4.33 pm

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)

Like all other hon. Members who have spoken, I welcome this very important debate, which was secured by the hon. Member for Basildon and Billericay (Mr Baron) and others. Although he is, uncharacteristically, not in his place, for very important reasons—we all send him and his wife our very best wishes—I want to place on the record that this House and, indeed, the whole country owe him a huge debt of gratitude for all that he does on the issue and for his sterling leadership as chair of the all-party parliamentary group on cancer in aiding our work in fighting this terrible disease.

I thank my hon. Friend the Member for Scunthorpe (Nic Dakin), who opened the debate. Like me and several others, he is a chair of an all-party group on cancer; his group is on pancreatic cancer. He works tirelessly on this issue, and he chaired the “Britain against cancer” conference with aplomb this week. He set the scene today so well, and his knowledge and passion shone through.

I thank all hon. Members who have spoken in the debate: the hon. Member for Crawley (Henry Smith), my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), the hon. Members for Bosworth (David Tredinnick), for Strangford (Jim Shannon) and for Castle Point (Rebecca Harris)—the hon. Lady is also the chair of a cancer all-party group—the hon. Member for Harrow East (Bob Blackman) and my very good friend the hon. Member for Bury St Edmunds (Jo Churchill), who is also vice-chair of the all-party group on breast cancer, of which I am a co-chair. They all made excellent contributions, and each and every one has made some important points about where we need to go next with the cancer strategy.

Much of the debate has focused on the report published by the all-party group on cancer, which looked at the progress made in implementing the cancer strategy one year on from its publication. The report makes many valid points and recommendations, and I look forward to hearing from the Minister on the specifics mentioned in it. The strategy can go a long way towards helping some of the estimated 2.5 million people living with cancer and the people who are diagnosed each year with cancer. The strategy, if implemented in full, could save 30,000 more lives per year by 2020.

That should be paired with the deeply worrying news that broke at the beginning of November that more than 130,000 patients a year have not been receiving cancer treatment on time, because cancer patients did not see a cancer specialist within the required 14 days. In some areas, the problem was so severe that more than ​6,000 patients were forced to wait 104 days or more. In addition, our findings show that the Government met their 62-day target only once in the last 20 months. That should drive the Government to do more, and it is clear that we are seeing issues around the transformations already. That should not be knocked, and I am certainly not knocking it, but we must all continue to hold the Government to account where we can.

That is why in my contribution I want to touch on two areas: improvement in preventive measures that can help to reduce the occurrence of cancer, and the significant concerns that have recently been raised regarding the cancer workforce. We can all agree that prevention is key to addressing many health conditions, illnesses and diseases, and cancer is no different. As we have heard from several hon. Members in this debate, four in 10 cancers are preventable, and we should be doing much more to prevent cancers from developing, especially those that could have been prevented by lifestyle changes. Prevention was a central pillar of the cancer strategy, along with the five-year forward view.

The Minister is surely prepared for what I am going to say next, because I have said it to him often enough in my short time as the shadow Minister with responsibility for public health. It remains true, sadly. The false economy of cutting public health funding with no assessment of the ramifications of doing so on various aspects of our lives, or on other parts of the NHS and the wider health service, is seriously worrying. According to data collected by the Association of Directors of Public Health, smoking cessation services are expected to be reduced by 61% in 2016-17, with 5% of services completely decommissioned. For weight management support there will be a 52% reduction, with 12% being decommissioned. That is damning information when smoking and obesity are, as we have heard, two of the biggest preventable causes of cancer. We know that 100,000 people are dying each year from smoking-related diseases, including cancer.

It is right that the cancer strategy strongly recommended the introduction of a new tobacco control plan post haste and an ambitious plan for a smoke-free society by 2035, as has been outlined. We still have not seen the plan, despite being promised repeatedly over the last year that we would. I am sure that the Minister will give us further information on that in his response, and we all look forward to it. I hope that we see that plan sooner rather than later, and that hope has been echoed by several hon. Members from both sides of the House.

A continued delay will never be beneficial for our shared vision of a smoke-free society or for preventing cancer from happening. Another plan we have finally seen, although it has been considerably watered down, is the one for childhood obesity. After smoking, it is understood that obesity is the next biggest preventable cause of cancer. If we allow current trends to continue, there could be more than 670,000 additional cases of cancer by 2035. This completely goes against the vision set out in the cancer strategy. We saw some of the detail of the sugary drinks levy earlier this week, and it will be interesting to see how this develops in the months ahead, but I hope the Minister can outline a little bit more about what else he and his colleagues plan to do on obesity and its links to cancer.

As part of the cancer strategy, a review of the current workforce was called for so that we could fully understand the shortfalls—the areas of investment needed and the ​gaps in the training of new and existing NHS staff—and meet the ambitious and noble goals set out in the strategy. In my capacity as chair of the all-party group on ovarian cancer and co-chair of the all-party group on breast cancer, I along with colleagues from both sides of the House—some of them are in the Chamber, notably the hon. Member for Bury St Edmunds, who is a vice-chair of the all-party group on breast cancer—raised this at the beginning of the year with Health Education England, which is conducting the review. In our letter, we raised the need for immediate solutions to fill the specialist gaps in our cancer workforce, but also the need for a strategic, longer-term solution to be put in place.

The issue of the cancer workforce is an incredibly important one, especially given that Cancer Research UK warned over two weeks ago that pathology services in the UK were at a tipping point, and that the Royal College of Radiologists warned earlier in the year that 25% of NHS breast screening programmes were understaffed, with 13% of consultant breast radiologist posts left vacant, a figure that has doubled since 2010. That should spur on the Department to push ahead on the workforce issues that have been raised so often with Ministers.

Only this July, organisations such as Macmillan and Cancer Research UK joined with other organisations to call for a set of principles to be taken up by the Government, including a review of the current and future workforce. The Minister should also heed the words of Dr Harpal Kumar, who during an oral evidence session for the inquiry by the all-party group on cancer into progress on the implementation of the review, said that workforce issues remained “significant and severe”.

