Global Health Framework

Will Quince Excerpts

Monday 22nd May 2023 Written Statements

[The Minister for Health and Secondary Care (Will Quince)]

We are pleased to announce the publication of the “Global Health Framework: Working together towards a healthier world”. The framework sets out our vision to play a leading role in improving health globally and in building resilience to future threats. It outlines the actions we will take over 2023-2025 in support of health and for a safer and more prosperous UK and world. It is available here: https://www.gov.uk/government/publications/global-health-framework-working-together-towards-a-healthier-world.

The pandemic shone a spotlight on the importance of global health and the need for strong health systems to protect nations and economies from future global health threats, not least the need for collective action to deliver the third sustainable development goal—to “ensure healthy lives and promote well-being for all at all ages”.

The framework aims to harness capabilities across Government to deliver our global health aims as set out in the international development strategy and recently published “Integrated Review Refresh”. Historically, the UK has been a proud leader in global health. We are well placed to continue this leadership by building on our strengths such as the UK’s health system, our expertise in public health and our excellent health science and research sector.

We will use this leadership to achieve the key aims of the framework.

We will strengthen global health security through improving our preparedness and response to future epidemics, pandemics, drug-resistant infections, and climate change.

We will reform the global health architecture, including through a strengthened World Health Organization, to drive more coherent governance and collaboration across the international system.

We will strengthen country health systems and address key risk factors for ill health, working towards ending the preventable deaths of mothers, babies and children in the world’s poorest countries, and enabling women and girls to exercise their rights.

Finally, we will advance UK leadership in science and technology, strengthening the global health research base of UK and partner countries, while supporting trade and investment.

Our global work contributes to the UK’s ability to handle health threats and strengthens our life sciences sector. A significant part of the solution to the challenges we face at home will come from overseas and having strong relationships with other countries. The global health framework therefore sits alongside the wider international engagement conducted by the Government to achieve better domestic health outcomes. For example, our involvement in global health research means we can be at the forefront of technological innovation and bring those benefits to our own population, while being part of global disease surveillance systems ensures we have access to early evidence of health risks that could affect the UK directly or indirectly.

Over the next two years we will collectively progress key activities across the four objectives set out in the global health framework. We will work across Government to maximise the impact of these ambitions. Now is the time to act to realise the importance of health for all by treating it as a global priority.

[HCWS786]

Future of Stoma Care

Will Quince Excerpts

Wednesday 17th May 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Clacton (Giles Watling), my near neighbour, on securing this important debate. He is a tireless advocate for his constituents and for patients across the country who suffer from conditions such as bowel cancer. They are fortunate to have him as their advocate.

Let me start by touching on the importance of reducing stigma. Stoma care is a topic that not everyone feels comfortable talking about, and as a Minister at the Department for Health and Social Care I want to play my part in reducing the stigma around living with a stoma. I hope that this debate and the event to which my hon. Friend referred will play some part in encouraging people to talk more about stomas and to come forward for services such as bowel cancer screening. I am hugely grateful to him for the opportunity to discuss this important issue in Parliament.

We know how important prevention and early detection are to health. Bowel cancer screening is available to everyone in England aged 60 to 74, and since 2021 we have been expanding the screening offer in England to younger patients so that everyone aged 50 to 59 will be included by 2025. We also know that the early proactive management of bowel disease is far better for patients, as my hon. Friend rightly pointed out. In many cases, it will reduce the amount of surgery resulting from stomas.

My hon. Friend referred to patient choice and the differing quality of stoma products. I know how important patient choice is, not just in this area but in so many areas across our NHS. I also know—my hon. Friend put this point eloquently and articulately—that one stoma product does not always work for all patients, which is why it is so important that there is patient choice. I recognise that having the right stoma product to support patients’ quality of life is as important as the medical need itself. My hon. Friend raised a serious point about general practitioners deleting items; I will ask my officials in the Department to investigate that point and write to him.

I am grateful for the opportunity to update the House on the levels of NHS spend. Current NHS expenditure in this field is about £350 million every year, which is predominantly used to provide stoma products to patients. Over 9,500 different stoma products are available on the NHS, and these products are prescribed to patients under part IX of the drug tariff. I am pleased to remind colleagues that one area of focus in our inaugural medtech strategy published in February this year, which has been widely and largely welcomed by industry, is medical devices used in the community, which include prescribed stoma products.

We have a stoma products consultation, which I will touch on, and the Department of Health and Social Care is leading a piece of work to review how the tariff operates in order to ensure that appropriate and effective products are prescribed to patients. I acknowledge that it is currently difficult to know the position and to compare the differences between products on the drug tariff. We will work to make things as transparent as possible so that clinicians are far better informed and can provide the right product for each and every individual patient.

We will also continue to support the provision of a range of stoma products through part IX of the drug tariff to ensure equitable access for patients, an issue that my hon. Friend touched on. We do not want a postcode lottery. I want to make sure that patients, regardless of where in the country they live, have a voice in determining the product range available on the tariff, so that the interests of patients are at the heart of how the tariff operates.

[Janet Daby]

I thank the Minister for responding to the questions that have been asked. When the Government are looking to purchase products for people who have a stoma, will there be some consultation with patients so that they can help to make a decision as to the types of product that they feel will work for them?

[Will Quince]

I thank the hon. Lady for her intervention and for sharing her personal experience, which is a hugely valuable part of this debate. As I have said, a large number of products are already available on the NHS. She is absolutely right to say that we should engage with patients, because product selection should always be based on the clinical need of individual patients, not on manufacturing brand, pressure from particular companies or relationships with individual trusts. Yes, patients will be at the heart of the decision-making process, and rightly so. We are currently engaging on that exact point with a number of patient groups and with the industry, which is an important part of this as well. We will launch a targeted consultation over the summer, and I encourage patients, charities, organisations and industry to take part; I think they naturally will. We must ensure that the tariff continues to provide effective products to patients, wherever they live in the country.

My hon. Friend the Member for Clacton touched on patient care. I, too, recognise that the patient pathway for stoma care differs depending on the model of care that commissioners have adopted, hence my reference to a postcode lottery. Stoma service delivery models have been supported nationally through past NHS initiatives such as the QIPP, the national quality, innovation, productivity and prevention programme—it is a mouthful —which published recommendations on best practice for delivering stoma services. There are already really good examples across the country, such as in Rotherham, Nottingham and the midlands, of stoma services being delivered effectively based on those fundamental principles. It is important that we share that best practice and ensure that it is rolled out across all the country’s integrated care systems.

[Giles Watling]

In the rush for equity, which I am asking for so that everybody has equal access to the best possible care, we must not lose sight of the fact that each individual is individual and requires specialist care. There cannot be a one-size-fits-all answer.

[Will Quince]

I totally agree. It has to be based on clinical need and on the choice of the individual patient. However, when we look at the examples of the areas that do this really well and get those pathways so right, we can see that patients are followed up with regularly, receive annual reviews and have a wide range and choice of products. As my hon. Friend rightly points out, it is based on independent clinical advice on the best product for their need that they know best suits them as a patient. That is the exemplar, if you like—the model that we want to see across the country.

My hon. Friend talked about medtech and research and development investment in life sciences, a passion of mine. Colleagues may previously have heard me speaking about the Department’s work to ensure that the UK has a flourishing life sciences sector with a focus on innovation. I want to make sure that we always bring the best possible medtech, medicines and therapies to UK patients as quickly as possible.

The Medicines and Healthcare products Regulatory Agency is currently updating the medical devices regulatory regime, which is designed to support innovation and improve patient access to innovative medical devices by improving the regulation of novel and growing areas such as artificial intelligence, which we know will play such a big role. The medtech strategy is a meaty document, but I recommend that hon. Members look at it: it sets out a clear ambition to provide a streamlined pathway from pre-registration products through, ultimately, to adoption within the NHS.

My hon. Friend is right to say that we must work with industry to make sure that the UK is its launch platform or country of choice, because we want UK patients to be the very first to get access to the most cutting-edge and innovative medtech. We work closely with industry and across the system to implement actions to address the barriers to adoption in the UK. That predominantly involves removing duplicative evaluations to ensure that procurement processes are as streamlined as possible for companies, thus making the UK a best-in-class destination.

The medtech community is a key focus area for implementation of the strategy. As part of my Department’s engagement with industry and patient groups on its upcoming consultation on part IX of the drug tariff, officials have planned various roundtables and engagement points with stakeholders. That engagement will include industry and patients, which speaks to the point that the hon. Member for Lewisham East (Janet Daby) made about the importance of putting the patient voice at the heart of everything we do. As my hon. Friend the Member for Clacton knows, the Government’s medtech strategy sets out how we will ensure that the health and social care system can reliably access safe, effective and innovative medical devices. I am pleased to assure my hon. Friend that it is absolutely a priority for me, for the Department and for the Government.

