Acquired Brain Injury

Seema Kennedy Excerpts

Tuesday 2nd July 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank the hon. Member for Rhondda (Chris Bryant) for introducing the debate, and for challenging the Government on this important issue. He is an indefatigable champion for those living with acquired brain injury, about which he has taught me a lot in the few months for which I have been in my position.

I also thank all right hon. and hon. Members who have spoken, and those who have been present but have not spoken. People have shared personal experiences—things that are painful to them, and that they have lived with for a long time. I particularly welcome the hon. Member for Newport West (Ruth Jones) to her place. I think that this is the first time that I have responded to a debate in which she has spoken.

As with many long-term conditions, ABI affects not only a person’s health but aspects of their family life, work and relationships. I responded to the debate on 9 May. I am still chasing ministerial colleagues in other Departments for their comments, but because time is quite short I will focus today on the many points that have been raised about the health aspects. However, I will go back to ministerial colleagues, chase them and impress on them that this important issue affects many Government Departments.

I met representatives of Headway after the debate on 9 May, and I thank those who work with Headway and organisations such as the UK Brain Injury Forum. Such organisations are really valuable to people living with ABI. They raise awareness and provide help to support those with the condition, as well as families and carers. The hon. Member for Darlington (Jenny Chapman) mentioned how important that is. I take on board the report of the all-party group, to which the Government responded, and I pay tribute to the hon. Member for Rhondda and my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes).

In 2014, two years after the introduction of major trauma centres, there was an independent audit of the regional trauma networks, commissioned by NHS England. That audit showed that patients had a 30% improved chance of surviving severe injuries, and that the networks had saved 600 lives. That does not mean that they are perfect, but some progress has been made since their inception. Although the majority of rehabilitation care is locally provided, NHS England commissions specialised services for those patients with the most complex levels of need. For people who have ABI, timely and appropriate neuro-rehabilitation is an important part of their care.

I thank the APPG for all the work it has done on rehabilitation prescriptions, which reflect the assessment of the physical, functional, vocational, educational, cognitive, psychological and social rehabilitation needs of a patient, and are an important element of rehab care. Of course, the APPG report stated that all patients with ABI should benefit from an RP.

I will touch on lots of the points that Members have mentioned. In particular, I thank the hon. Member for Rhondda for drawing the House’s attention to the third and final report of the audit, which was published in April 2019, only a few days before we last discussed this matter. It is encouraging that 94% of patients accessing specialist rehab have evidence of functional improvement, but the report suggests that there is more work to be done to ensure that all patients who could benefit from specialist rehabilitation can access it.

[John Woodcock (Barrow and Furness) (Ind)]

Does the Minister share my concern that there is no universal information for when people present at A&E or the doctor’s with a head injury? After I fell off a ladder in 2012, I was surprised that I was not given so much as a leaflet to say that there might be long-lasting effects. Some people are clearly good at picking it up, but it should be absolutely obvious that everyone who strikes their head should be given extra attention by the NHS in case they develop symptoms.

[Seema Kennedy]

I thank the hon. Gentleman for raising that point. I was talking to another colleague who had a brain injury just last year, and she said exactly the same thing. That was not in A&E; it was at a GP practice. There are of course training modules for GPs to access, but debates such as this one and my conversations with NHS England can only help in raising awareness. I thank the hon. Gentleman for bringing that point to my attention.

To return to the audit, its authors estimate that current provision caters for 40% of those who need the services, so there is a lot more to do. On capacity, the audit made some recommendations, including that trauma centres should review their processes and ensure that standards for rehabilitation provision and availability are met, and that commissioners should consider opportunities for development of specialist rehab capacity, both for in-patient and community-based services—a point that hon. Members have raised. These are important points. Although we only had this debate two months ago, I am glad that the hon. Member for Rhondda has raised the subject again. I will discuss with NHS England what it is thinking, what it is doing on the audit and what the next steps are. We need to impress on it the importance of bed provision.

The majority of rehab care is commissioned and managed locally and there are guidelines produced by NHS England, such as the principles and expectations for good adult rehabilitation, which describe what good rehabilitation care looks like. There is additional guidance that covers both adults and children.

Many hon. Members mentioned neuro-rehabilitation for children, and I know that NHS England is aware that there is variability in the provision for children. Best practice guidance was published in 2016, but there is always more to be done. I will take the points away and speak to NHS England. We are looking at how we can educate people on foetal alcohol syndrome, and I am happy to report back to the House on that.

The hon. Member for Newport West raised a specific issue about speech and language therapists and physiotherapists. I very much agree that we need a joined-up approach to care and I am concerned to hear that there is a gap. Members can make representations to NHS England on that. I know the situation is different in Wales, but I would be very happy if the hon. Lady would keep me informed.

The hon. Member for Rhondda raised the injury cost recovery scheme. Again, that is a matter for the DWP and I will be pressing ministerial colleagues to respond on that point. That scheme allows for the recovery of costs for providing treatment to an injured person where that person has made a successful personal injury claim against a third party. It recovers funds from insurance companies and pays into the NHS or hospital ambulance services. The current cap is around £53,000, renewed annually in line with inflation. I will follow up with more detail—the hon. Gentleman looks slightly sceptical.

[Chris Bryant]

I do.

[Seema Kennedy]

I have found it is always good to be sceptical in this place.

The NHS long-term plan was announced in January this year. There are some key actions designed to improve the care, treatment and support of people with long-term conditions, such as ABI. Community services, which play a crucial role in helping people with long-term conditions such as brain injury, remain as independent and well supported as possible and are to receive significant investment. The long-term plan set out £4.5 billion of new investment in primary and community care, including for expanded community multidisciplinary teams, providing rapid targeted support to those identified as having the greatest risks, including those with long-term health conditions.

There is also the comprehensive model of personalised care, which includes self-care, care planning, personal health budgets and social prescribing, and which we hope will reach 2.5 million people by 2023-24.

[Jenny Chapman]

I am worried about the long-term plan. Yes, brain injury is included, but so is just about everything else. My concern is that brain injury is getting lost and is not getting the priority it needs; although I appreciate the Minister taking the trouble to raise points and ask questions, that will not be sufficiently effective. We need something with more teeth. We need to be very clear what a patient can expect, what their rights are and what their family can do about it if those things are not provided. Trusts and whatever the structures are in the different parts of the country must be compelled to provide a certain level of service.

--- Later in debate ---

[Seema Kennedy]

I take the challenge set by the hon. Lady. On the question of the response to the audit, I will ask NHS England to show me how it is implementing that. Guidelines are great, and trusts should be doing certain things, but I accept that there is variability.

The hon. Member for Rhondda and my right hon. Friend the Member for South Holland and The Deepings used some great quotations in their speeches, so I will conclude my remarks with a quotation attributed to Sir Francis Drake, who said:

“There must be a beginning of any great matter, but the continuing until the end until it be thoroughly finished yields the true glory.”

Ministerial office is not something that I take for granted, but I hope that today’s debate has demonstrated how seriously this Government and this Minister take ABI and the devastating effects it can have on our constituents.

Heated Tobacco

Seema Kennedy Excerpts

Wednesday 26th June 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray. I thank my right hon. Friend the Member for Clwyd West (Mr Jones) for raising the important issue of heated tobacco products and their contribution to reducing harm from smoking, and for his lifelong service as a fellow of Cancer Research UK. He put it very well: smoking is still prevalent in certain communities in our country, and still causes over 78,000 deaths a year in England. It is one of the leading causes of preventable illness and premature death. We have made great progress, particularly over the past 10 years. Adult smoking prevalence is now 14.9%—the lowest ever recorded level—but, as he pointed out, we have much further to go, particularly among certain groups and in certain parts of the country.

In the 2017 tobacco control plan, we set out our ambition to reduce smoking and ensure a smoke-free generation. Part of that strategy is about helping people to stop smoking by adopting the use of less harmful nicotine products. They may, for example, take up chewing gum. I have never seen my hon. Friend the Member for Broxbourne (Mr Walker) spit out his gum on the pavement.

[Mr Charles Walker]

I quit 15 years ago, but it took me 12 years because the only choice besides smoking was nicotine gum, and it was simply revolting. I would have quit a lot earlier if we had some of these modern products around 15 years ago.

[Seema Kennedy]

I hear what my hon. Friend is saying. For a lot of people, nicotine substitutes are a good transition to giving up smoking or other things completely. We have seen a dramatic rise in the use of e-cigarettes from 1.6 million users in 2014 to about 2.5 million in 2017. Encouragingly, about half of them in England have quit smoking completely. E-cigarettes are not risk-free, however. The evidence is increasingly clear that they are significantly less harmful to health than smoking tobacco. They can help smokers to quit, particularly when combined with stop smoking services. Recent studies have shown they can be twice as effective as nicotine replacement therapy in helping people quit smoking. As my right hon. Friend the Member for Clwyd West pointed out, the sales of e-cigarettes are plateauing, and we are coming to the stubborn 5% of people who are still smoking.

