Oral Answers to Questions
Steve Brine Excerpts(6 years, 7 months ago)
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Maggie Throup (Erewash) (Con)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
Me now, Mr Speaker. Improving care for people with lung disease is crucial to this Government. We do not need reams of new plans or strategies, but continued action to implement existing plans, including the NHS outcomes framework, which details NHS priority areas and includes reducing deaths from respiratory disease as a key indicator. Key initiatives include the implementation of quality standards on idiopathic pulmonary fibrosis, asthma and chronic obstructive pulmonary disease, and a national pilot to improve care of breathlessness.
Maggie Throup
I thank the Minister for that answer, but I think that more probably still needs to be done. Last month, I launched the British Lung Foundation’s latest report into idiopathic pulmonary fibrosis. Delayed access to diagnosis, support services and care is still commonplace for people with IPF and other lung conditions. Will the Minister agree to meet me and the British Lung Foundation, which is leading a taskforce for lung health, to establish what more can be done to address the issue?
Steve Brine
I thank my hon. Friend, who speaks with great passion—I know that she has tragic personal experience. I will be meeting the British Lung Foundation shortly, and I am happy for my hon. Friend to join that discussion or part of it. As I said, one of the NHS’s priority areas, as set out in the outcomes framework, is reducing early deaths from respiratory diseases such as IPF. I understand that the number of cases has risen in recent years, which is rightly a cause for concern. She is right to raise the matter, and I look forward to meeting her.
Mr Gregory Campbell (East Londonderry) (DUP)
I have long been a supporter of COPD groups in my constituency in Northern Ireland, but what help is the Minister offering to voluntary groups and families? In particular, what is he offering to the tens of thousands of young children diagnosed as asthmatic to help and assist with their condition?
Steve Brine
Respiratory illness affects one in five people in the UK, and it is responsible for around 1 million hospital admissions annually, so it is very much in our interest, as I said to my hon. Friend the Member for Erewash (Maggie Throup), to implement the outcomes framework. I look forward to having further discussions with the hon. Member for East Londonderry (Mr Campbell), and I am happy to meet him if he wishes.
Andrew Selous (South West Bedfordshire) (Con)
Does the Minister, who cares deeply about these issues, share my concern that lung capacity often never recovers after being damaged in childhood? Is not that a powerful reason why we need to make significant progress on air quality issues?
Steve Brine
Absolutely. I have just returned from a meeting of G7 Health Ministers, and one of the subjects under discussion was environmental factors in climate change and its impact on human health. We had challenging discussions on many areas, but air quality and its impact on respiratory disease was not one of them.
Mr Speaker
It is always useful to have a bit of additional information, for which the House is grateful.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Under this Government we have seen lung disease admissions to A&E rise at double the rate of general admissions. That is even more concerning when the bulk of lung disease admissions happen over the winter months, when A&E departments are already under significant pressure. Will the Minister commit today to introducing a lung disease strategy to ensure that we can reverse these worrying trends and this pressure on people’s lives and on our NHS?
Steve Brine
The meeting was in Milan, Mr Speaker, but we do not mention football in relation to Italy or Milan any more. I hear it is a touchy subject. [Interruption.] Very topical.
There is no plan for a new national strategy or taskforce, but we work closely with charities like the British Lung Foundation. We have to remain committed to implementing the NHS outcomes framework for 2016-17. As the Secretary of State said, we are better prepared for winter than we have been before, and the hon. Member for Washington and Sunderland West (Mrs Hodgson) is right to raise that point.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
Adult smoking prevalence is now 15.5%, the lowest ever. As the House will be aware, in July we published a tobacco control plan for England, which sets out stretching ambitions to reduce smoking prevalence still further and commits us to a series of actions to deliver those ambitions. Our end goal, as we have made clear, is a smoke-free generation.
Bob Blackman
I thank my hon. Friend for that answer. Does he agree that one of the most effective ways of helping people to give up smoking is the provision of smoking cessation services? In Harrow, the local unit managed to help 4,000 people attempt to give up smoking, with more than 50% doing so, but the answer from the local council has been to close the unit—that is very ineffective. Will he take action to make sure that this does not happen across the country?
Steve Brine
My hon. Friend is right to raise the issue. Local authorities, not Ministers in Whitehall, are best placed to take local spending decisions, but they must be accountable for their decisions. That is why we publish information at local authority level on smoking prevalence and quit numbers, so that local decision makers can be held to account. We also offer them expert support from Public Health England. I have a strong feeling that he will continue to hold those in Harrow to account.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
Steve Brine
What an offer, Mr Speaker! Sustainability and transformation partnerships in all areas are to draw up local plans across one NHS area, including on the public health prevention agenda. I suggest that the hon. Gentleman volunteers his services to his local STP; I suspect it will take his hand off.
Colin Clark (Gordon) (Con)
Clive Efford (Eltham) (Lab)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
Ministers have held no such discussions. The procurement of local health services by means of competitive tendering is a matter for the local clinical commissioning group, rather than for Ministers. Greenwich clinical commissioning group is an independent statutory organisation and is responsible for commissioning services for local people in order to ensure the best possible clinical outcomes at the best value to the taxpayers, who are the hon. Gentleman’s constituents.
Clive Efford
That is an incredibly complacent response. The cost of the contract, which was allocated to a private provider, has gone up by 14% in six months. It claimed at the Greenwich Overview and Scrutiny Committee that that was due to a 14% increase in the tariff costs of health services, but my local health care trust says that that is about 0.6%. How does the Minister explain that increase and why is the Department not looking into these private companies, which are literally naming their price once they have won the contract?
Steve Brine
It is not a complacent answer; it is a factual one. That is an important point to make. The Circle contract has been uplifted by approximately £10 million because of the increases in tariff costs, as the hon. Gentleman rightly says. That increase would have been applied to any provider, not just Circle. I am sorry that he does not support the new MS services across his constituency. My understanding is that, previously, those services were delivered by a number of different providers, with a wide variation in clinical outcomes for his constituents, in costs of care and in-patient experience. This is a step forward.
Mike Amesbury (Weaver Vale) (Lab)
Hannah Bardell (Livingston) (SNP)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
This is an incredibly sensitive subject. The report of the expert working group on hormone pregnancy tests will be published tomorrow. There will be a written ministerial statement with a copy of the report. This follows a rigorous review of all the available data on this subject by a panel with expertise in the relevant fields of science and healthcare.
Hannah Bardell
I welcome the Minister’s statement, although there are some questions about the opaqueness of the inquiry and many other concerns. The lives of my constituents Wilma and Kirsteen Ord and many others have been blighted by the hormone pregnancy drug Primodos. Will he appear in front of the Health Committee, look at the way in which that inquiry was conducted and consider a public inquiry into Primodos so that the families can get truth and justice about how they have been affected by this drug?
Steve Brine
I thank the hon. Lady for her question. I am open to offers from any Select Committee. It would be premature to consider issues of liability before considering the strength of the evidence and seeing the report, which we will study carefully. The report will conclude whether there is a causal association between the use of HPDs such as Primodos and adverse outcomes of pregnancy. We look forward to seeing its outcomes and its recommendations.
Clive Lewis (Norwich South) (Lab)
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
NHS England has a duty to commission primary care dental services to meet local need, including for the most deprived groups. Nationally, access continues to grow with 1.9 million more patients seen between 2010 and 2016. The Starting Well programme, of which I am sure the hon. Lady is aware, will work to improve the oral health of children under the age of five in 13 high- needs areas. The dental contract reform programme is also working to improve access and oral health.
Chi Onwurah
Seven people per day in my constituency are going into A&E because of toothache, and the poorest among us are twice as likely to be hospitalised for dental care. Yet there is no mention of dental care in the “Five Year Forward View”, and funding has fallen by 15% since 2010. Why is the Minister leaving my constituents in pain and overburdening A&E by neglecting dental care?
Steve Brine
I am interested to hear the hon. Lady say that, because the January to March 2017 GP patient survey results, which were published in July, show that 97% of those trying to get an NHS dental appointment in the Newcastle Gateshead clinical commissioning group area were successful, compared with the 95% England average.
Tim Loughton (East Worthing and Shoreham) (Con)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
Sustainability and transformation plan footprints were determined as a result of discussions between local areas, NHS England and NHS Improvement. They reflect a number of factors including patient flow, the location of different organisations in the local health economy and natural geographies. We stated in the next steps of the “Five Year Forward View” that adjusting STP boundaries is open to discussions between us and NHS England when that is collectively requested by local organisations, and we mean that.
Julie Cooper (Burnley) (Lab)
Last month, Lloyds announced the closure of 190 community pharmacies. The company’s managing director was very clear that this action was a result of recent cuts to pharmacy budgets. Does the Minister have any idea how many community pharmacies are at risk of closure as a result of Government cuts, and what assessment has he made of the likely impact of these closures directly on patients and the wider NHS? Will he join me in asking the Chancellor adequately to fund this vital service?
Steve Brine
The hon. Lady will have to wait for the Budget like everybody else. We continue to monitor the market carefully in the community pharmacies sector. Access to pharmaceutical services is very good in England, with 88% of people falling within a 20-minute walk of a community pharmacy. For areas with fewer pharmacies, our access scheme continues to provide additional protection, and a growing number of internet pharmacies also support access, offering patients greater choice. Pharmacies are a critical part of the primary care infrastructure in this country.
Kelly Tolhurst (Rochester and Strood) (Con)
Diana Johnson (Kingston upon Hull North) (Lab)
The Minister has just said that pharmacies are a critical part of our primary care infrastructure. Does he therefore share my concern that Lloyds Pharmacy has announced 190 branch closures across England due to funding cuts exacerbated by rising drug costs and cash-flow problems? At least two of those are in Hull. Why can 30% of pharmacies in the Health Secretary’s constituency get remedial help under the pharmacy access scheme but only 1.3% of pharmacies in Hull get that help?
Steve Brine
The simple answer is that it is because it is a rural constituency. On the Lloyds Pharmacy announcement, when I first heard that news my thought was not to play any politics with it but for the staff who will be affected by it. As I said at the all-party parliamentary group on pharmacy, chaired by the right hon. Member for Rother Valley (Sir Kevin Barron), Lloyds has made a commercial decision. We do not yet know which pharmacies within its portfolio will close, but we do know that 40% of pharmacies are within a 10-minute walk of two or more others.
David Tredinnick (Bosworth) (Con)
Steve Brine
Consistency personified, Mr Speaker. It is the responsibility of local NHS organisations to make decisions on the commissioning and funding of any healthcare treatments for NHS patients, such as and including homoeopathy. Complementary and alternative medicine treatments can, in principle, feature in a range of services offered by local NHS organisations, including general practitioners.
Liz McInnes (Heywood and Middleton) (Lab)
What safeguards will the Secretary of State put in place to ensure that NHS trusts do not finance the lifting of the pay cap by making staff cuts, downgrading roles or reducing terms and conditions under the guise of reforms?
Johnny Mercer (Plymouth, Moor View) (Con)
Congratulations, Mr Speaker, on noticing that it is actually me behind this extremely impressive facial growth for Movember, which is a serious cause promoting men’s health, particularly this year with the addition of mental health. In 2015, three out of four suicides were young people, and suicide is still the biggest killer in men under 45. Will the Minister commit to renew this Government’s relentless pursuit of parity of esteem between mental health and physical health?
