Genetic Haemochromatosis

Mark Pawsey Excerpts

Wednesday 3rd July 2019 Westminster Hall

[Mark Pawsey (Rugby) (Con)]

It is a pleasure to serve under your chairmanship, Mr Sharma. It is a great privilege to secure this important debate on genetic haemochromatosis. I chair the all-party parliamentary group for genetic haemochromatosis (iron overload). I want to raise awareness of the condition, within Westminster and beyond. I will explain what genetic haemochromatosis is and its prevalence within the UK. I will also look at how the condition fits into the NHS priorities. I will conclude with three asks to the Minister on behalf of the charity Haemochromatosis UK, which is represented here, and the APPG.

Until recently I knew nothing about the condition. Two or three years ago I visited the charity Haemochromatosis UK, which was based in my constituency, and the condition was explained to me. The lack of awareness of the condition and the importance of early diagnosis were brought to my attention. As a consequence of those discussions with the charity and some other hon. Members, some of whom are here, we formed the APPG earlier this year.

The APPG was based on the report published by Haemochromatosis UK in October 2018, which highlighted the previously underestimated impact of the condition, in terms of the number of people affected and the chronic effect it has on people’s lives. The APPG first met in January and we met again in May to talk about the adoption of clinical guidelines, which I will refer to later.

What is genetic haemochromatosis? It is a genetic condition in which the body fails to control the absorption of iron. Some hon. Members may have heard it described as iron overload or iron overload disorder. Iron builds up within the body and reaches a highly toxic level. That can lead to a multitude of different health problems. Iron builds up particularly in the liver and the damage is progressive. At its worst, iron overload can kill through liver and heart failure.

[Bob Stewart (Beckenham) (Con)]

I stand as an ignoramus on this matter, but I want to support my hon. Friend who is leading the debate, and I want to know more about the matter. Is this something that is in a baby from birth, and if not, what is the normal age at which it develops?

[Mark Pawsey]

This is a genetic condition that becomes apparent in some people who possess the gene. People are affected to a variable degree. I will come on to some of the debilitating consequences of genetic haemochromatosis, which include arthritis, joint pain, diabetes, fatigue, psychological or cognitive difficulties, skin conditions, menstrual problems in women, impotence, breathing and heart problems, abdominal pain, liver problems and hair loss.

Just because the condition is not widely spoken about, in either medical or public life, that does not mean that it is not prevalent in the UK. The white UK population of north-European extraction, particularly people of Celtic extraction, gives the UK the highest prevalence anywhere in the world. The condition is found around the world wherever the Irish and Celtic population has migrated to, including Australia, the Americas and South Africa.

One in eight people in the UK carry a faulty copy of the GH gene. That faulty gene is known as HFE. One in 200 people carry two faulty copies of the HFE gene. Those are the people at risk of iron toxicity. In layman’s terms, people must have two copies of the gene in order to be affected by the condition. It is estimated that around 380,000 people worldwide have the genetic haemochromatosis mutation. Of those 380,000 people, 200,000 are under 40 years old, which is why early diagnosis is important. If we can diagnose the condition early, people will not be overlooked and can attend to their symptoms.

[Rachel Maclean (Redditch) (Con)]

I congratulate my hon. Friend on securing the debate. I thank him for outlining, for those of us who do not have as much knowledge, how prevalent the disease actually is and how important it is that we get services and treatment right. I thank my constituent Roger Keyte, who is a trustee of Haemochromatosis UK. He has done a good job educating me. I thank him and others who are working hard to help the many people who are affected.

[Mark Pawsey]

My hon. Friend is exactly right. That charity, which serves to raise awareness, has done a fantastic job, and that includes her constituent. I should point out that this is a condition rather than a disease, because a disease may be considered to be contagious.

