UNCORRECTED TRANSCRIPT OF ORAL EVIDENCE To be published as HC 408House of COMMONSMINUTES OF EVIDENCETAKEN BEFOREHEALTH COMMITTEE
THE RESPONSIBILITIES OF THE MINISTER OF STATE FOR PUBLIC HEALTH
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This is an uncorrected transcript of evidence taken in public and reported to the House. The transcript has been placed on the internet on the authority of the Committee, and copies have been made available by the Vote Office for the use of Members and others.
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Transcribed by the Official Shorthand Writers to the Houses of Parliament: W B Gurney & Sons LLP, Hope House, Telephone Number: 020 7233 1935
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Oral Evidence
Taken before the Health Committee
on
Members present
Mr Kevin Barron, in the Chair
Jim Dowd
Sandra Gidley
Dr Doug Naysmith
Mr Lee Scott
Dr Howard Stoate
Mr Robert Syms
Dr Richard Taylor
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Witnesses: Gillian Merron MP, Minister of State for Public Health, Professor David Harper, Director General, Health Improvement and Protection, and Chief Scientist, and Ms Clara Swinson, Director for Health Protection, gave evidence.
Q1 Chairman: Good morning. Welcome to this one-off evidence session with the Minister for Public Health. Could you introduce yourselves and state the current positions you hold, please.
Professor Harper: I am David Harper. I am the Director General for Health Improvement and Protection in the Department of Health.
Gillian Merron: Gillian Merron, Public Health Minister.
Ms Swinson: Clara Swinson, Director of Health Protection in the Department of Health.
Q2 Chairman: Good morning and welcome once again. Minister, we understand that £50 million will be saved on public health campaigns in order to help fund free personal care at home. Could you tell us which campaigns are going to be cut?
Gillian Merron: Good morning to the Committee. Thank you for inviting me. The intention is not to cut particular campaigns. The intention is to seek better value for money about how we do things. There are a couple of areas in particular in respect to our public health campaigns. I am very open to the fact that we look at doing things better, because I am interested in what the results are. The first thing would be reducing our admin costs, negotiation of better-priced deals in terms of advertising spend and also better use of our in-house commercial skills. Also, we need to make greater efforts to reduce consultancy spend. If I could give a bit of a summary, for me that is about reducing the cost of how we do things rather than cutting particular campaigns, and I can assure the Committee that we will not be compromising our approach because obviously our public health campaigns are hugely important. If it is helpful, Mr Barron, I could bring in Clara Swinson, who can give some examples of what we have done already on Change4Life.
Q3 Chairman: Yes, please.
Ms Swinson: On Change4Life we recently published a report of its first year. That looked at the effectiveness of different channels of communication, which allowed us to see which were the best value for money. For example, distributing materials via schools was more effective than through letterboxes: it got a better response and it is cheaper to do. Another example is that a lot of our marketing material is sent out by post, and we need to keep a post channel, but, the more people are online, we can save money by using the online route more often.
Q4 Chairman: We understand the Government seek to adopt more of a social marketing approach to health promotion. Is there any evidence that you can save money in that way? More to the point, is there any evidence that social marketing works? Has it been piloted? Has it been proved? Do we have measurement of outcomes in terms of social marketing?
Gillian Merron: We are looking at how we do our social marketing. As I said earlier, there are areas in which we could do it for better value and that is what we are intending to do. One of the figures that hit me last week, following an evaluation on Change4Life, is that just in its first year alone we know we have one million more mums who are shopping more healthily, getting their families to move more and putting healthier food on the table. I thought that was a tremendous return, and quite encouraging to others as well. Clara could probably comment in much greater detail.
Ms Swinson: First, the research programme behind Change4Life but also other social marketing is what allows you to target that most effectively. Instead of a universal approach for everyone, it is thinking which groups are most at risk here and what is the language and the tone that will mean we are talking to them directly. The evidence of social marketing is that if you use a strong evidence base in the first place you can get a better return.
Q5 Chairman: Can you measure that return as well?
Ms Swinson: As the Minister has said, there are then quite a lot of stages. Through Change4Life, we now have one million mothers claiming that behaviour change. The programme sets out that claiming change is only one step and in year two and in year three we will want to see that tracked through to actual behaviour change, using a range of methods, like the Health Survey for England, to see if and when that translates into actual behaviour change.
Gillian Merron: Mr Barron, you will notice from our new Change4Life for Adults, where the campaign has started now for adults, that we are particularly looking at men with spare tyres. But no-one round the table has one, so we are all right! We felt that was a particular area that we needed to get message across and the challenge was particularly great, so I think we have become ever more refined in what our message is. The thing I like is that we are very straightforward in our language. That, for me, is very important in social marketing.
Q6 Chairman: Saving money on advertising is very difficult to do, in a sense. We have the figures for how much the Government spent on alcohol information and education campaigns in 2009-10. They spent £17.6 million. The alcohol industry itself spent somewhere between £600 million and £800 million to promote alcohol. You are completely disadvantaged in this area. I suppose some would say, "If it works" - and we assume advertising does work - "you ought to be talking about spending vast amounts more money on alcohol education and advertising to try to get this imbalance right." What do you think to that?
Gillian Merron: I do not think it is easy for me to make that comparison. I think they are saying different things. I am sure the Committee is not suggesting we should match that sum - and if it is, I will take that back.
Q7 Chairman: No, I think we have said in our report that maybe you should restrict.
Gillian Merron: Okay. Going back to the initial question, it is hard to make the comparison, not least of all because the alcohol industry is also promoting one brand over another. We are not engaged in that. We have been engaged, as the Committee knows and has been very interested in, seeking to inform people in order that they can make the choice. We have moved into a whole new area recently, explaining that it is not just liver disease that is the problem, but strokes, heart disease, cancer - which I myself did not realise until I looked into it and I am sure many people did not themselves. I think our purpose is rather different and that is why I would struggle to make the comparison in all honesty. My biggest message to the Committee is that, for me, all that matters is that what we do works. I also would not be inclined to measure it in terms of how much we spend per se but the results we get and the changes we see in people's behaviour. It is not easy, as the Committee knows, and we are tackling some very long-term challenges.
Chairman: I also remember that brand sharing was the defence of the tobacco industry for many years, Minister, in this country.
Q8 Dr Stoate: Minister, you are talking about what works, but with alcohol we are seeing a huge increase in binge drinking and a huge increase in the number of young people dying of alcohol-related diseases, so it is not working.
Gillian Merron: It is too soon to say that. It is right to say the challenge is immense. Certainly when I came before the Committee before it was to discuss the whole area of alcohol but we are seeing changes and I will bring David in on the facts, to show some of the improvements. I have to say that, as far as I am concerned, we are seeing some pretty exciting developments since I last came before the Committee. I am sure Committee members have seen the Alcohol Effects campaign, which is that point that it is not just about liver disease, it is not just the kids out on a Saturday night, but it is you in your own home. We have worked with charities to do that. The Home Secretary announced cracking down on worst excesses and I know the Committee is very well aware of that. For me, the fact that smaller measures of wine, beer and spirits will be available, and free tap water, are all sensible, serious things that we have not had before. I talked about the Alcohol Improvement Programme when I was last here. Trying to get people in their most teachable moments will make a difference. The Committee will also know that we have recently launched - important again for me - a consultation on labelling in terms of alcohol. In fact, in quite a short period since I last appeared before you, we have made some great strides. Perhaps I could bring in David to talk about the situation.
Professor Harper: Thank you, Minister. The bottom and the top line at the moment, as you imply, is that there is a huge problem here and we need to take all of these actions to make some impact on the problem. It remains one of our highest priorities and it will, as the Minister says, take some time for the impact of the various measures that we are trying to put in place to come to fruition and to demonstrate impact, so we do have a high level of alcohol-related admissions to hospitals. In process terms, we have a vital signs indicator, we have the majority of PCTs who have identified this absolutely as a local priority. It might not sound like a huge achievement but, as we move forward, to get that recognition through the whole system is one of the fundamental planks in how we begin to deliver some of the benefits.
Q9 Dr Stoate: Minister, let us just assume for the moment that it is too early to tell whether the programme is working. We still said in our alcohol report that we felt the Government was too close to the industry. What do you say about that?
Gillian Merron: I am aware that the Committee has taken that view. It is not a view that I would share. I know it is a suspicion and I understand the view of the Committee on it, but we do work with industry. I particularly would flag up the Drink Aware work that we do, which is a good positive example of partnership with the industry with the Drink Aware Trust. It is not controlled by the industry but they are funding it to some £5 million, and that is the kind of partnership that I think we should be doing. We work independently of the industry in a regulatory role. I have been perfectly clear on labelling, for example, that we had higher expectations of what the industry would do than they have done. There have been some good areas of progress, but overall it has been disappointing. That is why we are consulting on what we should do next, and if industry will not respond, we will take action. It is that, but also the fact that we work with other stakeholders. We work with Alcohol Concern, with the medical profession, with academics. We do work independently of industry, but, yes, we do talk to them, and, yes, we do seek to get them on board, particularly on regulation. My own view is they should not need us to regulate to get the labels right - but if they do, we will have to take action. I do not think it is a great use of our time when they could do it.
