Tag: Neil O’Brien

The speech made by Neil O’Brien, the Minister for Primary Care and Public Health, at Policy Exchange in London on 11 April 2023.

It’s an enormous pleasure to be here today at Policy Exchange to set out the government’s next steps on vaping and smoking.

Everybody agrees that we must do more to prevent ill health in the first place – not just treat it afterwards.

Cutting smoking is one of the most evidence-based and effective interventions that we can make.

That’s why in 2019, this government set the bold ambition for England to be Smokefree by 2030 – reducing smoking rates to 5% or less.

Everyone knows about the health impact of smoking.

It’s still the sadly the single biggest cause of preventable illness and death in England.

Up to two out of three lifelong smokers will die from smoking.

Cigarettes are the only product which will kill you if used correctly.

The positive impact of stopping smoking is immediate. For those who quit, after just a few weeks lung function increases by up to 10% and circulation improves, and the risk of heart attack is half that of a smoker after one year of quitting.

The person who quits today is the person who isn’t in a hospital bed next year. So, cutting smoking will help us hit the fourth of the PM’s five priorities – to cut waiting lists.

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But as well as the health impact, the economic impact of smoking is also huge.

The excellent 2010 Policy Exchange paper ‘Cough Up’ noted that – “it is a popular myth that smoking is a net contributor to the economy”

In fact new analysis from ASH on the costs of smoking in the UK in 2022 found that smoking has a £21 billion total cost to the public purse.

To talk you through that – people used to argue that although there was a cost to the NHS from smoking, the taxes paid offset this.

But this ignores the fact that smokers are more likely than non-smokers to become sick and be out of work, and more likely to stay unwell for longer. Smokers are absent for an average of 2.7 more days per year than non-smokers.

Reducing smoking rates not only improves health outcomes and reduces the burden on the NHS, it also boosts productivity and economic growth too.

Current smokers are 7.5% less likely to be employed compared to never smokers and ex-smokers are 5% more likely to be employed than current smokers.

In places like Birmingham, an additional 6,000 people are out of work because of smoking. Quitting could help to put that right.

As well as the productivity impact, quitting smoking would save the average person around £2,000 a year.

In poorer parts of the country going smokefree could mean far more money circulating in the local economy. There is a positive productivity benefit but also helps to level up across the nation.

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Today, as well as tackling smoking, I also want to start to address a new threat… the growth of vaping among children.

There has been a very sharp increase in children vaping – particularly disposable vapes. NHS figures for 2021 showed that 9% of 11- to 15-year-old children used e-cigarettes, up from 6% in 2018. That’s a rapidly rising trend we need to stop.

Whether it’s disposable vapes marketed to kids with bright colours, or low prices, or cartoon characters or child-friendly flavours…

…Or indeed products being sold that don’t meet our rules on content.

Today we step up our efforts to stop kids getting hooked on vaping. My message is this: if your business plan relies on getting kids hooked on nicotine, we are coming for you.

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So today I will set out

• What we will do to stop children and non-smokers from starting vaping…
• How we will exploit the potential of vaping as a powerful tool to stop smoking.
• … And how we will help more people quit smoking, particularly where rates are highest.

I’d like to thank Javed Khan for his independent review which has helped inform many of our next steps.

And I’d also like to thank Bob Blackman in his role as the Chair of the All-Party Parliamentary Group (APPG) on Smoking and Health, who has been a hugely positive advocate for keeping smoking on the public health agenda.

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Let me start with vaping.

We need to do two things:

On the one hand, stop children taking up vaping.

On the other, exploit the huge potential of vaping to help adult smokers to quit…

NHS figures for 2021 as I mentioned showed that 9% of 11- to 15-year-old children used e-cigarettes in 2021 – that’s a rising trend.

Dr Mike McKean, vice-president of policy for the Royal College of Paediatricians and Child Health, has estimated that prevalence may well be even higher now.

I think many of us as parents worry about our kids’ health, about them getting addicted to nicotine. The Chief Medical Officer who is here today has also raised concerns about children vaping. I also pay tribute to my colleague Caroline Johnson who highlighted this issue.

That’s why today, as part of work on stopping people starting smoking and vaping, we are opening a specific call for evidence on youth vaping to identify opportunities to reduce the number of children accessing and using vape products – and explore where the government can go further. We will look at where we can go beyond what the EU’s Tobacco Products Directive allowed us to.

This will explore a range of issues including how we ensure regulatory compliance, look at the appearance and characteristics of vapes, about their marketing and promotion of vapes, and the role of social media which is crucial. It will also seek to better understand the vape market, looking at issues such as the price of low cost products and disposables.

We are also working closely with colleagues at the Department for Environment, Food and Rural Affairs (Defra) to consider the environmental impact of vapes – particularly disposable vapes which have become so appealing to young people. In 2022, 52% of young people who vaped were using disposable products, compared to just 8% in 2021.

Over 1.3 million disposable vapes are thrown away each week. This accumulates to 10 tonnes of lithium a year, equivalent to the lithium batteries of a staggering 1,200 electric vehicles.

The call for evidence will be open for the next 8 weeks.

We hope that everyone concerned will take this opportunity to share their views to help shape our future approach particularly for our young people.

We are already taking action to enforce the current rules.

I was extremely concerned to hear of certain disposable vaping products that don’t adhere to our regulatory standards. There has been a particular issue about the Chinese-made “Elf Bar”.

Working closely with the MHRA and Trading Standards we have agreed a voluntary withdrawal of some of these products from the UK market. Some large supermarkets like Tesco are setting a good example by working across their distribution network and ensuring all their products meet the requirements.

I urge the rest of the retail sector and vape manufacturers to follow suit and to  our vaping product rules. If they do not do this, it could result in an unlimited fine. Companies failing to comply with the law will be held accountable.

To that end today I can announce that we will go further to enforce the rules.