[Sir Kevin Barron (Rother Valley) (Lab)]

The Minister will know that expenditure on smoking cessation programmes has fallen rapidly in the past few years. I promoted a ten-minute rule Bill to put a levy on tobacco companies to fund smoking cessation programmes and research into less harmful products. The greatest problem we have had for many years—this is anecdotal at the moment—is that products such as patches and gums cannot get heavy smokers to quit. There is some evidence, although it is not firm, that heated products are a way of getting to people who have a real problem with addiction.

[Seema Kennedy]

The right hon. Gentleman makes an important point. Those of us who represent seats in the north and the devolved nations know that in some communities a very high proportion of people—particularly older men—are still smoking. Smoking cessation services are obviously part of the conversation about public health that the Department will be taking forward to the spending review.

My right hon. Friend the Member for Clwyd West has argued that it would be timely for the Government to commission independent research into heated tobacco products’ potential for harm reduction. Obviously, if the tobacco companies were paying for it, it would not be independent. The right hon. Member for Rother Valley (Sir Kevin Barron) has set me an interesting challenge on tobacco levies. The new levy is being introduced in a few days, and I will definitely keep that under review.

The primary focus of our research at the moment is e-cigarettes, because heated tobacco is still very new on the market in this country. We will keep it under review and we will monitor the evidence through Public Heath England’s reviews. I agree entirely that it is important to look carefully at the evidence of harm reduction. I assure the House that we are, and will continue to be, led by that evidence.

Heated tobacco products are regulated under the Tobacco and Related Products Regulations 2016 as novel tobacco, in accordance with the EU’s tobacco products directive. We know far more about e-cigarettes than we do about heated tobacco products. The research and evidence base is still in its infancy, and is mainly conducted by the tobacco industry. We asked the Committee on Toxicity to research the toxicological risks of heated tobacco products and compare them with those attributed to conventional cigarettes. It reported in December 2017, and the evidence suggests that heated tobacco products still pose a risk to users. There is likely to be a reduction in risk for cigarette smokers who switch to heated tobacco products, but quitting tobacco entirely is the most beneficial thing that anybody can do.

We have asked Public Health England to update the evidence base on e-cigarettes and other novel nicotine delivery systems annually. The PHE 2018 evidence review also had a comprehensive chapter on heated tobacco. It concluded the same as the Committee on Toxicity. As my right hon. Friend the Member for Clwyd West said, it stated that e-cigarettes are less harmful than heated tobacco. The latest PHE evidence review in February 2019 did not cover heated tobacco products, essentially because there was insufficient new evidence since the previous review in 2018.

My right hon. Friend pointed to the experience of other countries. I agree that we must look beyond our shores and learn lessons, but we must also acknowledge that there are different contexts in which heated tobacco products are used. For example, Japan has banned e-cigarettes, but it has introduced heated tobacco products, which have made an impact there. The Food and Drug Administration in the United States has permitted the sale of heated tobacco products, but is yet to pronounce on whether Philip Morris International may make claims of reduced risk for its IQOS product. I believe, therefore, that we need to be cautious about assuming that heated tobacco products are likely to find a large market in the UK.

I recognise that more independent research on heated tobacco products would be helpful for understanding their relative risks. The Department and its arms’ length bodies will consider research proposals in this field, but at present none has been forthcoming. I need to be clear that such proposals would need to demonstrate good use of public money. We will continue to monitor the international evidence and develop our policy as such evidence develops.

[Mr David Jones]

I have listened carefully to what the Minister has to say. It seems that the Government’s position now is identical to their position six months ago, when they published their response to the report of the Science and Technology Committee. Is that right? Has nothing moved?

[Seema Kennedy]

There is a definite need for more research to be done on heated tobacco products. Only through proper, independent research can we draw different conclusions. However, my right hon. Friend has raised a very important issue about these products, which are helping certain people in this country and other jurisdictions to quit smoking. He has set me a challenge and I will certainly ask my officials to look closely at the issue.

It is important to remember that heated tobacco products are tobacco products, and we must apply suitable caution. Although switching from traditional cigarettes is likely to reduce risk, the best approach is to quit entirely. The Government remain committed to helping people quit smoking and promoting reduced-risk products where it makes sense for smokers. We will continue to be driven by the evidence.

Question put and agreed to.

Electromagnetic Fields: Health Effects

Seema Kennedy Excerpts

Tuesday 25th June 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Gower (Tonia Antoniazzi) for securing the debate and giving us the opportunity to discuss this important subject.

People are exposed to radio waves in the home, at work and throughout their daily lives. As the hon. Member for Gower mentioned, people have been talking about the issues for about 100 years, since early in the last century, but the numbers of devices and transmitters have increased rapidly, and the pace of change in how this technology becomes part of our lives can be very unsettling to some. People ask whether radio wave exposure levels are increasing and whether there could be health consequences, and I want to put on record right at the beginning that, very importantly, radio waves are non-ionising radiation. That means that the packets of energy that form the radiation are too small to break chemical bonds: the radiation cannot damage cells and cause cancer in the same way as ionising radiation. Even so, there are concerns that this type of radiation could have health effects, and a great deal of research has been done in the United Kingdom and around the world to clarify the matter, which is something the Government take very seriously.

A number of issues, both for my Department and for colleagues in others, have been raised during the debate, and I will try to address them. I will also pass them on to colleagues.

Health concerns about electromagnetic fields have been raised in relation to each successive wave of new communications services, from 2G to 3G and 4G mobile phone networks, and with wi-fi, smart meters and now 5G. I have certainly noticed the growing number of letters I have received from parliamentary colleagues, passing on their constituents’ concerns, and I am grateful for the opportunity to address some of them today.

Concerns about telecommunications networks first came to the fore in the late 1990s. A report containing an evidence review and recommendations was prepared for Government by the independent expert group on mobile phones, under the chairmanship of Sir William Stewart. A major research programme was undertaken and the international exposure guidelines were adopted, with a commitment from industry that they would be followed. Although many new services and technologies have been launched, the basic way they are delivered—by radio—has not changed, and the science of how radio waves affect the body does not change when a new technology is launched. However, the Government take people’s health concerns about electromagnetic fields very seriously. They have committed, and continue to commit, significant resources to supporting research and analysis on the topic, and policies are in place to ensure the exposure guidelines are followed.

Public Health England monitors the health-related evidence and collaborates internationally to ensure that any important new evidence is identified and responded to.

[Tonia Antoniazzi]

Will the Minister give way?

[Seema Kennedy]

The hon. Lady might be about to refer back to her speech. I was going to respond to a comment she made, but I will happily give way.

[Tonia Antoniazzi]

I thank the Minister for allowing me to ask this question: is she able to point out where the recent evidence that the Government and Public Health England have is? Is it in the public domain?

[Seema Kennedy]

I think the hon. Lady talked about accurate information, and about honesty concerning the information put out by Public Health England. Public Health England conducts extremely rigorous research, all based on the best available international evidence and on monitoring assessments of expert reviews. Some of those things will, of course, be in the public domain, and others will not. I will happily write to the hon. Lady with all the evidence that is available in the public domain.

The Committee on Medical Aspects of Radiation in the Environment has a watching brief on non-ionising radiation. It assesses all the available data to give health advice. Many scientific studies have been done over several decades, and a wide range of health topics have been investigated, including cancer, reproduction, cognitive effects and electrical hypersensitivity.

[Carol Monaghan (Glasgow North West) (SNP)]

The Minister referred to the frequency range. It is true that we are talking about lower frequencies than the ionising radiation that would be beyond the visible spectrum. However, it is not true to say that all low frequencies are not harmful. Looking at microwave radiation, for example, if we get a high enough intensity of non-ionising radiation we can still cause harm. I would not want to be in a microwave oven and I am sure the Minister would not either. So it is not just about frequency; it is about the intensity of the radiation.

[Seema Kennedy]

The hon. Lady is talking about risks and hazards. [Interruption.] Yes, we are talking about two different sorts of radio wave, but she said that I would not want to go in a microwave oven. I am not suggesting that I would put myself or anyone else in a microwave oven, so we are talking about hazards and risks. The best scientific evidence given to Government is that the radiation is safe, and I was going to go on to talk about the evidence that Government have used before addressing some of the points that the hon. Member for Gower raised. I apologise if I have not quite understood the point made by the hon. Member for Glasgow North West (Carol Monaghan); I will happily discuss it with her later.

Expert groups in the UK and around the world have examined the evidence and published many comprehensive reports. In the UK, the Advisory Group on Non-ionising Radiation produced reports in 2003 and 2012. The Government have played their role in the international effort to learn more about the health effects of radio- wave exposure. They supported the dedicated mobile telecommunications and health research programme that ran from 2001 to 2012 and they continue to fund research.

A challenge in understanding the evidence is that some studies report effects, while others do not. Sophisticated analyses are needed to draw studies together, considering their strengths and weaknesses and working out what they mean collectively, which is the role of expert groups. Simply counting or listing studies that have found effects is not an adequate way of assessing where the overall evidence lies.

