Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 17th November 2015 Commons Chamber

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

I am aware that there is an increased risk of recessive genetic conditions in births that occur as a result of first cousin marriages. It is a complex issue, and other factors are also significant, but experienced health professionals use some well-established tools and materials. Specialist clinicians in my hon. Friend’s area are looking at this important issue.

[Philip Davies]

I am grateful to my hon. Friend for that reply, but given the severe medical conditions that are caused by first cousin marriages, is it not time that the Government considered the only proper solution—outlawing first cousin marriages in this country?

[Jane Ellison]

Such a change in the law would not be for the Department of Health. Let me respond to my hon. Friend’s specific point about the particular localised challenges. He might be interested to know that in May 2012 a major conference was held at Leeds town hall, with groups drawn from across the area he represents and from the wider West Yorkshire area to look at these issues. As he knows, I have already written to the public health director in Bradford asking what is being done locally to address this issue, and I suggest that it would be useful if my hon. Friend followed up on that. I would be happy to hear how that conversation goes.

[William Wragg (Hazel Grove) (Con)]

11. What steps his Department is taking to ensure that the NHS recruits, trains and retains adequate numbers of therapists, clinicians and other staff to improve access to psychological therapies.

--- Later in debate ---

[Peter Grant (Glenrothes) (SNP)]

16. What assessment he has made of the effect of poverty on the incidence of health problems.

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

Across Government we are working to improve the life chances of children, and that is at the heart of our efforts to tackle the real causes of child poverty and improve the prospects for the next generation. That involves taking a broad approach to improving poor health and tackling health inequalities which the last Government embedded in the law. The wider causes of ill health, such as worklessness and unhealthy lifestyles, are all being addressed at the moment. I welcome the fact that we have record numbers of people in work and a dramatic drop in the number of children living in workless households. That goes to the heart of some of the broader drivers of ill health and poverty.

[Tommy Sheppard]

I am pleased that the Government accept that there is a causal link between poverty and poor health outcomes. They will also know of the widespread concern that the proposed changes to the tax credits regime will result in greater poverty, which will in itself cause poorer health outcomes and may put great pressure on the NHS. Will the Department consider putting in place mechanisms to monitor the effect of the tax credit changes on demands on the national health service?

[Jane Ellison]

We do far more than monitor health inequalities; we are taking action to deal with them. The heart of my portfolio is comprised entirely of tackling health inequalities in our nation. Let me give just a couple of examples: the expanded troubled families programme, on which the Department of Health is working closely with other Departments; and the family nurse partnership, where we support some of the most vulnerable young parents in the earliest years of their children’s lives. Those programmes have the greatest impact on our most disadvantaged communities. The matters that the hon. Gentleman raises are for other Departments, but I assure the House that improving the life chances of all our children is core business for the Government.

[Peter Grant]

Interesting answer, but unfortunately it was not the answer to the question that was asked. No doubt my hon. Friend will follow that up later. Is the Minister aware of work produced by, for example, Sir Harry Burns, the former chief medical officer of Scotland, which clearly indicates that although there is a very strong link between poverty and poor health, that link is not inevitable and should not be allowed to become inevitable? What are the Government doing to change policy, so that that link can be broken?

[Jane Ellison]

I have already given some examples of the work the Government are doing to tackle health inequalities in our nation. Let me give the hon. Gentleman another practical example. The burden of disease that tobacco brings falls disproportionately on poor communities. As well as the action that we have taken on standardised packaging and on smoking in cars with children, we are committed to a new tobacco strategy. I have said publicly that at the heart of the strategy there must be effective action to look at the areas in which the effect of tobacco falls most heavily—disadvantaged communities. We are taking practical action to close gaps in health outcomes in a range of ways.

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

13. If he will discuss with the Secretary of State for Work and Pensions provision of winter fuel payments to people infected with hepatitis C by NHS blood transfusions.

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

Those affected by the contaminated blood tragedy are entitled to receive Department for Work and Pensions winter fuel payments if they meet its eligibility criteria. For the benefit of the House, if not the hon. Gentleman, it is worth explaining that there are separate programmes of support. The bodies that put support in place for affected individuals also provide some winter payments. If somebody is eligible for both, receiving something from one body does not preclude them receiving a DWP winter fuel payment if they meet the criteria, but they are two different schemes.

[Drew Hendry]

With the UK Government dragging their feet on the £25 million transitional compensation payments for those in receipt of infected blood products, will they now make a firm commitment to supporting patients through this winter, and then get on with the business of getting a just and lasting settlement?

[Jane Ellison]

I have had conversations with my opposite numbers in Scotland about this issue and, as the hon. Gentleman knows, Shona Robison wrote to me about it. We are looking at her proposals in the context of wider scheme reform. I have also ensured that my officials are talking to the other devolved Administrations as we move forward to a better solution to this tragedy.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

14. What progress has been made on integrating and improving care provided outside of hospitals.

--- Later in debate ---

[Fiona Bruce (Congleton) (Con)]

T3. This is alcohol awareness week. In Scotland, the number of drink-driving offences dropped by 17% in the first three months after the introduction of a lower drink-driving limit. In the light of this encouraging evidence, is the Minister’s Department looking at the public health implications of reviewing the drink-driving limit in England and Wales as part of its alcohol review?

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

Obviously, tackling drink-driving remains a priority for the Government. We will be interested to see a robust and comprehensive evaluation of the change to the Scottish drink-driving limit, and I can confirm that Public Health England’s review of the public health impacts of alcohol will include drink-driving. Obviously, some of the issues my hon. Friend raises are for the Department for Transport, but I can confirm that we will be looking at this issue, and I will be interested to see the evidence.

[Heidi Alexander (Lewisham East) (Lab)]

On Sunday, independent experts, the King’s Fund, the Nuffield Trust and the Health Foundation, had this to say about the coming winter:

“Expect the inevitable: more people dying on lengthening waiting lists; more older people living unwell, unsupported and in misery; and a crisis in Accident and Emergency.”

Are they all wrong?

--- Later in debate ---

[Imran Hussain (Bradford East) (Lab)]

T5. According to Public Health England, life expectancy in the most deprived areas of Bradford is 9.6 years lower for men and eight years lower for women, demonstrating that there are clear health inequalities in urban areas in Bradford. The Government’s attack on the poor makes this issue worse, so will the Minister tell me what they are doing to tackle these inequalities and give people in Bradford the quality of life that they deserve?

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

The hon. Gentleman will be aware of my earlier answers to other questions. A wide range of aspects of the public health work that this Government are taking forward attack that very issue—the inequality of outcomes for some communities. I gave examples earlier, including the family nurse partnership and the troubled families programme, which has a health aspect to it. More widely, the universal health visiting programme, which has just moved into commissioning by local government, contains significant elements that were designed exactly to support poorer families and disadvantaged communities.

[Heidi Allen (South Cambridgeshire) (Con)]

For the avoidance of doubt, will the Secretary of State please repeat again that he will enter into completely open-minded, non-preconditional negotiations with the British Medical Association? The public need to see that we are approaching this matter with an open mind.

Gay Conversion Therapies

Jane Ellison Excerpts

Tuesday 3rd November 2015 Westminster Hall

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

I thank my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for initiating this debate on this important issue. Let me start by wholeheartedly agreeing with his opening premise. The Government do not believe that being lesbian, gay or bisexual is an illness to be treated or cured. We are concerned, therefore, about the issue of so-called gay-to-straight conversion therapy and we have consistently spoken out against the need for that practice.

I will outline some of the background to the work my hon. Friend touched on and try to respond to some of his concerns, but I suspect that this is the beginning of an ongoing conversation—I am happy to say that at the outset. The UK Council for Psychotherapy first raised its concerns about the perceived increase in this type of therapy with the Department of Health in late 2013. Department officials met with the council to discuss those concerns and agreed to work with it and others to identify ways to eradicate the practice. At that time, we also welcomed the fact that the key professional counselling and psychotherapeutic bodies had already made public statements on the issue.

