Medicinal Cannabis from The Netherlands

Jo Churchill Excerpts

Tuesday 26th January 2021 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I would like to update the House on progress made by the Department of Health and Social Care towards ensuring patients can continue to access Bedrocan cannabis oils from the Netherlands.

The UK has left the EU, and the transition period after Brexit came to an end on 31 December 2020. From 1 January 2021, prescriptions issued in the UK can no longer be lawfully dispensed in an EU member state.

Dutch law does not permit the export of finished Bedrocan oils from the Netherlands. Prior to 31 December, Bedrocan oils were supplied in the Netherlands against UK prescriptions through the proxy of a specialist importer. This was allowed while UK prescriptions were recognised in the Netherlands.

Bedrocan cannabis flowers produced in the Netherlands, and other unlicensed cannabis-based medicines imported from other countries, can continue to be supplied to the UK.

The Government have worked quickly with the Dutch Ministry of Health, Welfare and Sport to resolve the issue. I am delighted to announce that the Dutch Government has agreed to the continued access to the medicine for existing UK patients until 1 July 2021.

This news will bring enormous relief to the families who depend on these medicines and I am hugely grateful to the Dutch Government for working with us closely and quickly on this.

The Department has communicated this to patient groups, clinicians and the supply chain to ensure immediate action is taken to resume supply of these products and that no patient faces a break in their treatment.

The Department are also working in earnest to rapidly explore options for a more permanent solution for supply of these products, and will engage patient representatives and the supply chain.

[HCWS734]

Covid-19: Dental Services

Jo Churchill Excerpts

Thursday 14th January 2021 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I congratulate the hon. Member for Putney (Fleur Anderson) and indeed the hon. Member for Brent North (Barry Gardiner) on securing this important Back-Bench debate. It is the second debate we have had on dentistry in about 10 weeks. Access to dentistry is, I think, something that unites us across the House. There has been something of a paradox during the debate, however. On the one hand, we have spoken about how patients cannot access the service they need and how we have seen demand rise so that now we essentially have only urgent and essential care waiting out there for us when we get through the pandemic; and then we have spoken about the fact that it is challenging—I agree, it is challenging—to reach 11.25% of an annual quota in the next three months. I hope to explain how we are ensuring that that is to support patients. I was quite saddened that support for patients was perhaps a quieter voice in the debate than support for the profession. This is only going to work if we support them both.

The pandemic has had, and continues to have, a significant impact on dentistry. First, I want to put on record my gratitude to dentists and their teams for their work in this difficult year. Dentists and their staff kept vital care going through the initial peak both remotely and in frontline urgent dental care centres. In addition, many volunteered to be deployed, if needed, on frontline covid services. Their contribution as healthcare professionals has been, and continues to be, greatly appreciated.

In early 2020, the nature of the novel virus that causes covid-19, and consequently the risks for dentistry, were unknown. However, we knew that the risk of transmission via aerosols, which are frequently generated in dental procedures, was high. As a result, face-to-face urgent care at the start of the pandemic was restricted to designated urgent dental care centres. Over 600 were stood up and they remain open to support all our constituents. The remainder of NHS high street practices were asked to provide remote consultations, complemented by the triple As: advice, analgesics and, where appropriate, antimicrobials.

In the initial guidance issued by Public Health England, dentists had to wear enhanced PPE and, crucially, to upgrade transmission-based precautions through their practices. This meant, obviously, that there was more time between patients and fewer patients could be serviced. I would just like to clarify a point. All NHS dentists can access free PPE from the e-portal, which has now delivered over 1 billion items to our frontline NHS services. To reduce the risk of subsequent transmission by airborne or droplet route, a post-procedure fallow time is needed.

All dental practices, as we have heard, were able to start offering face-to-face NHS care from 8 June, providing they had the appropriate PPE and infection prevention and control procedures in place. All dentistry could start, including private dentistry. Most dentists—this has not come out today, particularly—operate a mixed NHS and private model, but whether private or NHS, as a profession, dentists put their patients’ needs first and they resumed their services as soon as they could.

All NHS dental practices in England should now be offering face-to-face care, but during this difficult period practices have been asked to prioritise urgent care, address any delayed planned care and ensure provision for vulnerable groups. So they are not taking the easy route of just doing the routine, but focusing on the people who need it most. Actually, dentistry was difficult beforehand in rural and coastal areas. The UDA introduced in 2006 does not work particularly effectively, but we cannot change that here and now, so we have to try to provide care to as many people and as many of the most vulnerable as we can.

Between 1 April and 31 December, dental contracts were paid in full, minus the abatement—the agreed deduction for running costs—in the initial lockdown period. As stated, that has not yet been taken. The focus is now on increasing dental provision as safely as possible. Important work has been done to determine how we reduce those fallow times in surgery. The advice has been made available through the UK infection prevention and control guidance for dental settings set by the Scientific Advisory Group for Emergencies. It is a national benchmark for infection prevention and control that is applicable to patient care in all practices in England. The consensus on fallow time published in the IPC guidance has allowed for a reduction in the time between patients and in some cases, if possible—particularly where there is ventilation—to reduce it to 10 minutes from the time the dentist places their equipment down, perhaps while the patient leaves the room, until they pick it up again for the next patient. This is an important step forward.

We have been working closely with NHSE on what level of NHS dental services can be safely delivered to the end of March. The letter was published in December setting out the requirements for NHS dental contractors in the next three months, and where activity targets are not met, perhaps through sickness or other challenges, an exceptions process is quite rightly in place. We are asking dentists to record the DNAs—patients who did not attend—sickness and all other things that might militate against them being able to deliver 11.25% down to 9%, so less than 10% of the activity they were delivering last year.

I hope that provides reassurance, and I hope that all hon. Members will understand that at the forefront of these considerations is the safety of patients and the safety of dentists and their dental teams. They are essential workers. They are in category 2, they are patient-facing frontline health workers and they are to be vaccinated in the first swathe. Indeed, I know that the chief executive of my own CCG is contacting all the dental surgeries that have been listed so that they cannot be missed. Obviously there is little jurisdiction over private practices; we have an influence over NHS practices, but not over how private businesses proceed.

My personal view is that a transformation in dentistry is necessary, particularly if we are to address the challenges that the pandemic has highlighted and the inequalities, particularly around children’s oral health. I wish to see a change in the way we approach dentistry and oral health. I have asked officials and NHSE to ensure that high-quality preventive work is at the forefront of future provision and that a transformation in commissioning takes place. We have an enormously talented profession out there whose skills are not being utilised. They can help us not only with the mouth cancers that are not getting diagnosed if they are not seeing patients but with dietary advice. They can do so much more. They diagnose conditions such as diabetes, by noticing the inflammatory nature of the mouth. There is a huge opportunity to deliver a greater range of health advice, monitoring and support, using dentists and their teams. Arrangements for 2021-22 and beyond are being worked on, and I expect this to be done despite the pandemic and worked on urgently.

Before I close, I would just like to add my support to the call by my hon. Friend the Member for Mole Valley (Sir Paul Beresford) for fluoridation. That is something I am extremely sympathetic towards, for the benefit of children’s health. I am clear that, in looking at these options, nothing should be ruled out and patients should be our first priority.

Vitamin D: Covid-19

Jo Churchill Excerpts

Thursday 14th January 2021 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I am extremely grateful to my right hon. Friend the Member for Haltemprice and Howden (Mr Davis) for having secured this debate, as well as to the hon. Member for Strangford (Jim Shannon); it would not be an Adjournment debate if he did not play his part.

As we have always said, the Government consistently review the latest data and information on covid-19 as it emerges. This, of course, includes the progress there has been in treatments for those suffering with the virus, as well as preventive measures. I would like to express my thanks to health and care workers and to the scientific community, whose dedication and hard work has made this possible, and I am sure right hon. and hon. Members from across the House will join me in doing so. Over the past months, there have been reports about vitamin D potentially reducing the risk of coronavirus, and I am aware of colleagues’ interest in the relationship between vitamin D and covid-19. I welcome the opportunity to discuss it today because, as my right hon. Friend says, nothing should be taken off the table, and we should be constantly vigilant when it comes to new science and information.

Several nutrients are involved in the normal functioning of the immune system; however, there is currently insufficient evidence that taking vitamin D will mitigate the effects of covid-19. In collaboration with Public Health England and the scientific advisory community on nutrition, NICE has published a rapid guideline on vitamin D in relation to covid-19, which my right hon. Friend mentioned. That data was reviewed by an expert panel and included the best available scientific advice published so far, including both randomised control trials and observational trials. That expert panel supported current Government advice, and the recommendation for everyone to take a 10 microgram vitamin D supplement throughout autumn and winter. However, it concluded that there is not currently enough evidence to support taking vitamin D in order to help, or treat, covid-19. There are still significant gaps in the current evidence, and studies to date have not reached the high level of data quality required to revise the guidance.