Steve Brine
The Mercer moustache is impressive indeed. I am a big supporter of Movember, because it has a positive mindset—it is very honest. As Movember says on its website, one in eight men in the UK have experienced a mental health problem and, tragically, three out of four suicides are men. So we welcome this campaign this month, focusing as it does on raising awareness of prostate cancer and of testicular cancer—“Check your Nuts”, to stay on message. Movember has also built partnerships with mental health services in the NHS and across the charity sector. I wish my hon. Friend well with his growth.
Jenny Chapman (Darlington) (Lab)
Will the Department urgently review waiting times targets for children to access mental health services? Even if CAMHS—child and adolescent mental health services—in my constituency achieves its targets, on current referral rates more than 100 children will need to wait more than nine weeks for their first appointment.
Vaping
Steve Brine Excerpts(6 years, 7 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
Like the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), I congratulate my hon. Friend the Member for Dartford (Gareth Johnson) on securing another timely debate. Only a couple of weeks ago we had an excellent three-hour debate in the main Chamber on the Government’s new—I suppose it is still new—tobacco control plan. I want to say a little about the state of the evidence as we see it on e-cigarettes and how they fit into our plans to cut smoking further. I will touch on vaping by young people, which a few hon. Members have mentioned, and our approach to regulation.
E-cigarettes were a popular subject during the debate in the main Chamber on the TCP. Every speaker bar none mentioned them in one way, shape or form, so there is a lot of interest in them across the House. That reflects the radical changes in popularity of alternative nicotine delivering products in recent years. We have moved from a position where the nicotine delivery market—if I can call it that; I think we need a better term—is dominated by the traditional cigarette, to one where we have a much wider range of nicotine delivering products.
About 2.4 million people in England use e-cigarettes. That represents huge growth over the past decade. However, we cannot be complacent. My hon. Friend referred to the number of smokers; there are still 7.3 million smokers in this country. Two hundred people die every day due to smoking and it is still the biggest preventable killer in our country. The financial burden that that puts on the NHS in England and other public services is obviously huge, but that is dwarfed by its impact on people’s lives and the unnecessary loss of loved ones. Let us remember that a regular, long-term smoker loses an average of 10 years of their life due to their habit. It is a high cost.
The tobacco control plan sets out stretching ambitions to reduce, during this Parliament, adult prevalence to 12% or less; the prevalence of 15-year-olds who regularly smoke to 3% or less; and that of pregnant smokers—an issue rightly raised by a number of hon. Members—to 6% or less. We have been somewhat criticised for that not being ambitious enough, which is why I stress the words “or less”. They are not targets; they are the absolute maximum that I expect, and we want to do better and beat them. We want to reduce the burning injustices that see some of the poorest in our society die significantly earlier than the richest in our society, so the plan will focus on people in routine and manual occupations, where rates are higher. We want to focus on other groups particularly affected by smoking, such as people with mental health conditions, those in prison and pregnant women.
In the previous debate on smoking, colleagues on both sides of the House highlighted the increasing role that e-cigarettes play in helping people to quit smoking. We heard all sorts of examples from right hon. and hon. Members of parents, friends and family members who have used e-cigarettes to wean themselves off smoking, which is always good to hear. Let us be clear that quitting smoking and nicotine use completely is the best way to improve health, as was said in the opening remarks of that debate. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The Government outlined in the new plan that we are committed to supporting consumers to stop smoking and to use less harmful nicotine products.
E-cigarettes have become by far the most popular smoking quitting aid in the country. The evidence shows that they can help smokers to quit, particularly when combined with additional support from local stop smoking services. That is why, as part of the TCP, the Government asked Public Health England to include messages about the relative safety of e-cigarettes in its quit smoking campaign for Stoptober. I look forward to seeing how that played out when the data are available. There has never been a better time to quit and I am hopeful that many people took up the challenge this Stoptober. I am pleased to say that the Stoptober campaign highlighted e-cigarettes for the first time among the array of tools that smokers can use to improve their chances of successfully quitting. Public Health England, for which I am responsible, is already preparing its new year quitting campaign, and I am sure that hon. Members will be pleased to know that it will reprise those messages. It is through consistent messaging that we hope to reverse the harmful, mistaken and increasingly widespread belief that vaping is no safer than smoking.
My hon. Friend rightly raised the issue of independent evidence on e-cigarettes. I reassure him that the Government are utterly committed to rigorous scrutiny of the evidence on e-cigarettes. We do not do non-evidence-based policy making and nor should we. In that spirit, I highlight highly reputable organisations such as Cancer Research UK, led by the brilliant Sir Harpal Kumar, and the Royal College of Physicians, which hon. Members have mentioned. They rightly support e-cigarettes as a measure to stop people smoking, to ultimately move to no nicotine dependency.
I commend the work of the UK e-cigarette research forum, an initiative developed by Cancer Research UK in partnership with Public Health England and the UK Centre for Tobacco and Alcohol Studies. The forum brings together policy makers, researchers, practitioners and the non-governmental organisations to discuss the emerging evidence and knowledge gaps on e-cigarettes. There are big knowledge gaps, which the hon. Member for Ipswich (Sandy Martin) mentioned a number of times. Such groups will allow us to keep strengthening the evidence base on e-cigarettes, which hon. Members have called for. We look around the world for our evidence base, and I note with interest that the New Zealand Ministry of Health recently published a position statement on e-cigarettes that recognises their potential contribution to achieving its “Smokefree 2025” goal.
The public rightly have genuine concerns, however, about the benefits and potential long-term dangers of e-cigarettes and new, so-called novel tobacco products. We take those concerns seriously, as any responsible Government would, and we outline in the plan that the Department will monitor the impact of regulation and policy on e-cigarettes and novel tobacco products in England, including evidence on safety, uptake, the health impact and effectiveness of these products as smoking cessation aids, to inform our actions and regulate their use. That has to be the right thing to do. Public Health England will also update its evidence report on e-cigarettes and other novel nicotine delivery systems annually until the end of the Parliament in 2022.
In the spirit of independent scrutiny, I warmly welcome the recent announcement by the Science and Technology Committee, which hon. Members have mentioned. It is chaired by the right hon. Member for North Norfolk (Norman Lamb), who I spoke to recently but who is unable to be here, and will hold an inquiry to examine the impact of electronic cigarettes on human health, the suitability of regulations guiding their use, and the financial implications of a growing market, both for business and for the NHS. This is an excellent opportunity for an independent view of the risks and benefits of e-cigarettes. What is there not to like about that? I say that as a Minister: people are doing the research for me and paying for it. The Government have a statutory duty—we will not leave it all to everyone else—to conduct an implementation review of the Tobacco and Related Products Regulations 2016 by the end of May 2021, to assess their impact, and we will do that.
I will touch on the regulatory framework introduced by the EU tobacco products directive, which my hon. Friend the Member for Dartford mentioned. The directive has enabled us to regulate e-cigarettes to reduce the risk of harm to children, protect against any risk of re-normalising tobacco use, and provide assurance on relative safety for users and legal certainty for businesses. The inclusion of e-cigarettes in the directive ensures that we can sensibly regulate these products. The directive is not perfect and nobody pretends that it is, but it gives a sensible basis for regulation. My hon. Friend asked me to put March 2019 in my diary—it is inked in. With one leap we will be free and we will be able to take back control, as the phrase goes. It will be an opportunity for us to look at every regulation that we are subject to, review them and go through them with a fine-toothed comb, and he has my assurance that I will do so in every area for which I am responsible.
I recognise that there are real concerns that vaping is a gateway for youth smoking, as my hon. Friend the Member for Gordon (Colin Clark) touched on. However, there is no great evidence in the UK that vaping is leading young people to smoke. There is some evidence that some young people experiment with e-cigarettes, but that regular e-cigarette use is confined almost entirely to young people who have smoked, so it is the gateway out as opposed to the gateway in. To ensure that that remains the case, we have implemented domestic age-of-sale legislation that prevents the sale of e-cigarettes to under-18s and we have prohibited the advertising and promotion of e-cigarettes in the major media streams, including TV, radio, newspapers and the internet. By and large, the banned media streams are those with the largest reach, and by controlling them we have significantly reduced children’s exposure to marketing and images of those products. The Government have no plans to ban advertising in other media, but we keep everything under review.
There is a vibrant e-cigarette market in the UK—in many ways it is a business success story—with nearly 2.4 million users. The industry is worth nearly £l billion to the UK economy. It started out as small, independent, non-tobacco-industry organisations—a cottage industry—intent on designing solutions for people to get the benefits of nicotine delivery without the harms of smoking.
My Department will continue to work closely with the vaping sector through the Independent British Vape Trade Association. The Department does not work with the UK Vaping Industry Association because of its links to the tobacco industry. Her Majesty’s Government take their duties seriously, as they should as a signatory to the World Health Organisation framework convention on tobacco control. I feel that I should put on the record that, under article 5.3 of that convention, we have committed to protect our public health policies from the commercial and other vested interests of the tobacco industry. The guidelines for the implementation of article 5.3 permit parties to engage with
“the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products.”
I will briefly mention another innovation, namely heat-not-burn products, which the shadow Minister asked about. Two heat-not-burn products have been notified for use on the UK market as novel tobacco products. It is important to stress that, even in comparison with e-cigarettes, that market is relatively new and very small-scale in the UK. We simply do not know enough about those products. We will continue to adopt a pragmatic, sensible and cool-headed approach to regulation, based on the best possible public health advice, which I receive from advisers including Public Health England. As part of that approach, my Department has asked the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment to give a view about those products’ potential harm reduction in comparison with conventional smoking. The committee is due to respond later this year. I hope that that helps the shadow Minister, who I know will remain on my case—that is not in doubt.
We will discuss Brexit today, tomorrow, the day after and probably the day after that, too. There are concerns among people in the industry and e-cigarette users about the introduction of the EU tobacco products directive impacting on e-cigarette innovation and consumer choice. As stated in the tobacco control plan, the Government will review where the UK’s exit from the EU offers opportunities to reappraise tobacco and e-cigarette regulation to ensure that it continues to protect the nation’s health.
The hon. Member for Ipswich spoke excellently, as always. I congratulate him on quitting and not going back; that is excellent. The hon. Member for Linlithgow and East Falkirk (Martyn Day) talked about innovation and, as always, made a calm and sensible speech. I congratulate him on getting his birthday on the record—that, too, is now inked in our diaries.
The shadow Minister referred to “something new and shiny”. This is literally something new and shiny, but it is not for Ministers to get carried away by new and shiny things in any way, shape or form. The Government have been criticised both for being too tough on e-cigarettes and for being too lenient. That suggests to me that we have the balance about right while we look for more evidence. We have proportionate regulation that allows us to protect children, and that is absolutely right. We keep the evidence under constant review.
Gareth Johnson
I mentioned previously to the Minister that he may wish to meet the vaping industry. I am glad that he has the Brexit date in his diary, but I wonder whether he will be kind enough to indicate whether he is willing to put in his diary a meeting with the vaping industry.
Steve Brine
I mentioned that we work closely with the Independent British Vape Trade Association, which I am perfectly happy to meet, but I also mentioned that we take the WHO framework convention seriously. The door is always open to people we can meet. That is all part of us trying to understand the evidence base.
To conclude, we are clear that e-cigarettes can play a useful role in helping people to quit smoking. As my hon. Friend the Member for Dartford said, the majority of smokers want to quit, and we should help them. E-cigarettes are one of a variety of stop-smoking tools available to support them.
Pompe Disease
Steve Brine Excerpts(6 years, 7 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
I congratulate the hon. Member for Torfaen (Nick Thomas-Symonds) on securing this debate. I often think this about Adjournment debates, but this shows how excellent the House of Commons is in that it can debate a Finance Bill and then discuss a condition like Pompe disease.