Working hand in glove with our enforcement agencies and learning from our work with Trading Standards on illicit tobacco, we will provide £3m of new funding to create a specialised “flying squad” to enforce the rules on vaping and tackle illicit vapes and underage sales.

This national programme will help share knowledge and intelligence across regional networks – including on organised crime gangs.

It will bolster training and enforcement capacity in Trading Standards and undertake specific projects such as test purchasing in convenience stores and vape shops. We will produce guidance to help build regulatory compliance. We will remove illegal products from shelves and at our borders, and we will undertake more testing to ensure compliance with our rules.

But while we want to make sure children don’t take up vaping, vaping can play an important role in helping the government achieve its Smokefree 2030 ambition.

Vaping is effectively a double edged sword. On the one hand, we do not want children to develop an addiction to any substance at a young age.

But on the other hand for adults, vaping is substantially less harmful than smoking and we now have high quality evidence from Oxford University that compared to nicotine gum or patches vapes are significantly more effective as a quit tool, but not more hazardous.

This is particularly true when they are combined with additional behavioural support from local stop smoking services.

Vaping is already estimated to contribute to about 50 – 70k additional smoking quits per year in England.

However, vapes are not yet being used widely enough to reach their full potential as smoking quit aids, showing the potential power of it as a tool.

A “swap to stop” partnership is a scheme where smokers are provided with a vape starter kit alongside behavioural support to help them completely stop smoking.

There have already been successful local pilots of ‘swap to stop’ schemes in many areas, such as in Bath, Southampton, Sheffield, and Plymouth…

Learning from these proven effective pilots, today, I am delighted to announce that we will be funding a new national ‘swap to stop’ scheme – the first of its kind in the world.

We will work with councils and others to offer a million smokers across England a free vaping starter kit. Smokers who join this scheme which will run initially over the next two years must join on one condition – they commit to quit smoking with support. For our part we will make it as easy as possible, referring people to stop smoking services and developing a digital approach to help people quit smoking. Once that is done, we will offer support to those who want to go on to quit vaping too.

We will target the most at-risk communities first  – focusing on settings such as job centres, homeless centres, and social housing providers. And we want to work with retailers on this journey too.

Among the first of these exciting projects will be in the North East. I have already been working with local councils in Northumberland, Gateshead, South Tyneside and Hartlepool to start a joined-up delivery of a ‘swap to stop’ scheme in their most deprived neighbourhoods.

This scheme represents an exciting opportunity to capitalise on the potential of vaping as a tool to help smokers quit.

The latest international research shows that smokers who use a vape every day are three times more likely to quit smoking, interestingly, even if they didn’t actually intend to quit smoking.

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So we will offer a million smokers new help to quit.

Let me now turn to other steps we will take to stop smoking and start quitting.

And let me start with our next steps to tackle illicit and underage sales.

Taking action against those who break the rules firstly protects legitimate shops from being undercut.

But we also know that this is very important to stop underage people starting smoking, because illicit tobacco and underage sales are strongly linked.

We’ve already implemented a successful new UK-wide system of track and trace for cigarettes and hand rolling tobacco to deter illicit sales.

This system requires all cigarettes and hand rolling tobacco to be tracked right from the manufacturer to the first retailer using unique ID codes applied to the products.

Track and Trace will be extended to all tobacco products in May 2024. This means not only will we track cigarettes and hand rolling tobacco but also cigars, cigarillos, shisha and other tobacco.

‘Operation CeCe’, a UK-wide intelligence hub between HMRC and National Trading Standards, has also bolstered our efforts against illicit tobacco, and we have given it long term funding.

Operation CeCe resulted in more than £7 million worth of illegal tobacco products being removed from sale in its first year, and prevented far more illegal activity.

HMRC are also introducing tougher additional sanctions to track and trace to deter repeat offending, including a new civil penalty of up to £10,000 for more serious offences.

I can also announce that this year, HMRC and Border Force will be publishing an updated strategy to tackle illicit tobacco.

It will lay out strategically how we continue to target, catch and punish those involved in the illicit tobacco market.

If you supply tobacco for sale in the UK you must be registered for Tobacco Track and Trace and also obtain an Economic Operator ID.

We want to start using this existing system in a new way – to help strengthen enforcement and target the illicit market.

From now on where people are found selling illicit tobacco, we will seize their products, we will remove their Economic Operator ID and they will no longer be able to buy or sell tobacco.

We are also exploring how to share information with local partners about who is registered on the Track and Trace system, so they know who is and who isn’t legally entitled to sell tobacco in their local areas, helping to drive enforcement.

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Now of course some would go further to stop people to start smoking in the first place. The Khan Review last year advocated the New Zealand approach – a full phase out of smoking, with the age of sale increasing over time to cover all adults.

This would be a major departure from the policy pursued over recent decades which has emphasised personal responsibility and help for people to quit. And it is the help for current smokers to quit that we want to focus on.

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And, there is much more we can do to help people quit smoking.

Over half of all smokers – that’s 3 million people – want to quit smoking. One million of these people want to quit in the next three months.

But nicotine is highly addictive. We know that 95% of unsupported quit attempts relapse within a year.

So we will do more to help people quit.

First, we will use the latest treatments – proven to give smokers a much greater chance of quitting.

Some of the most cost-effective treatments that we have are not currently available in England. We are working closely with suppliers to give access to prescribers, to put licensed medications in the hands of those who would benefit the most from them. For example, ensuring the availability of proven smoking cessation medicines such as Varenicline and Cytisine. We have been working urgently with business to unblock supply chain problems to support more people who want to quit.

Second, we’ll join up services through the new Integrated Care Systems, to make the NHS more like a national prevention service.

The pioneering work being done by the Humber and North Yorkshire Integrated Care Board – is leading the way in devoting local health service resources, organising the local system to have a local voice in driving down smoking rates in their most deprived communities.  In April – this month – they will ‘go live’ with their comprehensive tobacco control program. They will go first in implementing many of our national plans, including the provision of incentives for pregnant women to stop smoking, providing vapes as a first line quit aid in local stop smoking services, lung health screening and joining up local services to tackle illicit tobacco.

