Junk Food Advertising and Childhood Obesity

Gregory Campbell Excerpts

Tuesday 16th January 2018 Westminster Hall

[Maggie Throup]

I agree completely. We need to consider prevention, cure and treatment. It is a huge problem, and it will not go away unless we tackle every aspect of it. The hon. Gentleman makes a good point.

The debate in Parliament on the impact of junk food, by which I mean food high in fats, salt and sugar, is not new. I talked to somebody just last week who gave me the insight that we have been discussing it for getting on for 15 years—probably more than that, if we backtrack even further—and we still do not have the courage to ban the advertising of products with such a major impact on the health of our nation and our future generations.

Recently, the Select Committee on Health held an inquiry and produced a report, “Childhood obesity—brave and bold action”, followed up in a short report early last year. Both reports contained a strong call for a ban on junk food advertising before the 9 o’clock watershed, yet that was sadly missing from the Government publication “Childhood obesity: a plan for action”, introduced in August 2016.

I am delighted that new rules on advertising were introduced by the Committee of Advertising Practice in July 2017—their impact is still being analysed. The rules banned the advertising in children’s media of food or drink products high in fat, salt or sugar. The restrictions now apply across all non-broadcast media, including print, cinema, online and social media, but that does not solve the problem. In 2015, Public Health England recommended extending current restrictions to apply across the full range of programmes that children are likely to watch, rather than limiting them to children-specific programming. Yes, restrictions apply to advertising high fat, salt and sugar products during prime time, but only when the audience is made up of 20% children or more.

A recent study commissioned by the Obesity Health Alliance found that 59% of food and drink adverts shown during family viewing time would be banned from children’s TV, yet hundreds of thousands of children are exposed to them every week. In the worst-case example, children were bombarded with nine adverts for products high in fat, salt and sugar in one 30-minute period. Adverts for fast food and takeaways appeared more than twice as often as any other type of food and drink advert, while adverts for fruit and vegetables made up just over 1% of food and drink adverts shown during family viewing times. The study also showed that the number of children watching TV peaks between 7 pm and 8 pm, definitely not when children-only programmes are shown.

Although I recognise that advertising restrictions in the UK on high fat, salt or sugar products are among the toughest in the world, we need to be even tougher. The childhood obesity plan published by the Government in August 2016 states that it is only the start of the conversation. This debate aims to help continue that conversation and focus on other measures that the Government can take to stop and reverse the obesity epidemic.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Lady on securing this debate, which is similar to one that I secured six years ago in Westminster Hall. The situation has worsened considerably in that time. Does she agree that the plan that she just elaborated on needs action points from the Government along the lines that she has intimated? We need outcome targets so that the next generation of children will see a significant improvement, rather than the deterioration in the current generation.

[Maggie Throup]

I agree completely, and I thank the hon. Gentleman for that intervention. I was always taught that measures put in place with no targets or goals to meet are meaningless. We need to know where we want to be, and by when.

Oral Answers to Questions

Gregory Campbell Excerpts

Tuesday 19th December 2017 Commons Chamber

[Jackie Doyle-Price]

I thank my hon. Friend for sharing that very moving case. We have no evidence at this stage that those drinks cause such outcomes, but we know that all stimulants, whether alcohol or caffeine, have consequences that can affect people’s mental health. That is something that bears examination.

[Mr Gregory Campbell (East Londonderry) (DUP)]

What discussions is the Minister having across the United Kingdom to ensure that best practice in dealing with suicide rates, and in particular the escalating rates in the regions of the UK, can be replicated across the United Kingdom as a whole?

[Jackie Doyle-Price]

I am always keen to learn from areas of the United Kingdom where things are going well. As the hon. Gentleman will be aware, our suicide prevention strategy is very much rooted in local prevention plans. Although 98% of the country is covered by those plans, we really want to do a proper audit of how good they are. That will enable us to share best practice across the nations.

Drug Addiction

Gregory Campbell Excerpts

Wednesday 22nd November 2017 Westminster Hall

[Craig Mackinlay (South Thanet) (Con)]

I beg to move,

That this House has considered the human and financial costs of drug addiction.

