Pancreatic Cancer

Tessa Munt Excerpts

Tuesday 4th March 2014 Commons Chamber

[Tessa Munt (Wells) (LD)]

I congratulate the hon. Gentleman on securing this debate. I should like to pick up on what he said about NanoKnife—there is also CyberKnife and Gamma Knife. Those are all modern, stereotactic treatments for cancer. I hope that he agrees that we need to concentrate not just on the drugs but on those particular types of radiosurgery, which can make sure that people live longer if they are given the trials that they need.

[Eric Ollerenshaw]

The hon. Lady makes an important point. Our point is that because of the poor pancreatic cancer survival rates and its late diagnosis, which is the key, it always seems that the pancreatic cancer patient is last in the queue. The quality of life assessments do not look long enough to justify a new drug or new radiotherapy, as has been pointed out.

Again, I pay tribute to Pancreatic Cancer Action, which got a great deal of press from an advert, not used at the time, saying, “I wish I had breast cancer”. That was effective in raising publicity about the impact of pancreatic cancer.

I am trying to put whatever pressure the Chamber is capable of exerting on the cancer drugs fund when it makes its decision on Thursday and on NICE for what it does to follow. Providing Abraxane and an extra two months could help ease this year’s 8,500 tragedies and start the process of making up for 40 years of lost hope.

--- Later in debate ---

[Jane Ellison]

The hon. Gentleman has made that point in other contexts before, and it is a perfectly good one. Of course, health is a devolved matter, but as regards research and what we know about drugs, there are lots of aspects on which England has taken a lead and on which the devolved Administrations co-operate. I regularly have exchanges of letters with my opposite numbers. When there are important lessons to be learned on behalf of all our constituents, we would naturally share that information and expect it to be looked at in all parts of our United Kingdom.

Our priority is to make sure that we get the best possible results for all NHS patients with the resources we have. That is why we have asked NICE to look at how drugs are assessed to ensure that patients can get the treatments they need at the best value for the NHS, and that the price the NHS pays is more closely linked to the value a medicine brings. These can sometimes sound like quite cold decisions, but they are designed to help us to have a sense of objectivity in what are always very difficult decision-making processes. I assure my hon. Friend that NICE will carry out a full public consultation before implementing any changes in the way that it makes these assessments.

My hon. Friend referred to NanoKnife, which was also mentioned in an intervention. I am advised, I am afraid, that NICE has published guidance on that procedure which states that current evidence on the safety and efficacy of irreversible electroporation for treating pancreatic cancer is inadequate in quantity and quality, and it recommends that the procedure should currently be used only in the context of research.

My hon. Friend mentioned research funding. We are often asked about the amount of funding put into one area or another and I always like to make the point that, rather than specifying subject areas, the National Institute for Health Research welcomes funding applications for research into any aspect of human health. These applications are subject to peer review and are judged in open competition, with awards made on the basis of the importance of the topic to patients and the NHS, value for money and scientific quality.

I have no idea whether parliamentary interest is part of that mix, but I cannot believe that it hurts at all. Such issues come up regularly, and whenever I meet people from different health institutions and the NHS I always make a point about the things in which Parliament has shown a particularly keen interest to debate and progress.

[Tessa Munt]

Will the Minister give way?

[Jane Ellison]

I do not think I have time, sadly, but I would be happy to speak to my hon. Friend after the debate.

I hope it will be of interest that the Government are investing a record £800 million over five years in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool biomedical research unit in gastrointestinal disease, which has a major focus on pancreatic cancer. Some really interesting things are coming out of the opportunities for biomedical centres.

Recruitment to studies associated with pancreatic cancer by the NIHR clinical research network has also increased more than fivefold, from 447 in 2008-09 to 2,744 in 2012-13, which is another measure of the increased emphasis and interest.

I again pay tribute to my hon. Friend the Member for Lancaster and Fleetwood for his campaigning on this issue and the work he has done to raise its profile in Parliament, and to all hon. Members for the interest they have shown. As I have said, it is great to see such good attendance at this debate. That is on the record and it is of great interest.