I mentioned that the prevalence is higher in Ireland. According to the Irish Haemochromatosis Association, in Northern Ireland one in five people are carriers. The incidence among people of Celtic origin leads to some people referring to genetic haemochromatosis as the Celtic curse, a term that is not looked on favourably, but does underline the prevalence among Irish, Scottish and Welsh people, and the need for them and their doctors to be aware of the condition. I am delighted to see hon. Members representing Welsh and Scottish constituencies here, some of whom I know will contribute to the debate.

I have already mentioned that the condition is poorly diagnosed. Recent research shows that at least 45,000 people affected in the UK are loading iron as their bodies fail to control the absorption. Only 10% to 13% of these cases are diagnosed. For every patient diagnosed, between eight and 10 have the symptoms but have not been diagnosed. They are suffering unaware of what is happening to them.

Dr Ted Fitzsimons of the University of Glasgow has done a great deal of work in this area. He highlights that 80% to 90% of individuals who have this condition are unaware that they have it. They do not know what it is. They know the symptoms, which affect them, but they do not have an explanation for them.

Professor David Melzer, from Exeter University, and the Haemochromatosis Research Group have conducted a UK Biobank study of half a million patients, which was published in January 2019. They found that people with the double haemochromatosis mutation had four times the risk of liver disease, twice the risk of arthritis and frailty among older age groups, and a 50% higher risk of pneumonia and diabetes compared with those who do not suffer from the condition. In the UK, there are currently 136,000 people with the condition aged 40-plus. The study found that of that generation of 136,000, approximately 12,200 will have had a hip replacement, which they would not have needed if they had been diagnosed earlier and treated for iron overload. However, the study has a caveat, as there is uncertainty about whether all those operations would have been avoided by early diagnosis. But as with any condition, we know that early diagnosis is crucial.

[Liz Twist (Blaydon) (Lab)]

Two of my constituents, Jane and Andrew, have haemochromatosis and have contacted me about this debate, stressing the importance of early diagnosis. Does the hon. Gentleman agree that it can be difficult sometimes for people to be clear about the symptoms, therefore making it can be difficult to get a diagnosis, and that we must work on that?

[Mark Pawsey]

The hon. Lady is exactly right. Very often, people suffer from the symptoms and persevere. They feel tired and just generally unwell, but they do not know why they are affected, so awareness of the condition among the medical profession when people present with those symptoms is vital in identifying those affected.

In terms of the additional demands placed on the NHS, we can estimate an extra 564 patients diagnosed with liver disease and 125 new liver cancer patients every year from among those with the condition. If we can diagnose it, enable patients to be aware of it and deal with it earlier, we can prevent it from making such a substantial demand on the NHS.

[Bob Stewart]

I congratulate my hon. Friend on securing this debate. As I am half-Scottish, have had my hip replaced and feel tired most of the time, I am worried, but not as worried as doctors must be, because it seems to me that if someone goes to a general practitioner with normal symptoms like that, it must be bloody difficult for them to diagnose the condition. Everyone here is nodding, so I presume that is right.

[Mark Pawsey]

My hon. Friend makes a valuable point. Next time he visits his GP, he can ask, armed with the knowledge that he has as a consequence of this debate, whether the condition might be something to consider.

Let me turn to the cost saving to the NHS. The basic test for iron levels in blood would cost only £1 per patient if routinely done at the same time as other blood tests. The test is not commonly done; perhaps it should be. Iron testing could be added to the NHS health check, which people receive at the age of 50. That might provide a pointer to some of the symptoms that my hon. Friend has referred to.

The UK Biobank study also indicates that the HFE gene is associated with significant morbidity, in particular associated arthritis and liver disease. Of course, because of the influence of the liver, there is a highly increased risk of liver cancer compared with the general population. There are approximately 6,000 cases of liver cancer per annum nationally, and the outlook for those with liver cancer is particularly poor. The survival rate for liver cancer is among the lowest of all cancers. Professor Ted Fitzsimmons of Glasgow University estimates the cost of a liver transplant at around £100,000. That is a broadbrush estimate, which excludes personal costs such as loss of employment and the need for family members to help with caring. Again, we know that early diagnosis could not only improve the lives of those affected but result in significant savings for the NHS.

