E-cigarettes

Jo Churchill Excerpts

Thursday 31st October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate, and I thank the whole Committee for the report, for its tone, and for the intelligent way in which it has approached the difficult subject of trying to stop behaviour that is detrimental to individuals.

We want smoking to reduce to zero, and for us to be smoke-free by 2030. It is an ambitious programme, but it will benefit many more people than just the individuals who smoke themselves, as it affects those around them. I thank the right hon. Gentleman, whom I have always highly respected, for his important work leading the Science and Technology Committee, and for his broader work on the health agenda. Although today’s debate might be his last in this place, I hope that it will not be the last time I hear him waxing lyrical on the airwaves about this subject. I say the same for the right hon. Member for Rother Valley (Sir Kevin Barron), who has really been quite formative in this area, both on the Health Committee and in his work with the all-party parliamentary group on smoking and health.

It is timely that we are having this discussion at the very end of this year’s Stoptober campaign; I pay tribute again to the right hon. Member for North Norfolk for his work in starting it. There is never a better time to stop smoking, and I encourage everybody who is thinking about doing so to visit their local stop smoking service, or to go online, and consider all the options available to help them to quit.

I am really proud of the tobacco control work over the past two decades and the progress that has been made, for which we have been recognised internationally. According to the Association of European Cancer Leagues’ tobacco control scale, the UK has been rated consistently as having the most comprehensive tobacco control programme in Europe. As we have heard from the numbers discussed, it is working—but we are not there yet.

Smoking remains one of the leading causes of preventable illness and premature death, with more than 78,000 deaths a year. That is not only a waste but a personal tragedy for all families affected. We are determined to do more, as set out in our tobacco control plan, the NHS long-term plan and the prevention Green Paper, which only concluded on 14 October. I am looking forward to seeing the results of that consultation.

Our ambition is to be smoke-free by 2030. We know that we need to work harder in certain groups, including pregnant women and those with mental health issues. Like the right hon. Gentleman, I was struck by the extremely high prevalence of smoking in some areas. He mentioned Blackpool but, as he knows from representing a coastal region, in many coastal areas there is a very high prevalence of pregnant women who smoke. They interact with many healthcare professionals during what should be the enjoyable, exciting time when they are expecting a baby. We should use every single one of those interactions to help them to quit.

I have already asked officials whether there are other forms in which we can message that particular group in a way that helps them to understand the risk, as well as the things that are available to help them. I listened to the right hon. Gentleman’s point about people with enduring mental health issues. Facilities should allow e-cigarettes and provide more support. That is an ongoing part of the agenda. I will write to Simon Stevens to see where we are, and I will let the Committee know.

[Norman Lamb]

I thank the Minister for her very kind comments. I am pleased that she will write to Simon Stevens, because pressure from Government Ministers on NHS England to recognise the significance of the subject is really important. I am conscious that I asked a lot of questions in my contribution, and she may well be unable to answer them all, but will she write to me before Parliament rises next week, if possible, to answer those questions that she is able to, so that we get that on the record?

[Jo Churchill]

I will do my very best. If there is anything I have not covered, I hope that the answer will be winging its way to the right hon. Gentleman on Monday.

The Government are absolutely clear that quitting smoking and nicotine use entirely is the best way for people to improve their health. We recognise that e-cigarettes are not risk-free, as has been stated by all Members who have contributed; however, they can play an exceedingly important role in helping smokers to quit for good, particularly when combined with stop smoking services. It is an addiction, and we are trying to achieve a step change in people’s practices and behaviours that enables them to quit entirely. We do not know the long-term harms of e-cigarette use, and no authorities in the UK assert that they are harmless. Based on current evidence, Public Health England and the Royal College of Physicians estimate that e-cigarettes are considerably less harmful than smoking because of the reduction in levels of exposure to toxicants in e-cigarette aerosols compared with tobacco smoke. However, I reiterate that quitting smoking is the best option.

It is fair to say that opinions on e-cigarettes are divided, both in the UK and globally. It is important that we listen to concerns, while looking objectively at the evidence base and seeking to build it further, which I think is the point that the right hon. Member for North Norfolk was making. On the question of research, I assure him that there is an NHS England dedicated lead—a director for prevention—in place, overseeing the NHS long-term plan commitments. I note the right hon. Gentleman’s comments about India and the fact that making decisions too quickly, not based on the research that is available, has unintended consequences.

As the House is aware, we have introduced measures in the UK to regulate e-cigarettes: to reduce the risk of harm to children; to protect against e-cigarettes acting as a gateway to starting smoking—another important point that has been made today—to provide assurance on relative safety, and to give businesses legal certainty. Regarding what has happened in the United States of America, we take those concerns seriously—we are aware of the tragic deaths associated with vaping in the United States and are monitoring the situation carefully. Public Health England and the Medicines and Healthcare Products Regulatory Agency are in close contact with the US agencies. Investigations are ongoing; they have not yet been able to confirm the definite cause of the deaths, although it appears that the majority of those who died had used illicit cannabidiol with THC products, which led to those unfortunate deaths.

To date, there have been no known deaths from e-cigarette use in the UK. The MHRA yellow card reporting system is in place to report any adverse effects. It has been running for three years and, to date, has been notified of about 85 individual cases; all have been minor, and none has been considered life-threatening. However, I assure the right hon. Member for North Norfolk and all other Members who have contributed to this debate that we remain vigilant on the issue and are grateful for all research done in this area, including—my hon. Friend the Member for Dartford (Gareth Johnson) alluded to this—by those within the charity sector who do a great deal of work in looking at the harms caused.

In our tobacco control plan, we made strong commitments to monitor the impact of regulation and policy on e-cigarettes and novel tobacco products. To inform future policy, we are looking closely at the evidence on safety, uptake, health impact and the effectiveness of these products as smoking cessation aids. Public Health England will continue to update its evidence base on e-cigarettes and other novel nicotine delivery systems.

The use of e-cigarettes by young people was mentioned by the right hon. Member for Rother Valley and by my hon. Friend the Member for Dartford. Such use currently remains low, at 2%, and we have not seen the rise that has occurred in the United States. However, we will monitor the data closely to ensure that regular use does not increase and it is not seen as a gateway to tobacco use, and will also keep a close eye on any new evidence about long-term harms caused by flavourings. If the evidence shows that we need to address either or both of these issues, we will consider taking action, including further regulatory action where necessary. I would like the industry to show stronger leadership in the areas of e-cigarette product labelling and, in particular, design to ensure that its products do not appeal to young people. Some of the current naming appears to lean in that direction.

In future, we will have the opportunity to reappraise current tobacco and e-cigarette regulation to ensure that it continues to protect the nation’s health. I thank all Members who have spoken today, particularly the right hon. Member for North Norfolk, who will be leaving this House. Today has been a bit of a goodbye party for him, for my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant)—I am staggered by the revelation that he smoked 50 a day; I wonder that he had time to do much else, let alone run around being a fireman—and for the right hon. Member for Rother Valley. I am sure that all of them will continue to work in this area.

I reiterate the Government’s commitment to help people quit smoking, which is ultimately the best course of action, and to seek evidence on reduced-risk products. We will continue to be driven by that evidence. Although we can celebrate the fact that adult smoking in England has fallen by a quarter and regular smoking among children has fallen by a half, I will truly be able to celebrate—like all right hon. and hon. Members present, I am sure—if we reach the goal, which both the report and the Government are aiming for, of being smoke-free by 2030.

Oral Answers to Questions

Jo Churchill Excerpts

Tuesday 29th October 2019 Commons Chamber

[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

5. What recent assessment he has made of the merits of using genomics in healthcare.

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

We are world leading in genomics and should celebrate that. A recent trial at Addenbrooke’s Hospital in Cambridge provided whole genome sequencing, identifying underlying genetic conditions for babies and children in intensive care. As a result, three quarters of those young patients received changes to their care. The NHS genomic service is working to embed genomics in routine healthcare. Later this year, the national genomic healthcare strategy will set out the ambitious programme for the next 10 years.

[Bill Grant]

With increasing direct-to-consumer genomic testing by private companies, can my hon. Friend advise what assessment has been made of the potential impact of self-referrals on NHS services?

[Jo Churchill]

Patients who need a genomic test from the national genomic test directory will be referred to the NHS genomic medicine service. However, I recognise that some patients may contact their GP for advice after taking a commercial test. NHS England is working with partners to ensure that GPs receive training to help them respond correctly. Public Health England and the National Screening Committee have also published guidance on private screening.

[Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)]

Health service professionals in the Black Country are concerned that the removal of local funding for in-house molecular testing for cancer in April in favour of regional genomic laboratory hubs could in certain circumstances cause delays in diagnosis and be more expensive. Will the Minister look at this again in order to refine the processes to address these particular issues?

[Jo Churchill]

Clinicians should be in charge of the process, and I have been assured that the change, using genomic testing, is better for patients and better for outcomes, but I would of course be happy to meet the hon. Gentleman and discuss it further.

[Mr David Davis (Haltemprice and Howden) (Con)]

I commend the Minister for the progressive approach the Government have taken to genomics, but for a large number of genetic diseases the symptoms do not manifest themselves until after developmental damage has been done. Will the Government consider whether we should extend genomic testing to all neonates—all newborns—at some point in the future?