An expert group reporting to the European Commission delivered a review in 2015, and the World Health Organisation is currently carrying out a major review on radio waves and health, which will include studies performed over the past 25 years. Overall, those expert groups have not found any clear evidence of adverse health effects occurring if the International Commission on Non-Ionizing Radiation Protection exposure guidelines are followed. The ICNIRP exposure restrictions have been incorporated into a 1999 European Council recommendation on limiting public exposures to electromagnetic fields. The United Kingdom and Public Health England support that recommendation.

Since 1996, the World Health Organisation has been running an international electromagnetic field project that provides a forum for countries to gather together, discuss and share knowledge on this topic. The WHO’s main conclusion is that electromagnetic field exposures below the limits recommended in the International Commission on Non-Ionizing Radiation Protection guidelines do not appear to have any known consequence for health. However, as the hon. Member for Gower and other Members have mentioned, that does not mean that people who have electrical hypersensitivity do not have symptoms. Those symptoms are real and can be very debilitating, and the Department’s guidance is that those people should seek medical advice, so that their personal situation can be taken into account and the best possible treatments found.

I will also address the points raised by many hon. Members about the effects of screen time on the mental health of children; as any parent can attest, there are some effects. The shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), referred to SCAMP, and the Government conduct research that looks at the effects of technologies on schoolchildren.

Exposure levels reduce very rapidly with increasing distance from transmitting antennae, which means that being in immediate proximity to the transmitting antenna of a mobile phone handset held next to the head is different from living near a base station. There is long-standing precautionary advice from Public Health England and the NHS for mobile phone users, and research is continuing. We are continually looking at the evidence and updating our advice.

[Tonia Antoniazzi]

What work has been undertaken by Public Health England to look for evidence of risk in mobile phone usage? Is it looking at what damage it is actually doing, rather than saying, “Well, it is not really hurting anybody”?

[Seema Kennedy]

Public Health England takes its role very seriously, and is always monitoring the evidence. Since perhaps 10 years ago, there has been a lot of research into having mobile phones next to one’s ear. Of course, the way we use our phones is changing, but Public Health England is always looking at this issue and reviewing the best available evidence.

There has been a general trend from 2G through to 5G for transmitters to become smaller, to be mounted nearer to the ground, and to use less transmitted power. The hon. Member for Stroud (Dr Drew) raised a point about the electronic communications code, which I think is a matter for colleagues in the Ministry of Housing, Communities and Local Government. The hon. Member for Swansea West (Geraint Davies) has left, but I do not think we are cutting down trees; in fact, I am sure that the Government have committed to planting more trees. I know that the Secretary of State is very keen on them, so I will write to him on that issue.

To answer the questions that were asked about radio frequency fields and cancer, a working group of the International Agency for Research on Cancer reviewed the health effects of exposure to RF fields and concluded that such exposures are possibly carcinogenic to humans—group 2B, based on IARC’s classification scheme. There was a minority opinion in the working group that current evidence for humans was inadequate, and therefore there was no conclusion about a causal association. In terms of the different classes of carcinogens, there is a statement on the PHE website that responds to the IARC classification. PHE has summary advice statements that it sends to inquirers with a full explanation of different carcinogens; there is a broad spectrum, including petrol engine exhausts, bracken fern and talc-based body powder.

Since 2001, the Office of Communications has been carrying out an audit of the emissions from mobile phone base stations. The Advisory Group on Non-Ionising Radiation’s 2012 report contained a summary of over 3,000 measurements made at over 500 sites by Ofcom. The maximum exposure found at any location was hundreds of times below the international guideline levels, and typical exposures were much lower still. Public Health England advises that there may be a small increase in overall exposure to radio waves when 5G is added to an existing network or a new area, but that is expected to remain low relative to guidelines.

I hope I have demonstrated that the Government take seriously the potential health effects of the introduction of 5G, and that Public Health England is well placed to identify and respond to any important new evidence that may emerge. I reiterate that the public’s levels of exposure to electromagnetic fields from telecommunications networks are currently very low in relation to the international guideline levels, and are expected to stay that way after the deployment of 5G.

Oral Answers to Questions

Seema Kennedy Excerpts

Tuesday 18th June 2019 Commons Chamber

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

7. For what reason he chose not to refer the Thames Valley PET-CT scanning contract to the independent reconfiguration panel.

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

I am aware of the views that have been expressed on this matter. I can confirm that, having taken advice, we considered that the letter received from the Oxfordshire health overview and scrutiny committee does not constitute a valid referral under the relevant regulations. However, I have emphasised to NHS England, Oxford University Hospitals and InHealth the importance of continuing local discussions and working together at pace to find a service offer that works best for patients.

[Anneliese Dodds]

The Churchill’s PET-CT cancer scanning service is world renowned, yet NHS England, apparently with the consent of this Government, is forcing it into partnership with a private company. That is what is happening. It is not a discussion; it is being forced into a partnership. NHS England has even warned the trust against staff raising their voice on this issue because of their concerns about patient safety. Surely this unprecedented partnership is illegitimate and must be called in by this Government.

[Seema Kennedy]

As I have said to the hon. Lady, we do not consider it to be a valid referral. What I would say is that NHS England remains committed to ensuring that the public are involved in decision making. Part of the extensive public engagement included completing a 30-day engagement about the phase 2 procurement proposals in 2016. I understand the strong passions that this has raised on both sides of the House and I urge all parties to continue working together.

[Mr Edward Vaizey (Wantage) (Con)]

I have made it clear to my constituents that, in principle, I have no objection to private companies providing NHS services, but totally legitimate concerns have been raised about the consultation involved in awarding this contract. May I simply thank the Minister for agreeing to meet Oxfordshire MPs this afternoon? I know that she is very much engaged in this issue and, although it may not technically be overseen by the Department of Health and Social Care, I know that she will do all she can to help us to reach a solution.

[Seema Kennedy]

I thank my right hon. Friend for his question. I am looking forward to the meeting this afternoon. As I have said, I am assured that the decision will maintain services in Oxford and that there will be improved patient access, with new scanners in Milton Keynes and Swindon for people living there as well.

[Layla Moran (Oxford West and Abingdon) (LD)]

Surely the reason we have got to this point is that the clinical commissioning group was never actually consulted on what was right for the local population. How can the Minister ensure that, in future, centralised procurement services and local CCGs are always consulted as a matter of course?

[Seema Kennedy]

As I have said, there has been engagement with local people, Members of Parliament and the local health community. I think that the outcome that we are all looking for is good PET-CT scanners for the people in Oxfordshire and for the whole of Thames Valley.

[Anna Turley (Redcar) (Lab/Co-op)]

8. What steps he is taking to ensure that vulnerable people are not unfairly penalised for incorrectly claiming free prescriptions.

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

Last year, prescription and dental fraud cost the NHS an estimated £212 million. It is absolutely right that the Government take steps to recoup that money, so it can be reinvested into caring for patients. Our system for claiming free prescriptions should be simple for people and clinicians to understand, which is why we are currently piloting technology that allows pharmacies to check digitally whether a patient is exempt from charges before prescription items are dispensed.

[Anna Turley]

I appreciate the Minister’s response, but I am afraid that that is just not the reality out there. One of my constituents—a woman with severe learning disabilities and anxiety, who is entitled to free prescriptions through her employment and support allowance claim—was hit with a £100 penalty charge when the NHS failed to obtain the correct information from the Department for Work and Pensions. My office challenged that decision and got the £100 back to her, but the situation was extremely distressing, and the communication is clearly at fault and punitive. Will the Minister implement a review into the prescription penalties to protect vulnerable people?

[Seema Kennedy]

It is distressing to hear of such a case, and these situations are very distressing for patients and their carers. The NHS Business Services Authority has taken steps to make things clearer, including with an easy-read patient information booklet and an online eligibility checker. We are also running a national awareness campaign, but of course we do need to ensure that people are not claiming for things to which they are not entitled.

[Sir Desmond Swayne (New Forest West) (Con)]

I have constituents who are furious at repeatedly receiving penalty notices that subsequently have to be quashed. The system is rubbish, isn’t it?

[Seema Kennedy]

I do not agree with my right hon. Friend that the system is rubbish. If somebody does receive a penalty charge notice incorrectly, there are procedures in place to challenge that notice. If somebody thinks they have received a penalty charge that they should not have received, they should contact the NHS Business Services Authority.

[Mr Speaker]

What is not rubbish is the very pithy line of questioning typically deployed by the right hon. Member for New Forest West (Sir Desmond Swayne). I will call the hon. Member for Westmorland and Lonsdale (Tim Farron) if his question consists of a sentence, rather than a speech.

[Mr Speaker]

Well done.

[Seema Kennedy]

We recognise the importance of community pharmacies. Pharmacists are specialists who have a great role in primary care, which is why they are highlighted in the NHS long-term plan.

[Julie Cooper (Burnley) (Lab)]

Since 2014, 5.6 million penalty charge notices have been issued, including a staggering 1.7 million to people who are entitled to free prescriptions. FP10 prescription forms and the criteria for eligibility for free prescriptions are far from straightforward. Some people in receipt of universal credit are eligible for free prescriptions and some are not—and, by the way, universal credit is not mentioned at all on the form. Those claiming exemption on grounds of low income can see their eligibility change from one month to the next. Is it any wonder that some patients tick their box? What steps are the Government taking to sort out this chaotic system that is too often treating vulnerable people like criminals?