I encourage all other ICBs to follow their example and develop similar partnerships with local authorities to create effective tobacco control programs. This is a really good example of integrated care systems working together to drive prevention.

Third, we’ll help pregnant women quit. Nationally 9% women still smoke in pregnancy – but it affects as many as nearly one in four births in some areas. Of course smoking in pregnancy increases the risk of stillbirth, miscarriage, and sudden infant death.

All maternity services in England are establishing pathways to ensure rapid access to stop smoking support for all pregnant women. We’ve already rolled out carbon monoxide testing widely to mothers.

Recently financial incentive schemes have been proven effective to increase the number of pregnant women successfully quitting. In trials women receiving financial incentives are more than twice as likely to quit. The return on investment for these schemes is £4 for every £1 invested.

These schemes have been effective in a number of local areas, including Greater Manchester, which has seen the biggest drop-in maternal smoking rates over the last two years.

So today we build on that local evidence and I’m announcing that we will offer a financial incentive scheme to all pregnant women who smoke by the end of next year.

This will unlock a lifetime of benefits for the child and the mother.

Fourth, we will provide further help for people with mental health conditions to quit.

Smoking is more than twice as high in people living with mental health issues. They will die 10 to 20 years earlier, and the biggest factor in this is smoking.

It is a common misconception that smoking helps anxiety. Actually smoking exacerbates anxiety and depression. Quitting smoking has been proven to be as effective as taking anti-depressants.

So we will work with mental health services to improve the signposting to evidence based support for smokers. At a minimum, all mental health practitioners will be able to provide signposting to specially developed, evidence based, digital quit resources.

Fifth, to help people quit, we will use a new approach to health warnings.

The front of cigarette packs has contained ‘smoking kills’ warnings since 1991. We will continue this, but we also want to give people hope and connect them in a hassle-free way to the best offer of support.

We will consult this year on introducing mandatory cigarette pack inserts with positive messages and information to help people quit.  In Canada, health promoting inserts are required by law and have been in place since 2000. Evidence from the experience in Canada shows pack inserts are an effective measure to increase the number of people attempting to quit smoking.

We have commissioned the University of Stirling to undertake testing with UK adult smokers and young people to help get this right.

We are exploring how best we can use innovative approaches within this, such as the use of QR codes to make it as easy as possible for people to get help to quit.  You could take a pic with your phone and be taken straight to stop smoking support, the kind I’ve been talking about in this speech.

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In conclusion, the evidence is overwhelming that stopping smoking not only has major health and economic benefits.

It is crucial to extending healthy life expectancy, particularly levelling up the places it is lowest.

That’s why today we’re:

• Stopping the growth of vaping among children
• Introducing new help for a million smokers to quit.
• Increasing enforcement of illicit sales
• Expanding access to new treatments.
• Backing joined-up, integrated approaches
• Rolling out a national incentive scheme to help pregnant women quit,
• Consulting on new pack inserts using modern technology

All these are ways we will help people quit.

These proposals to reach our goal of a Smokefree 2030 are some of the most innovative in the world.

They will give more people the help that they need to quit smoking for good.

So thank you to all of the experts in the room today that have fed in ideas to inform the speech today – and I look forward to your questions.

The speech made by Neil O’Brien, the Parliamentary Under-Secretary of State for Health and Social Care, in the House of Commons on 1 February 2023.

I am grateful to my hon. Friend the Member for Scunthorpe (Holly Mumby-Croft) for securing this debate on such an important issue. I am extremely sorry to hear about Nathan and about Stephen and Gill and, indeed, about the constituents of the hon. Member for Merthyr Tydfil and Rhymney (Gerald Jones). I would very much welcome the meeting that my hon. Friend described with her constituents, and we will set that up.

We recognise, though it is hard to understand, the devastation caused to families by the sudden cardiac death of a young person. Sudden cardiac death is an unexpected and sudden death that is thought to be caused by a heart condition.

The implementation of genomic laboratory hubs across England provides an opportunity to explore the systematic introduction of post-mortem genetic testing for SCD. Seven NHS genomic medicine service alliances play an important role in the support of genomic medicine. Those NHS GMS alliances are supporting several transformation projects, including a national project with the NHS inherited cardiac conditions services, the British Heart Foundation and the country’s coroners.

The project will test the DNA of people who died suddenly and unexpectedly at a young age from a cardiac arrest, and their surviving family can also be offered genetic testing to see if they carry the same gene changes. In addition, a pilot project based in the NHS South East Genomic Medicine Service Alliance is aimed at people who have had an unexpected cardiac arrest and survived. They will be offered a genomic test to enable access to treatment, and further genomic testing will be offered to identify immediate family members at risk if a gene change associated with a heart condition is found.

As my hon. Friend the Member for Scunthorpe mentioned, screening programmes in England are set up on the advice of the UK National Screening Committee. These are not political decisions; they are decisions based on the best currently available evidence, and they determine whether the introduction of a screening programme would offer more good than harm. As my hon. Friend said, in 2019 the National Screening Committee reviewed the evidence to provide general screening, and concluded at that time that there was not enough evidence to support the introduction of a national screening programme.

Research showed that the current tests were not accurate enough to use in young people without symptoms, because incorrect test results can cause harm by giving false reassurance to individuals with the condition who may have been missed by the screening test, while individuals without the condition may receive a false positive test result that could lead to unnecessary treatments. The review found that most studies for SCD were in professional athletes, whose hearts of course have different characteristics from those of the general population. Tests can work in different ways in different groups of people. That is why it is very important that research is gathered in a general population setting, as to base it on athletes would not provide a good indication of what would happen if we tested all young people under the age of 39.

