Smoking in Private Vehicles Carrying Children

Jane Ellison Excerpts

Tuesday 15th July 2014 Written Statements

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

The Government have today published “Smoking in private vehicles carrying children—consultation on proposed regulations to be made under the Children and Families Act 2014”.

Parliament has voted in favour of legislation that gives Ministers powers to bring forward regulations to make private vehicles carrying children smoke-free. The Government are proceeding with the introduction of regulations and are seeking views on draft regulations before they are made.

Under the proposed regulations, existing smoke-free legislation as set out in the Health Act 2006 will be extended, so that it would be an offence to:

smoke in a private vehicle with someone under age 18 present; and

fail to prevent smoking in a private vehicle with someone under age 18 present.

The proposed regulations will not apply to anyone driving alone in a private vehicle.

Exposure to second-hand smoke is a serious health hazard, especially to children. Every time someone breathes in second-hand smoke, they breathe in over 4,000 chemicals. Many are highly toxic and more than 50 are known to cause cancer. The only way to provide effective protection is to prevent people breathing in second-hand smoke in the first place. The World Health Organisation found that second-hand smoke is a real and substantial threat to child health, causing a variety of adverse health effects including increased susceptibility to lower respiratory tract infections such as pneumonia and bronchitis, worsening of asthma, middle ear disease, and decreased lung function. Children from socio-economically disadvantaged backgrounds are generally more heavily exposed to second-hand smoke than other children.

The consultation will run for six weeks until 27 August 2014. I would encourage all those with an interest to give their views on the draft regulations that would prohibit smoking in private vehicles carrying children.

Smoke-free legislation is a devolved matter and these regulations would apply to England only. The regulation-making powers allow for Welsh Ministers to introduce regulations and we are liaising with the Welsh Government to co-ordinate our approaches.

“Smoking in private vehicles carrying children—consultation on proposed regulations to be made under the Children and Families Act 2014” has been placed in the Library. Copies are available to Members of the House of Commons from the Vote Office and the House of Lords from the Printed Paper Office.

Health Provision (Sittingbourne and Sheppey)

Jane Ellison Excerpts

Wednesday 9th July 2014 Westminster Hall

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

I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this debate. He demonstrated his masterly understanding of the health challenges in his area and deep knowledge of and concern for the more deprived parts of his constituency. I thank him for that. His constituents will be grateful to know that he has such a handle on those issues.

Before I respond to some of the particular issues that my hon. Friend highlighted, I want to highlight the excellent work carried out every day by those who work in the NHS, not just in my hon. Friend’s constituency, but in mine and throughout the country. I hope we can always take the opportunity in a health debate to put on the record our thanks to hard-working NHS staff for everything they do in our constituencies.

I turn first to renal policy and particularly my hon. Friend’s local campaign. End-stage renal failure is an irreversible and long-term condition, and he was right to highlight the problems caused by more and more people living with long-term conditions, particularly when combined with other long-term conditions. It results from chronic kidney disease and needs regular dialysis treatment or transplantation.

Since 1 April 2013, NHS England has been responsible for securing high-quality care for dialysis patients as part of its specialised commissioning responsibilities. It has established a clinical reference group specifically for delivery of renal dialysis services, which brings together clinicians, commissioners and public health experts with dialysis patients and carers. It has published service specifications for both home dialysis and hospital and satellite dialysis, which my hon. Friend described. The specifications are important because they define clearly what NHS England expects to be in place for providers to offer safe and effective services. They are there to ensure equity of access in a nationally consistent, high-quality service for patients everywhere.

NHS England has recently consulted on amendments to a range of service specifications, including for renal services and dialysis. Those updated specifications are expected to be published later this year following consultation this autumn. My hon. Friend will take a great interest in that because it is obviously directly relevant to the campaigns in which he is engaged. I know that he has had meetings, and the feedback from NHS England is constructive about the excellent way in which he is engaging with it, and I am glad to hear that.

My hon. Friend mentioned the possibility of a satellite dialysis unit at Sheppey or Sittingbourne community hospital, but I gather that to date it has not been possible to provide such a unit because there is concern that not enough people in the area need that service. However, he is rightly pressing local NHS officials on that. One issue that comes into the calculation about setting up such a unit is the safe level of staffing to meet patient need, as well as viability and efficiency. Those are important calculations to ensure that any service meets needs.

[Gordon Henderson]

The point about what I am trying to achieve is that renal services are trying desperately to get more people into home dialysis, because that is an inexpensive way of providing dialysis. All I am suggesting is that when patients cannot have it at home because they live alone, it should be available at the local hospital. I do not believe the cost should be too much of a factor.

[Jane Ellison]

That is a fair point and one that my hon. Friend has raised in the discussion. NHS England is exploring the possibility of a self-care unit in the area. Such units have been developed in a few places around the country and, as he outlined, those units are particularly useful for people who can get themselves on and off machines or bring carers with them to help because they tend not to be staffed units. It is similar to home dialysis but, as he rightly said, can be used by people whose homes are not suitable for that.

I encourage my hon. Friend to continue the discussions. I met local NHS officials yesterday and encouraged them to continue to keep in regular touch on the matter. I understand that the area director for Kent and Medway will write to my hon. Friend shortly following his recent meeting. I would be happy if he kept me informed of how the discussion goes because I am interested in it.

My hon. Friend rightly highlighted in great detail a particular challenge with local funding. Obviously, the Government have protected the overall health budget for the NHS in England and NHS England in turn has ensured that every clinical commissioning group in England will continue to benefit from stable real-terms funding in the next two years. Reflecting changes in population around the country and better targeting is key. Something that often comes across my desk as public health Minister is the challenge of getting that right where there are pockets of deprivation, particularly deep deprivation, in areas that might not flash up on the radar when looking at how resources are meted out. We want the NHS to be in a good position to offer the best services to patients where they can do the most good and meet need. Responsibility for CCG allocation rests with NHS England, but the Government’s mandate to NHS England makes it clear that equal access for equal need is at the heart of the approach to allocation.

NHS England’s decisions in December last year mean that over the next two years every CCG should receive real-terms funding growth. The purpose of doing that for the next two years instead of just one was to try to provide stability and certainty so that local commissioners can plan services. The sort of issues that my hon. Friend highlighted and the long-tem problems associated with deprivation, such as co-morbidity, over-indexing on smoking and so on, need stability of commissioning because they need long-tem consistent intervention in many cases to ensure that we are meeting patients’ needs. That means that every CCG will receive cash growth in funding of at least 3.9% over the next two years, and those with the fastest-growing populations will get more. Swale CCG’s funding allocation increase of 2.63% in 2014-15 is just above the national average and its increase of 2.05% in 2015-16 is just below the national average. That real-terms growth was given to all as a minimum of 2.14% in 2014-15 and 1.7% in 2015-16.

In order that the issue is looked at objectively, free from political considerations, the Health and Social Care Act 2012 made how health funding is allocated between different areas a responsibility of NHS England. NHS England has taken an evidence-based approach that balances the demands of growing populations and looks at historical underfunding, which is probably one of my hon. Friend’s great concerns, and at maintaining stability.

NHS England has also decided to leave the weight given to the inequalities indicator unchanged at 10%. The new indicator has less variation in it than the old indicator when looking at variation across CCGs, and it is now able to pick up pockets of deprivation within CCGs. That adjustment should favour my hon. Friend’s area for the very reasons that he outlined, and NHS England has accepted the advice it has been given by an independent committee that that is a better measure of inequality for this purpose.

NHS England’s consultation on the impact of the new formula earlier in the year did not have an inequalities weighting at all, which led some people to jump to the wrong conclusion, but it does not reflect the final decision, which is to include an indicator of inequality with a weighting of 10%. They are finely balanced judgments, particularly around the progress of the pace of change towards the right amount for a particular area.

[Gordon Henderson]

While the Minister is talking about the funding and the formulas, I point out that there is an anomaly, which goes back to the dialysis treatment. The CCG is not responsible for the commissioning of dialysis, so it cannot control where the patients go, but it is responsible for funding the transport of those patients to the hospitals. It seems a bit of an anomaly that the CCG has no control over where the patients go, but is expected to fund the transport. I wonder whether that could be looked at.

[Jane Ellison]

It is a fair point, and I will ask the NHS team in my hon. Friend’s area to consider that as part of his ongoing discussions with it. As I said, getting the funding formulas right is not a perfect science, but the new formula is more responsive to pockets of deprivation. However, he has highlighted some challenges around smaller CCGs in a fair way.