[Seema Kennedy]

A wide range of activity has been undertaken to help people to understand whether they need to pay for their NHS prescriptions, and I remind the House that 84% of NHS prescriptions are available for free. My Department and the DWP are working together to provide further clarity to universal credit, and hopefully we will be adding a universal credit tick box to the prescription form.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

9. What steps he is taking to ensure that people can access Changing Places facilities when they use NHS services.

--- Later in debate ---

[Ellie Reeves (Lewisham West and Penge) (Lab)]

14. What recent assessment he has made of progress in implementing Childhood obesity: a plan for action, chapter 2, published in June 2018.

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

The Government are taking a world-leading approach to obesity. We have held consultations on ending the sale of energy drinks to children, calorie labelling in restaurants, restricting promotions of sugary and fatty foods by price indication, and further advertising restrictions, including a 9 pm watershed. We are considering all the feedback, and will respond later this year.

[Paul Blomfield]

Alongside prevention, we have to do more to help the growing number of children who are already overweight or obese. It is more than a year since the Health and Social Care Committee highlighted the lack of tier 3 and 4 services. Voluntary groups such as Shine Health Academy in my constituency fill the gap. They take children on referral from GPs, but they do not receive any public funding. There can be no other serious health condition affecting children where the NHS says, “Sorry, we can’t help.” Will the Minister take action and agree to meet me to discuss it?

[Seema Kennedy]

I completely agree with the hon. Gentleman that childhood obesity is a massive challenge to our nation. It is a problem internationally, and we are taking serious steps to tackle it. I am happy to meet the hon. Gentleman to hear more about Shine.

[Ellie Reeves]

Public health budgets have fallen by over 5%, with millions more in cuts anticipated. In both Lewisham and Bromley, the ring-fenced public health budget has fallen by 2.6% this year. The Government expect local authorities to play a greater role in tackling obesity while simultaneously cutting funding to councils, schools and the NHS. When will the Minister take action to tackle childhood obesity by restoring funding for public health?

[Seema Kennedy]

I have set out to the hon. Member for Sheffield Central (Paul Blomfield) the measures we have taken. Through the childhood obesity trailblazer programme, we are working with local authorities—I am hoping to visit one in Blackburn later this week—that want to see how they can use their powers to best effect, doing things such as limiting new fast-food outlets. We have spent billions of pounds over the past five years. The public health grant will be subject to the spending review.

[Andrew Selous (South West Bedfordshire) (Con)]

Given that 46% of food and drink advertising is spent on unhealthy food—and unhealthy foods are three times cheaper than healthy food—will the Minister follow in the footsteps of her predecessor, and go to the Netherlands to look at the Marqt supermarket, which has 16 stores around Amsterdam and does not market any unhealthy food to children? It is a profitable business and a model for our supermarkets, so will she go and look at it?

[Seema Kennedy]

I thank my hon. Friend for his interest in this area. The Amsterdam model has been very successful, but it is not just about food—it is about place and culture. I would hope to be able to visit the model very shortly.

[Mr Speaker]

If the hon. Member for South West Bedfordshire (Andrew Selous) has been trugging round Amsterdam in pursuit of the public interest he is a remarkably assiduous and dedicated fellow. We are all deeply obliged to him—it is way beyond the call of duty, but we are appreciative none the less.

We now come to topical questions. I call Justin Madders.

--- Later in debate ---

[Mrs Hodgson]

Thank you, Mr Speaker. The Government’s second childhood obesity plan will celebrate its first birthday a week today, but we will not be celebrating. The Government have ducked and dived on their responsibility to the children in this country and have failed to produce any policies as a result of the six consultations the plan has promised, but the rate of childhood obesity is still at a record high. Instead of waiting for the chief medical officer to report on obesity, will the Government act now to tackle the childhood obesity crisis, and introduce and implement the policies they have consulted on already?

[Seema Kennedy]

We have a very ambitious aim to halve childhood obesity by 2030. We are still considering all the answers to the consultations, and we are hoping to respond to them very shortly.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Neil O’Brien (Harborough) (Con)]

T4. What steps is my right hon. Friend taking to improve the diagnosis and treatment of prostate cancer, in particular increasing the use of new technologies such as gel spacers, laser ablation and MRI in diagnosis?

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

More than 94% of men survive prostate cancer for one year, and 86% for five years, but there is more to do. That is why last April the Prime Minister announced £75 million over five years so that 40,000 men can take part in innovative research into early diagnosis and treatment. The long-term plan sets out our commitment to speed up the path from innovation to business as usual, spreading proven new techniques and technologies faster. Safer and more precise treatments in diagnostic techniques will continue to improve prostate cancer survival.

[Emma Dent Coad (Kensington) (Lab)]

T2.   Kensington has an ageing population, many of whom will need residential care at some point, yet our council seems determined to move needy elders out of the borough, far from family and friends. Our last ever council-owned care home was sold off to a provider of caviar care, which lets luxury flats at £300,000 a year, with care, plus caviar, on top, for those who can afford it. Will the Minister explain what, if any, statutory obligations councils are under to provide affordable residential care for their residents? We are not all billionaires in Kensington.

--- Later in debate ---

[Stephen Morgan (Portsmouth South) (Lab)]

Thousands of my constituents will be left without access to dental care because a Swiss-owned investment firm has decided to shut three practices in my city. What is the Department doing to ensure that the people of Portsmouth have access to vital oral health services?

[Seema Kennedy]

I understand the hon. Gentleman’s concern. As I understand it, the Colosseum dental group practices will remain open until 31 July. NHS England has put in place plans to ensure that where possible patients currently undergoing dental treatment will complete their course of treatment before the practice closures and is working with other local dental practices to provide additional capacity to treat patients as well as considering the longer-term options for procuring dental services in the Portsmouth area.

[Vicky Ford (Chelmsford) (Con)]

I declare an interest as a doctor’s wife. If the sub-dean at Chelmsford’s brilliant new medical school continues to teach the students and work in the hospital, she faces a 90% tax rate. If she continues to do the weekend hours the hospital needs, she faces having to pay more in tax than she is earning. Will the Minister look again at the taper, which is driving our consultants out of our hospitals?

Fortification of Flour

Seema Kennedy Excerpts

Thursday 13th June 2019 Written Statements

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

Further to the Government’s announcement on 23 October 2018 of the intention to consult on the issue of mandatory fortification of flour with folic acid to help prevent neural tube defects in foetuses, I wish to inform the House that the consultation will launch today and will run for 12 weeks.

Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first few weeks of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. These can be devastating conditions and the Government are fully aware of the effect these have on the individuals themselves and their families.

There is strong evidence that many neural tube defects can be prevented by increasing women’s intake of folic acid.

Unless you are pregnant or thinking of having a baby, you should be able to get all the folate (the natural form of folic acid) you need by eating a varied and balanced diet. Existing pregnancy advice to women who are trying to conceive or who are likely to become pregnant is that they are advised to take a daily supplement of 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods, for example spinach and broccoli, and foods voluntarily fortified with folic acid such a wide range of breakfast cereals.

However, we know that in the UK around half of pregnancies are unplanned. In those which are planned, it has been estimated that only half of all mothers took folic acid supplements or modified their diet to increase folate intake. This has led to calls for mandatory fortification of flour with folic acid, so women can get it from dietary sources other than foods that naturally contain it.

The Scientific Advisory Committee on Nutrition (SACN) has recommended mandatory folic acid fortification of flour to improve the folate status of women most at risk of neural tube defect-affected pregnancies. Further detail on this is in the consultation document.

We are now opening a consultation to seek views on this proposed change and we hope that members of the public as well as industry and the scientific community respond so we can accurately consider this proposal.

I have agreed with the Governments of Scotland and Wales, and the permanent secretary of Northern Ireland that this will be a joint consultation between the devolved Administrations and England. This is because any resulting decisions would need to be taken on a whole-UK basis to minimise impact on trade and for industry to comply. Similarly, the Department for Environment, Food and Rural Affairs has been closely involved as flour falls within its remit.

[HCWS1618]

Public Health: County Durham

Seema Kennedy Excerpts

Wednesday 12th June 2019 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Owen. I thank the right hon. Member for North Durham (Mr Jones) for raising this important issue, and the hon. Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their contributions.

The Government fully appreciate the importance of protecting and improving the health of the population. We share hon. Members’ commitment to prevention and public health, which this debate has highlighted. The costs, both to individual lives and to the NHS, are simply too great to ignore.

The population in England is growing, ageing and diversifying rapidly. Some 40% of morbidity is preventable, and 60% of 60-year-olds have at least one long-term condition. Helping people to stay well, in work and in their own homes for longer is vital. As hon. Members have highlighted, the gap in healthy life expectancy between the most and least deprived areas of England is approximately 19 years for both sexes. As somebody who was born in Lancashire and represents a Lancashire seat, I see that disparity in my constituency. It is a great motivating factor for me in my role, as it was for my right hon. Friend the Prime Minister when she set her grand challenge of extending a person’s period of healthy, independent and active life by five years by 2035.