Since my involvement with genetic haemochromatosis began, one thing that has had an impact on me is the stories of patients affected by it. I will read out a couple of patient testimonies. One comes from another trustee of Haemochromatosis UK, Michelle Weerasekera. This is her account:

“I was diagnosed with genetic haemochromatosis after suffering from chronic fatigue for some time. I had visited my GP and been told to take folic acid and wouldn’t have returned had I not had a routine blood test carried out for an insurance policy that I was taking out.”

She therefore became aware of her condition accidentally. She continues:

“I returned to my GP, who, thinking that I may be anaemic, ran a ferritin test. This showed that my results were elevated and I was referred to a Haematologist. I had a FerriScan carried out which showed some stored iron in my liver but luckily with regular venesections”—

the taking of blood—

“over the last eighteen months I have managed to reduce my ferritin levels and am now in what is called the ‘maintenance phase’. I hope to soon become a regular blood donor”—

an issue that I will raise with the Minister later on—

“so that my blood can be put to good use. I know how lucky I have been by being diagnosed when I was. Having talked to my GP since diagnosis, I know that Haemochromatosis was not on his radar and this is why raising awareness is so important. Had I not returned to the GP, my body would have carried on storing iron and the outcome and my future health may have not have looked so positive.”

The second piece of testimony comes from another patient with genetic haemochromatosis, a young woman. Katharine Hough is only 27 and has had to fight to be taken seriously by the medical profession, largely because genetic haemochromatosis generally affects older people. The key point about Katharine’s concerns is that she is relatively young. She says:

“Despite the advantage of being diagnosed young, I have often had to fight to be taken seriously by the medical profession. Doctors seem to think it will not affect me as I am young and they are accustomed to solving health issues rather than helping to maintain good health and prevent problems.

I have had many cases where specialists think that, as I am a young woman and my symptoms are not as severe as those suffered by older people, I am healthy and have nothing to worry about. But I am only 27...If they stop and think for a moment to consider it, I should not have joint pains, and my knees should not hurt when I walk. I want to prevent further damage and not wait until my symptoms are very bad…It is my health and only I can fight for it.”

Both these stories highlight the importance of early diagnosis and increased awareness of the condition among GPs and other medical professionals.

The frustrating thing is that in a large number of cases treatment will alleviate many of the symptoms. The earliest intervention prevents many of the problems that I have described, including the build-up of iron in the liver and heart. In the vast majority of cases, treatment is venesection, which is essentially giving blood. Done intensively, this removes excess iron from the body effectively. Done regularly, it will maintain iron levels. In simple terms, the body uses some of the stored excess iron to make red blood cells to replace those that have been removed.

Venesection is a safe and proven procedure. It is similar to donating blood, as those of us who donate blood will realise. The blood taken from a haemochromatosis patient is perfectly useable and would go some way to addressing NHS blood demand. However, blood taken in a venesection clinic is discarded, which does not seem to make sense. I will come back to that in my final remarks and asks of the Minister.

Why is this condition not higher on the UK health agenda? There are many and varied reasons, but one key reason is the lack of consistent clinical guidelines. What protocols exist are often non-mandatory, related to an individual trust, inconsistent and poorly adopted. The University of Exeter has conducted some research into the impact of iron overload, which shows wide inconsistencies in the experience of patients, and the prevalence of chronic symptoms arising from non-diagnosis is much higher in the UK than was previously thought. I am looking for the Minister to respond to the point about introducing guidelines. If there were guidelines, that could increase diagnosis perhaps as much as tenfold. That would prevent many people from developing the follow-on conditions, such as cancer, heart failure and diabetes, that I have referred to.