I thank my hon. Friend the Member for Clacton and the hon. Member for Lewisham East once again for bringing this issue to the Government’s attention and for flagging particular areas. I look forward to continuing to work with charities and hon. Members across the House on the matter. Finally, on my hon. Friend’s most significant ask, I would be absolutely delighted to meet him, charities and Coloplast to take this forward.

Question put and agreed to.

Epidermolysis Bullosa: Drug Repurposing Trials

Will Quince Excerpts

Tuesday 9th May 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

I congratulate my hon. Friend the Member for Orpington (Gareth Bacon) on securing this important debate, which has been helpful to highlight this serious condition and the efforts to find treatments. I thank him for sharing the experience of his constituent, Wendy.

I very much recognise the challenges faced by people and families affected by epidermolysis bullosa, which as he rightly pointed out is a rare disease. It is estimated to be diagnosed in one in 17,000 babies born in the UK. Rare diseases are defined as those affecting fewer than one in 2,000 people and, although they are individually rare, sadly, these conditions are collectively all too common. One in 17 people will be affected by a rare disease at some point in their lifetime. In the UK, that amounts to more than 3.5 million people. It is therefore vital that these people have access to the right care, the right treatments and the right support.

I turn to the rare disease strategy. The “UK Rare Diseases Framework”, published in 2021, embodies our commitment to securing a better future for all people living with rare diseases. It sets out our vision on how to improve the lives of people with rare diseases through four vital priorities. They are helping patients to get a final diagnosis faster; increasing awareness among healthcare professionals; better co-ordination of care; and improving access to specialist care, treatments and drugs. To deliver on the Government’s ambition, all four nations have published rare diseases action plans, which set out our tailored approaches to deliver the aims of the framework in ways that are most effective for each nation’s populations and healthcare systems. In England, we published the second rare diseases action plan on 28 February, in which we set out 13 new actions to drive improvements across the health system.

My hon. Friend rightly pointed to research funding. The UK is internationally recognised for our leadership in research, the excellence of our scientific institutions and our fantastic healthcare system. We must continue to utilise those resources to benefit those affected by rare conditions. The Government are committed to increase spending on research to £22 billion by 2026-27, moving towards our target of investing 2.4% of GDP in research and development by 2027. Alongside industry and medical research charities, the Government primarily fund research into rare conditions such as EB via UK Research and Innovation and the National Institute for Health and Care Research.

Through the NIHR, the Department of Health and Social Care invests over £1 billion a year to fund, enable and deliver world-leading health and social care research. Pioneering research is a cross-cutting theme of the rare diseases framework. We recently announced significant new funding of over £12 million via the Medical Research Council and NIHR for a rare disease research platform. The hon. Member for Strangford (Jim Shannon) rightly referred to the importance of Government-backed research funding. Since 2019, the NIHR has funded three studies specifically into EB, with a total award value of over £4 million, and we have supported the delivery of more than 25 studies.

Research is vital—that has been well articulated today—but treatment is, too. I agree with my hon. Friend the Member for Bracknell (James Sunderland) that therapeutic treatments are also a part of the solution and are absolutely key to improving the quality of life for EB patients. As my hon. Friend the Member for Orpington said, unfortunately there is no cure for EB. However, as he also rightly pointed out and I am very pleased to say, the National Institute for Health and Care Excellence is currently evaluating two treatments: birch bark extract, as he pointed out, for treating skin wounds; and the gene therapy—I am afraid I am will not make a much better job of pronouncing this than him—beremagene geperpavec. I apologise to all medics and research professionals for that pronunciation; I am not a medic. If either of those treatments is given a positive recommendation by NICE, NHS England will ensure that service provision is in place to deliver it into the hands of those affected by EB.

My hon. Friend also rightly pointed out the drug repurposing process, which could be absolutely life-changing for people with EB. There is substantial interest in repurposing existing medicines to treat rare diseases, as repurposing is often quicker and less costly than developing new medicines. Our medicines repurposing programme identifies and progresses opportunities to use existing medicines in new ways that are not included in the current licence, with the aim of improving clinical outcomes, patient experience and, also importantly, value for money. As one approach to identifying candidate medicines for repurposing—my hon. Friend touched on this—the NIHR has an innovation observatory, which searches for suitable clinical trials nearing completion. That routine scanning has identified a French trial investigating the use of—I again apologise for my pronunciation, Madam Deputy Speaker—ixekizumab, a licenced treatment for other conditions such as psoriasis, for simplex generalised severe EB. The medicines repurposing programme is monitoring the study and will use the results when available to assess whether the drug is a suitable candidate for the programme.

My hon. Friend mentioned the MRP and evidence of efficacy. I want to clarify that for a medicine to enter the MRP programme there has to be some evidence of efficacy and safety, but—this is the important point—conclusive proof of efficacy and safety is not required. Projects that need a further clinical trial are potentially eligible to enter the programme, at which point we would liaise with the NIHR about trial funding.

My hon. Friend’s first specific ask was on funding. This is always the difficult bit, because it would be easy to say yes. He makes a compelling case, but I do not think he would expect me—nor would it be appropriate—to commit to funding at the Dispatch Box, though his point was very well made. I will look into it carefully and discuss it with officials, and I will be happy to meet him.

I re-emphasise that the Government very much encourage healthcare professionals, voluntary sector organisations—some of which my hon. Friend mentioned—and companies to propose candidate medicines for the medicines repurposing programme. The details and eligibility criteria are available on the NHS England website. As I said, I would be happy to meet my hon. Friend to discuss that further, which was his second request. Further to that, my understanding is that the medicines repurposing programme has invited the EB charities DEBRA and Cure EB to meetings to discuss specifically the repurposing of medicines for EB. The timing of this debate could not be more spot on, as I believe the DEBRA meeting is scheduled for tomorrow. Those meetings are happening, and I would happy to meet my hon. Friend. He certainly has his finger on the pulse.

[James Sunderland]

Since the Minister is clearly on a roll, if he is available will he commit to come to the DEBRA reception here on 19 June?

[Will Quince]

If I am available I would be happy to do that. I thank my hon. Friend for his support for that charity, which is based in his constituency but works nationwide. The support that constituency Members of Parliament provide to charities through this place should not be underestimated. If I am able to attend, I will.

[Jim Shannon]

When we spoke earlier, I was quite sure that the Minister is truly a compassionate man. He has given us the answers that we wish to hear, and I thank him for that. He talks about the possible cures for EB. Will that information be shared with all devolved Administrations? I think he said that it would be, but I wanted to check.

[Will Quince]

Absolutely. We work on clinical and medical research across our United Kingdom, and rightly so. We work very closely across all four nations.

I am conscious of time, and I want to pick up on the final question from my hon. Friend the Member for Orpington about generic versus branded medicine and the MRP. Branded medicines are potentially eligible for the medicines repurposing programme. I understand that the eligibility criteria state that the programme can support generic, biosimilar and branded medicine. I would be happy to look at my hon. Friend’s list.

In closing, I give my thanks again to my hon. Friend for securing today’s important debate, and to all Members who have contributed. I also pay tribute to the whole EB community and charities such DEBRA and Cure EB, which I know work tirelessly to improve the lives of people affected by the condition. They are fortunate to have my hon. Friend in this place as their champion.

Question put and agreed to.

Branded Medicines Voluntary Scheme and the Life Sciences Vision

Will Quince Excerpts

Wednesday 3rd May 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank my hon. Friend the Member for Newton Abbot (Anne Marie Morris) for securing this important and timely debate—I will come on to why it is so timely in a moment. I thank Members from across the House who have contributed to what has been a highly informed discussion, especially as the House is now technically in recess, as the hon. Member for Bristol South (Karin Smyth) has said.

Members will know that the current VPAS scheme is the latest in a long line of such agreements, which date back to 1957. For many years, those agreements have been at the heart of a collaborative relationship between the Government and industry. As my hon. Friend the Member for Newton Abbot says, the partnership helps to manage the affordability of medicines while, vitally, supporting our life sciences sector to deliver for UK patients and provide them with access to the most innovative and cutting-edge medicines both now and in the future.

VPAS has proven to be a powerful tool in both improving patient outcomes and supporting economic growth. Hon. Members will be aware that a key goal of VPAS, as my hon. Friend pointed out, is to ensure the sustainability of NHS finances by limiting total growth in spending on medicines. Since its inception in 2019, VPAS has driven significant improvements in patient access to cost-effective medicines. It has also ensured predictable spending growth, which is key for the NHS during a period of economic uncertainty.

I can absolutely assure hon. Members that the Government remain firmly committed to the scheme and to continuing to work with the pharmaceutical industry to create a strong, innovation-friendly environment for the development of medicines here in the United Kingdom. We set that out in our life sciences vision, as my hon. Friend said. As she also pointed out, there is only so much I can say, because it is commercially sensitive and negotiations start tomorrow, which is why this debate is so timely.

