Hernia Mesh in Men

David Hanson Excerpts

Thursday 5th September 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered hernia mesh in men.

I have brought this issue to the House because, to be truthful, I was not aware of this problem among men. I am well aware of the hernia mesh issue for women, and have represented their viewpoint for a number of years in this House and back home, where the Northern Ireland health service has responsibility. I asked for this debate after a number of gentlemen came to see me some months ago—I will give a little background on that in a few minutes.

I thank the Backbench Business Committee for selecting this topic for debate. Back in July I accepted its offer of this first Thursday back, even though I know it is the graveyard shift, unless there is a three-line Whip in the main Chamber. Given today’s one-line Whip, many Members have returned home after everything that has happened in the last two days. None the less, I am very pleased to bring this matter to Westminster Hall. I am also pleased to see the Minister in her place. This will be a hat-trick of debates for her—one yesterday and two today. I look forward to her response.

I raised this issue after a meeting I had with some men in Northern Ireland. My party colleague and health spokesperson in the Northern Ireland Assembly, Paula Bradley, who represents North Belfast, initially made me aware of the issue. My hon. Friend the Member for Upper Bann (David Simpson) also brought it to my attention, as he had met constituents to discuss the matter. It is only over the past nine months that I have been aware of it. The men I met that day were aged between 30 and about 55. I understand that in Northern Ireland some 400 men have had problems, and the number across Great Britain will be even higher. They outlined their experiences and the difficulties that they attributed to hernia mesh. I thought that their problems should be considered in this place, as those problems have been replicated throughout the United Kingdom.

The matter has been brought to the attention of the Department of Health and Social Care. The hon. Member for Linlithgow and East Falkirk (Martyn Day), the Scots nats spokesperson, is aware of the issue and will offer his experience. I will not steal his speech, but I understand he will tell us a wee bit about what he has experienced personally and about the health service in Scotland. I am also pleased to see the shadow spokesperson, the hon. Member for Washington and Sunderland West (Mrs Hodgson), in her place.

I urge that serious consideration be given to an investigation, on the same scale as the Australian investigation, and that action be taken after the findings are collated. Australia took action, and I hope the Minister will assure me that the Government will do the same. I promised my constituents and those 400 men across Northern Ireland who have had problems with hernia mesh that I would raise awareness in this House because, unfortunately, we do not have a functioning Northern Ireland Assembly so cannot raise the issue there.

In November 2018, the Health Issues Centre undertook social research to investigate adverse health experiences among Australian men and women who had undergone a medical device implant. The research was product non-specific, to identify any devices that demonstrated a pattern of failure. Many hernia operations are successful. In our job as elective representatives, people do not tell us how good things are; they tell us their complaints. Therefore, we do not always hear about the successful hernia mesh implants, but we certainly hear about the problems.

The issue was highlighted on the “Victoria Derbyshire” programme on 26 December 2018. A spokesperson from the Royal College of Surgeons said that hernia mesh complications “affect more than 100,000” people. They went on to say:

“It is clearly tragic if even a single patient suffers horrible complications from any type of surgery, not just hernia operations. Unfortunately the nature of surgery in general, not just mesh surgery, carries with it an inherent risk of complications which surgeons will always seek to assess, and will discuss with patients according to their individual clinical circumstances before surgery takes place.

It is important to make a distinction between groin hernia, the most commonly carried out repair and other forms of abdominal wall repair where a hernia has arisen, for example, in an incision or scar after a previous operation. These are more difficult and the complications rates are much higher.

A recent 2018 study found that both mesh and non-mesh hernia repairs were effective for patients and are not associated with different rates of chronic pain. The Victoria Derbyshire programme is right to point out how a minority of hernia mesh operations are associated with complications. However, it is also important to stress that such complications range dramatically from minor and correctable irritations to the more serious complications highlighted in its programme. Complications can also occur with non-mesh hernia repairs, and by not operating on a hernia at all. It is extremely important that patients are given the full picture by surgeons, regulators, and the media.”

A large number of studies have looked at the available treatments, but unfortunately we do not have all the appropriate information. The spokesperson continued:

“There have already been a number of scientific studies looking at the use of different types of mesh in hernia and we should continue to review the evidence and patients’ experiences to make sure the right advice is given and the right action is taken. Along with the regulatory authorities, we will continue to listen to patients’ experiences. Patients suffering complications or pain need help, not silence.”

That is very important and we must underline that point. They continued:

“There must also be an ongoing review of the data to make sure that previous studies have not missed any serious, widespread issue. It remains vital that surgeons continue to make patients aware of all the possible side effects associated with performing a hernia repair.”

Those gentlemen who came to see me earlier this year to ld me that they were not aware of the complications. I will give an example a little later. I do not want to criticise surgeons because they are under incredible pressure, but people have told me that they were not aware of the ins and outs and relevant information, so I believe there is a case to answer.

The Health Issues Centre inquiry specifically focused on people who had suffered a hernia, to better understand the nature and the impact of adverse outcomes. Over a period of four weeks, 183 respondents reported hernia mesh-related injury across a range of brands and of categories of hernia. Several serious problems with hernia mesh implants arose, too. It is hard sometimes to explain the physical, emotional and mental effect. The people I met were very clear that in the vast numbers of cases that they knew of, there were several serious problems. The vast majority of respondents—87% of them—did not feel that they were given enough information before their treatment to give informed consent. Indeed, they were never told about the risks and the impacts. They were not aware of any problems.

A senior member of the Conservative party—I will not mention his name—told me yesterday, “I have had a hernia mesh implant, but mine was successful.” Many are successful, but we should highlight those that are not. Some 91% of respondents suffer ongoing post-operative chronic pain as well as other health impacts. For example, some of the men who spoke to me have had serious bouts of depression and allergic reactions. Only 8.7% of respondents said that they had had successful treatment to address the problematic outcome of the operation.

Past cases of mine have involved women who have had mesh operations, which are intimate operations. I have had cases of ladies who have been unable to work or keep relationships going. They have been unable to cope with life, so the impacts of hernia mesh when it goes wrong are very real.

Men represented some 70% of the respondents to the survey. Those figures are from Australia, of course, but I just want to illustrate the matter. I will move on to the United Kingdom, but those figures are relevant.

Years ago in Northern Ireland a man developed a limp four years after surgery. People told him, “We have experienced pain as a result of similar surgery.” Damien Murtagh, who lives in Banbridge and has given me permission to tell his story, has been left with a limp as a result of his operation six years ago. He said:

“For years no one could tell me what is causing this pain. I can no longer ride my bike, go fishing, I work part-time”,

because of the chronic pain and the effect it has had on his lifestyle. He continued:

“The pain in the lower stomach and groin area makes me feel physically sick. I have no private life.”

It has been difficult for him to maintain relationships with other people. The issues caused off the back of the surgery are genuine and life changing.