[Tessa Munt]

Do NICE and similar organisations accept reviews and evidence from other countries, be they in Europe or America, when they deliberate and make considerations, or is it only home-grown evidence that counts? Is there an acceptance of the views of clinicians from other parts of the world?

[Jane Ellison]

I will, if I may, take my hon. Friend’s question away and respond to it formally. Obviously, it is a matter for NICE and I will make sure that I get an answer for her. My understanding, however, is that an awful lot of peer-reviewed research from all around the world is looked at and that it is the quality of that research that is taken into account. I will respond formally to my hon. Friend and make sure that I have that absolutely right.

In conclusion, I thank those who have participated in this important debate and those who have stayed to show their support for it, which is valuable. This disease remains very difficult to treat, but the Government will continue to work with patients and charities—which have done so much good work—and with researchers, the pharmaceutical industry and, of course, the NHS to improve results for people with pancreatic cancer and to see whether we can make more rapid progress than we have made in the past four decades.

Question put and agreed to.

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Speaker]

Last but not least and I hope with exemplary brevity, I call Tessa Munt.

[Tessa Munt (Wells) (LD)]

What steps is the Secretary of State taking to ensure that the number of cancer indications treated in this financial year by stereotactic ablative radiotherapy does not fall below the number of treatments delivered in the 2012-13 financial year?

[Jane Ellison]

That is an area that the hon. Lady and I have discussed at some length. I know that she feels strongly about it. We have meetings coming up to discuss it and I think that it would be easier to deal with her detailed points in those meetings.

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

We have spoken to NHS England, which has advised me that it is not aware of any reason to think that the March 2014 will not be met. As my hon. Friend knows, however, the day-to-day management of CCGs is a matter for NHS England, and I am sure he would not approve of Ministers trying to micro-manage CCGs from Whitehall. His strength of feeling is clear, and I am happy to have an ongoing dialogue with him and the all-party group on this matter.

[Tessa Munt (Wells) (LD)]

Having heard the Minister’s answer on survival rates and the importance of early diagnosis, may I ask her whether cancer patients in need of life-saving treatment recommended by their clinicians who have waited for more than two weeks because of the commissioners’ delay in agreeing funding have the legal right to insist on being treated once they have gone past the two-week deadline? If so, how would they do that?

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

There are problems, particularly in large cities and at weekends. In fact, in the case of the reorganisation of services at Trafford general hospital, one of the things that we can invest in as a result is mental health facilities in neighbouring A and Es so that people have better access to the services they need.

[Tessa Munt (Wells) (LD)]

The Secretary of State will be aware of the case of Nadejah, the face of the Teenage Cancer Trust, who at the age of 23 has been refused the CyberKnife cancer treatment that could save her life. Her mother Michelle is here today. Will he intervene so that this young woman gets the treatment that her consultant, Professor Hochhauser, recommends, and will he meet Nadejah’s mother and me so that we can work together to unblock the funding so that she can get the treatment she so desperately needs?

[Anna Soubry]

I am more than happy to meet the hon. Lady and the family but, as she knows, this is a treatment that we have talked about endlessly, and we have had many meetings, which I am more than happy to continue to have with her.

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

We are building two new machines specifically to deliver that treatment. I accept that these things often take a long time, but those machines are planned. In the meantime, NHS England has made it clear that people who need this specific type of treatment can receive it overseas and it will be funded accordingly.

[Tessa Munt (Wells) (LD)]

Two years ago, the Prime Minister accepted the installation of CyberKnife as the latest in cancer radiosurgery equipment at the world-leading Royal Marsden hospital cancer centre. At the last Health questions, I asked the Secretary of State whether he would accept one of the countless invitations to visit the Royal Marsden. The consultant clinical oncologist has issued and reissued that invitation, but has had no response from the Department. Will the Secretary of State now please visit CyberKnife at the Royal Marsden?

[Anna Soubry]

I have to tell the hon. Lady that, as she knows, there is some controversy over this treatment, which is backed by a very large and powerful American company. The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), has visited, and I know that the Secretary of State has an extremely busy and full diary. It is not as simple as a visit; it is all about whether there is any clinical value.