As both my hon. Friend and the hon. Member for Bristol South said, and as I have set out previously, the idea is to create a four-way win—a win for UK plc, and I will come on to why that is important; a win for our NHS, and the hon. Lady eloquently set out why that is so important; a win for patients, so that we are getting the most cutting-edge and innovative medicines to patients here in the United Kingdom first; and, importantly, a win for industry because of its importance to UK plc. As my hon. Friend the Member for Newton Abbot pointed out, life sciences falls under multiple Government Departments, which makes it complex and not the easiest thing to navigate around Government.

As my hon. Friend rightly says, life sciences falls under the Departments for Business and Trade and for Science, Innovation and Technology, is covered by us at the Department of Health and Social Care and therefore also by NHS England, and is also covered by the Treasury —ultimately, everything comes back to the Treasury. But then we have the Office for Life Sciences, which sits partially in DSIT and partially in DHSC and co-ordinates life sciences across Government.

I understand what my hon. Friend says about the important link between medicine pricing and life sciences investment in the UK, but we are in danger of simplifying a very complex situation. If it were simply down to medicine pricing, that would be a far easier argument to make to Treasury. The reality is that it is not; when we look at the investment environment in the UK, we see that it comes down to a number of things.

Yes, medicine pricing is part of that investment environment, but it also comes down to regulation, as my hon. Friend said, with MHRA and NICE, and to adoption and take-up in the NHS. Each individual trust and GP practice is autonomous. GPs, surgeons and clinicians prescribe the drugs they wish to prescribe—that is not something we centrally mandate—which means that adoption and roll-out across the NHS are not always as easy or as simple as some of the pharmaceutical companies would like it to be, solely within the gift of the Department, Ministers and clinicians at NHS England.

Clinical trials, as the hon. Member for Bristol South rightly said, are hugely important, and I will come on to talk about that later. The hon. Member for Cambridge (Daniel Zeichner) set out eloquently the importance of academia and the role it plays in inward investment into UK plc by pharmaceutical companies because of the golden triangle between London, Cambridge and Oxford—and beyond. That work is spread far more widely around the United Kingdom, but those three places are hubs, and rightly so, and I have enjoyed many a visit to see the incredible work being done there.

There are other issues, such as access to finance, R&D tax credits and, vitally, the NHS as an innovation partner, which is often forgotten. We talk about Oxford, Cambridge and some of the big university and teaching hospitals in London. Actually, the key is every district general hospital—and, in fact, I would love this to be the case for every GP practice up and down the country—being part of clinical research, and encouraging its patients to take part, because we know the impact that that would have.

I recognise the link, but it is wider than that; it is about the environment here in the UK. That is important because when I speak to UK CEOs of pharma companies —the hon. Member for Cambridge set this out—they raise not only VPAS but lots of other issues. My role, and that of my counterparts in other Government Departments —in fact, of all those involved in life sciences—is to ensure that we are giving them the tools in the arsenal to go to their global boards and make the case, as I know they want to, for investment in the United Kingdom. As the hon. Gentleman set out, there is global competition, and to some extent we are falling behind. We need to address that.

Why do life sciences matter? Why is this so important? There are three reasons. First, it is important for UK plc, as has been set out already. It is an enormous investment and part of the UK economy. Of course, it could be so much bigger. That is why it is so important that we continue to encourage life sciences investment in the UK. The second reason is its importance to patients, as the hon. Member for Bristol South set out. This is about ensuring that patients across our NHS get access to the most innovative and cutting-edge medicines that exist globally, and that we are getting UK patients access to them as quickly as, or quicker than, anywhere else.

The third reason, which the hon. Lady also touched on, is that the NHS is under considerable pressure. Some of the challenges that it faces will be addressed by more funding, and some by workforce. Those things will be very important here and now, and in the medium term. However, if we want to address the challenges that the NHS faces in the long term, that depends on genomics and gene cell therapy, and on investment in innovation and transformation around pharma, med tech, systems and AI. Ensuring that the UK is an attractive market for investment is really important to the future of the NHS, and we have world-leading academic and scientific expertise, as the hon. Member for Cambridge set out. We have a competitive tax regime, and a health system that is committed to acting as a good innovation partner. Can we do better? Yes, of course, but it is a good innovation partner. We have to unlock the transformative power of real-world data—something that the NHS is unparalleled in being able to provide.

Despite the relatively gloomy picture that my hon. Friend the Member for Newton Abbot set out, there are huge signs of hope. Take the recent investment and deals that are coming to the UK from Moderna or BioNTech. These are huge investments in UK plc and UK life sciences, which we should be very proud of. Of course, we want to see far more. We also have some exciting opportunities, as my hon. Friend set out, through the O’Shaughnessy review and our desire to massively turbocharge clinical trials in the UK. As my hon. Friend and the hon. Member for Cambridge pointed out, we are losing market share to other countries across Europe. If we look, however, at foreign direct investment, in 2021 it was £1.9 billion from 49 projects, coming in only behind the United States in terms of value—a significant increase. Furthermore, the UK life science industry raised £7 billion in equity finance. It was placed third behind only the USA and China.

I can make the case for UK life sciences—it is a strong one—but we have to do better. We have to always continue to drive forward. I understand the influence of boardroom sentiment, which the hon. Member for Cambridge set out, and that price regulation schemes such as VPAS have to be a consideration in the decision to locate investment. That is exactly why we are committed to agreeing a deal.

[Daniel Zeichner]

The Minister is giving a very thorough reply. I wonder whether he will acknowledge—I have not heard him concede this point—that the 26.7% factor is a real problem that needs to be addressed.

[Will Quince]

I thank the hon. Gentleman; I am going to come to that exact point. I want to respond to as many of the issues as possible, and—rarely for a Westminster Hall debate—we actually have a little time.

We are committed to agreeing a deal that supports a strong UK life sciences sector and drives economic growth through investment, but I recognise what my hon. Friend the Member for Newton Abbot says: we have to do far more in many other areas—clinical trials, regulation, the life sciences missions and the investment therein. There is also the ongoing work around uptake.

The hon. Member for Cambridge talked specifically about the higher VPAS percentage rates, so let me move on to those directly. Of course I understand the industry concerns about higher payment rates, but it is important to stress that those were projected when the scheme was agreed—they were agreed with industry and negotiated by the ABPI on behalf of industry. They reflect the scheme working as intended: to limit to 2% the annual growth in the sale of branded medicines within the NHS.

We are firmly committed to VPAS and to continued working with the pharmaceutical industry to create an environment that facilitates innovation and maintains the UK’s world-leading position in the life sciences sector. I remain hugely grateful to industry for its continued participation in VPAS, which has offered much-needed financial security to our NHS during a period of significant economic uncertainty.

[Daniel Zeichner]

rose—

[Will Quince]

Let me conclude the point, as I may well answer the hon. Gentleman. He has pushed me on the negotiation that we are about to start—on our mandate and where we would aim to get to. The scheme ends at the end of this year and the negotiations for the successor scheme start tomorrow. As I have mentioned, what I can say today is limited by commercial sensitivity. The negotiations will be overseen by Sir Hugh Taylor, which is hugely welcome—he brings a wealth of experience and expertise that will be of immense benefit and, I genuinely believe, will ensure that we continue to get the best outcomes for patients, the UK life sciences sector and the taxpayer.

But in response to the hon. Gentleman’s question, I should say that we are very much open to ideas about how a successor voluntary scheme should operate from 2024 onwards. I look forward to working with industry, as I know Sir Hugh does, to agree a mutually beneficial scheme that supports the sustainability of the NHS spend on branded medicines, which is critical, and also improves patient outcomes and facilitates a stronger UK life sciences industry.

[Daniel Zeichner]

This is my final intervention, I promise —I am grateful. I think I heard the Minister say that the scheme was working as intended. There is not much transparency in this process, for reasons that are perhaps understandable, but my understanding was that the current situation was not really anticipated when the scheme was drawn up and that a range of things in between have led to it. Will he clarify that point?

[Will Quince]

I am happy to. I will answer by making two points. The first is that the situation was entirely predicted. Forecasts and projections were given; whether industry believed them to be possible is another matter, but my understanding—the scheme was negotiated several years ago, prior to my time as a Minister in the Department —is that it was projected that we could have got to this point through growth. Growth has been significant, which is why it is important that we negotiate a new scheme that takes on board industry’s concerns. More broadly, we have talked a bit about medicine pricing and it is important to stress international comparisons.