The ageing population, which means that more and more people could be diagnosed with cancer, and the much welcomed push to improve earlier diagnosis of cancer mean that pressures on the workforce will rise if the right support is not found, especially given the projection that 500,000 Britons will be diagnosed with cancer by 2035. That should remain at the forefront of the Minister’s mind, and in the minds of his officials and those who deal with workforce capacity.

It is clear that investment is failing to keep up with demand. That was raised in the cancer strategy, which called on NHS England to invest to unlock the extra capacity we need to meet the higher levels of cancer testing. The Opposition support the calls made only a few short months ago by the national cancer advisory group for NHS England’s cancer transformation board to prioritise a focus on the cancer workforce in the coming months. I hope the Minister will ensure that that happens, and that when we come back from the Christmas recess, we will start to see the much needed progress that has been called for.

In conclusion, the work that has started on the transformative programme is to be welcomed. It is a large task to undertake, yet the Government will not be allowed to sit back; I know that they and the Minister will not do so. It is up to all of us in this House, along with many people outside this place, to continue to do all we can to hold the Minister and the Government to account on what are such important and personal matters for all of us who have been affected by cancer, be it ​personally or through family and friends. We must all be critical friends in this drive to fight off cancer once and for all. We all agree that cancer should be at the top of our list of health priorities. It is so destructive, and, very sadly, it will affect us all in some way. We must ensure that we get this right, because we cannot afford to get it wrong.

Mrs Hodgson

4.37 pm

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)

I welcome the opportunity to speak in the Chamber for a second time today, on yet another important topic. This time we are debating health inequalities and I thank the Backbench Business Committee for allowing this debate to take place following the application by the hon. Member for Totnes (Dr Wollaston) and other hon. Members across the House. The hon. Lady made an excellent speech, and we are very grateful to her for that. I also want to thank other hon. Members across ​the House for their excellent contributions today. I especially want to highlight the excellent speeches by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and my hon. Friends the Members for Stockton North (Alex Cunningham), for Bradford South (Judith Cummins), for Heywood and Middleton (Liz McInnes) and for Hackney South and Shoreditch (Meg Hillier).

I enjoyed the speeches by the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile)—a fellow member of the all-party parliamentary group on basketball—and by the hon. Member for Erewash (Maggie Throup), who made an excellent speech on obesity and childhood obesity. I also enjoyed the speech by the hon. Member for Glasgow Central (Alison Thewliss). As she knows, I agree with most of what she says, especially about breastfeeding. We have had an excellent debate, with excellent contributions all round.

When it comes to addressing health inequalities, there are many conversations about the need for systemic change to reverse the trends. However, in my contribution today I want to look at tangible specifics that the Minister can get to work on in her remit as Minister for Public Health. I will do that by looking at the current state of health inequality and then the two key areas of smoking and childhood obesity and what more can be done to address those signifiers. I will then move on to the cuts to public health grants, which are exacerbating the situation.

The most recent intervention on health inequality came from the Prime Minister, who used her first speech on the steps of Downing Street to highlight that,

“if you’re born poor, you will die on average 9 years earlier than others.”

We have heard clear examples of that from constituencies around the country. That welcome intervention set the tone of her Government’s serious work to address health inequalities.

It is hard not to agree when the facts speak for themselves. Two indicators from the most recent public health outcomes data show that London and the south-east have the highest life expectancy while the north-east and north-west have the lowest. The same pattern appears when looking at excess weight in adults, about which we have also heard today. Rotherham comes out the highest at 76.2% and Camden is the lowest at 46.5%. Those figures prove what we all know to be true: people living in more deprived parts of the country do not live as long as those in more affluent areas. Contributors to ill health such as smoking, excessive alcohol consumption—which we heard about from the hon. Member for Congleton (Fiona Bruce)—and obesity are more prevalent in deprived areas.

On a moral level, it is important for the Government to address such issues, so that we can improve our nation’s health, but there is also an economic argument to be made. If we have an unhealthy population, we will not be as productive. In England, the cost of treating illnesses and diseases arising from health inequalities has been estimated at £5.5 billion a year. As for productivity, ill health among working-age people means a loss to industry of £31 billion to £33 billion each year. Those two facts must spur the Government into action, but there are many issues to tackle and multiple ways for the Government to address them. Many such issues ​have been raised in the debate but, as I said, I will examine two key areas that the Minister must get right: smoking cessation and childhood obesity.

My first outing as shadow Public Health Minister was to debate the prevalence of tobacco products in our communities and the need for the Government to bring forward the new tobacco control plan.

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

indicated assent.

Mrs Hodgson

The Minister is nodding, so she remembers it well. The Government need to set out key actions to work towards a smoke-free society. Smoking is strongly linked to deprivation and has major impacts on the health of those who do smoke, such as being more prone to lung cancer and COPD and facing higher mortality rates. If we look at that by region, which I have already established is a factor in health inequality, smoking levels are higher in the north-east at 19.9% compared with the lowest in the south-east at 16.6%. When looking at smoking by socioeconomic status, we find that smoking rate in professional and managerial jobs is less than half that in routine and manual socioeconomic groups, at 12% and 28% respectively.

In the debate held just over a month ago, the Minister was pushed on when the new tobacco control plan would be published. Concerns have been raised by various charities, including ASH, Fresh NE and the British Lung Foundation, about how the delay could jeopardise the work already done. Sadly, the Minister evaded my specific question back then, so I will ask her the same thing again: when can we expect the new plan? Will it be this year or next year? The plan will not only go a long way to work towards a smoke-free society, but help to reduce health inequalities in deprived areas. The Minister can surely understand that and the need to come forth with the plans.

