our group meetings, “You will be cancer Minister one day.” If she could predict something else great for me, that would be excellent.
Steve Brine
Oh yes; the hon. Lady has already said Chancellor today. I am not sure about that one.
As the cancer Minister, I want a future where there is no breast cancer. The hon. Member for Strangford (Jim Shannon) mentioned that, and I think all hon. Members who have contributed this afternoon would like to see a future where there was no breast cancer. One day, perhaps—but the statistics show that we are making good progress. That is why I said that there are things to celebrate. We are ensuring that more people than ever survive breast cancer. As has been said, 10-year survival rates have almost doubled, from around 40% to nearly 80%, in the last 40 years.
I hope I do not need to say it, but cancer is a huge priority—the priority—for me. The Prime Minister chose to make it a central point of her party conference speech this month, and there was a reason for that; it is a huge priority for her and for her Government. Survival rates have never been higher, and they have been increasing year on year. Of course the Prime Minister celebrates that, but it is also why she announced a very ambitious package of measures for cancer care and treatment, showing that cancer will be absolutely central to the long-term plan for the NHS, which she has challenged NHS England to write before the end of this year and of which I will say more later. We are committed to investing an extra £20 billion a year in our NHS. The investment will build on the success we have already achieved through the implementation of the cancer strategy for England. I pay tribute to Harpal Kumar and those at Cancer Research UK who put that strategy together. We will build on that legacy and take it forward into the long-term plan.
In opening the debate, the hon. Member for Crewe and Nantwich raised a number of good points. She talked about secondary breast cancer data collection—a number of people did so, but she raised it first. She is right that the robust and timely collection and sharing of data is vital for improvements in breast cancer services. If we do not measure it, we do not know, and if we do not know, we cannot act. The National Cancer Regulation and Analysis Service, or NCRAS, collects data on all cancers diagnosed in England, with the data collection specified by the cancer outcomes and services dataset. That data collection of secondary breast cancers was mandated as part of the COSD for diagnoses from April 2013 onwards.
I remember, with my shadow Minister, taking a delegation to see Prime Minister David Cameron in No. 10 to talk about that exact issue just before Christmas; I remember our photo by the tree. It is good that that happened, but it is evident, comparing the collected data with sources in academic literature, that a large proportion of cases are still not being reported in the COSD. That is of great frustration to me. NCRAS continues to work with NHS trusts to improve the completion of the data, and we have redesigned aspects of the COSD to allow more relevant information on occurrence to be captured, but I do not for one minute shirk the fact that there is more to do in this area, and I assure the House and colleagues that I will constantly redouble my efforts in that regard.
Dr Whitford
I touched on the quality improvement project that we started in 2000 in Scotland, looking at many measures right along the pathway that the patient went through. In essence, it was assessing the whole team: how the team functioned, what the surgery was like, what the diagnosis was like and what the chemotherapy was like. The problem is that that sort of audit has not happened, other than for screening patients, in England for quite some time. While I welcome the collection of data on secondary cancer, we need units to have the ability to look at their performance on patients the first time around, to try to prevent that secondary cancer.
Steve Brine
The hon. Lady is right. That is why COSD stands for the cancer outcomes and services dataset. It is not specific to breast cancer, nor should it be, because there are sadly lots of different cancers, but she is right that it should be measuring, judging and analysing both the outcomes and the services that lead to that outcome. As ever, she is dead right.
The point was made about off-patent drugs being found to be effective in new uses. The Prime Minister set out, both in her party conference speech and when we launched the new NHS long-term plan, how a key ambition of that plan will be to speed up access to groundbreaking treatments, with a quicker translation of new breakthroughs into practice through investment in world-leading cancer research centres.
Although bisphosphonates—I always struggle to say that—are not licensed for the treatment or prevention of secondary breast cancer, clinicians can prescribe them off-licence or off-label, subject to local funding policies, if they consider them to be clinically appropriate for an individual. The hon. Lady was right to raise that point.
Steve Brine
Not at the moment. The hon. Lady and others also talked about the long-term funding of cancer alliances. NHS England and I are absolutely committed to the cancer alliances. We have backed them with significant funding and we will continue to support their development fully, ensuring that they have the funding that they need—in this cycle, at the very least—to transform cancer services in the long run.
I take a close and continued interest in the cancer alliances, as Members would expect. Just this week, I sat down with Cally Palmer, the NHS England’s national cancer director, to do what I call a deep dive, going through each cancer alliance in England. I want to know who runs them, where there are leadership challenges, where they struggle to meet the 62-day target and why, and I want to know their turnaround plans for that, including replacing people who are not performing. We do not expect or accept poor performance in a trust, and we do not expect or tolerate it in schools. Cancer alliances spend a lot of public money and they should not be treated any differently.
I want much greater transparency from the cancer alliances. I suspect that if I asked every Member here whether they knew the name of their local health trust chief executive, they would say that they did—and they probably have them on speed dial, as I do. If I asked those Members whether they knew the name and number of the person who leads their cancer alliance, I doubt that they would. I assure Members that that will change.
Dr Whitford
Bisphosphonates and other off-patent drugs are usually old drugs, which ought to be cheaper and therefore very cost-effective. The Minister and another Member mentioned that these drugs are not relicensed. A private Member’s Bill to set up a method for relicensing drugs for a new purpose was unfortunately talked out by the then Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), in November 2016. We have agreement that these drugs will go into the “British National Formulary”, which will hopefully increase their use. However, I notice that the shocking increase in prices of off-patent drugs that led to the introduction of the Health Service Medical Supplies (Costs) Act 2017 has not changed. The regulations are not being used. NHS England is being charged ridiculous prices for old drugs and for specials that are made up for individuals. Why are we not using that legislation to drive down those prices, so that all women in England could access drugs that are not—or should not be—actually that expensive?
Steve Brine
There is so much more that I want to get on to, so I will not go into that in any great deal, but I will give the hon. Lady a note on that. Lord O’Shaughnessy, who is part of the Department’s drugs team and who speaks on health in the other place, is working on the implementation of that legislation. The hon. Lady has asked me about this before, and it frustrates me incredibly that that Act is not being implemented more quickly, but that should not be taken as any indication of a lack of desire on our part to do so. However, I take the hon. Lady’s point.
It is still right for those prescribing decisions to be made by clinicians. However, I want breakthrough drugs to make it on to the market more quickly, instead of staying in the cancer drugs fund. There are good examples of that related to breast cancer, and we want to see it happen much more quickly.
My dear hon. Friend the Member for Bexhill and Battle (Huw Merriman) spoke personally and passionately —as always—about these matters, and I thank him for that. He raised lots of issues, including the screening programme. Everyone says that the breast cancer screening programme is a critical tool in ensuring that we catch breast cancers as early as possible, when there is a higher chance of successful treatment. However, we know that there is much more to do to improve uptake. In her party conference speech, the Prime Minister set out that we would transform our screening programmes, making them more accessible and easier to use and utilising the best research and technology. Further detail on that will be set out in the long-term plan later this year.
My hon. Friend also asked about technology in screening. I will come on to the screening scandal in a moment, but it is very much our aim that in the future patients will be able to make much greater use of technology to be informed of things, such as GP or screening appointments, rather than relying on Royal Mail. Our NHS app is being piloted and will be rolled out from December this year. That is just the start of the technology revolution that we want to see and that the Secretary of State has made one of his priorities. We expect the independent breast screening inquiry to make recommendations in that area.
Several Members asked about the inquiry into the breast screening problems that we had. We expect that to report shortly. I do not have an expected date, but several Members, including the hon. Member for Central Ayrshire and the shadow Minister, asked whether it is on schedule. I believe that it is, and I look forward to that report very much. With somebody as serious as the Macmillan chief executive leading that review, alongside others, I know that it will challenge us, as it is meant to; the former Secretary of State set it up to do so.
My hon. Friend the Member for Bexhill and Battle mentioned the importance of early diagnosis. I am proud of Public Health England’s Be Clear on Cancer campaign, which I am responsible for. PHE ran its 14th Be Clear on Cancer campaign through February and March of this year, focusing on breast cancer in women aged over 70—a subject that is very close to the hearts of members of the APPG. Research shows that older women are more likely to delay presenting to their GP with breast cancer symptoms.
The campaign previously ran in 2014 and 2015, and an evaluation showed an increased awareness of the key messages that it promoted and, even more importantly, that more cancers were diagnosed during the campaign period. We are running the “Blood in Pee” campaign at the moment—I have all the glamourous things in my portfolio—and Be Clear on Cancer will go forward and from strength to strength.
Huw Merriman
I am incredibly impressed by what the Minister has said so far. Will he keep an open mind on the age limits for screening—particularly the entry age? I know that it has been reduced, but will he keep an open mind on reducing it further?
Steve Brine
I always keep an open mind. The truth is—the hon. Member for Central Ayrshire knows exactly what I will say—that although the screening review will no doubt make recommendations on that, there is a very heated and divided debate within the breast cancer community around screening, and not just about the age at which to begin it. We had the AgeX age extension trial, which broadened the range of ages at which we screen, but there is absolutely no consensus within the breast cancer community on the benefit of screening. That debate continues and rages strongly, and it is for policy makers to listen to all the different views, as the screening review will do.
Several Members, including the shadow Minister, rightly mentioned clinical nurse specialists and the cancer workforce. Last December, Health Education England published its first ever cancer workforce plan, which committed to the expansion of capacity and skills in fighting the big C.
Steve Brine
Let me make this point. That plan includes an ambition to attract qualified people back to the NHS through domestic and international recruitment. HEE also plans to expand the number of clinical nurse specialists and to develop clear CNS competencies and routes into training. This will see every breast cancer patient having access to a CNS or other support worker by 2021.
We are committed to ensuring that all that happens. I saw a lot of news coverage last weekend on access to CNSs, and I completely accept that we have more to do. However, I have been very interested in listening. These debates are not only about me sitting here and waiting to read out my speech; they inform me, as much as anything. I was very interested in the discussion between the Labour and Scottish National party Front Benchers about what CNSs are called and the multidisciplinary team that they could be part of to offer support to women as they are going on this journey. I will definitely take that away.
Karen Lee
May I ask the Minister to respond directly to my comment that according to the figures out this morning—I know, because I was given them and asked to comment on them—the numbers of people training to be a nurse have dropped by just over 30% since the bursaries were withdrawn? The Government talk and talk about associate nurses and apprentice nurses, but there is not the take-up for those posts, and an apprentice nurse takes four years to train, so will he respond directly to my comments? Of course, the issue affects not just nurses but radiographers, as I said.
Steve Brine
The general point I would make is this. The hon. Lady said that people cannot live on good will; they have to have pay rises, and that is why I am very pleased that we have lifted the public sector cap pay. The significant pay rise that will be coming is welcome. Also, as well as expanding the number of nurse training places by 5,170, we are expanding the skills of specialist cancer nurses. There are 52,000 nurses training in the NHS, with more to come, thanks to our 25% increase in training places. The debate on bursaries is very live. That is discussed every single time we have Health questions—I dare say it will be again on Tuesday—but the Government have been very clear about our vision for the health education workforce and where we see nurse training places and the nurse apprenticeship scheme sitting in that. That is probably all I can add at the moment on that issue.
I want to touch on so many other different things. The hon. Member for Central Ayrshire, the shadow Minister and everyone else who spoke in the debate talked about prevention, and of course the title of the debate on the Order Paper is “Future of breast cancer”, so yes, we need to do a lot more to prevent people from developing cancer—not just breast cancer, but cancer—in the first place. As the Minister responsible for public health and dealing with cancer, I know that encouraging people to live healthier lifestyles can be one of the most effective ways to prevent cancer. Yes, there have been challenging budgets since we took office in 2010, but I refuse to bring politics into the cancer debate. All I will say is that Governments do have to live within their means. Governments do not have any money of their own; they have only our constituents’ money. We are spending £16 billion on the public health budget in England during this spending review period, but difficult decisions have been made. Clearly, I cannot pre-empt the spending review next year. I know what the NHS is getting, because we have pre-empted that ourselves, but we will make our announcements around the future of the public health grant, which obviously comes through a different Department, in due course.
