24/11/2016 House of Commons


24/11/2016

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members to bomb views on that. But I will certainly be leader colleagues

:00:00.:00:00.

in defence the importers that he and other honourable members attached to

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this matter. Point of order, Mr Alex Salmond. During business questions,

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in answer to the right Honourable member for Rhondda, the Leader of

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the Coasting to suggest there was? Over with their resolution would

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come forward on the second reading of the boundaries Bill but this has

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class overwhelmingly last Friday. You will remember that there was one

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example in the last parliament with this happens, I wasn't viewed at the

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time. Due to the incoherence of the Coalition Government not being able

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to agree itself, that many previous leaders of the house have been on

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record many times saying that such a procedural device would not be used

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as a means of impeding progress on a bill such as the bill we put forward

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last Friday. Leaders of the house, and the support of the whole house.

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The present leader of the house in his short tenure has had that, as

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exemplified by his magnificent statement earlier on in the session.

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But can I say to you that if a Leader of the House loses support

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across the chamber by such 's procedural shenanigans, if that's

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what he meant, then he would be long in his tenure. -- he won't be long

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in his tenure. that, the right honourable member for Rhondda. He

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said it was feared an of not enough members turned up to vote, then it

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should fall. Well, we all turned up last week in large numbers, taking

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him at his word, carried by 257 votes, to 35, including members of

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the Conservative benches. Surely it be enabled to go to committee now by

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the Leader of the House's own logic, because there were plenty of people

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who turned up to vote, and the people who did not were the people

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who maybe did not want the bill. Very well. I will ask the leader if

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he wants to say anything, he is not obliged to do so, but these are

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essentially political matters, but I have comments to make in due course.

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Both sides of the House are concerned by this issue, but by

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convention, money resolutions follow, and that has been a

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tradition of this House. There is only one occasion I can see, which

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is what he referred to. The majority the House gave to that bill last

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Friday was in fact the biggest majority other than the other one

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that did not get a money resolution. I do hope that we can get a

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statement from the leader that they will not -- that a money resolution

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will follow, as speedily as other money resolutions have come. If it

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will help matters, I want to make clear that all I was saying earlier

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is that there is a process to be followed when a Private members Bill

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receives a second reading. First of all, the government, particularly

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the Treasury, have to consider whether a money resolution is needed

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and what the scope of that is, and then it has to be drafted. So that

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is the process going through at the moment, and I need say no more than

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that. It might be helpful, both to the right honourable gentleman who

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raised the original point of order and to all who have subsequently

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taken part in this brief exchange, if I say the following. Ministers

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are responsible for what they say, as are other honourable members, let

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me however confirm two things. First, the decision as to whether a

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bill requires a money resolution is for the cleric of legislation, not

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the Treasury. I understood the meaning of the leader's remarks

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earlier was to the effect it was for Treasury ministers to decide on

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tabling a money resolution. -- clerk of the Treasury. I confirm that it

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is indeed for them to decide upon the tabling. The question of the

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requirement is determined by the clerk of legislation. I hope that

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responds by me helps both distinguished privy counsellors in

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this matter. In which case, I wonder whether the clerk of legislation has

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decided if it needs money resolution already? The short answer is yes,

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the clerk of legislation has so decided that it does. We're not

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going to have an extended conversation on the matter. At least

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not any more extended than we have had, but I think I have made the

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position clear. People can seek advice from whomsoever, and the

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government may choose to seek advice from the Treasury. In my experience

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the Treasury is ready invariably to offer advice, whether that is wanted

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on zero. It may very well offer it, and people may want the advice, but

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the fact is that it is the clerk of legislation who decides whether that

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is required. Look, let me go as to -- so far as to say it is

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overwhelmingly the norm that the tabling then follows. I do not think

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that the Leader of the House has sought to gainsay that. He confirms

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through a very helpful shaking off the head that he has not sought to

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gainsay that. I hope that will suffice today. If there are no

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further points of order, if the appetite has been satisfied for

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today, we moved to the backbench motion on the support further

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arrangements of people affected by contaminated blood and blood

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products. To move the motion, I called Diana Johnson. Thank you. I

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begged them you've -- move the motion on the order paper. I would

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like to start with the backbench committee, who have always been

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generous in understanding the importance of this to our

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constituents. This is the third backbench business debate we have

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had on the subject. It has now been over 45 years since the first people

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who get infected with HIV, hepatitis C and other viruses from NHS

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supplied blood products. Their lives and those of their families were

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changed forever by this tragedy. The contaminated blood scandal is now

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rightly recognised by a grave injustice, the worst disaster in the

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history of the country's health service. But those affected are

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still waiting for the proper financial settlement which

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recognises the school effect this scandal has had on them and their

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families. This group of people have campaigned for too many years for

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justice, at the same time dealing with illness and disability. The

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current financial support for those affected are simply not fit for

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purpose, and this fact was laid bare in the enquiry of the all-party

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group for haemophilia in January last year. One quote in the first

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page of the report said, you cannot give us back our health, but you can

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give us back our dignity. This torture abroad has been too long for

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many of us, but for the rest of us please let this be the final road to

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closure. Thankfully, we all now agree that the current support

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arrangements cannot continue, and we need to create a scheme that gives

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this community back their dignity. I welcome the efforts of the previous

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Prime Minister in what he did in office. And I would also like to

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welcome the honourable member for Oxford West and Abingdon to her new

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post and I welcome global Lord prior in his new position. I was happy to

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meet with him last week alongside other APPG members to discuss the

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new support arrangements. While we all agree that there is a need for a

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reform scheme, I cannot agree with the Department of Health that the

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settlement they have proposed is sufficient. And the purpose of this

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backbench debate is to highlight those aspects of the new support

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scheme that will not actually provide the support these people

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need, following the hasty announcement made by the Prime

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Minister as he left office in July. So in my speech I want to stress

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five key issues which the Department of Health urgently need to address.

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The first is the country differences in the schemes between Wales,

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Scotland and Northern Ireland. Firstly we need to know what support

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people in fore countries of the United Kingdom will get. Scotland

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and England have set out their own separate support schemes, but people

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in Wales and especially Northern Ireland desperately need some

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certainty about the help they will receive. I will give way. And I

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thank her for giving way. And thank her for bringing forward this debate

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along with other honourable and right honourable members. Could I

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say that I have been in touch with the Minister for health in Northern

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Ireland and that there is no progress in relation to this

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particular issue, and I and other honourable members from Northern

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Ireland have constituents who have suffered from the ill effects of

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contaminated blood for over 45 years. That is worrying to hear

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there is no progress on what is going to happen in Northern Ireland,

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so that is something the Minister needs to provide to the House what

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is going on. -- explain to the House. I thank her for giving way.

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What is clear is the Scottish scheme is more generous than England. Which

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she agree that at the very least the government should have parity, and

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in particular that nobody should be worse off under the new scheme than

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they were under the old scheme? He makes that point well and I will

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come on to compare and contrast the Scottish scheme, which I think is

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more generous. I will give way. The difference between the schemes is

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important because we will have honourable members representing

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constituencies across the UK who have constituents with one person

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getting compensation from an English scheme and one person getting

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composition from a Scottish scheme, and it may be a different amount of

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money and different level of compensation. I think he makes a

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very important point. I think this is perhaps one of these unintended

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consequences of devolution, we are ending up with this mishmash of

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schemes, concerning the people affected. One of my constituents

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says exactly that point, it is unfair that the Scottish settlement

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is so different to the settlement for him in Stratford-upon-Avon, but

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one of my constituents in the public gallery will remind the House that

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there are less than 300 primary beneficiaries left and it is

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important that they are not forgotten. That is a very important

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point, and I will move on to that in a little while. That was my first

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concern, about the different schemes available. Secondly, I think this is

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an important point as well. We know that at some point next year the

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existing five trusts will be amalgamated into a single body to

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administer the scheme. I am deeply troubled by the fact that the

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administration of the new scheme looks likely to be done by a

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profit-making private company and I know that companies have attended

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meetings with Department of Health officials about the new contract.

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Formal tender submissions will be made soon, with the decision made

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next year. No minister in the Department of Health have the

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courtesy to tell the APPG of his plans, neither were the

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beneficiaries asked for their views in the Serbian January 16, and even

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in the department's response in the survey published in July, made no

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mention of this prospect. Alongside honourable members on both sides, I

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cannot... Let me remind the House of how many in this community were

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infected in the first place. Many contracted HIV and hepatitis C from

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American blood products supplied by profit-making private companies. The

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United States, unlike the UK, has always allowed the commercial

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purchasing of blood products, these were often donated by people who

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desperately needed money and so were willing to be less than honest about

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their chances of infection. This was the reason that so many harbour such

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distrust of private companies. I will give way. I am grateful. I have

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been contacted by constituents in Dublin who tell me how grateful we

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are to her for the lead and campaigning she has done on this. I

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want to place that on record. One in particular has written to me about

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allegations of impropriety in relation to doctors being encouraged

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by pharmaceutical companies to use plasma concentrates instead of a

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different method and blood transfusions, does she agree that

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this should be investigated? Yes, I am happy to agree that this should

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be investigated. I want to return to this concern people have about the

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use of private companies. We also know that in the past six years

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there has been a sense of mistrust by the disability assessment regime

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which was operated by a TOS before they walked away from the contract

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with the DWP. If there is one thing which could fatally undermine

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progress towards a better support scheme it is this, that the plans

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for the new scheme be administered by a private company, and I strongly

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urge the government to look again at these plans and show empathy for the

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people who have been affected. Give way. Could I congratulate her for

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her tireless work on this particular topic. Would she agree with me that

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there is a deep issue here about trust, not just in relation to the

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potential new providers, but in relation to what happened

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previously, were some of the survivors or the families who

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survived, victims who passed away, that senior health professionals

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knew about the contamination but decided for cost reasons they needed

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to continue with the intervention. One of the points I want to make the

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Tehran is for the needs still for some form of enquiry. I'll come to

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that in a moment. I want to continue with this point about why who runs

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the scheme is so important. One of the big criticisms of the new scheme

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is a continuation of discretionary payments. I think Department of

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Health officials still are not listening to concerns raised about

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this. The enquiry uncovered huge issues, with a highly conditional

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and purely managed discretionary support scheme. As one respondent

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told us, the whole system seemed designed to make you feel like a

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beggar. I also believe that the current administrators of the trust

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had not fought hard enough for their beneficiaries, which legally they

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could have done, but instead, they saw their role as dispassionate

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managers and conduits to the Department of Health. They left the

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affected community alone to fight for themselves. If the new support

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scheme ends up being managed by Aptos or capita, it will do nothing

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to address these fundamental issues, it could even make the situation

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much worse and add insult to injury. I call on the Minister to say she

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will do the right thing and scrap plans for a private profit-making

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scheme administrator and replace the current scheme with with the more

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beneficiary organisation with no profit motive. I would also ask the

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Minister to set out what kind of discretionary support the new scheme

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will provide, as it remains unclear whether any or all of the current

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support will continue, and this does contrast starkly with the Scottish

:17:43.:17:47.

scheme, where the financial review group agreed that nobody should

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receive less financial support under the new scheme. So will the

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government urgently provide the same guarantee and publish full details

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of any obligations which the new scheme administrators will be

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subject to? There are also issues with the current welfare benefits

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assessment regime, that many people are having to go through, for

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example, moving from DLE onto PIP, so that individuals can be passport

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it straight onto benefits, and I hope the minister will agree that is

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the sensible way forward for the people affected. My third point in

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the third issue I am concerned about relates to the families of those

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affected needing better support under this scheme. Under the new

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English proposals, widows and widowers will continue to be

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eligible for discretionary support, whatever that means, and I have

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already raised concerns about that. This will come top of the new

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?10,000 lump sum, provided their loved ones died partially as a

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result of contracting HIV or hepatitis seen. But I've already

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heard from many clinicians telling me that this could see many people

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excluded from the system, simply because their partner's death

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certificate did not include mention of HIV or hepatitis C, sometimes at

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the family's request. But these new proposals could be considerably less

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generous than the support that some widows already received, because of

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the huge? Hanging over exactly what discretionary helper can under the

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reform scheme. Thank you for giving way and also the leading this. I

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have at least two constituents, who sadly passed away as a consequence

:19:46.:19:51.

of contaminated blood and the disease they contracted. For their

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loved ones, the concern is absolutely what she indicates, that

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the dependence on potential discretionary payments is

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insufficient, the one off payment as it is not to be backed up by the

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regularity of annual payments means those people have to give up work

:20:13.:20:15.

and give up their own opportunity to have a pension. That leads me onto

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my next point, which was about the Scottish proposals, which offer a

:20:25.:20:29.

better settlement and guarantee the believed 75% of their partner's

:20:30.:20:34.

previous entitlement in addition to continued access to the Scottish

:20:35.:20:39.

discretionary scheme. This gives some much-needed security in the way

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the English scheme does not, so I would ask the Minister whether she

:20:43.:20:47.

will look again at adopting the Scottish model and provide more

:20:48.:20:50.

guarantees on non-discretionary support for Windows and widowers. My

:20:51.:20:56.

fourth point is about support for primary beneficiaries, which was

:20:57.:21:01.

raised in a previous intervention. We would ask that the government

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looks again at some private beneficiaries who need better

:21:06.:21:11.

support than currently provided. I had an e-mail this morning from

:21:12.:21:16.

someone who has hepatitis B, contracted through contaminated

:21:17.:21:20.

blood products, he was not, under the skin, eligible for any help at

:21:21.:21:26.

all, but is obviously suffering. I would hope that the Minister would

:21:27.:21:29.

be prepared to look at the very small group of people who are not

:21:30.:21:38.

covered. Secondly, if more assistance was provided, this would

:21:39.:21:41.

reduce the need for discretionary support they are great deal of our

:21:42.:21:46.

constituents' worries. I would urge the Department of Health to contrast

:21:47.:21:49.

the support announced in the Scottish scheme and look into

:21:50.:21:52.

whether more ongoing payments could be made. I applaud her for bringing

:21:53.:22:03.

this debate to the House. I see that the new payment scheme is an

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improvement, I didn't particularly want to speak up from one of my

:22:08.:22:14.

constituents, he is one of the 256 out of the 1250 haemophiliacs, who

:22:15.:22:20.

is infected with multiple viruses. Their lives have been devastated,

:22:21.:22:25.

absolutely blighted by this, and they feel they really are not being

:22:26.:22:29.

fairly treated in this new arrangement and I wonder if she

:22:30.:22:34.

would consider expanding on whether we could help them a little bit

:22:35.:22:39.

more. I do want to come onto ways that I think the current funding the

:22:40.:22:43.

government have put together could be used more effectively to assist

:22:44.:22:49.

more people who have been infected by receiving contaminated blood,

:22:50.:22:53.

including her constituents. I just want to talk a little bit about the

:22:54.:22:57.

overall funding of the new scheme. There is much that the government

:22:58.:23:01.

could do to improve the scheme without additional cost to the

:23:02.:23:05.

public purse. Even in the Scottish proposals, particularly for Windows

:23:06.:23:09.

and primary beneficiaries, if they were adopted in England, this would

:23:10.:23:15.

fall in the budget allocated every year. This is set out in an analysis

:23:16.:23:21.

conducted by the Haemophiliacs Society, which was presented to the

:23:22.:23:24.

Department of Health last week's meeting, and I hope officials

:23:25.:23:30.

considered it carefully. Any need for additional funding could come

:23:31.:23:37.

from to identifiable sources. If we sell our stake in plasma UK, and any

:23:38.:23:45.

reserves left in the accounts of the three discretionary charities were

:23:46.:23:50.

near closed next year, I think could also be made available. Further, can

:23:51.:24:01.

I ask, will this continue to be rolled over to support beneficiaries

:24:02.:24:06.

in the next year? At last week's meeting, it appeared that any

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unspent money would have to be given back to the Treasury, and I think

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that would be a gross act of betrayal towards those affected. I

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want to move onto my conclusion, which is, does the Department of

:24:20.:24:24.

Health except that there are new scheme is one that still has

:24:25.:24:28.

substantial issues needing to be addressed? The new support scheme

:24:29.:24:31.

will not command the full confidence of the people it needs to. Indeed,

:24:32.:24:37.

in some crucial respects, it will be worse than the system it replaces.

:24:38.:24:46.

Two final points on behalf of both the APPG. The APPG still believe

:24:47.:24:50.

there should be a lump sum payments as part of any new scheme, to give

:24:51.:24:54.

people the opportunity to decide for themselves what is best for them,

:24:55.:24:57.

either a regular payment or a one-off lump sum. She is very

:24:58.:25:10.

generous. I wanted to put to her, why can't lump sum payments be an

:25:11.:25:14.

alternative to regular payments? Why does the government have to be

:25:15.:25:19.

grudging on this matter? These are people to whom the government or the

:25:20.:25:23.

huge debt and obligation and it should be a properly funded scheme.

:25:24.:25:26.

We should have a proper investigation of this, so we can

:25:27.:25:31.

have the truth in what is a terrible scandal and staying on this country.

:25:32.:25:37.

He puts that point very well, and I do think, from the work that the

:25:38.:25:44.

APPG did on this and the Honourable member for North Beds did, in terms

:25:45.:25:48.

of talking to people about what they would like to see happen in this and

:25:49.:25:53.

any new revised scheme, one of the options people did see if they'd

:25:54.:25:56.

like to be able to think about whether a lump sum payment was

:25:57.:25:59.

better for them than regular payments. Giving people the ability

:26:00.:26:04.

to make those decisions for themselves is really quite

:26:05.:26:09.

important. The second point from the APPG's point of view, is we still

:26:10.:26:14.

believe that we need to have a Hillsborough style panel and quietly

:26:15.:26:18.

to allow people to tell their stories, say what happened to them

:26:19.:26:22.

and how it affected them. I'm happy to give weight to my right

:26:23.:26:25.

honourable friend, who has great knowledge on this point. She is

:26:26.:26:33.

making a very, very powerful case, as she always does. I congratulate

:26:34.:26:37.

her on the way in which she is doing so. I think she is right for that

:26:38.:26:44.

potential that a Hillsborough style enquiry offers. I know that the

:26:45.:26:48.

Prime Minister is a great fan of that process and has said so on

:26:49.:26:53.

previous occasions. I think we just need to be a bit careful that the

:26:54.:27:00.

setting up of such an enquiry doesn't put all of the important and

:27:01.:27:04.

urgent issues she has raised into the shade, while that process takes

:27:05.:27:08.

place. The two things need to be separate. I agree with him, he makes

:27:09.:27:17.

that point very well. We do need to make sure that any new support

:27:18.:27:20.

scheme moves quickly, we need to get on with this. The Prime Minister,

:27:21.:27:28.

when he apologised on behalf of the nation 18 months ago, also allocated

:27:29.:27:33.

some money, 25 million. And that has been spent yet, as I understand it,

:27:34.:27:38.

and we do need to make sure that any scheme is introduced as quickly as

:27:39.:27:43.

possible, obviously with concerns we have being addressed. The two things

:27:44.:27:47.

can go in parallel, we can have that panel enquiry to give people that

:27:48.:27:53.

opportunity for a truth and reconciliation enquiry. I still

:27:54.:27:56.

think it is an important requirement for any real sense of justice being

:27:57.:28:04.

achieved and the closure. Very grateful for a second intervention.

:28:05.:28:06.

Could I make the point that there are documents in which families who

:28:07.:28:14.

have suffered a loss following this scandal, have expressed, that they

:28:15.:28:17.

would like to get hold of those documents and see them and see what

:28:18.:28:22.

happened and who knew what. They just what that sense of justice. I

:28:23.:28:28.

will now conclude. I know you later speeches members will want to raise

:28:29.:28:33.

the deeply moving stories of their own constituents. That is the same

:28:34.:28:37.

reason that has led me to campaign on this issue over many years. Was

:28:38.:28:43.

mindful of the struggles faced by my own constituents, Glenn Robinson.

:28:44.:28:47.

When was diagnosed with hepatitis C following aged operation when he was

:28:48.:28:52.

just 19. He's had to live with the virus of his life and is still

:28:53.:28:55.

waiting for a proper recognition of the way this has affected him. I

:28:56.:28:58.

hope the minister and government will my work to ensure that Glenn

:28:59.:29:03.

and others can live the rest of their lives in dignity. I'm going to

:29:04.:29:11.

impose a ten minute limit to start with and then we'll see how we get

:29:12.:29:23.

on. Could I begin by congratulating her for her consistency in relation

:29:24.:29:29.

to this issue. And the work that she and the all-party group of done over

:29:30.:29:34.

a length of time. I also thank the Backbench Business Committee to for

:29:35.:29:41.

allowing this to come forward. We start by knowing that this is not

:29:42.:29:49.

her portfolio responsibility, and I personally know how difficult it is

:29:50.:29:52.

to be dealing with something that isn't actually in your own

:29:53.:29:55.

portfolio. So I know she will communicate very faithfully what the

:29:56.:30:01.

debate passes on to work, though she will not be in a position to pass

:30:02.:30:07.

all the questions we will raise. Without that we are here again

:30:08.:30:10.

raising the question is should be an important point that she will bring

:30:11.:30:14.

forward, both as Secretary of State and others. In relation to the

:30:15.:30:19.

speech, a couple of points which I will emphasise and pick up. Firstly,

:30:20.:30:27.

on the administration of the scheme, can I say how much I agree with her

:30:28.:30:30.

on the point about who should run it. This is not one of those we were

:30:31.:30:37.

looking to outsource because it's an ideological issue or anything like

:30:38.:30:41.

that, there is something that is really important at the heart of

:30:42.:30:45.

this issue, and we know from everything we know from the United

:30:46.:30:49.

States, that the plot profit motive in selling the blood in the first

:30:50.:30:53.

place was the primary source of everything that flowed since. And

:30:54.:30:58.

accordingly, to recognise that and have some sensitivity on that is

:30:59.:31:03.

really important. I think the government can run some things. I

:31:04.:31:08.

think running something publicly is a good thing. You have to choose,

:31:09.:31:12.

and we have all lived in a political lives from the government running

:31:13.:31:17.

British Telecom and British Airways and things have changed, but there

:31:18.:31:21.

are some things that are actually important that they are publicly

:31:22.:31:24.

owned and publicly run and dealt with and this is one of them.

:31:25.:31:38.

And how this is handled, with the group who will act on the half of

:31:39.:31:45.

the beneficiaries rather than on the half of the government interest,

:31:46.:31:47.

which has to be carefully put together. Would he agree with me

:31:48.:31:56.

that one area in which the private sector could play a part and should

:31:57.:31:59.

be, is contributing to the compensation. There is an analogy

:32:00.:32:05.

and off-the-shelf scheme we could look at which is how thalidomide

:32:06.:32:09.

victims were supported themselves with a composite of public funding

:32:10.:32:14.

and funding from the drug companies responsible, and like the Scottish

:32:15.:32:18.

scheme, that has brought us an annual payment to allow those people

:32:19.:32:26.

who struggle with conditions due to this, this can be afforded to the

:32:27.:32:32.

survivors of loved ones who passed away because of contaminated blood.

:32:33.:32:38.

The compensation on thalidomide was on a clear accountability and

:32:39.:32:44.

responsibility are lying, which the company admitted. This has not been

:32:45.:32:49.

completely the same, but I can come on to financial matters in a second.

:32:50.:32:55.

Can I move on from the speech, which I support, and say it is a matter of

:32:56.:32:59.

some despair that we are here again. I remember those friends that came

:33:00.:33:04.

to the public meetings in the House of Commons, saying they were sick of

:33:05.:33:07.

coming to the House of Commons, they had been here so often over the

:33:08.:33:12.

years. The one main thing I would be grateful if my honourable friend

:33:13.:33:15.

would take forward to government, I have not been able to get the point

:33:16.:33:19.

over. This dripping approach over the years is not working. The

:33:20.:33:25.

government can find money at various times for bigger fears, if there is

:33:26.:33:32.

a national disaster -- natural disaster, a banking collapse, vast

:33:33.:33:35.

sums of money suddenly appear. We have not been able to give this

:33:36.:33:39.

issue the same priority, and it cries out for it because the fact we

:33:40.:33:43.

are here again means the issues will not go away, they cannot be dealt

:33:44.:33:48.

with on a drip by drip bases, and someone has not grasped how

:33:49.:33:53.

important it really is to settle this for so many reasons. I will not

:33:54.:34:00.

rehearse the history of it, but will raise the business -- raised the

:34:01.:34:06.

business by way of a backbench debate. I will also not read some of

:34:07.:34:11.

the accounts of individuals involved La Paz because frankly I find it too

:34:12.:34:14.

difficult to read them into the record, and I cannot do it again. I

:34:15.:34:20.

would like to make a couple of points and three comments on where

:34:21.:34:24.

we might go from no. I campaigned on this for many years, I campaigned in

:34:25.:34:30.

government and opposition, when I was minister and when I wasn't. I

:34:31.:34:35.

was pleased the honourable lady mentioned David Cameron because I

:34:36.:34:40.

think his response to the question I raised at Prime Minister's Questions

:34:41.:34:44.

on October 2013 began the current change of events and continued the

:34:45.:34:47.

progress that had been made over many years. I was grateful he saw

:34:48.:34:52.

myself and that constituent of hours, and he seemed to understand

:34:53.:35:00.

more money was going into this game. In June I was invited again to join

:35:01.:35:04.

the Prime Minister in the Department of Health, at which point I went

:35:05.:35:09.

campaigning as far as the public was concerned. I know that some people

:35:10.:35:14.

misinterpreted that. My position in the Department of Health was not

:35:15.:35:17.

conditional on the fact I had been involved with contaminated blood,

:35:18.:35:20.

neither was my decision in the Foreign Office or my decision to

:35:21.:35:24.

leave the Department of Health earlier this year, but the

:35:25.:35:29.

ministerial convention is clear. You cannot have two colleagues firing on

:35:30.:35:35.

the same issue, I did indeed go quiet for a time publicly, but

:35:36.:35:39.

inside the department I made my own representations. I also want to put

:35:40.:35:45.

on record my appreciation of what the honourable member for Battersby

:35:46.:35:51.

did for the scheme. I think I made a mistake when the original proposals

:35:52.:35:57.

on the current scheme came forward in January earlier this year. I sat

:35:58.:36:03.

beside her on the bench and understood the gist of it, but did

:36:04.:36:06.

not understand the detail that only became clear in the consultation. I

:36:07.:36:11.

made a mistake by thinking at that time we had solved the problem. We

:36:12.:36:16.

clearly haven't. I hope I have contributed to the debate as we

:36:17.:36:22.

tried to deal with these proposals. As the honourable lady said, they

:36:23.:36:27.

move us on from where we were, but we're not yet there, and I might say

:36:28.:36:31.

a couple of things as to where we might call. Firstly, I think we got

:36:32.:36:36.

in the original proposals the discretionary payment wrong, and

:36:37.:36:40.

number of discretionary payments made have become effectively fixed,

:36:41.:36:44.

and people have become dependent upon them. That should have been

:36:45.:36:47.

known to the department, but clearly it was not in enough detail. And has

:36:48.:36:55.

led to people feeling they may not be as financially compensated as

:36:56.:36:58.

they are at present. That cannot be the case, we cannot have a situation

:36:59.:37:02.

and I am not so bid prepared to support anything that would make

:37:03.:37:34.

people I thank him for the work he has done and for the work of the

:37:35.:37:38.

honourable member for Kingston-upon-Hull. My constituent

:37:39.:37:39.

is co-infected with many conditions as a result of receiving

:37:40.:37:41.

contaminated blood. It has affected every part of his body and his life,

:37:42.:37:44.

and he worries he may lose up to ?6,000 in discretionary payments and

:37:45.:37:47.

that the cost of his many treatments may count against a settlement. We

:37:48.:37:49.

know that the Minister is listening carefully. Does he he joined me in

:37:50.:37:54.

urging the honourable gentleman to look carefully at this? I do.

:37:55.:38:07.

Regarding payment, I do not think people were fully aware that the

:38:08.:38:10.

discretionary payments had in fact become fixed and a fixed part of

:38:11.:38:14.

peoples income. There is much better awareness now, and I think that is

:38:15.:38:19.

essential because people are extremely worried because they do

:38:20.:38:22.

not see that included in specific terms in the scheme and I hope that

:38:23.:38:26.

will be part of it. I would also like to see a small amount of money

:38:27.:38:33.

made available for the things that were thrown up through the system

:38:34.:38:38.

that are not recognised. I am thinking particularly of a family

:38:39.:38:43.

where two young boys lost their father and two uncles, and they were

:38:44.:38:47.

taken into care, and the lives were changed usually because of it. Now

:38:48.:38:51.

part of the scheme fits the agony they went through and I wonder if

:38:52.:38:56.

there could be some recognition of that. In relation to the enquiry, I

:38:57.:39:08.

must reiterate my determination that there must be some form of enquiry

:39:09.:39:14.

into what has happened. It is on the record, the sense of scandal around

:39:15.:39:26.

this, and materials have been spoken about being scrapped. And I quote,

:39:27.:39:32.

there was a decision to clean up the files and stop some of the

:39:33.:39:35.

incriminating evidence. This cannot be the case that we have this issue

:39:36.:39:43.

that has led to so many deaths, and it is not that public space for

:39:44.:39:49.

those affected to no. The process did well with Hillsborough and

:39:50.:39:58.

Bloody Sunday, and is clouded. I do not think a public enquiry is the

:39:59.:40:04.

necessary vehicle. But in some way... I will not get any further if

:40:05.:40:16.

I give more interventions. I think some process of that remains

:40:17.:40:22.

essential that we press upon. Thirdly, can I now raised

:40:23.:40:26.

specifically the issue of those who were co-infected. The majority of

:40:27.:40:32.

those infected by contaminated blood were mostly hepatitis C infected. A

:40:33.:40:38.

number were co-infected with HIV and hepatitis C, and it is known that of

:40:39.:40:44.

that number there are some 250 only left alive. I think the degree of

:40:45.:40:48.

suffering of those co-infected is different to those who have been

:40:49.:40:54.

mono infected. There is monitoring and treatment for hepatitis C, which

:40:55.:40:56.

we all welcome and has changed the we all welcome and has changed the

:40:57.:41:01.

outlook considerably for many of those infected. For the co-infected,

:41:02.:41:05.

this is not available. This is a discrete group which cannot grow

:41:06.:41:08.

larger. It is diminishing all the time. They have had things that have

:41:09.:41:14.

affected their lives that have not affected others, their length of

:41:15.:41:17.

life at the beginning. I know of those who when they were young were

:41:18.:41:21.

told they may only have five or six years left. The education they were

:41:22.:41:25.

going through was of no consequence, nor was looking through any sum of

:41:26.:41:31.

money because they were not going to live. The outlook is different

:41:32.:41:36.

because they have been able to stay alive, but their condition is still

:41:37.:41:40.

serious and varies from day to day. From that diminishing number, the

:41:41.:41:46.

possibility of lump sums might be the possibility. They do not want to

:41:47.:41:51.

be dependent on the system. They want recognised what they have lost

:41:52.:41:55.

and the opportunity is lost, and a lump sum might be the answer to

:41:56.:41:59.

that. I would be very grateful if some consideration will be given to

:42:00.:42:03.

the co-infected, because I think much of the debate tends to be for

:42:04.:42:08.

the majority, and they do not think that is necessarily wrong, and what

:42:09.:42:11.

is being provided for the majority is important, but the co-infected

:42:12.:42:17.

matter. We have been here too often, and sadly I doubt if the Minister

:42:18.:42:22.

responsible will be the last to talk about this. But we will not leave

:42:23.:42:29.

this. It is a collective shame because government after government

:42:30.:42:32.

will not grasp that this needs a final settlement. This issue cries

:42:33.:42:36.

out for a settlement and we will not stop. I am very pleased to speak in

:42:37.:42:44.

this debate on the half of children who have lost their father and a

:42:45.:42:49.

mother who has lost her son, and a spouse who lost her husband. And for

:42:50.:42:54.

the many people who still suffer an injustice. I want to focus my

:42:55.:42:59.

remarks on the question of transparency in the public sphere.

:43:00.:43:07.

As the Member for north-east Beds mentioned earlier, it has become

:43:08.:43:11.

obvious that there has become evidence -- and it was stated that

:43:12.:43:23.

when he went to the Department of Health while health minister runs

:43:24.:43:27.

boxes of notes on the subject that this raised questions in his mind.

:43:28.:43:30.

He decided he needed a team to deal with this. But when he returned a

:43:31.:43:34.

week later all the paperwork had been shredded. So, I wonder whether

:43:35.:43:40.

we could, through this debate, perhaps ask the Minister to reply in

:43:41.:43:45.

writing to us whether we could give permission to others who perhaps no

:43:46.:43:50.

more to come forward. I agree with the honourable member that perhaps

:43:51.:43:55.

it is not correct to have a full-scale, lengthy enquiry. There

:43:56.:43:58.

must be some way of holding individuals to account who knew

:43:59.:44:06.

more. That covers the justice point. But the other point that is linked

:44:07.:44:09.

in with this is the question of trust in health providers. As I am

:44:10.:44:15.

sure you're aware through listening to this debate, there was a wide

:44:16.:44:20.

knowledge at the time, even from health professionals, and I wonder

:44:21.:44:23.

whether we could also see whether health professionals who may have

:44:24.:44:26.

been working in the National Health service at the time be able to shed

:44:27.:44:30.

some light on how it could possibly be the case that individuals knew

:44:31.:44:35.

about the contamination but decided not to continue with it and the use

:44:36.:44:43.

of contaminated products for reasons of cost and because it was said

:44:44.:44:51.

there was no alternative. We're in this situation now, years later,

:44:52.:44:56.

trying to find the truth. Now was the time look at these questions of

:44:57.:45:01.

trust and justice. Could I add my voice to those of the two speakers

:45:02.:45:09.

in this debate who have said that by bringing in a TOS and other private

:45:10.:45:17.

providers it could help in resolving this matter, and could we look at

:45:18.:45:21.

this as being an NHS led process, which underlines honesty and a sense

:45:22.:45:29.

of communicating well with those who have suffered to many years of

:45:30.:45:30.

trauma from this situation. Could I also put on record the

:45:31.:45:39.

excellent work of the all-party group and that of the haemophilia

:45:40.:45:45.

community, who has helped MPs researched this matter so

:45:46.:45:48.

diligently? And who have called for this proper investigation for so

:45:49.:45:52.

many years now. And once again thank the honourable member for Kingston

:45:53.:45:57.

upon Hull North for bringing forward this debate. Thank you. Thank you.