The UK NSC was due to review SCD in 2022-23, as my hon. Friend mentioned, but has been unable to do so for a variety of reasons to do with covid and competing priorities. I am unable to confirm this evening when the regular review of SCD will take place, but I am assured that it will take place as soon as constraints allow. I will write to my hon. Friend setting out more details very shortly, because I know how urgent it is to understand when that will happen.

In 2022, the NSC’s remit was expanded to set up a research sub-group to keep abreast of ongoing research related to screening, and to identify research requirements and advice on mechanisms to address them. The committee has encouraged stakeholders to submit any peer-reviewed evidence it may have on incidence for review by the NSC via its early update process, but so far it has not received anything. My hon. Friend asked a series of detailed questions and made a series of very helpful suggestions about how we change the process. The NSC will doubtless have heard the issues that she has raised in this House, but I also undertake to raise directly with the NSC all her very constructive points.

The consensus at present has been to focus on rapid identification of sudden cardiac death and automated external defibrillator use in people who suffer a cardiac arrest, in line with the NHS long-term plan. The Government continue to encourage communities and organisations across England to consider purchasing a defibrillator as part of their first aid equipment, particularly in densely populated areas. My hon. Friend the Member for Brigg and Goole (Andrew Percy) mentioned some of the excellent work that has been done in his local area on this front. At the end of last summer, the Government announced that all state-funded schools across England will receive at least one AED on site, with more devices delivered to bigger schools, boosting their numbers in communities across the country. In December, we also announced the community defibrillator fund, which gives communities matched funding and aims to install about 1,000 more defibrillators across the country. I know that many hon. Members in this House will want to take up that offer and are spearheading work to get more AEDs out into the community.

To conclude the debate and start the process that we will be going through, I again thank my hon. Friend the Member for Scunthorpe for raising this hugely important issue. We have heard some truly heartrending stories this evening, and I thank all those involved in The Beat Goes On and other similar organisations for their hugely important work. I promise that this issue will continue to get our utmost attention as a Government.

The speech made by Neil O’Brien, the Parliamentary Under-Secretary of State at the Department for Health and Social Care, in the House of Commons on 19 December 2022.

Let me start by congratulating the hon. Member for Salford and Eccles (Rebecca Long Bailey) on securing this important debate. I share her frustration and am aware that some areas in the country face serious difficulties with access to NHS dental care. She used some powerful examples, which are exactly the kinds of things that we are trying to fix.

As we recover from the pandemic, activity is going back up again and we want it to go up faster. Dentistry is an important part of the NHS. We are committed to addressing the challenges that NHS dentistry faces in some parts of the country. We are continuing to take important steps to improve access for patients. There are variations around the country, which was already an issue before the pandemic.

The specific risks from covid in dentistry, for obvious reasons given the nature of the treatment—looking down people’s throats and breathing in the same air—resulted in the need to reduce the amount of care that could be delivered, in line with infection prevention and control measures to keep patients and the workforce safe. The pandemic placed further pressure on the system. However, NHS dentistry provision has been increasing gradually and safely. I am pleased to say that NHS England asked all dental practices to return to 100% of their contracted activity in July this year. Many practices are already delivering at that level and, in some cases, beyond. I will go on to talk about delivering beyond.

To support the industry during this testing time, we took unprecedented action and provided over £1.7 billion in income protection, to ensure that NHS dentist capacity was retained and services were provided and available after the pandemic. We made an additional £50 million available for NHS dental services at the end of last year, to increase capacity in NHS dental teams. Appointments were given to those in most urgent need of dental treatment, including vulnerable groups and children. As a result of that funding, I am pleased that say that an additional 1,110 patients were seen in Salford. To support the provision of urgent care, more than 170 urgent dental care centres remain open across the country. One of those centres is in the Salford locality, as the hon. Lady knows.

Across the nation, the system is recovering and delivery of dental care is increasing. In 2021-22, 24,272 dentists performed NHS activity—an increase of 539 on the previous year. In the 12 months to 30 June this year, 5.6 million children were seen by an NHS dentist, compared with 3.9 million children in the same period the previous year. That represents a 43% increase.

John McDonnell (Hayes and Harlington) (Lab)

There have been reports in a number of our constituencies of almost a dental health epidemic. Can the Minister explain whether there will be targeted resources for a number of our constituencies where there is such a high level of child dental ill health?

Neil O’Brien

I am exploring how we can best target the places with the most acute problems. There are problems in a lot of different places, and we are thinking about that actively at the moment. I will come back to that as I make progress.

Jamie Stone (Caithness, Sutherland and Easter Ross) (LD) rose—

Madam Deputy Speaker (Dame Rosie Winterton)

Order. I gently say to the hon. Gentleman that if he wanted to intervene, he ought to have been here right at the beginning, because it is the hon. Lady’s Adjournment debate, and it is about Salford and Eccles? I leave it to him to decide whether he wishes to intervene.

Neil O’Brien

I am happy to take whatever interventions are appropriate.

We know that there are still further improvements to be made. Although I am pleased that over 75% of the patients who tried to get a dental appointment over the last two years were successful, this is not back to the level that we were seeing pre-pandemic, which was 92%. That is why in July and in our plan for patients, which the hon. Lady mentioned, we announced some improvements to the 2006 contract to ensure that patient access was improved, although I want to reassure her that we do not regard those as the end of the story; they were a stepping stone.

Those changes included: making sure that dentists were remunerated more fairly for complex work, which will improve access for patients; implementing a minimum value of £23 for each unit of dental activity, boosting incomes in the places where the UDA value is lowest; and enabling dental practices to deliver up to 110% of their contract levels, to increase activity and allow those practices that are delivering NHS care most effectively to deliver more. This effectively takes away the cap that has been in place since the 2006 contract, which the hon. Lady mentioned.

This package will increase and improve access to dental care for patients across the country. We have already taken action to implement these changes, including through regulations that came into effect on 25 November. The changes have all been decided with careful consideration, working collaboratively with the dental sector. The Department has worked with the General Dental Council on legislative proposals that will make registration processes for dental professionals qualified outside the UK more proportionate and streamlined, making the process to join the UK workforce more efficient for dentists from overseas. These changes are another way in which we are seeking to improve access for patients.

