Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Dunne]

An all-party parliamentary group has been established this week, I believe, to take this issue forward, and I look forward to speaking to that group, if invited, next month. The remedial order will follow due parliamentary process, which involves its being laid for 60 days and then, after an interval, for a further 60 days.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

There have been 15,000 violent assaults on mental health workers in the west midlands over the last five years. What is the Government’s response to the Care Quality Commission’s opposition to routine searches of all mental health service users for weapons on admission or return to acute in-patient units?

[Mr Hunt]

I have a great deal of sympathy with what the hon. Gentleman has said. We are putting a lot of effort into patient safety and staff safety in mental health trusts, and we are discovering that there is a wide variation between practices. The hon. Gentleman has made an important point, and, if I may, I will write to him to inform him of our progress.

Deafness and Hearing Loss

Steve McCabe Excerpts

Thursday 30th November 2017 Westminster Hall

[Steve McCabe (in the Chair)]

I draw hon. Members’ attention to the fact that our proceedings are being made accessible for people who are deaf or have problems with hearing, and the interpreters are using British Sign Language. If Members bear that in mind while making their contributions, that will be helpful for everyone.

--- Later in debate ---

[Jim Fitzpatrick]

On a point of order, Mr McCabe. I asked my staff to monitor the transmission of the sign language. It is not being broadcast; the cameras do not meet the interpreters. Westminster Hall debates do not have subtitles, unlike in the main Chamber. Obviously I would very much appreciate it if you took that matter back to the Panel of Chairs and discussed it in due course.

[Steve McCabe (in the Chair)]

I understand that the sign language is being filmed today, and when the debate is re-broadcast it will appear in a box, as is normal in other TV transmissions. Obviously this is an early stage. I will report back on how the whole debate goes and any points that Members raise, but I understand that the arrangements for today are that when the debate is re-broadcast, the sign language will appear.

[Jim Fitzpatrick]

I am grateful for that clarification, Mr McCabe.

Children’s Oral Health

Steve McCabe Excerpts

Tuesday 31st October 2017 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered childhood oral health.

Good morning, Mr Bone; it is a pleasure to serve under your chairmanship today. I am glad that we have been granted this debate by the Backbench Business Committee, because child tooth decay represents a much bigger public health issue than appears to have been recognised so far. It is a problem affecting millions of children, including some of the most vulnerable. It should be a real concern to us all.

As well as thanking the various parties for their help in raising this matter, I also want to thank the Faculty of Dental Surgery at the Royal College of Surgeons and the British Dental Association for their efforts in helping to bring this issue to Parliament’s and the public’s attention.

Public Health England reports that 25% of all five-year-olds in England experience tooth decay in at least three to four of their teeth, and that in some parts of the country it can affect as many as 50% of all five-year-olds. Perhaps not surprisingly, there is a link between deprivation and childhood tooth decay, with the poorest areas suffering the worst levels of oral health and the least contact with dentists. A report, shortly to be published by the Nuffield Trust and the Health Foundation, shows that five-year-olds eligible for free school meals are significantly less likely to attend dental check-ups and have more difficulty in finding an NHS dentist.

If we look at the scale of the problem, we will see that more than 45,000 children and young people aged 0 to 19 were admitted to hospital in England over the past year because of tooth decay. They included 26,000 five to nine-year-olds, making tooth decay the leading cause of hospital admissions and emergency operations for that group. Last year more than 40,000 hospital operations for tooth extractions were performed on children and young people, which is the equivalent of about 160 operations every single day.

[Catherine West (Hornsey and Wood Green) (Lab)]

My hon. Friend is making an excellent speech. Does he agree that it is extraordinary that it appears that more children go into hospital because of poor oral health than because of broken arms, whereas when we were children it was definitely the other way around?

[Steve McCabe]

I absolutely agree with my hon .Friend. That gives us some sense of the scale of the problem.

Those 160 operations every single day are not only detrimental to the health and wellbeing of the children; they are also costly to the NHS. In the financial year 2015-16, more than £50 million was spent on tooth extractions for those aged 0 to 19. The average cost of a tooth extraction for a child up to the age of five is approximately £836, and there were some 8,000 such procedures during 2015-16. Dental treatment is a significant cost to the NHS, with spending in England amounting to £3.4 billion on primary and secondary dental care.

In Birmingham, 29% of five-year-olds suffer from tooth decay, which is significantly higher than the national average. Five-year-olds in Birmingham are three and a half times more likely to suffer tooth decay than those in the South West Surrey constituency of the Secretary of State for Health, and yet Birmingham is a city with fluoride in the water. In Manchester, where the water supply is non-fluoridated, the percentage of five-year-olds with tooth decay is 4% higher than in Birmingham. Hospital admissions related to tooth decay for those under the age of 18 in Birmingham have almost doubled in the past four years.

The way in which data are collected and the regional nature of the information sometimes mask the scale of the problems in the same towns and cities. We know that 20% of five-year-olds have tooth decay in south-east England, compared with 34% in north-west England. In Sutton Trinity ward in the Sutton Coldfield constituency, the figure is less than 10%, but the figure for another part of the same city—the Selly Oak ward in my own constituency—is 47%, which is almost twice the national average. Shocking as those figures might be, tooth decay is almost entirely preventable.

Many health experts now agree that early tooth decay can have a broader impact on health and wellbeing, affecting physical and mental health, and impacting on the child’s development and confidence. Poor oral health can also cause children problems with eating and sleeping, which often results in time away from school. Public Health England has conducted research on the number of school days lost due to tooth decay in north-west England. It shows that the average number of days lost per year was three, but many children missed as many as 15 days owing to dental problems.

Some might wonder why childhood tooth decay matters, because children lose their primary teeth which are replaced by new, permanent teeth. The issue is that a high level of disease in primary teeth increases the risk of disease in the permanent teeth. The child’s self-confidence may also be damaged. More than a third of 12-year-olds said in a recent survey that they are embarrassed to smile or laugh because of the condition of their teeth, and that can often make it harder for them to socialise.

