Oral Answers to Questions

Steve Brine Excerpts

Tuesday 4th July 2017 Commons Chamber

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

5. What assessment he has made of the adequacy of the number of GPs.

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

In answering my first Health question, may I thank the cardiac intensive care unit team at Barts hospital in London, where my father-in-law, the just retired Supreme Court Justice Lord Toulson, sadly passed away last week? They did absolutely everything they could and showed the very best of the NHS.

We have committed to there being an extra 5,000 doctors in general practice by 2020 as part of a wider increase in the total workforce in general practice. NHS England and Health Education England are working together with the profession to increase the GP workforce. We believe that that is an essential part of creating a strong and sustainable general practice, and indeed NHS, for the future.

[Bridget Phillipson]

In recent years, the number of family doctors in Sunderland has plummeted. All the evidence shows that doctors are more likely to stay in the areas where they have trained. 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?

[Steve Brine]

I thank the hon. Lady for her question. Since 2016, Sunderland’s GP Career Start scheme has recruited 10 newly qualified GPs. A further five newly qualified GPs will be recruited each year over the next three years. I understand her point about medical school provision. Undergraduate medical education is delivered in the north-east in partnership between Newcastle and Durham universities. There are currently 25 medical schools in England offering just over 6,000 Government-funded medical school places. We are funding 1,500 additional places each year. Five hundred have already been allocated, with 24 of them in Newcastle.

[Alex Chalk (Cheltenham) (Con)]

Recruiting more GPs in Cheltenham is vital to share the growing workload they face, but rising indemnity costs, particularly for out-of-hours care, can act as a disincentive. Does my hon. Friend agree that this must be addressed decisively?

[Steve Brine]

Indeed we do. We recognise the role that GPs play in the delivery of NHS care. Following the GP indemnity review, additional money was included in the contract last year to address indemnity inflation. We said in our manifesto that we will ensure appropriate funding for GPs to meet rising costs in the short term and work with the industry to produce a longer term solution.

[Mrs Madeleine Moon (Bridgend) (Lab)]

17. As the number of GPs goes down, there is increasing pressure on the time they have with their patients. One area being missed is that of suicide and self-harm. We now know there is an increased risk of suicidal behaviour for those on unstable and irregular zero-hour contracts, and that those on employment and support allowance are more than two thirds more likely to take their own life. What are we doing to advise GPs on that?

[Steve Brine]

The hon. Lady, who chairs the all-party group on suicide and self-harm prevention, does a huge amount of work in this area. The GP patient survey last year showed that 85% of respondents rated their GP experience as good. We are investing about £30 million of taxpayers’ money in the releasing time for care programme, which we hope will increase the time GPs can spend with patients on issues such as those she raises, but in my new role I am very happy to meet her.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

GPs are the first line of defence against antibiotic resistance, which has the potential to be an uncontrollable global new black death. Will the Minister confirm that the UK will retain its position as a world leader on this issue, and will he tell us when the global antimicrobial resistance innovation fund will open for applications and when the pilot reimbursement model for drug development will begin operating?

[Steve Brine]

The Government have committed £50 million of official development assistance towards setting up the global antimicrobial resistance innovation fund. We are one of the world leaders on this subject. I am meeting my hon. Friend and my hon. Friends the Members for Stafford (Jeremy Lefroy) and for York Outer (Julian Sturdy) shortly, when we can take this forward.

[Julie Cooper (Burnley) (Lab)]

I spoke to one GP last week who told me that because he has been unable to recruit help he has only been able to take one week’s leave in three years. That is clearly not sustainable. The morale of GPs is at an all-time low, the number of GPs continues to fall, surgeries are closing, and patients are finding it harder and harder to get an appointment. The Secretary of State promised an extra 5,000 GPs by 2020, but given that it takes 10 years to train a GP will the Minister tell the House how exactly he is going to deliver on that promise?

[Steve Brine]

I thank the hon. Lady for her question and I look forward to engaging with her on such matters. The “General Practice Forward View” is a landmark document, which was published in April last year. As she knows, it sets out extra investment that GPs have been calling for for years: £2.5 billion a year for GP services. That means investment is rising. The good news, as the Secretary of State said, is that more people are coming into general practice. We want to continue to encourage that, but we also have to take action to prevent early retirements and to bring people back to general practice. We are indeed doing that.

[Mr Marcus Fysh (Yeovil) (Con)]

6. What steps are being taken to broaden routes into nursing.

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[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

9. What guidance he provides to clinical commissioning groups on decision-making processes to improve healthcare provision.

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

Clinical commissioning groups, as statutory organisations, have a duty to deliver the best possible services and outcomes for patients within their financial allocation. NHS England supports them in this by providing several sets of guidance, as do the National Institute for Health and Care Excellence and other arm’s length bodies.

[Daniel Kawczynski]

I thank the Minister for that answer. He will know that the clinically driven Future Fit process in Shropshire could lead to hundreds of millions of pounds of investment in our local hospital. That is being jeopardised by Telford CCG and Labour-controlled Telford council. When there is this gridlock and impasse between two local CCGs over a long period of time, what more can the Government do to break the deadlock?

[Steve Brine]

I am aware that my hon. Friend has been concerned about this for a long time. An independent review of Future Fit is taking place, and he will know that Professor Simon Brake has been appointed as the independent chair of the joint committee of CCGs, agreed between them both. The review will report in July and be considered by the local CCGs before next steps, including on public consultation, are decided. Clear rules apply to any significant reconfigurations and I expect these to be followed in Shropshire as anywhere else.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

Patients at the Manchester Royal infirmary with serious congenital heart problems found out last week that the services will now no longer be provided in Manchester, or in fact anywhere in the north-west, due to a Government review of services which means that staff cannot be retained and recruited. What has the Minister got to say to those patients who now have to go to Leeds or Newcastle to get the lifesaving surgery that they need?

[Steve Brine]

I understand that this is an independent review of services, and it will report in due course.

[Lucy Allan (Telford) (Con)]

Does my hon. Friend agree that, when political activists mislead and misinform my constituents about the future of our Princess Royal hospital, the CCG should communicate directly and clearly with residents so that they can be reassured that our A&E and our women’s and children’s services are safe?

[Steve Brine]

Yes, I do. The CCG should communicate directly with patients, and that should be clinically led when making the clinical case for any service reconfigurations. As I said to my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski), there are clear guidelines that the CCGs must follow. There are now five tests that must be met before any reconfigurations are brought forward, and that should be the same for my hon. Friend’s area as for everywhere else in England.

[Layla Moran (Oxford West and Abingdon) (LD)]

The Abingdon community hospital is a treasured asset in my constituency, but in trying to find savings of £176 million, the local clinical commissioning group is launching a consultation on its future imminently. May I seek reassurance, on behalf of my constituents, that the hospital will not close and that, as part of the consultation, their voices will be not only heard but acted upon?

[Steve Brine]

Clinical commissioning groups have a statutory responsibility to consult the public, and Members of Parliament have a key role in ensuring that members of the public engage with those consultations, as I do in my area. I will be following the hon. Lady’s case closely, and she is welcome to come and see me about it if she likes.

[Sandy Martin (Ipswich) (Lab)]

10. When the Government plan to publish a tobacco control plan.

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

The UK is a world leader in tobacco control, and we will publish a new tobacco control plan shortly, building on our success. That plan will set out new national ambitions to further reduce smoking prevalence, particularly among disadvantaged groups.

[Sandy Martin]

I need to declare an interest as a Suffolk county councillor. Given the health responsibilities of local government, will the Minister tell the House what can be done to deal with the situation in which the actuarial advice from local government and other public sector pension schemes is that they are not at liberty to disinvest from tobacco stocks?

[Steve Brine]

I will have to look into the exact point that the hon. Gentleman raises, but I should like to welcome him to his place. I worked closely with his predecessor, and the hon. Gentleman has a tough act to follow. When we publish the tobacco control plan, there will be clear local tobacco plans as part of it. We in the Government can give the best evidence of what works, but we need to recognise what is needed in each local area. I know that he has specific needs in his local area in relation to tackling this issue.

[Bob Blackman (Harrow East) (Con)]

I welcome the Minister to his place. Does he agree that it is vital that anyone who approaches the national health service with a smoking-related disease should be pointed towards smoking cessation services? Does he also agree that it is vital that local authorities continue to run those services?

[Steve Brine]

Yes, absolutely. Local authorities have an obligation to do that, but as I said to the new hon. Member for Ipswich (Sandy Martin), it is important that local plans come forward alongside the new national plan. Local solutions are needed for different areas, and that will be the case in my hon. Friend’s borough just as it is in my area of Hampshire.

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

Last week marked the 10th anniversary of the smoking ban across the UK, but sadly the celebration was dampened by the fact that we have yet to see the Government’s new tobacco control plan, which was promised in December 2015. The previous two Health Ministers I have shadowed repeatedly said that we would see the plan shortly, but they failed to set out an updated strategy for working towards a smoke-free society. I welcome the Minister to his new post—we have worked well together in the past on the all-party parliamentary group on breast cancer—and I am hoping that, although he has not yet given us a date for the plan, he will be able to give us an indication. Is it going to be published before Christmas?

[Steve Brine]

I thank my hon. Friend for her question. I think I can call her that; we have worked closely together in the past. I am new to my ministerial post, but I have been through the plan, and it is I who has to stand up and defend it. I want to be sure that it is right and that I am as happy with it as everyone else in the Government. My intention is that it will be published before the summer recess.