Finally, to make it easier for patients to find dentists taking on new patients, we have made it a requirement for NHS dentists to update their information on the NHS website, which has historically been out of date, but of course we are looking to go further to ensure that those appointments are there. These changes are just the beginning. They are the necessary first steps of our work to improve NHS dentistry. These are the measures that we can take immediately, and they will have a noticeable impact, but we will go further.

Looking forward into the new year, we have been working with NHS England and the sector on further changes to improve access. Our priorities for this next phase of reform include: improved access to urgent care for patients who need to see someone immediately; better access to care for new patients; and further workforce and payment reform. We aim to take the necessary steps to implement these changes next year, but I am keen to seek every opportunity to take action wherever I can, and ahead of those reforms we are also actively considering what support we can offer to help patients who do not currently have access to the dental system and those who are not attached to a practice, who have the worst access. We are also considering how the recruitment and retention of dentists can be improved, particularly in the parts of the country where the need is greater. We are also thinking further about how overseas qualified dentists can be supported to start working in the NHS more quickly.

I am strongly committed to improving our NHS dental system wherever I can for all those who need it. The hon. Lady has set out a powerful case today on why we need to go further, and we will go further. I thank her for raising this important debate, and I hope that she will be reassured that although the reforms we have made so far will make a difference, they are far from being the end of the story, and that we will continue to take action to improve access to NHS dentistry across the nation.

The speech made by Neil O’Brien, the Parliamentary Under-Secretary of State for Health and Social Care, in Westminster Hall, the House of Commons on 15 December 2022.

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this important debate. He has been a strong advocate for eye health for a long time. He speaks from huge knowledge and personal experience, and I listened to his speech with great interest. Given that health is a devolved matter, a lot of my response will focus on England, as he suggested. I understand that the devolved nations are facing similar challenges. We are always interested in sharing ideas and working with our counterparts, in answer to the question asked by the hon. Member for Motherwell and Wishaw (Marion Fellows).

There are 2 million people living with sight loss, and that is predicted to double to 4 million by 2050 as a result of an ageing society. Sight loss is often preventable, and that is why prevention and early detection, along with access to diagnosis and timely treatment, are key. One of the best ways to protect our sight is to have regular sight tests. The hon. Member for Strangford rightly underlined why that is so important with his powerful story about the tennis ball-sized tumour that his constituent had taken out.

When combined with early treatment, sight tests can prevent people from losing their sight. That is why we continue to fund free NHS sight tests for many, including those on income-related benefits, those aged 60 and over, and those at risk of glaucoma and diabetic retinopathy —two of the main causes of preventable sight loss. More than 12 million NHS sight tests were provided to eligible groups in 2021-22. We also provide help with the cost of glasses and contact lenses through NHS optical vouchers. Eligible groups include children and those on income-related benefits. The NHS invests over £500 million annually to provide sight tests and optical vouchers.

The risk factors for sight loss include ageing, medical conditions such as diabetes, and lifestyle factors such as smoking and obesity. We are taking action to reduce obesity and smoking. Smoking rates in England are already the lowest in history, and we remain committed to going further to be smoke free by 2030. We are working to drive down the number of people who take up smoking, and we are supporting those who wish to quit. We are also working with the food industry to ensure that it is easier for people to make healthy choices, and we are supporting adults and children living with obesity to achieve and maintain a healthier weight.

Turning to the medical conditions that lead to sight loss, diabetic retinopathy—a common complication of diabetes—is a potentially sight-threatening condition. The diabetic retinopathy screening programme now provides screening to over 80% of those living with diabetes annually. Between 2010 and 2019-20, the number of adults aged between 16 and 64 who are registered annually as visually impaired due to diabetic retinopathy has fallen by 20%, meaning that it is no longer the main cause of sight loss in adults of working age. The screening programme has played a major role in that.

Jim Shannon

I thank the Minister for his helpful response. The target of providing retinopathy screening to 80% of those living with diabetes has been achieved. Are there any plans to try to reach the other 20%? I am diabetic. I had my retinopathy test about four weeks ago; I get it every year. I know the encouragement and confidence that testing gives people once they know they are okay. Are there any ideas for how we can get to the other 20%?

Neil O’Brien

Absolutely. As the hon. Gentleman says, we are keen to constantly drive that rate up, and we can talk more offline about the different things that we can potentially do to drive it up even further. The healthy child programme recommends eye examinations at birth, six weeks and age two, and school vision screening is also recommended for reception-age children.

The hon. Member for Strangford raised a question about a special school, which I will address specifically. The NHS long-term plan made a commitment to ensure that children and young people with a learning disability, autism or both who are in special residential schools have access to sight tests. NHS England’s proof of concept programme has been testing an NHS sight-testing model in both day and residential schools, and it is currently evaluating its proof of concept as part of programme development, which we expect to conclude towards the start of 2023. The evaluation will then inform decisions about the scope, funding and delivery of any future sight-testing model. I reassure the hon. Gentleman that, at present, absolutely no decisions have been made; we are waiting for the evidence that that programme is generating.

I turn to secondary care. Once an issue with eye health is detected, it is vital that individuals have access to timely diagnosis and any necessary treatment. The NHS continued to prioritise those with urgent eye care needs throughout covid-19. However, we acknowledge the impact that the pandemic has had on our ophthalmology services, as it has had on other care pathways. Our fantastic NHS eye care teams are working hard to increase capacity and provide care as quickly as possible. We have set ambitious targets to recover services through the elective recovery plan, supported by more than £8 billion over the next two years, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund announced last year.

Marsha De Cordova (Battersea) (Lab)

Will the Minister give way?

Neil O’Brien

I give way with pleasure to the hon. Lady, who has been hot-footing it from a funeral to attend the debate. I will seamlessly fill in, so she can catch her breath. I congratulate her on making it here.