This is an expansive subject, with a huge number of facets, and is covered by a huge amount of UK and international data. Pleasingly, two Members raised drugs issues at Prime Minister’s questions today. They probably sought to steer us towards their views about liberalisation and legalisation, which I must say are somewhat the opposite of mine.

I thank the Minister for being here to respond to the debate. This issue cuts across many Departments. It is not just a health issue; it cuts across policing, justice and home affairs, health, border matters and education, and it is even an issue for the Treasury. I thank the many organisations that supplied data and their interpretations in advance of this wide-ranging debate, including the Royal College of Psychiatrists, Release and the House of Commons Library, which has considered data from a huge variety of sources.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing this debate. He talks about data. Does he agree that the information from the Library about the increase in male mortality from drug misuse, particularly in the past five years, is alarming and demonstrates the urgent need not only for this debate but for action to be taken after it?

[Craig Mackinlay]

The hon. Gentleman highlights one of the key tenets of my speech. I am most concerned about death rates.

I thank the Library for its diligent service; it is an invaluable source of information. I also received information from Smart Approaches to Marijuana, or SAM, a US agency that has done a lot of work on how decriminalisation of cannabis in particular has affected various states in the United States. I consulted papers by the National Treatment Agency for Substance Misuse and by the Advisory Council on the Misuse of Drugs, and the National Audit Office evaluation of the Government’s 2010 drugs strategy, which is a seven-yearly document. I also consulted the Government’s July 2017 drugs strategy.

The real trigger for me calling this debate was the rising death toll in the USA due to the use of opioids and their derivatives—notably fentanyl, with which I am sure many hon. Members are familiar—whether they are legally obtained or illicitly produced. Some 64,000 drug-related deaths were recorded in the US in 2016, an increase of just over 21% from the year before. There was a 33% rise in one year in the state of Ohio alone. There were 4,050 deaths in Ohio, which has a population of just 12 million. To give Members an idea of scale, the entire US military losses over the 20 years of the Vietnam war were a fraction under 60,000. Scaled up to the UK population, Ohio’s current death rate would represent 22,000 deaths in the UK each year. Thankfully, the figure here is lower; according to the last reported data, there were 2,677 deaths in 2015.

Medicines Regulation

Gregory Campbell Excerpts

Tuesday 21st November 2017 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Bishop Auckland (Helen Goodman) on securing the debate and on introducing the topic in such a comprehensive manner.

This debate is both timely and hugely important. It is timely due to the announcement yesterday that Amsterdam is to become the new home of the European Medicines Agency when it leaves London—a relocation that is necessitated by our departure from the EU, and which also symbolises the changing regulatory environment—and it is hugely important because, although the word “medicine” conjures up images of bottles of cough medicine being bought over the counter, it encompasses the whole range of drugs and pharmaceutical products used to treat the many different illnesses, diseases and chronic conditions that could affect each and every one of us over our life course.

If we think the EMA leaving London is bad, the potential implications of the UK leaving the EMA are far worse, and we should be clear—leaving the EMA is precisely what the Government envisage happening. As the Health Secretary said when he appeared before the Select Committee on Health in January this year, he does not expect us to stay in it. The Prime Minister’s ideological red line on European Court of Justice jurisdiction makes it impossible. The loss of 900 jobs and all the associated economic activity brought to our country as a result of the EMA being headquartered in London pales into insignificance when we contemplate the possible consequences of withdrawing ourselves from the EMA’s pan-European drug-licensing processes and its supervisory and compliance mechanisms, which have a key role in ensuring that medicines on the market here are safe and effective.

The Government have given little information about how their desired future close co-operation with the EU might work on medicines regulation. Indeed, as recently as July, the chief executive of the Medicines and Healthcare Products Regulatory Agency, the national regulatory body that works alongside the EMA in the UK, suggested that two options were being considered by the Government. One is a partnership approach, where presumably the UK would seek to mirror future EU authorisations in order to maintain regulatory equivalence going forward; the second is a stand-alone system, whereby the UK could diverge from EU regulations, perhaps aligning itself more closely with American, Australian or Canadian systems.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Would the hon. Lady agree that, whatever route the Government decide to take, one of the things that we must protect—this was alluded to earlier in the debate—is the excellence of the research and development facilities that we have across the United Kingdom? That must be paramount in the considerations by the Government, as we go beyond March 2019.

