Defending Public Services

John Glen Excerpts

Monday 23rd May 2016 Commons Chamber

[John Glen (Salisbury) (Con)]

It is a pleasure to follow the hon. Member for Huddersfield (Mr Sheerman). Having listened carefully to his remarks, I would take issue with his assertion that many on the Government Benches are fully committed to the notion that private sector is always good and public sector is always bad. That is not my approach. I wanted to speak in this the third day of the debate on the Queen’s Speech because I think that the delivery of quality public services is critical to what we deliver to our constituents, and it is really important that we have an open mind about how we deliver those services effectively. The biggest employer in my constituency, Salisbury hospital, is from the public sector. It has just gone through the rigours of a Care Quality Commission inspection, and I am grateful to Professor Sir Michael Richards for his constructive observations around that and the way to move forward.

I welcome the many Bills in the Queen’s Speech that seek to address the biggest issues facing our nation, both now and under all Governments: how we create the conditions where the most vulnerable can be helped on to a better pathway. I was genuinely shocked and saddened when listening to the response from the Leader of the Opposition last week, when he said:

“Apparently, it is all about instability, addiction and debt—all things that can be blamed on individuals about whom Governments like to moralise… Poverty and inequality are collective failures of our society as a whole, not individual failures.”—[Official Report, 18 May 2016; Vol. 611, c. 16.]

I agree that it is a failure of society as a whole that people in our communities must endure complex, ongoing problems, but it is not about labelling society collectively or people individually as failures, and it certainly is not about moralising; it is about a credible analysis of the diversity of individuals’ problems, recognising that it is incumbent on Government to deliver a customisation, adaptation and reformulation of public service delivery if they are sustainably to meet the needs of our communities. It is naive to say that a financial measure of poverty, by itself, is likely to provoke a meaningful recognition of the complexity of poverty.

I want to make some observations about several of the proposed Bills, but three themes will emerge as I contemplate them. The first is about the need to innovate in public service delivery and the second is about the need to integrate. Going back to my opening remark, it is not about public versus private; it is about recognising that sometimes we need to innovate and integrate good public services, bringing in new ideas and providers able to improve how we have done things to date. The third important element is about timeframes. I vividly remember, in my six years’ service as a magistrate, seeing individuals come back again and again before the court for crimes related to the same underlying problems—typically addictions—in their lives. On average, it takes people seven attempts at rehabilitation to overcome some of those addictions. There is no one template for delivering those sorts of services. That is why we need to be careful, when we frame the legislation, to put in place reasonable measures of what success looks like and to show an understanding of the complexity of the lives of the people we are trying to help.

My enthusiasm for the children and social work Bill is infused with a strong conviction that the Government are absolutely right to look at looked-after children and care leavers, who experience some of the worst outcomes, in terms of life trajectory, of any in our society. It is important, however, that innovation is examined. In local authorities near me and across the country, we are beginning to look at schemes, such as those run by Safe Families for Children, where trustworthy families are engaged to look after children when underlying issues need to be dealt with in families. I recognise that the pathway to securing the engagement of safe families for children obviously necessitates more work in order to complete the process of safeguarding, but this is an example of where innovation and integration with existing public sector provision—in this case, within local authorities —can deliver enhanced outcomes.

On all the Bills, we need to look at how health, education and social services can work better together, so that the payback is significant. I remember, three or four years ago, being asked to visit a residential centre in Devon, with the Amber Foundation, which was working with young adults leaving the criminal justice system and in grave danger of not finding their way—often they were without family support and, being low-skilled, finding it difficult to get into employment, and typically they had been engaged in the criminal justice system previously. I hope that when we come to consider the proposed legislation, we will find room to enfranchise groups such as the Amber Foundation into the delivery of services. It is through commitment over time that those individuals are able to find a sustainable trajectory into independent living. We need to be honest and real about the challenges that those individuals face. I welcome the overdue reform of adoption. I have seen too many cases in which the evaluation stresses reasons why not, while in the meantime too much time passes and the individuals are left behind.

I welcome the education for all Bill, and there is particular enthusiasm in my constituency for the fair funding formula. Wiltshire is the third worst funded local authority, and that has a significant impact on the ability of schools to plan their budgets going forward. It is critical at the moment in the formation of a multi-academy trust, because trying to anticipate what the uplift will be is significant in giving assurance to governors as they come together.

When we look at options facing young people at 18-plus, it is important to be clear about the integration of the great macro-policy goal of having 3 million new apprenticeships with enabling children from difficult backgrounds to get on to a pathway that will deliver the skills and employment opportunities that they crave.

The prisons and courts reform Bill is also very welcome. The emphasis on rehabilitation to reduce reoffending is wholly necessary. Importantly, it will introduce new boards with external experts and emphasise prisoner education and the necessity to have a pathway to employment.

Finally, there is the digital economy Bill, and this is a massive issue for rural Wiltshire. I have campaigned on it for many years. We must have a reliable plan for the last 5% in particular. The universal service obligation must have meaning and teeth in ways that my constituents and those across rural England can fully understand.

I finish where I started. I have no ideological objection to the integration of innovative ways of delivering public services. I hope that this Government will continue to have ambition and will measure their success in a way that allows further developments to take place so that we can meaningfully address the conditions of the poorest in our society with solutions that give them dignity and the justice that they deserve.

Junior Doctors Contract

John Glen Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

I know that that is a view that some colleagues share. Doctors have obligations even now under the Medical Act 1983 not to take action that would harm patients, and under their responsibilities to the General Medical Council; they have to be aware of those. What I hope is that that question simply does not arise again. We are now having constructive discussions with the BMA; I think that is the way forward and I hope that neither I nor any future Health Secretary has to go through what has happened in the past 10 months.

[John Glen (Salisbury) (Con)]

I applaud the tone and content of the Secretary of State’s remarks. I think this agreement will go down as a breakthrough in the NHS. It has been very uncomfortable to engage in dialogue with constituents who are junior doctors, who have felt aggrieved, so I particularly welcome the way my right hon. Friend has been able to look at non-contractual issues. I urge him to give serious consideration to the outcome of the Bailey review so that progress can be made on morale and the wider issues that have been raised.

[Mr Hunt]

I finish by saying that I completely agree with my hon. Friend. It has been a very sad dispute for all of us, because we all recognise that junior doctors are the backbone of the NHS; they work extremely hard and they often work the most weekends already. That we now have an agreement is a brilliant step forward. We all have constituents who work hard for the NHS. They are people we value, so dialogue, negotiation and constructive discussion must always be the way forward.