However, we will not achieve that by simply adding five extra years at the end of life; as with many things, the earlier we start, the more we stand to gain. Investment in early years and onwards is essential if we want positively to influence future lifestyle choices, prevent disabling conditions and enable people to contribute fully to society. We must continue to focus our efforts on areas such as digital technology and behavioural science so that we can show the public that the healthy choice is the easy choice.

We are doing work—on childhood obesity, smoking, air quality and more—that has the potential to make a real difference to people’s health and wellbeing. The amount of sugar in drinks has been reduced by 11% and average calories per portion have been cut by 6% in response to our soft drinks industry levy. By 2020, the NHS diabetes prevention programme will support 100,000 people at risk of diabetes each year across England. Last year’s ambitious prevention vision statement and the forthcoming prevention Green Paper will enable us to meet the ageing grand challenge and address health inequalities, supporting people to live longer, healthier lives.

We recognise that the funding position for local authorities is extremely challenging and understand the huge efforts that local government has made to focus on securing best value for every pound it spends. The 2015 spending review made available £16 billion of funding for local authorities in England over the five-year period. I remind the House that that is in addition to the money the NHS spends, which is part of the public health offer on prevention and includes our world-leading screening and immunisation programme and the world’s first national diabetes prevention programme.

Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Historically, funding for public health services in the NHS was left to local decision and was not necessarily based on need, which led to wide disparities in the amount of funding dedicated locally to public health services. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for the distribution of the public health grant. The introduction of that formula meant that some local authorities received more than their target allocation under the ACRA formula and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject to growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”.

In 2015, ACRA was asked to update the formula to take account of the transfer of responsibility for commissioning health visiting services from NHS England to local authorities. We consulted on this formula and ACRA made recommendations to Government in 2016. I understand that the public health formula is more heavily weighted towards deprivation than either the adult social care formula or the clinical commissioning group formulation.

[Mrs Hodgson]

It is not working.

[Seema Kennedy]

Of course we want evidence. The shadow Minister says from a sedentary position that it is not working. We did an impact assessment in 2015-16 and we are reviewing all the evidence in preparation for the next spending review.

[Phil Wilson]

Just for clarification, did the Minister actually say that the formula is not working?

--- Later in debate ---

[Seema Kennedy]

No, I was repeating what the shadow Minister had said.

The recommended formula, which would create winners and losers in terms of overall levels of funding because of the disparity in historical spend compared with current need, has not been implemented because of the Government’s intention to extend the system of retained business rates. We continue to review the position, and future spending levels will be decided as part of the spending review, where we will review all available evidence.

I commend all local authorities on the efforts they are making to improve population health, as well as third-sector groups such as the children in Cleves Cross with their edible walkways. We continue to believe that local authorities are best placed to make decisions about the services that best meet the needs of their populations.

[Dr Blackman-Woods]

I am sure the Minister would accept that any formula that moves services from areas of relatively high need to areas of low need cannot be working properly. Does she also accept that it is simply not fair to push the onus to provide more services on to local authorities? As my right hon. Friend the Member for North Durham (Mr Jones) made clear, Durham County Council’s budget has been cut by 60% since 2010.

[Seema Kennedy]

I believe that local authorities and local communities are the right place for public health to be situated, because they best understand the needs of their communities.

[Mr Kevan Jones]

Will the Minister give way?

[Seema Kennedy]

May I just finish addressing the point made by the hon. Member for City of Durham? I also want to ensure I give the right hon. Gentleman, who moved the motion, time to wind up the debate. We recognise that there has been pressure on local authorities and we commend them for the work they have done. As I have said, we continue to review the position, and future spending levels will be decided as part of the spending review.

[Mr Jones]

I agree with the Minister that local communities are best placed to decide these things, but is she happy with the fact that under the new funding formula, there is no onus on local government at all to use money for public health?

[Seema Kennedy]

I think public health is ring-fenced, and local government does have to use the funding for that. We are reviewing the position, and we will look at all the evidence carefully in the upcoming spending review.

Across England, we are seeing examples of councils adopting new service models and commissioning more effectively and innovatively. Stakeholders often tell us, most recently through the review of commissioning sexual health and health visiting services, that councils are achieving better value for money while maintaining or improving outcomes in challenging financial circumstances.

However, we need to acknowledge that improving public health is about far more than the grant, and we know that spending more money does not necessarily improve outcomes. What we spend it on matters a lot. That covers all local government activity, including transport, planning, housing and the economy, all of which contribute to population health and wellbeing. The work that local government does on the ground through place-based approaches makes joining up those different factors easier, and the NHS long-term plan has a significant focus on prevention and reducing health inequalities.

We do not know what the outcome of the spending review will be, but I am committed to working closely with local government and other partners to build on the achievements of the past six years. We need to take action on a local, national and global level to meet the public health needs of the present and rise to the public health challenges of the future.

Vaccination and Public Health

Seema Kennedy Excerpts

Wednesday 12th June 2019 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Davies. I am pleased to stand before the House in recognition of one of our greatest achievements in health. I thank my hon. Friend the Member for Bolton West (Chris Green), my Lancashire neighbour, for tabling the debate. He is a great champion for his constituents and for raising science and health issues on to the parliamentary agenda.

Immunisation offers every child the chance of a healthy life, from their earliest beginnings and into old age. It saves millions of lives every year, and after clean water is the world’s most successful and cost-effective public health intervention. Our vaccination programmes are a cornerstone of the UK’s public health offer, and I know that all hon. Members here will join me in commending those involved in the delivery of our world-class vaccination programmes, which protect both individuals and all our communities. Our routine vaccination programme protects against 16 different diseases that, even today in developed countries, can cause serious long-term ill health, and even death, if not prevented.

The Government are committed to keeping vaccination uptake rates as high as possible. We constantly review ways to do that, and we are committed to ensuring that everyone eligible for vaccination takes up the offer. We should be proud that our routine vaccinations in England continue to have a high uptake, with more than 90% coverage for almost all childhood vaccines. That reflects the high levels of confidence that the vast majority of parents rightly have in our vaccination programmes.

[Dr Whitford]

The levels are above 90% for the majority, but does the Minister accept that the WHO advice is that the figure should be 95%, for community safety? We have to tackle this drop of even a few per cent.

[Seema Kennedy]

I wholeheartedly agree with the hon. Lady, who brings to this place her great expertise from a career as a doctor. The Government have a commitment to reach the WHO target of 95%.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) is no longer in his place, but he made an intervention. He referred to mothers, but I think that all parents—mothers and fathers—have a responsibility to ensure that their children are immunised. I urge parents who are thinking of getting the last rounds of MMR vaccines for their children to do so. In every classroom, there will be children who are immunosuppressed and unable to have those vaccinations, so it falls to all the rest of us, as parents, to ensure that our children have their vaccinations.

Evidence from Public Health England’s annual attitudinal surveys, which have been run since the early 1990s, shows that more than 90% of parents trust our vaccination programmes and most people automatically get their children vaccinated. Regrettably, there has been a small, steady decline in coverage since 2013. That is of concern. There are likely to be many factors contributing to it, not just a single one. We are not complacent and we know that we need to take action now to halt the decline. That is why I am so glad that my hon. Friend the Member for Bolton West sought this debate: it enables me to outline some of the measures that my Department is taking.

The Department of Health and Social Care leads on policy for immunisation in England, and officials are working very closely with Public Health England and NHS England to take steps to improve vaccination coverage and reverse the downward trend. That includes better national co-ordination of our vaccination programmes; making it easier for people to access vaccinations; making information readily available to parents and those needing vaccines; and better training for staff to enable them to answer questions that parents may have.

In addition, we have data systems to ensure accurate information on the immunisation status of children and young people, so that health professionals can provide a “catch-up” on any missed vaccinations. We will continue to improve those systems. For example, the Digital Child Health programme, which includes the development of a digital personal child health record, will create a system that allows parents and healthcare practitioners to access a child’s immunisation history, improving the ability to give immunisations at every opportunity.

NHS England is reviewing vaccinations in the context of the GP contract, to ensure that GPs are properly reimbursed for vaccinating their populations and that the right incentives for increased uptake rates are in place. That is set out in “The NHS Long Term Plan”, published in January of this year.

My hon. Friend the Member for Bolton West asked about community pharmacies and the very important role that they have to play in our primary care. I thank him for his suggestion. The Government recognise the value and importance of the services that community pharmacies provide. We want to see them working with primary care networks to encourage more people to use their local pharmacy to keep them healthy.

With regard to vaccinations, I am aware of the success, which my hon. Friend highlighted, of seasonal flu vaccines. Indeed, the number of seasonal flu vaccinations provided by pharmacies between September 2018 and March 2019 was more than 1.4 million. I had my seasonal flu vaccine in my local pharmacy in Penwortham. I am sure that my hon. Friend, as a very responsible parliamentarian, had one as well. His facial expression suggests otherwise; perhaps he will have one this September. I will write to him regarding his suggestion. NHS England is currently leading a review of GP vaccinations, and I would not want to pre-empt its findings.

