Fortified Flour

Steve Brine Excerpts

Wednesday 16th May 2018 Westminster Hall

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

Thank you, Mr Hanson. Should that be the miller, Steve Brine? I like the notion from the shadow Minister that the European Union is waiting for us to lead. That is a new concept.

It is a pleasure to serve under your chairmanship for the first time, Mr Hanson. I congratulate the hon. Member for Pontypridd (Owen Smith) on securing the debate and I thank him for devoting it to an issue that I know he cares about. He works closely with Shine, which he mentioned and which was mentioned by others, and is based in his constituency. It does some fantastic work supporting people with spina bifida and anencephaly and their families. I have asked my officials to see if Shine will come in and see me as soon as possible. It is not a charity that I know, so I want to speak to and get to know its staff.

I hope I can reassure hon. Members a little bit—I suspect it will not be a lot—that the Government and those who provide us with expert independent advice are looking incredibly closely at all of this, as I will set out. I will say at the outset that I am sorry to disappoint the shadow Minister, but I cannot give the House an exclusive announcement today, I am afraid. However, I may be able to give some encouragement.

Part of the pregnancy advice currently provided to women is of course to take folic acid supplements. The consequences of folate deficiency in the general population are that pregnant women are at greater risk of giving birth to low birth-weight, premature babies with neural tube defects. Unless someone is pregnant or is thinking of having a baby, they should be able to get all the folate they need by eating a generally varied and balanced diet. Women who are trying to conceive, or who are likely to become pregnant, are advised to take a daily supplement of, we say, 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods such as spinach and broccoli, which sounds lovely, and foods that are voluntarily fortified with folic acid such as, as has been said, a wide range of breakfast cereals.

As has been said by pretty much every Member who has spoken, around half of pregnancies are unplanned. Of those that are planned, it has been estimated that only half of all mothers take folic acid supplements or modify their diet to increase their folate intake. That is one of the main reasons behind the calls for mandatory fortification and is one of the reasons why the debate was called.

UK wheat flour is currently fortified with calcium, iron, niacin and thiamine in accordance with the Bread and Flour Regulations 1998—introduced under the last Labour Government—which apply in England, Scotland and Wales, with parallel regulations in Northern Ireland. This mandatory fortification is a domestic, not an EU, requirement and is done for public health reasons. It has the primary objective of restoring those nutrients lost during the milling process, with the exception of calcium, which is added in larger amounts than that lost.

To date, successive Governments have not considered that the mandatory fortification of flour with folic acid is the best way of protecting public health and have instead promoted the use of supplements as part of a wide range of pre and post-conception advice to women of childbearing age. That may be merely stating the obvious of where we have come from, but it does not necessarily need to mean where we are headed.

While it may appear straightforward to just add folic acid to the existing mandatory flour fortification measures, a problem that arises with the proposal to move from the current advice of taking a measured supplement is of how to ensure that women are able to assess their folate intake if getting it from foods made from flour instead. Women in the targeted age group may not eat the relevant products in sufficient quantities.

We also want to consider the population’s wider dietary advice, and to educate women to encourage them to achieve a greater folate intake by way of eating those folate-rich vegetables that I mentioned earlier, rather than relying on flour-containing foods, which may not be the best contributor to a balanced diet. It will be necessary to consider properly women’s consumption of all wheat flour-containing products to fully understand the impact of any mandatory fortification on diet and folate intake levels. Additionally, we are aware that the universal fortification of flour with folic acid may not be readily accepted by the general public, especially when the measure is intended to benefit only a specific section of the population.

The aforementioned Scientific Advisory Committee on Nutrition—SACN; it was indeed called COMA—is a committee of independent experts on nutrition that provides advice to Public Health England, for which I have ministerial responsibility, and other Government agencies and Departments across the UK. It has recently updated the evidence on folic acid in response to a request from Food Standards Scotland, which was prompted by Scottish Ministers expressing a desire to proceed unilaterally with the mandatory folic acid fortification of flour north of the border.

In its most recent July 2017 report, SACN saw no reason to change its previous recommendations, made in 2006 and 2009, for mandatory folic acid fortification, to improve the folate status of women most at risk of NTD-affected pregnancies, provided that this is accompanied by restrictions on voluntary dietary fortification with folic acid. Again, this emphasises the need to fully understand all the sources of folate intake by women, to ensure that their health is protected as well as to protect their unborn children. The Wald paper, which is a new scientific paper published on 31 January this year in Public Health Reviews, has again raised this issue. However, the paper suggests that there should be no upper limit on folate intake, which would remove some of SACN’s concerns.

The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—COT—is another independent scientific committee that provides advice to the Government on, among other things, the safe upper levels for vitamins and minerals. The Wald paper was brought to the attention of COT by its chairman, and COT agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT discussed a scoping paper in March this year and will have its first detailed discussion in July to see whether Wald’s analysis of the data is correct and whether the original tolerable upper level recommendation is not appropriate. COT will then receive a second paper in September considering all of that and is hoping to be able to report its findings towards the end of this year.

I wanted to put that on the record because it is the advice I have been given, but I have to say that, frankly, I am the Minister, and that is not good enough for me. I want it sooner than that, so I have asked COT to come and see me by the end of this month to explain itself and to see whether we can move forward more quickly.

To conclude, I am moved by the testimonies given today. The right hon. Member for Belfast North (Nigel Dodds) is a gentleman and an excellent parliamentarian, and his speech about his son, Andrew, cannot have been an easy one to make. I thank him for putting those personal things on the record in the way he did. There are many issues to consider, but I wholeheartedly agree with the sentiment of the debate. I will do my utmost as the public health Minister, working with other colleagues across Government—this impacts on other Departments as well—to work through the issues to give the best effect to the aim of the debate as soon as we possibly can.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 8th May 2018 Commons Chamber

[Imran Hussain (Bradford East) (Lab)]

9. What guidance his Department provides to NHS England on the redistribution to other healthcare areas of funding clawed back from dentists who have not met their contracted units of dental activity.

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

The Department does not issue guidance specifically to NHS England on the redistribution of funding that is recouped from dental contracts. Of course, any decisions on the provision of healthcare are rightly a matter for the local NHS, because local commissioners are best placed to assess the dental needs and priorities among their local population, including the one that the hon. Gentleman represents in Bradford.

[Imran Hussain]

People in Bradford cannot get an NHS dentist, child tooth decay rates are soaring, and people are being admitted to hospital because they cannot get dental care. It was announced over the weekend that Bradford will receive an extra £332,000, which I of course welcome, but between 2014 and 2017, more than £300,000 was taken from dental care funding in the district. Is it not the case that the new funding is just a misleading announcement?

[Steve Brine]

I think that is what is known as a back-handed welcome. We have made great progress on improving access to dentistry in England, but we know that there are parts of the country, including the hon. Gentleman’s area, in which we can do more. That is why NHS England in Yorkshire and the Humber—with which I liaise on matters raised by a number of Opposition colleagues—is finalising plans to improve access to dentistry throughout the region, paying particular attention to 20 areas. Bradford East is one of those areas and, as the hon. Gentleman said, will shortly receive additional recouped funding to support his constituents.

[Dr Paul Williams (Stockton South) (Lab)]

Why are dentists, such as my constituent Peter Sharp in Thornaby in Stockton South, funded less per unit of dental activity than his colleagues who are working in more affluent areas? Surely, to reduce health inequalities, it should be the other way round?

[Steve Brine]

That goes to the heart of why we are reforming the dental contracts. Our 73 high street dental practices are continuing to test the preventive focused clinical approach to a new remuneration practice. [Interruption.] Someone on the Opposition Front Bench has just said “when” from a sedentary position. It will be when we have got it right.

[Mr Speaker]

The hon. Member for Tonbridge and Malling (Tom Tugendhat) has beetled into the Chamber like a perspiring postman just in time. It is very good to see the fellow.

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[Neil Gray (Airdrie and Shotts) (SNP)]

12. What recent discussions he has had with Public Health England on the potential merits of introducing minimum unit pricing for alcohol in England.

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

The Government remain committed to tackling all alcohol-related harms, which is why we are developing a new alcohol strategy. As part of that, I am commissioning Public Health England to undertake a review of the evidence for minimum unit pricing in England.

[Neil Gray]

That is welcome news. The Scottish National party Government have taken the lead in this matter by taking the bold step to set a minimum unit price for alcohol as part of wider interventions to help tackle excessive consumption. In particular, they want to end the days of strong white ciders being sold at pocket money prices. The British Medical Association has long called for that, so at what stage will we learn of further progress in the Government’s thinking?

[Steve Brine]

The previous consultation in 2013 found that the evidence, as it stood at the time, was not entirely conclusive. That is still the case, which is why the Government intend to keep the policy under review. Many times in this Chamber we are given the benefit of experience north of the border as to whether a policy has been a success, but it is not always strictly spot on. Given that the policy only came in last week, it is probably premature to say that it is a success, but we will welcome the opportunity to see the evidence emerge from Scotland’s implementation of minimum unit pricing, and we will be watching very closely.

[John Grogan (Keighley) (Lab)]

Does the Minister agree that it is significant that major pub companies and brewers such as Greene King, Coors and Tennent’s now support minimum pricing, and that what is good for the nation’s health is good for the nation’s pubs and the promotion of sensible drinking?

[Steve Brine]

We want to get on and tackle all avoidable harms, including alcohol. The vast majority of our constituents enjoy a drink and have a healthy relationship with alcohol, but that is not the case for everybody. Some people can harm themselves, society and, as we have heard, their children. What is happening north of the border in Scotland is very welcome. I think that there will be an early evaluation there at the one-year point, and we will be watching that like a hawk.

[Victoria Prentis (Banbury) (Con)]

13. What steps the Government are taking to tackle obesity.

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

Evidence from cities such as Manchester and London is very clear that centralising stroke treatment in hyper-acute stroke units considerably improves outcomes, with patients having access to a specialist at all times and immediate access to imaging and investigative facilities, giving them the best chances in terms of outcome.

[Kate Green]

My 82-year-old constituent, Freda, is recovering well from a serious stroke, but she has been told that there is an 18-week wait for physiotherapy and that this is the NHS standard. Does the Minister think that that is good enough?

[Steve Brine]

I cannot comment on the individual case, but I can say that NHS England and we at the Department are working closely with the Stroke Association to develop a new national plan for stroke in England which we expect to publish this summer. The hon. Lady’s constituents and mine will benefit from the national policy narrative, but they will also benefit from some brilliant charities that work on the ground with constituents. Yesterday, I saw Chandlers Ford Stroke Support Group at the amazing Funtasia in my constituency. That group does a lot to support people in stroke as well.

[Rachel Maclean (Redditch) (Con)]

In Worcestershire, we are fortunate to have some excellent stroke services serving my constituents across the whole county. Does the Secretary of State agree that the most important aspect of any service is leadership? With that in mind, will he update the House on his progress in appointing a new chair for our trust to deliver stroke services and other services to Redditch?

[Steve Brine]

I am not close to that issue, but I am told that we have some excellent candidates, and I think that my hon. Friend will be pleased.

[Ruth George (High Peak) (Lab)]

The most important service that stroke patients need is priority in getting to hospital for the treatment they need. A patient in my constituency recently had to wait five hours for an ambulance, with a GP sitting next to her begging the service to send one. East Midlands Ambulance Service has now had a review and will be getting an increase in its funding, but can that be made faster over the next two years?

[Steve Brine]

The new ambulance standards are designed to do exactly that. I note the hon. Lady’s welcome for that in her area. That is critical, but of course it is critical that people get to the right place and get the right treatment. That is why I said at the start of these exchanges that centralising stroke treatment is not always popular but is often the best thing for clinical outcomes.

[Alex Cunningham (Stockton North) (Lab)]

15. How many people have accessed NHS dentistry services in the last 12 months for which data is available.

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

Access to NHS dentistry remains consistently high. The most recent figures show that 22 million adults were seen by an NHS dentist in the 24 months from January ’16 to Christmas last year and 6.9 million children visited a dentist last year.

[Alex Cunningham]

Twelve thousand of those people in my constituency were left without a dentist when the Queensway practice in Billingham, in common with many dentists across the country, ditched NHS work. People are trying to build capacity there, but the funding system for dentists is a major impediment. What plans do the Government have to address the crisis in NHS dentistry, encourage dentists to stay with the NHS, and make dental health a priority?

[Steve Brine]

We have been in correspondence about the Queensway practice, as the hon. Gentleman knows. When a dental contract ends and patients need to find another dentist, NHS England has a legal duty, as he knows, to commission alternative services to meet local need. I understand that that is happening in his area and that he is being kept regularly updated on the situation. In answer to a previous question, I mentioned the dental contract, which is a key part of our reforms to keep people in, and attract people into, the dental profession.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

It is shameful that our older and vulnerable residents living in care homes do not have the access to dental treatment that they need. The Minister revealed in a written answer to me that older people living in care homes are less likely to have any natural teeth and are more likely to have serious tooth decay, but still no specific action has been taken. Will the Secretary of State meet me and commit to do everything he can to help prevent serious tooth decay for our older and most vulnerable residents?

[Steve Brine]

As I said, NHS England has a legal duty to commission dental services and primary care dental services for the hon. Lady’s constituents. If she wants to bring a specific example from her constituency to me, I will be happy to look at it.

[James Morris (Halesowen and Rowley Regis) (Con)]

16. What steps he is taking to protect children’s mental wellbeing from the harmful effects of social media.

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[Faisal Rashid (Warrington South) (Lab)]

T3. Chapelford medical centre in my constituency has been operating out of a portakabin on waste land for many years, due to excessive delays and the failings of various NHS bodies involved in this project. What action will Ministers take to resolve these shocking delays, and will they meet me to give assurances to my constituents?

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

I will be very happy to meet the hon. Gentleman to look at his local issue.

