Bladder and Bowel Continence Care

Will Quince Excerpts

Thursday 29th June 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Graham. It is unusual to have almost an hour to respond to a Westminster Hall debate. I assure you that I do not intend to use all that time, but I will endeavour to answer as many questions as possible.

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate, and on his appointment as chair of the all-party parliamentary group for bladder and bowl continence care. I join him in paying tribute to campaigners such as the Urology Foundation for their incredible work during Continence Week and throughout the year.

I thank my hon. Friend for sharing the experience of the young adult who contacted him. That is what this debate, and this place, is all about. It is about destigmatising the issue, which was the No. 1 ask of that young adult. It is also about trying to bring about positive change not just for him but for patients up and down the country, especially given how many people we know are affected by continence issues.

We know—my hon. Friend set this out very articulately and eloquently—that incontinence is an issue with which too many suffer in silence. We must all learn to speak more openly about it. As the hon. Member for Bristol South (Karin Smyth) rightly set out, it is estimated that around 14 million men, women, young people and children, of all ages, are living with bladder problems. As has also been pointed out, all continence problems can be debilitating and life-changing. As we have heard, they can affect a wide range of care groups and can be of particular concern to the ageing population.

As my hon. Friend the Member for South West Bedfordshire rightly set out, this also creates pressures for our healthcare system. Complications and treatments for continence problems—for example, pressure ulcers, urinary tract infections, catheterisation, which my he pointed to, or faecal impaction—can all lead to admission and extended stays in hospital, which we should try to avoid wherever possible. The need to do what is right for patients and healthcare professionals alike means that care pathways should be commissioned to ensure the early assessment and effective management of incontinence.

To improve continence care across the whole public health and care system, NHS England has established the national bladder and bowel health project to improve continence care. As my hon. Friend rightly pointed out, it has also published “Excellence in Continence Care”, which is a practical guide for leaders and commissioners. That includes guidance for commissioners—so ICBs—and leaders in healthcare systems to ensure that people who are diagnosed with UTIs receive high-quality treatment.

I have heard my hon. Friend’s concerns about the implementation of the continence care guidelines. I will, as he asked, take this back to the Department and raise it with the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), to discuss what more we can do alongside NHS England.

On 9 May, NHS England published its delivery plan for recovering access to primary care. It is an ambitious plan that includes proposals to improve options for community-based services to treat urinary tract infections. As part of that, appropriately trained community pharmacists will be commissioned to provide a clinical service to care for patients with urinary symptoms, providing timely access to assessment, information and advice.

In addition—this does fall within my direct remit in the Department—the National Institute for Health and Care Excellence has produced guidance on the management of faecal incontinence in adults, which healthcare professionals and commissioners are expected to take fully into account as part of the delivery of services. That guidance outlines that management strategies should consider diet, bowel habit, toilet access, medication and, importantly, coping strategies. Those management strategies will be required to account for the sensitive and socially stigmatising nature of incontinence, as my hon. Friend the Member for South West Bedfordshire set out. We know how important that is to patients, their families and—as the hon. Member for Strangford (Jim Shannon) pointed out—their carers.

I want to touch on another area, which my hon. Friend the Member for South West Bedfordshire touched on also, which is antimicrobial resistance, because we have updated the 2019 to 2024 national action plan on tackling antimicrobial resistance. The plan is core to this debate because it outlines that the UK will enhance the prevention of UTIs by providing early, accurate diagnosis and treatment of suspected and confirmed UTIs. That includes the prescription and use of antibiotics and therapeutics for older people, both in their own homes, which is critical, and in care homes, so that patients get the care they need, when and where they need it, and are less likely to suffer from the discomfort of urinary tract infections, or indeed secondary infections, which we know can follow.

To improve bowel care for people with spinal cord injury, NHS England has also published a service specification, with specialist multidisciplinary teams that provide advice and care in bowel management, including promoting and managing continence. My hon. Friend also referred to medtech, and I am really passionate—

[Andrew Selous]

The Minister might not be able to respond to this now, but before he moves on to the tech, the Spinal Injuries Association made the very good point that a lot of people with spinal injuries have carers—trained people—who are willing to come in and assist the very hard-pressed hospital staff, but are unable to. Can that be looked at? I get the complications, and I am not asking the Minister for an answer now, but one of my children spent some time in healthcare in hospitals in Africa, and in many parts of the world, if a patient’s family and friends do not go into the hospital, they will not survive. If we completely keep carers out and bar the door, have we not gone a little too far? There have to be standards, of course—it would have to be done in agreement with the staff and there would have to a be risk assessment. I absolutely get all that, but the current position seems bizarre, when there are hard-pressed staff and carers who are willing to come into hospital with their patients, so I wonder whether that could be looked at.

[Will Quince]

My hon. Friend makes a very good point. Instinctively, I totally agree with him, and I would be very happy to meet him to discuss, alongside NHS England, what more we would need to do to enable that to happen. I suspect that, in this kind of area, an individual with incontinence would often much rather have a family member, a carer or another trusted loved one support them through that process, alongside trained medical professions than anything else. So it is a good point, a fair challenge and one I will take away and consider in more detail.

Let me turn to medtech, which is a real passion of mine. We want to make sure that patients in our NHS get access to the most cutting-edge technological advances. We talk a lot about pharmaceuticals, but medtech is something that we should take very seriously, too. Earlier this year, we published our first ever medtech strategy, which says that the lowest price does not always translate to the best value. That is an important point, because the Government believe that the value of a product should be considered across the whole patient pathway, not in terms of the individual cost.

The application and adoption of value-based procurement in the NHS is a key priority in the medtech strategy, in order to realise, as I have set out, the potential of that technology to improve patient outcomes and, importantly and alongside that, to support the NHS workforce. Without getting too technical, the strategy includes a commitment to modernise part IX of the drug tariff, which lists devices that can be prescribed in the NHS.

The reason I am labouring this point is that the Government and I recognise how important patient choice is, and that a range of continence products is really important to living well with this condition. That is why there is a focus on making changes to part IX. By re-categorising part IX into groups of clinically comparable products that are interchangeable by their nature, cost-effectiveness can be compared fairly, and ICBs and clinicians will be more informed and more likely to use part IX. Doing so will also enable companies that are making innovative products to enter the market and encourage further innovation in this space, which will ultimately only benefit patients. We will continue to support the provision of a range of continence products in part IX of the drug tariff, to ensure equitable access for all patients.

The reason I labour the point about patient choice is that we must ensure that patients have a voice in the product range available in the drug tariff, so that patients’ interests are at the heart of how the tariff operates. We are currently engaging with patient groups, which is really important, and a targeted consultation will be launched later this summer to ensure that the tariff continues to be able to provide effective products to patients.

My hon. Friend and others also referred to the long-term workforce plan and the need for specialist continence nurses. I have spent the last few months saying that the plan will be published “soon”, then “very soon” and now “imminently”. I do not know if I can say “very imminently” —I am not sure there is such a thing—although I have spent most of today talking about the NHS long-term workforce plan. I anticipate spending most of tomorrow, and indeed Monday, talking about the NHS long-term plan. My hon. Friend and others will not have to wait very long before they will be able to read the plan in full. I am sure that he and others will understand why it would not be right for me to share details of it ahead of publication, but I mean it when I say that he will not have to wait very long at all.

On the points about public toilets and accessible toilets, I am conscious that I am straying into the territory of the Department for Levelling Up, Housing and Communities, which has responsibility for building regulations. It approves documents for the provision of toilets in publicly accessible buildings, which falls under the Building Act 1984 and the Building Regulations 2010. That legislation does not currently require sanitary bins in men’s toilets, but I understand the points made by my hon. Friends the Members for South West Bedfordshire and for Don Valley (Nick Fletcher), as well as the hon. Member for Strangford, about the anxiety that men feel. They make a compelling argument, and I would encourage them to raise it with the relevant Minister at DLUHC—I will do that too.

I understand that Colostomy UK has a stoma-friendly toilet campaign that is aimed at organisations, businesses and individuals. The campaign focuses specifically on accessible toilet facilities and the needs of people living with a stoma. The hon. Member for Strangford makes a fair challenge to the civil service and Government Departments to lead by example on that point. I will raise the issue with the Cabinet Office to see whether it is something we should explore further.

I thank my hon. Friend the Member for South West Bedfordshire for alerting me to the bladder and bowel CONfidence app, which was something that I was not aware of before my research ahead of the debate. I now know that a number of NHS trusts and medical centres are aware of the app and promote its use. Following this debate, I will look into whether NHS England could reference the app on its health webpages, which would be really helpful. I will also look into what more we can do to promote the app, as it sounds like a great tool.

My hon. Friend the Member for Don Valley raised the possibility of a men’s health strategy, and specifically a Minister with responsibility for men’s health. I know it is an issue that he is hugely passionate about and has campaigned long and hard on. I can give him the assurance that the major conditions strategy will take into account the needs of both men and women. Of course, we recognise that different approaches need to be taken for men and women in the provision of treatment of major conditions, especially over the whole course of life.