Q10 Dr Stoate: You say that you talk with health experts, and I am sure you do, and many health experts have told us that they think the best way of controlling alcohol is to put the price up. Obviously the industry does not agree. What do you think?
Gillian Merron: I think price is a factor, for sure, and I do not think any one thing is going to tackle the problem which we are all agreed is very considerable, but it does have a role to play. I do not think dealing with price is the solution, but, yes, it is part of it. That is why you see some idea from the Home Secretary's recent efforts in terms of stopping "All you can drink for a certain amount" and "Women drink for free" et cetera. There is no doubt that is not the kind of activity that is going to help tackle our problem. I know I have said this before to the Committee but I think there are four areas: information; the environment - so tackling the most irresponsible promotions is most important; advice and support, which I have spoken about already; and treatment. These four areas will all help us to tackle it, but no one thing will do it. Price, yes, is a part of it. My last point is that if we are to talk about price - and I know the Committee has a big interest in that, and rightly so - I would go back to the point that we want to make sure that we will do the right thing that has the right result with the right people. That is also a bit of a challenge for us.
Q11 Dr
Stoate: I entirely appreciate that it is a multi-factorial
approach, and I entirely accept your views that there is more than one thing
that needs to be tackled, but your own Chief Medical Officer, the Royal College
of Physicians, and
Gillian Merron: We have not ruled it out, as the Committee will be aware. One of the things which struck me when I launched the Alcohol Effects campaign with the Stroke Association, the British Heart Foundation and Cancer Research UK, was that they all said to me that their view was that price was indeed a factor but they themselves thought that minimum unit pricing could almost be too simple an answer. That is why I always prefer, myself, to talk about price rather than minimum unit price. I do not want to labour the point but I do think no one thing will sort the issue out. I do want to leave the Committee with the view that I understand that price has an impact - because I do understand that very well. Forgive me if you feel this has been said before, but most people do enjoy a drink responsibly and it is important to put that on record. That is not the group that we are seeking to get.
Q12 Dr Stoate: We agree with that, and there is no problem with that, it is just that a minimum price actually would not affect to any significant degree people who are going to the pub, because it would not have an effect on pubs, and it would not have an effect on restaurants because they always charge more than a minimum price. It would only affect those who spend vast amounts of money buying very, very cheap alcohol. The majority of ordinary consumers of alcohol would be barely affected, if at all.
Gillian Merron: I would want to add - and it relates to Dr Stoate's earlier question as well - that the Home Office has commissioned further research on pricing, because I do think we have some gaps in our evidence about who it affects and what effect it will have, but I do want to emphasise that we have not ruled it out. We accept that price is an issue but that we also need to do some more work on this. I know that David has a view that he could perhaps add, if that would be helpful.
Professor Harper: Thank you, Minister. I was going to make that very point, that the Sheffield Study to which you allude of course provides a very substantial amount of information adding to the evidence base on the health impact of minimum unit price and other pricing measures as well. It does not go into the effects on other parts of the population, on other societal groups, on the economy, which in itself has a knock-on effect in public health benefits. The Home Office research to which the Minister refers that has been commissioned recently aims to fill some of those gaps, so that we can then seek the expert advice that brings all of these things together, so that we do not just focus on the one fairly clear course of action according to the Sheffield study but that we take into account the wider picture as well.
Q13 Mr Scott: Minister, good morning. One of the problems it has been said by some, not necessarily by me, is that the duty on spirits was frozen in 1997 and up to 2007. Do you think this freeze encouraged consumption?
Gillian Merron: I think it is hard to draw that conclusion, in all honesty. It is hard to know all the ins and outs about what develops greater consumption of anything in particular. We do know there is an impact where people have more money in their pockets, and a whole range of other factors. The thing that is interesting is that wine consumption has gone up by something like 40% and duty has also gone up. My only point is that I would find it hard to draw that direct conclusion, that it has encouraged consumption, because there is a whole range of factors that would need to be considered - and, of course, tax is a matter for the Chancellor.
Q14 Mr Scott: You do not think it was a mistake.
Gillian Merron: I am not suggesting it was a mistake.
Q15 Mr Scott: If the duty on spirits had increased at the rate of earnings, you would be looking at about £62 for a bottle of whisky, according to the statistics I have been given. Obviously that sort of price would affect people purchasing whisky. I want to say again that I am not sure that I would agree with whisky being £62 a bottle, but, nonetheless, if it were, do you think that would be one answer. If duty was increased, would this reduce consumption?
Gillian Merron: Going back to our further discussion, price does have an impact but it depends which group you are trying to get at and what you are trying to achieve. The fact is that the Chancellor will make a decision on duty in the light of information from other departments ---
Q16 Mr Scott: Probably not in the near future, I would guess.
Gillian Merron: --- including the Department of Health. Perhaps the thing I would like to emphasise in this regard to the Committee is that we are pushing hard to get health impact assessments more into the focus in other departments when they are making their considerations on any policy, and that does include the Treasury. Health is part of the impact assessment and does need to be considered and I think we need to do more work on getting it more upfront. That point I would certainly emphasise.
Q17 Mr Scott: Young people are being particularly badly affected by drinking alcohol and the problems that go with it. There is voluntary regulation of alcohol advertising. Do you think it is time that we ended self-regulation? Some of the adverts we see on TV or in cinemas are promoting alcohol in a way that makes it look fashionable, sexy - whichever way you want to put it - to drink their product. Surely self-regulation is not working.
Gillian Merron: I do not think we have a wholly voluntary system of regulating alcohol advertising. We have broadcast advertising, which is under statutory regulation and Ofcom deals with that, and then there are responsibilities with the Advertising Standards Association. Interestingly I am sure Mr Scott and the Committee will know that they have recently consulted more widely - we will have that review published in the next few months - about what more, if anything, needs to be done particularly in respect of young people. My concern is that, while we need to be proportionate in what we need to do, we also need to assess if young people are being made more vulnerable and whether we need to take greater action to protect them. There is a question in my mind that I would share but I am very much hoping that the consultation will deal with that. There are, of course, broadcast and non broadcast codes, as the Committee will be aware, and also Ofcom did tighten the rules in 2005. If there is more to do, I should be interested in what that is, but the judgment will have to be proportionate and the effective concern would be if young people are more vulnerable because of advertising.
Q18 Mr Scott: I do not know if you, Minister, have noticed, but over the last few months particularly - and I do not intend to promote any products and do their advertising for them - there have been certain commercials shown which make alcohol look fun, that it is great to be slightly inebriated or worse. In relation to the impact of that on young people, it seems to me that they are playing with the codes right on the limit. They are really playing it to the limit of what they can get away with within the current measures, and maybe, would you agree, they need tightening a little more?
Gillian Merron: That is what I think the consultation will lead us to and that is what I shall be very interested to see the results of. I understand the point, but I would like to be informed and I am keen to see the results.
Q19 Mr Scott: I have one final question. A witness to our inquiry stated that if every drinker kept within the recommended limits, the alcohol industry would lose 40% of its sales. Would you agree with that or not?
Gillian Merron: It is difficult for me to comment on the figure and how it is calculated. I am sure profits are dependent on a whole range of factors, including how much people drink, but I imagine in the trade it is not as simple as that. It is a bit difficult for me to comment on somebody else's suggestion.
Mr Scott: Thank you, Minister.
Q20 Dr Naysmith: Minister, welcome to our Committee. It is nice to have you here. You have said that you clearly recognise that the price of alcohol is something that has an impact on the consumption of alcohol. Then we went on to talk about government action recently. Alcohol now is cheaper than it has probably been for many, many years. Are you saying that reducing the price of alcohol, which is the major government action, has not had an effect on increasing the consumption of alcohol? You seemed to suggest that you did not accept that.
Gillian Merron: I was trying to express that a whole range of factors affect consumption ---
Q21 Dr Naysmith: I agree with that, but one of them must have been reducing the price of alcohol.
Gillian Merron: --- including how much money people have in their pockets.
Q22 Dr Naysmith: I accept that too. It is not logical, is what I am saying.
Gillian Merron: I do not think Dr Naysmith is suggesting this, but so that I am clear for the record: I am clearly saying that I do think price has an impact and it is one of a range of factors. If any one thing were that simple, the answer would be obvious about what we should do. The Committee knows at least as well as me, probably better, the range of complexities. Not everybody overdoes it, it is a fact, no matter what the price, and so there are other factors at play. My only point is that it is a fact, an important fact, which is why we are doing more work on it. We have not ruled out particular aspects of action, but we just want to get it right.
Q23 Chairman: Can we assume that when you, as the Government, get round to replying to our recent report on alcohol that some of the areas that you have just covered will be covered in that response?
Gillian Merron: Indeed. I hope the Committee has been kind enough to grant us a few extra days.
Chairman: Well, yes.
Q24 Dr Naysmith: We are going to move on to smoking now, where obviously there is a lot more talk that seems to be positive than when talking about alcohol. The ban on smoking in public places in 2007 - which had considerable support from this Committee, as I know you are aware, Minister - has generally been greeted as having been successful. Perhaps you could comment on how you assess the success departmentally. If you think the legislation has been successful, have any problems arisen as a result of it?