As a result of the UK Council for Psychotherapy’s approach, the Department agreed to support the publication of a statement that made clear that the major therapy bodies in the UK were united in speaking out against conversion therapy, because they believe that that particular approach is based on the assumption that homosexuality is a mental disorder or that it begins from the preconceived view that the client should change their sexual orientation. As homosexuality is not an illness, as my hon. Friend said, the professional bodies argue that it is both logically and ethically flawed to offer any kind of treatment. The House may be interested to know that the American Psychiatric Association removed homosexuality from its diagnostic glossary of mental disorders in 1973 and the international classification of diseases produced by the World Health Organisation eventually followed suit in 1992.

A consensus statement was published in February 2014 as a result of the exercise we convened. It was initially signed by eight organisations and others added their support later on. The statement is clear: those bodies believe there is no good evidence that such therapy works and that, actually, it has great potential to cause harm. It goes on to say that such approaches are often based on religious interpretations of sexuality rather than on a researched and informed understanding of sexual orientation.

As my hon. Friend said, the Department agreed to host a roundtable event on 2 April 2014 to which we invited a range of interested organisations comprising signatories to the consensus statement as well as royal colleges, the Association of Christian Counsellors, regulators and other counselling bodies. The right hon. Member for North Norfolk (Norman Lamb), who was then the Minister responsible for equalities, was fully supportive of the work and attended and contributed.

I am pleased to say that the meeting was positive and that out of the discussions came agreement that more could and should be done by those present to prevent this kind of therapy from being offered. The participants agreed to develop the memorandum of understanding, which has been referred to. The UK Council for Psychotherapy agreed to lead on the work, in partnership with other bodies and the Department.

The memorandum was published in January and launched at a second roundtable event at the Department. Once again, my former colleague the right hon. Member for North Norfolk was present and publicly made clear his support for the memorandum and its commitments. Its purpose was to set out an agreed framework for activities for all the parties concerned to help address the issues raised by this practice. One such aim is to ensure that the public are well informed about the lack of evidence and the risks of so-called conversion therapy. There are a range of other important professional objectives.

Professionals from throughout the healthcare and psychological professions committed to work together to promote the public interest. Each of the signatory organisations committed to actions appropriate to their function and purpose. To give one example, those with practitioner members agreed to review their statements of ethical practice and consider whether there was a need to publish a specific ethical statement on conversion therapy. Secondly, those with a responsibility for training committed to work together to ensure that training prepares therapists sufficiently, so that they can work effectively with their lesbian, gay or bisexual clients.

The memorandum is owned by the organisations who signed it. They have continued to meet together and to work on those commitments throughout the year. The Department fully supports that work.

My hon. Friend drew attention to the NHS’s part in such therapies. Discussions with the sector uncovered the fact that there were no reliable, up-to-date figures on the use of conversion therapy. However, a 2009 survey of 1,300 mental health professionals found that more than 200 had tried to help at least one client to reduce the attraction they felt for someone of the same sex. A third of those clients were said to have been referred for therapy by a GP and 40% were reportedly treated in the NHS.

The Government are clear that moneys from the public purse should not be used to fund such therapy. Ministers in the previous Administration wrote to NHS England in March 2014 seeking confirmation that such treatment was not taking place on the NHS and I am pleased that we received a robust and supportive response from Simon Stevens. Not everyone in the House may be aware of his response, which was that

“so-called gay-to-straight conversion therapy is harmful nonsense and the NHS should never be funding it.”

[Wes Streeting]

Clearly, the memorandum has been effective since it was introduced, but it concerns me that the briefing from Stonewall suggests the Nursing & Midwifery Council, the Care Quality Commission, the General Medical Council and the Health and Care Professions Council are not yet signatories. Does the Minister agree that they should sign up? It has clearly been helpful for other organisations and is a powerful statement of intent.

[Jane Ellison]

The hon. Gentleman will see, when I propose some next steps, that I might be able to respond to his point.

Simon Stevens went on to say that he would direct NHS England to make that position—that the NHS should never fund such therapy—clear and explicit in all public statements on the issue in future. I cannot be clearer than that. If Members have examples of the NHS funding such therapy, I would be particularly interested to know about them.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

[Jane Ellison]

I will, of course, give way to my former colleague.

[Dr Poulter]

I pay tribute to my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for securing the debate and to my hon. Friend the Minister for the work she does to raise awareness of the LGBT community’s needs. It is, of course, unacceptable for the NHS to sponsor these therapies. All registered medical professionals can be disciplined by their professional bodies, whether that is the Royal College of Psychiatrists or the GMC taking action against doctors in these cases for discriminating against certain patients. Is the real issue not, however, that the regulation is not there for some therapists? This is the issue that needs to be looked into: do we need to regulate more effectively some of the therapists in this field?

[Jane Ellison]

My hon. Friend speaks from a position of great knowledge. I am well aware of the challenges to the current position, which I will outline, from hon. Friends and other Members. I will try to respond to those.

I want to make this point, for the record: we are not saying that lesbians, gay men and bisexual people should not seek counselling or therapy if they are distressed about a particular aspect of their sexuality. It is important we recognise that family arguments over sexuality or hostility from other people might well be a reason for someone to seek support for that aspect of their life. That is obviously a core part of what many therapists do, so I want to be clear that there is a place for that in supporting people appropriately.

[Ben Howlett]

May I pick the Minister up on a point? She referred to lesbians, gay men and bisexual people, but it is transgender people as well.

[Jane Ellison]

I am duly chastised, having recently given evidence to the excellent inquiry being led by the Women and Equalities Committee, of which my hon. Friend is a member. The Chair of that Committee, my right hon. Friend the Member for Basingstoke (Mrs Miller), has just joined us in the Chamber. I duly correct myself and thank my hon. Friend for his intervention.

I fully understand the concerns about so-called gay conversion therapy, but the Government have no current plans to ban or restrict it via legislation, or to introduce statutory regulation for psychotherapists. I say that in the knowledge that that position is challenged, and I will go away and reflect on that after the debate.

The Health and Social Care Act 2012 introduced provisions to enable the accreditation of voluntary registers for unregulated healthcare professionals and healthcare workers across the UK, social care workers in England and certain students. We should not underestimate the fact that these voluntary registers are having an effect and can be effective. They are accredited by the Professional Standards Authority For Health and Social Care where statutory regulation would be neither proportionate nor an effective response to patient safety. These accredited voluntary registers already provide some safeguards for the public. We feel they are working, and we have examples of that.

Both the Government and the PSA recommend that when a patient or service user chooses to visit a health or care practitioner who is unregulated, only those on an accredited register are consulted. That ensures that organisations holding an accredited voluntary register have been thoroughly assessed by the PSA. The PSA also ensures that those organisations handle complaints fairly and thoroughly. If a practitioner is removed from one register, they are not allowed to join another. We have seen some recent examples. In one case, the British Association for Counselling and Psychotherapy removed a practitioner from its register for professional malpractice after they were associated with this sort of therapy. The Department is clear that it encourages employers and commissioners, when recruiting, to choose practitioners who are committed to the highest standards and who are on accredited registers.

Although we have decided at this stage not to take a legislative approach, I wholeheartedly agree with my right hon. Friend the Minister for Women and Equalities who my hon. Friend the Member for Finchley and Golders Green quoted at the outset of the debate as saying that these therapies must be eradicated. We want to keep up the momentum to do that. I suggest to the House that as we pass the anniversary of the MOU, we should convene another roundtable in the new year, at which we ask the original signatories to report on their progress and challenge them to identify where we can be more ambitious on ending conversion therapy. That would be an opportunity to pick up on some of the specific challenges mentioned by my hon. Friend in his opening speech, as well as one or two of the points made in interventions. I am open to discussing how we bring the concerns raised by Members to the attention of that group and to discussing who comprises it, although I think it originally included some organisations representing LGBT people, as well as professionals in this area. I commit to doing that.