NHS Bursaries

John Glen Excerpts

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

I do believe that. The Opposition were wrong back in 2010, and had we followed their advice, fewer people from disadvantaged backgrounds—precisely the people Labour was elected to represent and support—would be going to university. As a result of our taking forward brave proposals, in the teeth of much opposition, we have done more for the prospects of people from disadvantaged backgrounds than any Government dealing with this matter since higher education was reformed after the second world war.

I come now, I am afraid, to the motion tabled by the hon. Member for Lewisham East. It implicitly accepts that we have made progress. The fact that it is so anaemic in offering an alternative makes it clear that there is no alternative suggestion that she thinks would achieve the aims that she and I want: an increase in the number of students going into nursing and training, and of those coming from a diverse background. It also implies that she accepts, like me, that workforce planning over the last 10, 15, 20, 30 or 40 years has failed. I can say that, whereas she is not willing to, because everything we are doing now to correct workforce numbers—for example, the 5,000 additional GPs my right hon. Friend the Health Secretary fought the last election campaign on and will be delivering in the next few years—is the result of poor commissioning decisions made not under the coalition Government, or even in the latter years of the Labour Government, but under Governments 20 and 30 years ago.

The failure to predict the number of GPs needed, and the number and types of other professionals needed, lands us perpetually in this perverse situation where we are not accepting British students on to training courses at British universities and, as a result, are not creating the numbers of domestically trained nurses we need. In response to the inadequacies in care uncovered as a result of the Mid Staffordshire NHS Foundation Trust scandal and the failure of the Labour Government to provide the number of nurses needed in hospitals across the country, we are having to import nurses from abroad and to fill nurse places with expensive agency posts. That is something we are putting right now.

[John Glen (Salisbury) (Con)]

One of the main pieces of feedback I have had from Salisbury NHS Foundation Trust is its frustration at the reliance on agency nurses, so I welcome the Government’s moves, because they will open up supply and reduce that reliance and the significant additional costs we have seen over the last few years.

[Ben Gummer]

It is precisely to help my hon. Friend’s hospital that we are introducing these reforms.

End of Life Care

John Glen Excerpts

Wednesday 2nd March 2016 Commons Chamber

[John Glen (Salisbury) (Con)]

It is a great pleasure to make a modest contribution to the debate. When I speak on matters to do with the NHS, the emphasis always seems to be on more resources, greater transparency, greater accountability and greater universal provision of reliable quality. Everything is important in the NHS—everything is a priority—but the resources are not infinite.

End-of-life care is a painful and emotive subject that is difficult to get right. As has been mentioned, about half a million—I think the actual figure was 470,000—people died in this country in 2014. They died in different circumstances, with wide variations in their experiences of what the NHS was able to offer. In my constituency, I acknowledge not only an excellent hospital and a number of GPs, but a high level of respect in our community for Salisbury hospice. One of the challenges is to arrive at a settlement that makes clear where the boundaries of responsibility lie between funding from the NHS and the charity element. Clearly, there is a massive amount of good will, but that must not be abused.

The national director at Hospice UK has said:

“The things that make a better death are so simple. It’s basic knowledge about good pain control and conversations with people about the things that matter”.

That goes to the heart of what is required. It will be about resources, to some extent. It will be about transparency, and greater reliability and sufficiency of provision. But it will also be about us, as leaders in our communities, being able to speak about our constituents’ experience of dying. Just as we put great emphasis on the provision of wills to ensure that people’s estates are in good shape, we need to ask people what choices they want to make about the way in which they are looked after and cared for in their last days. We need to ensure that people have greater awareness and make more informed choices so that we can make a better estimate of how to allocate resources and better integrate the different elements in our society.

One challenge that has frustrated me concerns free social care at the end of life. The Select Committee recommends in its excellent report that

“the Government clarify the eligibility criteria for the NHS Continuing Healthcare Fast Track Pathway”.

Some of my constituents have waited far too long to have such matters resolved; for example, I raised the situation of the Vaughans last week in business questions. Ambiguity and long delays in sorting things out cause enormous distress to families who are trying to make sensible provision.

I recognise the great emphasis that is placed on dying at home, and the tragedy that almost half—47%—of the 470,000 people who died in 2014 died in hospital, although the latest survey shows that only 3% of people who stated a preference wanted to die in hospital. By any measure, that is a failure of society, Governments and us all in not delivering what people want. That is not efficient for public services—it is more expensive—but it is also really unpleasant for the families involved when they cannot deliver what their loved ones want.

I hope that the Government will be able to give real and costed responses to the report and to all the various groups that have commented on the need for greater clarity about the Government’s intentions. Our constituents need that, and we need to do more to ensure that this does not become a taboo subject, but one on which there is greater engagement, so that we can secure better outcomes for those who are dying and for their families.

Sugary Drinks Tax

John Glen Excerpts

Monday 30th November 2015 Westminster Hall

[James Berry (Kingston and Surbiton) (Con)]

rose—

[John Glen (Salisbury) (Con)]

rose—

[Helen Jones]

I am not sure which of these defenders of the Government to take first. I will take the hon. Member for Kingston and Surbiton (James Berry).

[Helen Jones]

Yes, the hon. Gentleman is right that we need much clearer labelling. As I will come on to say, the proposal in the petition is one avenue for tackling the problem, but not the only one and not a silver bullet.

I will take the intervention of the hon. Member for Salisbury (John Glen), but then I will make some progress.

[John Glen]

I am extremely grateful to the hon. Lady. She is making a powerful case, of which I am somewhat persuaded. However, does she not feel that it would be best if the Government were given an opportunity to develop the responsibility deal and to do a lot more to change public attitudes and consumption patterns before a sugar tax, the effects of which are not yet fully known, is implemented?

[Helen Jones]

The public health responsibility deal has had a fair trial over the past five years. The House of Lords Science and Technology Committee said of it that

“the current Public Health Responsibility Deal pledge on obesity is not a proportionate response to the scale of the problem.”

The reason for that, as the British Medical Association has pointed out, is that the deal does not set targets for individual food and drink products, or a timescale in which changes have to be made. That is why I have come to believe that there is a great deal of merit in what the petitioners are asking for, as one method among a whole lot of ways to tackle the problem.

A tax on sugary drinks would probably have to be at the level of 10% to 20% to make a change in behaviour, apparently—Public Health England suggests that range. There is evidence from Mexico and France that at that level, people’s behaviour starts to change and they start to choose sugar-free alternatives. However, that has to be part of a whole-Government effort to reduce obesity, which has to begin in schools.

Much work has been done on improving school meals, setting better nutritional standards for them and removing vending machines from schools. The problem is that those things do not apply to academies and free schools, and as more schools become academies we are putting more children at risk of poor nutrition. We should not tolerate that. It is good that food and nutritional education is compulsory at key stage 3, but we need to look at how that operates. Much more investment in equipment is needed. Schools need to be outward-facing and need to encourage local people to visit them to talk to children about food and how it is grown. The best schools do that, but often the curriculum is not appropriate for all children.