It is very important that our vaccination programmes continue to evolve. They are constantly reviewed and updated to reflect the changing nature of infectious diseases, based on expert advice. The Government receive expert advice on vaccination programmes based on decisions from the independent Joint Committee on Vaccination and Immunisation. That includes advice on new and existing programmes and on which vaccines should be used. Recent examples of JCVI advice leading to improvements to our vaccination programmes include the extension of the seasonal flu immunisation programme to children and the extension of human papillomavirus vaccination to adolescent boys.

It is important to remember—the House will be aware of this—that if we do not continue to vaccinate, diseases that we rarely see in the UK at the moment will return. Examples of such diseases are diphtheria, measles, tetanus and polio. Vaccines are responsible for a substantial reduction in the number of those infections.

Let us cast our minds back to the early 1950s, when there were epidemics of polio infections, with symptoms ranging in severity from fever, to meningitis, to paralysis. At the time, there were as many as 8,000 annual notifications of infantile paralysis caused by polio in this country. Following the introduction of polio immunisation, the numbers of cases fell rapidly to very low levels. The last outbreak that started in the UK was in the late 1970s. Today, protection against that disease is included in our 6-in-1 vaccine, and owing to the success of the vaccination programmes, that disease and its effects are now rarely seen in the UK.

We should be very proud of our successes in the UK and of the public health benefits afforded by our immunisation programmes. However, as I hope I have made clear to hon. Members today, we are not complacent. We will continually seek to improve those services, seeking advice from experts and taking proactive action, to ensure that we have the best vaccination offer in order to protect the health of our nation.

Question put and agreed to.

Cystic Fibrosis Drugs: Orkambi

Seema Kennedy Excerpts

Monday 10th June 2019 Westminster Hall

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

It is always a particular pleasure to serve under your chairmanship, Mr Hanson. I thank my hon. Friend the Member for Sutton and Cheam (Paul Scully) for opening the debate on behalf of the Petitions Committee. I pay tribute to the more than 100,000 people who signed the petition, and I thank all right hon. and hon. Members who have spoken in the debate; I am sure that they will be rushing back for the wind-ups.

I have been very touched by the stories that we have heard today and the compassion shown by my hon. Friend and all hon. Members in speaking about cystic fibrosis and its physical effects, emotional effects and effects on mental health for those who live with it and for their families. It is a debilitating condition, and I know how absolutely desperate sufferers and families are for access to treatments.

I recognise the great work undertaken by the Cystic Fibrosis Trust and its strong voice in supporting families and bringing cystic fibrosis to the attention of parliamentarians. I also pay tribute to my young constituent Lucy Baxter, who was on “BBC Breakfast” this morning and who lives with cystic fibrosis. She spoke to me very soon after I became a Member of Parliament and is an absolute inspiration to me and to the whole cystic fibrosis community.

Today’s debate has been heartfelt and passionate. The stories that we have heard clearly make the case that Orkambi and other drugs for people with cystic fibrosis should be available on the NHS at a price that is fair and affordable. The Government and I share that view. As the Chair of the Health and Social Care Committee, the hon. Member for Totnes (Dr Wollaston), set out so clearly, we must remember that the NHS must use its budget fairly for the good of all patients. That is why we rightly have a system whereby experts, not politicians, determine the fair price for medicines, based on robust evidence. That system has helped many thousands of patients to benefit from rapid access to effective new medicines.

[Karl Turner]

Forgive me, but I genuinely do not know the answer to this—I find it completely confusing. If the Republic of Ireland and Scotland can get an interim agreement, why cannot we sort this out for patients here in England?

[Seema Kennedy]

I will talk about the interim measures, but I think the more important thing that we need to grip is having a permanent solution for everybody living with cystic fibrosis.

Throughout the negotiations, which are rightly being led by NHS England, the Government have been crystal clear that Vertex must re-engage with the NICE process. I know that hon. Members have questions about that process, and I will try to address some of the points that have been raised. The hon. Member for York Central (Rachael Maskell) raised more detailed points for me to consider; if I do not address them, I will write to her with more detail, but there are some points about the NICE process that I will address later in my remarks.

[Jim Shannon]

Would it be possible for the Minister to give her Department’s and her own opinion on the buyers’ group that is seeking to buy similar drugs from Argentina for cystic fibrosis? Have the Government given that possibility any consideration?

[Seema Kennedy]

I shall turn later in my speech to that specific avenue that some sufferers have gone down.

[Dr Wollaston]

The Minister referred to the importance of Vertex engaging with NICE. Does she share my concern that when I wrote to Vertex and NICE about the failure to make progress, Vertex assured me that it had contributed “substantial new evidence” on the three products in question, yet I subsequently heard from NICE that it had received only

“an overview of the clinical evidence”,

rather than genuine engagement? Will she join me in calling on Vertex to properly engage with the process, so that we can get the full evidence base on which to make these decisions?

[Seema Kennedy]

I agree with the Chair of the Health and Social Care Committee and urge Vertex to re-engage with the NICE process. To date, unfortunately, it has continued to refuse to accept the process or has suggested unacceptable conditions on the NICE value assessment of its product, which would render the outcome meaningless. That comes despite NHS England’s latest proposals offering to reimburse Vertex ahead of a positive NICE recommendation, which for a deal of this size is unprecedented; agreeing to implement real-world data collection, as the Committee has called for, to help Vertex to demonstrate the value of its medicines; and offering significantly increased prices in comparison with their offer last July.

NICE has a 20-year history and is internationally renowned and independent. Its methods and processes for the development of its guidance have been in place for 20 years, but it recognises that it needs to evolve. It continues to review its procedures to ensure that they remain fit for purpose; it is now undertaking a review of its technology appraisal methods in line with the commitment in the 2019 voluntary scheme, and it encourages all stakeholders to engage. NICE has recommended 75% of the drugs for rare diseases—some of which I will touch on later—that have been assessed through its technology appraisal programme for the eligible patient population.

Last week, the Association of the British Pharmaceutical Industry made it clear that

“NICE is the cornerstone of NHS efforts to ensure the price being charged by a company represents the value being delivered.”

Commenting on the current situation, it said that

“the APBI would always encourage companies to fully engage with NICE at all stages of the process.”

Furthermore, it commented on the current structure of NHS England’s proposed deal with Vertex, saying that

“the structure of the offer represents exactly the sort of flexibility the industry has been calling for, for some time.”

However, Vertex is willing to accept only its own valuation of Orkambi; I draw your attention, Mr Hanson, to comments directed at Vertex by Members from across the House, including those made by the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson).

[Jeremy Lefroy (Stafford) (Con)]

I am grateful to the Minister for giving way and I apologise for not being here at the beginning of the debate, because of important statements in the main Chamber.

My constituent William Smith, who is a pupil at Cooper Perry Primary School, has cystic fibrosis. Along with his entire class, he presented me with the facts of his case and with letters to the Government, and they made it quite clear that they expect not only the Government but Vertex to come to a decision on this matter. Is it not absolutely vital that a company such as Vertex should engage with the Government given that the lives and futures of people such as William Smith, my 10-year-old constituent, are at stake?

[Seema Kennedy]

My hon. Friend makes a very good point. Members from across the House have told very moving stories of their constituents, the lives they lead, and the stresses and the strains put on them by the lack of an agreement on this matter. However, other drug companies are developing medications for rare diseases, and agreements have been reached on those. I will turn to them very shortly.

We can look at what happened in Spain earlier this year, when Vertex did not accept the terms of Spain’s health outcome-related proposal. The Spanish proposal, which is similar to the recent NHS England offer, is based on the ongoing collection and interpretation of real world data. Why is that not acceptable to Vertex? I also note that dialogue between Spain and Vertex has been ongoing for three years, which is similar to the situation here in England.

We will never walk away, but Vertex must now agree to engage with NICE and we urge it to accept all the flexibilities that NHS England has put on the table. There is nothing unusual about Vertex that means that this is not the right thing for it to do. Recently, we have seen deals reached as part of the NICE appraisal process, including that for ocrelizumab, which is an innovative multiple sclerosis drug, that for Spinraza, which is for people with spinal muscular atrophy, and that for axicabtagene ciloleucel chimeric antigen receptor t cell, or CAR-T, treatments.

Given that Vertex remains an extreme outlier in both pricing and behaviour, it is no wonder that patients and families have been looking at alternative solutions to secure access to this drug, and we have heard about the buyers’ club. Hon. Members have also talked about Crown use licensing, and the hon. Member for Bristol East (Kerry McCarthy) talked about large-scale clinical trials.

Unless Vertex changes its approach and behaves responsibly, I have a moral obligation to look at these other options. Of course NHS England and NICE will carry on the negotiations, because a negotiated outcome is the desired option. However, I have no alternative but to look at these other options on the table.