A consultant rheumatologist at St George’s Hospital in London, Dr Kiely, says that the cost of a typically large joint replacement is in the order of £10,000—which may be of interest to my hon. Friend the Member for Beckenham (Bob Stewart). Dr Kiely has also said that the big impact on healthcare costs would be in primary care, from delays in diagnosis. Those who suffer from genetic haemochromatosis suffer from less productivity when they are at work. They often have to take time off work, but also often want to continue at work. That leads to presenteeism, where people turn up for work but are ineffective because of the debilitating conditions that they suffer from. All those are costs to society, and are burdens that patients have to deal with.

A January 2019 editorial in The Lancet on gastroenterology and hepatology said:

“We wholeheartedly support the need to increase education and awareness of genetic haemochromatosis among clinicians to improve early diagnosis. The necessary tools are in hand, the guidelines are clear, and”—

very significantly—

“their implementation would be…cost-free. It is difficult to imagine a clinical problem that represents lower-hanging fruit for the…NHS. As such, there is no time like the present to elevate the priority of genetic haemochromatosis on the UK healthcare agenda.”

Professor Ted Fitzsimmons of the University of Glasgow, who attended the most recent meeting of the all-party parliamentary group for genetic haemochromatosis, has produced a set of guidelines for this condition. Those guidelines have been endorsed by a number of professional medical bodies, and the APPG would like them to be adopted and expanded on by the National Institute for Health and Care Excellence in order to improve and increase diagnosis, and to improve and, importantly, standardise care after diagnosis. We believe that doing so would put genetic haemochromatosis higher on the NHS agenda.

This condition fits into two of the priorities of the NHS long-term plan. First, the plan talks about prevention. Prevention of genetic haemochromatosis affecting patients means effective diagnosis before the damage is done. If we can identify it, we can save the NHS money and ensure that patients’ health is protected early. The Secretary of State for Health and Social Care drew attention to that in November last year, when he said that

“if we get prevention right, it holds the key to longer, healthier, happier lives and a sustainable, high quality health and care system… It’s why…I made it one of my big three priorities”.

There is no easier win than adopting prevention for this condition.

Another NHS priority is supporting people to age well. The University of Exeter report highlighted the impact of genetic haemochromatosis on our ageing population, and we know that the condition affects arthritis and frailty in older age groups and increases the risks of diabetes and chronic pain. It is an issue that we need to address.

My three asks of the Minister, which I hope she will respond to in her remarks, are as follows. First, what steps can she take to ensure that those who are affected are promptly and correctly identified, regardless of where they live? We have already heard that early diagnosis saves lives, yet so frequently people with genetic haemochromatosis suffer needlessly as a consequence of late diagnosis. Secondly, what steps can she take to encourage the NHS to adopt, share and embed the best practice we have referred to, both through screening and associated therapies, to ensure that venesection is available? We know from Haemochromatosis UK’s 1,800 members that NHS standards vary widely across the country. With a single system, we could offer a consistent, world-class approach.

That brings me on my third point. How can the Minister encourage different areas of the NHS system to collaborate more effectively to realise the economic benefits of joined-up care, and also the benefits to the patient? One example would be making use of the blood taken during venesection, incentivising NHS Blood and Transplant to make greater use of genetic haemochromatosis patient blood to meet ongoing needs. It is astounding that the blood collected is wasted. That distresses many of the people affected by genetic haemochromatosis, who take the view that if they are going to have their blood taken, they would love for it to be used productively to support other patients.

Mr Sharma, I know that other Members wish to contribute. I look forward to the Minister’s response to our asks at the conclusion of the debate.

Oral Answers to Questions

Mark Pawsey Excerpts

Tuesday 19th February 2019 Commons Chamber

[Matt Hancock]

In the event of a problem at the Dover-Calais strait, we will bring in radioisotopes by air, and we have already contracted an aircraft to ensure that that happens. That part of the planning is well advanced.