The Minister knows that I also take a keen interest in childhood obesity. She has said repeatedly that the publication of the childhood obesity plan was the start of the conversation. Childhood obesity is the issue on everyone’s lips right now as it is the biggest public health crisis facing the country. I will not repeat the stats we all know about the number of children who start school obese and the number who leave obese—they are shocking. Many organisations and individuals, including Cancer Research UK, the Children’s Food Trust and Jamie Oliver, have made clear their dismay at the 13-page document that was snuck out in the summer and have said that it did not go far enough. Incidentally, it came out on the same day as the A-level results, so it looked like it was being hidden.

Obesity-related illnesses cost the NHS an estimated £5.1 billion a year, and obesity is the single biggest preventable cause of cancer after smoking. It is also connected to other long-term conditions such as arthritis and type 2 diabetes. When obesity is linked with socioeconomic status, we see real concern that the plan we have before us will not go far enough to reverse health inequality. National child measurement data show that obesity among children has risen, and based on current trends there could be about 670,000 additional cases of obesity by 2035, with 60% of boys aged five ​to 11 in deprived communities being either overweight or obese. There is a real need for the Government to come to terms with the fact that many believe the current plan is a squandered opportunity and a lot more must be done. That is why I hope the Minister will be constructive in her reply to this debate, giving us reassurances that move us on from this being “only the start”. At the end of her speech, the hon. Member for Erewash gave us a list of four or five items that we could start straightaway, which would certainly take us further on.

The Government have stalled or not gone far enough on the plans I have mentioned, but there is also deep concern that the perverse and damaging cuts to public health spending will widen the health inequality gap. The Minister knows the numbers that I have cited to her previously, but I will cite them again, even after my right hon. Friend the Member for Kingston upon Hull West and Hessle has done so. We are greatly concerned about the £200 million cut to local public health spending following last year’s Budget, which was followed by the average real-terms cut of 3.9% each year to 2020-21 in last year’s autumn statement. I want to add some further concerns that go beyond those raised by Labour.

Concerns were identified in a survey by the Association of Directors of Public Health, which found that 75% of its members were worried that cuts to public health funding would threaten work on tackling health inequalities. Those concerns are backed up by further evidence published by the ADPH, which found that local authorities are planning cuts across a wide range of public health services, because of central Government cuts. For example, smoking cessation services saw a 34% reduction in 2015-16, and that will become 61% in 2016-17, with 5% of services being decommissioned. That is seen across the board among local public health services and will be detrimental to reversing health inequalities. For the Government to fail to realise that cutting from this important budget will not help the overall vision on health inequality, set out by the Prime Minister earlier this year, is deeply worrying and shows a distinct lack of joined-up thinking around this issue.

In conclusion, health inequality is a serious issue that we cannot ignore or let the Government get wrong, as the health of our nation is so important, not only in a moral sense, but economically. I know the Minister will fully agree with the Prime Minister’s statement from earlier this year—there is no second-guessing that, as we all do—but we need radical proposals that get to the bottom of this persistent issue, which blights the lives of so many people living in our most deprived communities. We all want to see a healthier population, where nobody’s health is determined by factors outside their control, and we must all work together to get to the point where it is no longer the case that the postcode where somebody is born or lives determines how long they will live or how healthily they will live that life.

1.27 pm

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)

It is a pleasure to speak in such an important debate. I want, first and foremost, to thoroughly thank my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who for many years now has championed and pushed on this vital matter. Her work cannot and must not go unnoticed or unrecognised. I am sure people across the country, and indeed across the House, will want to join in thanking her.

The experiences of those men and women affected by this awful scandal should never be out of our minds as we continue to do all that we can to support them. Doing all we can for them is paramount, knowing full well that whatever we do will not be enough to give them back their life or a life without suffering or pain. HIV and hepatitis are terrible conditions. Someone living with HIV or hepatitis will face fears of developing other conditions and have to face the stigma that comes with these conditions. This debate is welcome, as it is the first time the House has had the chance to debate the new scheme since it was announced and to continue to hold the Government to account to do more. It is important that we now have the chance to discuss that in a considered and comprehensive manner.

In my contribution, I want to touch upon three areas: first, the current funding system in England; secondly, the involvement of private companies to administer support to beneficiaries; and, thirdly, the need for an independent Hillsborough-style panel to recognise the failures of the system that these people have had to live with.

It was announced earlier in the year that a new financial arrangements system would be introduced, and a public consultation was conducted to get views ​and opinions on how that would take shape. Although there has been a welcome, if somewhat modest, increase in the annual payment to people with HIV, hepatitis C at stage 2 and those who are co-infected, as well as the first guaranteed ongoing payments for people with stage 1 hepatitis C, it is concerning that these payments fall short of what has been drawn up in Scotland.

Also, the current English system makes no mention of support for people who have been cleared of hepatitis C prior to the chronic stage but who, despite fighting off the disease, may still exhibit symptoms ranging from fatigue to mental health issues and even diabetes. These people have never been entitled to any support, and continue to get none. The scheme does not include support for those infected with other viruses, such as hepatitis B, D or E, and for those people it has meant continuous monitoring of their liver function. It is estimated that that group is extremely small and, according to the Haemophilia Society, would be a minimal cost to the Department of Health.

We find that the new scheme does little or nothing for bereaved partners, parents or children of those who have sadly died from diseases contracted through the contaminated blood scandal. The new system should have gone a long way to supporting those various groups within the affected community. I hope that the Minister can give us some reassurance that those concerns have been noted, and that she will go away and look into what more can be done to help the people I have just mentioned.

There are also concerns regarding the discretionary payments, which, thankfully, were saved, despite it being announced in the consultation earlier this year that they could be scrapped. That should be welcomed, but there is a clear concern that the discretionary support will not go far enough to improve the support on offer for those with HIV or those who are co-infected. The Government need to consider that impact and what more they plan to do. It is worrying that the Government have yet to make clear the minimum and maximum discretionary support that people will be able to receive.