My hon. Friend also highlighted issues and concerns about GP recruitment, and I know he has raised them before. A number of GPs in Swale are due to retire in the next few years. That is a challenge we see elsewhere in the country, and it has also been reported that Swale has a higher ratio of patients per GP than some other areas, so we recognise that that is a potential challenge. GPs work hard and do a vital job, so we are all concerned about making sure that we have the right number of GPs in our area. At a national level, despite a decrease in headcount, there has been a small increase of 1.2% in full-time equivalent GPs since 2012, and the number of practice nurses and other practice staff has also grown. My hon. Friend talked about the great public health challenges, such as co-morbidities, and there are many things that practice nurses increasingly deliver and their interventions can be extremely effective.

However, we recognise that the work force need to grow to meet rising demand. In our mandate to Health Education England, we have required it to ensure that 50% of trainee doctors enter GP training programmes by 2016. The Government will also be working with NHS England, Health Education England and the professions to consider how we improve recruitment, retention and return to practice in primary and community care. That is something that my ministerial colleague, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is very closely considering and is engaged in active discussions on.

I understand that the Kent and Medway area team from NHS England are working closely with the local CCGs, GP practices and HEE to improve the overall recruitment and retention levels of qualified doctors entering general practice as a specialty. I also understand that Swale clinical commissioning group has set up the north Kent education, research and innovation hub, which met in June and is meeting bi-monthly. The hub will be looking, at a local level in particular, at what needs to be done to address expected shortages. That is right because, with the best will in the world, these things cannot be solved with a grand plan in the centre. We also need to address some of the local issues and some are very granular with regard to what can help to attract GPs to particular areas. It is right that that is being done at a local level.

In the few minutes remaining, I want to touch on proposals for out-patient care, because, again, my hon. Friend the Member for Sittingbourne and Sheppey highlighted the value of early intervention and community health services, and of keeping people well in their own homes. In particular, as well as being good for individuals, that takes pressure off A and Es. We do not want to see routine conditions presenting in A and E at an acute stage, so it is really important that we get out-patient care right.

Proposals in my hon. Friend’s area include consolidating services into six co-ordinated out-patient clinics from the current 15 sites. The benefits of that include value for money from modern facilities and equipment, a wider choice of appointment times, and a greater ability to perform enhanced diagnosis—the Government have made early diagnosis a real priority; far too many conditions are still being diagnosed at an acute stage in A and E, so early diagnosis is critical. A greater proportion of his local population will also be within 20 minutes of an out-patient appointment, which is important. The East Kent Hospitals University NHS Foundation Trust is working with the NHS Canterbury and Coastal clinical commissioning group in consultation. A public consultation on out-patient services was completed in spring this year. I know that my hon. Friend will have been very engaged with that and that those proposals have now been brought forward.

A number of other workstreams are in place to address the issues that my hon. Friend outlined. I encourage him to talk with the public health directors in local authorities. The public health lead now sits in local authorities, and I am seeing some great innovation around the country from local authorities and directors of public health to address some of the really deep-seated challenges that he outlined. Many of the figures that we are seeing for public health are going in the right direction at a population level, but they often mask what is happening with smaller sub-groups of the population, for whom the figures are not moving in such promising directions. That is exactly what my hon. Friend was describing, so along with all the other people he is engaging with, I encourage him to make sure he engages with directors of public health and, in particular, the local Public Health England teams.

My hon. Friend should ask them what they are seeing in areas around the country that is really working. Some of the places I have visited, with similar demographic challenges and similar public health challenges, are piloting interventions that are really effective. One of the great opportunities of more devolved public health is that it gives rise to local innovation, and we see that imaginative approach being brought to bear by people who really know their populations. However, one slight challenge is how we identify good and emerging best practice and ensure that we get it promoted more widely. I encourage my hon. Friend to ask questions of his local public health specialists, and in terms of the population challenges he faces, he should ask about things that are being piloted elsewhere that might effectively be brought into his area.

I end by congratulating my hon. Friend again on being a really effective champion with regard to the local health challenges his community face. It is great to see a constituency Member with such a grasp on the range of challenges. I often respond to debates on the reconfiguration of bricks and mortar, but understanding the deep health challenges that a particular population face, and doing so at a granular level, is also really important in how we shape services for the future, so I congratulate him on that. His constituents have a great champion in Parliament for their health needs. I am very happy to continue to engage with him, and I encourage NHS England in his area and his CCGs to continue the constructive dialogue that they have had—and continue to have—to provide the best services to his constituents.

Organ Transplants

Jane Ellison Excerpts

Tuesday 8th July 2014 Westminster Hall

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

This has been an excellent debate, and I am only sorry that I have less than 12 minutes—slightly less time than the shadow Minister took—to respond. As always, I hope colleagues realise that if I cannot respond to substantive points during the debate I will write to them afterwards.

I will try not to reiterate some of the excellent points made about the backdrop to the debate, but I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate and on being such a stalwart supporter of health debates generally—we are in this Chamber together very often and it was excellent to see him leading today’s debate. There have been many thoughtful contributions today. I would also like to note that as a former member of the Backbench Business Committee I particularly welcome the fact that it has given Parliament the ability to have timely debates. It is excellent that we are having this debate in national transplant week. The Committee is a real innovation that has worked out well.

I join those who have paid tribute to donors and their families and all those who work in the NHS to make organ donation and life-saving transplants such a success story for our nation. Rightly, however, colleagues have focused on where we can do even better, and I will try to respond to some of their points. I will certainly draw the attention of NHSBT to the many good points that have been made.

It has been well established how many people are on the register of those waiting for a transplant. It is also well established what a success the taskforce set up under the previous Government has been. In the six years between April 2008 and April 2014, we saw a real strengthening of the donation programme, with donation rates going up by 63%, and transplant rates by 47%. However, we know that there is more to do, and programmes in other countries are producing even better results.

We have heard of people—in some cases, we have heard moving personal examples of constituents—who are waiting far too long for suitable organs to be donated, and I will touch later on what NHSBT is doing to work with surgeons in that regard. Sadly, many of those people have lost their lives waiting for a transplant, so it is heartening that the number of people registering for organ donation has increased by more than 3 million since 2010 and is now more than 20 million. I pay particular tribute to people in Northern Ireland for the impressive rates there, which the hon. Member for Strangford highlighted.

The critical issue, and one of the things NHSBT wants us all to focus on in national transplant week—indeed, many speeches did focus on this—is the need for people to discuss organ donation with their family. People need to add their names to the register, but they also need to talk with their families about the fact that they have done so. The shadow Minister and others alluded to the fact that a relatively small number of people die in circumstances where they could be donors, and there is some reason to think that that pool of people might actually diminish. The need for people to have a conversation about registering was movingly explained by the hon. Member for Bridgend (Mrs Moon), who used a personal example that highlighted the issue so much better than any number of statistics could.

The UK’s consent rate is the area of particular concern and focus, because it is one of the lowest in Europe. Last year, four in 10 families said no to allowing their loved one’s organs to be donated. In 2012-13 105 families, and in 2013-14 119 families said no, even though they knew their family member was on the organ donation register. Obviously, it is a real concern that they knew that person’s wishes and still said no.

On the point my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made about children, it is worth noting that young people can give consent and go on the register if it is obvious they can make that consent real. If they are judged to be old enough to give consent, they can do so; if they are too young, consent will still be down to the parents. That comes back to the point that it is important to have a family discussion, for all the reasons that have been highlighted, and I will talk a little more about that later.

One group of people who play a really important part, and who have made a contribution to the success of our programme, with its higher rates of donation and transplant, are the specialist nurses for organ donation—the SN-ODs. They do amazing work at an absolutely tragic time in a family’s life, and their specialist training has been one of the critical factors in moving us forward. When we last debated this issue, I said that the reality is a long way from cool, calm debating chambers such as this, where we exchange statistics and thoughts on how to improve things. Many decisions about transplant are made at a moment of great trauma; it might be 3 in the morning, and somebody might not even want to be parted from the body of a loved one who has just died. At that moment, the clinicians have a real duty of care towards the family, who will be very distressed, and the reality is that, operationally, clinicians will not overrule a distressed family who are absolutely determined they do not want to donate. This is about having a conversation beforehand, which, as the hon. Member for Bridgend underlined, is so important.