The Secretary of State for Health and Social Care, in Men’s Health—which is not a magazine I have read, but I have seen the cover—explicitly invited men to respond to the call for evidence to help us to ensure that the strategy takes into account the needs of men. I know that my hon. Friend the Member for Don Valley wants the Government to go further on this issue. He has already raised the issue with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), and I would also be happy to meet with him to discuss it.

[Andrew Selous]

I ask the Minister to forgive me if he was coming to this, but before he concludes, will he say a little bit about the third of dementia patients who go into hospital continent and come out incontinent? Many of them are actually trying to get to the toilet but have had difficulty. I find that very upsetting. As I said, it is not an easy issue, and I 100% get the pressures on the staff, but I think the issue is something that has not been spoken about. It has just happened under the radar. I am not expecting an answer today, but I would like a recognition that the Minister has clocked it, is concerned about it, and will take it back to the Department, because I was really upset when I learnt about that figure.

[Will Quince]

I entirely understand why my hon. Friend would be upset. In truth, I do not have an answer for him immediately. If he holds fire, however, I am going to make a broader offer to meet with him directly or alongside the APPG to discuss that and any other issues with NHS England and officials in the Department who are experts in the area. He raises a powerful point, and it is an issue that we need to explore further.

The hon. Member for Strangford raised prostate cancer statistics. I will write to him specifically, because I know he would like more detail on this issue. He is absolutely right that there has been a considerable increase in diagnoses of prostate cancer. I think the statistics are that in 2020 we diagnosed something in the region of 36,000 cases, whereas in 2000 it was 25,000, which is something like a 45% increase. Diagnosis is generally a good thing, especially early diagnosis, because it means that we are catching the disease early. However, I understand that about 51% of prostate cancers were diagnosed at an early stage in 2021, which demonstrates that we have a lot more to do in that space. I will write to the hon. Gentleman on that point, and will raise it with my hon. Friend the Member for Faversham and Mid Kent.

I have not answered all the questions that my hon. Friend the Member for South West Bedfordshire asked. As tempting as it is to take up the remaining 35 minutes of the debate, I will commit to meeting with him personally, or indeed with the all-party parliamentary group and campaigners, alongside NHS England and the Department, to talk about some of the other issues in detail. I think they certainly warrant that, so I would be delighted to do that.

In summary, NHS England has published its delivery plan, which sets out our proposals to improve options for community-based services to treat urinary tract infections. In addition, NICE has produced guidance on the management of faecal incontinence in adults. The annual spend on incontinence products from part IX items alone is approximately £255 million. As I said, we know how important patient choice is and understand that having a range of continence products is important to living well with this condition. That is why I can promise that there will be a focus on making changes to part IX of the drug tariff.

To conclude, I know that many people who experience bladder and/or bowel problems experience stigma, a point made eloquently by my hon. Friend the Member for South West Bedfordshire. They can be embarrassed to talk about the symptoms with friends, family and even, to some extent, healthcare professionals. That is why I am particularly pleased that my hon. Friend secured today’s debate, which has provided me the opportunity to play a small part in tackling the stigma that surrounds this issue. I think all hon. Members that have taken part in this debate have helped to defeat the stigma that surrounds the issue. I am not so naive as to think that there will be thousands watching this debate at home, but the debates are kept online and I hope people will watch. They will realise that it is vital to talk to medical professionals about their health issues and problems in this space and, wherever they feel it is necessary, to seek out professional care.

Draft Healthcare (International Arrangements) (EU Exit) Regulations 2023

Will Quince Excerpts

Wednesday 28th June 2023 General Committees

[The Minister for Health and Secondary Care (Will Quince)]

I beg to move,

That the Committee has considered the draft Healthcare (International Arrangements) (EU Exit) Regulations 2023.

It is a pleasure to serve under your chairmanship, Mrs Murray. Reciprocal healthcare arrangements offer additional healthcare security to all UK residents and provide greater safeguards and support when they are travelling abroad. Where there is no arrangement in place, those who require treatment may face very expensive insurance premiums or may have to fund life-sustaining healthcare privately. When a reciprocal arrangement is in place, however, people can travel safe in the knowledge that they can access public healthcare in an emergency. Such arrangements particularly benefit people with long-term pre-existing conditions, such as those who need kidney dialysis.

The UK Government were therefore pleased to secure a continuation of our arrangements with European countries through the trade and co-operation agreement. The Government have also set out our ambition to extend the benefits to the public more widely, to be delivered through a number of new arrangements with countries outside the European Union. Thanks to the Healthcare (International Arrangements) Act 2019, we now have the legal powers to make good on this commitment and to implement reciprocal healthcare arrangements with our international partners. I am pleased to be introducing the secondary legislation necessary to implement our arrangements.

The draft regulations will confer functions on the NHS Business Services Authority and local health boards across the UK. They will require them to give effect to the international commitments made by the UK under each arrangement. Those functions include making payments to international partners, processing applications and claims and providing necessary information to the public.

The draft regulations are substantively very similar to those currently in force. However, I draw hon. Members’ attention to two main differences. First, the draft regulations will enable the Secretary of State to make payments outside an arrangement, but only where there are exceptional circumstances that provide justification, and where a reciprocal healthcare arrangement is already in place.

Let me expand on that a little. The power to make discretionary payments enables the Government to support UK residents should they face difficulty in extraordinary circumstances when they are abroad. Alongside the legislation, we have consulted on a policy framework that sets out the circumstances under which we would expect such a power to be used. To be absolutely clear, it will be used sparingly, but it will help those who benefit to avoid facing onerous financial consequences if funding for critical healthcare were to be refused. Given the difficulties in anticipating such circumstances, the Secretary of State will consider, on its own merits, each and every case referred by our partners.

Secondly, the schedule to the draft regulations, on pages 5 and 6, brings together all the UK’s healthcare arrangements in one place. That includes our healthcare arrangements with the EU and Switzerland, as well as new arrangements such as those with our overseas territories and Crown dependencies. It also includes our existing arrangements where no money is exchanged and where the cost of treatment is waived, such as with Australia and New Zealand.

As the Committee would expect, we have consulted devolved Administration Ministers throughout the process; they have confirmed that they are content. The draft regulations will enable the devolved Administrations to implement the planned treatment provisions that are included within our comprehensive arrangements with the European Union and Switzerland. In Northern Ireland, in the absence of an Executive, we will ensure that planned treatment functions can continue to be delivered by saving the relevant aspects of our existing legislation.

The draft regulations will allow us to honour our commitments under existing healthcare arrangements. Importantly, they will also provide us with the legal framework to extend healthcare security to UK residents when they travel abroad, through these new arrangements. I commend the regulations to the Committee.

--- Later in debate ---

[Will Quince]

I thank the hon. Lady for her support. Let me take both those questions in turn, starting with the one relating to exceptional circumstances. I know that the Committee will forgive me for not going into the details of specific cases, although there have been cases in which we have needed to provide help on an exceptional basis to UK citizens abroad who need health support.

The purpose of the power is to support UK residents abroad where we already have a reciprocal healthcare arrangement in place but they face difficulty, and the circumstances are therefore, by their nature, extraordinary. The policy framework set out in the regulations proposes that the Secretary of State will consider whether the healthcare treatment falls narrowly outside the scope of the arrangement in place and whether refusal to fund healthcare treatment would result in unjustifiably harsh consequences for the individual. However, the framework will retain the necessary flexibility to allow the Secretary of State to evaluate each case individually. In the one case that I am aware of—I know there have been others—it has been vital in ensuring that the UK resident and patient was able to get the support that they would not have got without the exceptional arrangements being put in place.

On the hon. Lady’s second point about scrutiny, we will of course look at other reciprocal arrangements. Some of those will be fee-waived and others will be reciprocal in relation to charging. No doubt the hon. Lady and the Labour party will rightly scrutinise any efforts that the Government take. The Committee should be assured, however, that we will only ever take those steps when they are in the interests not only of UK citizens, patients and those travelling abroad, but of our NHS. That is an absolute guarantee.

I hope that I have answered the hon. Lady’s questions. If she has any specific further questions, she knows me well enough to know that she can write to me or, indeed, call me and I will gladly answer those.

In closing, I take this opportunity to reassure right hon. and hon. Members that very little will change under the regulations. As I said, they remain substantively very similar to those that they will replace. I reiterate the importance of the regulations, as the hon. Lady did, to ensuring that the UK continues to honour our current commitments and support those requiring access to healthcare abroad. I commend the regulations to the Committee.

Question put and agreed to.

Podiatry Workforce and Patient Care

Will Quince Excerpts

Tuesday 20th June 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

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

Let me say first how grateful I am to the right hon. Member for Hayes and Harlington (John McDonnell) for raising this important issue. He said that he did not know a huge amount about podiatry. I must say that I did not either, because I am not the Minister with responsibility for primary care, but I do have responsibility for the workforce. One of the powerful aspects of debates of this nature is that they force not only Ministers but the Department to focus on a particular issue and give Members from across the House—including the Minister —a crash course in it. As a result of my research ahead of the debate, I know far more about podiatry than I did yesterday. I thank the right hon. Gentleman for that.