So what can we do? There seem to be three crucial steps to addressing the problem: getting children to brush their teeth twice a day; ensuring they see a dentist regularly from a young age; and reducing the amount of sugar that children consume.

Scotland has been running an educational programme called Childsmile since 2001, which has been credited with making a significant improvement to children’s oral health. The programme supports supervised tooth brushing sessions in primary schools and nurseries, as well as providing twice-yearly fluoride varnishes. Perhaps we will hear more about that later.

A similar initiative, Designed to Smile, was introduced in Wales in 2009. Teeth Team, which is supported by Simplyhealth, has invested £137,000 in a dental programme that takes dental education directly to children in local primary schools in the city of Hull.

[Wendy Morton (Aldridge-Brownhills) (Con)]

Teeth Team has visited one of the schools in Brownhills in my constituency. Does the hon. Gentleman agree that we need to further consider such innovative new schemes and other ways to educate children on dental health and tooth-brushing?

[Steve McCabe]

I absolutely agree with the hon. Lady. An education programme for young children and their parents is crucial. I want the Government to play a bigger role, but there are other approaches, too. As I have said, Simplyhealth is supporting the venture in the city of Hull and in East Riding of Yorkshire, as well as in the hon. Lady’s constituency.

A pilot programme called Starting Well is about to commence in 13 areas of England, although none of those pilots will be in Birmingham or the west midlands. I would be grateful for details of the pilot. How long will it run? How will it be evaluated? How were the 13 areas selected? It would also be useful to know exactly how the programme is being funded.

A new initiative by the British Society of Paediatric Dentistry, “Dental Check by One”, is seeking to raise awareness of the importance of getting young children to attend the dentist from an early age. It is supported by organisations across the dental professions. I am pleased to report that it is due to launch in Birmingham tomorrow, despite some torturous negotiations about funding. It seems likely that funding issues will prevent it from being implemented by other regional NHS teams.

What else might be done? Has any consideration been given to proposals from the Faculty of Dental Surgery to use school breakfast clubs to deliver supervised tooth brushing sessions? Analysis by Public Health England has suggested that if public health professionals such as health visitors are involved in supporting oral health improvement programmes, that can lead to significant improvements and long-term savings. Health professionals who have regular contact with children, such as midwives, health visitors, school nurses, pharmacists and early years practitioners, are all ideally placed to help identify children who may be at risk of tooth decay.

Equally, dentists look at all the soft tissues in the mouth and are often able to help identify a number of conditions, from diabetes and Crohn’s disease to oral cancer. According to recent figures on dental attendance, 42% of children aged 0 to 17 did not visit an NHS dentist in the 12 months to 31 March 2017.

[John Grogan (Keighley) (Lab)]

Does my hon. Friend share my concern that a cursory review of the NHS Choices website yesterday showed that there are many areas of the country, including Keighley, where there is no advertising at all of dentists who are available to take on new children as patients? Might one answer to the age-old problem of poorer areas having fewer dentists be an expansion of salaried dentists in the NHS?

[Steve McCabe]

There is certainly an issue with access to dentists in some areas, although it is probably also true that some parents need to realise that visiting the dentist is free for children. There is certainly a question about how we incentivise dentists and provide better coverage.

As I was saying, 42% of children did not see an NHS dentist in the 12 months to 31 March 2017; in Birmingham, that figure is 47%. The Faculty of Dental Surgery has reported that, in the same 12 months, 80% of children aged between one and two did not see a dentist, but official advice recommends that children begin dental check-ups as soon as their first teeth come through, which is usually at around six months.

We may need to reconsider certain elements of existing dental contracts to see if we can better incentivise some dentists to pursue a preventative dental strategy with children. At present, three visits for fluoride treatment equal one unit of dental activity, which is roughly worth about £60 to the dentist. Perhaps we should look at that again. I am sure that both the Minister and local authority public health officials will be keen to remind me about money if I urge greater activity, but I remind hon. Members that parliamentary questions have revealed a clawback of £95 million through undelivered units of dental activity in 2013-14, rising by 36% to £129 million in 2016-17.

Dentistry remains a highly siloed service in the NHS and has been largely neglected from future NHS plans, such as the five year forward view and sustainability and transformation plans. As I have said, education programmes and regular visits to the dentist are needed if we are to begin to tackle the problem, but we also need action to tackle sugar consumption.

There are question marks over how likely the soft drinks industry is to meet the targets agreed under the voluntary reformulation programme. Earlier this year, the Food and Drink Federation announced that it was unlikely to comply with the optional 20% reduction in sugar content by 2020. It has also been revealed that it will be March 2018 before we even know whether the industry has achieved the first target of a 5% reduction by August of this year.

We desperately need to make significant progress towards reducing the amount of sugar in soft drinks and other products. The Government need to look again at their obesity strategy. As luck will have it, it is Sugar Awareness Week. What better time could there be for the Government to seriously consider the suggestion of the Local Government Association and others that we introduce teaspoon labelling on the front of high-sugar products? We should certainly look at advertising, and consider a ban on two-for-one offers and other price promotions on high-sugar products.

Childhood tooth decay is a problem that affects millions of children. It can be extremely painful and it often results in costly tooth extractions under general anaesthetic. Addressing tooth decay is not complicated; we know what works, and the actions I have outlined today could make a real difference. I hope that the Minister will consider those arguments, and that he is in a position to tell us that the Government are considering a series of preventative measures so that good oral health can be enjoyed by all our children.

[Several hon. Members rose—]

--- Later in debate ---

[Dr Whitford]

I thank the hon. Gentleman for that intervention. I was not trying to give any other impression. I said that the core programme is the education of 90,000 children about how to clean their teeth and discussions with their parents about that. The problem is that we waste an opportunity if we stop there. There needs to be a link between health visitors, nurseries and dental practices, and there certainly needs not to be a contract that punishes and penalises dentists for investing in patients. The fact that dentists do not have long-term registered patients means that they do not look at patients with a long-term view and say, “If I do more work now, they will have better dental health later.”