[Ms Nusrat Ghani (Wealden) (Con)]

Within East Sussex, Wealden has the highest number of smoking-related deaths. I welcome the update on the tobacco control plan, but how will my hon. Friend raise awareness and provide equal access for rural communities?

[Steve Brine]

Rural communities are as important as any other. It is up to East Sussex County Council to come forward with a local tobacco control plan, and I know my hon. Friend will be taking a close interest in that, as she does in all matters when representing her constituents.

[Paula Sherriff (Dewsbury) (Lab)]

11. What steps he is taking to reduce the number of children admitted to hospital for dental surgery.

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[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

13. What assessment he has made of the consistency and quality of GP services in (a) Newcastle and (b) England.

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

In 2016, 85% of patients surveyed across England reported a good overall experience of their GP surgery. In the Newcastle Gateshead CCG, patient satisfaction is even higher than the national average at 88%.

[Chi Onwurah]

Newcastle has fantastic GPs, but many of my poorest and most vulnerable constituents suffer from GP unavailability and a constant change of providers due to the requirement to re-tender every couple of years to a market that, quite frankly, does not want them because they are too poor or too marginalised to make money from. Will the Minister meet me and my local CCG to find out how we can ensure that those people get the quality and consistency of GP services that they deserve?

[Steve Brine]

I am very happy to do that.

[Mark Pawsey (Rugby) (Con)]

Following the closure of their GP surgery, my constituents in Brownsover have had to make do without one over the past few years. Approvals are in place for a new surgery and it is due to open next summer. Will the Minister confirm that the timeline set out by NHS England will be met?

[Steve Brine]

I will ask NHS England, but if that is what it has told my hon. Friend, that is what will happen.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

14. What plans he has to improve the integration of mental health services for young people and adults.

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[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

T5. Nothing is more important than that people can access a GP when they need one. With that in mind, will the Minister join me in welcoming the move made by South Tees clinical commissioning group to enable 90,000 more appointments a year to be generated for people in Middlesbrough, Redcar and Cleveland by ensuring that appointments are available on evenings, weekends and bank holidays?

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

I do indeed welcome that. Improvements to GP access in the NHS in South Tees have been put in place. Patients in Middlesbrough, Redcar and Cleveland can now benefit from accessing GP appointments at a time that is convenient for them, seven days a week—that is exactly as it should be.

[Ronnie Cowan (Inverclyde) (SNP)]

T2. With the Scottish Government now committed to a soft opt-out system for organ donation similar to that implemented in Wales in 2015, is it not time that the UK Government followed the lead of the Welsh and Scottish Governments by introducing a similar system south of the border?

[Matt Warman (Boston and Skegness) (Con)]

T6. One-year cancer survival rates are now at a record high of 70%, but does the Minister agree that we should and can go further by improving early diagnosis and screening?

[Steve Brine]

Yes. Progress is really encouraging, and I am sure that Members on both sides of the House will have been encouraged to see today’s press coverage about the chief medical officer’s independent report on genomics—the age of precision medicine is truly here. The NHS has always been at the forefront of new technologies, and so it must be with this; we are determined that it will be.

[Patrick Grady (Glasgow North) (SNP)]

T3. Would a Minister be willing to meet the all-party group on blood donation after it has been reconvened next week and would they be able to provide an update on the work of the Advisory Committee on the Safety of Blood, Tissues and Organs in respect of lifting or easing the deferral period for gay men who want to donate blood?

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[Maggie Throup (Erewash) (Con)]

I was delighted to hear that, in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman), the Minister was positive about the progress of genome screening. On a recent visit to Nottingham University, I saw similar techniques applied to Alzheimer’s research. Will he back using the process for that, as well as for cancer diagnosis and treatment?

[Steve Brine]

The chief medical officer’s report—I am sure that my hon. Friend will read it in due course—is clear that this is an exciting new innovation in medicine. We will tackle cancer first, but there is real potential for applying it to rare diseases and the other disease that she mentioned.

[Several hon. Members rose—]

BMA (Contract Negotiations)

Steve Brine Excerpts

Monday 21st March 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David.

I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on the eloquent way in which she introduced the debate on behalf of the Petitions Committee. Under her stewardship, the Committee has gathered in a short space of time a reputation for allowing issues that are important to the public to be debated in this Chamber and for some great innovations in how democracy is dealt with in this place.

My hon. Friend helpfully set out the history and the research. She characterised as “rash and misleading” the conclusions drawn from such research about higher weekend death rates and staffing levels. We rightly say it is not easy to find a link between the cause and effect, as she mentioned in her opening remarks, but, despite a wealth of evidence showing that we cannot draw straightforward conclusions on cause and effect, the Secretary of State has proceeded on that basis. The proposals, which will see dramatic changes in how the health service will be run in the future, seem to be based on evidence that does not necessarily justify the conclusions drawn.

I will refer to contributions made by other Members. I congratulate the hon. Member for Morley and Outwood (Andrea Jenkyns) on being the only Conservative Back Bencher present. I know she is genuine in her concern about patient safety, but I was sad to hear some of the comments she made. I am afraid she repeated the mistakes that have characterised the dispute by demonising the BMA, portraying it as a militant faction. Let us not forget that these people have had 40 years without a strike, so can she not see that something has gone very wrong for them to decide to take industrial action and that they do have genuine concerns about patient safety?

I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) on her contribution. She has great experience in this area and she spoke about the potential exodus of junior doctors that the proposals may mean. She rightly highlighted the serious questions about the proposals that need to be answered.

I am glad to see my hon. Friend the Member for Hammersmith (Andy Slaughter) still in his place. He spoke with great sincerity about how unhelpful the character assassination of certain members of the BMA has been and about how he believes—I believe most Members who have spoken tonight agree—that junior doctors are still willing and able to reach a compromise, but they have been met with an intractable Government.

My hon. Friend the Member for Hornsey and Wood Green (Catherine West) described what she considers to be a Government with a determination to sabotage the relationship with junior doctors. She has spoken to a number of constituents about issues of concern to them, and she was right to say—I wholeheartedly agree—that this is about valuing staff.

My hon. Friend the Member for York Central (Rachael Maskell) spoke with great personal experience and exposed the massive dichotomy at the heart of the proposals. She rightly paid tribute to the staff who, by their good will, add so much more value to the NHS than will ever show up on a balance sheet. I agree with her that the dispute causes massive anxieties about what the future holds for recruitment and retention of our staff. She is right that industrial relations is about sitting down and getting into a constructive dialogue. I hope that, as many Members have said tonight, that is still possible.

The hon. Member for Central Ayrshire (Dr Whitford) spoke with the great experience that she brings to every debate on these matters. She correctly identified the Secretary of State’s wilful conflation of statistics. She highlighted that the ratio of trained nurses is a significant issue and gave good examples of how challenges were resolved in the past by dialogue in conflict—dialogue was raised numerous times by Members. She was right to ring the alarm bells about the fact that fewer than half of junior doctors apply to stay in the NHS and she talked with great knowledge about some of the current pressures in the system on finding staff.

Finally, I pay tribute to my hon. Friend the Member for Bristol West (Thangam Debbonaire). It is so good to see her back here and to hear from her about her recent personal experience of the NHS. She spoke with great passion and sincerity about the treatments and flexibility she was afforded by those staff. It is clear that she has received excellent treatment—she was hugely impressed by staff’s willingness to go that extra mile. The three words she highlighted should be reflected on by the Government: they need to treat staff respectfully, honourably and professionally. I could not agree more with that.

I am aware that in this Chamber we strive for a note of consensus, recognising that the main Chamber is where the theatrics, which do little to enhance Parliament’s reputation, tend to take place.

[Steve Brine (Winchester) (Con)]

They are right now.

[Justin Madders]

Yes, I am sure there are plenty of theatrics going on at this very moment. I will try to be measured in my response on behalf of the official Opposition, but it is our role to point out where we believe there are shortcomings in the Government’s approach, and on this occasion I believe that the Government have been found wanting. The sad reality is that we should not be debating this matter today at all. It could have been different if the Secretary of State had demonstrated a genuine desire to listen, engage and negotiate.

We all know that from time to time an employer will want to change the terms and conditions of their workforce. As a former employment lawyer, I know that change can be sometimes be difficult to deliver, but rarely—if ever—have I seen one side approach a negotiation with such stubbornness, intransigence and provocation. Whatever legal method the Government choose to draw this dispute to a conclusion, the reality is that it is far from over, and the well of resentment that has been built up by the Government’s approach will last for years. Everyone, including the BMA, has recognised the need to reform the current contract, but we have seen a Health Secretary giving the impression that he is looking for a fight, not a solution. In the past year he has described junior doctors as “militant”; implied incorrectly that they do not work weekends; insinuated that they are in some way to blame for deaths among patients admitted at weekends; questioned their integrity by suggesting that they may not be on hand to respond to a major terrorist incident; and insulted the intelligence of some of the brightest and best minds in the country by telling them that the 99% of them who backed industrial action had been somehow misled by the BMA.

I know how important junior doctors are to the smooth running of any hospital, how they consistently go the extra mile to deliver superb care—we heard that from many Members tonight—and how vital they are to the NHS’s future success. Yet they are repaid with insults. That is no way to treat any public servant, least of all those whose good will has kept our health service afloat as it has suffered from years of mismanagement and underfunding.