[Jo Churchill]

The Government are very open to such an approach. Genomics is transformative, and the early detection of disease means that we can treat patients from birth better and more efficiently.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Surely all this must be put in the context of the Topol review, with so much innovation and not just in genomics? There is so much innovation going on in the health service, but we have to make sure that there are well-managed and efficient hospital trusts running these programmes. Many are not like Huddersfield and are not up to speed, and we have to get hospitals up to speed in using the new technologies.

[Jo Churchill]

I totally agree with the hon. Gentleman, and my constituency neighbour, the Secretary of State, is totally on this programme.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

In January, the Secretary of State announced that genomic testing would be provided in NHS England to healthy subjects for a few hundred pounds. This ill-advised plan, which would have widened health inequalities, seems to have gone quiet, so can the Minister confirm that the Government no longer plan to sell genetic testing and genomic testing in NHS England?

[Jo Churchill]

As the hon. Lady knows, because we have worked together on this agenda, it is never about selling the product; it is about better patient care and ensuring that we get technology to the patient as speedily as we can for better and appropriate diagnosis.

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[Mike Wood (Dudley South) (Con)]

10. What steps he is taking to improve cancer (a) diagnosis and (b) treatment.

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

Cancer survival rates are, thankfully, at a record high. Last year, the NHS carried out 53 million diagnostic tests, which is 53% higher than the number carried out in 2010, but we need to do more. Our aim is to diagnose three quarters of all cancers early, so that 55,000 more people each year survive cancer for another five years. To achieve that, we are radically overhauling screening programmes to improve access and uptake, investing £200 million in diagnostic equipment and accelerating the adoption of the most innovative cancer treatments.

[Mike Wood]

Bowel cancer claims 16,000 lives a year, which is 45 every day, yet just 55% of people in Dudley take up bowel cancer screening. What are the Government doing to ensure that more people take up this life-saving cancer screening?

[Jo Churchill]

I thank my hon. Friend for all the work he does to make sure people are aware of cancer screening and taking it up. Diagnosing bowel cancer early is vital if we are to beat this disease. We have committed to lowering the age of bowel cancer screening from 60 to 50 and we rolled out the fit bowel screening test in June. It is easier to use and is expected to improve uptake by 70% in towns like Dudley. Sir Mike Richards’ screening review sets out important recommendations, using prioritisation of evidence-based incentives. We will set out our plan for implementing it next year, so that people can access screening more accessibly—in car parks or wherever else it suits their lifestyle—and we can save more lives.

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

Access to screening is a function of people’s poverty. For example, in Newcastle, cervical screening rates vary from 85% to 23%. A Macmillan Cancer Support report said clearly that we need to have access to screening in the places where people are, particularly for those who are running two jobs and so on. What is the Minister specifically doing to make screening available where people are?

[Jo Churchill]

I agree with the hon. Lady on this. The Richards review and working through the recommendations will enable us to put more screening in places where people can access it. The Eve Appeal, specifically directed at cervical cancer, is looking to put screening in workplaces and so on, but anybody who is worried must get tested.

[Mr John Baron (Basildon and Billericay) (Con)]

The Secretary of State is absolutely right in his intent to put the one-year cancer survival metric at the very heart of the cancer strategy, to encourage earlier diagnosis, which the all-party parliamentary group on cancer has long campaigned for. Will the Government ensure that adequate funding is attached to the metric, so that we can finally start closing the gap on international survival rates?

[Jo Churchill]

I thank my hon. Friend for all his work leading the all-party parliamentary group on cancer. We are putting more money into diagnostic tests, which means that there will be more than 7.9 million more tests. Making sure that we have the correct data on survivability, in which the one-year test is an important metric, is part of that programme.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

In the past year, more than 34,000 cancer patients have waited beyond two months for treatment. Every single waiting time measure for cancer has worsened in the past year. Surely, the Minister should be ashamed that so many more cancer patients are waiting longer for treatment.

[Jo Churchill]

I probably know as well as most that waiting for a cancer diagnosis is traumatic and that it needs to be done as speedily as possible. There is nothing more frightening than that wait, so what have we done? In 2018, 2.2 million people were seen by a specialist for suspected cancer—that is more than 1.2 million more people per annum since 2010. Getting to the specialist an individual needs as quickly as possible is what this Government are focused on, and that is why we have put so much emphasis on having specialist clinical nurses in the cancer workforce. We will carry on making cancer a priority.

[Jonathan Ashworth]

But the problem is that that is not happening, is it? Cancer patients are waiting longer for treatment. In recent weeks, we have had an avalanche of hospital board papers blaming understaffing and George Osborne’s pension tax changes for the deterioration in waiting time standards. The Prime Minister promised to fix Osborne’s pension tax mess. How many more patients need to be added to the waiting list before it is fixed?

[Jo Churchill]

The guidance for doctors’ pensions was changed last month. As I said, making sure that everybody can access a GP as soon as they are worried and then get to a specialist as soon as possible is our top priority, and making sure we have a broad-based cancer workforce is part of that plan. Delivering these things, as well as rapid diagnostic centres with £200 million in new machinery, is how we are going to do it.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

11. What steps he is taking to establish a national programme for PrEP by April 2020.

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[Sir David Evennett (Bexleyheath and Crayford) (Con)]

T8. Does the Minister agree that the latest data on the soft drinks industry levy is encouraging and a positive step in the campaign to improve health, particularly of young people?

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

Absolutely; I thank my right hon. Friend for putting it so eloquently. This just shows what can be achieved. We have seen great results from the soft drinks industry levy. The average sugar content of drinks subject to the levy decreased by 28.8% between 2015 and 2018, so we have been able to make significant investments in activity and healthy eating in schools.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Mr Speaker, as this is the last time that we will have Health questions with you in the Chair, I want to thank you for being a fantastic Speaker—particularly through your support for Back Benchers and ensuring that we can be heard through urgent questions.

Last week, we found that the number of people receiving publicly-funded social care has fallen by 15,000 in the past year. We know that 95 people a day die while waiting for care and that cuts of £7.7 billion have been made from social care budgets since 2010. Older and disabled people are paying the price. Labour has set out our plans to deliver free personal care for people aged over 65 who need it. We are providing dignity in old age. When will the Secretary of State give people the dignity and care they deserve, and bring forward the Government’s plans for social care?

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[Mr Speaker]

Preferably in a sentence—Jo Churchill.

[Jo Churchill]

Digitising the process by using electronic prescribing will save the national health service up to £300 million, freeing up vital time for GPs and pharmacists to spend with their patients. It will start on 19 November.

[Mr Speaker]

Splendid.

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

T5. The Government have finally completed their consultation on mandatory fortification of flour with folic acid. When can we finally expect to see that eminently sensible policy implemented?

[Jo Churchill]

That was part of the prevention Green Paper. We have the consultation responses, which we will assess and come forward with proposals.

[Caroline Nokes (Romsey and Southampton North) (Ind)]

There is still too much reliance on body mass index as an indicator of good health in sufferers of eating disorders. Will the Secretary of State get behind the “Dump the Scales” campaign and meet the indomitable campaigner Hope Virgo, to ensure that GPs realise there is more to eating disorders than just weight?

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[James Brokenshire (Old Bexley and Sidcup) (Con)]

I am delighted to echo that again in the context of the fact that next month, November, is Lung Cancer Awareness Month. I ask my right hon. Friend to commend the Roy Castle Lung Cancer Foundation and all those who are highlighting the signs of this disease to save lives, quite literally, because of the need for early diagnosis. Equally, could he update the House on the lung health checks programme, which is targeted screening that could quite literally save lives from this terrible disease?

[Jo Churchill]

Along with my right hon. Friend, I pay tribute to the Roy Castle Lung Cancer Foundation, but also to all the charities that work in the cancer space and do the most tremendous work on awareness raising, because it is only by awareness raising that we can actually get earlier diagnoses and beat this disease. We are looking very seriously at what my right hon. Friend suggests.

[Dr Sarah Wollaston (Totnes) (LD)]

May I thank you, Mr Speaker, for all the support you have given to Select Committees during your time in the Chair?

After a long period of engagement with patients, staff and partner organisations, the NHS has come up with a clear set of recommendations to the Government and Parliament for the legislative reforms it needs. I hope all political parties are listening to that. Will the Secretary of State confirm that he will accept all its recommendations, including the one that recommends scrapping section 75 of the Health and Social Care Act 2012 and other provisions, which would end wasteful contracting rounds in the NHS?

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[Alison Thewliss (Glasgow Central) (SNP)]

Will the Secretary of State speak to his colleagues in the Home Office and get them to allow Glasgow City health and social care partnership to open a supervised drug consumption room in my constituency and get vulnerable people into a service that will keep them alive?

[Jo Churchill]

We currently have no plans to change the law on drug consumption rooms. We support a range of evidence-based approaches to reducing the health-related harms associated with drug misuse. I keenly await the summit in Glasgow, which will focus on tackling problem drug use and bring together the experts we need. Dame Carol Black’s report is out in the next few weeks, but putting better resources into treatment and recovery is vital and I urge the Scottish Government to invest.

