Health Council

Jane Ellison Excerpts

Tuesday 9th December 2014 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council met in Brussels to discuss health issues on 1 December. The UK was represented at the meeting by the UK Deputy Permanent Representative to the EU.

The Italian presidency provided a progress report on the medical devices regulations. Member states recognised the importance of making swift progress under the upcoming Latvian presidency. The UK underlined that it did not see the value in introducing an additional pre-market scrutiny mechanism.

Council conclusions were adopted on: vaccination as an effective tool in public health; patient safety and quality of care, including the prevention and control of health care associated infections and antimicrobial resistance; and innovation for the benefit of patients.

There was an exchange of views on the mid-term review of the Europe 2020 strategy, and the value of including health in the strategy. The UK argued against expanding the strategy to include health policy on the grounds that the management and delivery of health care is a national competence and stated that a strategy focused on jobs and growth would be the most effective.

Under any other business, the Health Commissioner gave an update on the work being done by the Commission to combat the Ebola outbreak. Spain called on member states and the EU to sign the Council of Europe Convention against trafficking in human organs. There was discussion on an agenda item tabled by Luxembourg which focused on the admission criteria for men who have sex with men (MSM) to donate blood. The Italian presidency provided information on the outcomes of conferences held during their tenure.

The incoming Latvian presidency discussed its priorities. There will be three overarching priorities: competiveness and growth, the digital economy, and the EU’s role in the global arena. On health, they will prioritise:

Healthy lifestyles;

the medical devices regulations;

the new EU alcohol strategy;

the upcoming Eastern Partnership conference on multi-resistant tuberculosis.

During the ministerial lunch, there was a discussion on Ebola. The UK outlined the action it had taken so far and encouraged other member states to make further contributions.

The Italian presidency also drew attention to the fact that the meeting coincided with World AIDS day.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 25th November 2014 Commons Chamber

[John Robertson (Glasgow North West) (Lab)]

7. Whether the Government have made a final decision on whether to introduce standardised packaging of tobacco products.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Government have not yet made a final decision on whether to introduce standardised packaging. We are carefully considering a large number of responses from the summer consultation, together with detailed responses from EU member states.

[John Robertson]

I thank the Minister for her answer, albeit a disappointing one. Given the majority support for standardised packaging in this place and the fact that elected Members have backed it, perhaps she could explain why the Government have not come to a decision? Will she consider having a debate in the House on the subject, with a vote that people can take forward so that they believe that this Government actually care about people who are trying to stop smoking?

[Jane Ellison]

We are taking this forward. Not everyone in the House may be aware that we are obliged to go through a process with Europe, whereby we notify this policy to EU member states and there is a statutory three months during which member states can give a detailed response. If any member state does so, there is a six-month pause. Four states—Bulgaria, the Czech Republic, Portugal and Romania—have given that detailed opinion, and the window has not yet closed. The House might be interested to know that Ireland received eight detailed responses on this subject. That is part of the process.

[Ian Paisley (North Antrim) (DUP)]

I welcome the Minister’s statement that she will wait for the evidence before moving forward rather than relying on emotion. She knows that the policy, if implemented, would threaten 1,000 jobs in my constituency. Furthermore, will she agree to await the outcome not only of the evidence from Australia but of the tobacco tax directive that is being pushed through Europe?

[Jane Ellison]

I am encouraged by the evidence from Australia. We have seen some really impressive statistics regarding the cessation of smoking. The Government have not yet made a final decision on the matter, but Health Ministers are on the record as saying that we are minded to move forward on this, and we want to make progress. I regret the loss of jobs in the hon. Gentleman’s constituency, but I know that he will be working hard to assist his constituents in looking for other employment.

[John Cryer (Leyton and Wanstead) (Lab)]

If plain packaging were introduced, what assessment has there been on whether that will make life easier or more difficult for the counterfeiters?

[Jane Ellison]

That is one issue that we will weigh up before making a final decision. Obviously, we received a large amount of evidence from the consultation, and we are looking at it in detail. Some of it was around that matter, although it is also the case that Sir Cyril Chantler made some robust statements in his report, rebutting some of the claims, but that is all part of the final consideration that the Government will make.

[Andrew Stephenson (Pendle) (Con)]

8. What steps his Department is taking to accelerate access to innovative medicine and health care technology in the NHS.

--- Later in debate ---

[Mr Speaker]

Order. On both sides of the House the questions have been too long. It is not fair on other Members who are waiting to contribute. Please cut it out.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I commend my hon. Friend, who, as many of us know, has worked enormously hard on a whole range of health issues in her constituency. In particular, I know that she has helped deliver the Winter Wellness programme with a number of local organisations. It is important to highlight what help and advice is available for people who need it most in order to stay warm. The Government’s cold weather plan has a series of cost-effective and simple measures that people can take to reduce the harm caused by cold weather.

[Andy Burnham (Leigh) (Lab)]

Two weeks ago, news emerged of serious problems at Colchester hospital. People there still do not know the precise details, as Ministers have not made a statement and the Care Quality Commission has not published its report. But Colchester is not the only hospital in difficulty; we have learnt that hospitals in Scunthorpe, Middlesbrough and King’s Lynn have been turning patients away and others are already on black alert, and that is before winter has even begun. We do not have an accurate picture of what is happening in the NHS right now, because NHS England was due to begin publishing weekly reports on 14 November but has failed to do so. Why has that information not been published, and will the Secretary of State today instruct NHS England to do so without delay?

--- Later in debate ---

[Ann Coffey (Stockport) (Lab)]

T5. Recent reports indicate that the extent of child sexual exploitation and abuse is more widespread than previously recognised. The trauma of sexual abuse can have massive, life-long consequences on the physical and mental health of victims. Will Ministers consider designating child abuse and child sexual exploitation as a public health priority in the same way as smoking, alcohol, drug use and obesity?

[Jane Ellison]

The hon. Lady is quite right to say that those are incredibly important issues, and we do see this as an important public health issue. We are committed to tackling child sexual abuse. In May the Department published its response to the recommendations of the independent health working group report on child sexual exploitation and we accepted the recommendations in full. We are taking this very seriously.

--- Later in debate ---

[Caroline Lucas (Brighton, Pavilion) (Green)]

Do Ministers agree that it is a scandal that cold homes are costing the NHS in England more than £1.3 billion every year, with kids growing up in cold homes twice as likely to contract diseases such as asthma? Do they also agree that it is hugely disappointing that not one penny of Treasury infrastructure funding is devoted to energy efficiency? Will they speak to their Government colleagues about that?

[Jane Ellison]

The hon. Lady will know from the answer I gave to my hon. Friend the Member for Truro and Falmouth (Sarah Newton) that the Government published the first fuel poverty strategy for England, which aims to address that very issue. It is also really important that all Members do everything they can locally to publicise the Government’s cold weather plan. Members can really assist local public health officials and their local NHS to get the word out to all communities about the simple measures we can take to keep our constituents warm and safe this winter.

[Charlotte Leslie (Bristol North West) (Con)]

One of the key challenges in improving access to GPs is improving recruitment of GPs. Will the Secretary of State work with the Royal College of General Practitioners and other medical groups to see whether there might be merit in introducing a mandatory stint of working in a GP surgery for junior doctors?

Breast Cancer

Jane Ellison Excerpts

Tuesday 25th November 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

May I begin by thanking my right hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke), not just for securing this debate, but, as has been rightly said, for her work throughout her parliamentary career and in this Parliament on this issue, and for the thorough and humane way in which she has introduced the debate? I congratulate her. We are lucky to have a very active all-party group on breast cancer. Unsurprisingly, my hon. Friend the Member for Winchester (Steve Brine) is in his place, as are other Members who are interested in and have engaged with this important subject.

I echo the words of thanks to the charities that operate in this area. I deal with many of them regularly and, like other hon. Members, have taken part in some of their fundraising and awareness-raising activities. They do great work and it is good that we have a regular opportunity to record our thanks to them.

As my right hon. Friend the Member for Mid Dorset and North Poole mentioned, the Government want to lead the world in tackling cancer, but we know that we are not there yet. As she said, the Government’s cancer outcomes strategy, which is backed by more than £750 million, set the ambition to save an additional 5,000 lives a year from cancer by 2014-15. That of course includes breast cancer.

One study alone has shown that we could save 2,000 additional lives each year from breast cancer if we matched the best European survival rates. That is quite thought-provoking in itself, but we are starting to close that gap. The NHS is treating more people for cancer than ever, and we are helping more people than ever to survive. Sometimes when people hear of large numbers being referred, they perhaps think that that is a sign of failure. However, we know that referral, particularly early referral, is so important, so large numbers being referred is in many ways a sign of success, because we are intervening and getting them into services more quickly. We also know that there is a long way to go.

[Steve Brine]

May I thank the Minister for thanking the three big breast cancer charities? Breakthrough, with support from the others, provides the secretariat for our all-party group. She will be aware of the work of CoppaFeel and its “Rethink Cancer” campaign. Treatment and survival are obviously critical—today’s debate is about that—but prevention is clearly better than cure. Will she take this opportunity to endorse CoppaFeel’s work in educating young women, and men, to spot the signs and symptoms of cancer early so that we can prevent primary breast cancers from developing in the first place? She will know that Kris, who runs CoppaFeel—she has a terminal diagnosis—is passionate about this, and has done so much to put it on the agenda for young women in this country.