[Helen Whately (Faversham and Mid Kent) (Con)]

I welcome the Green Paper on mental health in schools, which was published earlier this year, but it does prompt a question about the mental health of students in further and higher education. Does my right hon. Friend have any plans to look into that issue? If he does not, may I urge him to do so?

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[Keith Vaz (Leicester East) (Lab)]

T4. There is a clear connection between obesity and type 2 diabetes. Will the Secretary of State confirm that that issue will be addressed in the national diabetes prevention programme?

[Steve Brine]

Obesity has rightly had a strong outing today. We know that it is a leading cause of type 2 diabetes; supporting people to live healthier lifestyles can only reduce the incidence of the disease. So far, more than 170,000 people have been referred to the national diabetes prevention programme. Those who are referred receive tailored, personalised help, including education on healthy eating and lifestyle choices, and bespoke physical exercise programmes.

[Mr Philip Dunne (Ludlow) (Con)]

Is my right hon. Friend aware that following his decision to make the capital allocation to Shrewsbury and Telford Hospital NHS Trust before Easter, that trust has had sufficient confidence to successfully appoint five additional consultants in 10 days in April, thereby improving resilience in acute healthcare in Shropshire?

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[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Dispensing practices are a lifeline in rural constituencies such as Sleaford and North Hykeham. Does my right hon. Friend agree that patients who live far from a pharmacy and attend their local dispensing practice should all have access to that dispensing service?

[Steve Brine]

Yes, I do: dispensing practices are an important part of the widening primary care mix. That is important for constituents in rural areas such as my hon. Friend’s. Community pharmacy and dispensing practices, which she refers to, are increasingly important when they are part of an integrated primary care pathway. That has got to be the future.

[David Linden (Glasgow East) (SNP)]

T6. What discussions have the Government had with Vertex regarding the availability of Orkambi? Many Members packed out Westminster Hall in a debate about that issue. Will the Government give us an update on this really serious issue?

[Steve Brine]

This issue has received a lot of publicity in recent weeks. My noble Friend Lord O’Shaughnessy and I wrote to Vertex following that debate and asked it to be reasonable and continue, with vigour, its negotiations with NHS England. That letter was made public, as was the company’s actually quite positive response last week. I urge the company again to come to a reasonable conclusion.

[Alan Mak (Havant) (Con)]

Healthcare delivered by app and other new technologies is increasingly popular with patients. Will my right hon. Friend undertake to ensure that the NHS fully explores the possibilities of new technologies when delivering front-line services?

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[Thelma Walker (Colne Valley) (Lab)]

Does the Minister agree that eating a nutritionally balanced meal can reduce snacking between meals and therefore help to reduce childhood obesity? If so, will he speak to his colleagues in the Department for Education and ask them to ensure that the 6,400 children in Kirklees who are set to lose out on a well balance nutritious free school meal do not?

[Steve Brine]

I talk to colleagues across Government all the time. The first round of the child obesity plan—it was maligned earlier—contained many good things, such as the sugary drinks tax. A couple of months ago we launched, with Public Health England, changes in relation to the nutrient profiling of foods marketed to children. That is positive for the hon. Lady’s constituents and for mine.

[Jeremy Lefroy (Stafford) (Con)]

Five years on from the Francis report, how does my right hon. Friend assess patient safety in the NHS?

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[Leo Docherty (Aldershot) (Con)]

Will the Minister update me on the FIT—faecal immunochemical test—for bowel cancer? It has long been promised and we know it saves lives. When will it materialise?

[Steve Brine]

I updated Members on this last week in a Westminster Hall debate. Bowel cancer is the fourth most common cancer in the UK and the second leading cause of cancer deaths. My hon. Friend is right that the FIT has long been promised. There have been a lot of challenges—making sure we get it right and referrals into the secondary sector—but the FIT will be rolled out from autumn.

[Hilary Benn (Leeds Central) (Lab)]

The European health insurance card enables British citizens to get medical treatment in the EU, including kidney patients who need dialysis. Without it, many of them simply could not go on holiday at all. Will the Secretary of State tell the House whether it remains the Government’s objective to keep the EHIC in place after we have left the EU, and, if so, what progress is being made to ensure that that happens?

[Bim Afolami (Hitchin and Harpenden) (Con)]

Will the Minister explain how and when the community pharmacy sector will gain access to the pharmacy integration fund? Millions have been promised. When will it be delivered?

[Steve Brine]

The pharmacy integration fund is a great success. It needed to be ramped up and it is being ramped up. Pharmacists, working within general practice, are making a great difference to the multidisciplinary team within primary care.

[Mr Speaker]

I feel sure that “ramped up” is the technical term.

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[Chris Skidmore (Kingswood) (Con)]

Several of my constituents have contacted me to welcome the Government’s recent announcement of additional investment for prostate cancer funding. Will the Minister update the House on what the money is and what it will be spent on?

[Steve Brine]

Gladly. Prostate cancer survival rates are at a record high, but we want to do even better, so last month the Prime Minister announced £75 million to support new research into the early diagnosis and treatment of prostate cancer. The National Institute for Health Research will recruit 40,000 more patients, which is a lot, for more than 60 studies into prostate cancer over the next five years.

[Judith Cummins (Bradford South) (Lab)]

I welcome the recent news that NHS England has committed to redirecting extra funding for dental services to Bradford as an area of need—it comes after a high-profile campaign in the Bradford Telegraph and Argus—but I urge the Minister to recognise the need for long-term reform of the dental contract and for a sustainable funding settlement for all. Will he meet me and others campaigning on this issue to discuss what progress has been made?

[Steve Brine]

Yes. The dental contract has had a good outing this afternoon. I am always happy to see the hon. Lady and I can tick the Telegraph and Argus off my bucket list if they come along as well.

[Several hon. Members rose—]

HPV Vaccination for Boys

Steve Brine Excerpts

Wednesday 2nd May 2018 Westminster Hall

[Sir Roger Gale (North Thanet) (Con)]

I beg to move,

That this House has considered the case for HPV vaccination for boys.

I am delighted to find you in the Chair, Sir Henry. Before I start the substance of my speech, I want to place on the record my appreciation for the help I have received from a number of people, most notably Professor Christopher Nutting, one of the country’s most eminent oncologists specialising in throat and thyroid cancers, and Peter Baker, the campaign director for HPV Action. I am grateful to them both for educating me. I am also indebted to Stephen Bergman and Jamie Rae, two sufferers from the condition we are going to discuss—I shall say more about them later. Finally, I place on record my appreciation of the work done by my hon. Friend the Member for Finchley and Golders Green (Mike Freer). The Minister will understand that he cannot be here this morning; he has Government duties and a vow of Trappist silence as a Government Whip.

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

I have been there.

[Sir Roger Gale]

My hon. Friend the Minister indicates that he knows the problem only too well. My hon. Friend the Member for Finchley and Golders Green has done a significant amount of work in achieving the provision of human papillomavirus vaccine for gay men—a small but significant step in the direction in which I hope we may travel further this morning.

Until a relatively few weeks ago, I knew very little about this issue. I concede that entirely. Unlike one of my colleagues who was here in this Chamber yesterday morning while I was in the Chair listening to the debate, who had a relative who had died of bowel cancer, I have no personal experience. However, when I met Professor Nutting and Peter Baker, I was astonished at the speed with which they convinced me of the argument—and I am not a pushover when it comes to spending taxpayers’ money. I think it is a no-brainer, and I hope to persuade my hon. Friend the Minister, and others, on this cause.

The human papillomavirus causes, among other things, cervical cancer, throat cancer, anal and penile cancers, and cancer of the back of the tongue. The virus is carried by about 80% of the population, which means somebody in this room is a carrier; it is not uncommon. I would like everybody to take that on board. Go on the tube in the morning and there will be dozens of people carrying the virus—most of it dormant, and a lot of it non-malignant. It is contracted in sexually active youth and, for men, usually in their teens or 20s.

The point is that it is a slow-burn issue. Its effects are not experienced overnight. A condition contracted as a teenager or at university may not rear its head for 30 years. We are talking about men now in their 50s and 60s, who some of the eminent people sitting behind me in the Public Gallery are treating, waiting that length of time without realising that they have anything wrong with them at all, because there is no screening process for men, unlike the screening process for cervical cancer.

I spoke yesterday to two people, Jamie Rae and Stephen Bergman—both sufferers, and both in their mid-50s—who described their experiences to me. I will not go into too much of the gory detail. I heard again this morning of another experience: somebody’s colleague, himself an eminent surgeon, who had throat cancer and suffered many months out of work, which was a loss to the health service, damage to his family and, of course, the treatment. The treatment involves chemotherapy and radiotherapy; it may involve a tracheostomy; and it inevitably damages the saliva glands in the mouth, leaving the patient who survives with permanent dryness, considerable pain and ongoing discomfort. As I have indicated, there is also the social damage. Both Jamie Rae and Stephen Bergman described to me in graphic detail the processes they have been through and the discomfort—I use that word very modestly indeed—they have experienced. They described themselves as the lucky ones, because both those gentlemen have come through it relatively unharmed, but of course there are many others who do not.

The HPV vaccine has been available to adolescent girls since 2008. A pubescent girl of 12 or 13 is offered the opportunity to be vaccinated in school. The parents, quite properly, have a right to refuse that vaccine. Just in case anybody has any doubt, I am aware that there are a small number of cases where parents believe that things have gone wrong and that children have suffered as a result of the vaccination. That is medically unproven, but we have to recognise that the parents believe it. Parental choice is vital, and in the case of pubescent girls there is parental choice.

The process ties in directly with the Department of Health and Social Care’s cancer strategy, which of course is about prevention. The Department has done significant work on preventing or seeking to prevent other prominent cancers. Lung cancer is the obvious one, and the anti-smoking campaign is highly relevant in this context. Melanoma is another; something that people of a certain age, such as myself, probably did not bother with at all has suddenly become prominent as the realisation of the damage that the sun’s rays can do to the skin and the cancers that can arise from that has dawned on the population. Any responsible parent or grandparent now takes the trouble to ensure that their children have appropriate sunscreens at all times when enjoying the sun. HPV vaccine falls directly into that category. It is usable for prevention and, used properly, it works. That is proven. As I said, this has been available to adolescent girls since 2008.

We now come to the hard bit of the argument, because up until now I think everybody would probably agree that we are on a winner in using HPV vaccine, but of course there is the question of cost and efficacy. The argument has been deployed that herd immunity, to use the colloquial phrase, will mean it is not necessary to vaccinate boys, because if we eliminate the infection in girls, boys will not catch it from the girls. That is nice in theory, but wrong in practice.

I am told by those who know better than I do that the average young male has at least 10 sexual partners. The Minister might find that surprising; I did myself, but it is so. It depends whom we believe, but in the United Kingdom the vaccine has an uptake of between 70% and 83%, although in some parts of the country it is as low as 50%. A young man embarking on an exciting night out with his girlfriend therefore has a very high risk of contracting HPV from a girl who has not been vaccinated, and that is just in the UK. We overlay on that the foreign travel that many young people are now happily able to enjoy. Sometimes, with sun, sea and sand goes sex, and the risk of exposure to HPV in those circumstances can be even greater. Therefore, the idea that herd immunity will in time address the problem is fallacious, and this is where I have to accuse those who are responsible for taking the decisions—that is not the Minister—of short-termism.

I can see the attraction of the argument that extending vaccination would not be cost-effective and that herd immunity is coming downstream. Yes, the cases coming through now are historical, in the sense that the disease was contracted 20 or 30 years ago, so well before any immunisation. If we want to save money and damage health at the same time, that is quite a good way of going about it. I am seeking to persuade the Minister of the real value of having the courage—he is not lacking in courage—to take a long-term decision now.

The cost of immunising every adolescent boy within the relevant range in the UK is estimated to be, at the top end—this includes the purchase of the vaccine, which of course has to be negotiated by the health service, and its application—about £22 million a year. That is a lot of money, but in health service terms it is almost a bagatelle. Set against that, I am told by those with real experience, some of whom are sitting behind me in the Public Gallery, that there are about 2,000 patients a year—men in their 50s and 60s—who have developed throat, penile or anal cancers. The cost of treating those is about £21 million a year. Of course, that takes no account of the social costs and the other damage that can be done. In the case described to me this morning, of a surgeon who was taken out of play for a considerable time, the cost of treatment—of a replacement jaw, as well as the chemotherapy, radiotherapy, hospitalisation and everything else that goes with it—is looking like being somewhere between £50,000 and £100,000, and that is just one case.

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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, Sir Henry, I think for the first time. I congratulate my hon. Friend the Member for North Thanet (Sir Roger Gale) on securing the debate and bringing this important subject to the House. He was in the Chair the last time I was in Westminster Hall, which was just yesterday. I am surprised that so few Members are present for the debate. As the shadow Minister suggested, perhaps matters elsewhere in the House and outside are occupying their minds.

As my hon. Friend the Member for North Thanet mentioned, our expert group, the Joint Committee on Vaccination and Immunisation, is considering this matter, and it is important that I do not pre-empt its final advice, as he rightly said. That does make the timing of the debate challenging, but I will respond as fully as I can and give as much context as possible.

I will first set out some of the context. In 2008—before I was even a Member of the House—on the advice of the JCVI, an HPV vaccination programme for girls was introduced. The primary objective was to protect against cervical cancer. As the hon. Member for Washington and Sunderland West (Mrs Hodgson) kindly said, my mission in life—not just in my job—is to challenge and beat that dreadful disease. While I am on the subject, I pay tribute to Jo’s Cervical Cancer Trust and the brilliant Rob Music, who leads it—I know that the hon. Lady knows them well. The trust’s work in this area over many years, including with me as Minister, has been truly transformative for many women’s lives.