I want to talk about the prevention point. Better prevention is not a silver bullet. I wish it were, but the truth is that cancer is indiscriminately cruel. We have had statistics today on the number of cancers that are preventable. Some two thirds of cancers are just down to bad luck. That is a horrid fact of life, and a horrid fact of life that every Member in this Chamber lives with every day. Cancer can have devastating effects on children, and on people who have lived the healthiest of lives, but we can have a huge impact and ensure that more people live their lives free of cancer if we focus on the prevention message.
Obesity is relevant. We talk a lot about childhood obesity. That is obviously because big children become big adults. Cancer Research UK has been very good in this space in making the connection between obesity and cancer. When we made the connection between smoking and lung cancer, it was a game changer. CRUK makes the connection between obesity and cancer. I am not fat shaming in saying that; it is just a matter of fact that obesity is a contributing factor to cancers. I am told that 8% of breast cancer cases in 2015 were the result of being too heavy. We need to do better on obesity, and we could talk for hours about the childhood obesity strategy alone. There are of course the issues of diet and physical activity. Earlier this month I was at the G20, talking about strengthening health systems, obesity and physical activity, and everyone around the world concurs on that.
I shall close on prevention by talking about alcohol, which the hon. Member for Central Ayrshire mentioned. It is a big breast cancer risk. That is the truth. Women who drink more alcohol have higher rates of breast cancer; women who do not drink have a lower risk of breast cancer compared with those who do. Risk rises with alcohol consumption, and no particular level of intake is risk free. That is the truth.
I want to return to the screening failure, because screening was referred to by the hon. Member for Strangford. He is in his place as always—God bless him. However well we are doing, we cannot be complacent. I constantly look at and worry about the screening figures. With regard to the failing in the national breast screening programme in England, many things come across our desk as Ministers that we wish did not come across our desk, and there are many things that we lie awake at night and worry about. Some things kick you where you do not want to be kicked as a man, and the breast screening programme failure in England kicked me very hard there when it happened. It resulted in thousands of women between the ages of 68 and 71 not being invited to their final screening. That is a stark reminder that however well we think we are doing, we have to do better. The former Secretary of State apologised unreservedly for it. He said that all we can do is put it right, and we are putting it right in terms of inviting people back for screening. We are determined; the independent review was set up to investigate and report on the circumstances of breast screening failure. That is expected to report shortly. It will challenge us and make very challenging recommendations. I look forward to discussing that with hon. Members.
The five-year survival rate for breast cancer is already 86%, as has been said. Some in the breast cancer community worry that the long-term plan and the Prime Minister’s new 75% early-stage detection ambition for cancer mean that we have no ambition left for breast cancer. Earlier this week the national cancer director and I discussed the long-term plan. I was absolutely clear with her, and she agrees, that our long-term ambitions cover all cancers, including breast cancer. The 75% five-year survival aim is ambitious—we would love many cancers to be even remotely there—but it is not the limit of our ambition.
As I said, I want a future in which there is no breast cancer. The NHS does well at diagnosing breast cancer, but it must do a lot better at preventing it. We must continue until the five-year survival figure is 100%, and I do not say that as a naive ambition. I want to make that point clear, because I know that some in the breast cancer community are concerned about that.
I pay tribute to the selfless work done by the people who will deliver the vision in the cancer strategy and the wider long-term plan. Obviously, doctors and nurses are at the sharp end, and I visit them when I go out and about. They, not Ministers, are the people behind the highest ever survival rates. I also want to add my thanks to the charities, which I have enjoyed working with. Breakthrough Breast Cancer joined with the Breast Cancer Campaign to become Breast Cancer Now. I enjoy working with Delyth, Baroness Morgan, of Breast Cancer Now and with Breast Cancer Care and Breast Cancer Haven. I have a lot of time for Breast Cancer Haven, which creates havens to help women to feel human and normal again after treatment. It does a lot of good work.
NHS England and I, with the support of what I always call Team Cancer, are utterly committed to making the ambitions that we set out in our long-term plan and our new cancer strategy a reality. That will ensure that we take a huge leap forward, over the next 10 years, to a future in which cancer has no future.
GP Extended Access Services: Privatisation
Steve Brine Excerpts(5 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
It is a pleasure to serve under your chairmanship, Mr Hosie—it is the first time we have done this. I congratulate the hon. Member for Stockton South (Dr Williams), who I always enjoy listening to, on securing this debate on an important issue for him as both a Member of Parliament and member of the important Health and Social Care Committee, and—as I think he is still—a practising GP.
We know that primary care literally, by definition, comes first. It has always been and always will be the bedrock of the national health service. The Secretary of State and I have made that absolutely clear, and the long-term plan, when it is published later this year, will make it even clearer. As the hon. Gentleman rightly says—I think there is unanimity—we are committed to ensuring that everyone can see their GP at a convenient time by increasing the availability of routine evening and weekend appointments. Millions of patients have already benefited thanks to our investment of some £2.4 billion into general practice by 2021. I join him in paying tribute to his colleagues for making the leap and making that available to his constituents.
We have asked all clinical commissioning groups to ensure by March next year that patients have extended access to general practice across the whole of their registered population. That includes ensuring that access is available during peak times of demand such as bank holidays, and across the Easter, Christmas and new year periods. We have made great strides in delivering extended access, with the vast majority of England now offering weekend and evening appointments. Apologies to you, Mr Hosie—this of course is a devolved matter and we are talking about the English health service. That extended access will, as the hon. Member for Stockton South rightly says, help to reduce the pressures on general practice—it is not all squeezed into the original sessions—and, importantly, to reduce pressures across the wider NHS ahead of winter, which is creeping up on us.
Good access is key to improving quality and is not just access for access’s sake. Problems with access make it harder for people to get the right care from the right person at the right time. It is a publicly funded health service and it is there for the public, and that is what the public say they want. However, for us improving access is not simply about all GPs working seven days a week or doing more of the same. There was certainly a comms failure with the 2012 Act, in that it was allowed to be presented as saying that we just wanted GPs to just do more and to work seven days a week. Many people work seven days a week—all MPs certainly do—but improving access was not just about asking GPs to do more of the same. It can be and often is about practices coming together to offer services to a larger population—I have seen it most recently at the brilliant Granta surgery in Cambridge, which does it very well—using technology in different ways to make it easier for patients to access services, and broadening the skills mix. The hon. Gentleman and I have talked about the multidisciplinary team many times. It is also about working smarter in greater partnership across the health and social care system. The Secretary of State was at Granta just last week.
The hon. Gentleman mentioned the Health and Social Care Act 2012 and asked in effect why we do not just do away with the requirement in that Act—the section 75 rules—so that CCGs are, as he says, no longer required to tender for contracts. Let me assure the hon. Gentleman and you, Mr Hosie, that any fears of privatisation of our NHS are, we think, completely groundless. I do not accept the title of the debate on the Order Paper. The Government are fully committed to the NHS as a public service that is free at the point of need, as it has been since day one in 1948—70 years ago this year, of course—whether care is provided by NHS organisations, as the vast majority is, or by the private, voluntary or social enterprise sectors. That guiding principle remains absolutely the case today. The mechanisms for deciding who provides what service may vary, but the basic structure of our NHS remains exactly the same. The key question is, and will remain, the pragmatic one: how do we best secure the outcomes that we want for patients and the best possible value for the taxpayer? I completely respect the fact that the hon. Gentleman started his speech by saying exactly that. He is spot on, of course.
We should avoid the blanket assumption that one form or other of provision is always the best or worst, as the evidence does not support that sort of sweeping conclusion, which the hon. Gentleman understands. As long as patients receive care that is high quality, timely and free at the point of use, the status of the provider is of little if any significance. That has been the policy of successive Governments for many years. It was certainly the policy of the last Labour Government and was what Tony Blair believed when he was in office. I know that many Opposition Back Benchers do not share the ideology of those on their current Front Bench, which is to make those sweeping conclusions that one form of provision is bad and one good. Where healthcare is free at the point of use, people are not as concerned about who provides the care as we think and often hear in the House. The British social attitudes survey showed that 43% of people had no preference whatever between a private provider, an NHS provider and a not-for-profit organisation.
A clear framework for public sector procurement is both necessary and, we think, desirable, just as it has been since it was introduced in 2006, under a previous Government, to implement the EU procurement directive. It is necessary to ensure that where a local, clinically led CCG decides that it is in the interests of patients and taxpayers to look at a range of potential providers for a service, it is able to do so. That is in the best interests of patients and taxpayers. Securing the best possible treatment for a patient is what we all want to achieve, but we also have to use NHS resources for the good of all patients. Achieving value for money is not just about making the numbers add up. It is about how we ensure that everyone gets the quality of treatment that they deserve.
Dr Paul Williams
The Minister has said that the CCG puts things out to procurement when it decides that that is in the interest of patients. Do I understand from his words that the local CCG had the option within the law of not going out to procurement on this service?
Steve Brine
I might have to send the hon. Gentleman a note on that, but I will repeat what I said, just for the purposes of accuracy—I know he is seeing the relevant people later this week. Where the clinically led CCG decides that it is in the interests of patients and taxpayers to look at a range of potential providers for a service, it is able to do so. Those are the words I have for him. What we need and have is a sensible, proportionate framework that effectively balances the need of commissioners to secure the best-quality service at the best price with their need to ensure the security and sustainability of supply. It has worked that way and worked well for the past 12 years.
Steve Brine
I will happily give way to the constituency neighbour of the mover of the motion.
Alex Cunningham
I wish to push this point. I know the Minister said that he might have to send my hon. Friend a note, but in putting the service out to tender, the CCG either is acting within the law or is not. Did it have the option within the law not to put this particular service out to tender? We need a very clear understanding of that.
Steve Brine
Let me repeat that the local, clinically led CCG absolutely decided that it was in the interests of patients and taxpayers to look at a range of potential providers for the service that they wanted to be provided. That is the process that it is going through. The hon. Member for Stockton South rightly said that he would not expect me to wade into the middle of the procurement process. I cannot do that, but I will say that sensible, dynamic commissioning will be central to the NHS meeting the challenges that it faces today and in the future despite the commitment to increase the funding by £20.5 billion a year. That is vital to ensure that the NHS delivers on our triple aim of improving quality of care, cost control and population health which, as I am the Public Health Minister and absolutely focused on prevention, is one of my and the new Secretary of State’s key priorities. It is central. To achieve that triple aim, NHS commissioning will need to continue to develop as it has done since its inception. NHS England has designed a new commissioning capability programme to support commissioning systems. The programme provides tailored support delivered through place-based solutions to equip NHS commissioners with the skills they need to deliver on the challenges of today and the future.
Let me stress one of the fundamental principles of the 2012 reforms of the NHS—I served for many weeks on the Standing Committee that considered the Bill. That principle is delegating power away from Whitehall and Ministers such as me, who come and go with political cycles, to local clinical commissioning groups. They are led by fantastic GPs and other local health experts, who are best placed to make the important decisions that matter to local people. Darlington CCG and the Hartlepool and Stockton-on-Tees CCG are rightly making the decisions about how best to ensure that people in their areas have access to a GP when it suits them. Bids for local extended access GP services are currently being closely assessed with a view to the contract starting in April 2019. I have faith that those local commissioners will award this contract in a way that, as I have set out, improves access and quality for patients. Let me say that very clearly: I have faith that those local commissioners will award the contract in a way that I think the hon. Member for Stockton South will find satisfactory.
Steve Brine
We still have two minutes, so I will let the hon. Gentleman come in again.
Dr Williams
If the Minister had been asked for his advice as the Minister with responsibility for primary care by the CCG about whether it should put this out to tender, what would his response have been?
Steve Brine
My response would have been that the CCG needs to act in accordance with the law, with the Act, and I believe it is doing that.