:45:58.:46:04.

Can I congratulate my honourable friend for securing this debate? All

:46:05.:46:12.

the fine work done on the all-party group in keeping this in the public

:46:13.:46:20.

eye. I associate myself with many of the previous speaker's comments,

:46:21.:46:25.

which I shall not repeat. I would like to highlight a couple of my

:46:26.:46:30.

constituents who are have suffered the terrible effects of this

:46:31.:46:35.

scandal. I spoke again this week to one of my constituents who

:46:36.:46:41.

contracted hepatitis C, following a blood transfusion at the age of 17,

:46:42.:46:47.

40 years ago. She told me she had received some terribly bad news. Her

:46:48.:46:54.

illness had progressed to cirrhosis of the liver. She is currently

:46:55.:46:59.

undertaking tests and biopsies to find out how long she has left to

:47:00.:47:04.

live. I ask the host to imagine a kind of strain of family have been

:47:05.:47:08.

living with all these years, knowing that her condition would probably

:47:09.:47:13.

get worse and yet hoping that it would not. Helen Wilcox has had four

:47:14.:47:24.

strokes, suffers from rheumatoid arthritis and osteoarthritis. She

:47:25.:47:27.

takes 35 tablets a day and can barely get out of bed.

:47:28.:47:32.

Understandably, Helen Wilcox says she has no life. She doesn't go out

:47:33.:47:37.

and you can make plans. She barely has the energy to bring up her

:47:38.:47:45.

children. And had to give up her job ten years ago. I'm sure that the

:47:46.:47:48.

Minister will agree that she and her family deserve the certainty and

:47:49.:47:53.

clarity of a decent settlement in keeping with the pain and suffering

:47:54.:48:00.

she has endured. And she is not alone. Many of my reliable friends

:48:01.:48:04.

will have similar stories from the constituencies. And another victim

:48:05.:48:12.

in my constituency, Richard Warwick, was multiplying affected with HIV,

:48:13.:48:19.

hepatitis C and hepatitis B, by the NHS. And has had his life ruined

:48:20.:48:27.

through no fault of his own. Of the 13 classes in the special school --

:48:28.:48:37.

of the 13 children in the class of the special school he attended, only

:48:38.:48:41.

four are still alive. He has campaigned long and hard. One of the

:48:42.:48:46.

most heartbreaking and emotional meetings I had was speaking with his

:48:47.:48:50.

parents, who told me about the impact it had on their lives,

:48:51.:48:54.

particularly about their terribly difficult decision to decide against

:48:55.:49:00.

having a family on the basis of the health implications that would have.

:49:01.:49:09.

I welcome the points made by the haemophilia Society, that the new

:49:10.:49:14.

payment scheme is an improvement on proposals from the original January

:49:15.:49:18.

consultation. I think it makes sense to one single scheme going forward,

:49:19.:49:23.

rather than multiple schemes. I am pleased more money has been

:49:24.:49:29.

identified to pay to the victims. On behalf of my constituents and others

:49:30.:49:34.

like them, I would ask the Minister to ensure that no one is worse off

:49:35.:49:40.

under the new system, take into account where those who are

:49:41.:49:52.

receiving discretionary payments... Would he give way? Thank you. He is

:49:53.:49:57.

giving a very emotional speech. It is hard to listen to these things. I

:49:58.:50:02.

would speak up for the idea of the lump sum payment. For the cull

:50:03.:50:08.

infected because they have even more strange than others. If we could

:50:09.:50:13.

help out with that, and there are becoming fewer and fewer of them, I

:50:14.:50:17.

think it is up to us to try to make their lives as good as we possibly

:50:18.:50:23.

can. She makes a very good point. It echoes the comments of the chair of

:50:24.:50:26.

the all-party group, that perhaps that should be an option that could

:50:27.:50:34.

be taken. Of course, the victims have lived with their illnesses for

:50:35.:50:39.

decades. Now they want to insure families are compensated for losses

:50:40.:50:43.

they endured because of it. Referring back to Mr Warwick, he

:50:44.:50:47.

also had to give up his job many years ago. When his employers

:50:48.:50:52.

discovered he was infected with HIV, he was asked to leave. This meant

:50:53.:50:58.

his wife became the main breadwinner. She could only work

:50:59.:51:01.

part-time because the rest of her time is devoted to his care. Given

:51:02.:51:07.

the fact that she might be near to or at retirement, it might be

:51:08.:51:11.

difficult for her to find a full-time job. Mr Warwick tells me

:51:12.:51:15.

that he wants more than anything to be able to put his mind to rest by

:51:16.:51:21.

knowing that Mrs Warwick will continue to receive monthly payments

:51:22.:51:25.

throughout her lifetime. I urge the Minister to think about the terrible

:51:26.:51:31.

impact this injustice has had on Helen Wilcox, Richard Warwick and

:51:32.:51:35.

their families. And many others like them. And offer them greater clarity

:51:36.:51:40.

and a fear settlement so that they can have peace of mind this

:51:41.:51:47.

Christmas. Thank you. Can I commence in the same vein that other

:51:48.:51:51.

honourable and writable members have done, which is to pay tribute to the

:51:52.:51:59.

work done by the Member for Hull North? I see other members across

:52:00.:52:07.

the chamber who have also played a part. This is not a party political

:52:08.:52:11.

issue. The core of this issue is quite simply about doing the right

:52:12.:52:17.

thing. It is Parliament and all-party groups at its best when

:52:18.:52:24.

members come together to deal with the difficult stories such as we

:52:25.:52:30.

have just heard. Based on personal stories of our constituents. I have

:52:31.:52:35.

two constituents who have given me quite an inspirational lead in

:52:36.:52:40.

attacking the problem. Debra has HIV. She received it from a partner

:52:41.:52:48.

who himself had received contaminated blood products. She

:52:49.:52:51.

didn't tell her at the time. It took several years to work out that all

:52:52.:52:56.

her health problems had derived from this infection. He obviously became

:52:57.:53:01.

her ex-partner and that person later died of his illness. But Debra has

:53:02.:53:07.

never been able to hold down a job because of the continuing,

:53:08.:53:12.

persistent illness and nature. Also, in common with the previous

:53:13.:53:18.

description, has been asked to leave her job before now. The career has

:53:19.:53:23.

been badly affected. Neal has hepatitis C. He got it as a

:53:24.:53:28.

haemophilia patient as a child and again he is unable to hold down a

:53:29.:53:33.

job. That means he is unable to hold down decent housing. Part of the

:53:34.:53:38.

problem affecting him means that his body retains water and he has to go

:53:39.:53:42.

to hospital regularly to have his body drained of excess fluid. She

:53:43.:53:48.

can work, but he has great problems with fatigue. His whole life has

:53:49.:53:53.

been dominated by this. I make a point to the House that the only

:53:54.:53:59.

mistake, the only crime that these constituents of mine and other

:54:00.:54:04.

honourable members have committed is to be unlucky. That is the only

:54:05.:54:08.

thing they have done. They were unlucky in the circumstances of

:54:09.:54:16.

being given contaminated blood products or receiving an infection

:54:17.:54:22.

from another partner. Without being told of the circumstances. And the

:54:23.:54:26.

other victims, as we have said, of what could be considered a crime. I

:54:27.:54:33.

cannot get away from the fact that we need to be doing more still for

:54:34.:54:37.

people whose basic problem is that they were unlucky at a difficult

:54:38.:54:47.

time in their life. My concern is, when we simplify things, they also

:54:48.:54:53.

become less valuable. But the current system is chaotic at the

:54:54.:54:57.

moment. As honourable members have said, when it is simplified and

:54:58.:55:03.

schemes are brought together, no recipient should be any worse. I

:55:04.:55:08.

welcome the amalgamation of the different types of schemes. Up until

:55:09.:55:16.

now, there has been perhaps unwitting or deliberate policy of

:55:17.:55:20.

divide and rule, so there are various different types of schemes

:55:21.:55:25.

for different types of sufferers. We know as well there are different

:55:26.:55:30.

schemes and levels of schemes across the different countries of the

:55:31.:55:33.

United Kingdom. We have the absurd situation whereby somebody who is

:55:34.:55:38.

living in England might be able to qualify for a Scottish scheme

:55:39.:55:41.

because it is based on the country that the recipient was in at the

:55:42.:55:46.

time that he or she was infected. It seems to me the House to be a level

:55:47.:55:51.

of consistency and fairness for people who are rightly angry and

:55:52.:55:58.

rightly feeling let down, they are forced to look at the circumstances

:55:59.:56:02.

of other victims and compare themselves, rather than look to the

:56:03.:56:07.

real culprits in this situation, which are the companies, private

:56:08.:56:13.

companies so eloquently described earlier who put profit before

:56:14.:56:16.

patient safety all those years ago and have never been brought to

:56:17.:56:20.

account. In that respect, I support the call is to have a proper

:56:21.:56:25.

enquiry. I put down some questions to the Department of Health on this

:56:26.:56:29.

matter a short while ago. It transpires that has never been any

:56:30.:56:33.

compensation paid by these corporations at all. They have never

:56:34.:56:41.

been sought for compensation. One honourable member pointed out it

:56:42.:56:44.

might be difficult to pin down exactly who was responsible and

:56:45.:56:47.

wine, but there needs to be an effort at least to track down those

:56:48.:56:52.

responsible and make them contribute for their misdemeanours. I did ask

:56:53.:57:00.

Deborah annual further comments. And what they would be looking at here.

:57:01.:57:04.

Deborah is going to lose money under the current proposals. No doubt

:57:05.:57:09.

about that. She found the words of the former Prime Minister David

:57:10.:57:15.

Cameron rather distasteful when he told us that today I am proud to

:57:16.:57:18.

provide them with the support they deserve. Deborah has every right to

:57:19.:57:26.

be angry. She gleaned from that that she deserved to be worse off as an

:57:27.:57:32.

HIV infected partner. She is unclear whether money is going. She wants to

:57:33.:57:41.

know where the money is going to. Is the money the same? Again, I go back

:57:42.:57:50.

to this idea that if victims of this scandal are losing money, they are

:57:51.:57:54.

being asked to turn in on themselves, rather than direct their

:57:55.:58:04.

fire at the real culprits. There is a feeling that the scheme will be

:58:05.:58:14.

taking financial support from those who have no cure, who were forced to

:58:15.:58:19.

take toxic medication to keep them alive and struggle with mental

:58:20.:58:26.

illnesses and the stigma. Despite medication, people are still dying

:58:27.:58:30.

from HIV and AIDS. There is a sense that Deborah has that by moving the

:58:31.:58:33.

schemes around, there is a sense of robbing Peter to pay Paul. Neill

:58:34.:58:41.

also supports the idea of the Hillsborough - style enquiry.

:58:42.:58:52.

?15,500 is far too low, he points out. It doesn't take into account

:58:53.:58:56.

how much the expense is of being ill, travelling to and from

:58:57.:58:59.

hospitals up and down the country and he asks again that payments be

:59:00.:59:04.

linked to inflation, otherwise they grow ever slower. He mentioned the

:59:05.:59:13.

Hillsborough style enquiry and I wanted to add my support to the

:59:14.:59:21.

proposal for this to be considered by the government. I took up the

:59:22.:59:30.

case of the stepfather of one of my constituents, who received unheated

:59:31.:59:33.

Scottish blood products after they had been withdrawn in Scotland. He

:59:34.:59:37.

received them in England. There was a time lag in England. We don't know

:59:38.:59:42.

how many people were affected in this way. He ended up dying. There

:59:43.:59:46.

is a particular sense of injustice they are. Does he feel this is

:59:47.:59:51.

another reason why this sort of enquiry is necessary? I absolutely

:59:52.:59:56.

do. We need to get to the truth. Victims, families and surviving

:59:57.:00:03.

members of families deserve the truth. Culprits need to be held to

:00:04.:00:09.

account. It seems there is knowledge this was going on at the time. The

:00:10.:00:17.

truth is, and honourable member for Bednar -- Bedfordshire made this

:00:18.:00:21.

point, this matter will not go away. The longer it goes on, the greater

:00:22.:00:29.

will be the calls for a final resolution. The government has an

:00:30.:00:32.

opportunity and I'm grateful the Minister will be sure to listen

:00:33.:00:36.

today to do the right thing, too left that black cloud of uncertainty

:00:37.:00:46.

and to end this very eloquently put by the honourable member for

:00:47.:00:51.

Bedfordshire, drip- drip approach to get a final solution and a final

:00:52.:00:58.

answer to this question. That will give certainty which has been

:00:59.:00:59.

missing for so long. Madam Deputy Speaker, I want to pay

:01:00.:01:09.

tribute to my honourable friend and the honourable lady. Without them,

:01:10.:01:16.

we wouldn't have got as far as we have. With them, we have got to go

:01:17.:01:22.

way because there is still more to do. I don't want to repeat what they

:01:23.:01:28.

have said, but I do want to say, the hosting library which produced a

:01:29.:01:36.

very good debate pack, which I think is useful to people. I commend the

:01:37.:01:44.

tainted blood website which has a timeline and a chronology which

:01:45.:01:50.

reminds us the first case of haemophiliacs being infected with

:01:51.:02:01.

Hep C was known in 1961. We know this was designed to help, Philly

:02:02.:02:08.

acts, but it has harmed them. I know about this a bit indirectly. In

:02:09.:02:13.

1975, my wife received eight pints of blood and went on to come and

:02:14.:02:19.

join us in the House of Commons. She was before the factor eight had been

:02:20.:02:25.

spread around and the first member of my family unknowingly to take an

:02:26.:02:34.

HIV test was my mother who had a pancreatic operation and had to have

:02:35.:02:38.

a lot of blood, she heard what was going on and went to be tested. When

:02:39.:02:44.

I was a minister in Northern Ireland in 1989, 90, because of a friend of

:02:45.:02:51.

mine who had been infected with HIV and AIDS after the blood was

:02:52.:02:56.

infected, I spent a lot of time doing the best I could within my

:02:57.:02:59.

department giving advice on trying to bring these issues into the open.

:03:00.:03:05.

I pay tribute to those of my constituents and my friends who have

:03:06.:03:09.

given me the insight into their circumstances living with Hep C,

:03:10.:03:13.

living with HIV and living with AIDS. I want to make a few extra

:03:14.:03:22.

points, the first is, is it possible all the people who are affected by

:03:23.:03:28.

infection could have something on their medical notes which stops

:03:29.:03:37.

every new hospital, clinician, and caregiver asking the questions as to

:03:38.:03:41.

why they have this problem. The first thing people should be

:03:42.:03:45.

entitled to is an understanding that the circumstances requires them not

:03:46.:03:51.

to have to say several times a year to strangers why they need the care

:03:52.:03:57.

and help. The second thing, given some of the specialist treatment and

:03:58.:04:00.

I welcome the advances in dealing with Hep C, people who live away

:04:01.:04:06.

from London, come to specialist hospitals, having to get here

:04:07.:04:13.

reasonably early, and travel costs need to be met. We should have some

:04:14.:04:25.

way in making sure that the difficulties in finding

:04:26.:04:30.

accommodation and paying for their needs, we can be more sympathetic.

:04:31.:04:33.

The last thing I want to say, for those who are very young, who were

:04:34.:04:39.

very young at the time, not the people of my age coming towards

:04:40.:04:44.

retirement years, not that I have to retire soon! But some of those who

:04:45.:04:48.

are young, who are perhaps coming up to middle age, they may have felt

:04:49.:04:53.

lonely because they didn't feel they could have an active social life,

:04:54.:04:59.

probably some have had no particular interest in pursuing higher

:05:00.:05:04.

education to a degree they could work. They probably have, besides

:05:05.:05:09.

physical health issues, probably the need for other therapy, that people

:05:10.:05:13.

go out of their way to put arms around them and get around them

:05:14.:05:18.

properly and meet all their needs in a way they find acceptable. I wish

:05:19.:05:24.

colleagues in the Department of Health well. These aren't easy

:05:25.:05:28.

issues to tackle. I know perfectly well the Treasury has a job of

:05:29.:05:34.

trying to oversee every bit of the department's changes and spending. I

:05:35.:05:38.

will say to the Prime Minister, I hope she will do whatever

:05:39.:05:42.

predecessor did, after a few months of letting this debate settle down,

:05:43.:05:46.

meet with my right honourable friend and the honourable lady and

:05:47.:05:48.

representatives of the haemophilia Society and say, are we getting it

:05:49.:05:55.

right? Is there more we can do? Because the Prime Minister's

:05:56.:05:59.

position is bringing the relevant departments together and say, what

:06:00.:06:03.

can we do to get rid of most of the problems. The one question I will

:06:04.:06:06.

ask my honourable friend on the front bench to an answer today, is

:06:07.:06:12.

is the government still giving help to the haemophilia Society? The load

:06:13.:06:15.

on them has been increased by this work. Their involvement has been

:06:16.:06:20.

important both to governments, those affected and those who are trying to

:06:21.:06:24.

represent both. If the haemophilia Society is being charged extra cots,

:06:25.:06:30.

the government can provide the funds be used to provide. I am grateful.

:06:31.:06:41.

We come into politics, not for politics or high office, but because

:06:42.:06:44.

we care and want to make a difference to lives. If I ever get

:06:45.:06:51.

round to writing a list of my political heroes, the honourable

:06:52.:06:54.

member for Hull North has secured her place on that. Many people have

:06:55.:07:01.

been affected by this, not just for those infected, but their families

:07:02.:07:06.

and loved ones, people who are grieving the loss of someone they

:07:07.:07:11.

thought they would have longer with. A great distance has been made, but

:07:12.:07:15.

we have a long way to go to see real justice. I am here to represent my

:07:16.:07:22.

constituent Alex Smith. He was infected by hepatitis C, but to add

:07:23.:07:26.

insult, his wife died from the same infection from a blood transfusion

:07:27.:07:31.

while she was giving birth to their child. He has suffered the loss of

:07:32.:07:36.

his wife, raised children by himself, he has been ill himself,

:07:37.:07:41.

has not been able to work. What I resent about the approach to this,

:07:42.:07:46.

it feels inhumane. It feels as though the starting point is, how

:07:47.:07:50.

much money is the government willing to pay and then working within that

:07:51.:07:54.

money, rather than looking at it from a human being point of view. I

:07:55.:07:59.

struggle with the idea that the best on offer is to offer the victims of

:08:00.:08:06.

blood contamination, just about living above the poverty line, the

:08:07.:08:13.

hopes, the dreams, the ambition, the potential of so many people have

:08:14.:08:17.

been ruined. Not just by the contamination, but by the treatment

:08:18.:08:20.

they have received by the hospital in trying to find out information

:08:21.:08:25.

and get their own medical records. In poor diagnosis, poor treatment

:08:26.:08:29.

and trying to get justice and fair funding to make sure they can live a

:08:30.:08:35.

decent life. It is more than the infection taking hold of people, it

:08:36.:08:40.

is the issue in the way it has been handled, has dominated the lives of

:08:41.:08:43.

tens of thousands of people. Their lives have been put on hold while

:08:44.:08:48.

they try to get answers, trying to seek justice and where they can just

:08:49.:08:51.

about keep their heads above water when the knot comes on the door

:08:52.:08:55.

because the bailiff is there, when the red letter comes because you

:08:56.:08:58.

could not pay the utility bill, council tax or the rent. I feel

:08:59.:09:05.

government has a duty, not to be themselves accountable for what went

:09:06.:09:13.

on in the 70s and 80s. We cannot act set -- accept the garment is

:09:14.:09:20.

responsible for that, but they are responsible today. The government

:09:21.:09:24.

relaxed the humanity required, the recognition of the pain and

:09:25.:09:27.

suffering so many have gone through and the willingness to give answers

:09:28.:09:33.

and justice for people who have been affected. I absolutely give my

:09:34.:09:35.

support for the call for an independent enquiry. There are many

:09:36.:09:40.

questions that haven't been answered, that do need to be

:09:41.:09:43.

answered. Not just for the victims and their families, but make sure

:09:44.:09:46.

the same mistakes don't happen again. I read the Manchester evening

:09:47.:09:52.

News yesterday and there was an excellent investigation carried out,

:09:53.:09:56.

heartbreaking investigation carried out about how patients were treated

:09:57.:10:02.

by the Pennine acute trust. The stories about children who died

:10:03.:10:07.

because of ill treatment. What was most hurtful about that, wasn't just

:10:08.:10:13.

the poor treatment, it was the way the hospital didn't face up to the

:10:14.:10:18.

mistakes are made, the way it tried to block information coming out and

:10:19.:10:21.

when the journalist tried to get the information, it was withheld and

:10:22.:10:26.

frustrated when it was due to be released in the public interest.

:10:27.:10:30.

That is the experience of many people who are affected by blood

:10:31.:10:33.

contamination as well. When they try to seek information they should have

:10:34.:10:39.

been entitled to, medical records, details of who knew what and when,

:10:40.:10:43.

they are frustrated by the medical institutions who were responsible

:10:44.:10:47.

for that infection in the first place. It is a gross in just met. If

:10:48.:10:52.

you are trying to move on in your life, the fact so many cannot see

:10:53.:10:57.

clarity or a future and the government, to be honest, has taken

:10:58.:11:01.

far too long to come forward with a comprehensive plan to address the

:11:02.:11:06.

answers that are very much needed in this situation. I would urge the

:11:07.:11:10.

government, for no party political gain, it is beyond party politics,

:11:11.:11:16.

it is about human beings, to come forward with a properly funded and

:11:17.:11:20.

logical scheme that doesn't just keep people out of poverty, but

:11:21.:11:24.

reflects they have the right to live a decent and fulfilling life. Come

:11:25.:11:30.

forward with an answer that peels the lid to get to the answers people

:11:31.:11:35.

need to know about how did this happen and learn lessons to make

:11:36.:11:39.

sure it cannot happen again. And more than that, this is the issue we

:11:40.:11:43.

are debating today, but there are lots of people who were affected by

:11:44.:11:48.

poor public service and when they tried to get answers, they were

:11:49.:11:51.

frustrated. If there is one thing this place can do in that case,

:11:52.:11:55.

absolutely apologise, if it is needed, but more than that, be the

:11:56.:12:00.

champions for justice and help them get the answers they deserve. Since

:12:01.:12:07.

being elected to this House, every Friday at surgery I have had one or

:12:08.:12:13.

two of my constituents who I will hopefully share with you in a few

:12:14.:12:17.

moments I have two address the House about this extraordinary tragedy in

:12:18.:12:23.

many ways. I have had, rightly so lived with them, all the

:12:24.:12:29.

frustrations, the false hope in many ways. Hopefully we will finally come

:12:30.:12:37.

to a settlement. Before I start, can I pay tribute to the honourable

:12:38.:12:43.

member from Kingston upon Hull for the incredible work she has done in

:12:44.:12:46.

leading us on a cross-party basis, to get the message across from all

:12:47.:12:53.

those people, those human beings, the human suffering. May I also

:12:54.:12:56.

congratulate the Minister on her role and pay tribute to her

:12:57.:13:03.

predecessor who work hard with many others to try to get to a full and

:13:04.:13:08.

final settlement. I hope the Prime Minister and the Treasury will be

:13:09.:13:11.

listening carefully to this debate and that it is not beyond us to work

:13:12.:13:16.

together now, to get what we have been promising our constituents,

:13:17.:13:21.

these people, through no crime of their own who have been infected

:13:22.:13:27.

with HIV, Hep C, that they will actually get a settlement and as the

:13:28.:13:31.

previous Prime Minister said, nobody will be worse off. This is a

:13:32.:13:40.

question about fairness, in my view. The member for the City of Chester

:13:41.:13:47.

quite rightly emphasised. I don't think it is fair that my

:13:48.:13:56.

constituents should feel that people infected in Scotland should get a

:13:57.:14:01.

better deal than they do in Stratford. The difficulty for Mr M,

:14:02.:14:15.

as I will refer to him, because it is important I maintain his privacy,

:14:16.:14:19.

is that for a very long time there has been something called a

:14:20.:14:24.

discretionary payment, which in reality is not discretionary in any

:14:25.:14:30.

way. It is absolutely that he relies upon, to make sure at the end of the

:14:31.:14:33.

month he can balance the books, he can live just well enough to be able

:14:34.:14:39.

to feel that he has regained his dignity and his freedom in many

:14:40.:14:47.

ways. The difficulty for the Minister is clearly that there is

:14:48.:14:56.

this sum of money, but I would urge the government to relook at this.

:14:57.:15:01.

Because I think it could, and my constituents are considering this,

:15:02.:15:06.

lead to a legal challenge if people feel that they are being unfairly

:15:07.:15:15.

treated over the Scottish settlements or other parts of our

:15:16.:15:16.

country. To now move on to another

:15:17.:15:30.

constituent whose anonymity I am protecting. Her issue is with the

:15:31.:15:44.

McFarlane trust. It isn't just her feeling that the trust was not fit

:15:45.:15:45.

for purpose. The message to the front bench is it

:15:46.:16:04.

would be an outrage if the McFarlane trust carried on in any way in

:16:05.:16:09.

dealing with my constituents. They simply are not fit for purpose. I

:16:10.:16:18.

would end my speech with another gentleman who has been infected with

:16:19.:16:23.

hepatitis C. And remind colleagues of the urgency. We can't come back

:16:24.:16:31.

next year and be debating this again and looking at a settlement again.

:16:32.:16:37.

Just this morning, I received a call from the gentleman's wife. She works

:16:38.:16:45.

in our NHS. She told me he has been admitted to hospital with severe

:16:46.:16:49.

deterioration in his liver due to the advancing hepatitis C. He may

:16:50.:16:55.

not be around by the time we come to a settlement. I would urge the

:16:56.:16:59.

Minister to remind her government that this is about fairness and

:17:00.:17:04.

speed settlement. Thank you very much indeed. During this debate

:17:05.:17:10.

today, firstly I want to pay tribute to my honourable friend, the

:17:11.:17:14.

honourable Lady for Kingston-upon-Hull for her strong

:17:15.:17:22.

campaigning zeal regarding this particular subject. The contaminated

:17:23.:17:26.

blood scandal has touched the lives of many people over the past 40

:17:27.:17:32.

years. Many people have sadly died, leaving loved ones who have spent

:17:33.:17:39.

lives caring for them. The contaminated blood and blood

:17:40.:17:47.

products scandal did not just affect the lives of those infected, it

:17:48.:17:50.

changed the lives of their families as well. We have had many debate

:17:51.:17:55.

here and in Westminster Hall calling for a final and Phil settlement for

:17:56.:18:03.

those infected. What we have today is an improvement on what was

:18:04.:18:07.

offered in January, but still we have a distance to go, to give those

:18:08.:18:11.

people and their families that means they need to have a decent standard

:18:12.:18:17.

of living and questions do remain unanswered about why those blood

:18:18.:18:23.

products that were infected and infected others were imported from

:18:24.:18:28.

the United States and perhaps other places. Into Northern Ireland and

:18:29.:18:37.

beyond. Whilst she is not the Minister responsible, I hope she

:18:38.:18:41.

will be able to answer those questions today, but also will

:18:42.:18:47.

preserve Lord prior in the other place to ensure we do get answers

:18:48.:18:50.

because, as the honourable member across the House from Mid

:18:51.:18:57.

Bedfordshire said, there is collective shame regarding this

:18:58.:19:05.

issue. This is an issue without political barriers because it has

:19:06.:19:09.

impacted on families right throughout the UK. And I would like

:19:10.:19:14.

to refer to the matter of my intervention earlier to highlight

:19:15.:19:17.

the issues we face in Northern Ireland. I have written to the

:19:18.:19:23.

health minister in Northern Ireland, Michelle O'Neill, Asda has been no

:19:24.:19:28.

announcement yet on the scheme for Northern Ireland. And she said to

:19:29.:19:35.

back in early August, ask the Prime Minister's statement in the House of

:19:36.:19:38.

Commons, I am currently considering options for the future of financial

:19:39.:19:42.

support for patients and families in the North of Ireland before making a

:19:43.:19:49.

decision. This is a similar answer to those I have received from her

:19:50.:19:58.

predecessors. There is no particular urgency, no particular recognition

:19:59.:20:03.

or acknowledgement that this is a serious case, that it impacted on

:20:04.:20:08.

peoples lives. I have written again to the Minister to urge her to

:20:09.:20:12.

address this as soon as possible. And I would appreciate if the

:20:13.:20:22.

Minister could inform us of any forthcoming conversations with her

:20:23.:20:24.

counterpart in Northern Ireland. People affected in Northern Ireland

:20:25.:20:30.

can stay in the current scheme, as long as the English scheme remains

:20:31.:20:37.

on reformed. At once the new English administrator is replaced, that

:20:38.:20:46.

leaves my constituents and the constituents of my honourable friend

:20:47.:20:53.

and other infected people in Northern Ireland and great peril.

:20:54.:20:56.

And we do not want that to happen. And in fact the haemophilia Society

:20:57.:21:02.

has raised this as a particular issue in their document. And it

:21:03.:21:12.

would -- I would also remind the House that the Irish government took

:21:13.:21:15.

the courageous decision some years ago to do except responsibility for

:21:16.:21:21.

this tragedy, which has compromised the health and immunity of so many

:21:22.:21:25.

people. They delivered a compensation scheme. I thank my Bob

:21:26.:21:32.

Friend giving way. Just on that point. It is important because the

:21:33.:21:36.

House has been misinformed of this number of times in previous debates.

:21:37.:21:42.

The scheme for compensation in the Irish Republic was established even

:21:43.:21:47.

before liability was acknowledged. The tribunal system for compensation

:21:48.:21:58.

was established. That is what is missing still in the UK. Thank you

:21:59.:22:11.

for that helpful intervention. That illustrated quite clearly that the

:22:12.:22:16.

needs of people came first, before all of the other extraneous matters.

:22:17.:22:23.

I welcome the fact there has been some progress in this, but there are

:22:24.:22:27.

matters the government must address, if it wants to be responsible for

:22:28.:22:32.

the long overdue settlement that these people require and are

:22:33.:22:37.

entitled to. It is not clear what we all face, following 2020. People

:22:38.:22:44.

need time to plan and should not have the worry of the scheme

:22:45.:22:47.

deteriorating or being pulled out from under their feet. I am also

:22:48.:22:59.

concerned by the lack of clarity. I have spoken many times in the

:23:00.:23:03.

chamber about constituents of mine who have been affected by

:23:04.:23:06.

contaminated blood and they have given me permission to name them.

:23:07.:23:10.

One constituent I have known for most of my life, Brian, has to go to

:23:11.:23:18.

weekly hospital appointments and has associated health problems. Over a

:23:19.:23:24.

year ago, he was diagnosed with non-Hodgkin's lymphoma. Thankfully

:23:25.:23:28.

he is in remission. Two other constituents who live in cocaine,

:23:29.:23:42.

twins, both infected, both haemophiliacs, have found their

:23:43.:23:57.

lives were affected. -- who live in Kilcean. They were unable to work

:23:58.:24:01.

and unable to provide further families. The strain and challenges

:24:02.:24:12.

that people face cannot be overlooked. It is a direct result of

:24:13.:24:15.

this tragic situation. That can never really be a remedy for the

:24:16.:24:19.

lives of those who were affected, but the government can recognise

:24:20.:24:24.

their suffering and alleviate the financial strain on the experience

:24:25.:24:29.

as a result of it. And try and resolve what the honourable member

:24:30.:24:33.

for Mid Bedfordshire talked about. The collective shame. And that

:24:34.:24:37.

legacy of shame that goes back over many many governments, to try to

:24:38.:24:44.

bring some form of relief to people. Some of those people sadly have

:24:45.:24:49.

passed on. Regular payments must be replaced and access to ask --

:24:50.:24:55.

discretionary grants must be made available. Like the Member for

:24:56.:25:02.

Kingston-upon-Hull who has been such a stout campaigner on behalf of

:25:03.:25:07.

these individuals, I too would like some form of enquiry. Added don't

:25:08.:25:12.

want that enquiry to hold up whatever form of compensation will

:25:13.:25:18.

be available eventually. But what I would say is we need to find out the

:25:19.:25:22.

reasons and the causes. And hope those people who did this -- hold

:25:23.:25:34.

those people who did this accountable. This must never happen

:25:35.:25:37.

again. The government has made progress on this, but it must ensure

:25:38.:25:43.

this is a fool and a settlement, allied to an enquiry. That is what

:25:44.:25:48.

these people deserve and so vitally need. And for which they are along

:25:49.:25:55.

overdue, for those lost lives, for those compromised lives and for

:25:56.:25:59.

those lives that have been so damaged by bad health as a result of

:26:00.:26:03.

those infected and contaminated blood products. Thank you. It is a

:26:04.:26:13.

pleasure to take part in this debate. I would like to thank the

:26:14.:26:28.

member from Kingston-upon-Hull for ensuring this debate. I rise as a

:26:29.:26:36.

Scottish member representing a Scottish constituency in this debate

:26:37.:26:41.

for two reasons. Firstly, on behalf of constituents like Cathy Young, a

:26:42.:26:48.

stage one widow and a member of the Scottish forum who wishes to express

:26:49.:26:52.

solidarity to those in other parts of the UK who find themselves in a

:26:53.:26:54.

different scheme. The infection did not take place in

:26:55.:27:10.

Scotland but elsewhere in the UK, so another scheme is used. That is an

:27:11.:27:15.

important point. Honourable members in other parts of the UK will find

:27:16.:27:19.

they have constituent part of the Scottish scheme. And it looks like

:27:20.:27:28.

they will benefit greater than that. My constituent wrote to me last

:27:29.:27:32.

night and said, for me personally being a widow, obviously those still

:27:33.:27:37.

living with the horror of this disaster must be financially looked

:27:38.:27:51.

after and not just be fobbed off. I would like widows and children of

:27:52.:28:01.

those who have passed away to be respected. Justice is long overdue.