I read the hon. Gentleman’s article in The Times this morning. The article was well written, and it set out very clearly the heart-breaking impact that this disease has had on his constituent’s health. I am sure his constituent appreciates very much the way he has taken up the issue. Well done for getting an article in The Times!
I hope my response will go some way to reassuring the hon. Gentleman and his constituent that the importance of understanding how to recognise and treat rare diseases such as Pompe disease is increasingly recognised by policy makers and healthcare service providers, not just in England but across the UK and internationally.
The hon. Gentleman spoke movingly about the subject, and he is of course right to praise the army of carers in our country. Carers Week is a big deal in my constituency, as I am sure it is in his, and he is absolutely right to praise the work of Muscular Dystrophy UK. When I was a Back-Bench MP, I was a member of the all-party parliamentary group on muscular dystrophy, which was chaired by a now former Member. Having grown up with friends who suffered with muscular dystrophy, and who ultimately lost their fight, I have a lot of time and respect for Muscular Dystrophy UK.
The number of rare disease patients can be very small. For example, Pompe disease has an estimated prevalence of one in every 40,000 births, but collectively some 3.5 million people in the UK alone are affected by what we term, in policy terms, rare diseases. To put this in context, one in 17 people will therefore suffer from a rare disease at some point in their lives. As we have heard, patients with Pompe disease are deficient in or completely lacking the activity of an enzyme that affects the ability of cells to degrade glycogen, causing its build-up in the body cells, which impairs their ability to function normally. Pompe disease often affects neonates—newborn children—and becomes apparent from within a few days to a few months after they have been born. Sadly, affected infants often require long periods in paediatric intensive care units, with many going on to require long-term mechanical ventilation, as the hon. Gentleman said.
Nick Thomas-Symonds
I thank the Minister for that positive introduction to his speech. One issue that my constituent raised with me was that because this disease is genetic it can be picked up by a blood test from birth. He has asked whether such testing could be done on a more regular basis. I understand that this is difficult because the disease is so extraordinarily rare, but I flag it up for the Minister’s attention.
Steve Brine
The hon. Gentleman makes a good point, and I know my officials will be listening carefully to what he says. I may come to touch on that point, if I do not deal with it specifically, but I am sure he will remind me.
Some patients with Pompe disease are treated with an enzyme replacement therapy called Myozyme, which is a direct replacement of the missing enzyme via infusion therapy. Myozyme dramatically alters the natural history of the disease in infants, but many patients still require complex long-term follow-up, as the hon. Gentleman’s constituent does.
NHS England commissions its service for patients with Pompe disease from eight national centres; five of these are for adults and three are for children. The centres provide an inclusive, holistic, multi-disciplinary service—the point the hon. Gentleman rightly makes—for patients with lysosomal storage disorders. That is the wider term for these conditions, including Pompe disease. The centres provide rapid diagnosis, an assessment of disease burden, provision of disease-specific therapy, advice on symptom control and palliative care, where this is, sadly, necessary for patients with untreatable disorders. In conjunction with patient advocacy groups, the centres also provide support for affected families. We of course support these centres utterly—that point was put on the record so well, as usual, by the hon. Member for Strangford (Jim Shannon).
As the hon. Member for Torfaen says, late-onset Pompe disease may not become apparent until later in childhood, adolescence or most commonly, as in the case of his constituent, Mr Foxwell, in adulthood. Although late-onset Pompe disease is usually milder than the infant forms of the condition, patients can experience progressive muscle weakness in the legs and trunk—the main body—and it can affect the muscles that control breathing, which is why the mechanical ventilation becomes necessary. As we have heard, as the condition progresses, breathing problems can become more serious and often prove fatal.
We know more can be done to diagnose rare conditions earlier. Currently, the average rare-disease patient consults five doctors, can receive up to three misdiagnoses and waits four years before receiving their final diagnosis. These delays in diagnosis often mean that opportunities for timely interventions can be missed and/or that patients may be given unsuitable or harmful treatments to treat their misdiagnosed condition; more than half of patients wait for more than one year after the first symptoms and some have waited over 20 years. Although not a great term, I am reliably informed that this is called a “diagnostic odyssey”, which causes uncertainty and distress for those affected, as well as considerable costs for health and social care budgets. We should remember that.
The 100,000 Genomes Project—
Steve Brine
I was going to touch on that project, but before I do I shall give way to the hon. Gentleman again.
Nick Thomas-Symonds
I am grateful to the Minister for giving way again. Before he moves on to the genomes project, I just wanted to touch on the issue of the diagnostic odyssey. My constituent’s diagnostic odyssey was seven years, and clearly although the symptoms, particularly the issue involving the diaphragm, were very apparent and were picked up, this was about making the link from there to the rare disease. Clearly, one always has to take into account statistical probabilities—there is no direct criticism of any medic or anything like that here—but part of trying to reduce that diagnostic time must be about increasing awareness among the medical profession of many of these rare diseases.
Steve Brine
Yes, I absolutely agree. I also have ministerial responsibility for cancer—if only I had a pound for every time I heard early diagnosis mentioned in the office. I shall explain how I think the rare diseases strategy can help with that. Of course, it is important not just for rare diseases, but what the hon. Gentleman says is absolutely right.
The 100,000 Genomes Project addresses parts of the unmet diagnostic need I have described. It focuses on patients with a rare disease and their families and on patients with cancer. The sequencing of an individual’s genome is increasingly utilised as a diagnostic tool in cases where an individual has unrecognised signs and symptoms and to support the diagnosis of a rare disease. I am pleased to say that around 25% of patients whose genome is sequenced through the project now receive a diagnosis for the first time. In addition, despite their often chronic and progressive nature, the associated long-term complications of some rare diseases can be targeted and addressed early if they are diagnosed as such. That is clearly the holy grail. The UK rare diseases policy board has been tasked with looking at the diagnostic issues—the odyssey that I mentioned—and I look forward to it reporting its initial findings to me. I am told that they will come in early 2018, so I shall look out for them.
I assure the hon. Gentleman that the Government are and remain dedicated to improving the lives of all patients with rare diseases. The publication of the UK strategy for rare diseases in 2013 represented a significant milestone for all patients with rare diseases, and it is now being implemented throughout the country. The strategy set out our strategic vision and contains 51 commitments, concentrating on raising awareness, better diagnosis, which has been touched on, and patient care. It also has a strong emphasis on the importance of research in our quest to better understand and treat rare diseases. Research is so important. The Government are committed to implementing the strategy in full by 2020, and we know that the real test of success will be when patients and families affected by rare diseases experience real improvements.
The Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne), announced in a 28 March Westminster Hall debate on the implementation of the strategy that NHS England will produce an implementation plan for the commitments in the strategy that it has lead responsibility for, and I shall hold NHS England to account ministerially. The Department of Health is now working collaboratively across stakeholders to produce the implementation plan for all those commitments that fall outside NHS England’s remit. Both NHS England and the Department are aligning the publication of those complementary plans, and I want them on my desk by the end of the year.
We appreciate the fact that any specific rare disease is, by its nature, very rare, so we should be honest about the fact that there is often a scarcity of patients and expertise in any single country. The diagnosis, treatment and management of rare diseases strongly benefit from cross-border collaboration. Through an EU initiative on patients’ rights in cross-border healthcare, European reference networks were set up throughout European countries earlier this year. These virtual networks act as centres of knowledge, skills and expertise in the field of rare diseases and complex conditions, and provide a platform to create partnerships between healthcare providers here in the UK and throughout Europe.
The UK is already a key player, leading six ERNs—more than any other member state—and participating in 23 of 24 networks, including what is known as the Metab ERN, which covers rare hereditary metabolic disorders such as Pompe disease. Six NHS trusts participate in the Metab ERN, which aims to ensure a joined-up approach to care by bringing together paediatric and adult metabolic physicians throughout the EU. That is really important. The ERNs are a cornerstone of the UK rare diseases strategy, and the Government are committed to ensuring that no patient should be put at a disadvantage through the UK’s exit from the EU—and that is a priority for me. Therefore, an important element of our future plan will be to continue to play a leading role in promoting and ensuring public health—I am also the Public Health Minister—both in Europe and around the world. Hopefully, that will further strengthen the long tradition of international collaboration, which our clinicians and scientific community have in this country, and often lead across Europe and the world.
Let me touch further on research. The full potential for improving our knowledge of rare diseases and our work towards better treatment and, hopefully, prevention can only be realised by continued research into rare diseases. That is why the National Institute for Health Research has established 20 biomedical research centres that develop new groundbreaking treatments, diagnostics and care for patients with a wide range of diseases.
The centres enrolled patients across 60 NHS trusts and, in partnership with Genomics England, led a pilot for the rare diseases element of the 100,000 Genomes Project that has delivered the sequencing of whole genomes of more than 12,000 bioresource participants.
Steve Brine
I think that I can anticipate the hon. Gentleman’s intervention. Go for it.
Nick Thomas-Symonds
I am very grateful to the Minister for his generosity in giving way. My constituent has been unable to demonstrate the exceptionality required to access the treatment through an individual funding request. In reality, there is only this one standard treatment. One thing about the research into rare diseases that the Minister has referred to is the need to discover more options for treatment rather than having only one realistic one, as is the case so much of the time.
Steve Brine
I completely agree with the hon. Gentleman. That is why I said that research is absolutely central to this. Let us be honest: this country has led the world in this field. We have an absolutely fantastic record and long may that continue, because people’s lives benefit and depend on that. Once again, he is spot on. Let me conclude my point. In 2016-17, the NHIR research infrastructure supported studies into Pompe disease across nine of its centres and facilities.
The hon. Gentleman referred to national variations in access to Myozyme treatment for Pompe disease across the UK. In England, NHS England funds this treatment for all patients, regardless of age or the form of the disease. In Scotland, the Scottish Medicines Consortium does not accept Myozyme for routine use, but it is funded for children and adults by its ultra-orphan drugs risk scheme. NHS Scotland also provides any patients with particularly complex needs access to highly specialised services in England. In Wales, I understand that the treatment is funded for children and adults with late onset of the juvenile form of the disease, but not the adult form where the symptoms are less severe.
As the hon. Gentleman will be aware, healthcare in Wales is a devolved matter, but I am sure that he will raise any concerns with the Welsh Government. I was delighted to hear about the setting up of Pompe Wales, which he talked about in his speech. It sounds really interesting. Obviously, it is in Wales, so perhaps he could send me details of it when it becomes available.
Nick Thomas-Symonds
The Minister is entirely right. It is commissioned in Wales for the infantile aspect. There is no general commissioning for late onset. There has to be what is called an individual patient funding request, where a patient has to demonstrate certain things, including exceptionality.
Steve Brine
The hon. Gentleman has put that clearly on the record.
Finally, it is worth noting that the rare disease landscape has been greatly transformed since the UK strategy was published in 2013, especially considering Brexit, the evolving legacy of the 100,000 Genomes Project and new emerging technologies such as genome editing. The recent independent chief medical officer’s report “Generation Genome”, which I said at Health questions was a landmark piece of work, and the “Life Sciences: Industrial Strategy” make it clear that genomics has an important role to play in future healthcare delivery, including the treatment of rare diseases. The House of Commons Science and Technology Committee is also currently engaged in an inquiry into genomics and genome editing in the NHS, and I look forward to seeing its report in due course. I can assure the hon. Gentleman that we will harness the remarkable prospects that these new developments present for the benefit of our rare diseases patients. The NHS has always harnessed new technology to lead the world, and it will continue to do so in this field.