In my entire school career I did a term and a half of cookery, because it was considered that those who were academically inclined did not need to learn how to cook. The only thing I can remember being taught is how to make rock buns, something that I have not indulged in before or since. Another example is that my son specialised in Indian cooking. It was supposed to be brought home for the evening meal, but anyone who suggests that has never met a teenage boy. That was interesting, but expensive. What most of us need to know when we first set out in the world is how to eat healthily on a restricted budget. That is the sort of thing that we need to look at with our children.

In fact, all public institutions should be promoting healthy eating. Dare I suggest that we start with some of the vending machines in this place, so that I do not walk down the corridors thinking, “Get thee behind me, Satan”, every time I pass machines full of chocolate and fizzy drinks? That needs to be done in hospitals as well—there have been a number of articles about that recently.

I challenge people to walk into the foyer of many hospitals. There are machines selling chocolate and fizzy drinks, and the outlets often sell cake and biscuits quite cheaply but overcharge for a piece of fruit. If someone wanders in to buy a paper, they will be offered a big, discounted chocolate bar at the till. That makes it much harder for people to resist temptation. Of course, that is difficult to do, but the message that hospitals are giving their patients, staff and visitors is, “Don’t do as we say; do as we do.” The Government urgently need to negotiate with trusts and with NHS England to see how the issue can be remedied. It is nonsense to take an income from those sorts of outlets in one part of the hospital and then to deal with the effects of poor diet in another.

--- Later in debate ---

[Dr Wollaston]

In an ideal world, I agree, it would be nice not to have to do any of that, but I return to the point about whether the Government also have a responsibility for the health of the nation’s children. Should the Government step back? Should any of us feel that it is acceptable to condemn one in four—a quarter—of the most disadvantaged children in Britain to a lifetime of ill health? If we can do something simply to nudge people a different way, should we not consider the possibilities, and ask how different those children’s life chances could be? As I said, such a tax would not be regressive because there is always an easier, untaxed alternative. We are talking not about telling people that they cannot have a product that they enjoy but about nudging them to choose a healthier one.

There is an interesting phenomenon whereby education, for example, is sometimes taken up by the people in society who are already healthier, which can inadvertently end up widening the health inequality gap. We should target measures to help those who are suffering the most harm. As for this being regressive, look at who is suffering the most harm. Is my right hon. Friend happy with the situation as it stands?

[John Glen]

Does not that point also suggest that the distribution of education interventions is not being focused in the right way? The Government could do significantly more to improve support, advice and education to allow that group of people who consume too much to make informed choices before going down the route of a tax.

[Dr Wollaston]

I ask my hon. Friend to look later in our report, where we set out some of the evidence on delivering education and advice. I am afraid that it does not provide the solution that he imagines it will, but I encourage him to read the report. I wish education alone could solve the problem, but it will not, and it tends to be short-lived. The scale of the problem demands our attention.

A tax would not be regressive because there would always be an alternative. No one is thinking of introducing a sugar tax of the type that sometimes people imagine when they hear “sugar tax”, which is one that would apply to the bag of sugar that they buy off the shelf or to biscuits, cakes and sweets. We are not suggesting that, because it is difficult to reformulate those products as entirely sugar-free alternatives. We are considering only products with an easy alternative. Why did we choose sugary drinks? Look at the data in our report, particularly on teenagers’ diets. A third of their entire sugar intake comes from sugar-sweetened drinks. In other words, there is an easy win here, through which we can help to take calories out of children’s diets, but no one is suggesting that that is the entire answer.

--- Later in debate ---

[Paul Flynn (Newport West) (Lab)]

It is a great pleasure to speak in this debate and to follow the two marvellous opening speeches. It is a shame that the right hon. Member for Cities of London and Westminster (Mark Field) has now gone after intervening so often—I think he intervened seven times—and then complaining that there was no debate. Now he has deserted us to spend more time with his prejudices.

This is a debate of great importance. I will not go into detail about what generation I was part of, but there were certainly no sugary drinks when I was a child. There was a lot of water—we had that in abundance—but, being a child of the war, I had the benefit of a system of rationing whereby the amount of food was carefully controlled. We were probably the healthiest generation there has ever been, because we were quite rightly denied the damaging drinks that children often have now.

I want to make just one point, which is about who comes first in the Government’s thinking. Where does public opinion come? Where does the health of children come? We all know the misery that is felt by overweight children, and how they suffer mockery at school. It is extremely damaging for them. There is no question but that we have to do all we can to avoid obesity as far as possible. We can do something about it, but a number of decisions taken by the Government have been extremely worrying, and one of them is this—turning down the idea of a sugar tax.

Recently we had a debate in the House on a sensible Bill, which was supported by the hon. Member for Central Ayrshire (Dr Whitford), a Scottish National party Member. She is a breast cancer surgeon, and she made a splendid, well-informed speech in support of the Off-patent Drugs Bill, which would have been greatly beneficial to people in need of drugs, as it would have made them cheaper, and also to the health service. Members of all parties spoke in the debate, but the only voice for the party of Government was the Minister’s, and we know that the pharmaceutical industry—big pharma—has the Government in a throat hold. It is big pharma that decides what happens.

I believe it is the same with “big sugar”—that the Government are excessively influenced by the commercial interests of the sugar industry. They are also influenced by other industries—the alcohol industry is very powerful. We recall that at the time of the 2010 election there was an impassioned plea by the future Prime Minister. He said he knew what the next scandal in Britain was going to be: it was going to be a lobbying scandal. He knew about lobbying, of course, because he was a lobbyist himself. He knew about the influence of lobbyists—the odd word here, the invitation to a reception there, getting someone on side by inviting them to a seminar in the Alps, or in Bermuda. That is the way they work. Are the Government listening to the financial concerns of the greedy lobbyists, or to the pleas for a more rational, healthy policy?

[John Glen]

Would the hon. Gentleman like to reflect on the comment made earlier, about the record of his party in government in Wales? If the sugar tax is such a priority, why has there not been more progress in Wales?

[Paul Flynn]

We have had a—[Interruption.] Exactly, and I thank my hon. Friend the Member for Swansea West (Geraint Davies) for saying so. I respect my hon. Friend. We had a little exchange in Welsh about who made the remark in question. I find the story most unlikely, and I would like to check on it.