[Jane Ellison]

I certainly pay tribute to all those who are trying to drive awareness of this issue. There are a number of very important campaigns. Prevention is so important; for example, it was good that it was right at the heart of the recent NHS “Five Year Forward View”. There is a lot more to do, and I have recently had discussions with some of the breast cancer charities about how we use their reach and undoubted public credibility, which is enormous, to raise awareness more about some of the things that people can do on the prevention front, as well as about their important work on care and drugs. I join my hon. Friend in paying tribute to those campaigners.

The NHS is treating more people with cancer than ever, as I have said. Survival rates for breast cancer are improving, with more than 85% of women with breast cancer in England and Wales now living for more than five years. The work that all the charities have done in that regard is really important. They have all made significant contributions, but we know that more needs to be done, and that is the focus of this debate. We need to catch breast cancers earlier, and to avoid the risk of secondary breast cancers. We also need to improve the detection and treatment of secondary breast cancer, as my right hon. Friend has highlighted.

My right hon. Friend spoke very movingly about pain and its management. I am sure that we all agree that our NHS doctors and nurses do everything that they can to alleviate pain. In fact, it was good to see from the 2014 cancer patient experience survey that only 1% of patients reported that they did not think that hospital staff did everything they could to control their pain. Indeed, 86% of patients—the highest level in the four surveys so far—reported that staff did everything they could to control their pain. She is right to say that referral to specialist palliative care services can provide more by way of effective pain relief. The NHS must do what it can to ensure that women with secondary breast cancer have access to the right services. She is also right to highlight the room for improvement on that.

On the patient experience for women with secondary breast cancer, the results of the 2014 cancer patient experience survey show improvements in many areas, with 89% of all patients reporting that their care was either excellent or very good. As my right hon. Friend said, there are two specific references to secondary breast cancer in the NICE quality standard. The first states that people who develop it should

“have their treatment and care discussed by the multidisciplinary team”,

and the second states that people with recurrent or advanced breast cancer

“have access to a ‘key worker’, who is a clinical nurse specialist whose role is to provide continuity of care and support”—

she mentioned that—

“offer referral to psychological services if required and liaise with other healthcare professionals, including the GP and specialist palliative care services.”

NICE clinical guidelines represent best practice, and we expect commissioners and clinicians to take them into account when making decisions, including on the provision of cancer nurse specialists. On the whole, breast cancer patients reported a more positive experience than many other cancer patients, and 93% were given the name of a clinical nurse specialist. My right hon. Friend is right to highlight the fact that we are not doing as well for patients with secondary cancer or a recurrence of cancer—those patients reported a worse experience and were less likely to have a clinical nurse specialist. NHS England is working with NHS Improving Quality, Macmillan Cancer Support and strategic clinical networks to improve the cancer patient experience and spread good practice across hospitals providing cancer care. That includes support from a clinical nurse specialist for those with secondary breast cancer.

[Jim Shannon]

The Minister is good in debates such as this and we always appreciate her response. One thing that is not always mentioned is the work done by pharmaceutical companies and their investigations to find and perfect new drugs to combat cancer. Current TV programmes often show people saying, “We’re almost there” when speaking about a cure for cancer—well, we are halfway there anyway. Together with pharmaceutical companies, universities such as Queen’s university in Belfast do fantastic work to find new drugs to address cancer and many other things. Sometimes that point is missed in debates such as this, so perhaps this is an occasion to get that on the record.

[Jane Ellison]

I pay tribute to the hon. Gentleman who is always present in health debates and makes an important contribution. If he were to secure a debate on research and clinical trials, I would be delighted to respond. He is right to say that that topic is sometimes a bit unsung, and it is enormously hope-giving for people to hear what is in the pipeline. He is right to highlight that issue, and perhaps we could explore it in a bit more detail on another occasion.

I alluded earlier to work that is taking place to bring everybody up to the best standard. That includes pairing highly rated cancer trusts with those that have potential to improve, regional events for commissioners to consider how patient experience survey results inform commissioning decisions, and the publication of guidance on using survey data to drive improvement. The survey is used in very hands-on ways, and in previous debates I have been impressed at the extent to which data are used right at the front line to say, “This is what really good looks like”, or to highlight where services can be improved by reference to those who are doing things well.

The need to improve is recognised by the NHS. In his forward to the 2014 survey report, Sean Duffy, NHS England’s national clinical director for cancer, recognised the importance of clinical nurse specialists and the need to be particularly sensitive to the needs of patients with a recurrence of cancer. We all recognise the picture that my right hon. Friend painted of people telling others of their diagnosis and what they say and the enormity of the news they are trying to convey not really being understood. Sean Duffy also highlighted the need for sensitivity when the cancer has not responded to treatment as had been hoped.

I understand that NHS England has no plans to discontinue the cancer patient experience survey. I have drawn on it a number of times when responding to debates, and it has been extremely valuable to front-line clinicians for understanding where excellence is being practised. I am keen and have stressed to NHS England on a number of occasions how much Members of the House appreciate the survey and feel that it informs our debates and the knowledge of our constituents.

The survey is overseen by the cancer patient experience advisory group, chaired by Neil Churchill, NHS England’s director of patient experience. Suggestions for amendments or additions to the survey can be addressed to that group. I will obviously draw this debate to the attention of NHS England, and the all-party group on breast cancer will continue to engage with it on ways that the survey could be improved or amended.



My right hon. Friend mentioned the need to improve detection and treatment of people with secondary breast cancer. We need to have good data about those affected. As she said, in the 2011 cancer outcomes strategy we committed to pilot the collection of data about metastatic disease, which had previously not been recorded. In March 2012, a report on the pilot data collection project was published. The pilot programme included data from 15 units and enabled the National Cancer Intelligence Network to identify deficits in the information recorded for those patients. Lessons learned from the pilot have now been applied to a country-wide programme. Since April 2012, all breast units have been required to submit information on all patients diagnosed with a new recurrence or with metastatic disease through the cancer waiting times process.

Analysis of the cancer waiting times data, based on referrals to hospital between 1 April 2012 and March 2013, shows that 7,176 patients were diagnosed or treated for recurrent breast cancer in England. However, we know we need to improve the quality of the data to ensure that we are getting the full picture. There are significant discrepancies between trusts and the analysis will need to be updated with more recent cancer waiting times data to ensure that the figures are robust. The NCIN, Macmillan and the Public Health England knowledge and intelligence teams are working collaboratively on a system to detect patients with recurrent breast cancer by looking at treatment patterns. Results from that collaborative work should be available in 2015. I know it is a source of frustration that they have not been available to date, but that work is at least ongoing. I will pursue that point further with Public Health England after the debate. We have regular meetings. I will of course raise the issue and ensure we keep the House up to date.

On the national peer review programme, I would like to assure my right hon. Friend that NHS England is currently reviewing the national cancer peer review programme with a view to considering how its success might be extended into other new areas of specialised commissioning. Regardless of the outcome of the review, cancer peer review will continue to play a critical part in any broader peer review programme the NHS might introduce. Further details will be published shortly as part of the wider review into specialist commissioning.

The clinical commissioning group outcomes indicator set is not designed for use as an accountability tool. For that, NHS England uses the CCG assurance delivery dashboard—I apologise for the jargon, which, unfortunately, is a feature of these debates—to hold CCGs to account. “Everyone Counts: Planning for Patients 2014/15-2018/19” was used by NHS England to identify the relevant indicators for reporting in the CCG dashboard. In addition, as new data have come on line throughout 2013-14, as well as feedback received on the indicators that are currently being used, NHS England has reviewed whether there is potential to make improvements in 2014-15. The cancer indicators used in the CCG assurance dashboard are based on cancer waiting times. NHS England is continually looking to improve the delivery dashboard. I know the all-party group will continue to engage with that process, as will the charity that supports it and the other charities.

As well as improving patient experience, we want to ensure that women are informed about the risks of metastatic disease so it can be diagnosed early. NHS England breast cancer clinical reference group is determined to ensure that everything possible is done to reduce the risk of secondary breast cancer. It is preparing a service specification for the provision of breast cancer services in England. NHS England knows that the information currently given to patients on the risk of secondary breast cancer is variable and frequently inadequate. That was brought to life for all of us in the Chamber by the deeply moving extracts from the comments of sufferers that were read out by my right hon. Friend. I do not think that any of us could have been unaffected by them. The clinical reference group’s service specification will require that all patients should have an end of primary treatment consultation, which will include advice on signs and symptoms that might indicate secondary breast cancer. That information needs to be delivered together with an holistic needs assessment as part of a recovery package. The evidence that this has been done will have to be recorded in the records of every breast cancer patient.

Touching briefly on research, the National Institute for Health Research is enabling patients to take part in trials of new treatments for metastatic breast cancer through its clinical research network.

As we all know, early diagnosis is key. Alongside the work to increase awareness, the Government have committed £450 million to achieve earlier diagnosis and the associated improved cancer survival rates. On breast cancer specifically, in February and March, we ran a Be Clear on Cancer campaign to increase awareness of breast cancer in women over 70. The proportion of women spontaneously mentioning breast cancer rose significantly, as did confidence in people’s knowledge of signs and symptoms of breast cancer. The campaign was well recognised, with many agreeing that the advertising would prompt them to talk to somebody close to them about the symptoms to watch out for. As well as increasing awareness, the campaign appears to have resulted in a large increase in referrals to secondary care in the target age group. The analysis, although only interim, suggests a significant increase in the number of women over 70 self-referring for breast screening. We are encouraged by that.

In addition, Public Health England is funding the biggest randomised control trial in the world and extending the NHS breast screening programme to women in the 47 to 49 age group and the 71 to 73 age group. As the trial is studying the effects of screening on breast cancer mortality rates over time, the results will not be known until the early 2020s, but it is an important and extensive study.