Marsha De Cordova

I honestly thank the Minister for giving way. I have just got here from the funeral of a dear friend, Roger Lewis, who, as a totally blind man, was also a strong advocate for a national plan for eye care in England and the devolved nations. I congratulate my dear and honourable friend, the hon. Member for Strangford (Jim Shannon), on securing this very important debate.

As many Members will know, I currently have a Bill calling for a national strategy for eye health in England. We need to ensure that eye care provision is joined up across England to reduce avoidable sight loss but also, more importantly, to end the fragmentation of services. Is the Minister willing to meet me to discuss some of the provisions in the Bill, to ensure that we can create an eye care pathway that ensures that nobody who is losing their sight—or has already lost it—will go through the pathway without the right support and timely treatment?

Neil O’Brien

I am grateful for the hon. Lady’s intervention, and I will be happy to meet her. It sounds like there is an important connection between where she has just been and this debate. I am extremely happy to meet her to talk about that.

I will continue setting out our strategy. I have already talked about screening in primary care, and I was setting out the sums of money that we are investing—the £8 billion plus the £2 billion—in elective recovery following the pandemic. NHS England has been supporting NHS trusts to increase capacity in surgical hubs, and the independent sector has also been used to increase the delivery of cataract surgery, in particular. In 2021-22, nearly half a million cataract procedures were provided on the NHS, which is actually more than before the pandemic, so that is recovering.

Beyond recovering from the pandemic and looking to the future, hospital eye care services are facing increasing demand. As a number of hon. Members have pointed out, ophthalmology is already the busiest out-patient speciality, and the predictions are that the demand for services will increase by 30% to 40% over the next 20 years as the result of an ageing society.

To help address these challenges, NHS England’s transformation programme is looking at how technology could allow more patients to be managed in the community and supported virtually through image sharing with specialists in NHS trusts. Current pilots for cataracts and glaucoma are allowing primary care practices to care for these patients and refer only those who need to be seen by specialists. The learning from these pilots will feed into any possible future service model. That could allow us to use the primary care workforce to alleviate some of the secondary care pressures.

I am delighted that the NHSE has appointed the first national clinical director for eye care, Louisa Wickham, who will oversee this work programme. I am aware that the APPG on eye health and visual impairment has called for there to be one Minister responsible for primary and secondary care services. I can confirm that my portfolio covers both those areas, so I will be taking an active interest in the development of that transformation programme and strategy.

A number of hon. Members have raised questions about the workforce, and we acknowledge that there are challenges across the system, including in ophthalmology. NHS England is developing a long-term workforce plan that will consider the number of staff and roles required and will set out the actions and reforms needed to improve workforce supply and retention. We have already invested in growing the ophthalmology workforce with more training places in 2022, but there is more to do. We are also improving training for existing staff so that they can work at the top of their licence.

Research is an area that the hon. Member for Strangford is interested in, and I was extremely sorry to hear from the hon. Member for Tooting (Dr Allin-Khan) about her keratoconus. That is one area where, fortunately, research and new treatments are coming online, so research is hugely important. While we have effective treatments, particularly for macular disease, we absolutely cannot rest on our laurels because medicine continues to evolve. We recognise that research and innovation are crucial to driving improvements in clinical care and improved outcomes for people living with sight-threatening conditions. The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s commitment to supporting research into the most pressing challenges of our time, including sight loss.

Over the past five financial years, the National Institute for Health and Care Research has invested more than £100 million in funding and support for eye conditions research, and many of the studies focus specifically on sight loss. The NIHR Moorfields Biomedical Research Centre has recently been awarded £20 million from the NIHR for another five years of vision research, allowing it to continue its mission of preserving sight and driving equity through innovation. Through the NIHR, England, Scotland, Wales and Northern Ireland work together on a range of research topics, and the devolved Administrations co-fund several research programmes.

To assess how well interventions are achieving their intended aims, it is important that we track their impact, which hon. Members have mentioned. The public health outcomes framework’s preventable sight loss indicator tracks the rate of sight loss per 100,000 population for three of the most common causes of preventable sight loss: age-related macular degeneration, glaucoma and diabetic retinopathy.

We are making progress. The indicator shows the impact that the new treatments have had on the rate of sight loss due to age-related macular degeneration. Despite an ageing population, the rate of sight loss in 2019-20 was 105.4 cases per 100,000, down from 114 per 100,000 in 2015-16, so there has been an improvement on macular degeneration. The open availability of this data provides a valuable resource for integrated care boards to draw on in identifying what is needed in their areas and for local democratic accountability for any variation in performance against public health outcomes.

Jim Shannon

The answers are very helpful. One thing that all three Members referred to was the waiting list, and those who lose their eyesight just because they have been on a waiting list for diagnosis, examination and investigation. I know the pandemic created lots of problems in relation to the waiting list. Does the Department intend to have a strategy that will reduce the number of people on waiting lists to ensure that those waiting for a diagnosis retain their eyesight?

Neil O’Brien

I mentioned earlier that one of the main goals of the huge £8 billion plus £2 billion investment is in elective recovery because, as the hon. Gentleman said, the pandemic has had a huge impact. We have already cleared the number of people waiting for two years. The next milestone is to clear those waiting 18 months and then to work through the plan and bring down the numbers using that additional money over time, reducing those waiting the longest first and then steadily reducing the number of people waiting in total.

I acknowledge the importance of good vision throughout life, and especially as we get older. I hope that what I have outlined today provides some reassurance that we acknowledge the ongoing challenges faced by eye care services and are taking action to address them.

The statement made by Neil O’Brien, the Parliamentary Under-Secretary of State for Health and Social Care, in the House of Commons on 9 December 2022.

The Government are delaying the implementation of the introduction of further advertising restrictions on TV and online for less healthy food and drink products until 1 October 2025.

Due to a delay to Royal Assent of the Health and Care Act 2022, and recognition that industry needs more time to prepare for the restrictions, in May 2022, Government announced a year delay to the implementation of these restrictions to 1 January 2024.