[Anne Marie Morris]

I apologise for interrupting the Minister’s flow. He is right that there was a forecast, but my understanding is that it was wrong and that there was an under-growth in all those years bar one. The consequence was that it was not possible for industry to have the predictability that he outlines. Forecasting will clearly always be a challenge, but, as I understand it, in this case it did not give industry what it needed.

[Will Quince]

I hear what my hon. Friend says, but we are talking about what is now history. I do not think anybody is realistically advocating any kind of change to the existing VPAS scheme—in effect, we would be saying that there would be a retrospective rebate to big pharma, despite what was agreed and negotiated. I do not think anyone here is proposing that today. What we are proposing is something that we get right—something that is totally transparent and open for the future in the new VPAS scheme. I know that getting this absolutely right will be at the forefront of the minds of the ABPI and industry as we approach new negotiations.

I want to briefly touch on international comparisons. While direct comparisons of rebate rates can be misleading —as has rightly been pointed out, they are not necessarily as clear internationally and there are differences in the structure of systems between countries—we none the less continue to monitor and consider UK spending on medicines in an international context. It is important to point out that the UK is around the median for spending on medicines per capita among comparable countries in Europe. We tend to spend the same as or more than Denmark, Sweden, Portugal, Spain and the Netherlands, and less than Germany, France and Italy. It is important to provide context.

I come back to the initial point: as important as medicines pricing is, it is part of a wider bricking-up of a UK environment on which global boards will make a decision as to whether the UK is a good place to invest. Yes, we take this matter very seriously. However, as important as VPAS is, I am equally concerned by and keen to address some of the other issues that industry is rightly pointing out. Understandably, given that we are just about to start negotiations and its importance to industry, the issue of the day is VPAS. However, I know how interested industry also is in getting our regulation right, in our speed in setting up clinical trials and our ability to get patients on to clinical trials, and the uptake of new and innovative medicines and medtech into our NHS. Those are huge issues for industry too, and they are areas I am focusing on.

I am conscious of the need to give my hon. Friend the Member for Newton Abbot time to wind up, so I will conclude by once again reassuring her and Members from across the House that the Government are committed to a mutually beneficial voluntary scheme that supports patient outcomes, a strong, thriving life sciences industry here in the UK and—vitally—a financially sustainable NHS. We can all agree that this scheme is vital to keeping the branded medicine bill affordable for our NHS and ensuring that the UK life sciences industry can earn the money it needs to fund research and development into the new and improved medicines of the future. We cannot overestimate the impact that the scheme has had for thousands of patients by ensuring that they have rapid access to new life-saving and life-extending treatments. We remain firmly committed to VPAS and to working with the industry to deliver a new branded medicines agreement. I will ensure that we put patients’ needs at the forefront of these discussions and at every step of the process.

Oral Answers

Will Quince Excerpts

Tuesday 25th April 2023 Commons Chamber

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

11. What progress his Department has made on improving access to NHS appointments.

[The Minister for Health and Secondary Care (Will Quince)]

We are investing at least £1.5 billion to create an additional 50 million GP appointments by 2024. To improve access to hospital appointments we are giving patients choice about their care and offering alternative providers, with shorter waiting times, to long-waiters. We are also investing £2.3 billion in community diagnostic services, which will improve access to tests, checks and scans. One hundred community diagnostic centres are already open, and they have delivered more than 3.6 million additional tests.

[Jamie Stone]

If we have a power cut in north Scotland, people get a text message from SSE saying that engineers are coming out and that they will have power by, say, 3 o’clock. Missed NHS appointments are a waste of resources. I understand that some dental practices in England offer some sort of reminder service, but would it not be helpful if a leaf could be taken out of SSE’s book so that everyone with an NHS appointment receives a text to remind them, “You have a test at 10 o’clock tomorrow,” or possibly, “There is a big queue and there are delays, so your appointment has been changed to 4 o’clock”?

[Will Quince]

The hon. Gentleman is right to raise this issue. Better communication with patients was one of the five principles at the heart of our elective recovery plan, which was published in February. We recommend that all providers use appointment reminders, often through text messages. As he suggests, in some cases that has been shown to reduce “did not attends” by up to 80%. Providers have told us that they see better results when communication is two-way, for example, where patients can reply to cancel their own appointments. Alongside that, we also launched the My Planned Care website, so that patients can access information ahead of their planned appointment, and of course we are doing a lot more with the NHS app. This is just one of the ways in which we are putting patients in control of their own care.

[Paul Bristow (Peterborough) (Con)]

I am the father to two beautiful daughters, Becky and Eris, one of whom was conceived through in vitro fertilisation. Being a father is one of the best things that has ever happened to me, and I was very proud to see IVF services reinstated in Peterborough and Cambridgeshire, following a campaign that I supported and helped to lead. What plans does the Minister have to ensure that IVF services and appointments are routinely offered across the NHS, in line with National Institute for Health and Care Excellence guidance?

[Will Quince]

I, too, have two daughters, so I recognise much of what my hon. Friend said—

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I do, too.

[Will Quince]

You do, too. Mine were not through IVF, but as a Back Bencher I also campaigned on IVF issues, because there was a postcode lottery on that around the country. That still exists to some extent and I would be happy to work with my hon. Friend to make sure that wherever people are in this country they can get IVF services.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

The Conservatives have cut 2,000 GPs since 2015 and now too many patients cannot get an appointment when they need one: 3,000 patients are waiting a month to see a GP in Dover; 3,500 are doing so in Mansfield; 3,500 are doing so in North Lincolnshire; and 5,000 are waiting a month in Swindon. So why will the Government not adopt Labour’s plan to double the number of medical school places, paid for by abolishing the non-dom tax status, so that patients have the doctors they need to get treated on time?

[Will Quince]

I recognise the pressures on the system, but Labour has spent the non-dom money 10 times over. We are taking real action on this issue: real-terms spending on general practice is up by more than a fifth since 2016; as I said, we are investing £1.5 billion to create an additional 50 million GP appointments; we have recruited more than 25,000 additional primary care staff; and there are 2,167 more doctors in general practice; and we have the highest number ever in training.

[Greg Smith (Buckingham) (Con)]

12. What steps he is taking to reduce the waiting time from receiving a cancer diagnosis to first treatment.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

Investors need certainty and the British people need access to more medicines. The growth cap in the voluntary pricing agreement for branded medicines between the pharmaceutical industry and Government makes the size of the medicines rebate unpredictable. Will the Minister remove the growth gap from the 2024 voluntary scheme for branded medicines pricing and access, to supercharge investment that is currently leaking to Germany and Ireland?

[The Minister for Health and Secondary Care (Will Quince)]

I can certainly ensure the House that we are seeking a mutually beneficial voluntary scheme that supports patient outcomes, a strong life sciences industry and a financially sustainable NHS. We have been working directly with industry to understand the impact of changes to VPAS on investments into the UK life sciences sector, and we remain firmly committed to VPAS, which, it is important to say, has saved the NHS billions of pounds and saved millions of lives by supporting patients with life-threatening conditions and giving them rapid access to new medicines.

[Jeff Smith (Manchester, Withington) (Lab)]

T3. I was very grateful to get fantastic treatment for a detached retina at the brilliant Manchester Royal Eye Hospital, but 551 patients have lost their sight as a result of delayed eye doctor appointments since 2019, and the backlog for ophthalmology appointments is, at 630,000, the second largest in the country. The treatments are there, but what will the Government do to sort that problem out?

--- Later in debate ---

[Will Quince]

My hon. Friend is right to raise this issue. Over 12,000 more participants a month are recruited into clinical trials than before the pandemic, but we recognise that there is much more to do in order to be internationally competitive, including around regulation and speed of approval. I am pleased to say that in the coming weeks, Lord O’Shaughnessy will publish his independent review into UK clinical trials, and I very much look forward to receiving his recommendations.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

T10.   When we had a shortage of doctors, the last Labour Government established the Hull York Medical School. We now have a shortage of dentists, so it is time for a Hull York dental school. This proposal has cross-party support in the Humber, so I wonder whether a delegation of MPs could meet the Minister to discuss taking the initiative forward.

Medicinal Cannabis: Economic Contribution

Will Quince Excerpts

Thursday 20th April 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this important debate, which would be considerably better attended if it was held on any other day, because I know from my inbox and from speaking to Members from across the House that there is considerable interest in this issue.

Although this is the first debate on this important topic that I have responded to as a Health Minister, I know that the House has debated medicinal cannabis at great length in the past, in good, constructive debates. I appreciate the depth of passion that hon. and right hon. Members from across the House have on this issue. I recently met members of the all-party parliamentary group for access to medical cannabis under prescription and, as mentioned by my hon. Friend the Member for Strangford (Jim Shannon), I visited one of Jazz Pharmaceuticals’s sites to learn more about the industry, the applications of its products—the medicines—and the challenges that it faces. I also learned about the huge opportunities for not just UK life sciences and UK plc, but, importantly, our NHS and patients.