I find it odd that this surgery can create such problems. I am not a medical professional. I can make no judgment about the operations, but I can ask whether they should continue without the assurance that every possible investigation has been carried out into the prolonged side effects. The patients should know, at every stage, the potential implications if the operation does not go as planned.

Figures specific to the United Kingdom also outline the problem. In a survey of 653 people, 18.8% said that they had developed antibiotic-resistant infections as a result of mesh complications. A person’s general health can go down dramatically. Some 40% of respondents described their pain levels at worst to be 10 out of 10. Usually, 10 out of 10 means someone is doing well, but in this case it means they are not and that they are in severe pain. In addition, 85.6% of respondents said that they could not sleep because of the pain. The men told me that their sleep patterns had been destroyed. They are in constant, nagging pain that never leaves them. When it gets to that stage and someone’s personal life is so affected, we have to look very seriously at the issue.

The problems of lack of information are not specific to Australia. Some 91.7% of respondents were not even told that they would be getting a mesh implant. Some did not even know what was happening. They went for the operation and knew there would be a repair job; they accepted that, but they were not aware of the implications. Some 96.2% said they were not shown the mesh implant that they were about to be given, while 91.7% were not told that the mesh implant was made of plastic, and 98% said they were not told the size of the mesh implant. When it comes to serious operations—in most cases it is probably a minor operation, but it has the potential to change lives—we need to make sure that patients are aware of such things.

Patients feel that they are not being told the risks of the surgery and the potential issues. We understand that that is partly because a decision is made when the patient is open and the need dictates the method; sometimes a decision has to be taken when the operation is at an advanced stage and it might not be possible to let the person know. I understand the pressures that surgeons and their staff are under, but I feel that an essential part of the care is an understanding of what to expect, and that can make a difference to the outcome. It would certainly have made a difference to the 400 men in Northern Ireland who have experienced problems. It would certainly have changed their lives if they had known about the implications for them. None the less, we find ourselves in a very difficult position, and they find themselves physically, mentally and emotionally changed. For some of them, their relationships have broken down as well.

Informed consent is fundamental to any surgery. I had three minor operations in 2017 and, to be honest, I would have signed any paper just to get the operations over because the pain was so extreme. At the end of the day, you sign the paper and you understand. In my case, it was a straightforward operation on the three occasions.

I mentioned Damien from Banbridge earlier. Outlining his case could help people make the all-important decision to go ahead with surgery, knowing that there could possibly be some serious downsides, although not in every case. That would be a more ideal situation for the patients, rather than being struck with post-operation issues without having been aware of the risks. At least they would know that they had taken the risk, not the surgeon, who they might feel had hidden the risk from them. It is a natural reaction. It is not pointing the finger or judgmental. I stress again that in no way can I ever accuse surgical teams of deliberately withholding information from their patients.

In an ideal world, post-operative problems would not exist and the NHS and private hospitals, which some patients are transferred to, would be able to shape the surgery in such a way that the pain that many patients cite would not occur. Problems created by surgery have knock-on effects. Physical problems quickly become mental problems. If Members had heard the stories of the gentlemen I met, they would understand where the mental problems come from. The pain is absolutely unbearable. Many experience depression as a result of surgery. They all cite anxiety, panic attacks and nightmares, and—this is serious—some people hear things that are not there. It clearly affects them mentally.

I congratulate and thank the men for making their information and backgrounds known. I also thank my colleagues from my own party who took the time to let me know about their individual cases. When we hear their stories, we clearly see how their lives have been changed.

In the United Kingdom study, 27.6% of respondents had been formally diagnosed with a mental health condition such as PTSD, which can affect people in many different ways, and 4.7% said that they had self-harmed because of mesh complications. That is probably off the back of the depression and the pain that becomes almost unbearable. I never realised just how much pain can affect people. I met a lady who had a problem following an operation—it was nothing to do with hernia mesh. The pain was so bad that she asked for her right knee to be taken off to remove the pain. Doing that removed the pain, because that is where the pain was, but it was a dramatic step to take, so when people start to self-harm, as some have said they have, because of the mesh complications, we must take serious cognizance of what has happened.

Some 24.3% of respondents had psychotherapy or counselling as a result of mesh complications. Again, the counselling was to try to stop them self-harming, and to help them to deal with a physical, surgical problem that would be long-term. Almost half of respondents—43.6%—revealed that they had suicidal thoughts, which underlines their clear anxiety and the importance of doing something; and 4.7% had tried to take their own lives. Unfortunately, nearly every day of the week we elected representatives deal, in our offices, with people suffering depression and anxiety, whatever the reasons may be. We understand what drives people to the brink of despair. It can be money issues, marital problems, family issues or a physical problem, as in the case we are considering. The figures reveal the dark reality of post-operation life for many of the respondents, and reinforce the urgency of the issue, which needs to be addressed as soon as possible. That is why I have brought the matter to the House for consideration, and it is why the Backbench Business Committee was pleased to provide an opportunity to highlight it. Many complications surround the issue of hernia mesh surgery, and there is a need to give urgent attention to solving them. The figures more than reinforce that point.

I mentioned the effect on families. The gentlemen who came to see me and my colleague, Paula Bradley MLA, on the occasion I spoke of, were able to tell me something about that. More often than not, when someone is sick or ill or having problems they are not the only one travelling that road; their wife or partner and family travel it with them, so there are also family issues. Post-operation care is prevalent among the issues, and 33.1% of respondents in the UK survey said that their partner was now their carer. When we get married we know it is for better or for worse—and sometimes a partner becomes a carer. Clearly that is a great responsibility for them. Three per cent. of respondents said that they had to put their parents into a retirement home as a result of mesh complications and problems with the surgery. People would obviously have loyalty and feel a duty to try to look after them, so that tells me, and should tell everyone present in the Chamber, that clearly the problem affects all the family. If one suffers, all suffer.

I have been told that there are clear problems associated with mesh implants that need to be addressed. We are dealing with issues, following the surgery, that people believe are related to it. They include adverse mental health issues and the fact that 78.4% of people experience depression—more than three quarters of the people in question. For the people I met, depression was clearly now a part of life. Some had stopped work altogether. Family relationships had broken down; they were no longer able to hold them together. Some 40.7% of respondents said that their child acted as a temporary carer. I know the good things that many children do for parents and perhaps siblings, but whenever a child, growing up, who should be enjoying childhood and focusing on their education, must be a temporary carer, there are clearly issues to address. Some men cannot have children after surgery, as some of the men I met told me. That is another issue that means we need to hasten an investigation.

There is also a need to address the issue of post-operative pain that lasts many years. I understand that what I have said is perhaps topical and anecdotal. The hon. Member for Linlithgow and East Falkirk will tell the House about some of the cases, but it is clear to me from meeting the men I have mentioned, and from the evidence that I have seen, that some hernia mesh operations in men have led to serious physical problems. That is why I have brought the matter forward today for consideration. It is the reason for this debate in Westminster Hall today.