In Scotland, 92% of the population is registered; the number of people who are registered has risen from 2.6 million to 4.9 million. Registration is actually higher in deprived areas than in rich areas. Unfortunately, attendance is not always higher, but people are at least already registered with a practice.

[Steve McCabe]

The hon. Lady is making an excellent speech. I am conscious that this debate is about children’s oral health, but does she accept that, given the growth in the elderly population, the problems that she has indicated will only get worse if we do not have better registration and intervention?

[Dr Whitford]

I totally agree. In so many areas, the health of an adult—even an elderly adult—is actually laid down in their first five years. That is nowhere clearer than in dental health. Laying down good foundations in childhood is critical to allowing many more older people to have healthy teeth and, in particular, healthy gums—in the end, more tooth loss is due to gum disease—and to hang on to their teeth. Registration is important, because it gives people a relationship with a dentist. For people who are frightened of the dentist, knowing their dentist and having access to extra support such as hypnosis, if that helps, is valuable.

Childsmile costs £12 million a year in Scotland in terms of total dental health, but it has saved £5 million in dental treatments and extractions. We heard from the hon. Member for Birmingham, Selly Oak (Steve McCabe) about the money that is coming back. That could be used to set up a programme in England. I welcome the pilots, but those are in only 13 of the 23 worst areas in England. Why do the UK Government feel that they need to pilot? The evidence is there from 10 years of Childsmile in Scotland. If they just looked at the data and designed a national programme for England, in the end they would save not just money but children’s dental health.

--- Later in debate ---

[Steve McCabe]

I thank the Minister and all Members who have taken part in a thoughtful and well-informed debate. I think that £130 million a year clawed back by the Treasury in unused units of dental activity could be put to much better use, and I wish the Minister well in his battle with the Treasury on that.

I was pleased to hear what he said about the dental contract, although I think that two years is a bit long when so much more coverage is required. Obviously, I would like education programmes to be rolled out as quickly as possible across the country, because that is key to what we are trying to achieve. I personally think that we need an even bigger push on sugar, and particularly sugar promotion, as that will make a massive difference to all children.

Question put and agreed to.

Resolved,

That this House has considered children’s oral health.

NHS Shared Business Services

Steve McCabe Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

I am happy to confirm that. I think that in such situations it is important to allay public concerns about what might have happened. What happened was unacceptable, but no patient data were lost.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State says that no patients were harmed and that the documents were securely stored, but 35 sacks of mail were destroyed. How does he know that he made the right call in every situation?

[Mr Hunt]

Just to be clear, what I said was that to date there is no evidence of any patients being harmed, but the process of proper clinical review, with multidisciplinary teams, will take until the end of the year. We have to do this properly to get to the answer. We hope that it remains the case that no patients were harmed, but we will not know that until the end of the year. However, throughout this whole process we have prioritised the highest risk cases and made sure that they get the most urgent attention.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 21st March 2017 Commons Chamber

[Nicola Blackwood]

My hon. Friend has raised this case with the Department and has been making a number of pleas on behalf of his constituent. It is a very difficult case and I would like to pass on my sympathies to his constituent. Obviously, the National Institute for Health and Care Excellence is independent and this drug is not recommended for TRAPS. I do not know the details of the case because it is confidential, but I will be very happy to meet my hon. Friend and his constituent to see if anything can be done.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I do not know if you spotted the rather topical news story about children’s dentistry this morning, Mr Speaker: there were 1,464 hospital admissions for children for teeth extractions across one clinical commissioning area of Birmingham last year, the highest figure since 2010-11. How does the Minister account for this, and what is he going to do about it?

[David Mowat]

The figures for child extractions are clearly disappointing and two key actions need to take place: less sugar, which we expect the soft drinks levy to help with; and getting more fluoride on to teeth, particularly through fluoride varnishing. That has increased across the NHS over the last year, and by 12% in Birmingham. We hope that that will make a difference.

Health and Social Care

Steve McCabe Excerpts

Monday 27th February 2017 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Often, the NHS estimates day debate is a rather perfunctory affair, but this year, five years into the reign of the present Secretary of State, we are entitled to ask what on earth is happening to our NHS and social care system. Can we any longer afford the extraordinary complacency of this Government? As an Opposition MP, I sometimes worry that, either by design or simple neglect, they will finally fulfil our worst fears that the Tory party is destined to destroy the NHS.

[Kevin Foster]

So much for cross-party dialogue.

[Steve McCabe]

I don’t think I need any lectures on cross-party dialogue from the party of the death tax and the £8 billion financial fib.

In Birmingham, we have seen £28 million cuts to the social care budget, bringing the service to its knees. Elderly people are being treated like cattle, lying around on trolleys, waiting in corridors and dispatched from hospital in the middle of the night. Everywhere we look, we see our hospitals, GPs and social care services collapsing under the strain.

This Secretary of State is quite happy to flex his muscles when it comes to bullying junior doctors, but it is always someone else’s fault when it comes to resources, management and administration of the NHS. There was a time when the deal was simple: in return for the red box and a ministerial salary, Ministers took responsibility —the buck stopped with them. But no more. I have lost track of how many parliamentary answers begin with the words, “The Department does not collect that data centrally,” or “It would not be cost-effective to provide information in that format”. Basically, Ministers do not know, do not want to know and do not want us to know what is really happening. They no longer preside over a genuinely national health service. Whether it is the postcode lottery that characterises the provision of IVF, with clinical commissioning groups ignoring NICE guidelines and making up their own criteria as they go along, or children’s dentistry, where there is a growing crisis and a heavy reliance on hospital emergency surgery because of the lack of provision and monitoring of proper dental services for children, all this Government want to do is hide behind and blame others for their shambolic decisions.