[Heidi Alexander]

I agree with the hon. Gentleman, but when I speak to scientists at institutions across the UK, they are already seeing the effect of last year’s referendum result in terms of EU-wide partnerships being withdrawn and being harder to secure.

It would be helpful if the Minister could update us on which of the two approaches the chief executive of the MHRA talked about in July the Government now favour. It would also be helpful if he could tell us what discussions he has had with Ministers in the Department for Exiting the European Union or with the EU negotiating team about future co-operation on medicines regulation. Has the Minister or anyone from the Department of Health had contact with Australia and New Zealand about potential alignment with their regulatory systems?

I have a lot of questions for the Minister today. Can he be clear about the Government’s plans for the so-called transition period that the Prime Minister thinks will follow the conclusion of the article 50 negotiations? After all, it is a mere 16 months away. If pharmaceutical businesses will have to deal with only one set of changes, as the Prime Minister promised, presumably the licensing arrangements for new drugs will stay the same for that period.

I see two main problems in setting up some sort of stand-alone replica system to fill the gap vacated by the EMA if we leave the EU. First, will UK patients get the same quick access to new innovative drugs that come on to the market? Secondly, will UK patients benefit from the same high levels of safety and compliance checks that the EMA currently performs for already-authorised medicines in its role in enforcing standards in the pharmaceutical manufacturing process and at clinical trial sites?

I fear that we could see delays in new drugs being launched in the UK. If a small pharmaceutical company has to choose between paying to get a licence in the EU, which accounts for 25% of the global pharmaceutical market, and paying for one in the UK, which accounts for 3% of the global market, which will it choose? The UK is currently a priority location for launching new innovative treatments, but how long before we become a second-tier country?

What guarantees can the Minister give about the next phase of immunotherapies, which are three to four years away from coming to market? They are potentially twice as effective as current immunotherapies and could give cancer sufferers an extra three to four years of life. Will UK patients in a post-Brexit regulatory environment get them as quickly as they would if we were still part of the EMA? Can the Minister guarantee that adverse effects among uncommonly used drugs will be picked up as quickly if the expanded patient pool that would be available for checks across the EU is limited to the UK? Will the UK still have access as quickly to orphan drugs to treat the rarest of diseases, for which pharmaceutical companies have less of an incentive to develop products? What about the participation of UK patients in pan-European clinical trials, which are critically important, full stop, but all the more so for rare diseases and illnesses in children, for which the patient pool is smaller? At the moment, a quarter of cancer research clinical trials involve one or several European countries. Will we comply in the future with the new EU clinical trials regulations, which have been postponed and may not be implemented until March 2019?

The Minister needs to answer many questions if the Government intend to diverge from European processes, but there will be basic problems no matter what new system is put in place. How much will all of this work to reinvent the wheel and beef up our regulatory bodies cost? Will we have to ask UK taxpayers to pay a greater amount for this process, given that we currently share the cost with 27 other member states? What preparatory work has the MHRA done to ascertain what the impact of leaving the EMA will be on both its income and its future staffing requirements? What training of staff will need to be done so they can take on responsibility for tasks they have not previously performed? What impact will the relocation of the EMA have on medicines regulation across the whole of Europe?

I read the EMA’s Brexit preparedness business continuity plan yesterday, and I admit to having a feeling of utter shame about the disruption that our decision to leave the EU has forced on that agency. The huge upheaval will undoubtedly have an impact not just on this country but on others, too. As anyone who has ever moved office knows, projects get put on hold and the basics become harder to deliver.

There are so many questions to ask, and I am sure I have not touched on even half of them. I would like to finish with some more general observations. In 10 years’ time, when we have delayed access to new cancer treatments, compared with, say, France or Germany, will the fact that we have blue passports make up for it? Children with rare diseases will not be able to get new drugs as quickly or easily as they can now, but is that a price worth paying for coming out of the jurisdiction of the ECJ? This is all utter madness. Ministers can bang on about creativity in the negotiations all they like, but we need certainty and clarity. Pharmaceutical companies and patients need certainty and clarity, and the mums and dads of seriously ill children need that, too.