Let me close by saying that I know the hon. Gentleman, and possibly his neighbour, the hon. Member for Stockton North (Alex Cunningham), are meeting regional representatives of NHS England later this week—probably on Friday, when they get back to their constituencies. Ultimately, these decisions are for the local NHS, not for Ministers. We merely set the legislative framework. They are absolutely the best people to discuss the concerns of the hon. Member for Stockton South. As I said, I have faith that the local commissioners will award this contract in such a way that he will be happy that it improves access and quality for local patients, as I have set out.
Question put and agreed to.
Childhood Obesity
Steve Brine Excerpts(5 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Let me start by reiterating what my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), my good friend, has said: childhood obesity is one of the top public health challenges for this generation, if not the top one. I thank her for mentioning my two beautiful children—we are not sure where they get it from, although undoubtedly it is Mrs Brine. They are watching us right now, so for once I shall be useful to Mrs Brine and say, “Surely it must be time for bed after you’ve seen daddy.”
As Members will be aware, figures released only last week in the national child measurement study continue to show that our child obesity rates remain far too high. About a fifth of children are overweight or obese when they start primary school, and that rises to about a third by the time they leave. What is worse, as we have heard, is that the burden of obesity does not fall evenly across our society. The number of severely obese children living in the most deprived areas is more than four times that of those living in the least deprived areas—this is one of the burning injustices of our age. The effects of obesity have a profound impact on a child’s opportunities in life—on both their physical and mental health. We know that obese children are more likely to be bullied and have low self-esteem as a result. They are also more likely to become obese adults, which will give them a higher chance of developing certain types of cancer, type 2 diabetes, and heart and fatty liver disease.
So the Government are determined that we will lead the way in tackling childhood obesity. We have already heard from my hon. Friend about our 2016 childhood obesity plan, part 1—there was a clue in the title—and I agree with her that it is a good plan. It introduced bold, world-leading measures, such as the sugary drinks levy. I was in Argentina at the G20 earlier this month, giving a presentation about the work we are doing in this area. Many other countries around the world look to what is happening in England and are copying it. Since bringing in the levy, we have seen the equivalent of a staggering 45 million kg of sugar taken out of soft drinks through reformulation. As a result, hundreds of millions of pounds have been poured into improving opportunities for physical activity for children. My hon. Friend asked where the money was going—that is where it is going. It is going into the sport premium in schools. The Treasury has kindly agreed to double that sum. I will expand on the point about where it is being spent. She mentioned one example, but I have others.
We also challenged manufacturers to reduce the sugar content in some of the foods children eat most, and they responded. Tesco, Lucozade Ribena Suntory, Kellogg's, whose people I met this afternoon, Waitrose and Nestlé are just some of the companies that deserve credit and deserve a mention, as they are dramatically lowering levels of sugar in their products.
Dr Johnson
I have a quick question: are these manufacturers of food and drinks products removing the sugar and making the products less sweet, or are they replacing the sugar with artificial sweeteners?
Steve Brine
They are doing both. As the representatives from Kellogg’s were at pains to say to me today, it is about healthy eating and quality taste. I passionately believe that that is true.
We were always clear that our 2016 plan was just the start of the conversation, and we are clear that more needs to be done. We always said that we reserve the right to do more, which is why in June this year we published chapter 2 of the child obesity plan. My hon. Friend the Member for Mid Bedfordshire asked whether there is a cross-departmental strategy; yes, chapter 2 is very much a cross-departmental strategy. It sets a bold ambition—what we like to think of as a north star—to halve child obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030. As with our initial plan, the new policies were informed by the latest research and emerging evidence, including from many debates in Parliament and various reports from key stakeholders. Those stakeholders include the Health and Social Care Committee and, yes, the Centre for Social Justice. In fact, the latter’s “Off the Scales” report is on my coffee table in the Department. It was the Centre for Social Justice that told me all about Amsterdam and it is because of it and its good work that I went to Amsterdam to see the work being done there.
Key measures in the next chapter include looking to address the heavy promotion and advertising of food and drink products high in fat, salt and sugar on television, online and in shops. Alongside that, we want to equip parents with the information that they need to make healthy and informed decisions about the food that they and their children eat when they are out and about.
My hon. Friend mentioned Brexit. Of course, there is never a debate in which we do not mention it, but there is a Brexit connection for this debate. One thing that campaigners call for is traffic-light labelling on the front of products. We are unable to do that while we are an EU member state, but once we are no longer, we will have new freedoms in that regard. I do not know whether that is what was meant by taking back control, but I put that on the record for the House.
I was pleased to hear of the efforts of Shillington Lower School in my hon. Friend’s constituency. Staff there are obviously doing all the right things to encourage children to take part in physical activity. I have seen great examples in my own constituency, most recently at Western Primary School, and I am sure that many other Members have seen good examples, too. Yes, it is about recognising that we need foods to be reformulated, but it is also very much about the importance of physical activity in tackling obesity. Yesterday, I opened a major physical activity and health conference across the way at the Queen Elizabeth II centre. It is going on all week and will consider the benefits of physical activity and health. As part of chapter 2, we are promoting a new national ambition for all primary schools to adopt the initiative of an active mile—or healthy mile; people call it different things.
I agree with my hon. Friend that achieving our ambition to reduce child obesity will require a concerted effort from many others, including families, schools and local authorities, which she mentioned. At the recent Local Government Association conference, I announced the trailblazer programme, which will work closely with local authorities to show what can be achieved and find solutions to barriers at a local level to address child obesity. I took great inspiration from what has been done in the city of Amsterdam. My hon. Friend is absolutely right that local authorities know their local areas best. By sharing ideas with each other—some very good things are going on—they can achieve the full potential of the powers and levers that they have. Many local authorities already have great powers and levers to change their areas. For instance, they have powers over junk-food advertising in the areas around schools. We want to see those powers used better.
As part of the second chapter, we have already launched the consultation on banning the sale of energy drinks to children—the message is clear: we do not think that they are appropriate for children—and the consultation on calorie labelling for food and drink served outside the home, or in the out-of-home setting, as they say. Later this year, we will launch consultations on restricting the promotion of fatty and sugary products by location and by price, and we will consult on further advertising restrictions, including a 9 pm watershed on high fat, salt and sugar products. Currently, products deemed HFSS are banned from being promoted only during programmes predominantly aimed at children. We will consult on taking that through to a 9 pm watershed. That work is with the Department for Digital, Culture, Media and Sport, the sugary drinks levy—the sugar tax—work is with Her Majesty’s Treasury, and the trailblazer programme work is with the Ministry of Housing, Communities and Local Government, so I gently reject the idea that this is not a cross-Government strategy. These consultations are genuine and are open to everybody, and we welcome full and considered responses from across society and industry.
So far as the future is concerned, we continue to learn from the latest evidence; my hon. Friend mentioned evidence. The Policy Research Unit informs us all the time of new approaches from across the UK. We welcome the action taking place in Scotland, which is consulting on its own obesity plan at the moment. It is good to see that many of our ambitions align. As I said, I often talk to partners in other countries about work going on internationally—I have mentioned Amsterdam a couple of times—and about where we can learn from them and, possibly, where they can learn from us..
My hon. Friend is also right to mention the additional £20.5 billion a year for the NHS that will support the new long-term plan. I cannot pre-empt what the NHS will put into the plan—the Prime Minister set NHS England the challenge of writing it—but we have been clear from the outset, and the new Secretary of State has been clear, that prevention should be a key part.
Our ambition is bold but simple. We have a lot to gain by reducing obesity, and we have an awful lot to lose. We believe that the hard, evidence-based actions that we propose will encourage healthier choices and will make those choices more readily available and identifiable to parents. Taken together, we are confident that those actions will have a real impact on child obesity. We will continue to monitor progress and emerging evidence. As we have always said, this is not the end of the conversation. We watch things like a hawk.
Finally, I reiterate my thanks to my hon. Friend for securing the debate, and to you, Madam Deputy Speaker, for facilitating it.
Question put and agreed to.
Draft Medicines and Healthcare Products Regulatory Agency Trading Fund (Amendment) (EU Exit) Order 2018
Steve Brine Excerpts(5 years, 7 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 Medicines and Healthcare Products Regulatory Agency Trading Fund (Amendment) (EU Exit) Order 2018.
It is a pleasure to see you in the Chair, Mr Bailey, and to see other Committee members present. I look forward to spending the rest of the day with them. [Laughter.] I do not see why that is funny.
The Medicines and Healthcare Products Regulatory Agency regulates medicines, medical devices and blood components in the UK on behalf of my right hon. Friend the Secretary of State for Health and Social Care. It is financed by a trading fund established by the Medicines and Healthcare Products Regulatory Agency Trading Fund Order 2003, which was made under the Government Trading Funds Act 1973. The Act introduced trading funds as a means of financing the revenue-generating operations of Departments, which had previously been financed through the Supply process. A trading fund operates outside that process and has standing authority to meet all outgoings from its receipts. Operations financed by a trading fund must be managed so that the fund’s revenue is sufficient to meet its expenditure on them.
Schedule 1 to the 2003 order sets out the MHRA’s funded operations—the operations that it can fund using the revenue that it generates from them. In places, the schedule identifies them with cross-references to specified EU legislation. The draft order’s primary purpose is to remove those cross-references prior to the UK’s withdrawal from the European Union, so that the MHRA trading fund remains fully operational after that time. We would not have detained the Committee today if that had not been necessary, but since it was, we have also taken the opportunity to set out the MHRA activities covered by the trading fund in a clearer and more transparent way.
The changes that the draft order will make are purely administrative; they will not alter the activities that can be carried out by the MHRA under its trading fund. The agency does not seek to carry out any new activity on the basis of them, nor will they enable it to introduce new fees that it could not otherwise introduce. No impacts on third parties will result from the draft order. It has been drafted so that the trading fund will work regardless of the outcome of the EU exit negotiations. We therefore see no reason to delay making these changes, which will also bring greater clarity and transparency, so the draft order is scheduled to come into force the day after it is made.
The draft order makes a simple, but necessary, administrative change. I commend it to the Committee.
Steve Brine
There are lots of wider points, but we have gone off-topic. The order is very specific and seeks to make sure that the agency can still function after Brexit, regardless of the deal or no-deal scenario. The shadow Minister, the hon. Member for Ellesmere Port and Neston, asked about the impact on the NHS and on NHS funds. As I have said, the MHRA is self-funding, and this will not impact the NHS at all. It is not as if the MHRA is going to come and ask for its slice of the £20.5 billion extra funding that we will be giving the NHS every year from next year as a result of the new funding settlement in the long-term plan.
It is self-evident that we cannot have the vast significant change of leaving the European Union without there being a change in our relationship, but as we have made very clear—the Prime Minister made it very clear in her Lancaster House speech and subsequently—the UK is seeking active participation in the EMA, as part of the future economic partnership. That is still very much subject to negotiations, but it is where we want to get to.
As a trading fund, the MHRA is required to cover its costs by charging for its work. The hon. Member for Ellesmere Port and Neston therefore asks an important question, but as part of the Brexit contingency planning, the agency is working in conjunction with the Government and the Department to ensure that it has a balanced budget post-Brexit, irrespective of the outcome. The majority of its licensing activity and the associated income derive from domestic—national, not EU—licensing.
The future trading relationships for the agency were outlined as part of our no-deal preparation planning. On 4 October, the MHRA opened a consultation on EU exit no-deal listed proposals. That is a live consultation which seeks views on how the agency’s legislation and regulatory processes would have to be modified in the event of the UK not securing a deal, and it covers no-deal proposals on medicines, clinical trials and medical devices. That live consultation closes at quarter to midnight on 1 November, so it would not be appropriate for me to pre-empt what it will say, but I am not concerned that the MHRA will raid NHS funds. Of course there are concerns—and we share them—about the change in relationship, but the UK has made clear that it seeks a new relationship, one of associate membership and creative partnership, with the EMA, as part of the future economic partnership.
Dr Whitford
I thank the Minister for giving way. I am sure that he is well aware that no “associate membership” of the EMA exists. It is one of the agencies that simply does not have any opportunity for associate membership, so expecting it to set up an entirely new structure for a member that is leaving seems over-hopeful. The Minister is still talking about no new activities and no rise in fees. It is still hard to understand, particularly if the consultation is still open, how he is able to give that guarantee and yet tell us how the MHRA will have funding to go forward.