We need a governmental investigation, and there must be a directive to do that, and funding to enable it to happen. That is why I look to the Minister. I hope that we will get a helpful response. I hope that in the future all the post-operation issues with hernia mesh surgery can be resolved. I hope that the NHS will receive appropriate funding to tackle mental health issues caused by the surgery. I am very pleased that in the Chancellor’s statement yesterday he reaffirmed the commitment to spending on health—I think it was £34 billion. Is the Minister in a position to suggest that some of that money could be focused on enabling the investigation to happen, and getting the data to try to address the issue? The mental health issues can never be ignored, any more than the physical ones. Perhaps the NHS will be able to improve the surgery process so that patients will not have to cope with being left in serious pain for years and perhaps for ever afterwards.

Now that the issue has been raised it is important that it gets the attention that it deserves and that the problems are tackled. I again ask the Minister—and she knows I do so respectfully and sincerely—whether we can start the process of answering the questions and providing empirical data on the side effects of hernia mesh in the United Kingdom. I know that her responsibility is to the mainland, but the inquiry will have to start somewhere, and I hope that it starts here.

[David Hanson (in the Chair)]

The hon. Member for Strangford (Jim Shannon) has summarised the case very succinctly. We move seamlessly to Front-Bench responses. I call Mr Martyn Day.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I was alarmed when you walked in, because I think you have held more ministerial posts than anyone else in the House of Commons—or you are pretty close to holding the record, anyway. So to have you in the Chair, judging me as a Minister, is quite daunting.

I thank the hon. Member for Strangford (Jim Shannon) for bringing up this important debate. You always bring debates to the Chamber that you are heartfelt and passionate about. That is so important. It is a delight to be opposite the hon. Member for Washington and Sunderland West (Mrs Hodgson). We have both been in this place for 15 years, and I know that you also bring the same passion and commitment. You always speak from your heart. We might be a bit similar in that way.

[David Hanson (in the Chair)]

Order. “You” refers to me.

[Ms Dorries]

Of course, Mr Hanson. I am amazed that after 10 years in the Chair I make these mistakes—it is because I am nervous. I am delighted to serve opposite the hon. Lady; it will be great.

This is a serious subject. It is incredibly important to hear the voices of patients who have suffered as a result of inguinal hernia mesh repair operations, because without allowing those patients to be heard, we cannot move forward to find solutions to deal with this issue. I will go off-piste from my speech, because there has been some conflation during the debate of vaginal mesh repair for the purpose of urinary incontinence and inguinal mesh repair for an inguinal hernia. The two operations are entirely different and have completely different outcomes. Vaginal mesh repair is for urinary incontinence. Inguinal mesh repair is for hernia, and without repair, there is a possibility of death. That is because of the pattern of development of an inguinal hernia. It is due to a break in the muscle wall. The hernia is a part of the bowel that comes through the muscle wall, and it can quickly strangulate and develop into peritonitis. The result of that can be death.

--- Later in debate ---

[David Hanson (in the Chair)]

Although we have finished early, the hon. Member for Strangford can have three minutes to respond should he wish to, but no more than three minutes.

Mental Health Act 1983

David Hanson Excerpts

Thursday 25th July 2019 Westminster Hall

[David Hanson (in the Chair)]

The hon. Member for Bermondsey and Old Southwark has the opportunity to wind up, if he so wishes.

Batten Disease

David Hanson Excerpts

Monday 22nd July 2019 Commons Chamber

[Seema Kennedy]

I could not have put it better myself.

[David Hanson (Delyn) (Lab)]

My hon. Friend the Member for Rhondda (Chris Bryant) made the point about international co-operation, which already exists. A European agency examining the treatment of rare diseases was established in January. It is funded by €101 million and the UK is currently a participant. My question for the Minister is, will we still be, in the event of withdrawal after 31 October?

[Seema Kennedy]

There will be co-operation with other medicines agencies, and I have no doubt that future co-operation will also come under any agreement that we reach with our European partners following our withdrawal from the European Union.

Drug Treatment Services

David Hanson Excerpts

Tuesday 16th July 2019 Westminster Hall

[Jeff Smith]

I agree with the hon. Gentleman; not for nothing is the UK labelled the drug-death capital of Europe. That should worry us across the UK.

The second theme that emerged from the reports is the real worry about the future of services after 2020 if the ring-fenced public health grant for local authorities ends and funding moves to general local authority funding. A report by the Select Committee on Health and Social Care showed that public health budgets have been cut every year since 2013, with alcohol and drug treatment services facing the biggest cuts. Councils have reduced spending on adult drug misuse by an average of 27% since 2015-16, and almost one in five local authorities have cut budgets by 50% or more since then.

The highest cuts have been disproportionately concentrated in areas with high rates of drug-related deaths, according to the Camurus report. More than half of the directors of public health surveyed believe that the removal of ring-fenced public health grants will result in further cuts. Service providers are struggling to maintain their current offer, and have even less capacity to make additional outreach efforts that are needed, such as offering proactive early prevention measures or engaging under-represented groups and communities who come less into contact with available services.

I wish I had more time to talk about hepatitis C, which is a really important issue. Stuart Smith, the head of community services at the Hepatitis C Trust, said:

“I walk into many drug services around the country and it’s chaos. They’re being asked to do so much with so little resource. I’m not sure how many of them can even feasibly have it on their priority list to discuss hepatitis C with clients.”

Hepatitis C is a very harmful condition but it can be prevented and cured if we have the resources to do so.

This is another story of austerity hitting the services that are most needed by the most vulnerable in society, but—this is the third theme that emerges from the sector responses—it is also a story of false economies. Spending on the recovery and reintegration of people who struggle with drug and alcohol dependency is one of the smartest spend-to-save investments that a Government can make. Strong evidence suggests that properly funded drug treatment services help to drive reductions in drug deaths, crime, and rates of blood- borne viruses. Research that the Government themselves commissioned concluded that drug treatment can “substantially reduce” the social costs associated with drug misuse and dependence, with an estimated cost-benefit ratio of 2.5:1. Depending on the breadth of the definition of “social costs”, that ratio could be calculated far more favourably and take into account factors such as lower crime, fewer health problems, less benefit dependency, lower social services spending and so on. Public Health England estimates that for every £1 invested in drug treatment services, there is a £4 social return.