I know having undertaken that research—and, indeed, from my constituency inbox—that podiatrists are a hugely important part of the workforce. They are an invaluable part of our NHS, as the right hon. Gentleman eloquently set out. I join him in saying how hugely grateful I am for their vital work supporting patients day in, day out across our NHS. The Government know that personal care that is responsive to people’s needs is essential and the service that podiatrists provide to local communities is important in helping people maintain their mobility, independence and wellbeing.

As the right hon. Gentleman rightly pointed out, early identification of foot problems helps to prevent or delay the onset or exacerbation of long-term conditions, thereby reducing the risk of wounds, infection and, ultimately, amputation. He also pointed out that foot problems have a significant financial impact on the NHS through out-patient cost, increased bed occupancy and prolonged stays in hospital. Working mainly at the heart of primary care, podiatrists are well placed to ensure patients receive a quality foot screening service, as well as the appropriate onward referrals for foot and lower-limb interventions.

The right hon. Gentleman correctly pointed to our ageing population. That is not exclusive to us; it is a global problem, certainly in the western world. I say “problem” but, actually, it is a great thing that people live longer. However, it is a challenge for health systems, because people are living longer with long-term conditions and complex needs that we need to ensure we can support and manage as a society. As the right hon. Gentleman pointed out, the need will continue to grow.

The right hon. Gentleman raised a number of issues but, with his permission, I will focus mainly on the workforce rather than on podiatry more generally. I recognise that the workforce remain under sustained pressure, having worked tirelessly throughout the pandemic to provide high-quality care for those who need it. I recognise that podiatrists’ role in supporting our NHS is as important as ever. It is vital that we support the workforce both now and in the future.

[Jim Shannon]

The right hon. Member for Hayes and Harlington (John McDonnell) referred to volunteers. I have them in my constituency, and if it were not for the volunteer podiatrists who give their time every day of the week, free of charge, I believe the NHS would be suffering even more. That is why we need to push for the recruitment that he referred to.

[Will Quince]

I thank the hon. Member for his intervention, and I pay tribute to all those who volunteer. This is not the only area in our national health service where volunteers play an important role, but it is important that they are add-on and add value—supporting professionals as opposed to replacing professionals. That is why, at the heart of this debate, we must ensure that we have the podiatry workforce that we need across all four nations—although this debate is specifically focused, understandably, on England.

As the right hon. Member for Hayes and Harlington pointed out, demand for the NHS continues to grow. That is why we have already done a significant amount to invest in the education and training of our future workforce. NHS England—until recently, this was done by Health Education England—has worked extensively to enhance and modernise the podiatry profession. One central factor, which the right hon. Gentleman alluded to, is the development of the foot health standards for the education and training of the foot health support workforce.

However, I am certainly conscious that we have more to do. As part of that process, we developed the podiatry apprenticeship, which is a degree apprenticeship, and supported the implementation of that route into the profession. The numbers are still small, but they are growing, which is great to see. We are keen to promote that route into the profession, not least because it comes with significantly reduced costs for those taking part in the training.

With the promotion of more podiatry apprenticeships, we are offering a more diverse number of training options for students. Furthermore, the learning support fund, which the right hon. Member for Hayes and Harlington pointed to, provides all eligible nursing, midwifery and allied health professional degree students—including podiatrists—with a non-repayable training grant of a minimum of £5,000 per academic year. I say “minimum” because there is an additional hardship element to that of up to £3,000 per year, and additional support is available for childcare, dual-accommodation costs and, where appropriate, travel. The right hon. Gentleman specifically asked for an increase; there are no plans for that at present, but I will of course take that away and have a look at it.

[John McDonnell]

I am here if the Minister needs any assistance in—I was going to say beating—negotiating the Treasury into submission.

I think I mentioned a figure of one podiatrist to every 5,500 people, but I think that I have got that wrong; I think it is actually one to every 55,000 people. That is a huge demand that is placed on podiatrists.

On the Minister’s point regarding the bursary, the British Society of Rheumatology pointed out in one of its briefings that an estimated £15 million a year would be saved on the costs of rheumatoid arthritis if sufficient support was given, particularly through podiatrists. In our argument or discussion with the Treasury, this is therefore an investment that will save money, and we know that directly from the evidence that has been provided.

[Will Quince]

I thank the right hon. Gentleman for his intervention. We are constantly looking at those spend-to-save arguments in areas in the health service where it makes sense to invest. Following this debate, I will gladly look at the podiatry courses and see how over-subscribed or under-subscribed they are, because that may—or may not—help to make the case.

I just spoke about training. Training is important because, of course, we need to see new podiatrists coming in to practise. However, as the right hon. Gentleman mentioned, retention is as important as recruitment. As important as increasing numbers of podiatry trainees is, it is also important to retain the highly qualified, highly skilled, experienced people we already have practising podiatry in the NHS.

I am determined—I know that the Secretary of State is too, because we have had this conversation many a time—to ensure that staff in our NHS feel supported and that the NHS works to ensure that staff feel valued, both by individual organisations and across the system. We are working closely with NHS England—and indeed, through NHS England, with individual trusts—to ensure that that is happening. We regularly meet staff to get a better understanding of how they could better feel valued and supported in their workplace.

The actions of the NHS people plan and the NHS people promise are helping us to build the kind of culture that will go a long way towards helping to support and hold on to dedicated and hard-working colleagues. That very much includes a stronger focus on health and wellbeing and, importantly, on strengthening leadership. People often say that they do not leave trusts or organisations but their managers, so we must make sure that management culture is right. We also know from speaking to staff that it is vital to increase opportunities for flexible working.

One of the right hon. Gentleman’s other asks was on the long-term workforce plan. He is absolutely right. To help us ensure that we have the right numbers of staff with the right skills to transform services and deliver high-quality services that are fit for the future, we have commissioned NHS England to develop a long-term workforce plan for the NHS for the next five, 10 and 15 years.

That high-level workforce plan will look at the mix and number of staff required across the country and will set out a number of actions and reforms that are needed to reduce those supply gaps and, importantly, improve retention. We have committed to publishing that plan shortly—and it will be shortly; I know it is soon. I am very keen to ensure that it is published, because I know how much work NHS England has put into it. In addition, the Chancellor committed that it will be independently verified. We have to make sure that we get it right.

The plan will also include projections for the number of professionals that will be needed, which goes directly to the right hon. Gentleman’s point—it will include podiatrists—and will take full account of improvements in retention and productivity that we plan and hope to see. I thank the right hon. Gentleman for securing this important debate. Through long-term planning, we are ensuring that the NHS has the robust and resilient podiatry workforce that it needs for the future.

The third and final question the right hon. Gentleman posed was on integrated care system guidance relating to allied health professionals. As tempting as it is to make policy on the hoof, that does not sit within my portfolio. I will commit to raise that with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), who is the Minister with responsibility for primary care. I will ask him to write to or meet the right hon. Gentleman.

We are working to ensure that we have the right people with the right skills in the right places and are working to ensure that they are well supported and looked after, so that they in turn can look after those who need our great NHS services and can keep delivering the great standard of care that people need now, but also in the future.

Question put and agreed to.

Neuroblastoma Treatment

Will Quince Excerpts

Thursday 15th June 2023 Commons Chamber

[The Minister for Health and Secondary Care (Will Quince)]

I thank my hon. Friend the Member for Darlington (Peter Gibson) for securing this important debate. I thank him especially for sharing the experience of his constituent Mark Bell, and the challenging events leading up to the devasting loss of his much-loved son Luke to neuroblastoma. I am pleased that Mark and Carol could be here for this debate. As a parent who has sadly lost a child myself, I send my heartfelt condolences to Mark and his family. No parent should have to go through what his family have; I know that it is a void that can never be filled. I am full of admiration for Mark and his family: as my hon. Friend pointed out, following their tragic loss, they established their charity, the Team Luke Foundation, to help other parents in a similar situation. I commend and applaud its important work in raising awareness of neuroblastoma and supporting parents in accessing the information and advice that they need.

My hon. Friend also referenced the letter to my right hon. Friend the Prime Minister from the hon. Member for Batley and Spen (Kim Leadbeater) about her constituent Beau. I too would like to extend my deep condolences to the family of brave and beautiful Beau, who also lost her life to neuroblastoma. My thoughts are also very much with Shirley and her family. I would like to assure my hon. Friend and all families who are affected by cancer that one of my and the Government’s top priorities is speeding up the diagnosis and improving the treatment of cancer, including neuroblastoma.

Working together with our colleagues in the national health service, the Government have three priorities for cancer care. The first is to recover from the pandemic and the backlog. The second is to get better at early diagnosis, which my hon. Friend made a very eloquent and articulate case for, and to get better treatment using the tools and technologies available to us. The third is to invest in research and innovation, because we know that things such as genomics and AI have the potential to transform our experience of cancer as a society. With my hon. Friend’s permission, I will focus on diagnosis and research.