Steve Brine
I am not giving the hon. Lady that guarantee. I am saying that it is a live consultation and it would not be appropriate for me to pre-empt it. I do not share the hon. Lady’s half-full view of our ambition for the future, which the Prime Minister set out in terms of our relationship with the EMA. The EU does not have a relationship with the UK as a third country at the moment. That is why we have set out an ambitious proposal for our new relationship with the EU and its agencies, including the EMA. I am hopeful, as are the Prime Minister and the Government whom I speak on behalf of, that we will secure a good deal. We still think that that is the most likely outcome. That includes a new relationship with the EMA. We should remember that the expertise that we have in this country, and the work we do with the EMA, will not suddenly change because it is based in Amsterdam. It will still need that expertise and that relationship. I am ambitious about the future, which is why I say what I say.
The matter before the Committee today is technical, to make changes to enable the agency to function after exit day.
Justin Madders
The Minister is speaking with great confidence, without any basis in fact, in saying that the MHRA will not need any state handouts in the future. Will he commit to report back to Parliament, if it turns out that it is not, in future, self-financing?
Steve Brine
Of course, if there is any change to any arm’s length agency that the Department works with, we will come back to Parliament for that discussion. That is partly what the consultation is about at the moment. So if the hon. Gentleman wants a blank cheque to say that we would come back to the House to have discussions around any future changes, the answer is self-evidently yes.
Question put and agreed to.
Oral Answers to Questions
Steve Brine Excerpts(5 years, 9 months ago)
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Ronnie Cowan (Inverclyde) (SNP)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I attended the most recent cross-Government board meeting, which was held in June and chaired by the Home Secretary, to discuss the implementation of the drugs strategy. We know that drugs can devastate lives and damage our communities. The Government’s approach remains clear: we must do everything that we can to prevent drug use and support people through successful treatment and recovery.
Ronnie Cowan
Given the recent statistics showing that drug-related deaths in Portugal are three per million, compared with the UK figure of 64 per million, does the Minister agree that the UK Government should follow Portugal’s example and make drug policy reform a matter primarily for Health and Social Care, rather than the Home Office?
Steve Brine
The truth is that we work together. In July 2017, the Government published a comprehensive new drugs strategy, setting out what we think is a balanced approach that brings together the police, health, and community and global partners to tackle the illicit drugs trade, and to protect the most vulnerable in our societies who are struggling with drug dependency and help them to recover and turn their lives around. I know the hon. Gentleman takes a very different view, but that is our approach.
Vicky Ford (Chelmsford) (Con)
My nine-year-old constituent is currently having up to 400 epileptic seizures every week, and his family believe that medicinal cannabis may be beneficial. Will my hon. Friend update the House on what progress is being made regarding the use of medicinal cannabis for epilepsy sufferers?
Steve Brine
Obviously, our thoughts are with my hon. Friend’s constituent. A two-part review is going on. In the first part, the chief medical adviser considered the evidence available for the medicinal and therapeutic benefits of cannabis-based medicinal products, and found conclusive evidence of the benefits of those products. Part 2, which will be led by the Advisory Council on the Misuse of Drugs, will provide an assessment, based on the balance of harm and public need, of whether we need to do anything regarding the misuse of drugs regulations. While the review is under way, we have established, as an interim measure, the expert panel of clinicians to advise Ministers on any licence applications from senior clinicians, which helped Alfie Dingley, for example.
Sir Vince Cable (Twickenham) (LD)
What action is the Minister taking with colleagues in the Home Office in respect of the drug Xanax, which is reputedly freely available at very low prices, and is more addictive than heroin? What action is he taking to raise awareness and deal with rehabilitation?
Steve Brine
We are very aware of this drug and its dangers. A few months ago, I responded to an Adjournment debate on the matter that was secured by the hon. Member for Enfield, Southgate (Bambos Charalambous). We are watching the issue very closely. I will find out some more details and write to the right hon. Gentleman. I know that he takes a close interest in this, and we will speak about it.
Victoria Prentis (Banbury) (Con)
Sir Paul Beresford (Mole Valley) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Our expert group, the Joint Committee on Vaccination and Immunisation, issued its final advice on HPV vaccination for boys on 18 July. I have carefully considered its advice, and I wanted to tell the House first that the Government will introduce a nationwide HPV vaccination programme for adolescent boys. This will bring clear health benefits for boys, providing them with direct protection against HPV infection and associated disease, including a number of cancers.
Sir Paul Beresford
I declare an interest as a very, very part-time dentist.
I am delighted by the response, but given the importance of head and neck cancer prevention for both sexes, but especially for males, who are twice as susceptible, will the Minister supplement this programme with a catch-up programme, as was done for girls in 2008, to make the vaccine available for 14 to 18-year-old boys?
Steve Brine
I thank my hon. Friend for welcoming this. The British Dental Association has been key in lobbying on this issue, as has—I give credit where it is due—The Mail on Sunday, which has campaigned on it for a long time. I have asked NHS England and Public Health England to work together to advise me on the implementation of the programme, including with regard to the issue that he raises, which makes a lot of sense and for which there is precedent from the girls’ programme. I will of course consider the advice and confirm the implementation plan as soon as possible.
Diana Johnson (Kingston upon Hull North) (Lab)
I congratulate the Minister on that announcement. The vaccine also plays its part in protecting against sexually transmitted disease. Will he saying something about the fact that syphilis is now at its highest rate since the second world war and that there are strains of gonorrhoea resistant to treatment? What are the Government going to do about this?
Steve Brine
They are linked but separate issues. Yes, the HPV vaccine is very important for adolescent boys, for men who have sex with men and for people before their sexual debut. Sexual health is of course a huge challenge. We work closely with local authorities—top-tier local authorities are all public health authorities—and, through the ring-fenced public health grant, which is £16 billion during this spending review period, we are providing those services.
Alex Chalk (Cheltenham) (Con)
Cancer survival rates are now at an all-time high thanks to the brilliant and dedicated work of clinicians, including at Cheltenham General Hospital, but prevention is better than cure. Will the Secretary of State direct his customary energy towards prevention work, including vaccinations, but also tackling risk factors such as obesity?
Steve Brine
Yes, he will. I am pleased to say that prevention is one of the Secretary of State’s three key priorities. The HPV vaccine is a key prevention measure, while one of the drivers behind the child obesity plan was Cancer Research UK’s very clear advice that being overweight was one of the big risk factors, alongside diabetes, in cancer. Yes, prevention is always better than cure.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
I welcome the Government’s acceptance of the JCVI’s recommendation to extend the vaccination programme to adolescent boys, but the Minister will know that there are huge regional differences in the take-up of the vaccination among girls. What steps will he take to tackle these regional differences before and during the roll-out to boys?
Steve Brine
The shadow Minister is absolutely right to raise this issue, which she also raised with me in the Westminster Hall debate on the same subject introduced by my hon. Friend the Member for North Thanet (Sir Roger Gale), who has done a lot in this area. I have already spoken to Public Health England about this in respect of the girls’ programme, and I will be speaking to it again now that we have announced the boys’ programme, because the equality of doing the dual programme must be matched by the equality of its taking place in her constituency as much as in mine in Hampshire.
Eleanor Smith (Wolverhampton South West) (Lab)
Kwasi Kwarteng (Spelthorne) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Alcohol addiction has a devastating impact on individuals and their families, and it is unacceptable that children bear the brunt of their parents’ condition. That is why we are investing £6 million over three years to support vulnerable children living with alcohol-dependent parents. I pay tribute to the former Secretary of State and to the shadow Secretary of State for their leadership in making this happen.
Kwasi Kwarteng
I thank the Minister for his answer, but this is obviously a much wider problem, affecting more than just the children of alcohol-dependent parents. Will he tell the House what more can be done to ensure that people in the wider community can access that kind of help?
Steve Brine
We are working on an alcohol strategy, which is being led by the Home Office, and I have spoken to a number of stakeholders in the last two weeks at the various roundtables I have been holding. On the question of alcohol-dependent parents with children, we are working through local authorities, which is important, but as part of the investment that I have mentioned, there is also £500,000 going into expanding the helpline provision for children who find themselves in this position. I have heard time and again when talking to children affected by this that being able to say that they are not alone in this is often a great place to start. The helpline will be very important in that regard.
Caroline Flint (Don Valley) (Lab)
I welcome the comments made by the Public Health Minister today. I also welcome how open he has been to cross-party lobbying on this issue, including from my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Secretary of State. The £6 million is welcome news. Just to put it in perspective, more than 4,000 children phone Childline each year about alcohol use—it is the biggest concern that children have about their parents when they ring that service. We have something in Doncaster called the Family MOT—Moving On Together—and I hope the Minister will take the opportunity to see some of the good practice that is going on around the country. Will he tell us more about how that £6 million is likely to be spread around the country?
Steve Brine
I probably cannot do all of that without trying Mr Speaker’s patience, but I should like to thank the right hon. Lady, who is one of my predecessors, for the work that she does through the all-party parliamentary group on children of alcoholics, and with the charity Adfam. Charities and other third sector organisations will play a key part in putting in bids to work with local authorities, as part of the £6 million. Public Health England is leading on that, and I look forward to having ongoing discussions with her and with other Members who I know have a deeply held personal interest in this matter.
Bob Blackman (Harrow East) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
Smoking rates are at their lowest ever, but we need to make more progress on tackling smoking in pregnancy, as I outlined in the general debate last Thursday. We are determined to redouble our efforts in this area, because smoking is still the biggest preventable killer in our country today.
Bob Blackman
I thank my hon. Friend for his answer. Smoking rates among pregnant women are still stubbornly high. What steps can he take to encourage the partners of pregnant women to give up smoking so that both partners play a part in preventing damage to the unborn child?
Steve Brine
My hon. Friend makes a good point, which he made in last week’s debate. Public Health England and NHS England will continue to work with local areas in our constituencies to promote evidence-based ways of identifying and supporting pregnant smokers to quit. The overall ambitions in the tobacco control plan, which I published a year ago last week, will touch the general population, which of course includes the partners of pregnant women.
Jim Shannon (Strangford) (DUP)
Has the Department carried out investigations into the effects of vaping during pregnancy? If so, what are the results?
Steve Brine
Vaping and e-cigarettes were part of the Stoptober campaign that we ran last October through Public Health England. I am often criticised for not promoting vaping enough, and I am sometimes criticised for promoting it too much, which possibly gives me a steer. The advice is clear that the best thing to do, whether someone is pregnant or otherwise, is not to smoke.
Derek Thomas (St Ives) (Con)
Mr John Baron (Basildon and Billericay) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I, too, hope my hon. Friend the Member for Hitchin and Harpenden (Bim Afolami) is okay.
Saying that gave me a crucial few seconds. [Interruption.]
Mr Speaker
It is very good of the hon. Member for Hitchin and Harpenden to drop back in on us. Unfortunately, he beetled out of the Chamber at a most inopportune moment, just before his question was reached. If he sits there, and if he is a good boy, we might get to him in due course. We have moved on now, which is most unfortunate.
Steve Brine
We are very clear that achieving the 62-day standard is not a prerequisite for transformation funding, but the better the performance against the standard, the more funding alliances will receive. Most have now received 75% to 100% of the funding requested. This is taxpayers’ money, so we must ensure alliances are operationally strong and ready to achieve transformation.
Mr Baron
I welcome the new Secretary of State to his post.
There remains the inconvenient truth that, despite all Governments bombarding the NHS with process targets in recent decades, cancer survival rates are not catching up with international averages. The last Government’s estimates suggested that that needlessly costs 10,000 lives a year as a result. Will the Minister work with the new Secretary of State, in drawing up the next cancer strategy, to put outcome indicators at the very heart of the process? For example, holding the local NHS accountable for its one-year figures would encourage initiatives to promote earlier diagnosis, cancer’s magic key.
Steve Brine
I thank my hon. Friend for his work chairing the all-party group on cancer over many years, as I know he is about to step down. He has two answers in one here. Yes is the answer. Improving cancer patient outcomes will be the seam that runs through the centre of the NHS’s long-term plan, like the proverbial stick of rock.