[Mr Steve Baker (Wycombe) (Con)]

Will the Secretary of State visit Wycombe Hospital to discuss the future of our increasingly tired 1960s tower block?

Diabetes: Tailored Prevention Messaging

Jo Churchill Excerpts

Thursday 24th October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Buck.

I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate, on its tone and on how informative it has been. It is a powerful indicator of how a debate in this place can help to educate and spread information. As the hon. Member for Heywood and Middleton (Liz McInnes) said, types 1 and 2 are distinctly different conditions. It is important for us to note that so that when people talk about diabetes, they do not talk about it in the round as one condition, but nuance it. That goes to the heart of what the hon. Gentleman was asking for—information to be tailored to the patient and every individual, so that people receive the information appropriate for them.

I thank the hon. Member for Strangford and all Members who sit on the all-party parliamentary group for diabetes for their fantastic work. It is one of the most dynamic APPGs in this place. In particular, I thank the right hon. Member for Leicester East (Keith Vaz), who chairs it. I am afraid that I do not share his and the hon. Member for Strangford’s love for Leicester City, but as a regular visitor to Welford Road, I know his city and I like the tiger in it. I will leave it there.

More than 3 million people in England have been diagnosed with diabetes and, as the hon. Member for Washington and Sunderland West (Mrs Hodgson) said, an estimated further 1 million remain undiagnosed. Public Health England estimates that 5 million people are at high risk of developing type 2 diabetes, and that number rises each year. Like everyone in this room, and probably everyone in the country, I know someone with diabetes. My mum is in remission—she has lost a lot of weight and she exercises, but she is in her 80s, which shows that no matter people’s age, they can take steps to help them live healthily, even with a condition.

The hon. Member for South Antrim (Paul Girvan) spoke about his wife, and the importance of people looking after themselves during their journey with diabetes, so that they know they are as in control of their condition as they can be. As we have heard from several Members, diabetes has other effects on the body, and it is important that people with the condition look after their eyes, their kidneys and, in particular, their feet. That presents challenges for people attending multiple different clinics for multiple different things.

I will also mention Professor Jonathan Valabhji, the national clinical director for diabetes and obesity. I look forward to working with Jonathan, who strikes me as a truly inspirational person in this area. Only last week, he told me not to be too hard on the situation, and that we have come a long way over the decades. We no longer see the same number of amputations or complications. There has been improvement in the treatment, and it is important to recognise that clinicians have done an awful lot.

Preventing type 2 diabetes and promoting the best possible care for all people is a key priority. I am proud to say that NHS England, NHS Improvement, Public Health England and Diabetes UK have had great success with the first diabetes prevention programme to be delivered at scale nationwide.

[Keith Vaz]

With a new Minister, we get a new broom and, therefore, a fresh pair of eyes. The collection of data is a key issue. We have tabled parliamentary questions to Ministers and asked, for example, how many diabetic nurses there are in the country or how many doctors have a specialism in diabetes. Those facts are available in Scotland, but not in England. Will the Minister make it a priority, as a result of this debate, if nothing else, to get more of that data? With good data, we can plan better.

[Jo Churchill]

I certainly agree that good data and evidence lie at the heart of delivering good patient-centred programmes. I will take that issue away to look at it and write to him on it.

[Sir George Howarth]

Further to the points made by my right hon. Friend the Member for Leicester East (Keith Vaz), I tried to get information about waiting times in clinics and hospitals for various kinds of appointments related to diabetes out of the Minister’s Department, but I was unable to. When she looks at my right hon. Friend’s list, will she look at mine too?

[Jo Churchill]

I truly will. That brings me to the hon. Member for Heywood and Middleton, who wrote to me about the meeting she mentioned. I have written back to say I would really appreciate the chance to meet her to discuss the various challenges. Having already had an obesity roundtable and a Green Paper roundtable, I know there is an awful lot of overlap in these areas. I feel we could work on that. If she will forgive me, I will get back to answering the hon. Member for Strangford.

Over 2018 and 2019, the diabetes prevention programme achieved full national roll-out, making England the first country in the world to achieve full geographic coverage, which is a great achievement. There is strong international evidence demonstrating how behavioural interventions that support people to maintain a healthy weight and be more active can significantly reduce their risk of developing the condition in the first place, which I think the hon. Member for Washington and Sunderland West referred to. The programme identifies those at high risk and refers them on to behaviour change programmes, which, as we know, is very much more likely to lead to positive results than sending someone away and telling them, “Get on with it yourself.”

The NHS long-term plan commits to doubling the capacity of the diabetes prevention programme to up to 200,000 people per year by 2023-24 to address the higher than expected demand and specifically to target inequalities. Furthermore, NHS England and NHS Improvement have enabled digital routes to access the programme, which will support individuals of working age in particular. As the hon. Member for Strangford pointed out, it is important that people can get information where it is most accessible. Those digital routes went live across nearly half the country in August 2019, and full digital coverage is expected in the next year.

The hon. Members for East Londonderry (Mr Campbell) and for Upper Bann (David Simpson) spoke about children. That is where the prevention Green Paper, “Advancing our health: prevention in the 2020s”, targeted support, tailored lifestyle advice and personalised care using new technologies will all have an effect. I take on board the point that there have been a lot of consultations and so on in this area. We received an awful lot of responses to the Green Paper and we are considering them, but I will make announcements shortly, particularly on ending the sale of energy drinks, on promotions and on one or two of the other areas the hon. Member for Strangford mentioned, so watch this space. I have been in position for only 12 weeks, but this whole area is of huge importance to the nation’s health. I hope that, if we can target children and young people through their lifetime, we can stop problems later on.

[Jim Shannon]

I am very encouraged—I think we all are—by the Minister’s response on that point. When she brings recommendations and legislation forward, I think she will find that Members across the House will be very supportive of them. I am greatly encouraged by what she says.

[Jo Churchill]

I thank the hon. Gentleman. I hope Members noticed that yesterday we launched the National Academy for Social Prescribing. I think Members across the House understand that people do not always need a tablet when they go to the doctor. The hon. Gentleman spoke about the importance of mental health support, referral to exercise classes and various other things for people with diabetes. I was lucky enough to go to Charlton Athletic yesterday and see some brilliant things being put into practice in the community, where the messaging was much better received. Twenty-six per cent less men feel able to go and talk to their doctor, so perhaps we can give them the message at their football club, their rugby club or just their workplace. That applies to women too, now they have much busier lives and many more of them work. Targeting people appropriately so we can get messages to them in the right places about how they can look after themselves better has to be the right way to go.

A dedicated Type 2 Diabetes Prevention Week campaign was launched in 2018. The campaign aims to raise awareness among healthcare staff in primary care about the causes, complications and groups at risk of type 2 diabetes, which I think was mentioned, and the services available to manage patient health. Following the success of the last two years, the campaign will be rolled out again in 2020.

The hon. Member for Strangford mentioned the importance of ensuring that messaging to support those with diabetes is tailored to relevant sectors of society. In June 2018, Language Matters was launched to encourage positive interactions with people living with diabetes, to ensure tailored messaging to relevant sectors of society and to expand routes into the prevention programme. It is a little like health checks: people have to know about it, and know how to use it, in order to access it.

In 2017-18, and again in 2018-19, an additional £5 million per year was made available for diabetes specialist nurses. There is a need to beef up support in that area. Diabetes UK, which I have already met—I happen to be lucky enough to have known its chief executive for some time, and it was at the obesity roundtable, as was Cancer Research UK—does a fantastic job in helping to spread that message and to provide information. Another message that has come out is “think pharmacy first” to empower pharmacists. The 11,500 pharmacists on our high streets are a resource that is just waiting to be used, and I hope the new pharmacy contract will be the start of that relationship.

We will do more in the future to support those with type 2 diabetes. There are a range of apps in the NHS app store to further overcome many of the issues people currently face with traditional, face-to-face structured education. NHS England and NHS Improvement are developing online self-management support tools called Healthy Living for people with type 2 diabetes. Many in the Chamber will be familiar with DAFNE and DESMOND—dose adjustment for normal eating, and diabetes education and self-management for ongoing and newly diagnosed—as well as other programmes for those living with diabetes.

Healthy Living will consist of a structured education course with additional content focused on maintaining a healthy lifestyle, including content on weight management, alcohol reduction and cognitive behavioural therapy for diabetes-related distress. Once the course has been developed, NHSE hopes to commence its roll-out from January 2020. It will have universal availability, it will be free to users and local commissioners, and it is intended as an online resource to supplement other quality assured digital coaching programmes that can be commissioned in local health economies. However, it will be in addition to face-to-face support, because everyone has a preferred method of getting information.

As the right hon. Member for Leicester East said, the risk of developing type 2 diabetes is higher in black, Asian and minority ethnic communities. I am pleased to say that NHS England and NHS Improvement are working with the Cultural Intelligence Hub to deliver an insight project to support future communications and improve engagement with those communities. The aim is to support an increase in available places on the NHS diabetes prevention programme and the take-up of those places; to raise awareness of type 2 diabetes, its risk factors and complications, and ways to prevent it; and to promote messages.