:28:02.:28:08.

I sent my full support to all those affected by this disaster. I wish to

:28:09.:28:14.

raise issues with the proposed Scottish scheme that require this

:28:15.:28:22.

place to carry out some work. As the Haemophelia Society point out, the

:28:23.:28:26.

Scottish scheme is comparatively more generous. Patient involvement

:28:27.:28:41.

in government and means testing has been involved. The Department of

:28:42.:28:49.

Health could adopt many aspects of the Scottish scheme and still fall

:28:50.:28:54.

within its allocated budget, according to our analysis. The

:28:55.:28:57.

all-party group is calling for the government to adopt these measures.

:28:58.:29:03.

And to reverse plans for a profit-making private administrator

:29:04.:29:08.

of the discretionary scheme. Any additional funds to support those

:29:09.:29:17.

affected could be phones from the government stake sale of the plasma

:29:18.:29:23.

resources Branch. Those with both HIV and hepatitis C

:29:24.:29:41.

will have patients increased from ?30,000 to ?37,000 to reflect

:29:42.:29:49.

additional health needs. When a patient dies, the spouse will

:29:50.:29:54.

continue to receive 75% of the payment. There will be a ?50,000

:29:55.:30:03.

lump sum payment for hepatitis C. Those who have already received the

:30:04.:30:06.

law payment will receive an additional payment. A grant scheme

:30:07.:30:14.

will be set up to cover additional needs. Scottish funding for the

:30:15.:30:22.

scheme will be ?1 million per year. The Scottish Government will aim to

:30:23.:30:26.

deliver the new scheme through a single body, so those affected no

:30:27.:30:30.

longer need to apply to more than one body for funding.

:30:31.:30:36.

The timing of this payment system will depend on Her Majesty 's

:30:37.:30:42.

customs revenues and the Department of Health. What discussions have the

:30:43.:30:48.

department had with HMRC to pass on the relevant tax officer payments

:30:49.:30:53.

can be made to those entitled to compensation and they can receive

:30:54.:30:56.

this without the minimum of fuss? This will ensure those who receive

:30:57.:31:03.

compensation are not liable to tax. This has to happen, whichever

:31:04.:31:08.

mechanism is used to make the new payments. To use the existing scheme

:31:09.:31:14.

to make new payments, I understand, all the devolved nations must agree

:31:15.:31:17.

and at this moment, only Scotland has signed up to do that. Before the

:31:18.:31:23.

Scottish team is established, an important decision is to be taken,

:31:24.:31:27.

which includes changes to the thresholds for receiving ongoing

:31:28.:31:33.

support, the ability for those to apply for those medical records and

:31:34.:31:36.

an appeals procedure for those who think they should be in the Scottish

:31:37.:31:42.

scheme. That might happen to those residents in Scotland who reside

:31:43.:31:45.

elsewhere. A procedure for converting ongoing payments into a

:31:46.:31:49.

lump sum and how the new discretionary scheme will operate in

:31:50.:31:55.

practice. We will welcome the replacement of the five trusts with

:31:56.:32:00.

a single scheme administrator. However the news the new

:32:01.:32:02.

administrator under the proposed English scheme is likely to be a

:32:03.:32:06.

profit-making private company, something which was not mentioned in

:32:07.:32:10.

the consultation documents, will be met with considerable concern. As I

:32:11.:32:15.

understand it, the process for the new scheme administrator started in

:32:16.:32:21.

2016 and is now expected, following a transition period, the new scheme

:32:22.:32:26.

admin will take over in May 20 17th but it appears that new deadline has

:32:27.:32:29.

been pushed forward. It is of concern to many members of the

:32:30.:32:40.

companies have met with the Department of Health to bid for this

:32:41.:32:48.

contract. It is a complex beneficiary and it needs to be dealt

:32:49.:32:53.

with in a sympathetic way. All of us have concerns, as is likely the

:32:54.:32:56.

successful bidder is a private company, it is not clear how the

:32:57.:33:00.

discretionary aspects of the scheme will be delivered. Will the

:33:01.:33:03.

Department of Health publish a set of principles and the budget will be

:33:04.:33:11.

up to the scheme administrator to consider applications for grants and

:33:12.:33:19.

other support. The Scottish scheme as an alternative recommendations.

:33:20.:33:29.

In terms of discretionary support, the Scottish scheme will be better

:33:30.:33:34.

funded whereas the English scheme will see a modest 25% increase in

:33:35.:33:43.

2018, 19. There are a couple of issues I want to raise before I

:33:44.:33:53.

conclude my remarks. The number of concerns have been made principally

:33:54.:33:55.

around the issues raised by the member for Walden worst and that is

:33:56.:34:00.

in relation to health records. We know for a fact people who are

:34:01.:34:08.

infected by this disaster have, on death certificates, not the words

:34:09.:34:13.

HIV or hepatitis C, for very understandable reasons at the time,

:34:14.:34:20.

because of the stigma that was attached to those conditions. I

:34:21.:34:25.

would like to ask the Minister if the scheme administrator of the

:34:26.:34:28.

government is considering that issue and there are people infected by

:34:29.:34:33.

this where their death certificate says something different, but

:34:34.:34:35.

medical records will indicate. I will give way. I think he has made a

:34:36.:34:42.

good point to the Minister. The other question, you may have been

:34:43.:34:46.

plotting, but if he doesn't I will, how will government tried to get to

:34:47.:34:52.

those who may have died 25 years ago whose spouses may not know about

:34:53.:34:56.

this offer? Not everyone is involved in the networks. It is very

:34:57.:35:03.

important and it is also up to us to raise that issue with our

:35:04.:35:08.

constituents. He is quite right, there are people who don't know, who

:35:09.:35:13.

have lost partners years ago, about that and I thank him for his

:35:14.:35:17.

intervention. I hope the Minister will consider that point. So clear

:35:18.:35:25.

points about tax, to ensure the compensation is not subject to tax.

:35:26.:35:28.

That would be ludicrous and the issue of death certificates. I thank

:35:29.:35:35.

you, Mr Deputy Speaker for allowing me to participate in this debate and

:35:36.:35:38.

all members who have contributed, it has been a first-class debate, thank

:35:39.:35:45.

you, sir. I am grateful for the opportunity to participate in this

:35:46.:35:51.

debate. I would like to thank the business committee for scheduling

:35:52.:35:54.

this session and the member is responsible for bringing forward

:35:55.:35:59.

this motion. Particularly the honourable member for Kingston upon

:36:00.:36:02.

Hull North for leading this debate and the work she has carried out.

:36:03.:36:09.

She summarised the situation clearly and forcefully and I am grateful to

:36:10.:36:12.

her for outlining the risk of private operators administrating the

:36:13.:36:18.

scheme, concern raised by several members today on all sides of the

:36:19.:36:21.

House. A recurring theme has been that of justice and the question

:36:22.:36:26.

about how much is known about the contamination at the time. It has

:36:27.:36:30.

been asked and it deserves an answer. This subject is one of the

:36:31.:36:33.

most terrible chapters in the history of our NHS, truly horrific

:36:34.:36:37.

and impacting upon tens of thousands of people and their families,

:36:38.:36:42.

ongoing, in some cases, for over 40 years. Many have died and some have

:36:43.:36:48.

been left with long-term disability and hardship. Relatives have had to

:36:49.:36:51.

sacrifice career is to provide care and support and in some cases,

:36:52.:36:56.

carers and the bonds have become infected. I have had a letter from

:36:57.:37:00.

one surviving victim whose partner was subsequently infected and died.

:37:01.:37:07.

They have to deal with such difficulties with enduring courage

:37:08.:37:11.

and I wonder where many have found the strength from, physically,

:37:12.:37:14.

emotionally and financially, which brings me on to the proposed changes

:37:15.:37:19.

to the current X Gracia payments. As my honourable friend, the member for

:37:20.:37:25.

Glasgow South West has illustrated, in Scotland will see an annual

:37:26.:37:30.

payment for those with HIV and advanced hepatitis C increased to

:37:31.:37:35.

?27,000 a year, set at a level to reflect average earnings. I think

:37:36.:37:39.

this point about average earnings is extremely important. It is not about

:37:40.:37:43.

poverty, it is about a decent standard of living. Those

:37:44.:37:48.

co-infected with HIV in Hep C will have payments increased to 37,000 to

:37:49.:37:53.

reflect their additional health needs. Where the patient dies, their

:37:54.:38:01.

partner will receive 75% of the previous annual entitlement. That is

:38:02.:38:04.

important because many have given up their own careers. Bravo those

:38:05.:38:09.

infected with chronic hepatitis C will receive a ?50,000 lump sum

:38:10.:38:17.

payment and an additional sum. The Scottish discretionary support

:38:18.:38:21.

scheme is set to see its funding trouble, have an independent

:38:22.:38:24.

mechanism and there is a general guarantee no individual will be

:38:25.:38:28.

worse off than they are at present. To simplify things, those infected

:38:29.:38:32.

will no longer have to apply to more than one body for funding as the

:38:33.:38:36.

Scottish Government aims to deliver the scheme through a single body.

:38:37.:38:40.

Government arrangements are still to be detailed for this new

:38:41.:38:44.

organisation but likely to be administered by National Service

:38:45.:38:48.

Scotland. It is also worth remembering, the Scottish Government

:38:49.:38:53.

is committed to miss -- reviewing the stage one on stage to hepatitis

:38:54.:39:01.

C distinction. The Scottish scheme is more generous. It is not without

:39:02.:39:05.

its detractors, particularly those with less health impacts who will

:39:06.:39:08.

not receive the more generous payments propose. It is important we

:39:09.:39:13.

continue to listen to the views of beneficiaries as we design and

:39:14.:39:16.

implement the new Scottish scheme. To that end, future evidence of

:39:17.:39:22.

payment criteria will be carried out. In Scotland we want to improve

:39:23.:39:27.

the scheme for everyone, the greater priority for those with the severest

:39:28.:39:31.

needs must be given. We have heard of the many tragic, individual cases

:39:32.:39:35.

throughout the UK and I will spare you further examples from those I

:39:36.:39:38.

have received details. I would like to focus on some of the questions

:39:39.:39:42.

which have been raised with me by victims and their support groups and

:39:43.:39:45.

I hope the Minister can assist some answers. First, the compensation

:39:46.:39:51.

schemes of which there are five different organisations funded by

:39:52.:39:54.

the UK health department including the three devolved health

:39:55.:39:57.

authorities, need in order to use existing schemes to make the new

:39:58.:40:01.

Scottish payments, requires four or four Nations of the UK to agree and

:40:02.:40:09.

there must be agreement. Only Scotland is signed up and there will

:40:10.:40:14.

be a Scotland wide payment system, but the timing of this will depend

:40:15.:40:17.

upon the UK Government hater master your and the Department of Health

:40:18.:40:23.

and I will ask the UK Government is not stand in the way of the Scottish

:40:24.:40:27.

payments. Which brings me to my second as, Westminster must pass tax

:40:28.:40:34.

order so none of the payments are liable to fall tax. This must happen

:40:35.:40:37.

whichever mechanism is used to make any payments. Another question is

:40:38.:40:43.

what more can be done about cross-border infections? The current

:40:44.:40:47.

scheme is based upon where the individual was infected rather than

:40:48.:40:51.

residency. This means the English schemes affect numbers of Scottish

:40:52.:40:56.

residence and the Scottish scheme will affect those are resident in

:40:57.:41:04.

England. Hepatitis C sufferers are acutely aware of the cold and during

:41:05.:41:07.

the heating bills go through the roof. If they cannot heat their

:41:08.:41:13.

home, they are at risk of death through colds, flu and other

:41:14.:41:19.

illnesses. Perhaps ministers can provide a rationale for wanting

:41:20.:41:26.

remove the fuel payment. Also the liver damage test is outdated and we

:41:27.:41:30.

should look at the impact it is having on the whole body and this

:41:31.:41:33.

might be amplified by those who have made positive lifestyle choices,

:41:34.:41:39.

such as sustaining from alcohol and his liver appears to be less

:41:40.:41:43.

affected. Some certainty is sought regarding future funding. In

:41:44.:41:49.

conclusion, I always try to be positive and look forward to the

:41:50.:41:53.

future, but given the age of many victims and their medical

:41:54.:41:55.

complications, people are dying every week. Every year, there are

:41:56.:42:01.

fewer. Thousands have died and this is too little, too late.

:42:02.:42:05.

Positiveness is extremely difficult to find in those circumstances,

:42:06.:42:08.

however I am grateful to have had the opportunity to take part in this

:42:09.:42:12.

excellent and consensual debate. Thank you. It is indeed a pleasure

:42:13.:42:22.

to speak on such an important debate this afternoon. I want to first and

:42:23.:42:29.

foremost though, thoroughly thank my honourable friend, the member for

:42:30.:42:34.

Hull North, who for many years now, has championed and pushed on this

:42:35.:42:39.

vitally important matter. Her work cannot and must not go unrecognised.

:42:40.:42:43.

I am sure people across the country and across the House today will want

:42:44.:42:50.

to join me in doing that. Thank you. The experiences of those men and

:42:51.:42:54.

women affected by this awful scandal should never be out of our minds, as

:42:55.:42:59.

we continue to do all we can to support them. To do all that we can

:43:00.:43:03.

for them is paramount knowing that what ever we do will not be enough

:43:04.:43:07.

to give them back their life or a life without suffering or pain. HIV

:43:08.:43:13.

and hepatitis are terrible conditions. Someone living with HIV

:43:14.:43:18.

or hepatitis full face fears of developing other conditions and have

:43:19.:43:23.

defaced the stigma that comes with these conditions. It is welcome and

:43:24.:43:26.

this is the first time this House has had the chance to debate the new

:43:27.:43:31.

scheme since it was announced and continue to hold the government to

:43:32.:43:35.

account to do more. It is important we now have the chance to discuss

:43:36.:43:39.

this in a considered and comprehensive manner. And my

:43:40.:43:43.

contribution today, I want to touch upon three areas. Firstly, the

:43:44.:43:48.

current funding system in England, secondly, the involvement of private

:43:49.:43:51.

companies to administer support to beneficiaries and thirdly, the need

:43:52.:43:56.

for an independent, Hillsborough style panel to recognise the

:43:57.:43:59.

failures of the system that these people have had to live with. It was

:44:00.:44:04.

announced that a new financial arrangement system would be

:44:05.:44:08.

introduced earlier in the year and a public consultation was conducted to

:44:09.:44:13.

get views and opinions on how this would take shape. Whilst it is

:44:14.:44:16.

welcome to see a somewhat modest increase in the annual payment to

:44:17.:44:22.

people with HIV, hepatitis C at stage two and those who are

:44:23.:44:26.

co-infected, as well as those first guaranteed ongoing payments for

:44:27.:44:32.

people with stage one hepatitis C, it is concerning that these payments

:44:33.:44:36.

to fall short of what has been drawn up in Scotland. Also the current

:44:37.:44:40.

English system has no mention of support for people who have been

:44:41.:44:45.

cleared of hepatitis C prior to the chronic stage, who, despite fighting

:44:46.:44:49.

of the disease, may still exhibit symptoms ranging from fatigue, to

:44:50.:44:52.

mental health issues and even diabetes. These people have never

:44:53.:44:59.

been entitled to any support and continue to get non-. The scheme

:45:00.:45:02.

also does not include support for those infected with other viruses

:45:03.:45:08.

such as hepatitis B, D or E and for these people it has meant continuous

:45:09.:45:12.

monitoring of their liver function. It is estimated this group is

:45:13.:45:18.

extremely small and according to the haemophilia Society, would be a

:45:19.:45:20.

minimal cost to the department for health.

:45:21.:45:26.

The new scheme does little to nothing for bereaved partners,

:45:27.:45:32.

parents are children of those who have sadly died from disease

:45:33.:45:39.

contaminated through the contracted blood scandal. I hope the Minister

:45:40.:45:47.

in her reply can give us some reassurance that these concerns have

:45:48.:45:50.

been noted and she will go away and look at what more can be done to

:45:51.:45:55.

help those people who I have just mentioned. There are also concerns

:45:56.:45:58.

regarding the discretionary payments which thankfully received, despite

:45:59.:46:04.

being announced in the consultation earlier this year that they could be

:46:05.:46:07.

scrapped. They should be welcomed, but there is a clear concerned it

:46:08.:46:18.

will not support those with HIV or those who are calling affected. The

:46:19.:46:22.

government will need to consider this impact and what more of the

:46:23.:46:25.

need to do. It is worrying the government have yet to make clear

:46:26.:46:29.

what the minimum and maximum discretionary support people will be

:46:30.:46:35.

able to receive its. I understand the infected blood reference group

:46:36.:46:39.

are currently considering this policy and we will hear more about

:46:40.:46:42.

this in the New Year. Would it not be worthwhile for the Minister to

:46:43.:46:46.

give us some indication now so that those who will depend on less money

:46:47.:46:51.

and the years to come can have some reassurances, especially as we enter

:46:52.:46:55.

this festive period? There are many questions to be answered that is why

:46:56.:46:59.

I hope that in the time allowed to the Minister today, she will give us

:47:00.:47:05.

both in this House and those who will be watching this debate the

:47:06.:47:10.

reassurances they need. The new scheme will bring about a

:47:11.:47:15.

replacement to the current system whereby five trusts across the

:47:16.:47:18.

country who administer the payments will be amalgamated into one. I know

:47:19.:47:24.

this has been welcomed. Yet there is one very concerning point that needs

:47:25.:47:29.

to be addressed by the Minister. And was so eloquently put by my

:47:30.:47:32.

honourable friend who opened this debate. That is the potential

:47:33.:47:36.

involvement of a private sector company, such as Capita, who have

:47:37.:47:47.

bid in the tender process, along with other companies. This was never

:47:48.:47:52.

included in any talks with the all-party group on haemophilia and

:47:53.:47:55.

blood contamination. There was no consultation with the affected

:47:56.:48:00.

community, no mention in the department's responds to the survey.

:48:01.:48:04.

Yet we are seeing at happening now. The concern here is that many of the

:48:05.:48:11.

thousands of people affected by this mistake, which must be remembered

:48:12.:48:15.

was often made by US private companies, feel aggrieved that the

:48:16.:48:22.

potential involvement of a profit-making private company. This

:48:23.:48:25.

is justified, especially when it was a mistake of a private company that

:48:26.:48:30.

put them in their current situation. There should be no profit-making

:48:31.:48:36.

when it comes to compensating for the failures of the private sector.

:48:37.:48:40.

This was highlighted well by my noble friend earlier. Also mentioned

:48:41.:48:50.

by the former health minister. The Member for North East Bedfordshire.

:48:51.:49:02.

Also by the survey conducted of nearly 1000 people affected, who

:49:03.:49:06.

clearly had concerns of the involvement of a profit-making

:49:07.:49:08.

private company. It is important those affected have their say in the

:49:09.:49:13.

administering of the payments and support. Therefore I would be

:49:14.:49:17.

interested to hear the Minister's thoughts on their involvement, such

:49:18.:49:22.

as we have seen in Scotland. Weather has been an alternative scheme

:49:23.:49:27.

operator which includes beneficiary involvement, along with giving us

:49:28.:49:34.

answers on why private involvement is now being considered but was

:49:35.:49:39.

never consulted upon. Finally, my last point is the issue on

:49:40.:49:44.

coordinating an independent panel, in the style we solve for

:49:45.:49:48.

Hillsborough. The Prime Minister in September promised she would keep an

:49:49.:49:51.

open mind to the idea of an independent panel, yet has sadly

:49:52.:49:56.

quash this idea. The rational given is we have had two public enquiries

:49:57.:50:01.

into this matter already by Lord Archer and Lord Penrose. And this

:50:02.:50:07.

may be the case, but it is important we consider this approach to helping

:50:08.:50:12.

people get the justice they deserve. Especially since it is clear that

:50:13.:50:16.

neither of the two enquiries met the needs of the affected community. The

:50:17.:50:31.

affected communities are calling for something which is strongly

:50:32.:50:34.

supported by this side of the House, and that is the need for a truth is

:50:35.:50:42.

in process. Will she give way? Thank you. It is on that point of the need

:50:43.:50:50.

for some vehicle of enquiry into the real background here. I pointed out

:50:51.:50:59.

earlier that in the situation in the Irish Republic, compensation was

:51:00.:51:04.

established in 1995. There was an act in 1997. Following the tribunal

:51:05.:51:09.

of enquiry, the state admitted liability, so there was further

:51:10.:51:14.

legislation in 2002. The liability rested on the fact the tribunal

:51:15.:51:24.

found the state knew there was a risk but carried on, as did the UK

:51:25.:51:35.

and others. I am sure the Minister can understand the concerns across

:51:36.:51:38.

the House and out in the community with the affected people and their

:51:39.:51:45.

families. Before she replies, I would take this chance to ask her

:51:46.:51:49.

not to enter into the same language that was used by the Prime Minister,

:51:50.:51:54.

to use the lack of support for an independent panel is being down to

:51:55.:51:58.

the delay in the support system being introduced. It has clearly

:51:59.:52:03.

been put that an independent panel with the clear defined terms of

:52:04.:52:08.

reference would not impede on the developing implementation of the new

:52:09.:52:11.

system. I hope the Minister will keep this in mind in her reply and

:52:12.:52:16.

recognise how important it is for those affected to get the

:52:17.:52:20.

reconciliation they have fought so long for. The government must be

:52:21.:52:32.

and listening. This is an important and listening. This is an important

:52:33.:52:38.

issue we must get right. I want to thank the Member for Kingston upon

:52:39.:52:47.

Hull North for her steadfast campaign in this area. For those who

:52:48.:52:56.

have died because of the serious mistake and those who are still

:52:57.:53:00.

living with the rapper customs of this mistake, and those who have

:53:01.:53:03.

fought it off but still live with the impact of it, they are all the

:53:04.:53:08.

respect and dignity they deserve. I hope the Minister in her reply will

:53:09.:53:19.

give them just that. Thank you. I would like to congratulate the

:53:20.:53:24.

Member for Kingston upon Hull North and all the members of the all-party

:53:25.:53:28.

in the four haemophilia and contaminated blood, for helping to

:53:29.:53:33.

secure this debate. And I thank the backbench business committee for

:53:34.:53:40.

providing time for it. It has been a moving debate. It has been

:53:41.:53:43.

nonpartisan and I would like to thank all members from across the

:53:44.:53:47.

House for the constructive way in which they have approached the

:53:48.:53:52.

debate. I would like to formally add my personal apology to all those who

:53:53.:53:56.

have been affected by these tragic circumstances and the impact it has

:53:57.:54:00.

had on so many families. And to thank all colleagues and

:54:01.:54:11.

constituents -- all constituents of colleagues for being brave enough in

:54:12.:54:18.

lowering their stories to be told in the House today. I wish I could

:54:19.:54:21.

refer to all constituents who are mentioned today, but I listed them

:54:22.:54:26.

down and that would take most of the debating time we have today. I'd

:54:27.:54:30.

like to say thank you to all those who allowed their stories to be

:54:31.:54:35.

told. This is exactly why the government is introducing the

:54:36.:54:39.

reforms we have been debating today to the existing support schemes,

:54:40.:54:43.

alongside a commitment within the Spending Review period of up to 125

:54:44.:54:50.

million for those affected until 2020, which will more than double

:54:51.:54:54.

the annual spend over the next five years. I think we should be upfront

:54:55.:54:59.

however in the beginning in recognising that nothing can make up

:55:00.:55:02.

for the suffering and loss that those families have experienced, and

:55:03.:55:07.

no financial support can't change what has happened to them. But I do

:55:08.:55:12.

hope that all of those here today will recognise this is significantly

:55:13.:55:16.

more than any previous administration has provided, and

:55:17.:55:19.

recognise how seriously the government is taking this issue. I

:55:20.:55:23.

would like to join other colleagues in paying tribute to the previous

:55:24.:55:29.

Prime Minister and my predecessor, the Member for Battersea, for all

:55:30.:55:34.

their work on this issue, and reiterate the statement that the aim

:55:35.:55:36.

of this support scheme is that nobody will be worse off. As many

:55:37.:55:42.

colleagues have said, it is time that our reforms should bring an end

:55:43.:55:46.

to the tortured road that far too many people affected have been

:55:47.:55:51.

through. And it is time for a more comprehensive and accessible scheme

:55:52.:55:55.

that gives those affected back their dignity. But as I hope is clear from

:55:56.:56:00.

this debate, not all the details are yet resolved. I hope to answer as

:56:01.:56:03.

many questions as I can today, but I'm certain that the noble Lord

:56:04.:56:08.

prior will be listing closely to this debate and so he will be in

:56:09.:56:14.

contact with all of those who are here today to ensure we can resolve

:56:15.:56:21.

details that I cannot get to in the time available. Let's start with

:56:22.:56:25.

where we are. The reforms guarantee that all those chronically infected

:56:26.:56:29.

will for the first time receive a regular annual payment in

:56:30.:56:33.

recognition of what has happened to them. It includes all those 2400

:56:34.:56:41.

individuals with chronic hepatitis C stage one who previously received no

:56:42.:56:45.

ongoing payment, but will now expect to receive ?3500 per year. Increases

:56:46.:56:52.

to existing annual payments have also been announced. These are not

:56:53.:56:56.

designed to guarantee a reasonable standard of living in a cell. It

:56:57.:57:03.

needs to be considered in a whole package of support being available.

:57:04.:57:13.

The Member for Glasgow South West has rightfully raised this. I would

:57:14.:57:20.

like to address some of the issues raised about finances. The budget

:57:21.:57:32.

for the scheme comes within the Department of Health's budget, not

:57:33.:57:36.

the Treasury budget. If there is an underspend in any one year, the

:57:37.:57:39.

money will remain within the Department of Health and if any

:57:40.:57:46.

payments should be made in that year and a file into the next year, we

:57:47.:57:51.

can take that money forward. I would like to address concerns raised

:57:52.:57:57.

about the tendering for the scheme. The shadow minister is I am afraid

:57:58.:58:01.

not quite correct that Capita and another company have already put

:58:02.:58:13.

forward our bid. We have not yet sent an invitation to tender. I'm

:58:14.:58:17.

absolutely sure that the concerns raised in this debate will be heard.

:58:18.:58:21.

And concerns about trust and the history of the situation will be

:58:22.:58:28.

well understood by all those involved in the design. I am

:58:29.:58:32.

grateful for the Minister clarifying the position around the tender.

:58:33.:58:37.

Could she confirm that the only organisations and businesses that

:58:38.:58:41.

have been invited in for conversations with the Department of

:58:42.:58:46.

Health were two mentioned earlier? Is that correct or not? I have had

:58:47.:58:52.

no meetings on this issue because it is not within my departmental brief.

:58:53.:58:56.

I'm happy to try and find out if she would like. I would like to move on

:58:57.:59:02.

to some other issues because we are quite tight four-time. I would like

:59:03.:59:12.

to talk about the budget. The pressures on the health budget will

:59:13.:59:15.

come as no surprise to anyone here today. We had an animated debate

:59:16.:59:20.

about that just this week. I would like to assure everybody in this

:59:21.:59:25.

House that even in the context of those pressures, we fought hard to

:59:26.:59:30.

protect the money for this scheme through tough budget negotiations,

:59:31.:59:34.

in order to fulfil commitments that were made and to ensure that the

:59:35.:59:39.

concerns of those affected are addressed as far as possible. I

:59:40.:59:44.

would like in the context of that to talk in a little bit more detail

:59:45.:59:48.

about some of the concerns that have been raised today by colleagues.

:59:49.:59:52.

Colleagues have rightly raise the issue of support for the bereaved.

:59:53.:59:58.

And those relying upon discretionary payments. That is why we have

:59:59.:00:04.

introduced the one-off payment of ?10,000 to brief partners or spouses

:00:05.:00:08.

of primary beneficiaries where infection contributed to their death

:00:09.:00:12.

and in recognition of their relationship at the time of death. I

:00:13.:00:18.

will give way in one second. I want to respond to the point made about

:00:19.:00:26.

the certification of death. We understand that death certification

:00:27.:00:33.

may not state direct contribution, so the policy which is to be

:00:34.:00:37.

published will recognise other ways to show a causal link of infection

:00:38.:00:41.

upon death. We would like to make sure that is not a barrier to

:00:42.:00:45.

support under the scheme. I give way.

:00:46.:00:52.

Can we get some clarity on matters where the death certificate isn't

:00:53.:00:58.

ascertained and whether there will be more flexibility around that

:00:59.:01:04.

providing hepatitis can be proven? He makes a very important point and

:01:05.:01:08.

those are the issues which have been wrestled with at the moment by the

:01:09.:01:12.

Department and we are trying to resolve those at the moment. But, we

:01:13.:01:19.

do realise that Access ability to the bereaved for the payment scheme

:01:20.:01:25.

and the discretionary support scheme is going to be important. I am not

:01:26.:01:34.

able to give the complete details of the discretionary scheme at the

:01:35.:01:44.

moment. In 2017, 18 a single scheme will replace the three discretionary

:01:45.:01:48.

support schemes. It will be transparent and flexible so it can

:01:49.:01:54.

support the beneficiaries most in need. Until those details have been

:01:55.:01:58.

worked out, it would not be fair to speculate on exactly what they will

:01:59.:02:02.

be. But until we are in a position to introduce that new system, I do

:02:03.:02:07.

want to reassure you that the current discretionary payment will

:02:08.:02:11.

stay in place and I would also like to reassure you that the policy of

:02:12.:02:20.

?10,000 for the wreathed partners and spouses will be published by DH

:02:21.:02:25.

and it will be communicated to all major stakeholders to make sure we

:02:26.:02:33.

reach out to those bereaved a long time ago to make both these policies

:02:34.:02:39.

as accessible as possible. We do realise these payments can never

:02:40.:02:42.

make up for the personal loss of the wreathed partners or their spouses

:02:43.:02:47.

have experienced. We are trying to make sure the process is as smooth

:02:48.:02:51.

and effective as possible with as few barriers as possible so it does

:02:52.:02:56.

not make individuals feel as though they are having to jump through

:02:57.:03:04.

loopholes. I will give way. I thank the Minister for giving way. In

:03:05.:03:09.

relation to the point echoed by the member about death certificates and

:03:10.:03:12.

asking that is going to be dealt with in a sympathetic fashion,

:03:13.:03:18.

someone with a death certificate will not say how HIV but hepatitis C

:03:19.:03:24.

and the government is going to look at that? The issue of death

:03:25.:03:29.

certificates is one we are alive to an Bondad government is trying to

:03:30.:03:32.

address and I hope we will be consulting closely with the relevant

:03:33.:03:36.

groups to make sure we deal with it in a sympathetic manner as possible.

:03:37.:03:41.

I thank the Minister for giving way. One thing the Minister could comment

:03:42.:03:47.

on the points I made, particularly about the Northern Ireland executive

:03:48.:03:52.

and if it would be possible for further phone calls to be made to

:03:53.:03:58.

the Minister of health in Northern Ireland to accelerate this process

:03:59.:04:01.

and enable payments and the scheme to be made available? If the

:04:02.:04:07.

honourable lady will have patience, I have an entire section on the

:04:08.:04:11.

devolved nations coming up. I would like to move on a little bit before

:04:12.:04:18.

then to speak a little bit about the other sections of the scheme. The

:04:19.:04:28.

government's response to the consultation makes it clear they

:04:29.:04:32.

will be able to access discretionary on the tested basis. But this is not

:04:33.:04:37.

the end of the story. Mike officials will continue to work with a group

:04:38.:04:43.

of experts on the details of the policy for this new detail for the

:04:44.:04:46.

bereaved and wide elements of the payment as soon as the policy is

:04:47.:04:50.

confirmed the department will publish it and give guidance as to

:04:51.:04:53.

who is eligible and how to access the payment as easy as possible. I

:04:54.:04:59.

recognise, as has been clear, some feel the new payments that have been

:05:00.:05:03.

announced are sufficient. They are based on consultation response and

:05:04.:05:11.

judgment was made to provide support to the widest group of people

:05:12.:05:15.

possible to recognise the pain and suffering of those who have been

:05:16.:05:22.

affected this tragedy. There are never any right answers when

:05:23.:05:26.

designing support in recognition of such awful circumstances. Difficult

:05:27.:05:30.

judgments have to be made in relation to prioritise in support

:05:31.:05:33.

and we did consult on the proposals and use the sponsors gathered to

:05:34.:05:44.

make payments to all individuals, rather than waiting for people to

:05:45.:05:49.

get more ill be receiving support. I would like to speak about the issues

:05:50.:05:56.

raised by the honourable lady, the member for Kingston upon Hull about

:05:57.:05:59.

other viruses. We have not expanded the scheme to include other viruses,

:06:00.:06:06.

including the CJD. On the case of this, it is already every Seiji de

:06:07.:06:12.

compensation scheme that offers no-fault compensation. It was set up

:06:13.:06:18.

by the government for these patients and their families in recognition of

:06:19.:06:22.

their wholly exceptional circumstances. The scheme provides

:06:23.:06:27.

payments in 250 cases from a trust fund of 67.5 million. Over 41

:06:28.:06:33.

million has been paid out by the trust today. The currently aren't

:06:34.:06:37.

any proposals to extend the infected blood system of the payments to

:06:38.:06:43.

include other viruses or infections that are contracted through other

:06:44.:06:47.

routes other than NHS supplied infected blood. This is on the basis

:06:48.:07:03.

of the advisory and hepatitis B was not involved when they were set up

:07:04.:07:07.

because the screening test had been introduced in the 1970s and there

:07:08.:07:13.

are other reasons for not including hepatitis E, which I am happy to

:07:14.:07:17.

write to the honourable lady about in more detail, should she wish me

:07:18.:07:24.

to do so. But many colleagues have referred to the Scottish Government

:07:25.:07:31.

reforms and here we arrived at the devolved nations section which the

:07:32.:07:38.

honourable lady for Southdown has raised and we are working closely

:07:39.:07:42.

with officials from Northern Ireland in keeping them up today on our

:07:43.:07:48.

progress with implementation. Those beneficiaries will be eligible under

:07:49.:07:52.

the Northern Irish scheme to continue to receive support at their

:07:53.:07:56.

current levels. I am happy to raise her concerns with the Noble Lord to

:07:57.:08:02.

ensure he is aware of her concerns and raising the issue of the

:08:03.:08:07.

potential impact for Northern Irish victims. Another member has raised

:08:08.:08:14.

the importance of coordination between the devolved nations and the

:08:15.:08:20.

support schemes and on the significance of the pointy has

:08:21.:08:23.

raised on the coordination of business, it is important for me to

:08:24.:08:28.

ask my noble friend, the Lord prior to contact him directly on those

:08:29.:08:33.

points so they can be coordinated in an effective way. But I would like

:08:34.:08:36.

to reassure him on one point he raised, and that is the ?500 Winter

:08:37.:08:42.