Drug treatment and harm reduction services are cost-effective and offer good value for money, so this is a classic example of funding reductions in one part of the public services leading to spending increases in another. To quote Ron Hogg, police and crime commissioner for Durham and Darlington, who in my view is one of our most progressive PCCs:

“As PCC, I have concerns regarding the future allocation of public health funding in Durham, via the Public Health Grant, and the knock-on effect for policing. I am fearful that I will face the triple whammy of a reduction in police funding, a further reduction due to changes in the funding formula, and the consequences of a decrease in public health funding. The consequences of these changes are likely to include a significant increase in crime in County Durham and Darlington.”

We know that half of acquisitive crime in the UK is directly related to drug dependency.

[David Hanson (Delyn) (Lab)]

I am grateful that my hon. Friend has raised the issue of crime. Is he aware that crime prevention orders and drug and alcohol treatment orders attached to sentences have fallen? Drug treatment orders have fallen from 8,734 in 2014 to 4,889 in 2018, and alcohol treatment orders have also halved. People are not getting drug treatment orders as part of their sentence in the community, which leads to the same threats that my hon. Friend describes.

[Jeff Smith]

I thank my right hon. Friend for making that important point. Durham constabulary’s Checkpoint scheme, through which low and medium-level offenders with drug dependency are diverted into treatment rather than the criminal justice system, has reduced arrests by 11% and convictions by 9.7%, and has made a positive contribution in relation to participants’ drug use, physical and mental health, finances, accommodation status and relationships. There are benefits right across society when we send people into help and treatment, rather than into custody.

A number of stakeholders have identified that the lack of resources not only puts a strain on current treatments and activities, but stifles innovation in new ideas and treatments. That leads me to another key point, which is on our wider approach to drug treatment and policy. There are measures that we can take to reduce deaths and that would lead to less demand on drug treatment services, but the Government are either not encouraging or not permitting them. The most obvious is what many call drug consumption rooms, although I prefer the term overdose prevention centres, which are aimed at those with severe addictions. People will take their drugs—they have them in their possession, so they will inject them, and there is no way that we can stop them doing that—but rather than being left to inject their drugs in a bedsit or back alley, alone with an increased risk of overdose, they can go to one of the centres, where a nurse is on hand; they can use in a sterile clinical space with medical supervision, and naloxone on hand to reverse any overdose.

There are two great benefits to the centres. First, they save lives: no one dies of an overdose in such facilities. Secondly, they also have services for addicts to engage with. It might be the first time that addicts have come into contact with services, so they could be encouraged into other treatment options. At least 100 drug consumption rooms operate in at least 66 cities around the world, in 10 countries. In a number of European countries, such as in Spain, Germany and the Netherlands, supervised drug consumption has become an integrated part of services offered within drug treatment systems.

Police and crime commissioners and health professionals have been assessing the value of piloting such facilities in various areas, but the Government position is to block the pilots. Furthermore, the Government are unwilling to revisit the legislative framework, and so are insistent that we cannot make provision for the centres. However, according to the European Monitoring Centre for Drugs and Drug Addiction last year:

“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting”.

Equally:

“These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”

Drug consumption rooms, overdose prevention centres or whatever we want to call them simply make sense, and it is very regrettable that the Government will not allow them to become part of our treatment landscape.

On the subject of innovative models of service delivery, I mention the Checkpoint scheme in Durham.

Cystic Fibrosis Drugs: Orkambi

David Hanson Excerpts

Monday 10th June 2019 Westminster Hall

[Jim Shannon]

I thank my hon. Friend for those words. This is not an easy subject for the Minister to respond to, but it is one that has captured the interest of us all on behalf of our constituents, and we need the Government to grasp that and move it forward to the next place. We look for that.

If the Republic of Ireland is able to come to some arrangement with Vertex, if the Scottish Parliament is able to do similar and if, according to the background information, it is possible to go to Argentina and buy a year’s course of drugs for one patient at £23,000, compared with £104,000 for a year’s supply here, that tells me that something can be done if we had the willpower to do it, as my hon. Friend the Member for East Londonderry (Mr Campbell) has said. We can look around at our UK neighbours and look toward Scotland, whose Government have reached an agreement with Vertex.

The permanent secretary went on to say:

“In the absence of this positive NICE determination, the Health and Social Care Board…may take into account guidance produced by other appropriate HTA”—

health technology assessment—

“bodies based in other UK countries such as the Scottish Medicines Consortium…when making decisions about access to new drugs.”

I say to the Minister that I have made a comment about the Republic of Ireland, but I also make a comment about Scotland, because I think that the process enables us to use what Scotland has done as an example for us elsewhere.

The permanent secretary continued:

“The Department is aware that Vertex have re-applied to the SMC for consideration of approval for Orkambi, and that in the meantime there is currently limited access to the drug in Scotland via their PACS”—

peer approved clinical system—

“Tier 2 scheme, which is broadly analogous to our Individual Funding Request Process.

If Orkambi is approved by the SMC, details of the funding models in place, which are currently bound by commercial confidentiality, will be shared with the other UK countries. This will allow for us to have full access to the evidence and costs associated with this therapy and will inform any further decisions on access.”

The hon. Member for Colne Valley (Thelma Walker) referred to the destruction of some medications. Whatever the reason for that was—whether they had run out of time or whatever—I think it is disgraceful that people have destroyed some medicines rather than letting them be used by the general public, by those who need them. If that is not unacceptable in this day and age, I do not know what is. It is absolutely disgraceful; it really annoys me.

It is simply terrible that we are in a position where our hand are tied. I say again to the Government: look to your Scottish counterparts. I firmly believe that we can and must do more from this place and that that must start with acknowledging that the NICE guidelines do not currently take into account the differences, when it comes to pricing, between treatments for rare diseases and a new antibiotic strain. We need a new form of assessment for rare diseases and I would like to see that taking place as soon as possible to ensure that the mummy of my two-year-old constituent, who is asking me for this drug in order to give her child as normal a life as possible, can look forward to securing the best for her child. That is what every Member has said here today on behalf of their constituents.

Again according to the background information that I have, in May 2019 the Government said in response to a parliamentary question that discussions between Vertex, NHS England and NICE were ongoing. You know something? They have been ongoing for more than a year. Let’s get them sorted. Time is passing fast. I am joining colleagues in asking the Department to make the administrative changes necessary to end the Orkambi stalemate with NICE and to put in place a body designed specifically to address rare disease patients and their needs. We acknowledge that NICE does a tremendous job in ensuring that safe, cost-effective medicines are available on prescription, but we need a different set-up for those whose illnesses are very different and for the sake of my constituents and those represented by other MPs who have spoken today. I am asking that those decisions be taken and the changes made to enable Richard Pengelly, the permanent secretary at the Department of Health in Northern Ireland, to do what he knows he needs to do and allow the prescription of Orkambi to those whose lives would be radically altered and enhanced by it. It would give them life-changing opportunities. As others have said, give those children a chance.