I heard what my right hon. Friend said about not wasting time, but as he mentioned, the Spanish study to which he alluded only included 76 participants. The smaller the sample group, the more challenging it can be to draw conclusions about the effect. We are also dealing with very poorly people, with multiple different factors affecting how they are responding and what they are responding to, so it is important to ensure that we can rely on that data. Indeed, there was a good double-blind trial before Christmas that showed no effect. However, there is a large-scale trial currently at Queen Mary University of London. I hope that it will give us some good clarity when it reports later in the year.

The current evidence base is mixed, and dominated by studies that are not always of great quality, with substantial concerns about bias and confounding. At the moment, they are unable to demonstrate that causal relationship between vitamin D and covid-19, because many risk factors for severe covid-19 outcomes are the same as for low vitamin D status. Due to the lack of reliable evidence, the NICE guideline recommends that more research is conducted. Government guidance continues to stress the use of high-quality randomised controlled trials in future studies. There are 70 trials under way in the UK and internationally, including some very high-quality ones that will answer key questions from NICE, Public Health England and the Scientific Advisory Committee on Nutrition, and they are monitoring this new evidence. My right hon. Friend asked for my assurance that we are doing that, and I can give him that.

The long-standing Government advice is that, between October and early March, everyone should take a supplement containing 10 micrograms, or 400 international units, of vitamin D a day. Vitamin D helps to regulate the amount of calcium and phosphate in the body, and protects bone and muscle health. In April and autumn 2020, PHE reiterated its advice. It also ran a marketing campaign throughout December 2020. This had a specific focus on the communities mentioned by my right hon. Friend, in particular the BAME community, for whom vitamin D supplementation is very important. PHE advice to continue taking vitamin D supplements is important for those who are shielding, care home residents and prisoners, as well as for those who choose to cover most of their skin when outdoors. As he said, BAME individuals have a greater risk of not having high enough levels of vitamin D, and are advised to take a supplement all year round.

We are actively supporting the uptake of PHE’s recommendations to ensure that those who need vitamin D supplementation receive it. The Government are providing a free four-month supply of 10 microgram vitamin D supplements to all adults on the clinically extremely vulnerable list, going far beyond care home residents who have opted in, residents in residential and nursing care homes in England, and the prison population; Her Majesty’s Prison and Probation Service have made supplements available across England and Wales. Through this commitment, this winter we have offered 2.7 million eligible people in England free vitamin D supplements, and to further drive uptake we have extended the registration period to 21 February so that even more people can benefit.

The Government have prioritised groups who were asked to stay indoors more than usual in the spring and summer due to national restrictions. In addition, recipients of the Healthy Start scheme are also offered access to vitamin supplements by the Government, and of course GPs and pharmacists may be approached for general advice on taking vitamin D. However, we do not expect this measure to place any additional burden on either group, as they are under some pressure during the current pandemic. Guidance can be found online and we encourage individuals to buy 10 microgram vitamin D supplements, which are easily available from supermarkets, chemists, and health food shops.

We must keep looking at the evidence, and as research into the impact of vitamin D on covid-19 continues, we will continue to monitor it as it is published in real time. We have committed to keep this under review. PHE, the Scientific Advisory Committee on Nutrition and NICE will update advice if and when necessary. Of course, I welcome any further studies into this emerging area.

I know my right hon. Friend wants us to move at pace. He embarks on everything he does with enthusiasm and vigour. However, I am sure he will agree that we are nudging along and some progress has been made. Future decisions should and must be based on robust evidence.

Question put and agreed to.

Oral Answers to Questions

Jo Churchill Excerpts

Tuesday 12th January 2021 Commons Chamber

[Navendu Mishra (Stockport) (Lab)]

What assessment he has made of the effect of the second wave of covid-19 on cancer (a) diagnosis and (b) treatment delayed during the covid-19 outbreak.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

First, I am sure the whole House will want to join me in sending our best wishes to my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire) and his family for his treatment. We look forward to seeing him back in this place in due course.

The NHS has been clear since the beginning of the pandemic that the continuation of urgent cancer treatment must be a priority. Latest data showed urgent cancer referrals continuing to increase, with nearly 88% of all patients seeing a specialist within two weeks of referral and nearly 96% of patients receiving treatment within 31 days of a decision to treat. However, I must caveat that by saying that the context for this data was before the recent rise in coronavirus cases. The NHS is open. It is hugely important that any person worried about any symptom comes forward and knows that care is there.

[Navendu Mishra [V]]

I would like to associate myself with the comments regarding the right hon. Member for Old Bexley and Sidcup (James Brokenshire) and I wish him a speedy recovery.

I also want to thank the hard-working colleagues in the NHS who are doing everything they can to ensure that cancer care and treatment can continue. However, unfortunately, due to the unprecedented demand on ICU capacity caused by the pandemic, an increasing number of urgent priority 2 cancer surgeries have been cancelled. Can the Minister assure me that everything is being done to work with the Treasury to increase capacity available to the NHS by continuing to commission the independent sector to ensure that urgent care and treatment can continue so that cancer does not become the forgotten “c” in this crisis?

[Jo Churchill]

I can unreservedly say yes to that. The NHS is under huge pressure and there have been some instances where, for totally understandable and unavoidable reasons such as staff ICU capacity or the safety of patients themselves, treatment has been rescheduled. Any such decisions are always made as a last resort. However, we have changed the way we operate, making sure that we have covid-secure cancer hubs, consolidated surgery and centralised triage to prioritise those patients whose need is most urgent. We have utilised the independent sector, and will continue to do so, to increase capacity. These measures, and, as the hon. Member said, the tremendous efforts of our NHS cancer workforce and their teams, are helping to ensure that those who need treatment can continue without delay.

[Alex Norris (Nottingham North) (Lab/Co-op)]

Throughout the pandemic we have been calling for a cancer recovery plan, so we were glad to see one published in December, but disappointed that it ran only for a couple of months. Events have clearly overtaken us since that publication, and the unprecedented demand on our NHS risks further delays to treatment and to people entering the system for treatment. These plans must now go much, much further. Will the Minister make a commitment today to work with the sector and interested parliamentarians to develop the recovery plan into one that properly addresses the backlog and builds improved treatment pathways for the future?

[Jo Churchill]

The cancer services recovery plan was worked on by clinicians and stakeholders, including the charities, to make sure that we had a robust plan for addressing the challenges that have come about throughout the pandemic. The levels remain high for referral and treatment, despite other pressures on the NHS. I assure the hon. Gentleman that I regularly meet Cally Palmer and Professor Peter Johnson, who lead for the NHS in this area. We have made it absolutely clear, since the beginning of the pandemic, that the continuation of urgent cancer treatment is a priority, as is its restoration. We are doing what we can to ensure that swift treatment is there for everybody. I regularly meet all-party parliamentary groups—indeed, I am meeting one on Thursday of this week—so I can assure the hon. Gentleman on that front.

[Mr Speaker]

We are going back to Scotland for the second question from Dr Whitford, to be answered by the Secretary of State.

Covid-19

Jo Churchill Excerpts

Tuesday 12th January 2021 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I start by echoing the remarks of the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), and by reflecting on my gratitude. As I have sat and listened to the speeches today, what I have heard is the gratitude of the whole House to all those who work on the frontline with such determination. As the hon. Member for Ellesmere Port and Neston (Justin Madders) said, there are people throughout the health and social care system going above and beyond every single day, and for that we are truly, truly grateful. Wherever they work, we have rightly congratulated them—whether it is those working on rolling out the vaccines, which includes the mother of my hon. Friend the Member for Hazel Grove (Mr Wragg), or those who have come forward to volunteer to add to our effort.

I also thank those diverse and important elements of our healthcare system that very often do not get our thanks, but are the glue that sticks all the different parts of the system together. I am talking about the community health teams, who are tired. They have been working hard on the frontline, going into people’s homes, working in primary care, ensuring that, when people are discharged, they are looked after and cared for. Then there are the practice nurses, who are valiantly vaccinating every single day, and our allied health professionals—the physios, the speech and language therapists and the health visitors. Healthcare is still standing up while this pandemic rages, and those individuals are having to work with this virus in order to keep our services going. My hon. Friend the Member for Wycombe (Mr Baker) said that people should still please go to their health provider if they have something that they are worried about, and they will still help.

[Andrew Griffith]

My hon. Friend is making exactly the right point in thanking our dedicated health care professionals who, both in the length and the breadth of their contribution, have been very significant. I went to the Pulborough Medical Group late last week to see one of the first vaccine roll-outs in my constituency, and I saw how complex it is, how dedicated the staff are and how fundamental teamwork is to dealing with every aspect of what is quite a complex vaccination process. There are other GP surgeries in my constituency that I would also love to see avail themselves of the vaccine, but would the Minister join me in thanking them and the many others across the United Kingdom?

[Jo Churchill]

I would be happy to join in my hon. Friend’s remarks. For me, when I visited one of the surgeries in Woolpit in my constituency, it was also the gratitude of those older members of our society who were being vaccinated. As one nursing member of staff said to me, “It’s just the gratitude of people”. They have heard more thank-yous in 10 months than they have across their careers before.