The HPV vaccine that is used in the UK offers protection against the two types of HPV that are responsible for about 70% of cervical cancers, and since the introduction of our vaccination programme the number of young women infected with HPV has fallen dramatically. Protection is expected to be long-term, eventually saving hundreds of lives each year, which I am sure we all agree is very welcome. Today, however, our focus is on boys and men.

[Jim Shannon (Strangford) (DUP)]

Is the Minister aware of the paper on this subject by Dr Gillian Prue of Queen’s University Belfast? Dr Prue’s six recommendations are very similar to what the hon. Member for North Thanet (Sir Roger Gale) and others have put forward today. They include: first, that both men and women should be vaccinated against HPV-related diseases; and secondly, and more importantly, that the significant human cost of HPV-related diseases should be the primary consideration for including boys in vaccination programmes. If the Minister has not been made aware of the paper, I am happy to furnish him with the copy. Its recommendations are integral to moving forward on the issue.

[Steve Brine]

Not wishing to mislead the House, my honest answer is that I am not aware of that paper. Whether my officials are aware of it is another matter—I will ask them. I know that the hon. Gentleman will not be shy about putting a copy in my hand after the debate.

The good news is that HPV vaccination of girls also provides some—I emphasise “some”—indirect protection for boys. When the vaccination uptake rates are high, as they are in England, there are fewer HPV infections in heterosexual males, because the spread of HPV infection between girls and boys is reduced. There is evidence to back that up; it is not just words. For instance, diagnosis of first-episode genital warts in young heterosexual men between the ages of 15 and 17 declined by 62% between 2009 and 2016. That suggests that there is some—again, I emphasise “some”—herd protection from the existing HPV vaccination programme. However, that is not the start of the story, and neither is it the end, and I have to put it on the record that nobody in Government has ever said that it was. Nevertheless, I take the points that have been made today about herd immunity; it is only part of the story.

Of course, it will take much longer to see the impact that the girls programme has on HPV-related cancers, but we should not wait for those results before considering whether more needs to be done now for boys. As my hon. Friend the Member for North Thanet said, this is a slow-burn problem.

[Sir Peter Bottomley]

It is just a matter of pure mathematics. If 100%, or nearly 100%, of any age cohort —male and female—gets the vaccination, the herd immunity develops much faster than just relying on vaccinating up to 50% of that cohort.

[Steve Brine]

I think that my hon. Friend is stating facts, and I know that the JCVI officials who are here today will have heard him.

The JCVI keeps all vaccination programmes under review, as it should, and it keeps Ministers informed of any reviews. As my hon. Friend the Member for North Thanet is aware, given the increasing evidence about the link between HPV infection and oral, throat, anal and penile cancers, alongside the incidence of genital warts, the JCVI has considered whether HPV vaccination is now needed for males.

I understand the point that the hon. Member for West Dunbartonshire (Martin Docherty-Hughes) made about the surprise about penile cancer. He has more experience of the subject than I do, but it is not a surprise to me. I work with a very good charity called Orchid Cancer, some of whose staff attend my cancer roundtable regularly. It deals with male cancers and is trying to raise awareness of penile cancer as a challenge in society today. It is an issue that is difficult for society, let alone for men, to talk about. I thank the hon. Gentleman for what he has said today.

The JCVI considered its current piece of work in two parts: first, whether the HPV vaccination should be introduced for men who have sex with men—MSM—and secondly, whether it should be introduced for adolescent boys. MSM, as we know, are a group at high risk of HPV infection. Unlike heterosexual men, of course, they are unlikely to receive much, if any, indirect protection from the HPV vaccination programme for girls. The JCVI advised us that a targeted HPV vaccination programme should be introduced for MSM up to the age of 45 who attend genitourinary medicine clinics or HIV clinics. Following a successful pilot in 42 clinics that was led by Public Health England, we announced in February that the programme would roll out across the country from April, and it is now being rolled out. That programme is welcome, but again I fully appreciate that it is not the start and it is certainly not the end of the story, for some of the reasons that the hon. Member for Washington and Sunderland West set out in her very coherent remarks.

Let me turn to the issue of adolescent boys. Of the non-cervical HPV-associated cancers, not all cases are caused by HPV—indeed, the percentage of cases that are attributable to HPV is widely debated. My hon. Friend the Member for North Thanet mentioned The Swallows, which I do not have much contact with, although I have heard of it. I passed a note to my officials asking them to get in touch with the charity as a result of this debate, so it should look out for that. For head and neck cancers, alcohol is an important risk factor to take into account, but HPV does play a role, and that is why the JCVI is considering whether vaccination for boys should be introduced.

The JCVI issued interim advice on HPV last July. As Members know, that was subject to consultation. It is reviewing the evidence ahead of finalising its advice to Ministers. Its members are the experts, and they are best placed to consider the evidence and provide advice to Ministers. That is the system that Parliament has mandated. Parliament could change it, but that is our system.

[Sir Peter Bottomley]

When the Minister sends a report of this debate to the JCVI, it might be worth him respectfully saying that some of us here are aware of how long it took it to agree to bring in HPV protection even for females. It might want to consider whether postponing that decision was right or wrong. In my view, it was wrong. The people at the British Association for Sexual Health and HIV knew that it was wrong, and it took an awfully long time for them to change their minds. Can we please ask them respectfully not to make the same mistake again?

[Steve Brine]

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

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

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

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

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

[Mrs Hodgson]

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

[Steve Brine]

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

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

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

[Mrs Hodgson]

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

[Steve Brine]

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

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

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

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

Bowel Cancer Screening

Steve Brine Excerpts

Tuesday 1st May 2018 Westminster Hall

[Sir Roger Gale (in the Chair)]

Order. The situation we are in is entirely of my making, and for that I can only apologise. Given that there are so many Members present who might wish to intervene, I am prepared to stay in the Chair for six minutes of injury time to enable the hon. Gentleman to take interventions. I am sure that is illegal, but I am willing to do it, provided that the Minister and the hon. Gentleman, who are in charge of the debate, are prepared to accept that.

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

indicated assent.

[Nick Thomas-Symonds]

I am grateful for that kind offer, Sir Roger. I am delighted to hear that we can continue for an extra six minutes.

The hon. Member for Eastbourne (Stephen Lloyd) is absolutely right. This is a cross-party issue. I believe that his predecessor spoke in favour of the system that he proposes, and the hon. Member for Hexham (Guy Opperman) contacted me to draw attention to the debate that he led back in 2011. There is broad cross-party consensus for looking at the screening age and at more accurate screening methods, which I will come on to.

Participation rates remain an issue. We should send a very simple message to people: “Please do not ignore your bowel cancer screening kit, which could save your life.” There is no doubt that we must also do more to raise awareness of symptoms. Bowel cancer is often mistaken for other conditions, such as irritable bowel syndrome. That only reinforces the point that a number of hon. Members have made about the importance of highly accurate screening.

Previously, the standard screening test was considered to be the faecal occult blood test—the FOB test, as it is known—and all men and women between 60 and 74 received a home test kit, but that has been changing across the country. The best available test is now the faecal immunochemical test—the FIT—which can detect more cancers and can be set to different sensitivity levels, enabling any traces of human blood that are found to be investigated. The Royal College of Pathologists sent me a useful briefing, in which it indicates that it would expect a 45% increase in demand on pathology if the test were set at one level, but a 480% increase if it were set at a more sensitive level. That sensitivity level is important.

The Welsh Government are introducing the FIT from March 2019. I believe that it was due to be introduced in England in April. I hope that the Minister can update the House on when that will happen. I hope that there will be a decision for Northern Ireland soon. Of course, Scotland already screens people using the FIT at age 50.

--- Later in debate ---

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

I congratulate my friend the hon. Member for Torfaen (Nick Thomas-Symonds) on securing the debate. I pass on my condolences, as others have, for his loss just a few months ago. It takes a great deal of bravery to stand up in the House of Commons and talk about the passing of a mother so soon after it happened—I am not sure that I could have done so when it happened to me. As the Minister with responsibility for public health and cancer, I thank him for his interest in this subject and for the support he has shown. He mentioned the runs he has done—I am sure I could not do that—and his support for our excellent bowel cancer charities, Beating Bowel Cancer and Bowel Cancer UK, which recently joined together to become one charity. We await with interest what the new name will be—answers on a postcard to the Department of Health and Social Care.

Let me start by assuring the hon. Gentleman that bowel cancer is a priority for me, the Government and NHS England. That is simply because it affects so many of our constituents—about one in 20—during their lifetimes. It is the fourth most common cancer in the UK and the second leading cause of cancer deaths, with up to 16,000 people sadly losing their lives to the disease each year. If we want to improve on what are the best ever cancer survival figures, we need to do better with bowel cancer and, indeed, with all other cancers. Thankfully, more than 76% of men and women now survive for one year, which is a crucial landmark, and about 60% survive for five years. It is encouraging that survival in those detected and treated following bowel cancer screening is about 97%.

Let me talk about FIT, the subject of our discussion. Rolling out FIT—faecal immunochemical testing for haemoglobin, to give its full title—is recommended in the independent cancer taskforce’s strategy for England. We have much more to do to catch bowel cancer early and achieve better figures, which is why the Government accepted the recommendation of the UK National Screening Committee, which provides the Government with independent, internationally regarded evidence relating to screening, that FIT should replace the current home test. The pilot work showed that FIT will increase by about 7% the proportion of people taking part. Importantly, we expect those communities not returning the current home test kits to show the most interest in using the new ones. That is an important part of England’s cancer strategy. I am sure we will all welcome that contribution to the reduction of inequalities in screening and cancer mortality for those communities.

NHS England, Public Health England and NHS Digital are working together to finalise a number of practical arrangements regarding sensitivity, rightly mentioned by the hon. Gentleman, as well as production and distribution of FIT kits and diagnostic and pathology workforce capacity—I will return to that—to ensure that when FIT is implemented, it is, critically, sustainable.

It was important to get this right first time. When I was appointed last June, I was aware of the issue. One of the first questions I asked was about it, and I am as frustrated as anyone that it has taken so long. However, I am pleased to say that we fully expect that FIT will begin to be rolled out in the autumn. The hon. Gentleman mentioned NHS Wales and next spring and it being great that devolved Administrations follow best practice. Perhaps NHS Wales could follow NHS England’s best practice and bring forward its timetable.

[Nick Thomas-Symonds]

I am grateful to the Minister for his tone and constructive approach. May I press him for a little more detail? He said that FIT will be introduced in England in the autumn, but when will we get closer to a precise date?

[Steve Brine]

I cannot give the hon. Gentleman the precise date today, but I know of his and other Members’ interest in the matter, and as soon as I can give that date I will tweet it and tag him. I assure Members that I will let the House know as soon as I have the date, and I have a funny feeling that Members will be watching closely for that.

On lowering the age for screening, many right hon. and hon. Members and their constituents are concerned that the age at which we invite people for bowel screening should be 50 rather than 60. Such concern is sometimes driven by personal experience of the impact of cancer on families as well as on constituents. The hon. Member for Eastbourne (Stephen Lloyd) feels particularly strongly about the issue and has worked on it for a long time—I worked with him a lot during his first iteration as an MP, and it is good to see him in his second chapter. I thank him and his constituent Lauren Backler, who sadly lost her mum to bowel cancer, for personally delivering to my Department last week a petition on the screening age with, as he said, 400,000-plus signatures. I was in my constituency; otherwise, I would have come down and got it myself. I saw him on “ITV News Meridian”, our local news, walking up Victoria Street with the petition. I thank him for that and will take great note of the petition. We will, of course, consider it carefully and respond in due course, but I hope what I will say today will give him some cause for optimism.

When the bowel cancer programme was introduced in 2006, it focused in the first instance on those aged 60 to 69, and then in 2010 it was extended to 70 to 74-year-olds. When we consider that eight in 10 cases are in over-60s, we can understand why that was the starting point, but that does not have to be the end point. It is therefore crucial that the clinician looking at the bowel following a finding of blood in a stool is as skilled an expert as possible, and the NHS has to make sure there is enough clinical capacity to follow up referrals.

The hon. Member for Torfaen rightly mentioned NHS England capacity, which is critical. To boost clinical capacity in the NHS in England, Health Education England has recently pledged to fund the training of 400 clinical endoscopists by 2021, which will significantly increase the endoscopy capacity in England and is a key part of the jigsaw.

This decision to screen from the age of 60 was also based on the fact that, as I have said, the risk of bowel cancer increases with age and people in their 60s are found to be most likely to complete a testing kit. However, that does not have to be the end of the conversation. Therefore, five years ago, in 2013, we started to introduce bowel scope screening for those aged 55. In the research that underpinned that decision, those who took up the offer of a bowel scope test and follow-on treatment reduced their chances of dying from bowel cancer by more than 40%. Those are good stats. Now, with the introduction of FIT, we have an important, evidence-supported opportunity to consider the totality of the bowel cancer screening programme and maximise the benefits of bowel cancer screening.

[Nick Thomas-Symonds]

One of the issues with the scope test is its geographical spread: as I understand it, at the moment only about half of England is covered. First, will the Minister comment on when it will be extended? Secondly, I would welcome his commitment to reviewing screening in its totality.

[Steve Brine]

I will indeed ask the question that the hon. Gentleman raises about geographical spread. It is a key point.

I am pleased to say that the UK National Screening Committee is now considering how to optimise bowel cancer screening using those two evidence-based testing methods, namely bowel scope screening and FIT. It will advise on the optimal strategy—the hon. Gentleman rightly used that term—for England, this summer. To inform that advice, it ran a consultation, which ended on 9 April. That focused on whether the current evidence supports a change to the current tests approved for use in bowel screening programmes. In particular, it considered whether an optimal bowel screening programme should use both BSS and FIT. Both those screening methods require significant numbers of highly trained people and significant amounts of hospital resources in the NHS. With the introduction of FIT, it is therefore timely to carry out further work to decide the best combination of tests for the English programme; that includes the issue of sensitivity. I know that there is a lot of debate in the clinical community about the range and the number of people affected. We must get that right.