NHS England and NHS Improvement have invested £39 million in each year of transformation funding. That funding is key to improving structured education, reducing variation and helping with foot care for diabetic foot disease.

I agree that new technology is key to the management of diabetes. I hope the shortage in the supply of flash monitors will be overcome shortly, but what fantastic news it is that so many people, including many of our colleagues in this place, now have access to those monitors. I know how much difference they can make to people’s lives, and that is only to be welcomed.

I thank the hon. Member for Strangford for highlighting this issue. I look forward to meeting the all-party parliamentary group and working further with it on these messages. I hope I have demonstrated that we are working hard so people can receive the treatment and support they need to live longer but enjoy quality of life.

Health Visitors (England)

Jo Churchill Excerpts

Wednesday 23rd October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on securing this important debate.

I also congratulate Members on the degree of consensus that there has been about how important health visitors are to each and every family they touch. I may not be able to answer Members’ contributions directly, but I will ensure that if there are further points to make after this debate, I will write to Members in due course. I pay tribute to my hon. Friend’s leadership and support on the issue of children and young people, and particularly his efforts to focus on those first 1,001 days, which can impact on social, economic and physical outcomes throughout life. I strongly agree about the importance of early years intervention, and that strengthening support at the very start can stop problems escalating and help the broader family. As both my hon. Friend and the hon. Member for Liverpool, Wavertree (Luciana Berger) pointed out, we can stop these problems before they start, or we can certainly intervene.

My hon. Friend made strong arguments for the value of health visitors and their ability to cross every threshold, which cannot be overestimated. Good health is one of our country’s greatest assets, and we cannot take it for granted; just as we save for retirement, we should be investing in our health throughout life, from the cradle to the grave. Starting in childhood—actually, even before a child is born—we can help to ensure that our children enter the world, and that they are raised, healthy and happy.

Most babies get a fantastic start in life, benefiting from the support of loving parents and dedicated health professionals. However, we know that some lives can be easier than others, often because of circumstances over which those babies have no control and the conditions in which they are brought up. Children who live in more deprived areas are more likely to be exposed to avoidable risks and have poorer outcomes by the time they start school. As the hon. Member for Liverpool, Wavertree pointed out, some of those things have impacts further down the line: at the weekend, a teacher said to me that if a child has poor linguistic skills, that will affect their ability to learn to read because of phonics and so on. It is right, therefore, for support to have a clear focus on reducing inequalities and targeting investment to meet higher needs.

The Government remain absolutely committed to working with partners to identify how to support growth in the community workforce, including through district nurses, general practice nursing, GPs, health visitors and school nursing—the team that my hon. Friend the Member for East Worthing and Shoreham described so well. We are taking significant actions to boost the workforce, including training more nurses, offering new routes into the professions, enhancing reward and pay packages to make nursing more attractive and improve retention, and encouraging those who have left nursing to return. I know that there is still post-qualification, but I do not pretend that there are no challenges; many Members have articulated the challenges that exist, particularly issues such as CPD, which we are aware of and are working on.

We know that the electronic staff records show a reduction in the number of health visitors employed by NHS organisations. However, we also know that this is not a complete picture of the health visitor workforce, who may be employed in social enterprises, private sector organisations or local government. I want to work with partners such as the Local Government Association and the Institute of Health Visiting to establish a much clearer picture, which is what the IHV asked for in its “Health Visiting in England: A Vision for the Future” report—I think it was recommendations 12 and 13. That will help to move the debate forward.

I am pleased that Health Education England is also leading on the development of a specialist community public health nursing standard. That standard will cover several roles, including those of health visitor, school nurse, occupational health nurse and family health nurse, and I am keen for that development to progress swiftly. Currently, as my hon. Friend mentioned, a specialist level 7 community and public health nurse apprenticeship is in development. That apprenticeship will offer an alternative route directly into the health visiting profession, on top of existing pathways that enable people to qualify as health visitors. We must make the best use of these highly skilled and valued members of the profession and of the broader healthcare family, and we must ensure that they can optimise the good they can do when they intervene in children’s lives.

Local authorities remain well placed to commission health visiting and early years support, but they should do so in partnership with all those around them.

[Mr Jonathan Lord (Woking) (Con)]

Like many other Members, I have been contacted by some terrific health visitors, in my case from Woking. They do a wonderful job, but against a very difficult financial backdrop. As the Minister looks to resource this area in the future, can we make sure that there is fair funding across the country, including to our counties?

[Jo Churchill]

I thank my hon. Friend for his intervention, which links to the fact that fragmentation also remains a challenge throughout the system, running counter to the aim of whole family support that my hon. Friend the Member for East Worthing and Shoreham mentioned. I believe strongly that there is scope to improve collaboration between councils and NHS bodies in order to improve delivery, particularly on important issues such as breastfeeding, immunisation and the like. The digital child health programme is one area in which we are helping to overcome barriers, securing national backing so that information is shared properly between key professionals. That is particularly important for strengthening the links between primary care and health visitors. However, there are further areas in which we can work together better to support those with higher needs, and I intend to reflect on the points made during this afternoon’s debate and work further on the recommendations of the “Vision for the Future” report.

The commitment to grow the public health grant as part of the local government settlement underlines the Government’s commitment to protecting and improving the health of the population. Local leaders remain well placed to make decisions for their communities; there is a disparity across the piece, and we need to better understand the data. Local decisions should be based on robust assessments of local needs, supported by workforce plans.

Research also suggests that there are short and long-term educational and socio-emotional benefits from early childhood education and care. That is why we have prioritised investment in early education; the 15 hours of free early education for disadvantaged two-year-olds is welcome. However, those benefits start earlier—with a person’s interaction with their health visitor when they are 28 weeks pregnant, or even before that, in personal, social and health education lessons in schools. In those lessons, we talk about healthy relationships and equip our young people with advice on issues such as substance abuse and parenting.

In the prevention Green Paper, we announced our commitment to modernise the Healthy Child Programme to reflect the latest evidence about how health visitors are part of a wider integrated workforce, providing support. Doing so provides an important opportunity to work with partners, and I will take my hon. Friend the Member for East Worthing and Shoreham up on his offer, made in his recent letter, to bring with him academics and other interested parties—I note that there are interested parties across this Chamber—to talk about how we can best move this forward. I want to ensure that support is both universal in reach and capable of a personalised response, focusing support where the additional needs suggest we should put it.

I understand the continued focus on five mandated contacts, which provide a vital opportunity for contact with families, and national data shows that coverage has improved. However, I take on board the points that have been made; I do not want to reduce contact to those five moments, and there have been some interesting conversations about other points of contact. I have heard some within the health visiting profession say that they are being pushed to tick the box but miss the point, and I have spoken to my local health visitor lead about that issue. Health visitors are highly qualified professionals who have an important leadership role, and I wish to reinvigorate that role. Through working closely with commissioners and other professionals, particularly midwives, health visitors are critical to a child’s journey.

If we are serious about supporting early intervention, that means starting with relationships. Becoming a parent is an important time in anyone’s life, but it does not come with a manual; we all need help, and professionals have an opportunity to give evidence-based advice and support. Our vision for prevention encompasses the whole of life. We are now reviewing the prevention Green Paper, including the response to it by my hon. Friend the Member for East Worthing and Shoreham. We will ask ourselves what more can be done, and we will work with local authorities and NHS bodies to address that question.

To give every child the best possible start in life and the opportunity to fulfil their potential, we need to fundamentally change the way we operate. I want to ensure that systems are in place to help infants as they develop, move to school and grow into adulthood; to overcome fragmented service provision; and to make the best of what exists, while using the evidence to maintain a resolute focus on additional needs. I look forward to working with my hon. Friend, and I am optimistic that we can make the change.

[Mr Peter Bone (in the Chair)]

I apologise to right hon. and hon. Members, but time has beaten us, so I am afraid that the sitting stands adjourned.

Hypermobility Syndromes: Healthwatch Calderdale’s Report

Jo Churchill Excerpts

Monday 7th October 2019 Commons Chamber

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

I congratulate my hon. Friend the Member for Calder Valley (Craig Whittaker) on securing this debate on such an important issue, and for taking the first step to bring the broader element of education and communication to the Chamber tonight by outlining the report from Healthwatch Calderdale on hypermobility syndromes. I join him in commending the work of local Healthwatches in championing the patient voice and in doing all that they do.

My hon. Friend has rightly highlighted how critical it is for those living with hypermobility syndromes to be able to obtain the right diagnosis and sometimes how challenging that is, because of the nature of all the different elements of the syndrome involved. This is also about people having their symptoms taken seriously by healthcare professionals. As he and the hon. Members for Strangford (Jim Shannon) and for Halifax (Holly Lynch) outlined, sometimes just being taken seriously is the first step on the path to accessing the relevant treatment that they need. Those professionals need to be aware of the spectrum of the condition. All those things are incredibly important so that patients can access the right care at the right time. For example, someone may access physiotherapy if they feel particularly unwell, but if they then feel like they have to go back down the snake, it can often seem like more of a fight, as the hon. Member for Strangford alluded to, so making sure that pathways are streamlined is exceedingly important.