Let me turn first to early diagnosis. Cancer services, including those for children, are an absolute priority for the NHS—I know that and have seen it at first hand. The NHS is working to raise further awareness of the symptoms of cancer, lower the threshold for referral by GPs and accelerate access to diagnoses and treatment. The NHS long-term plan for cancer aims for three quarters of cancers to be diagnosed at stage 1 or 2. NHS England launched operational delivery networks in June 2021 to enable clinicians to lead and improve cancer pathways for children and young people.

We are also making interventions to diagnose cancer early. NHS England has announced that it is expanding direct access to diagnostic scans across all GP practices, which will cut waiting times and, importantly, speed up diagnosis for patients. Non-specific symptom pathways are transforming the way that people with symptoms not specific to one cancer, such as weight loss or fatigue, are diagnosed or have cancer ruled out. This gives GPs a much-needed referral route, while speeding up and streamlining the process so that, where needed, people can start their treatment sooner. Thankfully, the majority of people referred will be given the all-clear. It is crucial that people who are diagnosed start their treatment promptly, while giving peace of mind to those who do not have cancer.

We have previously discussed this, but I hope my hon. Friend will be pleased to hear that the Department has committed an additional £8 billion over the next two years to increase our capacity for elective activity and for adult and children’s cancer services.

Community diagnostic centres have played a huge role in recovering the cancer backlog. We have 108 community diagnostic centres open and operational as of today, and our aim is to open 160 by 2025, but I want to go much faster. So far, we have delivered over 4 million additional vital tests and checks since 2021, including for cancer. Testing and diagnosing early means we can provide the right treatment on time, which is why, as my hon. Friend said, it is so important.

The NHS continues to do groundbreaking research to improve treatment for children with neuroblastoma. Supported by the National Institute for Health and Care Research and Great Ormond Street, it has identified a new drug target for children with neuroblastoma, with the hope that new, less intrusive therapies will be developed by targeting a developmental cell type that exists only in neuroblastoma tumours after a child is born. This team of scientists and doctors at Great Ormond Street and University College London has been awarded a £519,000 Wellcome Trust innovator award to continue its ground- breaking research using image-guided surgery for childhood cancers—that is specifically for neuroblastoma.

The NIHR has also awarded funding to support the development of a treatment decision aid for parents of children with neuroblastoma that has sadly relapsed. The study will consist of two phases and aims to develop an intervention to support parents who are having to make multiple different treatment decisions after their child has relapsed. I will gladly meet my hon. Friend and the NIHR to see what further steps we can take to boost research into neuroblastoma.

My hon. Friend referenced the letter that the hon. Member for Batley and Spen sent to my right hon. Friend the Prime Minister regarding the bivalent vaccine trial, which is not currently available in the United Kingdom. UK clinicians and researchers are hesitant about the US trial of bivalent vaccines for children in remission with neuroblastoma, because it has no comparator group to enable measurement of the treatment’s effectiveness and effect. I also understand that the trial involves very intensive and invasive post-treatment monitoring. Nevertheless, I know discussions are ongoing in the international community, including here in the United Kingdom, on the optimal trial design that will generate the high-quality evidence needed to understand the real efficacy of the bivalent vaccine in this group of patients.

Again, I thank my hon. Friend the Member for Darlington for bringing this hugely important matter to the House and, importantly, for sharing Luke’s story. I thank Luke’s family for the work they are doing, not just in raising awareness, which of course is hugely important, but in the support they are giving to families in similar positions. I am pleased to assure my hon. Friend that, together with groundbreaking research supported by the NIHR and the continued efforts of the NHS in recovering cancer services, the treatment of neuroblastoma and all other cancers remains an absolute top priority for not just me but this Government.

Let me conclude by saying that my hon. Friend asked three specific questions, and my answer to all three is: yes, yes and yes.

Finally, I ask you to indulge me on something, Madam Deputy Speaker. Without embarrassing the Whip on duty—Whips rarely get a mention—let me say that I understand my good friend, my hon. Friend the Member for North Cornwall (Scott Mann), is marrying his partner Nicola this weekend. I wish him all the very best for a wonderful day and them a very happy future together. [Hon. Members: “Hear, hear.”]

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am sure that the whole House will join the Minister and me in sending our congratulations and best wishes to the hon. Gentleman and his fiancée and family for a wonderful wedding at the weekend—we hope the sun shines for them.

I also thank the House for a very constructive debate. I have said before that I do wish that people who watch our proceedings would pay more attention to these kinds of debates, where we are discussing a matter of great importance and sensitivity, and where the House can welcome the family of a little boy such as Luke, and let them know that we, as a whole Parliament, are working for them and that this place is not only about loud and aggressive argument.

Question put and agreed to.

New Hospital Programme and Imperial College Healthcare NHS Trust

Will Quince Excerpts

Tuesday 13th June 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Mark. How do I follow that speech by the hon. Member for Bristol South (Karin Smyth)? Well, first, I would like to congratulate the hon. Member for Hammersmith (Andy Slaughter) for bringing forward the debate. I also thank my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) and the hon. Members for Westminster North (Ms Buck), for Strangford (Jim Shannon), for Reading East (Matt Rodda) and for Brentford and Isleworth (Ruth Cadbury). Time is short, but I will try to answer as many points as possible.

The new hospital programme is the biggest hospital building programme in a generation, which will help us deliver on our manifesto commitment to build 40 new hospitals by 2030. The hon. Member for Hammersmith raised a number of specific questions. I am not responsible for the new hospital programme, because that matter sits with Lord Markham. Nevertheless, I will endeavour to answer as many of the hon. Gentleman’s questions as possible. Furthermore, I know that Lord Markham would be pleased to meet him and colleagues, and I will ensure the hon. Gentleman gets a response to his letter.

On 25 May, we announced that the Government remain committed to building 40 new hospitals by 2030, and the new hospital programme is expected to be backed by more than £20 billion in funding for hospital infrastructure. It is the biggest hospital building programme in a generation. Going forward, new schemes will be considered through a rolling programme of capital investment in hospital infrastructure.

[Matt Rodda]

Will the Minister give way?

[Will Quince]

Time is very short, and I ask that the hon. Gentleman to let me answer as many of the questions as I can. If there is time, I will give way.

The programme is part of a more sustainable and consistent approach to delivering state-of-the-art new hospitals and will mean further investment to upgrade NHS facilities across the country. Our announcement is hugely significant to all hospitals in the programme and it gives funding certainty for trusts to progress their schemes in line with revised indicative allocations, most of which are a significant uplift on previous allocations.

I now turn to the specific questions. The hon. Member for Hammersmith said that the debate is about the defunding of the trust. I want to be clear that the trust has been informed of a significantly larger indicative allocation for both schemes than was previously given in 2019. Far from being defunded, the funding envelope has increased significantly.

Furthermore, no schemes have been removed from the programme, as the hon. Gentleman suggested. It is one programme, with a small number of schemes that will now complete beyond 2030. If I might correct the hon. Gentleman, he said that the pot is £20 billion; to be clear, it is over £20 billion.

On Charing Cross, I believe that the hon. Gentleman said that the temporary ward or decant facility will not be necessary until the main construction starts on the tower. That is part of the enabling works that have been raised, which can and should be completed well in advance of the main construction, and therefore can be used as extra capacity should there be a gap between the works. It is the first phase of that floor-by-floor work.

I understand that the main construction itself has not been postponed to start after 2030. We have been clear that, as part of the rolling programme, we may move schemes forward and backward—that question was raised by the hon. Member for Westminster North—based on their readiness to progress. The reason the two Imperial schemes were already in cohort 4 and are now in the rolling programme is that their plans are at such an early stage of development. If they are ready to progress sooner—or indeed other schemes, as the hon. Lady suggested, encounter problems along the way—some schemes may move forward and others may move back. Having the enabling works and business case ready is vital, and I know that hon. Members will have those conversations with the trust.

I will answer some of the other questions in a moment, but specifically on funding, I can confirm that Imperial and all other trusts will now have received confirmation of the individual indicative funding envelopes that give them the basis on which they can submit their proposals through the business case stages. Those individual scheme figures will not be released into the public domain, because they are commercially sensitive. I know that the hon. Member for Hammersmith would like to know the figures, but I hope he will understand why we will not release them: it could prejudice the future ability of contractors for tenders.

We announced that the programme is expected to be backed by over £20 billion, which gives trusts the funding certainty to deliver. We remain committed to delivering all the hospitals in the programme as soon as possible. Specifically on Imperial College, we are working closely with the trust on its two new hospital schemes within the programme. As the hon. Gentleman rightly said, that includes the rebuild of Hammersmith Hospital, the refurbishment of Charing Cross and the redevelopment of St Mary’s in Paddington, as well as any opportunities to commence supportive work ahead of the main construction starting.