NHSBT and clinicians are very aware of the possible consequences of getting adverse publicity for overriding a family’s wishes. There is a delicate balance to be struck. I should remind Members that lung transplants need to take place within 12 to 16 hours of retrieval of the organ—for hearts, it is up to six hours. That is not a big window of opportunity, and it comes at a terrible moment. That is where specialist trained nurses such as the SN-ODs are so fantastic. However, we need discussions to happen much earlier.

As these debates always do, this debate has touched on diverse opinions about introducing opt-out. I will not go into that in any detail, because we have rehearsed these issues before. However, I would just say that my hon. Friend the Member for Montgomeryshire (Glyn Davies) is right to say that the jury is out on the international evidence regarding whether it is opt-out or opt-in that makes the difference, rather than a concerted programme of many other things—the sort of things, in fact, that our organ donation taskforce has addressed. The strengthening of donation programmes and other steps have made a significant difference, but we will watch with interest the impact on donor numbers of the proposals in Wales. However, we are yet to be entirely convinced that they alone will make the big difference. Again, if a family are strongly against donation when their loved one has died, their strong wishes will not be ignored and overridden, even in the situation in Wales. This still comes down to understanding what families want.

The “Taking Organ Transplantation to 2020” strategy is very much evolutionary, and it builds on the infrastructure we have in place, particularly as regards response rates. Members have mentioned other aspects of it. One aim is to have 5% more donated organs transplanted. Some of the work going on to support that is on improving organ function before retrieval, improving the function of retrieved organs, reducing the rate of declined organs and supporting surgeons in understanding risk. Work is therefore being done under the strategy on those important issues.

During the debate, Members highlighted lots of the good ideas we are using in promoting organ donation and encouraging people to sign up to the register. The Cabinet Office is working on further initiatives, but it always welcomes suggestions. Everyone involved in policy development on this issue is extremely open to good ideas, and I will certainly ensure that the debate is brought to the attention of colleagues in the Cabinet Office.

I also urge Members to do what they can this week. Tomorrow afternoon, NHSBT is hosting a good event of its own, and I hope Members will attend. There have been lots of suggestions of what Members can do. The hon. Member for Strangford said he is using his Facebook page. We can also use links on our websites and social media—MPs are increasingly good users of social media. This week, people are using #spellitout to try to get a conversation going. I urge Members to support the NHSBT event and to use that hashtag. If they are planning an end-of-term bulletin to their constituents, I urge them to pick this issue out to help spread the word.

As was rightly said, it is disappointing to see both the length of time members of ethnic minority communities are waiting for a transplant and the refusal rate in such communities, which is nearly 80%, compared with about 40% nationally. There is a real challenge, which is why my Department is supporting the National Black, Asian and Minority Ethnic Transplant Alliance in looking at some of these issues and addressing the inequality people from such backgrounds face in waiting for a donor.

In June, I supported the launch of a new project to train peer educators from the Pakistani Muslim community in Birmingham to work in communities to increase rates. Sadly, because of parliamentary business, I was unable to join them on the day, but I have suggested that we ask them to join us later this year in Westminster to talk about the project. I will make sure Members are told of the event at the time so that Members—particularly those of us with diverse constituencies—can come and hear about the experience of those involved. In our previous debate, Members mentioned the challenge of trying to recruit more SN-ODs from within ethnic minority communities, because we face a similar challenge with recruitment as we do with the consent rate.

Earlier this year, following our previous Adjournment debate on this issue, the hon. Member for Bristol East (Kerry McCarthy) and I debated cystic fibrosis, and progress has been made. The point about the zones has also been made. The cardiothoracic organs advisory group has recommended that NHSBT review the consequences of introducing the two levels of priority for listing—urgent and routine—along the lines that have been described. Obviously, it is important to make sure the arrangements do not lead to inequity, and I can assure Members that NHSBT will keep the issue under regular review.

I will be talking to NHSBT imminently, at tomorrow’s meeting. Indeed, I have regular meetings with it. In the half a minute remaining, I want to reassure Members that the organisation is extremely proactive and open-minded, and I find it very receptive to new ideas. Many good, constructive and thoughtful ideas have been put across in the debate. I will have a discussion with NHSBT and ask it to review the debate and to respond to hon. Members through me where I have not been able to respond today. I reassure Members that all good ideas are considered and that we are all working in the same direction: we want to increase donation and transplantation rates and to give many more people a chance of life.

Meningitis B Vaccinations

Jane Ellison Excerpts

Monday 7th July 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) on securing this debate on the meningococcal B—or MenB, as I think we will call it—vaccination. It is a hugely important topic to which he has done great justice. Obviously, this is a very topical public health issue. He is not alone in this House in having had constituents who have felt the devastating effects of MenB, and he put his case passionately; I certainly respect that. Of course, we recognise the devastating impact that MenB disease can have, and Members have described it. It is often known among clinicians and parents as a parent’s greatest fear.

Children aged less than five years are most affected by MenB. As my hon. Friend mentioned, the peak of the disease is in infants aged 6 to 12 months. MenB is fatal for about one in 10 of those who develop meningitis and/or septicaemia. With early diagnosis and treatment, most people can make a full recovery, but around a tenth of survivors have major physical or neurological disabilities, including amputation, deafness, epilepsy and learning difficulties, so it is truly devastating. It is, thankfully, relatively uncommon, with an average of about 1,000 cases per year in England and Wales over the last decade. Incidence has been decreasing in recent years, as was alluded to in an intervention, but it is unpredictable and it could rise again quickly. That is why the advent of a vaccine that could provide protection against MenB is so welcome.

If the House will indulge me, I will go over the history of the investigation into the vaccine and the work of the Joint Committee on Vaccination and Immunisation. It is worth noting for the record that the JCVI is an independent departmental expert committee that provides scientific advice to inform policy making. It is a statutory standing advisory committee for England and Wales under the National Health Service Act 1977. It has no statutory basis for providing advice to Ministers in Scotland or Northern Ireland, although Health Departments in those countries may choose to accept the committee’s advice or recommendations, and they generally do.

In anticipation of a MenB vaccine being developed and licensed, the JCVI began work to consider a possible MenB immunisation strategy in 2010. The MenB vaccine Bexsero, manufactured by Novartis, was licensed by the European Medicines Agency in January 2013. The JCVI’s work before that date enabled it to provide advice at the earliest opportunity, so it is not quite right to say that there has been a great delay. The work had begun in anticipation to try to get us ahead of the situation. The JCVI looked to base its recommendations on the best available evidence for efficacy and cost-effectiveness.

Following the licensing of the vaccine, my right hon. Friend, the Secretary of State for Health requested a recommendation from the JCVI on the use of a MenB vaccine under the provisions of the Health Protection (Vaccination) Regulations 2009, which provide the basis for the public’s right of access to national immunisation programmes in the NHS constitution. The Secretary of State has a statutory duty to implement a recommendation from the JCVI on a new immunisation programme, so far as reasonably practicable, where cost-effectiveness has been demonstrated.

The Secretary of State and my predecessor, my hon. Friend the Member for Broxtowe (Anna Soubry), subsequently met to discuss the MenB vaccine with the national meningitis charities Meningitis Now and the Meningitis Research Foundation. Like my hon. Friend the Member for The Cotswolds and other Members in previous debates, I pay tribute to those charities for their excellent work.

The JCVI published an interim position statement on the MenB vaccine for consultation in July 2013 to assist it in making a complete assessment of the available evidence. That interim statement did not recommend a national immunisation programme because of uncertainties about the vaccine’s effectiveness and cost-effectiveness. In response to its consultation, the JCVI received new and recently published evidence on the MenB vaccine. The JCVI also considered comments and queries received in response to its interim position statement. Many of those comments and queries followed similar lines to those raised by my hon. Friend and made the same points on the severity of the impact on children who survive MenB. All the evidence and submissions led to further detailed analysis of the cost-effectiveness of a MenB immunisation programme.

Having considered the outcome of the further analysis at its meeting in February 2014, the JCVI recommended on 21 March that there should be a carefully planned national MenB immunisation programme for infants, starting at the age of two months. The JCVI made it clear that that recommendation was subject to the vaccine being available at a cost-effective price lower than the list price of £75 a dose.