To conclude, I thank my right hon. Friend once again for bringing this debate to the House, the manner in which she introduced it and her important work on this subject throughout her parliamentary career, and I thank my other hon. Friends who have supported her and who also take a great interest in this subject. She is right to point out that fundamentally there is a message hope: so great is our progress that we can now compare of where we want to be with secondary breast cancer with where we increasingly are with breast cancer. However, she also rightly reminds us that more progress needs to be made.

I shall draw this debate to the attention of the national clinical director, Sean Duffy, and make him aware of the concern expressed in the House on this subject. I reassure my right hon. Friend of the Government’s commitment to reducing the incidence of secondary breast cancer and to improving outcomes for everyone diagnosed with this terrible disease. I offer a message of hope and improvement to all of them.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council

Jane Ellison Excerpts

Monday 24th November 2014 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 1 December in Brussels. The Health and Consumer Affairs part of the Council will be in the morning of 1 December.

The main agenda items will be the following:

Medical Devices Directive—The presidency had planned a general approach, but has now decided to have a discussion of a directive and to take stock of the progress made in negotiations.

Council conclusions—The Council will adopt the Council conclusions on: vaccination as an effective tool in public health; patient safety and quality of care, including the prevention and control of healthcare associated infections and antimicrobial resistance; and innovation for the benefit of patients.

Information from the Commission on the European response to the Ebola outbreak in West Africa.

The Latvian delegation will also give information on the priorities for the forthcoming presidency, which will run from January until June 2015.

The Luxembourg delegation will introduce an item under any other business on ‘Admission criteria for homosexuals to blood donations’.

Physical Inactivity (Public Health)

Jane Ellison Excerpts

Tuesday 18th November 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

First, I thank the hon. Member for Blaenau Gwent (Nick Smith) for securing this debate on such an important topic. It is one of my personal passions, particularly while I have been in this job. It is evident from the contributions of so many colleagues, who made so many thoughtful points, that many share my passion for this area. I do not pretend to think that I can respond to every specific point that was raised, because it has been a varied and wide-ranging debate, which demonstrates Parliament’s appetite to get stuck into this topic. I will return to the powerful role that MPs have in increasing levels of physical activity if I have time towards the end of my remarks.

Society has changed a great deal, and that sits behind everything we have been debating this morning—why we have become more sedentary—and other Members have laid that out. I will not spend too much of my speech going over the evidence base, because it has been well covered by the hon. Gentleman and other Members, but the evidence base is well established for the problems that the level of physical inactivity in our nation is causing. I was pleased to hear Members talk about not only physical conditions, but mental health. I think dementia was also mentioned. There is an important evidence base for the fact that becoming more physically active can benefit people in a great many ways. One of my personal passions is how physical activity can impact on social isolation and exclusion; I will try and touch on that later. I will not reiterate what other Members have said on the statistics on how inactive we have become as a nation, because they are all on the record; I would prefer to use my time—I am conscious of leaving a little bit of time for the hon. Gentleman to wind up—by telling the House what the Government are doing.

I will say a few words about obesity. It is a slightly complex area, as I was saying to the hon. Gentleman just before we came into the Chamber. We are clear that all the expert evidence suggests that while physical activity brings the important health benefits that we have been discussing—such things as stronger muscles and bones and improved cardiovascular health and metabolic health, as well as some of the psychological well-being aspects—tackling obesity is fundamentally about eating and drinking less. That is what will lead to significant weight loss. That is not to belittle the role of physical activity, but to emphasise its importance. Physical activity cannot just be seen through the narrow prism of its role in weight loss, because it is bigger and more important than that and goes to the heart of so many well-being and other social issues. I am keen that it is not cast only in the light of weight loss. We need to understand its role in tackling obesity, not least in encouraging active lifestyles in children from the very start and not building up problems for future generations, but it is a little more complex than that.

[Barbara Keeley]

Will the Minister acknowledge that it is important for overweight people and large people to take exercise, because they will be healthier, whatever size they are, if they do that? There is a danger in focusing just on weight loss, instead of exercise. If people take exercise, it is likely to lead to a healthier lifestyle and a desire to lose weight.

[Jane Ellison]

Absolutely. I could not agree more with the hon. Lady. It is exactly why we should not just link obesity and physical activity together. It is better for everyone to move. I will come on to some of the conditions that are helped by that, but she is right that whatever someone’s age, weight or state of health, moving more is always a better option.

Members have touched on this, but it was an important moment when we saw prevention put right at the heart of the NHS with the publication of the “NHS Five Year Forward View”. Public Health England collaborated closely with the NHS on the prevention chapter of that forward view, which states:

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

It cannot be said more profoundly than that that this issue is important. The attention given to that aspect of the forward view was heartening to me as the public health Minister, because I had not heard the prevention agenda put quite so much at the heart of the health debate in our country and related to the sustainability of our great public services to that extent.

Members have talked about shifting the narrative. With the best will in the world, Governments can only do so much. We have to shift the population’s thinking from where we are now to where we need to be. A couple of Members touched on the role of some of the major charities. I have been having conversations with some of the major health charities about how they can harness the reach and reputation they enjoy among our population. For example, Macmillan Cancer Support is famous for its wonderful cancer care, but it is a bit less famous for the excellent work it does with the Ramblers on the evidence base on walking as a key element of physical activity. I have been talking to Macmillan and others, including some of the big cancer charities, about what more they can do to get people to understand more widely the role of physical activity in preventing diseases, because those charities have enormous reach into the population.

I pay tribute to Breakthrough Breast Cancer on its message, “Raise your pulse, reduce your risk”, which is a campaign that tells women that 30 minutes of daily physical activity can reduce the risk of breast cancer by at least 20%. Arthritis Research UK launched a piece around understanding arthritis, which addresses exactly the point that the hon. Member for Worsley and Eccles South (Barbara Keeley) made in her intervention. It is tackling the misguided belief that someone should rest if they have joint pain and is trying to put some of its weight, resource and reputation behind simple messages on standing, walking and being more active, even for people with some of those physical challenges.

We have dwelled a lot on physical inactivity among the young, and I will come on to some of the things that the Government are doing to help that, but the most inactive generation is the oldest generation. Only one in 10 men and one in 20 women over 75 are active enough to stay healthy. I am lucky enough to have both my parents still with me—one is 80 and the other is just under 80—and very much active and healthy. My father is still cycling 50 miles a week at 78. I look at their lifestyles and I see how much can be gained from staying active as people grow old. It helps them to remain independent for longer and tackles some of the thorny issues of social isolation. Active older people are unlikely to be lonely. We must be passionate about the activity agenda for older people, as well as the sensible focus on getting the young into good habits.

On the role of Government, experience from across the globe shows that getting everybody active every day will work only if everyone is involved, including all levels of government, so I want to discuss what we have been doing recently, because the level of activity is good. At a national level and following up on the Olympic legacy—I chair a cross-ministerial group on the physical aspect of the legacy—we started “Moving More, Living More” as a cross-Government policy to get more people active. It stresses that physical activity is everyone’s business. If it just sits in a health silo, we will fail again. I have had conversations with Lord Coe, who recognises that we have been around this circuit before. Physical activity cannot just be a health measure; it must be embedded across all levels of Government and local government.

Following on from that, we have taken a much more granular approach and have provided a proper toolkit. Just last month, Public Health England published the “Everybody Active, Every Day” framework. It was going to be published early next year, but I urged it to bring that forward to this autumn, so that it was available to local authorities when planning their 2015-16 spend. We have provided £8.2 billion for public health over three years, and it is important that we also provide the best evidence base for how to spend that money for local populations.

I want to describe how the scheme was produced, because it has been a wide-ranging collaborative effort. I hope that MPs all received their toolkit. It might still be lurking in the inbox—we all receive a lot of e-mails—but please look for it, because it was designed to give MPs a role in promoting the agenda. The campaign was co-produced with more than 1,000 cross-sector organisations and individuals at national and local level. It was begun at a workshop in January this year. Since then, we have had nine expert round tables attended by more than 200 experts. Five regional forums have been attended by some 750 individuals, including people from local authorities. The “Moving More, Living More” policy and the recommendations of the all-party commission on physical activity—I see one of its members here—fed into the process. We held sector-specific presentations and workshops, bilateral meetings with Government and nine expert rapid topic overviews.

Good and promising practice has been collated, and we have also commissioned work on what constitutes such practice, with more than 960 submissions for assessment. I have also commissioned a review of return on investment data, which is critical for local government. A public consultation was held on the draft documents, with 183 submissions raising 550 specific issues. The output from the exercise, which was launched at the Oval last month, includes a toolkit, as mentioned, for elected representatives—I worked with Public Health England on the MP toolkit and we are looking at one for locally elected members as well—and free British Medical Journal-sponsored e-learning modules. Regarding the review of promising practice in communities, we have commissioned the Centre for Sport and Exercise Science and ukactive’s research institute to consider and rate submissions. We have also done some detailed topic overviews, in particular looking at some in-depth guidance for addressing complex issues around deprivation and health inequalities, which will respond to one of the points raised by the hon. Member for Blaenau Gwent.

I have attended a high-level round table with local government leaders, who I must say are a great deal more optimistic than the shadow Minister about their ability to deliver on this agenda. The meeting was cross-party and extremely positive, and I have seen many of the things that they have been doing. This is a collaborative effort right across local and national Government to take us to the next level in terms of an evidence-based approach to physical activity. Like the right hon. Member for Rother Valley (Kevin Barron), who spoke about public health sitting well with local government, I absolutely think that it has landed in the right place. I have seen some fantastic examples of real leadership, but we need to give local government the tools to do the job. We do not want people endlessly reiterating the evidence base and endlessly trying to work out what works and carrying out their own evaluations when that can be done at a national level through the resources of Public Health England.