I am pleased that as part of its deliberations, UKNSC will also consider the most appropriate age at which FIT screening will start. It would be wrong of me, however, to pre-empt its recommendations or, as the hon. Member for Eastbourne said, to announce an exclusive from Westminster Hall. However, it is being considered and Ministers, including the Secretary of State, take a close interest. That is as clear as I can be. We are clear that recommendations must be achievable, so the availability of high-quality follow-on tests—colonoscopy and pathology—will be central to ensuring that we can turn the benefits of a better test into thousands fewer people getting and dying from bowel cancer. I am asking NHS England to consider that carefully. It knows of my clear interest in the matter.

I am thankful that survival rates are improving year on year, with about 60% of bowel cancer patients now surviving for five years or more, compared with about 25% 40 years ago. That is a significant change. As hon. Members have said, early diagnosis is vital—for all cancers, but certainly for bowel cancer—which is why the independent cancer taskforce included driving a national ambition to achieve earlier diagnosis among its six strategic priorities in the cancer strategy for England, which I am passionate about implementing. We remain on track to deliver that priority and to deliver every one of the 96 recommendations in the strategy by 2021. We are, of course, thinking about post-2021 as part of the long-term vision for the NHS, which the Prime Minister spoke about at the Liaison Committee recently.

We hope that the introduction of FIT as the primary test in the bowel cancer screening programme later this year will further enhance the drive towards early diagnosis and ensure that we catch more cases of bowel cancer early and allow for better treatment outcomes.

[Lady Hermon]

Northern Ireland has not had a Health Minister since January 2017. It would be enormously encouraging if the Minister would confirm that he has spoken to the permanent secretary for the Northern Ireland Department of Health about introducing the FIT technology in Northern Ireland, which is a part of the United Kingdom.

[Steve Brine]

I personally have not, but I will do so, as a takeaway from this debate. The hon. Member for Strangford (Jim Shannon), who is no longer in his place, has made the same point to me in other contexts. I shall speak to my officials and make sure that happens. I will keep the hon. Lady informed.

I have mentioned the bowel cancer charities. I have a regular roundtable with all the cancer charities—it is one of the great privileges of my position. They have worked on the narrative of needing, as they put it, to talk about poo. When mainstream drive time presenters talk, as they did on BBC Radio 5 Live last week, about looking at poo and “taking a look back” as the presenter put it, it shows how far we have come. Breaking down barriers and Members talking about their experience is important, as is the way in which charities approach the subject. We look forward to seeing what the new combined charity can do. It is an important part of changing the narrative and culture, in addition to the Government’s work with NHS England to change the testing regime and the other issues I have mentioned. The battle is long, as it always is with cancer, but with the support of “Team Cancer”, in which I count all hon. Members present, I think we are winning.

Question put and agreed to.

Cancer Targets

Steve Brine Excerpts

Tuesday 1st May 2018 Westminster Hall

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

Thank you very much, Mr Streeter, and it is a pleasure to see you in the Chair. As always, it was a pleasure to hear the debate.

I, too, congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing yet another debate on cancer in this place. I do not know how he does it; he must have a special line to Mr Speaker.

My hon. Friend and I worked very closely together in my previous iterations on the Back Benches. I am hugely appreciative of all his work as chair of the all-party parliamentary group on cancer. I did not know until today that he is coming towards the end of his tenure, but my goodness—he has certainly done his bit. He will be a hard act to follow, and I do not know who will succeed him. Who knows? Maybe that next person is with us today, Mr Streeter; you never know.

We have had some excellent contributions today. I do not know why the hon. Member for Scunthorpe (Nic Dakin) is looking at me that way; he is welcome to intervene on me.

May I just say that the hon. Member for Central Ayrshire (Dr Whitford) made a speech that was, as always, very sensible, balanced and packed with experience, which most of us can only hope to get near to. It is very welcome and very important in these debates that she speaks about her long time working in the breast unit in Edinburgh—

[Dr Whitford]

In Ayrshire.

[Steve Brine]

In Ayrshire—sorry. The hon. Lady is one of my successors as the chair of the all-party parliamentary group on breast cancer and she was so right in what she said about prevention; she was right in a lot of things she said, but she was so right about prevention. As we meet here in Westminster Hall, a certain well-known TV chef is giving evidence to the Health Committee upstairs; I am sure that can be seen on all good news channels this evening. One of the things the Committee is considering as part of its inquiry is child obesity, and one of the first things that I did in this job was to publish the tobacco control plan. I am passionate about that and I am also passionate about our alcohol challenge.

Plenty of people in this country—the majority—have a very healthy relationship with alcohol, but there are some people for whom that is not the case. As the hon. Lady knows, alcohol is also a big cancer risk factor. She was spot on in saying that this debate is not just about a cancer plan; it is about a health plan. I see the obesity challenge, the smoking challenge and the alcohol challenge as a holy trinity, if you like, in the task of tackling cancer.

[Dr Whitford]

I would just like to mark the fact that Scotland starts its minimum unit pricing on alcohol today. That will not be a panacea, but we hope that it will at least help to make the dirt-cheap white ciders no longer dirt cheap and keep them away from our teenagers.

The obesity strategy introduced by the previous Prime Minister appeared to be quite comprehensive, yet the final version published by the current Government—or the Government before; it is always hard to keep track—was only about a third of the original strategy. Is a much more ambitious plan likely to be issued and will it include attempts to tackle things such as advertising, which make our living space so obesogenic?

[Steve Brine]

Nice try. We always said that addressing child obesity was chapter 1 and therefore the start of a conversation. There are a lot of things within that plan that we are still to do, or in the middle of doing. For instance, Public Health England will shortly publish the initial results of the sugar tax on soft drinks—the industry levy—and we said that we would watch that tax very closely, to see whether we needed to continue the conversation. The hon. Lady will also know that there have been lots of discussions in this Chamber and in the main Chamber about advertising, “buy one, get one free”, labelling and reformulation. As she knows, I am very interested in said agenda and I watch these things like the proverbial hawk. So I thank her for raising that issue.

I always enjoy listening to the hon. Member for Scunthorpe; he speaks so well and I see him at so many different events in this House. He mentioned the cancer dashboard and blood—or non-solid—cancers. He knows that I agree with him; it is something that I am looking at very closely with officials and with NHS England. I also pay tribute to the work that he does on pancreatic cancer. I met one of the pancreatic cancer charities with my right hon. Friend the Secretary of State for Health last week—or was it the week before last? Time flies.

The hon. Gentleman talked about the survival figures for pancreatic cancer, and they are terrible in comparison with those for other cancers. However, sometimes we have to recognise that there is an enormous challenge with pancreatic cancer, in that it is very hard to diagnose because often it is not symptomatic until its latter stages. That is one of the reasons why I was very interested in the 16-day referral to surgery pathway that he talked about and the challenge that he identified within his cancer alliance. My officials will have heard what he said, and I will take it away and consider it, because it is a really important point.

The hon. Member for Ellesmere Port and Neston (Justin Madders), who is the shadow Minister, asked about the cancer strategy and the next update to it. It is not a “three year on” update, but the next update will be in the autumn of this year. I was glad to hear his welcome for the first ever cancer workforce plan, which Health Education England published in December. It sets out how we will expand the workforce numbers. Just last week, I was with Harpal Kumar of Cancer Research UK before he steps down, and we were talking about the critical importance of that plan. I, too, would have liked to have seen it sooner, but we are committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers by 2021.

I was at the Royal College of Radiographers annual dinner last week in London, and its members did not miss an opportunity to make the case to me about the workforce. The cancer workforce plan is a really positive innovation, and I look forward to working with HEE and my colleagues as we take it forward.

I said in this place this morning that cancer is a huge priority for this Government, and I think that everyone in here knows it is a priority for me. Yes, survival rates have never been higher. Our latest figures showed an estimated 7,000 more people surviving cancer after successful NHS treatment than three years earlier, and our aim is to save 30,000 more lives by 2020. However, we know that there is a huge amount still to do, and that is why we accepted the 96 recommendations in the cancer strategy and have backed that up with the £600 million of additional funding up to 2021.

Two years into the implementation of the strategy, we are making progress, as I said in the Backbench Business debate that my hon. Friend the Member for Basildon and Billericay secured in February. I hear what he says about standards and targets, and in some part I agree, but they are only part of the story. The alliances are not targets; they are about pathways and best practice—not just learning best practice but implementing it. The NHS is very good at sharing best practice, but perhaps not always brilliant at implementing it. The example given by the hon. Member for Scunthorpe about the pancreatic pathway—

[Dr Whitford]

rose—

[Steve Brine]

I will not give way. I remember Mr Streeter’s ruling.

There are eight cancer waiting time standards and, since one in two of us born since 1960 will be diagnosed with cancer in our lifetime, they are an important indicator—to patients, clinicians and politicians and the public—of the quality of cancer diagnosis, treatment and care that NHS organisations provide to millions of our constituents every year. They are a component of the success we have had with survival rates, so it is good that we are discussing them here today. I use the word “target” cautiously, because I have always been clear that standards should not necessarily be targets. If someone has a suspected cancer, 28 days is 28 lifetimes too long—I will talk about the urgent diagnostic centres in a moment. Sometimes we are not trying to get to the maximum, so “target” can be a misleading term.

As has been said, we are currently meeting six of the eight standards. One of those we are not meeting is the 62 days from urgent GP referral for suspected cancer to first treatment, which is important because we want to ensure that patients receive the right treatment quickly, without any unnecessary delays. The standards contribute to cancers being diagnosed earlier—only “contribute to”—and that is crucial to improving our survival rates. However, our rates have historically lagged behind those of some of the best-performing countries in Europe and around the world. That is why we have the cancer strategy; we want to do better. The primary reason for those rates is late diagnosis. Early diagnosis is, indeed, the magic key. My hon. Friend the Member for Basildon and Billericay has used that term many times—I have heard him use it at the Britain Against Cancer conference—and he is absolutely spot on.

Going back to the 62-day standard and the recovery thereof, my hon. Friend the Member for Basildon and Billericay will know that due to factors such as an ageing population and the increase in obesity, which we have touched on, the incidence of cancer is increasing. The NHS is treating more patients for cancer than ever before. It is testament to the hard work of NHS staff across all four nations of our United Kingdom that we are treating more people, and do so with the care and compassion for which we know the NHS is world-renowned. However, those numbers are making the achievement of the 62-day standard challenging. To be perfectly honest, the standard has not been met since December 2015 and, although we do not yet have the figures for March 2018, it is unlikely to have been met in 2017-18 either. However, we remain committed to the standard and want to see it recovered. That is why, through this year’s mandate from the Secretary of State to NHS England, we have agreed that the standard will be achieved in 2018-19, while we maintain performance against other waiting time standards.

[Mr Baron]

Will the Minister give way?

[Steve Brine]

I will very quickly. I know that my hon. Friend wants me to come on to the funding.

[Mr Baron]

The Minister will be aware that about a quarter of all cancers are first detected as late as at an emergency procedure. What I would like him to do in the few minutes he has left is to focus on the need to break the 62-day target link with the transformation funding because it is unfair, penalising as it does those cancer services that need help most. Will he consider that?

[Steve Brine]

That is exactly what I was coming on to. I know that my hon. Friend has expressed concern, to put it mildly, about the methods used to allocate funding for the alliances in 2017-18, and in last December’s report by the all-party parliamentary group on cancer it was clear that the alliances should not be linked to achieving the 62-day target. I am aware that my hon. Friend has met with the Prime Minister to discuss the issue and I will reiterate what I am sure she will have told him. Achievement of the 62-day standard is not a prerequisite for funding. Instead, it provides a basis on which NHS England and NHS Improvement, along with senior clinical advice, can assess an alliance’s readiness to transform services.

The alliances are an important mechanism for us in improving performance on the 62-day standard from urgent referral to treatment. They bring together clinicians from primary and secondary care, ensuring collective responsibility for the multidisciplinary teams and the services that they provide, and enabling the leadership that is crucial to the transformation of services. But the bottom line is that it is taxpayers’ money that is being allocated, and it is right and proper that alliances can demonstrate their preparedness for the funding. In 2018-19, NHS England has modified how it will fund alliances, and I can confirm that all alliances will receive transformation funding to support earlier diagnosis and better quality of life for patients.

The national support fund is a genuinely new approach to distributing funding that we have introduced in 2018-19, within the £200 million over two years funding envelope announced in 2017-18. That was in no small part in response to advocacy by my hon. Friend the Member for Basildon and Billericay, and I pay great credit to him and to others for their work on the link—but not the pre-requisite—that was introduced in 2017-18 between transformation funding and 62-day performance.

The fund has a number of purposes. NHS England uses it to help iron out significant variations between alliances in the amount of funding for which they originally bid. The money will be used to support alliance activity to improve 62-day performance, as well as to enable all alliances to deliver priorities, such as accelerated pathways for lung, colorectal and prostate cancer, and other innovations, such as those we heard from the hon. Member for Scunthorpe, which are included in the 2018-19 CCG planning guidance. The Secretary of State, NHS England’s national cancer director, Cally Palmer, and I all agree that the link to the 62-day standard is the right approach and the right thing for patients. I hope that that clears the matter up, even if it does not go all the way towards satisfying Members.

Although I accept that there is anxiety in some quarters about the link between the performance and the funding, I and the Government are of the view that retaining the link is in the very best interests of patients. Ultimately, they must be our primary focus, and this is public money. We will keep the matter under review. I thank my hon. Friend for his advocacy on the subject.

By the end of the cancer programme, we want to have improved survival and provided equity of access to the highest standards of modern care across all our constituencies in England. As the cancer Minister, I seldom sleep and when I am not sleeping I think very little about anything else, because we are focused on meeting the recommendations in the cancer strategy and doing better for all our constituents—those who are here, those who will live with cancer, those who are living with it now, and those who have passed, who we all know. We are on our way to realising the transformation in services that we all want to see, to make our NHS the world leader in the treatment of cancer that I know it can be.