Briefly taking each hospital in turn, Charing Cross is a large district general hospital with specialised services. It is a primary undergraduate training centre, and work is under way to explore practical options for a mix of new builds and refurbishment that will be phased across the site. We recognise that the 14-floor tower will need to be refurbished rather than rebuilt, as I mentioned. Other preparatory work that will be necessary, which the hon. Gentleman asked about, includes site-wide surveys and a new energy centre. As with all schemes in the programme, the funding is available for early enabling works such as those as soon as the trusts have their plans ready.

Hammersmith Hospital is a specialist hospital, as the hon. Gentleman said, whose specialisms include renal, haematology, cancer and cardiology care and, of course, its specialist heart attack centre and its research function. Plans for that scheme are also at an early stage of development and will require a phased approach due to space constraints.

Finally, St Mary’s is a large general district hospital, as my hon. Friend the Member for Cities of London and Westminster rightly pointed out, providing highly specialised services. The hospital will require a complete rebuild, and there are a range of options for a new site. We have been clear that we are establishing a new, centrally led programme to deliver those hospitals, which includes a new approach that enables standardisation.

The hon. Member for Hammersmith asked about the completion date for each hospital. The timelines are at an early stage. As a result, they are fluid, but I know that Lord Markham, the Minister in the Lords, will keep him updated on progress as work is undertaken with the trust to develop its proposals.

With a minute to go, I thank the hon. Gentleman for rightly raising this important issue and for his interest and engagement in the new hospital programme. I absolutely assure him that we are committed to the delivery of the two schemes at Imperial College Healthcare NHS Trust, and I thank all Members who have taken part in the debate.

Cancer Medicines: Appraisals

Will Quince Excerpts

Tuesday 13th June 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate on appraisals for cancer medicines and thank all Members who have contributed to a hugely valuable discussion.

The hon. Member said that he thought the debate would be a presentation of a united front, and that has been demonstrated today. He also said that he hoped he was pushing at an open door. On many of the points he made, he certainly is doing that. He spoke with great passion and empathy for those who suffer from this terrible disease, and I commend him for bringing this issue to my attention and the attention of the Government. Unusually, for a Westminster Hall debate, I have some time to respond to the points, so as ever, I will offer all Members who would like it a meeting to discuss any of the issues that have been raised in greater depth, but I will try to cover them in as much detail as I can in my response.

According to Cancer Research UK, one in two people will develop cancer at some point in their lives. There are around 290,000 new cancer diagnoses a year, equating to around 780 every single day. I am acutely aware as a Health Minister that when we use statistics such as these, we must remember, as the hon. Member for Mitcham and Morden (Siobhain McDonagh) eloquently and articulately pointed out, that these are people; these are human beings who we all know and love—a dear friend, a loved one, a member of our family. It is important when we talk about statistics that we do not lose sight of that.

Let me turn to the hon. Lady’s contribution. She made a powerful speech, and it is not the first that I have heard from her and had the good fortune to respond to. She rightly made a powerful and emotive case on behalf of her sister Margaret and all those who suffer and have suffered with brain tumours. I think she knows my commitment to doing all I can to improve the situation in relation to brain tumours. In truth, I think I have spent more time on this particular issue in my time as a Minister than I have on any other condition under the umbrella of the major conditions strategy. I will continue to do so, not just because of the powerful case that she makes, along with others across this House and campaigners, but because I know there is an injustice in that this area does not get the attention it deserves, and I want to address that. I have raised it with the chief scientific adviser, who heads up the NIHR, and it is important to also raise it with NICE.

I have met the hon. Lady, and I would be happy to do so again. She makes a powerful case that we need the pharmaceutical industry to step up in this space, and I am keen to work with her to see what more we can and should do to make sure that happens. Finally, let me thank her for her kind words about my leaving Parliament at the next election. I assure her that I will do all I can for as long as I am in this role to help her achieve the objectives she seeks.

I join the hon. Member for Strangford in paying tribute to all the cancer charities—some very large and some very small—that work to support patients up and down this country. He is right to draw the House’s attention to that.

The NHS has seen enormously high demand for cancer checks. More than 2.8 million people were seen in the 12 months to April this year, up by 26% compared with the same period pre-pandemic. That returning demand is positive after the falls we saw during the pandemic. We are working closely with NHS England to reduce the amount of time people are waiting to receive a diagnosis, and we are making progress; it is not as fast as I would like, but we are working very hard to make progress. The latest published figures show that the 62-day cancer backlog for the week ending 30 April stood at 22,533. It has fallen by 34% since its peak in the pandemic, but I am acutely aware—this preys on my mind every single day—that it amounts to more than 22,000 people, too many of whom have had to wait 62 days and are struggling with the anxiety of waiting for either a diagnosis or the all-clear.

The hon. Member for Strangford set out the scale of the challenge we face, which I touched on there, but I will move on to what we are doing to address this. The Government are spending more than £8 billion on the elective recovery fund, £700 million on the targeted investment fund and, importantly, as has been referenced in a number of contributions, £2.3 billion of capital funding has been made available to increase our diagnostic capacity—those 160 additional community diagnostic centres. I was able to give the hon. Member for Denton and Reddish (Andrew Gwynne) some good news on that for his constituency recently.

We have 108 community diagnostic centres operational at the moment. I announced a further number only last week, and we have another eight coming on stream. We want to get to 160 centres by 2025, but I want to do it as quickly as we possibly can. There will also be additional surgical hubs. Those CDCs have already since July 2021 delivered over 4 million checks, so we have to get those open and operational as quickly as possible.

[Liz Saville Roberts]

The Minister is of course aware of the proposal for a medical radioisotopes facility in north Wales, which is crucial for diagnosis in the future. I wonder whether he is also aware that this would complement Bangor University’s Nuclear Futures Institute and its planned new medical school. We are all aware of the shortage of clinicians. I am concerned that the centre for doctoral training in nuclear energy futures at Bangor, which plays a vital role for PhD projects and their funding, has had its application for renewal rejected by the Engineering and Physical Sciences Research Council.

I would be grateful if the Minister clarified whether he is aware of this issue. I appreciate that it is local, but when we are looking at the future, these local solutions will be absolutely critical. If he is not aware of this, could he commit to raising it with the Department for Science, Innovation and Technology and his counterparts in the Welsh Government? Most importantly, could I plead with the Minister for a meeting with him to discuss the wider issue of radioisotopes availability, their cost and the security of supply in the future?

[Will Quince]

The answer to both is yes, and yes. If the right hon. Lady would write to me with the details, I will certainly raise the issue and meet to discuss radioisotopes specifically.

NHS England is working very closely with the independent sector to ensure that we are using all the available capacity to us to deliver both diagnoses and treatment as quickly as possible. The Government announced the major conditions strategy on 24 January, which is important for cancer as it draws on previous work on cancer. Over 5,000 submissions were provided as part of our call for evidence last year, and we will continue to work closely with stakeholders, the public and patients—whose voice should never be forgotten, as the hon. Member for Strangford rightly points out—and the NHS in the coming weeks to identify the actions we need to take as part of the strategy that will have the most impact.

Specifically on NICE appraisals, the hon. Member raised several concerns about the way in which cancer medicines are appraised. Members will know that NICE is rightly independent of Government. It is an expert body that makes evidence-based recommendations to the NHS on whether new medicines should be routinely funded by the NHS on the basis of on assessment of clinical and cost effectiveness. Those recommendations then develop, mainly for the NHS in England, but as was mentioned, they are usually adopted by the NHS in Wales and in Northern Ireland. Scotland has its own system. This is a difficult matter to raise, but it is important to point out that every pound that we spend on a new medicine is money that is not available for other services, and the NICE appraisal process ensures that NHS funds are spent in a way that provides the greatest health benefit to society. That is a hugely difficult job, which NICE does with great professionalism.

Again, it is important to point out that NICE appraises all new medicines and that its approval rate for cancer medicines has consistently been around 90%–I think that the latest figure is 92%. It is absolutely right that when NICE recommends a medicine for the NHS, it is available for patients and NHS England is required to fund that drug or treatment. I know that the NHS in Northern Ireland and in Wales has adopted a similar model.

NICE’s methods and processes for assessing new medicines are internationally respected, and they have evolved over time to ensure that they reflect best practice and keep pace with advances in medical science. As my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) pointed out—I will come on to this in some detail— NICE concluded a comprehensive review of its appraisal methods and processes last year, which it carried out with a high level of ambition and transparency. As she pointed out, changes include the introduction of a new severity modifier, which will give NICE more flexibility to recommend medicines for more severe diseases at higher prices. The severity modifier replaces the previous flexibility for end-of-life treatments.

My hon. Friend raised some concerns about that, and I always listen very carefully to what she says on this and many other issues, especially given her personal experience and campaigning. She is right to say that the situation is hugely complex, and her point about data is a really good one, because decisions need to be informed by good-quality data. I would be happy to meet her to discuss how we can ensure that we are collecting data not just on a regional basis, but nationally, so that we can make sure that NICE is making informed decisions. As she rightly points out, we need to ensure that patients and their voices are always at the heart of all the decisions made by not just the Government, but NICE. I would be happy to meet her to discuss that in greater detail.