However feedback from industry and the regulators is now clear that there is insufficient time to prepare for implementation on the previously announced date of 1 January 2024.

This is because ahead of implementation there are a number of steps that need to be taken including: a Government consultation on draft regulations that are required to set out the details of the advertising restrictions, such as the definition of product categories in scope of the advertising restrictions and the definition of the exemptions for small and medium enterprises, audio only content and services connected to regulated radio; the subsequent making of such regulations; a consultation from the statutory regulator (Ofcom) on the designation of a frontline regulator; the possible designation of a frontline regulator by Ofcom; and publication of guidance to support business compliance with advertising restrictions, following consultation on such guidance from the frontline regulator.

Through discussions with key stakeholders it is clear that this process cannot be delivered by January 2024.

We have listened carefully to the concerns raised by advertisers, broadcasters and regulators about the importance of having sufficient time with these documents to fully prepare and restructure their advertising. We also recognise that businesses need time to reformulate their products. This is why we have decided to delay implementation of this policy until 1 October 2025.

Parliament included a power in the Health and Care Act to delay implementation of the advertising restrictions if necessary. We will be utilising this power to amend the date of implementation for the advertising restrictions by secondary legislation, which we are laying today.

To illustrate our commitment to this policy, we are also launching a consultation on the definitions included in secondary legislation, to provide detail to that included in the Health and Care Act. This consultation will run for 16 weeks, until 31 March 2023.

This consultation will not be inviting opinions on the policy or looking to deviate from anything announced in the consultation response in June 2021—it will be to confirm the clarity of the definitions used and that the text in the secondary legislation is fit for purpose.

Addressing obesity remains a priority for the Government. Having a fit and healthy population is essential for a thriving economy and we remain committed to helping people live healthier lives.

New regulations on out of home calorie labelling for food sold in large businesses including restaurants, cafes and takeaways came into force in April 2022 and restrictions on the promotion by location of products high in fat, salt or sugar came into force in October 2022.

The speech made by Neil O’Brien, the Parliamentary Under-Secretary of Health and Social Care, in the House of Commons on 1 December 2022.

Let me start by congratulating all Members from across the House who have taken part in what has been an incredibly informative and high quality debate. Let me join others in congratulating the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), on a speech that mixed huge personal experience and knowledge, years of advocacy and successful campaigning, and a huge number of insights.

I undertake to look at numerous issues raised by the hon. Member, but to pick just a few, he asked about: the bureaucratic barriers stopping syphilis testing from being added to the opt-out testing that we already do for HIV and hepatitis B and C; some of the risks around the shift to online clinics; people on PrEP being tested regularly; and the promising experiment by the Terrence Higgins Trust with saliva testing for HIV. He raised a number of other points, including the important issue about patent waivers. There was a huge amount in his speech to take away and look at.

The same is true of other hon. Members. My right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made hugely important points about women and girls, and gave some incredibly striking and harrowing statistics. She made important points about the barriers to testing, particularly among minority groups. We can learn from the way that we are tackling that problem in other fields, including in covid vaccination work.

The hon. Member for Strangford (Jim Shannon) gave us insights on what is happening in Northern Ireland, such as the role of the Public Health Agency there and what it is doing on PrEP. He talked about the role of the church in his constituency and the connection between Swaziland and Strangford, which might surprise outsiders. He talked of the work of the Positive Life charity in Northern Ireland, which I commend.

My hon. Friend the Member for West Bromwich East (Nicola Richards) spoke powerfully about her constituents’ experiences of stigma. She made the important point that, as a high prevalence area, it should be considered for the expansion of opt-out testing. A similar point was made by the hon. Member for Slough (Mr Dhesi) and my hon. Friend the Member for Heywood and Middleton (Chris Clarkson). I join my hon. Friend in commending the work of Middleton Health Centre.

The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about some important lessons that we can learn. We are keen to learn across the UK about the rollout of PrEP in Scotland. On the roll-out of our world-leading vaccination campaign against mpox—one of many issues raised by the hon. Member for Denton and Reddish (Andrew Gwynne) in his speech—we are talking to that relatively small number of clinics that have had to deliver the huge majority of the campaign about its impact financially and on their day-to-day work.

World AIDS Day is an invitation to underline our commitment to tackling HIV, to show our support for people living with HIV and to remember those we have lost to AIDS. I am proud of how far we have come: from the stigma and the sidelining of the past, which a number of Members have mentioned, to where we are today thanks to collaborative efforts and the commitment of the Government, together with HIV patients, their friends and family, campaigners, medics, researchers and the health and care system at all levels.

Today, when diagnosed early and with access to antiretroviral therapy, most people living with HIV in England can expect a near-normal life expectancy. People diagnosed with HIV can expect to receive world-class, free and open-access HIV care. That has been a result of our collective and collaborative partnerships. However, despite successes, HIV has not gone away. There is still more that we should do. That is why last year, this Government published their commitment to end new HIV transmissions in England by 2030 through the HIV action plan. That plan is the cornerstone of our approach in England to drive forward progress and achieve our bold ambitions.

We have come far in the first year since its publication. The UK met the UNAIDS 95-95-95 targets for the first time in 2020: 95% of HIV-positive individuals were diagnosed; 99% of those diagnosed were receiving treatment; and 97% of those receiving treatment were being virally suppressed. I am pleased that the number of people being newly diagnosed with HIV in England continues to fall. The latest data on HIV diagnoses shows that 2,955 people were diagnosed with HIV in England in 2021—a 33% decline compared with 2019, when the Government first made their commitment to end all new HIV transmissions in England by 2030. We are conscious of the need to avoid flatlining or slowing the pace in any way. We are still understanding the impact of the covid pandemic and the things that happened during that period, but there has been progress.