The Conservative Government have abused their position repeatedly to attack the achievements of the health service in Wales. In one week, the Daily Mail had the Welsh health service as its No. 1 story for four days running. There is no way, by news standards or by the value of the stories, that that was justified. I am proud of the achievements of the health service in Wales, and I am glad that today is the day when the presumed organ consent system begins. Wales is leading Britain on that matter, and there is much other pioneering work being done by the Labour party and the Labour Government in Wales.

Unfortunately, the Tory Government like to use the Welsh health service as a stick with which to beat the Labour party. That is irresponsible and dangerous, because one of the most important things is that people should have faith in their own health service. It is an important part of therapy and confidence: when people go into hospital, they are of course nervous and concerned, and when they read these lying stories about political—

--- Later in debate ---

[John Mc Nally]

I could not agree more. That is one of the biggest problems. People drink lots of sugar, which gets them high quickly, but they then come down and go into a never-ending cycle of having to drink it again. It is an extremely worrying state of affairs for everybody, so I totally agree with the hon. Lady.

I believe that raising tax on sugary drinks would be an effective means of reducing childhood obesity. I thank all the MPs here, and I hope they all agree that Jamie Oliver should be applauded for setting up this petition and making use of his profile and that of the charity Sustain. I, for one, echo his concerns about the health and welfare of our future generations, and I share his belief that

“we can shift the dial on the epidemic of childhood obesity.”

I thank the right hon. Member for Leicester East (Keith Vaz), who is no longer in his place, for his diligent work in pursuing better public health awareness for the people of this country.

It is commonly known that sugar-sweetened drinks are associated with a higher risk of weight gain than similarly calorific solid food. Evidence indicates that there is a link between the habitual excess consumption of sugar, type 2 diabetes, and weight gain. A large study of European adults showed that there is a 22% increase in diabetes incidence associated with the habitual consumption of one daily serving of sugar-sweetened drinks. Sugar-sweetened drinks contribute a significant amount of sugar to children’s diets. A reduction in their consumption would, in my view, significantly lower the intake of sugar and therefore reduce obesity and the associated detrimental effects on personal health.

According to statistics released in 2014, 64% of adults in the UK are overweight or obese, which cannot be good for anybody. I am sure my hon. Friend the Member for Central Ayrshire (Dr Whitford) will talk about that fact later. International comparisons indicate that the UK has above-average levels of overweight and obese adults. The cost of our obese population is not just felt in the increased risk of a range of serious diseases, including type 2 diabetes, hypertension, heart disease and some cancers; there is also an economic cost. It is estimated that obesity costs the NHS up to £600 million in Scotland alone, and the McKinsey Global Institute estimates that the cost to the UK is equivalent to 3% of gross domestic product. The Scottish Government await the outcome of the Cochrane review on that issue.

Worryingly, for the majority of adults, obesity starts in childhood. Evidence shows that being obese in childhood increases the risk of becoming an obese adult. If we do not encourage adults and children to reduce their sugar intake, the economic costs and the cost to the NHS will continue to be a significant burden. Perhaps that is where a bit of libertarian paternalism is needed. As was said earlier, it is possible and legitimate to nudge people.

[John Glen]

Will the hon. Gentleman reflect on the fact that, sadly, a massive proportion of those who are obese are the poorest in our society? No Government of any party can ignore that fact. The poorest do not have a free choice when they buy sugary items.

[John Mc Nally]

The hon. Gentleman is right. Once again, it is the poorest who do not know how to make such choices. I hope to come on to that point later.

Although I welcome the proposal to increase tax on sugary drinks and agree with the rationale behind it, I am slightly cautious about it, simply because the body of evidence on this subject does not robustly demonstrate the effect it would have in isolation on rates of obesity and type 2 diabetes. I feel strongly that a raft of measures should be developed to reduce sugar intake and obesity. Taxation of this kind is an important tool in shifting the population’s dietary patterns. Educational messages alone simply will not achieve the reduction that we need, so fiscal and reformulation measures need to be introduced. We MPs can help to nudge that decision. We should improve the decision-making process to allow the choosers whom the hon. Gentleman mentioned to make better choices for their own welfare.

In conjunction with a sugar tax, we require legislation on the reformulation of foods to reduce overall calorie intake. If that is not possible, the industry should be compelled to reduce portion sizes—although not of Mars bars. We also need to introduce marketing restrictions on unhealthy foods to restrict the marketing of foods that are high in salt, sugar and fat to children. Restrictions should be applied most stringently to TV and online advertising, as evidence suggests that under-16s are strongly affected by advertising through those mediums.

We must improve our confused labelling system. We should continue to support a consistent front-of-pack labelling system and should extend caloric labelling, such as the traffic-light system, to all food and drink. Arguably, it is most crucial for the Government to invest more heavily in active travel by dedicating a national budget to walking and cycling; I am absolutely with the hon. Member for Warrington North on that.

The obesity epidemic is not going away. If anything, it will get worse for successive generations unless the Government take action. Implementing and evaluating a sugar tax as part of a childhood obesity strategy would be one step towards improving the health of our nation. I urge the Government to take heed of the petition and implement such a tax.

Finally, I holidayed in Cornwall this year, so I appreciate what the hon. Member for St Austell and Newquay (Steve Double) said about weight—such is the quality of the food in Cornwall.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Thank you, Mr McCabe. I am actually Dr Whitford; Eilidh Whiteford—my hon. Friend the Member for Banff and Buchan (Dr Whiteford)—is the other one, whom I always get mixed up with.

Like the hon. Member for St Austell and Newquay (Steve Double), I am clearly not skinny. I was not overweight as a child; it was the usual comfort eating later on, middle age, lack of exercise and all the rest of it. I know what it is like to move through a world where everything shouts “eat me” all the time. We live in a totally obesogenic environment. The idea that it is easy to resist things is simply not true. Everything is geared towards making people eat unhealthily. We spend a little more than £600 million on obesity prevention, but £256 billion is spent on advertising unhealthy foods. It is David and Goliath. It is difficult for people to make the right choices.

Obviously the debate is about the sugar tax, but as Members have said, the issue goes much wider than that. The hon. Member for Totnes (Dr Wollaston), who is the chair of the Health Committee, talked about the sheer scale of the problem. One third of children leaving school are obese or overweight and a quarter are obese—that is the reason for the differing figures mentioned earlier. It is predicted that 70% of the population will be overweight or obese by the mid-2030s. That is an astronomical number. Our health service will not cope with all the directly obesity-related problems such as type 2 diabetes, cancers and heart disease. We have heard figures about the cost of that from other members of the Health Committee, but it is estimated that the societal costs are £27 billion. We all know someone who was overweight or obese as a child, and we know about the bullying, exclusion and self-contempt that occurs and the impact that that has on schooling, and therefore on jobs, which leads to another generation of deprivation. People say that a tax might be regressive, but it would be no more so than duty on cigarettes or alcohol. It is important to see it in that light.