The dispute, unnecessarily inflamed by the Health Secretary, reached a new low last month when he claimed support for contract imposition from NHS leaders across the country only for many of them later to come out and confirm that that was simply not the case. That was the latest in a long line of statements he has made that do not stand up to any kind of scrutiny. Contrast that rapid evaporation of support when imposition was announced with the solidarity shown by representatives from every part of the health sector who believe that contract imposition was the wrong move to make. At least 10 professional groups, from the Royal College of Midwives to the Royal College of General Practitioners, have warned about the dangers of imposing a contract on junior doctors at a time when staff morale in the NHS is at rock-bottom.

If the Health Secretary, the self-styled patients’ champion, will not listen to the doctors and nurses, perhaps he will listen to the patients instead. The chief executive of the Patients Association, Katherine Murphy, said:

“The Government’s decision to impose contract terms on junior doctors is unacceptable. The health and social care system depends entirely on the great people who work in services across the community for the benefit of patients…It is clear that the acrimonious dispute over the junior doctors’ contract is unnecessary and damaging.”

Unfortunately, it appears that he is not listening to patients, either. He has tried to point the finger of blame at the BMA for the dispute, but if he wants someone to blame he should look no further than the mirror. His actions up to the decision to impose the contract are not those of someone trying to calm things down and reach a resolution: they are the very opposite.

What is in many ways just as unacceptable and unforgivable is the Health Secretary’s complete inaction after the decision was taken to impose the contract. A few weeks ago I asked him, in a written parliamentary question,

“what steps he has taken to avert further industrial action by junior doctors”.

The answer was quite telling. The truth is that since he announced imposition, he has not picked up the phone, opened his door or lifted a finger to try to avoid the most recent industrial action. There was virtually a month from the announcement of imposition to when the Government knew perfectly well that there was going to be further industrial action, but they did absolutely nothing to avert it.

We all need to remember that the NHS is ultimately there to serve patients, and they are now suffering because the Secretary of State has sat on his hands. It has been a complete dereliction of duty. Therefore, when the Minister responds, I ask him to confirm that the Government have not taken, and do not intend to take, any steps to prevent further industrial action.

I have some further questions for the Minister. Was a risk assessment of the effect on patient safety carried out before the decision was taken to impose the new contract? What assessment has he made of the likely impact of the contract on the recruitment and retention of junior doctors, given the crisis that the health service already faces? Does he accept that imposing a new contract that does not enjoy junior doctors’ confidence will further damage morale? Is he concerned by the 10-fold surge in inquiries by doctors planning to emigrate on the very day that the Government announced imposition? What legal advice did he take about how an imposed contract would work in practice? Will he tell the House when we will see the final terms and conditions? It is important for us to see that final detail, particularly as the BMA claims that a cost-neutral proposal was personally vetoed by the Health Secretary. We have never had an answer on that, so I should be grateful if the Minister would confirm whether the assertion is correct, and what the impediment to a deal was, given that it was cost-neutral and we already know that junior doctors work seven days a week.

The Secretary of State has sought, in recent months, to present the negotiation as a symbolic battle to unlock the delivery of a seven-day NHS. If that is the case, can the Minister explain why seven-day services are not mentioned once in the original heads of terms for the negotiations set out in 2013? The truth is that the Secretary of State only decided that the issue was about seven-day services half way through the negotiations when it was clear that doctors were going to put safety first, and he was looking for a way to divert blame away from his disastrous handling of the whole affair. Given that junior doctors already work seven days and seven nights a week, I cannot see how they can be the barrier to the safety of patients. Can the Minister name a single chief executive who has told him that the junior doctor contract is the barrier to providing high quality care 24/7? Even the chief negotiator whom the Secretary of State personally appointed, Sir David Dalton, says that changes to junior doctors’ contracts will have the least impact on arriving at seven-day working.

We all want a seven-day NHS, but no evidence has been provided about how the contract will do anything to further that ambition. Nothing coming even close to a credible delivery plan has yet been provided to set out how the seven-day NHS will be delivered. The truth is that the whole dispute has been used by the Secretary of State to detract from the challenges facing the NHS; those will only be harder to overcome thanks to his industrial relations approach, which is straight out of the Thatcherite 1980s playbook. Picking a fight with a group of people who will be critical to the future of the NHS is a mistake that I believe the Government will come to regret. The Secretary of State recently announced a number of measures aimed at making the NHS more open to learning from mistakes, and we of course support him in doing that, but when will he learn from his mistakes? When will he learn how to conduct a negotiation in a measured way?

On any analysis the Secretary of State has failed. He has failed to win the trust of the very people who run our hospitals, and the support of patients and the public. The Health Secretary may be content with a legacy of failure, but the way in which he has alienated a whole generation of doctors is something we will have to live with for many years to come.

Cities and Local Government Devolution Bill [Lords]

Steve Brine Excerpts

Monday 7th December 2015 Commons Chamber

[Liz McInnes]

I am sure that, like me, the hon. Lady does not agree with the cuts that have been made to the Northumberland national park authority. I am sure, too, that she would rather we had a proper debate on this matter instead of discussing a new clause that has been snuck in at the eleventh hour.

[Steve Brine (Winchester) (Con)]

I understand that the hon. Lady has not spoken to the national park authorities, but that is not necessarily a reason to oppose the proposal. I have spoken to members of the board of the South Downs national park authority—Margaret Paren, who leads it, and Councillor Barry Lipscomb, who is a Winchester City councillor—and they very much welcome it. They think that this general power of competence will allow them to be full players at the table in the devolution bids that are so important in my area. I do not know what “Aunt Sally” means, although I remember her on the television, but this is nonsense. It is opposition for opposition’s sake. The Government should get with the plan here. Just because the Opposition have not talked to the national park authorities does not mean that they should vote against the proposal. I have spoken to the national parks, and they want this.

[Liz McInnes]

I am sure the hon. Gentleman believes that the Government should get with the plan. However, we are the Opposition. I am not opposing the proposal for opposition’s sake; I am opposing it because I think we need a proper debate on it. It could have a far-reaching effect on our national parks, which are loved and valued by the general public.

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[Robert Neill]

Thank you, Mr Speaker.

That was without any doubt the least-informed speech I have heard from a Front Bencher in the whole of my career in the House of Commons. I am sorry to say that to the hon. Member for Heywood and Middleton (Liz McInnes), but she has simply not read the new clause and understood what it is about. It extends the power of general competence that applies to local authorities, which her party supported as a welcome thing when I introduced it as a Minister, along with my colleagues, to local national parks authorities; it does not affect planning in any way whatever. I am horrified that an Opposition Front-Bench spokesman does not understand the difference between the role of a national parks authority qua local authority and its role as a planning authority, which is not changed in the slightest by any of this. The Opposition’s approach is therefore worrying.

[Steve Brine]

As the shadow Minister would not give way to me for a second time, I wish to put on the record the fact, which my hon. Friend will confirm, that we did have advance notice of the new clause. I met the South Downs national park authority on 13 November, when it made clear its support for the provision. It, like me, has had that much time to look at it. The Opposition may have been distracted by other matters, but that is a whole other matter—and, for the record, Aunt Sally was in “Worzel Gummidge”.

Oesophageal Cancer

Steve Brine Excerpts

Monday 23rd February 2015 Commons Chamber

[Mike Weatherley]

I could not agree more. Early diagnosis is one of the key recommendations that I shall be making.

It is clear that cancer is one of the leading causes of death, but there are risks for survivors as well. It is estimated that 2.5 million people are living with and beyond cancer, and we know that at least one in four cancer survivors face poor health or disability after treatment. Cancer of the oesophagus is the eighth most common type of cancer in the UK among men. Only 40% of those who are diagnosed with it will live for at least one year after the diagnosis, and, tragically, 85% will die within five years. Let me put that into a personal perspective. According to the statistics, if I survive for another four years, I shall be part of a very small minority of just 15%. When people ask why I am leaving Parliament after one term, I reply that one of the reasons is that, given such a high probability, there is a chance that I will not see out another Parliament, and that does make one think about other options.

[Steve Brine (Winchester) (Con)]

I congratulate my hon. Friend on raising this issue in the House. As ever, he is making a powerful speech. He will know—because he is living proof of it—that oesophageal cancer is curable if diagnosed early, and I know from all the work that has been done in connection with cancer, and particularly as a result of the interest that I have taken in the House over the years in the subject of breast cancer, that early diagnosis is the key. However, although timely and equitable access to diagnostic tests is hugely important, there is considerable evidence that access to referral for endoscopies is not as readily available in less affluent areas, and that treatments differ widely across the country. The equity of access for endoscopies from which my hon. Friend was so lucky to benefit is the key to early diagnosis, and hence to enabling many more people to survive oesophageal cancer.

[Mike Weatherley]

My hon. Friend makes a very important point that I was not going to cover, and I thank him immensely for doing so.

Crucially, as with many other types of cancer, the outcome of oesophageal cancer depends on how advanced it is when it is diagnosed. The reason not many people can have surgery is that by the time a difficulty in swallowing is recognised, the tumour has become fairly large and has spread. As my hon. Friend pointed out, the surgeons see most people when they are already too late for curative treatment, which makes it difficult to identify survival rates for each individual stage of the disease.

What measures would I like the Minister to consider? Let me make six points. First and, I think, most important, we should make the process of seeing the doctor much easier. No one should be put off from making an appointment at the first available opportunity. Access to evening and weekend GP clinics remains patchy at best, and, as we know, that has a knock-on effect on A and E departments.

Secondly, we should make every effort to improve testing at the point of contact with GPs, and to ensure that there is rapid follow-up access to hospital diagnostic tests. Giving some GPs direct access to hospital specialist tests such as endoscopies and CT scanning would speed up the process of diagnosis.

