Dame Carol Black’s Independent Review of Drugs Report

Tommy Sheppard Excerpts

Wednesday 27th October 2021 Westminster Hall

[Dan Carden]

Absolutely. That is a valuable intervention, and it is good that we have a Health Minister responding to this debate, because it is a health response, joined up across Government, that this issue calls for.

Part two of the report goes on:

“Areas of the country with the highest rates of drug deaths or the poorest treatment services are the very same areas where the need to level up is greatest. These communities want to see urgent and effective action to tackle the violent drugs market, alongside purposeful efforts to rebuild treatment services and recovery support so that people can get the help they need.”

[Tommy Sheppard (Edinburgh East) (SNP)]

The hon. Gentleman is making an excellent speech, and I very much endorse and support the recommendations of Dame Carol Black’s review. However, I have heard her present these reports, and she has been very clear that the framework that she was given—the parameters that she was allowed to look at—deliberately excluded any review of the legislation that frames this whole matter. Given that this is a unique health pandemic—because the victims of it are liable to criminal prosecution if they seek help, and many who would seek to help them would be liable to criminal prosecution if they tried to do so—is it not time for the Government to begin a review of the Misuse of Drugs Act 1971, to ensure a more up-to-date legal framework to deal with these problems? Would that not assist in the implementation of Dame Carol Black’s recommendations?

[Dan Carden]

The hon. Member makes an important point, although it is one that I will not get drawn into today.

A month after part two was published, the Office for National Statistics confirmed that drug-related deaths had hit an all-time high in England and Wales—the highest number of deaths since records began. Drug deaths have risen 60% in the last decade. In 2020, 4,561 people lost their lives to drugs. Each life lost represents years of pain and suffering; each life lost leaves a family devasted and shattered irreversibly; each life lost is evidence of a missed treatment opportunity; and, most importantly for us today, it is important to accept that each life lost is a failure of policy, too.

I want to make special mention of the stigma that surrounds addiction. Someone who finds themselves dependent on a substance deserves the evidence-based health treatment and support that works, yet stereotyping and prejudice remain all too common in our approach to addiction. It was disappointing to see the Government’s response to the review referring to addiction as a “scourge on society”. The dehumanisation of people who become drug-dependent feeds into the stigma that we must eradicate, so we must steer the discussion, the policies and the treatment towards a compassionate and person-centred health response.

Last week I joined the Forward Trust at the launch of its “Taking action on addiction” campaign, which aims to improve public understanding of addiction as a erious, chronic mental health condition. The Duchess of Cambridge, patron of the Forward Trust, spoke there. I want to quote her at length:

“Addiction is not a choice. No one chooses to become an addict. But it can happen to any one of us. None of us are immune. Yet it’s all too rarely discussed as a serious mental health condition. And seldom do we take the time to uncover and fully understand its fundamental root causes.

“The journey towards addiction is often multi-layered and complex. But, by recognising what lies beneath addiction, we can help remove the taboo and shame that sadly surrounds it. As a society, we need to start from a position of compassion and empathy.”

As many as 80% of the public support more treatment and care for people struggling with addiction; less than 10% believe more punishment and condemnation would help. Intolerance, shaming, tougher punishments and denial will not rid society of addiction, because addiction is an illness. It is a matter of public health, and Dame Carol puts it best when she says,

“It must be recognised that addiction is a chronic mental health condition, and like diabetes, hypertension or rheumatoid arthritis, it will require long-term follow-up.”

Sadly, as things stand, I cannot think of another illness that causes so much harm to society, that is given so little, and the sufferers of which are treated with such contempt. It is the only illness in which blame is placed on the person suffering. Instead of blaming the individual for making bad choices, we need to ask why so many people are turning to substances in the first place.

Now to the prevention, treatment and recovery system as it stands: not fit for purpose, in urgent need of repair, years of austerity, continued disinvestment, fragmentation and a dire lack of accountability throughout. The Health and Social Care Act 2012 shifted addiction treatment out of the NHS mental health services on to local authorities, at the same time as their budgets were being slashed. On that matter, Dame Carol is clear:

“We recommend that funding for drug treatment be allocated to local authorities based on a needs assessment and then protected.”

We also urgently need to improve the situation for people suffering co-occurring mental ill health and drug or alcohol dependency. Too many people are being bounced between fragmented services and end up falling between the cracks. It is simply wrong that mental health services can require patients to reduce their alcohol or drug use, without providing the proper support to do so, before they can receive the treatment they need. Or that drug and alcohol services do not possess the competencies to support someone with significant mental health issues, thereby often leaving sufferers with no support whatsoever.