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Jeremy Hunt]

If the hon. Gentleman had listened to my previous answer, he would have heard that the regulations are consistent with the procurement guidelines that his own Government sent out to PCTs. It is not our job to be a champion for the private sector or the NHS sector; we want to be there to do the best job for patients. That is the purpose of the regulations.

[Tessa Munt (Wells) (LD)]

T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there?

[Anna Soubry]

I understand that the Secretary of State has been to the Royal Marsden, but I am more than happy to accept the invitation and look forward to going along and seeing it for myself.

Backbench business

Tessa Munt Excerpts

Thursday 14th February 2013 Westminster Hall

[Tessa Munt (Wells) (LD)]

I congratulate the hon. Members for Romsey and Southampton North (Caroline Nokes), for Enfield, Southgate (Mr Burrowes), and for North Tyneside (Mrs Glindon) on recognising the importance of eating disorders awareness week 2013. As we have heard, more than 1.6 million people in the UK are affected by eating disorders; they are young, middle aged and older. They are every age from eight to 80, and they are women and men. This serious mental illness has the highest mortality rate of any mental illness.

Over the past 25 years, the incidence of eating disorders has increased enormously. There are many possible contributory factors. I observe the tiny size of models, actors and actresses, and screen, tabloid and magazine heroines and heroes; the cult of celebrity; the obsession with gyms and exercise; the constant barrage of advertising through every medium; the pressure on us to diet and to eat low-fat, low-calorie food; the ranges of “light” foods on sale and the so-called “healthy eating” regimes. There is bullying and name calling in the playground, in the workplace and during our leisure, and pressure to remove what is called excess weight and achieve someone else’s idea of a perfect body shape. We have life on the run. Eating on the go is now more common. There is an absence of what I used to have: formal lunchtime at school, at which a teacher sat at my table and watched me eat—even the semolina. If a child takes in a packed lunch, they can give it away or bin it, and no one has any control or sight of what they are eating.

[Mr Charles Walker in the Chair]

I also observe that things are different from when I was young, which was quite a long while ago. Young women are often physically mature at a very early age. It is confusing for an eight, nine or 10-year-old to find out that they are much larger than their friends; they will not necessarily understand that their body is getting ready for full maturity.

We can even look to an escalating divorce rate, which means that many of us are single. There is huge social pressure to have a partner, and there is the implication that in order to count, we must be gorgeous, attractive or at least half of a couple, rather than an individual, with our own rights and responsibilities. I recognise that I am saying this on Valentine’s day. My list, of course, is not exhaustive, but feeling inadequate, worthless and lacking in self-esteem are common factors, and the list starts to provide some clues to the settings in which eating disorders can be triggered, and how they are sustained. That constant pressure has contributed to the suffering of those 1.6 million people, and their families and carers.

So often, eating disorders are evident when a patient perceives that choosing whether they eat or not is the only area of his or her life where he or she can exert complete control. Anorexia and bulimia are serious mental illnesses, and need recognition and the appropriate responses from our national health service. In the next few minutes, I will refer to anorexia, but I want it to be noted that my concerns also relate to bulimia and eating disorders generally.

Most patients with an eating disorder in this country struggle to find effective treatment. They may find that a GP looks at the figures, and not what is in front of them—the patient. I refer to cases where patients are told that they are “not ill enough”, and that their body mass index would need to be lower for them to qualify for referral for help or treatment. When they do qualify, in many cases patients are admitted to medical wards in hospitals where the nurses unfortunately know little about psychiatric problems, and even less about nutrition. Patients are given little or no family therapy or individual therapy.

Others go to psychiatric units, where they are offered psychological support, but where their physical problems and need for weight gain are severely neglected. The few good dedicated units, which combine re-feeding with therapy and education, are mostly privately run. However, at £700 a night, these units are often out of the reach of most families, unless their primary care trust or its replacement NHS organisation funds the treatment.