Thirdly, we should educate patients so that they recognise the symptoms of oesophageal cancer. That will lead to earlier detection of cancer, which in turn will lead to higher survival rates. A good oesophageal awareness campaign is currently running on television.

Fourthly, 1 believe there are some “quick wins” which, if implemented, could speed up processes, remove inefficiencies and save money. For example, at the moment if someone is referred for a chest X-ray and the findings are abnormal, the results go back to the consultant or GP and the person has to have another appointment before they can be referred for an additional test, such as a CT scan. If a chest X-ray was found to be abnormal and the person was then referred straight for a CT scan, it would save on unnecessary GP or consultant appointments, and ensure that when the person is seen, their GP or consultant has all the information they need to make a diagnosis and set out next steps.

Fifthly, another factor in poor care is that it is almost invariably because of pressure on specialists due to the volume of work. When campaigns are announced by the Government, they create a surge in demand, which causes problems for medical staff because they cannot cope with the high volume of work. I would like the Minister to consider allocating extra resources for endoscopy. Targets and high outputs mean that patients are treated as statistics rather than as individuals. Take this quote, for example, from an upper-GI surgeon:

“I get lists of potential 62 day target breaches with no details of the patients themselves. We see about 20 patients in two hours in our cancer clinic on the one morning we have for these appointments—that equates to just six minutes per patient. In order to give patients dignity and respect, most doctors would need an hour per patient to talk them through their diagnosis, treatment and surgery.”

Here is a similar point direct from another specialist surgeon:

“I fully support the ‘Action Against Heartburn’ organisation emphasising the need to take seriously symptoms of persistent heartburn and dysphagia, and not having more and more medications without investigation.”

This will increase demand on endoscopy services significantly, as well as CT scanning, which of course would need extra funding to cope. However, the increased detection of early disease will enable more minimally invasive endoscopic therapy, avoiding surgery and saving money.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Hove (Mike Weatherley) on both securing this debate and moving it in such a personal way and giving us an account of his own experience of this dreadful disease. I am sure his words will resonate with all of us who have listened tonight, and in particular the way he took us on that journey from the first difficult moments of diagnosis through to treatment. It was a vivid and thought-provoking, but also a heartening, account.

My hon. Friend is absolutely right to draw attention to the dedicated and inspirational NHS staff, who work so passionately up and down the country for their patients. How nice it was of him to take the opportunity to put that on record this evening; that was tremendous. Never is the debt of gratitude we owe the NHS staff felt more keenly than when we personally benefit from the care they provide, often at our most vulnerable and weak moments. They are, as he says, not just care-givers, but life-savers in those situations.

My hon. Friend rightly challenged us to do better in this area. Improving cancer outcomes is a major priority for this Government and, as the annual report on our cancer outcomes strategy last December showed, we are on track to save an extra 12,000 lives a year by 2015. That is the projection based on the figures to date. We all want to see the best possible results for all cancer patients, but he was right to highlight the fact that outcomes are particularly poor for patients with oesophageal cancer. I am aware, from all our debates, that this is an area in which we have not seen the sort of movement that we have seen with other cancers. Each year in England, about 7,000 people are diagnosed with oesophageal cancer and 6,000 people are diagnosed with stomach cancer. Those diseases cause around 10,200 deaths in England each year.

We had some exciting news recently: the NHS England cancer taskforce was announced on 11 January. NHS England announced that this new independent cancer taskforce would develop a five-year action plan for cancer services with the aim of improving survival rates and saving thousands of lives in England. The cancer taskforce has been set up to produce a new cross-system national cancer strategy to take us through the next five years to 2020, building on NHS England’s vision for improving cancer outcomes that was set out in the NHS’s “Five Year Forward View”. It was formed in partnership with lots of different cancer charities and other parts of the cancer community, along with other health system leaders, and it is chaired by Dr Harpal Kumar, the chief executive of Cancer Research UK.

The taskforce will cover the whole cancer pathway through prevention, diagnosis and treatment to provide support for those living with and beyond cancer and end-of-life care, as well as covering how all those services will need to develop and innovate. My hon. Friend was right to challenge us to look creatively at different ways of doing things, and that is exactly what the taskforce has been charged with doing. NHS England is assessing the opportunity for improved cancer care and will produce initial views by March—next month—with the new five-year cancer strategy to be published in the summer.

As my hon. Friend emphasised, early diagnosis is absolutely key. Tackling late diagnosis will be an important element if we are to achieve our ambition to improve cancer outcomes, which is why our cancer strategy invested £450 million during this Parliament in improving earlier diagnosis. As his own experience has attested, it can be difficult to diagnose oesophageal cancer, especially in its early stages. I congratulate him again on securing this debate and I hope that there is someone out there tuning into the debate who has heard his words. I am sure that they will help to publicise the message about taking notice of symptoms.

When symptoms do manifest themselves, it is often an indication that the cancer has developed. That is why early diagnosis is crucial. Just under 70% of people diagnosed with oesophago-gastric cancers at the earliest stage survive for at least five years. My hon. Friend has highlighted what it means in human terms for those who are diagnosed at a very late stage. It has been estimated that around 950 lives could be saved in England each year if our survival rates for oesophageal and stomach cancers matched the best in Europe, and that clearly has to be our aim: we have to do better.

NHS England has launched a major early diagnosis programme, working together with Cancer Research UK and Macmillan Cancer Support to test new approaches to identifying cancer more quickly. I hope that that programme will give my hon. Friend some encouragement, because it touches on some of the issues that he has mentioned. It will include offering patients the option to self-refer for diagnostic tests; lowering the threshold for GP referrals; creating a pathway for vague symptoms; and setting up multi-disciplinary diagnostic centres so that patients can have several tests done at the same place on the same day.

[Steve Brine]

Southampton has been mentioned, as has my constituent Tim Underwood, who leads the team there. What the Minister is saying is absolutely right. Does she agree that regional centres such as Southampton—which do things that, quite rightly, not everyone does—are the key to providing regional areas of specialism to help us to do even better on the diagnosis and treatment of oesophageal cancer?

[Jane Ellison]

In a recent Back-Bench debate on cancer, mention was made of the tension that we all feel as constituency Members between the desire to have services nearby and the recognition that the expertise resulting from seeing lots of cancers, particularly the rarer ones, is really important to developing clinical excellence. We have to be clear that there are areas where concentrating excellence and clinical experience will save lives, and my hon. Friend perhaps highlights one such area. We often underestimate just how few cancers of any kind the average GP sees, and that is especially true of rarer cancers.

Let me go back to the different ways of looking at earlier diagnosis. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England to collect evidence on approaches that could be implemented from 2016-17. In 2013, Macmillan Cancer Support, partly funded by the Department, piloted an electronic cancer decision support—CDS—tool for GPs to use in their routine practice. It covers lung, colorectal, pancreatic, oesophagus and stomach, and ovarian cancers. Following the pilot, the CDS tool has been refined and is currently installed in more than 1,000 GP practices across the UK. It is designed exactly to deal with the point about helping people who do not see certain things very often with those diagnostics. Macmillan is working with software companies to adapt the CDS for different IT systems and make it available to GPs as part of their standard software offer.

I just wish to mention the Be Clear on Cancer campaign, which I am glad my hon. Friend the Member for Hove mentioned.

Breast Cancer

Steve Brine Excerpts

Tuesday 25th November 2014 Commons Chamber

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I am very pleased to have secured this debate, as it permits further discussion on some of the work that my hon. Friend the Member for Winchester (Steve Brine), the hon. Member for Washington and Sunderland West (Mrs Hodgson) and I, as co-chairs of the all-party parliamentary group on breast cancer, have been engaged in over the past four years. We work with all the major breast cancer charities, including Breakthrough Breast Cancer, which provides the secretariat for our group, Breast Cancer Campaign, which is merging with Breakthrough next year, and Breast Cancer Care. We thank them all for their work and support.

Breast cancer is a disease that many of us will know about and have experience of. With nearly 55,000 people diagnosed with the disease in the United Kingdom every year, everyone will know of somebody—a loved one, a friend or even themselves—who has experienced this disease. It is still the most common cancer in the UK, and around a third of all new cancers diagnosed in women are breast cancer.

Over the past few decades, great strides have been made in treatment and care, leading to much improved outcomes. Since the 1980s, breast cancer deaths have fallen by more than a third, and today more people survive breast cancer than ever before. More than eight out of 10 people are living five years or more following their diagnosis. The all-party parliamentary group recently carried out an inquiry into breast cancer in older women. The resulting report is entitled “Age is just a Number”. We discovered that there were many improvements that could be made to ensure earlier diagnosis, better communication, and better treatment and support. We are pleased that many of our recommendations will be implemented and hence overall life chances will be improved further.

[Steve Brine (Winchester) (Con)]

I congratulate my right hon. Friend, at the end of her time in the House, on bringing the topic of breast cancer to the Floor of the House of Commons in the way that she has. She conducted the inquiry with me and, as she knows, one of the things that I was so struck by is the belief out there that the risks of contracting breast cancer go down as one gets older and passes the screening age, whereas we know and the evidence shows that, on the contrary, they go up.

[Annette Brooke]

I thank my hon. Friend for the great leadership that he gave in the inquiry. I believe we brought out a great number of myths, which will much improve the approach to primary breast cancer. However, fewer people know about secondary breast cancer.