Fuel Payment is now automatically included in the payment people in

:08:43.:08:47.

England are getting as part of this support scheme. This means they do

:08:48.:08:53.

not have to apply for it, as was the case previously. I hope he will

:08:54.:08:56.

accept this is some progress in that area. But many colleagues point to

:08:57.:09:04.

the Scottish scheme as a blue blueprint for what they like to see

:09:05.:09:07.

in England but there are some differences, as the honourable

:09:08.:09:16.

gentleman noted. There are individuals with hepatitis C stage

:09:17.:09:19.

one who do not receive an annual payment. We have introduced an

:09:20.:09:24.

annual payment for them and they can get support now rather than waiting

:09:25.:09:27.

for their health to deteriorate before they are legible for support.

:09:28.:09:32.

The Scottish Government have chosen to provide a lump sum payment and

:09:33.:09:37.

there are currently no proposals for annual payments to hepatitis C stage

:09:38.:09:44.

one group. We have also put in place some other measures to avoid the

:09:45.:09:51.

sense which has been raised by the honourable member for Hammersmith,

:09:52.:09:55.

that this support is begrudging and the comments made by the honourable

:09:56.:10:01.

lady the Kingston upon Hull that people should feel like they are

:10:02.:10:04.

being treated as beggars. We have put in measures to avoid this. One

:10:05.:10:09.

of them is what we have announced in the public consultation, people

:10:10.:10:14.

should feel they don't have to jump through hoops to feel worthy of

:10:15.:10:20.

support. We have no intention of introducing individual health

:10:21.:10:23.

assessments as a means of making people feel as though they don't

:10:24.:10:25.

have to prove their eligibility. One of the other key elements is a

:10:26.:10:32.

special categories mechanism with an appeal for hepatitis C stage one,

:10:33.:10:36.

who considered the impact of their infection of the treatment for

:10:37.:10:40.

hepatitis C is similar to or greater than those at stage two. So that

:10:41.:10:48.

they may qualify qualify for stage two annual payments. This is a

:10:49.:10:53.

particularly beneficial aspect of this scheme. Finally, there are

:10:54.:10:56.

others who have raised the issue of those who could clear Hep C

:10:57.:11:03.

infection and they will remain entitled to compensation under this

:11:04.:11:08.

scheme. The Shadow minister is right that those who clear the virus

:11:09.:11:15.

during the acute phase are not included in the scheme because the

:11:16.:11:19.

body does fight off the infection before the Sophia health impacts and

:11:20.:11:22.

that has been the judgment of the expert advisory group. The last

:11:23.:11:29.

thing I would like to turn to you is the public enquiry, which of

:11:30.:11:33.

colleagues have raised. I will give way. Could she just outline the

:11:34.:11:41.

question that come up in the debate in relation to tax orders and the

:11:42.:11:46.

discussion she has had with HMRC on that issue? I thought I had already

:11:47.:11:54.

answered that, these schemes are exempt from tax and we are

:11:55.:11:57.

continuing to ensure ongoing schemes will be subject to the same tax

:11:58.:12:02.

rules. The Prime Minister has made it clear that they do not believe a

:12:03.:12:06.

public enquiry would provide further information. The five things that a

:12:07.:12:14.

public enquiry could achieve according to media reports is

:12:15.:12:17.

establishing the facts, learning from events, preventing every

:12:18.:12:22.

parents, catharsis and understanding of what happened, rebuilding

:12:23.:12:26.

confidence and accountability. Given in the UK, action was taken as soon

:12:27.:12:30.

as possible to introduce testing and safety measures for blood and blood

:12:31.:12:34.

products as they became available, as well as the introduction of

:12:35.:12:40.

health and heated products. As well, considering the government has

:12:41.:12:44.

published all documents associated with this event and from the period

:12:45.:12:49.

19721985 in line with the Freedom of Information Act, it is difficult to

:12:50.:12:54.

see what more information could be made available through a public

:12:55.:13:00.

enquiry. However, I am sure campaigners will continue to make

:13:01.:13:08.

their case. We have also made a lot of when this year's payments will be

:13:09.:13:15.

made. I was appointed as the Parliamentary under Secretary of

:13:16.:13:18.

State and I made resolving this issue one of my priorities. I am not

:13:19.:13:22.

prepared to suffer any further delays, it is not fair to affected

:13:23.:13:26.

patients that they should suffer this continuing uncertainty that has

:13:27.:13:32.

been raised by colleagues. So I have told the Department they must

:13:33.:13:40.

announce the scheme immediately. I am pleased to announce the letters

:13:41.:13:44.

to all stage one hepatitis C sufferers will be sent out on the

:13:45.:13:48.

11th of November informing them of their new annual payment and asking

:13:49.:13:52.

them to claim this through the existing schemes. The schemes have

:13:53.:13:59.

said they will be able to make these payments by the 22nd of December,

:14:00.:14:04.

subsequently letters to those at stage two and those with HIV have

:14:05.:14:08.

been sent this week. There are additional payments to be made

:14:09.:14:12.

before Christmas. The schemes are planning to send all letters to

:14:13.:14:16.

bereaved partners and spouses before Christmas with the aim of making

:14:17.:14:20.

their new lump sums before the end of the financial year and certainly

:14:21.:14:25.

during March 20 17. Details of the payment schedules are available on

:14:26.:14:29.

the website of the scheme. All payments and increased payments will

:14:30.:14:34.

be backdated from April 2016, or the date of the adjoining schemes if

:14:35.:14:39.

later. I do believe it is right the government's focus is to consider

:14:40.:14:42.

how best to implement the scheme with a budget that is affordable and

:14:43.:14:47.

redesign the inconsistencies that we have heard exist and support those

:14:48.:14:51.

most affected by these tragic events now and into the future. I will

:14:52.:14:54.

continue to listen to the concerns of those affected and I do hope that

:14:55.:15:00.

in answering this debate, I have responded to those concerns as

:15:01.:15:05.

effectively as I possibly can today. I will try to be very brief. I just

:15:06.:15:10.

wanted to thank all the excellent contributions we have had today from

:15:11.:15:15.

members across the chamber. I think I was very grateful because I did

:15:16.:15:19.

speak for quite a long time at the beginning, but I missed out some

:15:20.:15:23.

important things such as the fact this new scheme is only in place

:15:24.:15:28.

until the end of the spending review in 2021. That is of concern to many

:15:29.:15:30.

people. I was remiss not to mention the

:15:31.:15:41.

shadow all public health minister. I want to welcome her to her new role.

:15:42.:15:47.

Pastor recognise this is not the Minister's one policy area, I was

:15:48.:16:00.

relieved she was able to talk about underspend. Hopefully any underspend

:16:01.:16:11.

will be used to help beneficiaries. Her comments on death certificates

:16:12.:16:15.

was welcomed. I am still very worried about the tendering process

:16:16.:16:20.

the government seem to be set on pursuing, to decide on the new

:16:21.:16:24.

administrator for the scheme. I think it is absolutely wrong if the

:16:25.:16:29.

government to a private sector provider to do that. You'll never

:16:30.:16:35.

comment I wish to make was about welcoming the stage one hepatitis C

:16:36.:16:42.

payments. I am happy to give way. Who ever does administer the scheme,

:16:43.:16:46.

can we hope the government will say to them, if there are anomalies are

:16:47.:16:51.

cases which come outside the rules, they will be free to tell the

:16:52.:16:56.

government they should change them? There is a big debate to follow with

:16:57.:17:03.

a lot of we speakers. Are now eating into that time. I will be quick.

:17:04.:17:11.

?3500 is not a large amount of money for people who been affected. Under

:17:12.:17:16.

the Scottish model, there is that ?30,000 lump sum payment made if

:17:17.:17:21.

they have already received the 20,000 lump sum payment. Over the

:17:22.:17:25.

spending period, and not sure the government can really say they are

:17:26.:17:32.

helping those stage one C people more than is happening in Scotland.

:17:33.:17:37.

I wanted to do that on the record. But thank you. The question is as on

:17:38.:17:47.

the order paper. As many are of the opinion say I. The I smack habit. We

:17:48.:17:52.

have 11 backbench contributions to the next debate.

:17:53.:18:03.

The Prime Minister referred to the burning injustice in life expectancy

:18:04.:18:18.

between the richest and poorest in our society. The purpose of this

:18:19.:18:22.

debate today is to try to assist the government in how to tackle that

:18:23.:18:28.

life expectancy gap. I would urge her to look not just at that, but

:18:29.:18:33.

the gap in the healthy life expectancy, because what we know is

:18:34.:18:40.

that if you are born based on ONS data from 2012, if you are born in

:18:41.:18:47.

Tower Hamlets as a woman, your life expectancy will be 52.7 years. In

:18:48.:18:54.

Richmond on Thames, it will be 72.1 years. A gap of around 20 years.

:18:55.:19:00.

That gradient, the social gradient for disability free life expectancy

:19:01.:19:11.

is even greater. This is not just a social justice issue, but also an

:19:12.:19:16.

issue which adds hugely to the cost to the NHS and economic cost more

:19:17.:19:22.

widely. Is a compelling economic and social justice case for tackling

:19:23.:19:27.

this. So what should she do? In a nutshell, she should follow the

:19:28.:19:31.

evidence, start immediately, start with the very youngest in our

:19:32.:19:37.

society, even before they are born. And follow all the wider

:19:38.:19:42.

determinants of health. I think she should take across government

:19:43.:19:45.

approach because of that, with leadership at the highest level in

:19:46.:19:50.

Cabinet. She needs to take the long view. Many of the benefits of this

:19:51.:19:56.

will be coming evident in 20 or 30 years' time. But not ignore that

:19:57.:20:00.

there are quick wins. She needs to look at all of the things that need

:20:01.:20:04.

to be done to tackle this. I would like to start because I hope this

:20:05.:20:08.

will be a consensual debate, in congratulating the Labour government

:20:09.:20:12.

for the work needed to tackle health inequalities which is starting to

:20:13.:20:18.

pay dividends. I would like to pay tribute to Sir Michael marmot and

:20:19.:20:25.

for his ground-breaking work. The blueprint issued in 2010 forms the

:20:26.:20:30.

basis of what we do. Giving every child the best possible start in

:20:31.:20:36.

life. Allowing people of all ages to maximise capabilities and exercise

:20:37.:20:41.

control over their lives. It is about healthy environment and

:20:42.:20:45.

communities. Standards of living and housing. It is about preventing

:20:46.:20:51.

ill-health as well. There are many members across this House that will

:20:52.:20:56.

speak with great expertise on the wider determinants of health. I know

:20:57.:21:01.

that tackling this starts long before people come into contact with

:21:02.:21:06.

health services. But that is still an enormously important part of

:21:07.:21:11.

tackling health inequalities. I will focus on those aspects today.

:21:12.:21:18.

Preventing early deaths, we need to look at all those lifestyle issues

:21:19.:21:22.

around smoking and obesity. We need to look at issues of preventing

:21:23.:21:31.

suicide, the greatest single cause of death in men under the age of 49.

:21:32.:21:37.

Public-health plays such a critical role. There was a call for a radical

:21:38.:21:44.

upgrade in public health. We have seen cuts to public health budgets

:21:45.:21:49.

and that is very disappointing. It will severely impact on the

:21:50.:21:55.

government's ability to tackle health inequalities. When we look at

:21:56.:21:58.

what is happening in public health, we have seen from a survey from the

:21:59.:22:03.

Association of directors of public health, who surveyed members in

:22:04.:22:11.

February this year, this is affecting areas like weight

:22:12.:22:16.

management, drugs, smoking cessation and alcohol. These are all key

:22:17.:22:21.

determinants we need to tackle. In my own area, part of which covers

:22:22.:22:28.

Torbay, cats to cancel budgets for public health of around ?345,000 are

:22:29.:22:34.

resulting in the decommissioning of healthy lifestyle services,

:22:35.:22:38.

affecting education, affecting active intervention and supporting a

:22:39.:22:43.

network of fantastic volunteers. I really regret this will be going

:22:44.:22:49.

ahead and call on the government to stop the cuts to public health at I

:22:50.:22:53.

would like to tackle a few key areas. First of all smoking. Smoking

:22:54.:22:58.

is still the biggest cause of preventable death in the United

:22:59.:23:02.

Kingdom. 100,000 people are dying every year prematurely as a result

:23:03.:23:07.

of smoking. And so I hope in her closing remarks the Minister will be

:23:08.:23:11.

able to update the House on her plans for the Tobacco control plan.

:23:12.:23:20.

I will give way. 25 years ago, I took an interest in how many death

:23:21.:23:26.

certificates mentioned smoking. The answer was four. It may be larger

:23:27.:23:34.

now. I think we should be encouraging it should be recorded.

:23:35.:23:45.

We need to learn the lessons in cutting drink-driving deaths. These

:23:46.:23:55.

are extremely important points. There are things that government can

:23:56.:24:01.

do in terms of policy to make sure the incentives are there within the

:24:02.:24:06.

system to make that happen. For example, the drink-drive limit I

:24:07.:24:10.

think is a very important point. Going back to smoking, the reality

:24:11.:24:15.

here is it is a key driver for health inequality. If we want to

:24:16.:24:20.

make a difference in that gap in disability free life expectancy,

:24:21.:24:24.

were not likely to do that without tackling smoking. It accounts for

:24:25.:24:31.

more than half of the difference in premature deaths between the highest

:24:32.:24:37.

and lowest social economic groups. I would like to briefly touched on

:24:38.:24:41.

obesity because this is something the health committee has also looked

:24:42.:24:46.

at. Just to put this in context, looking at data from the child

:24:47.:24:50.

measurement programme, the most recent, what we know is that just

:24:51.:24:58.

looking at your sex, 26% of the most disadvantaged children are leaving

:24:59.:25:02.

your sex not just overweight but obese. It 11.7 of the least deprived

:25:03.:25:10.

children. Overall, it means that for schools for all children leaving in

:25:11.:25:15.

your sex, one in three are now obese or overweight. This is storing up

:25:16.:25:20.

catastrophic lifetime problems for them. It is not something we can

:25:21.:25:26.

continue to ignore. In our report, we called for bold and brave action.

:25:27.:25:34.

Although I welcome many aspects of the childhood obesity plan, for

:25:35.:25:39.

example the sugary drinks levy is already having an impact, I think it

:25:40.:25:44.

has been widely acknowledged there were glaring deficiencies and missed

:25:45.:25:50.

opportunities in the plan. I would like to have seen far greater

:25:51.:25:55.

emphasis on marketing and promotion being tackled. 40% of voters bought

:25:56.:26:10.

in the supermarket is bought under marketing and promotion. Sometimes

:26:11.:26:14.

we focus entirely on what people should not do. We could have an

:26:15.:26:21.

opportunity to look up a -- look at what people should do. Shifting the

:26:22.:26:29.

balance to a healthy lifestyle would've helped. The affordability

:26:30.:26:34.

of good nutritious food is a huge factor. I urge the Minister to to

:26:35.:26:39.

encourage that that to be brought back into the strategy. With the

:26:40.:26:43.

sugary drinks levy, extending it to other drinks, those that have sugar

:26:44.:26:50.

added to milky products. There is no reason why that should be necessary.

:26:51.:26:58.

I also welcome the plan and its mention of the Daily Mail. I met an

:26:59.:27:10.

inspirational headteacher. She talks about the strategy. And how having

:27:11.:27:15.

leadership from directors of public health makes a real difference. I

:27:16.:27:18.

hope the Minister will urge and update the House until those values

:27:19.:27:23.

can be taken forward. We shouldn't just think about obesity, we should

:27:24.:27:31.

think about physical activity and the benefits it can bring to school

:27:32.:27:39.

children. When money is so restricted, making health a material

:27:40.:27:45.

consideration in planning matters. It was stressed in the report. I

:27:46.:27:51.

don't think this would be a brake on growth. I think it would be a brake

:27:52.:27:55.

on unhealthy growth and allow local authorities to have the leverage

:27:56.:28:00.

power when you're making licensing decisions, making planning decisions

:28:01.:28:04.

for communities. This is something the government could do with

:28:05.:28:09.

low-cost but enormous benefit. I wonder if the Minister would refer

:28:10.:28:14.

to that. There is an area the health committee is actively considering at

:28:15.:28:18.

the moment and that is how we reduce the toll of deaths from suicide. For

:28:19.:28:28.

men, the Samaritans have identified that those living in the most

:28:29.:28:31.

deprived areas are ten times more likely to end their lives by suicide

:28:32.:28:33.

than those in the most affluent areas. We know there are many things

:28:34.:28:40.

that contribute to this. Economic recessions, debt, unemployment. Many

:28:41.:28:44.

factors. But I think again when we look at trying to tackle health

:28:45.:28:50.

inequality, we will not really make the inroads that we need to make

:28:51.:28:56.

unless we look at the inequality in suicide and particularly the

:28:57.:28:59.

inequality as it affects men. Three quarters of those who die by suicide

:29:00.:29:04.

are men. I hope the Minister will look carefully at the emerging

:29:05.:29:10.

evidence from our current enquiry as they are actively considering the

:29:11.:29:14.

refresh to the strategy. And do so at every point, looking at how we

:29:15.:29:17.

tackle health inequality in doing so. I would also like the Minister

:29:18.:29:25.

to look at the impact on drugs and alcohol on health inequality. When

:29:26.:29:29.

we look at the fact there are 700,000 children living in the

:29:30.:29:33.

United Kingdom with an alcohol dependent parent, that is a

:29:34.:29:38.

staggering cause of health inequality, with huge implications

:29:39.:29:44.

for their life chances. But also for the individuals involved. Again,

:29:45.:29:49.

alcohol has a gradient for deprivation. We know there is clear

:29:50.:29:53.

evidence about what works. We have had very encouraging news from

:29:54.:29:59.

Scotland. Scottish courts have ruled that minimum pricing is legal. I am

:30:00.:30:05.

disappointed the Scotch whiskey association has yet again taken this

:30:06.:30:09.

to a further stage of appeal. As soon as these hurdles are cleared,

:30:10.:30:14.

think it would be a great shame if England were undermining potentially

:30:15.:30:18.

ground-breaking work in Scotland, by allowing people to buy across the

:30:19.:30:22.

border. I think it will be a great shame if we don't follow suit at the

:30:23.:30:27.

earliest possible opportunity in introducing minimum pricing.

:30:28.:30:34.

I think it is disappointing, but perhaps there is a lot to look up

:30:35.:30:43.

from Scotland in terms of what we have done with the smoking ban,

:30:44.:30:50.

which England then took up? I congratulate the Scottish

:30:51.:30:52.

Government, it does seem to be the case of West Scotland Leeds, England

:30:53.:30:55.

will eventually follow. But Scotland is good at following the evidence

:30:56.:31:00.

and I call on us to do likewise here. I am particularly concerned

:31:01.:31:05.

that the benefits that come about when Scotland does introduce minimum

:31:06.:31:09.

pricing, would be undermined if we didn't follow suit here. I would

:31:10.:31:13.

call on them to do that as soon as per the. In summary, because I know

:31:14.:31:19.

there are many other members who wish to speak. There is a huge

:31:20.:31:23.

amount we can do, not all of it has a cost. I would urge the Minister in

:31:24.:31:29.

summing up to actually look at all the possibilities to stick with the

:31:30.:31:34.

agenda, taking a cross government approach, but to make sure there is

:31:35.:31:38.

leadership at the highest level. It was hugely encouraging the Prime

:31:39.:31:41.

Minister said those words in Downing Street. We are calling on her to

:31:42.:31:50.

appoint somebody at Cabinet level to take over responsibility for health

:31:51.:31:53.

inequalities and putting those fine words into action. The question is

:31:54.:32:04.

as on the order paper. I rise to express my support for the work of

:32:05.:32:08.

the health committee under the superb leadership of the honourable

:32:09.:32:13.

member for Totnes. I also pay tribute to the Prime Minister for

:32:14.:32:16.

her description of health inequalities as a burning injustice

:32:17.:32:22.

and for placing it at the top of her agenda, as virtually the first thing

:32:23.:32:25.

she did as Prime Minister of this country. This is an unusual debate

:32:26.:32:34.

that in backbenchers are usually trying to press the government to

:32:35.:32:39.

take on a priority. This is a kind of top-down issue, where the need to

:32:40.:32:46.

tackle health inequalities has been forcibly expressed by the Prime

:32:47.:32:50.

Minister and we are trying to translate those words in this debate

:32:51.:32:57.

into effective action. For those of us who have grappled with the nuts

:32:58.:33:02.

and bolts of tackling the obscenity of health inequalities, because that

:33:03.:33:06.

is what it is in the 21st century. The Prime Minister's words were,

:33:07.:33:14.

enormously encouraging, because they demonstrated the leadership that

:33:15.:33:18.

this issue requires if these awful statistics are to be properly

:33:19.:33:26.

addressed. I want to set this in its historical context in order to

:33:27.:33:32.

demonstrate the in approach which bans the 37 years from the first

:33:33.:33:38.

woman Prime Minister to the second. While life expectancy had improved

:33:39.:33:43.

dramatically since the creation of the NHS in 1948. By the 1970s there

:33:44.:33:49.

was a strong suspicion that persistent health inequalities

:33:50.:33:52.

existed and they were defined largely by social class. There was,

:33:53.:33:59.

however, an absence of easily understood statistical evidence on

:34:00.:34:05.

which to base a clear assertion. The then Health Secretary in 1977

:34:06.:34:11.

commissioned the president of the Royal College of physicians to chair

:34:12.:34:15.

a working group that would report to government on the extent of health

:34:16.:34:19.

inequalities in the UK and how best to address them. The report proved

:34:20.:34:25.

conclusively, that death rates from many diseases were higher among

:34:26.:34:28.

those in the lower social classes, stripped bare, this was the first

:34:29.:34:34.

official acknowledgement that the circumstances into which a person

:34:35.:34:38.

was born would largely determine when they died. This remains the

:34:39.:34:47.

thrust of the argument expressed by the health committee report, except

:34:48.:34:51.

they have added the new dimensional highlighted in the indicators for

:34:52.:34:55.

health inequalities in November 2015, of the difference in years

:34:56.:35:03.

spent in good health. Where there is an extraordinary gap between the

:35:04.:35:08.

most and least disadvantaged of almost 17 years. By the time the

:35:09.:35:13.

Black report was published a new government had been elected, which

:35:14.:35:17.

displayed its enthusiasm for tackling health inequalities by

:35:18.:35:21.

reluctantly publishing less than 300 copies of the Black report in the

:35:22.:35:25.

depths of the summer recess on an August bank holiday Monday, with the

:35:26.:35:29.

forward from the new Health Secretary, who couldn't even raise

:35:30.:35:36.

the enthusiasm to dampen the rapport with faint praise. He dammed it and

:35:37.:35:40.

virtually ignored it and that remained the case for 18 years.

:35:41.:35:46.

During which, and this is important because people assume health as

:35:47.:35:50.

improved for everyone since the 1940s, and by and large it has. But

:35:51.:35:58.

many of the problems that black highlighted got worse. The mortality

:35:59.:36:02.

rate among young men of working age in the early 1970s was almost twice

:36:03.:36:08.

as high in unskilled groups as for those in professional groups. By the

:36:09.:36:15.

early 1990s, it was three times as high. The most awful statistic that

:36:16.:36:20.

begun to emerge in the 1980s was that those who were long-term

:36:21.:36:25.

unemployed, with 35 times more likely to commit suicide than those

:36:26.:36:34.

in work. It would be inconceivable today for a Health Secretary to be

:36:35.:36:38.

as dismissive of an issue so critical to the life chances of so

:36:39.:36:46.

many. But we are also more aware today than we were then that health

:36:47.:36:50.

care is only part of the problem. Indeed, the Minister has a difficult

:36:51.:36:56.

job, it's almost a minor part, calculated that between 15 and 25%.

:36:57.:37:07.

Professor, the world leading epidemiologist established the

:37:08.:37:11.

social determinants of health as the report in the late 1990s explained,

:37:12.:37:18.

poverty, low wages, occupational stress, unemployment, poor housing,

:37:19.:37:22.

environmental pollution, poor education, limited access to

:37:23.:37:28.

transport and the Internet, crime and disorder and a lack of

:37:29.:37:33.

recreational facilities all have an impact on people's health. Beverages

:37:34.:37:40.

five Giants, disease, once, ignorance, squalor and idleness were

:37:41.:37:43.

more pithy than Polen at it way of describing the problem. And

:37:44.:37:52.

beverage's brother-in-law page tourney, set the template we should

:37:53.:37:57.

follow. He said the issue was not about some romantic illusion that

:37:58.:38:01.

men are equal in character and intelligence, rather it is about

:38:02.:38:05.

eliminating the inequalities that had their source not individual

:38:06.:38:13.

differences but in organisation. The report, which I commissioned as

:38:14.:38:20.

Health Secretary in 2008, to form policy in 2010 onwards.

:38:21.:38:22.

Unfortunately electorate decided we wouldn't be there to carry it out,

:38:23.:38:27.

but it recommended six policy areas where we should focus upon. The best

:38:28.:38:34.

start in life, maximising capabilities and control, fair

:38:35.:38:37.

employment and good work, healthy standard of living, healthy and

:38:38.:38:42.

sustainable places and communities, strength and role in provision of

:38:43.:38:45.

ill health prevention. These six areas were advised to be focused

:38:46.:38:53.

with the scale and intensity proportionate to the level of

:38:54.:38:56.

disadvantage. He called this proportionate universalism. The

:38:57.:39:04.

Coalition Government recommended the recommendations. They responded with

:39:05.:39:07.

a policy of healthy lives and healthy people with a focus on

:39:08.:39:10.

individual lifestyle and behavioural change. This, as Sir Michael pointed

:39:11.:39:16.

out, is only one part of the problem, just as the NHS is only one

:39:17.:39:21.

part of the solution. What's more, the only piece of cross Goldman 's

:39:22.:39:30.

-- cross government coordination was scrapped in 2012. The select

:39:31.:39:34.

committee on Public health and today's debate, together with the

:39:35.:39:38.

Prime Minister's pledge give us an opportunity to capitalise on the

:39:39.:39:43.

brilliant work done by Sir Michael and his institution of health equity

:39:44.:39:48.

at UCL. And the political consensus, I am pleased to say, now exists

:39:49.:39:54.

around this issue, by forging a fresh and dynamic response across

:39:55.:39:57.

government to tackling health inequalities. One of the committee

:39:58.:40:04.

's recommendations was a Cabinet Office minister be given specific

:40:05.:40:08.

responsibility for leading on this issue across government. I have a

:40:09.:40:14.

more radical suggestion. I believe the Prime Minister herself should

:40:15.:40:18.

take personal responsibility for this issue. The Prime Minister is

:40:19.:40:22.

also first Lord of the Treasury and the minister responsible for the

:40:23.:40:26.

civil service. Previous prime ministers have taken on other

:40:27.:40:32.

ministerial positions. Wellington was Home Secretary, Defence

:40:33.:40:35.

Secretary and Commonwealth Secretary. Churchill was Prime

:40:36.:40:40.

Minister and Defence Secretary. It would be a wonderful example for the

:40:41.:40:45.

Prime Minister to follow up her words by saying, I am going to lead

:40:46.:40:50.

on this, I am going to chair the cross government committee that

:40:51.:40:54.

tackles health inequalities. I think it needs that level of leadership,

:40:55.:40:58.

because only then will there be meaningful cross departmental work

:40:59.:41:06.

to tackle this. I echo the health committee's view that devolving

:41:07.:41:09.

public health to local authorities was the right thing to do, not

:41:10.:41:12.

everything in the health and social care bill was approved by us on

:41:13.:41:17.

these benches, or many other people, but that was the right thing to do.

:41:18.:41:22.

Their cuts in budget need to be restored. 200 million in year cuts

:41:23.:41:26.

and I would suggest the ring fencing should be extended to at least the

:41:27.:41:35.

end of this Parliament. With so many problems local government have, if

:41:36.:41:37.

you break the ring fence on public health, it is going to go elsewhere

:41:38.:41:43.

and not be focused on these issues. Only a minority of health inequality

:41:44.:41:47.

issues involved the Department of Health, but in closing I want to

:41:48.:41:50.

highlight one that certainly does. The biggest cause of hospitalisation

:41:51.:41:55.

for children between the ages of five and 14 is dental problems.

:41:56.:42:05.

Thousands of children went into hospital to be any the tie is done

:42:06.:42:09.

have 30 extracted over the past year. 11,000 more than the second

:42:10.:42:17.

biggest cause of hospitalisation for children, which is abdominal and

:42:18.:42:23.

pelvic pain. Believe it or not, it was the 12th highest cause for

:42:24.:42:26.

hospitalisation of tiny children below the age of four. This is a

:42:27.:42:34.

health equality issue. Almost all of the children who went into hospital

:42:35.:42:38.

will be from deprived communities, including 700 from the city I

:42:39.:42:44.

represent. There is a safe and proven way to dramatically reduce

:42:45.:42:49.

tooth decay in children, which also has a beneficial effect on adults.

:42:50.:42:55.

It involves flora dating water up to the Ottoman level of one part per

:42:56.:43:03.

million. The cost is small, for every ?1 spent there is a return to

:43:04.:43:08.

the taxpayer of ?12 after five years and ?22 after ten years. The

:43:09.:43:14.

evidence from the West Midlands to the North East, two countries across

:43:15.:43:17.

the world, has been there now for many years. A child in Hull aged

:43:18.:43:26.

five has 87.4% more tooth extractions than a child living in

:43:27.:43:34.

fluoridated Warsaw. The whole of the medical profession, the dentist

:43:35.:43:38.

profession, the BMA and the Department of Health have recognised

:43:39.:43:43.

this for many years. In Hull we intend to fluoridated water as part

:43:44.:43:47.

of a consolidated policy to tackle this element of health inequality.

:43:48.:43:51.

We need the Department of Health to show moral leadership in encouraging

:43:52.:43:57.

local authorities in deprived areas to pursue fluoridation and support

:43:58.:44:04.

them when they do. The Health Secretary retains ultimate

:44:05.:44:06.

responsibility for public health, including health prevention. Here is

:44:07.:44:12.

one issue where he can begin the process of reducing hospital

:44:13.:44:15.

admissions by encouraging preventative action and in terms of

:44:16.:44:20.

health inequalities giving poor kids prosperous kids teeth. I agree with

:44:21.:44:30.

him completely. Has he solved the problem how water supply companies

:44:31.:44:32.

and businesses can feel protected and not find themselves facing

:44:33.:44:41.

unjustified claims or difficulties? My understanding, as this is an

:44:42.:44:48.

intervention on a conclusion, by putting the focus onto local

:44:49.:44:53.

authorities, and I have talked to Yorkshire water on this, it changes

:44:54.:44:57.

the whole dynamic of how various conspiracy theorists can attack this

:44:58.:45:08.

issue. It is a great pleasure to be able to follow the Right Honourable

:45:09.:45:12.

member and his very thoughtful speech. To those debates on reducing

:45:13.:45:17.

health and inequalities is very far reaching, so I want to focus on

:45:18.:45:24.

obesity, as I chaired the party group on obesity and sits on the

:45:25.:45:27.

health select committee responsible for producing the report.

:45:28.:45:33.

To make no apologies for talking about obesity again in this chamber.

:45:34.:45:43.

-- today I make no apologies. This poses a major threat to our nation.

:45:44.:45:48.

With more than one in five children being overweight or obese before

:45:49.:45:52.

they start primary school, and with this figure rising to more than one

:45:53.:45:58.

in three as they start secondary school, our future generations are

:45:59.:46:05.

at risk of developing serious health complications. Recent data has shown

:46:06.:46:16.

a continuing widening inequality gap in these categories. 60% of the most

:46:17.:46:21.

deprived boys aged five to 11 are predicted to be overweight or obese

:46:22.:46:29.

by 2020. Just 16% of boys in the more affluent group. 60% versus 16%.

:46:30.:46:38.

Overall, 36% of the most deprived children are predicted to be

:46:39.:46:42.

overweight or obese by 2020. Compared to just 19% of the most

:46:43.:46:50.

affluent. These vast inequalities must be tackled. We need to take

:46:51.:46:56.

brave and bold action. Every study around at the moment shows that

:46:57.:47:02.

higher obesity rates are linked to deprivation. Critically, the

:47:03.:47:04.

national Child measurement programme showed the gap between areas less

:47:05.:47:10.

affected and those where child obesity is less affected is growing.

:47:11.:47:23.

This is a wake-up call. The future many young people face could be

:47:24.:47:34.

complicated with the riddles of obesity. Diabetes, heart disease and

:47:35.:47:38.

cancer. Strain on public services. The emotional impact as well on our

:47:39.:47:50.

population. Medics report that cases of type 2 diabetes are occurring in

:47:51.:47:55.

children. Until recently, it was just seen as a disease of the older

:47:56.:48:02.

population. Action is needed to prevent a public health calamity.

:48:03.:48:08.