The four areas within “Everybody Active, Every Day” are “Active society”, “Moving professionals”, which is about ensuring that our professionals are geared up to make every contact count, “Active environments”, and “Moving at scale”, which is about the big interventions—as opposed to small, excellent micro-interventions—that will really make a difference to the population. The framework contains a lot more detail, and I urge Members to have a look at it, because it is what we are now engaging with local government leaders on. I was asked about the data that local authorities have at their disposal and the Active People survey provides them with areas to target.

In addition to all that, my Department has given £11.4 million to the Change4Life sports club programme, through which 13,500 clubs have been established to help our children to be more active. Those clubs have deliberately been set up in areas of high childhood obesity and significant deprivation. We are also investing £180 million over three years into the primary PE and sport premium to improve health outcomes for primary-age children. We have provided £30.5 million to fund the School games organisers, who are responsible for delivering the games and co-ordinating Change4Life sports clubs. Much work is ongoing with the Department for Transport around cycling cities, and we have augmented its funding by putting money into five walking cities.

Sport England recently announced that it is also making more money available to help to get people more active. I echo everything that has been said today about women’s participation and removing barriers to entry. Some extremely good points were made. I welcome the fact that Sport England has recognised that and is looking to fund things that many of us would not traditionally recognise as sport and things beyond team sport. Like my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), I remember the Lycra shame of the 1980s and the “feel the burn” movement. We do not want people to go to something once and then give it up. We must remove the barriers to entry. I heard about wonderful local government initiatives, such as T-shirt swimming days for people who do not want to swim in just a swimsuit, and other clever things.

However, we need to get the message out there, which much of the debate concentrated on. I must be honest that I do not believe the chief medical officer’s guidelines are well understood. They are difficult for health professionals to understand and the same is certainly true for the public. I have commissioned a piece of work from Public Health England to develop a mantra for physical activity similar to “five-a-day”, which, if not universally observed, is widely known and understood.

I hope that I have provided a sense of how we are trying to follow up on the Olympic and Paralympic legacies. Lord Coe has been clear that that will be judged over decades not years, because although the shadow Minister suggested that it has developed over the past five years, the problem has developed over decades, but we are taking action. MPs have a valuable role to play. It is a huge job, but we are making great strides towards getting everybody active every day. I thank Members for their participation in the debate.

Transient Ischaemic Attacks

Jane Ellison Excerpts

Wednesday 5th November 2014 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I am glad to have the opportunity to debate transient ischaemic attacks, or TIAs. They are also known as mini-strokes, but we should be careful with our terminology, because a TIA is a serious matter; it is a warning of a possible future stroke. Because it is a serious matter, I am a bit perturbed that no one is sat on the Government Front Bench. I hope that the Minister will join us shortly. A possible future stroke could kill or incapacitate someone temporarily or permanently, and the risk is greatest in the first few days after a TIA. In fact, one in 12 people will go on to have a stroke within a week of a TIA, yet TIAs are often not taken seriously by members of the public and are sometimes not recognised by health staff.

We have known for some time, however, that dealing with TIAs urgently can prevent future strokes. In fact, research published in The Lancet in 2007 indicated that 10,000 strokes a year could be prevented if all TIAs were treated urgently, but that still does not happen. Those strokes could be prevented, people could avoid serious disability and the NHS could save a huge amount of money.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I intervene only to apologise most profusely for not being here at the start of the debate. We checked with the Doorkeeper following the Division and were advised that a quarter of an hour would be added and that this debate would start at quarter to 5. I would never be so discourteous to the hon. Member for Warrington North (Helen Jones). I really am extremely sorry, but that was the advice that we received. We were only next door.

[Mrs Linda Riordan (in the Chair)]

Order. The sitting was suspended at 4.15 pm, but Members were back shortly after the vote. The rules are that we start again as soon as the Minister, the Member who proposed the debate and the Chair are back. As long as three Members are here, we can resume, which we did, and the debate finished at 4.38 pm. Helen Jones began her debate then.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Once again, my apologies to the hon. Member for Warrington North (Helen Jones) for missing the first two minutes of her contribution, because of a misunderstanding on our part.

The hon. Lady is a great expert on the subject and, as she said, we have debated it in the past—in fact, it was the subject of the first debate that I responded to as a Minister, about a year ago. It is good to see her commitment. As the chair of the all-party group on stroke—she is one of Parliament’s great champions of the issue—she also takes great interest in transient ischaemic attacks. The debate is timely, because it was world stroke day last Wednesday, which this year focused on the impact of stroke on women.

As ever, I will try to respond to as many of the points that have been made as I can, but the matter is obviously the responsibility of the NHS. In a debate of this nature, I always undertake to draw to it the attention of the key people in NHS England, in particular the national clinical director—

[Helen Jones]

I am sorry to interrupt, but Ministers are in the end responsible for what happens. If they are not, there is no point in them being Ministers. A huge bureaucracy has now been set up, but it is still open to a Minister to pull the strings to ensure that the things that need to be done are done. I hope to see the Minister doing that.

[Jane Ellison]

I note the hon. Lady’s comments. NHS England is the lead on the subject, because it is ultimately a clinical matter. I always draw the attention of our clinical leaders to the views of Parliament and, where I need to underline them, I of course do so, but it is also important to recognise that in a large organisation the views and leadership of senior clinicians are vital. I will refer to that.

[Helen Jones]

The Minister is gracious to give way, but I am sorry, I had to intervene at that point. The clinical details are not in doubt. We know what works and what best practice is; the problem is that best practice is not always followed.

[Jane Ellison]

I note the hon. Lady’s comments.

Turning to the Act FAST campaign, when people have a TIA, getting medical attention quickly is key, as the hon. Lady said. Ensuring that the general public are familiar with the signs and symptoms is important. Public Health England continues to run the highly impactful Act FAST stroke awareness campaign, which covers similar signs to those of a TIA—I note that she is right to draw the distinctions—and the simple message to call 999 if such signs are witnessed. The campaign was run again in March this year, and new adverts feature an Afro-Caribbean man to underline the fact that people from some ethnic groups, whether south Asian, African or Caribbean, are at higher risk of TIA and stroke than others. PHE plans to run the adverts again later in the financial year. Over the summer, the Stroke Association also ran a campaign to raise awareness of TIA, “Not just a funny turn”. It was welcome and many of us saw it.

The hon. Lady also referred to front-line staff and to raising awareness of signs and symptoms. Act FAST and the Stroke Association’s campaign were aimed at public and professionals alike to ensure that everyone acts swiftly. PHE plans to run its adverts, which do not only face the public, again before April 2015.

In addition, NHS England has produced a resource for clinical commissioning groups, to support them in setting and delivering on the level of our ambition to reduce premature mortality. TIAs form an important part of that. The resource includes information on the most high-impact interventions that CCGs can consider commissioning to reduce premature mortality, and TIAs fit into that description. One such intervention is to increase the proportion of patients suffering a TIA treated within 24 hours from 71% to 100%. Let us recognise that TIAs sit right at the core of all the resources being distributed to our front-line staff and produced by NHS England.

NHS England has also been working with the 111 service to ensure that the protocols and triaging systems on the phone lines are used to identify as many people with stroke and TIAs as possible. We recognise that there is more to do and that such work is ongoing.

On getting patients the treatment that they need, quite a lot of work is under way in many parts of the country to reorganise services. That involves reconfiguring care for patients with TIAs as well as acute strokes. For example, in Birmingham and the black country, Warwickshire, Surrey and Sussex standards for TIA care have been set and services are being redesigned to ensure that patients with high-risk TIA can be seen and managed within 24 hours.

The reorganisation of vascular surgery services into a smaller number of higher-volume units is also improving the efficiency of the provision of surgery for TIA. There have been huge improvements in TIA patients’ access to neurovascular clinics in recent years. That is important because, as the hon. Lady said, we know that the risk of stroke in the first four weeks after a TIA can be as high as 20%. It is vital that people are seen urgently and their symptoms investigated, and that a management plan is put in place.

The hon. Lady said that services can be inconsistent. We want to ensure that we work towards making all services as good as the best, but part of that work is to define what the best standards are and to disseminate best practice. I will talk about some of the ways in which that is done.

The 2012 national clinical guidelines for stroke recommend that patients who have had a TIA are seen, investigated and treated in a neurovascular clinic within one week. A few years ago, such clinics were relatively unusual and waiting times could run to weeks or months. Information from the latest Sentinel stroke national audit programme organisational audit published in 2012 shows a picture of real improvement. According to the audit, 100% of trusts in England, Wales and Northern Ireland now have a TIA or neurovascular clinic, with a median of 20 clinics held in each four-week period. There has been a really big improvement in access to those clinics.

The same audit also said that there are very few areas of the country where a high-risk TIA patient would need to wait more than a week, and that over half of high-risk in-patients could be seen the same day, seven days a week. We are waiting for an update of that audit, which is due to be published quite soon. I hope to see further improvement.

In the mini-exchange I had with the hon. Lady at the beginning of my contribution, we touched on best practice. The strategic clinical networks are important for that. They bring together clinicians from across health care settings and the wider health and care system in 12 geographic areas. The SCNs share best practice and promote initiatives on their core service areas, which include cardiovascular disease. The networks hold regular meetings to enable communication and information sharing. As an MP for a London constituency, I saw the benefit of bringing that clinical excellence to bear in the reorganisation of stroke services in London. Such work is ongoing, to make sure that best practice is disseminated around the country.