As my hon. Friend the Member for Calder Valley will be aware, the NHS England specialised commissioning team in Yorkshire and the Humber responded to the report only last month. I gather that the specialised commissioning team and the clinical commissioning group continue to engage with Healthwatch Calderdale on the report’s findings. Ensuring that that engagement is beneficial and delivers what patients want, and that it is as broad as possible, is important. I urge both him and the hon. Member for Halifax to make sure that they are engaged with the process and with holding the CCG and Healthwatch Calderdale to account in understanding whether objectives are being met and a better service is being delivered.

We have heard from my hon. Friend that hypermobility syndromes can have devastating effects on quality of life but often go undiagnosed or misdiagnosed for many years, which also adds to the stress. This situation must improve. As he pointed out, good communication and information sharing could make a big difference to how an individual feels their journey is progressing, and I assure him that we are committed to improving the diagnosis of rare diseases and to assisting patients so that their diagnosis feels less like a fight, as the hon. Member for Strangford put it.

[Craig Whittaker]

One of the key problems is that the hypermobility syndromes are treated by NHS England as rare diseases. As we have heard, Healthwatch Calderdale has 11 complaints on the books, but if we times that across Yorkshire and the Humber, it means there are several hundred complaints, and that is only people who have complained, not people who have been diagnosed. My challenge back to the Minister is this: we keep calling it a rare disease, but is it really a rare disease?

[Jo Churchill]

The challenge with rare diseases is that they are collectively common but rare in and among themselves. As my hon. Friend articulated, there are many different elements to this syndrome that may be diagnosed as Ehlers-Danlos or a plethora of other things. That makes treating them more of a challenge and is why there has to be communication and information sharing to make it a proper pathway for an individual. Although for each life it is really challenging, 11 is not a large patient cohort. That is one of the challenges when dealing with diseases and syndromes such as Ehlers-Danlos and hypermobility syndromes more broadly.

Improving the diagnosis using cutting-edge technology is key. The genomic medicine service, which was announced last October, aims to provide consistent and equitable access to the most up-to-date genomic testing in England, which may help, and I am pleased that hypermobility syndromes are included in the national genomic test directory, which underpins this service. That may provide more of the cohesion that my hon. Friend is looking for.

As my hon. Friend points out, improving awareness of hypermobility syndromes among healthcare professionals, particularly general practitioners, is key. It is critical to ensuring better diagnosis and treatment of these conditions and is vital if we are to build trust and confidence in the system and actually help those with rare diseases. As I say, they are collectively common—3.5 million people across the UK are affected—but there is a significant gap in our understanding of their diagnosis because of the number of different ways they can present.

On raising awareness, there is always more that can be done, and we must learn from areas of good practice. For example, Ehlers-Danlos Support UK has developed a toolkit in collaboration with the Royal College of General Practitioners. I am pleased to hear that my hon. Friend’s clinical commissioning group, NHS Calderdale, has issued the links to the EDS toolkit to its GP member practices and encouraged clinicians to consider adding this topic to their learning needs, because building awareness is very much part of the answer.

Recently, a clinical update on Ehlers-Danlos syndromes was published in The BMJ. That is another excellent example of how the clinical community is working to improve knowledge and awareness and help provide positive NHS care for patients by transferring that knowledge into better diagnosis.

NHS England commissions specialised diagnostic services for hypermobility syndromes, including Ehlers-Danlos syndrome, osteogenesis imperfecta and Stickler syndrome. It is currently implementing a new “rare disease insert”, which aims to improve the patient experience through provision of a single person responsible for the co-ordination of care for hypermobility patients; I think that that was one of my hon. Friend’s constituents’ main asks. It also aims to improve the transition pathway from child to adult rare diseases services, including services for those with hypermobility syndromes.

Several centres in England deliver services for hypermobility, although, as we heard from the hon. Member for Halifax, not all of them are always accessible to everyone. They include two centres delivering complex EDS services, four delivering osteogenesis imperfecta and childhood osteogenesis imperfecta services, and a specialist centre for Stickler syndrome. Those centres help to co-ordinate specialist regional care and manage the transition to non-specialist NHS care. I did very much hear my hon. Friend’s request for a more co-ordinated service for his constituents. I encourage him to engage with his clinical commissioning group, as the idea has much merit. It could potentially secure better diagnosis and provide a better pathway for patients through discussion of the single point of contact, giving them much-needed continuity and a timeline for provision in Calder Valley and for patients more broadly.

My hon. Friend said that he thought virtual GP services would help people with hypermobility syndromes, because they would no longer have to travel all the time. He will be pleased to hear that virtual GP services are beginning to be rolled out in general practice. That means that patients will have the right to web and video consultations by April 2021, which I hope will also be of benefit.

As was announced by my colleague Baroness Blackwood this summer, we need a national conversation on rare diseases to help to inform and communicate. We will be engaging with patients, researchers and clinicians, gathering evidence, and identifying the major challenges faced in the field. We welcome the input from the hypermobility syndromes patient cohort and from healthcare professionals, and the work that they have done on the report.

Let me end by thanking my hon. Friend, who has spoken so passionately and so knowledgeably about this issue. I am grateful for the opportunity to discuss such an important report in the Chamber. We are dedicated to trying to improve the lives of all patients living with hypermobility, and, as my hon. Friend said, that is laid down in the NHS long-term plan and our implementation of the UK strategy. I hope that I have given a little reassurance to patients who are struggling for diagnosis that we are here to try to make the pathways stronger and diagnosis easier, and to improve the lives of all those affected by hypermobility syndromes and other rare diseases.

Question put and agreed to.

Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019

Jo Churchill Excerpts

Monday 7th October 2019 General Committees

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

I beg to move,

That the Committee has considered the Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019 (S.I. 2019, No. 1247).

It is a pleasure to serve under your chairmanship, Dame Cheryl. I am confident that we all share the intention to ensure that the high standards of food and feed safety and consumer protection that we enjoy in this country are maintained when the UK leaves the European Union. As my hon. Friend the Member for Winchester (Steve Brine) stated previously, this instrument and the original instrument, which it amends, seek only to protect and maintain those high public health and food safety standards. Changes are limited to the necessary technical amendments to ensure that the legislation is operable on exit day. I stress that no policy changes are made through these instruments and we do not have any intention of making any at this point.

This instrument amends a previous EU exit SI: the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. Further clarity was required in setting out the authorisation process for approving products that can be used to remove surface contamination from products of animal origin. The clarification will ensure that the process is robust and can be applied clearly in assessing the risk in respect of new products.

This instrument needed to be in place to support the UK’s application for third-country listed status with the EU, so that the UK can continue to export animals and animal products to the EU. We anticipate that that is due to be voted on by the European Commission on 11 October.

This instrument has been made using the powers in the European Union (Withdrawal) Act 2018 to make necessary amendments to UK regulations to prevent, remedy or mitigate deficiencies in retained EU law that arise as a consequence of the UK’s withdrawal from the EU. The instrument was made on 9 September under the urgent “made affirmative” procedure, which was considered appropriate to meet the deadline for the European Commission’s third-country listing vote on 11 October.

As hon. Members know, the Government have made it clear that our priority is to seek a negotiated deal with the EU, but we are taking sensible action to ensure that we prepare for every eventuality. The UK’s third-country listing application was a particularly important part of our no-deal preparations. Third-country listed status guaranteed that the export of animal products and most live animals from the UK to the EU could continue. That market is worth approximately £5 billion to the UK annually.

I shall expand on the specific detail of the minor and technical changes made by the instrument. The primary purpose of this legislation is to refine an amendment to retained EU law made by the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. We considered that the regulation would benefit from further clarity in describing the authorisation process and the appropriate authority responsible for the process to approve substances that may be used to remove surface contamination from products of animal origin. Lack of clarity might affect implementation and has the potential to undermine the responsibilities for authorisation; this instrument rectifies that.

The new instrument makes it clear that the responsibility for approval of substances that may be used to remove surface contamination from products of animal origin rests with the Secretary of State for Health and Social Care and the appropriate Minister in each of the devolved Administrations. This measure introduces no substantive policy changes to what has already been successfully made and passed in Parliament in March 2019.

Food business operators are not permitted to use any substance other than potable water—or, where permitted, clean water—to remove surface contamination from products of animal origin unless that has been approved. This relates to business establishments that handle products such as meat, eggs, fish, cheese and milk and that do not supply to final consumers.

Currently, approval for such substances is given by the European Commission, but after EU exit this responsibility will be carried out by Ministers. The amendment to Regulation (EC) No. 853/2004 made by the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019 is being further amended to make it absolutely clear that Ministers will be responsible for prescribing the use of any other substances and that the process of consulting the food safety authority is retained. That decision will be based on independent food safety advice from the Food Standards Agency and Food Standards Scotland.

If after EU exit any additional substances are proposed to be approved for this purpose, they will be subject to risk analysis by the FSA, which has established a rigorous and transparent risk analysis process for assessment and approval of any such new substances. Any request for substance approval would be subject to thorough scientific risk assessment and risk management, before being put to Ministers for a final decision.