We have discussed evidence from Mexico, which we heard in the Committee, but other countries such as Norway, Hungary and Finland have taken the same approach. Although not all the evidence has been peer-reviewed, published and assessed, all the details of the national experiments point in the same direction. Cochrane reviews coming up in the next year to 18 months will be able to put that information in a solid position based on experiments and data. At that point it will not be possible to ignore the issue, but we need to be thinking now about our options and what we will do.

Although this is a debate about sugar tax, the Health Committee made nine recommendations. Sugar tax is the one that the media are interested in, because it catches the light, but it is part of a whole package and a sugar tax is not even in our top three recommendations. The first is about promotions, because 40% of food bought in our shops is on promotion, and that is heavily weighted towards unhealthy foods. We need to look to rebalance that. One Member who has scuttled off said that we would come up with other rules such as getting rid of discounting, or we would suggest portion control—darn tootin’ we will!

We need to realise what we are fighting, because we are talking about something deeply shocking and very dangerous. The argument is that people who are less well off save money if they can buy one for £1 or two for £1.50. However, the evidence we heard is that, if that means they buy two packets of biscuits, one will not be put in the cupboard for next week; both will get eaten this week, and the same mum or dad will be back the following week to shop for another packet of biscuits. Therefore they have not only eaten far more unhealthy food and sugar but spent more money. Promotions of unhealthy foods in multi-buys are not helping anyone.

We also see a change in portion sizes. Packets are getting bigger, and there is the bottomless cup at McDonald’s or wherever. There is the end of the aisle, the pester power and the stuff at the till. Every mum and dad out shopping at the supermarket with their wain—that is Scottish for child—will know what it is like: they can see the light at the end of the tunnel, then their child hangs out of the trolley and grabs something. They may put it in their mouth, which means the mum or dad is obliged to pay for it. Some supermarkets have been good at taking that opportunity away, but not all of them. My local supermarket still has sweets right at the till.

Promotions have a big impact and should be tackled. So should marketing, because of the sheer scale of the budgets for and against obesity. It is not just about asking for advertising to be put after 9 o’clock; it is particularly about what is emerging on the internet in social media and advergames, as the hon. Member for Totnes mentioned. Things keep wriggling around, so we need a strategy broad enough to cover that.

Reformulation is almost the holy grail. We have seen its success with salt, but it took a long time. We have taken about 40% of the salt out of the British diet, and by and large people have not noticed. However, we do not have 10 years to do that. Reformulation is also much harder to do with sugar, because it has an impact on the structure and texture of food, but we need to get on with it. The reason why we are spending so much time talking about sugary drinks is because, as the hon. Lady said, they are one product where reformulation is easy: we can replace sugar with sweeteners.

We also need to reformulate to drive down sweeteners. We need to reset our sweet tooth—we have all seen someone washing down a big slab of sticky cake with a diet soft drink—because the craving remains. Even those who choose diet soft drinks will find that their craving for sugar remains, so when they cook they will add more sugar and they will eat more cake and biscuits. Sweeteners can really help us to speed up the removal of sugar, but we still need them to be on a downward journey. That must be done with industry, which has done a lot. Many soft drink manufacturers provide a choice, so if a sugar tax is introduced, hopefully that should nudge people across to less sugary drinks, as the hon. Member for Totnes said. It would be ideal if there was no tax collected at all, because that would suggest that the policy was working. At the moment, however, the traditional product is still absolutely packed with sugar.

[John Glen]

The hon. Lady is speaking with her customary authority on the subject. Does she agree that the industry has the potential to go a lot further so that we can make more progress before a sugar tax, which has attracted all the attention, is instituted? It is a matter of providing choices, and a lot of consumer power could be harnessed to help us make that progress.

[Dr Whitford]

As the hon. Member for Totnes mentioned, the people who make such choices tend to be those who are more oriented towards a healthy diet anyway. It is about trying to teach people in the mire of deprivation, and often in the mire of despair, who smoke more, use more alcohol and take more sugar. They are the very people who are hit by all our measures to try to bring about health improvement.

All the industries are making efforts, but they are afraid of being out there on their own and seeing their competitors mopping up their business. That is why we need regulation. In our inquiry, that came out from the retailers in particular, who said they wanted a level playing field. Whether it is through a sugar tax or regulation, they want to feel that everyone has to move forward.

We also need leadership. The Food Standards Agency was important in leading on salt reformulation, so we need to work out who will be the leader on this, because we need a focused project to get not just sugar but fat and calorific intake out of our diet. As has been mentioned, there are also hidden sugars, particularly in tomato products such as baked beans, tomato sauces and bolognese sauces in which it is easy to hide sugar. When we start to look at that, we see that it is quite scary.

That is where labelling and education comes in. The traffic light system has been helpful for a broad range of foods. When we are looking for a sandwich in a rush, we can spot the green and amber on the label as opposed to the red and red. However, that will not help with sugary drinks, which get a red light and two green lights because they do not contain salt and fat. Therefore, someone who picks that up might think, “Two greens— that must be quite good.” That is why the labelling of teaspoons of sugar is important. The industry could be applauded as it took every single teaspoon of sugar out of a drink.

We have heard talk about the nanny state and people having the freedom to do what they like, but as a doctor for 33 years I heard that about seatbelts and crash helmets. People want to feel the wind in their hair, but they do not look so good if they have come off their bike. We talk about the challenge of cigarettes and alcohol, and sugar is the same. All Governments have a responsibility to look at the report and all the measures it suggests, and to bring them in as a full package, because we need to tackle this, and we need to start now.

Antibiotics (Primary Care)

John Glen Excerpts

Monday 23rd November 2015 Commons Chamber

[Maggie Throup]

My hon. Friend is right. That is what we need to make clear. People often do not understand that the causes of those illnesses are quite different.

My local clinical commissioning group, Erewash CCG, is working hard to empower patients to take responsibility for their health, very much along the lines of the antibiotic guardians idea. As part of the initiative, it wants patients to learn to recognise when it is right to visit the GP and when it is right to seek alternative advice, such as that of a pharmacist.

I want to come back to where I began: the little device that performs the C-reactive protein point-of-care test. I can tell that hon. Members are wondering what C-reactive point-of-care testing is. A point-of-care test is a diagnostic test that is quick and easy to perform. It can be used during a patient consultation or completed while the patient waits. It allows for immediate diagnosis and treatment choice. Such point-of-care tests are designed to be used by people who are not laboratory scientists.