I understand that the Reference Group on Infected Blood is currently considering that policy and that we will hear more from it in the new year, but would it not be worth while for the Minister to give us some indication now, so that those who will depend on this money in the years to come can have some reassurance, especially as we enter the festive period? There are many questions to be answered. That is why I hope that in the time allowed the Minister will give us in the House and those who will be watching the debate the reassurances that they need.

The new scheme will replace the current system so that the five trusts across the country that administer the payments are amalgamated into one, and I know that that has been welcomed. However, there is one very concerning point that was so eloquently put by my hon. Friend the Member for Kingston upon Hull North when she opened the debate and which needs to be addressed by the Minister. I refer to the potential involvement of a private sector company, such as Atos or Capita, which both bid in the tender process. The Minister no doubt expects me to make the typical party political point, but I am not going to do that.​

That potential involvement was never included in any talks with the all-party parliamentary group on haemophilia and blood contamination, no consultation was held with the affected community, and there was no mention of it in the Department’s response to the survey, yet we see it happening now. The concern here is that the many thousands of people affected by the mistake—which, it must be remembered, was often made by US private companies—feel aggrieved at the potential involvement of a profit-making private company. That resentment is justified, especially as it was the mistake of a private company that put them in their current situation. There should be no profit making when it comes to compensating for the failures of the private sector. That was highlighted well by my hon. Friend in her speech and was also touched on by the former Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt).

The issue was highlighted too by the APPG’s survey of nearly 1,000 people affected by the scandal, who clearly had concerns about the involvement of a profit-making private company. It is important that those affected have their say in the administration of the payments and support. I would therefore be interested to hear the Minister’s thoughts on their involvement, as we have seen in Scotland, where there has been an alternative scheme operator which includes beneficiary involvement. Perhaps the Minister can tell us why private involvement is now being considered, but was never consulted upon.

My final point is about co-ordinating an independent panel, such as in the case of Hillsborough. The Prime Minister promised in September that she would keep an open mind about an independent panel, but she has, sadly, quashed the idea. The rationale given is that we have had two public inquiries into this matter already, by Lord Archer and Lord Penrose. That may be the case, but it is important that we consider the approach to helping people to get the justice they deserve, especially as it is clear that neither of the inquiries met the needs of the affected community. The two inquiries were narrow in their focus and were not about apportioning blame. The affected community is not calling for that. What it is calling for, which is strongly supported by the Opposition, is a truth and reconciliation process and public disclosure of the failures, which those affected rightly deserve.

Mark Durkan

On the need for some vehicle of inquiry into the background, in an intervention, I pointed out that, in the Irish Republic, the right to compensation was established in 1995. There was an Act in 1997, but it was following a tribunal of inquiry that the state admitted liability, so there was further legislation in 2002. The liability of the Irish state rested on the fact that the tribunal found that the state knew that there was a risk and carried it because the UK and others were prepared to carry the same risk.

Mrs Hodgson

I am grateful for that important intervention, which emphasises why we need an inquiry into issues such as the one that the hon. Gentleman has raised.

I am sure the Minister can understand the concerns across the House and out in the community among the people affected and their families. Before she replies, I ask her not to adopt the same language as that used by the Prime Minister, who attributed the lack of support ​for an independent panel to the delay in the introduction of a support system. An independent panel with clearly defined terms of reference would not impede the development and implementation of the new system. I hope the Minister will keep that in mind when she responds, and recognise how important it is for those affected to get the reconciliation for which they have fought so long.

The Government must be committed for reforming the system and listening—must be commended, rather, for reforming the system and listening. I know they are committed to that. However, this is such an important issue that we must get it right, and once more I thank my hon. Friend the Member for Kingston upon Hull North for her steadfast campaigning on this issue over many years. I am sure the community will also recognise that fact. Those people who have had their lives marked so significantly by the failures of the past should rightly be compensated and respected. Those who have died because of that serious mistake, those who are still living with the repercussions of the mistake, and those who have thankfully fought it off but still live with the impact of it all deserve respect and dignity, and I hope that in her reply the Minister will give them just that.

2.58 pm

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)

It is an honour to serve under your chairmanship today, Mrs Gillan.

I welcome today’s timely debate on access to diabetes technology, which falls in Diabetes Awareness Month. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate and I pay tribute to my hon. Friend the Member for Copeland (Mr Reed), who is not present today, for all his campaigning, work and efforts on the subject over the years.

I also thank the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the Scottish National party, and I commend my right hon. Friend the Member for Knowsley (Mr Howarth) on his excellent contribution on young people with type 1 diabetes, and for highlighting the worrying danger of abuse by young people who skip insulin in order to lose weight. I had heard of that before, but I am grateful that he brought it to our attention today, so that the Minister may respond. As my right hon. Friend said, it is often due to the pressures of society and body shaming and it can, sadly, often be fatal. It is yet another pressure on these young people: aside from having the diabetes diagnosis in the first place, it is something else that they have to deal with.

I also want to disclose from the off that sadly I was diagnosed as a type 2 diabetic just a year ago, but through getting control of my diet and achieving weight loss, which is still ongoing, my diabetes is thankfully very well under control. This debate is therefore very close to my heart.

More than 4 million people and counting in the UK are now living with diagnosed diabetes. Some 400,000 live with type 1 diabetes, and 29,000 of those are children. I am hopeful that in the future, artificial pancreas technology, which we have heard about today, will be effective, safe and accessible to patients, and that eventually, thanks to important research undertaken by the Juvenile Diabetes Research Foundation, Diabetes UK and others, we will create a world without diabetes.

However, until that time comes, it is paramount that we do all we can to support adults and children living with the condition. Patients need accessible and high-quality education and support, and access to technology that ​will allow them to manage their condition and to achieve positive outcomes. Not only will that have a positive effect upon the lives of those 4 million people, especially including children, but it could also reduce NHS spend on diabetes-related complications.