The latest disaster is the business rates revaluation, which in Birmingham is estimated to see a rise for University Hospitals Birmingham’s Queen Elizabeth hospital from £2.8 million to £6.9 million per year—talk about robbing Peter to pay Paul! And yet Ministers from the Department for Communities and Local Government and the Department of Health have not even met to discuss the problem—although I note that private hospitals get an 80% reduction because they are registered as charities.

In my constituency, we have been fighting a battle to save our Katie Road walk-in centre for several years: we have had stop-go consultations, money wasted, explanations and excuses that vary from month to month, consultations announced and then scrapped, and now we have a sustainability and transformation plan that sadly, as acknowledged, has turned into a secret strategy drawn up by non-elected bureaucrats from which the public and their elected representatives have been largely excluded. It seems that Katie Road is now caught up in this fiasco. With its contract scheduled to finish on the 31st of next month, we still do not know what is happening, although if rumours are true, even more money that ought to be spent on healthcare in Birmingham is about to be siphoned off to rescue bankrupt neighbours.

Only the other week, I discovered that the contract for South Maypole GP services was to be cancelled. It is apparently no longer cost-effective—not cost effective to provide GP services to the sick and elderly! Only under this Secretary of State could the NHS have come to this.

[Kevin Hollinrake]

In my remarks, I talked about a cross-party conversation. I could easily have pointed out that between 2011 and 2014 there was an 8.6% real-terms drop in health spending in Wales, under a Labour Administration, while there was a 4% increase in England, but would it not be better to have a constructive conversation about how we take the NHS and social care off the front pages of the tabloids and to sit down and work out a solution together?

[Steve McCabe]

It is always desirable to have that conversation when the Tories are in power. When Labour is in power, we talk about death tax campaigns and we hear about £8 billion funding fibs. It is funny how the argument always changes when they are responsible.

As I was saying, the contract for South Maypole GP services is about to be withdrawn. I found that out not when the CCG, which it turns out has been ruminating on this since November, told me, but when I was contacted by anxious constituents who had just found out they had eight weeks to find a new GP. Many of them are elderly people, and some have long-term conditions and rely on regular medication, but they are dismissed as if they do not matter. The loss of their GP service is treated like the closure of a local hairdresser or petrol station. They are told to shop around. Apparently the CCG thinks there are enough GPs in the area—enough at any rate to satisfy their little diagrams and tables on their secret little plans. Reducing demand for acute care is one of the Government’s plans to ease pressures in the NHS. Exactly how do we achieve that by closing walk-in centres and GP surgeries? Is that not the fastest route to our already overstretched A&E departments?

It is not just the estimates at issue here, but a proper long-term plan for the NHS and social care. This Secretary of State has failed us. His stewardship is a disaster. Rather than accepting more of it, the House should be calling for a motion of censure. The Government and the Secretary of State are presiding over the steady dismantling of the country’s greatest peacetime achievement. It is a total disgrace.

NHS Fertility Services

Steve McCabe Excerpts

Thursday 19th January 2017 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered decommissioning of in vitro fertilisation and other NHS fertility services.

It is a pleasure to serve under your chairmanship today, Mrs Gillan.

I am grateful to the Backbench Business Committee for granting this debate; to the right hon. Members for Carshalton and Wallington (Tom Brake), and for Wantage (Mr Vaizey), for their support in securing it; and to the many other Members who are either here today or who have indicated their support for a debate on IVF. Change is urgently needed in this area, and we have broad, cross-party support for such change.

I know that it is not customary, Mrs Gillan, to refer to the Public Gallery during debates such as this one, but perhaps I can just say in passing that I am told that a number of people have travelled here today because of the importance they attach to this issue, and because of their strong feelings that what is going on is not fair and needs to change. It is through listening to their experiences that I have begun to understand the extent to which the present arrangements are not working.

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

Does the hon. Gentleman agree that, rather than imposing a postcode lottery on our constituents by withdrawing these services, the areas under financial pressure need to become more efficient and to look at how other areas manage their health systems better to make efficiencies, so that in vitro fertilisation can be provided everywhere?

[Steve McCabe]

I certainly agree with the hon. Gentleman about a postcode lottery; there is a massive variation in service, so we must strive to achieve a cost-efficient system that is genuinely national in the way it is delivered. I agree with that absolutely.

This debate is about IVF and related services. At a time of so much concern about the NHS generally, the debate could easily drift towards becoming a series of questions about other aspects of the NHS, but I am clear that we asked for this debate to raise concerns associated with those who need treatment for infertility issues.

Infertility is a problem that does not get a lot of Government or parliamentary attention; in fact, it was not debated at all in the previous Parliament. Yet we know that it is an issue that affects one in six couples in the UK and is the second most common reason for a woman to visit her GP. The problems of infertility are recognised by the World Health Organisation as a condition for which medical treatment should be provided, but that is not how we approach the matter today in England.

I am immensely grateful to my constituent Louise Jackson for bringing this issue to my attention and for giving me permission to share some of her experience with people today. Louise and her partner have been together for more than 13 years and have been trying for a baby for nearly six years. After tests confirmed that they would need IVF treatment, they were refused it because Louise’s partner already had a child, as a result of a previous relationship in 1975. That child is actually older than Louise herself, who has said:

“Anyone who is experiencing fertility problems will understand the agonising pain and upset it brings on a daily basis. The fact that we have been refused treatment on the NHS just adds to the anguish. We cannot express enough how hard it is to not be able to have children naturally, never mind being faced with the fact we’ve been saving for years for the thousands needed for this treatment. I hope one day these laws will be changed for couples like us and others in the near future.”

My information is that four clinical commissioning groups in England—Mid Essex, North East Essex, Basildon and Brentwood, and South Norfolk—have already decommissioned their assisted conception services, essentially as a cost-saving measure. Also, more than one in 10 CCGs in England are currently consulting on reducing or entirely decommissioning NHS fertility treatment. That means that more than 60 Members of Parliament represent seats where the provision of IVF services is at risk.