[Mark Pawsey (Rugby) (Con)]

On Thursday, with Rugby’s mayor, I had the great pleasure to open the new Brownsover surgery, which came about because of the hard work of the patient action group. Will the Secretary of State welcome the work of patient groups in delivering NHS services?

[Matt Hancock]

I am absolutely delighted to welcome the work of the group, which has raised so much money, and of my hon. Friend, who stands up and makes the case for Rugby. More broadly, we should welcome all those who want to make a contribution to our hospitals and hospices. We take a broad-minded and open approach to welcoming people who volunteer hours or raise money to improve our great NHS.

Leaving the EU: Tobacco Products and Public Health

Mark Pawsey Excerpts

Monday 7th January 2019 Commons Chamber

[Mark Pawsey (Rugby) (Con)]

I want to follow the remarks of the hon. Member for Central Ayrshire (Dr Whitford) about the impact of these regulations on vaping products. The vaping industry welcomes the Government’s sensible planning, but has a particular concern about products that are already registered with the EU. The industry producing such products is looking for some clarification from the Minister and some assurance about whether products that are already registered will need to be re-registered under the new UK-based system.

The Minister has spoken about the opportunity to reappraise our legislation. Of course, e-cigarettes are controlled by the tobacco products regulations, despite there not being any tobacco at all in such products. There are three issues that are of concern to users in particular. The first is the cap on nicotine strength in vaping liquids. In many cases, it is too low to encourage heavy smokers to switch to e-cigarettes, which we know are far better for their health and which we want to encourage. There are restrictions on both the size of bottle in which vaping liquids can be sold and the tank size of vaping devices, both of which appear to be completely arbitrary, with no basis to them.

Both users of e-cigarettes and the manufacturing sector are hoping that this may be an opportunity for the Minister to rectify the regulations, which, frankly, are nonsensical. I look forward to the Minister’s response on those points.

Medicines and Medical Devices Safety Review

Mark Pawsey Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

This is something for Baroness Cumberlege to consider, but the broader point is right. We have for too long in each of these three cases, and in others as well, had processes that have not had the confidence of patients. That is why we are proposing today not just specific measures on each of the three issues, but a broader look at the regulatory structure to make sure that patients’ voices are louder and we avoid precisely what the hon. Lady said.

[Mark Pawsey (Rugby) (Con)]

I welcome today’s announcement, which I am sure will also be welcomed by my constituent who had surgical mesh implanted in 2008 during a hysterectomy, and, significantly, without her knowledge or consent, which has led her to suffer severe distress and significant pain. When she raised that with her doctors, she was told it was all in her mind and she was imagining it, and she believes that she is still not being taken seriously 10 years later. Does the Secretary of State share my hope that the very existence of the review will encourage a more sympathetic response to people such as my constituent from the medical profession?

[Mr Hunt]

I very much hope so, and the crucial point that has come out from the contributions of Members in all parts of the House is that the processes we have had in place to date have not had the confidence of the families affected. That applies to a whole range of issues, and I believe medicine is changing fundamentally: people who are passionate about medical innovation and life sciences know that we need to have a very close partnership with patients in order to make proper advances. But we have not always got this right, and that is what I hope Baroness Cumberlege’s review will help us to do.

Oral Answers to Questions

Mark Pawsey Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

That area will obviously be very important in the negotiations, but we have made our preference clear: a deep and special partnership with the EU in which the benefits of co-operation that we currently have can continue.

[Mark Pawsey (Rugby) (Con)]

T6. Public Health England has stated that e-cigarettes are at least 95% safer than tobacco products and are now the most popular way to stop smoking. What is being done to encourage smokers to quit using this method, and what steps are being taken to ensure that e-cigarette users are not forced to share their space with people who continue to smoke?