Gillian Merron: First of all, I should thank the Committee, always, for its interest and support. I think it has been a tremendous success. It is something I am very proud of. Compliance with the law has been very high from day one, with something like 95% premises reported free from tobacco smoke. The other interesting thing is the very high public support. I think that has been the key to it. Over 80% support. Of further interest for me is that the majority of smokers support the ban. An additional effect has been how many smokers have said the ban has encouraged and focused them to give up. When I go round the Stop Smoking Services, that is often what people who are about to quit or have quit tell me. It has been a huge thing. There are no real problems as far as we are aware. I am sure all honourable Members have had the same experience as me. There are some of our constituents who will never like it, and I understand we cannot all agree 100%, but it has shifted attitude and culture in this country and I think has opened the door for us to move still further to help people to give up smoking and protect young people from doing so. I would say there are no real problems as far as we are aware. Of course we have committed to review the law after three years, so that probably would be the time to have a more informed discussion about it, but we are not aware of any, no.
Q25 Dr Naysmith: You will be aware that at the time the ban was being considered - not at the time of the passage of the legislation, but while it was being drawn up - the then Secretary of State John Reid claimed to be quite worried about the fact that it would drive smokers back into the home. Is there any evidence that that has happened?
Gillian Merron: No, there is not - not to our knowledge.
Q26 Dr Naysmith: What has been the effect of the smoking ban on public houses? Have there been any deleterious effects that you have been able to measure?
Gillian Merron: Again there is no evidence of direct impact between the smoking ban and the pub trade - although the pub trade does have challenges, of course, and I am very aware of that. It is not the case that the ban has led to pub closures.
Q27 Dr Naysmith: Members of this Committee would say that the thing that hits them more is the lack of a minimum price for alcohol, but we have dealt with that.
Gillian Merron: I have heard that.
Q28 Dr Naysmith: With the ban on smoking in public places, smoking in homes and cars is claimed to be the main cause of passive smoking, with children being the group that is most affected. How could exposure be reduced for children whose parents smoke at home and in cars?
Gillian Merron: I do think it is a real problem, I have to say. Our recent strategy starts to move us on in addressing that, but, in the first instance, we are suggesting in there that we should work to take people with us. There is good reason for that. Where we have had success in this country with quite radical legislation - and I would go back to seat belt legislation, even - the public were ready. With the smoking ban I think the public were ready. We have had greater challenges on things like the use of mobile phones in cars. The reason I mention that to the Committee is that I am increasingly of the view that there is a right time to take people with you. There is a problem, without any shadow of a doubt, about the issue of smoking in front of children in cars and in homes, but we are seeking, in the first instance, to raise awareness, to give support and to encourage people. Again, I know Dr Naysmith is not suggesting this, but we should not jump to regulation in order to do that. I think we can make greater inroads as people become more aware. The measures that we have recently agreed in the Health Bill will move us on even further, with the banning of vending machines, the stopping of tobacco dispersal. All these things give a very strong signal and a different environment that takes the public with us. I think the public want that. Interestingly, in my own county, last October the National Smokefree Homes Conference was hosted by the county council and Lincolnshire Smokefree Alliance because they want to share good practice on promoting smoke-free homes, so there is also quite a lot of activity around this that we are keen to support and see.
Q29 Dr Naysmith: It is interesting that you say you have to take the public with you, you have to wait for it to be ready. I know you did not quite say that, but that is the implication. Around the time of the introduction or the run-up to the introduction of the banning of smoking in public places, there was not anything like an 80% acceptance.
Gillian Merron: No.
Q30 Dr Naysmith: It was more than 50% but it was not hugely above it. So the Government has to give a lead as well.
Gillian Merron: Yes.
Q31 Dr Naysmith: As well as waiting for public opinion.
Gillian Merron: I agree with that. It is also the case that we have to seek the right result. If we can get that by education, co-operation, and change in the culture where certain things are not acceptable, that is a far more sustainable effort than moving down a road that is, frankly, very hard to police and unwise to do so.
Q32 Chairman: Minster, the legislation was about smoking in enclosed public places. We have the bans in football stadiums and athletics stadiums up and down the land, and yet not in cars with young children in them, which could not be more enclosed. You have not thought at this stage about taking action in that particular area?
Gillian Merron: In the strategy it does refer to that, which is why I talked in answer to Dr Naysmith's question about going down a road of education, encouragement, support, and making people aware of the dangers in the first instance. What may be obvious to the Committee is not always obvious to everybody else, unfortunately. I do think we have to do that. I want to keep a very close eye on this one. The Committee is not suggesting we should go down a regulatory road, and we also, as a government, would not wish to bring in legislation that is impossible to monitor or police. That would be highly unsuccessful and it would not serve the purpose of protecting children - because that is, I know, what we are all interested in doing.
Q33 Dr Naysmith: You are talking about the Tobacco Control Strategy, A Smokefree Future. That says that smoking is a priority. Are you going to announce an implementation plan for this strategy soon?
Gillian Merron: Yes, we are.
Q34 Dr Naysmith: When?
Gillian Merron: It will be soon.
Q35 Dr Naysmith: How soon?
Gillian Merron: Very soon. Officials are working on that, to do it like a project plan with dates and actual achievements. We are very happy to share that with the Committee.
Q36 Dr Naysmith: This Committee has been touching recently on trying to ensure, when pilots and plans are introduced, that built into them is a way of measuring whether they have been successful or not.
Gillian Merron: Yes.
Q37 Dr Naysmith: This is really important.
Gillian Merron: I agree.
Q38 Dr Naysmith: You are well aware of that.
Gillian Merron: I do agree with that, yes.
Q39 Dr Naysmith: This is going to happen, is it?
Gillian Merron: Yes.
Q40 Dr Naysmith: Thank you.
Gillian Merron: That was a big yes.
Q41 Jim Dowd: Following on from that line on the Tobacco Control Strategy, this is the first time the Government has adopted harm reduction as a specific objective within the strategy. I wonder (a) how will you pursue that and (b) if you see any significant disadvantages or problems you might experience.
Gillian Merron: Perhaps I could start and then turn to David. There are three aims of our approach. One is encouraging more tobacco users to quit. The second is to improve and expand the NHS Stop Smoking Services. One of the things that people have said to me as I have gone round talking to them across the country is that the kind of support in terms of the means and the methods of support on harm reduction to them, and knowing what harm they were doing, has been hugely influential. I am sure Committee Members have seen that themselves. The third area is to provide more options for effective quitting and to improve the effectiveness of all the attempts. They are our three areas. Perhaps I could bring David in on harm reduction.
Professor Harper: Thank you, Minister. I think this is an approach that we have adopted in other areas, as you will know very well if you look at the drugs area. We talked a little earlier about Drink Aware and alcohol and the part that in that case industry is playing in supporting the charity Drink Aware to look at harm reduction. In relation to the difficulties, if you like, or the challenges, or the pitfalls, we need to have the strongest evidence base. We have to know as far as possible what will work and how it will work and what the possible ramifications of taking harm reduction approach will be. You could look philosophically, for example, at somebody becoming, in the drug sense, addicted to a lower risk drug and nevertheless reducing the harm. There is a great deal of interest academically and intellectually and philosophically around the harm-reduction approach, but we have seen this approach begin to pay dividends in other areas. We need to be clear here that we have an evidence-based harm-reduction approach, that it is driven by the clinicians, so that it is clinically led. That is very important, that we make sure that the right partners are engaged in the process.
Q42 Jim Dowd: Is there not a danger of diluting the central message, particularly with regard to smoking, which should be to stop. I would imagine that smoking five cigarettes a day is less harmful than smoking 20, but it is the act of smoking itself which is the primary cause.
Professor Harper: Absolutely. We are not advocating substituting that sort of approach, but if we look at harm reduction in a broader sense - looking at nicotine replacement therapies, whether or not people inhale smoke - that is, the evidence base would show, a major factor but we need to be careful that what we are substituting is not an unacceptable risk or a hazard in itself, so we have the Medicines and Healthcare Products Regulatory Authority looking very carefully at regulating nicotine replacement therapies.
Q43 Jim Dowd: I do not have the figures in front of me now, but I recall reading recently that smoking reduction is still least effective in the lower social groups, if you like. It is still disproportionately those who, paradoxically, are on the lowest incomes as well who tend to smoke more than their counterparts in other social groups. Is anything being done to address that?
Gillian Merron: Yes. I have to say this is the area that really concerns me a lot, having seen, obviously, that information. Whilst we have made great strides in the reduction of smoking, our strikes have been rather smaller in the groups to which Mr Dowd is referring. I have described it as unjust and unfair that we almost condemn groups to early death and bad health by not putting in extra support. Part of the work of the Stop Smoking Services is to be working to reach those groups much more effectively than we are doing. We have made good progress in reducing the numbers of smokers, without a doubt. We are making good progress on reducing the number of young people who are being recruited to smoking. The real focus has to be the groups that we are finding it harder to get that message across to and why. Again, I know from my own visits to the Stop Smoking Services how they are doing that by working, for example, in workplaces. They are taking it to people, rather than expecting people to come to them. The Committee will have seen Stop Smoking shops opening up on high streets, in locations were people can just go in and not be frightened to go in. We are going into a whole new realm now, but I do very much want to assure the Committee that I have a huge concern and need for action on that group, yes.