Moving away from child obesity, I want to focus on the overall impact

:48:09.:48:15.

of obesity in adults. It's important we provide parents with every tool

:48:16.:48:18.

possible to make sure they can be great role models when it comes to

:48:19.:48:23.

what we eat and our lifestyles. Thank you for giving way. I am sure

:48:24.:48:29.

my honourable friend is aware that Tesco announced last week some major

:48:30.:48:37.

differences to sugar in drinks. It was done off their own bat. I wonder

:48:38.:48:46.

what my rubble friend's views are about pressure from supermarkets to

:48:47.:48:51.

influence the outcome for children? She makes a good point. Waitrose and

:48:52.:48:57.

Morrisons have also done this. And I am sure many more. It is good major

:48:58.:49:02.

retailers are taking on board the severity of this challenge we face

:49:03.:49:09.

as a nation and globally as well. But parents need to be role models,

:49:10.:49:16.

retailers need to be role models and sometimes the need to do more. It is

:49:17.:49:25.

not just child obesity link to social class. So is adult obesity.

:49:26.:49:34.

The highest level of excess weight is found amongst the lowest

:49:35.:49:50.

socioeconomic groups. Obesity is the single biggest preventable cause of

:49:51.:49:54.

cancer after smoking. With the government acknowledging the

:49:55.:50:01.

importance of early cancer diagnosis and dedicated NHS staff at all

:50:02.:50:06.

levels committed to delivering this, surely everything which can be put

:50:07.:50:12.

in place must be put in place? In addition to cancer, obesity leads to

:50:13.:50:17.

a greater risk of type 2 diabetes and heart disease. These are all

:50:18.:50:21.

conditions which are life changing and life limiting. I am sure people

:50:22.:50:25.

now understand there is a link between obesity and diabetes, but

:50:26.:50:31.

sadly I fear so many people think they can take a pill and keep

:50:32.:50:34.

diabetes under control. Sadly far too many people sufferers with

:50:35.:50:40.

diabetes have found this is not the case. Many need lower limb

:50:41.:50:49.

amputations. Many suffer kidney disease, liver disease and sight

:50:50.:50:54.

loss. Action must be taken now to turn around what I believe has

:50:55.:51:02.

become an obesity epidemic. Everything had talked about today

:51:03.:51:06.

should prompt a review of the Department of Health's child obesity

:51:07.:51:10.

plan. Despite a government leading the world in producing the plan for

:51:11.:51:15.

action, many, myself included, said when it was published it was quite a

:51:16.:51:21.

let down. I stand by that view today. This simply wasn't enough

:51:22.:51:26.

detail in the 13 page document. It was aspirational rather than a

:51:27.:51:34.

focused plan of action. It ignored the recommendations of Public Health

:51:35.:51:37.

England. It didn't set firm timescales to turn the tide on

:51:38.:51:41.

childhood obesity. The plan we have is insufficient for the scale of the

:51:42.:51:49.

task we have to tackle. We need to do more. We need clear actions and

:51:50.:51:56.

queer timescales. There is a fine balance between the nanny state,

:51:57.:52:02.

between business cooperation and parental responsibility. I'm sure it

:52:03.:52:06.

is not impossible to find common ground. Yes it is the responsibility

:52:07.:52:12.

of parents to ensure children eat healthily and are physically active

:52:13.:52:16.

and learn good habits to last a lifetime, but that by itself has

:52:17.:52:20.

proven time and time again it is not sufficient. Parents need more help.

:52:21.:52:24.

The current child obesity plan cannot and will not give them what

:52:25.:52:28.

we need. It would be a mistake to think the answer is lie in

:52:29.:52:36.

regulating business. Demonising the food and drink sector is unhelpful

:52:37.:52:42.

and unfair. Some producers, manufacturers and retailers are

:52:43.:52:47.

already taking great strides in encouraging healthy consumer

:52:48.:52:50.

behaviour and we must commend them for doing this. We welcome these

:52:51.:52:55.

actions. Evidence suggests the least affluent households in the UK have

:52:56.:53:02.

higher exposure to junk food advertising. The soft drinks levy is

:53:03.:53:21.

likely to have a positive impact. Just as the current plan does not

:53:22.:53:26.

help parents, it does nothing for the business that would be better

:53:27.:53:30.

served by clear goals and reformulation and for advertising

:53:31.:53:35.

and labelling and four time frames in which these need to be achieved.

:53:36.:53:40.

Publicly and privately, many sectors know that they themselves would be

:53:41.:53:46.

better served by clearer, more far reaching government recommendations

:53:47.:53:50.

that at least gave a certainty for the future. We may be horrified by

:53:51.:54:00.

the data figures we read on a daily basis. Cancer Research UK revealed

:54:01.:54:05.

this week that teenagers drink almost a bathtub of sugary drinks I

:54:06.:54:18.

hear on average. Will she give way? I am very grateful. She is making an

:54:19.:54:23.

excellent speech. Very thoughtful. There has been nothing I have

:54:24.:54:27.

disagreed with so far, she will be pleased to hear. Would she agree

:54:28.:54:34.

with me about how disappointed I was about the targets removed from the

:54:35.:54:41.

child obesity plan? Targets around having childhood obesity and figures

:54:42.:54:48.

about advertising and marketing which would have helped? I am just

:54:49.:55:00.

coming on that. Thank you. We know that child obesity levels will not

:55:01.:55:03.

drop tomorrow. What we need to see some signs in the next few years

:55:04.:55:09.

that they are declining. The foundations of an effective strategy

:55:10.:55:14.

are readily available in the form of recommendations from Public Health

:55:15.:55:17.

England and the health committee's report. I would like to hear a firm

:55:18.:55:25.

commitment for the soft drinks levy. Clear goals for product reform.

:55:26.:55:33.

Action on junk food advertising during family viewing. Promotions

:55:34.:55:44.

such as being given a free bar of chocolate with a newspaper. Such

:55:45.:55:52.

measures will ensure we have a strategy rather than just a vision.

:55:53.:55:57.

Will be able to tackle the obesity challenge we find in our society

:55:58.:56:03.

today. Thank you. Thank you. Thanks to the honourable member who is the

:56:04.:56:13.

chair of the health committee. And to the backbench committee for

:56:14.:56:21.

providing the time. The speech from the honourable member demonstrated

:56:22.:56:26.

clearly their knowledge in this area. It is a pleasure to follow the

:56:27.:56:34.

honourable member. And to learn more about obesity. Many will say that

:56:35.:56:40.

health inequality stems from the overarching inequality of education

:56:41.:56:43.

and opportunity both across the country and even within communities.

:56:44.:56:50.

And it is true. Mountable friend outlined the historical context for

:56:51.:56:55.

all that. Health inequality starts even before birth. Before a child is

:56:56.:57:00.

born into affluence or poverty. Long before they have the opportunity of

:57:01.:57:05.

starting a good mercenary or are left to make use of what is left.

:57:06.:57:13.

Health inequality begins in the womb and the child's development could be

:57:14.:57:17.

very much restricted or enhanced by the diet of the mother, the tendency

:57:18.:57:22.

to drink alcohol or smoking pregnancy, and dozens of other

:57:23.:57:29.

factors relating to antenatal care. Where you live has an impact. It can

:57:30.:57:36.

be mitigated by the actions of the NHS, local authorities and

:57:37.:57:39.

government. Economic kind of intervention is needed to support

:57:40.:57:43.

people who support is needed. It is that issue of resources. Everything

:57:44.:57:50.

from budgets to mount to discourage smoking in pregnancy, to hospital

:57:51.:57:56.

provisions which need to be the best in areas of greatest needs. I want

:57:57.:58:02.

to talk about the north-east of England to illustrate the reality of

:58:03.:58:11.

health inequalities. Government policy is putting the brakes on the

:58:12.:58:16.

process made in the years up to 2010. Some facts. There is a life

:58:17.:58:21.

expectancy gap of 17 years between men in the most deprived ward in

:58:22.:58:26.

Stockton compared with the least deprived. 12 years for women. This

:58:27.:58:33.

gap has increased by? Yours over a five-year gap. I fear it will

:58:34.:58:38.

continue to grow. Called development is an important contributor.

:58:39.:58:50.

In Stockton, a child who has a low quality of health due to parental

:58:51.:59:01.

lifestyle is more likely to be out of school, especially when it comes

:59:02.:59:07.

to dental health. 72% of children in the most deprived areas have tooth

:59:08.:59:17.

decay. Solutions were offered. In my constituency, the biggest causes of

:59:18.:59:23.

early death are cardiovascular disease, cancer and smoking related

:59:24.:59:35.

diseases. 1500 hospital stays per year more than the average related

:59:36.:59:41.

to alcohol. Smoking-related deaths, 320 worse than the average for

:59:42.:59:54.

England. 57% of people living in the north-east, 1.2 million individuals

:59:55.:59:59.

aged 18 and over, have suffered at least one is due to the drinking of

:00:00.:00:05.

others in the last 12 months. 62% of people, not least one heavy drinker.

:00:06.:00:18.

-- know at least one heavy drinker. One in five binge drinks on a weekly

:00:19.:00:24.

basis. Over 60% of us worry about violence caused by drinking and 90%

:00:25.:00:28.

of us are concerned about people being drunk and rowdy in public.

:00:29.:00:32.

There is a strong relationship between alcohol and crime, almost

:00:33.:00:36.

half of all crime is alcohol-related and it is having a significant

:00:37.:00:41.

impact on individuals and communities.

:00:42.:00:52.

Nearly 9000 children start smoking in the north-east region every year,

:00:53.:00:59.

according to Cancer Research UK. The north-east has the highest rate of

:01:00.:01:06.

economic activity in England. Up to June 2015, 20 3.5% of the working

:01:07.:01:11.

age population was inactive with a quarter of that inactivity due to

:01:12.:01:15.

ill health. The regional unemployment rate is the highest at

:01:16.:01:21.

7.9%. Life expectancy is lower than the English average. Men and women

:01:22.:01:25.

in the North East typically live over a year less than the national

:01:26.:01:30.

average. My constituency reflects the picture across the poorer parts

:01:31.:01:33.

of the country and evidence from charity and experts on these issues,

:01:34.:01:37.

show them to be highly significant. The British Lung foundation created

:01:38.:01:42.

a briefing and found people living in the poorest areas will die seven

:01:43.:01:48.

years earlier than those in the richest. There is a correlation,

:01:49.:01:52.

backed with evidence that affluence and opportunities affect your help.

:01:53.:01:57.

Cancer Research UK has carried out research that shows inequality is

:01:58.:02:01.

linked to 15,000 extra cases of cancer in England and children from

:02:02.:02:05.

the most deprived groups are twice as likely to be obese than the least

:02:06.:02:09.

deprived groups. Quite a dire picture across the north-east

:02:10.:02:13.

region, but not for the want of action by health groups, local

:02:14.:02:18.

authorities and charities. They have had some remarkable successes over

:02:19.:02:27.

the years despite the poor hand dealt them, but they need the

:02:28.:02:30.

support of government to make better progress. In order to reduce health

:02:31.:02:32.

inequalities we need more resources to support those who seek help, and

:02:33.:02:34.

investment in health service to detect illnesses earlier, do have a

:02:35.:02:37.

greater role for health care in schools, stop those 9000 children a

:02:38.:02:41.

year taking up smoking and to ensure the NHS has the means to be able to

:02:42.:02:45.

look after and treat everybody that needs it. But back to Stockton. How

:02:46.:02:52.

do we ensure those in Stockton are not at a significant disadvantage

:02:53.:02:55.

from birth compare to those in more affluent areas? We stop in the

:02:56.:02:59.

beginning, investment in early years education making sure all children

:03:00.:03:03.

have the best start and can reach their key development milestones to

:03:04.:03:07.

the best of their ability. Or, before they are born. The borough

:03:08.:03:11.

council has taken a number of measures to address the health

:03:12.:03:13.

inequality within the borough with the delivery of the health and

:03:14.:03:18.

well-being strategy, increasingly shape to ensure a targeted approach

:03:19.:03:23.

to those who need support. The Stockton seasonal health and

:03:24.:03:26.

well-being strategy coordinator targeted approach to making sure

:03:27.:03:28.

those who need the most support are getting at. 18,000 people received a

:03:29.:03:34.

winter warmth assessment, making sure their home is prepared for the

:03:35.:03:39.

winter. Stockton council working with Public Health England to

:03:40.:03:43.

implement a child dental health programme in schools, including

:03:44.:03:46.

nursery. Even in nursery and reception children. In our poorest

:03:47.:03:52.

wards, the council runs a community led initiative which focuses on

:03:53.:03:58.

outcomes for children up to three. Cognitive development, speech and

:03:59.:04:01.

language development and nutrition. These schemes ensure children have

:04:02.:04:07.

more opportunities to break this health inequality in my constituency

:04:08.:04:10.

to promote a healthier and safer upbringing. But they all need

:04:11.:04:16.

resources, which are sadly diminishing. I could now go on to

:04:17.:04:21.

bleat about the Pudil the north-east got from the coalition and now gets

:04:22.:04:25.

from the Tory government. The movement of health resources from

:04:26.:04:29.

north to the south, the huge cuts to local authority spending, which has

:04:30.:04:33.

impacted the ability to maintain services they need to close the

:04:34.:04:37.

quality gap. But I won't. But I will remind the government that whilst

:04:38.:04:42.

new hospital projects and Liberal Democrat and Tory constituencies

:04:43.:04:45.

planned by the last Labour government went ahead in 2010, the

:04:46.:04:52.

one to serve my own and neighbouring constituencies was axed. Our health

:04:53.:04:57.

trust is a remarkable job in difficult circumstances and I hope

:04:58.:05:01.

one day they will have the 21st-century hospital and facilities

:05:02.:05:05.

they need to serve our community and close the inequality gap. Maybe the

:05:06.:05:11.

provision of a hospital should form part of the transformation plan for

:05:12.:05:15.

our region. The study based the potential downgrading of our

:05:16.:05:19.

hospital and potential loss of our accident Emergency department. The

:05:20.:05:23.

challenge posed by health inequality is not just in my area, it is bigger

:05:24.:05:28.

than any other individual parent, bigger than any local authority and

:05:29.:05:32.

health trust. There must be a unified strategy to ensure health

:05:33.:05:36.

and equality is a thing of the past and my constituents, and as well as

:05:37.:05:40.

the constituents of many in this chamber have the best start to live

:05:41.:05:43.

under good quality of life to follow. Need early intervention, we

:05:44.:05:50.

need help for people with mental health problems and greater action

:05:51.:05:53.

to break the cycle of health inequality in the poorest areas of

:05:54.:05:57.

our country. We had one of the gloomiest outlooks for the country

:05:58.:06:03.

from the Chancellor yesterday, he spoke of the uncertainty ahead of

:06:04.:06:05.

rising debt and borrowing and falling growth and tax revenues. My

:06:06.:06:15.

great fear is that if the tough years ahead, coupled with the

:06:16.:06:17.

failure of the government to properly fund public health, the NHS

:06:18.:06:24.

and social care, we will see health inequalities Grot and the huge gap

:06:25.:06:27.

in life expectancy will not be closed for many decades. Mr Deputy

:06:28.:06:32.

Speaker, we shouldn't have a country where the future opportunities and

:06:33.:06:37.

health of children is determined by their socio- economic status, or the

:06:38.:06:40.

availability of resources to tackle the issues around smoking, alcohol,

:06:41.:06:47.

drugs and inactivity. But one where children yet to be born, have the

:06:48.:06:50.

freedom to choose which parts they want to take without the negative

:06:51.:06:53.

health implications holding them back. Thank you. I have to say, I

:06:54.:07:02.

entered this debate with trepidation about those people have spoken

:07:03.:07:07.

before me. I hope I can live up to them. Can I congratulate the member

:07:08.:07:15.

opposite, the shadow spokesman, and who I have worked closely with on

:07:16.:07:20.

issues to do with basketball as well. Can I register an interest as

:07:21.:07:28.

well. Can I congratulate my honourable friend who is a fellow

:07:29.:07:33.

Devon MP. Some of the issues I may be talking about one she may

:07:34.:07:39.

something about as well. Congratulations on securing this

:07:40.:07:47.

debate. In my constituency, there is an 11 year life expectancy

:07:48.:07:50.

difference between the north-east of my patch, which is where the

:07:51.:07:54.

professionals live, and the south-west, which is best known for

:07:55.:08:00.

its dockyard. Last week, I chaired a supper implement with health

:08:01.:08:05.

practitioners and academics, over iron deficiency and anaemia in

:08:06.:08:10.

Devon. It is a condition where the body, and I'm not going to pretend I

:08:11.:08:14.

am a medical expert, which you can probably tell, but it is a condition

:08:15.:08:20.

where the body has low red blood cell counts, resulting in less

:08:21.:08:25.

oxygen getting to organs and tissues. It can have serious

:08:26.:08:29.

consequences, often leading to more admissions to hospital or

:08:30.:08:37.

deterioration in health. This is a result of poverty, especially, but

:08:38.:08:41.

not exclusively, amongst the over 75 's. I was horrified to learn that

:08:42.:08:48.

Plymouth is top of the national list for iron deficiency. The rates of

:08:49.:08:53.

iron deficiency anaemia are four times the national average. Indeed,

:08:54.:08:57.

in north, east and West Devon, which includes Plymouth, there were 1530

:08:58.:09:07.

in patients with this in 2014 and 19% increase on 2013 and following

:09:08.:09:12.

the steady rise over the past few years. I understand in 2014, this

:09:13.:09:17.

amounted to an avoidable cost to the local health economy of just over ?1

:09:18.:09:22.

million as well. During my comments, which I will make now, I want to

:09:23.:09:27.

concentrate on NHS England's recent announcement and desire, to close

:09:28.:09:36.

three GP surgeries in my Plymouth, Sutton and Devonport constituency by

:09:37.:09:40.

March next year. This action, which I fear will serve to put greater

:09:41.:09:51.

pressure on the hospital, I am told the reason why NHS England is

:09:52.:09:55.

considering these closures is the size of the GP practices. I

:09:56.:10:01.

understand there is a report which suggests that should not be the only

:10:02.:10:08.

thing taken into account. The GP practice has a 1800 patient

:10:09.:10:15.

practice. Hyde Park, 2800 and Saint Barnabas, 1700. They are considered

:10:16.:10:22.

to be unsustainable and too small, despite the fact they are growing

:10:23.:10:27.

practices. I have mentioned some of these issues before, but I have no

:10:28.:10:31.

problem repeating them. I was told closing these practices is not down

:10:32.:10:35.

to saving money, but deliver better value for money. However, before I

:10:36.:10:41.

speak about both issues, let me put my own constituency into some

:10:42.:10:49.

context. It runs from the a 38 to the River Tame. It is home to one of

:10:50.:10:55.

the largest universities in the country, with thousands of students,

:10:56.:10:59.

thousands of whom live in the city centre. It is unable and a Royal

:11:00.:11:05.

Marine commander garrison city, as the health Minister, for whom I was

:11:06.:11:12.

a previous Parliamentary Secretary two, in a previous life, knows only

:11:13.:11:13.

too well. Fortunately Perth Plymouth, the MoD

:11:14.:11:33.

announced the Royal Marines and their families would be transferred

:11:34.:11:38.

from shipping in the north of Devon, our brave in Scotland and Taunton,

:11:39.:11:44.

just up the M5. Whilst the city's population is growing, this will put

:11:45.:11:51.

more pressure on schools, hospitals, both that the Rufford and GP

:11:52.:11:58.

practices. Although Plymouth has a global reputation for Marine science

:11:59.:12:03.

and engineering research, it is a low-wage and low skills economy. It

:12:04.:12:08.

is an inner city, something pretty unique for a conservative to

:12:09.:12:13.

represent, if I might say so. I do not have a single piece of

:12:14.:12:16.

countryside in my constituency, unless of course you include the

:12:17.:12:23.

pony Sanctuary, which is a rather muddy field. In the run-up to the

:12:24.:12:29.

2010 general election, when I won the seat on the third attempt, the

:12:30.:12:33.

Conservative Party pledged to do something about health care in

:12:34.:12:36.

deprived inner cities. We started to make a good two word and in 2014,

:12:37.:12:42.

the member for central and Suffolk and North Ipswich, one of the

:12:43.:12:50.

ministers, it to open the GP practice which is now very much

:12:51.:12:54.

under threat. Other facilities on the campus include minor injuries

:12:55.:13:00.

unit, the Devonport health centre and the pharmacy. The GP practice

:13:01.:13:05.

was set up by Plymouth community health care, and the Peninsula

:13:06.:13:13.

medical School. There was and a desperate need to provide

:13:14.:13:16.

tailor-made alternative service to the existing practice. Then, the

:13:17.:13:23.

Marlborough Street practice. Now the health centre for this deprived

:13:24.:13:28.

community, and the need to look after drug users and the city

:13:29.:13:33.

homeless in hostels such as the neighbouring Salvation Army

:13:34.:13:37.

hospital. The practice, also offers practical placements for students at

:13:38.:13:41.

the Plymouth medical school. Until earlier this year, it was funded by

:13:42.:13:47.

a social enterprise which found it too expensive to maintain. Despite

:13:48.:13:53.

Devonport's real deprivation, NHS England did not want to get involved

:13:54.:13:58.

in providing a contract to the Cumberland GP practice which is

:13:59.:14:01.

consequently been operating without a formal contract and is managed by

:14:02.:14:08.

Access health care. I understand that whilst the neighbouring

:14:09.:14:11.

Devonport health practice has not been offering...

:14:12.:14:27.

NHS England's reason for putting the GP practice under threat is because

:14:28.:14:36.

it would be too small and is operating in and sustained,

:14:37.:14:40.

unsuitable, cramped premises. Unless we are very careful, we could

:14:41.:14:46.

potentially put more pressure on the acute emergency unit, which is

:14:47.:14:53.

already under pressure. NHS England's proposals for three GP

:14:54.:15:03.

practices in the summer recess. NHS England expected me under the

:15:04.:15:05.

members of Parliament expected us to be won parliamentary trips are

:15:06.:15:10.

taking a holiday. Hard luck, I was there. I put together a series of

:15:11.:15:15.

meetings with the City Council director of public health, the

:15:16.:15:18.

leader of the Council, the member for adult social care, people from

:15:19.:15:23.

NHS England, the dean of the medical School and the Doctor Who runs the

:15:24.:15:25.

GP practice. At that meeting, I suggested the

:15:26.:15:35.

Cumberland GP practice should share a the health centre was my brand-new

:15:36.:15:41.

building, which has space and operates as a federation, sharing

:15:42.:15:44.

receptionists and backroom staff. The City Council's health and

:15:45.:15:48.

well-being board supported it following an inquiry that read some

:15:49.:15:52.

of measures to allow the Cumberland GP practice to continue. However, I

:15:53.:15:56.

understand that Devonport health care might not be willing to do

:15:57.:16:00.

this, and it appears that the Devonport community may be deprived

:16:01.:16:04.

of a second GP practice that patients will have no choice in

:16:05.:16:09.

which Doctor they go to. The new Devon CCG is looking at ways in

:16:10.:16:14.

which it might try and keep the Cumberland GP practice open, but it

:16:15.:16:19.

needs space in the short-term whilst it considers alternative locations I

:16:20.:16:24.

have also had representation of patients at Boghead Park and Saint

:16:25.:16:29.

Barnabas surgeries at Hyde Park, although Doctor Stephen Warren is

:16:30.:16:33.

keen to continue as a GP following a heart attack, he has transferred

:16:34.:16:37.

ownership of his practice to access health care, as he no longer wishes

:16:38.:16:41.

to deal with the backroom task of administration, which is part of

:16:42.:16:44.

running a practice. He argues that his and his partners' growing 2800

:16:45.:16:51.

practice has attracted outstanding reviews and he would not be able to

:16:52.:16:56.

inform his patients where he was going if he relocated to another

:16:57.:17:01.

practice. He also thinks that some patients like to have a relationship

:17:02.:17:05.

with an individual doctor, who they can see speedily, rather than having

:17:06.:17:11.

to wait weeks. It is like having your own personal bank manager, is

:17:12.:17:15.

it not? I think that is important. Saint Barnabas surgery, also run by

:17:16.:17:18.

access health care, was set up in a new development next to a

:17:19.:17:21.

residential care home for the elderly, were patients do not have

:17:22.:17:26.

to walk very far. In all three cases, NHS England, for technical

:17:27.:17:32.

reasons, gave patients only 24 hours notice of their initial engagement.

:17:33.:17:37.

I must say, I found the public consultation process is frankly

:17:38.:17:41.

utterly appalling. And I wrote to NHS England asking to give more time

:17:42.:17:46.

to engage with local communities, and I am grateful that they actually

:17:47.:17:51.

did bother to listen. Recently, as my constituency surgery, I was asked

:17:52.:17:54.

to write to NHS England to ask whether they had engaged with other

:17:55.:17:58.

GP surgeries. And with Derriford Hospital, and whether it consulted

:17:59.:18:03.

them, because some GPs will have to accommodate more patients. This is a

:18:04.:18:06.

very big issue. But there are wider issues of all others. At the moment,

:18:07.:18:11.

the commissioners in North, east and West Devon spend a higher amount of

:18:12.:18:18.

money East Devon than in the West locality. The government success

:18:19.:18:20.

regime is keen to correct this so that resources are focused on

:18:21.:18:28.

deprived communities such as Devonport. Finally... I thank him

:18:29.:18:32.

for giving way. It was just an observation, really. Given the

:18:33.:18:36.

detail that my honourable friend has gone into how he seems to be the

:18:37.:18:39.

presenting his community in these deprived areas, how very fortunate

:18:40.:18:44.

they are to have this concerned MP in this inner-city area. I will try

:18:45.:18:55.

to intervene to a similar extent later as well. Thank you! Yes, there

:18:56.:19:01.

have been no mentions of jobs in this debate at all. Finally, as my

:19:02.:19:06.

honourable friend Maynor, I am the government's pharmacy champion, and

:19:07.:19:09.

the government is reviewing the role of pharmacy to take pressure off our

:19:10.:19:13.

GPs and Major acute hospitals, like Derriford. Much has been made of the

:19:14.:19:19.

6% cut, but there has been very little publicity of the ?90 million

:19:20.:19:23.

that is going to be made available through the government's pharmacy

:19:24.:19:27.

access fund. Perhaps, my honourable friend made use for winding up

:19:28.:19:30.

speech to give us slightly more information about all of this, and

:19:31.:19:34.

explain how the Department of Health is going to provide the resources

:19:35.:19:38.

performances to take pressure off GPs by delivering flu jabs,

:19:39.:19:41.

opticians, mental health and obviously smoking stuff as well. A

:19:42.:19:47.

nationwide minor ailment facility. If she cannot do that now, perhaps

:19:48.:19:51.

she might like to write to me about it. Mr Deputy Speaker, Plymouth

:19:52.:19:54.

putt-mac health services under real pressure. We do not have --

:19:55.:20:00.

Plymouth's health services are under real pressure. Part of the

:20:01.:20:03.

constituency are very deprived and we need to do something about those

:20:04.:20:07.

living your life expectancy difference. The government must make

:20:08.:20:11.

sure that resources follow health needs. Finally, we need to make much

:20:12.:20:16.

more use of pharmacies, as my honourable friend the Minister

:20:17.:20:19.

knows, I am the government's pharmacy champion so what are going

:20:20.:20:22.

to do to make sure that pharmacy have the funding and how they will

:20:23.:20:26.

be able to operate as well? Thank you. Thank you, Mr Deputy Speaker,

:20:27.:20:32.

for calling me to speak on this very important debate, one which in my

:20:33.:20:37.

opinion is overdue. May I place on record my thanks to the Chair of the

:20:38.:20:41.

Health Select Committee, the Member for Totnes, and also my thanks to

:20:42.:20:44.

the backbench business committee for allowing the time. Today, I wish to

:20:45.:20:49.

focus my remarks on one particular area of health inequality, an area

:20:50.:20:53.

which receives disproportionately less funding than most others, and

:20:54.:20:58.

sadly receives far less attention from government ministers than

:20:59.:21:01.

Israeli due. The area I am of course talking about is dental and oral

:21:02.:21:07.

health inequality. -- ban is really cheap. You ask most people to

:21:08.:21:14.

describe what health inequality in this country look like, the name a

:21:15.:21:18.

long waiting lists for common ailments, difficulties in GPs and

:21:19.:21:21.

the rationing of licensed drugs from those suffering from treatable

:21:22.:21:25.

diseases. I could of course go on. But most, Mr Deputy Speaker, would

:21:26.:21:28.

not immediately name dental and oral health. But inequality in dental and

:21:29.:21:34.

oral health is just as widespread across this country as in many other

:21:35.:21:39.

important inequalities violated, quite rightly, in today's debate. --

:21:40.:21:46.

inequality is highlighted. Let me share with the House some unfit

:21:47.:21:51.

figures which have caused me more than a few sleepless nights.

:21:52.:21:55.

Official figures revealed that five-year-old children in Bradford

:21:56.:22:00.

are 4.5 times more likely to suffer from tooth decay than their peers in

:22:01.:22:04.

the right honourable member for South West Surrey, the Health

:22:05.:22:10.

Secretary's constituency. The number of women, children admitted to

:22:11.:22:13.

hospital for truth extraction usually requiring a general

:22:14.:22:16.

anaesthetic has gone up by one quarter over the last four years. --

:22:17.:22:22.

tooth extraction. 667 children spent time in hospital for this entirely

:22:23.:22:25.

avoidable reason within Bradford alone, just in the last year. I

:22:26.:22:32.

certainly will. Thank you. As somebody born in Bradford, and I can

:22:33.:22:37.

barely proudly say I have only got one filling in my teeth at my age,

:22:38.:22:43.

it is also, as with obesity, partly due to parental responsibility as

:22:44.:22:51.

well as environmental factors. That is an interesting point and I will

:22:52.:22:54.

come onto some of those issues later on during my speech. And according

:22:55.:23:00.

to the latest figures, almost one third, that is 32%, of children in

:23:01.:23:03.

Bradford have not seen a dentist for more than two years and as the House

:23:04.:23:07.

will be aware, ideally they should attend for a checkup every six

:23:08.:23:14.

months. Dental and oral health continues to be the Cinderella of

:23:15.:23:19.

health provision, something nice still have, something to be tackled

:23:20.:23:22.

after the good ship NHS returns to calmer waters, only due to

:23:23.:23:28.

much-needed extra finances once the financial black holes elsewhere in

:23:29.:23:30.

the NHS have been plugged. Such inequality in dental and oral health

:23:31.:23:34.

is plain wrong. An unspoken injustice intraday's society, and

:23:35.:23:39.

tackling it cannot and should not be your after you're kicked down the

:23:40.:23:44.

road like the proverbial can. Tooth decay, Mr Deputy Speaker, is an

:23:45.:23:49.

almost entirely preventable disease. It is a scandal, without

:23:50.:23:51.

exaggeration, that the number one reason for children between the ages

:23:52.:23:55.

of five and nine being admitted to hospital is tooth decay. It is a

:23:56.:23:59.

scandal, Mr Deputy Speaker, not only because it causes children needless

:24:00.:24:04.

pain and suffering, but in this final posterity, it wastes countless

:24:05.:24:09.

millions in NHS resources but its impact goes much deeper than this.

:24:10.:24:14.

-- this year posterity. In an increasingly competitive and

:24:15.:24:18.

globalised world, with the need for children to exceed in school,

:24:19.:24:24.

improve their skills and excel in internationally benchmark exams,

:24:25.:24:27.

Oliver children need to be healthy and energised to face the school

:24:28.:24:33.

day. Too often, tooth pain arising from poor oral and dental health

:24:34.:24:37.

hinders their school readiness, and peers there and broadband cripple

:24:38.:24:41.

the development the ability to thrive, and socialise with each

:24:42.:24:45.

other. A recent survey confirmed that more than one quarter of our

:24:46.:24:47.

young people feel too embarrassed to smile or laugh due to the condition

:24:48.:24:52.

of their teeth. For our teenagers, this injustice is no less, Mr Deputy

:24:53.:24:57.

Speaker. More than ever, being ready to succeed and get on and make your

:24:58.:25:02.

way any competitive job market... Thank you for reading this, and I

:25:03.:25:07.

know that in my constituency I can tell someone's poverty by the state

:25:08.:25:10.

of their teeth. Not only is it the decay issue, but it is not having

:25:11.:25:14.

the money to have the necessary treatment, perhaps cosmetically, so

:25:15.:25:18.

that the issues that she described about embarrassment and confidence

:25:19.:25:23.

also kick in. I thank my honourable friend for that very valid and

:25:24.:25:28.

important point. But disproportionate levels of poor oral

:25:29.:25:31.

and dental health predominantly in deprived low-income areas, such as

:25:32.:25:34.

those found in Bradford, hampers these young people from forging

:25:35.:25:38.

their careers. Survey after survey confirms that young people who

:25:39.:25:43.

suffer from poor oral and dental health these poor job prospects.

:25:44.:25:47.

Dental and oral health plays, rightly or wrongly, an important

:25:48.:25:53.

part in selling yourself intraday's competitive job market. Now, Mr

:25:54.:25:56.

Deputy Speaker, I have said the depressing skill of the challenge,

:25:57.:26:00.

but the question it begs is what we do? Or, perhaps more accurately,

:26:01.:26:04.

what can and should the government do to tackle this scandal is health

:26:05.:26:08.

inequality? As I highlighted to the former Prime Minister, Mr Cameron,

:26:09.:26:12.

when I challenged him about this inequality in my constituency and

:26:13.:26:15.

city, there are some simple step that can be taken. The first is due

:26:16.:26:21.

to be implemented in the foreseeable future, that is tax on sugary

:26:22.:26:25.

drinks. Although, the government's final proposal was very much weaker

:26:26.:26:29.

than it should have been in my view, it was nevertheless a much welcomed

:26:30.:26:32.

step in the right direction. The Royal College of Surgeons' faculty

:26:33.:26:38.

of dental surgery, a professional body which sees these problems

:26:39.:26:42.

first-hand in its day-to-day work, suggests a number of low-cost,

:26:43.:26:45.

easily deliverable measures which could readily be adopted by

:26:46.:26:50.

government. Tighter restrictions on advertising high sugar products on

:26:51.:26:54.

television, such as restricting advertising and before the name PM

:26:55.:26:59.

watershed. Limiting price promotions and supermarkets for high sugar food

:27:00.:27:01.

and drinks and excluding these products from point locations, like

:27:02.:27:08.

a checkout and counters. Most sensibly, limiting the availability

:27:09.:27:11.

of high sugar food and drinks in our school system. But perhaps the most

:27:12.:27:16.

important measure this Government could take is highlighted by the

:27:17.:27:20.