[Steve Brine]

The truth is that we do not yet know enough about e-cigarettes. I welcome the Science and Technology Committee’s investigation into them. We have asked Public Health England to include messages about the relative safety of e-cigarettes in its Quit Smoking campaign next month, but it is for local organisations and businesses to implement their own policies on e-cigarette use in the workplace.

Hormone Pregnancy Tests

Mark Pawsey Excerpts

Thursday 14th December 2017 Commons Chamber

[Mark Pawsey (Rugby) (Con)]

I congratulate my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) on securing this debate. I add my weight and support to his call for a statutory inquiry into the scandal of the supply of Primodos as a pregnancy test. He drew attention to the years that the product was in use. Like him, I am a product of 1957, and it could just as easily have been my mother taking this drug. Hon. Members across the Chamber have mentioned their constituents, and it is contact with one of my constituents that brings me to contribute to today’s debate.

The resident who came to see me and who has contacted me on many occasions is Irene Creed, who lives in Long Lawford in my constituency. I owe Mrs Creed something of an apology because I am afraid that I gave a rather standard reply at our first point of contact. I did not really know or understand enough about the issues that were affecting Mrs Creed. However, she continued to write to me and to draw my attention to the issue. We eventually met in June 2014 and then again at my surgery in August 2015, when she brought along her daughter, Tamara. Tamara was born in February 1973, which means that she is now 44. Like the constituent of my hon. Friend the Member for North Devon (Peter Heaton-Jones), Mrs Creed was able to tell me the very date on which she was first given Primodos. It was 19 June 1972, when she understood that she was approximately seven to eight weeks pregnant. She gave birth to a daughter with brain damage, which has led to other debilitating conditions such as learning difficulties and epilepsy.

When we met, Mrs Creed asked me to meet Marie Lyon, who runs the Association for Children Damaged by Hormone Pregnancy Tests. I think we should pay tribute to the association for the work that it has done in drawing attention to the issue and for ensuring that the Members who are present today were informed and knew exactly what had happened.

The other key point made by Mrs Creed was that she was given no advice whatsoever about any side-effects of the drug. She drew my attention to the many meetings of the all-party parliamentary group on oral hormone pregnancy tests. I know that the hon. Member for Bolton South East (Yasmin Qureshi) has done a tremendous amount of work in bringing together the members of the APPG and adding to the lobbying on this issue.

The most recent contact that I have had about the issue was with Tamara herself, who began her letter of 23 November by telling me that she was a victim of Primodos. She referred to the inadequate nature of the report produced by the expert working group and set out the case made by my right hon. Friend the Member for Hemel Hempstead for a further look at the issue, which many other Members have also requested. I agree with my right hon. Friend that we badly need to get to the truth, and, like everyone else who is present today, I look forward to whatever positive remarks the Minister may be able to make.

Tobacco Control Plan

Mark Pawsey Excerpts

Thursday 19th October 2017 Commons Chamber

[Sir Kevin Barron]

Clearly that is the case. I agree with this publication and its intention, but there will be issues to address on different forms of funding. I will discuss that a little later in my speech. We can see from the two figures from central London and Blackpool that there is a challenge out there; this difference alone can have a dramatic impact on health inequalities, as maternal smoking causes up to 5,000 miscarriages, 300 perinatal deaths and 2,200 premature births in the UK each year.

In my area of Rotherham alone, the smoking rate among people in managerial and professional occupations is about 10.2%, but that leaps to 29.4% among those who have never worked or are long-term unemployed. Such facts clearly show that we are still struggling to get through to certain groups within society, and the Government must do more to identify ways of getting through to these difficult-to-reach groups.

[Mark Pawsey (Rugby) (Con)]

The right hon. Gentleman is setting out the harm caused by tobacco. As a recent convert to the benefit of e-cigarettes in assisting people to stop smoking, I wonder whether he will be talking about the valuable role they play. Does he agree that it is a bit of a shame that the tobacco control plan does not go further in recognising the role that e-cigarettes can play?