There was some rather inaccurate media reporting when the JCVI’s recommendation was published that suggested that external influences might have led the JCVI to change from the position in its interim statement. The JCVI is an independent committee that greatly values its independence, so I remind Members that, in response to its consultation, the JCVI received new and recently published evidence and relevant comments that led to further analysis and the recommendation that the programme should be cost-effective subject to vaccine price. That is why the JCVI’s position shifted; there was no question of external interference.

[Geoffrey Clifton-Brown]

I am grateful for the way in which my hon. Friend is presenting her reply. From what she has said so far, the only issue seems to be the cost-effectiveness of the vaccine. Will she give any indication of when the cost-effectiveness issue is likely to be resolved so that a roll-out can begin for two-month-old babies, with a catch up for four-month-old babies?

[Jane Ellison]

Rather frustratingly, for me and for my hon. Friend—he alluded to this in his speech—I am not in a position to answer that, because to do so would be to pre-empt the stage we have reached with the issue. What I can say is that this country has world-leading vaccination programmes and a great deal of experience in planning them and rolling them out very effectively. I can assure him that all our experience would be brought to bear in a positive way at that stage. I cannot pre-empt either the timing or the price, but he can be assured of the expertise that sits behind the UK’s vaccination programme.

The Government welcomed and accepted the JCVI’s recommendation and hope that the UK will be the first country in the world to launch a national immunisation programme for MenB. As I have just said, that would continue our successful track record in providing a world-leading national immunisation programme.

I acknowledge that some people might say—I would not blame them—that cost-effectiveness should not be an issue when talking about a vaccine to protect very young children from a potentially fatal disease. However, it is important to consider cost-effectiveness so that money spent on new immunisation programmes does not use finite NHS funds that would otherwise provide more overall benefit to the wider population if spent on other treatments or services. We all recognise that those decisions are not easy, which is why so much expert thought and careful consideration go into them.

My hon. Friend asked when immunisation would start, and I have explained that we are not in a position to comment on that, but we are in a position to draw on great expertise when we face that issue. As I have said, the JCVI recommended that a MenB vaccine be introduced but only at a cost-effective price, below the list price published by Novartis. Therefore, the first essential step is to agree a cost-effective price for the vaccine with the manufacturer. We want to agree that with Novartis as soon as possible so that children can benefit from the vaccine, but we need to ensure NHS funds are used effectively, as I have explained. We must also follow due process on spending approvals within the Government before launching any procurement. That is quite a complex process involving a detailed business case.

We see the onus as being on the manufacturer to respond positively to the JCVI’s recommendation so that we can purchase the vaccine at a price that represents good value for money for the NHS. If we can obtain the vaccine at a cost-effective price, the introduction of the new vaccination programme would need to be carefully planned with the manufacturer and the NHS so that parents can be confident of a sufficient and sustainable supply of vaccine, with arrangements in place in the NHS for it to be provided and for clear information to be given to parents to enable them to make an informed choice.

I hope that it will give my hon. Friend some reassurance to know that last year the NHS introduced three new vaccination programmes and another one was rescheduled, which demonstrates that that is something we can do. That large expansion in the national immunisation programme was unprecedented. We must ensure that the NHS is fully equipped to be able to deliver another programme safely before introducing it. We hope to be able to start the procurement process soon and to purchase the vaccine at a cost-effective price.

My hon. Friend asked about adolescents. The JCVI’s advice was that research was needed on the effectiveness in adolescents of preventing transmission of infection. I am aware of the cases on US campuses to which he alluded. The Department is considering how best to commission the necessary work. If I have any update on that situation, I will write to interested Members after the debate. In addition, I will give an update on where we are in the process as soon as I am in a position to do so. If the procurement is successful, we will be in a position to make firm plans for the introduction of the new MenB immunisation programme. At that point I will be able to say a lot more. I accept that it is frustrating that I cannot say as much as he would like.

I thank my hon. Friend for raising this incredibly important subject. All of us, as constituency MPs, and certainly those of us who are Health Ministers, are extremely aware of the importance that many parents place on this subject and the fear that MenB raises for some many people. He was right to ask me to come to the House and address the subject, even if I cannot do so in quite as much detail as he would like. I look forward to updating the House in due course and will do my very best to ensure that I keep all interested Members fully up to date as we progress with this important process.

Question put and agreed to.

Head and Neck Cancer

Jane Ellison Excerpts

Tuesday 1st July 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Mole Valley (Sir Paul Beresford) on securing this debate on this important issue and on continuing to champion it. It shows Parliament at its best when Members bring to bear here the expertise and insight they have acquired outside this place, and that is certainly what my hon. Friend is doing and I commend him on it.

Let me set the scene before dealing with some of my hon. Friend’s specific concerns. As he said, we have debated this issue before and I am anxious to try to keep him up to date with any developments as well as to make sure the House has a general picture of what we are doing in this area.

The Government want England to lead the world in tackling cancer. That is why our 2011 cancer outcomes strategy set the ambition to save a further 5,000 lives a year from cancer by 2014-15, including head and neck cancer. As my hon. Friend rightly said, the incidence of head and neck cancer has been increasing since the 1970s, with over 6,500 people in England diagnosed with oral cancer alone in 2012. That is due to the prevalence of the major risk factors for oral cancer, such as heavy alcohol consumption and smoking. Chewing betel quid, which is more common among south-east Asian communities, is also a risk factor for oral cancer and that may have contributed to the trend. As the House knows, we have major programmes of work in place to tackle smoking and excessive alcohol consumption —and it is heartening that, although there is a long way to go yet, we did see smoking prevalence rates dip below 20% for the first time in England in the most recent figures.

There is now growing evidence that HPV, already linked to the development of nearly all cervical cancer in women, is also a major risk factor for oral cancer. That is not disputed. The types of HPV that are found in the mouth are almost entirely sexually transmitted, and they have been associated with about a quarter of head and neck cancers. So if we can reduce the incidence of HPV in females through a high uptake of the national vaccination programme, a reduction of other HPV-associated cancers in females and males is likely to follow. I note, however, that my hon. Friend feels that that herd immunity is not going far enough and there is further to go. It is worth restating that the aim of the current HPV vaccination programme is to prevent cervical cancer related to HPV infection—that is where it started. When introducing the vaccine in 2008 the Joint Committee on Vaccination and Immunisation, which advises the Government on all immunisation matters, did not recommend HPV vaccination for boys because the reasoning was that once 80% coverage among girls had been achieved there would be little benefit in vaccinating boys to prevent cervical cancer in girls.

Judged by any standard, the HPV immunisation programme has been very successful. More than 7.8 million doses have been given so far in the UK since 2008, and we have among the highest rates of HPV vaccine coverage achieved in the world. I encourage hon. Members to look at their own local statistics, because although we achieve a very high average vaccination rate, there is some local variation. That matter is worth pursuing, particularly with schools, as this vaccine is delivered in schools almost universally. Some 86% of girls who are eligible for routine vaccination in England in the 2012-13 academic year have completed the three-dose course and 90% have received at least two doses, but in some schools the rates are lower and we want to get those up.

There is an increasing evidence base on the association between the HPV infection and oral, throat, anal and penile cancers, and on the impact of HPV vaccination on those infections. As a result, the JCVI issued a call for evidence in August 2012 to inform a review of HPV vaccination. The JCVI is very much aware of the issues concerning HPV vaccination for men who have sex with men, and at its October 2013 meeting recognised that the current immunisation programme may be of little benefit to those men and agreed to create an HPV sub-committee to consider the evidence for extending that vaccination programme. The sub-committee will aim to identify and evaluate the full range of options.

[Sir Paul Beresford]

The Minister has just talked about extending the programme, but to what or to whom?

[Jane Ellison]

On to my next paragraph. The sub-committee will look to identify and evaluate the full range of options for extending the protection from HPV infection to men who have sex with men, including by vaccinating them, and the potential extension of the programme to include adolescent boys. That deals with the point my hon. Friend was making. The JCVI HPV sub-committee—I apologise for all the acronyms but they are inevitable in a health debate—met for the first time on 20 January 2014 to review the available evidence on the impact and cost-effectiveness of potential extensions to the HPV programme. Any recommendation by the JCVI must be based on cost-effectiveness; there is a particular formula it uses to look at that within our health economy. The sub-committee will report its findings to the JCVI following consideration of a yet to be completed study by Public Health England into the cost-effectiveness of extending the HPV vaccination in both those directions. I hope I can give my hon. Friend some reassurance by confirming that the study will consider the impact of vaccination against penile, anal and oropharyngeal—head and neck—cancers and genital warts. Those things definitely form part of the studies that will be made and of the calculation about cost-effectiveness. There is no evidence to suggest that the current HPV vaccines will offer protection against skin cancer—I do not know whether he wishes to develop things further in that area, but we are aware of no evidence that makes that link.