I thank the hon. Gentleman once again for highlighting these issues in this debate and in today’s media for his constituent and for all those who suffer from Pompe disease and other rare diseases. I hope that I have helped to reassure them a little that the Government and the NHS are working hard to tackle these conditions and to help to improve the lives of people suffering from Pompe disease and other rare diseases because, ultimately, that is what we are here for.
Question put and agreed to.
Children’s Oral Health
Steve Brine Excerpts(6 years, 7 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
I thank everyone who has spoken and the hon. Member for Birmingham, Selly Oak (Steve McCabe) for securing the debate via the Backbench Business Committee. He has proved once again that he is on his mettle. There are a number of things I want to get on the record and there are lots of things I want to respond to. We know that, as many Members have set out, poor oral health for children can lead to pain, poor sleep, days missed at school—the hon. Gentleman said that three days are missed on average, but the figures can be much higher—and impaired nutrition and growth. It is a serious business and we take it seriously.
The shadow Minister spoke passionately about the subject and the risk to our economy. I am glad that she recognises that there are no quick fixes. If there were, I suspect many of my predecessors would have quick-fixed.
It is a fact that the two main dental diseases of decay and gum disease—dental caries and periodontal disease—can be almost eliminated by a combination of good diet and correct tooth brushing, backed up by regular examinations by a dentist. They are preventable. It is worth putting it on the record—it is not all doom and gloom—that children’s oral health is in fact better than it has been for years. The most recent data from 2015 show that 75% of five-year-old children in England are now decay-free. That is good, but it clearly leaves 25% who are not. Between 2008 and 2012, the numbers of five-year-old children who showed signs of decay fell by approximately 10%. Improving children’s oral health and that of the adult population is a priority for the Government. Indeed, our manifesto earlier this year set out our commitment to improve coverage and achieve better outcomes, especially for children in deprived areas.
Dr Whitford
Does the Minister recognise that total dental clearances in children, of which there are approximately 25,000, have seen an 11% increase in the past five years, so it is not possible to claim that dental health in England is getting better?
Steve Brine
I said that there is clearly a long way to go, and the hon. Lady also said that about Scotland. I am just putting it on the record that there are some positive stats; it is not a counsel of despair.
In explaining what I started to say, let me talk about the extensive work being led by Public Health England as well the wide range of activity nationally in reforming the dental contract, which a number of Members asked about, and locally, in initiatives such as “starting well” run by NHS England, which a number of people referred to. First, it is important that I, as the Minister, acknowledge the vital role that dentists play in this. They are a brilliant part of the NHS. There are just over 24,000 dentists currently providing NHS dental care and their commitment and contribution is vital to delivering our wider health and public health aims. Overall, access to NHS dentists continues to increase in England. In the latest figures for patients seen by NHS dentists, 6.8 million children were seen in the 12-month period ending 30 June this year, which equates to just over 58% of the child population. Looking at adults, this year’s January-to-March GP patient survey results showed that, of those adults trying to get an NHS dental appointment, 95% were successful.
Although those numbers are an encouraging start, clearly more needs to be done—I am not pretending that it does not—to reduce the inequalities in access and oral health that remain as a result. Nationally, Public Health England has an extensive work programme to improve oral health, particularly of children. Improving that and reducing inequalities in oral health is a priority for PHE, which I meet regularly. It was in the office just last week, when we discussed this subject. So many Members have mentioned the sugar levy, which addresses some of the root causes of dental disease.
Catherine West
May I make a brief intervention on the sugar levy? Will the Minister at least undertake to look at health trusts—that is directly in the gift of the Department of Health—and at what they are promoting by means of cabinets that sell sugary drinks and products?
Steve Brine
Yes, and I will write to the hon. Lady about that. That is a good point well made.
The sugar levy addresses some of the root causes of dental disease, and other action has included ensuring that the “red book” that all parents receive after the birth of a child has clear messages about the importance of good oral hygiene and early dental attendance—that point was made by my hon. Friend the Member for South West Bedfordshire (Andrew Selous). All new parents will therefore receive clear messages about the importance of oral hygiene and early dental attendance, and I will follow up his point about recording that first appointment in the book. That should be happening; I will follow that up. I thank him for raising it. Public Health England is working alongside local authorities in all our constituencies that are responsible for commissioning oral health improvement programmes.
The hon. Member for Birmingham, Selly Oak, the hon. Member for Central Ayrshire (Dr Whitford), and the hon. Member for Burnley (Julie Cooper) mentioned contract reform. Our manifesto sets out the Government’s continued commitment to introducing a new NHS dental contract that will improve the oral health of the population and increase access to NHS dentistry. That change will provide the foundation on which we will support other improvement activities.
A new way of delivering care and paying dentists is currently being trialled in 75 high-street dental practices. At the heart of that new approach is a prevention-focused pathway that includes offering all patients an oral health assessment and advice on diet and good oral hygiene, with follow-up appointments where necessary to support patients’ self-care and carry out further preventive treatments. That new approach aims to increase patient access by paying dentists for the number of patients cared for, and not just for treatment delivered, as per the current NHS dental contract—a number of Members raised that point. An evaluation of the prototype agreement scheme is due by the end of this year, and it will set out detailed findings from the first full year of testing that new system.
However, we feel that a single year is too short a period in which to make final decisions about whether the new system, when combined with the revised clinical approach, is viable for wider adoption as a new NHS contract. We have therefore decided to extend the prototype agreement scheme to allow it to run for a further two years, to allow for further testing. The prototypes will continue to be subject to evaluation to determine whether they can maintain access and improve oral health, including that of children, in a way that is sustainable for practices, patients and commissioners, before any decisions are taken on wider national adoption.
The important Starting Well initiative was recently launched for children under five, and as a number of Members have mentioned, the programme will work in 13 high-priority areas, with the aim of supporting dentists to see extra children under the age of five who do not currently visit a dentist. It will provide a model that ensures that when they are seen, the focus is on reducing their risk of future disease, as well as treating existing problems. The aim of Starting Well is to reduce the unacceptable oral health inequalities that exist for those children. The hon. Member for Birmingham, Selly Oak asked how long it would run, how areas will be selected and how it will be funded. It will run for as long as is needed locally—that is a decision for local commissioners. I will give him a bit of detail about how the areas will be selected. Selection of the 13 areas was based on 2015 oral health survey results that identified the number of decayed, missing or filled teeth—DMFT, as it is known in the trade—in those under five. To select the areas for Starting Well, a cut-off of 1.6 DMFT was the established marker, and that identified 13 upper-tier local authorities that would benefit from the Starting Well approach. Areas that scored below 1.6 DMFT were not selected, as it was agreed that those resources should be directed to areas where oral health had either declined or remained static. NHS England is funding the programme locally in those areas through underspends and, where the NHS chooses, the prioritisation of funds. I hope that that answers the hon. Gentleman’s questions on Starting Well.
Alongside that, NHS England, together with the chief dental officer—she has been mentioned a number of times; I have worked closely with her and she is excellent—is looking at ways to make the principles of that approach more widely available to all commissioners, and I want to talk to her about that in more detail. The aim is to ensure that commissioners have a clear framework within which to work when considering ways to increase access to dental services for very young children.
The hon. Gentleman was disappointed that Birmingham was not selected for the Starting Well programme, and I set out some of the reasons why we selected the areas that we did. I am, however, happy to say that NHS England is taking forward its own oral health initiative to raise awareness of the importance of early dental attendance, and that will be linked with wider NHS England national work, which I know is particularly championed by the chief dental officer, to encourage greater attendance.
I wanted to touch on so many other points. My hon. Friend the Member for Erewash (Maggie Throup) gave us the charming image of a bath tub full of sugary drinks. What an image—horrendous! That is why our sugary drinks levy is so important. We know that sugar is the leading cause of tooth decay, and the sugary drinks industry levy and the sugar reduction programme will reduce the amount of sugar consumed by children. We keep the childhood obesity plan under constant review. That is important to me, and something I am responsible for.
I did not know that this was sugar awareness week until that was mentioned by the hon. Member for Birmingham, Selly Oak—indeed, the irony of that, with tonight being Halloween, and the children with buckets of sweets, is not lost on me. My children will be attending an altogether different event this evening that does not involve buckets of sweets. It is a “let in the light and shut out the darkness” event—that is something that my wife likes to champion, so she will be pleased with the mention.
The hon. Gentleman also mentioned school dental clubs, as did the chair of the all-party group for dentistry and oral health, my hon. Friend the Member for Mole Valley (Sir Paul Beresford). Outreach, including to schools, is important for reaching children who do not normally attend a dentist, as part of Starting Well and other initiatives being taken forward to reach children in schools. Sure Start centres will also be commissioned locally to be part of the Starting Well programme.
My hon. Friend said that kids love brushing their teeth, but that is not entirely my experience at home. The hon. Member for Strangford (Jim Shannon) mentioned singing toothbrushes. I am not aware of them, although I am aware of singing while brushing. My children are encouraged to hum “Happy Birthday” twice while brushing, so that they brush for longer, and they love me for it. I responded to the hon. Member for Bradford South (Judith Cummins) in an Adjournment debate on this subject. She has been to see me, and I understand that she is meeting the NHS in her area on 9 November. I urge the NHS to share the findings of the pilot with her, and if it does not, she should let me know. My hon. Friend the Member for South West Bedfordshire made a point about the first dental check being placed on the record, and I take his point and will follow it up. On schools being sugar free zones and the advertising ban before 9 pm, I said that we would keep the childhood obesity strategy and the measures within it under constant review. My hon. Friend should continue to work with me on that; it is important that Members vocalise their support to go further on that strategy.
In closing, we have had a good debate. I hope that in setting out some of the work done by Public Health England, the Department of Health and NHS England, I can reassure Members about our commitment to improving children’s oral health for the future. There is an awful lot of good news, but an awful long way to go. I am happy to learn from anywhere in the United Kingdom where such work is going well, and conversations with the hon. Member for Central Ayrshire (Dr Whitford) are always illuminating and useful.
Tobacco Control Plan
Steve Brine Excerpts(6 years, 7 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson), my ministerial shadow and my friend—she certainly is that.
I congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) on securing this important debate. The Backbench Business Committee was an excellent innovation that arrived in this House at the same time as me—there is no correlation between those two things, I should point out—and debates such as this would not necessarily have happened without it. So well done to the right hon. Gentleman, and to all the Members who have participated. As the shadow Minister said, it is Stoptober, which is an excellent time to have this debate, but of course our passion to cut back on smoking rates is not confined to October.
Let me say a bit about the tobacco control plan and try to respond, as far as I can, to the points raised in the debate. My ministerial brief covers a wide area: public health, primary care, and cancer. That might appear to be a disparate agenda, but there is a plan. For me, all of my responsibilities come back to prevention and in particular how we prevent some of the major diseases; cancer is, of course, still the biggest preventable killer in our country, and the link to smoking is obvious and has been given by many Members. To give some obvious examples, our work to tackle the harmful use of alcohol, our strategy to tackle obesity and specifically childhood obesity, and our tobacco control plan are all about doing more to prevent ill health in our country, and above all cancer.
The TCP is not an end in itself; it is part of a plan. The shadow Minister kindly said that publishing it was down to me. At our very first health orals, she asked when it would be published, and I gave the answer that it would be published by the summer recess. She then shouted out, “Which summer recess?”, but the plan had been started and I wanted to get it right and to get it out. It is amazing what announcing things at oral questions will do to our officials. Anyway, we got it out, and I am very pleased with it.