In October 2010, the United Kingdom had its first secondary breast cancer awareness day. In secondary breast cancer, sometimes known as metastatic, advanced or stage 4 breast cancer, the breast cancer cells have spread to other parts of the body, most commonly the bones, brain, liver or lungs. Secondary breast cancer is incurable and, sadly, 11,600 people die every year as a result of secondary breast cancer—the equivalent of 32 people every day. Many people diagnosed with secondary breast cancer live with the disease for a number of years. In such cases, the care and support that they receive can make a real difference to their quality of life.

I was able to raise the issue of data collection directly with the Prime Minister during Prime Minister’s questions in 2010. At that time there was no reliable data collection on how many people were living with the disease in the UK, meaning that care and support services could not be accurately costed or developed. Subsequently the main breast cancer charities and the three co-chairs of the all-party parliamentary group met the Prime Minister to discuss what was needed. We were very pleased to welcome in 2011 the publication of the Department of Health cancer strategy, “Improving Outcomes: A Strategy for Cancer.” The strategy included the aim of beginning a full collection of statistics on secondary breast cancer from April 2012, yet there still seem to be considerable gaps, as I shall outline later in my speech.

The purpose of data collection is to make sure that the quality of services offered is improved. Although we can undoubtedly find examples of best practice, there are still many concerns about the overall level of service provision in this area.

[Steve Brine]

I am sorry to interrupt my right hon. Friend’s flow again. One of the things that came out of our time with the Prime Minister on collecting the data on secondary breast cancer was the importance of secondary breast cancer care nurses. I pay tribute to the work of Breast Cancer Care in this respect. Does my right hon. Friend agree that those nurses can make a transformative difference to women and their families who are going through secondary breast cancer, by linking them up to other services in the NHS and providing knowledgeable support to them?

[Annette Brooke]

Again, I thank my hon. Friend. Over the years we found that the provision of a specialist nurse makes a crucial difference. When someone has a symptom that they are not quite sure about and they think, “I don’t want to bother to go to my GP”, being able to pick up the phone and get expert advice deals with the problem quickly, takes away the worry, and if it is necessary to see a doctor, they can go, confident in the knowledge that they are not just imagining the symptom and that it is important for them to follow it through.

A recent survey by Breast Cancer Care, which was released to mark this year’s secondary breast cancer awareness day on 13 October, reported that 90% of people with a secondary breast cancer diagnosis have experienced pain as a result of the disease in the past month. Half of those described their pain as moderate or severe. For 78% of people, their pain meant that they were unable to undertake normal everyday activities, such as household chores, work, child care, hobbies or socialising. Pain is one of the most common symptoms of secondary breast cancer, but much of it can be controlled and managed through access to palliative care. In fact, guidelines from the National Institute for Health and Care Excellence state that referrals to palliative care should be offered soon after a secondary breast cancer diagnosis. However, the same survey by Breast Cancer Care found that only 41% had been offered a referral to a palliative care team. That means that thousands of people are experiencing pain that could be controlled and managed. I am sure that we can all agree that it is unacceptable that anyone should be expected to live with unnecessary pain.

Another indicator of where the care and treatment for secondary breast cancer is not good enough is the lack of secondary breast cancer clinical nurse specialists. The NICE quality standard for breast cancer highlights that everyone with secondary breast cancer should have access to a clinical nurse specialist. The most recent results of the national cancer patient experience survey also found that access to a named clinical nurse specialist was often associated with having a more positive experience in care. For primary breast cancer—I am pleased that progress has been made in this area—it is much more routine for patients to have a clinical nurse specialist to help to co-ordinate their care and provide the support they need.

--- Later in debate ---

[Annette Brooke]

I thank the hon. Gentleman for his intervention. I hope that the Minister has taken that point on board, because it is really important. Although data are being collected, they are not being received by various groups, and the purpose of this debate is to address that.

The pilot was run by the National Cancer Intelligence Network in collaboration with Breast Cancer Care, and it involved 15 breast cancer units across England. The pilot report, published in March 2012, identified 598 patients with recurrent or metastatic breast cancer. Of those, only 53% were recorded as being referred to a clinical nurse specialist, palliative care nurse specialist or other key worker at the time of diagnosis. That is despite the NICE quality standards and the evidence in the cancer patient experience survey of the benefit to patients of a named nurse.

[Steve Brine]

The pathway—the person who can help to pilot the patient through services—is not only found in the public sector; there are also services in the third sector. Is my right hon. Friend aware of the amazing work of Breast Cancer Haven, which has two centres—and, I hope, a third on the way in our Wessex area next year? It provides a complementary service that helps women to feel human again after they have had surgery and a devastating secondary diagnosis. This is not just about connecting them to services in the NHS; it is also sometimes about the charitable sector.

[Annette Brooke]

I thank my hon. Friend for reminding us of those very important services. I very much hope that I can visit one of Breast Cancer Haven’s units in due course, because I have not yet done so.

The pilot recommended that all breast cancer units in England submit data on patients with recurrent and metastatic breast cancer using existing data collection mechanisms. However, since the pilot no such data have been published. Since January 2013, it has been mandatory for all new recurrent and metastatic diagnoses to be recorded in England. The third annual report on the strategy confirms that this collection is taking place, but the problem is that the data do not seem to be publicly available.

A recent parliamentary question by the hon. Member for Ealing, Southall (Mr Sharma) about diagnosis of metastatic breast cancer in his constituency was responded to by the Office of National Statistics, which said:

“Detailed information about secondary cancer diagnoses is not routinely recorded on individual cancer registrations sent to ONS for processing and publishing as National Statistics. For these reasons it is not possible to provide figures on secondary breast cancer.”

This information needs to be made publicly available to allow scrutiny of the data and to help highlight areas that require action. It would be helpful if the Minister outlined what plans are in place to start publishing these data and whether the data include routes of referral. If there are no such plans, what is the reason for not making the data publicly available?

Not only have we seen no data published on secondary breast cancer, but there is also evidence to suggest that the data collection is not happening consistently across England. Breast Cancer Care is concerned that this will impact on the quality of the data that could be made available. Whether we will have a clearer picture on the needs of secondary breast cancer patients remains to be seen. Once consistently collected, it is also imperative that data can be accessed by research organisations, including charities, to drive improvements in care. Obviously, it is crucial that there are strong safeguards on privacy, but for numerous other reasons, including uncertainty following the restructuring of the NHS, there is great concern that routinely collected pseudonymised data sets are not consistently being made available for health research.

Breast Cancer Campaign has drawn my attention to some detailed points about data collection. The first relates to the current review of the national cancer peer review programme, which routinely monitors the quality and safety of NHS cancer services. I understand that it collects data on a number of key measures related to secondary breast cancer. There are concerns that it may not continue next year in its current form, or at all. I hope the Minister will comment on that. How will patients be provided with information on the safety and quality of their local cancer services, should the national cancer peer review programme be discontinued?

Secondly, if we are to achieve the Health Secretary’s goal of being among the best in Europe for cancer survival, measures to hold clinical commissioning groups to account for the cancer services they provide are vital. What consideration has the Minister given to the inclusion of indicators on cancer patient access to a clinical nurse specialist and multidisciplinary teams in the CCG outcomes indicator set, and what steps can she take to ensure that CCGs are held to account on their performance against that set? What further discussions is the Minister actually having?

In conclusion, the Government should be congratulated on the important progress they have made on cancer over the past four years. Initiatives such as the cancer drugs fund have made a big difference to patients in improving access to clinically effective drugs and treatments. However, in order to achieve the Government’s stated ambition of being the best place in Europe to survive cancer, more needs to be done. For that to happen, evidence is needed to provide the intelligence and insight required to enable local commissioners and health care professionals to plan effectively to meet their patients’ needs. I hope the Minister will join me in agreeing that it is no longer acceptable that the collection of data on secondary breast cancer does not consistently take place.

This is an important public issue. A petition by Breast Cancer Care calling for secondary breast cancer to be a priority for this Government has to date secured almost 12,000 signatures—a fitting milestone, given that almost the same number are dying from secondary breast cancer every year. Will the Minister commit to making secondary breast cancer a priority for her Department and, once more evidence is highlighted from the data, to working with Breast Cancer Care and other charities to improve the support and care that patients receive?

Only once everyone has the opportunity to access a clinical nurse specialist to support their care, to be referred to palliative care so they are not in unnecessary pain, and to receive the best possible care and treatment to live as good a quality of life as possible with the disease can we truly consider the United Kingdom to be one of the best in Europe for cancer care.

--- Later in debate ---

[Steve Brine]

May I thank the Minister for thanking the three big breast cancer charities? Breakthrough, with support from the others, provides the secretariat for our all-party group. She will be aware of the work of CoppaFeel and its “Rethink Cancer” campaign. Treatment and survival are obviously critical—today’s debate is about that—but prevention is clearly better than cure. Will she take this opportunity to endorse CoppaFeel’s work in educating young women, and men, to spot the signs and symptoms of cancer early so that we can prevent primary breast cancers from developing in the first place? She will know that Kris, who runs CoppaFeel—she has a terminal diagnosis—is passionate about this, and has done so much to put it on the agenda for young women in this country.

[Jane Ellison]

I certainly pay tribute to all those who are trying to drive awareness of this issue. There are a number of very important campaigns. Prevention is so important; for example, it was good that it was right at the heart of the recent NHS “Five Year Forward View”. There is a lot more to do, and I have recently had discussions with some of the breast cancer charities about how we use their reach and undoubted public credibility, which is enormous, to raise awareness more about some of the things that people can do on the prevention front, as well as about their important work on care and drugs. I join my hon. Friend in paying tribute to those campaigners.