As we work towards that event, I am happy to engage outside the Chamber with hon. Friends on where they think we can do more. I have taken on this brief since the election. Before that, I was a Minister for inequalities; I am now a Minister for inequalities and equalities—I think that makes me even. It is a brief I take extremely seriously and one that I have committed a huge amount of time to.

[Nick Herbert (Arundel and South Downs) (Con)]

I sense the Minister might be about to end, but I hope she will accept this point. While a ban might not be appropriate, a stronger statement of guidance from the Government, reflecting the comments of colleagues, to all parts of our national health service would be welcome, because of not only the harm these conversion therapies do to individuals but the signal their availability sends to the wider public that it is somehow abnormal to be gay and that being gay is a condition that can be cured. That is not acceptable in today’s society, and our major public service should not be allowing the promotion of that idea in any part of it.

[Jane Ellison]

I completely understand my right hon. Friend’s point, which he made extremely well. I am happy to talk to Simon Stevens at our next regular meeting about that, and it is perhaps an issue we can explore further at a roundtable. My right hon. Friend makes an extremely fair point about how we send those signals. I will reflect on what more I can do.

To conclude, I ask hon. and right hon. Members present, perhaps in anticipation of the next broad discussion of this issue, to seek the counsel and insight of their local LGBT communities. I regularly guest-chair my local LGBT forum in Wandsworth, which I find a useful opportunity to engage with the issues and get up-to-date insight. I encourage all colleagues to do that, because it will greatly inform our deliberations in the new year. I will take away all the points made and the continued challenge to the Government to go further on this issue. I know that all Members present look forward to a time when this practice is a thing of the past.

Question put and agreed to.

Resolved,

That this House has considered gay conversion therapies and the NHS.

Health Informal Council

Jane Ellison Excerpts

Friday 30th October 2015 Written Statements

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

An informal health Council meeting was held in Luxembourg on 24-25 September 2015 as part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council formation. The UK was represented by a senior official.

Among the issues discussed were prevention, removing stigma, early diagnosis and investment in research. The UK’s work on dementia was recognised and there was agreement on the need for further work following the World Health Organisation (WHO) conference that was held earlier in the year in March.

Trans Fatty Acids (TFAs)

A variety of views were expressed about whether regulation or a voluntary approach should be taken towards trans fatty acids (TFAs). Most member states would await an upcoming Commission report on TFAs before taking a firm view. The UK outlined its national voluntary action to reduce TFAs and the importance of an evidence based approach. The Commissioner said that they were in the process of finalising the report and that it would be presented in December.

Migration

The UK outlined work it is undertaking with Syrian refugees in countries bordering Syria, called for a comprehensive approach to the crisis, and referred to the work of the Health Security Committee. The Commission called for solidarity and outlined the extra funding that had been allocated as well as a letter that had been sent to all Ministers on this issue.

European semester

A vast majority of member states argued strongly against the involvement of the European semester in healthcare. The UK welcomed the recent narrower focus of the semester and called for it to concentrate on sustainability and cost effectiveness. The UK also called for Health Ministers to be more involved in the Social Protection Committee process on matters relating to healthcare.

Cross Border Directive

Most member states were positive about progress that has been made on the cross-border directive, with a number suggesting that patients should be better informed about their rights. The UK welcomed the Commission’s report on the operation of the directive but added that, whilst the principles of the directive are sound, more needs to be done at EU level to clarify and simplify the interaction of this new legislation with existing patient mobility rules (the EU social security co-ordination regulations).

[HCWS280]

Cardiac Screening: Young People

Jane Ellison Excerpts

Tuesday 27th October 2015 Commons Chamber

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

I thank my hon. Friend the Member for Eastleigh (Mims Davies) and all the other Members who have contributed to the debate for raising what is—as has been more than amply demonstrated—a serious and important issue. We have heard from Members who have suffered tragic losses, and I myself have lost a friend in similar circumstances. I thank all Members for bringing their experiences to the Chamber to inform our debate. Obviously, our sympathies are with the families who have been affected.

I suspect that some elements of my speech will not satisfy my hon. Friend, but I want to try to identify the areas in which I think we are making some progress, and also those in which some of the real difficulties lie. Many of them involve clinical challenges rather than political decisions.

I join my hon. Friend in paying tribute to her constituents Graham and Anne Hunter, who have worked tirelessly to raise awareness of sudden adult death syndrome because of the personal tragedy that they suffered. My right hon. Friend the Secretary of State met them in June 2013, along with the UK National Screening Committee’s secretariat and Public Health England’s director of screening programmes, Dr Anne Mackie.

Sadly, as we know, not everyone survives cardiac arrest, and 100,000 people die of heart disease annually in the United Kingdom. As my hon. Friend said, an estimated 400 to 500 cardiac deaths each year are unexplained, and most have a genetic basis. In some cases there is no definite cause of death, even after the heart has been examined by an expert cardiac pathologist. Most sudden deaths in people under 30 are caused by inherited cardiomyopathies and arrhythmias. The situation is very tragic.

My hon. Friend mentioned three possible solutions. The principal one was population screening, but she also mentioned defibrillators, the provision of testing and advice for the families of those who suffer a sudden cardiac arrest, and GP awareness. I shall try to touch on all those points, although time is slightly against me: I have only about 10 minutes.

I think that if population screening were easy and obvious, we would do it, but it is not easy or obvious, despite the compelling reasons why we would all want to respond to the challenge. Let me try to explain why. As many Members will know, screening programmes in England are set up on the advice of the UK National Screening Committee, so these are not political decisions. They are decisions based on the best currently available evidence and expert advice from those who are most qualified to provide it, and many factors are weighed in the balance. The evidence is drawn from the United Kingdom and from other countries around the world.

Earlier this year, the UK NSC carefully considered the evidence in favour of introducing cardiac screening for people between the ages of 12 and 39. They took account of, for instance, the fact that sudden cardiac death covers a range of extremely complex conditions which are very difficult to detect by means of screening. Although it is such an important health problem, the committee found little peer-reviewed evidence that would have enabled it to make an accurate assessment of the number of people affected.

There is no single test that can detect all the conditions involved, nor is it possible to say which abnormalities will lead to sudden cardiac death. Moreover—this applies to other kinds of screening, but it applies particularly in this context—there is currently a risk that a false positive or a false negative could result. There is a clear risk that a positive result could be given to someone who was not affected by these conditions, and we can all imagine some of the effects that that might have. Someone might worry unnecessarily about having a heart problem, and might refrain from exercise that would be beneficial for their health, or give up a promising career in sport. A false negative would also present significant challenges. It is possible to have a heart problem that a test will not pick up. Fabrice Muamba, for example, had several screening tests throughout his career which did not identify any problems, but we saw his sudden collapse on the pitch at White Hart Lane.

Telling someone they have a condition when they do not could cause unnecessary anxiety to everyone concerned, even though it might not affect them. That causes difficulties, as does telling someone they are in the clear when they are not. These are the difficult elements of decision making and evidence that our expert committees have to sift in coming to a conclusion and making a recommendation. In the review that has just taken place, no studies reporting on test performance, sensitivity or specificity were identified by academic evidence. It was therefore felt that it was not possible to recommend the use of such a test in a national programme.