The last TCP ran from 2011 to 2015 and was considered highly successful; I am grateful to the many Members from all parties for saying that. All the ambitions we set out in that plan were exceeded. We introduced a significant amount of legislation over the course of the plan, as did the Labour Government before then. There was the ban itself, then the ban on smoking in cars containing children, and then, last year, the introduction of standardised packaging, which is a first for Europe. The UK remains a world leader in tobacco control, and Governments of both parties have a proven track record in reducing harm caused by tobacco. The country has made a significant reduction in the prevalence of smoking over the past 25 years, from 27% in 1993 to just over 15% today. That is some achievement.
Will Quince
At the moment we have symbols on every bottle of alcohol sold in the UK. I appreciate that this is under EU rules, so other Government Departments would need to look at this, but could we consider having “no smoking while pregnant” symbols on all smoking products, rather than just one in six, as is the case at present?
Steve Brine
I will look at that point; as ever, my hon. Friend makes a pertinent point from the Back Benches—where I do not think he will be forever, I might add. [Interruption.] It is evidently not my decision.
I have given the relevant figures, and we are now considered by independent experts to have the best tobacco control measures in Europe. We published the new plan this year to build on that success, but there is no room for patting ourselves on the back in this game, and we still have a huge amount to do.
We still have 7.3 million smokers. That exerts a huge impact on our communities and our NHS. Tobacco use is the biggest contributor to cancer, accounting for more than one in four UK cancer deaths, and nearly a fifth of all cancer cases in this country. Research by the Independent Cancer Taskforce reported that up to two thirds of long-term smokers will die as a result of smoking if they do not quit. We have heard from a number of Members across the House about people whom they have loved and lost, and they are not statistics; they are people’s mothers and fathers, and sons and daughters, who have been lost to cancer. Cancer is not contracted through smoking alone, of course, although it accounts for a huge part of the cancer rate. We must remember that 200 people die every day due to smoking; I think every Member will join me in saying I want us to do better than that.
The plan sets our interim ambitions en route to that goal. Over the next five years we want to reduce the prevalence of adult smokers to 12%. In answer to my hon. Friend the Member for Harrow East (Bob Blackman), I would like to go lower than that, but that is the current figure in the plan. It is not necessarily an end-point, however, and it is not an end in itself. We should also remember the prevalence of 15-year-olds who regularly smoke. We want to get that down to 3%, and the prevalence of pregnant smokers—which so many Members have mentioned today—down to 6%. We want to reduce the burning injustice—a number of Members have used that term today— that sees some of the poorest in our society die on average nine years earlier than the richest, so we will focus, as the plan says, on people in routine and manual occupations.
We want to focus on other groups particularly affected by smoking, such as people with mental health conditions and those in prisons. The hon. Member for Stockton South (Dr Williams) rightly spoke about that being part of a wider poverty reduction programme. That has to be central to the plan, which is not just owned by the Department of Health and me. It is a cross-governmental plan and everything that we do should be part of that aim to reduce poverty. That is why the Prime Minister said what she did. I guess that the hon. Gentleman does not agree with everything she said, but surely he must agree with her words on the steps of Downing Street about poverty reduction.
John Grogan (Keighley) (Lab)
The statistics in some of our cities are much higher than in others. In my city of Bradford, the Minister will know that the figure for smoking prevalence is about 22%. Public health is so important; does he recognise the importance of giving more resources to public health and councils, which have experienced significant cuts in recent years?
Steve Brine
I simply say to the hon. Gentleman, who has not been present for the debate, that that point has been made. I also point out that we are giving £16 billion of ring-fenced public health spending to councils in England, which is significant. However, I shall come back to his point if he will bear with me.
To achieve the ambitions in the plan, we need to recognise that smoking is increasingly prevalent in particular groups in society and in particular areas. That is why we need to shift the emphasis from national to local action, and support smokers, particularly in disadvantaged groups, to quit. Now is not the time for more legislation—we have done that bit. I do not rule it out forever, but successive Governments have done that part. Now is the time to redouble our efforts to focus on our top priority groups such as pregnant women, young people and people with mental illnesses. We must focus on the people and areas with the greatest need.
Let me give an example. Yesterday, we published the two-years-on plan from the national cancer taskforce, which looks at the cancer strategy. It is full of good case studies. One that especially struck me was the Manchester lung cancer project, whereby we screen people arriving at supermarkets in certain parts of Manchester. That has led to improved cancer detection and outcomes for the local community that are quite staggering. Why do that in Manchester and not in Hampshire—in Winchester in my constituency? That is because there is a high prevalence of lung cancer driven by smoking in the Greater Manchester area. I visited Macmillan’s headquarters in London and sat and listened to some callers on their support line. I asked about regional disparities and they said that when they got calls from that part of England, they were about lung cancer, and that is no coincidence.
The example I gave is a policy response from the Greater Manchester authority, led by Andy Burnham, formerly of this parish, who has already put in place a plan that will mean 115,000 fewer smokers by 2021. I pay tribute to Andy, with whom I worked a lot in the House through my chairmanship of the all-party parliamentary group on breast cancer. I know that he has been greatly affected by that, and he is great partner for us on this matter. That is exactly the kind of thing we meant when we said in the tobacco control plan that we wanted local areas to develop their own local strategies.
There are many other good schemes locally—for example, the Fresh programme operates in a dozen local authorities in the north-east. I wonder whether the hon. Member for North Tyneside (Mary Glindon) is aware of it. She made an excellent personal speech, and I congratulate her on managing not to turn into a smoker, given the family background that she described. All the evidence suggests that children who grow up in families where the parents smoke go on to do so. The hon. Lady clearly knows something that we do not.
Leicester provides great examples of innovative stop smoking services, and the right hon. Member for Rother Valley mentioned Leicester and namechecked the council officer, who I suspect will keep that Hansard report. Well done to Leicester.
I recognise that hon. Members are concerned about local stop smoking services, but as I said in response to an intervention, we have a £16 billion ring-fenced public health budget. The Government believe that local authorities are best placed to make decisions on how the services should be prioritised to meet the needs of their populations. That is why I gave the example from Manchester. I am many things, but I am not best placed to decide what works in Leicester or Manchester; locally elected politicians are best placed.
The Government will continue to publish data that help local people hold those locally elected leaders to account. That is a crucial part of the plan. Public Health England, for which I am responsible, will continue to offer support to local authorities to help them develop their local approaches in the most cost-effective and evidence-based way. As Minister, I will continue to be a passionate advocate for evidence-based tobacco control plan policy making. It is an integral part of my mission to reduce the toll of preventable cancers.
I want to say something about the Government’s approach to e-cigarettes, which almost every Member who spoke mentioned. The new control plan commits to monitoring the safety, uptake, impact and effectiveness of e-cigarettes and so-called novel tobacco products. We must find a better term than that. The plan charges Public Health England with the responsibility of including messages about the relative safety of e-cigarettes in their quit smoking campaigns. I am pleased to say that that is already under way and that PHE’s current Stoptober campaign, for the first time, highlights e-cigarettes among the array of tools that smokers can use to improve their chances of quitting successfully.
As we like to say during Stoptober, there has never been a better time to quit. I will leave to my right hon. Friend the Chancellor the several Budget submissions around e-cigarettes. The suggestion of my hon. Friend the Member for Colchester (Will Quince) of providing free e-cigarettes to pregnant women who are smokers is certainly worthy of consideration. I noted that the hon. Member for North Tyneside is not necessarily a fan of changes to e-cigarette levies, so it is fair to say that we so not have unanimity across the House on that. PHE is already preparing its new year quitting campaign, which is rolled out in January each year, and it will reprise the hard-hitting messages that we have seen on our televisions. It is through consistent messaging that we can hope to reverse the harmful, mistaken and increasingly widespread belief that vaping is no safer than smoking. It clearly is.
The right hon. Member for Rother Valley made an excellent speech, touching on health inequalities and how smoking disproportionately hits the poorest in society. There is huge variation in the figures for pregnant women, with smoking rates of between 2.3% in London and—to correct the record—28.1% in Blackpool. He also made an excellent point about dentists and oral health. PHE-commissioned training will continue to ensure that local authorities have access to the training they need to provide effective help to quit and the information they need to work with patients. He chairs the all-party parliamentary group on pharmacy—I think we will be meeting soon—so he would say this, but he spoke about pharmacists and healthy living pharmacies, which have been particularly good. He referred to Government research, and PHE is committed to reviewing the evidence on e-cigarettes on an annual basis, and is working closely with Cancer Research UK and the UK Centre for Tobacco and Alcohol Studies to deliver a forum to ensure that we continue to have that strong evidence base.
I think I need to wind up by 3 o’clock, Madam Deputy Speaker. Is that right? [Interruption.] “Well by,” she says. Okay, let me conclude by thanking everyone who has spoken today. I particularly enjoyed the speech of my hon. Friend the Member for Chippenham (Michelle Donelan). It was hypnotic in many ways but very good, and I noted her Budget submission. As usual, I thank my hon. Friend the Member for Harrow, although I suspect that his berating me on this subject will not have started and ended today. The hon. Member for Ipswich (Sandy Martin) made a consistent point about local authority pension schemes, and it must be for local authorities to make such decisions and then answer to members of the scheme, their elected members and, of course, the residents who elect them and get to make such decisions every day.
In closing, I appreciate the many challenges and I appreciate the support that the House has given to tobacco control legislation over many years. It is now up to us to provide a national lead and to support our local authorities and ensure that they carry through what is in the plan. I thank my friend the right hon. Member for Rother Valley for introducing today’s debate and ensuring that tobacco control is no longer a partisan issue; this is now about the tobacco control plan.
Oral Answers to Questions
Steve Brine Excerpts(6 years, 8 months ago)
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Ian Austin (Dudley North) (Lab)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
The National Institute for Health and Care Excellence is developing guidance on the use of Eylea for the treatment of myopic CNV. NICE has published draft guidance for appeal that recommends use of the drug subject to a patient access scheme that makes it available to the NHS at a discounted price. NICE expects to publish final guidance this November.
Ian Austin
NICE needs to get a move on, because these drugs have been available to patients in Scotland and Wales, but patients in England will be going blind in the meantime.
Some people are told that their eyesight is too good to be treated, but by the time it has declined, they are told that nothing can be done to help. Will the Secretary of State meet my constituent, Elaine Shaw, who has been campaigning on the issue, the Macular Society and the Royal National Institute of Blind People so that we can discuss how to prevent people from facing an increased and unacceptable risk of preventable sight loss?
Steve Brine
Obviously I would be deeply concerned if patients were losing their sight due to treatment not happening in a timely way. Dudley clinical commissioning group tells me that it has already made funding available for Eylea following consideration of the NICE evidence summary issued in June 2016. This is the first drug that we have appraised through the new fast-track process for treatments that demonstrate clear cost-effectiveness. Patients will have routine access to Eylea from 1 December should the guidance remain unchanged. Of course, I would be happy to meet the hon. Gentleman and his constituent.
Paul Masterton (East Renfrewshire) (Con)
Jeff Smith (Manchester, Withington) (Lab)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
We thank the ACMD for its report, and we take its advice seriously. Discussions will happen across Government, and we will respond fully in due course in the usual way.
Jeff Smith
The ACMD says:
“England had built a world class drug treatment system… This system is now being dismantled due to reductions in resources.”