[Jim Shannon]

One problem I am aware of—I suspect the hon. Member for Warrington North (Helen Jones) is as well—is that TIAs pass in two or three minutes and there is no real understanding of what is happening among friends, relatives or others who are close by when they occur. The hon. Lady is trying to push for raising the level of awareness, and I am sure the Minister would wish to achieve that as well. How can we better achieve that within the Act FAST campaign? That was what I was hoping the Minister would set out.

[Jane Ellison]

I am happy to put that issue on the agenda for my next meeting with Public Health England, which puts together such campaigns. We all wish to raise awareness of the symptoms of a lot of different conditions, but one has to be realistic about how many public information campaigns we can run and how those can be organised. However, I am happy to have that discussion with Public Health England, because we are pleased with the way in which the Act FAST campaign has been received. There is clearly something to build on. I also know that the Stroke Association feels strongly about the issue. I am happy to discuss it and perhaps feed back in due course.

Hon. Members might be interested to know that the National Institute for Health Research has recently funded research on TIAs to look at the pathways taken by patients, from symptom onset to specialist assessment. That research found that factors contributing to delay included incorrect interpretation of symptoms and failure to involve the emergency services. The research is something else we can build on in order to understand what needs to be put in place so that we can do better.

Work is under way, and I am happy to look at what has been said today about public information. However, we have made a really good start. The picture for stroke care is also really improving. Sometimes I respond to debates on issues where we have not seen improvements of the kind that I set out on specialist clinics and surgery. We can see some real momentum, so it is case of building on that and on awareness of symptoms. I pay tribute to the work of the Stroke Association and its report. I saw the “Not just a funny turn” campaign over the summer, which I thought was well judged and was put across well. It did a good job of attracting publicity to stroke and TIA, so I congratulate the association on the campaign.

I hope that what I have said will reassure the hon. Member for Warrington North that the Government and the NHS both recognise that it is vital to ensure that people who have had a TIA receive the right treatment and care to help them to recover. I have not touched on the issue of psychological support, which was the subject of our debate last year, at which time there were encouraging signs. I will write to her about how those have been built upon over the past year and whether we have continued to make progress.

The picture is improving, but we recognise that there is more work to do. I congratulate the hon. Lady on keeping this issue very much at the forefront of Parliament’s attention. As ever, I congratulate the hon. Member for Strangford (Jim Shannon) for contributing to this debate on health in the way in which he always does. We are all keen to see the best possible services for people to ensure that TIA care is of the highest quality and that we minimise the number of people who go on to suffer a stroke.

Question put and agreed to.

Ovarian Cancer (Gene Testing)

Jane Ellison Excerpts

Tuesday 4th November 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank the hon. Member for South Down (Ms Ritchie) for bringing this important issue to the House today. She has a long-standing interest in health issues and she has made the case very well for why we need to look closely at this important disease. I will come back to her after the debate on any point that I am not able to respond to now, particularly the technical aspects. I want to give the House a bit of the picture on what else is happening on ovarian cancer, as well as addressing the specific issues that she raised.

As the hon. Lady said, ovarian cancer is the fifth most common cancer for women in the UK. The current five-year survival rate is 44%, but we know that if we get the critical early-stage diagnosis, up to 90% of women survive for at least five years. We know that we could save 500 additional lives each year if we matched the best European survival rates. The debate comes at a poignant time for me, because I lost a very dear friend to ovarian cancer less than three weeks ago. I am well aware of the pressure that the disease brings to bear on the families of those affected. We are investing an additional £750 million over four years in England to improve early diagnosis, and I will discuss the details of that and of treatment later.

The hon. Lady’s speech focused on testing and the BRCA1 and BRCA2 genes. As she rightly said, a family history of cancer is one of the most important risk factors for ovarian cancer, with about one in 10 ovarian cancers being caused by an inherited faulty gene such as the two to which she referred. Incidentally, the genes also increase the risk of breast and prostate cancer. We know that women with a mother or sister diagnosed with ovarian cancer have three times the risk of ovarian cancer of women without such a family history.

NICE’s most recent guidelines recommend offering genetic testing to people with a 10% risk of carrying a BRCA mutation, which is lower than the 20% risk previously recommended. I remind hon. Members that NICE clinical guidelines represent best practice and that we expect NHS organisations in England to take them fully into account when designing services to meet the needs of the population. As a result of their complexity and the different states of readiness for implementation in the NHS, clinical guidelines are not subject to the same statutory funding regulation as technology appraisals. Clinical guidelines therefore have a slightly different status, but it is none the less important that NICE has revised them. NHS England is considering the new recommendation in developing and publishing a single national clinical commissioning policy to confirm the routinely funded NHS threshold for testing.

Like the hon. Lady, I thank Ovarian Cancer Action for all its work in this area. The recently released report on BRCA testing raises important issues, some of which were aired in the hon. Lady’s speech and in interventions. NHS England has said that moving to routine testing at a 10% risk would require a significant capacity and funding investment in genetic testing, diagnostics, counselling and treatment. NHS England is currently considering the potential for funding a revised 10% testing threshold in 2015-16 as part of its annual funding prioritisation process. I will draw NHS England’s attention to the strength of feeling in this debate and to the interesting points that my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the hon. Member for South Down made about cost-effectiveness. I will also stress that Parliament continues to have considerable interest in the subject.

The hon. Lady touched on groundbreaking techniques, which provides me with an opportunity to refer to the 100,000 genomes project. We can see the potential of genomics to understanding cancers and rare illnesses and finding new treatments. In 2012, we launched the 100,000 genomes project, through which 100,000 whole genomes from NHS patients will be sequenced by 2017. The project will focus on patients with a rare disease and their families, as well as patients with cancer. Ovarian cancer is in the programme’s scope, and it will hopefully enable us to continue our record of groundbreaking cancer research here in the UK.

I will update hon. Members on the two major screening trials for ovarian cancer taking place in the UK. The first is looking at two possible techniques: trans-vaginal ultrasound and a blood test for cancer antigen CA125. Both of them are being tested as part of the UK collaborative trial of ovarian cancer screening. The study is being funded by the Medical Research Council and Cancer Research UK, with the Government funding the NHS costs of the study. The first phase of results was promising for both techniques, and the final results are due in January 2015. The UK National Screening Committee, which advises the Governments of England, Scotland, Wales and Northern Ireland on screening matters, is preparing to assess the results of the trial against its internationally recognised criteria for a screening programme and to make a recommendation on that basis, which could be a significant move forward. A second study, the United Kingdom familial ovarian cancer screening study, which began in 2005, is also looking to develop an optimised screening procedure for ovarian cancer in high-risk women, such as those to whom the hon. Lady referred.

Returning to early diagnosis, there is cause for encouragement, but we must continue to consider early diagnosis at every possible moment. The hon. Lady is right to draw attention to the impact of early diagnosis on survival rates. The Government have committed £450 million to achieving earlier diagnosis and improving survival. The funding supports improved direct GP access to four key tests, including non-obstetric ultrasound, to help with speedier diagnosis of ovarian cancer. Those tests are being used; in June 2014, GPs requested more than a quarter of all tests that may have been used to diagnose cancer under the direct access arrangements. The test with the highest proportion of GP referral was ultrasounds that may have been used to diagnose ovarian cancer, 46% of which were requested by GPs.

I also want to update the House on the “Be Clear on Cancer” preventive work in England. We want to improve outcomes for women, which is what Public Health England is working towards. With the Department and NHS England, it ran a regional “Be Clear on Cancer” ovarian pilot campaign early this year to raise awareness of the symptoms of ovarian cancer. Like other cancers with poor survival rates, many of the early symptoms can be similar to those of benign conditions, making early diagnosis difficult. The next step is to assess thoroughly the data from the regional pilot, which will help us make informed decisions about which cancer and symptom-awareness campaigns to take forward in 2015-16.

On research, the National Institute for Health Research’s clinical research network is currently recruiting patients to more than 30 ovarian cancer clinical trials and studies. In partnership with Cancer Research UK, the NIHR is also funding 14 experimental cancer medicine centres across England, six of which have a focus on ovarian cancer. A good amount of research is ongoing.

In addition to giving some sense of where NHS England is on BRCA testing, I hope that I am also providing a rounder picture of what else is going on in the field, including screening, diagnostics and awareness campaigns. It is important that the matter gets this level of attention.

[Ms Ritchie]

Has the Minister had any discussions with the NHS in Wales and in Northern Ireland? Like her, I have personal experience from knowing people who have died. Perhaps their situation could have been made easier had they had much earlier diagnosis.

[Jane Ellison]

Although the decision is one for NHS England, the debate has highlighted the fact that interesting work is going on in Scotland. The scale of the challenge is smaller in numerical terms, but I am interested in finding out more about what is going on. I will certainly initiate a conversation to understand what is going on in the four countries of the United Kingdom. I have regular conversations with Health Ministers from other nations for other reasons, as the hon. Lady knows. It may not be possible to raise this specific issue in those conversations, but I will ask for more information to see whether lessons can be learned and to understand the points identified in studies about the cost-effectiveness of early testing, in order to ensure that we have bottomed that out.

I hope that this short debate has served to highlight the issue’s importance. I am always grateful for an opportunity to discuss such important issues and to ensure that the House expresses its interest in making better progress on cancers with the poorest survival rates. I hope I have also updated the hon. Lady and other interested Members on what else is going on to try to improve outcomes for family and friends and to achieve better results in future. I thank for bringing the debate to the House today.