The decision on the vaccination of adolescent boys requires the development of complex models to determine whether or not it would be cost-effective. Obviously, this would mean extending an already big programme to a much larger group. These models may identify a need to generate additional evidence, and therefore a decision on vaccination of adolescent males is not likely before 2015 at the earliest.

[Sir Paul Beresford]

One difficulty with models is that they take absolutely no account of the unpleasantness of the disease and the damage it does. Head and neck cancer is one of the most frightful conditions to deal with and to live with.

[Jane Ellison]

My hon. Friend makes a good point, but I will have to come back to him on it. I will not speculate at the Dispatch Box. Many factors go into these calculations, but I will make inquiries with regard to other JCVI decisions. I think that the severity of effect is taken into account and is part of the calculation, but I will clarify that and come back to the hon. Gentleman. None the less, he is right to remind the House of that matter.

The evidence to support a decision on a selective programme to target men who have sex with men may become available at the end of this year, which is earlier than expected. Obviously, the Department will consider carefully the advice from JCVI once the Committee has completed its assessment. As that is all in the future, it is worth talking about some of the things that we have at our disposal now in terms of early diagnosis. In addition to taking steps to tackle unhealthy lifestyle factors and the virus linked to head and neck cancer, we have also set out, through the mandate to NHS England, a clear ambition for the NHS to improve outcomes for all people with cancer.

One of the most common symptoms of oral cancer is a persistent sore or lump on the lip or in the mouth, so there is an opportunity for both doctors and dentists to play a role in supporting earlier diagnosis.

Since 2005, the referral guidelines for suspected cancer, published by the National Institute for Health and Care Excellence, has supported GPs to identify symptoms of oral cancer and urgently refer patients. The National Institute for Health and Care Excellence is currently updating that guidance to ensure that it reflects the latest available evidence.

[Sir Paul Beresford]

With great respect, on the question of the sore or the ulcer, the problem with cancer is that it is not sore until it is too late.

[Jane Ellison]

I will reflect on that point. I do not pretend to have the hon. Gentleman’s professional expertise. He has corrected the record, if he feels that it needs correcting. I hope that he will not disagree with me when I say that dentists have a key role to play in the early detection of oral cancer.

[Sir Paul Beresford]

indicated assent.

[Jane Ellison]

All dentists are trained as undergraduates to look for such signs during routine check-ups and to pay close attention to patients’ self-reported history of smoking and drinking—both key risk factors. A new patient pathway, currently being piloted in 94 practices, includes an oral health assessment, which requires dentists to examine the soft tissue of the mouth; assess a patient’s risk in relation to oral cancer; and offer advice on lifestyle changes.

I am also pleased to say that the General Dental Council has confirmed that improving early detection of oral cancer is to be included as a recommended topic in its continuing professional development scheme.

The hon. Gentleman will also be aware that the Department has run a series of “Be Clear on Cancer” campaigns, and we keep all forms of cancer under review to see whether they might be considered within that campaign. As he made the case that oral cancers and head and neck cancer are becoming more common, they too will be kept under review.

As I have mentioned in previous debates, the NICE improving outcomes guidance in head and neck cancer, which was published in 2004, provides advice on the organisation of health care for adults with those cancers. Head and neck cancer has also been referred to NICE as a topic for quality standard development.

The NICE guidance has informed the development of NHS England's service specification for head and neck cancer, which was published last summer. This clearly sets out what NHS England expects to be in place for providers to offer evidence-based, safe and effective services.

Of particular relevance to patients with oral cancer is the £23 million radiotherapy innovation fund, which supports the radiotherapy centres across England to deliver increased levels of intensity-modulated radiotherapy. That is a more precise form of radiotherapy, which reduces the risk of patients with oral cancers suffering from a permanent dryness of the mouth as a result of treatment.

[Tessa Munt (Wells) (LD)]

The hon. Lady refers to innovative radiotherapy and I wonder whether she is aware of how much work is being done on the indications suggested by my hon. Friend the Member for Mole Valley (Sir Paul Beresford)—I congratulate him on this debate. I also wonder whether NHS England does not recognise that this type of radiotherapy can be used for anything except lung cancer.

[Jane Ellison]

I know that my hon. Friend has ongoing concerns in some of these areas and I will certainly draw her comments to the attention of NHS England and respond to her after the debate, if that is acceptable.

Since October 2010, the cancer drugs fund has helped more than 50,000 cancer patients in England and cetuximab is available through the fund for the first-line treatment of advanced head and neck cancer when certain clinical criteria are met.

I would like to reassure my hon. Friend the Member for Mole Valley that the National Institute for Health Research clinical research network is recruiting patients to 34 studies of head and neck cancer, of which three are focused on HPV-associated cancer. The NIHR also funds 14 experimental cancer medicine centres across England with joint funding from Cancer Research UK. Two of those centres have a disease focus on oral cancer.

I should make it clear, as I like to in every debate that we have on any health condition, that the NIHR welcomes funding applications for research into any aspect of human health, including head and neck cancer. I would certainly encourage my hon. Friend to encourage those that he knows in research circles to come forward with projects for which they might like to seek funding.

I thank my hon. Friend once again for securing today’s debate. I hope that the discussion, although it has covered some familiar ground for him, has been helpful in providing reassurance of our commitment to reduce the incidence of head and neck cancer and to improve the outcomes for those diagnosed with the disease. In particular, I thank him for championing the cause as these cancers are less well-known and for that reason they particularly benefit from parliamentary attention of this sort. I will undertake to keep him fully informed, as I hope that I have to date, as the matter and the JCVI’s considerations progress. I will also undertake to draw the attention of the JCVI to the debate and to my hon. Friend’s speech in particular.

Question put and agreed to.

Standardised Tobacco Packaging

Jane Ellison Excerpts

Thursday 26th June 2014 Written Statements

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

The Government have today published the “Consultation on the introduction of regulations for standardised packaging of tobacco products”. This consultation is being conducted on a UK-wide basis.

In November 2013, the Department of Health commissioned Sir Cyril Chantler to undertake an independent review of whether the introduction of standardised packaging of tobacco is likely to have an effect on public health, in particular in relation to children. The report of the Chantler review, which was published in April 2014, concluded that if standardised packaging was introduced, it would have a positive impact on public health.

Before reaching a decision on whether to introduce standardised packaging of tobacco products, we are holding a final, short consultation. This consultation will run for six weeks until 7 August. So that our decision on whether to introduce standardised packaging is properly and fully informed, the consultation includes a set of draft regulations so that it is clear how such a policy would work in practice. The draft regulations set out proposed requirements for the packaging of cigarettes and hand-rolling tobacco, and requirements for the appearance of individual cigarettes, should standardised packaging be introduced.

In the consultation that has been published today, we ask, in particular, for views on anything new since the last full public consultation on standardised packaging that we ran in 2012 that is relevant to the development of this policy, including evidence relating to the wider implications of introducing standardised packaging. In July 2012, we published the “Consultation on standardised packaging of tobacco products”. The report of the 2012 consultation was published in July 2013.

The consultation on the introduction of regulations for standardised packaging of tobacco products has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

I encourage any person or organisation with an interest in standardised packaging of tobacco products to engage with the consultation.

We have also today published on the web the detailed responses that were received to the 2012 consultation. These can be seen at:

www.gov.uk/government/consultations/standardised-packaging-of-tobacco-products

Health Council

Jane Ellison Excerpts

Thursday 26th June 2014 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council met in Luxembourg on 19 and 20 June 2014. Health issues were discussed on 20 June and the United Kingdom was represented at the meeting by the UK deputy permanent representative to the EU.

The presidency provided a progress report on the medical devices regulations and asked member states for an exchange of views on a compromise text on the designation of notified bodies, post-market surveillance and the tasks allocated to the medical devices co-ordinating group. Member states provided a range of opinions on these questions and the presidency and Commission thanked member states for their views.

The Council adopted Council conclusions on the economic crisis and health care, and on nutrition and physical activity. Italy and Romania tabled a joint declaration, expressing concern with the call upon the Commission to implement nutrient profiles.