More than 100 local authorities have had to reduce spending on addiction services this year as a result of Government cuts. Will that reduction in addiction treatment budgets not just cost the NHS more in the long term?
Steve Brine
The Government are already investing £16 billion in public health services over the spending review period. We made it a condition of the public health grant that local authorities have regard to the need to improve the take-up and outcomes of their drug and alcohol services. Local authorities are best placed to make those decisions. The investment in effective services means that the average waiting time is just three days and, according to our monitoring systems, treatment outcomes in Greater Manchester are generally better than or in line with the rest of England.
Mary Glindon (North Tyneside) (Lab)
Richard Burden (Birmingham, Northfield) (Lab)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
The building of the new health and wellbeing centre is supported by NHS England for funding in principle through the estates and technology transformation fund, subject to due diligence checks including a value for money exercise.
Richard Burden
That is fine, but is it not the case that although approval was given by the NHS technology and transformation fund last autumn, NHS England has spent the past 18 months negotiating new procedures for the premises cost directions? The delays in those procedures are jeopardising things such as that health and wellbeing centre. Is it not time that Ministers stepped in to ensure that projects on which everyone agrees can be approved under existing regulations and should not have to wait for the renegotiations?
Steve Brine
The hon. Gentleman is right that NHS England has been negotiating changes to the premises cost directions, which govern how we manage premises costs for general practitioners, but that is not the reason for the delay. We are working through the detail of the content of the scheme and it is not yet at the point of seeking approval. At the end of the day, this is public money and I think that the hon. Gentleman and everybody in this House would expect me to make sure that things are done properly.
Lucy Powell (Manchester Central) (Lab/Co-op)
Robert Neill (Bromley and Chislehurst) (Con)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
The Government want and expect strong relationships and joint working between the NHS and local authorities to make a success of STPs. They are meant to be a one-system solution.
Robert Neill
The London Borough of Bromley has had considerable success in joint working with its clinical commissioning group, through joint appointments, a multi-agency use of funding and a complete sign-up from the council, but we are concerned that reorganisation may detract from this operation at the local level. Will the Minister agree to meet me to discuss Bromley’s proposals to build on the success it has had so far?
Steve Brine
We are confident that we have some of the best STP leaders in place. I was looking last night at the figures for south-east London, and I saw that my hon. Friend’s local STP is highly rated, both on leadership and overall. I was thinking about him in the gym last night and I thought he might say what he did, so let me say that I am very happy to meet him and to broker a meeting between him and the NHS.
Mr Speaker
It is interesting to hear about the thoughts of the hon. Gentleman when he is on the treadmill or the exercise bike—it is always useful to have a bit of additional information.
Steve Brine
I am always happy to meet Members, including the hon. Lady in order to talk about York. As the shadow Secretary of State said, the STP proposals are not about Tory cuts; they are about redesigning services in the local area. So I am happy to meet her to talk about her area.
Mr Jim Cunningham (Coventry South) (Lab)
Royston Smith (Southampton, Itchen) (Con)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
I thank one of my constituency neighbours for that question. Improving outcomes for all cancers is one of my main priorities in this job. I visited the Christie hospital in Manchester last week to see the progress being made on the proton beam therapy facility there. I know Barratt’s Wessex in my hon. Friend’s constituency, as it also does work with some of my constituents. We must do better on these rarer cancers with poor outcomes. I will look at what BW does exactly.
Several hon. Members rose—
Craig Tracey (North Warwickshire) (Con)
This Friday marks Secondary Breast Cancer Awareness Day. In 2015, the Government recognised that data collection for this type of cancer was not good enough. However, research by Breast Cancer Care shows that less than a third of trusts collect the number of people diagnosed with secondary breast cancer. Will the Minister confirm what actions the Government are taking to ensure that all trusts are collecting this information, given its importance to improving outcomes?
Steve Brine
I thank the co-chair of the all-party group on breast cancer in what is BCAM—Breast Cancer Awareness Month. We must never forget the treatment and support we give to those living with and beyond the cancer diagnosis. We must always remember those living with secondary breast cancer and the work of the third sector—brilliant charities such as Breast Cancer Haven and Breast Cancer Care—so that we can focus on access to a specialist nurse. As my hon. Friend says, the collection of data is critical, and I will be discussing that at my roundtable with some of the main players in the cancer community later this week.
Grahame Morris (Easington) (Lab)
Will the Minister abolish the patient penalty and scrap hospital car parking charges, which punish both the sick and hard-working NHS staff, as well as causing problems for residents living adjacent to NHS hospitals, such as Peterlee Community Hospital in my constituency?
Kevin Hollinrake (Thirsk and Malton) (Con)
Antibiotic resistance is a major threat to humanity. Will the Minister outline the progress we have made in opening up the £50 million global antimicrobial resistance innovation fund to applications?
Steve Brine
I thank my hon. Friend for that. We expect the first launch to be the bilateral UK-China partnership £10 million fund, which we expect to go live early in 2018. Further information on the calls for the remaining £40 million will be announced in due course.
Mary Glindon (North Tyneside) (Lab)
Steve Brine
I am very happy to meet the group, and the hon. Lady should contact my office. The Home Office is the lead Department for cross-governmental drugs policy, and we obviously released the new cross-Government drugs strategy earlier this year. However, this cannot all be about drugs services and picking up the pieces after things have gone wrong; it can also be about prevention. We should, as somebody once said at this Dispatch Box, understand a little more and condemn a little less.
Wendy Morton (Aldridge-Brownhills) (Con)
This month is Stoptober, and someone who manages to stop smoking for 28 days is five times more likely to quit for good. Legislation is obviously part of this, but perhaps the Minister could update us on what more could be done.
Steve Brine
At the last health oral questions, I committed to publishing the new tobacco control plan. I did that on 18 July. We have had a lot of legislation, from this and the previous Government. It is Stoptober, and there has never been a better time to quit. We now need to take that legislation, work with the control plan the Government have published and work it through local authorities and smoking cessation services, because my hon. Friend is absolutely right that where buddying services are used, we have better outcomes.
Dr Rosena Allin-Khan (Tooting) (Lab)
There is a crisis in mental health staffing levels. Does the Secretary of State accept that today, throughout the country, there are 2,000 fewer mental health nurses than there were when he took charge five years ago?
Access to NHS Dentists
Steve Brine Excerpts(6 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
I congratulate the hon. Member for Bradford South (Judith Cummins) on securing the debate, which has come significantly earlier this evening than perhaps we had expected. I am sure that that is one of the reasons for the increased turnout, but the main reason is that this is a very serious and important subject, which affects lots and lots of our constituents. I thank Members for being here.
Of course, everyone should have access to a dentist, and those who want it should have access to an NHS dentist. It is a fact that the two main dental diseases—dental caries or decay, and periodontal or gum disease—can be almost eliminated by the combination of good diet and correct tooth brushing, backed up by regular examinations by a dentist. Let me acknowledge from the outset, therefore, the vital role that dentists play in maintaining and improving the oral health of all our constituents.
As hon. Members may be aware, NHS England has a statutory duty to commission services to improve the health of the population and to reduce inequalities. The hon. Lady spoke passionately about that, as she always does. In this instance, NHS England’s statutory duty is to commission primary NHS dental services to meet local need. I appreciate that, as she has highlighted, there are of course areas with access difficulties—to put it mildly—such as her constituency of Bradford South, as well as those represented by other Members in the Chamber, but overall access continues to increase.
The January to March 2017 GP patient survey results were published in July, and I looked at them today. They showed that 59% of adults questioned had tried to get an NHS dental appointment in the past two years. Of those trying to get an appointment, 95% were successful. Looking, as I did today, at the latest figures for patients seen by NHS dentists, I can tell the hon. Lady that 22.2 million adult patients aged 18 and over were seen in the 24 months ending 30 June 2017. This equates to 51.4% of the adult population. The number of adults seen by an NHS dentist had increased by 19,000 compared with the period ending June 2016. To prove that I have indeed swallowed the numbers box, let me put it on the record that 6.8 million children were seen in the 12 months ending 30 June 2017. This equates to just over 58% of the child population. Again, this was an increase of 75,000 compared with the period ending June 2016.
Dr Whitford
It is not just a matter of seeing children if they are simply being seen for caries and fillings or other remedial work. The payment structure means that a dentist is paid only for a check, not for advice, cleaning or fluoride sealant, and the problem is that that structure does not drive prevention.
Steve Brine
I absolutely agree with the hon. Lady, and if she will bear with me, I will come on to that point.
Dr Caroline Johnson
As a doctor, I have seen the distressing circumstances in which children as young as two come in for teeth extractions. Children sometimes have all the milk teeth in their mouth extracted. Does my hon. Friend agree that there is more to preventing caries and such extractions than just dental treatment and having more dentists? The answer, particularly for the very youngest children, lies in extra education about oral care, as well as good diet and not drinking fizzy drinks and the like.
Steve Brine
Yes, there should be a package, and I will come on to mention one or two of those points. This is as much about self-care as it is about interaction with the dental profession.
To conclude the point I was making, at a regional level in the period to 30 June, the north of England saw the highest percentage of patients seen—56.8% of adults and 63% of children. Although these access numbers are encouraging, I know that the hon. Member for Bradford South will not be sitting there thinking, “That’s all okay, then.” I know that more needs to be done to reduce the remaining inequalities in access, including in areas such as Bradford South, which she represents, and NHS England is committed to improving the commissioning of primary care dentistry within the overall vision of the five year forward view.
There are a number of national and local initiatives in place or being developed that aim to increase access to NHS dentistry. Nationally, the Government remain committed to introducing the new NHS dental contract, which the hon. Lady rightly referred to often in her speech. It is absolutely crucial to improve the oral health of the population and increase access to NHS dentistry.
A new way of delivering care and paying dentists is being trialled in 75 high street dental practices. At the heart of the new approach is a prevention-focused clinical pathway. It includes offering patients oral health assessments and advice on diet and good oral hygiene, with follow-up appointments where necessary to provide preventive measures, such as fluoride varnish, that can help the prevention agenda. Importantly, and this is of most relevance in this debate, the new approach also aims to increase patient access by paying dentists for the number of patients cared for—let me restate that: cared for—not just for treatment delivered, as per the current NHS dental contract. Subject to the successful evaluation of the prototypes, decisions will be taken on wider adoption. The prototypes are being evaluated against a number of success criteria, but let me be clear that they will have to prove that they can increase dental access before we consider rolling them out as a new dental contract.
I appreciate that this is taking a long time. It is as frustrating for me as it is for right hon. and hon. Members and for the profession, but Members will understand that rolling out a new dental contract is complicated and complex. We have to make sure that it is right and that what we put in place is better than what was there before.
Dr Whitford
I am very grateful to the hon. Gentleman for giving way again. Has he looked at the Childsmile project in Scotland? It covers dental care from zero to 18, including advice and education in nursery and in school, and therefore provides a whole package. It has reduced dental caries in Scotland—frankly, we have much worse teeth than you—by 24% and saved £5 million. That information is already there and it might help in the assessment of the Government’s plans for England.
Steve Brine
I thank the hon. Lady for that. No, I have not looked at that, as I am still relatively new to the brief, but I will certainly do so. I will make some progress and then conclude because time is limited.
Imran Hussain
I welcome the review of the system, in particular the dental contract prototypes. As the Minister has outlined, one issue is that many of the contracts, as in Bradford, are ancient contracts that have not taken account of the demographic changes over time. Some of the most disadvantaged areas are hit the worst by that. Can he give a definitive time by which the prototypes will be completed and he will have the report that we have awaited for over a year?