Health

Jane Ellison Excerpts

Monday 27th October 2014 Ministerial Corrections

[Heidi Alexander]

London ambulances are taking, on average, two minutes longer than they did three years ago to respond to the most serious call-outs. The chief executive of the service is quite open about the fact that she does not have enough staff on each shift every day. This is a service in chaos. Will the Minister be explicit about the support her Government are giving to ensure that my constituents, and Londoners, get the service they deserve?

[Jane Ellison]

This affects my constituents too, as I am also a London MP and therefore take a very close interest in it. I think it is unfair to say that the trust is in chaos. It is taking urgent steps to address the situation, including recruiting extra paramedics, increasing overtime, and reducing the number of multiple vehicles attending each call. We are working with Health Education England to increase the pool of paramedics, with 240 being trained in 2014, going up to 700 in 2018. Urgent measures are being taken to address the problem right now. I have had those assurances directly from managers in the trust whom I met very recently.

[Official Report, 21 October 2014, Vol. 586, c. 748.]

Letter of correction from Jane Ellison:

An error has been identified in the response I gave to the hon. Member for Lewisham East (Heidi Alexander) during Questions to the Secretary of State for Health.

The correct response should have been:

[Jane Ellison]

This affects my constituents too, as I am also a London MP and therefore take a very close interest in it. I think it is unfair to say that the trust is in chaos. It is taking urgent steps to address the situation, including recruiting extra paramedics, increasing overtime, and reducing the number of multiple vehicles attending each call. We are working with Health Education England to increase the pool of paramedics, with 340 being trained in 2014, going up to 700 in 2018. Urgent measures are being taken to address the problem right now. I have had those assurances directly from managers in the trust whom I met very recently.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 21st October 2014 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

7. What recent assessment he has made of the adequacy of ambulance response times in London.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

First, I praise the hard-working staff of the London ambulance service, who responded to 100,000 more calls last year. We know that the service is under some pressure, and that is why we are providing extra support to the NHS in London, including £15 million for the ambulance service to help to ensure that the trust meets standards in future.

[Heidi Alexander]

London ambulances are taking, on average, two minutes longer than they did three years ago to respond to the most serious call-outs. The chief executive of the service is quite open about the fact that she does not have enough staff on each shift every day. This is a service in chaos. Will the Minister be explicit about the support her Government are giving to ensure that my constituents, and Londoners, get the service they deserve [Official Report, 27 October 2014, Vol. 587, c. 1-2MC.]

[Jane Ellison]

This affects my constituents too, as I am also a London MP and therefore take a very close interest in it. I think it is unfair to say that the trust is in chaos. It is taking urgent steps to address the situation, including recruiting extra paramedics, increasing overtime, and reducing the number of multiple vehicles attending each call. We are working with Health Education England to increase the pool of paramedics, with 240 being trained in 2014, going up to 700 in 2018. Urgent measures are being taken to address the problem right now. I have had those assurances directly from managers in the trust whom I met very recently.

[Mr Jamie Reed (Copeland) (Lab)]

It is a fact that ambulances are taking longer to reach patients in the most critical condition. Today we are publishing figures regarding the increasing use of private ambulances. Nobody expects a private company to respond when they dial 999. Private ambulance usage has grown by 82% in the past two years nationally and by over 1,000% in London over the same period. Will the Secretary of State now admit that he sees no limit to the role of private companies in the national health service?

[Jane Ellison]

That is complete nonsense. The previous Government occasionally deployed private ambulances, which trusts use occasionally when they need to do so. This is another part of Labour’s myth of creeping privatisation, which is not true—it is absolute nonsense. It is important, however, in the interests of patient safety and as a short-term measure, that if that is what it takes, trusts must do it, as happened under the previous Government, because patient safety comes first.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

9. What estimate he has made of the number of mental health nurses working in the NHS in each of the last three years.

--- Later in debate ---

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

10. If he will take steps to encourage greater co-operation between the NHS in north-east England and in Scotland.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Of course, it is important that the national health services in all four parts of the UK work together. Good examples of that are happening at the moment on major public health issues, as my right hon. Friend can imagine. Providers in England can and do treat patients referred from Scotland, Wales and Northern Ireland. In England, we put emphasis on enabling patients to choose where they will be treated, not on restricting that choice to providers in England.

[Sir Alan Beith]

Does my hon. Friend agree that if someone’s nearest hospital or health centre is on the other side of the border, the health bureaucracy should not set up artificial barriers to access and any advice the Department gives should reflect that principle?

[Jane Ellison]

I am aware that this concern has been highlighted for my right hon. Friend by a very difficult constituency issue with regard to Northumberland clinical commissioning group. To be clear, the CCG is free to commission services from Scottish providers if it wishes to do so. No one instructs a CCG on where to commission services from—that is a decision for the CCG and one of the strengths of the system. Convenience may not be the most important factor in making that decision, but CCGs need to be assured of quality and standards. I am happy to talk to my right hon. Friend further about his particular case.

[Jason McCartney (Colne Valley) (Con)]

11. When the third stage of the review into the closure of surgery at Leeds children’s heart unit will be published.

--- Later in debate ---

[Mr Graham Allen (Nottingham North) (Lab)]

12. What contribution his Department is making in support of the health objectives of the rebalancing project on dental checks for three-year-olds, foetal alcohol syndrome and lung screening for people over 60.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The hon. Gentleman and I have spoken a number of times about his valuable project. He knows that I am very interested in it and its outcomes. The Government are committed to improving oral health, with a particular focus on children, to reducing the incidence of foetal alcohol syndrome and to improving outcomes for all cancers. Results of major trials on lung cancer screening, including our own £2.4 million UK trial, are due in 2015. At that point, the UK national screening committee will review all the available evidence, looking towards a pilot.

[Mr Allen]

The rebalancing project, which covers my constituency, is I hope an innovative way of working that does not require additional money from the Government, but focuses on key health inequalities, such as a dental check for every three-year-old, the foetal alcohol syndrome prevalence study that we are trying to do and lung cancer screening for everyone over 60. Will the hon. Lady keep an eye on this work, use her reputation as a very committed Minister and visit us in Nottingham to see whether the work we are doing can be spread elsewhere in the UK?

[Jane Ellison]

All the issues that the hon. Gentleman outlines are extremely important. We, too, are very interested in the prevalence study on foetal alcohol syndrome. He may be aware that the World Health Organisation has just launched some work in that area, which will be of great interest to him. It would of course be a delight to visit the project.

[Mr Speaker]

These are splendidly succinct answers. Perhaps the Minister should issue her textbook to her colleagues. That would be extremely useful.

[Bill Esterson (Sefton Central) (Lab)]

The Canadian Government say that foetal alcohol spectrum disorder is the most important preventable cause of severe childhood brain damage. The Minister told me in Westminster Hall last week that the chief medical officer’s review of the evidence is continuing. Is not the truth, however, that the evidence has been available for years, and that the time has come for the review to be published and for there to be much greater protection for the thousands of children who are damaged each year by women drinking in pregnancy?

[Jane Ellison]

We had a good debate last week in Westminster Hall. My reply remains what it was then: there is not complete clarity in clinical evidence on safe levels of drinking. That is exactly why the chief medical officer—[Interruption.] From the Opposition Front Bench, I hear cries of “Yes, there is.” I am sorry, but I am backing the UK’s chief medical officer over Opposition Front Benchers when it comes to the clinical basis for this. The review is important and is under way. I know that all Members will be interested in its outcome, and in how we can help to publicise good guidance to women on this very important issue.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

13. What steps he is taking to improve access to and reduce waiting times for children’s mental health services.

--- Later in debate ---

[Mr Stephen Hepburn (Jarrow) (Lab)]

16. What recent representations he has received on hospital walk-in centres.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Ministers have received 34 representations regarding NHS walk-in centres.

[Mr Hepburn]

The NHS walk-in centre in Jarrow sees more than 27,000 people a year, yet the local management propose to close it to pay for the reorganisation that the Government have brought in. Will the Minister intervene on this occasion, overrule the manager and back the local people?

[Jane Ellison]

I find the hon. Gentleman’s question slightly mystifying. Responsibility for walk-in centres was passed to local commissioners in 2007, and as I understand, South Tyneside CCG is looking to improve urgent care in the area and reduce reliance on A and E. It reckons that 33,000 people did not need treatment in 2012-13 in the local A and E, so I quite see why it would want to review that. I urge the hon. Gentleman to engage with the consultation, and to get involved with some of the excellent north-east public health projects such as North East Better Health at Work, which is an award-winning scheme that would do a lot to relieve pressure on services.

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[Philip Davies (Shipley) (Con)]

T2. The Public Health Minister is pursuing a long list of nanny state proposals that we might have better expected from the Labour party, including plain packaging of tobacco, outlawing parents smoking in cars and having higher taxes on alcohol. Will she give us a list of which policies, if any, she is pursuing that have a Conservative flavour to them?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Following on from the Secretary of State’s previous answer, tobacco control is an integral part of tackling cancer. I am delighted to let the House know that smoking prevalence among adults in England fell to 18.4% in 2013. This is a record low, which means that the Government have hit their tobacco control plan target for 2015 two years early. I am sure that even my hon. Friend would welcome that news.

[Andy Burnham (Leigh) (Lab)]

At their conference, the Tory party promised flat funding for the NHS in the next Parliament, but experts say that the service is at breaking point now and that the funding promised is not enough. Now, the Secretary of State’s own side are saying the same thing. The Chair of the Health Committee said last night:

“The Chancellor is going to have to write a bigger cheque”

or we will

“see reductions in services or waiting times increase”

and

“go down the route of top-ups and charges”.

Does the Secretary of State agree with her, and will he concede that a flat budget for the NHS in the next Parliament will not stop it tipping into a full-blown crisis?