Those successes have been underpinned by clear national leadership and strengthened partnership working. I am grateful to Professor Kevin Fenton, the Government’s chief adviser on HIV, who has been chairing the HIV action plan implementation steering group, involving the key partners in the delivery of the HIV action plan, including local government, the NHS, and our voluntary and community sector. The steering group has met quarterly throughout the year to monitor progress on our commitments and ensure that appropriate action was taken to keep us moving forward with our objectives. Within the remit of the group, they have established specific task and finish groups focusing on key priority areas for action, such as improving equity and access to HIV drug prevention—PrEP—and addressing workforce challenges, among others.

We are also thankful for the work of the UK Health Security Agency, which excels as a world-class leader running high-quality data collection and surveillance systems to help us to better understand and address the challenges on HIV. Those have enabled us to truly understand developments, emerging issues and where we can have the greatest impact with our prevention efforts, and add to our growing repertoire of world-leading British innovation, systems and technology.

Of course, none of this could have been possible without the brilliant efforts of our local government, NHS and voluntary and community sector partners to deliver the highest-quality healthcare tailored to the needs of their local populations. We know through their work that different areas face different challenges, and we remain committed to helping level up outcomes for the whole population across the country.

A key priority, therefore, of the Government’s approach is to ensure that all under-served populations benefit equally from improvements in HIV outcomes. A range of important suggestions have been made in this debate about how to go further. The approach includes scaling up our prevention efforts and increasing access to PrEP. We have already invested £33 million to roll out PrEP access across sexual health services over the past two years. PrEP is now being commissioned as a routine service through the public health grant.

In delivering against these commitments, UKHSA has now developed and published a monitoring and evaluation framework to support local authorities, sexual health services and other key stakeholders to inform continuous service development in PrEP commissioning and delivery, using the existing available data. I am sure many of the people involved in delivery of those services will have followed this debate with great interest and noted some of the challenges posed by different hon. Members.

Lloyd Russell-Moyle

One of the problems is that the Department does not collate data on the average wait times for sexual health clinics or the availability of stocks for PrEP appointments in those clinics. Without that data, we rely on voluntary organisations to make freedom of information requests and report periodically. Having a baseline set from the Department would make a big difference and help us to understand areas that are struggling to roll out PrEP versus areas that maybe are not. Is that something the Minister could take back to the Department? I understand why in the past we have been nervous about publishing data on sexual health issues, but now is the time when we can be a bit more open about that and maybe publish that data, or collate it if that is not already done, so we can start to target our actions.

Neil O’Brien

That is certainly something I will take away and look at. As the hon. Gentleman points out, there are a number of challenges in doing that and in unpicking the activities of sexual health services on different diseases, and he has already alluded to some of the risks. However, I will certainly undertake to go away and look at that important point.

We know there is still more to do to improve PrEP access for key groups and we are in the process of developing a plan for provision of PrEP in settings beyond sexual and reproductive health services, to help us to reach those who are underrepresented—something a number of hon. Members have called for. Our efforts are also focused on scaling and improving testing levels in targeted, high-risk populations, including in black African communities, to be able to reach those 4,500 individuals who we believe are living with HIV but unaware of their status.

As part of implementation of the action plan, NHS England is investing £20 million over the next three years to expand opt-out HIV testing in A&E departments in the local authority areas across the country with the highest prevalence of HIV and across the whole of London. As a number of hon. Members have pointed out, it is a proven effective way to identify new HIV cases, as it promotes testing on admission to hospital of anyone who has not previously been diagnosed with HIV, therefore rapidly helping to identify the virus. Some 33 A&E departments are now live, delivering that important initiative.

We also took the opportunity to link the initiative to the hepatitis C elimination programme, backed by a further £6.85 million, to provide hepatitis B and C testing as well. As several hon. Members alluded to, NHSE published its report on the first 100 days yesterday, describing the progress, challenges, results and learning from the first period of this initiative.

Those very early findings show the benefits of the approach: more than 200,000 HIV tests were conducted over just the first 100 days of opt-out testing across London, Manchester, Salford, Blackpool and Brighton, which meant that more than 600 people were identified with a previously unknown blood-borne virus. Of those, 128 people were newly identified as living with HIV and an additional 65 people living with HIV who were previously diagnosed but were not under the care of an HIV clinic were also identified.

This approach is important to ensure everyone living with HIV can access testing and rapid linkage to treatment and care, allowing them to live a long and healthy life. Moreover, 325 people were newly identified with hepatitis B and 153 people were newly identified with chronic hepatitis C virus; a further 50 were found who had disengaged from care for both diseases and seven people were identified who had previously cleared the hepatitis C virus.

We will be considering the initial evidence from the first year of testing alongside the data on progress towards our ambitions to decide how and whether we further expand this programme. We are in the very early days of evidence on this, but I must say that evidence is extremely encouraging. I hear what hon. Members across the House are calling for, given the success of that programme in its first 100 days, but we need further evidence as it develops.

We redoubled our efforts to increase HIV testing throughout the country during National HIV Testing Week, which took place in February this year. Results are promising: 30% of the almost 25,000 users who ordered an HIV and syphilis self-sampling kit during the campaign had never tested before, and a majority of the campaign’s target audiences reported having taken some kind of preventative action as a result of the campaign.

We know there is still more we need to do to achieve our ambitions. The HIV action plan monitoring and evaluation framework developed by UKHSA, published today, will explore in detail the inequalities and gaps in HIV prevention, testing and care and other indicators of the progress required to achieve our shared ambitions and will help inform our progress. Our actions continue to be closely monitored by the HIV action plan implementation steering group, which includes key delivery partners such as local government, the NHS and the voluntary and community sector, to ensure we remain on track to meet the 2025 and 2030 objectives. The Secretary of State will report annually to Parliament on progress towards our objectives.

World Aids Day gives us the chance to reflect on progress and challenges, being accountable for what we have done over the past year and where we need to continue improving. But, most importantly, it gives us the possibility of coming together to restate our collective commitment to continue working together to end new HIV transmissions in England by 2030 and to finish the race.