The guidelines produced by the National Institute for Health and Care Excellence are fairly clear on the provision of IVF services. NICE recommends that all those women who are eligible for IVF should have access to three full cycles of IVF if the woman is aged under 40, and in 2013 it updated its guidance to recommend further that women aged between 40 and 42, and who meet some additional criteria, should have access to one full cycle.

Fertility Fairness is an umbrella body that has the support of several organisations, including the Royal College of Nursing, the Association of Clinical Embryologists, the British Fertility Society, the National Gamete Donation Trust and the Miscarriage Association. In 2016, it undertook an audit of every CCG in England and found that only 16% of CCGs offer three cycles of IVF, which is the NICE recommendation. That was down from 24% in 2013, while the number of CCGs offering just one cycle of NHS-funded IVF treatment has leapt to 60%. The Minister is on record as saying that she finds the decommissioning of such services “unacceptable”, so she will not be surprised if I ask her what she plans to do in response to these figures.

According to NICE, a full cycle of IVF treatment should include one round of ovarian stimulation and the transfer of all resultant fresh and frozen embryos, but only four out of 209 CCGs comply with the NICE definition of a “full cycle”. As a result, in many parts of England, these efforts to provide IVF on the cheap are—perversely—wasting resources, because this incomplete offer is rarely successful and compromises the cost-effectiveness of IVF as a treatment. It is a bit like giving less than the recommended dosage of any other drug or treatment.

As I have said, NICE offers guidance on age appropriateness for IVF. However, without being required to offer any kind of explanation, some CCGs have lowered the maximum age for IVF to 35; others have introduced non-medical criteria, such as refusing couples treatment if one of them has a child from a previous relationship, as happened in the case of my constituent, Louise Jackson; and apparently even more criteria are applied for same-sex couples, including a requirement to demonstrate that they have already paid privately for six cycles of treatment before they can be considered by the NHS. Those requirements do not look like medical criteria to me; they look like crude, discriminatory rationing, based on pseudo-moralistic prejudices.

In Birmingham, CCGs justify their approach by testing their proposals via public consultation, and in 2014 a consultation covering the criteria for eight CCGs across the west midlands was undertaken. Of the 351 people who responded, 40% were against providing IVF to a couple where one party has a child from a previous relationship; 40% disagreed with that view; and 20% did not know. Nevertheless, those proposals are now the criteria that must be met. I cannot imagine such a crude approach being adopted for determining treatment eligibility for any other medical condition, but that of course is part of the problem.

Too many people think, in defiance of the World Health Organisation, that it is a lifestyle issue and not a medical condition. That is not helped by the fact that the Department of Health merely asks that CCGs “have regard to” the NICE guidelines. This recognised medical condition can have a number of related impacts. If left untreated, it can result in stress, anxiety, depression and the breakdown of relationships. A recent survey of almost 1,000 people with infertility problems conducted by Middlesex University found that 90% of respondents reported feeling depressed and 42% reported feeling suicidal, which was up from 20% when a similar study was conducted in 1997. Some 70% reported a detrimental impact on their relationship, and 15% said that it had led to the break-up of their relationship.

The debate is not about statistics, though; it is about real people and the devastating impact that being denied treatment for infertility problems can have on their lives. On Monday afternoon, I took part in a digital debate with many members of the public, and they helped contribute to our debate today. Hundreds of people shared their experiences. I cannot name them all, but I would like to take this opportunity to thank them for their contributions. I want to briefly share just a few examples that illustrate the kind of problems that mean we need to see some significant change in the delivery of this service.

Kelly Da Silva from south Derbyshire said:

“This is such an important issue for me, the anxiety and depression caused as a direct result of infertility and involuntary childlessness has affected every aspect of my life and caused me to leave a successful 12-year teaching career. The emotional and social impacts are absolutely devastating.”

Becky Thomas is from Hertfordshire, and comes under the direction of a Cambridgeshire CCG. She said:

“My local CCG cut the amount of cycles they offer from three down to one and are considering getting rid altogether. I live in one area that actually offers three full cycles however I come under a completely different CCG. It shouldn’t be a postcode lottery. It’s not a lifestyle choice. It’s a medical condition.”

Erin Nina Desirae from Sheffield said:

“I am in a same-sex marriage. My wife and I have been together for six years and have always talked about having children. We assumed that the law in this country would support us and enable us to try for a family with help from the NHS. Unfortunately, we were surprised and hurt to find that same-sex couples are not offered fertility treatment on the NHS until we have first self-funded at least six cycles ourselves. Whilst a heterosexual couple can receive NHS treatment after two years of trying to conceive. This feels like discrimination. Why should we be treated differently?”

What of the costs? Evidence suggests that many of the decommissioning and service reduction decisions are driven largely by budget considerations. Reports show that the cost to CCGs of commissioning one cycle of IVF can range from £1,300 to £6,000. It varies dramatically across the country. For example, it is much cheaper in Newcastle than it is in Birmingham, without any obvious explanation. What kind of way is that to run a health service and provide a vital treatment? Is it not a classic example of the fragmentation of the NHS that many predicted would follow the Lansley reorganisation?

In England, more than 200 CCGs are responsible for setting their own criteria and commissioning their own IVF services. To make matters worse, research suggests that the high cost of IVF in the private sector is forcing people to travel to such countries as the Czech Republic, where IVF treatment is far cheaper. The problem is that IVF is not anywhere near as well regulated in those countries as it is in the UK. As a direct result of reducing services in the UK, the NHS is being saddled with the high cost of complicated multiple pregnancies and births and other postnatal issues. There is also the additional cost to mental health services, which I touched on earlier. [Interruption.] As you can see, Mrs Gillan, I have successfully transposed a page of my notes. I hope you will bear with me for one second.

[Mrs Cheryl Gillan (in the Chair)]

Mr McCabe, this sort of thing happens to people all the time. We will bear with you.

[Steve McCabe]

I cannot believe I have done it, but I am extremely grateful for your patience.

As I was saying, the costs of people having to go abroad fall on the NHS, and that leads to further complications that may impact on our mental health services.