I note that the interest from my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale is largely a constituency one; he talked about Hilltop Leaf. He has long championed investment in Scotland, particularly in rural and remote areas, where it has sometimes been a challenge in the past to attract certain high-skilled jobs. This issue is an example of that—and here, the investment would be accompanied by research capability. My right hon. Friend has eloquently and articulately made his case. I am very much alive to the fact that this is a complex issue, and complex issues rarely have simple solutions. I will try to respond to as many of the points that he and other hon. Members have made in the available time, which is reasonably substantial—in a Westminster Hall debate, it is rare to have more than seven or eight minutes in which to respond.

As my right hon. Friend pointed out, this issue crosses multiple Departments—the Department for Science, Innovation and Technology, the Department of Health and Social Care, the Department for Business and Trade and, vitally, the Home Office, which has been alluded to, and NHS England. There was mention of the calls to grow the UK CBD industry, and hemp farmers’ harvests. I am straying somewhat out of my health remit for a moment to polish off some of these points, in so far as I have the bandwidth to do so. I understand that the Home Office has no plans to permit cannabis cultivation without a licence—my right hon. Friend pointed to the licensing programme and the challenges thereto—or to remove the distinction between the industrial hemp regime and the standard cannabis cultivation regime. I cannot say anything more specific on that. As I hope my right hon. Friend will agree, it is well outside my area of knowledge and expertise, and my brief. However, I do understand, having done some rudimentary research and obviously from my conversations with Jazz Pharmaceuticals, that this relates to plants being grown outside versus inside, and the use of leaves and flowers specifically.

[Ronnie Cowan]

If the Minister is struggling to understand, I am more than happy to give him a copy of the report by the all-party parliamentary group on industrial hemp and CBD products called “A Plan for a Legal and Regulated UK Hemp and Cannabis Sector”.

[Will Quince]

I thank the hon. Member for that; I will gladly take a copy on the way out. I hope he will excuse the fact that I am not an expert in this field, but I will happily take that report as my weekend reading and read up on the subject. I certainly agree to take this up with my counterpart in the Home Office, as my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale requested, and I am sure he will, too. I will especially take away my right hon. Friend’s important points on licensing, and on how the Government can support companies that want to invest in the UK, or that are here and want to diversify their agricultural business, and want to get the licences required to grow these products.

[Sir Jeremy Wright]

All of us understand that the Minister does not speak for each of the Government Departments responsible for this area, and I know he will take away from this debate that nobody is arguing that there should not be licensing of this process. There are obvious concerns that need to be met by regulatory intervention. The concern is the fragmentation of the regulatory landscape that applies to those seeking to grow these products. I am sure that the Minister can assist us by helping to better co-ordinate the way in which regulation is applied, as we are not seeking a removal of licensing.

[Will Quince]

I thank my right hon. and learned Friend for his intervention. I think we are probably in violent agreement on this point. I cannot specifically speak to regulation or licensing from a Home Office perspective. We are talking about a controlled drug; that may come as a disappointment to the hon. Member for Inverclyde, but it is—and is likely to remain, I hasten to add—a controlled drug. I will turn later to regulation from the perspective of the Department of Health and Social Care, but it is really important that there be consistency and coherence, and that we treat these products as we would any other medicinal product. However, my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale makes his point well, and I will raise it with Home Office colleagues.

More broadly on growing a UK CBD industry, I am of course aware of the growing consumer CBD wellness market. One only has to walk down any high street to see CBD products advertised in windows, and indeed in major supermarkets. DEFRA, which I did not mention, and the Food Standards Agency are taking action to regulate this side of the market. Importantly, that will protect consumers by ensuring that only safe, high-quality products are placed on the market. That is vital. Consumers will also be protected against misleading health claims. I was recently told about CBD products that come in aluminium cans, but in fact the CBD remains on the aluminium and is not contained in the product. That is just one example. This is a very complex area that I do not want to delve too much into, as it is very much a DEFRA and Food Standards Agency lead.

The Food Standards Agency is working closely with the Home Office on how CBD products are regulated, considering their composition and the possible presence of a controlled substance. This is very much a live issue, and I am told that the Home Office has sought the advice of the Advisory Council on the Misuse of Drugs. I understand that the Government intend to respond to the ACMD recommendations on this matter shortly.

My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale and my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) both raised a point about regulatory barriers. Not that this reminder is needed, but it is perhaps helpful if I remind the House that cannabis- based medicines are controlled drugs and are therefore regulated by the Home Office, which is responsible for all controlled drug regulation legislation. Then there is the controlled drugs licensing regime, which supports cultivation, research and, where the issue crosses over into the health sphere, clinical trials in the UK. This licensing regime enables the possession, supply, production and import and export of those controlled drugs to support industry, pharmaceutical research and healthcare. However, more and more these products are being grown in the UK, including Jazz Pharmaceuticals, for use in research.

[Ronnie Cowan]

This time, when the ACMD makes recommendations to the Government, will the Government acknowledge and accept them? They have knocked back its recommendations a couple of times in the past, most recently over nitrous oxide.

--- Later in debate ---

[Will Quince]

The hon. Member tempts me—it is always tempting—to respond on behalf of another Government Department and Minister. I mentioned that because it is my understanding that the Government intend to respond to the report and the recommendations. I am not the responsible Minister, so it would not be appropriate to comment, but I will gladly point the hon. Member in the direction of the Home Office Minister who will have responsibility for responding, and will ensure that he has the opportunity to have a conversation with them.

The point I was making is that the overall legislative framework on illicit drugs seeks to control harmful substances while enabling appropriate access to those drugs for legitimate medicinal research and, in exceptional cases, for industrial purposes. The example I touched on is Jazz Pharmaceuticals, which—I do not believe this is a secret—is providing a product for clinical trials here in the United Kingdom. That is something that I think we all welcome. I know that the legislation has recently been reviewed by the independent ACMD, which concluded that no legislative amendments are currently required, as there is not yet sufficient evidence that the law needs amending.

Turning to a key point of the debate—cannabis for medicinal use, which falls firmly within my sphere of influence—I am hugely moved by so many of the cases that I have heard about, and I will come back to the specific cases that right hon. and hon. Members have raised today. These are really difficult, because my overriding priority as a Health Minister must always be to ensure that patients have access to medicines that are proven to be safe and effective. That is the biggest challenge, and it is why I am committed—the hon. Member for Bristol South (Karin Smyth) rightly challenged me on this—to galvanising research in this area; that is key to unlocking so much of this debate.

The prospect of a future in which more licensed— I put the emphasis on “licensed”—cannabis-based products that are proven to be safe and effective can be prescribed on our NHS to help relieve suffering is genuinely exciting. That is where I desperately want us to get to as quickly as possible, but herein lies the problem. There are clinical concerns, which, having spoken to clinicians, I share, about the limited evidence on the safety and efficacy of unlicensed cannabis-based products. Only in a few cases have enough clinical trials been done to prove scientifically that the drug is safe and effective. However—I want to labour this point—progress is being made.

Let me turn to the cases of Sophia and Alfie, which were raised by the hon. Member for Strangford and my right hon. and learned Friend the Member for Kenilworth and Southam. I have two young children and am deeply moved by these stories. The debate around medicinal cannabis often centres on children with difficult-to-treat epilepsy, for whom I think the law was changed under my right hon. Friend the Member for Bromsgrove (Sajid Javid), when prescribing was made legal in November 2018. Of course, as right hon. and hon. Members have pointed out, that was to enable those children to access a product that their families believed would ease the symptoms of their desperately difficult-to-treat conditions, if a prescriber deemed it clinically appropriate.

I know acutely, because I have spoken to campaigners and members of the all-party parliamentary group, that there is disappointment that the law change did not relate to routinely being able to get these products, funded, on the NHS; that is rightly governed by a range of processes and procedures, to ensure the equitable distribution of funding. The NHS prioritises medicines that have proven their safety, quality, efficacy and cost effectiveness. Coming back to the heart of the issue—the hon. Member for Bristol South is right to push me on this—that is why research is absolutely essential, and I will talk about that a bit more in a moment. The Government have done all we can to remove legislative barriers, but it is now largely up to the cannabis industry to prove that its products are safe and effective for children.

[Ronnie Cowan]

What you are saying is that if I can afford to pay for a private prescription, I can access medicine that you are saying is not proven to be effective, because you are not going to allow its use on the NHS; it has to pass other tests. What about bedrocan? That is manufactured in the United Kingdom, so we do not have to import cannabis from the Netherlands anymore. Hilltop Leaf wants to grow and help to produce the product. The supply chain is already there for us, but you will not allow it to be prescribed. You will not train GPs, and you will not give them the legal framework to work in so that they can actually prescribe that for children on the NHS, but if I can afford to buy it privately, I can buy it privately.