Steve Brine
I cannot give the hon. Gentleman an exact time. I know that is annoying and I am sorry, but I cannot. It will happen ASAP—as soon as possible—and I will let the House know when it does.
Let me wrap up my speech by covering the other points that I need to make in response to the debate. We are about to launch the much anticipated and much discussed Starting Well programme, which is aimed at children under five. I think that it borrows from some of the stuff that is going on north of the border.
Children’s oral health is better than it has ever been, with 72% of five-year-old children in England now decay free. However, vast inequalities remain, as we have heard today. To tackle those inequalities, NHS England has been leading the Starting Well programme, alongside Public Health England—I was in Warwick today, speaking to its annual conference—the British Dental Association and, of course, colleagues at the Department of Health. The overall aim is to improve the oral health of children under the age of five who do not currently visit a dentist in 13 identified high-priority areas. The areas that have been selected will be confirmed shortly. My officials will have heard a passionate bid from Opposition Members today.
I am sure that the House will welcome the initiative. The intention is to reduce the unacceptable oral health inequalities that exist for children in this country. We know that visiting a dentist early in a child’s life can help lay the foundations for a lifetime of good oral health.
Locally to the hon. Member for Bradford South, I am aware that NHS England ran an initiative to tackle the dental access issues in west Yorkshire. The aim of the dental access pilot was to improve access to primary care NHS dentistry in the Bradford City, Bradford Districts and North Kirklees clinical commissioning group areas.
Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)
Will the Minister give way?
Steve Brine
I will not because we are almost out of time.
The initiative was for patients requiring routine or urgent treatment who approached 111 to access a dentist. Patients were triaged by Local Care Direct according to need. Twenty-five practices participated in the pilot: nine in Bradford City, eight in Bradford Districts and eight in North Kirklees. In March 2017, an additional practice in Dewsbury was recruited into the pilot; the hon. Member for Dewsbury (Paula Sherriff) is in the Chamber.
The pilot began in January 2017 and was due to end in March, but it was extended to the end of June 2017. Over the duration of the pilot, almost 7,800 appointments were made available for new patients. NHS England across Yorkshire and the Humber is currently reviewing the learning from the pilot and considering how it can improve access to NHS dentists in a number of areas across the region. I know that it would welcome representations from the Opposition Members who are present if they wish to feed into that process.
In closing, I would like to reiterate the commitment we made in our manifesto
“to support NHS dentistry to improve coverage and reform contracts so that we pay for better outcomes, particularly for deprived children.”
I hope that by setting out, in the very limited time we have for this Adjournment debate, the work being undertaken by the Department of Health, NHS England and Public Health England, I have been able to assure the hon. Lady and the House of the commitment we have and that I have personally. I hope there is no question but that this is a huge priority for me. I want to improve access to NHS dentistry and I want to improve the oral health of our children, especially in England, and of the population for the future. That is in all of our interests.
I thank the hon. Lady for bringing this debate to the House. I am certain that this conversation will continue.
Question put and agreed to.
Incontinence
Steve Brine Excerpts(6 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
I congratulate the hon. Member for Bridgend (Mrs Moon) on securing this debate. I completely agree that incontinence is a public health issue. I am the public health Minister, so it is appropriate that I am responding to the debate.
It is important that I reiterate some of the hon. Lady’s points from the Government Dispatch Box. Incontinence is absolutely an issue with which too many suffer in silence, and we all need to learn to speak more openly and honestly about it. Think of the subjects that the House of Commons has discussed today, on its first day back after recess: it is incredible what the House can achieve and bring to public consciousness. The hon. Lady has certainly added to that today. By talking about incontinence, we draw back the veil and encourage others to come forward for assessment. I hope that somebody is watching or listening to this at home and decides that they are going to take the first step and ring their GP tomorrow morning, without shame or embarrassment.
As the hon. Lady said, there are 14 million adults in the UK with bladder-control problems and 6.5 million with bowel-control problems. She is absolutely right to point out that this is not just an older person’s problem: it reaches across the sexes and across the generations. Incontinence has been touched on in previous debates—the hon. Lady has raised it in the House this year—but I am told that there has been no dedicated Commons debate on it since 2004, so it is now high time for one.
All continence problems can be debilitating and life-changing. They affect a wide range of care groups and can be a particular concern for the ageing population—although, as both the hon. Lady and I have said, not exclusively. As the hon. Lady said, incontinence is not just a physical problem; it can be, and very often is, psychologically distressing. When continence care and support is done well, it makes an enormous positive difference to patients’ lives.
As the hon. Lady acknowledged, some of the issues she raised go much wider than the brief of a mere health Minister, but I shall touch on some of the other points she made, as well as those for which I am directly responsible. We absolutely do need to develop the workforce of health professionals so that they are more informed and educated about continence issues across the board and are able to support and care for individuals in a safe, effective and dignified manner. We need to measure people’s health outcomes robustly—without measurement it is hard to take action—to make sure that services continue to improve and that we can provide the best care possible.
A good-quality, patient-focused service begins with getting the specification and commissioning right from the outset. For services in England, NHS England published its commissioning framework for continence services, “Excellence in Continence Care,” in 2015 to help to achieve this. Working with clinicians, third sector organisations and people living with the condition, NHS England brought together the most up-to-date evidence-based resources and research to support commissioners, health providers and professionals to make real and lasting changes to raise the standards of continence care. As well as outlining an individual’s pathway from assessment to treatment and recovery when possible, the guidance advocates integration across primary, secondary and tertiary services, as well as across health, education—as mentioned by several Opposition Members—and social care. It is designed to ensure that commissioners work in collaboration with providers and others so that safe, informed, dignified—a key word—efficient and effective continence care is consistently provided to patients.
Dr Drew
The Minister will have heard my earlier intervention. Will he and his colleagues in the Department for Education commit to write to each school to make sure that they have an incontinence strategy? In particular—it is just a simple thing—they should provide incontinence pads for children who suffer from this terrible condition.
Steve Brine
Clearly, it is not my place to promise work tasks for Education Ministers, let alone other Health Ministers, but they will have heard what the hon. Gentleman said. I have a feeling that he will be following this matter up, no doubt through the all-party group. The chair of that group, the hon. Member for West Lancashire (Rosie Cooper), is sitting but two rows in front of him.
As well as outlining an individual’s pathway from assessment to treatment and recovery when possible, the guidance advocates integration across the different areas. Strengthening the workforce’s knowledge is absolutely key. In England, continence care and the importance of this issue to the comfort of patients is already an important part of the basic training offered to a wide range of clinicians and care workers and is part of the Nursing and Midwifery Council’s training curriculum.
The commissioning guidance builds on that by setting out the minimum standards required along with the specific roles and responsibilities for every member of a patient’s continence team including the individuals themselves, their family—very important—and carers. It is important to acknowledge that, following assessment and with the right advice, self-management of a condition can improve outcomes considerably.
There will always be people, including some in care homes, who have a need for aids. A group of specialist nurses for adults and another group for children are currently preparing some consensus guidelines on commissioning continence products, which in due course the Excellence in Continence Care board will consider for endorsement as a supplement to the framework. Of course we need to make sure that commissioners are following the framework, and NHS England is taking several approaches to tackle this. Let me touch on a few of them.
Rosie Cooper
The Minister’s comments are very welcome, but what pressure can he really apply to get clinical commissioning groups to implement NHSE’s guidance and to get the GMC, the Nursing and Midwifery Council and medical schools to include training in continence? If we can get that right, those facilities will be there when people say that they have the problem. Then we will get the clinical intervention, not just the costly pads in response.
Steve Brine
I thank the hon. Lady for her intervention. I will take that away with me, and I will come on to the point about the CCGs.
I was just about to outline the approaches that NHS England wants to take to ensure that commissioners are following the framework. They include arranging for CCGs to have access to teams of expert clinicians, commissioners from areas that have adopted the guidelines and are following best practice, and people with lived experience to review their existing service against the best practice and make appropriate improvements. NHS England is also exploring the potential for a mandatory data set to provide transparency about the continence services being commissioned and encouraging CCGs to develop integrated commissioning arrangements to improve co-ordination, experience and use of resources. That is all very positive.
In addition, the National Institute for Health and Care Excellence—or should I say NICE as I am now getting to grips with all the acronyms—has produced a range of guidance for clinicians to support them in the diagnosis, treatment, care and support of people with continence problems, including the 2015 quality standards for urinary tract infection in adults, which sets out how treatment must be holistic.
I understand that the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), recently replied to the hon. Member for Bridgend on the issue of paediatric continence data and the risk of losing the National Child and Maternal Health Intelligence Network, which provides a valuable data resource. Let me take the opportunity to reassure the hon. Lady that the ChiMat legacy website can still be accessed. Paediatric continence is a very important issue. I understand that Public Health England is grateful to the Paediatric Continence Forum for its productive collaboration over the years and that it wishes this relationship to continue. It has agreed that if PHE’s infrastructure remains the best place within the health system to enable these reports and to make the data available at a local level, it will make every effort to recreate the paediatric continence needs assessments during its 2018-19 business planning process. I am the Minister responsible for Public Health England. I see its leaders regularly and I will raise it with them next time I see them.
Steve Brine
I would also like to use this debate briefly to mention transvaginal mesh implants, which the hon. Lady rightly raised in her speech. She was about to intervene to ask whether I was going to mention them. I know that some women experience severe side effects and complications post operation. I know that there has been considerable interest in this across the House. The hon. Lady mentioned the hon. Member for Pontypridd (Owen Smith) who chaired a working group on it recently and is looking to set up an all-party group on the subject.
I have heard heart-breaking stories and I have talked to colleagues in the House who have been contacted by constituents about this. We have to make sure that we listen, not only to provide the best support but to inform health services so that they can reduce complications from the treatment. When complications do occur, we must ensure that they are treated promptly and effectively.
We must also remember that these procedures help thousands of women each year who are suffering the distressing effects of stress urinary incontinence and pelvic organ prolapse. Surgical procedures using mesh devices have provided an effective form of treatment that can be far less invasive than alternative surgical procedures. Let us not throw the baby out with the bathwater. In 2014, NHS England set up its mesh oversight group which, in partnership with clinicians, regulatory experts and patient groups, published its final report in July this year which helps to address the three major issues highlighted by clinicians and patient interest groups alike: clinical quality, data and informed consent. That answers the point made by the hon. Member for Bridgend about the devolved Administrations. Yes, we liaise with them, and I welcome the news that both Wales and Northern Ireland will be setting up their own working groups. We would like to see more collaboration on this topic across all the devolved Administrations, and we will give them every support so that they can learn from what we have found in the NHS England working group. I hope that that answers that point.
The hon. Lady raised a couple of other issues. She made a really good point about non-domestic rates and public toilets. That issue is raised in the House more often than it should be—it should not need to be raised. I will make sure that my colleagues in the Department for Communities and Local Government hear her call. There is a discretionary relief scheme on non-domestic rates that councils can access, and I am sure that she has made her council aware of it. I encourage other Members to do so, because that is how the discretionary scheme can be used. It is exactly what it says on the tin—it is discretionary.
The hon. Lady made an excellent point about installing a shelf in public toilets. That would be welcome. As a parent of young children in the not too distant past, a shelf would have come in handy on lots of occasions. She made an excellent point about the changing of continence products. The hon. Member for Stroud (Dr Drew) made a point about ERIC. I was not aware of that, so I thank him for doing so and will look it up. He also spoke about the need for teachers to be informed about the subject. I urge him to pursue that with Education Ministers, but I am sure that they have heard tonight’s debate, given that they have been mentioned.