Cancer Treatment

Steve Brine Excerpts

Thursday 19th April 2018 Commons Chamber

[George Freeman (Mid Norfolk) (Con)]

May I say what a pleasure it is to follow the hon. Member for Dulwich and West Norwood (Helen Hayes)? She spoke with great passion and authority.

Thirty years ago this month, my father developed a cough and two months later he was dead from throat cancer. Being a man of that generation and age, he had never taken his health too seriously. He had never been for a check-up and had never received the care and treatment that would now follow, so what I say today is partly for dad. Eighteen months ago, I heard from a childhood friend of mine, Charlie Williams, that he had been diagnosed with the same form of brain tumour that Tessa has. Last week, Charlie posted on Facebook that he did not expect to see the next year out, so this is for Charlie.

I want to start by paying tribute to you, Tessa, for what you said in that remarkable speech. You spoke for us all, and to us all, and you spoke to the patients of this country not only with your condition, but with every other form of cancer—the patients I had a career working with who want us to make a difference for them. They want warm words, yes, and there were no words warmer than yours, Tessa, but they want us to turn the warm words into action. I believe that is the spirit in which we gather in this Chamber today, so this speech, Tessa, is for you.

Having come to this House after a career in medical research, it was my great privilege to be asked to lead, on behalf of the Government, a brain tumour research debate in Westminster Hall two years ago. I say this without a shred of criticism of my officials, who were simply doing their job, but the speech that I was given to read out said, as diligent speeches written by officials so often do, “There is no problem here. Move along. Everything is in good shape. Money is limited.” I read it with great respect, but I also listened to my colleagues with great respect, because unlike officials, we are sent to represent the people who put us here. As Tessa spoke for us all, I think it is our duty to speak always for the people who send us here.

I surprised my officials that day by announcing, as Under-Secretary of State for Life Sciences, that we would indeed create a taskforce to look into brain tumour research, never thinking that 18 months later my great friend the Secretary of State would announce £45 million of extra funding, in addition to the extra funding that he has recently announced on prostate cancer. That is a sign that, if we listen and speak on behalf of the people who put us here, we can make a difference, which is what Tessa wants us to do on her behalf and on behalf of all those people who send us here and the many patients around the country who are more impatient than anybody.

As you and patient colleagues know, Mr Speaker, I had a career in medical research. I want to highlight three important parts of this debate, the first of which is the new models of research that are coming—I was involved in my professional career in developing them. Secondly, I want to highlight the importance of patient voice in that model, and thirdly the importance of bold reforms to accelerate access to new treatments for our NHS patients.

My right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) referred to precision medicine. The truth is that the life sciences sector that I joined 25 years ago is undergoing a profound transformation. The sector that I learned about was basically in the business of making blockbuster medicines that work for everybody. It would start with a theoretical drug target and, after 15 years, $2 billion on average and an 80% failure rate, drugs would be developed and eventually brought through regulation to the all-too-patient patients who were waiting for the approval.

In the new model, based on the genomic information that we have and phenotypic hospital records, we are able to look at a population and know which are likely to respond to the drug and which are not. We can start with the patients that we know are likely either to respond or to receive the disease, which means that we can start with the patient. With patient consent, we are able to start with their tissues, their genetics and their hospital records, and we are able not to end with a patient waiting patiently for the system to authorise a medicine, but with patients volunteering up-front to be part of that research.

It has been my privilege in my professional as well as my political career to work with inspired NHS clinicians around the country who have been leading this model. I pay tribute to the work of Cancer Research UK as an organisation, but also to Harpal Kumar, whose leadership of that organisation has been transformational.

We should be inspired by the fact that breast cancer is now 95% curable. We are within living, touching distance of cancer being a preventable disease or a treatable disease. More than 800,000 people are now living and working with cancer: it is not the death sentence that is used to be. We are in the midst of the most phenomenal revolution led by cancer. We should applaud those involved and learn the lessons of how they have managed to do it, largely through genomics and informatics.

I will share with the House a story that illustrates where the value in the new model lies. During my last project before I came to Parliament, I was working with an NHS clinician who, at the end of the meeting, pointed to a shelf in his office and asked me, “Do you think there is any value in that?” I said, “What is it?” He said, “It is all the data from a £25 million study of 250,000 women at risk of gynaecological cancer, funded by the Medical Research Council and Cancer Research UK.” I said, “What have you got?” He said, “All the blood samples, all the genetic samples, and their patient records.” “That should be the Ageing Biomarker company,” I said. “We should form a company around that asset, because it will help us to identify ageing biomarkers.”

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

May I place on record at this point the work that my hon. Friend has done to get us to this point? He is very modest in not saying too much about it himself—although he mentioned the Westminster Hall debate and the way in which he went out on a limb in response to it—but his understanding of the business and this fight has taken us a long way towards where we are today. I hope he can now conclude his speech as he needs to.

[George Freeman]

That is very kind. I take the hint from my hon. Friend.

The assets that we have in our health system are phenomenal assets to drive this research model, and I think it is our challenge to release them, but in order to do so, we need patient consent. However interventionist we are as Ministers, we as a system will not and cannot release data on tissues and genetics without patient voice. This research model requires us to empower patients and the charities that speak to and for them. I would like us to think about setting up disease portals in which patients can slide the consent bar on their phones, share their records, and help the charities to drive research.

Finally, we need to accelerate the uptake of innovative medicines in the system, which is what the accelerated access reform that I put together with my right hon. Friend the Secretary of State was all about. I dream of—I think we are within touching distance—a model in this country enabling the NHS to use its genomics and data to drive research. If we reform NICE to drive accelerated access, we give Tessa and the people for whom she spoke the legacy that they really want. We will make this country the leader not just of research, but of accelerated uptake of new treatments.

--- Later in debate ---

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

On one of the hottest days for a long time, and certainly the hottest day of the year so far, being inside the House of Commons and listening to some of the speeches that have been made has been an absolute privilege. It has been an experience that I, as a Minister—let alone as a Member of Parliament—will remember for a long time.

Let me first thank the hon. Member for Croydon Central (Sarah Jones) for securing the debate. I thought she spoke brilliantly, and set the tone for the last two-and-a-bit hours. But we should not beat around the bush: we are all here primarily because of one person. That person is, of course, Baroness Jowell, who is present, sharing the Chamber with us, and whose strength and grace in the face of her illness have done so much to raise public awareness of the challenges of diagnosing and treating brain cancer. I do not have a long history of knowing the Baroness—in fact, I met her for the first time on Monday—but I am already well aware of her strength of character and her determination to make a difference in this latest campaign.

Like all Members, and especially, I suppose, as the current Minister responsible for cancer issues, I was captivated by the speech that Tessa made in the other place about her latest battle. Our debate today has been emotive and constructive, and I am grateful to the many Members who have had the opportunity to pay a similarly worthy tribute to Tessa’s bravery and determination in the House of Commons. For me—and many Members have said the same—perhaps the most memorable line of the Baroness’s speech in the other place was this:

“In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]

She is giving that line great meaning.

As has been mentioned many times, Tessa also referred in her speech to the importance of living with cancer—living longer with cancer, but living with cancer. As one who was motivated to go into this business in the House by fighting and losing far too many battles against cancer, I would say that, for all of us who are diagnosed with cancer, we are never just our cancer. Tessa is not just her cancer, and she is not just the cancer campaigner that she is now. She is still a mum, and she is still a wife. You spoke at the start, Mr Speaker, about the love. There has been one hell of a love bomb here today. When I have been able to, I have looked over at the Under Gallery, and I have certainly seen some love there this afternoon. It has been incredible and very moving to see it.

I think that what made that line in the speech in the other place so remarkable is that Baroness Jowell has given so much to our country, from being my predecessor as the first ever public health Minister to giving the country one of its greatest cultural events in London 2012. Through her enthusiasm and courage, she is driving people in the country and around the world to confront not just one of oncology’s most difficult challenges, but one of medicine’s most difficult challenges. We should not underestimate what a difficult challenge brain cancer is.

Let me say on behalf of the Government that we will do everything possible to meet the challenge. Those who know me as the cancer Minister know that I am impatient and determined—as is the Secretary of State—to do well, to do better, and then to do better again in fighting the big C, or cancer, or whatever we choose to call it. I say that not out of arrogance or ministerial bluster—I write my own speeches—but because I believe that this challenge is one that we can overcome. I was truly inspired when meeting the Baroness for the first time on Monday at the inaugural meeting of the UK brain tumour steering group, so ably chaired by my colleague Lord O’Shaughnessy, who I know has already become a firm friend of hers. So in my brief remarks I shall focus on three areas where we will do more, and which sum up pretty much what every Member covered in their speeches.

The first area is research. On 22 February, just a month after the Baroness’s powerful speech, Department of Health and Social Care Ministers met Tessa and representatives from the Eliminate Cancer Initiative at the Cabinet Office to try to find solutions to improving outcomes for people fighting brain tumours. That very day the Department’s task and finish working group into brain cancer research published its report on brain cancer research in the UK, setting out how to increase the level and impact of research into brain tumours going forward. The group was set up in 2016 and was chaired by the Department’s chief scientific adviser Professor Chris Whitty. It brought together clinicians, charities, patients and officials to discuss how, working with our research funding partners—key in this—we can address the need to increase the level and impact of research into brain tumours.

To back the report, as all Members will know, the Government and Cancer Research UK together announced an investment of £45 million over the next five years to turbocharge research in this area. This will begin—but only begin—to make up for the historical lack of research in this field and further strengthen a number of our existing centres of excellence in places such as Cambridge and the Institute of Cancer Research here in London.

The National Institute for Health Research spent £137 million on cancer research in 2016-17, the largest investment in any disease area. However, according to Brain Tumour Research, even though brain tumours kill more children and adults under the age of 40 than any other cancer, as has been said, just 1% of the national spend by all cancer research funders on cancer research has been allocated to brain cancers. That is why—as everyone has said today—we want to move quickly on beginning further research, and I am pleased to say that the NIHR began inviting applications for the new funding this Monday. We urge researchers to apply, and help us generate the breakthroughs that could give hope to the thousands of people diagnosed with brain cancer every year in our country.

My second point is on data sharing. We know that, due to the rarity of many types of brain tumours, it is vital that we use patient data more effectively—the hon. Member for Hove (Peter Kyle) spoke very well about that—ensuring that it is shared safely, securely and lawfully not only between the NHS, charities and academia, but between like-minded countries internationally. The UK has a proud history as a proponent of open data and data sharing, and I give my Government’s commitment to work with the Eliminate Cancer Initiative and partners nationally and internationally to make this a reality on brain tumours. The ECI made the point at our meeting on Monday that patients’ data must be given for the common good, not the almighty shilling; I know that Tessa shares that sentiment. Tessa’s daughter, Jess—who is also here today and whom I met on Monday—said that we support and advocate the sharing of data not as an end in itself, but as a vital means through which to improve patient care and develop new treatments; she is of course a chip off the old block and absolutely right.

Baroness Jowell exemplifies the ambition we have, and we will carry it forward. In the Houses of Parliament tonight, Tessa will launch the global universal cancer databank, and has committed to be the first donor to that databank, which we hope can catalyse the sharing of data across the world and save the lives of many. My right hon. Friend the Secretary of State will be pleased to be there.

Thirdly, and most importantly, I want to touch on patient engagement. We must ensure that patients are at the centre and heart of our work on brain tumours, so we will build on the existing work to develop a clear timeline and plan for reducing the time to diagnosis for brain tumours, which is as important in this cancer as in all others. We will also implement new models of patient care, such as the Cambridge model, and the national roll-out of innovative new tools such as the 5-ALA ‘Pink Drink’, which is very important. The National Institute for Health and Care Excellence is currently developing a new clinical guideline on brain tumours, which includes the use of 5-ALA, with publication expected in July. We will also redouble the Department’s efforts to ensure there are appropriate and ethical frameworks to allow patient access to experimental medicines, and allow for the re-purposing of drugs and the acceleration of the development of new patient-focused adaptive clinical trials, which is so important.

Many Members have spoken so well in this debate. I will not list them all, but it was a pleasure to see my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) back in his place, making his first speech from the Back Benches in a long time. I worked closely with him when he was in the Northern Ireland Office; he is one of the nicest guys in Parliament and he spoke brilliantly about #KeepOliviaSmiling—and it was good to see my right hon. Friend smiling again. He talked about ring-fencing money in the NIHR for brain tumour research for children. The level of research spend in a particular area, such as child-specific tumours, depends on the number and scale of successful funding applications. He will be aware of our joint announcement in February, which included the opening of Cancer Research UK’s new children’s brain tumour centre of excellence at the University of Cambridge. Maybe he will go along and have a look at that at some point.

My hon. Friend the Member for Congleton (Fiona Bruce) spoke well about prostate cancer, and I was proud that we were able to make that announcement last week. My hon. Friend the Member for Torbay (Kevin Foster) spoke about the ACE programme. I have said before that I do not easily get excited at the Dispatch Box, but I am genuinely excited about these new ACE multidisciplinary diagnostic centres. When people present to their GP with vague symptoms, these centres will provide a chance for them to get in and get an answer—a diagnosis or an all-clear—quickly. I visited one of the ACE centres, at the Churchill Hospital in Oxford, in February this year. The enthusiasm that I heard from the clinicians and patients there gave me real hope, and hope is a key word in today’s debate.