I want to concentrate particularly on the problems facing children and young people with anorexia and bulimia. In hospitals all over the country, there are children and young people—some as young as seven or eight—who are being treated by doctors and nurses who have very little training in dealing with eating disorders, and who often have no knowledge of how to set a safe target weight. Sometimes, they weigh patients who still have their clothes on, or who have their pockets filled with kitchen weights, or who have their stomachs filled with three or four litres of water. Families are not given the support they need, or clear-cut advice. Patients see a different doctor or specialist at each appointment, and the appointments are too far apart. Little heed is paid to the patient’s physical condition. I have heard about children attending out-patient clinics because of their weight loss, but having neither their pulse nor their blood pressure taken. Monitoring pulse and blood pressure is vital if we are to prevent a child from collapsing, and if we are to know when a child needs hospital admission.

There are very few doctors who specialise in the treatment of children with eating disorders, so the waiting lists for children who need to access those doctors are often dangerously long. Eating disorders must be a condition that students are taught about in medical school, and awareness of them must be included in the postgraduate training of GPs, psychiatrists and paediatricians. If children were seen early in their illness by professionals working as part of a multidisciplinary team, so that parents were given the consistent, sensible advice they needed on how to re-feed their child, and if patients were seen by a family therapist and an individual therapist, as well as having a medical doctor who understood the long and short-term risks, and who could make a referral to an in-patient unit before the patient became irreversibly damaged, we would have fewer chronically ill adults in later life.

No one should die from an eating disorder. At present, however, there are more deaths from eating disorders than from any other mental illness, and it is estimated that 10% of all sufferers of eating disorders die as a result of their condition. For adults, the courts always support an application for nasogastric feeding, but tragically the request for a court order is often made too late, or not at all. However, working with children with eating disorders reveals another serious problem, one that interferes with the ability to help them. That problem is the implications of the Children Act 1989, which deems children of 16 capable of making their own decisions about treatment. However, anorexic patients rarely want to eat voluntarily. Although many of them are crying out for help, the guilt wrapped around food and eating means that they need someone to help them to eat, and not someone to ask their permission as to whether they would like to eat.

Despite an excellent ruling a few years ago, which in summary states that anyone who seeks to starve themselves to death is not competent to make decisions, we nevertheless require 16-year-olds to give written consent before they can be admitted to a medical unit. There are some units where, in order to protect themselves and their staff, this permission is sought from 14 and 15-year-olds. Once children are in the unit, if they refuse to eat, no staff member would dare use a nasogastric tube for fear of being sued. Until the passage of the Children Act 1989, units treated anyone under the age of 18 and fed them if and when necessary, requiring only parental consent. What a ridiculous situation we are now in. The reality of the current situation leaves parents feeling completely ineffectual and frustrated. It also leaves the child feeling quietly victorious, as they go on their way home with medical permission not to eat.

Today we find ourselves in the ludicrous situation whereby staff have to tell parents of often very ill children who will not consent to eat that they must wait until their daughter or son loses another X number of kilos, whereupon that young person can be sectioned under the Mental Health Acts and treated compulsorily. That puts lives at increased risk, and being sectioned is an overly serious response to the problem. We should seek a more appropriate solution. Being sectioned jeopardises any hopes that that child in recovery might have of joining the armed forces, for example, or becoming a doctor or nurse, which is particularly sad, because when they have recovered, many of these children are attracted to working in the caring professions, such as health care. The Children Act might need to be amended, so that we are able to treat children who are damaging their health through starvation before they become so ill that their lives are in danger.

The hon. Members for Romsey and Southampton North, and for Enfield, Southgate, and I have met the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who is the Minister with responsibility for children, to explore the legal situation regarding the Mental Health Acts. I am very glad that the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) is here today. I am grateful to him for agreeing to meet us to explore whether practical solutions are available, or inventable, to allow those who care for young people with eating disorders to trigger some action short of using sentencing as a route to treatment and help.

I particularly want to recognise the work of two charities. One is the Somerset and Wessex Eating Disorders Association, or SWEDA, which is a user-led registered charity based in Wells in Somerset, in my constituency. It works on the principle of self-help, and its phone number is 07511 499 494. It has an online “health unlocked” community, and people can seek support and advice about self-help through that group.