Under any other business, France asked member states to work together to respond to the high price of a new hepatitis C medicine. Ireland briefly informed delegations of their plans to introduce standardised packaging of tobacco products, should the Bill successfully pass through their Parliament.

Most member states, including the UK, signed an agreement to be able to jointly procure vaccines in the future, if we choose to exercise this.

Italy presented their broad priorities for their presidency which begins on 1 July 2014. These cover a range of areas including dementia and anti-microbial resistance (AMR).

Melbourne Declaration on Diabetes

Jane Ellison Excerpts

Wednesday 18th June 2014 Westminster Hall

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

Thank you, Dr McCrea. I am aware that some colleagues who would normally be with us for a debate on this important topic have been speaking in the main Chamber. No doubt they will catch up with the debate online, at some point. I thank my hon. Friend the Member for Torbay (Mr Sanders), who opened the debate, and all those who have spoken. It has been another thoughtful debate on a topic that is very important, as he said. I congratulate him on his recent election as the first president of the Global Parliamentary Champions for Diabetes Forum. I am not sure whether he modestly did not mention that, but I give him credit for it. It is a tribute to his effective championing of the issue, and the global initiative is important.

As my hon. Friend said, we must not underestimate the global threat posed by diabetes. Other hon. Members have mentioned the numbers involved; the International Diabetes Federation estimates that by 2035 there will be 600 million people with diabetes worldwide, which is about one in 10 of the planet’s population. I think that the hon. Member for Strangford (Jim Shannon) described that as a ticking time bomb, but the debate has drawn out the fact that for the most part we do not have to accept that as inevitable. There are things that we can do, and it is right that we are beginning to talk about the issue as a global community, in global health terms.

In the UK, 3 million people are affected by diabetes. It is estimated that by 2025 the figure will be 4 million if we do not make progress. We estimate that around 850,000 people have undiagnosed type 2 diabetes. Diabetes is a priority for the Government. We have set clear objectives for the NHS and Public Health England to do more on prevention and to improve the care and management of people with diabetes. I accept that there is a challenge about the need for a national action plan. I have had meetings with Diabetes UK and it is one of the things mentioned in its briefing. We have set up clear objectives for the NHS and Public Health England and we ask them to deliver against those, so my contention is that we do indeed have a national plan, but that we may be carrying it out within a slightly different framework from the one advocated. The degree of priority we give it, and the importance that the Government accord to ensuring that the health and care system work together at all levels to give people with diabetes the care and support they need, should not be underestimated.

I hope that while I have been the Public Health Minister I have reassured colleagues about the personal priority that I give to the issue of diabetes. Indeed, my first public outing, slightly terrifyingly, was to speak to a meeting organised by my hon. Friend the Member for Torbay. Almost certainly, everyone in the room knew more than I did about the subject, but I attended to show, very early in my ministerial role, how important the issue was to me.

I have met the national clinical director. I try to have reasonably regular meetings with him, because the issue is such an important one. I have a continuing relationship with the all-party group on diabetes and the other diabetes campaigning groups and Members in the House. With respect to type 1 diabetes, I met my and other Members’ constituents at the JDRF event, which I have attended several times. It is always humbling to meet those fantastic young people who have learned very young to manage and live with a difficult condition.

What is NHS England doing to improve the management and care of people with diabetes? As I mentioned, I have several times met Professor Jonathan Valabhji, the NHS England national clinical director for obesity and diabetes. He has been generous with his time in attending parliamentary events, and is a great supporter of the work of groups and Members in the House. He regularly attends events focused on diabetes and is focused very much on improving outcomes for people with all types of diabetes.

Earlier this year “Action for Diabetes” was published, which describes the actions that NHS England is taking to improve diabetes care. It covers many areas, some of which have been highlighted during the debate, including developing GP contracts and incentives; working with primary care services to trial and roll out case-finding; and decision-support tools to help to detect and diagnose diabetes earlier. A national conversation is also going on about obesity and taking care of one’s own health. Hon. Members have touched on that with regard to the prevention of type 2. Every member of the public is a part of that conversation. We did not talk much about individuals during the debate, but I think we would all agree that we need constantly to emphasise personal responsibility in relation to preventable or avoidable type 2.

I sometimes worry—I talked about this with the head of Diabetes UK shortly after becoming a Minister—that, because few deaths are recorded as being due to diabetes, rather than its complications, there may be a slightly more relaxed attitude among people who think they might develop diabetes, which they would never in a million years have towards a disease such as cancer, which they would immediately identify as a threat. Through debates such as today’s, and the work that we all do, we can emphasise the fact that, although people may not know many people who can be said to have died of diabetes, they will know many whose diabetes contributed to premature death or a long period of ill health. There is more work for us to do, to get that message out. That is how we can empower people to help themselves.

[Jim Shannon]

The Minister could not have said a truer word, because many people see diabetes as a disease that they can manage—one that is not too bad. However, she is right: the complications are far reaching and can lead to consequences that are final. In my speech I talked about education, because people must manage the condition themselves, but they need to know what they have to manage. That is my point: some people need the information reinforced, with the seriousness that the Minister expressed.

[Jane Ellison]

That is right. We need to make sure of that. People cannot be empowered without information. We also know, having a duty to address health inequalities, that some people and groups in the community find things much harder. I was taken by some of what the shadow Minister, the hon. Member for Copeland (Mr Reed), said about deploying technology more. Work is going on, but I agree with him that we could go further faster with that, to find ways to empower people who may not have a good sense of what to do to take care of their health, and who find it harder than others to obtain the available advice. We must work harder to reach them and I shall talk about NHS health checks in relation to that.

As to the commissioning of integrated care, NHS England is working with other organisations to help to promote services that are integrated around patients’ needs across all settings. There has been much emphasis on that. That body is implementing what it calls a customer service platform to allow patients with diabetes to self-manage, through booking their own appointments, managing their prescriptions, monitoring the care they have received and being able to view their personal health records. That picks up on some of the shadow spokesman’s points.

NHS England has also produced a sample service specification for the management of type 1 and type 2 diabetes that is based on National Institute for Health and Care Excellence standards. It provides a model for commissioning integrated care for those with diabetes, and also highlights the specific needs of those with type 1 diabetes, where they differ from the needs of those with type 2. If the current trial of the service specification is successful, it will be offered as a tool that all clinical commissioning groups can choose to use to deliver high-quality care. That is therefore an important piece of work in progress.

There is always a challenge for any of us in making sure that the rest are as good as the best. Occasionally when we talk about the challenges of our current health infrastructure I worry about the assumption that there is a model out there, somewhere, that would absolutely guarantee the delivery of completely consistent care in a given area, across the country. In a country such as ours it is not possible to give such a top-down guarantee. Yes, we must find a way to drive care from the top, with a clear sense of direction from the strategy and mandate that we have given the NHS and Public Health England, but we must also put the tools in the hands of the clinicians, as I have been discussing. Most importantly, we must empower individuals and patients to know what they can expect and to demand good care. Nevertheless, I genuinely do not think that we could devise any system in which we could just issue a notice from the centre to say exactly how care will be delivered consistently across the country. We must find other ways to do it.

[Mr Jamie Reed]

I understand the Minister’s point, but we are talking about nine very simple, fairly cheap tests for people with type 1 diabetes that must be done in a primary care setting by medical professionals. We are talking about blood tests, the blood being processed and the resulting data being made available, all of which are critical to the self-management of the condition. Surely we can insist on those nine tests for every single type 1 diabetic patient.

[Jane Ellison]

I think that the shadow Minister has slightly misunderstood what I said. Those are the tests and that is exactly the standard to which we want everyone to work. What I am saying is that there is no top-down guarantee. We cannot sit in Whitehall and say, “It must be done like this and that is the end of it.” We have said that that is the standard, and NHS England has set a range of other standards, but to deliver that and to drive that consistency of excellence throughout the country requires a range of tools. We must acknowledge that. That is not to say that we accept patchy service—far from it—but we cannot do it with top-down diktat only; we must drive change at all levels of the system and drive towards excellence.

[Mr Sanders]

On that point, there is a difference between a treatment, which must be down to the clinician and what is right for the patient, and tests, which should be the same for everyone. They are just tests that would then dictate the right treatment regime, if additional interventions are required. There ought to be a mechanism to ensure that the tests are consistent for every patient with diabetes in the country, otherwise what is the point of having them?