[Sir Kevin Barron]

I will comment on that, but I think the hon. Gentleman ought to be happy that this is the first time in any tobacco control plan that e-cigarettes have been mentioned and there is some intent to do things with them.

I welcome the acknowledgment of the seriousness of the issue for people with long-standing mental health problems, as the smoking rate is a staggering 40% among those with a serious mental illness. That is another area that needs to be targeted and worked on. The control plan rightly states that joined-up working and integrated commissioning between local government and the NHS are very important. This is not just the case in hospitals when people are admitted; we must focus on prevention and early diagnosis. For example, dentists are the only healthcare professionals who frequently see healthy patients and so are in an excellent position to identify possible oral health problems early on.

--- Later in debate ---

[Sir Kevin Barron]

I actually had this conversation in Leicester, although I was not going to mention it in my speech. There is an issue—I think it was in a column in one of the national newspapers many months ago and I have tried to avoid it. If somebody avoids spending £20 or £25 a week on cigarettes, should they get free NHS prescriptions, if they are eligible, to help them to quit? There is a debate there, but I shall say no more than that at this stage.

I asked the team in Leicester what they thought about e-cigarettes on prescription for people who are eligible for free prescriptions, and they said that there might be a case for doing it for a month to break the person away from the cigarette-smoking habit and get them on to e-cigarettes. For the purposes of this debate, I shall leave that where it sits, but there might be a case for it. We clearly need more evidence on the use of e-cigarettes for smoking cessation so that we can make a better estimate.

[Mark Pawsey]

I accept that the right hon. Gentleman wishes to park the issue of whether e-cigarettes should be available on prescription, but does he think that e-cigarette manufacturers should have a little more freedom—the tobacco products directive places restrictions on the advertising of e-cigarettes—to tell people about the nature of their products and how they can help people to switch from tobacco?

[Sir Kevin Barron]

I shall address that briefly, because I know that other Members wish to get involved in the debate. The simple answer is that that is one of several issues that need to be addressed.

The best thing smokers can do for their health is of course to quit smoking altogether, but it is clear that e-cigarettes are significantly less harmful to health than smoking tobacco. Public Health England found that e-cigarettes are around 95% less harmful than smoking cigarettes. My instinct is that the remaining 5% is down to the fact that they have not yet been tested for long enough for it to be said that there is little or no danger at all. There is no evidence that e-cigarettes act as a smoking gateway for children or non-smokers, but research is still needed on their long-term use, and it should be carried out. Quitting smoking is always best, but there is clearly a hard core of smokers who have so far struggled to quit; they must be the people we focus on. It is worrying that an ASH survey found over a three-year period that the number of people who thought that e-cigs were “as or more dangerous” than cigarettes rose from 7% to 26%. That is why we need Government-funded research. I find it incredible that statistic is moving in that direction, rather than the opposite, although I must say that the debate on e-cigarettes, both in the Chamber and elsewhere, has not always been particularly clear.

Other innovations are continuing the “nicotine revolution”. Manufacturers are developing additional smoke-free products to persuade heavy smokers who would not otherwise quit smoking to switch to smoke-free alternatives, among which are the heated-tobacco products that have come on to the scene in the past year or so. Referred to in the “novel tobacco products” category of the tobacco control plan, such products could be the next step to reaching those hard-core smokers who, although they did not get on with e-cigarettes, are looking for another way out of smoking. I was pleased to see in the plan that Public Health England will continue to lead the investigation into the use of novel products as stop-smoking tools, with the evidence updated annually, and that PHE acknowledges that novel products are currently the most popular aid to stopping smoking in England.

Many people are wary of so-called novel products and the fact that many are produced or funded by tobacco companies. We must recognise that tobacco companies have in the past been extremely dishonest about the harms of smoking and the products they have sold, so we urgently need more research on these devices, and I hope the Government’s annual review will help to provide more information. I have been anti-tobacco for more than two decades in this House, but we should not ignore the potential benefits for people who have not been able to stop with more traditional smoking-cessation products just because some of these products have tobacco connections. It is vital that we all focus our minds on the reality of getting people off this habit that is still killing people and shortening the lives of more than 100,000 of our fellow citizens every year.