I think people are seeing this as a light at the end of the tunnel, as many speakers have said, but I also think we must be careful. While we are rolling out the vaccine, the way we can thank those right across the health service is to stick to the rules and to make sure that transmission between people is as minimal as possible and that we stay home. That is the way we can help them, because even when people have been vaccinated, there is a period of some three weeks before it starts to ensure that that individual is protected. There was a tweet by the Archbishop of Canterbury today who said that we wear a mask and keep our distance to protect our neighbour. We do all these things to protect others, making sure that through the course of this pandemic we follow the instructions. I do not feel they are confusing—stay at home, go out for one piece of exercise a day. It is pretty clear, and that is how we can help our health service, which is finding things tough at the moment.

[Bob Stewart]

I thank the Minister for allowing me to intervene. Could I ask the Minister to take away the fact that so many elderly people are really concerned about when they are going to get their vaccination? I have had three people in their 90s who have not been contacted, and this is about the lack of contact and the lack of information. The only way, or the best way, to deal with people of that age is not via the internet, but to have a local telephone number that people—the family perhaps, or the person themselves—can telephone. Can I ask the Minister to take that point away and try to set up something like that, because it would be so helpful and be good for morale among the elderly?

[Jo Churchill]

I thank my hon. Friend, and I would say a couple of things. Of course I will take that away and mention it to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi). I would also reiterate the Minister for Health’s comment to my hon. Friend during his opening speech that if at first we do not succeed, we will try, try and try again. It is really important that people feel secure, and that it is not just one hit. If someone has missed their appointment—there may be valid reasons why people cannot get there—we will keep trying over and over again to ensure that as many people can receive the vaccination in as swift a time as possible, because ultimately that is how we will be safe.

Many people mentioned how brilliant pharmacists and their teams have been. We are starting to roll out the vaccine to community pharmacists through the pharmacy network over the course of this week, and building up next week. Many people also mentioned supply. This is a process of driving more and more capacity into the system to make sure that as we build a system—from the mass vaccination sites, in one of which the mum of my hon. Friend the Member for Hazel Grove is working, cascading down through our communities and into more rural sites—those in care homes can get vaccinated without having to leave their care home. This is about making sure we are using GPs and pharmacists across our network, and mobilising the armed forces, who, as we heard in this place earlier today, have been absolutely at the forefront of making sure we get kit such as PPE to the right place, and have been out there helping with testing and helping with the vaccine roll-out. This has been a national effort and a team effort.

[Siobhain McDonagh]

Could the Minister comment on the supply of something fundamental: oxygen? I wrote to the Secretary of State on Saturday about supplies of oxygen to Epsom and St Helier trust, which had a specific problem, but it is not solely Epsom and St Helier—in London, a number of intensive care units are under great pressure and are worried about running out of oxygen.

[Jo Churchill]

I refer the hon. Lady to the in-depth answer on exactly that point that my right hon. Friend the Secretary of State gave during Health and Social Care questions this morning, when he said that there is no national shortage of oxygen in the system. He explicitly outlined the challenges and what is being done to mitigate them.

Pharmacists are being brought online, as are many other parts of our system, including all the staff working hard behind the scenes to keep vital services going and to keep people safe. I reiterate that all front-facing health and social care staff in category 2 can access vaccines, including all dentists and their teams; I think nurses and optometrists were the other professions mentioned during the course of the debate.

We are entering a critical period in our fight against this virus. As my hon. Friend the Member for Milton Keynes North (Ben Everitt) said, there are challenging days ahead—we are not there yet. We are dealing with a new, more transmissible variant of this virus that risks overwhelming our NHS, so we had to put in place these tough but vital rules to slow the spread of the virus. I know how hard these rules have been, not only for those we are asking to follow them but for most of us—it goes to our very core. We did not come into politics to stop people doing things.

[Mr Holden]

I re-emphasise the Minister’s point: none of us came into politics to put these rules in place. Can she please ensure that the rules are relaxed as soon as is practically possible and as soon as it is safe for our constituents?

--- Later in debate ---

[Jo Churchill]

I feel safe in saying that that is the ultimate wish of everybody who is involved in fighting this virus. As the hon. Member for Leicester West (Liz Kendall) said, most of us want a hug. We have been here long enough. The rules mean missing out on moments with loved ones and businesses having to shutter their doors once again. I am sure we have all had conversations with those businesses. Members from across the House spoke of the Chancellor’s unprecedented support, which he outlined again in this place yesterday. He will have been listening to my hon. Friends the Members for Bury North (James Daly) and for Bury South (Christian Wakeford) and others who made that strong case for hospitality and the self-employed.

However, we have to keep going. Our response is improving every day. We are expanding our test capacity. We have distributed massive amounts of PPE—6.7 billion items—to the system, 70% of which was made in this country, so I do not recognise the hon. Member for Ellesmere Port and Neston’s dire PPE forecast. It has turned, and we now have everybody on the frontline protected as they need to be. We are making the most of scientific advances, such as the two new treatments that passed rigorous clinical trials last week. I will not attempt the names like my hon. Friend the Minister for Health did; they appear to be tongue-twisters. As we fight this virus, we will support those impacted by the measures through our furlough scheme and support for the self-employed.

As well as support in the short term, we now have a way out in the long term thanks to the vaccines that we are rolling out: the Pfizer-BioNTech vaccine, which we were the first country in the world to clinically authorise; the Oxford-AstraZeneca vaccine, developed right here in the UK; and the Moderna vaccine, authorised on Friday, which we can soon add to our growing arsenal of vaccines. We now have a plan to get them far and wide, and I recommend to anybody who has not read the vaccine delivery strategy outlined yesterday that they do so. To date, we have vaccinated more than 2.4 million of the most vulnerable people, and 412,000 have had their second vaccine. That is amazing. From north, south, east and west, we have heard people praise this, and we are going from strength to strength. The work set out in the vaccine strategy will help us to return to normal life.

Today’s debate has been engaging, and I thank everybody who has taken part. We have a difficult few weeks ahead as we enter this final stage of our response. We are called upon to sacrifice some of the things that we love to get this virus under control, but as we do so we can take comfort from the fact that help is on the way. The incredible advances will see us through. We will get through this together.

Question put and agreed to.

Resolved,

That this House has considered covid-19.

Breast Cancer Screening

Jo Churchill Excerpts

Wednesday 16th December 2020 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Edward.

I thank my hon. Friend the Member for High Peak (Robert Largan) for securing this important debate. As he and many Members know, breast health—diagnosis, treatment and research, as well as screening—is a matter that is close to my heart. I am honoured to respond on this important issue on behalf of the Government, and on behalf of women and the 3% of men who are diagnosed with breast cancer every year.

I want to state clearly that screening services are back up and that the availability of breast screening to everyone who needs it is there. However, the recovery of those services from the disruption this year is not only a priority for me, but an enormous challenge, for exactly the reasons that have been laid out so eloquently by all contributors to the debate. We know that our cancer workforce had challenges before we went into the pandemic.

Let me remind Members of something that only the hon. Member for Strangford (Jim Shannon) briefly referred to: yesterday, 506 families lost a loved one to covid. It is still with us. We are in a covid-tinged world, and that affects how quickly we can drive other services. However, the resumption of cancer services across the piece—be they treatment, diagnosis or screening—has been the No. 1 priority for me from the time we understood and were able to drive those things in.

I am glad that hon. Members who have taken part in the debate recognise the importance of breast screening in the early detection of breast cancer. As with any diagnosis of cancer, early detection gives people a better chance. The simple fact is that screening saves lives.

I very gently take the Member for Westmorland and Lonsdale (Tim Farron) to task on the statistic that every four weeks represents a 10% lower chance of survival. Cancers, as he well knows, vary enormously in type, grade and everything else. I do not want people not to come forward for screening, diagnosis or treatment because they feel that any loss of time will have had a negative impact. It has to be that as soon as you have a symptom, you come forward. Campaigns such as “Be Clear on Cancer” and “Help Us Help You” are driving at giving people confidence.

We have ensured that services are safe, and our aim is for people to be able to access them as quickly as possible, secure in the knowledge that they are safe. I will cover this later, but while I understand what my hon. Friend the Member for West Bromwich East (Nicola Richards) and the hon. Member for Ellesmere Port and Neston (Justin Madders) were saying, the whole point of open appointments is to maximise the use of available capacity versus fixed-time appointments. A health inequality impact assessment has been done to try to make sure that nobody is disproportionately impacted, and I have asked for a specific eye to be kept on that. Now, if you like—

[Sir Edward Leigh (in the Chair)]

Order. As a matter of courtesy, it is normal for Ministers to address the Chair.

[Jo Churchill]

I am so sorry, Sir Edward. As I was saying, the challenge is that there is variation in the system. That variation occurs for a plethora of reasons, not only those that are covered by an impact assessment on accessibility via open appointments. It is important to keep an eye on all the data.