[David Hanson (in the Chair)]

The previous Chair set a time limit on speeches of six minutes, which has been successful, in that all right hon. and hon. Members have been able to take part in the debate, but it leaves us with a maximum of one hour and 10 minutes for the Front-Bench speakers to respond. Front-Bench speakers, who have more than the normal 10 minutes, can be more flexible and take interventions should they so wish.

The other point I wish to make is that because the winding-up speeches have started early, some Members who have spoken in the debate are not present for these speeches and they should be. If you are watching on television, please return to the Chamber now. This is an important debate; you have contributed to it and you should be present for the Front-Bench responses.

Clinical Trials and Clinical Research Capability

David Hanson Excerpts

Thursday 23rd May 2019 Westminster Hall

[Chris Green (Bolton West) (Con)]

I beg to move,

That this House has considered the matter of supporting clinical trials and the UK’s future clinical research capability.

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the Backbench Business Committee for granting time for this important debate on supporting clinical trials and the UK’s future clinical research capability.

This is an immensely important sector. Any generation wants its successor generation to be healthier and have a better standard of living, whether the treatments that are produced are life-enhancing ones or life-saving and life-protecting ones. That is increasingly important: there is an ageing population, not just in the UK but globally, so there is an increasing need for a variety of new treatments coming through the life sciences sector. Clinical trials play such a large part in that.

Monday was international Clinical Trials Day, marking the anniversary of the first clinical trial, conducted by surgeon’s mate James Lind on HMS Salisbury in 1747. Scurvy was a huge problem at that time, not just for the Royal Navy but for navies all over the world. Lind set up a clinical trial with 12 sailors who had scurvy, and in groups of two he administered cider, sulphuric acid, vinegar, seawater, oranges and lemons, and a spice paste washed down with barley water. The sailors who took citrus fruits made good progress, but the other participants did not make any progress, so Lind had evidence that citrus fruits worked to help those sailors recover from scurvy. Notably, there was a small, incremental improvement in the health of those sailors who drank cider; no doubt there are other, wider health benefits that come from cider, but it was a reasonably clear trial. Although it took many years, the Royal Navy later adopted the approach of compelling sailors to take lemon juice initially, and lime juice later on, to protect against scurvy. That is why American sailors began to call British sailors “limeys”.

Clinical trials have evolved substantially since that time. In 2017-18, there was a record number of participants and trials in the UK. It is so important, not just for people’s healthcare but for the life sciences sector of which clinical trials are such an important part, that Britain wants to maintain that position. People find fascinating, incredibly rewarding jobs in that sector.

As in all things, all sectors and all times, funding is of immense importance, and we have to ensure that our clinical research environment is properly funded in a number of different ways. My favourite part of the 2017 Conservative manifesto was the commitment to increase research and development spend in the UK from 1.7% to 2.4% of GDP by 2027. That is an important target, taking us up to the top quartile of OECD countries. The scientific community more broadly would like to see that increase as a stepping stone to a target of spending 3% of UK GDP on R&D. That would really enhance our position, which is world-leading at the moment; however, in an increasingly competitive world, we need to focus and enhance that contribution.

In the previous Parliament, I was a member of the Select Committee on Science and Technology, which was a very positive Committee. There was a huge amount of consensus across the party divide about the agenda that we wanted to set and pursue, and an important agenda to increase our R&D spend came out of that Committee. It was very positive to see that commitment in the 2017 Conservative manifesto; however, we have to deliver on it. At a time of funding challenges across all Departments and all areas, we have to maintain that level of investment.

It is important to recognise the Government’s commitment, outlined in the life sciences sector deal 2, with the Government working in conjunction with industry to strengthen further the environment for clinical research in the UK, and the infrastructure for the safe and responsible use of patient data through the digital innovation hub programme. We should also recognise the contribution that can be made to the continued development of the National Institute for Health Research, which should receive an uplift in line with the increases to funding through UK Research and Innovation, as recommended in the life sciences industrial strategy.

There are also further considerations when it comes to funding, such as whether the UK will fully participate in the EU’s flagship framework programme 9. At the moment, we participate fully in Horizon 2020; we are committed until the end of that project, and to any ongoing research projects beyond the end of that programme. However, we do not yet know whether the United Kingdom will participate in Horizon Europe, either fully or partly, post Brexit. That is a huge concern to so many people from the scientific community, as it is for many sectors and industries, not only because we want investment in buildings and laboratories and the development of skills and talents in the UK, but because we want to bring in people from abroad. People need that confidence. This is not just about funding, which is immensely important, but about the networks, the communications and the community that go with participating in that group.

I am certainly sympathetic to the idea that Brexit, no matter how well we deliver it, will be a challenging time for the United Kingdom and for organisations, whether in the charitable sector, business or academia. Delivering a healthy research clinical trials environment post Brexit will pose a challenge, and if we could make a commitment to—or at least express sympathy towards—our participation in Horizon Europe, the scientific community would appreciate being given that kind of confidence.

Funding is of great importance, and that topic may be further developed by other hon. Members present, but regulation is also an enormous priority for the UK. There is perhaps no other area like life sciences, clinical trials and the wider research community; it is such an international undertaking. Often, clinical trials are UK-only, but in many cases—especially those that deal with rare and very rare diseases, or with paediatrics—the potential population within the UK may be too small to deliver an effective trial. Nearly 30% of Cancer Research UK’s clinical trials involve an additional EU member state, showing the importance of international collaboration to that organisation. More widely, 50% of all UK cancer research is international.

The global direction of travel is towards the harmonisation of regulations and standards. The EU-UK relationship is of immense importance; it makes it easier and faster to set up trials, and to deliver on the conclusions of those trials. It would be useful if the Government could highlight what they were doing with regard to the clinical trials regulation, which is superseding the clinical trials directive. There is a concern in this. One concern that I have with the EU is that it can be slow to advance and assess what it has done, where it is and how it needs to move on. The clinical trials directive was first developed in 2001 and implemented in 2004. The decision to change, and that the regulation should supersede the directive, should have been taken in 2016, but there have been delays from that time. There is an ambition to deliver the regulation later this year, but there is concern as to whether that will be achieved. I appreciate that the Government’s position is that they will seek to fully participate in the regulation and adopt it wholly, but that is only part of what needs to be done.

Data from the trials will be collected in a variety of countries. While we may be able to contribute our data, there is no guarantee that we will be able to access that data in that international network post-Brexit. It is immensely important that we have certainty that we can use the portal post-Brexit and access the data to ensure that our scientific community has that information. It is an important part of providing confidence and a strong ongoing position for our research community.

Mobility of people is immensely important. It truly is a global undertaking to have an effective life sciences sector and the clinical trials that go with it. The people who contribute to the sector are very mobile. Our charitable sector is incredibly strong—stronger than it is in many other countries—and is a huge asset. We can go to any charitable organisation, business or university and see a wealth of talent that comes not only from the UK but especially from the EU. We also have people from America, Africa and Asia. We have people from across the world, but our close physical proximity to EU countries lends itself to a large number of people from the EU coming here.