The second charity is, of course, Anorexia and Bulimia Care, or ABC, which is a national registered charity that also happens to be based in my constituency. It is doing an amazing job. ABC was founded and is governed, run and supported by people whose lives have been touched by eating disorders. It offers kindness and compassion to sufferers at a time when they are desperate and alone. It has staff, professional advisers and a national network of volunteers, all of whom are carers or recovered sufferers. It provides positive, practical advice by telephone, by e-mail and via its website. It also offers a befriending service, and a range of literature and training advice. Lastly, it has a young people’s blog, called “To be honest”. ABC’s work is fantastic and its telephone number is 03000 11 12 13. That number will lead to a parent helpline, a sufferer helpline and a self-harm helpline.

We need a fairer system. Every child who develops an eating disorder should have access to first-class treatment, rather than the somewhat cobbled-together, inadequate provision that most have to accept. It is time that this life-threatening and debilitating illness was taken more seriously, and I truly hope that the Minister will consider what changes might be made to ensure that fewer lives are lost, recovery comes more quickly and families do not suffer the terrible consequences that often come with loving a patient with an eating disorder.

Lastly, I appeal to all those who suffer from this challenging mental illness: there is hope, and there is help out there for you. Our responsibility is to make sure it is better and easier for you to accept treatment and help.

Cancer Care (England and Wales)

Tessa Munt Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns]

I am grateful to my hon. Friend for sharing those data. In interventions, hon. Members have talked not only about pre-screening, awareness, social issues and treatment, which I will focus on, but the aftercare that is needed, the emotional support that is provided, and the need for and responsibility and role of a whole host of agencies, including those in the charitable sector.

Returning to the point about treatment, I had been comparing the different approaches to breast cancer in England and Wales. The wait before seeing a consultant in England is 10 days. It is interesting to note that the Welsh Government removed 10-day monitoring in 2006. Although data are recorded locally, they are not published nationally. In the interests of transparency, it would be helpful if those data were published to allow fair and just comparisons. Waiting time targets improve survival outcomes, reduce emotional distress and improve the quality of life for people with cancer and those who turn out not to have cancer.

There are similarly alarming figures for prostate cancer. Five-year survival rates can be higher than 80%. There are no figures comparing the rates of the home nations, but the side-effects of the sort of treatment one receives for prostate cancer can be significant and can have a huge impact on future lifestyle. Again, there is a different approach to prostate cancer care in the two nations.

I want to draw attention to the availability of treatment. There was significant attention some years ago to access to brachytherapy. Even when it was finally approved by the Welsh authorities, after having been widely available in England, Scotland and Northern Ireland, the threshold for intervention was much higher in Wales. As far as I know, that remains the case.

Currently an identical debate is focused on robotic surgery. A constituent who suffers from prostate cancer, who is qualified medically and who consulted widely before making the decision with his clinicians on the most suitable form of treatment for himself, wrote to the Welsh Health Minister. He shared a copy of the letter with me, in which he said:

“I was both surprised and disappointed to find that this option is not available to Welsh men in Wales and that a significant number of Welsh men are opting to go to England, where this technology is established and available throughout the country.”

[Tessa Munt (Wells) (LD)]

Does my hon. Friend accept that if that kind of treatment—be it robotic or radio surgery—was available perhaps in a location such as Bristol, it would be accessible for patients in south Wales, along the M4 corridor and elsewhere, and those who go down the M5, right the way through to Cornwall?

[Alun Cairns]

My hon. Friend makes a valid point about the need for joint working and better co-ordination between the health services. Devolution can provide valid comparisons to establish the success of various treatments, but on many occasions there is a need for joint working where capital investment is needed, allowing patients to benefit from a different sort of intervention, but with shared responsibility between the two organisations.

I was talking about my constituent who had wanted robotic treatment for prostate cancer. He was later forced, in his stressful situation, to raise the £13,000 necessary to receive the form of treatment that he thought best suited him. I am pleased to report that the outcome of the treatment was positive.