Oral Answers to Questions

Gregory Campbell Excerpts

Tuesday 14th November 2017 Commons Chamber

[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.

Vaping

Gregory Campbell Excerpts

Wednesday 1st November 2017 Westminster Hall

[Gareth Johnson]

I am not aware of that report, but I think there is an inherent problem with pregnant women today having to wait three years to make that decision. My gut feeling is that the best approach would of course be for pregnant women not to smoke anything at all—not to smoke any tobacco products, and not to vape. I am not qualified to say whether it is beneficial for pregnant women to vape instead of smoking if they are unable to give up tobacco, so I would not want to comment on the report the hon. Gentleman mentions, but it throws up interesting questions. That is why I believe that this whole debate should be based on facts and evidence, rather than on an instinctive dislike of tobacco products that leads to lumping vaping in with them.

The British Lung Foundation has also commented on vaping:

“Given half of long-term smokers die as a result of their habit, using vaping to help someone quit smoking could literally save their life.”

The British Lung Foundation is also clear that vaping should not be seen as a permanent alternative to smoking or promoted to non-smokers, but nor should it be banned in public in the way that smoking is.

Public Health England famously—or famously in the vaping world—said clearly that it believes vaping to be 95% safer than smoking tobacco. The Royal College of Physicians and Action on Smoking and Health have chipped in with similar comments, so there is plenty of evidence that such products have potential, but they have to be judged on their own merits and should not be in the shadow of tobacco products. That is why, in my view, the EU tobacco products directive was wrong to incorporate vaping, which should have been dealt with separately.

That ludicrous approach is illustrated in the regulations that companies have to follow. If someone buys a vaping machine, the machine has to have a warning on it that it contains nicotine. The one I have here, which was sent out by a company called Totally Wicked, says,

“This product contains nicotine which is a highly addictive substance”.

They all have to comply with that requirement. The silly thing is, of course, that the machine does not contain nicotine—but it says it does, because it has to as a consequence of the EU directive. It contains nicotine only when e-liquid is added to the product; it is not included in the product. Companies have to put a caveat at the bottom of the product to say that the statement is not true, so that they do not get prosecuted under the Trade Descriptions Act 1968. That is one illustration of the ludicrous nature of an approach that lumps vaping products in with tobacco products, and that expects vaping organisations to act in exactly the same way as those involving tobacco.

The EU directive also imposes a requirement to sell e-liquid only in small quantities with a maximum of 20 mg of nicotine, which I understand some heavy smokers find insufficient. I do not want to turn this into a Brexit debate—we have enough of those taking place in the House of Commons at the moment; there are plenty on today and tomorrow, if anybody is interested—but we have to recognise that there is an opportunity after Brexit to depart from some regulations, where appropriate. I ask the Minister to put March 2019 in his diary, so that he can consider which of the regulations can be looked at again, are unnecessary or can be altered.

The rules on advertising are also inconsistent. An advert on a bus is fine, but an advert in a magazine or newspaper is not. The trouble is that it sends out a mixed message, which helps neither the public nor the industry and adds to the problem whereby increasing members of the public believe that vaping is potentially more harmful than smoking tobacco. That ultimately stops the benefits that do seem to exist, according to people far more qualified in the medical field than me.

Most people agree that there is a necessity for more evidence, and I am pleased that the Select Committee on Science and Technology is about to carry out an inquiry on vaping, which aims to collate the available information and give recommendations. I hope that it will look at studies on the health implications and give its view on which studies are the most and least credible. The public should not have to rely purely on whichever report is given the greatest prominence in the press. The inquiry will be important, but what is ultimately needed is more fully independent assessments of the health considerations around vaping.

The Government have launched a tobacco control plan, which I am sure the Minister will mention. I welcome the aim in that plan to reduce the number of people smoking in the UK, and it is to be welcomed that the usefulness of vaping is recognised in the plan.