There must be a “no wrong door” policy. One young woman, whom I will call Jane, told me:

“It was as if I had to get more ill, drink and use more, until I got the right help and support. For 18 months, my mental health deteriorated. Mental health services couldn’t help me and addiction services struggled to support me because of my poor mental health. I was so frightened, I had to reach crisis point and rock bottom before I was able to be considered for residential treatment.”

Jane is now in recovery and leading a happy, healthy life, but she did not receive public funding. In fact, she was denied that. If it had not been for a chance meeting with Action On Addiction, which provided her with a bursary-funded bed, she would not be alive today. It should simply not fall to charities to catch the increasing numbers of people falling through the threadbare safety net. Access to treatment should not be about luck, only available to those who can afford it or those who live in a local authority that prioritises it.

Currently, the drugs treatment market operates in a similar way to that of adult social care. Providers are being squeezed and staff poorly paid. There is high turnover in the workforce and a depletion of skills. The number of medics, psychologists, nurses and social workers in the field is falling significantly.

It is time to repair that broken system and overhaul addiction treatment, and we have the road map for the future—the 32 recommendations of Dame Carol Black’s independent review of drugs. The scope of the recommendations is far-reaching and the solutions span many Government Departments, local government and other organisations.

Dame Carol’s review has pursued three main objectives: first, to increase the proportion of people misusing drugs who can access treatment and recovery support, including more young people, with earlier interventions to divert offenders away from the criminal justice system; secondly, to ensure that the treatment and recovery package offered is of high quality and includes evidence-based drug treatment, mental health and physical interventions, and employment and housing support; and thirdly, to reduce the demand for drugs and prevent problematic drug use, including use by vulnerable and minority groups and recreational drug users.

To achieve those objectives, significant changes need to be made in four areas: radical reform of leadership funding and commissioning; rebuilding of services; increased focus on prevention and early intervention; and improvements to research and how science informs policy, commissioning and practice. And the 32 recommendations cover a wide range of responsibilities.

The Government have already begun to set in motion some of the structural changes, which I welcome, and the policy commitments that will help to drive through the review’s recommendations. It is reassuring that Dame Carol herself will continue to act as an independent adviser to Government. However, the remaining recommendations are contingent on Government investment.

In January 2021, the Government announced £148 million of new money to cut crime and protect people from the harms caused by illegal drugs, which I also welcome, with £80 million of that money to be invested in treatment and recovery. That £148 million must be the first instalment of the £1.78 billion that Dame Carol has called for over the next five years and I hope that the Minister has come with hot-off-the-press Budget commitments. Dame Carol’s spending recommendation would restore addiction treatment to what it was before 2012. Although local authorities are well positioned to oversee services, drastic cuts to public health grants have led to cuts to addiction treatment services over many years. The Local Government Association has long argued that reductions to the councils’ public health grant, which is used to fund drug and alcohol prevention and treatment services, is a false economy, which will only compound acute pressures for criminal justice and NHS services further down the line.

I must stress to the Minister that if the Treasury is unable to find all the funding that the review calls for, the money it does find must not be thinly spread across the country. Instead, it should be targeted at those areas most in need, and efforts must be made at least to pilot the whole-systems approach that Dame Carol has called for. Small amounts of money given to each local authority will not bring about the long-term transformational change that the review demands.

There has simply never been the political will to act on prevention, treatment and recovery from drug and alcohol harm, but we have reached a crisis point, with record deaths, rising economic and social harms, and depleted treatment services. Dame Carol’s groundbreaking review, which was commissioned by this Government, is the moment for change, and the Government cannot meet their pledges to level up the deprived communities that they seek to represent, which are often found in the north, unless they recognise that. In the words of Dame Carol herself:

“The Government must either invest in tackling the problem or keep paying for the consequences.”

Oral Answers to Questions

Tommy Sheppard Excerpts

Tuesday 23rd June 2020 Commons Chamber

[Gareth Davies (Grantham and Stamford) (Con)]

What progress his Department has made on ensuring the provision of adequate critical care capacity in hospitals during the covid-19 outbreak.

[Tommy Sheppard (Edinburgh East) (SNP)]

What plans he has to ensure that the NHS has the capacity to tackle the next phase of the covid-19 outbreak.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Thanks to unprecedented action, we have protected the NHS. It was not overwhelmed during the peak of this crisis, and all covid-19 patients admitted to hospital were able to receive urgent treatment that they needed. We remain vigilant.