The Wales Minister argued that if local heath boards do not provide treatment routinely, people could follow a process for individual patient funding requests. The panel meets monthly, which hardly reflects the urgency of some cases. I am not aware that any case of robotic treatment has been successfully applied for.

That leads me on to the cancer drugs fund, which is available in England but not in Wales. The fund allows clinicians and patients to prescribe and receive the latest drugs. Again, that is not available in Wales, where there is a cumbersome process to seek such a prescription.

The Rarer Cancers Foundation reported that 24 cancer treatments that are not routinely available in Wales may be available in England through the cancer drugs fund. It concludes that people in Wales are five times less likely than people in England to gain access to a cancer drug that is not routinely available. It also states that if the same approval rate occurred in Wales as it does in England, 159 cancer patients in Wales would gain access to life-extending treatment, instead of the 31 recorded. I raised the issue with the Welsh Health Minister, and she reported that establishing such a fund would reduce the money available for treating other serious conditions, as in England. I find that worrying, and I would be grateful if the Minister could address that point in her response.

That deficiency applies to other cancers, too. Selective internal radiation therapy is an innovative treatment for inoperable liver tumours. Although the University hospital of Wales in Cardiff is part of the UK-wide phase 3 clinical trial, not one patient from Wales has been funded for treatment. The patients under trial have been financed by the cancer drugs fund, yet the hospital is in Wales and demonstrates the expertise that exists in Wales in the field.

Survival rates for pancreatic cancer also differ significantly, and I could go on at length about those. When it comes to five-year survival rates for pancreatic cancer, Wales scores better than England. Unfortunately, that tends to be the exception rather than the rule. Those differences are worrying, and had I referred to Scotland and Northern Ireland selectively, I would have been able to paint a more alarming picture, but that is not the point; it is not about the politics of the issue, but about sharing best practice and getting the right treatment for the right people.

The motivation for the debate came from individual cases in my surgery. Having researched the data, I was forced to bring the matter to the House’s attention. I hope the Minister and Members present will be able to use their influence on colleagues here and elsewhere to raise standards, allay fears and improve survival rates for cancer patients.

Oral Answers to Questions

Tessa Munt Excerpts

Tuesday 27th November 2012 Commons Chamber

[Norman Lamb]

Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.

[Tessa Munt (Wells) (LD)]

T7. Since the Prime Minister made his radiotherapy promise to current and future cancer patients last month, cancer centres all over the country have been telling me that it cannot be delivered, because there is not enough investment in new radiotherapy machines and in the recruitment and training of staff to operate them. Will the Secretary of State give the same financial commitment to the annual radiotherapy fund as he is giving to the cancer drug fund, and will he meet me to discuss the matter?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I thank my hon. Friend for her question, because it touches on a matter of concern to me, notwithstanding the £15 million radiotherapy innovation fund, which, as she said, was announced by the Prime Minister. Indeed, last night, at my ministerial surgery, the hon. Member for Easington (Grahame M. Morris) came along to discuss this very matter, and he raised several important issues, all of which I have this morning taken up with my officials. I am more than happy to meet my hon. Friend to discuss the matter further, however, as I think there is work to be done.

Nursery Milk Scheme

Tessa Munt Excerpts

Monday 5th November 2012 Commons Chamber

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

I congratulate my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) on securing this debate. During her years in the House she has not only shown a keen interest in the nursery milk scheme but has been a strong parliamentary ambassador for the National Society for the Prevention of Cruelty to Children and, since 2006, a champion of Save the Children. That is a long track record of supporting and standing up for issues that matter to children—in this case, the nursery milk scheme. She rightly outlined the tremendous health benefits not only of the nursery milk scheme but of a healthy diet in young children, and highlighted the benefits of drinking milk, given the proteins, minerals and vitamins that it contains. I want to confirm to the House again that the nursery milk scheme is here to stay.

Before I address the points that my hon. Friend raised, it is worth highlighting a few of the issues. While we fully endorse the provision of nursery milk, she is absolutely right to point out that the cost of the scheme has gone up considerably over the past few years. In an average supermarket, a pint of milk costs about 50p to 55p. According to the most recent figures of June 2011, within the scheme there are 23,000 claims—well over 50% of the total—where milk costs 70p to 79p per pint, and almost 9,000 claims where it costs over 90p per pint, which is almost double the cost in the supermarket.