I am proud that we have a national breast screening programme that offers every woman between the ages of 50 and 70 an appointment every three years. We will strain every sinew to ensure that nobody waits longer than 36 months. We will not step back from that, even with the challenge of driving the backlog down. The programme reaches millions of women and detects approximately 20,000 cancers each year. I recognise the challenge, but every single individual provider has been asked to produce a recovery plan, which should help us to understand the variation. I recognise that about half a million women are waiting, but there are also 500,000 women who have not replied. They will need to be re-approached and encouraged into the system. It is incumbent on everyone to give women the confidence to come forward.

We have also had to look at making sure that women are asked to come forward in accordance with priority by targeting the women who are most likely to have an occurrence of breast cancer. High-risk women will not have open appointments; they will be called immediately. We will then screen positive women in the pathway, followed by screening results that have not been processed, routine open episodes, those who have previously been invited but not screened, and the delays. It is important that we prioritise, so that we target the women we are most worried about.

I am aware that this year, the national breast screening programme could not maintain the service that it normally provides. In March, as the NHS responded to one of the biggest challenges that has faced our healthcare system in a generation, many local providers made the decision to pause appointments so that arrangements could be put in place to protect staff and patients from covid-19. We were unaware at that point what we were dealing with. Staff and facilities were redeployed to tackle the outbreak of the pandemic, but as soon as it was possible to do so, it was made an absolute priority that they were brought back in to do the job that we need them to do.

I am sure that there is not a single Member in this Chamber, or indeed the House, who does not pay tribute to the hard work of all NHS staff. Cancer staff and their teams have done a particularly incredible job of making sure that people across the cancer family have received treatment. Earlier today, I talked to a young man about the treatment he has had, and I talked to a young woman who experienced chimeric antigen receptor T-cell treatment earlier this year. The redeployment of staff left a shortfall in the breast screening programme, and screening appointments for many women have been delayed. I know that that wait, and the anxiety it drives, is incredibly difficult. For those who are looking for reassurance from their routine screen, or who are waiting to receive an all-clear or an early warning that something is wrong, this is undoubtedly a challenging time. However, I want to be absolutely clear that no woman has been left behind, and no woman ever will be. It is a priority to ensure that services are there. Improvements are being driven by the heroic efforts of staff, who have been working longer days and over weekends. They have gone above and beyond to schedule as many appointments as possible to help to drive down the backlog that was created earlier this year.

The first priority is to screen women aged 53 who have not yet had their first screening appointment; those who have passed their 71st birthday and have not yet received their final breast screen; those at very high risk of breast cancer, as I said; and those who have been identified for further treatment. I am pleased to say that the tremendous efforts of screening staff—the nurses, the radiographers and the whole team—are succeeding and the backlog is steadily reducing. The number of women waiting for screening, having received an invitation prior to the first wave, decreased by 98% between 1 June and 4 November.

Screening has been made a clear priority this winter and NHS commissioners have been instructed, where humanly possible, not to redeploy their staff or their facilities away from screening services. It is a priority, and that is absolutely the right approach. My message to everyone is that breast screening services are running, they are safe, they will continue to run through the winter and they are standing up to the increased capacity that is coming towards them.

When people receive an appointment to attend, I urge them to go. “Do not attends” are so frustrating. Those appointments could be taken by a woman who—although she would not want a diagnosis—might get into the stream quicker.

[Jim Shannon]

I suspect that on some occasions, ladies are not attending because of the fear of catching covid-19 at the hospital. I have spoken to some ladies back home and that was one of their concerns. How can we address that?

[Jo Churchill]

Essentially, by constantly reassuring them that the reason why we can do elective operations, have out-patient clinics open and carry on doing some of the business as usual is because heroic efforts have been made to make sure that there are safe places. I pay tribute to Dame Cally Palmer, who has made sure that rapid diagnostic centres have been stood up to ensure that patients can access care safely. We had 17 at the start of the pandemic, and we now have 45. The cancer alliances have worked extremely hard in all our regions. There is no one silver bullet, but it is important that we do what we can for patients.

If people have any concerns or notice any abnormal changes in their breasts, they should contact their GP. I pay tribute to my hon. Friend the Member for West Bromwich East, and I am pleased that her mum is now in good health. CoppaFeel! is a great charity and its website shows how to do a good check. Breast Cancer Awareness Month still went on—I did wear it pink—although it did not quite have the same profile as usual. It is every woman’s responsibility to make sure that they check their breasts monthly. If they see anything unusual that they are concerned about, such as puckering or discharge from the nipple, GPs are open and there to help women.

One thing that can help is to make sure that people go, but we are here to talk predominantly about screening services. Cancer diagnostics and treatments are back on track. The latest official data for October 2020 suggests that GP referrals are back to almost 85% of pre-pandemic levels, compared with August 2019. I appreciate that that leaves a lag, but we are heading in the right direction.

Urgent referrals were 156% higher in October than in April, which is when they were most affected. That shows that we are not only getting there, but beginning to go beyond. Nearly 88% of cancer patients saw a specialist within two weeks following their referral, and nearly 96% of patients received their treatment within 31 days of a decision to treat. In October, 83.5% of breast cancer patients received their first treatment within 62 days, and breast cancer treatment activity was at 101% of last year’s levels. However, these figures do not hide the fact that there is a backlog and we have to work as hard as we can to address that. The “Help Us Help You” campaign, launched in October, is a key part of this and reinforces that message of seeking help. We will closely monitor the effect of covid restrictions on referral rates to ensure that the number of people coming forward with symptoms remains high, because it is about confidence. Some pathways are more problematic than others, but the important thing is to make sure that we get as many people as possible through the pathway.

I turn to the theme of breast screening for younger women. As the hon. Member for Midlothian (Owen Thompson) has said, this has been found not to be evidenced-based. There is a risk in referring women for unnecessary tests, in over-treatment, and in operating on women who have diseases that mean that that is likely to cause harm. Women with a very high risk of breast cancer, such as those with a family history, may well be offered screening earlier and more frequently. Sometimes, in life, we just have to ask a question, and I recently asked a breast cancer specialist about this. My hon. Friends the Members for Chatham and Aylesford (Tracey Crouch) and for Norwich North (Chloe Smith), and the former Members for Dewsbury and for Eddisbury, all of whom are in the younger age group, are going through treatment—I think one of them is post treatment—and I was their age when I was diagnosed. Just because something looks right, it does not necessarily mean that it is, and we have to act on the evidence. That is where we are at the moment for young women.

We published the people plan in July, and I recognise, as Sir Mike Richards did, that the screening workforce is a challenge and it is important that we drive more individuals into the areas of radiography, mammography, pathology, nursing and cancer specialist nursing. The spending review provided another £260 million to continue to grow the workforce and support those commitments, which were so important in the NHS long-term plan.

Health Education England has also provided £5 million to support training and development programmes through the National Breast Imaging Academy, which aims to improve breast screening recruitment targets and early diagnosis. It has already made significant progress, launching the mammography level 4 apprenticeship; recruiting the first of the NBIA radiology fellows, who will benefit from specialist training in breast radiology; and developing e-learning for health programmes on the breast.

To improve screening uptake, we need to work with cancer alliances, primary care networks and the regional teams to promote the uptake of breast screening and to get to as many people as possible. As I said, the open appointments systems is something that we are looking at, and we hope that the result will be that we get more women through. The national cancer recovery plan was released this week. It is a joint effort from cancer charities, royal colleges, national teams and patient voices, and it was led by the national clinical director for cancer, Professor Peter Johnson. Its whole ethos is to outline the actions that need to be taken to restore demand to at least pre-pandemic levels by raising national public awareness through campaigns; ensuring that there are efficient routes into the NHS for people who are at risk of cancer; improving referral management practice in primary and secondary care; and setting out immediate steps to reduce the number of people who wait more than 62 days from urgent referral, so that patients are seen as quickly and safely as possible. Finally, it ensures sufficient capacity to meet demand through maximising the use of available capacity in both symptomatic and screening pathways, which both feed into the same funnel, optimising the use of the available independent sector capacity, enabling the restoration of other services, and protecting service recovery during winter.

This is an excellent plan, which will work towards the long-term plan ambitions for cancer services to continue during the pandemic. I am fully committed to seeing it through and working with Dame Cally Palmer and all the others to ensure that we can get to a better place. I recognise that, as the hon. Member for Westmorland and Lonsdale said, there have been some remarkable changes to treatments with radiography and other treatments in cancer. We must take those silver linings where we can.

I pay tribute to my hon. Friend the Member for High Peak for coming to me to say that High Peak was special due to its geography, and he did not want the women he serves in his constituency to be disadvantaged in any way by a loss of service. I understand that the decision to put breast screening services into static positions was taken to maximise capacity. I was quite amazed that, pre pandemic, 70% to 80% of screening happened in mobile units. They are particularly helpful in dispersed rural areas, but with some of the challenges of providing covid-secure spaces—some of those units did not even have running water—a decision was made to bring them back to a static site. The static units can stay open longer and at the weekend, making about 1,000 more appointments possible in a three-month period, so a lot more women can be seen.