British dental Association, to Expedia changes to the current

:27:21.:27:24.

dental contract. Critical changes are long overdue. The first would be

:27:25.:27:28.

to incentivise preventive work through the contract. The second and

:27:29.:27:33.

most important would be to incentivise the dental profession to

:27:34.:27:37.

establish new practices in deprived areas, areas which are so

:27:38.:27:42.

desperately need them. They typically faced the least

:27:43.:27:47.

availability. In my constituency, despite need being so high, there is

:27:48.:27:51.

a simple shortfall of NHS dentist appointments. Very few NHS dentists

:27:52.:27:56.

have open lists, meaning most in search of dental treatment simply

:27:57.:27:59.

give up and most who are determined to end up finding one outside of the

:28:00.:28:02.

city boundaries. That surely is not right. I understand the government

:28:03.:28:07.

hopes to initially begin rolling out a reformed dental contract in 2018

:28:08.:28:14.

to 2019 onwards. But this is simply not fast enough. In closing, I

:28:15.:28:19.

finish by asking a simple question. Is it just and equitable that a

:28:20.:28:23.

five-year-old child within Bradford, my home city, is 4.5 times more

:28:24.:28:29.

likely to suffer from tooth decay than their peers in the right

:28:30.:28:32.

honourable member for South West Surrey, the Health Secretary's

:28:33.:28:37.

constituency? I hope the House would agree with me that the answer is no.

:28:38.:28:44.

Thank you. Rebecca. Thank you, Mr Deputy Speaker. I am very pleased to

:28:45.:28:48.

follow the honourable member from Bradford, who gives a somewhat

:28:49.:28:51.

shocking account of oral and dental health. I am also very dilated to

:28:52.:28:59.

follow -- delighted to follow, and I come into the honourable member for

:29:00.:29:03.

Totnes, for raising this issue and ably piloting in her speech the

:29:04.:29:05.

impacts and causes of this health inequality. But I would like to

:29:06.:29:10.

focus on an area which my honourable friend has not mentioned yet, and I

:29:11.:29:16.

wanted to bring it to the Minister's attention. I particularly want to

:29:17.:29:20.

talk about natural and green solutions to helping reduce and

:29:21.:29:27.

prevent this greater disparity in inequality in health outcomes. I am

:29:28.:29:31.

not suggesting that some of the things I am going to talk about are

:29:32.:29:35.

the only solutions, but I do really believe that our natural environment

:29:36.:29:39.

has a very important and often underestimated role to play in

:29:40.:29:45.

improving our health and well-being. We know that health inequality can

:29:46.:29:51.

cost up to ?70 billion per year, with those below the wealthiest

:29:52.:29:55.

levels of society suffering the greatest degrees of inequality, and

:29:56.:29:59.

many of our colleagues have expanded on that today. I have a particularly

:30:00.:30:04.

deprived part of my constituency, it is called Falcon and is in the 4%

:30:05.:30:07.

most deprived parts of the country. That is in Taunton Deane. Many of

:30:08.:30:10.

the things mentioned today apply there as well.

:30:11.:30:19.

People in these areas are ten years less likely to live in the

:30:20.:30:27.

mysterious. -- people in deprived areas. So this would seem to me that

:30:28.:30:34.

it is more than a coincidence, there must be a link. There is clearly

:30:35.:30:38.

search to show disadvantaged people with greater access to green spaces

:30:39.:30:45.

are likely to have better health outcomes. A good natural and built

:30:46.:30:52.

environment can have a positive impact on mental and physical

:30:53.:30:56.

health. It is not just the impact, it is actually the most cost

:30:57.:31:01.

effective to talk about what I'm going to mention, which always makes

:31:02.:31:06.

the Minister's eyes light up, if there can be cost savings. Many

:31:07.:31:09.

people are beginning to realise this important link between health and

:31:10.:31:14.

well-being and the natural environment. I am very heartened

:31:15.:31:18.

that many service providers are already starting to think about this

:31:19.:31:22.

and put people in place to deal with it. The Somerset wildlife trust, for

:31:23.:31:28.

example, of which I am proud to be president, they appointed a health

:31:29.:31:34.

and well-being manager, which are truly heartening. I will watch with

:31:35.:31:37.

interest about the role played and what they will do to highlight the

:31:38.:31:46.

issue. I am going to turn to mental health quickly. The natural world

:31:47.:31:50.

can have a really positive impact on mental health. I am a firm believer

:31:51.:31:56.

of the therapeutic power in a brisk walk in the beautiful Somerset may

:31:57.:32:03.

be Cheshire countryside. How about a wonderful walk for restoring the

:32:04.:32:09.

spirits... I will give way. Does she agree that one of the great problems

:32:10.:32:14.

about mental health if it has been a Cinderella part of the health

:32:15.:32:25.

service for too long? It has, it is one of the Cinderella subjects. And

:32:26.:32:30.

the things I'm talking about, they are free, I am giving free therapy

:32:31.:32:34.

because nature is free. It is such a beautiful thing and it really does

:32:35.:32:38.

have power. What could be more relaxing than a walk by the

:32:39.:32:45.

Wellington Monument in my constituency on the hills, and I

:32:46.:32:48.

know hundreds of thousands of people got what they are, and lots of

:32:49.:32:50.

people with disabilities go up because it is easy to get to and it

:32:51.:32:57.

is flat. It beneficial, and I'm going to add that the Wellington

:32:58.:33:01.

Monument raised my spirits yesterday, or the government did,

:33:02.:33:06.

because they had just given as ?1 million for a restoration project,

:33:07.:33:12.

and there will be loads of spin offs to the public and health and

:33:13.:33:15.

well-being will be part of it because we will build a big

:33:16.:33:17.

community project around at encouraging more people to go up

:33:18.:33:21.

there. When I was looking for somewhere to live in London because

:33:22.:33:24.

obviously I have to stay here in the week, one of the criterion I had to

:33:25.:33:34.

include in when I had to stay was that I had to see a tree from my

:33:35.:33:40.

window, and I can. I could not live without one. Can I congratulate her

:33:41.:33:48.

on the points she is making. There is data to back up what she's

:33:49.:33:54.

saying. Public England estimate that an inactive person is likely to

:33:55.:34:00.

spend 37% more time in hospital than someone who is active, and active

:34:01.:34:10.

people are 5.5% -- people who are inactive at 5.5% more likely to be

:34:11.:34:13.

visiting doctors. Bid is good evidence behind this. Thank you for

:34:14.:34:19.

that. I will give a few more statistics as I go through this

:34:20.:34:24.

because I am not making this up. This is coming into our psyche. I

:34:25.:34:29.

will give way. Can I encourage her, when she's here in London, to a boat

:34:30.:34:34.

from Chelsea Harbour down to Greenwich, where you will see the

:34:35.:34:41.

magnificent layout of a number trees occurring in the West, but there are

:34:42.:34:45.

fewer of them than in the East of London. We do not need a forestry

:34:46.:34:55.

debate! I think we want to get back to health. I went out on a boat this

:34:56.:35:03.

morning, with Greenpeace, it was up the Thames, to look at Micro

:35:04.:35:08.

plastics in water. And we did see some trees as well. And they do

:35:09.:35:16.

serve a very good purposeful stop trees are important for taking in

:35:17.:35:20.

air pollution, which -- the server very good purpose. They take in air

:35:21.:35:30.

pollution, which is also very helpful. Mental health can be helped

:35:31.:35:36.

with being in contact with nature, and as a keen gardener I can

:35:37.:35:39.

absolutely vouch that getting your hands in the earth, planting seeds,

:35:40.:35:44.

watching seasons change, definitely lifts the spirits and is a pick-up.

:35:45.:35:55.

Give way. She makes a good point, it is not just about brisk walks to

:35:56.:36:00.

help health. Last Friday I was helping some young children at a

:36:01.:36:06.

junior school plant bulbs in their school grounds. The exercise we were

:36:07.:36:13.

getting and being out on fresh air, and that is in a built-up area,

:36:14.:36:15.

periurban, which must be a good thing for their health for the

:36:16.:36:22.

future. She is absolutely right. I know that many schools have

:36:23.:36:25.

gardening bits, and it is so much to be had from it in every respect. It

:36:26.:36:31.

can help unemployed groups and all sorts of different groups. Physical

:36:32.:36:38.

activity, but also watching things growing is very beneficial. The

:36:39.:36:41.

Royal horticultural Society have done research to show 90% of UK

:36:42.:36:46.

adults say that just looking at a garden make them feel better. Doing

:36:47.:36:55.

something in it is better, but there was recent data about watching birds

:36:56.:36:59.

on a bird table. And hedgehogs. If you got the chance to watch a

:37:00.:37:02.

hedgehog that would make you incredibly happy because they are

:37:03.:37:07.

still rare. I got excited when I saw one eating my cat food recently. I

:37:08.:37:15.

will give way. I do not want to rain on her garden but would she agree

:37:16.:37:19.

that there is also a negative impact of the surroundings -- if the

:37:20.:37:25.

surroundings are not as good. 30% of people in Glasgow live beside vacant

:37:26.:37:34.

land, which can have a negative effect. Yes, and we need to do

:37:35.:37:38.

something with the community, and the Woodland Trust have some great

:37:39.:37:44.

data, that if you live 500 metres from woodland, their health is

:37:45.:37:46.

better because they are going into it but they are also looking at it,

:37:47.:37:52.

they are enjoying it. And mental health charity has a report called

:37:53.:37:59.

feel better outside, feel better inside, and they are advocating the

:38:00.:38:05.

benefits of eco-therapy, which is really what I am talking about,

:38:06.:38:08.

mental and physical well-being, and boosting skills and confidence to

:38:09.:38:13.

get them back to work by doing things like gardening, farming,

:38:14.:38:23.

growing food, exercise, conservation work. And 69% of people who took

:38:24.:38:30.

part definitely saw an increase in their mental well-being, and 62% of

:38:31.:38:32.

them thought the overall health improved. These projects help 250

:38:33.:38:40.

word people afterwards to find full-time work, and that saved the

:38:41.:38:46.

nation money. In my constituency we have an agency called prospects,

:38:47.:38:52.

which has a contract to help get the long run one -- long-term unemployed

:38:53.:39:00.

get into employment. I've been out with them into an ancient woodland,

:39:01.:39:04.

and it definitely helps not just engage with nature, but it gives

:39:05.:39:07.

them confidence because they are speaking to each other, they are

:39:08.:39:13.

atmosphere, and very many of those people are then able to have the

:39:14.:39:16.

confidence to apply for jobs and get back to work. So it seems to me that

:39:17.:39:21.

there is a very clear case for prescribing access to green space in

:39:22.:39:26.

our armoury of traditional medicines to deal with the range of mental

:39:27.:39:32.

health. Then there is physical health, the great outdoors is a

:39:33.:39:37.

vastly underutilised tool in the wider sense, and many of my

:39:38.:39:43.

colleagues have been talking about obesity, and the outdoors can play a

:39:44.:39:46.

very important part in tackling our fight against obesity. Currently

:39:47.:39:52.

obesity costs ?16 billion to the government, particularly childhood

:39:53.:39:57.

obesity, which has been referred to, and those living in deprived areas

:39:58.:40:02.

are twice as likely to be obese. So with this in mind, I would really

:40:03.:40:10.

advocate some consideration being given to crime prescriptions. The

:40:11.:40:12.

local Government Association has recently called on the UK to

:40:13.:40:17.

implement a similar model to that used in New Zealand, and eight out

:40:18.:40:21.

of ten GPs in New Zealand have been issuing these crime prescriptions to

:40:22.:40:27.

patients. 72% have noticed a change in their health. So the Local

:40:28.:40:30.

Government Association is encouraging GPs to try to ) moderate

:40:31.:40:37.

physical activity goals for their patients, including things like

:40:38.:40:39.

walks in the park, family classes walks in the park, family classes

:40:40.:40:47.

they can go to, and a number of GPs are already using the schemes. One

:40:48.:40:53.

of the pilots is encouraging them to visit the National Parks, which are

:40:54.:40:56.

obviously beautiful and on their doorstep, and free to go into. So I

:40:57.:41:01.

recommend all of these things. The chairman of the Local Government

:41:02.:41:04.

Association health and well-being board said that by writing a

:41:05.:41:10.

prescription like this, it would encourage so many more people to get

:41:11.:41:16.

out, the doctor says you must do this, because often if the doctor

:41:17.:41:20.

says you must take this tablet, you take it. If the doctor says you must

:41:21.:41:24.

go out and walk, I think potentially you might do it. Anyway, to

:41:25.:41:31.

conclude, there are a great many initiatives taking place, such as

:41:32.:41:37.

NHS Forest, aiming to improve recovery time of patients and staff

:41:38.:41:41.

by increasing access to NHS Gardens, in other words the locations on the

:41:42.:41:47.

doorsteps of hospitals, and part of the health and social care act 2012

:41:48.:41:51.

there was a statutory duty placed on local authorities to create health

:41:52.:41:55.

and well-being boards, however the health select committee has reported

:41:56.:41:59.

that they find these were not working very successfully. They had

:42:00.:42:03.

few powers. Perhaps this is something the Minister could

:42:04.:42:06.

consider looking at as I believe they could really start to make a

:42:07.:42:09.

big difference in moving this agenda forward. And there was the proposed

:42:10.:42:15.

2015 nature and well-being act that was much discussed and debated,

:42:16.:42:20.

which wanted to put nature at the heart of all the decisions we make

:42:21.:42:27.

about health, education, the economy, flood resilience, and

:42:28.:42:30.

perhaps we could look again at some of the ideas in there because there

:42:31.:42:38.

are very good ideas. So we know that there are links between the access

:42:39.:42:43.

to green space, and health, and it seems a no-brainer to me that if we

:42:44.:42:47.

could improve access to green space and look into the idea of

:42:48.:42:51.

prescribing these treatments, we could make a difference to help and

:42:52.:42:56.

inequalities within health. It would be much easier if we had all the

:42:57.:42:59.

data, if we could prove these benefits with the data, and help is

:43:00.:43:03.

at hand because the wildlife trust have commissioned a piece of work,

:43:04.:43:10.

the School of biological sciences at the University of Essex, to gather

:43:11.:43:15.

just this data, and I think once we have got some solid facts we can

:43:16.:43:21.

move forward. So I would really like to think that you will consider some

:43:22.:43:27.

of these ideas, and when the Cabinet Minister for health and equality is

:43:28.:43:30.

put in place, as was recommended by my honourable friend, or even the

:43:31.:43:36.

Prime Minister, as recommended by the honourable friend from

:43:37.:43:38.

Kingston-upon-Hull, when they have these in place, perhaps my green

:43:39.:43:43.

points could be added to the agenda and we could move forward to a

:43:44.:43:52.

healthier society. Thank you, Mr Deputy Speaker. It is a pleasure to

:43:53.:43:56.

follow the honourable member, and I think she makes some very

:43:57.:44:00.

interesting points. The intervention from my neighbour, the honourable

:44:01.:44:03.

member for Glasgow Central was pertinent about the landscape in

:44:04.:44:08.

Glasgow. I would like to begin by commending the honourable member,

:44:09.:44:11.

who is campaigning efforts in health matters coupled with her ability to

:44:12.:44:15.

challenge her own government is second to none. I thank her for

:44:16.:44:20.

securing this debate and the backbench business committee for

:44:21.:44:22.

allowing the time to take place today. It is clear that we are

:44:23.:44:29.

united as a House and want to eradicate health and equality --

:44:30.:44:32.

inequality, but it is how we work together to achieve this. The

:44:33.:44:37.

honourable member referred to the Prime Minister using her first

:44:38.:44:41.

speech to proclaim her government would fight the burning injustice

:44:42.:44:45.

that plague society, and I believe it is fair to say that most burning

:44:46.:44:51.

injustices lead back to health inequality. Inequalities in health

:44:52.:44:54.

are underpinned by greater societal inequalities, the conditions in

:44:55.:45:00.

which we were conceived, born, grow up, live in, work in and grow old

:45:01.:45:04.

in, have an immense impact on our lives. Essentially we're

:45:05.:45:14.

Whilst they are on they are certainly not unavoidable. Many

:45:15.:45:21.

constituents will needlessly die each and every year as a result of

:45:22.:45:24.

these gross inequalities. This, wherever it occurs, the human and

:45:25.:45:29.

moral tragedy that shames us all. During this debate, the Right

:45:30.:45:32.

Honourable and honourable members from across these islands will quite

:45:33.:45:36.

rightly speak about their constituent nations, regions, local

:45:37.:45:40.

constituencies and the particular competencies. England will be a key

:45:41.:45:44.

focus. However, I would like to compliment this debate by talking

:45:45.:45:48.

specifically about Scotland, Glasgow and my constituency of Glasgow East.

:45:49.:45:55.

Despite vast progress in life expectancy in Scotland over the past

:45:56.:45:59.

150 years, are life expectancy remains law and are average

:46:00.:46:03.

mortality rate remains higher than our neighbours across the UK and

:46:04.:46:08.

throughout Europe. The poor health status of Scotland and our largest

:46:09.:46:11.

city Glasgow are well-documented, and much of this is explained by the

:46:12.:46:17.

experiences of deindustrialisation, deprivation and poverty. However,

:46:18.:46:20.

there is no greater levels of mortality that cannot be explained

:46:21.:46:25.

by deprivation, known as excess mortality. For example, premature

:46:26.:46:31.

mortality rates are 20% higher in Scotland than in England and Wales,

:46:32.:46:36.

even after deprivation is accounted for, and premature mortality rates

:46:37.:46:40.

in Glasgow is 30% higher than it in equally deprived areas like

:46:41.:46:44.

Liverpool and Manchester. The former has been dubbed the Scottish effect,

:46:45.:46:51.

the latter the Glasgow effect. All that counts for approximately 5000

:46:52.:46:55.

extra, unexplained deaths per year in Scotland. That is 5000 people

:46:56.:46:59.

dying prematurely, dying needlessly, over and above normal inequalities

:47:00.:47:05.

in health. Traditionally, the cause of this has not been entirely

:47:06.:47:09.

understood. Research suggests that the combination of change in

:47:10.:47:15.

political power, increasing income inequalities, disempowerment and

:47:16.:47:18.

deindustrialisation. The last one of which has impacted on people in many

:47:19.:47:22.

ways, such as through unhealthy behaviours, psychosocial stress and

:47:23.:47:27.

of course poverty. Indeed, in May of this year, the Glasgow Centre for

:47:28.:47:32.

population and health, NHS Scotland and the University of the West of

:47:33.:47:35.

Scotland and University College London produced a report entitled

:47:36.:47:42.

History, Politics, Explaining The Excess Mortality In Glasgow And

:47:43.:47:45.

Scotland, which confirmed deaths. The report was signed by over 30

:47:46.:47:49.

academics and health professionals and found that the city of Glasgow's

:47:50.:47:54.

population was more vulnerable to factors which impacted on health

:47:55.:47:58.

across the UK, such as poverty, deprivation, deindustrialisation and

:47:59.:48:02.

economic decisions taken by the UK Government which have led to the

:48:03.:48:07.

population having poor health outcomes. Such vulnerabilities arose

:48:08.:48:11.

from notoriously high levels of deprivation over a sustained period

:48:12.:48:15.

of time. Urban planning decisions in the post-war period, such as the

:48:16.:48:21.

creation of monolithic, poor quality peripheral housing estates, the

:48:22.:48:24.

regional economic policies of the UK Government and its Scottish office,

:48:25.:48:28.

and local government responses to UK Government policies in the 1980s.

:48:29.:48:33.

Again, where there are social economic inequalities, there are

:48:34.:48:36.

health inequalities. These inequalities are not a mistake and

:48:37.:48:47.

are not an accident, they are not inevitable and are not irreversible.

:48:48.:48:49.

Income inequalities were relatively narrow in the UK until the late

:48:50.:48:52.

1970s, and health inequalities declined dramatically. However,

:48:53.:48:54.

income and wealth inequalities soared again during the 1980s, and

:48:55.:49:00.

the 1990s, and likewise so that health inequalities. Again, this did

:49:01.:49:03.

not happen by accident, nor did it happen in countries all across the

:49:04.:49:07.

world. It happened in countries like the UK that made conscious decisions

:49:08.:49:14.

to rollback state to minimal level possible, to slash public

:49:15.:49:16.

expenditure like it was going out of fashion, to reconstruct the tax and

:49:17.:49:22.

welfare system to be less redistributive and to champion the

:49:23.:49:28.

wants of business and the financial at the expense of Leeds and workers

:49:29.:49:31.

and their trade unions. It was an ideological driven Conservative

:49:32.:49:35.

Government, hell bent on pursuing a neoliberal agenda at any cost, what

:49:36.:49:40.

may stop Mr Speaker, my apologies, Madame Deputy Speaker! To break

:49:41.:49:45.

somewhat from the conciliatory tone, there were worrying signs that this

:49:46.:49:49.

would be mirrored by the previous government, but we do have a new

:49:50.:49:52.

Prime Minister and she has offered encouraging words about her

:49:53.:49:57.

government's indenture despite injustice but what she does matter

:49:58.:50:01.

is what she says -- matters more than what she says. Hopefullytoday's

:50:02.:50:11.

debate is a starting point. Measures would utilise taxation, legislation,

:50:12.:50:14.

regulation and changes in the broader distribution of income and

:50:15.:50:19.

power could help. As Michael Aamodt, Chair of them Marmont review, said

:50:20.:50:24.

in 2010, "Are simply restoring economic growth, trying to return to

:50:25.:50:29.

the status quo, while cutting public expenditure should not be an option.

:50:30.:50:33.

Economic growth without reducing relative inequality will not reduce

:50:34.:50:38.

health inequalities." The government must acknowledge that health

:50:39.:50:42.

inequalities cannot be solved with health solutions alone, they are

:50:43.:50:47.

rooted in poverty and income inequality, as well as across all

:50:48.:50:49.

areas of government policy. Solutions from the Department of

:50:50.:50:54.

Health, or the NHS, will not suffice, as outlined by the right

:50:55.:51:00.

honourable member for Kingston upon Hull. Therefore, the government

:51:01.:51:04.

should commit to a joined up, evidence -based approach of cross

:51:05.:51:07.

departmental working with a specific minister form the Cabinet office

:51:08.:51:11.

given the specific responsibility for embedding health as a priority

:51:12.:51:16.

in all government policy. Madame Deputy Speaker, inequalities in

:51:17.:51:20.

health are a matter of life and death, of health and sickness, of

:51:21.:51:24.

well-being and misery. They represent misery on the greatest

:51:25.:51:28.

skill and marginal. If the government is looking to fight

:51:29.:51:34.

injustice, this is it. The only question is, are they up to the job

:51:35.:51:40.

and are willing to do it? Fiona Bruce. Thank you. On the doorstep of

:51:41.:51:46.

Number Ten, our Prime Minister taking up our leadership mantle even

:51:47.:51:50.

inspirational social justice beach, aimed at ensuring there is a

:51:51.:51:55.

reduction in health inequalities, including addressing the stark

:51:56.:51:58.

realities of mental health challenges that so many families in

:51:59.:52:01.

our communities live with daily. I want to speak about this, about the

:52:02.:52:05.

importance of healthy early relationships in life, even

:52:06.:52:09.

beginning before birth, of the mental health challenges that this

:52:10.:52:16.

can involve, and then lastly just to conclude with a reference to alcohol

:52:17.:52:26.

harm, with my hat on as the Chair of the Parliamentary group on that.

:52:27.:52:28.

Building healthy relationships beginning before birth and

:52:29.:52:31.

establishing these as building blocks within our family and

:52:32.:52:34.

community life in our earliest years are absolutely key for the

:52:35.:52:39.

prevention and reduction of mental health problems in childhood and the

:52:40.:52:47.

road later life. This sites in the womb, I thought I would just -- this

:52:48.:52:51.

starts in the womb. I thought I would commence by stating the early

:52:52.:52:54.

life key facts, from the early lives of children here in the UK today.

:52:55.:52:59.

Depression and anxiety affect 10-15 out of every 100 pregnant women.

:53:00.:53:04.

Over one third of domestic violence begins in pregnancy. 1 million

:53:05.:53:11.

children in the UK suffer from the type of problems, including ADHD,

:53:12.:53:15.

conduct disorder, emotional problems and vulnerability to chronic

:53:16.:53:17.

illness, which are increased by antenatal depression, anxiety and

:53:18.:53:25.

stress. The UK is the world's worst for breast-feeding. 50% of

:53:26.:53:30.

the-year-olds experience family breakdown. 15700 0-2 -year-olds live

:53:31.:53:44.

in families classed as homeless. By addressing some of these, beginning

:53:45.:53:51.

even before birth, we could help exponentially, particularly in terms

:53:52.:53:54.

of not just the physical but also the mental health of so many of our

:53:55.:53:58.

young people today. That helped lift their whole lives. We need to

:53:59.:54:05.

support our youngest, so that we can increase their life chances and

:54:06.:54:08.

reduce health inequalities that get in the way of them achieving their

:54:09.:54:14.

full potential. Points on the compass of scientific advancement

:54:15.:54:16.

are increasingly showing that the direction of travel for social

:54:17.:54:20.

determinants of health significantly pointed towards experiences of bomb,

:54:21.:54:28.

birth and beyond. Marmont's society healthy life report, referred to by

:54:29.:54:31.

the previous number, published as long ago as debris 2010, offered its

:54:32.:54:36.

top policy recommendation as giving every child the best start in life.

:54:37.:54:41.

The 1001 critical base manifesto, the UK's only children's manifesto

:54:42.:54:45.

which has the support of eight political parties, was launched just

:54:46.:54:49.

two years ago in response to this report. A child's development is of

:54:50.:54:58.

course mainly influenced initially by the primary caregiver, usually

:54:59.:55:00.

their mother, but often their father. And also by others who are

:55:01.:55:07.

engaged in helping with parenting of that child. Parenting begins before

:55:08.:55:12.

birth. We have known for a long time that how we turn out depends both on

:55:13.:55:16.

our genes and our environment. What scientists now realise is that the

:55:17.:55:20.

influence of the environment begins in the womb and how the mother feels

:55:21.:55:24.

during her pregnancy can change this environment and have a lasting

:55:25.:55:27.

effect on the development of a child. So, we all need to support

:55:28.:55:32.

and look after pregnant women, both for the sake and for the sake of

:55:33.:55:35.

future generations. A stable and secure home learning environment is

:55:36.:55:41.

critical in those early months. Children, right from their infancy,

:55:42.:55:43.

need to be protected and nourished and stimulated, to think and

:55:44.:55:48.

explore, to communicate and interact with their parents and others.

:55:49.:55:53.

Babies are primed to be in relationships and their earliest

:55:54.:55:58.

relationships really matter for the ABC, one to the building blocks

:55:59.:56:04.

which lead to school readiness. It is in those earliest relationships

:56:05.:56:09.

that we are influenced. That a young child's social brain develops, which

:56:10.:56:13.

will influence their later life. 80% of our brain significantly developed

:56:14.:56:16.

in those earliest years and through our earliest relationships. The

:56:17.:56:22.

reason I am focusing on this is because this assures that healthy

:56:23.:56:27.

relationships really matter. They matter for our health and well-being

:56:28.:56:33.

throughout life. Give way? Thank you for giving way. I know that we are

:56:34.:56:36.

trying to make this a non-partisan debate, but does she actually

:56:37.:56:41.

recognise that all the things she is talking about actually require

:56:42.:56:44.

resources and some of our most needy communities have seen a loss of

:56:45.:56:48.

those resources in recent times? We need to do something to redress

:56:49.:56:52.

that. Thank you for that intervention. We need to focus on

:56:53.:56:55.

the fact that learning about and enjoying healthy relationships is a

:56:56.:57:02.

key determinant of future physical and mental health. In the UK,

:57:03.:57:07.

between 1.3 and 2.5 million years of lives are lost as a result of health

:57:08.:57:12.

inequality in England. Many children never reach their potential

:57:13.:57:16.

throughout their lives, and one of the reasons is because of a lack of

:57:17.:57:20.

healthy relationships in your early years. Relationship breakdown is a

:57:21.:57:27.

significant driver of poverty and health inequality. A comprehensive,

:57:28.:57:31.

cross departmental strategy to combat health inequality must

:57:32.:57:35.

include measures to strengthen healthy relationships and to combat

:57:36.:57:43.

relationship breakdown, which is at epidemic levels in our country I am

:57:44.:57:49.

a Chair of a mental health charity for children in my constituency. I

:57:50.:57:59.

asked the CEO how many of the children that they help, how many of

:58:00.:58:04.

the problems are as a result of poor form relationships, poor early

:58:05.:58:10.

relationships. I should mention that this charity's overwhelmed by

:58:11.:58:15.

requests from children, on the half of children, children as young as

:58:16.:58:18.

four years old. Lucille looked at me and said," virtually all of them."

:58:19.:58:25.

-- this CEO. It is an absolute critical factor in a child's early

:58:26.:58:29.

development and healthy lives, particularly for mental health. It

:58:30.:58:33.

is interesting that recently a wide-ranging survey by the Marriage

:58:34.:58:37.

Foundation involving thousands of young people was published in May of

:58:38.:58:42.

this year, it found that there was a noticeable difference between the

:58:43.:58:44.

self-esteem levels of children who were brought up in stable households

:58:45.:58:50.

compared with those who did not. The self-esteem influence is a predictor

:58:51.:58:57.

of a range of real-world consequences in later life. When

:58:58.:59:01.

relationships break down, they do break in all social economic groups,

:59:02.:59:05.

but when they do break down, this disproportionately affects children

:59:06.:59:09.

in one come families. Because they are less resilient to combat this.

:59:10.:59:16.

Half of all children in the 20% least advantaged communities in the

:59:17.:59:19.

country now no longer live in a home where they have healthy

:59:20.:59:22.

relationships, now no longer live in a home, for example, where both

:59:23.:59:26.

parents are still with them by the time they start school. I am not

:59:27.:59:30.

saying you cannot have a healthy relationship with one parent or

:59:31.:59:34.

another, but it is important that we grasp this nettle and appreciate

:59:35.:59:40.

that healthy relationships with a range of people, including ideally

:59:41.:59:43.

with a mother and a father, are good predictors of early health. So we

:59:44.:59:49.

should support that and I think government should be brave enough,

:59:50.:59:52.

and the health ministers should be brave enough, to actually tackle

:59:53.:59:57.

this. For too long, ministers have shied away from tackling this arena

:59:58.:00:00.

of looking at healthy relationships and yet we are quite happy about

:00:01.:00:05.

helping people and educating young people about how to build healthy

:00:06.:00:08.

bodies, physical health and life. Relationship breakdown as a root

:00:09.:00:19.

cause of poverty. In a relationship breaks down, households suffered

:00:20.:00:22.

dramatic income reductions, then there is an impact on infant

:00:23.:00:28.

mortality rates, hospital and mittens, and others in poor health.

:00:29.:00:42.

So I agree,... Need to look at how children centres can be extended to

:00:43.:00:48.

family help, creating support for the whole family, something I

:00:49.:00:54.

recommended recently. We need to look at how couple relationship

:00:55.:00:59.

advice, not just parenting advice can be available, at how their is a

:01:00.:01:05.

stronger focus on relationship education in schools in its early

:01:06.:01:12.

lessons, we need to provide a fund so local authorities can share best

:01:13.:01:21.

practice on this issue. -- moral education lessons. We need to tackle

:01:22.:01:24.

the serious challenge of the mental health problems that so many of our

:01:25.:01:30.

children have in school now, that so many headteachers say is a major

:01:31.:01:34.

issue they can grapple with. -- have to grapple with. I would just like

:01:35.:01:40.

to referred to the final part of my speech, to a different area, alcohol

:01:41.:01:51.

harm. I do not think it is entirely went to because when people

:01:52.:01:53.

experience or fall into addiction it is often because they are looking

:01:54.:01:58.

for a source of comfort that is missing because they have not got it

:01:59.:02:04.

through the relationships the experience and why. I am not saying

:02:05.:02:10.

that it is not right to enjoy drinking, but it needs to be healthy

:02:11.:02:16.

drinking. Alcohol is a major issue in our society which I do not

:02:17.:02:18.

believe the government is doing enough to address. To tackle health

:02:19.:02:24.

inequality the government must do more. Let me give you an example.

:02:25.:02:31.

The Chief Medical Officer in January this year published his

:02:32.:02:36.

recommendation that it is wisest for pregnant women not to drink during

:02:37.:02:42.

pregnancy. That is a choice pregnant women are being advised to make, yet

:02:43.:02:51.

there has been inadequate publicity of that recommendation. I speak as

:02:52.:02:59.

someone who is vice chair of the all-party group, we have heard

:03:00.:03:04.

heart-rending evidence of the impact on their physical and mental

:03:05.:03:10.

well-being. What is particularly important is that the evidence we

:03:11.:03:15.

have heard is that women's bodies tolerate alcohol at different

:03:16.:03:18.

levels, which is why the best advice is not to drink at all during

:03:19.:03:23.

pregnancy, but I challenge health ministers particularly in the run-up

:03:24.:03:29.

to Christmas to get this message out so people can hear it and make that

:03:30.:03:32.

choice, because alcohol harm does not just impact on the health of the

:03:33.:03:37.

individual, but those around that individual. One in five children

:03:38.:03:46.

with a parent who drinks has adversely, alcoholism placated in

:03:47.:03:57.

child abuse cases. -- is implicated. It impacts on emergency services,

:03:58.:04:03.

and the all-party group will publish a report on this on the 6th of

:04:04.:04:07.