Grahame Morris (Easington) (Lab)
Only 5% of the NHS cancer budget, about £385 million a year, is spent on radiotherapy, and that underinvestment is affecting patient access to advanced modern radiotherapy and outcomes. Is it not time to make the cancer drugs fund a cancer treatment fund and extend those opportunities?
Steve Brine
We are looking at the future of the cancer drugs fund as part of the new 10-year plan. There is a radiotherapy review at the moment, as the hon. Gentleman will be aware. Knowing him, he will be engaging with the review in his area. He talks about the latest radiotherapy and, of course, we have the new proton beam therapy treatment coming online in London and Manchester, for which children and patients are currently sent overseas. That is a great step forward, but there is an awful lot more to do, which is why the 10-year plan will have cancer at its heart.
Mr Philip Dunne (Ludlow) (Con)
Martin Vickers (Cleethorpes) (Con)
My constituent, Aaron Winstanley, from Barton-upon-Humber is currently in Germany receiving immunotherapy treatment for a rare form of cancer. The local community has reacted magnificently, raising around half of the £300,000 that this treatment costs. Could the Minister outline what is being done to introduce this treatment into England?
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I wish my hon. Friend’s constituent well and pay tribute to the money that the local community has raised. I will connect my hon. Friend to the office of Cally Palmer, the national cancer director. As we write the new long-term plan for the NHS—to which the cancer stream is so central—we will ensure that innovative new technologies and treatments that were not thought of even a few years ago are also at its centre.
Liz Twist (Blaydon) (Lab)
Tobacco Control Plan
Steve Brine Excerpts(5 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I beg to move,
That this House considered the Tobacco Control Plan.
Last year—how time flies!—in response to a question from my shadow on the Opposition Front Bench, the hon. Member for Washington and Sunderland West (Mrs Hodgson), I confirmed my intention to publish a tobacco control plan for England. I published it and then we debated its lofty ambitions in this House. Today, on its first birthday, I hope that we can reaffirm the importance of the plan and welcome the progress that has been made, while recognising—as I always do at the Dispatch Box—there is much more to do.
Last year we announced an ambition to reduce the prevalence of adult smokers from 15.5% to 12%, of pregnant smokers from 10.7% to 6%, and of 15-year-old smokers from 8% to 3%. We also pledged to reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. Furthermore, we set out a long-term goal of a smoke-free generation, reducing adult prevalence to below 5%. We were very clear, however, that now—then or now—is not the time for more legislation. I am still of that view because there is quite enough for us to do in this House.
The UK has some of the toughest tobacco control laws in the world, and we are consistently considered by independent experts to have the best tobacco control measures in the whole of Europe. The plan recognised that smoking in certain groups is stubbornly high, although masked by the overall declines in prevalence. To achieve our ambitions, we need to recognise that smoking is increasingly focused on particular groups in society, and in particular areas. We need to shift the emphasis from action at the national level—hence no need for more legislation—to focused local action in support of smokers.
Pregnant smokers are one critical group. People with mental illness are also much more likely to smoke: a little more than 40% of people with serious mental health conditions smoke, which is more than twice the national average. I repeat: smoking among those with mental health conditions is more than twice the national average. We need to work across the system, as we are, to ensure that everyone is making their full contribution to deliver for those groups.
Earlier this year I was fortunate enough to visit the Maudsley Hospital, which has done an awful lot of very good and fruitful work in this area. I place on record my thanks to the team at the Maudsley for their dedication and hard work. It was good to meet them—staff and patients—and to thank them in person.
When I talk about working across the system to ensure that everyone is making their full contribution, that is what we are doing. Last month we published the tobacco control delivery plan, which sets out detailed commitments made by various organisations in central Government and the arm’s length bodies to help deliver on our 66 recommendations. We will be tracking delivery of those commitments, and adding to them, as we move through the lifetime of the plan.
Let me touch on the work that is under way. The Prison Service is making the whole prison estate in England smoke free—no ifs, and definitely no butts. Do you see what I did there, Madam Deputy Speaker? This is a huge achievement, and I would like to pay tribute to the hard work that has made it possible. Her Majesty’s Revenue and Customs has supported the UK Government’s ratification of the protocol on illicit tobacco under the World Health Organisation’s framework convention on tobacco control. This new treaty aims to eliminate all forms of illicit trade in tobacco products throughout the supply chain. The protocol has now been ratified by the necessary 40 countries and is in force.
Sir Kevin Barron (Rother Valley) (Lab)
When the Health Committee looked at the issue of smoking in public places and took evidence from different institutions, the Prison Service felt at the time that it would be impossible for it ever to get to a situation in which it was smoke free. We should all look back and thank it for what it has done, which it told us years ago was impossible.
Steve Brine
I agree with the right hon. Gentleman. Those of us who have secure estates in our constituencies and go in and visit them regularly will be aware of just how much of a challenge this is, given how ingrained smoking is within the cohort. That relates to the point I made about specific groups. I think that the Prison Service deserves great credit. Suffice it to say that it has a lot of pressures on it, and in some ways it probably felt that this was the least of its worries and the last thing it could deal with, but it is actually very important. That is why I say we are working well across the Government, and the Prison Service is really pulling out the stops in its area. I thank him for that intervention.
To finish on the protocol, HMRC will continue to lead on it on behalf of the Government, working with my officials at the Department of Health and Social Care. Through the protocol, we are sharing our expertise as a leading tobacco control nation; this is not just about what we are doing domestically. We are funding the FCTC secretariat with £15 million over the spending review period to support tobacco control in 15 low and middle-income countries. I am very proud of that work, and I am pleased to say that we are already having an impact. Georgia introduced smoke-free legislation and a ban on advertising on 1 May. It seems strange to talk about banning advertising as a new measure, given how long a ban has been in place in our country, but it shows that other parts of the world have a long way to go to catch up. I am very proud that we are using our experience and our evidence-based experience to help countries such as Georgia to do so. I want to place on the record my congratulations to Georgia.
Domestically, Her Majesty’s Treasury continues to maintain high duty rates for tobacco products to make tobacco less affordable, which is absolutely right. Public Health England, for which I am responsible, and NHS England are working on a joint action plan to reduce smoking in pregnancy. A key part of this is helping midwives to identify women who smoke and help them to quit and to support the implementation of National Institute for Health and Care Excellence guidance on reducing smoking during pregnancy and immediately following childbirth.
PHE has been encouraging the use of e-cigarettes to help people quit. As part of this, the most recent Stoptober campaign for the first time highlighted the role of e-cigarettes in quitting. The best evidence suggests that e-cigarettes are helping thousands of people to quit and that they are particularly effective in the context of a smoking cessation clinic. PHE’s data website, “Local tobacco control profiles for England”—another snappy title I dreamed up—is helping local commissioners and service planners to identify where they are succeeding, where they face the greatest challenges and how they compare with their neighbours and the rest of England.
Alex Cunningham (Stockton North) (Lab)
I very much welcome the Minister’s comments in The Guardian newspaper this morning about the activities of one tobacco manufacturer that has been contacting or at least trying to ingratiate itself with NHS staff by helping them to quit smoking. Will he write to all trusts and clinical commissioning groups telling them that they should have nothing at all to do with this initiative?
Steve Brine
I already have and NHS England already has: we have already done so. We think that Philip Morris International’s move is totally inappropriate and totally contrary to the protocol. I do not think I could have been clearer either in the press or at the Dispatch Box today, and I thank the hon. Gentleman for giving me the chance to say so again.
All our local activity has the overall goal of helping people to quit smoking and stopping others starting in the first place, so how are we doing? Here is the score card. Publications by the Office for National Statistics and NHS Digital earlier this month show that we are making progress. Since 2011, the number of adult smokers has dropped by a fifth to the lowest level since records began, and we are fully on track to achieve our 2022 ambition for adults. Among 15-year-old smokers, there is good progress, and figures published last year showed that the prevalence of smoking has reduced by a further percentage point from 8% to 7% since the publication of the plan. The number of e-cigarette users in that group is also falling. Latest figures from the ONS annual population survey reveal that smoking rates among 18 to 25-year-olds are falling faster than in any other age group. Considering that that age is when most smokers start smoking, I am particularly pleased with that.
We are also making progress on inequality. Although routine and manual workers continue to have higher smoking rates compared with the rest of the population, the gap has narrowed slightly, from 26.5% at the publication of the plan to 25.7% as reported by the ONS earlier this month. Those are achievements to celebrate. Nevertheless, I must be honest with the House and say that progress on tackling smoking in pregnancy is disappointing, and in truth the figures have barely moved in the past year.
What shall we do in year 2 of the plan? First and foremost, I am determined to redouble our efforts to support pregnant smokers to quit. That will be best for them and for their babies, and we need people to understand that. Secondly, we will use the opportunity of the Government’s investment in the NHS, which the Prime Minister announced last month, to embed prevention and cessation more firmly into the culture of the NHS. Last month, the Royal College of Physicians, which has a proud record of groundbreaking reports on tobacco, published “Hiding in Plain Sight: Treating tobacco dependence in the NHS”. That weighty report calculated that the cost of current smokers needing in-patient care is £890 million a year. It points out that smokers are 36% more likely to be admitted to hospital at some point than non-smokers, and it makes the powerful argument that smoking cessation repays the cost from year 1. I welcome that report, and I will be making that case loud and clear as we engage with NHS England on the content of the 10-year plan that the Prime Minister has asked it to produce.
Thirdly, we will continue to engage with local authorities —they are now top-tier public health authorities up and down the land in England—on promoting smoking cessation as the best evidence-based means of quitting smoking. Encouraging the NHS to do more on cessation is emphatically not about removing responsibilities from local authorities. This is about creating a whole-system approach in which addicted smokers can access the support they need to quit. Public Health England will continue to provide local councils up and down the land with facts and advice on tackling smoking—for example, it will work with sustainability and transformation partnerships, which should be leading that whole-system approach in the constituencies of all English Members.
Fourthly, as I have mentioned, we will continue to raise tobacco duty to make tobacco less affordable, while also taking action to tackle the illicit trade in tobacco. Fifthly, we will maintain a careful watch on so-called novel tobacco products. The Government are keen to use the opportunity of newer products, such as e-cigarettes, to help smokers to quit, without undermining the key message that the best thing someone can do for their health is quit completely. As I said in the Science and Technology Committee’s inquiry into this subject, we will continue to keep the harms of products such as heated tobacco products under review and continue to hold the industry to account. We have been explicit that the promotion of tobacco products is unlawful, as my recent letter to Philip Morris International makes abundantly clear—that letter was written before the one I mentioned in response to the hon. Member for Stockton North (Alex Cunningham).
Last but not least, we will continue to make the case for tobacco control internationally, building on our reputation as a leading tobacco control nation with credibility in that space. We have such credibility because our consistent work in this area goes back to the coalition Government, the previous Labour Government and the Conservative Government before them, and such consistency means that we are highly credible around the world. More than 7 million people a year across the globe die from smoking-related disease, and the UK Government can help make a dent in that toll by sharing knowledge and skills.
Bob Blackman (Harrow East) (Con)
I pay tribute to the Minister’s brilliant work both since he became a Health Minister and before then. Will he comment on some of the scientific issues raised about addiction to nicotine, compared with the very harmful by-products that are a part of cigarettes, cigars and other tobacco products? Will he comment on whether it is nicotine or the by-products that are harming people’s health and causing the most damage?
Steve Brine
I think cigarettes cause the most damage, because of the tobacco and the nicotine. The carcinogenic properties of the former are lethal. That link was proven with the lung cancer study that started the ball rolling. I pay tribute to my hon. Friend as the chair of the all-party group for the work he has done in this area. There are a lot of things that we know and there are a lot of things that we still do not know. Some people say that I do not go far enough to promote e-cigarettes and novel products, and some people say that maybe we go too far—I mentioned Stoptober. That generally suggests to me that we are in the right place. What I would say—I think that I said it earlier—is that an awful lot of research is still needed on e-cigarettes. One Member once told me that we should make e-cigarettes free on prescription to all pregnant women. The reason I did not say, “Yes, I think that’s a good idea” is that I still think there are risks to that product. I still think that the best thing people can do is to stop chuffing on anything, whether traditional cigarettes or so-called novel products. I thank him for his intervention, and I look forward to hearing what he has to say during the debate.