I should like to conclude by once again thanking everyone who has made such positive contributions to what has been a really memorable debate. I recognise that we are only at the start of our journey to beat brain tumours, but now is the time for patients, the NHS, charities and industry to come together—as we in this House have done today—both nationally and internationally and to redouble our efforts. The funding we have committed for additional vital research, and our ongoing work to look at every aspect of diagnosis, treatment and care, will help us to deliver ever more positive treatment outcomes for people with brain tumours, but we have a long way to go. This is of course happening alongside our system-wide transformation of cancer services in England through the cancer strategy, which we have debated at length here many times.

Baroness Jowell has been the catalyst for this rapid activity on brain tumours, and it is incumbent on us all to continue to work closely together over the coming months and years to build on this legacy. She is here today, and I know that she will be watching us closely. As Theodore Roosevelt once said, now is the time for

“painful effort…grim energy and resolute courage”

to beat this terrible disease. And, as I always conclude: for team cancer, the fight goes on.

Energy Drink Sales to Children

Steve Brine Excerpts

Tuesday 17th April 2018 Westminster Hall

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

All good things come to those who wait. After the delay, here we are.

It is a pleasure to serve under your chairmanship again, Mr Hollobone. I congratulate the hon. Member for Redcar (Anna Turley) on securing the debate. I know that there are competing pressures on Members’ time today, but I am surprised that there are not more here for this debate on a big, emerging issue that is gathering momentum. My ministerial colleagues and I have been asked about it at Health questions previously—perhaps that is what the hon. Lady was referring to. I thank her for introducing the debate and for setting out the case very clearly.

We all agree that the regular consumption of energy drinks by children is not appropriate at all. I say that as one who has young children. That applies especially to those under 16, as energy drinks often contain a lot of caffeine and sugar—I will talk about both. They are often coupled with other sources of caffeine and sugar in children’s diets. Too much of a good thing, or too much of a bad thing in this case, can lead to difficulties sleeping and headaches—I have heard stories about that—and there is obviously an effect in terms of tooth decay and weight gain. In addition to the health and wellbeing impacts of the risk to children of consuming large volumes of energy drinks, there is anecdotal evidence, notably from schools, that their consumption has a very negative impact on children’s behaviour and, in turn, their learning. The hon. Lady gave an example from her constituency, and I have heard about countless cases as a constituency MP and through the media. It is right that we are having this debate and that we continue to examine the issue of the consumption of energy drinks by children, but this is not just about children; adults should also look at the small print on such drinks, because too much is not good for anybody.

The hon. Lady gave some figures, and I will give some of my own. A 250 ml can of an energy drink usually contains about 80 mg of caffeine, which is similar to two or three cans of cola, a mug of instant coffee or, as the hon. Lady said, an espresso. Some of the smaller energy “shot” products contain twice as much caffeine.

EU food information regulations require specific labelling for high-caffeine drinks and foods where caffeine has been added for a psychological effect. Such labelling helps consumers to identify foods with a high caffeine content where they may not expect to find it. The British Soft Drinks Association’s code of practice states that high-caffeine soft drinks should not be marketed, advertised or promoted to children under 16. It is right about that, of course. Amid growing public concern, and in line with that voluntary industry code, we have recently seen major supermarkets banning the sale of such products to under-16s. When companies do the right thing, I always think it is worth putting that on the record. Asda, Aldi, Co-op Food, Lidl, Morrisons, Tesco, Sainsbury’s and Waitrose have all voluntarily decided to ban the sale of these products to under-16s and they deserve credit for that action.

It is important that the Government remain open-minded and continue to look at any new evidence that emerges. I promise the House that we certainly are and we certainly will. The European Food Safety Authority published an opinion on the safety of caffeine less than two years ago, in May 2015. It derived safe daily intakes for adults and children and concluded that, when consumed at those intake levels, caffeine raises no serious concerns for the general healthy population, but based on current evidence on caffeine safety, the Food Standards Agency, for which I have ministerial responsibility, advises that children or other people sensitive to caffeine should consume caffeine only in moderation. That advice has remained unchanged up to this point. The hon. Lady may be aware that in March, the Science and Technology Committee launched an inquiry into the consumption of energy drinks. We welcome the inquiry very much and we recently submitted our evidence on behalf of the Government—I know she will look for that.

In the light of renewed, obvious and justified public concern, recently the Food Standards Agency has undertaken a literature review to identify if any new robust scientific studies have been conducted since the 2015 EFSA review that I mentioned. On 20 March, the results of the review and the information provided by the #notforchildren campaign were presented to the UK’s committee on toxicity of chemicals in food, consumer products and the environment, for consideration. In particular, the committee is now considering whether a review of caffeine consumption in children and adolescents is required to ascertain whether the studies published since the EFSA opinion add significantly to the body of evidence.

Retailers have acted to restrict the consumption of energy drinks. I am pleased to note that alongside all the supermarkets that I mentioned, other prominent retailers such as WHSmith and Boots, which have a significant high street presence in my constituency and, I am sure, in the hon. Lady’s, have also voluntarily acted to restrict their sales to under-16s. She mentioned this but it is worth repeating that many small retailers, which may be seen as the villain in the piece—I do not think that the facts bear that out—restrict the sales of energy drinks to children. I understand that around half the Association of Convenience Stores’ nearly 50,000 shops have implemented a voluntary ban on the sale of energy drinks to under-16s. Good for them and thanks to them.

In schools, which were mentioned by the hon. Member for East Lothian (Martin Whitfield) and the hon. Member for Redcar, energy drinks are not permitted within the school food standards. Schools have the power to confiscate, retain or dispose of any item that is banned by the school rules, which can include energy drinks. Some schools already do that. I was very interested to hear about fizz-free February—I will google it later and see where it takes me.

The school food standards came into force in January 2015. They define the food and drinks that must be provided, those that are restricted and those that must not be provided. They apply to all food and drink provided to pupils on and off school premises. I am due to see the Schools Minister shortly about another matter, but I will discuss this issue with him and I thank the hon. Lady for raising it.

[Martin Whitfield]

Does the Minister have any comments about the advertising of high-energy drinks through computer games and on social media?

[Steve Brine]

That is an emerging policy area that I am taking very close interest in, as the Public Health Minister and someone with an interest in the public health and child obesity agendas. In the same way that the major retailers that I put on the record have shown what I suggest is a great deal of corporate responsibility, I suggest that the producers of these drinks might also take a long, hard look and consider their social and moral responsibility, so that they can stay within the spirit of the guidelines.

[Hannah Bardell (Livingston) (SNP)]

In the spirit of co-operation, because there was a mention of the Scottish Government’s study, what engagement has the Minister had with Public Health Ministers in the devolved nations? Does he agree that sharing ideas, approaches and policies across the UK and beyond will be the best way to tackle this issue?

[Steve Brine]

I completely agree. Personally, I have not had that engagement, but I will check with my officials and I will be surprised if they have not. If the hon. Lady wishes to facilitate that engagement, I would be very happy.

I want to touch briefly on sugar. Many energy drinks contain high levels of sugar. Studies conducted in children and adolescents indicate that higher consumption of sugars, including the sugar-sweetened drinks that we are talking about, is also associated with a greater risk of tooth decay, weight gain and all the other health impacts—look at the challenges that we have in the health service with type 2 diabetes. Latest figures continue to show that our childhood obesity rates remain far too high. Almost a quarter of children are overweight or obese when they start primary school in England, rising to around a third by the time they leave. That is not good enough and the Government and I are far from happy about it. Intakes of sugar are currently more than double the recommended amount across all age groups. Teenagers are consuming just over 14% of their energy from sugar, and over a fifth of this sugar intake comes from sugar-sweetened soft drinks.

Key measures in what I think was a well received, world-leading childhood obesity plan, launched in August 2016, include the soft drinks industry levy, which seems to have been around for ages but came into force less than two weeks ago, on 6 April. We are already seeing improvements—a number of soft drink manufacturers have announced that they have or they will reformulate their products to reduce sugar levels. I have mentioned many times in this House the manufacturers that I think deserve credit for doing that and I hope more will follow. More than half of all drinks that we estimate would otherwise have been in scope of the levy have reduced their sugar content to below the levy threshold, which was the intention of the policy.

The sugar reduction and wider reformulation programme is being led and run by Public Health England, for which I have responsibility, and applies to all sectors of industry: retailers, manufacturers and the out-of-home sector, which includes restaurants, takeaways and delivery companies, cafés and the good old-fashioned pub. Public Health England will shortly publish an assessment of progress on sugar reduction, which I eagerly await. We will use that to determine whether sufficient progress has been made in our view and whether alternative or additional levers need to be considered.

The hon. Member for Redcar mentioned the possibility of revision to the child obesity plan. We always said that the child obesity plan was the start of a conversation, not the end. She mentioned Jamie Oliver; I pay great tribute to his work and that of his team, who I met recently just before the Easter recess when we discussed this issue and many others. We have always said that if we need to go further we will, and that assessment that PHE is carrying out on the initial impact of the industry soft drinks levy will be part of the determination of whether we need to do that. I have said in the House before and I will say again that the hon. Lady should watch this space.

In conclusion, the actions that we have talked about and the stuff that we look to cannot entirely eliminate the sale of energy drinks to under-16s. However, I assure hon. Members and the public that this is a matter that the Government, the Secretary of State and I are looking at very carefully. We will monitor the situation extremely closely in the light of the emerging scientific evidence and public concern—I understand that we have to take both into consideration. If we conclude that further Government action is needed to restrict the sale of energy drinks to children, we will not hesitate to act. Our actions have shown in the past that we never hesitate to act when the evidence points us in that direction.

Question put and agreed to.

GP Recruitment and Retention

Steve Brine Excerpts

Wednesday 28th March 2018 Westminster Hall

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

It is a pleasure to see you on your throne this afternoon, Mrs Moon.

I have a lot of time and respect for my shadow, the hon. Member for Burnley (Julie Cooper), but what a counsel of despair that was. As the sun comes out after a day of rain in London, let me see if I can bring some sunshine to our proceedings.

I congratulate the hon. Member for Houghton and Sunderland South (Bridget Phillipson) on securing the debate. She spoke passionately, as always, about her constituents and her area. The hon. Member for Strangford (Jim Shannon) said that we are often in here together and share many of the same subjects. That is true but, to be fair, he is in here even more than I am.

I note the Prime Minister’s announcement yesterday that she intends to bring forward a long-term plan for the NHS with the Secretary of State, Ministers and our partners. That will build on our record of extra funding for the national health service in England year on year since 2010, to deliver a NHS that is fit for the future. I agree with the shadow Minister that this is about the wider NHS, and that we cannot see primary care in isolation. We are able to do what we have done for the past eight years because of the state of the economy, which we have got into a better place. When the economy fails, the NHS catches a cold or much worse, which is important.

[Jim Shannon]

rose—

[Steve Brine]

I will not give way at the moment.

As everybody has said, we recognise the importance of general practice as the heart not only of our NHS, but in many ways of the country. It is as much about prevention before people get into the NHS as it is a gateway to it. That point was made well by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the SNP. As others have kindly said, I am absolutely committed to ensuring that the NHS has the resources, workforce and Government backing to make it fit for the future.

As the hon. Lady said, it is a great success that we are living longer, but an ageing population and more people living with long-term conditions, or so-called comorbidities, means that general practice will become more important than ever in keeping well and living independently for longer. On Friday, I spent a morning sitting and observing—lucky patients—a general practitioner in Hampshire, not in but near my constituency. I watched him do his morning surgery. It was a brilliant thing to do as the Minister with responsibility for primary care, but I would recommend it to any Member who has that relationship with GPs in their area. By sitting and watching, it is possible to see what comes through the door and the pleasures of general practice, which is not dissimilar to the surgeries we hold as MPs.

The number of people over the ages of 60 and 85 is set to increase by about 25% between 2016 and 2030, and the number of people living with long-term conditions is increasing. In 2017, almost 40% of over-60s had at least one long-term condition. I am sure we can all think of people in our families who are in that position—I certainly can. We recognise that that places general practitioners in England under more pressure than ever before, and are taking comprehensive action to ensure that general practice can meet the demand.

The NHS set out its own plan for general practice in the general practice forward view. We have backed that with additional investment of £2.4 billion a year by 2020-21, from £9.6 billion in 2015-16 to more than £12 billion by 2020-21. That is a 14% increase in real terms. That is not made up—those are genuine figures, on the record. As has been said, we have also announced our ambition to grow the medical workforce to create an extra 5,000 doctors in general practice by 2020, as part of a wider increase to the total workforce in general practice of 10,000. We recognise that that is an ambitious target—it is double the growth rate of previous years—but it shows our commitment to growing a strong and sustainable general practice for the future.

This debate is about recruitment and retention, so let me break those down. NHS England, which we work with—it is approaching its fifth birthday—and Health Education England are working together with the profession to increase the GP workforce. That includes measures to boost recruitment, address the reasons why GPs are leaving the profession and encourage GPs to return to practice. We recognise that GPs are under more pressure than ever, but we want them to remain within the NHS and are supporting them to do so.

The hon. Member for Stroud (Dr Drew) made the point about recruiting and then following through. As I said at oral questions last week, there are things we can do, but there are things the profession can do too. If doctors in general practice are a counsel of despair, it is little wonder that people do not want to follow them. There are some good, positive voices in general practice, ably led by Helen Stokes-Lampard, who leads the Royal College of General Practitioners. She is a brilliant example of the cup being half full. That kind of positivity is very important—it is a partnership.

[Robert Courts (Witney) (Con)]

Will the Minister give way?

[Steve Brine]

I will, but just once.

[Robert Courts]

I am grateful to the Minister, because I am conscious of the time. He spoke about the support that can be given with regards to recruitment and retention. In my area, the cost of housing is part of the conundrum that we have to solve for everybody, but particularly for key workers. Does he agree that excellent, well-run district councils such as West Oxfordshire—ones that think creatively, outside the box, and help to provide affordable housing in a new way that is targeted at key workers—can be part of the solution to the recruitment and retention challenge?