[Will Quince]

The hon. Gentleman raises a fair point, but he raises it as if this is something new or novel; it is not. All medicines in this country are either unlicensed or licensed. For use and prescription in the NHS, they need to be licensed. That means that they have gone through both the Medicines and Healthcare products Regulatory Agency process and the National Institute for Health and Care Excellence process, which proves that they are safe, effective and—through the NICE element—cost effective. That is the difference here.

The “cost effective” factor relates to NICE. That is the reason I talk about why it is important that the cannabis industry steps up and proves that its products are safe and effective. I did not talk about cost effective; I am talking about safe and effective, because that element is through the MHRA. Let us not forget that many of these cannabis-based companies are multinational; they are not telling me that they cannot afford to go through the same process that any other pharmaceutical company can go through and has done to get their products prescribed through the NHS. Part of it is research and part of it is those companies stepping up and proving that their products are safe and effective for these children, more generally, through the MHRA process.

[Ronnie Cowan]

I am curious. What we have done is—

[Ronnie Cowan]

The Minister is saying that he is allowing a licence for a product to be manufactured in the United Kingdom, in East Kilbride, so that is okay. We are allowing it to be manufactured here in the United Kingdom—that is all right. We are saying that people cannot get it on the NHS, but it is okay for other people to have it. Surely it has passed all the tests that we need it to.

[Will Quince]

I do not want to labour the point, but the point is that it has not passed those tests. It is either a licensed product or an unlicensed product. To be licensed, a product must go through the MHRA process. That is something that these products have not done to date. Yes, they can be manufactured here and prescribed privately, at the risk of the doctor—the private general practitioner—but for a product to be prescribed on the NHS, it needs MHRA and NICE approval.

There are some exceptions to that, because the law was changed in 2018, as my right hon. and learned Friend the Member for Kenilworth and Southam referred to, for a specialist doctor or for some very specific conditions. He asked why there have been only three prescriptions. I did not know that that was the exact figure, but I will check; regardless, it sounds very low. I suspect that the reason is that the decisions are taken at the doctor’s own risk, and among general practitioners there is reticence to prescribe an unlicensed product that has not gone through the MHRA and NICE process.

[Sir Jeremy Wright]

The Minister is probably right, but I am sure that when he looks at this again he will also want to look at the NICE guidelines that apply, which are extremely restrictive. The risk to an individual doctor from making a decision to prescribe will be perceived to be much higher if the NICE guidelines appear to deter such a prescription. The Minister is right that there are many elements to this, but one of them is how much we encourage doctors to believe that this is the right thing to do. I go back to the point that I was making: there is some logical dissonance here. We have said already that it is right to reschedule these products as far as the Home Office is concerned. We are starting to see prescriptions in the NHS, but not in the numbers that will benefit the maximum number of patients.

[Graham Stringer (in the Chair)]

Order. We have not been short of time this afternoon, and every hon. Member has had the opportunity to speak. Interventions should be brief and to the point.

[Will Quince]

Thank you, Mr Stringer. My right hon. and learned Friend makes a good point. When we meet the members of the APPG, it is very hard not to be moved and to want to do all in our power to bring about the change that people want to see. I have considered the calls to change NICE guidelines, which have recently reviewed the basis of these products, but I am afraid the guidelines are unlikely to change until the evidence base develops, and that will happen through clinical trials and evidence. That is why I say all roads lead back to building an evidence base and a clinical trials base. That is the crux of this debate.

In January, the National Institute for Health and Care Research issued guidance recommending that the NHS prescribe cannabidiol to patients with a rare, seizure-causing genetic disorder, which is, I think, the fifth condition for which a cannabis-based treatment has been approved by regulators and offered to NHS patients in England. I understand that the treatment is also available and approved in Scotland and Northern Ireland. The NHS now funds thousands of these medicines each year.

I mentioned Jazz Pharmaceuticals earlier. I am not sponsored by it; it just happens to be the manufacturer and provider that I visited. It is a good example of the trailblazers in this space that not only create, but undertake the research, manufacturing and—the key part—licensing of cannabis-based medicines. It has shown what can be done. The key is very much in the research.

My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale mentioned consistency and coherence in policy, which is why it is key that we treat cannabis-based products as we would any other medicinal product that we wanted to prescribe on our NHS. There is an economic case as well, although that is not what drives the Government. My whole focus in this is what is right for our NHS and patients. I am aware that there is huge hope and patient demand for access to medicinal cannabis, and that it is claimed that it can help with an array of medical conditions from chronic pain to anxiety; I believe there is also research under way at the moment on how cannabis-based products might be able to help with psychosis. I very much hope that those trials are successful. That is the right approach.

To date, much of the evidence suggesting cannabis could be an effective medical treatment is anecdotal or observational. As I mentioned earlier, only for a handful of conditions have enough clinical trials been done to prove scientifically that the drug is safe and effective. However, I am acutely aware that there are thousands of patients who now pay to access those unlicensed products on private prescriptions. Having spoken with campaigners and members of the APPG, I also know that some patients believe that funding cannabis on the NHS will reduce overall healthcare costs by alleviating symptoms and reducing the extent of hospital visits and other treatments. I understand and hear that case, but—I apologise for labouring the point; I have to keep coming back to it—before any new medicine can be proven to be cost effective, it must be proven to be safe and clinically effective. That is why research is so essential.

The Labour Front-Bench spokesperson, the hon. Member for Bristol South, asked what steps we are taking. That is a challenging question, because it is a pioneering area of research. Following collaborative work with clinicians and patient representatives, the NIHR and NHS England have confirmed support for two clinical trials into early onset and genetic generalised epilepsy. If you will permit me, Mr Stringer, I would love to use this debate to highlight a tender opportunity that will be launched by University College London in the next few weeks. UCL is seeking a supplier to assist in a world-first randomised control trial comparing cannabis-based medicines containing CBD and THC in the treatment of drug-resistant epilepsies in adults and children. I hope that that tender process is successful and that UCL finds a commercial partner to supply products for the trials so that they can commence as soon as possible.

[Ronnie Cowan]

I have three kids and two grandkids. If one of them was suffering from intractable epilepsy and I had them on bedrocan, and they were either seizure-free or had the condition under control, I would not want to hand them over to a random control test where they might be fed a placebo and therefore incur more damage. Would the Minister?

[Will Quince]

That is a difficult question to answer. We need people to take part in clinical trials, which are the answer to so many of the challenges that we face in the health sphere. That is how we build the evidence base. I do not know what the study will involve in terms of the detail and the potential for a placebo, but I will put the hon. Gentleman in touch with UCL and those who are looking to run the trial so that they can give him a measure of comfort and reassurance. On his point more generally, the biggest risk is that the industry does not engage with the tender process. Notwithstanding the hon. Gentleman’s point, I hope that all right hon. and hon. Members here today will help me by amplifying my call for the cannabis industry to come forward and engage with this pioneering and world-first research. I have also committed to a roundtable with the all-party parliamentary group, and I invite all right hon. and hon. Members in the Chamber today to attend that, too, because it is very important that we hear all of the issues.

Once again, I thank my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale for securing this really important debate. I look forward to engaging with him and Members from all parties. To the point made by the hon. Member for Bristol South, I am absolutely committed to better determine why the cannabis industry is not, in the way that so many other pharmaceutical companies do, investing in the routine research required to prove that its products are safe and effective. I will of course explore how best to engage with industry on the issue. Until then, I implore companies to explore supplying their products to the UCL clinical trials. As I have said, they will be a world first and will give us the evidence that we need to determine whether the products should be funded in the NHS. I wish them every success. I genuinely hope that they provide that evidence base.

On the matters concerning the cultivation and licensing of cannabis and cannabis-based products, I will, as I promised my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale, raise that with my counterpart, the Minister for Crime, Policing and Fire, who I know will champion this cause, too. I thank all right hon. and hon. Members for their contributions to this afternoon’s debate.

Correction to Written Parliamentary Questions

Will Quince Excerpts

Monday 17th April 2023 Written Statements

[The Minister for Health and Secondary Care (Will Quince)]

Between May and June 2022, 13 parliamentary questions (PQs) were answered regarding the UK Health Security Agency testing covid-19 variants for a pre-exposure prophylaxis antibody therapy (tixagevimab and cilgavimab), known by the brand name Evusheld. The PQs are: PQ3627; PQ2654; HL215; HL219; PQ1507; PQ3710; PQ11547; PQ14599; HL157; PQ17128; PQ15321; HL653; and PQ691.

In simplifying the technical language, the responses to these PQs incorrectly indicated that testing was ongoing. During June, the UK Health Security Agency carried out isolation and characterisation of the BA.4 omicron variant in preparation for testing it against various compounds, which could potentially have included Evusheld. However, in the PQ responses, these activities were incorrectly interpreted as testing and the language was simplified. No further testing of Evusheld including against BA.4 omicron variant took place after 26 May 2022.