[Clive Lewis]

I thank the Minister for giving way. I raised the issue of compulsory licensing, which the Government have within their armoury. Of course it would be a measure of last resort, but given that we are dealing with people’s lives, the quality of their lives and a company that is quite simply being intransigent, and greedy, surely that option should be considered. That would send a message to those pharmaceutical companies—that global pharma industry—that if they are going to be greedy and put people’s lives at risk, despite being made fair offers, this option could be used by our Government.

[Seema Kennedy]

I thank the hon. Gentleman for his intervention. As my hon. Friend the Member for Sutton and Cheam said in his opening speech, which was very well made, we recognise the importance of British pharmaceutical companies and that companies invest hugely in developing new drugs. However, as the other examples of drugs for rare diseases that I have given show, it is possible to go through the NICE appraisal process and reach an agreement with NHS England. As one hon. Member who is no longer in their place said, this is an offer for a long-term agreement.

Vertex is an outlier, and I would like to put that on the record.

[Mrs Hodgson]

Will the Minister give way on that point?

[Seema Kennedy]

Yes, and I hope that I will be able to remember the hon. Lady’s question.

[Mrs Hodgson]

At this point I should clarify, for the benefit of the campaigners who I have spoken to about the Crown use licensing option, that it is not an immediate solution from their point of view; I understand that it would take at least a couple of years. If an agreement can be reached, there would be an immediate outcome. That is why the campaign is called Orkambi Now; it is about trying to get the drug now. Although the Crown use licensing option would be an option to consider if nothing else can be found, it would not give the sufferers and their families the drugs as quickly as we would like.

[Seema Kennedy]

As always, the shadow Minister makes an excellent point. Crown use licensing is not something that any Government would consider lightly. It is very rarely used in health. It has probably not been used—my officials will correct me if I am wrong—since the 1970s.

The ideal thing is to get a deal, and deals have been done with other pharmaceutical companies; that is the point I want to make. As I have said, Vertex is an outlier in this regard, but that does not mean that I do not have an obligation to look at other options. I will do that.

[Kerry McCarthy]

Will the Minister give way?

[Seema Kennedy]

Can I just make a tiny bit of progress first?

[Kerry McCarthy]

It is on this issue.

[Seema Kennedy]

All right, given that we have more than half an hour left.

[Kerry McCarthy]

I really welcome the fact that the Minister is saying so passionately that she feels she has a moral obligation to act. The question is: when? I say that because Vertex has been in these talks for a very long time now. How much longer will it be given before the Minister decides to look at the other options?

[Seema Kennedy]

Well, I have already said it, so I suppose that means—

[Kerry McCarthy]

When?

[Seema Kennedy]

Now. We will look at other options to consider what other methods we can use. As the hon. Member for Washington and Sunderland West said, Crown use licensing has other risks, so the best option is to get a deal. However, we will look at other methods that might enable families to receive the drugs they need.

Some Members have said that Orkambi is available in other countries and asked, “So why not here?” Although that is true, it is also true that other countries have faced problems in agreeing an acceptable price with Vertex; around 50% of the global cystic fibrosis population is unable to access Orkambi. It is not approved for reimbursement in Spain, which I have touched on, or in Portugal, and it is not used routinely in France. It is also of note that the Canadian equivalent of NICE has rejected the drug, saying that the benefit of Orkambi is small and uncertain.

We do not have sight of specific commercial agreements where Orkambi is approved and we do not have the same population needs, as we know, because of the specific population that the UK has; compared with other countries, the UK has a very high proportion of people with cystic fibrosis. So I am not able to make comparisons with other countries. Cystic fibrosis affects about 10,500 people in the United Kingdom—a far higher figure than in other countries. It represents 12% of the global cystic fibrosis population. The UK is a very important market for Vertex.

I thank all Members who have spoken so passionately here today. In particular, I thank the people who have joined us here in the Gallery; I pay tribute to them for all that they do to support their family members. I also thank those people, such as Lucy Baxter, who work so hard to raise awareness of this issue. I thank members of the Health and Social Care Committee, which is carrying out a very thorough and transparent inquiry into this issue, helping to shine a light on it.

As we have heard in great and moving detail today, cystic fibrosis is a devastating, life-limiting condition, and the bravery of those affected should be an inspiration to us all. Drugs that improve sufferers’ quality of life should be available where appropriate, and I urge Vertex to do everything it can to price its medicines fairly and in a way that reflects the health benefits to patients.

NHS England and NICE will, of course, continue their efforts to reach an agreement with Vertex. Access to treatment for all patients is, and always will be, a priority for this Government. My Department has a moral obligation to look at other options now, and that is what we shall do.

Medical Cannabis under Prescription

Seema Kennedy Excerpts

Monday 20th May 2019 Commons Chamber

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

This has been a very moving and important debate. As I know from my own constituency, and as has been outlined with such passion by Members on both sides of the House, this matter leads to great distress for patients and their families. I recognise the deep frustration of families and patients, which has come across strongly this evening. All of us who are parents or who have cared for a loved one can empathise with them. I pay tribute to the hon. Member for Middlesbrough (Andy McDonald) and his wife Sally, who shared their experience with us. It is them and parents like them whom we are concentrating on this evening.

It would be remiss of me not to mention my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) and the hon. Member for Gower (Tonia Antoniazzi), all their work on the all-party group and their tenacity in keeping this issue on the agenda. Many points have been raised. Great frustration has been expressed and I have heard that. I will be speaking to the Secretary of State again and taking back all the messages to the officials, but I will try in my remarks to answer the points made.

In November last year, the law was changed to ensure that doctors on the specialist register of the General Medical Council can legally prescribe cannabis-based products for medicinal use in the UK. It is right that we put these decisions in the hands of clinicians because they are the ones with the best knowledge of all the treatments available for conditions in which they specialise. The Secretary of State and I have been clear that whether to prescribe must remain a clinical decision, to be made with patients and their families, taking into account the best available international clinical evidence—I want to reassure the House that we are in close contact with colleagues in other countries to ensure that we learn from their experiences—and the circumstances of each patient.

It is not for me as a politician to second-guess or pillory clinicians’ decisions. I was alarmed to hear my hon. Friend the Member for South Suffolk (James Cartlidge) say that doctors are being trolled for the decisions they are or are not making. They have the best interests of their patients at heart and their primary focus is to do no harm. But I recognise that we do not have the optimal system in place yet. It is undesirable that patients are travelling abroad. The Secretary of State and I are determined to do everything we can to ensure that patients can obtain medicines in this country if it is medically appropriate. There are already systems in place to do that and I want to do everything I can to understand why patients are not using those systems to access medicines here in the UK.

We want to continue to refine the system so that the demands of patients who want to try medicinal cannabis are balanced against other demands on NHS funding. Given the embryonic state of the evidence base on the effectiveness and cost-effectiveness of medicinal cannabis, that is not easy. However, we are working hard to ensure we get this right, because it is crucial. I have had many discussions about this with my hon. Friend the Member for Reigate (Crispin Blunt), who spoke with great passion. He mentioned the need for more evidence and the issue of growing a market. We will explore that with the Department for International Trade.

I want to pick up on a point that my hon. Friend the Member for Henley (John Howell) made about the number of prescriptions issued since November last year. Data show that, until the end of February, there had been six items issued in the community under NHS prescription. He thought there were none at all.

[Sir Mike Penning]

The evidence from the families and the APPG that I co-chair is that there have only been two. If the Minister knows of six, we would love to know not the individual cases but where the other four have come from. The families are confused because at the moment we only know of two.

[Seema Kennedy]

My information is that there are six and I will happily write to my right hon. Friend with more information.

As the House heard last month, the Secretary of State for Health and Social Care has met many of the families and patients who Members know through their work on the APPG or their constituencies. All of us could not help but be moved by these distressing cases and the continued efforts of those who support loved ones. The Secretary of State asked NHS England to conduct a process review to identify any inappropriate barriers to clinically appropriate prescribing. I am pleased to say that the review is under way, and NHS England is working with my right hon. Friend the Member for Hemel Hempstead, the all-party parliamentary group on medical cannabis under prescription and patient representative bodies to identify cases that might best illustrate the experience of a range of patients.

[Sir Mike Penning]

We have lots of time, but the Minister is being generous in giving way. Can she confirm when the interim report will be issued on the blockages and when the final report will be made to the Secretary of State? It was indicated to us at a meeting with NHS England only last week that there would be an interim report by the end of May and a report to the Secretary of State in June. Would the Minister like to confirm that?

[Seema Kennedy]

I will come on to timelines later in my remarks. NHS England is currently obtaining patient consent and scheduling the necessary interviews with clinicians, decision makers and their patients. The first interviews were held today.

I want to touch briefly on devolved matters. Health is a devolved matter, but officials across the UK have been working closely on the development of this policy. The law is exactly the same in all four countries of the UK and only funding is devolved. Members have said that clinicians might be nervous about prescription and that we need to improve training. I will talk about this later, but the training package that has been commissioned from Health Education England will be made available across the UK.