The NHS is treating more people with cancer than ever, as I have said. Survival rates for breast cancer are improving, with more than 85% of women with breast cancer in England and Wales now living for more than five years. The work that all the charities have done in that regard is really important. They have all made significant contributions, but we know that more needs to be done, and that is the focus of this debate. We need to catch breast cancers earlier, and to avoid the risk of secondary breast cancers. We also need to improve the detection and treatment of secondary breast cancer, as my right hon. Friend has highlighted.

My right hon. Friend spoke very movingly about pain and its management. I am sure that we all agree that our NHS doctors and nurses do everything that they can to alleviate pain. In fact, it was good to see from the 2014 cancer patient experience survey that only 1% of patients reported that they did not think that hospital staff did everything they could to control their pain. Indeed, 86% of patients—the highest level in the four surveys so far—reported that staff did everything they could to control their pain. She is right to say that referral to specialist palliative care services can provide more by way of effective pain relief. The NHS must do what it can to ensure that women with secondary breast cancer have access to the right services. She is also right to highlight the room for improvement on that.

On the patient experience for women with secondary breast cancer, the results of the 2014 cancer patient experience survey show improvements in many areas, with 89% of all patients reporting that their care was either excellent or very good. As my right hon. Friend said, there are two specific references to secondary breast cancer in the NICE quality standard. The first states that people who develop it should

“have their treatment and care discussed by the multidisciplinary team”,

and the second states that people with recurrent or advanced breast cancer

“have access to a ‘key worker’, who is a clinical nurse specialist whose role is to provide continuity of care and support”—

she mentioned that—

“offer referral to psychological services if required and liaise with other healthcare professionals, including the GP and specialist palliative care services.”

NICE clinical guidelines represent best practice, and we expect commissioners and clinicians to take them into account when making decisions, including on the provision of cancer nurse specialists. On the whole, breast cancer patients reported a more positive experience than many other cancer patients, and 93% were given the name of a clinical nurse specialist. My right hon. Friend is right to highlight the fact that we are not doing as well for patients with secondary cancer or a recurrence of cancer—those patients reported a worse experience and were less likely to have a clinical nurse specialist. NHS England is working with NHS Improving Quality, Macmillan Cancer Support and strategic clinical networks to improve the cancer patient experience and spread good practice across hospitals providing cancer care. That includes support from a clinical nurse specialist for those with secondary breast cancer.

Mitochondrial Replacement (Public Safety)

Steve Brine Excerpts

Monday 1st September 2014 Commons Chamber

[Tim Loughton (East Worthing and Shoreham) (Con)]

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on introducing this debate. It is absolutely essential that Parliament has the opportunity to talk through these important details at greater length.

As my hon. Friend knows, I am usually very conservative on ethical matters such as this. I do not usually advocate anything that might be seen as playing God. I have severe reservations about euthanasia. I have always opposed and will always oppose anything that would modify human characteristics and be seen as creating some form of designer baby. However, there are times when one has to be pragmatic. I have met families of the victims of these terrible, deforming, disfiguring and life-shortening diseases. It is right that we should use our human knowledge for the good of fellow mankind. It is great that, as my right hon. Friend the Member for Havant (Mr Willetts) has said, British science is leading the way.

Science is about finding cures and solutions, and this is just a different way of preventing horrible things from happening to our children. It is fundamentally a human intervention and it should be judged purely on the basis of whether we are doing more good than bad. I believe that we are when one in 6,500 of our constituents each year contract, without any choice, these horrible inherited diseases. The longer we say, “We need more checks, more safety, more testing”, the longer we are delaying a cure.

We need to get on with it. It has been widely consulted on. I have received virtually no letters on this matter and we need to take a balanced judgment on when the risks of mitochondrial donation become proportionate to the severity of the diseases that are affecting our constituents now. As colleagues have said, it will be licensed by the HFEA based on the safety and efficacy of the evidence, and those licences can be withdrawn at any time.

“Mitochondrial donation only allows for unaltered nuclear DNA to be transferred to an egg or embryo that has unaltered healthy mitochondria. These techniques only replace, rather than alter, a small number of unhealthy genes in the ‘battery pack’ of the cells with healthy ones. Mitochondrial donation does not alter personal characteristics and traits of the person.”

That is an important consideration, because:

“Mitochondrial donation will enable mothers to choose to have children who are genetically related to them, with a natural combination of nuclear genes from both parents while being free from a potentially devastating disease.

Nuclear DNA is not altered and so mitochondrial donation will not affect the child’s appearance, personality or any other features that make a person unique—it will simply allow the mitochondria to function normally and the child to be free of mitochondrial DNA disease. The healthy mitochondria will also be passed on to any children of women born using the technique”—

so we are doing good for generations to come as well.

[Steve Brine (Winchester) (Con)]

I agree with what my hon. Friend is saying, and I do not agree with the motion of my hon. Friend the Member for Congleton (Fiona Bruce), although I have great respect for her, as a fellow Christian in this House. The work at Newcastle university is being funded by the Muscular Dystrophy Campaign and by the families and the people whom it supports and works with. Does my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) agree that the fact that they are putting money behind this, speaks volumes about the motives behind the work and about not letting the bad be the enemy of the good?

[Tim Loughton]

My hon. Friend is absolutely right. I think it is a great triumph that a British university is doing this important work. To those who say, “No other country allows this sort of thing,” I say, “Well, great; we are pioneering here, as British science has done in so many different areas.”

We need to be honest. We can raise a question about the ethics of it, but we should not hide behind safety considerations when certain people really oppose it for ethical reasons. Let us have that honest debate. I am prepared to give my support to these regulations and to us getting on with this science, with the assurances that there will be strict licensing conditions based on strong scientific evidence and that this in no way can lead to anything that can be remotely construed as designer babies, which I find completely and utterly abhorrent.

We should get on with it. Mankind has used its knowledge and skill to invent some pretty devastating and ghastly ways of disfiguring, maiming, neutering and killing human kind. We should celebrate this remarkable advance in using our scientific knowledge—our human skills—for good, and potentially for the good of generations to come in the families afflicted with these terrible illnesses.

--- Later in debate ---

[Steve Brine]

I am listening carefully to what the hon. Gentleman says, and the way in which this debate is being conducted shows the House of Commons at its best. He is one of the co-sponsors of this debate and he is speaking out of a great deal of fear about what might happen. Is his wish, in supporting the motion, to kick this into the longest of long grass or to see it stopped dead in its tracks? Will he be clear about that?

[Robert Flello]

I can be even clearer than that, because it is neither of those things. I want further research done on the safety implications and I want the consultation to which my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) referred a while ago actually to be taken forward. Let us consider the polling the Government did. Their response to the consultation on mitochondrial transfer, published the day before the summer recess, tells us that

“700 expressed general support for the regulations and 1,152 opposed the introduction of the regulations with the remainder not expressing a view either way.”

Yet the same day the BBC quoted the Department of Health as saying:

“A public review into the three person IVF technique has been broadly supportive”.

That in turn enabled Dr Jeremy Farrar, director of the Wellcome Trust, to say:

“As the Government’s latest consultation has again shown, there is broad public support for making mitochondrial replacement therapy available to patients”.

That raises the question: in which world does 1,152 against and 700 in favour equate to “broadly supportive”? Does the Minister support her Department’s briefing that the consultation responses were “broadly supportive”? What further action does she intend to take to correct the highly misleading statement? Someone may think that the public were misinformed or that only a small group of people were responding and the responses were thus disrupted, but what is the point of having that consultation if no notice is going to be taken of it?

At the end of the day, there is concern about this matter. I have a concern—perhaps I am the only Member in this House who does—but if, as I fear, this legislation goes ahead in the autumn, I do not want to have to come back to this House to say to future generations, “Look what we did.” Once we go down this route and children start being born, there will be no turning back—[Interruption.] Yes, it is the power sell of the cell. There is not enough research on what the mitochondrial part does. Is it just a battery pack, or is it more? We just do not know. I do not want to have to stand up in this House and explain to generations of future children why we let them down.

Care Bill [Lords]

Steve Brine Excerpts

Tuesday 11th March 2014 Commons Chamber

[Dr Poulter]

Let me make a little progress, because I have been generous in giving way.

Let us consider the following:

“The vast majority of trusts perform well, but in the rare instances where that is not the case, there must be transparent processes in place to deal with poor performance.”—[Official Report, 8 June 2009; Vol. 493, c. 544.]

I completely agree with those words—the right hon. Member for Leigh (Andy Burnham) used them when he described the purpose of the regime to this House in 2009. This is Labour’s regime, which it now tries to disown in opposition. The TSA regime is only ever used as the very last resort, and provisions in the Care Bill will introduce, importantly, a new role for the Care Quality Commission for triggering the regime when there has been a serious failure of quality; the emphasis will now be on quality, rather than merely on financial failure.

Clause 119 respects the coalition agreement that routine service changes will be locally led; it is about protecting patients and ensuring we can act rapidly and effectively in their best interests in examples of extreme failure. It may therefore be helpful if I set out some of the changes and improvements we are making to the regime under clause 119.

[Steve Brine (Winchester) (Con)]

I think I know the answer to this, but the opposite has been said so many times in the past three and a quarter hours that it is worth saying it again. The Minister knows that my local foundation trust is undergoing proposals that will lead to a public consultation on reconfiguration, which is supported on clinical grounds by the commissioners. Whatever view local representatives and others take on that—I am far from sold on this at the moment—will he confirm to me, as he did to my hon. Friend the Member for Bedford (Richard Fuller), that neither he nor his administrators will be on a train to Winchester any time soon?