[Steve Brine]

They can certainly be part of the attractiveness of coming to an area. My council in Winchester is one of the few authorities that is building new council houses—all power to it. My hon. Friend makes his point well, as always.

Increasing training in general practice is important. It is a top Government priority, which is why HEE has made 3,250 places in GP speciality training available every year since 2016. As a result, the number of doctors entering training has increased year on year. In 2017, a record 3,157 new starters were recruited to GP training posts.

The hon. Member for Houghton and Sunderland South spoke very well in introducing the debate, but hon. Members may not be aware that she asked me my first question as a Minister at Health questions in July. She said:

“Does the Minister accept that new medical school places should be created in areas such as Sunderland, where there is the greatest need to recruit and retain general practitioners?”—[Official Report, 4 July 2017; Vol. 626, c. 1008.]

All I can say is that we were listening. I did not say yes at the Dispatch Box, but we looked at the under-doctored areas and at the areas where it is hardest to recruit, which is why Sunderland’s bid was successful. I am glad she welcomed that.

The hon. Lady also welcomed the University of Sunderland putting that in place. As she said, the medical school will encourage general practice as a speciality after students have completed the two years of foundation training. It is envisioned that 50 new students will enrol in 2019 and 100 students in 2020. Experience tells us—this will be encouraging to the hon. Member for West Lancashire (Rosie Cooper), who is no longer in her place—that GPs tend to stay longer in the area where they train, so it is an exciting development for general practice in Sunderland. Once someone has gone there, why would they leave?

As we have heard, the Government have introduced the targeted enhanced recruitment scheme, which funds a £20,000 salary supplement for GP trainees who commit to work for three years in areas of the country where GP training places have been unfilled for a number of years. The hon. Member for West Lancashire is back in her place now—she missed her mention, but I am sure she will catch up on it. The scheme was launched as a one-year pilot in 2016. It was extended for a further year in 2017 and again in 2018. It is a positive innovation.

I am whipping through my brief because of the time. There are a lot of points to try to respond to, and if I do not respond to them all, I will write to hon. Members. A number of hon. Members asked about international recruitment. In August 2017, NHS England announced plans to accelerate its international recruitment to 2,000 GPs in the next three years.

A small number of pilot areas started recruitment last year. The next stage of the recruitment programme is on track to start at the end of the financial year as planned. The aim is to recruit 600 doctors by the end of March 2019 and the remainder by the end of March 2020. As the hon. Member for Houghton and Sunderland South said, that is part of the north-east and Cumbria submission to the national scheme, which runs from this year to source qualified GPs from abroad to work in England. She welcomed that, as do we.

On retention, in addition to our significant efforts to train and recruit more GPs, we want experienced GPs to stay in the NHS and are supporting them to do so. The GP retention scheme, which the hon. Lady mentioned, is a package of financial and educational support to help doctors who might otherwise leave the profession to remain in clinical general practice. It was launched to support GPs who cannot work more than four sessions per week and who cannot secure a suitable substantive post. In September, 218 GP retainers were working in general practice, which is a 40% increase on two years previously.

The induction and refresher scheme provides a safe, supported and direct route for qualified GPs to join or return to NHS general practice in England. By December, it had received 600 registrations. Of those, 368 GPs have completed or are progressing though the scheme back into general practice.

Several hon. Members rightly mentioned pensions. We need experienced GPs to stay. Pensions are an issue for them, alongside workload and indemnity. They are ultimately a matter for the Treasury—it would be a foolish junior Health Minister who wrote Budgets in Westminster Hall—but my hon. Friend the Member for South West Bedfordshire (Andrew Selous) recently made the point in Prime Minister’s questions—the Prime Minister assured him that the Chancellor was listening. He will also listen to hon. Members who have raised it today. We certainly need to address it. As the hon. Member for Central Ayrshire said, to have a full pension pot is a nice problem in some ways, but I take her caveat on board.

We recognise that indemnity is one of the challenges to people staying in the profession. It is a great source of concern to GPs and to me. We want to put in place a more stable and affordable system of indemnity for general practice. At the Royal College of General Practitioners conference in Liverpool in October, the Secretary of State announced that we would develop a state-backed indemnity scheme for general practice in England. We are working with GP representatives and those conversations are going very well. We expect to announce further details of the scheme in May, with the scheme going live in April next year.

Several hon. Members rightly mentioned the partnership model. The Secretary of State and I believe in the partnership model and that it has a role to play in the future of general practice, but times have changed, as the hon. Member for Stroud said in his first point. The Secretary of State announced at the RCGP earlier this year that we are setting up a review with the BMA and the RCGP to consider how it can be reinvigorated and sustained for the future. We hope to announce further details soon. I encourage hon. Members to engage with it.

I get excited about multidisciplinary teams and the wider workforce in primary care, because they are so important. They allow experienced GPs to deal with people with long-term conditions and comorbidities. Pharmacists working in general practice through the pharmacy integration fund, who will number 2,000 by 2020, are very important, as is community pharmacy. The hon. Member for Burnley is passionate about that, as am I. They are part of one NHS and are funded through public funds, so they should absolutely be part of sustainability and transformation partnership discussions. I discussed that with the Royal Pharmaceutical Society at the Department yesterday. The wider workforce is critical to us.

General practice is and always has been the heart of the NHS. GPs play a crucial role in our communities in terms of treatment and prevention. The hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) said that the majority of feedback that we get is negative—he mentioned the feedback from some of his GPs—but that is not what the GP patient survey says. In answer to his question, he should bring those GPs in. I would very much like to see them and I may even make them a cup of tea. He should contact me and I will do that.

I thank hon. Members for their contributions. A tremendous amount is going on, and we face a tremendous challenge, but good things are happening across the country and I am out and about visiting all the time. We have to take that best practice and not just share it, but implement it across the NHS in England to address many of our primary care challenges.

Lymphoedema Services

Steve Brine Excerpts

Tuesday 27th March 2018 Westminster Hall

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

I congratulate the new hon. Member for Gower (Tonia Antoniazzi)—I knew the last one—on securing her first debate in Westminster Hall, as she said, which is on a very important issue.

Lymphoedema Awareness Week took place earlier this month, so today’s debate is timely. We heard much from the hon. Lady on the impact of the condition, which she set out very well, although Members should watch themselves looking at people’s legs and feet in supermarkets. I am sure therein lies a problem for me in Winchester, but I take her point. She set out very well the difference that high-quality care and support can make. We can all agree that we want that for people affected by lymphoedema. I hope the debate will encourage service providers across England to consider the improvements that they might make.

It is estimated that between 75,000 and 220,000 people in England are affected by lymphoedema. The condition is caused by abnormal accumulation of lymph fluid in body tissue, which can be the result of a congenital defect, of damage to the lymphatic system or of removal of lymph nodes by surgery, radiation, infection or injury. Obviously, cancer plays a role in that, which I will come to. Regardless of the cause, it is important that the NHS responds appropriately in diagnosing and managing the condition, and that it provides appropriate support and advice to those affected. A lot has changed since we had the last debate.

[Mr Marcus Jones (Nuneaton) (Con)]

Will the Minister say more about consistency of services for lymphoedema across the country, and acknowledge the role of our hospices? In my constituency, the Mary Ann Evans Hospice, of which I am a patron, has a lymphoedema care service, which is very valuable to local people.

[Steve Brine]

In my response I will touch on services across England. My hon. Friend is right to mention the hospice movement. Many people working in hospices become experts in this field by virtue of their day-to-day work. I am very happy to endorse what he said, and I thank everyone working in the hospice movement who is helping patients affected by lymphoedema.

In Scotland, Wales and Northern Ireland, certain national lymphoedema initiatives have been developed—we have heard about the initiatives in Wales. Health is a devolved matter, and devolution is important. The devolution settlement from the last Government stands, and allows the four nations of our United Kingdom to develop the services that they believe meet the needs of their resident populations and the respective size of them. In England, responsibility for determining the overall strategic national approach to improving clinical outcomes for healthcare services lies with NHS England, and the provision of lymphoedema care is the responsibility of local NHS commissioners.

Although lymphoedema has no cure, interventions such as decongestive lymphatic therapy, skincare, exercise advice and weight management can ease symptoms and improve quality of life for those affected. The hon. Lady was absolutely right to raise the issue of weight management—there is a lot of discussion in this place about the obesity challenge that we face. This condition is a not-often-talked-about consequence of the obesity challenge, and I am grateful she raised it. People with lymphoedema can usually be treated through routine access to primary or secondary care services with access to dedicated lymphoedema clinics. I have experience in my family of attending such clinics.

To support clinicians in the diagnosis, treatment and support of patients with lymphoedema, an international consensus document on the condition was produced in 2006, which is endorsed by the British Lymphology Society and the Lymphoedema Support Network. Additionally, the Royal College of General Practitioners offers an e-learning course on lymphoedema—the hon. Lady said that that was one of her concerns. That often supplements GPs’ existing understanding of the condition, which is covered in the GP curriculum, and I am pleased to say that it is identified as a key area of knowledge that we expect of them in their qualifying exams.

We heard from the hon. Lady about calls for a national lymphoedema service in England. Hon. Members may be aware that, in 2015, the British Lymphology Society submitted a proposal for a nationally commissioned specialised lymphoedema service to the Prescribed Specialised Services Advisory Group—we like our titles and acronyms in health—which is an expert committee appointed by the Department to consider these very matters.

Four factors should be considered when determining which prescribed specialised services should be directly commissioned by NHS England, the first of which is the number of individuals needing the service. The second factor is the cost of providing the service—after all, it is a publicly funded health service. The third consideration is the number of persons able to provide the service—the workforce—and the fourth is the cost to clinical commissioning groups in England for providing the service.

Taking account of those four factors, the advisory group concluded that lymphoedema services were not suitable for national commissioning. As the patient population was high in England, there were numerous providers and the burden to commissioners was low. However, we keep that under constant review, which links to my next point about Wales. We recognise that there can be opportunities to learn from our partners in the devolved Administrations while taking high-quality clinical advice from our advisers, such as I just mentioned.

We are aware of the recent evaluation of the lymphoedema service in Wales, which was published in the British Journal of Nursing, and we agree that the results appear to be very positive in addressing the challenges faced in Wales. We also note the caution applied to some of the figures but, as I say, we keep it under constant review, and the hon. Lady’s debate is helpful in that regard.

In my experience as a Health Minister, NHS commissioners are always keen to hear about services that have demonstrated savings and improved care in other parts of the country and the United Kingdom. For example, the Healthy London Partnership, a collaboration including London’s NHS, councils and Public Health England, for which I have responsibility, has drawn on the work of the Welsh lymphoedema service for its own service. We watch that closely. NHS England is also aware of the evaluation of the Welsh service and—the hon. Lady asked about this—is in touch with the national clinical lead for lymphoedema in Wales, who is one of her constituents. That relationship is ongoing and bearing fruit.

The hon. Lady mentioned cancer, for which I am the Minister responsible. Lymphoedema resulting from cancer treatment, which, sadly, has touched my life, is common. About one in five people have lymphoedema of the arm after breast cancer treatment that affects the lymph nodes, which are so difficult. Much of the lymphoedema service improvement in England has developed as a result of national initiatives to improve cancer services and, sadly, the high number of breast cancer incidents. There is growing recognition of the need to support cancer survivors after they fall off the cliff edge when their treatment ends. Lymphoedema services are a key part of that, and I have seen them when out and about doing my job.

Over the years, the Government have driven forward the cancer survivorship agenda, which I am passionate about and committed to, first through the national cancer survivorship initiative, and then through the living with and beyond cancer programme, for which I am responsible. Central to that work has been embedding in mainstream NHS commissioning a recovery package, which is a combination of interventions that, when delivered together, can greatly improve outcomes and the co-ordination of care beyond the cancer pathway, which is what we are looking at, including through better and earlier identification of the consequences of treatment for conditions such as lymphoedema.

Members will be aware that our world-class cancer strategy for England, which has another two years left to run, was published in July 2015 by the independent cancer taskforce. It recommended that NHS England should accelerate the commissioning of services for cancer survivors, including the development of a minimum service specification to be commissioned locally for all patients, based on the recovery package I just mentioned. That specification was published in April 2016 and includes provision of lymphoedema care. It was followed by £200 million of funding to support the implementation of the recovery package and other areas of the strategy, which I am sure I will talk about again in debates in this place. Those services should be provided on the basis of need, not of whether someone has had cancer.

Finally, let me highlight the research that is being undertaken. We invest more than £1 billion a year in health research through the National Institute for Health Research. The NIHR is currently supporting three important lymphoedema studies: an analysis of genes and their functions in primary lymphoedema; an investigation of the pathophysiology of breast cancer-related lymphoedema of the arm, which I mentioned; and a feasibility trial of early decongestive lymphoedema treatment for women newly presenting with breast cancer-related upper limb lymphoedema, which is very important.

As well as thanking you, Mr Gray, for sitting through what I hope has been as interesting a debate for you as it has been for us, let me thank the hon. Lady again for using her first Westminster Hall debate to raise this important issue and highlight the many challenges that people with lymphoedema face. I am confident that, by continuing to build our expertise, increasing the research I listed and ensuring that our commissioners and clinicians have the training, tools and guidance to deliver high-quality lymphoedema care, we can ensure that patients receive the treatment and support they need and deserve. As ever, I am grateful to Members. We keep everything under constant review, because ultimately we have a publicly funded health service that is there for patients. As the Minister with responsibility for primary care, I have responsibility not only for cancer but for prevention, and I am interested in anything that can help us to reduce people’s suffering and the cost to that publicly funded health service.

Question put and agreed to.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 20th March 2018 Commons Chamber

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

Children’s oral health is better than it has ever been, and 72% of five-year-olds in England are now decay free. Of course, that means that 28% are not, which is why our Starting Well programme aims to increase access for young children in 13 high-need areas. NHS England is also looking at making similar approaches available in the areas of greatest genuine local need.