Although I take on board the point about travel, I am asking women to bear with us—to work with us. These are temporary changes, but they are a vital measure in the recovery of breast cancer screening services, allowing more women to be seen, particularly those who may have missed an appointment this year. I know that longer travel times are difficult. I know that those beautiful hills that my hon. Friend’s constituency is blessed with do not have particularly good bus services either. This is not always an easy proposition, but it was decided that, for now at least, optimising the service to see as many people as possible should take priority over optimising a mobile service.

When my hon. Friend came and met me, I could not give him any assurance, and he has pressed me again today. I assure him that this is a short-term measure. The increase of appointment availability will assist us in in being able to resume mobile screening for High Peak, safety permitting, by July 2021. I have been reassured by the Chesterfield Royal Hospital NHS trust that it is monitoring attendance, that this compromise is temporary, while services recover, and that the usual screening locations will be reinstated in the longer term to ease access. I take this opportunity to stress that the screening services are safe to attend and a range of measures have been put in place to ensure that people go.

I thank my hon. Friend and all other hon. Members who have participated today. I pay tribute to all the incredible staff across the country who are working so hard on the backlog and to make sure that cancer services stand up and catch up over the winter period. Hon. Members have my absolute commitment that we are focused not only on the short-term recovery of screening services, but on their long-term improvement too. Prevention, public health and early diagnosis continue to be a huge priority for me. We will continue to bear down on screening services, making sure we have the right kit in the right place and that we are delivering the different parts of the cancer pathway for men and women to have the best treatment.

Healthcare Support Services: Conception to Age Two

Jo Churchill Excerpts

Tuesday 15th December 2020 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank the right hon. Member for South Northamptonshire (Andrea Leadsom) for securing the debate. I know that her passion for this subject runs deep and has done for some considerable time, and she always speaks with great authority. That is why I was so pleased that the Prime Minister appointed her to lead the review. I am really looking forward to the results of that come the new year, because as so many right hon. and hon. Members have said, the time for change is here. Being able to deliver for families over those first 1,001 days is a responsibility that we should all share; we need to make sure that we not only speak about it, but actually deliver it.

I would also like to thank all hon. Members present, starting with my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton)—or, as I now like to refer to him, the hon. Member for health visiting, that very unsung part of our health ecosystem. I thank the hon. Member for Glasgow Central (Alison Thewliss), and commend her on the work that she does with her APPG on breastfeeding, which is such an important start to life. I also thank my hon. Friend the Member for family hubs, or for Congleton (Fiona Bruce), and the hon. Member for Strangford (Jim Shannon), who looks after the strength of the family in this place. Finally, I thank my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) for her plea for continuity of caring, but also for the fine work she does with the APPG on baby loss. I am following in some big shoes: those of my hon. Friend the Member for Colchester (Will Quince), of the former Member for Eddisbury, and of my hon. Friend the Member for Banbury (Victoria Prentis).

There is such power in this room for change, and it is both right and important that the Government have a care for the nation’s health. Just as we say about retirement, we should be investing in our health from the beginning: from early years through to older age. It must start from conception to be as effective as it can be. The period between conception and the age of two is absolutely critical in a child’s development, as we have heard. It is during this time that the important foundations are laid, creating that strong and healthy start that can see children through their life: to school, to work, to parenthood, and to better parenting themselves, as my right hon. Friend the Member for South Northamptonshire said, which very much struck me. This is a cycle that we really do need to get right.

Thankfully, most babies do have a fantastic start in life. They benefit from the support of loving parents and carers, as well as dedicated early years professionals. However, there are unacceptable variations across the country, both in different parts of the country and within regions, and both in terms of geography and population groups. We know that just over 66% of children in Bolton achieve a good level of development at age two to two and a half, but that rises to over 93% for a child born in Cambridgeshire. That differential should be unacceptable to us. Risk factors, often family based or socioeconomic, make our children—they are all our children—more vulnerable to poorer outcomes going forward.

The coronavirus has created enormous pressure, not only on services but on individuals. For many new parents, coronavirus has meant feeling isolated and losing that support mechanism, and my heart goes out to them. I think it was the hon. Member for Strangford who spoke about the importance of just meeting friends; just being able to have that little bit of “Does your baby do this? My baby does that.” They do not come with a manual, and I remember all four of mine, all under five at the same time, all being completely different: they all had completely different eating habits, and so on. Very often, I could not work out why. I thought, “I did a proper job before I had these children. Why on earth is this so difficult?” Some days, it was a real achievement to get the breakfast pots washed and go out with my pants on the right way around.

[Fiona Bruce]

The Minister is making such an important point. Does she agree that we so often undervalue how important mothering, parenthood and ensuring children have that best start in life is? As a society, we should value that much more highly, because it is not an easy job.

[Jo Churchill]

I agree wholeheartedly with my hon. Friend. We are in a different time as regards parenting. Many couples choose that the father will stay at home. Often they do an excellent job at raising their children, as that part of the family unit. It is about communicating, sharing responsibility, and the services that wrap around families. My hon. Friend the Member for East Worthing and Shoreham used a lovely phrase when he talked about supporting, not supplanting, parents: holding hands to make sure that there is help there when someone struggles with breastfeeding or to understand the right thing to help a child sleep, or when there might be conflict in the house and they reach out. I take the point made by my hon. Friend the Member for Truro and Falmouth about a trusted carer giving people signposting. I asked my sister, who recently became a grandparent, what the most challenging thing was, and she said it was definitely the isolation and separation, which did not even allow her to hold her new granddaughter for six weeks after her birth.

[Jim Shannon]

The Minister is responding in just the way we knew she would, and I thank her for that. I mentioned in my contribution the importance of church and community groups, which by their nature are on hand to help and assist. Does the Minister recognise the good work that they do? Church groups are important to those of faith—and those of no faith—and the community groups are also important for what they can do, such as mother and tots provision.

[Jo Churchill]

Indeed. I think that often the role of family hubs can be support and education. However, a good health visitor can change a life, when it comes to moving on. An excellent midwife changed my journey, when I was struggling to feed my children for the first 10 days. Everyone says that those things are easy, but there is nothing easy about it, but after managing to get support people, hopefully, really feel they can fly. That is why it is vital.

Coronavirus has meant that many parents feel isolated, as I have said. They have not had access to the support of those closest to them, or other supporting work—whether that is faith-based or otherwise. That has added to the emotional pressures that many new parents face. For many babies the pandemic will represent time missed in, for example, getting to know grandparents. For some families it has meant a lack of professional wraparound support. There has been pressure throughout the system, but we have been in the middle of a global pandemic. It is just a statement of fact, not an excuse.

I assure my hon. Friend the Member for East Worthing and Shoreham and others that the advice from the chief nurse, the Local Government Association and others is that redeployment should not occur unless it is unavoidable, because it is seen as so important that families with young children get assistance. As my hon. Friend said, there are challenges with respect to health visitor numbers. Both of us have debated that issue in this place, and I have also met Professor Viv Bennett. I am looking forward to the review because some of the open sessions at which I have joined my hon. Friend have highlighted the importance of the service.

For the first set of lockdown restrictions the health professionals in question were redeployed, although I assure Members that vital safeguarding functions were still carried on. I have spoken to health visitors on the ground who said that that was a key priority, to keep children safe. We recognise that that level of support is not what people would want or expect. However, I really want us to go forward from this point to deliver into 2021 and beyond.

As the vaccination roll-out is happening and we start, hopefully, to return to a more normal, albeit covid-tinged, way of life, there is still a long way to go.

Coronavirus has shown us, if we needed more proof, how valuable data sharing can be across the services, as my right hon. Friend the Member for South Northamptonshire said. The join-up between services for the early years has accelerated out of necessity, but has brought a bit of a silver lining to what has been a very difficult time. Some of the services and support can be provided digitally. I would be the first to say that I do not want 100% of services to be on a digital platform, but there are mothers of tongue-tied babies who have been able to access immediate support, with a professional on the other end of the video conference call who is able to explain what is going on at the point when the mother is getting quite stressed about the situation. There is therefore a place not for only better data and information sharing to improve services, but for different ways of working to ensure that we get the most out of them.

The early years are not only important for health and care. Many Government Departments have an interest or play an active role, which brings me on to family hubs. They sit very much under the Department of Health and Social Care, while being integral to ensuring that we deliver properly for families. On Sure Start centres and the use of family hubs, findings from the local government programme, the Early Intervention Foundation and the review of family centres, family hubs and other delivery models will inform the next steps, including any future consultation of the role of children’s centres. I know that my hon. Friend the Member for Congleton will not cease to fight for family hubs to be at the centre of all our communities.

[Fiona Bruce]

I thank the Minister for that comment. Will she also comment on the point made by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) about the need for a dedicated Minister for families, ideally at Cabinet level? Within just a few minutes we have referred to many different Government Departments—the Department for Education, the Department of Health and Social Care, the Ministry of Housing, Communities and Local Government and others—all looking at family hubs. There needs to be one Minister who can really pull the thinking together and drive it forward.