Alex Cunningham
I thank the Minister for giving way a second time. I join the tributes to both the Minister and the chair of the all-party group. There has been tremendous cross-party work on this issue—that has always been the case. The Minister mentions the role local authorities have to play. We all know the pressure they have been under in recent times. I wonder whether he could see a mechanism that would provide and ring-fence the funds to enable local authorities to fulfil their role. Currently, they are struggling to do so.
Steve Brine
I thank the hon. Gentleman for that intervention. On providing support to help smokers quit, as I said, we have moved from the national context of legislative work to local application. The challenge is that adult smoking rates vary considerably across the country—for example, they are 8% in Wokingham and 23% in Kingston upon Hull—so it is right that local councils have the flexibility to spend that money. There is some £16 billion in the ring-fenced public health grant during the spending review period, so there is a lot of money in the system. But am I happy with patchy services in areas where smoking rates are too high? No, I am not. That is why I have said that the Government have not made a decision on full business rate retention. I would be concerned about the impact that that might have. I would want all sorts of reassurances from local councils if I were to make that change. Do I think it right that local authorities can design services for their local area? Yes, I do.
The new Secretary of State and I have already discussed prevention, which is one of the three main pillars he wants to focus on. I have told him that the new investment of £20 billion that we are putting into the NHS is fantastic. Bluntly, we could have the money on the side of the bus three or four times over, but unless we get serious about prevention, in this space as much as any other, the NHS will continue to be under enormous pressure. Local authorities are a key partner for us.
I would also say, not least because the chair of the all-party group on community pharmacy is sitting behind the hon. Gentleman, that community pharmacists and pharmacies have a key role to play. They are an NHS centre on street corners up and down our land. Some of them provide really good work. The healthy living pharmacies I have seen help people to access the services they need. They provide a little bit of mentoring and support, using their experience to say, “Yes, you can beat this,” and signposting them to services, whether through the public sector or the third sector.
There is an awful lot that we can still do. That is why the 10-year plan will have prevention embedded at its heart, as the five year forward view said it would—and it did, but I do not think that it lived up enough to the ambition on that. Perhaps people would expect the Minister responsible for prevention to say that, but I am nothing if not consistent.
Tobacco remains the single biggest avoidable killer in our country today, causing a third of preventable cancers. It contributes to around half of health inequalities between rich and poor in our society and is a potent symbol of the burning injustices that the Prime Minister spoke about, which I think affect the life chances of poorer people up and down our land. The tobacco control plan represents the Government’s continuing commitment to tackling this epidemic. It was never presented as a panacea and it is still not a panacea, but it is a cracking good start.
Over the past year, we have seen some impressive progress, but I am absolutely not complacent. In World cup terms, I would suggest that we have made it through to the knockout stages, but nothing more. I hope to be able to demonstrate further progress in a year’s time, and no doubt we will discuss that again in the House. I look forward to hearing hon. Members’ contributions, and I am happy to introduce this important debate.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is a pleasure to be here to speak about the tobacco control plan, which celebrated its first anniversary only yesterday, as the Minister said. We are here to discuss the progress of the plan so far in reaching the Government’s goal of a smoke-free generation by 2022. I start by thanking the Government for allowing time for this debate to take place after all the drama and commotion of this week. As the Minister said, my first outing as shadow Minister for public health was in a debate on this issue, and thanks to him, we have the new, updated tobacco control plan that we are debating today. I know that it holds a very special place in both our hearts and, like him, I look forward to the debate.
The Opposition welcomed the plan and its ambitious goals, but we remain concerned about how they will be achieved by 2022. It is true that smoking is now thankfully at an all-time low, but the Government must not be complacent—I know that the Minister is not—and must not quit when it comes to measures that reduce smoking rates.
There are still 7.3 million adult smokers in the UK but, shockingly, smoking is an addiction of childhood, with the vast majority of smokers starting to smoke before the age of 18. Between 2014 and 2016, more than 127,000 children aged between just 11 and 15 started to smoke in the UK. According to a recent study by the Society for Research on Nicotine & Tobacco, this amounts to 350 young people starting smoking each day. That is equivalent to 17 classrooms of secondary school children starting to smoke every day. The Government therefore have a huge challenge on their hands—as we all do in Parliament—to tackle smoking in childhood and to reduce the rate of children smoking to 3% or less.
Between 2013 and 2016, the rate of decline in smoking among young people slowed down and the proportion of 15-year-old regular smokers had fallen from 8% to 7% but, at this rate, we will fail to achieve the ambition for England of 3% by 2022. The Minister mentioned in his opening remarks that we really will need to accelerate our progress when it comes to the number of children taking up smoking. Tackling this issue will be the first step to achieving a generation that is not only smoke-free, but healthier.
Smoking remains the leading cause of preventable premature death, such as from cancer or lung disease, and accounts for around 100,000 deaths each year in the UK. Each of those deaths could have been prevented. In 2015-16, there were approximately 474,000 smoking-related hospital admissions, with smokers also seeing their GPs 35% more often than non-smokers. In 2017, 22% of hospital admissions for respiratory problems were directly attributed to smoking. In 2015-16, smoking-related respiratory diseases cost NHS England £167.4 million in adult secondary care costs. I am sure that the Minister agrees with me that an ounce of prevention is better than a pound of cure.
The National Institute for Health and Care Excellence estimates that every £1 invested in smoking cessation generates £2.37 in benefits. However, according to the King’s Fund, spending on smoking cessation services in 2017-18 was reduced by almost £16 million compared with figures for 2013-14. Furthermore, the Health Foundation has found that next year just £95 million will be spent on smoking and tobacco control services, which is 45% less than in 2014-15. Has the Minister made any assessment of the impact that those cuts will have on local smoking cessation services?
A study conducted by Action on Smoking and Health—ASH—and Cancer Research UK found that in 2017 budgets for stop smoking services were reduced in half of the local authorities in England, following reductions in 59% of authorities in 2016 and 39% in 2015. It is a wonder that there are any smoking cessation services left at all. What that means on the ground is that smokers who want to quit do not have access to the services that they need, and smokers who may need an extra push to seek help to quit are not getting that push.
Given that local smoking cessation services are on their knees, how does the Minister’s Department expect to reach the goal of reducing smoking rates to 12% by 2022? The Government’s own plan acknowledges that
“local stop smoking services continue to offer smokers the best chance of quitting”,
but cuts in local authorities’ funding have led to unacceptable variations in the quality and quantity of services available to the public. In my region of the north-east, the current smoking rate is 16.2%, which is down from 17.2% in 2016. That represents the biggest fall in smoking in England. It means that smoking rates in the north-east have fallen by more than 44% since 2005, when 29% of adults in the region smoked, and that there are about a quarter of a million fewer smokers.
It has to be said that that decline in smoking rates is due to the excellent programme Fresh north-east. I know that the Minister has commended the programme before, and no doubt he will take the opportunity to do so again. Its vision is to make smoking history and to reduce smoking prevalence in the north-east to 5% by 2025.
Steve Brine
I am happy to place on record my thanks for the work of Fresh north-east, whose representatives I have met. It is a good example of what I was talking about—local systems working together. It is not just about what local authorities commission and the state provides. Fresh north-east is a coalition consisting of the public sector and the third sector.
Mrs Hodgson
That is important, especially when, as the Minister has acknowledged, we are in such straitened times when it comes to local authority budgets. I am sure that Fresh north-east will be very grateful for what he has said.
Sadly, other areas are not as lucky. They do not have a Fresh north-east; if only they did. Stop smoking services are roughly 300% more effective than quitting by going cold turkey, but in some places the specialist services are being decommissioned altogether. For example, in Blackpool, smoking prevalence is 22.5%, while the average for England is 15.5%, yet Blackpool Council recently decommissioned its specialist smoking cessation service, citing a number of factors including public sector budget cuts.
That example leads me to my next point. Between 2012 and 2014, the healthy life expectancy for newborn baby boys in England was the lowest in Blackpool at 55 years. Again, the shortest life expectancy among men was in Blackpool too, at 74.7 years. Interestingly, in 2014, Blackpool had the highest smoking prevalence at 26.9%. Wokingham had the lowest smoking prevalence at 9.8%, but the highest healthy life expectancy of 70.5 years. That is a 15.5 year difference between healthy life expectancies, and while there will be several factors in play in these figures, it is clear that smoking is one of the largest causes of health inequalities in England.
Some 26% of routine and manual workers now smoke, compared with 10% of those in managerial and professional jobs. This has slightly increased rather than decreased the inequality from 2016. Some 28% of adults with no formal qualifications are current smokers compared with only 8% of those with a degree. It is these people—manual workers or those from low socioeconomic backgrounds—who suffer the most when the Government cut spending to public health services. I therefore ask the Minister what steps his Department is taking to ensure that these people are reached by local smoking cessation services. What assessment has the Minister made of the impact that smoking rates have on widening health inequalities, and how does he intend to address them?
Finally, I move on to smoking in pregnancy. The Government’s ambition to reduce smoking in pregnancy to 6% or less by 2022 is laudable. In 2015-16 the rate was 10.6%. However, new data published recently showed that the rate of smoking during pregnancy in 2017-18 had increased slightly, to 10.8%. It is therefore deeply concerning that the Smoking in Pregnancy Challenge Group, which I recently met, has warned that this ambition is unlikely to be met unless urgent action is taken.
In 2010, 19,000 babies were born with a low birth weight because their mothers had smoked during pregnancy. Up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy. In addition, many other children will be three times more likely to take up smoking in later life because they live in smoking households. If we are going to have a smoke-free generation in the future, the Government must take urgent action to ensure that rates of smoking in pregnancy fall. We must not forget that it will be those very babies who will become the smoke-free generation that we all hope to see.
The current target is to reduce smoking in pregnancy to 6% or less by 2022. If that is achieved, it could mean around 30,000 fewer women smoking during pregnancy, leading to between 45 and 73 fewer stillborn babies, 11 to 25 fewer neonatal deaths, seven to 11 fewer sudden infant deaths, 482 to 796 fewer pre-term babies, and 1,455 to 2,407 fewer babies born at a low birth weight. That is something to aim for, but it will only happen if the Government take urgent steps to reduce the number of women smoking during pregnancy.
Bob Blackman (Harrow East) (Con)
It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson), who has done excellent work already in her shadowing role. I know that she was also at the forefront of this debate before shadowing these matters. Equally, I pay tribute once again to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), who set a precedent for future public health Ministers when, at his first outing at the Dispatch Box, he agreed to publish the long-awaited tobacco control plan. We should remember that it had been delayed for a year before it was published last year at the behest of my hon. Friend, probably much to the consternation of his officials.
I also want to pay tribute to the Minister’s predecessors, particularly the former Member for Battersea, Jane Ellison, who did a brilliant job of advancing many of the controls on tobacco that we now have in such a way as to ensure that they were delivered. I remember taking on the first debate on this subject in Westminster Hall, at which many of my colleagues were present. I think it was in September 2013, and it was the first debate after we came back from the summer recess. It took place at 9.30 in the morning, and I feared that I would have an hour and a half to fill by explaining why we should have standardised packaging for tobacco products. I have to say that both major parties were opposed to that idea at the time, but we were able to convince them otherwise and we changed the policy. That measure has now been enacted, which demonstrates the power that we on the Back Benches can have to change policy in a good way.
I must gently chide the Government, however, for taking over our Back-Bench debate. This means that we cannot pass the resolution that we wanted to pass today to encourage the Government not only to adopt smoking cessation policies but to resource them properly, to ensure that the plan is delivered. We understand that we are now having this general debate, however.