Another key test for screening is that once a problem has been detected, there must be something we can do about it, either by treating a condition or by helping someone to remain healthy. The conditions that lead to sudden cardiac death are poorly understood, and there is no evidence to guide clinicians as to what the treatment or lifestyle advice would be when a problem is found in a family member. That is not to say that in every circumstance people cannot give advice, but across a population-based screening programme it would not be possible to know what the advice would be for everyone screened. For some of the conditions implicated in sudden death there is no treatment. Delivering the message that someone has a condition is extremely difficult, but it is exacerbated where no known treatment is available. A person who tests positively will face significant dilemmas, and not just the ones I have touched on. Such dilemmas may involve ending a career they have mapped out for themselves or decisions about their family situation. They can also be penalised financially through higher insurance premiums.

On screening, the situation is extremely difficult. The evidence has been carefully weighed up recently, and we should introduce screening only when there is evidence that it can be effective. Overall, at this time, the UK NSC found insufficient evidence to support it. That position was supported by the British Cardiovascular Society, the national clinical director for heart disease in the NHS and the Royal College of Paediatrics and Child Health. They made that position clear in their responses to the public consultation. The difficulties were acknowledged even by Cardiac Risk in the Young, which, as many hon. Members have said, does wonderful work campaigning in this area. It acknowledged some of the concerns identified by the review, although I also accept that it took issue with some of the other matters raised in the conclusions.

This year’s decision by the UK NSC is not the end of the road in the consideration of screening for sudden cardiac death. The evidence is routinely reviewed every three years, but individuals and organisations can alert the committee at any time to any new peer-reviewed evidence published in the interval between regular reviews. It goes without saying that I will draw the committee’s attention to this excellent debate, how well supported it has been and the strength of feeling that has been expressed. Such a notification will be considered by the UK NSC, which can conduct an early update of a review in response.

Let me respond to the point that was made about Italy, because it has been raised before. My hon. Friend the Member for Eastleigh mentioned the example of Italy’s introduction of screening for all children involved in organised sport. Although there is literature on the screening of young people participating in sport, the evidence is again mixed, and some of the outcomes have been questioned. We are keen to understand what is going on in Italy, but it has yet to share its national data on the screening programme. The Secretary of State wrote to his Italian counterpart to request these data in August 2013, following the meeting that I mentioned earlier. This has been chased up on a number of occasions but the data have not been forthcoming, to date. Obviously, I will write again after this debate to say that we would like to see the data, because they might be one example of data that could inform a future NSC evidence review. My hon. Friend and other hon. Members may also be interested to know that the Sports Minister and I spoke today to some of the major sports governing bodies and raised this important issue. They are very much aware of their responsibilities towards young athletes, and we had a very productive discussion about what they have already done and what more they are considering in this area.

Let me touch a little on the research that is going on, because I have mentioned that we do not know much about some of these conditions and do not have treatments for some of them. The National Institute for Health Research is funding research on early detection of asymptomatic cardiomyopathies through its biomedical research centres and units, including the genetic aspects of the condition. It is also supporting a project with partners, including Manchester United football club, to identify the healthy limits and wider benefits of exercise for young elite athletes, normal healthy children and children with congenital heart defects. There is some really interesting and important work going on, and some of the data will be used to improve screening protocols for cardiac abnormalities in young athletes. The evidence from that research will be provided to the UK NSC when it next reviews the evidence, or earlier if new evidence comes to light.

Let me touch on defibrillators in the remaining three minutes. Tonight we have heard some wonderful examples of local campaigns across the country, and I pay tribute to all the people involved in ensuring that we accelerate access to defibrillators. In the March Budget my right hon. Friend the Chancellor of the Exchequer announced a £1 million fund to boost public provision of defibrillators in England and to support training in their use. That funding is now being administered by the British Heart Foundation.

Members of Parliament also have a role to play in that regard, for example if they think there are places where we need to have defibrillators. Many of them are in public buildings and sports grounds—I was discussing this with sports governing bodies only today—but they are of no use to wider communities when those buildings or grounds are closed. We can ask those questions on the back of debates such as this one, and I know that hon. Members are well placed to do that. The Hunter family, of course, have been extremely instrumental in making that change happen, and we pay tribute to them for that.

My hon. Friend also mentioned the importance of providing support to families of people who have suffered a sudden cardiac death and the need to ensure that GPs are aware of that. I make a commitment now to write to the Royal College of General Practitioners and draw its attention to the strength of feeling and the continuing concern that this might not be as well understood as it should be. When there is a sudden cardiac death, we need to take action to ensure that potentially affected family members are identified and offered counselling and testing to see if they, too, are at risk.

The national clinical director for heart disease, Professor Huon Gray, and representatives of NHS England, the Department of Health and the British Heart Foundation met the Chief Coroner in late 2013 to discuss that matter. Guidance has now been issued to the coronial system on how to deal with potentially affected family members. The Department will do all it can to encourage that, and I will write to the Royal College of General Practitioners to draw its attention to Members’ interest in spreading good practice in this regard. NHS England is committed to working with all stakeholders to ensure that we develop and spread good practice, particularly as evidence becomes available.

I will conclude by once again thanking my hon. Friend the Member for Eastleigh and all hon. Members who have attended the debate—I have responded to a great many Adjournment debates, and this is easily one of the best attended. That is clear evidence of the strength of feeling across the House on this important subject. We will continue to give it our utmost attention.

Secondary Breast Cancer

Jane Ellison Excerpts

Wednesday 21st October 2015 Westminster Hall

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

I congratulate all colleagues on an excellent debate. It is a shame that time has slightly beaten us. I fear it will beat me as well: if I am to allow a minute or so for my hon. Friend the Member for North Warwickshire (Craig Tracey) to respond at the end, I might not have the chance to make some of the points I would like to have made. Nevertheless, this debate in Breast Cancer Awareness Month is very timely for all the reasons mentioned. There have been some important contributions. I always enjoy listening to the hon. Member for Central Ayrshire (Dr Whitford); she brings incredible experience to debates of this nature.

As the cancer drugs fund was debated in this Chamber only yesterday with my hon. Friend the Under-Secretary of State for Life Sciences, I will not touch on that so that I save a little time. As others have said, we want to do a lot better in tackling cancer, and our aim is to lead the world. Survival rates are getting a lot better: for people diagnosed between 2011 and 2015, we are on track to save a projected 12,000 more lives a year. But we do want to go further. Nevertheless, as we ask what more we can do, we should acknowledge that we are making progress, although much of the rest of the world is too.

In January, NHS England asked the independent cancer taskforce to draw up a five-year strategy. It was published in July and recommends a range of improvements across the cancer pathway. Some Members were present in the House in July when the chair of the taskforce, Harpal Kumar, presented its conclusions to us. The strategy is an excellent bit of work and, as our manifesto made clear, we are working with the NHS, charities and patient groups to deliver it. It is important to tell the House that to support the delivery of the strategy, NHS England has appointed Cally Palmer, chief executive of the Royal Marsden NHS Foundation Trust, as NHS national cancer director. While continuing in her current position, she will lead the implementation of the strategy, alongside work to test new models of care at the Royal Marsden hospital and University College London hospital, in partnership with Manchester Cancer. Those are important developments.

The importance of secondary breast cancer was acknowledged in the taskforce report, which noted that all NHS trusts should now be recording recurrent and secondary breast cancer patients, but we acknowledge that uptake has been variable thus far, as highlighted in the opening speech. I made the importance of data collection one of the strategic priorities in my letter to Public Health England earlier this year, so we know that we need to do better.

Following a 2012 pilot managed by the National Cancer Intelligence Network, all breast units have been required to submit information on all patients diagnosed with a new recurrence or metastatic disease through the cancer waiting times process. For breast cancer cases, that now includes a data item on cancer recurrence. Data have been submitted monthly since January 2013, but collection remains challenging because relapsed patients may re-present in many different ways and through many referral routes, as the hon. Member for Central Ayrshire mentioned. For example, they might re-present through a routine follow-up appointment, by contacting their GP with renewed symptoms or by presenting with another unrelated condition, at which point secondary breast cancer has been diagnosed. There are some practical barriers, but we do need to do better.