To conclude, although vaping is not risk-free, it has been found to be a useful tool for millions of people who want to stop smoking. It should therefore be given the recognition it deserves. It has huge potential to save lives. I therefore ask the Minister to meet the vaping industry as soon as his diary allows, to discuss how vaping can be best utilised.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Before he comes to a conclusion, would he agree that part of the traditional problem with smoking has been that when the number of smokers declined and we got down to about 20%, it was then difficult to make further inroads? Similarly, if a third of smokers have still not moved to vaping, again we have the problem that we have reached the hard core of people on whom more work is needed. I also congratulate him on taking a responsible attitude to the issue of vaping, rather than endorsing people moving from non-smoking to vaping.

[Gareth Johnson]

The hon. Gentleman’s point does seem to be correct. Ultimately, if people want to smoke, are aware of the risks and are happy to take them, that is entirely their right as adults. I do not seek to dictate how people should lead their life. However, in my experience, most smokers do want to stop but find it very difficult to do so. That is why we should embrace the potential of vaping as an important tool in enabling people to give up. Patches, chewing gums and all those things—even a bit of willpower every now and then—are all very useful, but vaping potentially offers the most successful method for people to stop smoking, should they wish to do so.

We need an objective, logical and fact-based approach to vaping. In short, we should follow the evidence, which at present shows that it is an opportunity simply too good to ignore.

Oral Answers to Questions

Gregory Campbell Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I am happy to do that. Some interesting innovation is going on in many parts of the country. In Hove, a school I visited has a CAMHS––child and adolescent mental health services—worker based full-time in the school. That had a transformational effect, as it meant teachers always had someone they knew they could talk to and their understanding of mental health improved. That is the kind of innovation we want to encourage.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Further to that, what pressure and persuasiveness is the Minister bringing to bear in the education system, particularly in primary schools, where young people have, on occasion, had this kind of a diagnosis and problems have been created within the school environment?

[Mr Hunt]

This is a very important issue because, as the hon. Gentleman knows, half of all mental health conditions are diagnosed before or become established before people are 14, and the sooner we catch them, the better the chance of giving someone a full cure. We therefore need to find a way whereby there is some mental health expertise in every primary school, so we can head off some of these terrible problems.

European Medicines Agency

Gregory Campbell Excerpts

Wednesday 12th October 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate on a matter of great importance. May I congratulate the hon. Member for Cambridge (Daniel Zeichner) on securing it? As my party’s health spokesperson in Westminster, I have been contacted by pharmaceutical companies about this issue, and I will try to illustrate their concerns in the short time I have.

It was not difficult to predict the tone—I mean this respectfully—of those who are presenting a particular case about the EMA, given their concerns in relation to Brexit. I have a great deal of respect for Members’ opinions on Brexit, and while we must remember that the vote of each Member carries the same weight, I gently remind the House that the die is cast. The people have spoken, and the responsibility of ensuring that we are in the strongest possible position now lies with this House.

I very much welcome this important debate. It is interesting that while we are having this discussion in Westminster Hall, the main Chamber of the House is discussing parliamentary scrutiny of the UK leaving the EU. No doubt this issue will be brought up there. The EMA is one of the mountain of details that the Government must be aware of and plan for when we enter into negotiations for leaving the EU and establishing mutually beneficial trade agreements. The hon. Member for Cambridge set the scene clearly, and although we have different opinions on Europe and Brexit, I do not see any difference in what we are trying to achieve collectively on this issue. Our opinions, focuses and goals are similar, if not exactly the same. That is important.

I will begin with the statement made by the EMA after the referendum result in June. It made it clear that its work will continue as normal. As there is no precedent for a member state leaving the EU, the implications for the location and operation of the EMA are unknown. The EMA also stated that any decision about the location of the agency’s headquarters would be made by common agreement among member states.

The Brexit negotiation team—the Secretaries of State for Exiting the European Union, for International Trade and for Foreign and Commonwealth Affairs, and the Prime Minister—will need information to set out a strategy for dealing with this issue. The Secretary of State for Exiting the European Union and his team need the thoughtful consideration of those with an insight into this matter, so that they can strike the right way forward. It is important that we do that.

[Mr Gregory Campbell (East Londonderry) (DUP)]

The helpful debate pack we have from the Library indicates that the pharmaceuticals sector has unfortunately declined as a percentage of the economy in the past five or six years, when we have been in the EU. Does my hon. Friend agree that the outlook of every hon. Member, and throughout society in the UK, should be that we need to redouble our efforts to ensure that the line on that graph begins to go up, rather than continuing to decline?