I declare my interest as chair of the all-party parliamentary group on smoking and health. We could go through the history of the progress that has been made, and the speeches from the Front Benches have shown us where we are today. I want to take us back to 1974, when I was sitting my A-levels. My late parents were both very heavy smokers. In those days, half the men in this country smoked, as did more than 40% of the women. It is hard to imagine, but in many ways it was considered healthy to smoke; it was somehow considered to be good for our lungs. Sadly, both my parents died five years later of cancer, so for me this is not only a health issue but a personal one. I do not want to see other people going through what my family had to go through as a result of using tobacco products in the way that they are intended to be used.
Smoking rates have dropped remarkably. As has been mentioned, the number of adult smokers has dropped from 7.7 million in 2011 to 6.1 million in 2017. The difficulty with figures, however, is that, as the population increases, we have to go harder and further to reduce the number of people smoking. Smoking-related diseases are the leading cause of preventable death, with 80,000 people a year dying as a result of tobacco products. In Harrow, part of which I have the honour of representing, we still have 14,000 smokers, which is difficult to understand given the encouragement to quit and all the health issues, and the cost to public services is estimated to be £37.9 million a year in just one London borough, out of 32, that has about 250,000 adults. It is clear that we need further action.
The good news is that the UK is one of the leading countries in the implementation of tobacco control policies. We are recognised as a leader in the implementation of the World Health Organisation’s framework convention on tobacco control, and I want to remind the House of article 5.3, which states:
“In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”
The guidelines on implementing article 5.3 have been agreed by the UK and advise Governments not to enter into any partnerships, whether they be non-binding or non-enforceable, or agreements with the tobacco industry, not to accept voluntary contributions from the tobacco industry, not to accept tobacco-industry-drafted legislation or policy or voluntary codes for legally enforceable measures, not to participate in corporate social responsibility or related schemes funded by the tobacco industry, and not to permit tobacco industry representation on Government tobacco control bodies.
Former MP Paul Burstow, my predecessor as chair of the all-party parliamentary group on smoking and health, is now the chair of the Tavistock and Portman NHS Foundation Trust and co-chair of the Mental Health and Smoking Partnership. He wrote to the Minister about the letter sent by Philip Morris International, and I am pleased that the Minister has taken up the issue straight away. The company, which manufactures Marlboro cigarettes, wrote to say that it is
“keen to work with NHS Trusts and Foundations to see if we can support the NHS in helping its employees to stop smoking”.
I do not usually promote this publication, but an article in The Guardian today quotes me, Paul Burstow and the Minister making it clear that we do not want any interference from Philip Morris and that that company should not avoid its responsibilities under the code. I am delighted that the Minister has completely rejected the position of Philip Morris, which also states that it has
“written to the heads of all the NHS Foundations and Trusts in England, all Clinical Commissioning Groups, Simon Stevens, and the Secretary of State for Health and Social Care”
about the issue.
Most local authorities in England have signed up to the local government declaration on tobacco control, which is a public statement of the councils’ commitment to reduce the harm caused by tobacco. The declaration commits signatories to
“protect our tobacco control work from the commercial and vested interests of the tobacco industry by not accepting any partnerships”
and so on. However, local government officers have reported continuing efforts by the tobacco industry to engage with local authorities over tobacco control issues including, but not limited to, the illicit trade. We must be clear that the industry’s involvement is not required and not welcome.
I am delighted that, on 1 November 2017, the Minister made a clear statement in this House on the Government’s position, and I am delighted that will continue. I welcome his comments, both in his opening speech and in his letter. What else can he do to make sure that local authorities, the NHS and any other interested parties do not get sucked into this offer from Philip Morris?
On the risks we run, as the hon. Member for Washington and Sunderland West said, one of the problems is that the plan and the targets might not be met. We have to encourage everyone to get to that point. The reality is that smoking rates among young people have started to level out. There is a risk that we will not hit those targets. The target to get smoking rates down to 5% or less by 2022 is good, but I would like to see it at 0%—no one smoking. We could then say that we have achieved what we wished to achieve.
We clearly have to encourage young people not to start smoking. As has been said, more than 350 young people a day take up smoking, and 60% of them go on to smoke for the rest of their life. The huge risk is that those people will fuel the tobacco industry for the future.
There is therefore a case for further control measures, including increased funding for the initiatives, and new legislation. Although it is not appropriate to allow the tobacco manufacturers to make voluntary contributions, if they are offering to give money to the NHS and to local authorities as part of so-called corporate social responsibility, the industry clearly has money to pay for the measures we need to control tobacco and to mitigate the harm it causes, so let us make the tobacco manufacturers pay.
At a time when public sector budgets are under pressure both at national and local level, the tobacco manufacturers, if they have money, should pay an increasing share of the cost of control, as an application of the “polluter pays” principle. That is the clear recommendation of the all-party parliamentary group, and I trust my hon. Friend the Minister will therefore advance that recommendation to the Chancellor.
Steve Brine
Consider it advanced. Time will be limited for the wind-ups, so I will address the point about young people. Earlier this week, I held a roundtable in the Department of Health with a number of charities working on drug policy and with reformed drug takers. One gentleman said to me, “The trouble was that I really enjoyed taking drugs. What I didn’t enjoy was the outcome of taking drugs.”
I have heard young people say that they really enjoy smoking but that they do not enjoy the outcome. We should welcome today’s statement by the Secretary of State for Education on the new work that will be done in schools on health and relationships education. Specifically, health education can help young people to understand the health consequences of smoking, even if they might enjoy the process of smoking.
Bob Blackman
I thank my hon. Friend for his intervention, and I completely agree that health education is an appropriate way to consider the issue.
There is a model in the United States that we could introduce. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the US Food and Drug Administration the power to regulate the tobacco industry, funded through what is called a user fee on manufacturers. The total amount to be raised is set out in legislation and apportioned to manufacturers on the basis of their share of the US tobacco product market. I ask the Minister to look at that US legislation as a way of introducing such a model.
The major recurring costs of tobacco control, and they are important, are mass media campaigns to discourage uptake and to encourage quitting. An approach such as the one in the US would: raise hundreds of millions of pounds a year from the tobacco industry; help to protect the business of legitimate retailers who obey the tobacco control legislation; help to protect Government tax revenues—at the moment, the excise tax raised £9.9 billion in 2016-17, but the loss on illicit tobacco was estimated to be £2.4 billion; pay for the mass media campaigns to discourage smoking, which we desperately need; and provide a source of revenue to local authorities, which could help to fund local tobacco control measures, including enforcement activity and the provision of support to smokers seeking to quit. Funding for trading standards has fallen substantially in recent years, from £213 million in 2010 to only £124 million in 2016, and the National Audit Office estimates that the number of full-time staff has reduced by 56% in seven years. So there are fewer people to enforce the rules that we want to see enforced. Such an approach could also support regional partnerships working to tackle illicit tobacco. The success of that has been shown in the north-east and north-west, which have concerted multi-agency enforcement activity and effective, evidence-based measures to reduce demand. So it is clear that we can deliver on this.
Polling conducted for ASH—Action on Smoking and Health—asked respondents how strongly they would support measures requiring tobacco manufacturers to pay a levy or licence fee to help encourage people to quit and prevent young people from starting to smoke. The net support for that was 71%, with only 9% opposing. So the Minister should impress on the Chancellor the need for this and the benefit of doing it.
One key issue that I wish to emphasise above all else is the need for mass media campaigns to shock people into realising how desperate smoking is and how damaging it is to health. There is nothing like seeing those sorts of mass campaigns for encouraging people to realise that they are responsible for their health. The analysis of these campaigns has shown that they are very effective but that they have declined in recent years. Public spending on such campaigns in the UK peaked in 2008-09 at £23.38 million, but now that has fallen dramatically, to only £1.5 million in 2016-17. Clearly, we need to encourage local authorities and the Department of Health and Social Care to use the opportunity to shock people so that they understand the damage they are doing. I therefore ask the Minister to look at mass media campaigns and ensure that they are used as part of the strategy.
Finally, let me say that my area now has a large number of people from the European Union who have chosen to come here to live in this country. If we go to many eastern European countries, we see people smoking everywhere; these places do not have the tobacco control that we have in this country. Those people need to be reached to encourage them to give up smoking and ensure they look after their own health. It is those people we have to reach out to fully. I look forward to other contributions from right hon. and hon. Members, and I am sure that the Minister will reply in suitable fashion.
Steve Brine
With the leave of the House, I will also respond to the debate, Mr Deputy Speaker. I am aware that I am standing in the middle of the A14—almost literally—which is tonight’s Adjournment debate, but I will respond to the points that have been raised in this short and small but perfectly formed debate.
The shadow Minister—my good friend, the hon. Member for Washington and Sunderland West (Mrs Hodgson)—rightly mentioned the issue of pregnant women and smoking, to which I referred in my opening remarks. Public Health England and NHS England are working on a joint strategy at the moment, setting out recommendations for how local areas can work together to achieve our ambition on smoking in pregnancy. In a way, I guess that is given a greater impetus in the light of the flatlining figures—I suppose that is the accurate way of putting it. This work is part of the maternity transformation programme, which started in 2016 and which I know she is aware of. Public Health England will look at how its mass media campaign can more effectively reach young people, especially working-class women of reproductive age and their families and friends. I wanted to put that on the record.
The hon. Lady returned to the subject of smoking services. I repeat what I said during the debate: there are varying rates across the country, so it is right that local councils have the flexibility to respond. I will touch on the point that the right hon. Member for Rother Valley (Sir Kevin Barron) mentioned about this being all the responsibility of local authorities. There is a third way, he will pleased to know, as a Blairite—that has finished his career, I apologise. I put on record again that councils will receive £16 billion of the public health funding until the next spending review, when the spending plans will be announced. We expect them to use it wisely.
My hon. Friend the Member for Harrow East (Bob Blackman) talked about the Back-Bench debate and the general debate. I will leave that matter for the usual channels, but the important thing is that we are having the debate, which is very welcome.
The shadow Minister spoke about smoking cessation training and those services. The success of our plan hinges on all manner of professionals offering help that works, which is why effective training on supporting smokers to quit is central to the tobacco control plan—from doctors and nurses in the NHS to physiotherapists in the community, to pharmacists, who I have mentioned, and to the health professionals who need to equip smokers with the capability, opportunity and motivation to quit for good. It often involves very brief advice and there is a lot of online training out there. Twenty minutes or so of online training can teach a professional how to have a short conversation with somebody with a smoking challenge, with proven results. I wanted to put that on record.
My hon. Friend the Member for Harrow East mentioned Philip Morris International and its kind proposal to help NHS trusts, which has been in the newspapers today. I thought I would place on record for the House that what it talked about in its offer to trusts was “operating a scheme that allows employees who do not quit to trial one of our range of smoke-free alternatives”. We have to give them 10 out of 10 for effort, but it is totally inappropriate and that is why we have written to all trusts to make it clear.
I understand my hon. Friend’s Budget 2018 proposal for the Chancellor of the Exchequer on the need for the money in respect of the polluter pays principle. I know that the Chancellor will have heard that. My hon. Friend talked about the need for hard-hitting campaigns. We do have them, of course, and they are an essential part of tobacco control. In England for several years now, we have sought the balance between hope and harm. Every January, we have the Health Harms campaign and in the autumn, we have our more upbeat Stoptober campaign, and 2018 will be no exception.
The hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the SNP, talked about the illicit tobacco trade protocol, and I thank him for putting on record that we indeed ratified the protocol on 27 June to eliminate the illicit trade in protocols. The first meeting of the members of the protocol will be in Geneva from 8 to 10 October.
The hon. Gentleman talked about track and trace. The tobacco products directive contains a commitment for member states to provide the track and trace system by May 2019 for cigarettes and roll-your-own tobacco. The European Union has published draft recommendations on the track and trace proposals, and we voted in favour of implementing the regulations. I would say that the EU measures go beyond the requirements of the framework convention on tobacco control, but many of its benefits arise from the exchange of information between nations, so it seemed sensible to us for the UK to align with the EU after exit in this respect.