We have to value our relationship with EU nation states. Post-Brexit, we want people to be able to go to EU countries, because people leaving the UK to go to France or Germany make an immense contribution to those countries. There is huge value in the sharing of ideas. When people perhaps come back later in their careers, they have that wealth of knowledge that they can bring with them, which may be lost if we do not allow and support mobility. There is particular concern over the £30,000 income threshold that people coming to the UK would have to meet. There is ongoing debate about the threshold and whether it will stand and suggestions on how it will be amended. It is worth noting that it is a challenge for post-doctoral researchers and their research technicians, who may not be above that threshold. The threshold is more of a challenge outside London and the south-east, and other parts of the country and other nations within our United Kingdom will see a greater impact. The Government need to consider that.

We need to re-examine the costly and burdensome visa process. In 2008, it was estimated that a five-year visa for a researcher with a partner and three children coming to the UK would cost more than £11,000. The same researcher and family could obtain a four-year French talent passport for a little over £1,000. We do not want the UK to have barriers to people coming here, participating and making an enormous contribution. Immigration is a very sensitive subject for the country as a whole. It is positive that in the two or three years since the referendum vote in 2016, tensions or concerns have come down ever so slightly. There still is significant concern, which is a problem, but when I talk to people and raise the UK’s current approach or possible approach to immigration, they have immense pride in seeing our country as a destination for some of the most talented scientists and technicians from the EU and the wider world. They want to come to the United Kingdom and make an immensely positive contribution. We should be proud about so much in our immigration system and the people who come here. We should make more of how strong the scientific community is in the United Kingdom.

In my closing remarks, I want to highlight and repeat that the United Kingdom has a long and proud history of being a world leader in clinical trials. Not only were we the first nation to conduct one but we should be proud of the wealth of talent involved and the scale of our clinical trials. The Government are doing the right thing and are going in the right direction. We are being immensely ambitious with what we are doing for the future of medical research, but there are obviously challenges in making that a reality. Getting the regulatory framework is important, as is the immigration system. The national health service is immensely important as an organisation, but it is not quite playing up to its strengths and its potential with its data. That data is an incredibly valuable asset that is of increasing value as time goes on, both in how it can be used and how clinical trials can be held. Practitioners can access that data to develop the next generation of drugs to save lives and to enhance our lives.

We are going in the right direction, but more needs to be done. There are concerns about Brexit, but we can deliver a good relationship with the EU and the rest of the world. It can be a positive thing. The Government need to set out a more robust position. Academia and business in the UK want that, and I especially thank the UK’s charitable research sector, which does such an immense amount of good work. I highlight and thank Cancer Research UK, Parkinson’s UK and Breast Cancer Care.

[David Hanson (in the Chair)]

I thank the hon. Gentleman for introducing the debate. We now move seamlessly to the Front-Bench responses.

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[Jonathan Ashworth]

I think the hon. Gentleman beat me three years ago, although I have just beaten him this year.

[David Hanson (in the Chair)]

I didn’t run.

[Jonathan Ashworth]

I have not yet decided whether to run next year’s marathon, but should we decide to run, it would be great to have you running with us, Mr Hanson—or indeed the Minister.

Eurotunnel: Payment

David Hanson Excerpts

Monday 4th March 2019 Commons Chamber

[David Hanson (Delyn) (Lab)]

Was the Secretary of State for Transport advised by any officials that his decision to award a contract to Seaborne Freight would result in a challenge in the courts by Eurotunnel?

[Matt Hancock]

This is not linked to the Seaborne Freight contract; this is about ensuring that the contracts that are in place are able to deliver the unhindered supply of medicines in whatever Brexit scenario.

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[Mr Speaker]

Well, the Secretary of State has said what he has said, and colleagues will make their own assessment of it. I thank him for coming to the Dispatch Box.

[David Hanson]

On a point of order, Mr Speaker. The Secretary of State said in response to me a moment ago that the Seaborne Freight issue was nothing to do with this contract and the payment of £33 million to Eurotunnel, but it self-evidently and centrally is. Could you give me some advice as to how we can ensure that Ministers at the Dispatch Box who do not have departmental responsibility are better briefed and/or that the real Secretary of State comes to this House to answer legitimate questions on factual matters about which this Secretary of State does not know?

[Mr Speaker]

I think that the right hon. Gentleman’s question was more rhetorical than not, and there was not really a question mark at the end of it. I can only say, for my own part, that when discharging my duties to the best of my ability this morning, I was rather under the impression that the urgent question was about the cancellation of the contract on account of legal action and that it was to do with Seaborne Freight. It may be that my interpretation was notably eccentric, but I do not think so. I think I was pretty clear what it was about, and that my assessment was shared by the team that accompanies me at the 12 o’clock meeting on a Monday morning.

Healthcare on English Islands

David Hanson Excerpts

Wednesday 27th June 2018 Westminster Hall

[Stephen Barclay]

I am keen to work with my hon. Friend on that, because the Government have prioritised their research and development budget, as I know from my time at the Treasury. A significant investment has also been made in health R&D. The NHS has an opportunity to combine its patient data with our world-leading universities and R&D to attract researchers, drive forward the most innovative approach on healthcare and translate that cutting-edge research into day-to-day care. That can be a frustration for our constituents; it is fine to have the research, but we need to roll it out to scale in a way that is meaningful for patients. The challenge of the Island’s geography is also a huge advantage to it. I do not know what percentage of its patients are taking part in research, but that may be an area for him to explore and for the Department to work with him on.

My hon. Friend also raised the potential of digital. He will be aware that the Secretary of State has asked Dr Eric Topol, one of the world leaders on the use of digital in healthcare, to undertake a report for the Department. My hon. Friend is right that rather than a patient having to be physically present in all instances, as was traditionally the case, there is scope to use digital much more for them to see a consultant online and for information to be sent digitally. I recognise that if the clinical commissioning group is in deficit, finding the headroom to invest in that technology becomes a trade-off and a challenge, but that is one of the opportunities that will be opened up by the Prime Minister’s investment in the NHS and it is an area that the 10-year forward view will specifically examine.

In terms of timing, the Island has a chance to look at how it can become a leader, what has been done with digital enablers and early adopters in the NHS, and in which areas it can lead on in technology. I will come on to the challenges of travel, but reducing the need for journeys is a more sustainable solution than seeking to subsidise them. Our starting point should be how we can use technology to reduce the need for as many journeys, rather than how we can subsidise more journeys. That offers significant scope.