[Jim Shannon]

I thank my hon. Friend for his comment. I was not aware until seeing the briefing pack that there had been a decrease in the pharmaceutical business over the past few years; I actually thought we were holding our own and moving forward. Brexit will give us the opportunity to move forward, so we should look positively upon where we are.

This debate is not simply an opportunity for remainers to highlight something that may be difficult to negotiate, with no desire other than to prove their opinion on Europe. There is nothing wrong with that—people have different opinions—but let us work together to ensure that we deliver.

Psychosis: Early Intervention

Gregory Campbell Excerpts

Wednesday 7th September 2016 Westminster Hall

[Norman Lamb]

I am grateful to the hon. Gentleman for his kind comments. I totally agree. There is an awful danger of a damaging gap emerging between the rhetoric and the reality. The coalition Government legislated for parity of esteem, so it is in the legislation that people should be treated equally, but unless the reality of people’s experience is that they are treated equally, the rhetoric is absolutely meaningless waffle and they lose trust in the Government. That is why I feel so passionately that we must do concrete things to make parity of esteem a reality for people, and that is an example of how we can make a difference to people’s lives.

The standard was announced in October 2014, to be implemented by April 2016—it had to be met by this year. Why is it so important? If we fail on that, we fail so many people whom we have the chance to help and surely it would be scandalous if the NHS neglected a standard accepted by Parliament and introduced by Government that we know makes a massive difference to people’s lives. It gives people the chance of a better life and surely the NHS is fundamentally about giving people the chance to have happy, good lives.

What has happened in that period? We undertook a comprehensive Freedom of Information Act survey—now that I am out of government, I have to rely on such surveys to find out what is going on—and the answers from clinical commissioning groups and mental health trusts are deeply troubling. On the key findings, first the overall conclusion is that the implementation of the standard is just fundamentally flawed. It has failed to deliver what we committed to. If the Minister, on advice from her officials, is tempted to refer to the nationally published data that suggest that the standard is being met, I would discourage her from doing so because the data are a fiction—we have established that through our work.

The first detailed finding is that there is a complete lack of robust commissioning in many parts of the country. The whole purpose of the commissioner-provider split, which of course is fairly controversial in the NHS, is that the commissioners hold the money and are there to design services for their community to meet the needs of that community, yet a third of CCGs could not identify how much funding had been allocated to early intervention in psychosis. That in itself is scandalous. They just say that there is a block contract and that it is up to the mental health trust—a total abdication of responsibility. Later, I will ask what the Government are doing about that, because that is not acceptable and completely contradicts the national guidance that was published.

Incidentally, I should say that one of the excuses used around the country for slowness of implementation is that the final guidance was published in April this year—when the standard was supposed to have been met. That does not demonstrate particularly helpful leadership from the centre. Having said that, the draft guidance had been in place for the best part of a year, so clinical commissioning groups around the country knew the direction of travel and could absolutely have been getting on with the job of preparing for meeting the standard.

When we did the survey back in May and June, well into the financial year, another 18 clinical commissioning groups—that is 11%—were still in negotiation for funding for early intervention in psychosis for a standard that was supposed to have been met in April. The question I will keep repeating is: why is that is not being treated with the same seriousness as the cancer standards? Why do we treat that as less important than someone suffering from cancer? I absolutely support and endorse the cancer standards, because it is critical that people with cancer get access to treatment quickly, but why should not someone with psychosis? It is scandalous. No one stands up for them. The Government have to lead on that. More than one in three clinical commissioning groups could not provide an estimate of the number of people in their area in need of early intervention services, in spite of the national guidance that says that commissioning should be underpinned by estimates of the local incidence to ensure that services are designed to serve the needs in a particular locality fully. If CCGs have no idea because no work has been done to establish the need in that area, how on earth can they commission a service to meet that need?