There have been significant advances and improvements in care for people living with diabetes over the last 15 years or so, but it would be an enormous mistake for us to believe that the job was done. It is far from done and a significant amount of work needs to be undertaken to improve diabetes outcomes. That is because more than 24,000 people a year currently still die from a complication or condition related to diabetes, and many more will encounter life-altering, non-fatal complications. It is worth noting that diabetes-related complications account for a staggering 80% of the £10 billion annual NHS spend on diabetes.

Worryingly, there is also a regional dimension to the challenges presented in relation to positive diabetes outcomes. According to the national diabetes audit 2012-13, diabetes education courses are not being commissioned for people in more than a third of areas in England. Moreover, gateway treatment for both type 1 and type 2 diabetes is undertaken through primary care. However, with a GP shortfall of 40% across the north of England—my region—it is clear that accessibility is limited in certain parts of the country. Meanwhile, some CCGs have particularly large concentrations of people with type 2 diabetes and, it has to be said, there are correlations between those areas and socioeconomic disadvantage. The Government might well approach funding allocations with that in mind.

However, the issue we are discussing, which must be considered alongside the aforementioned points, is supporting patients to access technologies easily that will better help them to manage their condition, from insulin pumps to continuous glucose monitors, to flash glucose meters—a lot of them were spoken about by the hon. Member for St Ives. The technologies to which I refer make monitoring blood glucose more convenient for people than a standard blood glucose meter does, and in turn, those technologies can transform peoples’ lives. Continuous glucose monitors—CGMs—such as the Dexcom device, and flash glucose meters, such as the Abbott FreeStyle Libre device, are considered by many to be a less invasive technique than blood glucose meters for measuring blood glucose. They work 24 hours a day and CGMs can include alarms to indicate when glucose levels are too high. That is particularly important for people who do not know that they are experiencing hypoglycaemia, and children who may be unable yet to communicate it.

It is critical that the House understands the importance of blood glucose readings for people living with diabetes—both types—but it is of essential importance for people living with type 1. With type 2 patients, as I have found, blood glucose is usually monitored and controlled over a long period of time and the scope for immediate blood glucose correction is limited. For people living with type 1—people whose control depends upon the use of insulin delivered through an injection or a pump—accurate, real-time data is essential for blood glucose control.

To put it simply: better blood glucose control will result in better outcomes for people living with type 1 or type 2. It will relieve significant pressure on the NHS ​and result in a significant and positive long-term financial gain. Access to CGMs and flash glucose meters is limited on the NHS, and National Institute for Health and Care Excellence guidelines do not recommend that CGMs are offered routinely even to adults with type 1 diabetes, but funding should be considered in a small number of specified circumstances. Meanwhile, children and young people must either have frequent severe hypoglycaemia, impaired awareness of hypoglycaemia associated with adverse consequences, or the inability to recognise or communicate about symptoms of hypoglycaemia in order to be eligible for a CGM at the moment.

The guidelines, which can be difficult for health professionals, adult patients, and parents alike to navigate, are an obstacle to accessing life-changing technologies for people living with diabetes. As such, I hope that the Government will take steps to encourage CCGs to increase the take-up of CGMs—I apologise for all the acronyms—and flash glucose meters, and that eventually work will be undertaken, in conjunction with NICE, to look at increasing and improving access to diabetes technologies at a faster rate than patients currently experience.

The running cost of a CGM is around £3,000 to £4,000 a year, whereas a flash glucose meter costs around £1,300 a year. That represents a significant personal cost to many of those who are unable to access these technologies through their CCG, and who therefore have little choice but to self-fund. Lots of parents do this for their children especially. In considering the financial impact of diabetes, we must recognise that diabetic technologies should not be available only to those who can afford to self-fund. Allowing the continuation of the disparity between people with diabetes who can afford to make use of life-changing technologies and those who cannot undermines the principle of a truly national health service.

It is also important to consider that investment in the new technologies could save the NHS vast amounts in the long term. That is because they can help to avoid severe night-time hypos, and severe hypos cost the NHS £13 million a year. In addition, as I have mentioned, diabetes-related complications account for 80% of the total NHS spend on diabetes, and supporting patients to better manage their condition through access to CGMs and flash glucose meters will inevitably seek to reduce that cost. That is a significant saving, before we even begin considering the impact of hypoglycaemia on the UK economy as a whole.

Finally, during Prime Minister’s questions, in response to my hon. Friend the Member for Copeland, the Prime Minister stated:

“There are many youngsters out there, from tiny tots to teenagers, living with type 1 diabetes. It is important that we send a message to them that their future is not limited: they can do whatever they want.”—[Official Report, 20 July 2016; Vol. 613, c. 821-22.]

I am sure that all of us in the Chamber today very much welcome her comments. I hope that they represent a forthcoming commitment by the Government to improve access to life-changing technologies for adults and children to reduce any obstacles that they might otherwise face.

I ask the Government to commit to working to improve access to diabetes management education, support, and access to emerging technologies. We must ensure that emerging technologies reach the public in a timely ​manner, and that innovation, to make them even more user-friendly and to encourage take-up, is also supported and encouraged by the Government.

A national focus on access to diabetes technologies has its roots not only in clinical, but in financial arguments, as well having national support. So far, more than 26,000 people, from every single constituency in the UK, have signed a petition initiated by my hon. Friend the Member for Copeland calling for CGMs to be made available as a right on the NHS to adults and children living with type 1 diabetes. Moreover, 25 cross-party colleagues have signed an early-day motion in a similar vein. I extend my support to those cross-party calls to ensure that such technologies become accessible to adults and children living with diabetes—especially type 1—so as, ultimately, to improve the lives of those who need those technologies.

It is an honour to serve under your chairmanship, Mr Betts.