A C-reactive protein point-of-care test is a blood test that measures the amount of protein called C-reactive protein in a person’s blood, using just a drop of blood from the finger. Evidence shows that the test can deliver significant benefits when used in the primary care setting. It is used in the primary care setting in several European countries and has been shown to reduce unnecessary antibiotic prescribing by empowering GPs to make informed decisions.

[John Glen (Salisbury) (Con)]

My hon. Friend is making a powerful case for how innovation in the NHS can be the key to securing significant savings and a change in the culture of antibiotic use among the general public. Does she agree that it is about time NHS England moved quickly and decisively to empower people to change their behaviour in respect of managing their own health?

[Maggie Throup]

I completely agree with my hon. Friend. That is exactly why I secured this debate. We need to move quickly because this is a ticking timebomb that we must address sooner rather than later.

Point-of-care testing can reassure patients that they do not need antibiotics and will recover without them. There is evidence that C-reactive protein point-of-care testing could reduce the number of antibiotic prescriptions issued in primary care for acute respiratory tract infections by up to 42%. That represents millions of prescriptions every year. It has been calculated that using C-reactive protein point-of-care tests in primary care has the potential to save £56 million a year in prescription and dispensing costs. At the same time, C-reactive protein point-of-care testing could make a significant contribution to the UK’s antimicrobial resistance strategy.

I am sure that all hon. Members will have visited a GP with a cough and a cold and feeling pretty bad, and thinking that a short course of antibiotics is just what is needed to get rid of the bugs. They expect to leave the GP’s surgery with a prescription for antibiotics and already start to feel better. The problem with that scenario is that there is a high probability that those antibiotics will be useless, because the cold is not a bacterial infection, but a viral or self-limiting infection that antibiotics will not touch. The consequences are far reaching. First, the drugs will have been ingested unnecessarily, and it is likely that antibiotics will have increased antimicrobial resistance in the population. Secondly, a prescription will have been issued unnecessarily, which is a wasted cost to the NHS.

Let us consider an alternative. The hon. Member will still visit their GP with a cough and a cold and feeling pretty bad, but now by using just a drop of blood from their finger, a C-reactive protein point-of-care test can be carried out and will give an almost instant result. If the level of the protein is low to medium, no antibiotics are needed. The hon. Member will leave the GP’s surgery without a prescription, but knowing that they will start to feel better without one. If the level of the protein is high, a prescription for antibiotics can be issued. Such a simple measure is better for the patient, does not add to the ticking timebomb of antimicrobial resistance, saves the need for a prescription, and saves the NHS millions of pounds. I am sure hon. Members will be asking why it is not happening already.

Such a simple test can also be used for more complex cases than coughs and colds. With the life-limiting condition idiopathic pulmonary fibrosis, GPs find it hard to differentiate between the ongoing condition and an underlying infection. An underlying infection, which could be tested by using the C-reactive protein point-of-care test, may require hospitalisation, but the ongoing condition would not. In such instances, it is not just about whether to prescribe antibiotics; it is about whether a hospital bed and all the resources alongside it are needed. Surely a low-cost, point-of-care test is worth its weight in gold given that scenario.

Despite recent reforms, the NHS still works in silos and is inflexible when it comes to funding a test that originally would be carried out in the hospital laboratory. The majority of testing required by primary care is done by block contract through the local hospital, and additional testing is seen as a cost burden on the GP—that was the barrier I hit more than 20 years ago.

Today, C-reactive protein is included as a recommended area of best practice within the National Institute for Health and Care Excellence clinical guidelines for pneumonia, which state that

“clinicians should consider a point-of-care C-reactive protein test for patients presenting with lower respiratory tract infection in primary care”.

That recommendation was made by the NICE guideline development group and based on antibiotic prescription rates, mortality, hospital admission rates, and quality-of-life outcomes. Antibiotic prescription rates were felt by the guideline development group to be the most relevant direct outcome influencing that recommendation.

Junior Doctors’ Contracts

John Glen Excerpts

Wednesday 28th October 2015 Commons Chamber

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a doctor, and a veteran of truly awful rotas of the 1980s, involving one in two very often—that is every other weekend, every other night on duty, as well as a normal working day, which I would not recommend to either patients or practitioners. Thankfully, they are a thing of the past.

I welcome very much the Health Secretary’s statement today and the guarantees that he has given. On that basis, I am more than happy to support the Government this evening. However, I would say that we need to insist on evidence-based policy making. It is important to understand the difference between a causal effect and an association. My worry is that perhaps the Front Bench has been more influenced by Euclidean theorem than a proper understanding of statistics. My reading of the Freemantle paper and Professor Sutton’s remarks lead me to conclude that no causal link has been established between doctors’ rostering and excess weekend deaths. If we are serious about reducing weekend deaths, and reducing the difference in health outcomes between this country and countries with which we could reasonably be compared, which I know that my colleagues on the Front Bench are, we need to properly understand what are the drivers of those differences, and I do not think that junior doctors’ hours are a principal driver in the problem that we are trying to address today.

I think it is also right to appreciate that we are heavily dependent on the good will of all doctors—consultant grades and junior doctors. Most doctors that I know work well beyond their contracted hours—I know I certainly used to when I was in hospital medicine—and in dealing with them and in communicating with them, we need to keep that in mind and not take that good will for granted.

I very much regret the BMA action, and I very much regret the ballot on 5 November on strike action. The last time such action was taken was in 2012 on, ironically, the subject of pensions. It ended ignominiously and the only outcome was a reduction in the esteem in which the public held the medical profession. I would urge the BMA, armed with the assurances we have had today, to think again. I say “ironically” because, of course, the proposals, as I understand them to be, would increase core hours, which are pensionable—out-of-hours are not—and I have yet to see the BMA make any comment on that, or indeed reflect it in its pay calculator. Maybe a belated understanding of that has meant that it has chosen to take it down.

In trying to reduce weekend deaths and in trying to reduce that gap between our health outcomes in this country and those in the rest of Europe, we need to be focused much more broadly than on junior doctors’ hours. I know the Health Secretary is trying to work out how we can best configure the health service of the future. It is a dynamic thing; it never is fixed in one place. In my opinion, part of that means looking at our NHS estate all the time to make sure that we are getting the best from our assets. In my opinion, it means concentrating our specialist services in larger, regional and sub-regional centres. Those centres find it much easier to roster junior doctors and to concentrate expertise in one place. I am talking about stroke, heart attack and upper gastrointestinal bleeding—all things where we do less well in this country than in countries with which we should be comparable.

[John Glen (Salisbury) (Con)]

I am grateful to my hon. Friend and parliamentary neighbour for giving way. Does he agree that in the rural communities in south Wiltshire that we both represent, there does need to be a certain minimum proximity in order for patients to be able to access their hospital with confidence?