Q44 Jim Dowd: Finally, I accept the point you made earlier about the need to carry people with you wherever you can.
Gillian Merron: Yes.
Q45 Jim Dowd: Assuming that unfolds at a reasonably optimistic rate, when do you imagine the Government will move to the ultimate conclusion for all the processes that it has followed, not just of this Government but of its predecessors, and ban smoking altogether?
Gillian Merron: We have no plans to ban smoking.
Q46 Jim Dowd: I did not ask you if you had any plans to do it, I asked you what calculation you would make of when a government of any kind would move to that.
Gillian Merron: I think I will stick to my original answer. Thank you for the invitation.
Q47 Chairman:
Could
I pursue this issue about medicinal nicotine products. My time of looking at tobacco as a Member of this
House remembers that back in the 1980s we banned a product which was called
Skoal Bandit. It was a pouch of tobacco that
you put into the mouth, next to the gum where the receptors made it easier to
get it into the system, so the nicotine got in quickly. That was banned. There is an argument - and this has been put
to me not in Committee but on a number of occasions - that the nicotine
replacement products that we have now do not have the strength that is going to
satisfy the 30- or 40-cigarettes-a-day individual. The industry that supplies these medicinal
products and presumably licences them - and maybe this question is for you,
David, rather than the Minister - says that they would be reluctant to increase
the strengths of these products on the basis, potentially, that it could addict
somebody to nicotine - but obviously not through a cigarette - which is where a
lot of the harm-related things come from. Where is the debate on this at the
moment in the
Professor Harper: You are absolutely right, is the first thing I would say. I was talking earlier about harm reduction, and the situation you have just indicated, of keeping something in the mouth, was substituting - though probably, at the time, with good intention - an alternative that was clearly demonstrated to have an impact on mouth cancer and those sorts of things. It is very important, as I said earlier, that we have to be very clear - as clear as we can be, recognising that we will probably never have complete information - that the evidence base for harm reduction is as good as it can be, so that we do not inadvertently create a risk in trying to address the main risk on which we are focused. As far as the Department is concerned at the moment, we are looking right now at a smoke-free future. The sort of areas you are indicating in the complexities of social policy formulation in behavioural change - looking at the academic approach, the intellectual approach, and to creating the environment in which we can have behavioural change - are at the heart of the Smokefree Future strategy. Where we are right now is having published this month a Smokefree Future. We will have an implementation plan, as the Minster indicates and discussions on issues such as nicotine replacement therapies will inevitably form a part of our broader investigation.
Q48 Chairman: It will be the strengths of those therapies.
Professor Harper: Amongst a whole range of other issues.
Gillian Merron: It is their effectiveness, obviously, that we are keen to secure.
Professor Harper: Rates of absorption, the access to nicotine and all of those sorts of things in harm reduction terms are vitally important. I could not agree more.
Q49 Sandra Gidley: The Government says that it plans to insist that cigarettes can only be sold in plain packs. I can remember that during the Health Bill the Government resisted amendments which sought to do exactly this, so why was it wrong during the passage of the Health Bill and why is the Government keen to introduce plain packs now? What has changed?
Gillian Merron: The situation is not quite as described. I said during the passage of the Health Bill that we do feel there is a role to look at what the effect of plain packaging would be. The strategy clearly states that we want to develop the evidence to make sure that that is the right route to go down, so there is a huge amount of interest in pursuing it and it will be pursued. The resistance in the course of the Health Bill was simply on the basis of evidence. The principle and understanding of the point being made was, I remember, taken onboard, and that is reflected in the strategy. I think we have moved forward on it, because we have said how we are going to be taking it forward because there is thought that attractive packaging is almost the last bastion perhaps of advertising. We have already shown our direction of travel, but I also - as we do in all things - believe that it is absolutely crucial that we have the evidence that we will get the effect that we want if we are to pursue plain packaging, but I can certainly assure the Committee of the action that we will be taking in that regard to seek the evidence.
Q50 Sandra Gidley: The tobacco industry were very against the proposals, which makes me think that they probably are a good thing. The argument they were using was that counterfeiting would be easier. How would you respond to that? How are those claims going to be investigated?
Gillian Merron: I do not share that view. People who do counterfeit cigarettes are ingenious and are perfectly able to replicate fancy packets, so I do not buy that. The Committee will know that we are working very closely with HMRC to continue what I think is the very good progress that we have made in cracking down on illegal cigarettes, because that is another huge area. We have electronic devices available to customs officers and trading standards enforcement officers for this very issue, this very point. So, no, I would share the Committee's view that it is not the case that plain packaging would aid counterfeiting. I think that is a bit of a red herring myself.
Q51 Sandra Gidley: On a slight change of tack, the Committee has received representation that British American Tobacco is blocking public access to information held at its Guildford Depository. I wonder if the Minister would investigate this case and, if appropriate, insist on full public access.
Gillian Merron: If it is correct, then it is, indeed, very serious, there is no doubt about that, and I certainly will give a commitment to the Committee to investigate it. I am very happy to report back as well.
Sandra Gidley: Thank you.
Q52 Chairman: Maybe we could give you the letter that we received from Professor Haines at the London School of Hygiene and Tropical Medicine.
Gillian Merron: Yes, please.
Q53 Chairman:
That
goes into some detail about why they think the changes are taken down in
Gillian Merron: Thank you.
Q54 Dr
Taylor: Minster, just before we leave smoking, I am
slightly surprised that, in talking about harm reduction and the evidence of
success of the ban on smoking in public places, you have not mentioned the
reduction in the incidence of heart attacks.
Professor Harper, as Director General of Health Improvement you
hopefully have some figures that we could have on the reduction of the
incidence of heart attacks. They were first reported in
Professor Harper: I do not have them to hand, but we could provide information to you.
Dr Taylor: To me, it is the most important effect of the ban. You ought to, I believe, have those figures and blazon them abroad, because they are absolutely crucial to the whole measure.
Dr Naysmith: There are some figures from
Q55 Dr
Taylor: And figures from
Gillian Merron: I will bring Clara in to add detail, but certainly the work on obesity you will not see that of any less priority. As I said in answer to the very first question, it is how we do things, not the results. Our only interest is in what results we achieve and the challenge of obesity is without doubt upon us. I will ask Clara to talk about some of the detail that we do, if that would be helpful.
Ms Swinson: As Dr Taylor says, there is obviously a big health reason for doing work on obesity but government action needs to be across all departments really, and the cross-government obesity unit has a governance mechanism that includes departments such as Transport, Local Government, Children, Schools and Families and many others crucially, and I think that over the last two or three years, since the publication of the Foresight report and the understanding across government that action might not immediately seem to have an impact on obesity, the understanding that it does have an impact on obesity is much stronger, so we see a very good partnership with the Department for Transport on active travel, on walking and cycling schemes; really strong work with Children, Schools and Families on the Healthy Schools programme, school food, PE and sport; and really encouragingly, not just at a national level, work with DCLG through the indicators for local authorities. Over 100 local authorities have individually chosen the obesity indicator as something on which they want to take action locally. It is a cross-government central programme, but local authorities and PCTs also working together.
Q56 Dr Taylor: We can be reassured that that cross-party working is going to continue.
Ms Swinson: Yes, you can.
Q57 Dr Taylor: Thank you. On a change of tack, the Richards Report on top-up fees was really quite revolutionary because it allowed people to contribute to their healthcare without losing NHS rights. Does the Government believe that the same could perhaps refer to people who want to contribute to the treatment of obesity, thinking particularly of bariatric surgery, for which facilities are relatively limited? Is this something towards which individuals might be able to contribute financially?
Gillian Merron: We do not have any plans in that way. I think our focus is very much on helping people to reach and maintain a healthy weight. That is the important thing. Again we keep our focus on really what works and what is going to support people.
Q58 Dr Taylor: You have no thoughts that way at the moment.
Gillian Merron: No plans. Could I just add on the previous question that one of the reasons that the work will continue is that is the most effective way the Government can work.
Dr Taylor: Thank you.
Q59 Dr Stoate: Given Sir Michael Marmot's recent report on health inequalities, he did focus to some extent on obesity in particularly disadvantaged communities. What plans does the Government have to introduce specific measures to try to introduce health inequalities amongst obesity, particularly in disadvantaged families?
Gillian Merron: It also links, Dr Stoate, with the earlier question about smoking, that smoking is the big cause of disadvantage - which is shocking and not to be left alone, I should add. The first thing on Professor Marmot's report is that we very much welcome it. We are very keen to go through it to see what more we can do. My second point would be to say to the Committee that I am deeply conscious that we need to do more and there are some areas in which we are already doing more. Perhaps I could mention those. One, of course, as the Committee is aware, is that Spearhead areas receive extra funding to do the work of tackling disadvantage. The second area is that national support teams are focusing on performance improvements, actually working in local areas to find out what more they should be doing. Third, we have local initiatives, in which I am also very interested. In the North East, with Change4Life, we have convenience stores actively being encouraged - we are supporting them - to put in more fresh fruit and veg in a way that was never seen before. They are the kinds of things that are going to start making a difference, but I am in no doubt that we need to do more and Professor Marmot's report will assist us.