[Dr Poulter]

My hon. Friend is absolutely right in what he says. These are decisions, under the legislation that this Government introduced, that are being led by local commissioners and local clinicians engaging with patients; they are nothing to do with the TSA regime we are discussing today, which deals with examples of extreme failure in the NHS.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

The reason that we got rid of that guarantee was that the number of people who were able to see a GP within 48 hours was falling in the last year in which the target was in place. It was not working, and that is why the British Medical Association and the Royal College of General Practitioners were against it. In the same survey that the hon. Gentleman quoted, the RCGP said it estimated that there had been a 10% increase in the number of GP appointments compared with when his Government were in office.

[Steve Brine (Winchester) (Con)]

2. What recent steps he has taken to improve maternity care.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have made improving maternity services—so that women have a named midwife responsible for ensuring personalised care—a key objective in our mandate to NHS England. Since May 2010, the number of midwives has increased by more than 1,500 and a record number—in excess of 5,000—are now in training. Over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to over 100 maternity units.

[Steve Brine]

My local foundation trust is currently exploring a major service change which would see the creation of a new acute care hospital to handle the sickest and most complex patients. It would leave midwife-led units only in Winchester and Basingstoke, and centre consultant-led services on the new site. Does the Minister feel confident that the clinical case for this kind of centralisation has been made? Would he be comfortable to see it rolled out across the NHS?

[Dr Poulter]

My hon. Friend is right to highlight the fact that such decisions are clinical decisions and need to be made at a local level to ensure safe care, both with appropriate numbers of obstetricians in obstetric-led units and to give women the choice to deliver in midwifery-led units where appropriate. I am pleased that we, as part of the fund that I outlined earlier, have been able to give Hampshire Hospitals NHS Foundation Trust £50,000 to provide enhanced facilities in birthing rooms at Florence Portal house.

Early Childhood Development

Steve Brine Excerpts

Thursday 30th January 2014 Westminster Hall

[Andrea Leadsom (South Northamptonshire) (Con)]

I am delighted to have secured this debate, and I am grateful to the Backbench Business Committee for selecting it. Mr Weir, did you know that 36% of all case reviews into deaths or serious abuse involve a baby under the age of one, and that a quarter of all babies in the UK have a parent affected by domestic violence, mental health or drug or alcohol problems? Furthermore, if one asked most local authorities how much they spend on specialist parent and infant mental health services, the answer would be, “Nothing.”

I am proud of the fact that with three cross-party colleagues, I have launched the manifesto “The 1001 Critical Days” to propose specific ways that the Government can better support the needs of new families. The 1,001 critical days is the period of time from conception to the age of two. In our cross-party manifesto, the right hon. Members for Birkenhead (Mr Field) and for Sutton and Cheam (Paul Burstow), the hon. Member for Brighton, Pavilion (Caroline Lucas) and I seek to recognise the overwhelming evidence now available that a secure early relationship between baby and key carer is vital to the infant’s lifelong emotional and physical well-being.

We are grateful for the strong interest that the manifesto has received from Ministers and shadow Ministers, particularly the Under-Secretary of State for Health, my hon. Friend the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), and the hon. Members for Manchester Central (Lucy Powell) and for Washington and Sunderland West (Mrs Hodgson). We have also been delighted by the amazing number and range of endorsements for our manifesto, from the chief medical officer for England and Wales to UNICEF UK, the National Society for the Prevention of Cruelty to Children, the Centre for Social Justice, Barnardo’s, the Royal College of Midwives, the Royal College of General Practitioners and the Institute of Health Visiting. The list goes on and on.

Mr Weir, you might be wondering what on earth is left to debate if the topic is such a love-in, but the truth is that there is an enormous amount to be done if we are to seize the opportunity to change our society radically for the better. An NSPCC study shows that only 64% of NHS trusts have a perinatal mental health strategy. Other recent research shows that 42% of GPs feel that they have very little knowledge about the specialist services available for severe mental illness. Nearly a quarter—23%—of all maternity professionals say that they have received no education on maternal mental health, and the Royal College of Paediatrics and Child Health estimates that the annual short-term costs alone of emotional, conduct and hyperkinetic disorders among children aged five to 15 in the UK are £1.58 billion, and the annual long-term costs are £2.53 billion.

The Institute of Health Visiting is delighted by the Government’s commitment to significantly increasing the number of health visitors, and progress in training new health visitors is on target. However, in a recent survey by the institute, 87% of midwives said that their work loads had increased and that they were seeing the following worrying trends: 65% were seeing increased child behaviour problems, 61% reported seeing an increase in the prevalence of speech delay, 73% were seeing an increase in poverty that was having a bad influence on families, 82.5% were seeing an increase in domestic violence and abuse and 70% reported an increase in the incidence of perinatal depression. Perinatal depression includes antenatal depression—that is, before a woman has her baby—as well as the depression that can arise during birth as a result of a traumatic birth experience and, of course, post-natal depression, which is the main subject that people talk about when they talk about depression in the perinatal period, if they ever talk about it.

Everyone would agree that prevention is better than cure. Everyone, or pretty much everyone, would agree that many of our society’s greatest problems stem from alcohol and substance abuse and mental illness. But too few people realise that in a vast number of cases, those in our society who cause the most damage and cost the most money have been permanently set up for disaster from their own infancy. The absence of a secure bond between baby and carer in the 1,001 critical days has profound lifelong consequences for the baby. I am convinced that once the strong link between experiences in the earliest years and whole-life outcomes becomes more widely accepted, we will start to make huge progress in tackling society’s most intractable problems.

The efforts of 20th-century politics achieved great strides in tackling the physical health of our nation. The challenge for our 21st-century generation must surely be to secure sound mental health that will lead to a stronger and happier society. Imagine how wonderful it would be if we were to shut down prisons, not because of overcrowding or poor conditions but because we did not have enough criminals to fill them. Imagine if we could close psychiatric hospitals due to a lack of need for them.

[Steve Brine (Winchester) (Con)]

I congratulate my hon. Friend on this debate. I know that she is achieving quite a reputation in this area. The Select Committee on Justice, of which I am a member, held an inquiry recently into youth justice and the drivers of youth justice. As she will probably know, just 10% of children and young people in the general population have a speech and language difficulty, but in the prison population the figure is somewhere between 60% and 65%. Does she agree that delayed language development leads to issues at school, exclusion from school and many of the problems that cost our society so heavily?

[Andrea Leadsom]

My hon. Friend is absolutely right that delayed speech is a key contributor to later problems for the infant who does not reach the right level of speech capability in the first critical years.

Think of walking through any big city in the UK without seeing teenagers living rough in the streets. Finally, imagine a society where the number of babies and children being taken into care and removed from their families was falling, instead of rising as it is at the moment.

[Andrea Leadsom]

I completely agree, and I will discuss that in a moment. It is called the cycle of deprivation, and my hon. Friend is absolutely right to raise it.

I honestly believe that it is possible to change our society for the better, but it needs a concentrated focus on the mental health of our nation. I want us to build a third pillar to our great universal services. Alongside the achievements of free and universally available health care and education, I want a free and universal service focusing on the mental health of our people. It must start at the very beginning—the period of 1,001 critical days between conception and age two—and it must ensure that every child can build the emotional capacity and resilience to cope with life’s ups and downs.

I make the case that what we do with a baby from conception to age two is all about building the human and emotional capacity of that infant. Supportive interventions with a child after the age of two are often too much about trying to undo damage that has already been done. I would never advocate giving up on anyone, but it is an incontrovertible fact that if we want to change our society for the better, we must focus on the crucial period between conception and age two.

Human babies are unique in the animal kingdom in the extent of their underdevelopment at birth. What other animal cannot walk until it is nearly a year old and cannot fend for itself in any way at all until it is at least two years old? However, the physical underdevelopment is only a tiny part of it. The human brain is only partially formed when a baby is born. The billions of neurones in the brain are largely undifferentiated at birth, and parts of the brain are simply not there. Humans are born with only the fight-or-flight instinct and the earliest experiences of the human baby literally hardwire his or her brain and have a lifelong impact on the baby’s mental and emotional health.

What are a baby’s earliest experiences? It is quite simple. When a baby cries, he does not know that he is wet, tired, hungry, bored or too hot; he just knows that something is wrong, so he relies on a loving, adult carer to soothe his feelings. Most parents will remember, as I certainly do, long nights spent walking up and down, hugging a baby, saying, “Go to sleep, go to sleep,” desperate for sleep ourselves and determined to try one thing after another to sort the situation out. The baby whose basic needs are met learns that the world is a good place, and he or she will retain that sense as an instinct for life. That baby will be more emotionally more robust than the baby who does not have his needs met.

For the baby who is neglected or abused, there are two critical impacts on development. First, a baby cannot regulate his or her own feelings at all. If the basic needs are not met, he or she will simply scream louder and louder, and eventually take refuge in sleep. The first impact is that a baby who is left to continually scream night after night will experience raised levels of the stress hormone, cortisol. Excessive amounts of that damage the baby’s immune system permanently, and evidence suggests that a baby left to scream for hours at a time, day in and day out, will develop a higher tolerance to their own stress level, meaning that in later life, they will have more of a predisposition to high risk-taking behaviour than a baby who has only a normal level of cortisol. A lot of evidence shows that violent criminals have a high tolerance to their own stress levels. However, it is not only that—for a mother who is very stressed during the time that her baby is in the womb, the outcome is that the baby can physically be very desperately damaged. For example, maternal stress during pregnancy can lead to a thinning of the baby’s arteries, which has profound consequences later in terms of congenital heart disease, diabetes and obesity.