Today we are debating arthritis and what more can be done to help those who suffer from this terrible health condition. It is very welcome that the Backbench Business Committee allowed this debate to happen today, which is in arthritis awareness week and so soon after World Arthritis Day. I also thank the Members from across the House who secured the debate with the Backbench Business Committee, and the hon. Member for Strangford (Jim Shannon) for leading the debate this afternoon. He eloquently and clearly set the tone, and I thank him for that.​

As we have heard, this condition can often go unnoticed or ignored by individuals and wider society, and I hope that the awareness work seen this week has helped somewhat in changing that, along with the role that everyone here has played in supporting that culture change. Nearly 10 million people in the UK live with arthritis. The symptoms can vary; there are over 200 known types of arthritis and rheumatic disease. The symptoms include inflammation of the joints, pain, fatigue, stiffness and difficulty moving. It is quite a common misconception that arthritis is a health condition affecting only the elderly, but it can often affect all ages. That is why it is important that we raise awareness, and that more be done to educate the public on the symptoms, and on the support and help that is out there.

However, we must also be aware that, given the ageing population, more people will suffer with arthritis. The number of sufferers is expected to rise by 50% by 2030. It has to be said that the Government’s short-sighted cuts to public health grants will only cause havoc if the proper finances are not put in place to address our nation’s health.

Arthritis may not be a killer, but it does attack the way of life of many people. As has been put so eloquently today, this condition can make life a very painful struggle, with one in 10 people saying that they live with unbearable pain, day in and day out. The words of those who suffer with this condition can make the strongest cases for reminding us just how tough it can be to live with arthritis.

In the words of Sharon—I am not talking about myself in the third person here, Mr Betts—who suffers with psoriatic arthritis,

“It’s the forgotten condition that no-one thinks is important. It affects everything. It’s exhausting, depressing and makes you feel angry and frustrated.

It robs you of the life you thought you were going to have, the one you planned with your family. It robs you of a sense of purpose. You can’t do what you want, when you want, it’s unpredictable.

Life has to be adapted and constantly changed. The drugs make you feel sick and depressed and have side effects as long as your arm. It becomes important not to look back at what is lost and make an effort every day to look forward and think positively. But it’s invisible, other people don’t see any of that, you just look a bit stiff.”

Those are extremely powerful words and should be a reminder to us all of how important it is to do more to help those suffering with arthritis.

Hearing the stories and experiences of those who live with the condition is important to help raise awareness. That is why the aim of the awareness campaign “The Future is in your Hands” for World Arthritis Day last week was to highlight the stories of those who suffer. It reinforced the comments made by the chief medical officer back in 2012, who said that osteoarthritis, the most common musculoskeletal condition, is a

“generally unrecognised public health priority”.

The Government must listen to contributions of medical experts such as the chief medical officer, and to the expert opinion of those who experience arthritis. They must then act to do more to help those suffering with the condition.​

The Government could help to prevent the development of arthritis with preventive measures that relate to obesity and physical activity. Studies have shown that obesity is the single biggest avoidable cause of osteoarthritis in weight-bearing joints. With two out of three obese people developing osteoarthritis, it is important that we seriously get to terms with addressing obesity; that will create an environment in which those suffering with arthritis can flourish, rather than struggle.

One key way to alleviate symptoms and support people who suffer with arthritis is by promoting physical activity, as it has been shown that regular physical activity can be beneficial in helping to reduce the impact of the condition on people’s lives. My hon. Friend the Member for Neath (Christina Rees), who is no longer in her place, pointed out that it was a lifetime of sporting activities—she is a very well-known squash player—that probably caused, or exacerbated, her arthritis. However, the National Institute for Health and Care Excellence has published clinical guidelines that recommend exercise as a core treatment for people with arthritis, irrespective of the severity of their condition.

We need to know which services are out there, so that we can help people acquire the recommended treatment. That is why it would be beneficial for the National Audit Office to conduct a review into physical activity services for people with arthritis. That would help to ensure that we, as policy makers, have the necessary information to drive the policy agenda, and would help to map areas with a shortfall in support and services for those with arthritis. I hope that the Minister will shed some light on plans to undertake that work. Such an investigation would also be important in the light of the cuts to public health grants under this Government. Those cuts are a false economy, and compound the problems accessing services for people who are seeking to manage and improve their lives.

I quoted the following figures to the Public Health Minister at about this time last week from this very spot, but they are worth repeating to the Minister here today. In the autumn statement, the former Chancellor announced further cuts to public health grants, which amounted to an average real-term cut of 3.9% each year to 2021. That translates to a further cash reduction of 9.6%. That is in addition to the £200 million of cuts to public health grants announced in the 2015 Budget. The Minister must bear those figures in mind when responding to the debate and whenever the Department takes action on public health issues. It really is a false economy to cut funding to already overstretched and burdened public health services, as that will obviously exacerbate the problems with those services in the long term.

The need for further awareness of arthritis and its symptoms was clearly shown in a UK-wide survey of more than 2,000 people conducted by Arthritis Care last year, which found that more than a quarter of arthritis sufferers had waited two years to seek help after their symptoms began. When asked why, some 52% said that it was because it did not occur to them that they could have arthritis, and 28% felt that nothing could be done to address their arthritis. I hope that those who have listened to this debate have heard, loud and clear, that help is out there, and that delaying seeking that help will not aid them or their long-term health and wellbeing. That point was made eloquently ​by my hon. Friend the Member for West Ham (Lyn Brown), who, I think hon. Members will agree, looks 10 years younger than she did a little over a year ago.

Raising awareness is vital. Last week, world-famous performer Robbie Williams gave a candid interview explaining that he suffers with arthritis and describing the impact that has had on his performance; as a Robbie fan, that concerns me. The more we talk about the condition, and the more that high-profile people, such as the MPs here today, talk about their experiences, the better.

There have been so many eloquent and personal accounts in this debate. I particularly mention the brave and moving account of my hon. Friend the Member for West Ham. She will be playing tennis soon with our own parliamentary tennis champion, Mr Speaker, and I, for one, definitely want a front-row seat for that one. My hon. Friend is a true inspiration to the 10 million arthritis sufferers across the country.