December, which I am pleased that the honourable member contributed

:04:08.:04:14.

to, so I hope members will take note of that because there is a

:04:15.:04:18.

disproportionate impact that alcohol abuse is having on emergency

:04:19.:04:24.

services but also on the number of accidents in home, the number of

:04:25.:04:30.

accidents in the home, and this will spell that out. Again, a charity has

:04:31.:04:36.

shown that between 2014 and 2015, the rate of alcohol-related

:04:37.:04:44.

admissions in England had -- in the most deprived area was five times

:04:45.:04:58.

higher. I also want to touch on the impact of cheap alcohol. Let me tell

:04:59.:05:02.

you something that will surprise or shock you. It did me when I first

:05:03.:05:07.

heard it. For the cost of a cinema ticket, it is possible to buy almost

:05:08.:05:12.

7.5 litres of high-strength white cider. It contains as much alcohol

:05:13.:05:22.

as 53 shots of vodka. Yet many, many people in a vulnerable state in

:05:23.:05:27.

life, many homeless people, are drinking this product and it has

:05:28.:05:32.

been likened to a death sentence. 78% of the deaths in hostels run by

:05:33.:05:37.

the homeless charity Thames Reach were attributed to this

:05:38.:05:41.

high-strength alcohol. So I urge ministers once again, because this

:05:42.:05:46.

is not for the first time, for the sake of these most vulnerable

:05:47.:05:54.

people, to consider a minimum unit price, which would sides and reduce

:05:55.:06:03.

health inequality considerably. According to the Institute of

:06:04.:06:08.

alcohol studies, it would result in eight out of ten lives being saved.

:06:09.:06:23.

We also need improved alcohol treatment services. They are

:06:24.:06:31.

inadequate. Over half of drug addicts receive treatment, but only

:06:32.:06:37.

a fifth of alcohol dependent people do. Whinny better and more effective

:06:38.:06:45.

alcoholism diagnosis and hospitals, better rehab programmes, and better

:06:46.:06:47.

support the education to help those not fall

:06:48.:07:01.

into the difficulty in the first place. -- we need better. Thank you.

:07:02.:07:10.

It is a pleasure to follow the honourable member for Congleton. I

:07:11.:07:12.

think she has made some very interesting points, and a very

:07:13.:07:14.

convincing argument for introducing compulsory PSE in schools, something

:07:15.:07:17.

the government do in terms of fostering good, healthy

:07:18.:07:19.

relationships, which would go a long way to reducing health inequalities,

:07:20.:07:25.

which is what we're here to debate today. I would like to congratulate

:07:26.:07:31.

the honourable member for Totnes for securing the debate, and also to

:07:32.:07:36.

thank the backbench business committee for recognising the

:07:37.:07:40.

importance of the subject. I was pleased to hear the honourable

:07:41.:07:43.

member for Totnes in her opening remarks referred to drug and alcohol

:07:44.:07:48.

treatment services, as indeed did the honourable member of Congleton.

:07:49.:07:58.

The future of substances treatment is in jeopardy, when so many places

:07:59.:08:07.

are facing cuts, and it really is something we need to be addressing

:08:08.:08:12.

when we are talking about health inequality. And I would like to add

:08:13.:08:16.

to that list, I do not think anyone has mentioned it yet, but the

:08:17.:08:20.

responsibility of local authorities in England to commission sexual

:08:21.:08:23.

health services. Sexually transmitted infections at increasing

:08:24.:08:29.

because of cost efficiency rather than clinical need seems to be the

:08:30.:08:32.

overriding factor in commissioning the services. We do need to ring

:08:33.:08:39.

fence funding around to sexual health services as a matter of

:08:40.:08:44.

urgency. Otherwise we face a serious risk developing to public health.

:08:45.:08:50.

But I want to concentrate in this debate with particular reference to

:08:51.:08:59.

diabetes and diabetic care. And throughout my speech I will make

:09:00.:09:06.

reference to the APPG diabetes report, entitled levelling up,

:09:07.:09:10.

tackling variation in diabetes care, which was launched yesterday, and I

:09:11.:09:14.

would also like to declare an interest as the secretary to that

:09:15.:09:18.

group. It is an excellent report and I would urge anyone with an interest

:09:19.:09:24.

in diabetes care and health in general to get a copy and read it.

:09:25.:09:29.

We took evidence from people with diabetes from health care

:09:30.:09:31.

professionals and when the call commissioning groups, and one theme

:09:32.:09:38.

that came out from people with diabetes was inconsistent quality of

:09:39.:09:43.

care. And I am pleased to say that the government and NHS England have

:09:44.:09:48.

recognised that there is a need for improvement in diabetes services.

:09:49.:09:56.

During the investigation NHS England announced ?40 million funding for

:09:57.:09:59.

diabetes improvement. Diabetes being one of the six clinical priorities

:10:00.:10:05.

in the improvement and assessment framework for clinical commissioning

:10:06.:10:09.

groups, and it is vital that this opportunity to transform diabetic

:10:10.:10:16.

services is taken. Our report identified three key areas that

:10:17.:10:19.

people with diabetes need undeserved. The first one is

:10:20.:10:25.

high-quality consultations with the right health care professionals. The

:10:26.:10:30.

second and support to manage their condition. And the third is access

:10:31.:10:37.

to key technology. On the first point, a big part of how care is

:10:38.:10:44.

perceived by people with diabetes is how they are communicated with by

:10:45.:10:48.

health care professionals. People said to us that sometimes they felt

:10:49.:10:53.

they were being criticised an appointments for not meeting

:10:54.:10:57.

treatment targets and dictated to about how to manage a condition that

:10:58.:11:00.

they had to live with. Our report found that people who had an input

:11:01.:11:04.

into their own care had better treatment outcomes. Consideration of

:11:05.:11:09.

their own lifestyles alongside their diabetes management, as well as an

:11:10.:11:18.

interpretation of NICU guidance to meet their needs Ledford tailored

:11:19.:11:21.

treatment plans and it seems in this that collaboration has far better

:11:22.:11:27.

results than confrontation. People speak to us about difficulty in

:11:28.:11:30.

getting access to specialists with some reporting that services were

:11:31.:11:38.

simply overwhelmed. Others said they had to proactively seek local

:11:39.:11:42.

services to get a referral. But services that were really valued by

:11:43.:11:51.

patients where nurses, dietetics and podiatry. Additionally people

:11:52.:11:56.

affected by diabetes valued the pharmacist, and saw how the role

:11:57.:11:59.

could be significantly expanded to provide greater information and

:12:00.:12:02.

support, something that may well be worth reflecting upon, given the

:12:03.:12:09.

government's recent course to pharmacy services. The next point,

:12:10.:12:15.

giving support to help manage the condition, this showed a huge

:12:16.:12:17.

variation in the information and education given to those with

:12:18.:12:23.

diabetes. Those who attended structured education courses

:12:24.:12:25.

generally reported that they find them valuable and that they helped

:12:26.:12:31.

them better manage their condition. However, there is huge variation in

:12:32.:12:35.

the offer and uptake of these courses, and in my own constituency

:12:36.:12:40.

of Heywood and Middleton, only about 20% of people with diabetes are

:12:41.:12:44.

offered these courses, with the uptake being even less. Clearly this

:12:45.:12:51.

is a health inequality that needs to be addressed. One-off and report a

:12:52.:12:55.

problem for those who worked was getting time off work to attend a

:12:56.:13:01.

five-day intensive course, and for those with children, child care was

:13:02.:13:04.

also reported as a problem. There is a lot of work to be done in

:13:05.:13:09.

persuading employers that they will also reap the benefits of a happier,

:13:10.:13:13.

healthier and more productive employee if they are reasonable

:13:14.:13:21.

about allowing time off. The third point, access to key technologies,

:13:22.:13:25.

serves to emphasise that technology now please a key role in diabetes

:13:26.:13:30.

care, particularly for type one diabetes, but again patients face a

:13:31.:13:38.

postcode lottery to get the help they need. This was given as a major

:13:39.:13:43.

concern for parents of children with diabetes. Many type two diabetics

:13:44.:13:47.

worryingly reported that they had to self fund their own blood glucose

:13:48.:13:53.

meters and test strips, an essential test for self-management of the

:13:54.:13:58.

condition. Some type one diabetics also reported the same thing. Which

:13:59.:14:02.

sounds harsh, as it is a legal requirement that diabetics on

:14:03.:14:05.

insulin must test before driving. And the DVLA now advises people who

:14:06.:14:17.

take the medication that contains hypoglycaemia to test as well.

:14:18.:14:24.

People were denied access to insulin pumps, which can also help diabetics

:14:25.:14:30.

improve their condition and help health outcomes. Sadly inequalities

:14:31.:14:34.

in health outcomes persist because only the better off are able to

:14:35.:14:37.

access devices that make living with diabetes easier. The motion we are

:14:38.:14:44.

discussing calls for support for policies to reduce health

:14:45.:14:48.

inequality, and our report has identified four area as the

:14:49.:14:49.

government should be looking at. The first is care and support

:14:50.:15:01.

planning, the second support management, access to key

:15:02.:15:04.

technologies and a strong, local diabetes system. Variation and

:15:05.:15:09.

inequality in diabetes care shows us that good care can be achieved, but

:15:10.:15:13.

our task and this Government's task is to make it happen everywhere. For

:15:14.:15:17.

best practice to be shared in order to end the postcode lottery in

:15:18.:15:23.

diabetes care and to tackle the diabetes crisis. Thank you, Madam

:15:24.:15:31.

Deputy Speaker. It is a pleasure to follow the honourable lady for he

:15:32.:15:35.

would and Middleton in the very important points that she was

:15:36.:15:46.

making. I would like to the Member for bringing forward this important

:15:47.:15:51.

debate today, and for everybody who has participated in their work in

:15:52.:15:54.

this place today and for highlighting this issue and for the

:15:55.:15:57.

very excellent debate that we have had. This issue is about unequal

:15:58.:16:03.

lives and unequal life chances. Now, like all members, I naturally take

:16:04.:16:08.

every opportunity that I can to talk about all that makes me proud to

:16:09.:16:11.

represent my constituency, and whether it is Telford's industry,

:16:12.:16:16.

its history of innovation and enterprise, its vibrant new town,

:16:17.:16:20.

its green spaces, its high-tech businesses and jobs. All of which I

:16:21.:16:23.

have spoken about with great pride and at some length. However,

:16:24.:16:28.

sometimes we must, as the honourable member for Stockton North so

:16:29.:16:33.

eloquently did, we must raise the issues that deeply affect the

:16:34.:16:36.

quality of life of our constituents. The itches -- the issues that need

:16:37.:16:42.

to be addressed, the issues that are too often overlooked and glossed

:16:43.:16:46.

over. It is often the glossing over of these issues that makes those who

:16:47.:16:51.

experience these difficulties feel left behind and ignored. Telford is

:16:52.:16:57.

a finer, former miner -- a former mining area and became a new town in

:16:58.:17:02.

the 1960s and with business, jobs and new growth, it is starting to

:17:03.:17:06.

thrive in very many ways and yet retains significant areas of

:17:07.:17:09.

deprivation, with a total of 13 super output areas that are ranked

:17:10.:17:14.

in the 10% most deprived areas nationally. Hand-in-hand with areas

:17:15.:17:21.

of deprivation and disadvantage are marked health inequalities. Hilt

:17:22.:17:25.

inequalities that exist relative to the national average, and relative

:17:26.:17:29.

to the West Midlands average. -- health inequalities. Pertinently

:17:30.:17:33.

relevant to the surrounding Moore affluent rural area of Shropshire,

:17:34.:17:37.

which has more good schools, higher incomes and significantly better

:17:38.:17:41.

health outcomes. Judged by any measure you might care to choose,

:17:42.:17:49.

obesity, less -- life expectancy or smoking, the outcomes are

:17:50.:17:51.

significantly better in Shropshire. Today could be today for a moment,

:17:52.:17:56.

which Simon Stephens. The new smoking, as a killer disease, in

:17:57.:18:04.

Telford, 72% are overweight or obese, one of the highest rates in

:18:05.:18:11.

the country. It compares to a lower number of it. 32% of adults in

:18:12.:18:19.

Telford or obese, whereas in Shropshire the figure is 23.1. I

:18:20.:18:22.

congratulate and admire organisations in Telford that are

:18:23.:18:27.

doing such good work to tackle this. However, the figure is continuing to

:18:28.:18:30.

increase and this is something we cannot ignore and something we must

:18:31.:18:39.

talk about and take more seriously. I wanted to take this opportunity to

:18:40.:18:43.

flag up the statutory obligations that local CCGs, NHS England and

:18:44.:18:48.

indeed the Secretary of State has to address health inequalities.

:18:49.:18:51.

Particularly want to do so as Telford and Shropshire continues to

:18:52.:18:55.

undergo a controversial reorganisation of its future health

:18:56.:18:59.

care provision. The Health and Social Care Act 2012 introduce legal

:19:00.:19:05.

juices on the Secretary of State, NHS England and CCGs to reduce

:19:06.:19:09.

health inequalities and to move towards greater investment in health

:19:10.:19:14.

care levels of deprivation are higher. The NHS guidance says that

:19:15.:19:23.

health inequalities must be properly and there is taken into account when

:19:24.:19:25.

making decisions and it is necessary to demonstrate the appropriate

:19:26.:19:30.

weight has been given to tackle health inequalities. I know that

:19:31.:19:43.

this executive is committed to tackling health inequalities, and it

:19:44.:19:45.

is at the heart of everything the NHS does, but somehow it is not

:19:46.:19:49.

happening. It is right that local decisions are made locally by local

:19:50.:19:52.

health commissioners, but we need to ensure that Commissioners pager

:19:53.:19:56.

regard to health inequalities and that the evidence that they have

:19:57.:20:00.

paid due regard to these inequalities. It is not about box

:20:01.:20:04.

ticking or paying lip service to an ideal. In Telford Shropshire, we are

:20:05.:20:09.

in the third year of a review into the reconfiguration of health care

:20:10.:20:14.

provision, including women and children centre and and A And

:20:15.:20:21.

whilst I welcome the proposed investment for the health provision

:20:22.:20:24.

for the wider area of Telford and Shropshire as a whole, I wanted to

:20:25.:20:27.

be a voice for my constituents and want to ensure that health

:20:28.:20:31.

inequality is prioritised in the decision-making process, and when

:20:32.:20:37.

bringing new investment to our area. As the review of Telford and

:20:38.:20:40.

Shropshire's health care draws to a close after a protracted and

:20:41.:20:45.

expensive process, it has been confirmed the preferred option is

:20:46.:20:49.

the closure of Telford was made newly opened women and children

:20:50.:20:54.

centre at Princess Royal hospital, and this is to be moved and rebuilt

:20:55.:20:58.

in the more affluent area served by Royal Shrewsbury Hospital, and that

:20:59.:21:01.

that hospitals should in addition have extra investment in emergency

:21:02.:21:06.

care. My constituents are rightly concerned about this proposal, and

:21:07.:21:11.

that not only is this much-needed investment to be redirected

:21:12.:21:15.

elsewhere, but the Telford may also lose other key services. Telford has

:21:16.:21:23.

the greatest need. It has the fastest growing population. It is a

:21:24.:21:25.

rapidly expanding new town, and above all it has the greatest

:21:26.:21:31.

inequality of health outcomes. We are steering too often in Telford

:21:32.:21:37.

that rural sparsity is prioritised for additional investment or

:21:38.:21:40.

funding, rather than deprivation, health inequalities and need. Madam

:21:41.:21:45.

Deputy Speaker, this is wrong. I am pleased to have had this opportunity

:21:46.:21:49.

to raise this issue, and I would ask the Minister in her summing up for

:21:50.:21:56.

assurances that addressing health inequality both in Telford and other

:21:57.:22:00.

areas of deprivation and meat, where there is a stark contrast between

:22:01.:22:02.

more affluent neighbouring areas, to please prioritise health

:22:03.:22:07.

inequalities, and as the honourable member for Plymouth and Devonport

:22:08.:22:10.

said, that resource really must follow need. Thank you, Madam Deputy

:22:11.:22:20.

Speaker. May I join colleagues across the House in congratulating

:22:21.:22:23.

the honourable member for .net and her committee for their work in this

:22:24.:22:30.

area, and on securing this debate today? -- for Totnes. The honourable

:22:31.:22:34.

lady brings a calm and clear knowledge to every debate on health,

:22:35.:22:38.

but on this one, this is where we do need a long-term vision and I know

:22:39.:22:42.

that she, like me, wants to see that, whatever party is in

:22:43.:22:46.

government. I stand to speak today both as an MP for a constituency

:22:47.:22:51.

with a very large gap in health and well-being and life expectancy, very

:22:52.:22:56.

much determined by place of birth, early years experience and poverty.

:22:57.:23:00.

And of course as cheer of the Public Accounts Committee were just this

:23:01.:23:04.

year alone my committee, Madam Deputy Speaker, has published ten

:23:05.:23:08.

reports on the national Health Service, some of which shine a light

:23:09.:23:12.

on the debate today. These show the huge pressures on the National

:23:13.:23:16.

health budget and the huge increases in demand on that budget. Take for

:23:17.:23:23.

example, just take diabetes, which is 4.8% of the population is

:23:24.:23:27.

currently diabetic, set to rise to 8.8% in the next few years. As Chair

:23:28.:23:32.

of the Public Accounts Committee, it is my role and the role of my

:23:33.:23:37.

committee to look at funding very specifically looking at the economy,

:23:38.:23:41.

the effectiveness and efficiency of how government spends taxpayers'

:23:42.:23:45.

money. I want first of the doc about how we are spending the money

:23:46.:23:50.

allocated to our health service, how it is key to tackling health

:23:51.:23:54.

inequalities. -- I want first of all to talk. And then how we look at the

:23:55.:23:57.

impact of decisions both within the health service and in other parts of

:23:58.:24:01.

government on health inequalities, what we call in the committee of

:24:02.:24:07.

shunting. So first of all, the NHS budget spending is in the region of

:24:08.:24:10.

?110 billion per year and government is keen to industry reminder that

:24:11.:24:16.

the moment that it has injected ?10 billion into the NHS over the

:24:17.:24:19.

six-year period to 2016. At the same time, we see an ageing population, a

:24:20.:24:24.

large and increasing demand, including on specialised services.

:24:25.:24:29.

The health service is squeezed at each step of the journey. We have

:24:30.:24:34.

had evidence from general practice, from the specialised services around

:24:35.:24:39.

diabetes and neurology and on acute trusts and social care, all of which

:24:40.:24:43.

show the impact on the budget. This has been caught up in what I would

:24:44.:24:47.

have to say, Madam Deputy Speaker, is sadly rather childish debate over

:24:48.:24:49.

headline figures. Very subtle changes in language offered from

:24:50.:24:54.

government about who is too good. Ministers have moved from the mantra

:24:55.:24:58.

that we have injected an extra 10 billion to send the NHS has been

:24:59.:25:00.

given what had asked for. As though they are scolding a naughty child.

:25:01.:25:07.

"We will manage with this within the NHS," as the Chancellor said

:25:08.:25:09.

yesterday when I questioned him on why he had not considered the NHS

:25:10.:25:13.

had it in the Autumn Statement. In today's Daily Mail, there is an

:25:14.:25:18.

exaltation that the NHS, quoting sources close to government or in

:25:19.:25:21.

government, that the NHS England is to manage its resources better and

:25:22.:25:26.

can endlessly be given more money. I am Chair of the Public Accounts

:25:27.:25:29.

Committee, this is taxpayers' money. I do not think we should endlessly

:25:30.:25:33.

pour money into any government department without a lot of that

:25:34.:25:36.

department. And I am clear that there are always efficiencies to be

:25:37.:25:43.

found in a system so large and with such a large overall budget. Every

:25:44.:25:46.

pound saved if the pound to spend on something else. That is really the

:25:47.:25:53.

key point. Every pound feed and the Department of Health budget can be

:25:54.:25:56.

spent on other things, public health in particular. But if we look at the

:25:57.:25:59.

budget in the NHS, are highlighted at the beginning, there are many

:26:00.:26:02.

pressures on it. But all of these discussions and figures being

:26:03.:26:06.

bandied around, we need to take a closer look and in 2015 slashed 16,

:26:07.:26:10.

the Department of Health but it was predicted to have a 2.45 billion

:26:11.:26:18.

deficit, and the measures used this year, the last financial year, two

:26:19.:26:20.

balance the budget were extraordinary, a one-off and led to

:26:21.:26:23.

an unprecedented 3.5 page explanatory note from the Auditor

:26:24.:26:28.

General alert in all of us, particularly the department, to

:26:29.:26:32.

concerns he had that these were not replicable, not long-term and not

:26:33.:26:35.

sustainable. He reiterated that any committee hearing only a few weeks

:26:36.:26:40.

ago. If you look at the figures overall this year, just taking acute

:26:41.:26:44.

trusts alone, and I will not spend too long going over figures in the

:26:45.:26:48.

budget, the debate needs to move on on from that. Trusts overspend by

:26:49.:26:55.

648 million and the deficit for the first six months forecast to the

:26:56.:27:01.

year end is 669 million. So we are seeing a similar trend. We have seen

:27:02.:27:06.

this trend increased quite largely, because this was a decision in 2011

:27:07.:27:10.

to allow for 4% efficiency savings across the NHS by the then

:27:11.:27:16.

Chancellor of the Exchequer. Everybody in the system knew that

:27:17.:27:20.

was not realistic, not on a long-term basis. People knew there

:27:21.:27:24.

was going to be a problem with the budget two years or more out from

:27:25.:27:29.

the crisis that we had in the budget settlement of the last financial

:27:30.:27:33.

year. Yet there is not an open is about discussing how we spend money

:27:34.:27:37.

on the NHS, what we spend it on and what we focus on. That brings me to

:27:38.:27:42.

the issue of public health. We are seeing public health budgets raided

:27:43.:27:46.

to deal with day-to-day crises, too often. We see money taken out of NHS

:27:47.:27:51.

education. We see plans for transformation which is not

:27:52.:27:54.

necessarily at all a bad thing, and the danger is if it is done in the

:27:55.:27:57.

wrong climate, with the wrong tone, it can be seen as an excuse for

:27:58.:28:01.

cuts. Transformation of services can be so much better for patients, for

:28:02.:28:06.

preventative work and in terms of efficiency of spending of taxpayers'

:28:07.:28:09.

money. Too often, the transformation plans we are seeing are going to be

:28:10.:28:13.

driven by financial pressures. A lot of pressure was put on financial

:28:14.:28:18.

directors of acute trusts, in particular, at the end of the last

:28:19.:28:21.

financial year, many being encouraged to move capital funding

:28:22.:28:24.

into the resources side of their budget in order to balance the book,

:28:25.:28:29.

a short-term measure which can lead to underinvestment in facilities

:28:30.:28:32.

that is invested in did actually save money and improve patient

:28:33.:28:36.

experience. This short-term year-on-year, or even spending

:28:37.:28:39.

review period planning, is just not going to tackle health inequalities.

:28:40.:28:46.

We need a longer term approach. We need to prevent Michael ill-health

:28:47.:28:49.

and treat your patience. And as others have highlighted, the age of

:28:50.:28:56.

debt is increasing. -- we need to prevent ill-health. And treat

:28:57.:29:01.

patients. I refer to a report that Public Health England brought out

:29:02.:29:05.

towards the end of 2015, which highlights some of these figures,

:29:06.:29:09.

including that the cost of treating illness and disease arising from

:29:10.:29:13.

health inequalities estimated at around ?5.5 billion per year. If we

:29:14.:29:20.

go back to cost shunting, a very big concern, if we do not tackle these

:29:21.:29:23.

things, it is not just patient individually that suffer order

:29:24.:29:27.

families, not just the taxpayer funding it, but there is a wider

:29:28.:29:34.

impact on Friday. Productivity losses of up to ?34 billion per on.

:29:35.:29:38.

Lost taxes and higher welfare payments cost in the region of 28-

:29:39.:29:43.

?32 billion per annum. If we just tackle tobacco issues, and I go back

:29:44.:29:47.

to what my honourable friend the Member for Totnes with him earlier

:29:48.:29:50.

about smoking, in my neighbouring borough of Newham, it would be about

:29:51.:29:54.

?61 million per annum as smoking was tackled. Which would make a big

:29:55.:29:59.

contribution to the local health budget in east London. If you

:30:00.:30:02.

replicate that across just east London, think what we could be

:30:03.:30:06.

contributing to the NHS budget. Work they've lost to sickness are about

:30:07.:30:11.

1.3% per week in London alone, lower than a lot of the country, and all

:30:12.:30:14.

these things contributed to our productivity gap and have a big

:30:15.:30:18.

effect. If we are going to do what the Chancellor said yesterday and

:30:19.:30:21.

ensure that our workers producing 40 is what we are now producing and

:30:22.:30:28.

five, we need workers who are well, that can work to the increased

:30:29.:30:32.

retirement age to made it. I think of colleagues like the honourable

:30:33.:30:34.

member for Glasgow East and others in Glasgow that represent a city

:30:35.:30:37.

where people will die before they qualify for the state pension age,

:30:38.:30:40.

and there are many people in my constituency, although that would

:30:41.:30:43.

not be the average, would face that. That is a sign of a failure of

:30:44.:30:47.

preventative work and tackling these health inequalities at the right

:30:48.:30:52.

point. We also need to look in terms of joining up government, not just

:30:53.:30:56.

the silos of what owes on within the various parts of the health budget,

:30:57.:31:00.

but a boiler, healthier society. Take, for example, the land disposal

:31:01.:31:04.

the government is undertaken in order to provide public land to

:31:05.:31:05.

build new homes. We have seen that on the one hand,

:31:06.:31:15.

and on my committee we have seen that in a great deal. In my area we

:31:16.:31:19.

have seen Glenn at hospital, the site of a former workhouse in

:31:20.:31:25.

Hackney. When the reorganisation of the NHS took place in 2011, it was

:31:26.:31:33.

moved to a property company that the NHS holds centrally, managing NHS

:31:34.:31:38.

Estates. So we no longer have local control over what to do on the site,

:31:39.:31:41.

and given the state of homelessness locally, if we could provide more

:31:42.:31:47.

homes on the site for families who were not overcrowded, we would do

:31:48.:31:52.

more for public health and health inequalities than a lot of the

:31:53.:31:57.

fiddling around than whether -- with whether they are here at the. My

:31:58.:32:06.

committee will continue to push for one disposals, because from the

:32:07.:32:10.

perspective of my constituency, if we can release land and provide

:32:11.:32:13.

homes that would provide homes for key workers, this would contribute

:32:14.:32:21.

to the outcomes of those departments, and I am determined

:32:22.:32:24.

that government is clearer in its outcomes, and it may be that in

:32:25.:32:27.

other constituencies that the needs might be, as the honourable member

:32:28.:32:34.

highlighted, for green space, and other facilities that would improve

:32:35.:32:37.

and promote health. If we do not have the wider view about what we're

:32:38.:32:42.

doing with public assets, there is a danger that we will just sell to the

:32:43.:32:48.

highest bidder and lose the chance for several generations. 1's land is

:32:49.:32:53.

gone, it is gone. It is also important I touch on the increasing

:32:54.:32:56.

challenge of homelessness, particularly in London and in my

:32:57.:33:02.

constituency. London households in temporary accommodation now account

:33:03.:33:06.

for three out of four of all such households in England. This is not a

:33:07.:33:12.

surprise given the increasing price of houses, rent, the impact of the

:33:13.:33:16.

benefit cap which means you cannot now rent as a bee or four-bedroom

:33:17.:33:19.

home on housing benefit anywhere in London or the south-east of England,

:33:20.:33:26.

and I have people who are coming to see me now, who five years ago even,

:33:27.:33:32.

ten years certainly would not have come to see me about the housing.

:33:33.:33:34.

They were living in the private sector, paying their rent, working.

:33:35.:33:38.

But now, one woman who came to see me have lost her job because she was

:33:39.:33:42.

unwell. She hoped to go back to work. Her job was a good job, but

:33:43.:33:45.

not well paid, but with professional prospects. She became unwell, her

:33:46.:33:49.

rent increased and she became notionally in arrears well trying to

:33:50.:33:53.

find a new home because the benefits cap would not cover the rent. She

:33:54.:33:59.

tried to find something in Hackney or the neighbouring six barrels, but

:34:00.:34:04.

then nothing. Because of the complexities of how the housing

:34:05.:34:08.

benefits were allocated, the landlord would not take her in and

:34:09.:34:10.

why she had a guarantee that she would receive that benefit, and the

:34:11.:34:15.

system does not allow for that. Women to no fault of her own,... She

:34:16.:34:34.

is just one of many people I have experienced in this since being

:34:35.:34:47.

elected member. If you're homeless, your 1.5 times more likely to have a

:34:48.:34:54.

physical health problem, and 1.8% more likely to have a mental health

:34:55.:34:57.

problem, but it seems to me that from the experience I have speaking

:34:58.:35:03.

to people face-to-face, those are underestimates, may be masking a

:35:04.:35:05.

temporary housing problem compared to the reality of what we're seeing.

:35:06.:35:10.

That has a huge impact, and it is focused on the purist, also people

:35:11.:35:18.

like them and I referred to, who hit a rocky patch in their life and

:35:19.:35:21.

something has gone wrong causing a downward spiral towards

:35:22.:35:23.

homelessness. We have so many hidden households in my constituency,

:35:24.:35:27.

families living on the settee in the living room, sometimes an adult and

:35:28.:35:32.

two children, and another family is living in the bedroom because they

:35:33.:35:40.

do not qualify for housing at -- Council housing, or sometimes

:35:41.:35:43.

because the legal status does not yet allow them to afford on their

:35:44.:35:48.

income to rent privately and have no other options. Temporary

:35:49.:35:51.

accommodation is costing Hackney Council 35 billion a year, and I

:35:52.:35:56.

commend the Hackney Gazette which has done a lot to highlight

:35:57.:35:59.

conditions in temporary accommodation and hostels in my

:36:00.:36:02.

borough and across London. We have the homelessness reduction Bill

:36:03.:36:05.

which passed through Parliament, but this is only part of the picture.

:36:06.:36:11.

Saying that the councils must accept people who are homeless is fine, but

:36:12.:36:15.

unless we have homes available to provide to those people at an

:36:16.:36:17.

affordable level, we will not solve this problem. I will give way. Just

:36:18.:36:24.

to point out that I believe ?10 million was given by the government

:36:25.:36:28.

yesterday to help homes particularly in London, so things are being done

:36:29.:36:32.

and things are on the move, and I would like to put that on record.

:36:33.:36:39.

That pre-empts my next point that I wish to thank the government for

:36:40.:36:46.

making some moods to give freedom and make sure they will not buy into

:36:47.:36:55.

it on a ball basis, but also freeing up housing associations to use

:36:56.:37:01.

government money for affordable housing set locally. The fact that

:37:02.:37:06.

affordable housing would be 80% of private rent is ridiculous. Most of

:37:07.:37:14.

the young people in Hackney share a home because they could not afford

:37:15.:37:16.

to rent somewhere privately and certainly cannot get on the housing

:37:17.:37:20.

ladder. So it will take a generation to solve this problem, so while I

:37:21.:37:24.

welcome what the government has done, it could have been sooner.

:37:25.:37:34.

Very often we speak in this House, those of us from London, and it is

:37:35.:37:40.

as if we are a different world from others, but we do have this big of

:37:41.:37:47.

homelessness, overcrowding and temporary use of accommodation. If I

:37:48.:37:50.

could finish on a story that should never be true in our world, other

:37:51.:37:53.

women living with her toddler and husband in a hostel because she was

:37:54.:37:57.

waiting to get council housing. I used to say to people three years

:37:58.:38:00.

ago, hang on in there and you will find a home. -- we will find a home

:38:01.:38:07.

for you, but now it is a year or 18 months. She went to hospital to give

:38:08.:38:10.

birth, and came back to that one room with her newborn baby, toddler

:38:11.:38:17.

and husband. The people living in that hostel are vulnerable, not an

:38:18.:38:21.

ideal environment to bring children home to, and a lot of people crowded

:38:22.:38:25.

into one place without the support they need. This is not what anyone

:38:26.:38:29.

in this House wants to see, I am sure, but we must tackle this

:38:30.:38:33.

because all of the health problems that spin off that for older

:38:34.:38:37.

generations of children living off that are immense. I had a plea from

:38:38.:38:41.

my local constituents Lee as well as my national perspective that

:38:42.:38:45.

tackling homelessness is a vital issue in contributing to tackling

:38:46.:38:51.

health inequalities. Thank you very much. I am very proud to participate

:38:52.:38:57.

in this debate and I am glad the honourable member for Totnes has

:38:58.:39:00.

brought it to the House today because it is not only a very

:39:01.:39:04.

important debate, but one which I have a lot of interest in. This was

:39:05.:39:11.

one of the first issues, health inequalities, that I got interested

:39:12.:39:17.

in as a teenager in modern studies. I could not understand why any

:39:18.:39:19.

government would allow a situation to arise that would allow people in

:39:20.:39:23.

less well-off areas to disproportionately suffer ill-health

:39:24.:39:28.

and die prematurely. I was frustrated reading about the inverse

:39:29.:39:31.

care a lot, and I was angry then and I am still angry that political

:39:32.:39:37.

decisions we take, it is actually the root cause of mortality and

:39:38.:39:43.

morbidity that blights too many lives and our country. It is

:39:44.:39:46.

unacceptable that male life expectancy in parts of Glasgow and

:39:47.:39:52.

baby by 15 years. For men it goes from around the age of 66 to the age

:39:53.:39:57.

of 81, the gap for women is 11 years. I got interested in politics

:39:58.:40:01.

because I wanted to change that, I wanted to understand why and I

:40:02.:40:04.

wanted to know what I could do to help. I joined the SNP when I was at

:40:05.:40:08.

school, and I know that this debate has not been to party political, but

:40:09.:40:12.

it is important to put this on the record because I could see the

:40:13.:40:18.

health of Scotland's people has not been prioritised by Westminster.