[Jane Ellison]

I agree. The Government, NHS England and Public Health England are all looking at how we drive that consistency. How do we drive consistent excellence? What tools can we use to do that?

Perhaps it would be helpful if I gave an example. Public Health England is developing a tool to drive improvements in diabetes care and iron out variation. It will be launched later this year, and although I am not able to give much detail now, I am sure that my hon. Friend the Member for Torbay will be interested when it is launched. It will provide a clear picture of how diabetes care and outcomes vary across the country and among practices, which will support decisions on how to make improvements.

The Government have made transparency of data a real priority, and being very transparent about what is being delivered and identifying variation is one of the ways in which we can drive the rest to be as good as the best. I suppose I am trying to explain that, although I could send out a memo tomorrow outlining my national diktat on diabetes, that is not how we drive change. It is crunchy, it is detailed and it is about getting to that local variation and ensuring that we drive up standards in every way possible. That is one of the tools we are developing, but there are others as well.

[Jim Shannon]

In my speech, I called for a strategy that was not just regional but UK-wide, and I hope the Minister can respond to that. Other Members have spoken about the need for an English strategy, but there must also be one for Wales, one for Scotland and one for Northern Ireland. All four must work together so that we can address the issue together. The Melbourne initiative is very much worldwide, so although people refer to England, we must go further. What are the Government doing to initiate a UK-wide strategy?

[Jane Ellison]

As the hon. Gentleman knows, health is a devolved matter. That is not to say that I am not at all interested in what is going on in Northern Ireland—far from it—but it is nevertheless a devolved matter. As I have said to him in other debates, there is clearly an awful lot that we can learn from each other. People can learn from everything that I report to the House on innovation and the progress that we make in England, as well as, indeed, things that other Health Ministers report from other parts of the United Kingdom. Nevertheless, I currently have no plan for a UK-wide strategy because health is a devolved matter.

[Jim Shannon]

Will the Minister give way?

[Jane Ellison]

If the hon. Gentleman does not mind, I am going to make some progress.

Of course, the fact that health is a devolved matter does not mean that we cannot find areas of joint working, and the Melbourne declaration shows us the way forward on that. That is probably where we end up—the fact that it is devolved does not mean that we cannot share learning and knowledge, learn from one another’s initiatives, or operate in that global context.

[Jim Shannon]

I hope that the Minister will accept that I am not being argumentative, but we had a UK-wide strategy until 2013—last year—so we have shown that we can work together. All I am asking really is: why do we not initiate a similar plan to what was there before 2013—a 10-year plan that started in 2003—and have the four regions work together? That is exactly what the Melbourne initiative is about, and we could do it because we have done it before.

[Jane Ellison]

I will reflect on the hon. Gentleman’s comments and perhaps we will discuss the idea again.

[Jim Shannon]

Thank you.

[Jane Ellison]

I want to discuss another area in which we can make a difference by empowering patients. Colleagues might be interested to hear about the patient experience of diabetes services survey, part of the national diabetes audit, in which I know there is always great interest in the House—we regularly answer a number of parliamentary questions about it. The survey measures the health care experiences of people with diabetes in England and Wales. It collects information online from people with diabetes by asking questions about their care using a short, validated questionnaire, and it is being tested.

Any diabetes service in England and Wales should be able to use the survey to get feedback from patients. We want to publish the first results this month or this summer. That is going to be an interesting extra tool in the box, not only to help to drive excellence and drive out variation, but to empower local services to understand at a local level what is going on and how satisfied their patients are with the service being provided. That can lead only to upward pressure to improve services, not least from patients.

Let me talk a little about the NHS health check programme. Alongside the work being done by NHS England to improve the management and care of people with diabetes, the Government are working on prevention and earlier detection, which all Members mentioned. We are continuing to roll out the NHS health check programme, which identifies those aged between 40 and 74 who are at risk of diabetes and other vascular diseases and helps them to reduce that risk. More than 15 million people are currently eligible for an NHS health check. Our economic modelling has shown that the programme has the potential to prevent more than 4,000 people a year from developing diabetes and to detect at least 20,000 cases of diabetes or kidney disease earlier. It is all about helping people to better manage and improve their quality of life.

In the past year, almost 3 million NHS health check offers were made and almost 1.5 million appointments were taken up, during a time of great change across the health system. We are now looking to challenge the system to go further and faster and to continue to increase the number of people who participate in the programme. I have been out and about and seen some great local initiatives. I visited an NHS health check team in Southwark and witnessed the important conversations they were starting with people in their local area.

Another example is Bolton, where health trainers have worked with 134 people identified as being at risk of diabetes through the NHS health check. The health trainers have supported people to make lifestyle changes such as eating more healthily and increasing physical activity levels, and they have helped almost half the group to return their glycaemic level to normal. That is really good evidence of effective intervention.

In Tower Hamlets, where more than 50% of the population are from ethnic minority groups, the prevalence of type 2 diabetes has been growing rapidly. To help to combat that, Tower Hamlets has incorporated the health check programme into its managed practice network scheme. I have talked to staff about that and heard about how they are approaching it. Tower Hamlets has worked hard to ensure that all diabetic patients have a care plan, and that focus has resulted in a 70% increase between 2009 and 2012. There has also been a lot of focus on the take-up of retinal screening for people with diabetes, and, again, there has been a significant rise.

We are seeing that such local interventions can really work. I firmly believe that a localist approach is important in some of these areas, because there is no one-size-fits-all approach that we can devise in Westminster that will work for every community. Such local innovations are important. I constantly challenge myself to think about how we can ensure that we spread the word about some of this great local action. We have started initiatives in that regard, but Parliament has a great role to play, and I encourage Members to tell us of effective local initiatives, so that we can spread the word.

Research on the NHS health check programme carried out by Imperial college London and Queen Mary university of London is under way. That research will improve our understanding of who is taking up the opportunity, their risk of cardiovascular disease and the incidence of diseases such as diabetes in those groups. When that work comes back, it will help us to understand how we can make those interventions count more.

We have already talked a little about obesity and sedentary lifestyles. Physical activity is a big priority of this Government, and I have had a couple of meetings in the past couple of days alone on the cross-Government action we are taking to try to hardwire physical activity into all aspects of life. We have a long way to go yet because, for too long, physical activity was left in a silo marked “health” when it is more important than that. We know that all parts of local and national Government need to address inactivity; that is one of the factors that can help to prevent diabetes.

I also want briefly to address the responsibility deal. The Government have been working with business—the hon. Member for Strangford mentioned this—on its responsibility to consider calorie reduction and clearer labelling of food. We are starting to see calories and other contents displayed on the packaging of many more foods, as we roll out consistent food labelling on a voluntary basis across the country.

The Change4Life social marketing campaign, which is one of Public Health England’s flagship programmes, is encouraging individuals to make simple changes, and it is trying to work with people in the way that the shadow Minister mentioned. The campaign is trying to talk to people in language that makes it straightforward and easy for them to understand the good choices they can make for the health of both themselves and their family.

The national child measurement programme’s findings on childhood obesity are encouraging. We know that far too many people are overweight and obese, but we are seeing signs of encouragement. In 2012, childhood obesity rates fell for the first time since 1998, so we must not despair over the actions we have all taken and advocated over many years. We are beginning to see that such action can have an effect, but we must never underestimate how far we have to go.

In 2013, the global burden of disease study showed that the UK has the lowest rates of early death due to diabetes of the 19 wealthy countries included in the analysis. The last data on diabetes care showed a 60% completion rate for all eight care processes recommended by the National Institute for Health and Care Excellence, which is a five percentage point improvement on 2010. We see progress, but we know there is much more to do. The Melbourne declaration is a timely reminder of the serious threat posed by the disease across the world, as well as here in the UK. I assure the House and my hon. Friend the Member for Torbay, who led this debate and leads the all-party group in such an exemplary way, that diabetes is a priority on which we continue to work hard. We are pleased to see progress, but we do not underestimate how much more there is to do. Such debates are welcome opportunities to keep the issue firmly on Parliament’s radar.

[Dr William McCrea (in the Chair)]

Mr Sanders, we still have a few moments. Do you want to make a few closing remarks?

Organ Donation Register

Jane Ellison Excerpts

Tuesday 17th June 2014 Westminster Hall

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

I will do my best to respond to all the points raised, although I suspect I have the least time of any speaker in the debate. I may prove challenged in that regard, but as colleagues know, I will always follow up afterwards if there is some point which I am unable to get to.