Both the hon. Member for Stockton North (Alex Cunningham) and the hon. Member for Linlithgow and East Falkirk talked about smoking and the media. The Government do not interfere in editorial decisions. I think it right that content makers decide what to include in their programmes, provided that they comply with the broadcasting code, and I ask them to take their responsibility seriously. Obviously, as Members have said, they are regulated by Ofcom. Last month, it published a note to broadcasters reminding them of the rules in this area, and advising them on the depiction of branding and health warnings. The last time Ofcom found a breach of the broadcasting code related to smoking was in 2015, so I think that broadcasters take the code seriously.
Many Members mentioned the British Board of film Classification, which I know well and which is a well-managed organisation. Its guidelines were last updated four years ago, in 2014. Consultation on the new guidelines began late last year, and they are expected to be published early in 2019.
There was a lot of talk about e-cigarettes, which were partly dealt with at the beginning of the debate. Public Health England will update its evidence report on e-cigarettes and other novel nicotine delivery systems annually until the end of the current Parliament in 2022, and we will include that in our “quit smoking” campaign messages about the relative—I underline “relative”, if Hansard can underline—safety of e-cigarettes. I enjoyed the comparison that the right hon. Member for Rother Valley made with Ireland: I thank him for that.
The right hon. Gentleman also said that not everything could be done by local authorities. We have not said that it should. I have made it very clear to Public Health England that where we have more work to do is where they should target their help and support, but there is also a new grant to support the tobacco control plan. The Government have launched a competitive scheme whereby organisations can apply to undertake work to support the plan’s ambitions. The grant is £140,000 a year for three years, from 2018-19: a total of £420,000 is available. Applications are currently being assessed, and we will contact the successful applicants in the autumn. I will find out some more details and send them to the all-party group.
The hon. Member for Strangford (Jim Shannon)—as always!—asked whether we would introduce vaping areas in hospitals. Public Health England advises that the smoking of e-cigarettes should not be routinely treated in the same way as smoking tobacco, but it is true that it is for NHS trusts to make their own policies. Some, including the Maudsley, have designated areas both indoors and outdoors.
Mr Deputy Speaker (Sir Lindsay Hoyle)
It is up to the Minister. He said that he wanted to speak for only one minute.
Alex Cunningham
Let me tease the Minister on three matters. One, what are we going to do about the “tab houses”? Two, what is his position on cigarette pack inserts? Three, what is he doing to do about the fact that mass media campaign funding has been cut by 90% in the last 10 years? We need that funding in order to be effective.
Steve Brine
I will write to the hon. Gentleman about his first two points. As for the mass media point, the hard-hitting campaigns that we conduct through the mass media are incredibly powerful. Last year’s campaign showed a gentleman rolling a cigarette with roll-your-own tobacco made of blood and gore. That was very hard-hitting, and it had an incredibly good response mechanism when we tested it and when we rolled it out. In this year’s campaign, “between hope and harm”, I think the hon. Gentleman will see a good balance of that mass media campaign that he talked about.
I realise that that was more than a minute, Mr Deputy Speaker. There is so much to say about this subject! It is so exciting.
Let me end by reaffirming the Government’s commitment. What everyone has said today has been very kind. Yes, I am committed to this subject, but ultimately we will be judged on our record. We are committed to making further sharp reductions in smoking prevalence, not so that we can meet the ambitions of the plan, although that is all very nice, but so that we can make a difference to people’s lives, because as the right hon. Member for Rother Valley said, if our constituents were dying in these numbers in road accidents we would be calling for crossings.
We want to make the smoke-free generation a reality to help people’s lives and to make a difference. Tobacco control is a key priority for us, and it will be a key priority for the 10-year plan that the Secretary of State and I will be working on with NHS England. I was interested to hear the comments of Simon Stevens at the Select Committee, and I agree with Simon, not for the first time.
I thank all Members who have spoken for their contributions—and it is amazing how far a minute can go, Mr Deputy Speaker.
Question put and agreed to.
Resolved,
That this House has considered the Tobacco Control Plan.
Use of Chamber (Women MPs of the World Conference)
Resolved,
That this House welcomes the events organised to celebrate women’s suffrage and to mark the centenary of the Representation of the People Act 1918; recognises that the Women MPs of the World Conference provides a unique opportunity to gather parliamentarians from across the world to engage in discussions about equal representation and bring about social change; and accordingly resolves that parliamentarians who are delegates participating in the Women MPs of the World Conference should be allowed to hold a debate in the Chamber of this House on a day in November other than a day on which this House is sitting or a day on which the UK Youth Parliament is making use of the Chamber.—(Mims Davies.)
Access to Orkambi
Steve Brine Excerpts(5 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I say from the outset that there are 22 people in the Chamber for this Adjournment debate. Normally, it is me, the proposer of the debate and the hon. Member for Strangford (Jim Shannon). I say to the hon. Member for Bury South (Mr Lewis) that it is nice for other people to be here with us. I will say at the start that I will not take any interventions. A lot of Members have come to listen to this debate, and they want to hear the Minister. There are things that I as the Minister need to put on the record, and I am going to put them on the record before we finish at 8.5 pm.
I thank the hon. Gentleman for securing this debate and for giving me the opportunity to speak once more on an important issue that matters to me and my constituents as much as it does to his. May I again place on the record the sterling work undertaken by the Cystic Fibrosis Trust? Its support for cutting-edge research, campaigns to drive up standards of care and support for the CF community is fabulous. We are lucky to have it.
Once more, we have heard hon. Members make compassionate—that is a very good word—pleas urging an immediate resolution in the ongoing discussions between NHS England and Vertex to make Orkambi available on the NHS in England. To the hon. Member for North Down (Lady Hermon), who raised this in an intervention, I say that, absolutely, I will make sure my officials are talking to the permanent secretary—the very hard-working and probably overworked permanent secretary—at Stormont, because we need to make sure we have a joined-up approach. I wholeheartedly agree with everyone’s calls for exactly that: every effort must be made to ensure that precision medicines are made widely available to cystic fibrosis patients.
Many people have raised concerns this evening and in many other places about NICE’s process for the assessment of drugs for rarer diseases. I said this in the last debate in Westminster Hall and I will say it again: it is a key commitment of this Government to ensure that people with comparatively rarer conditions, such as CF, get the same quality, safety and efficacy in medicines as those who have more common conditions. I assure the House that where a company is willing to set a fair price for a drug, NICE’s technology appraisal process has been proven to be suitable for the assessment of drugs for rare diseases.
Steve Brine
I said I would not give way, and I will not do so.
I thought the hon. Member for Bury South made a good point when he said if NICE did not exist, we would have to invent it. I agree. Indeed, NICE has been able to recommend a number of drugs for patients with rare diseases through its technology appraisal process, including pirfenidone for pulmonary fibrosis and mifamurtide—why they cannot produce easier names, I will never know—for a rare form of bone cancer, to name but two.
I know that it is distressing, to put it mildly, for patients and their families, as well as campaigners, when NICE is not able to recommend a treatment. Unfortunately, there will continue to be occasions when NICE is not able to a recommend one for routine use on the NHS. As we know, NICE has not so far been able to recommend the use of Orkambi for treating CF, because the benefits were not sufficient to justify its considerable cost. At list price, the cost per quality-adjusted life year of Orkambi is many times higher than the upper end of the threshold used by NICE in deciding whether to recommend a treatment. NICE does not stick rigidly to a cost per QALY threshold, and it applies plenty of flexibility in deciding whether to recommend treatments where the decision is a borderline one. However, it must be stressed that the cost per QALY is not an arbitrary measure, but a tool to assess what the impact would be on other NHS patients if the NHS were to spend money on a particular treatment.
I want to talk about the discussions with Vertex. As Members know, NHS England has been in intensive discussions with Vertex to encourage it to lower the cost of Orkambi to a level that would allow NHS England to fund its use without adversely impacting other patients. I and the Under-Secretary of State Health, Lord O’Shaughnessy, who sits in the other place—he leads on this area for us—have been keeping an extremely close eye on these discussion, as I promised the House in the Westminster Hall debate I would do. As Members will remember, we wrote to Vertex in April, urging it to commit to pricing that is responsible and proportionate. I have the personal assurance from NHS England that it is committed to seeking a way forward in these negotiations, and I think it has shown flexibility.
Sadly—I am not ratcheting up the rhetoric or name-calling, as this is just fact—Vertex has been unwilling to price responsibly thus far, which has, as we have heard today, meant that patients have missed out on two years of treatment. Vertex claims that it has made the NHS
“the best offer in the world”—
but it has yet to substantiate that claim. I would challenge Vertex to waive confidentiality—which it can do: I cannot—so that we can all see, in the interests of transparency, the kind of prices it is trying to charge the NHS and, as a result, our constituents.
As mentioned this evening by the hon. Member for Bury South, NHS England wrote to Vertex yesterday to set out a proposed five-year deal with an option to extend, which provides the potential for Vertex to secure revenues from the NHS in the region of £500 million over the next five years. NHS England has made the content of this proposal public, to give patients and taxpayers the opportunity to make a judgment about the fairness of this offer. The proposed deal, if accepted, would guarantee immediate and expanded access, as clinically appropriate, to the two licensed medicines, Orkambi and Kalydeco—as was said earlier, Orkambi is not the only show in town. It would also provide immediate access for Symdeco from the date it is licensed for use in the UK, which is expected in coming weeks.
If Vertex is not willing to accept the deal, it must return to discussions with NICE and go through that process. Let me be clear that I truly hope it does not come to that, but until Vertex adjusts its prices, NICE will not be able to recommend the drug’s use. I repeat that we have put a figure on the table. The ball is in Vertex’s court. It has made a preliminary response today, saying that it is good to see that NHS England is negotiating. NHS England has been negotiating throughout. It is not Ministers who are negotiating on this.
Steve Brine
I will break my rule and give way to the hon. Gentleman who secured the debate.
Mr Lewis
That is kind of the Minister and I thank him for his serious response to the debate.
We said the last time we met that we did not want Ministers to keep an eye on the issue: we wanted Ministers to be actively engaged in it. The Minister gave us an assurance that his colleague would be actively engaged, not keeping an eye on it. Today, we repeat that we do not want NHS England and the drug company left in a room alone to work this out, otherwise we will be back here in six months’ time. We expect the Secretary of State to be in the room with the chief executive of NHS England and the drug company to bang heads together and come up with a satisfactory conclusion. Will the Minister respond directly to that point and give us an assurance that there will be political involvement and engagement in the negotiations, because we have waited for too long?
Steve Brine
When I say “keeping an eye”, I do not mean it like keeping an eye on the football scores on a Saturday afternoon. It is just my turn of phrase. Ministers are keeping very close tabs on this and making sure that NHS England is in no doubt that we want it to come to a conclusion with Vertex. But it takes two to tango, as we are seeing in another negotiation right now. We need Vertex to tango. The ball is in its court, and it is time to return it.
I stand by what I said at the last debate: it is vital that we go through the right process here. There is a process. I do not think for one minute that the Opposition are suggesting that if they were in government, Ministers would be making these decisions like Roman emperors, as that would be totally wrong. It is an important principle that the NHS must ensure that healthcare services get the best value for patients, and that is the approach NHS England is rightly taking.
NHS England has proven that it can strike innovative deals, working with the life sciences sector to make treatments available for patients, while securing fair value for taxpayers—our constituents. That includes hundreds of patients with multiple sclerosis who now benefit from a treatment called cladribine and the use of pertuzumab for breast cancer. It is important for me to be clear with hon. Members that Ministers should not make a decision on behalf of NHS England, which has the clinical expertise and the powers to purchase medicines.
I put it on record again that I urge Vertex to accept the proposal presented by NHS England, or it will only make those living with cystic fibrosis suffer. Yes, of course there are discussions among the new ministerial team. I spoke to the new Secretary of State just this evening in the Lobby. He is taking an incredibly close interest in this issue, less than a week into the job, and I pay tribute to him for that. I ask Vertex to recognise NHS England’s flexible approach. It would represent the largest ever financial commitment of its type in the 70-year history of the NHS. I certainly hope that they can reach a deal. Many, including in my own Winchester constituency, are counting on them.
Question put and agreed to.