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[Neil Carmichael (Stroud) (Con)]

T4. Meningitis Now, based in my constituency, is a keen supporter of the Men B vaccination for infants. Given the Joint Committee on Vaccination and Immunisation’s recommendation that it start, will the Minister update us on how the roll-out is progressing?

[Jane Ellison]

My hon. Friend is right to highlight this important issue. As he knows, the Department is negotiating with the manufacturer to purchase the vaccine at a cost-effective price, and he will understand that we need to ensure that NHS funds are used as effectively as possible. We are keen to see a positive conclusion to the negotiations as soon as possible so that plans for the Men B immunisation programme can be finalised.

[Valerie Vaz (Walsall South) (Lab)]

Will the Secretary of State explain why NHS England has entered into a contract with a company based in Kent to provide GP services, when my constituents have just seen a string of locum GPs at a higher cost to the NHS?

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[Tim Farron (Westmorland and Lonsdale) (LD)]

NHS England has identified south Cumbria as one of just three places in England where travel times to receive radiotherapy are unacceptably and debilitatingly long. Will the Secretary of State meet me and NHS England to talk about how Kendal hospital can be the place for a new radiotherapy centre this autumn?

[Jane Ellison]

I would be happy to meet the hon. Gentleman and discuss this important issue for his constituents.

[Kate Green (Stretford and Urmston) (Lab)]

The NHS Litigation Authority is piloting a new approach to improve feedback and learning in response to allegations of negligence. Will the Secretary of State say how patients can find out what feedback the NHSLA has given to individual trusts and how the trusts have responded?

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[Fiona Bruce (Congleton) (Con)]

Mitochondrial technique was last tried on humans in 2003 by John Zhang, resulting, I understand, in two still births and an abortion. Last week, one of the members of an expert panel of the Human Fertilisation and Embryology Authority said he had only just become aware of Zhang’s study. What action will Ministers take to ensure that this worrying study is properly examined before any steps are taken to bring this issue before the House?

[Jane Ellison]

My hon. Friend takes a great interest in this matter and led the Back-Bench business debate on 1 September. I will certainly ask the HFEA and the expert panel to look at the study to which she refers, but I can provide the reassurance I have given before—that the wide body of expertise and information out there about mitochondrial disease is regularly reviewed over a long period of time.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State makes great play of protecting the NHS budget, but NHS England, the Nuffield Trust and his hon. Friend the Chair of the Health Committee all agree that it needs another £30 billion investment, so how can he tell people that the NHS is safe under his watch?

Antibiotic Resistance

Jane Ellison Excerpts

Wednesday 15th October 2014 Westminster Hall

[Zac Goldsmith]

I absolutely agree with the hon. Gentleman, and will come on to that briefly—I am going to try to keep my remarks short. That is exactly the point. Many people felt that the ban on the use of growth promoters back in—actually, I forget the year, but I think it was 15 years ago, although I may have got that wrong and am happy to be corrected—

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It was in 2006.

[Zac Goldsmith]

It was eight years ago, then. Many people felt that ban heralded the beginning of the phase out of the routine prophylactic use of antibiotics on farms, but, as the hon. Gentleman just pointed out, use has continued to increase across the board and disproportionately with regard to those antibiotics that are critically important. Given that the antibiotics used in veterinary and human medicine are closely related it is impossible to believe that that increase has not contributed to antibiotic resistance and the transfer of resistant bacteria from animals to humans.

The problem is that the industry has dug its heels in and contested the link. We have been told that there is no proof, but we know that resistant bacteria can be passed to humans on food, through the environment, directly via raw meat and so on. Some strains of resistant bacteria can mix with human strains and pass on resistant genes. For example, E. coli in animals is different from E. coli in humans, but we know that resistance can be and is transferred between animals and humans.

The industry also says that levels of resistance on intensive farms are no different from those on extensive farms, but two reports from the Department for Environment, Food and Rural Affairs have shown that resistance is 10 times lower on organic farms. The industry says there is no problem because antibiotics have to be prescribed by vets and everything is handled responsibly, but more often than not it is the feed mills that place orders for antibiotics rather than the farmers themselves. Finally, we are told that the use of antibiotics is necessary for the provision of cheap food. Perhaps that is the case, but that food will feel a hell of lot less cheap if the cost that society has to pay is the loss of modern medicine.

A briefing has been sent out to a number of MPs by the industry body RUMA—the Responsible Use of Medicines in Agriculture Alliance—saying:

“Fluoroquinolones are rarely used in poultry in the UK.”

RUMA has stated that as fact in response to the points that I and others have raised today. But on 8 September, a few days before that briefing was released, I met representatives of the Veterinary Medicines Directorate, who told me that the British Poultry Council has so far refused to provide any kind of data on antibiotic use at all. How the industry body RUMA can make such a bold and plain statement is beyond me—I suspect it is simply nonsense.

The experts take a different view from that of the industry. Sir Liam Donaldson, chief medical officer before Dame Sally Davies, went so far as to say that

“every inappropriate or unnecessary use on animals or agriculture is potentially signing a death warrant for a future patient.”

The European Food Safety Authority said last year that it is a

“high priority to decrease the total antimicrobial use in animal production in the EU.”

The Minister’s predecessor, my hon. Friend the Member for Broxtowe (Anna Soubry), told me after a debate on the same subject last year:

“Routine prophylactic use of antibiotics in both humans and animals is not acceptable practice”

and that she would be writing to DEFRA

“to ensure that existing veterinary guidance makes that very clear.”

I do not doubt the commitment of the chief medical officer—I am a wild fan of hers, as I know many hon. Members here are. I have not read her book yet, but I will do; I have read much of her writing. I have also met Dr Felicity Harvey and seen the seriousness with which she takes the issue. But so far, at least, DEFRA seems to be dragging its feet. There has been no sense of urgency in any of the meetings I have had, and any response I have had from DEFRA has been far more likely to mirror the industry line than anything the experts have said. The body language of DEFRA as a Department is almost completely defensive.

Thanks to the Netherlands and other countries we no longer have any excuse to stall. The Netherlands has seen a 50% reduction in livestock antibiotic use and expects a 70% reduction by 2015. It has phased out almost completely the use in agriculture of critically important antibiotics. There has been similar action in Denmark, Norway and Sweden. As I understand it, even the US, the land of agribusiness—it is where it was invented—has banned the use of fluoroquinolones in poultry.

The UK has no such targets or aspirations, and it is time that changed. We need to stop hearing excuses about lack of data that the industry has not provided and require those data to be collected. That is a prerequisite, as the hon. Member for Blackley and Broughton (Graham Stringer) said earlier. If the five-year strategy is to be taken seriously when it is eventually produced, it must provide a pathway to ending the routine prophylactic use of antibiotics on farms. That is now a black and white issue. In addition, the strategy must provide a pathway to an eventual ban—ideally, sooner rather than later—on the use on farms of antibiotics that are critically important to humans. Those two measures are the least we can expect from the five-year plan if we are to have any hope at all of combating a threat that the World Health Organisation has compared to the threat of AIDS.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank all Members who have contributed to what has been an extremely good debate. I thank my hon. Friend the hon. Member for York Outer (Julian Sturdy), who led the debate and gave a thoughtful speech. I will try to respond to as many points as possible.

I will not spend much time on the scale of the threat, as many Members eloquently have outlined that. It was brought home to me clearly when, together with my noble Friend Lord De Mauley, on behalf of the Department for Environment, Food and Rural Affairs, and the chief medical officer, I represented the Government at a World Health Organisation conference in The Hague earlier this year. The conference started with a young woman talking to us. Essentially, she was dying: she had been through pretty much every stage of antibiotics available and all had failed. That brought home powerfully what we are talking about now and what Professor Dame Sally Davies has been writing about for some years. The case has been made by other Members and I will not dwell on it. This is an extremely serious global public health threat.

The Government have a “one-health” approach, working together across human and animal health with DEFRA. My hon. Friend the Member for Richmond Park (Zac Goldsmith) made some detailed points that I will probably ask DEFRA colleagues to respond to in more detail. We will be able to respond to some of them, and some will be encapsulated in the strategy, which will be published alongside an implementation plan. Virtually all the points made in today’s debate will be covered, as well as many additional points, in that publication; I will talk to Dr Felicity Harvey and the CMO to ensure that.

In the time available, I will try to outline what the Government have done to date and give Members reassurance that we are not complacent and that we recognise the scale of the threat. In response to questions raised by some Members, we are not waiting for a grand global strategy to try to take action ourselves; we already have many things in hand, because, as Members have said, time is running out.

In September 2013, we published the UK’s first five-year AMR strategy, taking the one-health approach that I have outlined to address the human, animal, food and environmental aspects of AMR, and set up the high-level steering group, to which some Members have referred, to oversee the delivery of that strategy and, importantly, to deliver metrics to assess progress and develop the implementation plan so that our progress can be judged. In June 2014, the steering group published the measures. Broadly speaking, they look at areas such as trends and resistance; antibiotic usage; the quality of antibiotic stewardship; public attitudes, knowledge and awareness; and changes in public and professional behaviour. All of those were touched on in the debate. I confirm to the shadow Minister that the Government published their response to the Health Committee’s report on 12 September.

The first annual progress report will be published later this year, alongside an associated implementation plan, which will pick up many of the points made in more detail. However, let me highlight some of the actions to date. I am delighted that the chief medical officer, Professor Dame Sally Davies, received so many plaudits from Members in the Chamber. I, too, have read her book, which is short but very alarming, and it brings home in graphic detail the scale of the problem we face—it certainly helped to focus my mind. She has led a global campaign of which the UK is right at the forefront.