--- Later in debate ---

[Matt Hancock]

Thanks to my hon. Friend’s assiduous work on behalf of his constituents in Grantham, and at his suggestion, I discussed this issue directly with NHS officials. Grantham’s unit will be open, 24/7, as an urgent treatment centre; this is part of plans to ensure that covid and non-covid services are kept as separate as possible. In addition, thanks to his intervention, we will ensure that that position will be reviewed quarterly.

[Tommy Sheppard [V]]

The NHS in England had more than 40,000 nursing vacancies at the start of the covid pandemic, but student nurses stepped forward to contribute to the response. So why are many of their contracts now being terminated, given that they may well be needed this autumn? Would a better approach not be to increase nursing bursaries to £10,000, as they are in Scotland, where nursing vacancies are half those of England?

[Matt Hancock]

We have increased by about 10,000 the number of nurses in the NHS in the past year, and during the crisis that number increased further. We also set out at the start how we are paying student nurses, as they stepped up to the mark, as the hon. Gentleman rightly said. I am delighted that so many of them did, and we are sticking to the agreements that we set out with the student nurses at the start of the crisis.

Access to Medical Cannabis

Tommy Sheppard Excerpts

Monday 8th April 2019 Commons Chamber

[Matt Hancock]

I am saying that if a patient needs medicinal cannabis, and if a clinician will sign off on that need, the prescription can happen. The guidance from the association does not override the individual judgment of that clinician. That can happen but, because it has not been happening in many cases that have been brought to light, some privately and some very publically, I am putting in place a system of second opinions to ensure that we can get that clinical decision right, at the same time as developing a stronger evidence base for the future.

[Tommy Sheppard (Edinburgh East) (SNP)]

Reuben Young is an 11-year-old boy in my constituency who suffers from myoclonic astatic epilepsy, which is a severe and rare form of epilepsy. His mother, Emma, is at her wits’ end. Conventional medicines do not work and she has tried to get a prescription for Epidiolex, which is a cannabis-derived medicine. She tells me that she is unable to get it because the physicians involved say that the guidelines prevent them from prescribing it. I do not know why, but for some reason the change in policy last November is not leading to a change in practice. I ask the Secretary of State to speak with the Home Secretary and to have an urgent—I mean in days or weeks—review to see how the existing guidelines can do better.

[Matt Hancock]

Those guidelines are not a matter for the Home Secretary; they are guidelines in the health space, although the association that writes them does not report directly to me but is independent. Those guidelines do not prevent a physician who is on the specialist register of the General Medical Council from prescribing. If anybody has been told that they do, they do not; it is up to the individual professional judgment of a specialist clinician on the register to prescribe or not.

Oral Answers to Questions

Tommy Sheppard Excerpts

Tuesday 19th February 2019 Commons Chamber

[Stephen Hammond]

I commend my right hon. Friend for being a tireless campaigner on this matter. We have always made clear that staff, patients and their families should not have to deal with the stress of complex and unfair charges, and we introduced tougher guidelines in 2014, but I must stress that this is a local matter.

[Tommy Sheppard (Edinburgh East) (SNP)]

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

[The Secretary of State for Health and Social Care (Matt Hancock)]

To provide the best care, the NHS needs the best technology, and we are therefore bringing together leaders of the digital agenda across the NHS under a new organisation called NHSX. We are also publishing a new code of conduct for the use of artificial intelligence in the NHS. NHSX will report jointly to the NHS and to me, and it will lead this vital agenda so that the NHS can be a world leader in emerging technologies that help to cut costs and save lives.

[Tommy Sheppard]

Meanwhile, in the real world, Scottish Care reports that 30% of social care staff in the highlands are nationals from other European countries. They are paid the real living wage of £9 an hour as a matter of public policy, but that is well short of the Government’s proposed limit of £30,000 for new immigrants in the future. Will the Secretary of State fight in the Cabinet to change that policy, or is he content to let these new immigration policies choke off the supply of labour to our social care sector?

[Matt Hancock]

We welcome people working in social care from the EU and from the rest of the world, and we need to ensure that that can continue, but we also need to ensure that we can train people locally to work in social care. That is incredibly important.