The hon. Member for Bridgend made a really good point about hospital data on continence, access to tertiary care and exit from hospital care. My family and I have experienced the fight on Parkinson’s on far too many occasions. I thank the hon. Lady for the work that she does on the all-party group and I look forward to meeting her in that capacity. I will ask officials to look at the very good point that she has made. She also raised VAT on sanitary and continence products. The Government have taken action on VAT on women’s sanitary products within the realms of what is possible as a member of the European Union. We have invested that money in women’s health charities, as she knows. On the wider point about VAT, we are restricted as a member state, but we will soon be free, and we will be able to make those decisions in the House—taking back control, as someone once said.
Finally, the hon. Member for Strangford (Jim Shannon) made an excellent point about employers and their understanding of the issue. Employers should show every understanding in this area, and I expect them to do so—I do not think that I can be clearer than that.
To conclude, I thank the hon. Member for Bridgend once again for highlighting these issues. For all those who suffer from continence issues, it is important that we talk about the topic, treat it seriously, and work together to overcome the taboo and stigma by speaking candidly about it. I genuinely believe that only by doing so can we truly provide patient-centred services, where patients are at the centre of everything we do. We work with the healthcare professionals, commissioners, providers, pharmacists and trusts to improve the advice and services offered to best meet the needs of the people who rely on and—let us remember—pay for these services.
Question put and agreed to.
Towards a Smokefree Generation—A Tobacco Control Plan for England
Steve Brine Excerpts(6 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
The Government have today published the Tobacco Control Plan for England, with a vision to create a smoke free generation. A copy is attached.
The 2017-2022 Tobacco Control Plan for England sets the overarching strategic direction for tobacco policy. The last tobacco control plan ran from 2011-2015. All the ambitions set in the previous plan were exceeded, during a period when the Government successfully introduced a significant amount of legislation, including standardised packaging of tobacco products and a ban on smoking in a car when a young person is present.
The new plan does not introduce new legislation. Instead, it shifts emphasis from action at the national level such as legislation to focused, local action, supporting smokers, particularly in disadvantaged groups, to quit.
The plan lays down bold ambitions for reducing smoking prevalence in England, en route towards creating a smoke free generation. These are:
Reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less by the end of 2022.
Reduce smoking prevalence among adults in England from 15.5% to 12% or less by the end of 2022
Reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population by the end of 2022.
Reduce the prevalence of smoking in pregnancy from 10.5% to 6% or less by the end of 2022.
Attachments can be viewed online at:
http://www.parliament.uk/business/publications/written-questions-answers-satements/written-statement/Commons/2017-07-18/HCWS56.
[HCWS56]
Worcestershire Acute Hospitals NHS Trust
Steve Brine Excerpts(6 years, 11 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health (Steve Brine)
Thank you very much, Mr Hollobone. First, I apologise to my hon. Friend the Member for Redditch (Rachel Maclean); the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), who is responsible for hospitals, is on the Front Bench in the main Chamber taking part in the important debate on contaminated blood, to which she rightly referred. He has sent me in his place, so I hope I will do.
I will attempt to answer many, if not all, of the questions that my hon. Friend asked in the 15 minutes or so that I have. I congratulate her on securing the debate and on her recent election. I knew her predecessor well, and as she graciously said in her maiden speech, she is some act to follow. She is a lovely person and I hope that she is doing well—I am sure that my hon. Friend is in touch with her.
Most of all, I congratulate my hon. Friend on the way she has tackled this issue in the short time she has been here and brought what she said on the campaign trail into the House of Commons and its various Committees—hitting the ground running would be an understatement. That is exactly why the people of Redditch placed their trust in her, and she is already a credit to them. I was in the House for her maiden speech, so I heard her refer to these issues and to the Alex in great detail. It reminded me of someone not so far from where I am standing now, who came to this House seven years ago and said that the future of Winchester’s hospital would be his priority. I have tried to stick to that, as I am sure she will to hers. I have not seen a family quite so proud as hers, sitting up top to watch her make her maiden speech. I think her children and partner were there, and it was great to see.
I understand that my hon. Friend is deeply concerned about the performance of local health services at Worcestershire Acute Hospitals NHS Trust, which has been in special measures since December 2015. On her first key question, I can reassure my hon. Friend and her constituents that Ministers keep a very—I emphasise “very”—close watch on performance at this trust and all trusts through the role of the chief inspector of hospitals, Sir Mike Richards. The Secretary of State put that in place, and it has made an enormous difference. My hon. Friend will know that, as she was able to join the Minister of State on his recent visit to the Alexandra Hospital during the campaign.
The recent CQC inspection report is clearly of great concern to my hon. Friend and to us, but I understand that the Minister of State was reassured to meet the trust’s new chief executive twice since her arrival from Australia at the end of March. She now has a substantive team in place for the first time in many years, and we know from experience that strengthening the leadership team is a significant step towards taking any trust out of special measures.
NHS Improvement has taken active steps to help drive improvement at the trust. That includes bringing in Birmingham Children’s Hospital, South Warwickshire NHS Foundation Trust and Coventry and Warwickshire Partnership NHS Trust to help address key areas of weakness and provide strategic, mentoring and practical support. An improvement director is also in place. That is the very least we expect, and I am pleased to report that it is happening.
Let me turn now to winter pressures. The Department has agreed to Worcestershire Acute NHS Trust’s bid for £920,000 of capital funding for primary care streaming in A&E. That funding is intended to ensure that the trust has appropriate facilities in place for this winter, and I strongly encourage the trust to spend the funding as quickly as possible, within the constraints of good governance, so that it is ready for when the weather turns.
That capital investment is one part of the urgent and emergency care plan being implemented across the NHS this year to recover A&E performance during 2017-18. The intention of the national plan is to redirect patient activity to primary and community care through GP streaming, GP weekend and evening appointments, and supported discharge and re-ablement in people’s homes. Worcestershire Acute Hospitals NHS Trust will benefit from these efforts to improve performance on delayed transfers of care—DTOC is one of the acronyms I have had to get to grips with in the past three years—as will other trusts.
Let me set the review of acute services, which my hon. Friend rightly mentioned, in the context of the Herefordshire and Worcestershire sustainability and transformation partnership. This represents a landmark attempt to address long-standing challenges to the provision of emergency care across the county, and to ensure sustainable A&E services and all other health services, because—we do not say this often enough—we are one NHS for the long-term future. The review of acute services has been incorporated within the STP, which is right. A draft was published in November 2016 and public consultation ran between January and March 2017. I will briefly outline the proposals.
The revised model would see 95% of patients experiencing no change in the way they access services in Worcestershire and all three of the county’s acute hospitals remaining open. Worcestershire Acute Hospitals NHS Trust would also retain its two A&E departments at Worcester and Redditch and the minor injuries unit at Kidderminster. Worcestershire Royal Hospital would become a specialist centre to support emergency and complex care, and the Alex in Redditch would provide more planned care.
Under NHS England’s proposals, both A&E departments, at the Alex and at Worcestershire Royal, would remain open 24 hours a day. However, due to the transfer of in-patient children’s beds, the A&E at the Alex would be for adults only. Both the Alexandra and Worcestershire Royal Hospitals would have new 24-hour co-located urgent care centres, which would treat adults and children with minor and moderate illnesses and injuries.
I must emphasise that no decision has yet been made regarding these proposals. As my hon. Friend said, the governing bodies of the three Worcestershire clinical commissioning groups will hold a meeting in public tomorrow, when they will each consider the decision-making business case and then make a decision on the recommendations. Depending on the outcome of that meeting—I have a funny feeling my hon. Friend will attend—the next step would be for the trust to go to NHS Improvement for approval of its outline business case. If successful, the next stage would be to commence procurement for the work and to take forward implementation of the clinical model. Suffice it to say, it would of course have to have clinical support in line with the five tests that we and NHS England have now set out for any service change.
I am encouraged to learn that the trust is progressing its plans for a £29 million investment in improved facilities at Worcester and Redditch Hospitals, in addition to the almost £1 million awarded following the Budget to improve patient streaming for those attending A&E. It is proposed that this money should be used to improve the operating theatres at the Alex so that the hospital can be developed into a centre of excellence for planned surgery, to develop a women’s centre at the Alex, to increase the number of beds at Worcestershire Royal, to provide a new children’s outpatient department at the Alex, to improve endoscopy facilities at the Alex and to improve the ever-thorny problem of car parking at Worcestershire Royal. I believe that the Worcester and Redditch are strong contenders for that proposed new investment funding, and my hon. Friend has made an extremely strong case for her constituency.
Let me touch on the Naylor report, which my hon. Friend mentioned—I have quite a lot of reading at the moment, but I will take seriously her advice about the insomnia cure that it provides. I assure her that I am not aware of any plans to dispose of the Alexandra Hospital. It does not propose closing any specific hospitals; it merely refers to where space and land can be released while continuing to deliver services. As my hon. Friend knows, the Naylor review was independent. Its report was prepared for the Department of Health and published in March 2017. As she would expect, my hon. Friend the Minister of State is considering its recommendations carefully and will respond fully in due course on behalf of the Government.
My hon. Friend rightly mentioned staff recruitment and retention, so I will touch on the problems that the trust has faced in recruiting staff, especially at senior levels, and its resulting reliance on interim and agency staff. The trust has a new chief executive and leadership team in place. We have found from the experience of many other hospitals that have been in special measures that low morale and high levels of attrition are usually never about staff commitment; they are about getting the right leadership in place, which is why I place such emphasis on the new chief executive and her team. My right hon. Friend the Secretary of State saw outstanding commitment from the trust’s staff when he visited the Alex and the Royal last month.
Let me turn to my hon. Friend’s concern about maternity services, which always touch the heart strings more than other hospital services. I of course recognise the strength of feeling in Redditch and, in particular, the concern about travel times to Worcestershire Royal. All hospital births in Worcestershire were moved on a temporary emergency basis from the Alex to the Worcestershire Royal in 2015 due to staff shortages. The safety of patients must rightly be our prime concern and I understand that the trust ran extensive recruitment campaigns for additional staff before this temporary decision was made. Worcestershire’s maternity services form part of the review of acute services, which must be right.
The CCGs’ published decision-making business case makes it clear that Worcestershire Acute Hospitals NHS Trust must review the scheduling of its outpatient appointments and operations to take account of patients’ travel needs and individual circumstances, and that the CCGs and the trust should work together with community transport providers in Worcestershire to provide an enhanced transport service between the Alex and the Worcestershire Royal. Decisions regarding those proposals are expected to be made by the governing bodies of the three CCGs at tomorrow’s meeting. I encourage my hon. Friend—I do not think I need to encourage her too much—to support the CCGs to agree a plan at that meeting.
Engagement with staff and local people must continue to influence and refine plans at every stage of the process. That is a key principle in the local reconfiguration of services, and it is dead right that the process is guided by those who best know and understand the local area, which of course includes the clinical support I mentioned.
In conclusion, I totally appreciate the concerns that my hon. Friend has set out so eloquently today, and I commend her once again for her work in such a short time in the House on local healthcare issues affecting her constituents and her own family, as she said in her maiden speech. I encourage her and her constituents to maintain an open dialogue with the local NHS, which they are doing, and I assure her that Ministers will continue to monitor the trust’s performance very closely.
Question put and agreed to.