The table below summarises the testing UKHSA carried out on Evusheld.

NHS England: Revised Financial Directions

Will Quince Excerpts

Thursday 30th March 2023 Written Statements

[The Minister for Health and Secondary Care (Will Quince)]

My hon. Friend the Under-Secretary of State, Lord Markham, has made the following written statement:

I am revising the 2022-23 variation to the financial directions to NHS England made on 30 June 2022 and setting the 2023-24 financial directions to NHS England. The amendment to the total revenue resource use limit for 2022-23 has been agreed with NHS England as required under section 223D(4) of the National Health Service Act 2006.

The directions include a number of transfers of funding between NHS England and DHSC that are in addition to the headline spending review/autumn statement settlement for the NHS. For example, funding is being transferred for the voluntary scheme for branded medicines pricing and access (VPAS), the covid-19 vaccination programme, as well as to fulfil manifesto commitments on primary care, car parking and nursing recruitment.

Furthermore, the directions also reflect the organisational changes which have occurred over the last year. The 2022-23 revised directions have now incorporated NHS Digital’s revenue and capital budgets into NHS England’s budget. Moreover, the 2023-24 opening directions will incorporate the full-year budgets of NHS Improvement, NHS Digital and Health Education England’s budgets. This is because those organisations have been (or in the case of Health Education England, will be from 1 April) formally brought together with NHS England into a single legal organisation.

They will be published on gov.uk. The existing NHS mandate remains unchanged by these publications.

[HCWS706]

Medical Technology Regulations and the NHS

Will Quince Excerpts

Tuesday 28th March 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Gary. I congratulate my hon. Friend the Member for Gosport (Dame Caroline Dinenage) on securing this important debate. I am grateful for the opportunity to update her and the House on the subject, and I am proud to showcase the investments that the Government are putting into life sciences.

My hon. Friend showed eloquently and articulately that medical technology is of huge importance to the UK and its health and care system. As she rightly said, the regulations that govern medtech have to protect patients and ensure public safety. It is also important that they encourage investment and drive innovation in the sector. The NHS spends an estimated £10 billion a year on medical tech, and the sector is an essential provider of jobs and specialist skills across the UK. The hon. Member for Denton and Reddish (Andrew Gwynne) set out the value of medtech to UK plc; there are no fewer than 138,000 jobs in the sector in this country.

My hon. Friend the Member for Gosport rightly highlighted how the UK’s decision to leave the EU, coupled with huge advances in life sciences and diagnostics —many of which the hon. Member for Denton and Reddish set out—has presented a great opportunity for us to reform our medical devices regulatory regime. We are well placed to do that, and we have to seize the opportunity.

We have a dynamic and pioneering medtech sector and a world-renowned regulator in the Medicines and Healthcare products Regulatory Agency, which most people know as the MHRA. I know that there have been challenges with the MHRA, as my hon. Friend the Member for Gosport set out, and I will come to that in a moment. Before I do, I want to touch on the work that the MHRA is doing to update the medical devices regulatory regime.

The first set of changes will be delivered this year—in fact, by the summer. The updated regime will deliver improved patient safety, greater transparency and closer alignment with international best practice, as my hon. Friend rightly pointed out, and it will ensure that regulation is proportionate. I am still very much alive to the scale of change and the huge importance of giving the sector—as the hon. Member for Denton and Reddish set out, many of its businesses are small and medium-sized enterprises—the time that it needs to adapt. Certainty of supply and access to medical devices in the NHS is critical, so we will intentionally phase in the regulatory changes in stages to give industry certainty.

I want to touch on two other areas, both of which are really important to the industry: artificial intelligence and new routes to market. In both cases, the new regulations will support innovation in the UK’s life sciences sector and, importantly, accelerate access to innovative medical devices for UK patients.

We are improving the regulation of novel and growing areas such as AI to ensure that our systems are responsive to technological advances. We have to ensure that we continue to be best in class and world class in this space. I want us to be world leaders in the regulation of new technologies and new approaches, such as AI. At the heart of that ambition is our desire for patients here in our United Kingdom to have access to the very latest innovations in medical technology. I want them to have that as quickly as possible, and agility is key to ironing out the bureaucratic processes that historically have caused delay.

New routes to market are important because they will enhance the supply of devices, including the most cutting-edge products. The regulations will introduce a new pathway to support the use of real-world evidence in the conformity assessment process, with proportionate regulatory oversight for these devices. To be absolutely clear, though, because we cannot lose sight of this, the focus of the MHRA must be patient safety. That must remain paramount.

Importantly for UK plc—I turn directly to the point made by the hon. Member for Denton and Reddish—I believe that these improvements will help to create opportunities for small and medium-sized enterprises, including by ensuring that UK businesses have the ability to supply their UK-made and UK-developed products to the NHS and get them in use for patients more quickly.

I mentioned that my Department’s priority is to ensure that innovative, safe and effective devices reach patients as quickly as possible. That is an area of real focus and one where I want us to improve. Our inaugural medtech strategy, which was published last month, has been mentioned by everybody who has spoken. The strategy is key, because it recognises many of the systemic challenges to adopting innovative products that hon. Members across the Chamber have set out. It sets out a clear ambition to provide a streamlined pathway from pre-registration through to adoption in the NHS, which the hon. Member for Strangford (Jim Shannon) rightly pointed out. Importantly, it will ensure rapid progression for priority innovative products, including drugs, as my hon. Friend the Member for Gosport rightly said. The medtech strategy sets out our ambition and clear signals as to what we want to achieve.

Both my hon. Friend and the hon. Member for Denton and Reddish asked how we identify the products needed for the future, so that we can set innovators off to design products that tackle the challenges we face. We are working closely with senior clinicians across the NHS. It is our ambition to set out the big challenges in the health and care system, and then to give those challenges to innovators—ideally, but not exclusively, in this country—and set their minds, businesses, organisations and capital to work to design the products and devices that we need. That will allow us to introduce novel products to the NHS, and therefore our patients, faster.

I genuinely believe that medtech has the most enormous potential to improve patient outcomes, and I know that my hon. Friend the Member for Gosport does too, as a former Health Minister and a former Digital Minister—two areas that are very much combined in this debate. I see that potential already on my visits around the country —from a particular type of plaster that enables a wound to heal faster, to robotic surgery equipment that costs many millions of pounds. They have very different functions, but both fall under medtech regulations. It is therefore vital that we work more closely with industry to ensure that we have a robust pipeline of innovations that can be adopted at pace and scale, and can then support the delivery of our and the NHS’s key priorities.

The inaugural medtech strategy is an important milestone, but it is also important to back it with funding. As my hon. Friend rightly pointed out, the Government recognise the opportunities that we have before us and the importance of this topic. That is exactly why, in the Budget—the evidence is there—the Chancellor of the Exchequer announced £10 million of additional funding for the MHRA over the next two years. That will help us to bring innovative medicines and medtech to patients more quickly. It will support the development of a shortened but still thorough approval process for cutting-edge treatments such as cancer vaccines, which is an area that we are investing in considerably alongside industry. There is also AI-based technology. I know that I have mentioned AI a number of times, but it is the most exciting area of medtech. For example, the relatively new AI-based app Sleepio, which provides tailored therapy for insomnia at the touch of a button, is the kind of technology that will transform the lives of patients in our NHS.

My hon. Friend rightly mentioned international recognition, which I recognise is so important and is one of the Brexit opportunities that has come about. The funding will also be used to establish an international recognition framework, which will allow the MHRA to fast-track the approval of medicinal products that have been approved in other trusted countries. That will address the unnecessary duplication of regulatory processes from countries with the same standards as us and therefore reduce the time it takes for essential products to reach our market. It will make the most of the MHRA’s resources. Finally and critically, the additional funding put in by the Chancellor only a week or so ago will ensure that the MHRA has the resource and infrastructure more broadly to deliver on our ambitious vision for UK patients, by increasing the availability of life-saving medtech devices on the UK market while maintaining proportionate regulatory oversight to protect patients.

My hon. Friend asked three specific questions. The first was about the timescale and the fact that we need to act fast. She is absolutely right. We have published the medtech strategy, which has largely been welcomed by industry. The first set of changes will come in this summer. Then there will be a transition period for CE-marked devices into law. Later this year, we will introduce post-market surveillance requirements. Other updates will follow, but I am acutely aware that industry must have sufficient notice, and I will ensure that it has that throughout.

My hon. Friend’s second question was in relation to dementia and Alzheimer’s drugs. I will look very carefully at that. Understandably, the MHRA and NICE are independent, but of course I would be very happy to meet representatives of Alzheimer’s Research UK, because I understand the importance of potential new drugs. If a drug has received FDA approval, we would want to look very carefully at it and consider how it might benefit patients here.