In the course of my speech, I have concentrated on the impact on women, but the issue does not solely affect women. It affects couples, same-sex couples and men. I understand that CCGs that are cutting back on IVF generally are also cutting back on ICSI—I am told that it stands for intracytoplasmic sperm injection and is the most common treatment for men with infertility problems—and I worry that men’s experiences of infertility are not fully appreciated. They may also suffer hidden trauma and stress as a result of their problems. I am grateful to Richard Clothier from Dunstable who said:

“The emotional strain served to us when our infertility was confirmed was absolutely horrific and debilitating. However, this does not touch the sides when compared with the mental health deterioration we endured from the precise point at which we learned our entitlement has been slashed by two thirds. Luton, in the same county, has three cycles, the rest of us in Bedfordshire get just one cycle.”

What do I hope to get from this debate? I hope that the Minister, by the time she has had a chance to reflect on all the contributions and the terrible experiences of so many people, will have heard enough to be convinced that she should set up an investigation into the provision of IVF services in England. I hope she will be persuaded to offer much stronger guidance to clinical commissioning groups that in all normal circumstances they should be expected to comply with NICE guidelines and at the very least offer a clear and unambiguous explanation for their reasons when they choose not to follow NICE guidelines. I hope she will be persuaded to look again at the case for setting a national tariff for the provision of IVF. It is simply ludicrous that when NHS resources are so stretched, as the hon. Member for South West Bedfordshire (Andrew Selous) said earlier, the same treatment can vary in price between £1,300 and £6,000. Those who have suffered with this condition feel they have been ignored and mistreated for far too long. They are entitled to expect that we will now act to address the problem.

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[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe), my right hon. Friend the Member for Wantage (Mr Vaizey) and the right hon. Member for Carshalton and Wallington (Tom Brake), who is not in his place, on securing this important debate. I am grateful for the opportunity to discuss NHS fertility services. This has been a moving debate and, on behalf of the Government, I recognise at the outset that infertility is a serious condition, affecting a growing number of people: women and men and same-sex couples. I personally thank all of those who have allowed their stories to be shared today. They remind us powerfully of the distress that infertility causes. The value of their being shared in the debate cannot be overstated.

It is important to remember that those stories are not isolated cases. As hon. Members are well aware, fertility problems are estimated to affect one in seven heterosexual couples and, for couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring in the following year is 25% or less. We should keep those figures in our minds.

As my right hon. Friend said, infertility can and does have a powerful and lasting impact on the quality of life of those affected. Research has shown that there can often be psychological effects, as powerfully described in the debate, for both men and women suffering from fertility problems. It can cause stress and it puts pressure on relationships, primarily between the couple themselves but also on relationships with family and friends. It is therefore important that the NHS provides access to fertility services for those who need clinical help to start a family.

The availability of NHS fertility treatment is and always has been a matter for local determination. As my right hon. Friend said, these are not easy decisions to make, but we expect them to be made fairly. Decisions on the level of service provision are underpinned by clinical insight and knowledge of local healthcare need. That has been the case since the introduction of the purchaser-provider split in the 1990s, and today that determination is, as we all know, made by CCGs, which are clinician-led and have a statutory responsibility to commission healthcare services that meet the needs of their whole population, reducing inequalities and improving care quality.

While provision of services will, by necessity, vary—for example, the health needs and priorities of the population of Birmingham will not be the same as that of Bournemouth—it is right that those difficult prioritisation decisions are led by clinicians who know their patients and local areas best rather than being made centrally. The Government have made it clear that blanket restrictions on any healthcare treatment—including fertility services—are unacceptable. Where a service is not routinely commissioned, clinicians can still make individual funding requests for their patients when a clinical case can be made and if treatment is likely to provide significant benefit. It is the role of NHS England to ensure that CCGs are not breaching their statutory responsibility to provide services that meet the needs of their local population and to take action if such breaches do take place.

[Steve McCabe]

I recognise what the Minister says about this being an issue for local determination. However, does she agree that it does not make sense to use moralistic criteria to ration the provision of services, which—as in the example I cited in Birmingham—is then put to a public poll that produces an inconclusive result on a very low turnout? Surely that is not the kind of local determination we want. Is that not something that NHS England should act on?

[Nicola Blackwood]

The hon. Gentleman gave a very good opening speech in which he raised some points that I will comment on. The quality of commissioning of fertility services is one of those points, and having regard for guidance already in place to guide local commissioners in commissioning fertility services is a point on which I am about to comment. He has anticipated my speech as only a seasoned politician can.

NICE first introduced its fertility guidelines in 2004. As with all clinical service guidelines, they have never been mandatory. Successive Administrations have supported the principle of locally determined implementation of key recommendations of the guidelines, because decisions about local services should be made as close to patients as possible by those best placed to work with patients and the public in their area to understand their needs. However, it is sadly the case that implementation has been variable over the years, particularly with the provision of three IVF cycles for qualifying couples, as we have heard. As the hon. Member for Birmingham, Selly Oak and the shadow Minister rightly said, the 2016 Fertility Fairness survey showed that just 16% of CCGs provided the recommended three cycles of IVF, with 22% providing two, 60% providing one and 2% providing no IVF funding at all.

I understand that commissioners in some areas are undertaking their own evidence reviews, as the hon. Member for Birmingham, Selly Oak said, to determine whether their CCG should offer IVF. I take this opportunity to say that that is unnecessary. NICE was established for the specific purpose of reviewing the available clinical and scientific evidence of a treatment’s effectiveness and, working with a wide range of stakeholders, to make recommendations based on that evidence about services that should be available to all within the NHS. NICE guidelines for fertility services are robust and fit for purpose, and there is no need for them to be second-guessed by commissioners.