Next, according to NHS England, the estimated annual cost of providing the full package of treatment is about £8,250 per patient per year. Only 60 CCGs in our study were able to estimate their investment at all and only 11 estimated that they will meet the NHS England guideline on the level of investment. The average investment per patient from those who were able to say was £5,199, but of course an average hides the fact that many are way below that level. To draw an analogy, that is like saying to a cancer patient, “Well, you can have the chemotherapy but we can’t afford the radiotherapy, so you’ll have to put up with what we can offer.” Of course, we would never allow that to happen—the Daily Mail and many others would be up in arms, and they should be about this issue as well because the situation is exactly the same.

On age, which the hon. Member for Upper Bann (David Simpson) raised earlier, as I said in response to his intervention, the access standard is to provide the service to people between the ages of 14 and 65, in line, I should say, with guidelines from the National Institute for Health and Care Excellence, which has done the work and provided the evidence-based guidance. Almost a quarter of trusts—23%—commission services only up to the age of 35, including my own county of Norfolk. How on earth can trusts justify anyone over the age of 35 not getting access to a service that we have deemed it appropriate to provide to people across the country? They are just ignoring the national guidelines. Again, that seems to me to be completely unacceptable. That totally conflicts with the clinical commissioning groups’ responsibility. Out of the 39 CCGs which commission only up to 35, nine said they had plans to expand the service—they have plans, but why are they not doing it now?—and another 10 said that that was under review, but the rest had no plan to provide a service to people over 35. Outrageous, in my view.

Next is staffing and skill mix. We found a widespread failure to provide the full range of interventions required by NICE as part of the package of treatment, which is due to the shortage of staff with appropriate skills to deliver the service. Most trusts reported shortages of staff trained in cognitive behavioural therapy for psychosis and there were many other training shortfalls.

On data recording, NHS England introduced new information standards to support the monitoring of standards so that we could have some confidence that they were being met. Providers are expected to use electronic care record for patients to enable the collection of data and monitoring of performance against the standard. The guidance says that commissioners should assure themselves that local providers have made the necessary updates to the electronic care record system to ensure that clinicians are able to enter the data required to monitor performance against the standard, but we have heard that many trusts have not upgraded their systems and so are incapable of doing what is in the national guidance. We talked to someone who was at the heart of the implementation of the standard in one part of the country who mentioned widespread failure to do that. That means, as I said earlier, that the national data published by the information centre, which we are all supposed to rely on to tell us what is happening in the NHS, cannot be relied on. I put this point to the Minister: can the information centre investigate that further to ensure that the data it publishes tell a true story of what is going on?

There was also a scandalous variation between regions. I met the woman who has been responsible for implementation in the southern region. She was driving a programme of implementation and had a complete handle on the whole of her region. She had enormous variation of performance across her region, but there was someone in charge, doing it. She was an impressive woman. She told me that she was being made redundant; she was told that her job was done, even though palpably it is not. However, in other regions there has been no programme of implementation—no one in charge, to take responsibility for making things happen. The situation in the midlands and east in particular is in my view a disgusting, outrageous shambles, which should not be tolerated.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the right hon. Gentleman on securing the debate. On several occasions he has talked about this important matter in the context of the entire country; he is now discussing comparisons. Does he agree—I have raised this issue on a number of occasions, particularly on health matters—that we need to ensure that best practice is replicated not just in local commissioning groups in England, but across the United Kingdom? Ministers would then share information across the devolved settlements, to ensure that best practice was replicated and improved on for all our citizens.

[Norman Lamb]

I very much agree. We should all be learning from each other—and internationally, as well; but so often we fail to do that in the NHS. People on the outside may think that the NHS is a Stalinist organisation where everyone does the same thing. Far from it—it is too often anarchic. In the context of the NHS England infrastructure that we are considering, there are regions of the country that just have not done their job as they should have, which is scandalous.

Support for Life-shortening Conditions

Gregory Campbell Excerpts

Tuesday 7th June 2016 Westminster Hall

[Stuart Andrew]

My hon. Friend is right. I saw great advances throughout my time in the hospice movement. When I first joined Hope House, the life expectancy of the children who suffered from Duchenne muscular dystrophy was usually no longer than 18 or 19. By the time I had finished my career in the hospice movement, some were living into their late 20s and possible even their early 30s. Transition is incredibly important for them, because often the style of care provided is geared more towards the older generation than to young people.