Q60 Dr Stoate: There are particular issues around childhood obesity. Recent studies of childhood obesity show that if we do not do something about the entire family unit then the evidence is that children do not lose weight. What can we do? What is the Government proposing to do to support entire family units in terms of weight loss, so that we can tackle this hugely difficult problem of childhood obesity?
Gillian Merron: I very much share that
view. I visited the Amend scheme in
Ms Swinson: I fully agree with the Committee. Part of the NICE Guidelines on the prevention and treatment of obesity is that for children it has to be seen within the family unit. You cannot take action just with the child. Going back to what we were saying before about cross-government action, one of the reasons that we are working very closely with DCSF and the Healthy Child Programme is that that is a programme that looks at the health of the child within the context of the family. There are reasons why we might separate out and particularly focus on obesity, but there are also reasons, working with low income families and families at risk, where you need to see the family with a range of risk and not just work with that family on one particular issue.
Q61 Dr
Naysmith: To follow up on very obese children and
children who are heading for really serious obesity problems, there are some
rather startling things emerging in this area. For instance, NICE guidelines
suggest 18 is the minimum age for the kind of bariatric surgery that Richard
was talking about a little while ago and in
Gillian Merron: The NICE Guidelines do not specify an age but they do specify an intent. Obviously under 18s would only be in exceptional circumstances. My general comment would be that it has to be a decision of a clinician about whether a patient undergoes surgery, but exceptional circumstances cover a whole range of things, including whether somebody is nearly at physiological maturity, what their BMI is, so certainly it is not an area of normality to look at under 18s nor is it an intent.
Q62 Dr Naysmith: But it does underline this real seriousness of this problem, that we are sitting here talking about something that just did not happen ten or 15 years ago: bariatric surgery for 16 year olds and possibly even younger, in line with your answer.
Gillian Merron: Yes. I know the Committee has welcomed, as we have, that we are seeing signs of childhood obesity levelling off, but that is why the actions that we have talked about and many others across departments are going to have to continue and to move up, otherwise we will face a situation that is totally uncontrollable, which is not where we want to be. And we are talking about something preventable, of course.
Q63 Dr Naysmith: Of course.
Gillian Merron: I always remind myself of that. That is the very essence of public health.
Q64 Dr Naysmith: That is what I meant when I said this was unknown ten or 15 years ago.
Gillian Merron: Yes, which is why the new approach is investing differently and we are trying to be very inventive and effective in our means across departments.
Dr Naysmith: Thank you.
Q65 Sandra Gidley: The first thing I see when I go into my local hospital - it is the first thing all patients see unless they go into A&E is Burger King. Sky News reported that out of 170 NHS trusts 40% of them rent space to chains such as Burger King, Starbucks, Subway, what are generally regarded as fast-food outlets. You also see vending machines all over the place. Other government departments have tackled the problem, for example, in schools. Why has the Department of Health just ignored this opportunity to send more positive health messages out?
Gillian Merron: We do send messages out and we do have expectations that we are clear about. These are decisions, as the Committee will know, that are made by the NHS locally. We do not collect the information centrally, so I cannot tell you in all honesty how many have Burger King and how many have Starbucks.
Q66 Sandra Gidley: This is a bit of a fudge, though, because you could have said exactly the same for vending machines in schools, that the decision is made locally, but the Department of Education, as it was at the time, brought in measures to stop that. Is that not just a bit of an excuse.
Gillian Merron: The vending machine industry will be glad to hear me say this, so I hope it is on record. It is not the vending machines themselves, obviously, it is what is in them and, secondly, it is the choices that people make of what is within them. Our requirement of the NHS locally is that they make more available - and they do have a responsibility to do this - healthy and nutritious food, not just for visitors but for patients and staff as well. What I would say is it would be hard for any NHS organisation now to justify entering into a new contract with a fast food restaurant, without a doubt. NICE did publish guidance in 2006 for the NHS about tackling obesity, and it did include recommendations about what the NHS as an employer should do in terms of healthier choices. The other point, of course, is that if a contract has already been entered into - I am afraid I cannot comment on when it is the case - but, obviously, an NHS hospital is not likely to use its public resources to get out of a contract that perhaps now it would not enter into afresh. I think it is about looking forward, about how we encourage, and I do see healthier food than I used to see in hospitals - there is no doubt about that - and there is more room for improvement.
Q67 Sandra Gidley: The problem is if there is a Burger King downstairs, they do not eat the healthy food, they just go and frequent Burger King. You are saying it will be voluntary and the Government have no plans to actually say this is wrong, we should not do it at all, with increasing financial pressures.
Gillian Merron: No, we have been very clear about what responsibilities are on local NHSs, without any doubt, but, as I say, some of the contracts will be existing ones that they would have to buy their way out of, and I do not suppose the Committee is recommending that. The thing I would say is that I would be surprised if you saw any new contracts with fast food restaurants.
Q68 Sandra Gidley: Can we move on. You have covered, to a certain extent, the Marmot Review and I think you said you hoped to look at it.
Gillian Merron: We will look at it. We are looking at it. Let us go further: we are, not hope.
Q69 Sandra Gidley: I was a bit worried you had not started.
Gillian Merron: I am sorry; we will; we are.
Q70 Sandra Gidley: Are you yet in a position to say whether you will fully implement the findings?
Gillian Merron: We are looking at the Marmot Review and it is going to be a major contribution. It would just be premature and not very honest for me to say that we would implement everything, but there is no doubt we are looking to it to assist us to do more, and we are happy to keep the Committee informed on that.
Q71 Sandra Gidley: To play devil's advocate for a moment, money is going to be tight. What justification is there actually for continued investment in addressing health inequalities: because the latest of review of PSA 18.2 shows that the inequality gap has not actually reduced? Are we not just chucking money down the drain in trying to do this and could it not be better spent?
Gillian Merron: On health inequalities? No. I think we have got a responsibility.
Q72 Sandra Gidley: But if it is not working.
Gillian Merron: We had a debate in Westminster Hall a few months ago. The challenge is without a doubt upon us, because, for example, life expectancies are going up. They are going up for everybody, but they are not going up as fast for those who are in the more disadvantaged groups as for those in the more advantaged groups, and that is why we continue to see the gap. I know that this was not being suggested directly, but it is important to put on record that it is not that disadvantaged groups are not seeing increases in their health and longevity - that is happening - but it is not quite at the same rate, and that is the challenge. Everyone is going up, but the gap is still our challenge.
Q73 Dr Naysmith: Actually not all the groups are going up; it is the average going up. There are some individuals in this core to whom it does not apply. They tend to be the really morbidly affected ones.
Gillian Merron: Yes, but talking in general terms, and I do take that point, when we are talking about groups the movement is there. David perhaps might have a comment.
Professor Harper: I think it is exactly the point that we have to be careful, as you all know very well, not to just focus on the gap itself because there are lots of ways of reducing a gap, some of which, of course, we would not consider. If we are looking at an increasing gap, we could reduce the gap by reducing the health of the majority of the population. That, of course, is not what we would choose to do. We need to keep a very careful eye on how we can improve the health of the more disadvantaged groups, exactly in the way that Michael Marmot is suggesting in his report, but there is clearly a gap, and just because we have a gap, it is not, as it appears on the surface from what you say, that our policies are not working. That is not the case. There are lots of reasons for that gap being there and for being maintained or even increasing, but that is not a reason for not continuing to invest in the inequalities agenda.
Gillian Merron: We would be putting in additional efforts and resources. I mentioned in answer to an earlier question the National Support Team for Health Inequalities, who are working closely with each spearhead area, who are also getting extra resources.
Q74 Dr Naysmith: You will remember, Minister, the report on health inequalities that this Committee produced. We were very critical in that report of the Department's inability to assess properly its programmes to reduce inequalities because it did not collect the baseline data in order to produce comparators that were necessary to make the appropriate conclusions. Has anything changed since we published our report?
Gillian Merron: My own feeling is that it is not so that we are unable to assess progress on health inequalities, because I think that is actually crucial to our work. In terms of change, perhaps I can offer a few things or, perhaps, rather than change say these are reassurances, I hope. First of all, national targets have been set with timeframes, but also we do regularly publish progress against these targets, which does shine a light on where improvement needs to be made, and that is as soon as possible following the release of information from the Office of National Statistics, and we have also published inequalities data across a range of other measures in our health inequality status reports, and they have been overseen by a scientific research group which has been chaired by Professor Marmot. We are not shy to shine the light and, to be honest, it often is not very flattering, but that is okay because I think that reminds us of where we have to go. So I am not afraid of that. I think that is important to say.
Q75 Dr Naysmith: You are quite right. In your response to our report you did say that you rejected and disagreed with what we said. However, you did go on to say that you welcomed the Committee's practical suggestions to help improve policy design and align it more closely to the best available evidence. I am just making sure that you have taken those things into account in the design.