Oral Answers to Questions

Tommy Sheppard Excerpts

Tuesday 15th January 2019 Commons Chamber

[Ian Murray (Edinburgh South) (Lab)]

3. What progress his Department has made on contingency planning for the UK leaving the EU without a deal.

[Tommy Sheppard (Edinburgh East) (SNP)]

18. What preparations his Department has made for the UK leaving the EU in March 2019.

[The Secretary of State for Health and Social Care (Matt Hancock)]

We do not want a no-deal scenario in our exit from the European Union, but it is incumbent on us to prepare in case. We asked medical suppliers to stockpile a further six-week supply over and above normal levels, and that work is going well. We will continue to work to ensure the unhindered supply of medicines in all Brexit scenarios.

--- Later in debate ---

[Matt Hancock]

As I said, thanks to the votes of Members in all parts of the House, no deal is a matter of the law of the land. They can’t get away from it: if they don’t like no deal, they need to join me in the Lobby tonight, and vote for the Prime Minister’s deal.

[Tommy Sheppard]

In Scotland, 6% of all social care staff are nationals of European countries. In England the figure is 8%. In Scotland, despite the Scottish Government paying the real living wage of £9 an hour, that comes nowhere near the £30,000 threshold proposed for a tier 2 visa. Can the Minister tell us here today what action he will take to avert a staffing crisis in social care?

[Matt Hancock]

We have brought into place already the EU settlement scheme to ensure that those EU workers who are working in social care and in the NHS can and should remain here and continue to contribute, as they do so valuably.

Deafness and Hearing Loss

Tommy Sheppard Excerpts

Thursday 30th November 2017 Westminster Hall

[Tommy Sheppard (Edinburgh East) (SNP)]

I will sign this comment: “Today, I will talk to you about deafness and hearing loss in Scotland.”

I will come back to my poor attempt at signing later. I wanted to speak about a number of things, many of which have already been mentioned. I very much welcome this debate and congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on bringing it here. Indeed, I commend him on the work he has done through the all-party parliamentary group on deafness to raise this issue across the House.

There are approximately 1 million people in Scotland who suffer hearing loss, and I am one of them. About 15 years ago, I found that my hearing was deteriorating, and I did not do much about it—I was just very irritating to my friends and family, not hearing things. Eventually, I was persuaded to get treatment. I was diagnosed with degeneration in the inner ear, an inherited trait that means that I cannot hear some frequencies, but I can hear others. I hear some frequencies at full volume, and others at just 30% or 40%, which means I lose a lot of the sense of what people are saying to me.

I am beyond grateful to NHS Lothian and our public health service for what it has been able to do for me. I wear hearing aids, like my hon. Friend, and the degree of technology and sophistication in these little things is quite remarkable. There are mini-computers in here that take in all frequencies and decide to boost the ones that I am weak on, which means that, by and large, I can hear relatively normally. I also want to place on record the efforts of the House authorities. In particular, I find the loop in the Chamber very effective indeed.

Of course, there are still drawbacks; those who, like me, wear hearing aids will be aware of this. For example, when I am in the Chamber taking part in a debate and I have them on the setting for the loop, if a colleague sitting beside me says something, I do not get it; I have to reprogramme the aid and try to find out what they were saying—or quite often I just nod and pretend I got the gist of what they were saying. I also notice that these aids can be irritating to me and others in close proximity, because of the feedback and whistling sound there is sometimes, but it is worth putting up with those minor drawbacks to take advantage of this great technology.

I got these hearing aids on the NHS, and I was very grateful indeed to receive them. These instruments are state-of-the-art technology that match anything available in the private sector. In fact, I have friends who, either through inclination or ignorance, decided to go private, and went to agencies on the high street that retail hearing aids, and their service is far inferior to mine. Eventually, on my advice, they went to the local audiology department and got better treatment.

That is just part of why I have a particular interest in the subject. I am of course also mindful that this is probably one of the most common disabilities that we as a species suffer. More of my constituents probably suffer hearing loss than voted for me on 8 June; that is how prevalent it is.

I want to spend a little time, because others have mentioned it, talking about the situation in Scotland, particularly with regard to BSL. Any BSL users watching what I did at the beginning will understand that I cannot sign, but I tried to learn that opening line because I know that, as time goes on, I will want to learn BSL, as it will be something that I rely on in later years and is therefore important to me, but it is important to me in the here and now because of so many people for whom BSL is a vital means of communication.