:40:19.:40:21.

When I was at school there was no Scottish parliament and no other way

:40:22.:40:23.

of dealing with this issue ourselves. The Member for Stockton

:40:24.:40:26.

North mentioned the Black report, and it is telling the way that

:40:27.:40:30.

report was greeted, and that we're still talking about a lot of issues

:40:31.:40:37.

now, and the report has not yet been implemented and the recent strategy

:40:38.:40:40.

is still not as strong as it could be to deal with these issues and

:40:41.:40:45.

tackle the underlying causes of health inequality. I believe the

:40:46.:40:49.

Scottish parliament -- if the ScottishPower Parliament had --

:40:50.:40:53.

Scottish Parliament had all the powers, I we would be able to deal

:40:54.:41:02.

with these issues more adequately. I do not disagree, I think she

:41:03.:41:06.

misinterpreted what I did. It was actually the Member for Hull that

:41:07.:41:14.

mention the report, and I was just indicating to him. There was no

:41:15.:41:19.

offence meant. I must have got my wires crossed. I thank them both for

:41:20.:41:23.

raising these points because it is important that we think about the

:41:24.:41:27.

context of this debate and where we get to. The honourable member from

:41:28.:41:32.

Glasgow East, and I have been reading the same report, and would

:41:33.:41:36.

like to pay credit to the very in-depth work and dedication of the

:41:37.:41:45.

Glasgow Central for public health. The team of researchers have done so

:41:46.:41:47.

much to lay out the history of health inequality in Glasgow and

:41:48.:41:52.

more widely in Scotland. They have done a huge amount of research and

:41:53.:41:56.

came up with not only the history of it but with some solutions as well.

:41:57.:42:00.

And I was first selected as a councillor in Glasgow, the most

:42:01.:42:05.

recent report at that time was let Glasgow for luggage, and they have

:42:06.:42:09.

done a great deal of work on Glasgow's mortality. It is not just

:42:10.:42:16.

that there is an impact on Glasgow, but this excess mortality applies

:42:17.:42:20.

across different causes of death, ages, gender, social strata,

:42:21.:42:23.

although it is most pronounced in the working age population living in

:42:24.:42:28.

the Buddhist neighbourhoods, living with alcohol, suicides particularly

:42:29.:42:34.

among men, which is absolutely stark. In Liverpool it is an extra

:42:35.:42:41.

4500 deaths over the years, from 2000 and 32 2007, and in Scotland it

:42:42.:42:45.

is an extra 5000 deaths a year for each year between 2010 and 2012. It

:42:46.:42:51.

is a very stark impact. I will not repeat what was said by my

:42:52.:42:54.

honourable friend from Glasgow East, but what is important is that

:42:55.:42:59.

governments of the time knew this was happening. The impact of their

:43:00.:43:03.

policies was known. There was a notable effect on the urban change

:43:04.:43:08.

that was happening. It was happening differently to Liverpool and

:43:09.:43:11.

Manchester, and had a disproportionate effect on

:43:12.:43:14.

population, the lag of which we still see today. Centre for

:43:15.:43:24.

population reports and 1971 report called the Glasgow crisis, which

:43:25.:43:28.

recognised the economically dangerous position Glasgow with

:43:29.:43:30.

them, but nothing at that time was done. The urban regeneration

:43:31.:43:33.

happening in Glasgow happened to the shopping centres in the middle of

:43:34.:43:36.

town, not the areas that needed it the most. So this poverty and health

:43:37.:43:41.

inequality is difficult to turn around, not something you're going

:43:42.:43:49.

to fix just with a sugar tax, not with individual health measures. It

:43:50.:43:50.

is a wide-ranging approach required from all levels of government.

:43:51.:43:56.

Glasgow has worked hard to look at these issues. The Scottish

:43:57.:44:00.

Government has invested heavily, administering a task force on health

:44:01.:44:04.

inequality, but we need to keep working hard and trying more things,

:44:05.:44:09.

working collaboratively to get a result on it. Clyde Gateway is an

:44:10.:44:15.

urban regeneration company in my constituency, and you may ask why a

:44:16.:44:20.

company that builds things is interested in health, they have been

:44:21.:44:24.

working for eight years in Glasgow and Rutherglen, learning lessons

:44:25.:44:28.

from previous regeneration efforts. They had brought down claiming

:44:29.:44:35.

benefits from 38% to 29%. And that is remarkable in itself, but they

:44:36.:44:40.

cannot go any further because they know that unless they start to

:44:41.:44:42.

tackle underlying health issues keeping people out of work, they

:44:43.:44:45.

will not be able to do that. So they are working in partnership with

:44:46.:44:49.

local organisations and people, and crucially people are part of that,

:44:50.:44:52.

they are not having things done to them, they are part of the solution

:44:53.:44:55.

and they are making the community part of what is happening here. So

:44:56.:45:01.

they have recently signalled the intention to seek a means of

:45:02.:45:03.

tackling health inequalities. They want to work to improve diet, cancer

:45:04.:45:07.

screening, which are both factors in the area's ill-health. There is a

:45:08.:45:14.

lot of evidence that people in areas of deprivation are not taking up

:45:15.:45:18.

screaming is the ad entitled to. So that might be around cancer

:45:19.:45:22.

screening at uptake of free eye tests which can also be an indicator

:45:23.:45:31.

of other conditions. The RNIB says it is really important people go

:45:32.:45:32.

further eye tests early. We also want to do a job in Health

:45:33.:45:41.

and Social Care Act rather than having stuff coming in from other

:45:42.:45:45.

areas to do health to you. I wholeheartedly agree with the notion

:45:46.:45:49.

that it ought to be everybody's business. It is not just the public

:45:50.:45:52.

health officials do on their own, because it is clear that the root of

:45:53.:45:56.

health and equalities can be found in income inequalities. In Scotland,

:45:57.:46:00.

we are tackling some of the underlying cause is that we can do,

:46:01.:46:04.

we have the Living Wage uptake in Scotland far exceeding other parts

:46:05.:46:07.

of the country, we are supporting families in helping to improve

:46:08.:46:17.

physical and social environment, improving housing, we have invested

:46:18.:46:19.

in housing heavily, because a lot of the ill-health has come from damp,

:46:20.:46:21.

substandard housing that was making people ill and that was not tackled

:46:22.:46:24.

at that time. We have increased free school meals and continued

:46:25.:46:27.

commitment to free prescriptions, concessionary travel, free personal

:46:28.:46:30.

care and as the Member for Bradford South was talking about earlier on,

:46:31.:46:34.

tooth-brushing. The rates in Scotland of tooth decay in primary

:46:35.:46:39.

one children entering school around the mid-19 90s, when I was starting

:46:40.:46:43.

secondary school, just under 40% of children had no dental cavities.

:46:44.:46:49.

That is now just under 70% have no dental cavities. That is pretty

:46:50.:46:53.

good, quite a shift to go from one to the other. To have 70% of

:46:54.:46:57.

children start school with no tooth decay whatsoever is pretty good. We

:46:58.:47:01.

still need to go a whole lot further, and initiatives like a

:47:02.:47:04.

child mall where all children regularly get free toothbrushes and

:47:05.:47:07.

toothpastes given out on really helpful in that effect. We are also

:47:08.:47:14.

doing, as a couple of members mentioned, a lot of work in minimum

:47:15.:47:17.

unit pricing to reduce alcohol consumption and to deal with a lot

:47:18.:47:20.

of the issues that cause people to buy low cheap alcohol, which is

:47:21.:47:26.

killing them. We have reduced smoking rates by, as I mentioned,

:47:27.:47:30.

bringing in the smoking ban first and are doing a lot of work to

:47:31.:47:34.

encourage active living, healthy eating and investment to improve

:47:35.:47:37.

mental health services. You would expect me as the Chair of the

:47:38.:47:40.

all-party group of inequalities to take the opportunity to talk about

:47:41.:47:43.

breast-feeding as Bill and the impact that it can have on health

:47:44.:47:48.

inequalities. James Peter Grant, the former director of Unicef during the

:47:49.:47:51.

1980s, said exclusive breast-feeding goes a long way to cancelling out

:47:52.:47:55.

the difference but between being born into poverty or being born into

:47:56.:47:59.

affluence. It is a lot of breast-feeding takes the infant out

:48:00.:48:02.

of poverty for those few vital months in order to give the child if

:48:03.:48:05.

first started certain life compensate for the injustices of the

:48:06.:48:09.

world into which you she was born. It is quite a statement. Sadly,

:48:10.:48:13.

there is huge inequality within breast-feeding, particularly in the

:48:14.:48:16.

UK. Women in areas of greater deprivation are far less likely to

:48:17.:48:20.

breast-feed, and are also often paying them for more expensive

:48:21.:48:26.

formula milk, which will put strain on the family budget. I was once

:48:27.:48:29.

told by a Labour councillor in Glasgow in his experience there was

:48:30.:48:33.

an inverse, perverse stigma around breast-feeding and his take on it

:48:34.:48:37.

that if a woman breast-fed, it looked as though she was too poor to

:48:38.:48:40.

afford formula. Cost was a big issue, and I have a doubt in my

:48:41.:48:46.

ruler straight. Families are being penalised for a societal problem.

:48:47.:48:50.

The UK does not provide enough support to various factors to ensure

:48:51.:48:54.

mothers are able to breast-feed as long as they would want to. Some of

:48:55.:48:57.

the economic agenda is having an impact on those important services

:48:58.:49:01.

and coverage is free and across the country as both local volunteer

:49:02.:49:04.

services are finding it harder to cope. -- coverage is fleeing.

:49:05.:49:09.

Whatever mothers do, however they feed their children, there is blame

:49:10.:49:12.

for mothers and many young woman have never seen anybody breast-feed.

:49:13.:49:17.

There is also evident towns that the longer woman who, from other

:49:18.:49:24.

countries -- the longer women who are from other countries stay here,

:49:25.:49:28.

the less they breast-feed. There is a lot we can do and I met with a

:49:29.:49:34.

minister earlier this week and then gladiator chiselling and keen Duggan

:49:35.:49:36.

is to address the breast-feeding within the country. On a population

:49:37.:49:43.

level, Unicef's preventing disease and saving recesses report points

:49:44.:49:49.

out that the images could save significant amounts of May by

:49:50.:49:52.

investing in first feeding services. They reckon there would be 3285

:49:53.:49:57.

fewer cases of hospital admission from gastrointestinal issues and

:49:58.:50:04.

5916 for respiratory tract infection, which would save ?10

:50:05.:50:08.

million across the country, no mean feat. I think it is quite important.

:50:09.:50:13.

There is also connected reductions in obesity, sudden infant death

:50:14.:50:16.

syndrome and reducing first and ovarian cancer in the mother.

:50:17.:50:20.

Breast-feeding is a significant public health intervention and I

:50:21.:50:23.

think the Unicef call to action indicates how important this is. To

:50:24.:50:28.

return briefly to the Glasgow centre of population of health, I would

:50:29.:50:31.

like to summarise the view of their suggestions, as this is indeed the

:50:32.:50:36.

purpose of today. We should not just look at the problems. The health

:50:37.:50:41.

interventions on smoking and alcohol have helped, but in the main means

:50:42.:50:47.

of resolving inequality, they have found it is not actually in those

:50:48.:50:51.

health interventions, it is a wealth redistribution. It is the widening

:50:52.:50:56.

gap in income perpetuated over many, many years by different governments.

:50:57.:50:59.

Fair and progressive taxation and fair wages would make a huge

:51:00.:51:03.

difference to this gap. Ensuring that all people have a sufficient

:51:04.:51:09.

income is absolutely critical. The government is continuing to slash

:51:10.:51:11.

Social Security spending and not only is it making a member but it is

:51:12.:51:15.

making them ill. There is an NHS health Scotland reported this month

:51:16.:51:18.

that said a quarter of lone parents in Scotland rated their health as

:51:19.:51:23.

they are, bad or very bad. Those parents that have to look after

:51:24.:51:28.

children. If there health is bad and very bad they are not able to be

:51:29.:51:34.

effective parents. The impact on health of the bank as clear as. If

:51:35.:51:39.

you are resorting to go to a good bank to get hand meals, not fresh

:51:40.:51:43.

fruit and vegetables, thumping out of a kind you may not even be able

:51:44.:51:47.

to heat, that will have an impact on your health, your mental health as

:51:48.:51:53.

well. -- something out of a can. We need to support people to live a

:51:54.:51:56.

life with dignity and one with choices, because choices should not

:51:57.:52:00.

be a luxury. If you do not have any control over what happens to you in

:52:01.:52:04.

life, that is going to have a huge impact on you and your family for

:52:05.:52:11.

years to come. They also support and recommend one, affordable and

:52:12.:52:15.

appropriate housing, as the Member for the Chair of the Public accounts

:52:16.:52:18.

commission mentioned, if you do not have some more work for them to

:52:19.:52:21.

live, that will have a huge impact. We need to learn from the mistakes

:52:22.:52:25.

of the past and look more widely at the policies we pursue and the

:52:26.:52:27.

things we think are important in the face, because they can have, as we

:52:28.:52:31.

have seen in Glasgow, very long-lasting effects. Most

:52:32.:52:37.

significantly, the world health organisation's principle of health

:52:38.:52:40.

and policies. This must run through everything that government does that

:52:41.:52:44.

impact on health. Yesterday, the Chancellor related field to address

:52:45.:52:48.

not only health spending but help at all. I would argue that he is

:52:49.:52:51.

billing the country, the people of this country, by not -- failing the

:52:52.:52:58.

country, by not acknowledging everything the government wants to

:52:59.:53:03.

achieve. Thank's thank you very much, Madame Deputy Speaker. It is

:53:04.:53:05.

welcome to be speaking in this chamber for the second time today on

:53:06.:53:11.

yet another very important topic, this time on health inequalities. I

:53:12.:53:14.

thank the backbench business committee for allowing this debate

:53:15.:53:18.

to take place following the application by the honourable member

:53:19.:53:21.

for Totnes, another honourable members across the House, and she

:53:22.:53:25.

spoke again in excellent speech on this topic, and we are very grateful

:53:26.:53:32.

for that. I also want to thank other Honourable members from across the

:53:33.:53:34.

House for the many excellent contributions we have heard today,

:53:35.:53:38.

especially wanting to highlight the speeches from some of my honourable

:53:39.:53:44.

friends, the member from Hull West and Hessle, Stockton North, Bradford

:53:45.:53:49.

South, keyword and Middleton and Hackney South and Shoreditch, who

:53:50.:53:53.

all gave excellent speeches, as well as the honourable member for

:53:54.:53:57.

Plymouth, five sudden and Devonport. My fellow all-party basketball group

:53:58.:54:02.

member! I particularly enjoyed his speech, as I did the Member for air

:54:03.:54:08.

watch. Excellent speech on obesity and childhood obesity. And the

:54:09.:54:11.

honourable member for Glasgow Central, who, as she knows, I agree

:54:12.:54:15.

with most of what she says with regard to breast-feeding especially.

:54:16.:54:18.

We have had an excellent debate, excellent contributions all round.

:54:19.:54:22.

But when it comes to addressing health inequalities, there are many

:54:23.:54:26.

conversations around the need for systemic change to reverse these

:54:27.:54:29.

trends. However, my contribution today, I want to look at tangible

:54:30.:54:33.

specifics that the Minister can get to work on in her remit as minister

:54:34.:54:38.

for public health. I will do this by looking at the current state of

:54:39.:54:43.

health inequalities, and then two key areas that smoking and childhood

:54:44.:54:46.

obesity specifically, and what more should be done to address these

:54:47.:54:50.

health inequalities at the fires. And then move onto the cuts to

:54:51.:54:57.

public health grants, which are exacerbating the situation. The most

:54:58.:54:59.

recent intervention on health inequality was by the Prime

:55:00.:55:02.

Minister, used first speech on the steps of Downing Street to violate,

:55:03.:55:06.

and I would, if you are born poor, you will die on average nine years

:55:07.:55:11.

earlier than others. We have heard examples of this given clearly from

:55:12.:55:18.

constituencies across the country. This was a welcome intervention and

:55:19.:55:22.

clearly set the tone of her government to seriously work to

:55:23.:55:24.

address health inequalities, and hard not to agree when the facts

:55:25.:55:27.

speak for themselves. Using two examples from your most recent

:55:28.:55:31.

public health outcomes indicators shows that by region, London and the

:55:32.:55:37.

south east have the highest life expectancy, while the north-east and

:55:38.:55:41.

north-west at the lowest. The same pattern appears when looking at

:55:42.:55:45.

excess weight in adults, as we have heard today also, were rather than

:55:46.:55:50.

converted 76.2%, the highest percentage, and can at 46.5%, at the

:55:51.:55:56.

lower end of the scale. -- Camden. These figures clearly prove what we

:55:57.:56:01.

more to be true, people living in more deprived parts of the country

:56:02.:56:05.

do not live as long as those in more affluent areas, and in these

:56:06.:56:08.

communities contributors to ill-health such as smoking,

:56:09.:56:12.

excessive alcohol, as we heard also from the honourable member for

:56:13.:56:19.

competent, -- from an honourable member, and obesity levels are more

:56:20.:56:23.

prominent. It is important that the government addresses these issues so

:56:24.:56:26.

that we can improve the health of our nation but there is also an

:56:27.:56:29.

economic argument to be made. If we have an unhealthy population, we are

:56:30.:56:34.

not being as productive as we can be. In England, the cost of treating

:56:35.:56:40.

illnesses and diseases arising from health inequalities has been

:56:41.:56:44.

estimated at 5.5 billion per year, and in terms of productivity,

:56:45.:56:46.

ill-health among working eight people means a loss to the industry

:56:47.:56:54.

or 31- ?33 billion each year. These two arguments must spread the

:56:55.:56:58.

government into action. I know there are many issues to tackle, in

:56:59.:57:01.

multiple ways, for the government -- and multiple ways for the government

:57:02.:57:05.

to address them. Many have been raised today but as I previously

:57:06.:57:09.

said, I will look at two key areas of importance for the Minister to

:57:10.:57:12.

get right, smoking cessation and childhood obesity. My first outing

:57:13.:57:18.

of shadow and is for public health was to debate the prevalence of

:57:19.:57:22.

tobacco products in our communities and the need for the government to

:57:23.:57:24.

bring forward the new Tobacco control plan. She remembers well!

:57:25.:57:30.

And also to set out key actions to work towards a smoke-free society.

:57:31.:57:36.

Smoking is strongly linked to deprivation and for those who do

:57:37.:57:39.

smoke, it has major impact on their health, such as being more prone to

:57:40.:57:45.

cancer and COPD and higher mortality rates. If we look at this by region,

:57:46.:57:53.

as I have already established is a factor in health inequality, smoking

:57:54.:57:57.

levels are higher in the north-east, at 19.9%, compared to lowest in the

:57:58.:58:03.

South East, at 16.6%. Also looking at smoking by socioeconomic status,

:58:04.:58:09.

we find these gaps or even wider. We find that smokers and professional

:58:10.:58:14.

-- in professional and managerial jobs are less than half those in

:58:15.:58:19.

routine and manual social economic groups, at 12% and 28% respectively.

:58:20.:58:25.

During that debate, over a month ago, the Minister was pushed on when

:58:26.:58:29.

the new Tobacco control plan would be published. Concerns have been

:58:30.:58:34.

raised by various charities, including Ash, Fresh North-east And

:58:35.:58:37.

The British Lung Foundation, on how the delay could jeopardise work done

:58:38.:58:44.

already. Sadly the Minister evaded my specific question back then, so I

:58:45.:58:48.

will ask again. Where will we be expecting the new plan? Next year or

:58:49.:58:54.

this year? It will not only go a long way to work towards a

:58:55.:58:57.

smoke-free society but will also help reduce health inequalities in

:58:58.:59:01.

our deprived areas. Surely the Minister can understand that and the

:59:02.:59:06.

need to come forth with the plans. Another area that the Minister knows

:59:07.:59:09.

I have a keen interest in is around childhood obesity. They have

:59:10.:59:15.

repeatedly said the publication of the sheltered obesity plan was the

:59:16.:59:17.

start of the conversation. Childhood obesity is the issue that is on

:59:18.:59:22.

everybody's with right now, at his -- as it is the biggest public

:59:23.:59:27.

health crisis facing this country. I will not resolve the statistics we

:59:28.:59:31.

have heard, they are shocking and we all know them. I know that many

:59:32.:59:36.

organisations and individuals including Cancer Research UK, the

:59:37.:59:40.

children of my food trust and Jamie Oliver have made very clear their

:59:41.:59:44.

dismay at the 13 page document which was snuck out in the summer and have

:59:45.:59:48.

said it could not go far enough. Incidentally, it was the same day as

:59:49.:59:53.

the A-level results, so it obviously looked like it was being hidden.

:59:54.:59:59.

Obesity related illnesses cost the NHS an estimated 5.1 billion per

:00:00.:00:04.

year. But also it is the single biggest preventable cause of cancer,

:00:05.:00:10.

after smoking, and is also connected to other long-term conditions, such

:00:11.:00:14.

as arthritis and type two diabetes. And when obesity is linked with

:00:15.:00:19.

socioeconomic status, there is real concern that the plan we have before

:00:20.:00:23.

us will not go far enough to reverse health inequalities. National Child

:00:24.:00:29.

measurement data shows that obesity among children has risen, and based

:00:30.:00:34.

on current trends, it could be around 670,000 additional cases of

:00:35.:00:41.

obesity by 2035, with 60% of boys aged 5-11 in deprived communities

:00:42.:00:43.

either being overweight or obese. There is a real need for the

:00:44.:00:51.

government to come to terms with the fact that many believe the current

:00:52.:00:55.

plan we have is a squandered opportunity, and a lot more has to

:00:56.:01:00.

be done. That is why I hope the Minister is constructive and her

:01:01.:01:03.

reply to the debate and gives us three assurances that moves us on

:01:04.:01:10.

from, and I quote, this is only the start. My honourable friend gave

:01:11.:01:18.

Alistair at the end of her speech of four or that you could start

:01:19.:01:23.

straightaway, and would certainly take us on. While the government has

:01:24.:01:26.

stalled or not gone far enough on the plans mentioned a moment ago,

:01:27.:01:30.

there is also concern that the perverse and damaging cuts to public

:01:31.:01:34.

health inequality gap. The Minister health inequality gap. The Minister

:01:35.:01:36.

knows the numbers I have given to knows the numbers I have given to

:01:37.:01:39.

her previously, but I will give them again, even after my honourable

:01:40.:01:48.

friend the Member for Hull West and -- but we're also concerned about

:01:49.:01:52.

the cuts to public spending following last year's budget which

:01:53.:01:55.

was followed by the average real term cut of 3.9% each year to 2020,

:01:56.:02:02.

2021, in the Autumn Statement of last year. I want to add some

:02:03.:02:06.

further concerns that will go beyond those raised in this side of the

:02:07.:02:10.

House. Concerns identified in the survey by the Association of

:02:11.:02:16.

directors of public health found 75% of their members were worried that

:02:17.:02:20.

cuts to public health funding would threaten work on health

:02:21.:02:23.

inequalities. These concerns are backed up by further evidence

:02:24.:02:28.

published by a DPH, who found that local authorities are planning cuts

:02:29.:02:32.

across a wide range of public services due to central government

:02:33.:02:38.

cuts. For example, smoking cessation services saw a 30% reduction in

:02:39.:02:47.

2015, 16, increasing to 51% in 16, 17, with 5% of services being

:02:48.:02:54.

decommissioned. Cuts to this would be detrimental. The government

:02:55.:03:02.

failing to realise that cutting this budget would not help is deeply

:03:03.:03:10.

worrying, and shows a lack of joined up thinking around the issue. In

:03:11.:03:16.

conclusion, health inequality is a serious issue we cannot ignore or

:03:17.:03:19.

elect the government get long as the health of our nation is so

:03:20.:03:23.

important, not only in a moral sense but also economically. I know the

:03:24.:03:27.

Minister will agree with the Prime Minister's statement from earlier

:03:28.:03:32.

this year than there is no second guessing that. What we need to see

:03:33.:03:36.

its radical proposals getting to the bottom of this persistent issue,

:03:37.:03:40.

which blights lives of so many people in our most deprived

:03:41.:03:44.

communities. We all want to see a healthier population where nobody's

:03:45.:03:51.

health is determined by factors outside your control, and we must

:03:52.:03:54.

work together to get to the point with that is no longer the case that

:03:55.:04:00.

the postcode where you were born or 11 determines how long you will live

:04:01.:04:03.

or how healthily you will live the life. I would like to congratulate

:04:04.:04:07.

the chair of the health select committee of her opening of this

:04:08.:04:12.

debate, and to the backbench business committee for agreeing to

:04:13.:04:18.

it. It has been a highly informed debate, but also wide-ranging, so I

:04:19.:04:22.

will start by apologising, I will not be able to respond in detail to

:04:23.:04:30.

all the points. I will reply in writing, but my colleagues are right

:04:31.:04:34.

that the government has set this as a priority, and it is not surprising

:04:35.:04:38.

that we share the responsibility of the size to reducing health

:04:39.:04:45.

inequalities. Currently we are recognised as public leaders in

:04:46.:04:51.

health, which has been achieved by avoiding temptation to put it in a

:04:52.:04:58.

silo. The approach to treating health alone will not tackle is what

:04:59.:05:02.

we know will be the most entrenched problems of our generation. We have

:05:03.:05:06.

avoided our health only approach in the past, which is why the

:05:07.:05:09.

Chancellor's Autumn Statement Chancellor's Autumn Statement

:05:10.:05:11.

yesterday announced some important and relevant measures, like raising

:05:12.:05:17.

the minimum wage, raising the income tax threshold and an additional 1.4

:05:18.:05:26.

billion to deliver 40,000 extra affordable homes, which is in

:05:27.:05:28.

addition to the homelessness introduction Bill. It is right that

:05:29.:05:35.

we also look to the work of industry and non-governmental actors, and I

:05:36.:05:38.

am pleased to see the food and drink industry has made progress in recent

:05:39.:05:46.

years. The focus on ball into the arrangements has been based on

:05:47.:05:48.

calorie reduction, and sugar and portion sizes have been reduced with

:05:49.:05:57.

many manufacturers tapping at 250 calories, which is an important step

:05:58.:06:01.

forward. Some retailers have also played their part by removing sweets

:06:02.:06:04.

from checkouts, while others have cut their own brand sugary drinks.

:06:05.:06:12.

We welcome this and urge others to follow suit. We challenge industry

:06:13.:06:18.

to make further substantial progress to stop we praise those who have had

:06:19.:06:21.

success but will continue to challenge those who lagged behind.

:06:22.:06:23.

Colleagues are right to highlight the importance of employment. It is

:06:24.:06:26.

encouraging to see there are some gaps that are narrowing, as the

:06:27.:06:31.

Chancellor said yesterday over the past year employment grew fastest in

:06:32.:06:34.

the north-east, pay grew more strongly in the West Midlands, and

:06:35.:06:40.

every new key -- UK nation Regents on improvement to employment. Health

:06:41.:06:45.

Green paper is specifically focused on driving down the disability work

:06:46.:06:50.

gap for those who wish to work. It is this emphasis on the social,

:06:51.:06:54.

economic and environmental causes of inequalities that convinces me that

:06:55.:06:59.

public health responsibilities as they are traditionally understood

:07:00.:07:03.

set in local government, we're national action can be reinforced,

:07:04.:07:10.

and resources targeted... I would like to respond to concerns raised

:07:11.:07:14.

by my honourable friend for Plymouth Sutton regarding his GP practices.

:07:15.:07:19.

When a GP practice closes, NHS England has a responsibility to make

:07:20.:07:23.

sure that patients still have access to services, and that patients are

:07:24.:07:26.

not misplaced. I am pleased to hear he is making progress on the matter,

:07:27.:07:33.

but if he reaches a roadblock, I would be happy to raise his concerns

:07:34.:07:38.

with the Minister for community health. While councils, as a number

:07:39.:07:41.

of colleagues have raised, have had to make savings and are acting in

:07:42.:07:44.

tough financial circumstances, they are still accessing ?16 billion in

:07:45.:07:52.

terms of the public health grant, and they have shown that good

:07:53.:08:02.

results can be achieved, there are some examples of outstanding

:08:03.:08:04.

practice to which we should pay tribute today. The innovation fund

:08:05.:08:10.

in collaboration with local gum and provides funding for services for

:08:11.:08:25.

HIV testing, at a time when it is a key public health priority. As my

:08:26.:08:31.

honourable friend rightly raised, we must focus on key determinants such

:08:32.:08:36.

as obesity, smoking, drug abuse and alcohol. We are working closely with

:08:37.:08:44.

our partners in the NHS, Ph.D., local government and schools to

:08:45.:08:46.

deliver childhood obesity plan, which has been raised by many today.

:08:47.:08:56.

We have consulted on the industry levy, and launched a broad sugar

:08:57.:09:09.

production, which should impact... These measures will have second and

:09:10.:09:13.

the benefits in terms of dental health and diabetes prevention. As

:09:14.:09:16.

my honourable friend the Member for error wash membered, -- mentioned,

:09:17.:09:27.

it is important of delivering a key part of that plan, which is an hour

:09:28.:09:30.

of physical activity every day, and one of the ways we will make sure

:09:31.:09:36.

this goes through effectively is introduce a healthy rating scheme in

:09:37.:09:39.

primary schools to recognise and encourage

:09:40.:09:49.

the way they deliver this. I agree with Lonrho board members... Parity

:09:50.:10:21.

of extreme must be paired with care,...

:10:22.:10:37.

Would need to refresh the suicide strategy with a focus on the

:10:38.:10:44.

alarming figures of suicides among men, and the figure is about self

:10:45.:10:49.

harm. There can be no complacency about the skill of the challenge, as

:10:50.:10:59.

figures today remind us. We know that inequalities can be difficult

:11:00.:11:03.

to tackle, and services are required to tackle this, so I am prioritising

:11:04.:11:10.

the tobacco control strategy. I will use our efforts to target vulnerable

:11:11.:11:18.

groups, such as pregnant women and addicts, to using data to understand

:11:19.:11:29.

the policies. Can the Minister of a timescale for the Tobacco strategy?

:11:30.:11:34.

I cannot because I am not satisfied it is as effective as I wanted to

:11:35.:11:40.

be. In addition, I am taking action, I am pleased with the action we have

:11:41.:11:46.

taken to improve standardised for cigarettes and other legislative

:11:47.:11:49.

measures, and we have launched the world's first diabetes prevention

:11:50.:11:56.

programme, and we had a good debate about how we can improve diabetes

:11:57.:12:01.

cure, and we have one of the most effective immunisation programmes in

:12:02.:12:04.

the world, showing our commitment to take action where evidence guides

:12:05.:12:09.

us, but this action must be government at a local and national

:12:10.:12:14.

level. Our job is to boot prevention and population health considerations

:12:15.:12:18.

at the heart of everything we do as the five-year forward view made

:12:19.:12:21.

clear. Devolution deals give areas local control over the social

:12:22.:12:27.

determinants of health, such as economic growth, housing, health,

:12:28.:12:31.

work, programmes and transport, and a focus on integrated public health

:12:32.:12:36.

services within devolution promises to remove many barriers to

:12:37.:12:40.

intervention we have discussed, making public-health everyone's

:12:41.:12:44.

business, as the SNP spokesman said. With devolution, though, and as we

:12:45.:12:49.

progress to the move towards business rates retention, as the

:12:50.:12:54.

honourable member for Kingston-upon-Hull macro said,

:12:55.:12:57.

transparency will be vital to ensure the outcomes in public health

:12:58.:13:00.

improve. This is happening but we need to go further than do more to

:13:01.:13:04.

engage local people and their elected councillors in highlighting

:13:05.:13:09.

the unjustifiable parities that exist. Transparency relating to

:13:10.:13:18.

accountability is a key part for me. Members across the House are right

:13:19.:13:21.

to launch the challenge today, and I take on board the suggestions on how

:13:22.:13:29.

we can collectively reduce health inequalities, but I hope that in

:13:30.:13:31.

replying today, I have made clear that the only way they believe we're

:13:32.:13:35.

going to make progress is to adopt a whole government and society

:13:36.:13:39.

approach. We have to constantly remind ourselves that reducing these

:13:40.:13:44.

inequalities is not just for the NHS or Public Health England, but for

:13:45.:13:47.

the whole of government, as well as local areas, industries and all

:13:48.:13:52.

members of the House. I reaffirm my commitment to work with the widest

:13:53.:13:55.

range of partners in and out of government to make progress on this,

:13:56.:13:59.

and I hope every single member today will do so, because we all our

:14:00.:14:05.

constituents nothing less. I would like to thank colleagues from across

:14:06.:14:11.

the House for a number of thoughtful contributions to this debate. This

:14:12.:14:14.

is everybody's business and we now want to see the government

:14:15.:14:17.

translates the ambition and the words into action. The question is

:14:18.:14:29.

as on the order paper. The ayes have it. The ayes have it. I beg to move

:14:30.:14:37.

this House adjourned. The question is that this House do know

:14:38.:14:43.

adjourned. Sir William Cash. Thank you. I want to make clear my

:14:44.:14:50.

Stromberg -- strong objection to proposals in section form a queue of

:14:51.:14:54.

HS2 phase eight, West Midlands to crew consultation documents on

:14:55.:15:01.

behalf of my constituents. I have registered my objection to HS2 many

:15:02.:15:07.

times, and indeed my honourable friend the Member for Stafford and

:15:08.:15:15.

Chesham and Amersham have also taken a strong line on the subject for a

:15:16.:15:20.

long time. It is also true that there will be a bill in future, we

:15:21.:15:26.

presume after December, when at some point there will be a hybrid bill on

:15:27.:15:30.

which members of my constituency will be able to petition if the need

:15:31.:15:38.

to do so. What I want to do is set out my objection is these initial

:15:39.:15:50.

proposals. They amount to an area which is likely to become, we

:15:51.:15:57.

believe, the depot at Crewe.

:15:58.:16:00.

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