To drive up the quality and completeness of the data, trusts are sent monthly reports so that they can benchmark themselves against other trusts, which has been effective in driving up performance in other areas of cancer care. Over the next year, those reports will include data on recurrence of cancer. In addition, more work is being scoped by NHS England and Public Health England based on the recommendation from the cancer taskforce to establish robust surveillance systems to collect relevant data. We know there is more to be done on the detection of secondary breast cancer, which can be diagnosed many years after primary breast cancer, as other Members have said. Although survival rates are improving, the breast cancer clinical reference group of NHS England is determined to ensure that everything possible is done to reduce the risk of secondary breast cancer. The group is in the final stages of producing a guideline on breast cancer services to improve information given to patients about the risk of secondary breast cancer. Such information is currently variable and sometimes inadequate, as highlighted by my hon. Friend the Member for Bury St Edmunds (Jo Churchill).

[Mark Durkan (Foyle) (SDLP)]

Will the Minister give way?

[Jane Ellison]

I will take the briefest of interventions.

[Mark Durkan]

The Minister touches on a point that reinforces the fact that, as a basic rule of thumb, policy makers and service planners should know the numbers and the needs. She addressed the numbers when she spoke about data. Knowledge about needs is best developed by listening to the patients themselves, who expressed those needs forcefully in the five-point bucket list from Breast Cancer Care.

[Jane Ellison]

I am sure we would all agree with that important point.

I will finish by discussing the new guideline that the clinical reference group is developing. The guideline will state that all patients with primary breast cancer should have a consultation with a clinician at the end of treatment that will include advice on spotting signs and symptoms that might indicate secondary breast cancer. That information will be delivered together with an assessment of the patient’s physical, psychological and social needs—I am interested in the distress thermometer that the hon. Member for Central Ayrshire mentioned, as well as in the contribution of the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). The overall recovery package is being developed in partnership with Macmillan Cancer Support. The evidence is that that work is very effective where it has been done well. The advice that has been given will be recorded in the records of every breast cancer patient so that we know it has happened and so that we can track it.

NHS England hopes to publish the new guidance as a cancer resource on its website in the next few weeks. We will promote that guidance through the usual channels, but we would appreciate it if hon. Members with a particular interest, and particularly my hon. Friend the Member for North Warwickshire—I congratulate him on his appointment as co-chair of the all-party group—could draw this important document to people’s attention.

The clinical reference group will also consider how the care and support of patients diagnosed with secondary breast cancer can be improved, including through the provision of clinical nurse specialists. Of course, we agree that clinical nurse specialists play an important role. The number of patients reporting that they have been given the name of a CNS rose from 84% in 2010 to 89% in 2014, including 93% of breast cancer patients. We are doing a lot better, but hon. Members are right to highlight that, in the case of secondary breast cancer, we have some distance to go.

Members have said that we need to step up on palliative care, particularly in the light of last month’s debate—the hon. Member for Central Ayrshire made an important speech in that debate. We are committed to ensuring that everyone has access to high-quality, personalised palliative care. Breast Cancer Care’s new report, “Too little, too late”, is an important contribution to the debate about what we need to do. The Government have introduced five new priorities for end-of-life care—those are five important new principles—and my ministerial colleagues will be taking that forward. Nevertheless, I welcome Parliament’s new focus on palliative care and quality end-of-life care, which is important.

In the few seconds that I have remaining, I want to give people confidence that a lot of research is going on in this area. There is more research into cancer than any other disease in terms of National Institute for Health Research funding. In particular, the NIHR’s clinical research network is currently recruiting patients for nearly 100 trials and studies in breast cancer. One is a global trial that aims better to control secondary breast cancer using a drug called a dual mTOR inhibitor. I am delighted to say that the network recruited the first patient in the world to this trial, which I hope is an indication of the importance of our research infrastructure.

[Dr Whitford]

Will the Minister give way?

[Jane Ellison]

I am afraid that I do not have time to give way. We can speak after the debate; I apologise.

A lot of other things are going on in that area, but I will leave just a few seconds to my hon. Friend the Member for North Warwickshire. However, I reassure Members that this subject is of huge importance to the Government.

[Nadine Dorries (in the Chair)]

There are 30 seconds left for Mr Tracey.

Alcohol Harm and Older People

Jane Ellison Excerpts

Thursday 15th October 2015 Commons Chamber

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

It is delightful to be here, a little earlier than expected, for this important debate on alcohol harm and older people, and I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing it. She laid out extremely clearly some of the challenges we face.

Alcohol is one of the four biggest behavioural risk factors for disease and death in the United Kingdom, along with smoking, obesity and lack of physical activity. As my hon. Friend alluded to, it is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, a number of cancers and depression. That evidence base is growing all the time, and it is important that we highlight that. Drinking can lead to a range of conditions and, as she said, it is estimated to have contributed to more than 1 million hospital admissions in 2013-14, costing the NHS a considerable amount of money. Much of that burden of disease and death is preventable. To this day, people continue to be affected by alcohol misuse, so it is right that we give the matter our attention. A lot of that is because of ignorance and misunderstanding, and because we perhaps do not talk about it as much as we should. My hon. Friend is also right to say that getting the tone of the debate and the advice right is sometimes a challenge.

There is a lot of interest in the issue in Parliament, and we have also heard about how alcohol misuse can have a significant and devastating impact on the lives of our constituents. I am sure that all parliamentarians present will have met people who, if they are not themselves personally affected, have seen their family affected by alcohol misuse. It is very sad when we see that.

Many of the concerns were set out in the all-party group on alcohol harm report earlier this year, and I congratulate the group on that work. Obviously, I have met affected individuals and I have read many letters sent to me by colleagues detailing the concerns and frustrations of those who see the cost of alcohol harm and the impact it has on their everyday lives. They want action to be taken right across public life, including from Government, industry and beyond.

The majority of people who drink alcohol do so in an entirely responsible way. Although I welcome recent falls in alcohol consumption, we cannot be complacent, which I certainly am not. There are still many who drink above the lower-risk guidelines. As my hon. Friend has said, Office for National Statistics data suggest that the proportion of over-65s who are drinking above those lower-risk drinking guidelines is increasing. Harms such as liver disease, as well as the social impacts such as crime and domestic violence, remain much too high. This is an important public health issue, to which I continue to give attention. I regularly meet Department of Health officials to ensure that progress is maintained on cutting the number of people of all ages drinking at harmful levels. Before closing, I will touch on occasions in the next few months when we might pay particular attention to that topic.

A number of actions have already been taken. For example, sales of alcohol below the level of duty plus VAT were banned in May last year, to tackle the worst cases of very cheap and harmful alcohol, meaning it is no longer legal to sell a can of ordinary lager for less than about 40p.

In the last Parliament we worked with the industry to take alcohol units out of the market. As my hon. Friend said, more than 1 billion units were taken out of the market. I have challenged industry to build on that: it is a good start, but we can go further and I have had discussions about what that new effort might look like. We can do more to make sure that we have the widest range possible of lower strength drinks available to the public. Some of the simple substitutions my hon. Friend has mentioned can make a considerable difference to help bring people back to lower-risk drinking.

We have also introduced an alcohol risk assessment into the NHS health check. It is aimed at 40 to 74-year-olds. Health checks provide a chance to identify and manage a range of risk factors, such as high blood pressure and cholesterol levels as well as alcohol consumption. They enable identification and brief advice interventions to be provided in primary care and, indeed, non-health care settings. We know that that can work, with one out of every eight people who receive an intervention to help them moderate their behaviour responding to it. Since April 2011, 5.6 million people have taken up the offer of a health check, and I continually challenge the system to build on that, because it can provide a reality check for many people who have not noticed harmful drinking creeping up on them. That is really important.