It has already been mentioned that in 2015 the Scottish Parliament passed the British Sign Language (Scotland) Act. A Labour MSP decided to bring it to Parliament. The Act was passed unanimously, with all five parties in full agreement. A key thing that the Act did was launch a process to establish a national action plan to promote and develop BSL in Scotland, with the simple objective of making Scotland the best place in the world to be a BSL user and to live, work and play. I say that not to blow Scotland’s trumpet, although it is part of my brief to do that, and not to say that Scotland is better than the rest of the UK, but simply to say that if people took the time and sat down to talk about these things and draw up a plan, they would be surprised at how much can be done. I ask the Minister and the Government to look at the situation as it is developing in Scotland and perhaps see how much of that could be replicated UK-wide.

The national plan was published in September. It is quite detailed and has 70 targets. I will not go into them all; it is available on the Scottish Government website. The process was really important. Once time is provided in a Parliament for a discussion that leads to legislation, because of the statutory force of the discussions taking place, things that people had never thought about begin to go on the agenda and come out of the woodwork. It is a stimulus to all manner of people in civic society and in Government agencies in thinking about how they can improve the situation.

The plan of action has 70 detailed targets set for the next three years. I will give Members a flavour of them. The first is to look at how we can build into the 2021 census a question or series of questions that identify in detail the number of BSL users taking part in the census, so that we have the data on which to plan in future. Target 10 talks about improving access to early years services, so that deaf children can access them. Target 16 is about removing the barriers that prevent BSL users from becoming teachers, so that they can not only teach in the medium of BSL, but teach hearing kids through interpretation. Target 25 is about targets for colleges and universities. Importantly, the next target makes loans available for BSL students. I am pleased to say that just this week the Scottish Government announced that loans will be available for students in Scotland to study throughout the UK if the course is not available in Scotland, so we now have a situation in which we can support BSL users who are students in Scotland, but who are able to go on courses in England and Wales as well.

Target 39 is about making sure that all our health screening and immunisation programmes have the medium of BSL built into them, so that BSL users have full access. Target 48 is about sport, and 53 is about placing obligations on transport and our rail and bus providers to make sure they understand the needs of BSL users and have it available as a means of communication. Target 57 is about access to the arts. Target 63 is about making sure that our emergency services understand the needs of BSL users and have a facility to be able to communicate with them. Finally, the last one I picked out is the target to improve electoral participation and voting in the political process by BSL users.

There is a series of very good targets, but probably the best thing about them is the way in which BSL users themselves have bought into the process and have become part of developing the action plan. A full £1.3 million has been provided to various deaf voluntary organisations to monitor how the targets develop and are implemented. In 2020 the intention is to come back with a full Government review across all agencies to make sure we look at the next stage. Those are practical, achievable steps that can be taken, many of which do not involve a lot of money. They can be done within existing budgets. They require changes in attitudes. We cannot overestimate the importance of having a statutory framework and setting all these things down as targets for Government agencies.

There is always pressure on a legislative programme, but a UK BSL Act that would do some of those things would not take a lot of parliamentary time. It need not be a very complicated Bill. It could be focused. Even if we had to give up three hours of a Back-Bench debate or two to get the measure through, it would be worth doing. I am sure that if the Government were to take the initiative, they would find all parties commending them.

Several people have mentioned Access to Work, but it is important to stress that claimants who had the benefit of the programme and were not limited until now—the cap applied to new claimants—will be subject to the cap as well. That will mean that some people who are in employment will have to reduce or leave their employment. That is the truth of the matter. It might not be a great number of people, but that is what will happen.

I note that the DWP says that only about 267 people will be affected by the cap. That is not a great number, but it really looks like penny-pinching when we compare it to the scale of the DWP budget.

[Jim Fitzpatrick]

The early statistics said that for every £1 spent on Access to Work, the Treasury got a cost-benefit analysis plus of £1.34 or £1.50. A lot of the people the hon. Gentleman describes are senior professionals, chief executives and so on, who will be on a 40% rate of tax, so it is an investment that will give the Treasury more money back than the basic rate of tax does.

[Tommy Sheppard]

I could not agree more. If somebody is in work and gets support through the scheme, not only are they earning money and paying tax, but the people who support them earn money and pay tax as well. There are all sorts of ways in which this makes sense. My key point is that given the small number of people affected, is the cap really worth it? Would it not be better to not have the cap, and assess the situation later? It is expensive because of the nature of the support that people need in this part of the programme if they are deaf and a BSL user. It is expensive because that support is undertaken by hard-working professional people such as the signers here today, who have trained very hard for the job that they do.

Perhaps in the future developments in audio technology and computer graphics will be such that we will get an app on our smartphone that will turn speech into sign in a way that works, but who knows? That is for the future. For now, we need professional human beings to be able to provide the service. We should accept as a society that for the limited number of people affected, the money is a price worth paying. We could perhaps look at other ways, rather than the cap and restricting the services provided, to reduce costs.