Gillian Merron: We are just having a discussion here. I am sorry; I apologise.
Professor Harper: Could I ask you, please, to repeat the question? I do apologise.
Q76 Dr Naysmith: The Minister is right that when we made our criticisms in our report you did say that you disagreed with us, but then you went on, after disagreeing with us, to welcome the Committee's practical suggestions to help improve policy design and align it more closely to the best available evidence, and you said you were committed to referring the Committee's recommendations to the Scientific Reference Group. I imagine you are a member of that group.
Professor Harper: Yes. Could I say I think there is a general point
here, and that is that, as far as we are able to, in line with codes of
practice, not least from within the Department's own research and development
directorate, it is an essential requirement - if it has not been all the
time, it certainly is now - that programmes that are funded are set up and
designed so that they can be properly evaluated, and that does not apply just
to this area, it applies to all of the research and development and the
programmes that we are setting up. That
is a general requirement of the code of practice for research, not only within
the Department of Health, but, I am sure, across
Q77 Dr Naysmith: That is very good and I am glad to hear that, but one of the things we were critical of was the Healthy Towns initiative, because it was designed in a way that it could not be assessed. They were doing different things in different towns and not proper control groups. Have you changed anything as a result of that criticism?
Ms Swinson: Since the report we have done two things on Healthy Towns. One is there is a national evaluation which will compare the towns, and I believe that has gone to Queen Mary's. Anyhow, through the Policy Research programme we have commissioned that national evaluation. Also, we asked for each of the nine healthy towns to come up with their own evaluation plans, importantly, including their baselines, before they put their interventions in place. As you will know, there is a range of robust types of evaluation. For an evaluation of what goes on in one town, it will not be as strong as a randomly controlled trial because there is not another town the same as Deptford, or Manchester, or any of our healthy towns elsewhere, but what they should be able to do is have a baseline, know what interventions they are putting in place and know what difference they have made, and, in addition to that, we will be able to compare and draw out lessons between the nine healthy towns.
Q78 Dr Naysmith: It is nice to know that our report had some influence.
Gillian Merron: But of course.
Chairman: Some.
Q79 Dr Naysmith: Some! Finally, one of the other things that we criticised at the time was asking the participants if they feel that things are better as a result of the Government programme. We said that was not really a useful way to evaluate things. Do you want another chance to defend that?
Gillian Merron: I do not share that view. If it was the only measure, fair point, but it is not the only measure. If you are asking about people's emotional or mental well-being particularly, I do not feel that is an unreasonable question. If it were our only measure, I would be absolutely signed up, but it is not our only measure. Clara, perhaps you could add on that.
Ms Swinson: Just to agree with what the Minister has said, depending what we are evaluating, there will be a range of questions, and in some it will be appropriate to ask how people feel it has made a difference, but it certainly should not be the only thing that we base an evaluation on.
Q80 Dr Naysmith: One of the things that might have been a problem with it is that people were not always quite sure what was being referred to when you were referring to the programme.
Gillian Merron: That is a fair point; yes.
Dr Naysmith: Fair enough. Thank you very much, Minister.
Q81 Jim Dowd: The Food Standards Agency - I am lead to believe there are those in the Food Standards Agency probably even listening to what we are saying now - found that people were eating as badly today as they were ten years ago, despite a lot of effort from a lot of agencies to try to change diet. It has been entirely unsuccessful. Certainly the evidence seems to indicate that. Why do you imagine that is and what can be done to improve matters in this regard?
Gillian Merron: Just some initial comments from me and then I will pass to Clara on this. Rather like earlier conversations that we have had in the Committee, there is not one thing that will sort this. We are talking about information, we are talking about advice, we are talking about support and we are often challenging how people do things. I think now people are seeing more information in a form that they can use, and we want to improve that further, and that is part of the FSA's work. We are encouraging people, if you look at our Change4Life work, to take small steps and encouraging them that that will mean a bigger result. I think people need to be encouraged in that direction. There is more choice available - that is for good and bad - in terms of eating. As I mentioned earlier, the school fruit and veg scheme, which I think does equip youngsters to have a much better sense. I see the work myself, as I know you will do, in Sure Start centres. Again, that is very long-term; that is doing that with the Early Years children and their families, with vouchers available, as the Committee will be aware, for healthy foods for low-income families. All of these encourage people to make the choice. In fact, I was at the FSA who had a launch yesterday of their strategy for the next few years, and, of course, that is going to be very important in terms of making a change. Change4Life, for example (and I am not trying to put everything on it) has actually only been there for one year and has made an impact because, I think, it is saying things in a way that people understand. It is not having a go, it is not even telling them what to do, but it is inviting them to understand and know what the consequences are if they do not. "Eat well, move more, live longer" seems to me very straightforward and understandable and it has been in place for one year, aimed at younger families. Now we are moving on to adults because of the success. There is an element of finding out what works, but Clara, I know, can add detail to that.
Ms Swinson: Thank you, Minister. In terms of healthy diet, I know that the National Diet and Nutrition Survey points out some improvements and some things that have got worse. I know, for example, there are reductions, not huge, in saturated fat intake and in sugar intake, so it is not a universal picture that this is worse, and they are two things that the Food Standards Agency has particularly focused on.
Q82 Jim Dowd: Was that a reduction in consumption or a reduction in saturated fats as an ingredient?
Ms Swinson: The FSA measure - sorry to get technical - the percentage of saturated fat or sugar as a percentage of overall energy intake.
Q83 Jim Dowd: What I am asking is are people deliberately eating less of that or is it because the products actually have less in them?
Ms Swinson: Certainly there is good evidence about reformulation, about there being less saturated fat or salt in individual products. The other interesting fact that we can see some of is the actual sales data. There is data showing a reduction, for example, in the number of sugary drinks, a reduction in the purchase of white bread versus brown bread, and so on. It is good to see both the FSA survey and also what we can see from the sales data from the big retailers.
Q84 Jim Dowd: Is not part of the problem that people just do not regard it as the Government's job to tell them what to eat? Is that not a difficult message to get across?
Gillian Merron: It is not our job to tell them, it is not our role, even though some would like to paint us in that role, but we absolutely have a responsibility to give people information, advice and support and advise them of the outcome, negative and positive, of their actions.
Q85 Jim Dowd: The argument is that we give them as much information as possible ---
Gillian Merron: It has to be in the right form.
Q86 Jim Dowd: --- and you hope that they will make a rational and intelligent decision. They may not.
Gillian Merron: No, they may not, but that is where information on its own is not going to work. Support through weight management programmes, for example, helping people to not just learn about how to eat healthily, it is why you should do it. I think that is the thing: that people know why it matters. I sometimes think that a number of us take it for granted that everybody knows, and they do not. The Government's role is not to tell, it is not to hector and it is not to direct, but it is to guide and it is to support, and actively support. It is not about eating but if I think about our "stop smoking" service, what better example of the NHS actively preventing ill-health than working with you to support you in a way that you are four times more likely to quit, for example; and that message goes out in all our other areas too.
Q87 Jim Dowd: I accept that, but if it is just being so ineffectual, would it not be better to save the money spent on these campaigns or spend it on something which is likely to have a greater effect, because it seems to be having no effect to date?
Gillian Merron: Change4Life is having an effect. As I mentioned earlier, in its year of existence it is changing behaviours and we are seeing childhood obesity levelling out. It is not the case that no improvement is being made, but we are back to the discussion about the scale of the challenge before us and the complexity and the need to attack the challenge on many different levels, without a doubt. I think if we did nothing, you should absolutely be criticising us. I think that would be a dereliction of duty on behalf of the Government.
Q88 Jim Dowd: At least you would not be wasting money.
Gillian Merron: I do not accept we are wasting money.
Q89 Dr Taylor: I forget how long ago it was that we did the obesity inquiry, but it was certainly a long time ago, and there we were feeling very strongly that the traffic light system should be pretty well enforced as possibly the most useful. We have got some information from the Food Standards Agency, I gather, that says that a growing number of supermarkets and food manufacturers are using the traffic light labelling on their products. Do you have any figures or details about this, and does the Government plan to make traffic lights compulsory?
Gillian Merron: First of all, our commitment is to work with the food industry. This is the important thing for me, going back to the previous discussion about understanding a single front-of-pack labelling approach, but on a voluntary basis. That is where we would like to get to. Next month the Food Standards Agency Board are looking at the outcome of a consultation with stakeholders and citizens' forums about how that kind of label can be delivered, and so we will be seeing the results of that. A general point on nutrition labelling. It is an EU competence, and at present we do not have the ability to make a form of front-of-pack nutrition labelling compulsory, but our job, I think, is to get the right result in the interests of the consumer, and we are very committed. I do want to see that simple straightforward approach on the front of pack without any shadow of a doubt.
Q90 Dr Taylor: Minister, you have mentioned labelling on alcohol. Is that just going to be a message like on cigarettes, that excess alcohol kills, or is it going to be a calorie count? Could you give us some details about that?