On travel, I heard my hon. Friend’s remarks about the cost and its wider impact on families. There is a correlation with a separate debate we have had about car parking charges. Clearly, there are specific challenges related to travel, but as he also set out, it is quite complex, because there are already arrangements with the ferry companies and national schemes for subsidies and assistance that can be given to people who are financially challenged. It is a question of looking at how we can fit in with the existing schemes and what agreements can be reached with the companies concerned. I am happy to meet him to pick up on that specific point to better understand our current approach and what can be done, given the challenges. Again, the challenge of distance is not unique to the Island, but as he mentioned, there are certain features of travel to the Isle of Wight and the Scilly Isles that pose challenges.

As my hon. Friend will be aware, the NHS healthcare travel cost scheme provides financial help for travel costs for patients on low incomes who are referred. The scheme is part of the NHS’s low-income scheme, under which people are also entitled to free prescriptions and glasses. Under the scheme, the full cost of transport can be reimbursed by the NHS to eligible patients. Schemes are in place, but I hear the wider points that he has raised and I am happy to discuss them with him.

In short, my hon. Friend has set out that the Isle of Wight is ideally placed to be at the vanguard of the NHS’s approach as we move forward with the 10-year forward view, in embracing digital and integration and in looking at how to deliver place-based commissioning most effectively. There are some specific challenges with regard to its population and its geography in terms of travel. The interplay of those two things is another challenge in terms of efficiencies of scale and the services that are considered essential on the Island, which may be dealt with at a larger-population level elsewhere.

In the NHS more widely, as we move to a hub-and-spoke model and to more flexible population sizes, and as we look at place-based commissioning, the Isle of Wight has huge potential to be at the forefront, as my hon. Friend has set out. I am very happy to follow up this debate by meeting my hon. Friend, and to facilitate a discussion between him and NHS England, to ensure that we deliver what he has campaigned passionately for—the best healthcare for residents of the Island—and that the significant investment set out by the Prime Minister is maximised for his constituents.

The shadow Minister quite reasonably asked whether we were open to changes to the legislation. As he will be aware, the Prime Minister said to the NHS leadership in her remarks at the Royal Free Hospital that we are open to such suggestions if NHS leaders feel that changes are necessary. As part of the workings of the long-term plan, those leaders will need to look at what they need, and whether much of the integration—I know that the Mayor of Manchester supports the integration that is taking place in Manchester—can be done under existing legislation, or whether changes are needed, and if so, what those are. That will be part of the discussions with Simon Stevens and others in the weeks and months ahead.

[David Hanson (in the Chair)]

The hon. Member for Isle of Wight has the opportunity to make any concluding comments, should he so wish.

Fortified Flour

David Hanson Excerpts

Wednesday 16th May 2018 Westminster Hall

[Several hon. Members rose—]

[David Hanson (in the Chair)]

Order. I intend to call the Scottish National party spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), at 5.10 pm. Three hon. Members wish to speak before that, so will they split the remaining time accordingly? I call Stuart C. McDonald.

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[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hanson; I think it is the first time I have had such a pleasure.

I thank my hon. Friend the Member for Pontypridd (Owen Smith) for securing the debate and for his eloquent speech. As always, he showed his knowledge and passion on this important topic. I also thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks for the Scottish National party and mentioned that the Scottish Government have looked at this policy and, as I understand the situation, concluded that it was impossible to bring in fortified flour on a Scotland-only basis because of the fluid nature of the UK food industry and the very fluid nature of flour. I therefore think it is definitely time that the UK Government looked at this issue again.

I thank the right hon. Member for Belfast North (Nigel Dodds) for his brave and personal speech, and I thank my hon. Friend the Member for Newport East (Jessica Morden) and the hon. Members for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) and for Strangford (Jim Shannon) for their excellent contributions to the debate. Finally, I add my thanks to my hon. Friend the Member for Redcar (Anna Turley), who raised this matter last week during Health and Social Care questions.

As we have heard, this issue has been on the table for decades now, and it is only right that it continues to be brought up at every possible opportunity. The UK Government continue their policy of voluntary folic acid supplementation for women of childbearing age, despite the evidence and the fact that the latest National Diet and Nutrition Survey states that 91% of women of childbearing age have a red blood cell folate level below the level estimated to lower the risk of NTDs. I therefore ask the Minister what he is doing to encourage women of childbearing age to take folic acid supplements. Additionally, what steps is his Department taking to ensure that women of childbearing age even know that they should take those supplements?

Incidentally, this was something that I was aware of when I was having my children 25 years ago. We think things have moved on, but my young researcher in my office said that she only found out about it when she was researching for this speech. So, the message is not out there—not everybody knows this information. The voluntary approach means that, more often than not, those who do not need the supplements will take them, whilst those most at risk will miss out. Young mothers and those from the most socioeconomically deprived areas are least likely to take supplements. What steps are the Government taking to ensure that these groups of women are included and reached?

I am sure that it will not come as a surprise to the Minister that as many as 40% of pregnancies are unplanned, and that means that many women will not have been taking supplements during the crucial phase, just before or just after conception. It therefore makes sense for flour to be fortified with folic acid, to ensure that women get the nutrients that they need in order to reduce the risk of NTDs. That already happens in over 80 countries worldwide, including the United States, Canada and Australia.

Currently, no countries in the European Union fortify their flour with folic acid. However, there is no legislation preventing any of them from doing so. Given the UK’s research on this matter, I believe that they are waiting for us to lead the way, and as we have heard, I believe Scotland is probably doing just that. Why are the Government not therefore taking the opportunity to lead the way and reduce NTDs, not only in the UK but, in turn, across Europe? I understand and sympathise with concerns about adverse effects that this may have on the population. However, there really is no evidence to suggest that from other countries that have fortified their flour with folic acid for many years.

I also note the response of the Parliamentary Under Secretary of State for Mental Health and Inequalities from Health and Social Care questions last week:

“We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems”.—[Official Report, 8 May 2018; Vol. 640, c. 537.]

However, the modelling undertaken by Food Standards Scotland in 2017 indicated that fortification at the recommended levels, with a capping of voluntary fortification and supplements, can achieve the reductions in NTD risk without increasing the number of people consuming the upper recommended limit. Has the Minister made any assessment of that finding, and could he stipulate where his advice is from? Finally, has the Minister’s Department made any assessment in the last five years of the benefits of fortifying flour with folic acid?

From this afternoon’s debate it is clear that there are benefits to the mandatory fortification of flour with folic acid. I really do hope that the Minister will take all of this away with him today back to his Department and reconsider this policy—unless, of course, he is going to announce that he is going to fortify flour forthwith.

[David Hanson (in the Chair)]

I call the Minister, Steve Brine.

Austerity: Life Expectancy

David Hanson Excerpts

Wednesday 18th April 2018 Westminster Hall

[Louise Haigh]

I am glad that my hon. Friend raises that important point, because I am not able to address all the factors behind declining life expectancy. The British Medical Association raised that point this week, saying it is very concerned about the 5 million children growing up in poverty and the implications that that will have in the future on life expectancy.