I hope that the Minister has listened not only to the debate and contributions from Members present, but to the voices of those outside this place who have called on the Government to do more for those living with arthritis and the pain that comes with it. There are many ways for the Government to do something, and ideas have come from across the House to steer the Minister in a direction that will help the 10 million people who suffer with the various levels of pain associated with arthritis. Let us hope that this time next year, when we recognise National Arthritis Week again, we will have helped more people to lead a healthier, happier and more pain-free life.

 2.55 pm

Mrs Sharon Hodgson

It is a pleasure to serve under your chairmanship again, Ms Buck. I start by paying tribute to my hon. Friend the Member for Stockton North (Alex Cunningham) and to the Backbench Business Committee for allowing him and others to secure this important debate. As we all know, he has done much during his time in Parliament to address the sale and use of tobacco products, not only in his own constituency just up the road from my own but across the country. That includes his excellent work with my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) to bring forward the ban on smoking in cars with children. I commend him for his tireless campaigning and commitment to this hugely important area of public health policy.

I thank right hon. and hon. Members who have taken part in the debate. I pay tribute in particular to the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, for the support and expertise she brings to the debate. Her predecessor plus one or two, my right hon. Friend the Member for Rother Valley (Kevin Barron), also has a huge wealth of expertise and knowledge across the whole health brief. In my new role, I will certainly be calling on him a fair bit—I hope that he is prepared and willing for that to happen. I also want to commend the other right hon. and hon. Members who spoke today: the hon. Member for Harrow East (Bob Blackman), the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke on behalf of the SNP.

I wish to say a few words to the public health Minister. This is our second outing together and I have had this role for only four days, so I think this will be a regular thing. I am definitely looking forward to keeping a close eye on her work at the Department of Health and to debating across the Chamber. I am sure we will do that on many important issues facing our country’s health. If the tireless work of my predecessor, the hon. Member for Denton and Reddish (Andrew Gwynne), is anything to go by, that will be often—surely he has his own seat in here with his name on it because he was in here so much. That is a daunting prospect.

Today we are debating the important topic of tobacco products. It is crucial that the message is put across to the Government that more can and should be done to ensure that we all lead healthier lives. The control of the sale and use of tobacco is an important public health matter not only for those individuals who use it but for all around them.

During Labour’s time in office, we recognised that fact, which is why we did a lot to address smoking in society, most famously with the introduction of the ban on smoking in public places. The ban brought in a culture change in our society. When we used to walk into any indoor public space, it was the norm to be met with a cloud of stale tobacco smoke, whereas now all of us—especially children and families—can enjoy ourselves freely without having to breathe in second-hand smoke or have the overhang of smoke in the air.

The Tory-led coalition Government came into power and brought in their own tobacco control plan, and it was welcome that it achieved so much over its lifetime, ​including the prohibition of point-of-sale displays in shops; the introduction of standardised packaging for tobacco products; and the national ambitions on reducing smoking, which were all met. However, when the plan ceased at the end of last year, it was vital that the Government published a new plan in a timely manner to build on the work of previous Governments. Sadly, nearly a year on, the Government have failed to come forth with such a plan, despite the promise and a commitment to do so last December.

Last month, the Health Minister in the House of Lords failed to commit to a final date for publication. We were expecting to have sight of that plan over the summer; we are now hopeful that we will see it during the Indian summer. Changes in Government meant the plan was put on hold. The delay is not too dissimilar in some ways to the constant delay to the childhood obesity plan—although at least that was rushed out over the summer.

A change in ministerial personnel should not be an excuse for delaying such an important intervention in the health of our society, especially when the new Prime Minister stood on the steps of No. 10 Downing Street in the summer and committed her Government to

“fighting against the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others.”

We were led to assume that was going to be the driving force of the Prime Minister’s Government, and I hope it is, but the rhetoric has not yet translated into reality when it comes to this serious public health issue facing our country.

The Government have faced a vocal chorus from charities and organisations, including the British Medical Association, Action on Smoking and Health and the British Lung Foundation, which have all called on the Government to get their act together and publish the new plan. In that regard I also commend the work of Fresh, which my hon. Friend the Member for Stockton North mentioned, which does such sterling work in the region with the highest smoking rates and some of the worst health outcomes.

The Minister and her officials at the Department of Health are being told loud and clear to get on with the job at hand and to answer the crucial question that has come out of today’s debate: what is the delay? I hope she will shed some light on that important question in her response and—finally—tell us when we can expect the new tobacco control plan.

I want to set the scene on why it is so important we have a new plan, on top of what has already been said today, by looking at the facts and figures on smoking, including the variation of smoking habits among certain groups of society—especially children, young people and pregnant women. The smoking rate in England is 19%, but that varies from region to region. It is highest in the north-east, where it reaches 19.9%, and lowest, at 16.6%, in the south-east. Those are regional figures. When looking at the figures borough by borough, my local authority of Sunderland does not fare well at all, with 23% of the population smoking. That is much higher than even the highest of the regional averages.

Looking at smokers based on their socioeconomic status, it is clear the less well-off in society are more likely to smoke. I am not going to go into all of the reasons for that. We just have to accept it is where we ​are—but what can we do about it? Smoking rates among those in the professional and managerial socioeconomic group are less than half the rate of those in routine and manual socioeconomic groups, at 12% and 28% respectively. When the net income of a family and their smoking expenditure are both taken into consideration across England, 1.4 million, or 27%, of the households with a smoker fall below the poverty line. If those costs were returned to the families, it is estimated that approximately 769,900 adults and 324,550 dependent children would be lifted out of poverty.

That is a striking statistic, especially given the study published only a few weeks ago that showed that 250,000 children will be pushed into poverty during the lifetime of this Parliament due to the Government’s policies. Getting it right on smoking could totally negate that impact, so it is definitely something worth looking it. The stats show we must do more to address the cycle of health inequality, which spans generations and continues the awful situation in which there are huge life expectancy gaps between the rich and poor, as we have clearly heard today. If the Government want to change that, one way would be to step up and continue the work of reducing smoking in society.