Many hon. Members representing rural constituencies will be concerned that dairy farmers across the country are struggling, and that the increased cost of milk is not rewarding those farmers in the farm-gate price. We must reflect on the cost of the scheme. Since the scheme costs a lot of money, it would be nice if those companies that profit from it also recognised that some of that profit could be passed back to famers in the farm-gate price. The Government and the National Farmers Union do not see that happening as part of the scheme, and although the NFU and the Department for Environment, Food and Rural Affairs support the nursery milk scheme as a way of supporting dairy farmers, it is nevertheless disappointing that companies that supply nursery milk are not supporting our farmers in the way we would like.

As my hon. Friend rightly said, the nursery milk scheme is of long standing and has been running throughout Great Britain since the 1940s. The devolved Administrations in Scotland and Wales fund milk supplied through the scheme to children in their countries, and Northern Ireland has its own, similar scheme—I am pleased to see the hon. Member for Strangford (Jim Shannon) in his seat as usual.

As we know, the scheme funds free milk for around 1.5 million children under five years of age at 55,000 child-care providers throughout Great Britain. Nursery milk is a universal benefit, meaning that child-care providers can claim the cost of milk provided to any child, regardless of the child’s home circumstances. The scheme is valued by parents and pre-school staff, and its health care benefits were thoroughly outlined earlier in the debate.

The Government recognise, however, that the nursery milk scheme is expensive, and the consultation was about improving its operation and ensuring that it remained fit for purpose. The scheme remains largely unchanged since it was first introduced as a wartime measure, and in recent years prices claimed for milk purchased under the scheme have risen significantly, owing largely to third-party agents who seek to make considerable profits by delivering milk to child-care providers. As I said earlier, unfortunately those profits are rarely paid back to farmers in the farm-gate price.

The prices claimed for milk supplied under the scheme have risen significantly, with some claims reaching almost £1 a pint. That has led to a corresponding increase in the overall cost of the scheme. In 2007 and 2008, the scheme cost £27 million, but by 2010-11 that had risen to £53 million—it almost doubled in only four years. If we do nothing, that trend looks likely to continue, with costs potentially rising to £76 million by 2016.

Under the current system, there is no limit on the price at which child-care providers may purchase milk, or even a requirement for each provider to review their milk expenses. In many cases, agents supplying milk handle the claims themselves, rendering child care providers unaware of the price paid. For those reasons, the total cost of the scheme has risen dramatically over the past few years, and although the amount of milk supplied has risen by 25% since 2009-10, the total cost of the scheme has risen by 45%.

[Tessa Munt (Wells) (LD)]

Does the Department of Health have a grip on the procurement process involved in this scheme? When providing milk across the nation, surely we should be able to supply from local sources or distributors. The costs that the Minister mentions seem to have escalated greatly, but farm-gate prices have not changed much. It seems extraordinary that someone has not got a grip on procurement.

[Dr Poulter]

My hon. Friend is absolutely right, and that is why the Government launched the consultation in the first place. The scheme was devised in the second world war, and its provisions mean that the Department of Health currently has no role in active procurement. The Government embarked on the consultation in view of the rising costs, and my hon. Friend will rightly feel concern for dairy farmers in her area of Somerset. Profits from this scheme are going to intermediate companies, and the cost has recently escalated out of control. My hon. Friend also highlights the fact that farm-gate prices have not improved as a result of those increased prices and profits for intermediate suppliers of milk.

It is worth pointing out that an important factor contributing significantly to the scheme’s accelerating costs seems be embedded in its design. No mechanism exists to incentivise child-care providers to economise and search for the highest attainable value for money in their local markets, to support their local farmers or to source their milk from a certain provider. Over the last three years, the average price paid for a pint of milk in a supermarket has been 50p, but the average charged by agents is 78p, which is well over 50% higher. That shows that the scheme is rapidly becoming unfit for purpose, which is exactly why the Department embarked on the consultation.