Many of the products I am talking about are covered by the EU tobacco product directive, which has resulted in many good things, including the establishment of reporting and notification requirements for tobacco products. Nevertheless, stakeholders have raised issues with some of the other requirements, and we may be able to use Brexit as a chance to look at the directive. I understand that we have been thrown into the TPD at the last minute. We have had the debate and I do not want to bore anyone with it further. We need to move on, because that is what happens in politics sometimes. We need to talk about what should be happening now and in future for the sake of our fellow citizens. Brexit is coming, so we should not be tied into a timetable for any changes to the TPD—although I do not even know the potential timetable for any further debate on Brexit. Nevertheless, if there is any discussion about changes to the TPD, we need to ensure that all stakeholders are involved in working groups to design a directive that works for the good of the United Kingdom, taking into account the issues I have mentioned.

For all its positives, there is a glaring problem with the tobacco control plan, and we all know what it is: money. Although not short on lofty ambitions, local authorities face huge strain and will not be able to deliver the kind of joined-up smoking-cessation services that the tobacco control plan deserves. Luckily, there are people who can help. Tobacco companies have made a fortune selling cigarettes. We might well argue that they got us into the mess we are now in, so it is only right they get should us out of it. They have the resources and customer base to help smoking cessation tools to get straight to the people who need them most. If the industry is willing to commit to a future based on e-cigarettes and other reduced-harm products, we should take them up on the offer and allow the Government and local authorities to partner with them to ensure we have the financial and technical assistance needed to help smokers to quit. I would not have said that five years ago, but five years ago we did not have these products that can clearly help a lot of our fellow citizens to get off cigarettes.

Contaminated Blood

Mark Pawsey Excerpts

Tuesday 11th July 2017 Commons Chamber

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

I, too, start by paying tribute to the hon. Member for Kingston upon Hull North (Diana Johnson) for her leadership and persistence on this issue, on which she and my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi) have done tireless work. I welcome the Minister’s statement that a public inquiry will happen on this most important of issues. The Prime Minister has clearly listened to views across the House on the matter.

At one of my first surgery appointments, Richard and his wife came to see me to tell me his story. Richard was a haemophiliac who was sent to a school for the physically disabled in Hampshire when he was 11. For six years, he was given hundreds of thousands of units of factor VIII. Prior to that he had been given cryoprecipitate, which was perfectly workable in moderating his condition. The factor VIII prophylactic treatment was meant to prevent the dangers caused by haemophilia. It changed Richard’s life. Sadly, 64 of the 75 people from Richard’s school are no longer with us. Many of those young people died in their early teens.

This case is a double tragedy. Richard and his wife told me the very good news that, in later life, they decided to have children, but due to the risk of his hepatitis affecting the unborn baby, they had to have a termination, so they are childless as well as having been affected by terrible diseases throughout their lives.

I neglected to congratulate the hon. Member for Oxford East (Anneliese Dodds) on her very fine maiden speech. She certainly made a far better job of it than I did of mine when I stood here two years ago. Her tremendous words were highly relevant to the topic under discussion. I am sure she will make many further fine contributions in the years ahead.

[Mark Pawsey (Rugby) (Con)]

Does my hon. Friend agree that the inquiry needs to consider the challenges faced by people affected by contaminated blood who want children? A constituent of mine had one round of IVF treatment covered by the NHS, but he was not entitled to a second round, so he had to pay for it himself. We should consider such issues and their effect on people in the round.

Oral Answers to Questions

Mark Pawsey Excerpts

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

I am very happy to do that.

[Mark Pawsey (Rugby) (Con)]

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

[Steve Brine]

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