Let me be clear that neither this instrument nor the instrument it amends introduces any changes for food businesses in how they are regulated and how they run, nor does it introduce extra burden. The overall changes to the food hygiene regulations will ensure a robust set of controls, which will underpin UK businesses’ ability to trade domestically and internationally.

It is also important to note that we have engaged positively with the devolved Administrations throughout the development of this instrument. Further, this ongoing engagement has been warmly welcomed. The devolved Administrations in Wales and Northern Ireland have provided their consent for this instrument; the Scottish Government have been made aware of these regulations, but have not yet had the opportunity to scrutinise them.

I would like to stress that we would not normally make EU exit regulations under this Act, where the policy area is devolved in competence, without the agreement of all of the devolved Administrations. However, as I have explained, this is a very minor drafting change to the regulation, which the Scottish Parliament has previously agreed. Regrettably, the potential impact should the instrument not be in place before 11 October on the third-country listing vote does not constitute a normal situation and could affect the farming industry across the whole of the UK, including Scotland.

Finally, I draw the Committee’s attention to the fact that, in line with informal communications, which the Food Standards Agency has had with the Joint Committee on Statutory Instruments, the FSA will, in accordance with the terms of the free issue procedure, be making this instrument available free of charge to those who purchased the earlier exit SI, namely the Specific Food Hygiene (Amendment Etc.) (EU Exit) Regulations 2019.

The Government accept that this instrument should have been made available under the free issue procedure at the time it was first made, but that did not happen. That situation will now be remedied. I apologise for that oversight and confirm to the Committee that this will be corrected and the Food Standards Agency will, together with colleagues in the national archives, be taking action to ensure that anyone entitled to a free copy of the instrument under that procedure will, where appropriate, be able to apply for a refund or otherwise obtain a copy.

[Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)]

Can my hon. Friend confirm that by laying this instrument the Government are demonstrating, beyond peradventure, that they will not tolerate any reduction in food safety standards as a result of the UK leaving the EU, contrary to what was asserted by some on television yesterday?

[Jo Churchill]

Indeed, that is so.

The action taken will allow one to obtain a copy of this instrument for free on request, in accordance with the usual terms of that procedure.

In conclusion, this instrument constitutes a minor—technical, but necessary—measure, to ensure that our legislation relating to food safety continues to work effectively after exit day. I urge hon. Members to support the amendment proposed, to ensure the continuation of effective food safety and public health controls. I commend the regulation to the Committee.

[Several hon. Members rose—]

--- Later in debate ---

[Jo Churchill]

Thank you, Dame Cheryl. I will resist the temptation to say “Howzat!”

I will first go over some general points that address several of the questions, and then I will address a couple of the specifics. The importance of food safety is paramount, and leaving the EU does not change that. Food safety in all cases remains our key priority; that means that business will carry on as normal. It is important that we acknowledge that, in many areas, food standards in this country are above those of other member states. Hon. Members commented that there will potentially be a race to the bottom, but actually we are trying to spread some of the good practice that goes on in all four parts of the UK in order to get others to raise their standards.

[Sir George Hollingbery (Meon Valley) (Con)]

The hon. Member for Wallasey implied that there is some sort of mercantilist imperative for us to drop standards so that we can sell our goods around the world, but does the Minister agree that to do so would be to shoot ourselves in the foot? It is quite clear that our food standards are what sell our goods overseas. The quality of British produce means that, for example, 35% of Chinese consumers surveyed said that they would particularly buy British products because they are of a higher standard.

[Jo Churchill]

I could not agree more. It is a great tribute not only to producers in this country but to the Food Standards Agency that people feel that our food and brands are to be trusted. I hope that will continue.

On the point raised by the hon. Member for Washington and Sunderland West, this was not missed. This instrument is purely to give clarification—hopefully that is what it does—to make doubly sure that everybody is clear. The devolved Administrations in Wales and Northern Ireland have said that they are fine; it is only Scotland that has not. Once again, I apologise for that. Scotland produces some of the finest quality products that go out of this country, so making sure we have done this properly is important to all the devolved nations.

Ensuring continuity of trade is important, and ensuring food safety here is hugely important. Mostly, we must ensure that we are open and transparent. The hon. Member for Washington and Sunderland West wanted clarification about the system. If there were to be any other form—the hon. Member for Wallasey alluded to chlorinated chicken, but it might be something else that is brought forward—it would first be risk-assessed by the FSA and would go through its very rigorous programme. It would then come to the Minister, and would come before the House by way of an SI. If there are any issues, that process must be walked through to ensure a degree of safety.

Specifically on chlorinated chicken, any substance used to remove surface contamination from chicken carcases must be specifically approved. Chorine has not been approved, and so cannot be used and could not be approved until it had walked through those processes. Each devolved Administration would then have individual responsibility for it. I feel that the concerns expressed in the media have perhaps over-egged the situation—we are all used to that—because those safety nets are in place. This SI simply helps to ensure that we are ready for Brexit on 31 October, whatever the circumstances, and that we are ready for all eventualities. Making sure we are prepared is the key job.

In closing, I hope I have answered hon. Members’ questions. As I said, the Government are working to agree a deal with the EU, but while we do that and until we have a finalised agreement, it is important that we prepare for the possibility that we will leave without a deal.

[Ms Eagle]

I thank the Minister for her responses, but could she address my question about the speed with which this instrument has had to be dealt with? She mentioned the meeting on the 11th. Is there scepticism about the state of our current law, and does that mean that this statutory instrument had to be dealt with quickly to help us with that meeting? Could she explain whom she is trying to reassure and why?

[Jo Churchill]

I suppose it was belt and braces. We felt that clarification was sensible to make it clear to all audiences that we are maintaining the highest standards. That is why we have done it. Given that we trade £5.4 billion of food and feed with the EU, ensuring that we have clarification before 11 October for third party status is paramount.

To reiterate, this instrument makes no changes to policy or to how food businesses are regulated and run. It is limited to drafting refinements and will ensure that the regulatory controls for food continue to function effectively after exit day if the UK leaves the EU without a deal.

Question put and agreed to.

Community Pharmacies

Jo Churchill Excerpts

Wednesday 2nd October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir David. I thank each and every right hon. and hon. Member who has contributed. Most importantly, I thank the hon. Member for Halifax (Holly Lynch) for securing this debate and allowing us to discuss the challenges and celebrate the opportunities that lie ahead in community pharmacies, as well as how we best deliver to patients. The right hon. Member for Rother Valley (Sir Kevin Barron) and the hon. Members for Scunthorpe (Nic Dakin), for York Central (Rachael Maskell), for Heywood and Middleton (Liz McInnes), for Great Grimsby (Melanie Onn), for Strangford (Jim Shannon), for East Londonderry (Mr Campbell) and for Westmorland and Lonsdale (Tim Farron) all made excellent speeches that gave food for thought, as did the contributions from the hon. Members for Motherwell and Wishaw (Marion Fellows) and for Washington and Sunderland West (Mrs Hodgson). They celebrated exactly what community pharmacies can do if they are embedded in the heart of their communities and what untapped potential there is for moving forward.

I am pleased to have the opportunity to set out the vision for community pharmacy at a pivotal time for the pharmacy sector. As we have discussed, the past three years have been challenging, but there is a new pharmacy sector agreement. I am continually inspired, as everybody has been—we heard about the experience of the hon. Member for Halifax of working in a pharmacy—by the compassion, dedication and commitment of those who work in the NHS family. I saw that myself last week when I met pharmacists and the chief exec of the Pharmaceutical Services Negotiating Committee at the local pharmaceutical committee conference. That underlined to me again what an essential part of the NHS the pharmacy is, working day in and day out on improving outcomes for patients and for the community, which lies at the heart of what they do.

We have heard about the challenges of different communities. The hon. Member for Westmorland and Lonsdale made his point very well, as did other Members who represent rural constituencies. The hon. Members for Strangford and for Motherwell and Wishaw mentioned that the challenges are slightly different in rural, dispersed communities. We hope that the new contract will not be one size fits all but will give additional help to rural pharmacies to help them deliver, because we know that they are an important and integral part of their local community. Ensuring that we maintain a good level of access in England and support pharmacy where there are fewer pharmacies is important and built in.

Community pharmacy always has been an integral part of our communities. We have 11,500 community pharmacies delivering. I pay tribute to the right hon. Member for Rother Valley for his work in chairing the all-party group on pharmacy. He explained clearly how pharmacies are close to 96% of people, who can get to one by foot or on public transport in 20 minutes. The key thing for me was when he said that the majority were in areas of high deprivation. That is hugely important as the contract moves forward, because we are determined to double down on health inequalities, and we know that the pharmacist is a key frontline expert who can help deliver in those communities. Pharmacy can play a greater part in helping people to stay well in their communities.

Today’s debate is timely because the new landmark arrangements for pharmacy—a five-year deal for pharmacies—came into force yesterday. I have heard the deal criticised as flat, but the PSNC said that it wanted certainty; it wants to be able to use its skills better and further, and we have determined the deal in collaboration with it. The deal is the beginning of a programme to transform the sector and to see community pharmacies play a much expanded role in the delivery of health and care across prevention, urgent care and medicine safety. Those new arrangements will support the pharmacy team to utilise all its extensive clinical expertise, further developing new roles and providing the community with the knowledge, skills and support to prevent ill health, manage minor conditions and stay happy and healthy for longer. We have heard from virtually every Member who has spoken about how much that goes on. The hon. Member for Great Grimsby told a moving story of how intimate the relationship is between the community pharmacist and the community that he serves.