[Jim Shannon]

The Minister has heard my comments on behalf of my young constituent, Sophia Gibson, who is getting medicinal cannabis through the trust area. May I suggest that, if that is how it is done for my constituent in Northern Ireland, it could be done for people across the rest of the United Kingdom through their trust area or non-governmental organisations—wherever the responsibility lies?

--- Later in debate ---

[Seema Kennedy]

I thank the hon. Gentleman for his comments. Prescription is in the hands of the clinician. Whether the prescription is paid for is ruled on locally and I will talk about that later.

I would like to tell my right hon. Friend the Member for Hemel Hempstead that a report, including any recommendations, is expected shortly. We will carefully consider any further action we might take to improve access in the light of that report and the clinical guidelines that are due to be issued by NICE. Members are rightly frustrated with the slow pace, because of the distressing cases and because of examples they have seen from abroad. NICE guidelines have been expedited. They would normally take two years to produce, but these guidelines will come out in half that time, this autumn.

Members have said that patient expectations are not being met and that clinicians are taking an overly cautious approach. With new medicines, we need a strong evidence base. That base is still in development, partly because of the historical overhang.

[Crispin Blunt]

Will the Minister give way?

[Seema Kennedy]

I was about to refer to my hon. Friend, but I will let him speak for himself.

[Crispin Blunt]

The Minister was probably going to pick up the point I made about the assessment of the risk-reward ratio. Humanity has goodness knows how many thousands of years of use of this plant, and it may need a different risk-reward assessment base from the classic medical variety. Sitting in the background for all the people who regulate our medicines is thalidomide and their anxiety about what might happen. We might need a different framework for this.

[Seema Kennedy]

My hon. Friend raises an interesting point, as he always does. The normal NHS medicines governance systems apply, and they are being used to support good clinical practice and safe and effective prescribing, but we could of course do more to educate and support the health profession.

I want to pick up another point raised by my hon. Friend the Member for Henley, about who does the prescribing of these medicines. These are not frontline medicines, and it is right that specialists who have detailed knowledge of all the treatments available for these particularly difficult cases are the ones who should be responsible for prescribing. Cannabis-based products would not normally be considered until a patient was at the stage in their treatment pathway when they were under the treatment of a specialist.

On education, Health Education England has been commissioned to develop an online training package. The aim of the package is to familiarise those working in the health sector with the change in the law and provide straightforward information about the products and what is known about their mechanisms of action. It will support and underpin the knowledge and understanding gained by specialists as experience in prescribing these products grows.

[Charlie Elphicke]

My hon. Friend is being generous in taking interventions. She has set out the risks, but may I pay tribute to her and the Secretary of State, who have not simply looked at all the risks and roadblocks that medics put up, but have said how important it is to produce answers, find solutions and take things forward? I urge them to continue with this excellent work to make sure that progress is made, and to continue to push forward.

[Seema Kennedy]

I thank my hon. Friend. That is why, after the urgent question last month, the Secretary of State issued the process review. As I have said to my right hon. Friend the Member for Hemel Hempstead, that review will be reporting shortly.

We cannot be sure that cannabis-based products are safe or effective. There is a body of anecdotal evidence of therapeutic benefit, and the chief medical officer concluded that the evidence was sufficient to recommend that these products be considered for rescheduling from schedule 1 to schedule 2 under the Misuse of Drugs Regulations 2001, and that their medicinal benefits be further examined. All products in schedule 2 can be prescribed; cannabis-based products for medicinal use are no exception.

I want to talk quickly about the evidence base. Some people have talked about randomised controlled trials, which are what we normally use when there is anecdotal evidence. As hon. Members have said, parents are arbiters of this evidence. The normal procedure is that we do not base prescribing decisions on anecdotal evidence, which is why we have asked the NIHR to stimulate further research. We need to build up the existing evidence base, including through observational trials.

[Julie Cooper]

Does the Minister accept that these are not normal circumstances? These families and parents are absolutely desperate to access the medication that they have seen work for themselves. Can she find some way to circumvent the usual processes?

[Seema Kennedy]

I recognise the deep pain that families are going through, and I do take the point about the great frustration and desperation of the families. What I would say is that we have asked for more evidence, and we are working with everybody necessary to try to get this done as quickly as possible. NICE is internationally recognised for its robust and evidence-based evaluations and guidelines.

[Ronnie Cowan]

I have two families in my constituency whose children are both suffering from epilepsy. They are taking Bedrolite today, and the families know it is beneficial for their kids. That is anecdotal evidence, but it is in their houses and they can see it working. The prescriptions for the sources they have will run out in June and in July. Can the Minister tell me what I should say to those parents when their kids’ prescriptions run out?

[Seema Kennedy]

I do not feel able to comment on a specific issue when I am not a doctor, a clinician or a scientist—

[Ronnie Cowan]

As a parent?

[Seema Kennedy]

Of course I could as a parent, but again, I am not a doctor, and I am not here to make that call. What I would say is that I am very happy to meet the hon. Gentleman to get more of the facts he is presenting to me.

What is needed to support such prescription is evidence of efficacy, and for public funding evidence of cost-efficacy. That is the system we apply to all medicines and medical devices in the UK, and cannabis should not be treated any differently. The current evidence base has been summarised by the professional bodies in their interim clinical guidance, and it will be further examined and reported on by NICE shortly.

[Tonia Antoniazzi]

I have one question for the Minister: has the cost analysis been done on a particular case? When I spoke earlier, I spoke about Alfie Dingley. It would be very interesting to see the impact of his case financially–the benefit that has been gained to the NHS and the money that it has saved the NHS since he has been taking the drug.

[Seema Kennedy]

I apologise to the hon. Lady, because she did ask me that, and I am afraid I forgot to send a note to the Box. I am happy to write to her about whether that analysis has been done.

Many hon. Members, including my hon. Friend the Member for South Suffolk, talked about funding. Funding decisions are local decisions with clear local procedures. The process review is looking at this, and as I have said, it will report shortly. I call on the industry to invest in more trials, and to publish the results and the full underpinning data, because we all want to see licensed products that doctors can use with confidence.

Where there is supporting evidence, the Government and the NHS will work with companies to make the products available. Indeed, more than 110 patients are now being treated with a pure CBD extract product—Epidiolex, which numerous hon. Members have referred to—on an early access programme, ahead of a licensing decision by the European Medicines Agency. In developing a licensed product, the evidence has been generated on the safety profile and effectiveness of the product. It is this that provides clinicians with the confidence to prescribe and the system with the evidence it needs to make decisions on routine funding. The NHS does not routinely fund any new medicine until it has been through a process of evaluation to ensure that it is safe, effective and represents value for money.

On another point that the hon. Member for Gower brought up, about one of her constituents going on the Epidiolex trial, the specialist centres around the country are referring patients to GW Pharmaceuticals. There are certain criteria and a certain number of places, but if she wrote to me, I would be happy to meet her and we could discuss that further.

We need to develop further our knowledge base on these products. That is why good-quality clinical trials are imperative. We need to know more about the scale of the benefit of cannabis-based products across a wide range of indications. We also need to understand how this compares with existing treatments and, indeed, other promising new drugs that may be as effective.

[James Cartlidge]

The Minister is obviously aware that Epidiolex is a CBD-based medicine. Many parents believe, based on their anecdotal experience, that those compounds do not have as much impact on reducing seizures as THC, so can she assure me that the trials will also look at THC-based products?

--- Later in debate ---

[Seema Kennedy]

I cannot say what will be in the trials, because I am not a scientist running them. What I can say is that we have made the call and want everybody who can to take part in the trials so that we have a much fuller picture and can get to a situation where we have licensed products that doctors feel safe prescribing.

I will conclude by thanking all hon. Members who have taken part in this useful debate. This is an extremely difficult area, and hon. Members have spoken movingly about heart-rending cases. I hope that I have shown that the Government take this very seriously. We are committed to ensuring that policy is implemented in a safe and sustainable way, making cannabis-based products available to patients where clinically appropriate.

Health and Social Care

Seema Kennedy Excerpts

Thursday 16th May 2019 Ministerial Corrections

The following is an extract from my reply to an Opposition day debate on Health on 14 May 2019.

[Seema Kennedy]

The hon. Member for Bury South (Mr Lewis) spoke about local mental health provision and the experience of his young constituent. NHS England’s planned spend on mental health in the year ending 2019 was just over £12 billion. For children’s mental health services, it is nearly £7 billion—an increase of 5.6% on the previous year. I would like to reassure him that we are definitely not aiming for a one-size-fits-all service.

[Official Report, 14 May 2019, Vol. 660, c. 191.]

Letter from the Under-Secretary of State for Health and Social Care, the hon. Member for South Ribble (Seema Kennedy):

An error has been identified in my reply to the debate.

The correct wording should have been:

[Seema Kennedy]

The hon. Member for Bury South (Mr Lewis) spoke about local mental health provision and the experience of his young constituent. NHS England’s planned spend on mental health in the year ending 2019 was just over £12 billion. For children’s mental health services, it is nearly £700 million—an increase of 5.6% on the previous year. I would like to reassure him that we are definitely not aiming for a one-size-fits-all service.