Gillian Merron: The consultation is covering a whole range of options. In terms of labelling, there is also a number of things. I will just ask David to re-clarify.
Professor Harper: Thank you, Minister. As you will be aware, last week we produced the information on the second report on monitoring how industry is complying with the voluntary requirement to put health labels on alcoholic drinks. We published alongside that (and this is just last week) the document to which the Minister refers, which sets out a range of options all the way from an enhanced voluntary system through to considering the possibility of a mandatory system for including that sort of information on labels on alcoholic beverages.
Q91 Dr Taylor: Moving on to the Healthier Food Mark, we have had some real criticisms of this from Which? They reckon that, of the bronze, silver and gold, bronze is actually almost lower than establishments are carrying out already, and they say that this will directly conflict with other initiatives, like the Food Standards Agency's salt reduction targets, and it is so easy for people to say they fulfil the bronze criteria. Can you comment on this? Should we banish the bronze criteria and just have silver and gold?
Gillian Merron: That would be good at the Olympics!
Q92 Dr Taylor: We are coming on to the Olympics, do not worry.
Gillian Merron: What I can say to the Committee is there have been concerns, so we have actually reviewed the entry level on the bronze criteria. We have done that.
Q93 Dr Taylor: So you might be going to tighten that up?
Gillian Merron: Yes. We are not going to abolish it. There are different percentages, whether you talk about bronze, silver or gold, and when we have talked to people like the Food and Drink Federation and the British Hospitality Association, they are keen there is a lower level entry point, because they want to encourage good practice, they want to encourage people in so they can then shift up, but we do understand that the revision of raising the bronze level criteria is important.
Q94 Dr Taylor: Is the idea that if we go into a posh restaurant each item on the menu will be marked as either bronze, silver or gold? Is that the idea?
Ms Swinson: On the Healthier Food Mark it is focused on public sector provision.
Gillian Merron: It depends where you eat!
Ms Swinson: We know that the public sector provides millions of meals every day.
Q95 Sandra Gidley: The House of Commons!
Ms Swinson: It would include the House of Commons canteen. We are piloting it in a range of public sector environments.
Q96 Chairman: Could I just ask a supplementary to that? When we were doing our Health Inequalities inquiry you announced a pilot scheme. We were taking evidence, one of them from the celebrity chef Jamie Oliver, about take-aways and the lack of information when people go into fish and chip shops, or Chinese take-aways, or Indian take-aways, where there is no guidance whatsoever in terms of what the food is cooked in or anything else. How is the pilot going and when do you think you will have some evidence from it?
Ms Swinson: You are quite right that the Food Standards Agency have been not just focusing on the retail sector but on take-aways. I think we would need to get more information from the FSA about how that pilot is going.
Q97 Chairman: Can I ask you to write to the Committee about how that is going and whatever evidence you are finding?
Gillian Merron: What we do know is that there are chains who are now (and you can see when you go in) putting calories up, which we have not seen before; so we are seeing progress.
Q98 Chairman: Minister, that has always been the case. I have from time to time eaten in fast food outlets and you have been able to get healthy options, and all sorts of things, for many years in some of them now. These are the issues of the stand-alone shops in our communities that have got them every other shop on occasions. It was put to us: do not be surprised if people in the communities that we have been describing earlier eat take-away food all the time if that is all there is for sale and not fresh food shops. It is an issue that I am sure this Committee, under any guise, will want to pursue in years to come around this whole debate, so if you could report back to us I would appreciate that.
Gillian Merron: Of course.
Q99 Dr Taylor: The Government aims to get two million people more physically active by 2012. We want to know if you are on track to meet this, and how is it being measured? We have just had a communication. Getting two million people more active and doing more sport was meant to have been a big part of the Olympic legacy. Within the two million, getting a million people more sporty is Sport England's responsibility under the DCMS, but getting a million people more physically active now falls under the Department of Health. How are you going towards meeting the Olympic legacy target?
Gillian Merron: First of all, it is not just health and not even just DCMS who are responsible, it is across a whole range of departments. We have got, for example, a Physical Activity Programme Board that is co-chaired by the Department of Health and DCMS, but there is representation there from other departments - CLG, DfT, Defra - Sport England and the Physical Activity Alliance, and the job of that Board is to oversee the wider physical activity programme. The first full year's data will be published next month; so I will make sure the Committee has that. It is probably interesting to note that from last year Sport England's Active People survey extended it to cover a wider definition of physical activity, which actually, I think, is right. It was including things like dance, active travel (so if you were cycling, et cetera) and I think it is right that we encourage people's activities. We are seeing an increase, but the proper answer to you will be available next month and, as I say, I will make sure the Committee has that.
Q100 Dr Taylor: It is very easy to set these targets but it is very difficult to measure success. At the Olympics, obviously, we can measure success with the medal tally, but the people we are thinking of much more are the ordinary people who are not Olympic athletes. How are you going to measure that they are getting more physically active?
Gillian Merron: I will ask Clara to comment on the detail. For me the Olympics, the medals are very important, and sport is very important, do not get me wrong, but this is our chance to use it to inspire people to change how they live in the way we have been talking about. If people walk a few extra of the bus stops that they might have stayed on the bus for, that is a good thing. If they start doing dance classes - and the Committee will know about our promotion on Dance 4 Life - that is a great thing too. It is about getting people to do those steps that will make the difference, but Clara can comment on the actual detail.
Ms Swinson: As the Minister indicated, the Active People survey will be the baseline for this measure, and so the data published next month will be the baseline year and that is how it will be measured. To get two million people more active we need to do that across all social groups; we cannot just do that through focusing on one social group.
Q101 Dr Taylor: When you survey people you are going to ask them how active they are, are you, or is there going to be some better way, because we will all exaggerate and say, "Yes, we walked ten miles to work", will we not?
Ms Swinson: Yes, we do.
Gillian Merron: We certainly do.
Q102 Dr Taylor: You are going to tackle that?
Ms Swinson: The Health Survey for England that was published in December showed both self-reported activity levels but also some levels done through giving people an accelerometer, and it did indeed show, as we expected, a disparity between reported levels and those that people actually did; so when the Active People survey is published we would need to look at what measures they are - I am afraid I do not know - and we can provide that to the Committee.
Q103 Dr Taylor: Going back to the Healthy Towns initiative that we
have just talked about, on various inquiries we have visited the Netherlands
and some of the Scandinavian countries that are far better geared up to cycling
than we are. They actually have
cupboards that you can put your bicycle in and lock it away safely out of the
rain. In this country the cycle tracks
are still an absolute joke, are they not?
You are on a cycle track and it suddenly ends, and then you are in real
trouble. Are you really going to make a
difference and make it easier for people to walk? You have only got to try and walk round
Gillian Merron: I am just reminding myself: I went to Enfield not many weeks ago to promote the fact that we had just given extra resources to a group called Living Streets, who do that exactly, as you are speaking, that very point. They take school children, members of the local community out in an area and with open eyes say, "What is it that is blocking us from walking?" and then they take the steps, talking to the right people, paying for it if necessary, to change the environment. The environment hugely matters. I was quite intrigued to go out with the youngsters and at what they saw. In fact, when they explain it, you suddenly do realise that the condition of the pavement or where parking is taking place makes it more attractive or less attractive to walk, particularly as a youngster going to school. That is the kind of work we are doing. Also, some of the points you make, of course, show the importance of working with DfT and their promotion of safer cycling, which indeed they do.
Dr Taylor: It is usually a huge great dual carriageway in the way that you have got to get across, is it not? At least you are addressing it.
Q104 Mr Syms: Teenage pregnancy: the Government have a target to reduce under-18 pregnancies by 50% by 2010. Government press releases have started to describe it as an ambitious target. Are you confident you are going to meet the target? If not, how much is it going to be missed by?
Gillian Merron: Our intention with targets
is they are not there for their sake; they are there to guide the work. I met with my colleague minister in DCSF on
this very matter and the thing we actually agreed on, the biggest change we can
make, is what we were discussing this week, which is about the education that
young people receive in schools. That
will be the single biggest shift that we can equip young people with. In addition, there is a reduction in
conceptions amongst younger people, which is welcome, and that is also, in
part, due to our investment in contraception, the improvement of sexual health
services and their availability. I
opened a new place in
Professor Harper: Just a brief comment. Since the start of that strategy, teenage conception rates have dropped by a little more than 10%, which I think is important, and that has reversed the trend prior to the start of our strategy. We are now just embarking upon the consultation process to take us into the next phase of the strategy. There was a ten-year strategy which is very shortly to come to an end, and, in fact, just a few weeks ago, the Minister and the Chief Medical Officer gave keynote presentations at a big consultation conference jointly organised by the Department and the Independent Advisory Group on Sexual Health and HIV, which is, as you know, chaired by Baroness Gould. The intention is to listen to as many good views as we can get at this stage and to build the strategy for the forthcoming period, including the very important issues around teenage conceptions, and so on.
Q105 Mr Syms: There are some variations on regions.
Professor Harper: There are.
Q106 Mr Syms: Does that impact on where you put the money in terms of budgets?