On the broader point about whether the introduction of a severity modifier in place of an end-of-life modifier will affect cancer drugs specifically, analysis was carried out by NICE in developing the modifier. It indicated that the vast majority of cancer medicines that would have been eligible for the end-of-life modifier would also be eligible for a weighting under the severity modifier. I am happy to meet my hon. Friend and any other Members who would like to meet NICE to discuss this issue further.

[Tracey Crouch]

I think it is very important that the Minister also meets the pharmaceutical companies, because there is a counterclaim to the statistic from NICE that he has just given. The pharmaceuticals say that, actually, a significant percentage—I cannot remember off the top of my head what it is—of drugs would not pass the test. My plea to him is to sit down with all interested parties and not just listen to NICE’s statistics on this issue.

[Will Quince]

My hon. Friend is absolutely right, and I regularly meet the pharmaceutical industry, not least because of VPAS, which I will come on to discuss because it has been raised by a number of Members. While I understand the concern, it is absolutely right that assessment of clinical and cost effectiveness reflect up-to-date clinical pathways, evidence and evaluative methods and processes. However, my hon. Friend is absolutely right to say that we should also hear and understand the views and concerns of the pharmaceutical industry so that we have a rounded, balanced view and the full picture, to make sure that there are no unintended consequences because of the action that is being taken.

The hon. Member for Strangford mentioned non-uniform pricing and VPAS, so let me come on to that specifically. The tricky thing is that the negotiations for the next VPAS are currently under way. Given that there are ongoing discussions, it would not be appropriate for me to go into too much detail, because of the commercial sensitivity. It would also be inappropriate to set up a working group to review NHS England’s policy on non-uniform pricing. What I would say is that if changes were made to the wording in the next VPAS on commercial flexibilities, they would be reflected in an updated commercial framework for new medicines.

The hon. Members for Strangford and for Denton and Reddish raised clinical trials. We are doing a huge amount of work in that space because I recognise some of the issues and challenges that the hon. Member for Denton and Reddish set out. That is why we commissioned the O’Shaughnessy review into clinical trials, and why we accepted Lord O’Shaughnessy’s recommendations in full. We should take a step back for one moment and look at the work that we did as a country and an industry on clinical trials, particularly relating to covid. We basically shut down huge numbers of clinical trials to focus on a vaccine. To be fair, this country absolutely led the way in that, and we should be very proud of what we did, but we have not been fast enough in switching clinical trials back on and we have lost some of our competitive edge in relation to other countries, as the hon. Gentleman pointed out. The reality is that it is a race; clinical trials are globally competitive, and other countries, including Spain, have seized the advantage and are fighting hard for market share. We have to make sure we are a competitive place. That is about clinical trials but also our regulatory environment.

The hon. Member for Midlothian (Owen Thompson) made good points about the MHRA. We are absolutely looking at its processes and procedures, and we are putting an extra £10 million into it over the next two years to ensure it is a world-class regulator that is one of the fastest and most effective and efficient. It is already highly respected, but we must ensure that it does things at the right speed. That is very much on my radar, and as I said we are accepting the recommendations.

The hon. Member for Denton and Reddish also raised the cancer drugs fund. Since 2016, NICE has been able to recommend medicines for use through the Government’s £340 million cancer drugs fund, which enables patients to receive promising new treatments for a time-limited, managed access period while further evidence is being collected. That is then considered by NICE when determining whether a medicine should be routinely funded by the NHS. Since that fund was created in 2016, it has helped more than 91,000 patients in England, and more in other places, to access innovative medicines.

[Siobhain McDonagh]

Those 91,000 did not include people suffering from a glioblastoma. We are not anywhere near NICE. We have not got that far. The drugs are not there. There is nothing. None of this works for people with glioblastoma. I do not want to mislead the Minister into thinking that I care only about my sister, Margaret. I draw hon. Members’ attention to early-day motion 1233, in my name, to commend the life of Laura Nuttall, a young woman diagnosed with a glioblastoma aged 18. She died on 22 May. I want to pass on all our condolences to her mum, Nicola, her sister, Gracie, and her father. Laura was a shining light and an ambassador for the Brain Tumour Charity. Although she was told that had only a year to live, she managed to live for four and a half years and secured a 2:1 in her degree. Laura highlighted that brain tumours are the greatest killer of people under the age of 40, who are being let down.

[Will Quince]

I totally take the hon. Lady’s point when she says that it is not all about her sister, Margaret— I know that from her contributions. Often in this place, we draw on our personal experiences, which enable us to bring to life powerfully and emotively what others are experiencing. I thank her for sharing Laura’s experience, and I send my condolences to Laura’s friends and family.

The hon. Lady is absolutely right that the cancer drugs fund can bring forward only innovative medicines that have gone through the clinical trials process. I will be very happy to work with her and meet her again to discuss how we get more research in this space. That is the key to so much, in relation to tacking brain tumours.

The hon. Member for Strangford spoke about the challenges presented by combination therapies. The commercial framework also recognises that realising the full potential health benefits from combination drug therapies can be challenging, given the requirement for commercial confidentiality and the need to maintain competition. Having said all that, NHS England has a proven ability to negotiate commercial agreements that secure combination treatments for patients. Just last month, deals were struck to enable NICE to recommend Keytruda and Lenvima for hundreds of women with advanced endometrial cancer. Progress is being made, but again, I would be happy to discuss the issue further.

Again, I thank the hon. Member for Strangford for securing this important debate and for his continued interest in the appraisal of cancer medicines and access to cancer treatments for NHS patients. I also thank other Members who have made such powerful contributions.

If one message comes across, Mrs Harris, I hope that Members are assured that the Government and I remain firm in our commitment to making the most promising and effective new cancer treatments available to NHS patients. The hon. Member for Denton and Reddish said that this is not a political issue, and I agree. It would be impossible to find anyone in the House who does not want to ensure that patients across the United Kingdom get access to the most innovative and cutting-edge medicines for cancer and other diseases, as quickly as possible. We all have a common endeavour there.

It is important to acknowledge the huge role that NICE has played, with its world-leading health technology assessment. It has enabled NHS patients to be at the forefront of access to new cancer treatments, in a way that also represents value for the taxpayer. I recognise the point that has been well made today, that we must always seek to improve and to go further and faster. I look forward to working with all Members present and others across the House to achieve that.

Obesity and Fatty Liver Disease

Will Quince Excerpts

Thursday 8th June 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to the hon. Member for Caerphilly (Wayne David) for securing a debate on this hugely important issue, and of course to the all-party parliamentary group that he chairs for its important work on tackling liver disease and liver cancer. I am responding on behalf of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), who is the responsible Minister in this area. Nevertheless, I will try to give as full a response as I can.

The Government welcome the opportunity to discuss the prevention of obesity and fatty liver disease, and I thank all hon. Members who have contributed today—particularly the hon. Member for Caerphilly, my hon. Friend the Member for Erewash (Maggie Throup) and the hon. Member for Ealing, Southall (Mr Sharma), who did not have to be here but who came to raise their points.

I particularly thank my hon. Friend the Member for Erewash for all her work as a Minister at the Department of Health and Social Care. She is a passionate advocate for tackling obesity and the conditions that result from it. She and I know that we do not agree on everything—we have had many a debate on this issue—but we both believe passionately in tackling it, because we know how important it is.

As has been said, liver disease is one of the most significant killers of working-age people in England, and I suspect that that is the same across our United Kingdom. In the last two decades, around 90% of liver deaths in England have been related to lifestyle and unhealthy environment, and the vast majority are alcohol related. These diseases are responsible for a four-times increase in liver mortality over the past few decades. The populations most at risk from non-alcoholic fatty liver disease are those living with obesity or type 2 diabetes.

Alongside its role in non-alcoholic fatty liver disease— I appreciate that the focus of today’s debate is obesity—obesity is also the leading cause of other serious non-communicable diseases, such as type 2 diabetes, heart disease and some cancers, and it is associated with poor mental health. As the hon. Member for Caerphilly pointed out, this represents a huge cost to the health and wellbeing of individuals, and also to the NHS, wider society and our economy. It is estimated—this must be correct, because the hon. Gentleman and I have exactly the same figure—that obesity costs the NHS £58 billion. That is a loss to the economy and, importantly, a reduction in the quality of life of people up and down the country.

Although obesity rates have been relatively stable over the past few years—in fact, over the past decade—they are still stubbornly high. About one in four adults, and one in four children aged 10 to 11, live with obesity, so the prevalence remains far too high. I am particularly concerned about childhood obesity, not just because I am a Minister at the Department for Health and Social Care, but because I am a former Children’s Minister and Minister with responsibility for school sport.

Two weeks ago, I represented the United Kingdom at the World Health Assembly. I spoke to representatives of about 25 other countries, and it was interesting how many times obesity came up as a challenge that they are facing too, so we need to work together. As the hon. Member for Strangford (Jim Shannon) said, it is not just about our United Kingdom; we need to work together and share best practice globally to make sure we are tackling this issue together. I raise the point about children because, from my work as Children’s Minister, especially on early years, and as a father of two children, I know too well that habits are formed really young, so we have to tackle this issue at the earliest possible point.