The hon. Gentleman also raised NICE guidelines for same-sex couples. NICE guidelines seek to offer heterosexual and same-sex couples the same access to investigation and treatment for fertility problems, the criterion for which is a failure to conceive over a set period of time. NICE sets that criterion to ensure that NHS funding is available for donor sperm for female same-sex couples, or surrogacy arrangements for male same-sex couples, on the basis that they are medically sub-fertile, not that their childlessness is owing to the absence of gametes from the opposite sex—sperm or eggs.

Access to NHS-funded investigations is commissioned in female same-sex couples who fail to conceive after six cycles of artificial insemination within a 12-month period. NICE recognises that same-sex couples could be disadvantaged, because they may have to pay for artificial insemination before they can be considered for NICE assessment and possible treatment. NICE considers six cycles to be equivalent to the 12-month period of unprotected intercourse required of heterosexual couples before they are offered investigation for fertility problems. Same-sex couples are offered access to professional consultation and advice in reproductive medicine before they embark on attempts to conceive, to ensure that they are informed about appropriate and safe self-funding attempts. I can tell the hon. Member for Birmingham, Selly Oak that NICE is due to review its fertility guidelines this year, and he may wish to write to NICE’s guidelines review team to offer his views on the issue. The Department of Health will certainly be doing so.

On the implementation of NICE guidelines, I commend CCGs, such as Camden, Oldham and others that have been mentioned, that have implemented the NICE fertility guidelines in full and continue to offer three IVF cycles to qualifying couples. That shows it is entirely possible for CCGs to implement NICE’s IVF provision recommendations. It was disheartening to learn from the Fertility Fairness survey that access to IVF treatment on the NHS has been reduced in so many places, and it is deeply disappointing that some CCGs have stopped routinely commissioning it. I strongly encourage all CCGs to implement the NICE fertility guidelines in full, as some CCGs are successfully doing.

--- Later in debate ---

[Steve McCabe]

I thank the various Members who have taken part in this debate: the right hon. Member for Wantage (Mr Vaizey), my hon. Friends the Members for Coventry North East (Colleen Fletcher) and for Ellesmere Port and Neston (Justin Madders) and the hon. Member for South West Bedfordshire (Andrew Selous), who has now left. It is never easy on a Thursday afternoon, but I really felt we had to have some focus on this issue in this place today.

I am extremely grateful to the Minister for the tone she adopted in her response. One reason why I asked her to instigate an investigation into what is happening is that I understand, from a parliamentary question I submitted, that the Government do not, as a matter of routine, centrally collect information on the provision of infertility services. While I acknowledge her point about provision being locally determined, the extent of the disparity has been a revelation to me. It is difficult to believe we are talking about a national health service when we see that level of disparity. I gently say to her that there would still be some merit in a further investigation into the extent of the variation in England at present.

I am extremely pleased to hear that the Minister plans to write to NHS England. I interpret that as meaning she will put pressure on NHS England to put pressure on the CCGs that are not complying with the NICE guidelines. I will certainly take the opportunity to write to NICE about the experience of same-sex couples, as she suggested, although the key here is obviously that the NICE guidelines have to be followed. That is the central problem.

I was extremely pleased to hear that the Minister is taking steps on benchmark pricing, which may well lead to the construction of a national tariff. All I will say on that is: the sooner, the better. If she were able at some stage to offer us a realistic timescale for that, it would be some comfort to the very many people who have contacted all of us to explain the pain and anguish they have suffered as a result of this condition. I am grateful to Members for their contributions and to the Minister for a thoughtful response.

[Mrs Cheryl Gillan (in the Chair)]

This has been a very valuable and important debate.

Question put and agreed to.

Resolved,

That this House has considered decommissioning of in vitro fertilisation and other NHS fertility services.

Child Cancer

Steve McCabe Excerpts

Monday 28th November 2016 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I begin by congratulating the hon. Member for Bath (Ben Howlett) on introducing the debate and on the thoughtful way in which he presented the arguments. I am pleased to make a short contribution. I have come at the urging of my constituent Debbie Moran, whose young daughter Abigail is just five and was diagnosed with a childhood cancer at the age of three. I understand Abigail is in remission, and we wish her and the rest of the family all the best for the future.

The figures I have seen suggest that each year more than 6,000 young people across Europe die of cancer, but by 2020 there will be nearly half a million childhood cancer survivors. I hope we will bear that progress in mind today. I welcome the work of the European Network for Cancer Research in Children and Adolescents, SIOPE—the European Society for Paediatric Oncology—and the European paediatric haematology and oncology community. I particularly welcome SIOPE’s seven-point plan to increase over the next 10 years the cure rate and the quality of survivorship for children and young people with cancer.

Like the hon. Gentleman, I hope that whatever decisions this country makes over Brexit, we will remain an active part of the important European cancer research and treatment community. As the hon. Member for South Ribble (Seema Kennedy) said, we need more innovative treatments introduced into child cancer care. We need the development of precision cancer medicine to help guide decisions on which therapies to use. We need to increase our knowledge of tumour biology and speed up the translation from basic research to clinical care. As my hon. Friend the Member for Alyn and Deeside (Mark Tami) said, we also need to improve the quality of survivorship and address the consequences of cancer treatment, such as the long-term side effects in all their various forms. Basically, we need to understand more about the causes of childhood cancers.

Although there has been significant progress over the past 50 years—the hon. Member for Bath described some of that—it has largely been achieved by using intensive chemotherapy regimens combined with surgery and/or radiotherapy. There is some evidence to suggest that patient survival has plateaued over the past five years, which hastens the demand for more innovative treatments.

The petition focuses on the problems we need to address, such as the lack of sustained and sufficient funding. As has been suggested, there is also poor access right across Europe to new paediatric drugs. Too many countries do not recognise paediatric haematology and oncology as a sub-speciality. For the sake of Abigail and thousands of children like her, and in memory of Poppy-Mai, whose parents are the originators of the petition, we need to dedicate ourselves to saying that we recognise the seriousness of the issue and that we are going to do more.