[Jo Churchill]

I know that the Education Secretary has been given a leadership role for families, and £2.5 million to research and develop best practice on how we integrate family services. I know that my hon. Friend the Member for East Worthing and Shoreham has often called for a families Minister, and in the last Parliament my hon. Friend the Member for Congleton also made such a plea. Joined-up cross-Government working in many areas is always a challenge. I leave the plea of my hon. Friend the Member for East Worthing and Shoreham resting there. It is something else that will probably come out in the review.

The Department is taking important steps to improve the healthcare outcomes of babies and young children to give them the best start in life, including the most ambitious childhood obesity plan in the world. The Minister for Mental Health, Suicide Prevention and Patient Safety has done a lot of work on transforming children’s mental health and maternity services to identify those mothers and members of the broader family who are struggling. We also have a world-leading immunisation programme, which I will come back to.

All those policies are informed by the guiding principle of prevention, which I totally agree is better than cure. We want to identify and treat problems from the earliest stage and help parents to care for their children, change and improve behaviours, and protect against preventable diseases. We know that if parents and babies are well supported in the vital period from conception to age two, they are set up for a lifetime of better mental and physical health. Attachments, stimulation and foundations really are the backbone of their lives. While my right hon. Friend the Member for South Northamptonshire was talking, I thought of it as an emotional reservoir on which we can spend our lifetime drawing to ensure that we live healthier and more sustainable lives.

We are doing everything we can to help the NHS to improve outcomes for babies and children, and we are building that into the NHS long-term plan. The pandemic has made the public rely on new methods of accessing childcare. Information has been accessed from conduits such as 111 to an extent that we have never seen before. I am keen to explore how that can be used further to support parents and children going forward.

We are embracing opportunities presented by technology and pleased that the personal child health record, better known as the red book, is being digitised and made available. There are enormous opportunities here. We are also making sure that the modernisation of the healthy child programme is universal and personalised in response to every child’s needs. We remain committed to improving perinatal health. My hon. Friend the Minister for Patient Safety, Suicide Prevention and Mental Health is making sure this is at the top of her agenda.

I ask Members to encourage parents in their constituencies to ensure that their children are vaccinated. As my hon. Friend the Member for East Worthing and Shoreham said, vaccination rates are falling, and we lost the World Health Organisation status for measles. It is vital that parents use the free vaccination service to protect their children from measles. The actual disease is much worse than the second it takes to get vaccinated. I would really like us all to push to make sure that we regain the WHO status. The flu vaccination programme rolled out to school-aged children has been a phenomenal success this year, but if parents are worried about anything to do with vaccinations, they should go to their GP or a health professional and ask questions.

Before I finish, I will quickly comment on support bubbles. I hear my right hon. Friend the Member for South Northamptonshire. In all tiers, single adult households can form a bubble, and we have expanded this provision because we understand the pressure that they are under. Specifically, households containing a child with only one adult, and adult households with a child under one, or a disabled child under five who requires continuous care, can now also form a support bubble. In addition, households with one or more people who have a disability and require continuous care, as long as there is no more than one other individual over 18 who does not have a disability, can also form a support bubble. As my right hon. Friend knows, it is a challenge in the current pandemic to make sure that we balance the safety of everybody with access to support, in this case for young parents or perhaps people with needs arising from terminal illness.

The Duchess of Cambridge’s report was mentioned by several hon. Members. I am keen to understand whether the five recommendations are woven into the review, when it finally comes to us in January.

I recognise the impact of domestic violence on families. It has been incredibly difficult, and it is unseen. I pay tribute to the Under-Secretary of State for the Home Department, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), for her work in this space and on the Landmark Domestic Abuse Bill. We all need to be aware of the issue, and highlighting services and support for families is key.

On that note, I hand over to my right hon. Friend the Member for South Northamptonshire. I look forward to receiving the review in the new year and discussing the outcomes with her.

Covid-19

Jo Churchill Excerpts

Monday 14th December 2020 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I beg to move,

That this House has considered covid-19.

I am pleased to say that all across the country the roll-out of the covid-19 vaccine is continuing at pace. Tens of thousands of patients, such as the very memorable Margaret Keenan and Martin Kenyon, have already received their jab, at more than 70 sites across the UK. That number will continue to increase, which is positive news, as I am sure we will all agree. This week also marks the start of the wave 1 roll-out of vaccination in GP-led sites, and I want to take this opportunity to thank general practitioners and their teams for their work in getting this programme up and running. I visited a practice this morning in Newham, where I talked to the team—to doctors, practice managers and the fantastic practice nurse, Raj, who had been busy caring for patients, delivering flu jabs and giving diabetes advice and is soon to be administering the covid vaccine. All those things, along with the promise of vaccines in care homes by Christmas, are encouraging developments, which colleagues from across the House will join me in welcoming. Right hon. and hon. Members will also be pleased with the announcement of 1,800 projects to upgrade and refurbish hospitals across 178 NHS trusts this winter; from fixing new roofs to new MRI machines, the £600 million package will make a real difference for patients and staff.

However, we all understand that this progress should be taken while bearing the current situation in mind. Coronavirus is very much with us. This past week, the average number of new cases each day was 15,960. Average daily hospital admissions currently stand at more than 1,500. As Professor Chris Whitty, the chief medical officer for England reminded us only last week, even with our mass vaccination programme we will “not have sufficient protection” for the next three months. The number of cases is flattening and even rising in some parts of the country.

So it is important to remember that this is one of the most difficult times of year normally for respiratory infections. The winter period is always the most challenging time for the NHS, let alone in these unusual covid-tinged times. Therefore, we must do everything we can collectively to avoid putting any further burden on the NHS. We should continue with our current efforts, so that we can give all health and care workers the best possible environment, despite the current circumstances of rolling out that vaccine and saving lives. I am sure I speak for everyone when I say that I would like to take this opportunity to express my continued gratitude to those frontline members of staff in our health and care service up and down the country for all they do, in hospitals and in the community.

To reiterate, this Government will continue to focus their response and build around three vital pillars: tiers, testing and vaccine. The House has just heard my right hon. Friend the Health and Social Care Secretary outline the latest changes in our system of tiering. The first formal review of tiering decisions is to take place this Wednesday, two weeks after the new rules came into force. However, when the virus is growing exponentially there is not a moment to spare, so we are acting ahead of the formal review date and putting in place stronger measures in several areas. I know these restrictions can be hard, but this action is absolutely essential not just to keep people safe, but because we have seen that early action can prevent more damaging and longer-lasting problems later on. We will continue to stand with those who are impacted through our furlough scheme and support for businesses and the self-employed.

Even with the review point ahead of us, and following my right hon. Friend the Secretary of State’s statement earlier today, the Government have wasted no time in taking bold action where it is needed. As soon as we became aware of these worrying trends in parts of London, Kent and Essex, a plan was put in place, and from last Friday surged mobile testing units have been deployed to where they are needed most. They are now in several boroughs of London, in parts of Essex that border London and parts of Kent where statistics show a high prevalence of covid-19, particularly among secondary school pupils. That is why our community testing is targeted towards the 11 to 18-year-olds and their families and teachers.

In addition to this testing support, we will continue to work with the local authorities and schools affected. Here I want to encourage anyone who has been asked to come forward for a test to do so, even if they are not displaying symptoms, for we know that community testing works. That is why this kind of deployment is available all across the UK. We are working with devolved Administrations in Scotland, Wales and Northern Ireland, and now over 100 local authorities across England, so that people in Kent and Medway, Derbyshire, Stoke-on-Trent and Darlington can access tests. I thank local authorities for their efforts in mobilising the power of community testing for their areas.

Community testing works because it is the best way that we can identify and then isolate people with the virus. We know that people with coronavirus will often feel unwell and may well seek medical attention or indeed, unfortunately, be hospitalised. However, one in three people have no symptoms at all, but they can still pass it on to others through asymptomatic transmission. So that we can reduce transmission and help people protect their friends and families, I would like to urge everyone to keep following the restrictions in place, taking the sensible steps that have, I hope, become part of everyone’s daily routine: washing our hands, covering our face and making space, as well as opening the window to ventilate places where we can. This will help protect those around us, our families and friends.

We cannot stop all our efforts just because a vaccine is here—that would be premature and risk everything that people have worked so hard for—but we do know that, in time, the vaccine represents our surest way out of the challenges we face. Many of the population will get their jabs in the first part of next year, as more vaccines come on stream, and I am encouraged by the peer review in The Lancet confirming that our home-grown vaccine candidate, the Oxford AstraZeneca vaccine, is clinically safe. We will be ready to roll out that vaccine along with any other vaccines in our portfolio if they are approved by the independent regulator, the Medicines and Healthcare Products Regulatory Agency. Vaccines are safe—so I urge people please to step forward.

Into the new year, our dedication to and efforts on the roll-out will continue. We will expand vaccination centres further. We will look to larger venues such as sports stadiums and conference centres. I remind everyone that they do not need to contact their doctor or the NHS; they will contact people when it is their turn for a jab. I know that many up and down the UK are eagerly awaiting that call.

Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020 Draft Health Protection (Coronavirus, testing requirements and standards) (england) Regulations 2020

Jo Churchill Excerpts

Thursday 10th December 2020 General Committees

[The Chair]

I remind Members to observe social distancing, and to sit only in places that are marked as available. Hansard colleagues would be most grateful if Members could send their speaking notes to [e-mail].

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I beg to move,

That the Committee has considered the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020.

[The Chair]

With this it will be convenient to consider the draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020.

[Jo Churchill]

The draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020 will remove covid-19 test services from Care Quality Commission regulatory requirements. Existing exemptions result in certain covid-19 testing providers being within scope of CQC regulation, and other providers being exempt. We want to tidy this up by removing this requirement, while introducing a requirement to apply to the United Kingdom Accreditation Service. This will simplify the complex regulatory system for covid-19 test providers.

The second statutory instrument, the draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020, will impose requirements on private test providers to become accredited by UKAS and to reach specified stages in the process towards accreditation within a specific timeframe that starts on 1 January 2021.

Last week, the independent Medicines and Healthcare products Regulatory Agency recommended authorising Pfizer-BioNTech’s covid-19 vaccine for use. While we wait for vaccine deployment, testing and contact tracing remain among the most effective ways of controlling the spread of the virus. The more rapidly we can identify people at risk of infection, the more effectively we can reduce the spread of the virus and get life back to normal. During the pandemic, we have built the largest diagnostic network in British history via Test and Trace, but we will defeat the virus only if the public and private sectors work together.

The private sector has a critical role to play in achieving this, and has shown its value time and again throughout the pandemic. It is at the forefront of testing innovation and is keen to support Test and Trace. It is vital that we look to open up our economy, and that NHS Test and Trace suppliers are focused where we need them most, taking pressure off the NHS. However, people must also be assured of the safety and reliability of services. The Government therefore support developing the private testing market, so that we can ensure that everyone has access to simple, effective, high-quality, affordable and reliable tests and test services, whether from a Government or private provider. As the demand for testing continues to grow, the need for public confidence in testing remains as important as ever. We need to support the system so that providers can enter quickly and efficiently, and so that we can meet demand without compromising the quality of testing services or undermining customer confidence.

There is a requirement in England for parties to register with the CQC if they are involved in the removal of bodily cells, tissues or fluid samples, or the analysing or reporting of those samples, for covid-19 testing. That requirement is subject to a number of exemptions. Notably, it depends on the type of covid-19 test sampling and analysis, and on the entity undertaking the sample collection. That has resulted in inconsistencies around requirements, and a degree of confusion. Test providers have voiced concerns about the complexity surrounding entry to the covid-19 testing market, and we have listened.

The first statutory instrument before the Committee will remove the requirement for covid-19 testing providers to register with the CQC by exempting covid-19 testing from being a regulated activity under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As the CQC is an English regulatory body, this does not apply to any other nation in the UK. The removal of the requirements will prevent confusion over regulations from causing restrictions in total testing capacity, which we are keen to ensure is sufficient. It is vital that we neither restrict testing capacity nor compromise on quality. The change from CQC to UKAS will provide the necessary agile but robust requirements to ensure that testing capacity is not restricted.

I turn to the second statutory instrument. UKAS is the sole accreditation body in the UK, independent of but appointed by Government. Accreditation by UKAS is the recognised gold standard for organisations that offer test services. Recognising the time it can take to gain full UKAS accreditation and the urgent need for high-quality private testing, on 27 November my Department and UKAS launched an adapted three-stage UKAS accreditation process for private test providers, ensuring that new and innovative providers can be accredited faster without compromising on rigorous safety standards.

The instrument requires providers that provide tests commercially to undergo this staged UKAS accreditation process within the specified timeframes. All providers offering test services to the English market will need to gain stage 1 applicant status by 31 December. After 31 December, new entrants to the testing market will be required to achieve UKAS applicant status before offering any test to the English market. The instrument also requires providers to achieve stage 2 UKAS appraisal and stage 3 UKAS accreditation status within a given timeframe.

Employers that provide test services only to their own staff, and organisations that supply tests at no cost, will not be required to gain UKAS accreditation. I would, however, advise that they endeavour to do so, thereby ensuring that their tests are of the highest possible standards.

From 15 December, international arrivals will be able to opt in to testing to release, and all test services used for this purpose will be required to work towards completing, and to have completed within the timeframe, the three-stage process.

Before I set out my final justification for the regulations, let me thank the Joint Committee on Statutory Instruments, which scrutinised them so quickly. I want to explain how tests for the presence of antibodies are covered by the regulations. Current forms of tests for antibodies are not covered by CQC legislation and will not be covered by UKAS legislation. The regulations do not leave any regulatory gap with regard to testing for antibodies, as no legislation existed, but test providers for the presence of antibodies to covid-19 can choose to apply for accreditation if they wish.

The new UKAS accreditation scheme will simplify the process of looking for a commercial test for the presence of covid-19. Consumers will be able to identify providers capable of delivering a quality end-to-end service. From booking to sample collection and reporting results, individuals and businesses will be able to get the assurance they need. We strongly advise that consumers and organisations procure test services only from gold standard providers that have started their journey through the UKAS accreditation, and a list of all those providers will be available on gov.uk.

In conclusion, this legislation will simplify the testing landscape for test providers and regulate the market with consistency. This will help to protect consumers and help test providers. We are enormously supportive of employers who have already chosen to begin testing their staff. They help reduce pressure on the NHS and ensure that Test and Trace can focus on situations where it is needed most. But wherever testing is done, it must be done properly, using the right test for the right purposes. These regulations will help the public to identify the right test services for their purposes. They will also help test providers to enter the market at a time when their services are vital to the country. I therefore commend the regulations to the Committee.

--- Later in debate ---

[Jo Churchill]

Thank you, Ms Rees; I will indeed. I will canter through the questions. As the hon. Member for Nottingham North knows, we work effectively together, and if I have missed anything I will come back to him.

The hon. Gentleman was right that all parts of the process, end to end, are treated similarly. I thank him for the measured view he took of what the measures seek to do, which is sort the market out, so the answer to his question is yes. He asked about the list. Yes, this is the final list. He asked about the process. Sign-up on 27 November through to 31 December is stage 1. Stage 2 is that existing providers have to meet the checklist of key requirements for the testing services by 31 January. New providers will need to complete this stage by 31 January or within four weeks of completing stage 1, whichever is later. Providing that the providers pass all assessments and are fully accredited for testing, the instrument will mandate that existing providers should meet stage 3 by 30 June or within four weeks, whichever is later.

We have worked very closely with UKAS to ensure that it has capacity to do this work within the four weeks. We have been assured that the current providers in the market can meet that. UKAS is a recognised mark of gold standard, and that is why we are working closely with it. Since the beginning of the pandemic, we have been working with it to ensure that people can access advice on quality assurance of tests and so on, and become accredited. What is being seen here is a slight lag to make sure that we get this right and introduce the legislation. As I say, my officials have been working with UKAS to ensure that we get the right balance. There are checks and balances in making sure that the adapted three-stage approach allows entry at speed, but also has a check. If a provider has not passed at four weeks, they do not get to move on any further. This preserves the gold standard, and UKAS embraces the innovation, but wants to make sure that its accreditation stays at that standard. Providers that continue to provide and have failed to meet the criteria will be committing an offence that is punishable on summary conviction by an unlimited fine.

If passed, we will review these regulations after six months to ensure that they are suitable and efficient. The hon. Gentleman and I have regular dialogues; if he has any input, I am always happy to listen to it.

That has probably cleared off the majority of the hon. Gentleman’s questions. I thank him for his contribution to this important debate. The Government have been clear that the highest priority is saving lives and reducing the spread of the virus while aiming to get life back to normal as soon as possible. The measures and amendments that we have debated today are necessary and proportionate to ensure that everyone can access simple, effective, high- quality testing services that they can count on. Testing is not a silver bullet. It is not the sole solution to the pandemic. However, it is part of the broader solution, and it is helping us to protect jobs and keep businesses open.

Testing is enabling hospital treatment to continue and transport to keep running, and is keeping our children in education. It is vital that we continue to open up the economy, and that NHS supplies are saved for the situations in which they are needed most. To ensure that, we need to enable the provision of new, innovative tests that are as reliable and effective as possible. To that end, the services that wrap around them need accreditation. The regulations will ensure that. They will provide public confidence in testing, and support private providers in entering the market.

As I have said, we need to create an agile regulatory environment for testing providers. We can enable that by removing CQC regulatory requirements for them and replacing them with the gold standard of UKAS accreditation. The measures will simplify the complex regulatory system for test providers, and simplify the process of looking for a commercial test that is reliable, assured by providers, and gives individuals and employers essential assurances about the test that they procure.

In conclusion, this legislation will simplify the regulatory landscape for test providers and regulate the market in a consistent manner. This is beneficial to consumers and test providers alike. I reiterate my thanks to the covid-19 test providers for their pivotal work in the past few months. We review these regulations regularly and assess them in the light of developments. I commend the regulations to the Committee.

Question put and agreed to.