Data shows that people in lower income groups are more likely to be living with obesity than the rest of the population. Nevertheless, the issue is prevalent across all groups, as the hon. Member for Ealing, Southall said. The hon. Member for Bristol South (Karin Smyth) raised health inequalities and the major conditions strategy, which sits with the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately). I know she would be happy to meet hon. Members to discuss the major conditions strategy ahead of the interim report, which I understand is due to come out this summer. I am happy to commit my ministerial colleagues to meet hon. Members, as I do regularly.

Obesity is a complex problem that is caused by many factors, and there is no single solution. My hon. Friend the Member for Erewash and I have had many debates on this issue, and there are many ways that we can tackle it. It is multifaceted and complex, and therefore the solution will inevitably be somewhat complicated.

I am not particularly fond of talking about my own health. I often hear people say that they prefer the expression “living with obesity” to “obese people”. When we come back to Parliament and are sworn in again, they take our photo. I was 19.5 stone at the time of the 2019 general election, and they still, to this day, use that photo. I turn up at events and people say, “You don’t look anything like your photo.” The point I am trying to make is that I know how difficult these things are; it is a daily battle to lose weight and keep it off. It is a mixture of diet and exercise. I passionately believe that we need to empower people to make better, healthier life choices. There are interventions that we are making and further interventions that we should make to tackle this issue. I assure the House that, although this is not my direct ministerial responsibility, I am a passionate but realistic advocate of the measures that we can and should take to tackle obesity.

I genuinely believe that a mix of actions at a local and national level are required to help with the prevention of excess weight gain and to promote healthy behaviours. We know that obesity does not develop overnight; it builds up over time. It is frequently about excessive calorie consumption. It does not have to mean overeating hundreds of calories a day, although we all do that sometimes, and we then have to overcompensate in another way. It often means small amounts of excess calories, consumed regularly, which add up for adults and children, so there is a big education piece that we need to do. We are doing that, but we need to do more.

As my hon. Friend the Member for Erewash said, yesterday, as part of action to treat those already living with obesity, the Government announced plans for a two-year pilot, backed by £40 million, to look at ways of expanding access to new weight loss drugs outside of a hospital setting through primary care that more eligible patients will be able to benefit from, therefore reducing their risk of obesity-associated illness.

One area that is certainly within my ministerial responsibility is our work on research with the National Institute for Health and Care Research. Obesity is one of our national healthcare missions; we are determined to look at some of the innovative solutions out there to help people to take control, and empower them to make healthier life choices and control their weight.

[Wayne David]

I note that the Minister said there is Government support—in a limited way, at the moment—for weight loss drugs. I welcome that, but I am cautious; there is a real danger of placing too much emphasis on drugs as a way to lose weight. They can be in addition to other measures, but those other measures are critical. I welcome the Minister’s views on that, but there is a danger of putting too much emphasis on those drugs.

[Will Quince]

The hon. Gentleman raises a good point; I totally agree. As further details are published, he will see the current criteria for accessing those drugs. The reality is that more and more are coming on stream, and they will be part of our arsenal and one of our tools to help people tackle obesity and make healthier life choices.

What do we also know about the drugs? Well, we know that they are effective. However, they are effective only for as long as someone takes them, unless they change their lifestyle and behaviour. Anything we do in relation to drugs must be alongside an education piece, and supporting and empowering people to make healthier life choices. Ultimately, and ideally, we do not want people to be on drugs for the rest of their lives where it is not necessary. We want the drugs to be a tool and enabler to help and support them to get to a place where they can manage their own weight. That might be difficult for some people and they may struggle to do so, and for others it may not. It is just a helping hand; the hon. Gentleman is right.

As hon. Members made their contributions, I scribbled down the actions—just in my own mind—that the Government have taken over the past few years, such as calorie labels on food in supermarkets. I know that that made such a difference, because when I am looking, I make active choices. I look at the traffic light system, I look at the calories, and I look at the amount of salt and sugar in these products; and doing so enables me to make healthier choices. That is important. There is the calorie labelling on food sold in large businesses, including restaurants, cafés and takeaways, which came into force back in April—not uncontroversially.

[Maggie Throup]

My hon. Friend is right that there is a lot more information there for people to make informed decisions on, but there are also hidden contents that people are not being informed about, such as the ultra-processed foods. Products may be labelled as low in fat, but they have other products in them to ensure that they will taste okay and still be low in fat. We need to not just look more at the overall messaging on packaging, but ensure that we reduce some other items in the products that are causing the obesity crisis.

[Will Quince]

My hon. Friend is absolutely right; we are constantly learning more. At the moment, I do not think there is a definition of an “ultra-processed food”. There has been a lot of work. We are learning more and more about the issue and it has recently exploded into the public domain. We need to ensure that more people are aware of and being educated about what is actually in their food, and that they are looking at labels. If we go back 20 years, we were all very much alive to E numbers —does everyone remember E numbers?—which no one looked at before. Now, we often look over the back of the packaging to see the number of E numbers in our products. The more that the public are educated and informed so that they can look out for these things, the better. My hon. Friend the Member for Harborough will be happy to discuss this further with my hon. Friend the Member for Erewash. I know that ultra-processed foods are an issue about which the public are concerned, and we certainly have more to do on food labelling.

[Jim Shannon]

The Minister always brings good responses. The SNP spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day), made a comment that I endorse totally, because it is something that I hear from my constituents every week. With respect, many people can look at the labels and see what they mean, but what do they look at first? They look at the price, because they are trying to make a meal for their family. What drives them will be, “What can I afford to do?” I am conscious that the Minister has been very constructive in his responses, but there must be a wee bit of reality as well.

[Will Quince]

I thank the hon. Member for that intervention. He is absolutely right; not everyone has the luxury to make choices, and they will often have to go for the cheapest products or products that are available in their area when others might not be. That is why it is so important that we continue the work with industry on reformulation.

Personally, I have been more of a convert to Government action in this area. The soft drinks industry levy has been hugely successful. The industry was already doing a lot of that work. Nevertheless, the levy has nudged and pushed it further in the right direction—but there is more work to do.

I would push back ever so slightly on a couple of the comments that have been made today about industry not wanting to do this. It is not moving at the pace that we want, expect and need it to, but it is doing it. The sugar content of cereal is down by about 15%, and it is down by about 14% in yoghurts and fromage frais. We need industry members to go further, but they are doing it because they are responding directly to what their customers and consumers are telling them they want, and to people actively choosing healthier products. However, we have more to do on reformulation and working with industry.

We will also introduce restrictions on the advertising of less healthy products before 9 pm. I will answer the question on that from my hon. Friend the Member for Erewash in just a moment. The major conditions strategy call for evidence is open, and, as I said, my hon. Friend the Member for Faversham and Mid Kent will gladly meet colleagues to discuss that.

There is also the piece of work around supporting people with weight management, such as the NHS digital weight management programme, the weight loss drug programme and pilot that we announced yesterday, which I just spoke about, and the better health campaigns—including the NHS weight loss app Couch to 5k, which, if anyone has not tried it, is a great way of getting into running, and Active 10. There is also the NHS health check, which includes checking on BMI, encouraging people and giving them the tools to take control of their health.

Then there is the research piece. As I say, this is one of our healthcare missions. Obesity is right there at the top; we want to see the newest and most innovative products and medicines coming forward and being used first in this country.

The hon. Member for Bristol South is absolutely right that this cannot just be an issue for the Department of Health and Social Care; it must be a cross-Government issue. I remember when I was the Children’s Minister and had responsibility for school sport: looking at school sport investment and premiums, at the upskilling of primary school PE teachers in particular, and at the holiday activities and food programme, which was specifically targeted at children in receipt of free school meals.

I remember visiting some eye-opening educational programmes. In one example—I would love to get a number of parliamentary colleagues to try this experiment—there was range of soft drinks, from a Monster energy drink through to flavoured water, and a big box of sugar cubes. The children were asked to put against each product the number of sugar cubes they thought it contained. You would be amazed, Mr Hollobone, how many children put six cubes against the water and very few against the Monster or the full-fat Coke, despite the can of Coke containing something like six cubes of sugar. In schools, we are also promoting the daily mile, the healthy schools programme and healthy school meals. That is all important work, but do we need to do more? Of course we do.

My hon. Friend the Member for Erewash asked about the delay to policies, specifically to the restrictions on advertising and promotions. I understand her frustration but the delay to advertising restrictions allows the Government and regulators to carry out certain processes necessary for the robust implementation of the restrictions. Those processes include carrying out consultations, appointing a frontline regulator, the laying of regulations and the drafting of guidance. She asked specifically when that is coming in; it will be in October 2025. She also asked about the volume price promotions ban, which was delayed due to the unprecedented global economic situation. I do not know the answer and I do not want to mislead her. The legislation states October this year, but I do not know latest position, so I will ask my hon. Friend the Member for Harborough to write to her.