[Dr Murrison]

I agree with that, which is where networks come into our national health service, and making sure that we have specialist centres that can deliver the right outcomes for people, and that there are protocols to ensure that ambulance services take people to the right place at the right time, so that they can receive the treatment they need. What we cannot do is continue with the current situation, in which our constituents can expect lower life expectancy and health in later life than, say, French or German patients. That is not sustainable and it is not right. It means looking again at how we configure our national health service. It may mean some difficult decisions in some parts of our NHS, but that should not be a barrier to making sure that we do it right.

What I would say to my right hon. and hon. Friends on the Front Bench is that this is not really about junior doctors; this is about consultant grades, who deliver the therapeutics and diagnostics in relation to upper GI bleeds, heart attacks and strokes. They are now, in our new NHS of the 21st century, at the coalface of delivery in a way that they previously were not. So, if I may say so, I would like a greater focus on consultant grades, perhaps at the expense of some of our junior doctors who are the principal subject of our debate today.

NHS: Financial Performance

John Glen Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

Across the country, trusts are struggling under the load of poorly negotiated PFI contracts. It is worth remembering that when the Labour party speaks about all the money it put into the NHS, a large part of it was borrowed via PFI—that part which was not borrowed as part of Government debt. The important point about PFI is to try to address each contract in turn. The Department is looking at this on an ongoing basis, not only as it concerns old contracts but in the letting of new ones.

[John Glen (Salisbury) (Con)]

Salisbury hospital enjoys an excellent reputation across the constituency. On a recent visit, having completed a number of easily found cost reduction programmes, the management expressed their determination to continue with patient-level costing service by service and to pursue electronic patient records reform. They asked me to raise their concern about obtaining visas for specialist scientists at the hospital and the need to have a better joined-up service between primary, secondary and tertiary elements of the NHS.

[Ben Gummer]

I thank my hon. Friend for bringing the attention of the House to innovation at a local level. This kind of innovation, which will allow us to transform the service into an even better NHS in the years to come, is being repeated in many trusts across the country. If I may, I will reply to him by letter on the specific issue of scientists after I have investigated the points he has made.

Oral Answers to Questions

John Glen Excerpts

Tuesday 7th July 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

The withdrawal of the minimum practice income guarantee was announced in 2013 because it was unfair. In fact, more practices will benefit from its removal than will lose from it. As for those that will lose, NHS England is already in contact with people about transitional care support. The practices that the hon. Gentleman mentioned have received some of that support, and I understand that the conversations are continuing.

[John Glen (Salisbury) (Con)]

T5. Following my fourth Adjournment debate on the future of Public Health England at Porton Down two weeks ago, I remain concerned about value for money for the taxpayer. Will the Minister confirm that she has assessed the full value of the life sciences work at Porton Down to the United Kingdom economy, and that she remains committed to maximising the site’s potential regardless of the outcome?

[Jane Ellison]

I congratulate my hon. Friend on securing so many Adjournment debates. Our most recent debate took place only a couple of weeks ago. He is right to continue to remind us of the contribution that the Porton Down site makes to the UK economy. I can assure him that the outline business case has been and is being scrutinised by Ministers, and that that includes an economic assessment. However, as I have said on previous occasions when we have debated the matter, Public Health England will remain committed to the site even if research staff are relocated.

Public Health England: Porton Down

John Glen Excerpts

Wednesday 24th June 2015 Commons Chamber

[John Glen (Salisbury) (Con)]

The first debate I secured as a Member of Parliament was five years ago on Monday, and it was on the future of the Public Health England site at Porton Down in my constituency. I did not imagine then that the first debate I would secure in the 2015 Parliament would also be on the future of that critical site, but I can think of no issue of greater significance to my constituency.

Porton Down is known across the world for the work that Public Health England and the Defence Science and Technology Laboratory do there. It would not be right to open this debate without first paying tribute to all the staff for the work they have done to tackle Ebola in Sierra Leone in recent months. It has been truly humbling to hear the stories of my constituents, who have travelled at great risk and put themselves on the front line in the fight against Ebola. Their expertise has been vital to the people of Sierra Leone, and it is testament to the UK’s reputation for excellence in infectious disease research. I welcome the recent decision to award a medal for their commitment and dedication, which I know a number of my constituents will be very pleased to receive.

It is almost seven years since the Department of Health authorised Public Health England, then the Health Protection Agency, to develop an outline business case for the refurbishment of the facilities at Porton Down. That was after the Science and Technology Committee found the category 4 containment laboratory facilities at Porton Down

“to be in need of significant investment given their age”.

It recommended in 2008 that

“the Department of Health consider the redevelopment of the HPA’s Porton Down site as a priority”.

Project Chrysalis, the proposal for that multi-million pound redevelopment, was put forward shortly after the Committee’s report was published. In January 2010, a former GlaxoSmithKline site where Public Health England could consolidate its assets in one place was proposed as the preferred option, and a business case was put to the Department of Health just six months later. That was rejected—rightly, in my opinion—after scrutiny and further work were commissioned, but not as part of Project Chrysalis. Instead, Public Health England began putting together the case for a single science hub programme, which some might argue was a clear signal of an intention at an early stage to centralise before the business case work had even concluded.

The new outline business case was finalised in July 2014, and recommended that the facilities at Porton, Whitechapel and Colindale should move to a single campus in Harlow. The PHE board asked for a decision to be made by September 2014. I would like to take the opportunity to ask the Minister why, if the outline business case is so rock solid, it has still not been signed off nine months after Public Health England wanted it to be and 11 months after it was submitted.

There are certainly doubts remaining among many of my constituents about the decision, for a number of reasons. First, co-location in Harlow was recommended as, according to Public Health England’s officials, it

“offers the best value to the taxpayer and delivers the lowest cost over the 60 year life of the programme”.

PHE also stated in its publicly disclosed annexe, however, that

“the differences in cost between the options are relatively small”.

Professor George Griffin estimated in his review of the single science hub work in 2012 that the difference amounted to 2.6% over 68 years, which I maintain is disputable given the complexities associated with modelling over such a long period. The resultant cost to the taxpayer might well be marginally smaller, but it is important to remember that the costs to my constituents will not be. The fact remains that they are being asked to uproot their lives and transplant to Harlow. For many of them, Salisbury has been their home for years. It is where their children go to school and where their family responsibilities lie.

Increasingly the trend in science is not to co-locate assets on single sites, but to harness the power of technology to work across larger areas. Centralisation remains an approach that the private sector left behind, in many cases a long time ago, in recognition that smaller specialist sites can be more effective. The direction of travel towards greater use of genomics and big data reinforces the argument for smaller entities such as Porton to continue to leverage global partnerships. I was previously told by Public Health England that it favoured the single hub model because of the approach taken at the Francis Crick Institute, but this is not a co-location of one entity’s assets; six distinctly different players all operate across multiple sites themselves and, in many ways, will continue to do so.