There is also a very real physical impact on the brain. The pre-frontal cortex—the social part of the brain—only starts to develop at about six months, and the peak period for that part of the brain to develop is between six and 18 months old. Growth is stimulated by the relationship between the baby and carer, and peek-a-boo games, gazing into each other’s eyes, singing songs, saying, “I love you, you gorgeous little thing!” and lots of cuddling all play a really strong role. Love literally shapes the baby’s brain. The brain develops millions of neural connections during that period and the pre-frontal cortex physically grows in size.

[Steve Brine]

Although I appreciate that saying, “You beautiful, delightful thing” is clearly the thing to do, at 3 in the morning, especially as a brand-new MP with a vote at 10 pm the next night, saying, “The Prime Minister really needs to be on my game” does not cut much ice with a newborn baby—I say that from bitter experience. My point is that parents have to learn how to be parents and how to give that love and care. Will my hon. Friend take a moment to recognise the amazing work of organisations such as Home-Start? They do brilliant work in teaching parents how to be parents.

[Andrea Leadsom]

Yes, Home-Start does a fantastic job, as do other volunteer organisations, peer-support groups and so on; there are many around the country. It is true to say that becoming a parent is the most difficult thing that someone ever does. There is no on-off button for a baby and no rule book, guidebook or handbook, so we all struggle on in our own way, with better or worser results—[Interruption.] Probably not “worser”—worse, thank you. The Secretary of State for Education is not responding to the debate, so we are all right, but the point is about being a good enough parent, and if a baby knows that he or she is loved, a parent does not have to say it at 3 o’clock in the morning when they are at their wits’ end. However, a baby does have to learn that their parent loves them.

When a baby does not receive attention from a loving adult carer, the pre-frontal cortex does not grow and may never grow. Many will remember the tragic story of the Romanian orphanages, where the minimal physical and emotional contact with babies left them profoundly and permanently brain-damaged. Some of them died literally from a lack of love.

It ought to be natural and automatic for families to form a loving and secure bond with their babies, but post-natal depression, problems with conception, trauma during childbirth, domestic violence and issues of poverty and deprivation all get in the way. Insecure attachment is no respecter of social class or wealth. One of the biggest obstacles to forming that crucial secure bond is when mum did not have a secure relationship with her own mother. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) pointed out, it truly is a cycle of deprivation that is all too often passed down through generations.

--- Later in debate ---

[Steve Brine (Winchester) (Con)]

It is a pleasure to follow my neighbour, my hon. Friend the Member for East Hampshire (Damian Hinds), whom I thank for the age check. I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing this debate and on the manifesto. She knows of my interest in this area, and she sent me a copy hot off the press. I read the manifesto avidly, and I am totally impressed with her work. She spoke eloquently about the cycle of deprivation, and she set out the case as to why, in many ways, society is broken. I will not go on about that, but I think the family unit is the answer that holds so much of this together. Some of my comments will probably tie together the interventions that we have had over the past 15 minutes.

Many Members will be familiar with the work of the Centre for Social Justice, which was set up by the Secretary of State for Work and Pensions when we were in opposition. The CSJ produced a report last year called “Fractured Families: Why stability matters,” which built on the seminal 2006 work “Breakdown Britain” and the 2007 work “Breakthrough Britain.” Basically, “Fractured Families” re-examines how family breakdown continues to plague our society, and it is blunt in saying that, despite the scale of the problem continuing to increase, Government action has been extremely weak. The report shows that the outcomes for children and adults who suffer from family breakdown are often terrible, and that there are huge costs to society. Someone mentioned a huge figure earlier, which I will repeat because it is so staggering. Family breakdown is currently estimated to cost the country some £46 billion a year, which is set to rise to just under £50 billion a year by the end of this Parliament. That is more than the Government spend on the defence budget—talk about ideas for deficit reduction.

The report also says that

“governments have chosen to ignore this problem, they have done so despite the public’s views.”

Those views are striking:

“89 per cent of people agree (52 per cent strongly agree) that ‘If we want to have any hope of mending our broken society, family and parenting is where we’ve got to start’…81 per cent of people think that it is important for children to grow up living with both parents.”

I think that it is time, and the report clearly agrees, that politicians on both sides of the House acknowledge that family breakdown is an issue that matters to the vast majority of people in this country and take whatever action they can to reverse it. The report makes a series of recommendations to all political parties in advance of the next general election, which people can read in their own time.

I want to restate something that my hon. Friend the Member for South Northamptonshire said. Earlier, I mentioned the statistics on speech and language difficulties among inmates. Some 80% of long-term prison inmates have attachment problems that stem from babyhood, which is staggering evidence. The good thing that must come out of that is to find a way to help families form the loving and secure bond that she talked so much about. That bond should come naturally when there is a new baby in the house but, as we know, post-natal depression, problems with conception or birth experience, domestic violence and the issues of poverty and deprivation set out by my hon. Friend the Member for East Hampshire can, and so often do, get in the way.

That is where Home-Start UK, which I mentioned earlier, has to be part of the toolbox. Its formula of parents helping parents has been incredibly successful over the course of my lifetime—40 years, as we have been reminded. In August 2013 I spoke at the annual general meeting of Home-Start Winchester and Districts, which has been going for a long time and does so much to help families through the really tough times.

When my wife and I had children, people said that children throw a hand grenade into marriages. I think that is nonsense; it is more like an atomic weapon. We had marriage preparation classes before we got married. The vicar who married us said that his one piece of advice was to share the teaspoon moments—the things that get on each other’s nerves. Ten years on—we celebrated 10 years last year—we still regularly share the teaspoon moments, more of them coming my way than going out. There is nothing like children, supercharged after a night of poor sleep or on a whiney day, to create teaspoon moments and to exaggerate them into whopping great soup ladles.

[Fiona O'Donnell]

I join the hon. Gentleman in praising Home-Start. I have experience of using its services in Banbury and it was the only group that came and said to me, “What do you need? What can we do for you?” Every other service said, “This is what we do. Is it of any use?”

[Steve Brine]

Absolutely. There are so many similar examples throughout the country. I urge all hon. Members who do not know their Home-Start people to get to know them. They work with families, and can share the teaspoon moments when they are there, or sometimes just shine a light of perspective. When new parents are exhausted, perspective is hard to come by. My experience of seeing Home-Start at work is that it helps parents to learn to live together after children. Learning to live together is hard enough, but doing so after children is a whole new skill.

Home-Start has been demonstrated to work. Its volunteer support and positive impact on parents and families have been shown to work. A three-year research project by a team at the universities of Amsterdam and Utrecht a couple of years ago revealed that children are still benefiting up to three years after their Home-Start volunteer stopped visiting. The good thing about what Home-Start is able to do here is that it is being copied: the Incredible Years programme and the family nurse partnership are both maternal and early-years public health programmes providing ongoing, intensive support to mums and dads and their babies.

The family nurse partnership is of particular interest to me. It is welcome that the Government have recently agreed to increase the number of family nurse partnership places to 16,000 at any one time by the end of this Parliament. I saw its inspiration at work last summer in Houston, Texas, where it is called the nurse family partnership. I was there with the Justice Committee and saw the partnership at work in Harris county. We were there as part of our major inquiry into crime reduction policies and the data we were shown were very impressive. The programme is expensive but the outcomes are good, with 60% fewer arrests and 72% fewer convictions among children of mothers participating in the programme than among those of mothers in a similar demographic and income bracket who did not. The number of days babies were hospitalised was reduced by around one third among programme participants. The figures are impressive.

It goes without saying that any remarks about early intervention in the first 1,000 days would not be complete without mentioning the troubled families programme. I am a big fan, and despite some mixed messages in the June 2013 spending review, the Government gave a commitment to extend the programme through the next five-year parliamentary period and confirmed £200 million from several Departments for a wider focus in 2015-16. That is sensible. I am regularly updated by Hampshire county council and Hampshire troubled families mapping, which have confirmed that 70% of client families are located in the top 30% of wards for health deprivation in the county. That laser-like focusing at a time of shrinking resources must be right. I know that it is bearing a dividend in Hampshire, as it is throughout the country.

The early years are about the state, but they are also about the big society, the third sector—the voluntary sector—and, ultimately, about creating more stable learned environments where those early years count, so that babies have a chance of normal development. The prize for us is absolutely huge, as all hon. Members who have spoken today have said, not just in money value, but in the value of human life. Ultimately, that is what we, as Members of Parliament, are about.

Tobacco Packaging

Steve Brine Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

We are not persuaded that legislation is the right way forward on that matter. There is still a lot of room for education, and I am sure that the hon. Gentleman would like to believe, as I do, that when parents are made aware of the dangers of smoking in cars when children are present, they will wish to desist from doing so.

[Steve Brine (Winchester) (Con)]

I welcome the Minister’s statement. In September, I visited the Cancer Research UK centre in Southampton to meet my constituent, Tim Underwood, who leads the oesophageal cancer team there. I suspect that the team will be pleased to hear today’s announcement. Will she assure us that, whatever happens at the end of this process, it will remain the Government’s intention resolutely to prevent young people from picking up this habit that kills in the first place?

[Jane Ellison]

Preventing children from smoking is a major priority for the Department of Health and for the Government, and my hon. Friend is absolutely right to suggest that, irrespective of this piece of policy—important though it has the potential to be—the Government are committed to spending significant amounts on public health campaigns and all the other mechanisms available to us to prevent children from smoking.