All health professionals have a public health role and we need to make sure that the system has enough capacity and that our workforce are adequately trained to tackle challenges such as alcohol misuse and, of course, drinking in pregnancy, which we have debated often in this House. There is keen interest in the issue and perhaps we will return to it in more detail when we consult on the revised guidelines, which I will mention in a moment.

Since April, the standard general medical services contract has included delivery of an alcohol risk assessment to all patients registering with a new GP. That is another important moment at which people think about their health and there is a chance to have such a conversation afresh. That assessment has the potential to raise awareness of alcohol as a risk factor with a large percentage of the population. By 2018, about 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems. It is important that in future doctors can give better advice on the health impact of the effects of substance use and misuse.

The Government have given local areas more powers and responsibilities to help them tackle harm in their populations. We have backed that with ring-fenced budgets to improve people’s health, and that includes responsibility for tackling problem drinking. We have given local authorities more than £8 billion in funding over three years. As I have seen during my many visits as the Minister with responsibility for public health, local authorities are very well placed to take forward the public health role. They know their communities well, often at a level of detail that the Government could never understand, and they know where to put the right services to help their communities.

The Government have continued to work with Public Health England, which is giving higher priority to alcohol issues. In looking at alcohol during the next 18 months, PHE will examine how a whole-system approach might provide a focus, particularly on return for investment. Local authorities are keen to make sure that they spend money wisely and that their budgets yield good results. That is no less true for public health than for anything else. The work is intended to assist the Government, local authorities and the NHS to invest with confidence in evidence-based policies, prevention and treatment interventions. Public Health England’s support for local authorities’ public health role will continue to be vital. I do not want local authorities to try to replicate the evidence base that national experts obtain. Such experts should provide the evidence base, and local authorities can then be in the position to take it, adapt it to the local needs and build on it.

To help local areas to target and tailor their activities, Public Health England has developed both liver disease and local alcohol profiles. Those are very important tools to put in the hands of commissioners and those who know their communities best. The profiles provide transparent, comparable information to health and wellbeing boards, commissioners, service providers and professionals, letting them look at their own performance and, importantly, at that of others to see how to improve their outcomes.

PHE will also expand the Healthier Lives web tool, which includes indicators on alcohol hospital admissions and figures for waiting times and completions of alcohol treatment. That will allow an area to build up a complete picture of how well it is doing, particularly against national averages and comparable areas. As in all things in the world of public health, there is considerable local variation—the challenges are not all the same in different areas—so we need to give local areas such tools. We have seen good practice in Lancashire, which has used local alcohol profiles to inform its joint strategic needs assessment and to look at the mix and quality of the services it commissions.

[Fiona Bruce]

The Minister is quite right about variation. One of my concerns is about the increase in drinking among older women. Is anything being done specifically to look at how they can be helped to reduce the effect of alcohol harm?

[Jane Ellison]

I will come on to matters relevant to that, but I will also say more about a possible opportunity for a wider debate on this important issue a bit further down the line.

It is important to consider what can be done through secondary care. About 139 district general hospitals already offer some level of specialist alcohol service. I saw for myself such specialist work when I visited Blackpool in 2014. One team told me about how it took the opportunity of people being admitted for something related to alcohol to talk to them about their drinking. They described, with huge understatement, as a “teachable moment” the time when someone is in hospital having suffered, either through a disease or an accident, an unfortunate effect from alcohol. They are right: the idea of talking to people at the moment when they are most receptive is vital.

We would like to have similar alcohol care teams in every hospital to take such opportunities to identify the problem and provide brief advice to patients, as well as medical management. That is again based on the evidence that higher-risk and increasing-risk drinkers who receive brief advice are twice as likely to have moderated their drinking six to 12 months after an intervention—a quick response—compared with drinkers who get no intervention. We want greater use of such really good opportunities. It is not costly or, indeed, lengthy; it is about timeliness.

There are means for people to monitor and manage their own alcohol intake. Technology is increasingly deployed to good effect in a number of areas of personal health monitoring, and alcohol intake is no different. Apps such as the one developed by Drinkaware, which my hon. Friend mentioned, can help people to track how much they are drinking, what it costs them and even the number of calories. We know that personal estimates of weekly drinking are not always as accurate as keeping a log. That is quite well documented, so individuals may find apps and tracking mechanisms particularly helpful.

The Big Lottery Fund, in partnership with the support charity Addaction, is investing £25 million in an alcohol-related harm prevention and awareness programme for the over-50s. Rethink Good Health is a UK-wide programme aimed at those aged 50 and over. My hon. Friend very thoughtfully explored some of the reasons why people may find themselves in such a situation in later life. We would recognise from our constituency case load and perhaps from our social circles how life events can take a toll on health and lead to people drinking more. She mentioned some of them, but I would highlight how such problems can be a driver, and sometimes a product, of loneliness and isolation.

As the House will know, Dame Sally Davies, the chief medical officer, is overseeing a review of the lower-risk alcohol guidelines to ensure that they are founded on the best science. We want the guidelines to help people at all stages of life to make informed choices about their drinking. The guidelines development group, made up of independent experts, has been tasked with developing the guidelines for UK chief medical officers to consider. The group has researched and is developing a proposal on the guidelines, including a UK-wide approach for guidance on alcohol and pregnancy. We expect to consult on that.

I know that that is an issue, and that there are worries about people receiving different advice, so let me say a word about the consistency of health messages. As I have said before at the Dispatch Box, where the evidence base is not completely certain—leading experts to reach slightly different conclusions—there will be a certain level of debate. I appreciate that that can be extremely challenging for the public and that there is a role for trying to provide clarity, but guidance must always be based on the best evidence base.

[Jim Shannon]

The Minister knows that Members of this House, myself in particular, have the utmost respect for her and her position, for what she does and for the guidance she gives. However, the very possibility of uncertainty poses an important question for us. The message must go out from the Minister and from us as elected representatives that during pregnancy, there must be no alcohol at all. That has to be evidence-based, as she said, but there should be the same message so that there is no uncertainty.

[Jane Ellison]

The UK chief medical officers are extremely alive to that challenge and it is something to which they have given considerable thought. Perhaps we will return to it when the guidelines are consulted on. I assure the hon. Gentleman that I have had that conversation and that I have been at pains to emphasise how regularly the issue comes up in Parliament. I know that it is being addressed and that it will be talked about when we consult on the new guidelines.

It is clear that there is more that all of us can do. We have to recognise the contribution that not just individuals, but businesses, communities and local government can make to help people better understand the risks associated with alcohol. I agree with my hon. Friend the Member for Congleton that we need to do more. We are working to ensure that there is a better understanding of the risks.

This is an issue to which we will return. The publication of the new alcohol guidelines will provide a moment in the national debate when we can look at it closely with the public, experts, health professionals and industry. That will be a stimulus to fresh thinking, more public education and debate. Those in Parliament who have a particular interest in the issue will want to participate in that important debate. However, change will not happen overnight. I know that the hon. Members who are here will agree that raising awareness of the issue is key. We have an evidence base to show that, in some cases, raising awareness with individuals is the most important thing we can do to help them.

This debate has been an important opportunity to revisit these important issues. We will return to them in more detail in the coming months. That will be a great opportunity to reflect not just on the good progress that we have seen among younger people, but on the work that we are yet to do.