[Tracy Brabin]

In Kirklees, 29% of under-five-year-olds have experience of tooth decay. Nationally, among five to nine-year-olds, tooth decay is the most common cause of hospital admission. Does the Minister agree that the system of penalising dentists for not hitting targets and not paying them when they exceed targets has led to a situation where there are virtually no NHS dentists available for my young constituents? What steps will he take to make more places available?

[Steve Brine]

We are testing the new prevention-focused dental contract, which the hon. Lady knows about, to improve access and outcomes for NHS dental treatment. We have also made great progress on children’s oral health, as I have said. NHS England in her area is currently finalising arrangements for extra funding to support dentists in offering additional access and places. That funding will be available from 1 April, so she and other Members should stand by their phones.

[Philip Davies (Shipley) (Con)]

The hon. Member for Batley and Spen (Tracy Brabin) is absolutely right about this particular issue. The Government have long acknowledged that there is a shortage of dentists in West Yorkshire, and in the Bradford district in particular, where the shortage is pretty chronic. Will the Minister set out what the Government are doing to ensure that there is an acceptable number of NHS dentists in the Bradford district?

[Steve Brine]

I will not pre-empt what the NHS in Yorkshire and the Humber will say to my hon. Friend or to the hon. Lady, because this is a local decision, but I will say that the 13 Starting Well areas—the programme was a manifesto commitment for us—were selected nationally based on overall need and using a wide range of data including access to NHS dental services.

[Julie Cooper (Burnley) (Lab)]

The Minister seems to be in denial. The British Dental Association reports that almost half of all NHS dentists are not accepting new patients—either adults or children. In several regions right across the country, from Yorkshire to Salisbury, patients are having to rely on the third world dental charity, Dentaid, with its now-famous wheelie bin dental surgeries. Does he think that that is an acceptable state of affairs? Will he outline what action he intends to take to improve access to NHS dentists?

[Steve Brine]

It is interesting that the hon. Lady should raise this; it is one of the things that we might be discussing shortly. According to the GP patient survey for January to March last year, whose results were published later last year, 59% of the adults questioned had tried to get an NHS dental appointment in the past two years, and of those, 95% were successful. Those are not bad figures.

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[Stephen McPartland (Stevenage) (Con)]

13. Whether he has plans to establish a satellite radiotherapy unit in Stevenage.

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

NHS England is working with the East and North Hertfordshire NHS Trust to determine the best way to deliver radiotherapy services to patients in Stevenage. This is part of a system-wide NHS England review of the way in which radiotherapy services are delivered.

[Stephen McPartland]

Hertfordshire has more than 1 million people and no radiotherapy provision. My constituents have to travel more than 80 miles for every treatment, which means thousands of miles during the course of their treatment—there is no public transport. My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and I have run this campaign for a number of years, and we have all the agreements from every part of the NHS. We are meeting the board of the trust on Friday, so will the Minister give them a direction to get on with building the facility?

[Steve Brine]

All trusts have been directed to get on with the review. The NHS England specialised commissioning team is in discussions with my hon. Friend’s local trust as it develops its five-year strategic plan for the cancer pathways. It is working with his local cancer alliance, including radiotherapy services. It is recognised that a more radical approach and a broader review of the radiotherapy options may be required in future. As my hon. Friend says, he and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) have that meeting later this week, and I hope the discussions are productive. I feel sure that my hon. Friend will come back to me if they are not.

[Mr Speaker]

Let us hear from the neighbour. I call Sir Oliver Heald.

[Steve Brine]

Obviously my right hon. and learned Friend is right to speak up for services in his area. The review is not about cutting those services, but about making sure that they are in the right places. We have to be mindful that sometimes the services have to be centralised to be in the right place to deliver the right outcomes for cancer patients.

[Mr Speaker]

I will take the next question on condition that Members are exceptionally brief, as time is constrained.

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[Craig Tracey (North Warwickshire) (Con)]

21. What steps he is taking to increase the capacity and availability of GP services.

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

We of course recognise the shortages in general practice, which is why we remain committed to delivering an additional 5,000 doctors working in general practice by 2020 compared with 2015.

[Royston Smith]

Like many other places throughout the country, Southampton is struggling to recruit and retain GPs. There are many reasons for that, but perhaps one is the practice of discouraging medical students from going into general practice while encouraging them to become specialist consultants. Is my hon. Friend aware of that and of how widespread is it? What is he doing to encourage more people into general practice?

[Steve Brine]

The Secretary of State has already outlined the plans for the new medical schools and the record 3,157 GP training places that were filled. I am aware of the practice that my hon. Friend mentions, and that is why we are working with the profession on a range of measures to boost recruitment into general practice. The existing professionals also have a role to pay, and the superb chair of the Royal College of General Practitioners, Helen Stokes-Lampard, is really leading from the front in that respect.

[Steve Double]

Does the Minister agree that part of the way to address some of the pressures that GPs face is to enhance the role of community pharmacies? Will he update the House on what steps he has taken to support pharmacies and further integrate them with general practice?

[Steve Brine]

We know that there are benefits to be had from the better integration of community pharmacies with sustainability and transformation partnerships. Through the pharmacy integration fund, we are integrating pharmacists into primary care. I hear good reports about how that is going and we will have 2,000 of them in general practice by 2020. Community pharmacies themselves should also be integrated, through STPs, because it is one NHS.

[Craig Tracey]

It is great to see that record numbers of medical students are going into general practice this year, but far too many GPs are choosing to retire and leave the NHS when they are in their 50s because of tax penalties on their pension scheme. Does the Minister agree that we need to address that situation so that experienced GPs are not penalised for staying in the NHS?

[Steve Brine]

Along with concerns about workload and, for example, indemnities, pensions are an issue that older GPs often bring up with me. Ultimately, it is a matter for Her Majesty’s Treasury. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised a similar issue at Prime Minister’s Question Time last week, and the Chancellor was on the Bench to hear it. I am sure he will read the report of these exchanges, too.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

In Stoke-on-Trent we have some fabulous GPs, not least the wife of the hon. Member for Stafford (Jeremy Lefroy), but too many people present to A&E because their primary carer is not up to dealing with the workload. That means that the A&E is over-logged so fines are levied on the hospital. What is the Secretary of State going to do to make sure that when hospitals pick up the slack from GPs, they are not subsequently fined by clinical commissioning groups for missing targets?

[Steve Brine]

We are going to integrate primary and secondary care properly through the new models of care—for instance, extended access is important in that. The new multidisciplinary teams—for example, I have talked about pharmacists working in primary care—are not only about providing the plaster when the cut happens, but about preventing the cut in the first place. The prevention agenda is very important.

[Chris Bryant (Rhondda) (Lab)]

Do we not need more salaried GPs?

[Steve Brine]

We need more GPs, which is why today’s announcement is very important. I am sure that the hon. Gentleman welcomes them.

[Mr Speaker]

Well, if there are to be more GPs, they will have to be paid.

[Bill Esterson (Sefton Central) (Lab)]

Patients at Hightown GP surgery were promised that their surgery would stay open, but, out of the blue, they were written to and told that the surgery would close on 8 June. The Government are belatedly taking action on the shortage of GPs, but will the Minister intervene to make sure that Hightown surgery is kept open and that a promise is kept to patients?

[Steve Brine]

I will look at Hightown surgery, and if the hon. Gentleman wants to talk to me about it, he is welcome to do so. Of course it is the responsibility of his clinical commissioning group and NHS England in his area to provide primary care services for the patients who are his constituents, but if wants to talk to me further, I am very happy to do so.

[Andrew Lewer (Northampton South) (Con)]

T1. If he will make a statement on his departmental responsibilities.

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[Mr Ranil Jayawardena (North East Hamp- shire) (Con)]

T5. Although my younger daughter, being at the discerning age of one, is a particularly fussy eater, childhood obesity is becoming one of the most quickly rising and important issues of our time. Does my right hon. Friend recognise that it is something that we really need to tackle, and quickly?

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

We are already delivering an ambitious plan to address childhood obesity, including taxing sugary drinks and helping children to exercise more, but we need to keep a close watch on this. We have taken the first few steps in a long race, and we are always looking to learn from successful initiatives elsewhere. Last week I was in Amsterdam looking at the system-wide approach there, which has led to very impressive reductions in child obesity. We should be listening and we are.

[Ruth George (High Peak) (Lab)]

T2. Head- teachers in my constituency tell me that they are asked by the child and adolescent mental health services to prove that children have tried to commit suicide before CAMHS is prepared to accept a referral. The Minister has just admitted that less than half of children who are referred are treated, and that under the new plans less than two thirds will get treatment. There is so much rationing going on. Will the Secretary of State please commit to improving the amount of ring-fenced funding now?

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[Ronnie Cowan (Inverclyde) (SNP)]

T4. This morning I met the family of Alfie Dingley and members of the End Our Pain campaign. Alfie’s case, along with those of Murray Gray and Billy Caldwell—and many, many more—highlight the case for medical cannabis. Will the Minister liaise with the Home Office to introduce medical cannabis for the thousands of people who would benefit, but who do not want to be branded as criminals?

[Steve Brine]

Obviously, everybody in the House is aware of this case, and our thoughts are with Alfie and his family. The policing Minister has met Alfie’s family and discussed options that may assist him. No decisions have been made, and any proposal would need to be led by Alfie’s clinicians using sufficient and rigorous evidence.

[Maria Caulfield (Lewes) (Con)]

Despite not hearing it from Opposition Members, I am sure that all Members in this House welcome the five new medical schools announced today. Will the Minister also welcome the extra medical school places in Brighton and Sussex Universities, supporting my constituents, and the launch last week of the new nursing apprenticeship scheme by the University of Brighton, which will enable more nurses to enter the profession?

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[Alan Brown (Kilmarnock and Loudoun) (SNP)]

T7. Over a third of children in the UK are either overweight or obese. The Royal College of Paediatrics and Child Health has warned that a trade deal with the US could lead to an influx of junk food with high fat, sugar and salt content. Will the Health Secretary make sure that health is put above trade going forward?

[Steve Brine]

As I have said, we are concerned about child obesity, which is probably the big public health challenge, not least in the impact that it can have on diabetes, heart disease and cancer. That is why I so welcome Cancer Research UK moving into this space. We have one of the most ambitious plans in the world. We have already said that it is the start of a conversation, not the end, and if we need to go further, we will.

[Helen Whately (Faversham and Mid Kent) (Con)]

May I welcome today’s announcement on a new medical school for Kent? In an area that struggles to attract doctors, this will make a huge difference: it is genuinely a game changer. Will my right hon. Friend congratulate the University of Kent and Canterbury Christ Church University on their successful bid?

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[Stephen Lloyd (Eastbourne) (LD)]

Bowel cancer remains a major killer in the UK. The National Institute for Health and Care Excellence recognises the new FIT—faecal immunochemical test—to be a far more effective bowel screening process, but there remains a lack of clarity about when it is going to be rolled out nationally. Will the Minister provide that clarity today so that people can be saved down the line?

[Steve Brine]

The UK National Screening Committee has recommended that FIT be the primary screening test for bowel cancer, and NHS England remains absolutely committed to implementing it in 2018-19. We expect to make a decision very shortly on when that will be.

[Sir Edward Leigh (Gainsborough) (Con)]

You wanted short, Mr Speaker. I thank the Secretary of State for our new medical school at Lincoln.

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[Judith Cummins (Bradford South) (Lab)]

My local paper, the Bradford Telegraph and Argus, has recently launched its “Stop the Rot” campaign, as children in Bradford have some of the worst dental health outcomes of anywhere in the country. Does the Minister agree that prevention is key to improving children’s dental health? Can he tell us what steps the Government are taking to ensure that prevention is a key element of any new dental contract?

[Steve Brine]

I think that would be the brilliant Bradford Telegraph and Argus. As I said, 75 dental practices are continuing to test the preventive focus clinical approach alongside the new remuneration system, which supports an increased focus on prevention through the dental contract. I know it is taking time, but I want to get it right.

[Mary Robinson (Cheadle) (Con)]

We know that early diagnosis of cancer is crucial for successful treatment outcomes, but for many cancers, such as pancreatic and ovarian cancer, early symptoms can be vague and the chance to diagnose early easily missed. What are the Government doing to ensure that hard-to-detect cancers are diagnosed early?

[Steve Brine]

That is an excellent question. We are testing the new Accelerate, Co-ordinate, Evaluate programme—ACE—which I visited recently at the Churchill Hospital in Oxford. Patients with vague symptoms can be referred for multiple tests and often receive a diagnosis or an all-clear on the same day. I do not get excited very easily, but that promises great excitement.

[Mr Speaker]

It is a delight to see the Minister in a state of high excitement. We hope to see it repeated on innumerable occasions.

[James Frith (Bury North) (Lab)]

Seventy MPs from across the House in yesterday’s Westminster Hall debate all agreed that we need Orkambi on the NHS now. Can the Minister tell me what he will be doing differently for sufferers of cystic fibrosis and when we will hear news of a breakthrough? Sufferers of cystic fibrosis are slowly drowning in their disease without access to Orkambi.

[Steve Brine]

It was a very good debate, and the hon. Gentleman spoke very well in it on behalf of his constituents. We have made a counter-offer to Vertex. I call on Vertex to be reasonable, and I call on Vertex and NHS England to get back round the table and get this sorted.

[Several hon. Members rose—]

[Henry Smith (Crawley) (Con)]

I would like to thank the Under-Secretary of State for Health, the hon. Member for Winchester (Steve Brine), for his response to the all-party parliamentary group on blood cancer report. Will he continue to ensure that cancer alliances and GPs are diagnosing early?

[Steve Brine]

That is an easy one—absolutely, yes.

[John Grogan (Keighley) (Lab)]

With a significant amount of public money at stake, should not NHS trusts that are proposing to set up subsidiary companies publish their full business cases?