The third question was about the global tech industry. I covered that off a little by saying how we plan to set out our big challenges and then say, “This is the innovation that we need you to come up with.” Of course we want to drive local innovation too, so if there are particular local challenges, we want to empower integrated care systems and integrated care boards to encourage local businesses and local innovators to come up with solutions to supply their local NHS.

My hon. Friend’s final question was about the ability of the MHRA to deliver. I referred to the £10 million. We have also recently increased the fees for the MHRA, which come directly from industry, because it is largely self-funding. I keep a real watchful eye on this. I regularly meet the chief executive officer and others from the MHRA. I have also visited the MHRA twice, which was fascinating. If anyone has not done so, I encourage them to arrange a visit with Dr June Raine; I know she would be very happy to set that up. It is an absolutely fascinating place, based in South Mimms.

In conclusion—I am conscious of time and I know that my hon. Friend would like some time to respond—I again thank my hon. Friend for securing this important debate. Dare I say that this is probably not an issue being discussed widely around dinner tables across the country? Nevertheless, it is of vital importance to UK plc, it is hugely important to our NHS, and of course it is really important to patients, too.

This afternoon, my hon. Friend has drawn on her personal experience as a former Health Minister and a former Digital Minister to highlight the importance of medtech, and in doing so she has done her constituents and patients across the UK a huge service. I very much look forward to working with her and others to seize the opportunities and break down the barriers, so that we can bring the very latest innovation to patients as quickly and as safely as possible.

[Sir Gary Streeter (in the Chair)]

Dame Caroline indeed has the final say.

Hospital Provision: Tees Valley

Will Quince Excerpts

Tuesday 28th March 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate my hon. Friend the Member for Hartlepool (Jill Mortimer) on securing this important debate about hospital provision in the Tees Valley. I know the issue is important to her and that she works tirelessly for the people of Hartlepool on not just healthcare but many other issues. As she knows, responsibility for the new hospital programme sits not with me but with Lord Markham, a fellow Minister at the Department of Health and Social Care. I am, however, hugely grateful to her for giving me the opportunity to update the House about the ongoing work in this area.

[Jill Mortimer]

I have been trying to meet Lord Markham for many weeks. Will my hon. Friend commit to helping me secure a meeting as soon as possible?

[Will Quince]

I absolutely guarantee and assure my hon. Friend that I will get that meeting with Lord Markham arranged as soon as is practically possible, but certainly in the next few days.

I am grateful to my hon. Friend for giving me the opportunity to highlight how the Government are prioritising capital spend in our NHS in order to transform and improve healthcare outcomes for people and put healthcare financing on a sustainable footing. She understandably and rightly focused on the North Tees and Hartlepool NHS Foundation Trust, her local trust, and of course the University Hospital of North Tees in Stockton, which serves many of her constituents. I will, of course, turn to that, but before I do I will briefly reference our capital funding plans more broadly, because the context is important.

We have already provided record sums to upgrade NHS buildings and facilities so that trusts up and down the country can continue to provide the best possible quality of care. Currently, the Department’s capital budget is set to reach upwards of £36 billion for 2022-23 through to 2024-25—a record capital settlement—and we are using that level of investment to address current care delays.

My hon. Friend made a strong case for why new hospitals are important. As important as they are, the broader health economy is, of course, about far more than that. It is about surgical hubs; it is about community diagnostic centres such as the one in Stockton, as she rightly pointed out; it is about ambulance hubs, and it is about discharge lounges. It is about all those value-adding capital projects too. As part of our urgent and emergency care recovery plans, the 5,000 extra beds that are being added to existing NHS hospitals ahead of next winter are also hugely important.

As I said, new hospitals are, of course, important, and we are aware of the need for further investment in the NHS estate. We are investing an extra £1.7 billion to 2025 for more than 70 hospital upgrades. As my hon. Friend alluded to, the Government have committed to building 40 new hospitals, backed by an initial £3.7 billion for the first four years of the new hospital programme.

[Matt Vickers]

We are incredibly grateful for the £40 million invested recently in the North Tees and James Cook hospitals, and for Stockton’s new diagnostic hospital and mental health crisis hub, but the incredible, committed, dedicated, grade-A workforce at North Tees deserve grade-A facilities. Will the Minister ensure that North Tees’s bid to rebuild and upgrade the hospital is given the fullest attention?

[Will Quince]

I thank my hon. Friend for his question. I know from his persistence in campaigning for the community diagnostic centre that his continued persistence in campaigning for a new hospital and upgrades will not have been missed by the relevant Minister, Lord Markham. I will come on to talk about the new hospital programme and the selection of the next eight hospitals.

As I said, the Government are committed to building 40 hospitals, backed by an initial £3.7 billion. Two schemes are already complete and five are currently under construction. The programme is delivering facilities that are at the very cutting edge of modern technology. Critically, it is engaging with clinical staff to ensure that we provide a better working environment for them. We know that enables increased efficiency; importantly, it also promotes staff wellbeing and improves retention.

[Alex Cunningham]

First, I apologise to the Minister—he was not, in fact, the Minister who turned down the funding for the centre of excellence in Hartlepool. I pay tribute to Julie Gillon, with whom I have worked for 16 years; she is a tremendous officer and I am sorry she is moving on. I very much welcome the diagnostic centre in Stockton, which is the result of many years of work between the local authority and the health trusts. We heard a tale of woe from the hon. Member for Hartlepool (Jill Mortimer), who spoke of a lack of capacity, difficult buildings, buildings falling down—all manner of problems after 13 years of Conservative rule. Does the Minister agree that we should work together to secure what we need: new hospital facilities to serve our communities on Teesside?

[Will Quince]

I agree with the hon. Gentleman that we need to invest in new facilities up and down the country. From spending time in Hartlepool speaking to residents, certainly during the by-election, I know how frustrated they are with public services more generally—or certainly they were, because they did not feel like they had a champion at the heart of Government making their case. However, they now have that champion in my hon. Friend the Member for Hartlepool, whose dogged persistence in campaigning for not just better health infrastructure locally, but broader investment in Hartlepool, is critical. My hon. Friend is making that case today, and I know she will continue to do so. On his point, the hon. Member for Stockton North (Alex Cunningham) is absolutely right that we need to work together to deliver better services for people.

Turning specifically to my hon. Friend’s constituency, I am pleased to say that we have received an expression of interest from the North Tees and Hartlepool NHS Foundation Trust for the University Hospital of North Tees in Stockton to be one of the next eight hospitals to be included in the new hospital programme. I can confirm that we have assessed the expressions of interest we have received, and the Government aim to make an announcement in due course.

I am sure my hon. Friend will understand, because we have had many such conversations in the run-up to the debate, that I cannot comment on individual bids while the selection is ongoing. However, she has made her case very articulately and eloquently, and certainly very strongly, and she has put it firmly on the record. I will ensure that her representations are brought to the attention of both the Secretary of State and Lord Markham, and that she secures the meeting for which she has been waiting too long.

If my hon. Friend will permit me to digress for a moment, I will take a couple of minutes to highlight some of the significant funding that North Tees and Hartlepool NHS Foundation Trust has been allocated recently, largely down to her campaigning efforts. The funding includes £23.9 million for a community diagnostic centre in Stockton-on-Tees—I note the nods from my hon. Friends the Members for Cleethorpes (Martin Vickers) and for Darlington (Peter Gibson); they too have been champions of that centre—£3.9 million as part of the targeted investment fund for elective recovery, which is really important because too many of our constituents are on waiting lists for surgery and out-patient appointments; £8.4 million from our community diagnostic fund; £6.5 million as part of the critical infrastructure risk fund to address some of the backlog maintenance issues in our hospitals; and £3 million from our A&E upgrades fund.

In addition, the Tees, Esk and Wear Valleys NHS Foundation Trust has been allocated £3.4 million from the mental health crisis fund to improve urgent and emergency care facilities for mental health, as mentioned by my hon. Friend the Member for Hartlepool. That is really important for taking the pressure off our accident and emergency departments. I know that my hon. Friend will agree that this investment has been invaluable in updating outdated infrastructure and ensuring that modern and sustainable facilities are available for both staff and patients.

Once again, I want to put on the record my sincere thanks to my hon. Friend for all the work that she is rightly doing to support her hospital and, more broadly, hospital and health provision in Tees Valley. She is absolutely right to champion the needs of her constituents and to hold me, Lord Markham and the Department to account on this important issue. Let me take this opportunity to reassure her that the Government are committed to delivering our improvement programmes and upgrades to hospitals and, importantly, to our NHS estate across the country. We very much look forward to delivering the step change in the quality and efficiency of care that we have promised.

Question put and agreed to.