Health Service Medical Supplies (Costs) Bill

Steve McCabe Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

I am grateful to my hon. Friend for raising that issue. Although the measures he mentions are not directly covered in this Bill, he reminds the House that the business of getting value for money from our drugs business is everyone’s business throughout the NHS. There is a huge amount of prescribing of medicines that is not strictly necessary. Indeed, we had further evidence of that from the Academy of Medical Royal Colleges this morning. My hon. Friend makes an extremely important point: this Bill is part of the effort to get better value for money from our medicines budget, but initiatives such as the one he talks about are equally important.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Further to that question, I can see how the Bill will deal with the issue of debranding, and that is very welcome, but I understand there are three other areas of concern. There is the question of price delay, which the Competition and Markets Authority has been looking at, and there are the problems of tying and bundling and so-called loyalty schemes, all of which act to inflate the cost of medicines to the NHS artificially. Will the Bill also deal with those areas?

[Mr Hunt]

It will deal with some of those concerns, and we will listen to all the concerns raised by hon. Members during the progress of the Bill. On the particular issue the hon. Gentleman raises, the CMA is already investigating the behaviour of pharmaceutical companies in certain situations, but it has become clear to us that there is a particularly unethical and unacceptable practice of drugs companies getting control of generic drugs for which they command a monopoly position and then hiking the prices. There was one product whose price increased by 12,000% between 2008 and 2016, and if the price had stayed the same as before the increase, the NHS would have spent £58 million less. The Government’s conclusion is that the simplest and quickest way to sort this out is through new legislation, but I will happily take the hon. Gentleman’s other concerns offline and look into them further.

--- Later in debate ---

[Justin Madders]

My hon. Friend tempts me a little way outside my brief. I note, though, that our health service is entering into partnerships with Google, so I hope that questions are being asked by Ministers about the taxation arrangements.

We know that the vast majority of the generics sector is well controlled by competition and delivers value for money to the taxpayer, and we welcome the extension of pricing controls where competition has failed. Is the Minister confident, however, that the steps taken in the Bill are adequate? We have seen, as my hon. Friend the Member for Wolverhampton South West mentioned, how adept international companies can be at moving figures around to avoid taxation, and we clearly want to ensure that the system that we develop is not vulnerable to the gaming that we have seen elsewhere. I do not think for a minute that given the vast sums of money at stake, the companies will just shrug their shoulders and take the hit if they can avoid it.

I was more than a little concerned when I read a section about this Bill in a Concordia investor presentation, which said that in the past the Department of Health

“would seek informal negotiations with manufacturers where it believed there were pricing issues. We believe this step will remain.”

The notion of informal talks with officials brings up uncomfortable memories of the sweetheart deals between multinationals and Her Majesty’s Revenue and Customs. Although I am happy for chains of communication to be open with such companies, can the Minister reassure us that in all cases prices will be regulated through a transparent, formal process and not through behind-the-scenes talks?

[Steve McCabe]

Where the advertising budgets of pharmaceutical companies dwarf their R&D budgets, is there not an argument for the Government to look again at the tax position of those companies, as well as at the price of their products?

[Justin Madders]

We will not get very far with this Government on corporation tax. They have been going in a direction that we would not have chosen. They have decided on the measures in the Bill as the best way to control prices and we will see how they get on. Will the Minister confirm that if it becomes clear in a few years that we have opened up another set of loopholes, we can expect the Department to take the lead and to be proactive in its investigations, rather than relying on a team of journalists to expose the problem?

We know that in Scotland the rebate that has been generated has been used to create a dedicated fund to give patients access to new medicines. Will the Minister consider investigating similar models and ensuring that the benefits of the scheme are used for the purpose of improving our frankly poor record in allowing patients to benefit from new medicines? We accept that there will always be challenges in matching funding to new drugs, but there is at least a degree of logic in allowing savings made in the drugs bill to be reinvested to enable new products to reach patients more quickly.

We welcome today’s report by the Accelerated Access Review, which sets out an ambitious plan that could see patients accessing new lifesaving treatments up to four years sooner. We hope the Minister will take this opportunity to give financial backing to the aims of the review by committing to using future rebates from the pharmaceutical sector to improve access to treatments. I ask the Government to seriously consider this, as there are growing concerns about access to new drugs and treatments in this country, and particularly about the widening gulf between the UK’s record on developing new drugs and the ability of the NHS to ensure that all patients benefit sufficiently.

The “International Comparisons of Health Technology Assessment” report published in August by Breast Cancer Now and Prostate Cancer UK shows that NHS cancer patients in the UK are missing out on innovative treatments that are being made available in some comparable countries of similar wealth. This is at the same time as a number of medicines have been delisted by the Cancer Drugs Fund after it overspent its budget, and the failure to extend this scheme to innovative treatments as well as medication. There was a report in The BMJ in July entitled “A pill too hard to swallow: how the NHS is limiting access to high priced drugs”. It came to similar conclusions when looking at new antiviral drugs that held out a real prospect of eliminating hepatitis C but which were very expensive.

NHS Sustainability and Transformation Plans

Steve McCabe Excerpts

Wednesday 14th September 2016 Commons Chamber

[Ms Abbott]

I need to make progress.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Will my hon. Friend give way?

[Ms Abbott]

Yes.

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[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I think we can spot that the hon. Lady has just given way to a Government Member and now she is giving way to an Opposition Member. We do not need the cheering to go with it.

[Steve McCabe]

I want to check this with my hon. Friend. The last time I checked, Simon Stevens had said that STPs were designed to make up the £22 billion shortfall that the Government are not prepared to put in. Is that not the case?

[Ms Abbott]

It is indeed the case; rather than being an anodyne managerial exercise, the sustainability and transformation plans are designed to make up the missing £22 billion.

One of the most alarming aspects of the STPs is their secrecy. England has been divided into 44 regional footprints, and it is worth noting that they are called footprints to distract from the fact that they are ad hoc regional structures—they are the exact same regional structures that the Tory health Bill was supposed to sweep away. Because they are ad hoc and non-statutory, they are wholly unaccountable. In the world of the STPs, the public have no right to know.