The adoption in May 2014 of the World Health Assembly resolution on AMR, which was co-sponsored by the UK, was a major step forward. It provided a mandate for the World Health Organisation to develop a global action plan to tackle AMR by 2015. We are actively contributing to support the delivery of that global action plan.

The international nature of the problem was highlighted by many Members. India was mentioned by my hon. Friend the Member for York Outer and other Members, and I confirm that the recently produced Chennai declaration has begun to tighten up on over-the-counter use, so we are beginning to see significant action. India also supported a World Health Assembly resolution on this matter. However, sitting the table and hearing the different contributions at the conference at The Hague certainly brought home to me the fact that there are differing attitudes across the world. It will be a big task to get some countries to where they need to be and we certainly need to lead by example, which is a point that has been well made.

One of the things that we can do in supporting the work at a global level is building capacity and capability. As with so many problems of our developed world, we cannot afford to wait for everyone to go through the same cycle of development, discovery and identification of problems; we need to try to share our understanding. Public Health England is piloting a laboratory-twinning initiative, where high-income Commonwealth nations are working with low and middle-income countries to build up AMR education, training and surveillance capability, rather than waiting for them to develop their own.

The drugs pipeline is a huge issue, which was explained well and in some detail by my hon. Friend the Member for York Outer. That is an area in which we need rapid and concerted international action to stimulate the development of new antibiotics. The O’Neill review, which was commissioned by the Prime Minister in July, was mentioned. It is an independent review looking at the economic issues that cause this problem, and will make recommendations on what collective action can be taken by Governments globally. I confirm to my right hon. Friend the Member for North West Hampshire (Sir George Young) and others that that review will investigate solutions such as pricing and the introduction of incentives. The review is independent, so that team can think what they want—that is what they are tasked with—and we want them to come back with solutions to a problem that we know requires innovation. The interim report is due next summer, with the final report the year after that.

The faster adoption of new ideas was touched on, in particular those brought forward by small suppliers—Bioquell was mentioned. That is integral to the brief of the new Minister with responsibility for life sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), who was recently given a joint appointment to the Department of Health and the Department for Business, Innovation and Skills to look at how we can accelerate the rate of innovation, because, as we know, we must not lose time on this.

Members were concerned to know whether, in the meantime, pending the O’Neill review, work was under way, and I can confirm that it is. Quite a lot of work is going on with the pharmaceutical industry. The industry is working with Chatham House and the Big Innovation Centre to explore issues about the pipeline and to look at possible options to stimulate antibiotic development. We expect the outputs of those initiatives to be published later this year, and they will feed into the independent O’Neill review. Other work is under way, some of which involves making public assistance available to smaller companies where they need it, but I can confirm that the pharmaceutical and biotech industries are fully engaged, as we need them to be, in exploring the issue and working together on the all-important research agenda.

Much of the focus for that research is diagnostics. We have commissioned work to improve our ability to diagnose infections quickly and increase the take-up and routine use of point-of-care diagnostics. That means being able to diagnose much more quickly—at the point of care—without the delay in having to send things away for study, and so on. The more quickly we can diagnose, the more quickly we can use appropriate medication. The Select Committee certainly pressed us on that when we gave evidence and we are aware that it wants us to take action on that issue. That is very closely linked to the work on improving prescribing, which is a key strand of efforts to reduce the overuse of broad spectrum antibiotics. Easy, cheap and accurate diagnoses will enable us to tailor patient treatment much more speedily and improve clinical outcomes, which is obviously a win-win.

Hon. Members have mentioned the award of the £10 million Longitude prize, which happened on the evening between the first and second days of the Hague conference, so it could not have been more appropriate and it was great news that came through while we were all there. It was fantastic on two counts: first, that money will go towards developing a new diagnostic for AMR, on which we expect further details to be announced shortly; and secondly, it felt like a great leap forward for public recognition and public engagement on the issue. That announcement was integral to a popular science programme on television—it was not just done by the scientific community; there was full public engagement, so I am really delighted about that and we have to build on it.

On research, hon. Members will be interested to know that the Medical Research Council is leading an AMR Funders’ Forum to improve the co-ordination of research relevant to all those different aspects of antibiotic resistance. In addition, there are two new National Institute for Health Research, or NIHR, health protection research units—I apologise for all the acronyms—with a focus on AMR and health care-associated infection. They were established in April at Imperial college London and at Oxford university, and they are in the process of agreeing their initial two-year work programmes, so more research is going on in those establishments.

In addition to important work to galvanise international action and stimulate drug development, we are trying to put in place the infrastructure and tools needed to improve infection prevention and control, and diagnosis and prescribing, in order to prevent the development and spread of AMR. That requires thinking about the problem in an entirely different way, because this problem is unique. The scale has been outlined by other people, but because of some unique aspects, we need to do things in a different way, and we are very aware of that.

Infection prevention is, of course, better than treatment, so we are refocusing attention on what more we can do to improve our ability to prevent infections and reduce reliance on antibiotics. To reduce the risk of importing very resistant infections from countries where the prevalence is higher—some of those countries have been mentioned—measures such as screening on admission to hospitals are now recommended and will be taken up.

Improving infection prevention includes work with NICE—the National Institute for Health and Care Excellence—and others to develop clinical guidance, best practice information and resources. We are also strengthening the code of practice on the prevention and control of infections to clarify for providers the measures they need to take to ensure effective infection prevention and, importantly, antimicrobial stewardship. That is being complemented by NHS England looking at the best ways to use levers on commissioning in the NHS and how it can establish local patient safety fellows to champion and help to embed best practice. On the animal side, DEFRA has provided guidance to assist with farm health planning. Work is under way to explore how we can make better use of vaccines and alternative treatments to reduce reliance on antibiotics and minimise the opportunity for resistant strains to develop.

I turn to the recent survey, the English Surveillance Programme for Antimicrobial Utilisation and Resistance —to which the shadow Minister nobly referred; it is quite a mouthful—or ESPAUR. That report from Public Health England was grim reading. It certainly made it clear that we have a long way to go in this regard, and it provided data that showed the enormous variability in the levels of prescribing across the health care system in England. It showed us some areas with extremely high prescribing rates, which often had the highest resistance rates. Although that report was tough reading, it was commissioned precisely because we did not really have a baseline report. We now have that, and it is a really important set of baseline information, from which we can go forward and help to improve practice.

[Zac Goldsmith]

Data are rigorously collected in relation to the resistance and use of antibiotics in human medicine, but they are hardly collected at all in relation to farm use. My understanding is that the whole system is entirely voluntary, and as a consequence, there are virtually no data at all. Is that an area where, at the very least, the Minister’s Department could pull rank on DEFRA and require the collection of data, so that we can have a meaningful discussion, because at the moment DEFRA does not seem inclined to pursue the matter with any great vigour?

[Jane Ellison]

I have already noted my hon. Friend’s concern about that, and I will bring it to the attention of my colleagues in DEFRA and ask them to give a detailed response. Although I had noted it as an area of concern, as I say, we work very closely together on this issue, which is why the UK, I think uniquely, sent two Ministers—one from agriculture and one from human health—to conference in The Hague.

To go back to GPs, we need to get to the bottom of why we have such variation around the country and why there is so much inappropriate use. That work is going on. There are some initiatives to support the optimisation of prescribing—essentially trying to give doctors more tools to enhance their professional skills. One of those is called TARGET—Treat Antibiotics Responsibly, Guidance, Education, Tools—and is being promoted by the Royal College of General Practitioners. Work is under way to develop this area and include it in health care training curricula. We have also developed new antibiotic prescribing measures for both primary and secondary care to try and help drive down that variability.

I think we can do more as MPs—all of us, in all our routine conversations with health and wellbeing boards, GPs and clinical commissioning groups, and with our local trust chief executives. This should be a standard question on our agenda for those meetings. That would really help, because I know, as a Government Minister, and I think we all know as MPs, that when we are aware that someone is going to ask us a tough question, we go away and start thinking about whether we have a good answer, so there is a lot more that we can all do to drive it at that routine level. There is only so much that the Government nationally can do to influence local GPs.

I want to reassure Members, however, that European antibiotic awareness day is on 18 November, and it would be a great moment for all of us to talk to our local health care professionals. I would be delighted if hon. Members here today, who are so interested in the subject, would work with me in putting together something in writing to all colleagues, with great questions to ask their local health care system. I would be delighted to do that and I can facilitate it. It would include posters for GPs’ surgeries as well as encouraging the public and professionals to become antibiotic guardians and to make pledges to undertake individual action in our effort to preserve antibiotics. Some members of the public are beginning to understand the scale of the challenge, but we are certainly not there yet, and I think Parliament has a role in trying to make that clear.

As a result of the work to date in the first year of the Government’s strategy, we have significantly better data and information, which we can use to inform the development of effective interventions. We have begun to define the scale of the problem much more, and I have outlined the action that we are trying to take in an international context to make sure that the spread of AMR is taken seriously across the world.

As I have mentioned, I will report all the points made in today’s debate both to the chief medical officer and to our cross-party high-level steering group to ensure that we have picked them up in the imminent publication. If there are any points that are not picked up, I will come back to hon. Members on them individually, but I want to reassure the House on the matter. I thank my hon. Friend the Member for York Outer for calling this debate and, indeed, the House for such a well-attended and thoughtful discussion. Everything we can do in this House to highlight the scale of the problem and the urgency of tackling it is very welcome, and I thank all hon. Members for their contribution today.

[Mr Christopher Chope (in the Chair)]

We now move on to a short debate on connectivity to Leeds Bradford international airport. I call Stuart Andrew.