I congratulate my hon. Friend the Member for Burton (Andrew Griffiths) on securing this debate. Just having this debate is part of the answer to the question he posed. The issue can affect us all, and I am grateful for the opportunity to raise its profile and to have the debate ahead of the special week coming up in July. The debate is particularly useful in giving us a chance to reflect on how we can best use that time in Parliament.

I put on record my tribute to those who work in the NHS with such dedication, determination and commitment. They provide such fantastic care, particularly, in the light of what we are talking about, at difficult times in families’ lives. To try to address some of the specific points raised, I will take as read many of the facts and figures put on the record by my hon. Friend and others. We acknowledge those figures. The one thing I want to do is thank everyone who donates and everyone who takes part in the programme. I also pay tribute to local leaders, such as William Saunders, whom my hon. Friend mentioned.

[Mr Peter Bone in the Chair]

We can take it as read that we do not have enough donors, but we have made significant progress. The Government are continuing the work of previous Governments by investing in the donation programme to optimise transplantation. The donation programme was strengthened between 2008 and 2014, increasing donation rates by 63% and transplant rates by 47%. The trend is positive, but today’s debate has explored how we can accelerate progress and address some of the more stubborn problems.

As hon. Members have already suggested, too many people are waiting too long for a suitable organ to be donated, even though organ donation has increased by over 3 million since 2010 to over 20 million. One organ donor can save or transform as many as nine people’s lives. The exchange is not one-for-one; it is an extraordinary opportunity to change many different lives. It is also worth recognising, as the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger), touched on, that although half a million people die in the UK each year, fewer than 5,000 die in circumstances in which they can become donors: the pool of people is not as big as we often think and is actually relatively small. If I have time, I will discuss how we are considering how the pool might be expanded.

Much of the debate rightly focused on the UK’s consent rate, which is one of the lowest in Europe. Last year, four in 10 families said no to allowing their loved ones’ organs to be donated. In 2012-13, 105 families and in 2013-14 119 families said no even though they knew that their family member was on the organ donation register and wanted to be a donor. That equates to many transplants and many people’s lives that could have been saved or enormously enhanced. Family agreement is a crucial part of the donation process, but because people do not always want to discuss their wishes, relatives tend to say no when in doubt.

I want to explore some of the operational aspects of donation. We all agree that we want more organ donation and more people on the register, but we should consider some of the challenges, in particular the one put forward by my hon. Friend the Member for Burton about why people’s wishes can be overridden. To be clear, we do not need to change the law, which currently protects the right of the individual to be an organ donor. The challenge comes from the complexity and sensitivity of operational issues and not legal issues. Clinicians have a duty of care towards the family. For example—I have every reason to believe that this is based on reality—if it is three in the morning and a clinician is faced with a family who do not want their relative’s organs to be donated and they are crying and clinging to the body, the clinician is likely to go with the family’s wishes.

[Glyn Davies]

Will the Minister give way?

[Jane Ellison]

If my hon. Friend does not mind, may I try to get through this point?

That example highlights a difficult situation for a clinician. Furthermore, if the family’s wishes are overridden and they make a big campaign out of it and express their grief and dissatisfaction publicly, even though they know the wishes of the deceased, the programme as a whole could be put in jeopardy. If the Burton Mail ran the headline, “They took my son’s heart against my wishes”, the impact on those on the donation register and on families who want to have that conversation could be significant. The issues are sensitive, but it is not for lack of will that people do not ensure that an individual’s wishes are respected. It is important to understand the pressure that clinicians are under in those difficult circumstances. I want to put it on the record that, once retrieved from a body, a heart needs to be used within six hours, livers and lungs within 12 hours and kidneys within approximately 24 hours. The decisions have to be made quickly. It is not like the reading of a will, which can take place weeks, months or years later once calm has been restored and people are more reflective. Such decisions must be made on the spot.

I hope that that provides a little context as to why clinicians face challenges. Most organ donors are not on the register, so the key thing is to change the culture around how we talk about the end of life and to make donation a natural thing for everyone to allow. For some people and communities, however, that is not easy.

I pay tribute to the specialist nurses for organ donation—the lovely SN-ODs—for their wonderful work. There is no doubt that having trained people who can have conversations at sensitive times is absolutely critical. I note the challenge about the number of specialist nurses drawn from minority and ethnic communities, who we know make a difference, and I will discuss it with NHS England and NHS Blood and Transplant.

Our strategy is evolutionary, but that does not mean that we cannot make big leaps forward in some areas. The nudge work to get more people to sign up has been extraordinary in some cases. In one of the largest public sector studies of its kind, over 1 million people took part to test eight different ways of asking people to join the register. That has resulted in some significant gains, as was mentioned by the shadow Minister. There is a range of other measures, including using social media and other points of contact. There is a schools project, “Give and Let Live”. Getting teenagers to discuss the subject with their families and become thought leaders is important. As a result of the work going on in schools, young people are often good at leading conversations within the family.

National transplant week is coming up. I do not have time to go into the details, but many things are happening around the theme of “Spell it out”. It is all about the conversation and about getting family members to talk to each other. Given the interest—I am sure that Members of Parliament can help—I will attempt to write to all colleagues with more details about the week and how we can play our part and do our bit in our constituencies to lead the conversation. For example, my hon. Friend the Member for Burton visited a local mosque to see whether he could help to lead the conversation there, something which in many cases is far more effective than top-down campaigns. I do, however, note the challenges around some of the big, high-profile, in-your-face campaigns that have been run in places such as Scotland.

I want to assure the hon. Member for Strangford (Jim Shannon) and others that work is going on to consider widening the pool of donors. The Royal College of Paediatrics and Child Health is doing some research on babies—a sensitive subject—to see what can be done about the challenge of child donation. The Advisory Committee on the Safety of Blood, Tissues and Organs is reviewing the evidence on the outcomes of UK transplants of organs from donors who had cancer or a history of cancer. We are beginning to learn more about the possibility of successful donation even when someone has suffered from cancer, and SaBTO is drawing up a series of recommendations to help transplant surgeons.

It is also worth saying that, even in Wales and in Northern Ireland were the private Member’s Bill to succeed, it is still the case that a family can override a decision in the circumstances that I have described. We must be sensitive to the circumstances in which decisions are being taken. In Wales, relatives will still be asked to support the donation and can object if they know that the deceased would not have consented.

In the remaining minute or so, I want to say that it is absolutely right for Members to place concerns on the record about donation from black, Asian and minority ethnic communities, where the refusal rate to donation is nearly 80% compared with around 40% nationally, which is significant. My Department supports the National Black Asian and Minority Ethnic Transplant Alliance, which does great work in this area, including, for example, on consent rates. Subject to parliamentary business, I intend to visit Birmingham next week to launch a new project to train peer educators from the Pakistani Muslim community in Birmingham. We are training community champions there to go out and do some of that work. I am happy to talk to colleagues to see whether we can replicate that elsewhere. There are some significant cultural, rather than doctrinal, reasons why—

[Glyn Davies]

rose—

[Jane Ellison]

I do not think that I will be able to give way to my hon. Friend. I hope that he will forgive me. We can perhaps speak immediately after the debate.

In conclusion, we can do many things to encourage more people to register. We are absolutely open to ideas from hon. Members on both sides of the House and all parts of the country and the world. We review and are led by the evidence, as my hon. Friend said. Debates such as this provide an excellent opportunity to raise the issue’s profile and we can hopefully do more in Parliament as national transplant week approaches. I will end by paying tribute to the great work of the excellent NHS Blood and Transplant.

Employment, Health and Consumer Affairs Council

Jane Ellison Excerpts

Tuesday 17th June 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 20 June in Luxembourg. The Health and Consumer Affairs part of the Council will be in the morning of 20 June.

The main agenda items will be the following:

Medical devices directive—The presidency plans a ministerial discussion on medical devices.

Council conclusions—The Council will adopt the two sets of Council conclusions on nutrition and physical activity, and on the economic crisis and health care. Departmental officials have been involved in negotiations on these texts, which are in line with UK priorities.

The Commission will present their work to improve the medical devices regulatory system before the new EU legislation is in place, and the joint vaccine procurement agreement.

The Italian delegation will also give information on the priorities for their forthcoming presidency, which will run from July until December 2014.