The deal sets a programme of work that the Department, NHS England, NHS Improvement and the PSNC have collaboratively developed and agreed—we have worked together to get there. Our direction of travel is clear, and we will continue to work together on the detail, strengthening the role of community pharmacy and the delivery of health and care year on year for the next five years and beyond.

[Nic Dakin]

The Minister is setting out the aspiration well, but does she recognise that having no increase—even by inflation—for five years is a desperately big challenge for community pharmacies?

[Jo Churchill]

On the matter of reimbursement, which was also raised by the hon. Members for York Central and for Westmorland and Lonsdale, we seek to ensure a fairer system of reimbursement for pharmacy contractors and value for money for the NHS. I am sure we would all agree that that is the challenge that we face the whole time. That is why, in July, we launched a consultation on community pharmacy drug reimbursement. We have engaged widely with pharmacy stakeholders and have had an excellent response. We will consider all those responses fully and set out plans for the fairer system in due course. I appreciate that the response will be, “But it’s needed now,” but a pharmacy is a private business, and reimbursement is not pharmacies’ only form of income. What I am talking about will take a shift. There is an acknowledgment that that shift—that transition—will need to be assisted. There is also an independent funding stream from the flu vaccine, for example. I would like to see—and have been discussing with officials—whether a broader vaccine programme could be rolled out through pharmacies as well, and reimbursed. We know we need to do better.

[Jim Shannon]

The Minister has so far given a comprehensive response to our concerns. I suggested in the debate that, when it comes to medical attention, pharmacies could do more to oversee small things such as the flu vaccination that she referred to and diabetes and glaucoma. As other hon. Members have mentioned, there are small things that pharmacists could do to take the pressure off GPs. Is that something the Government would consider—giving more responsibility to the pharmacist and taking pressure off GPs and accident and emergency?

[Jo Churchill]

If the hon. Gentleman will just bear with me for a second, he will hear me largely repeating what the right hon. Member for Rother Valley said when he so beautifully laid out the skills and expertise that lie in the pharmacy sector, and how they can be utilised better.

As I said, the deal sets out a programme of work we shall be working on. Our aim is that collaborative working across the system will deliver an integrated and accessible community health service for all. I want to name-check the hon. Member for Strangford here because, as he articulated, communication lies at the centre of this issue. One instance might be the digital expertise that the hon. Member for Washington and Sunderland West said exists in Gateshead, where people’s greater readiness to get services from pharmacists, and the fact that pharmacists can do more, is having a positive effect for patients.

First, pharmacists told us that we must utilise and unlock the potential of the highly skilled pharmacy teams that are embedded in communities throughout the country, including in the constituency of the hon. Member for Halifax, with everyone celebrating what pharmacists can deliver. That is why the settlement aims to deliver more fulfilling, patient-facing careers for community pharmacists and technicians, as highly valued members of the NHS team. Additionally, populations will be helped by much better services.

Secondly, pharmacists told us that they wanted continuity. The settlement funding over five years gives certainty, and gives community pharmacists the confidence to invest in their business. However, there is no one size fits all. Being in the centre of a town is not the same as being in a rural village. Looking at these things in the round is why we want this to be collaborative.

[Rachael Maskell]

How will the Minister measure the impact of the settlement, particularly on independent pharmacists? If more of them close or are struggling financially, what other interventions does she plan to make?

[Jo Churchill]

As I said, there is no one size that fits all. As the hon. Lady articulated in her speech, the difficulty is that we are not looking at a system where businesses are run on the same scale model. At any one point, there are single pharmacists. She stated that the pharmacy she visited was part of a seven-strong business. Then there are the multiples. We need to look at what is the best scheme. However, I would argue that independents have a much higher footfall from their local population, because they are more trusted than many of the multiple pharmacies due to the continuity that comes from their having been in their communities for longer. There are opportunities there for independents.

We know we will need to design new ways of working to make a success of this, and we will need patients to be confident in how they use the services. The enhanced role for community pharmacy will support patients in getting access to help where required and in using the NHS in the best possible way. When people are suffering from minor conditions such as earaches or sore throats and need health advice, we want them to think “Pharmacy First”.

We want to build on that, with other parts of the NHS proactively signposting to local pharmacists. We want everyone to recognise the high-level skills held by pharmacists and to get people to understand that we need them as a first-line service to go to. That will grow trust in the system and spread the load. We will, of course, need to reform the way we work to free up pharmacists’ time so that they are able to deliver these new services.

[Liz McInnes]

I am sorry to interrupt, but the Minister has not referred to delivery times yet, and we have only two and a half minutes to go. Will she mention what she is going to do about those?

[Jo Churchill]

I thank the hon. Lady, but I would like to push through and to come on to the supply of medicines, which the hon. Member for Halifax spent much of her speech discussing.

We must recognise that we need to work in partnership and that this is not only about treating ill health. One of the first services to come online under the new arrangements will be the community pharmacist consultation service, which will start on 29 October. It will establish the first ever national triage system, which will look at community pharmacies referring patients into pharmacy directly from NHS 111 for minor illnesses, wellbeing support and self-care advice, as well as urgent problems. It is important that everybody involved makes this work a success, because we want this to be a two-way process. Over the next five years, we want to include referrals from GPs, urgent treatment centres and NHS Online, but we want to do that based on evidence, sensibly and in collaboration with those in the sector. Registration opened only last month, and more than 2,000 pharmacies have been signed up.

Additionally, by 2020, being a level 1 healthy living pharmacy is expected to be an essential requirement, so that pharmacies can give advice. Integration across primary care is hugely important; the new contractual framework is about not moving minor illness, but about using the whole system better. Community pharmacies are a vital part of the picture if we want to think “Pharmacy First”.

Coming on to the question of medicine supply and shortages, I appreciate the issues that the hon. Member for Halifax mentioned, but, as recognised in last week’s National Audit Office report, we have done an enormous amount in collaboration with pharmaceutical and medical device companies. There are always ongoing shortages, but the Department works all the time to ensure that they are mitigated and that a proper supply of medicine can be got to people. With the issues of Brexit, we know that that is doubly important, and that is what the Department has been doubling down on.

[Sir David Crausby (in the Chair)]

I do not think there is really time for Holly Lynch to wind up.

Question put and agreed to.

Resolved,

That this House has considered the role of community pharmacies.

Improving Healthcare: Isle of Wight

Jo Churchill Excerpts

Tuesday 1st October 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Betts.

First, I thank my hon. Friend the Member for Isle of Wight (Mr Seely) for bringing forward this important issue and securing this debate. I recognise his support for the trust and his desire, and the desire of others, to improve services. Today, however, he has highlighted three specific issues.

We recognise that the Isle of Wight faces different challenges from those on the mainland. As my hon. Friend said, the Island represents a very distinct healthcare environment. It is heavily dependent on acute services close by, but there is the difficulty of travelling across water and the challenges that that lack of accessibility brings to the Island.

I know that the local Sustainability and Transformation Partnership is considering how to put healthcare on the Isle of Wight and in Hampshire on a sustainable footing, with the high-quality care that my hon. Friend has asked for, in the interests of the system as a whole and for the long term.

The impact that those challenges have on local NHS systems needs to be discussed. I reassure my hon. Friend that we are committed to providing the high-quality care that he seeks to meet the needs of people across the Island and to accommodate people irrespective of where they live.

It is important that we do not let the NHS stand still, and my hon. Friend alluded to telemedicine and to making use of all such technologies in the future. We know that people are living longer, and the Island has an elderly population that is higher than the national average. That elderly population is living with multiple co-morbidities, which puts a higher pressure on the service, as he said. However, he also spoke about how the Island is beginning to address those challenges, using blue boxes and using the whole system to help the entire system to work better.

The long-term plan sets out how we will provide high-quality healthcare for all and ensure that people live longer, healthier and more independent lives, which is what we all want. The plan recognises that the NHS needs to change and implement new systems to meet 21st-century challenges, so we are actually at a point of opportunity.

We are committed to delivering high-quality universal care, irrespective of location. That is particularly important given the challenges that Island life brings and that my hon. Friend outlined. He knows that there are benefits of being on an island, but that there are also some constraints, which we must now sit down and work through.

We accept that there are additional costs for providing healthcare on the Island. It has individual challenges, arising from delivering care on the Island with the diseconomies of scale that my hon. Friend spoke about so well. Earlier this year, we committed £2.7 million in extra funding for the Isle of Wight under the fair funding review, to help to start working through some of these issues. This money is to support the plan of the clinical commissioning group, the NHS trust and the local council for integration of public services, which will improve the care that patients receive. I hear what he says about how we must work together to find solutions for the long term.

As my hon. Friend said, the Isle of Wight will also benefit from the announcement of the 20 hospital upgrades, and I am grateful that he mentioned the £48 million for the Island. This extra investment will lead to improvements in patient care, and hopefully will allow flexibility for Maggie Oldham, the trust’s chair, and the rest of the team to progress their ideas further, allowing the Island better to utilise innovative technology, improve efficiency and improve the quality of care, which he has highlighted is his key objective.