[David Hanson (Delyn) (Lab)]

I do not want to divert my hon. Friend from the main course of her speech, but she knows that, over the past 30 years, infant mortality has fallen by 60%, yet from 2015 onwards it has risen in England and Wales each year. Holywell Central and Flint Castle wards in my constituency have child poverty rates of 43% and 42%. We have seen an increase of 100 children in poverty in my constituency in the last year. This is a long-term issue, which we need to address.

[Louise Haigh]

My right hon. Friend is absolutely right: these are long-term issues, which need addressing. They are all the more heartbreaking because we have seen decades of progress, and we all assumed that that would only go in one direction; little did any of us imagine that we would see a rise in infant mortality in the sixth-richest country in the world. These figures are, quite frankly, inexcusable.

On social care, care homes in deprived communities often no longer receive enough to cover the costs of care, which inevitably compromises the quality that they are able to provide. For those in such communities who cannot afford private care homes, that reduction of quality, and in some cases the lack of any available residential care at all, has had a punishing effect.

All Members present will have received casework regarding those still in their homes in the community who rely on care packages. Their care is simply unacceptable, relying on care workers who are paid far too little and who often do upward of 25 care visits every single day. There is not a chance, even by unsustainably drawing on the boundless good will of those care workers, that visits could last for 30 minutes, as defined by official guidance. It is beyond the realms of possibility. Those millions of hours of lost contact time for the 470,000 vulnerable—predominantly elderly—people who use home care will have undoubtedly compromised their long-term care and support needs and the management of multiple conditions.

It perhaps should not be a surprise that the rise in mortality and the fall in life expectancy came from precisely that cohort—older women living alone in poorer areas. In many senses, they were the early-warning sign of the deeply troubling trend in increasing mortality. This cohort, more reliant than any other on a functioning, effective, compassionate state providing quality support, have been badly let down in recent years. It should be a source of national shame that elderly women in some of the most deprived areas of our country are living in isolation, not properly cared for, and are losing their lives because the state has not supported them. However, it is not just that cohort of women. Some 7% of the extra deaths in 2016-17 were of people aged between 20 and 60. Almost 2,000 more younger men and 1,000 more younger women have died than would have if progress had not stalled.

I am sure that the Minister cannot look at the evidence presented here today, or at the research undertaken over the past two years, and not want to take steps to tackle those shocking statistics and to prevent those lives from being cut short. It is therefore critical that Ministers and the Government take seriously the fall in life expectancy and the evidence behind the growth in mortality. Up to now, Public Health England has regrettably tried to attribute it to the greater prevalence of flu. However, as Loopstra noted in her report:

“If Public Health England’s attribution of rising mortality to cold weather and flu is correct, then it should lead to an elevation of mortality in regional swathes across the nation. However…trends have varied considerably across local authorities, with no apparent geographic patterning consistent with regional outbreaks.”

The rise in unexpected mortality and the concurrent fall in life expectancy represents a significant moment in the history of public health in this country, yet the Department of Health has so far rejected the call from public health professionals for an inquiry into the sharp rise in deaths. I repeat that call today, and ask the Minister to look very seriously at the evidence presented on the link between life expectancy and austerity.

I will end on the words of Danny Dorling and Stuart Gietel-Basten, who have undertaken so much of the research in this area:

“demography is not destiny. Projections are not predictions. There is no preordained inevitability that a million years of life need be lost…but only through politics comes the power to make the changes that are now so urgently needed.”

The Minister has that power in her hands, and there can be no more pressing question for her than to ask why the citizens of our country are dying sooner than they should. I hope she leaves no stone unturned in pursuit of that answer.

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[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to see you in the Chair, Mr Paisley. I thank all hon. Members who have contributed. Clearly, we all want the best possible outcomes for all our constituents, and it is in that spirit that we approach this debate. I congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing the debate. I know her constituency well. Actually, looking at hon. Members opposite, I know the constituency of the hon. Member for Lewisham, Deptford (Vicky Foxcroft) well, also. That really brings into stark relief some of the issues we are talking about, because at the heart of the issue of life expectancy is the issue of inequality. I can speak from personal experience in my own constituency. The hon. Member for Washington and Sunderland West (Mrs Hodgson) talked about the differences between north and south, and rich and poor. Within my constituency there is a 10-year difference in life expectancy in the two-mile trip from the north of my constituency to the south, where it is poorest.

We are all acutely aware that inequalities lead to lower life expectancy. It would be a poor Minister for Health—indeed, a poor Member of Parliament or anyone involved in public life—who did not think that was important. It is important that we address it and we are determined to do so. I will run through some things, which tell a better story than the stark figures we have heard today. I will also address some of the points made about those figures, because I think it would be premature to draw too many conclusions at this stage about the causes of those and whether this is a long-term trend.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) also made some wise points. Ultimately, we can only spend what we collect from taxpayers. We are having an active debate on the extent of the funding we need to make available for health and social care. In this 70th anniversary year of the founding of the NHS, it is appropriate to focus on that. We will continue, notwithstanding the fiscal challenges that we face, to prioritise spending on health.

It is important to emphasise that this dip in life expectancy is not unique to the UK. We have seen it elsewhere in Europe. We need to be circumspect about drawing too much by way of conclusion.

The hon. Member for Washington and Sunderland West mentioned the Prime Minister’s speech. I want to supply the context of the Government’s approach against the background of that speech. The Prime Minister made it a priority to fight injustice and inequality. Ultimately, we know that by focusing actions on the people, communities and localities with the greatest needs, we will achieve the best health outcomes. As the hon. Lady said, we will also reduce long-term demand on the NHS and social care services, so it is smart to focus our strategy on tackling inequality.

We need to be honest about facing up to what the sources of inequality are. Sometimes, those will make us uncomfortable. One of the most disadvantaged groups in our society is those with learning disabilities. They will live 20 years less than the rest of us. For me, that is a very uncomfortable truth to live with. Successive Governments have tried to direct resources to help that group of people, but it is still not working. That leads to the realisation that this is as much about behaviour and leadership as it is about money.

[David Hanson]

Putting that aside for one moment, could the Minister explain to Members of the House why infant mortality rose for the first time in 30 years in 2016 and 2017? If it is not linked to the issues that my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) mentioned, what is it linked to?

[Jackie Doyle-Price]

The right hon. Gentleman knows that we have made tackling that a priority. It is too early to draw any conclusions. It is the case that poverty is a big source of inequality, but we need to do more work before drawing conclusions. Having developed the evidence, we will act. There is a reason that we have developed a national maternity safety strategy. There is a reason we are focusing resource on the perinatal phase, because we recognise it is critical. We will also continue to spend money on the healthy living supplements to give children a better start in life and to tackle some of those inequalities.