[Wayne David]

I think there was an intake of breath in the Chamber when the Minister mentioned October 2025 for the introduction of the limit on advertising. Is there any way that he would support measures to circumvent the excessively long delay? I think the will is there; it is a question of just dotting the i’s and crossing the t’s to ensure that everybody is on board. That can be done relatively quickly, if there is the political will.

[Will Quince]

As much as the hon. Gentleman tempts me to make Government policy on the hoof, as it is not my policy area I will refrain from doing so. I will ask my hon. Friend the Member for Harborough to speak directly with the hon. Gentleman to see if there is any way that process could be accelerated.

I will turn to early diagnosis and community diagnostic centres—a subject raised by the hon. Members for Caerphilly and for Bristol South, and by my hon. Friend the Member for Erewash. I am a massive fan of community diagnostic centres. In fact, I was in one in Roehampton this morning.

NHS England is playing a key role in helping to reduce preventable deaths from liver disease, and, as my hon. Friend the Member for Erewash alluded to, it has begun the process of fibroscans through community diagnostic centres. There is a £2.3 billion programme to increase the number of CDCs across the country to 160. The commitment so far is that 100 of them will be diagnosing liver disease by March 2025. If we can accelerate that, we will. We are accelerating the CDC programme. That is within my gift, and I will look at that closely to see what is within the art of the possible. Of course, I am keen to see what we can do to boost diagnostic capacity to diagnose liver disease and improve earlier diagnosis, which leads to improved health outcomes.

The hon. Member for Strangford asked about work in Northern Ireland. We do so much work across the United Kingdom on public health, research and medicines, as well as in the health space. I do not know the specific answer, because it does not sit within my portfolio, but I have no doubt that my hon. Friend the Member for Harborough will be working on that on an all-nation basis. The spirit of collaboration is important when it comes to these issues.

A lot of poor health is preventable; that point has been made a number of times during the debate. People instinctively want to be and to stay healthy. Sadly, however, most people who are diagnosed with liver disease at a late stage, when it is less treatable, are often diagnosed during an emergency hospital admission. That has to change, and the Government are determined to take action to make the needed changes. As the hon. Member for Caerphilly said, today is International NASH Day—a day to raise awareness of non-alcohol-related fatty liver disease and its more advanced form. I hope that by debating the topic, we have raised awareness of that hugely important issue, and of the disease.

Reciprocal Healthcare: 2021-22 Annual Report

Will Quince Excerpts

Wednesday 7th June 2023 Written Statements

[The Minister for Health and Secondary Care (Will Quince)]

I have today laid before Parliament the second annual report on international healthcare payments pursuant to section 6 of the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019.

The 2019 Act implements the social security co-ordination protocol to the EU-UK trade and co-operation agreement, the UK/Switzerland convention on social security co-ordination and the various separation agreements with the European economic area and Switzerland.

These European-wide arrangements ensure UK residents continue to benefit from reciprocal healthcare arrangements when they visit, study or live in European Union member states. Specifically, UK residents can access necessary healthcare when they travel to Europe (the global health insurance card scheme) or access planned healthcare if they meet certain criteria (known as the S2 scheme). Eligible UK state pensioners, frontier workers and certain other groups can have their healthcare costs covered by the UK Government when they move to Europe (known as the S1 scheme).

Building on the successful continuation of our European reciprocal healthcare agreements, the Government are now seeking to broaden the benefits of the GHIC. New or refreshed arrangements are being negotiated with our overseas territories, Crown dependencies and other states, where reciprocal healthcare cover will bring greater benefits to the UK. The amendments passed in the Health and Care Act 2022 will enable the Government to implement comprehensive healthcare agreements with countries outside the EEA and Switzerland when it comes into force in 2023.

The report I laid before Parliament today covers the Government’s expenditure on reciprocal healthcare under the powers conferred by the 2019 Act between 1 April 2021 and 31 March 2022, pursuant to our international commitments in the UK’s agreements with the European Union, member states of the European economic area and Switzerland. The report also includes the states and jurisdictions with which the Government are currently negotiating new reciprocal healthcare arrangements.

[HCWS829]

Oral Answers to Questions

Will Quince Excerpts

Tuesday 6th June 2023 Commons Chamber

[Mark Pawsey (Rugby) (Con)]

1. What assessment his Department has made of the adequacy of urgent and emergency care provision in towns with significant population growth.

[The Minister for Health and Secondary Care (Will Quince)]

Our recovery plan for urgent and emergency care provides £1 billion of additional funding for NHS capacity, alongside £250 million for capital improvement schemes up and down the country. Local integrated care boards are now responsible for working with their partners to decide how best to use that funding to improve services to meet the health needs of their changing populations, and all integrated care boards will shortly set out their plans for the next five years through a joint forward plan process.

[Mark Pawsey]

Rugby is the largest urban area within Coventry and Warwickshire that does not have its own A&E provision. In the wider region, Kettering, Shrewsbury, Redditch and Burton upon Trent all have similar or smaller populations, each with their own A&E services. Rugby is growing fast, with 12,500 homes being delivered between 2016 and 2031, when the population will exceed 135,000. Will the Minister say at what population level it will be appropriate for local health commissioners to upgrade the A&E provision at the Hospital of St Cross in Rugby?

[Will Quince]

As my hon. Friend knows, the provision of services, including accident and emergency, are a matter for local NHS commissioners and providers. I know that he regularly meets local NHS leaders about this matter and will continue to do so. I am very happy to meet him and, of course, visit. Funding for Coventry and Warwickshire Integrated Care Board has increased to over £1.6 billion this year. My hon. Friend is a huge champion for his constituents; I would be happy to meet and visit.

[John Cryer (Leyton and Wanstead) (Lab)]

The population of my constituency is due to grow rapidly over the next 10 years and beyond. On that basis, can the Minister give a completion date for the new Whipps Cross Hospital, which was announced last week?

[Will Quince]

By 2030, Mr Speaker.

[Mr Speaker]

And obviously we want 24-hour provision in Chorley, which has the fastest-growing population, but let us move on.

--- Later in debate ---

[Aaron Bell (Newcastle-under-Lyme) (Con)]

I know the Minister is very keen to see the numbers of elective waits fall, and they have been falling. My constituents in Newcastle-under-Lyme share that aim. So will he welcome the local hospital trust opening not only a new modular theatre for specialised hand surgery, but a central treatment suite for day patients at the County Hospital in Stafford funded by NHS England’s elective recovery plan, which will help cut waits for planned procedures?

[The Minister for Health and Secondary Care (Will Quince)]

I thank my hon. Friend for his question. He has articulately and eloquently set out the improvements being made at Stafford County Hospital, and he has been a strong champion for those works. This is real, visible, positive change that will benefit both residents and patients in Newcastle-under-Lyme and the surrounding areas.

[Stewart Malcolm McDonald (Glasgow South) (SNP)]

My constituent Brian Murray lost his wife Roberta six years ago, following years of chronic health conditions after an infected blood transfusion. He wants to know: when will the Government enact all of the recommendations regarding compensation from the second report by Sir Brian Langstaff?

Protection of Confidential Patient Information: Statutory Guidance

Will Quince Excerpts

Tuesday 23rd May 2023 Written Statements

[The Minister for Health and Secondary Care (Will Quince)]

My noble Friend (Minister for the Lords) the Parliamentary Under Secretary of State for Health and Social Care (Lord Markham), has made the following written statement:

Today, the Department of Health and Social Care publishes its guidance that sets out how NHS England will protect patient data, following the transfer of NHS Digital’s responsibilities. The guidance is available here: https://www.gov.uk/government/publications/nhs-englands-protection-of-patient-data.

On 1 February, NHS Digital legally became part of NHS England, creating a single, central authority responsible for all elements of digital technology, data and transformation for the NHS.

NHS Digital was a powerful force for change in the NHS and guardian of its key data IT and data systems. These IT systems and its expert staff transferred to NHS England.

Laura Wade-Gery was commissioned by the Government to lead an independent review of how we can ensure that digital technology and the effective use of data is at the heart of transforming the NHS. Her report “Putting data, digital and tech at the heart of transforming the NHS”, published in November 2021, recommended merging the functions of NHS Digital into NHS England, to provide a single statutory body for data, digital and technology to provide the right leadership and support to integrated care systems.

This integration is an important step in bringing together in a single place, the essential systems and programmes to digitally transform the NHS, and to harness the full potential of data. It will enable health and social care services to use digital and data more effectively to deliver improved patient outcomes and address the key challenges we face.

In harnessing the full potential of data to digital transform the NHS, this statutory guidance makes it clear that NHS England should maintain high standards of data protection, information governance, and transparency, as NHS Digital did, to demonstrate that it is a trustworthy custodian of health and care data. NHS England must have regard to this guidance and also undertake an annual review of how effectively it has discharged the data functions transferred over from NHS Digital.

[HCWS799]