Secondly, the unwillingness to grasp the potential opportunities at Porton or fully to engage in a conversation about them is disappointing. Public Health England says that

“the Harlow campus has the potential to become a campus with an international reputation for public health science”.

Porton Down already has an international reputation. It has 250 external partnerships across the world and is supported by $55 million of investment from the US Government. It already partners more international universities than universities in the UK, eight US Government agencies, five international health bodies and nine global pharmaceutical companies.

Public Health England has not yet articulated publicly precisely how being in Harlow will improve on that. How many new commercial partnerships does it believe will be generated from the site? What will be the impact on Public Health England’s revenue streams? Have those factors even been modelled thoroughly as part of the business case? I have long been concerned that the outline business case focuses too narrowly on Public Health England’s objectives as an organisation and the benefits it allegedly accrues from centralisation, not the wider opportunities for UK life science industries.

Thirdly, centralising in Harlow flies in the face of the Government’s agenda to promote more prosperous regional economies. The Chancellor said:

“The south-west contains some of Britain’s greatest economic strengths. It should be as central to our nation’s future prosperity as any other part of these islands”.

He said that it

“already has a strong reputation for life sciences”,

and even asked the chief scientific adviser and the chief medical officer to

“explore the potential for new proposals for investment in life sciences in the south west”.

In the light of that ongoing work, will the Minister assure me that the chief scientific adviser has been consulted about the single science hub, given its implications for the entire south-west?

I appreciate that not all of Public Health England would move to Harlow, should the business case be approved, and that Porton would retain the manufacturing facilities. I also recognise that Public Health England management have given an assurance that they will not be abandoning those remaining facilities, and that they are meeting representatives of Wiltshire Council on Friday to examine how Public Health England can facilitate the optimal exploitation of opportunities that will derive from a new science park, which this Government have supported, right on its doorstep. However, it is unacceptable to assume that that would be appropriate consolation for the loss of the remaining facilities and capabilities, and I remain concerned that, if the Porton site were cannibalised in that manner, the temptation to examine commercial opportunities for those remaining facilities would be high.

Indeed, I understand from a letter that was recently sent by the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), to an interested party on 10 June that Public Health England is

“continuing to investigate commercial opportunities for its activities at Porton”.

I have long been an advocate for greater capitalisation on the commercial potential at Porton, but I would like assurances that the vaccine manufacturing facilities will be treated with the respect they deserve and not simply sold off to provide a quick win to allow the Government to balance the equation. This is not just a vaccine factory, and any proposal to maximise its potential needs to recognise its value to the south Wiltshire and regional life science economy.

More importantly, how do these concurrent agendas best serve the interests of my constituents? Can the Minister reassure me that individual Government Departments are not operating on different agendas? It seems to me that any discussions about commercialisation in advance of a decision on the outline business case would be premature and potentially misaligned.

Fourthly, the opportunity to consider the more effective use of existing public sector assets has still not been fully considered. The Defence Science and Technology Laboratory, located on the same site, has existing synergies with Public Health England and the two organisations work together closely. DSTL also has category 4 containment facilities which were refurbished relatively recently and are considered to be of the highest standard. Indeed, it has spare capacity in its facilities, and when the size of refurbished labs at the Public Health England site was being discussed, the decision was taken to request a smaller facility on the basis that DSTL would be expected to provide back-up capacity in an emergency. Professor George Griffin also told the Science and Technology Committee in 2008 that

“the Ministry of Defence has a facility at Porton…there is spare capacity there, we know, and we would be able to use that if necessary”.

However, I have been told that there are conceivable emergency scenarios in which DSTL and PHE would need to occupy the entire space at the same time, resulting in a conflict of interest with severe implications for national security. Those scenarios have never been articulated—they may well be considered above my pay grade—but I would ask the Minister to put on record that the DSTL collaboration option has been fully explored with DSTL management and examined independently, and that the security concerns about the laboratories proved irresolvable.

DSTL and PHE have an important collaboration that benefits from their physical proximity. They are treated as the “Porton campus” by the regulator, enabling pathogenic samples to be transferred between the two sites without the need for additional licensing. Both are licensed for animal work, and I understand that PHE manages some of the sensitive resources occasionally used by DSTL. They can currently be safely transported at minimal risk, but a move to Harlow would completely remove that capability.

Fifthly, I again take the opportunity to emphasise that Porton Down is embedded in the Salisbury community. We support its staff and recognise the sensitive nature of the vital work they carry out. Porton’s relatively isolated location makes it an ideal secure site. Harlow remains untested, and rebuilding the relationship and acceptance of the sensitive work that Public Health England does will take valuable time and effort. As many of my constituents tell me, it is simply common sense to keep that work where it is, not move it to a more densely populated suburban area.

Finally, I reiterate that this is not just a conversation about keeping jobs in my constituency; it is a debate about what is best for our life science industry and the partners that depend on Porton’s expertise. I said in my previous Adjournment debate that my primary concern is that the decision is motivated by a desire to tidy up different entities within the PHE organisation on to a single site, when the advantages of co-location are notional, uncosted and unproven. Until I am permitted to see the full business case, my concerns will remain about the logic that is being used.

I appreciate that this is a decision that will have significant implications for our national security and I have always stressed it is imperative that we get it right. However, the Department of Health was informed in 2008 that the category 4 labs at Porton were

“built over 50 years ago and refurbishment and upgrading work is becoming increasingly difficult.”

In my debate five years ago this week, the then Minister with responsibility for public health, my right hon. Friend the Member for Guildford (Anne Milton), told the House:

“The site is 60 years old, the building structures are in a poor state of repair and the laboratories clearly do not meet modern safety standards, so something must be done.”—[Official Report, 22 June 2010; Vol. 512, c. 273.]

I believed her, yet five years later nothing has been done. The facilities are deteriorating and my constituents have lived in the shadow of this decision for five years, not knowing if they will be moving to Harlow, although we have had the positive news of a science park, which will, I hope, open in the next year or so. I will persist in my questioning on this matter, because, frankly, some of my questions have gone unanswered.

When I last met the PHE leadership team in November, I was told by the most senior official that he was the boss and he would decide how any re-examination of Porton’s potential would be evaluated, but I have heard nothing from him for six months. I have a responsibility to my constituents to seek assurance that the decisions that will have an impact on their lives are being made on the basis of rigorous analysis of the facts. I urge the Minister to finally clarify for my constituents, one way or the other, where their future lies. We owe the staff based at Porton Down that much.