DRAFT HEALTH PROTECTION (CORONAVIRUS, TESTING REQUIREMENTS AND STANDARDS) (ENGLAND) REGULATIONS 2020

Resolved,

That the Committee has considered the draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020.—(Jo Churchill.)

Childhood Cancers: Research

Jo Churchill Excerpts

Monday 7th December 2020 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Mr Mundell.

I want to begin by congratulating the petitioners, as other Members have, and by thanking the hon. Member for Gower (Tonia Antoniazzi) for securing this important debate. It has been one of the most poignant I have attended—I am sure we can all agree about that—and it is my fourth debate about cancer in the past five days. Each one shows the devastation that that disease brings to families, but that has been particularly so today, because we have been speaking of children. As the hon. Member for North Ayrshire and Arran (Patricia Gibson) said, there is no way to feel, in burying a child or grandchild, that that is the right order of things.

I agree entirely with those Members who said that we are stronger when we act together—particularly in the world of cancer. That brought me to this place, and I hope to do a little good while I am here, in this sphere in particular. I want to add my voice to the chorus of tributes to Fiona Govan, who, as we have heard, started the petition after the death of a much-loved grandson, Logan.

As many Members have expressed, DIPG is a brutal cancer—we are seeing success with some cancers, but DIPG is particularly difficult. Fiona has vowed to do everything she can so that future generations will never have to experience the pain of losing a child, as her family did. As we have heard today, however, Eva, Izzy, Atticus, Cameron, Daniel, Isla, Bradley, Georgia, Kaleigh, Benny, Grace, Reece, Evie and Ollie have all been treasured and lost. It is to their families that I address my remarks. Nearly 110,000 people stand in solidarity with Fiona, and I am grateful to the Petitions Committee for its important work.

I am honoured to speak about this most important of petitions on behalf of the Government this afternoon. My heart goes out to all families affected. The pain of the diagnosis of DIPG and the subsequent treatment is something that no mother, father or grandparent should ever have to go through. The very thought of it in the 21st century is unbearable, yet Fiona’s experience and others’ experiences, which we have heard about through the many powerful and compelling contributions to the debate, remind us too painfully that although we have come a long way—there have been improvements over the past 40 years—we have not come far enough, particularly with DIPG. The dial has not shifted.

In the past 40 years, we have seen good progress in the treatment of childhood cancers. Thankfully, the majority of children will now survive cancer. However, the most pernicious cancers, such as DIPG, remain a deadly threat. Our research must continue, and I agree with hon. Members that it must intensify. The National Institute for Health Research is the largest national clinical research funder in Europe. As has been said, we have invested over £1 billion so that some of the finest researchers in the world can work on this puzzle and try to find the answer. The largest of the disease areas is cancer, and such research receives over £130 million each year.

Many tributes have been paid, and I want to pay tribute to my predecessor, my hon. Friend the Member for Winchester (Steve Brine), for the work he did in this space, particularly with the Tessa Jowell Brain Cancer Mission in 2018. The Government have announced £40 million of funding over the five years, including for DIPG. The money is being invested through NIHR, making full use of its talents as an internationally recognised centre of research excellence. At the heart of the mission is translating the discoveries of scientists and doctors into treatments and diagnostics that can transform the lives of all young patients.

We know that research takes time. It is through heart-breaking experience that brain tumours give us one of the most persistent challenges, even for the greatest medical minds in this country and across the globe. We want researchers to submit high-quality research proposals in this area. In 2018, we made an appeal to the research community for more funding applications for brain tumours. The response was fantastic, with an immediate increase in proposals, and we have been able to fund the very best of them. As the hon. Member for Nottingham North (Alex Norris) alluded to, £5.7 million has been spent so far, but we need to make that appeal loudly and clearly so that the research proposals that come forward can be assessed.

One of the challenges of ring-fencing just for DIPG is about the scientific potential of the research and what we are looking at. When we ring-fence funding, sometimes it actually stops great research. Although I want to go full pelt behind intensification—I want more proposals to come forward—the challenge of ring-fencing is a difficult one.

Research has been a major part of covid, as many hon. Members have said. We have shown that we can do more, that we can speed up research, that we can do things in parallel, and that we can deliver speedily from the bench to the bed to the patient. We need to take every one of the lessons that we have learned from the pandemic and translate them, particularly into cancer research.

We know well that cancer in children presents unique challenges. The Royal Marsden’s biomedical research centre is a world-leading centre for children with cancer that does genuinely groundbreaking research, such as the work to develop a 91-gene panel test that can detect certain genomic mutations in childhood tumours. The study used next-generation sequencing and involved children whose tumours were no longer responding to treatment; we have heard about the limited treatment options available to parents.

The study found that 51% of tumours had mutations that could be targeted by anti-cancer drugs that are used for different tumours in adults—51% is really encouraging. That is the challenge of ring-fencing funding in a different area, however: we need to look at how we can use different treatments to target other cancers, as we are seeing more and more. We need to make the most of that. For example, drugs that are ordinarily used to treat skin cancer in an adult might be effective in treating a child’s brain tumour. That could clearly be a game changer.

The Royal Marsden is also a leader in DIPG research. As we know, DIPG is difficult to treat because it is comprised of multiple generations of different types of cancer cell. The biomedical research centre’s pioneering work has used genetic sequencing of individual cell types to explore how they interact, co-operate and stimulate the growth of that tumour. That opens up new avenues for the interpretation of tumour evolution and opportunities for new drug interventions. All that groundbreaking work is transforming how we think about childhood cancers, with powerful technologies that offer hope for future generations. What unites us all is that we never want to see parents go through that pain if we can work towards a solution to stop it. We are determined that the biomedical research centre at the Royal Marsden should remain a home for groundbreaking research. Since 2017, we have provided £43 million over five years.

The University of Nottingham is another such centre of excellence and the National Institute for Health Research is funding research there to look at the early diagnosis of childhood cancers. Early diagnosis is crucial across all cancer types. We know that we get much better outcomes when we diagnose in stages 1 and 2, rather than being presented with stages 3 or 4 when, obviously, the prognosis is much poorer. This represents a potential pathway that might avoid the painful journey that lies ahead.

In Nottingham, researchers are looking at cancer symptoms that are often non-specific and can mimic other more common childhood illnesses. We heard from many hon. Members how an initial tremor in the hand, a dragging of the leg or feeling unwell would perhaps not immediately be thought of as cancer in a child. Doctors do their best, but parents do not want every visit to the doctor to be a worry that their child has cancer. It is very difficult for those who diagnose. The research in Nottingham aims to address that challenge by increasing awareness of symptoms among healthcare professionals and addressing the lack of paediatric-specific diagnostic tools.

I say in answer to several hon. Members that the Department is working with charities large and small, such as Cancer Research UK and other medical charities, and Cancer52 and the smaller charities, as well as with many research bodies, including the Medical Research Council and others. Only by co-ordinating funding can National Cancer Research Institute partners maximise the impact of research for patients and the public. I pay tribute to those centres of excellence, but this journey is not theirs alone. We are seeing an ever more powerful network of partnerships and likeminded organisations that care passionately about brain tumours. In addition to the Tessa Jowell Brain Cancer Mission, we work with Cancer Research UK and many others. For example, in partnership with CRUK, the NIHR has funded £1.2 million for an experimental cancer medicine centre and a paediatric network, which brings together triallists, scientists, clinicians and NHS research infrastructure to increase availability and access to novel treatments. Several Members spoke of the challenge of having to go abroad to America or Europe to access those treatments. We want people to be able to take part in trials and access treatments here.

The Brain Tumour Charity does incredible work and provides £2.8 million of funding for the study of more targeted brain tumour drugs. The fantastic Tessa Jowell BRAIN MATRIX is pioneering a new trials platform to give people with brain cancer, including children, access to trials and treatments that are best suited to individual tumours. There are many hundreds, if not thousands, of different cancers. The Tessa Jowell BRAIN MATRIX is working across the four nations, and across the globe. Nobody has the sole right to make the discovery. Working together, we are much stronger. We are all here to make sure we deliver for young patients.

I pay tribute to the incredible partners across the country for the effort that is going into this generational challenge. I also pay tribute to the charities for their additional work in supporting families. When a person gets a cancer diagnosis, that is a horrendous journey. It is awful as an adult, but worse when it is someone’s child—my heart goes out to all those parents.

No child should have to suffer in the way the children we have heard about today did and do, and no adult should have to bear such a loss. Fiona and everyone else who has lost a very loved child or grandchild before their time have my deepest sympathy and respect. As we have heard, that is often not enough, so they have my absolute commitment that the Government will stop at nothing to make childhood cancer a thing of the past for generations to come.

We will look at getting better data. Transparency can be a challenge, because it is obviously important that we do not divulge too much about an individual patient. I have talked about the challenge with ring-fencing, but that does not mean that we should not be spending the money and calling for more research. We will also incentivise research, and I am happy to carry on the conversation about a UK strategy.

We will stop at nothing to make childhood cancer a thing of the past for generations to come. We will achieve that only through research, and we will do it better together.