I want to finish by talking about Parliament and some of the things that we might be able to do here. It is wonderful that we have our proceedings signed today. I do not know why we do not have a signer standing beside the Speaker’s Chair and filmed for all the proceedings in our Parliament. When we think of the amount of money we spend in this place, the number of staff that we have, the amount we spend on maintenance and the amount we are going to spend on refurbishment, it is not such a big price to make sure that during the 30 hours a week or whatever when the Chamber is in operation and debating, there is a signer there, signing for the people in the Chamber, and, more importantly, for the people who watch live online or wish to check back on proceedings.

Another thing that we could do has to do with the scheme in Parliament, which Members may be aware of—I have not taken advantage of it yet, but I am sure others have—to get tuition in a foreign language. Why do not we add BSL to that? Why does not each MP have an opportunity to learn that as part of our professional development as Members of Parliament, so that we are better able to communicate with our constituents, and more aware of the technological needs?

My central point, which I will stress as I end, is that it is impossible to overestimate the importance of a legislative framework, because of the sense of purpose it creates for civil society and statutory agencies, and the sense of worth, I suppose, that it gives to people who are looking to us to respond to their needs.

Oral Answers to Questions

Tommy Sheppard Excerpts

Tuesday 9th February 2016 Commons Chamber

[Alistair Burt]

I am aware of my hon. Friend’s keen interest in the rebalancing programme of work, and particularly the work on dispensing errors. We are fully committed to making that change. There are a number of stages to amending primary legislation through a section 60 order. Given the timetable, it is likely that the order will be laid before the Westminster and Scottish Parliaments in the autumn.

[Tommy Sheppard (Edinburgh East) (SNP)]

T2. The Secretary of State will be aware that Maximus is recruiting junior doctors to perform work capability assessments in the Department for Work and Pensions. The company is offering £72,000 a year, which is up to twice the salary that junior doctors would get in the health service. Is he concerned that that will result in inexperienced medical staff making judgments that relate to people’s livelihoods? Is he not also concerned that it will result in a drain of staff resources out of the NHS and out of providing general healthcare for the public?

[Mr Jeremy Hunt]

As a result of the changes the Government have made on welfare reform, we have 2 million more people in work and nearly 500,000 fewer children growing up in households where nobody works. Part of that is making important reforms, including having independent medical assessments of people who are in the benefit system. I think everyone should welcome that.

Oral Answers to Questions

Tommy Sheppard Excerpts

Tuesday 17th November 2015 Commons Chamber

[Alistair Burt]

There are two particular ways to do that. The first is to enhance GP training, and work is already going on to do that. The second is through continuing professional development, and the Royal College of General Practitioners and HEE are combining to ensure that a good range of materials is available for clinicians and others to improve their skills in that area. My hon. Friend is right to raise the issue.

[Tommy Sheppard (Edinburgh East) (SNP)]

12. What assessment he has made of the effect of poverty on the incidence of health problems.

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

Across Government we are working to improve the life chances of children, and that is at the heart of our efforts to tackle the real causes of child poverty and improve the prospects for the next generation. That involves taking a broad approach to improving poor health and tackling health inequalities which the last Government embedded in the law. The wider causes of ill health, such as worklessness and unhealthy lifestyles, are all being addressed at the moment. I welcome the fact that we have record numbers of people in work and a dramatic drop in the number of children living in workless households. That goes to the heart of some of the broader drivers of ill health and poverty.

[Tommy Sheppard]

I am pleased that the Government accept that there is a causal link between poverty and poor health outcomes. They will also know of the widespread concern that the proposed changes to the tax credits regime will result in greater poverty, which will in itself cause poorer health outcomes and may put great pressure on the NHS. Will the Department consider putting in place mechanisms to monitor the effect of the tax credit changes on demands on the national health service?

[Jane Ellison]

We do far more than monitor health inequalities; we are taking action to deal with them. The heart of my portfolio is comprised entirely of tackling health inequalities in our nation. Let me give just a couple of examples: the expanded troubled families programme, on which the Department of Health is working closely with other Departments; and the family nurse partnership, where we support some of the most vulnerable young parents in the earliest years of their children’s lives. Those programmes have the greatest impact on our most disadvantaged communities. The matters that the hon. Gentleman raises are for other Departments, but I assure the House that improving the life chances of all our children is core business for the Government.