I pay tribute to all those who have been involved with the trust, given the difficult circumstances it faced when it received a rating from the Care Quality Commission of “inadequate”. It has begun the positive journey to make things better. I recognise the hard work that everybody has put in across the health and social care system in the area, which is a really positive start.

We will now look at the local system, supported by NHS England and NHS Improvement, to protect and build on those achievements. I have already spoken to the Minister for hospitals, my hon. Friend the Member for Charnwood (Edward Argar), who is more than happy to arrange a meeting at which he and his officials would be present, so that some of the specific questions may be given the proper and appropriate attention, because my hon. Friend the Member for Isle of Wight would not expect specific answers today.

Moving forward, it is vital in the medium term that the Island develops a strong joined-up plan across its health and care system to deliver the vision of a person-centred, co-ordinated health and social care system that gives patients the support they need. That is a unique system that cares for people from birth to end of life. My hon. Friend highlighted the challenges around the ambulance service, for example, such as not being able to use the overlay ambulance services available more easily to those on the mainland. I have also heard his request about patient travel costs. I have been assured by my hon. Friend the Minister for hospitals that NHS England and NHS Improvement have been involved in the development of plans and will continue to work closely with colleagues on the Isle of Wight. I therefore hope that my hon. Friend the Member for Isle of Wight realises that we are all here to support both him and the development of the broader health system on the Island.

While I recognise the concerns of Members who represent island constituencies, I hope that they will be reassured by our ongoing work to ensure that appropriate NHS resources are available, both on the Isle of Wight and on similar islands, to support patients and to meet CCG obligations to commission the best possible care. The Government are committed to ensuring that all patients receive high-quality healthcare that meets their needs, irrespective of where they live. Whether it involves me or my hon. Friend the Minister for hospitals, I look forward this constructive dialogue continuing.

Question put and agreed to.

Maraviroc and Progressive Multifocal Leukoencephalopathy

Jo Churchill Excerpts

Monday 30th September 2019 Commons Chamber

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

I thank the hon. Member for Feltham and Heston (Seema Malhotra) for raising this matter in the House, and for the comprehensive and sensitive way in which she has set out problems that will certainly be well recognised by many patients—not only her constituent, but people throughout the rare disease community. A number of the issues that she has raised affect what are often very small cohorts trying to put their case for particular drugs.

As we have heard from the hon. Lady, progressive multifocal leukoencephalopathy is a terrible disease which can have devastating effects on patients whose immune systems are already impaired, often as a result of taking medicines. Maraviroc is an antiretroviral drug approved by the Medicines and Healthcare Products Regulatory Agency for the treatment of HIV. In this case, the hon. Lady’s constituent, who unfortunately has multiple sclerosis, has been paying privately for the drug, which I understand she feels has a positive effect on her condition.

The use of Maraviroc for people with MS is “off-label”. Medicines sold and supplied in the UK must, rightly, have a licence, which specifies the medical conditions that they are approved to treat, and also specifies the recommended doses, contra-indications, and special warnings as specified by the MHRA. All that is intended to ensure the safety of the patient. Off-label use, as I am sure the hon. Lady is aware, describes that situation where the licensed medicine is used for an indication other than that for which it is licensed originally. However, as she said, a decision to use a medicine off-label is one for the individual clinician. In each case, it is for that professional to make that decision if they think the treatment is appropriate for a patient and they are satisfied that there is robust evidence to support their prescribing decision.

As the drug in question is a licensed medicine for the treatment of HIV, not PML, it has not been fully tested with PML patients in clinical trials. Therefore, it has not been approved as safe and effective. Crucially, it is important to note that the use of this drug to treat Natalizumab-induced PML currently has an evidence base limited to small observational studies where no conclusive evidence of patient benefit was found. However, I fully appreciate that it is a real challenge to establish a clinical evidence base when the patient population is so small.

In fact, as the hon. Lady mentioned, NHS England and NHS Improvement were asked in 2018 to develop a commissioning policy on the use of Maraviroc for the treatment of Natalizumab-induced PML. They concluded, however, that there was insufficient evidence of benefit and advised against routine commissioning. Maraviroc is not currently appraised or recommended by national bodies for the treatment of PML, because there is a lack of evidence of effectiveness and a lack of any evidence-based clinical support in the treatment of PML. NHS England has therefore concluded that there is not sufficient evidence to support the routine commissioning of the drug—a conclusion that clinical commissioning groups are minded to follow. Of course, that position would be reviewed should further evidence become available.

Despite Maraviroc not being routinely commissioned by the NHS, it remains possible for patients to access the drug through the individual funding request, which, as the hon. Lady has said, her constituent did. An independent panel would have considered the circumstances of the request before making a decision. In this case I understand that the IFR was rejected, which I know would have been upsetting for the hon. Lady’s constituent. Following the outcome of the IFR, the reasons for the decision would, I am sure, have been explained to her constituent. If not, I urge the hon. Lady to ensure that they are explained in full.

[Seema Malhotra]

I understand that this is a technical matter in some respects, but I am a little surprised that I have not heard the Minister say anything new compared with the responses I have received to parliamentary questions. I have laid out the evidence and shown that there are nuances. In the case of my constituent, the medical benefits have been clear. I am surprised that the IFR was denied, including subsequently on appeal, and, given that I have laid out the evidence, that the Minister is not in a position to give advice on how we can move forward so that we do not keep going around in circles.

[Jo Churchill]

I think that part of the confusion has come from the fact that the NHSE advice not to commission is different from the independent funding route process. Clinicians can always apply for IFR funding in exceptional circumstances. The MHRA parliamentary question was about availability. One offer I can make is that we will try to unpick those four answers and to understand a little more in the round how we can be of assistance and give the hon. Lady’s constituent clarity, if nothing else.

[Seema Malhotra]

The Minister is very generous in giving way. Rather than restating the policy, will she support the request for the medical advice that was the reason for the treatment and funding being refused? There must have been some medical input into the decision made by the panel at NHS England. Will she also be able to meet me to review the process and what my constituent has been through? Clearly my constituent is in a very rare circumstance—she is possibly one of fewer than 10 people in the country—but surely we are able to work a bit faster and with more agility in a situation where, in a sense, the patient and the experts in the field should be leading.

[Jo Churchill]

I am, of course, happy to meet the hon. Lady, but we must be led by clinicians. As she says, her constituent has been supported by her clinicians, and it is up to them to make clinical judgments and to put the case for the best course of treatment in each particular case. The first thing to do is to seek clarification on where we know we are going, and hopefully we can move forward from there.

As the hon. Lady says, the PML group is around 10 in number, so getting robust evidence is obviously a challenge—that is all part and parcel of the issue. As she knows, another challenge is that the Department of Health and Social Care does not have direct responsibility for what is routinely commissioned. Instead, it is the responsibility of NHS England, NHS Improvement and the CCGs. Faced with an unprecedented level of demand for services, all those involved have to make difficult decisions about commissioning cost-effective care on a daily basis. They make those decisions based on patient need and clinical evidence, which I acknowledge can feel very cyclical for the rare disease community.

[Seema Malhotra]

Does the Minister agree it is slightly more problematic in this case, because the cost of Maraviroc is arguably a bit less than the MRI scans and the steroids every month that the NHS would otherwise prescribe or suggest to my constituent? The negative health impact of that treatment should also be taken into account.

[Jo Churchill]

I thank the hon. Lady, but I return to the fact that it is a judgment for clinicians to make; it is not one for me to make at the Dispatch Box.

My colleague Baroness Blackwood rightly said this summer that we need a national conversation on rare diseases to identify the big areas on which we need to focus so that we can offer the best possible care for rare disease patients and their families, who are often affected by what their loved ones are going through. I could not agree more so, starting this autumn, we will be engaging with patients, researchers and clinicians to gather evidence and identify the major challenges faced in this field.

[Jim Shannon]

I am pleased to see the Minister in her place. I offer her congratulations; it is well deserved.

Will money be set aside at the end of the consultation to address the medicines that are needed for those rare diseases? If money is not set aside, it will not go anywhere.

[Jo Churchill]

I am not in a position to say. Although each cohort is small, the overall rare disease community is large. That is why such debates make an important contribution to the broader conversation. I am grateful for how they raise awareness of the rare disease community, which comprises some 3.5 million people in this country.

[Seema Malhotra]

I will make this my last intervention. I just want to welcome the work that will be done in respect of the rare disease community. May I add to the comments in this House in welcoming the Minister to her place? I know that her experience will be extremely valuable in the work that she does in the Department.

[Jo Churchill]

I thank the hon. Lady sincerely for that and for speaking so passionately here today about the situation on behalf of her constituent. I know that her constituent may not feel that this is the answer that she wanted, but I cannot emphasise enough the positive effect of bringing this issue to the Chamber. Not only will it raise awareness, to help inform Government strategy, but it will support others in the rare disease community. As the hon. Lady said, allowing their voice to be heard is what is important here.

Question put and agreed to.