Question put and agreed to.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 13th October 2015 Commons Chamber

[Glyn Davies (Montgomeryshire) (Con)]

15. What steps he is taking to increase levels of organ donation.

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

Organ donation rates have increased by about 60% since 2008. The Government give about £60 million a year to NHS Blood and Transplant to support organ donation. NHSBT has a strategy, which it launched in 2013, to take us up to 2020 and increase that figure even further.

[Glyn Davies]

Does the Minister agree that one of the most effective ways of increasing organ donation is to ensure that the next of kin of every potential donor is offered a meeting with a specialist nurse in organ donation, irrespective of whether the potential donor carries a card?

[Jane Ellison]

My hon. Friend is absolutely right to highlight one of the principal difficulties we face, which is people not having a conversation about donation. Even if people are on the organ donor register, their wishes are sometimes overtaken by those of their families at that very difficult moment. He is right to highlight the brilliant work done by SNODs, as well as initiatives such as the one that will happen this Saturday, when the Daily Mail, together with the organ donor register, will produce a publication that will, we hope, stimulate thousands of conversations across the land. Having a conversation about consent is one of the ways we will crack this problem.

[Chris Skidmore (Kingswood) (Con)]

16. What steps his Department has taken to improve transparency in the NHS.

--- Later in debate ---

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

I have to tell the hon. Lady that the law for England and Wales changed on 1 October, so in fact we are in the vanguard, not Scotland.

[Mims Davies (Eastleigh) (Con)]

Given this Government’s continued excellent commitment to investing in our NHS and reducing preventable mortality, does the Minister agree that keeping healthcare provision as local as possible is very important for Moorgreen hospital in my constituency?

--- Later in debate ---

[Philip Davies (Shipley) (Con)]

What health problems are caused by first-cousin marriages, and how much does dealing with those problems cost the NHS each year?

[Jane Ellison]

I cannot give my hon. Friend a specific answer, but I would be very happy to get back to him because I know there has been some local discussion about this in the city that he represents. I know of the issues to which he refers.

[Several hon. Members rose—]

Life Sciences: Investment

Jane Ellison Excerpts

Thursday 17th September 2015 Written Statements

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

My right hon. Friend, Mr Chancellor of the Exchequer, has today announced the Government’s plans to invest £350 million in a world-class laboratory facility in Harlow, Essex by Public Health England (PHE).

This important investment will help to secure the United Kingdom’s place as world leader in life sciences, as well as ensuring state-of-the-art facilities to keep our country safe from infectious diseases. The Public Health England facility will be established in the London-Cambridge life sciences corridor, allowing researchers from our world-leading universities to be better connected to these vital facilities.

This investment will enable the relocation of a number of PHE’s functions currently at Porton Down to the new facility. The facilities at Porton are more than 60 years old and this investment will replace them with much needed modern facilities. However, PHE remains committed to the Porton site, and the publicly owned pharmaceutical company Porton Biopharma, as well as a regional PHE laboratory, will remain at Porton.

The Government will consider future plans for PHE’s other facilities as part of the spending review.

[HCWS208]

Foods Standards Agency (Triennial Reviews)

Jane Ellison Excerpts

Thursday 10th September 2015 Written Statements

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

I am today announcing the start of the triennial review by the Food Standards Agency (FSA) of the six Scientific Advisory Committees for which the FSA is the sole or lead sponsor. The six Committees are:

the Advisory Committee on Animal Feeding Stuffs;

the Advisory Committee on the Microbiological Safety of Food;

the Advisory Committee on Novel Foods and Processes;

the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment;

the General Advisory Committee on Science; and

the Social Science Research Committee.

The triennial review programme ensures that all Government Departments review their non-departmental public bodies on a regular basis.

Reviews are conducted in two stages. The first stage will examine the continuing need for the functions provided by each committee, and whether the organisation’s form, including operating at arm’s length from Government, remains appropriate. If the outcome of this stage is that delivery should continue, the second stage of the review will assess whether the bodies are operating efficiently and in line with the recognised principles of good corporate governance.

The FSA is reviewing all six bodies as a cluster, which will provide for a more efficient review process, and allow the review to consider any gaps or overlaps in the committees’ functions and opportunities for efficiencies in their operation,

The FSA will consult widely with relevant stakeholders, including: the Select Committees on Science and Technology for both the House of Commons and House of Lords, on Health, and on Environment, Food and Rural Affairs; Government Departments and their agencies; the devolved Administrations; and others with an interest in the work of the committees. The FSA will also launch an open call for evidence so that all those with an interest can contribute.

I will inform the House of the outcome of the review when it is completed and the findings of the review will be published.

[HCWS183]

Dementia Care Services

Jane Ellison Excerpts

Wednesday 9th September 2015 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Charnwood (Edward Argar) on securing this debate, on his excellent speech and on how he approached the debate, engaging and seeking consensus. I look forward to working with him over this Parliament as co-chair of the all-party parliamentary group on dementia.

I speak today not only the behalf of the Opposition, but as someone with personal experience of caring for someone with Alzheimer’s disease. My mum was 64 when she was diagnosed and I provided her care. I have spoken about it in the past, but it has certainly informed my view and led me to want to champion the Alzheimer’s Society and working together on this issue.

I will keep my comments brief because much has already been said about the challenge that our society faces. As has been said, 850,000 people are currently living with dementia in the UK, and the number is set to reach 1 million by the end of this Parliament. It is a distressing disease because of the impact not only on the person living with the condition, but on the carers, as it affects relationships with loved ones. I was lucky that my mum was in good health for much of the time, but the first time she could not recognise me really did have an impact.

As has been mentioned, the previous Labour Government made much progress on dementia. They launched the first ever national dementia strategy, which began the process of establishing memory clinics, providing better training for staff and improving the quality of dementia care for people in hospitals. They appointed the first national clinical director for dementia and commissioned a quality standard for dementia from the then National Institute for Health and Clinical Excellence. The current Government have built on that work, and I am delighted to support the Prime Minister’s challenge. There has also been welcome progress on the number of people with dementia receiving a diagnosis. However, I want to mention three areas where we need to push for more progress.

First is awareness. People are often frightened of dementia because they think nothing can be done, but it is important to remember that, although there is currently no cure, people living with dementia can live well with the right level of support. Like so many who spoke in today’s debate, I have been a big supporter of the Dementia Friends programme. Politicians have a responsibility to lead by example in this area, and I was pleased to see that the Minister recently underwent her training.

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

A year ago!

[Debbie Abrahams]

Fantastic. As the first MP to become a Dementia Friends champion, I ran a Dementia Friends session in Parliament to launch the “dementia-friendly parliament” last year.

We have also heard about the importance of involving young people. A lot of work has been done in my constituency, where, for example, the youth council has received training to be Dementia Friends. Making Oldham a dementia-friendly community is a priority of mine and, after starting with just a few hundred, we now have 2,000 Dementia Friends. I am proud that Oldham is one of more than 100 communities across the country that is working towards becoming dementia friendly, but we need to go further. Our ambition should be to ensure that everyone living with dementia feels included in their community and feels that they have control over their lives.

Secondly, we need improvements in the quality of care and support for people with dementia and their carers, which, as we heard today, is just not good enough in some parts of the country. Too often, people with dementia receive no care and their families get no support. Over the last Parliament, cuts of £3.5 billion were made to adult social care services, which have had a real impact on people with dementia and their families. Some 87% of social services departments can provide care only for people with critical or substantial need. For example, I called on a woman in her late 70s in the middle of the afternoon during one of my regular door knocks. She opened the door, looking dishevelled and confused, and had an empty bubble pack of medication in her hands. Her first words to me were, “I don’t know what I have to do.” I was able to call the pharmacy and to get support for her, but what if I had not been there? She obviously needed support and was not getting it.