Transition is incredibly important and centres such as Martin House, which I worked for, understand that. It built Whitby Lodge, a dedicated unit for teenagers and young people, which has state-of-the-art equipment designed to enable social interaction through things such as a mini nightclub—something that we all take for granted. As well as caring for children and young people in the hospices, members of the care team supported the family in their home. Even after a child has died, help is provided in the form of bereavement care for family members.

Transitioning to other services can sometimes present real difficulties. From dealing with new agencies and professionals, to transitioning to a completely different plan, the result can create quite severe gaps in service provision. The impact is, frankly, quite shocking, with 36% of families breaking down, 64% of mothers and 24% of fathers having to give up work entirely, and nearly 70% of siblings being bullied or feeling isolated at school.

All that can create a cocktail of problems that leads families into poverty. Therefore, at all times, it is vital that locally available, community-led children’s palliative care is at the heart of the service provision. These kinds of services are, thankfully, easier to find than they once were due to local offers and organisations such as Together for Short Lives, which provide directories of available services. That is just one example of how provision has changed since I began working in the hospice movement.

I will never forget seeing families, drained and exhausted, arriving straight from work or school on a Friday, the colour drained from their faces with no fight in them, dragging bulky equipment around in their car, when all they wanted to do was what we all like to do—go out for a simple meal on a Friday night. Great palliative care allows those families to have short respite breaks, the importance of which really cannot be overstated, because it provides support to everyone in the family. With the number of children and young people with life-shortening conditions increasing, it is becoming harder for the Government, the NHS and local councils to budget enough to meet those families’ needs, given that the number of people with such conditions is not being monitored, as the hon. Member for Torfaen (Nick Thomas-Symonds) mentioned. The complex care that such families need from multiple agencies and professionals is not joined up enough, and families have to fight with their last ounce of strength to get the services they need. I therefore ask my right hon. Friend the Minister what can be done to ensure that the number and needs of children and young people with life-shortening conditions are more accurately monitored.

Funding for voluntary sector providers of children’s palliative care is not being provided fairly or sustainably. It is limited to medical elements of care and does not include crucial non-clinical elements such as short breaks and bereavement support. Together for Short Lives expects to publish soon the results of a series of freedom of information requests it has made to clinical commissioning groups and local authorities. Those results will show the extent to which different elements of care are being commissioned, and I hope that colleagues from across the country will use those data to see how their own constituents’ care is performing.

Before that, I ask the Minister whether he can set long-term plans for funding children’s palliative care fairly, sustainably and in a way that reflects the growing demand for such services. Additionally, will he work with his colleagues to write to CCGs and local authorities to make it clear what their responsibilities are in commissioning palliative care? Local authorities have a duty to provide short breaks for disabled children. However, they are cutting funding for short breaks at a time when demand from seriously ill children is increasing. The Government and local authorities, of course, face a difficult situation in balancing budgets, and I fully understand the need for that to happen, but at the spending review the Government gave councils the ability to raise more money for adult social care through council tax. Children’s social care was left out and I struggle to understand why, so I would appreciate it if he expanded on that. Additionally, will he hold local authorities to greater account for the money they spend on short breaks for disabled children and ask them what action they are taking to secure access to such breaks?

As I have mentioned, without access to specialist adapted vehicles, which many families need and many of which I saw, families are unable to transport their seriously ill babies and young children to and from hospital. That often traps those babies and young children at home or in a hospital bed, preventing them from enjoying the things that we all take for granted. Children under three with life-shortening conditions are not currently eligible for the mobility component of disability living allowance, so will the Minister work with his colleagues in the Department for Work and Pensions to change the eligibility criteria so that nought to three-year-old children with life-shortening conditions, whose lives will end without heavy and bulky medical equipment, can have access to such important vehicles?

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does the hon. Gentleman agree that that single gesture would do more to transform the lives of many families than all the recommendations and assurances that we all want to give those families?

[Stuart Andrew]

I certainly agree. As I mentioned earlier, it was staggering to see the smallest child come with so much equipment to keep them alive. Larger vehicles enable such families to do the things that every family likes to do, for example to go out for the day. The lack of such a vehicle often creates more isolation for the siblings I mentioned a moment ago.