If those figures do not spur the Minister on to bring forward the new tobacco control plan, hopefully looking at the issue of smoking among our children and young people will. It is welcome that smoking among children and young people fell to an all-time low of 6% under the last tobacco control plan, as we have heard, but it remains an issue when two thirds of adult smokers report taking up the habit before the age of 18, with 80% saying it was before 20. That is compounded when children who live with parents or siblings who smoke are three times more likely to take up the habit than children from non-smoking households. It is also estimated that 23,000 young people in England and Wales start smoking by the age of 15 due to exposure to smoking in the home.

Kevin Barron

My hon. Friend uses the statistics very well. Do they not defeat the myth that smoking is an adult habit?

Mrs Hodgson

They certainly do. The situation on children smoking is quite stark. The earlier children start smoking, the more serious the consequences are for their health. Children who take up smoking are two to six times more susceptible to coughs and increased phlegm, wheeziness and shortness of breath than those who do not smoke. It can also impact their lung growth, which can impair lung function and increase the risk of chronic obstructive pulmonary disease in later life. As we heard from my hon. Friend the Member for Stockton North, 25,000 people a year die from COPD. Surely we do not want any child in this country to die in that way. The prevalence of these conditions among smokers shows it is paramount that we seriously tackle smoking among our children and young people. We do not want to see the children of today being the COPD sufferers of the future, as well as having those other conditions.

Alex Cunningham

I am really pleased my hon. Friend is framing the issue specifically around children. My wife, Evaline, worked as a school nurse and used to hold classes talking to young people about this. She would ​put forward the economic argument—“If you smoke so many cigarettes over so many days over so many months it costs £2,000, which could buy you a summer holiday.” She was then told, “No, Miss, you’ve got it wrong; it is only £3.20 a packet from Mrs Bloggs down the road.” Do we not also need to ensure we tackle illicit tobacco and ensure children understand the dangers of that as well?

Mrs Hodgson

My hon. Friend raises a very good point. The danger and quality of illicit tobacco can often be far worse for health than just long-term smoking. The substances used in those cigarettes can be life threatening.

I will move on to the dangers of smoking during pregnancy, which was raised by the hon. Member for Totnes. While we know the harms of living in a household with a smoker, for some that harm starts before birth as 10.6% of women are smokers at the time of delivery. That equates to 67,000 infants born to smoking mothers each year, while up to 5,000 miscarriages, 300 perinatal deaths and around 2,200 premature births each year have been attributed to smoking during pregnancy.

Smoking during pregnancy has been identified as the No. 1 risk factor for babies to die unexpectedly. According to research by the British Medical Association, if parents stop smoking, that could reduce the number of sudden infant deaths by 30%. Those are shocking figures that show the heartache and pain a mother and the family around her will go through from the horrific events of losing a baby through, for example, miscarriage, stillbirth or sudden infant death. That is especially pertinent this week as it is baby loss awareness week, which I know some of us are wearing little pins to commemorate. There is a debate currently going on in the main Chamber —there was; it has just finished—in which many colleagues gave heartbreaking accounts of their personal experiences or those of their constituents who have suffered the loss of a baby. I was able to intervene and give a personal account of my own experience.

Baby loss due to smoking is preventable if Government action is taken as soon as possible. Important work has been implemented on smoking during pregnancy that has seen the number of pregnant women smoking fall to its lowest-ever levels, but I welcome the calls from the Smoking in Pregnancy Challenge Group to see a commitment from the Minister today to work to reduce the percentage of women smoking during pregnancy to 6% or lower by 2020. It may be an aspirational figure, but it can be achieved as long as a comprehensive plan is put in place to control the use and sale of tobacco.

Regional variations, including those I mentioned earlier, must be addressed; other colleagues have mentioned them, too. We are seeing 16% of women in the north-east and Cumbria smoking at the point of delivery, compared with only 4.9% in London. This stark figure shows that more regional action and support must be offered by the Department of Health to ensure that regional inequalities are addressed. The regional variations and the other variations mentioned show that the slashing of the public health grants is a false economy when it comes to seriously driving forward the agenda on public health, especially in relation to smoking.

In last year’s autumn statement, the then Chancellor announced further cuts in the public health grant, which amounted to an average real-terms cut of 3.9% each ​year to 2020-21, and translates to a further cash reduction of 9.6% in addition to the £200 million worth of cuts announced in the 2015 Budget. As we know, specialist support and stop smoking services help to get people off cigarettes and to lead a far healthier lifestyle. However, cuts to public health funding have meant that it has proven far more difficult for local authorities to provide that much needed specialist support.

In a survey of local tobacco control leads conducted by Action on Smoking and Health and commissioned by Cancer Research UK, a total of 40% of local stop smoking services were being reconfigured or decommissioned in 2014-15. In Manchester, we have seen a complete decommissioning of stop smoking services. This is even more concerning when the initial results of the 2015-16 survey show that the rate of decommissioning and reconfiguring is increasing. Therefore, I hope that the Minister will be able to commit to ensuring that we have a substantial source of funding for specialist services that help to support in particular those in lower social economic groups as well as pregnant women to quit smoking. We must end the intergenerational cycle of health inequality that I have spoken about.

It is important that we have a plan and that we have it now—a plan that continues the work of previous Governments to reduce smoking in our society. We have seen inroads into creating a healthier society, but we all recognise we have a long way to go, as the facts and figures show. The Government’s delayed plan must be published now, and it must have measures in place that will address the many variations, from geographical variation to deprivation and socioeconomic background variation.

We must see further work to address the take-up of smoking by children and young people if we are to ever achieve our goal of the next generation being healthier than the last. We need to address smoking among young people head on. Achieving a smoke-free society is within our reach, but what we do not need is further delay and hesitation by the Government. What we need is bold action.

I hope that the Minister can give us that bold action today and that she does so by finally giving us the date when the new tobacco control plan will be published. The longer we wait, the more children will take up smoking, the more people will get ill and, sadly, the more people will die. The time for waiting is over. We now need bold action.