Councils are doing their best to save money through changing the way that care is provided and working more closely with the NHS, but the scale of the cuts is forcing many to cut the support that would have helped to keep people out of hospital. As a consequence, more and more people with dementia are ending up in hospital, with some estimates suggesting that one in four hospital beds are occupied by someone with dementia. The NHS has also seen delayed discharges from hospital hit a record high in recent months, costing some £526 million since 2010. Once people are in hospital the support is simply not in place in the community to enable them to return home.

In 2009 the then Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), called for national care services to be developed and to be provided on the same basis as for health. He has repeated that call. We will not be able to improve the quality of dementia services until we find a solution to the funding crisis facing social care.

At a meeting with the Saddleworth carers group in my constituency, I listened to predominantly elderly carers describing the hundreds of hours of often back-breaking work that they were providing for their loved ones. They did that because no support or respite was available. How are they meant to cope? Given that the Government have delayed the implementation of the care cap until 2020, or possibly later, and have gone back on their promise to raise the £118,000 assets threshold before someone has to pay for their own care, will the Minister tell us what assessment has been done to estimate the number of families with a family member with dementia who will be affected by that between now and 2020? In addition, is the Minister committed to the Alzheimer’s Society proposal to drive up the quality of residential care for people with dementia? If so, how is that being monitored, for example in the use of anti-psychotics?

My final point is about research. Research for a cure for dementia provides hope for people in the future. In addition, however, we must focus research into the cause and prevention of the different forms of dementia, and into how we can best care for people who are living with dementia today. The Government’s commitment to double dementia research by 2025 is welcome, but we are starting from a low baseline. Other countries have shown much greater ambition.

Last month Alzheimer’s Disease International called for a significant upscale in research support, given the 35% increase in the global cost of dementia since 2010. It estimated that by 2018 the cost will have increased to $1 trillion, equivalent in size to the 18th largest economy in the world. Will the Minister report on the progress made, as has been asked by other Members?

--- Later in debate ---

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

We have had some excellent contributions this afternoon. I will be unable to answer the questions of the shadow Minister, the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), because unfortunately she took several minutes of my time, but I will do my best to respond to the points made by my hon. Friend the Member for Charnwood (Edward Argar), who brilliantly introduced the debate. He follows a distinguished predecessor in the health field and Charnwood has clearly found another health champion. It was a terrific speech and there were excellent contributions from other Members.

Dementia continues to be an absolute priority of the Government. Several hon. Members have spoken about the devastating impact of the disease, which has touched many families in our country, mine included, and I suspect those of many others in the Chamber and of those listening outside. I will not outline the scale of the challenge, because others have done so eloquently, but it is huge and it is local, national and global. This is the first debate since the launch of the Prime Minister’s challenge on dementia 2020, which builds on the success of the challenge that ran between 2012 and 2015, as others have said. We are well aware that it is only a building block and that we need to carry on and to go further. I welcome the chance to refresh our commitment to going the extra mile, for which Members have called.

We have good news on diagnosis and have made significant progress. More people than ever before are receiving a diagnosis. Without it, they would not receive the support that they need. More than 400,000 people now have the opportunity to gain access to the care and support that they require. Almost 45,000 more people have received a diagnosis of dementia than would have done had earlier trends simply continued, so that is 45,000 more people getting access to support for living well with dementia. The diagnosis rate was increased by 20 percentage points from the baseline in 2010-11 and is now around 60%. We expect to meet our target this year. I will reflect on the challenge to me to achieve ever higher diagnosis rates.

On research, we are committed to tackling dementia through our research efforts at home and abroad. I was delighted to see how many people are volunteering to participate in dementia research. We have had really good news on that recently. Through Members and to those beyond the Chamber, I thank all those people for taking part in such vital programmes.

We are already doubling research spending on dementia. That money supports world-leading major research programmes and significant investment in infrastructure. Globally, the UK is leading the way and working with partners around the world to tackle dementia, boosting investment and accelerating research through the $100 million dementia discovery fund. We obviously have a spending review coming up, but we look forward to continuing that leadership and looking at how it can be provided—potentially through an international institute on dementia research, about which we will be talking to the Department for Business, Innovation and Skills after the spending review. I hear the call, however, and welcome the contribution of my hon. Friend the Member for North West Hampshire (Kit Malthouse).

Many Members spoke about the need to raise awareness. The job has begun, but it is by no means complete—it is an ongoing challenge to build awareness of dementia throughout our society through individuals and communities. In the Chamber this afternoon we have heard some fantastic examples of people with local groups and communities who are becoming more dementia-friendly. The first Prime Minister’s challenge set a target of 20 communities; I am delighted to say that we are exceeding this with 115 communities. My hon. Friend the Member for Wealden (Nusrat Ghani) spoke about one of hers. As she highlighted, there is a great range, from cities to villages and from urban to rural. I congratulate all those who are involved in that public-spirited initiative, but we need to go further. I ask any Member who wants information about how to do that and champion it in their area to please contact me, and we will put them in touch with the Alzheimer’s Society, if they are not already. We have always had good support on that.

It was great to hear tribute paid to the emergence of dementia-friendly cafés and initiatives such as Singing for the Brain, both of which I have seen in my local area. It is great to be able to praise the people leading those initiatives. My hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat) might be interested to know that one of the groups set up as part of the dementia-friendly communities strand of the Prime Minister’s dementia challenge is looking specifically at transport. He made a good point on that. It was also good to hear about the work of the local dementia café in Syston, run by the Alzheimer’s Society. I, too, echo the tributes made to the volunteers, who do such work in all our constituencies. We also provided support to the July 2015 launch of a new standard developed by the British Standards Institute, which encourages more communities to recognise what they can do to be dementia-friendly.

The first Prime Minister’s challenge included a programme to create 1 million dementia friends by March 2015. I am delighted to say that we achieved that target in February, but we want to build on that, and Members of Parliament have a great role to play in leading such work, as has been said. We are pleased that the Alzheimer’s Society has committed to reaching a total of 4 million dementia friends in coming years.

We have invested £50 million to support capital projects in health and care settings, designed to improve the environment of care for people with dementia; nearly £4 million of that was invested in the east midlands during the previous Parliament. Some great work led by Loughborough University on how we can give guidance on dementia-friendly environments is helping us to assess care environments. Some of that work has been led by patients, and there has been an encouraging start, with nearly three quarters of healthcare sites becoming dementia-friendly, including acute wards and hospices. Again, though, we want to build on that and see all such settings becoming dementia-friendly.

More than 500,000 of our dedicated NHS staff have received dementia awareness training so that patients with dementia can be better cared for. Much has been said about the vital role of social care and the people who work in it, and we recognise that key role—the hon. Member for Stockport (Ann Coffey) brought that point eloquently to life. More than 100,000 social care staff have been trained in better supporting people with dementia. Since April 2015, newly appointed healthcare assistants and social care support workers, including those supporting people with dementia and their carers, have undergone dementia training as part of their care certificate. That is encouraging, but, again, we want to build on it.

Post-diagnosis support is an area to which I give enormous consideration. It is going to be one of the big, important challenges in rising to the Prime Minister’s challenge in the next few years. My hon. Friend the Member for Charnwood is right to push us, because these are the practical ways in which we can make a real difference to people’s lives. We are committed to working on that and making sure that we provide advice and information. He mentioned Admiral nurses—again, a great example of what can be done.

There is a great deal to say about investment in future integration. On the vanguards, more are addressing the issue than perhaps my hon. Friend thought, given his concerns; perhaps we can discuss that after the debate. I liked his idea of pushing more Departments on the Dementia Friends programme and I am happy to take that up with the Cabinet Secretary to see whether we can do more there. The revised NICE standard is expected during 2017.

The Government’s commitment to the challenge is undimmed. I welcome the fact that so many new Members have been at this debate to speak about the issue. Seeing their passion to make further progress is inspiring in itself, and we will make that progress.