Professor Harper: How we tackle regional variation is not an issue only related to teenage conceptions. It is an issue. We do have the government offices for the regions with the regional directors of public health and their public health teams, funded by the Department of Health, and part of the challenge that they have is to look at the variation and try to learn, in the sense of good practice and sharing good practice, so the poorer performing areas of the country can come up to the best.
Gillian Merron: The variations are often at a very localised level, and that is another reason that we have to concentrate our efforts very specifically.
Q107 Sandra Gidley: Moving on to the other side of the coin, Chlamydia screening failed to reach the Government target of 17%. I just wondered why that was. If we are not reaching the people we should be reaching, is the scheme actually worth continuing?
Gillian Merron: Yes, the scheme is worth
continuing with, not least of all because it does not present with
symptoms. It is not easy, obviously, for
individuals to realise and it can lead to problems like infertility, so I do
think it is important, yes. That is my
first point. Second, when I look at the
coverage in 2008/2009, it was disappointing nationally. The coverage was something like 15.9%, which
is below our target of 17%, but it is worth crediting, I think, that 67 of the
PCTs did meet the 17% expectation and some, indeed, exceeded it, so we have got
better practice in some areas than in others.
That is an important point. I
think it has been challenging, and I will ask David to say more about it
because we have applied ourselves quite stringently to improving this one
because we are committed to it. I think
it was introduced at a time of some turbulence in the NHS. Hindsight is a wonderful thing about when we
start programmes. I think it was also
quite a tough call. It is the first of
its kind in
Professor Harper: Thank you, Minister. It is a very good question, of course. The World Health Organisation recognised Chlamydia as being a substantial public health problem, for the reasons that have just been alluded to. Looking to the future, we have a number of key actions that we need to build on. One, again, is focused on reducing the local and regional variation and improving the coherence of the national Chlamydia screening programme. Also, what we tried to do, given that this was quite innovative when we started the pilot work going back some years now, was to build in a step-wise process so that we were able to learn as we went forward, recognising the challenges that I think you are well aware of. Having said all of that, we do need to now move ahead quite quickly and establish a baseline for prevalence of Chlamydia. It is one of these things where people can say, "We could have done that at the start", but, in terms of cost-effectiveness and value for money, we felt it was important with all of the variables to reach some point (and I think we are there now) where we have a prevalence study and we commit with the Health Protection Agency - we are already considering piloting this in the future - to get this baseline against which we can then monitor far more accurately and evaluate the success of the programme. We need to have coherence, we need to have a prevalence indicator, but it is absolutely worth investing in this, and the World Health Organisation and the European CDC do tend to look to the UK as being in the vanguard for this sort of work internationally, globally, not just within Europe.
Q108 Sandra Gidley: I understand that two PCTs did actually reach the 35% target earlier.
Gillian Merron: Yes.
Professor Harper: Yes.
Q109 Sandra Gidley: One thing that some years on this Committee has shown me is that the NHS is still very poor at spreading best practice. What lessons are going to be learnt from the successful PCTs and also Dr Hussey's report? Will the Department be implementing all her recommendations? How are you going to get better?
Gillian Merron: Yes, is the answer on Dr Ruth Hussey's report and yes is the absolute need. I was even more convinced, once I met Dr Hussey, about the need to spread best practice, because it is true, in fact, I think three PCTs have exceeded that target. If they can do it, yes, there are differences, there have to be lessons to be learnt, so I am very focused on doing that, but, as I say, I am glad we have got that report because I think it is quite honest and open, "these are the problems; this is what you have got to do", but I would like the Committee to know how committed we are to making the scheme work.
Q110 Sandra Gidley: There has been some involvement of the private sector in screening: for example the Boots' Pathfinder scheme. Has that been a success and has there been any cost-benefit analysis of what works best?
Gillian Merron: I will make a few initial comments and then bring David in. It has been evaluated. It was between 2005 and 2007 and it has been evaluated. The main thing about it, not surprisingly, is the advantage that it was picking up individuals for screening who would not otherwise have come forward. I think that is the huge benefit of working with pharmacy chains and pharmacies like Boots: it is convenience, the fact that it is anonymous, and no need for appointments. All that was welcome, but I will ask David to comment a bit more about evaluation.
Professor Harper: I think it is always going to be challenging to evaluate this sort of programme, this sort of pilot, not least because in cost-effectiveness terms it is very much dependent upon the throughput. The number of people that are actually taking up the opportunity, the lower the unit cost for the test. There are those sort of challenges, but that is something that is shared with a number programmes in this area. What we have done is we have taken the evaluation, we have not published the results of the cost-effectiveness, the economic evaluation, partly because of commercial confidentiality reasons. We felt that that was an appropriate decision at the time, but we have taken the lessons learnt and those have already been fed back into the programme that we have just been talking about, and whilst the uptake levels, the opportunistic testing in pharmacies, are still relatively low, we have seen over the years immediately following Pathfinder, whether linked or not I am not actually going to say, but in 2007/2008 we had something of the order of 10,000 tests and we have seen an increase, a little less than a doubling, to about 16,000, a little over 16,000 tests through pharmacies. That might or might not be linked to lessons learned from Pathfinder, but at least it begins to be a bit of a surrogate for how the pharmacy sector is beginning to play a part in the Chlamydia testing programme.
Q111 Sandra Gidley: I am a little concerned, though. All pharmacies are effectively paid by the government for their core role. I am a little concerned that commercial confidentiality is often used as an excuse for not producing a cost-effectiveness study. Surely, if public money is being spent, there should be an understanding at the beginning of the process that this will be evaluated so that everybody can see what is best, and that will help PCTs, perhaps, in commissioning in the future.
Professor Harper: I think it is a very good point, and I can repeat a little of what I have said, which I will not do, but we have been learning the lessons from the Pathfinder pilot. Those lessons have been fed back in without actually going as far as publishing an economic evaluation of the Pathfinder study itself. The information is there and is being disseminated as part of best practice, and you will see, from Ruth Hussey's report that we have just touched on, it is absolutely essential that the core service element is embedded for the future, including service provision through the testing through pharmacies.
Q112 Dr Naysmith: Minister, can we switch to looking at the papilloma virus HPV vaccine programme? It is a bit soon, but has it been successful? Is it running nicely and smoothly? Do you have any results?
Gillian Merron: Yes. While David is looking at the point, the other thing is, of course, we hit a few challenges with some unfounded scares, but we have got back in place very quickly as well, so all credit to those involved in the programme.
Q113 Dr Naysmith: So no problems?
Gillian Merron: Absolutely; the programme carries on apace.
Q114 Dr Naysmith: I wanted to check on that before I began on the real meat of this question. On what basis did the Government decide to use Cervarix rather than Gardasil as the vehicle of delivery for the vaccination programme?
Gillian Merron: By going through the normal procurement process (and obviously there was pre-agreed award criteria, the savings, for example), the money saved by choosing the product that we are choosing has allowed us to extend the programme to 17 and 18-year-old girls in the school years 2008/2009, and that meant an extra 300,000 girls, for example, could be offered the vaccine; so some of the benefits that accrued have been that.
Q115 Dr Naysmith: Did you take into account that both Gardasil and Cervarix provide protection against HPV and type 16 and 18, but Gardasil also protects against HPV 6 and 11, which causes over 90% of genital warts, which is quite a serious condition that occurs?
Gillian Merron: Yes.
Q116 Dr Naysmith: By taking the slightly more expensive one you could end up protecting against another disease or condition as well.
Gillian Merron: It is a fair point to make. These are choices to be made, but there is a whole range of criteria in terms of procurement, as I know the Committee are aware. Certainly the protection offered against genital warts was part of the consideration. However, the absolute primary purpose of this, as we know, is to protect against cervical cancer, and that was the overriding consideration. Of course, I know that you are aware that genital warts are not a form of cancer, but we are always at all times guided by the evidence before us. David may want to add something.
Q117 Dr Naysmith: There is some evidence that the clinical costs to the NHS of genital warts was underestimated quite remarkably badly so that the comparison at the time was not very fair, and the second point to come out is that in Australia using Gardasil has been very successful in cutting down the incidence of genital warts. Do you want to say some more?
Professor Harper: Certainly I will say a little bit more. As the Minister says, the driver and the main purpose for the programme was to tackle the cervical cancer challenge that we face. Given that, with the procurement process that we went through, we did consider in quite some detail the clinical effectiveness, including the impact on genital warts. That, in a weighted sense, formed an essential part of the assessment. I would be very interested to have the information that implies that it was horribly wrong, because I have to confess that I am not aware of that.
Q118 Dr Naysmith: Some of it was published in the BMJ?
Professor Harper: I have seen different pieces of information. Maybe there is a different interpretation of the information that is produced and certainly the published information. I thought this was maybe information that had not been published. The other point is that Cervarix, of course, is used very widely globally; so the other factors that are taken into account in clinical terms have been very important. It is used in over 100 countries around the world.
Q119 Dr Naysmith: The other thing that has emerged fairly recently, it is bound to be more recent, is that the length of period of protection by the vaccine is now going up to 17 or 18 years; so that means that it is even more successful.
Professor Harper: Yes.
Q120 Dr Naysmith: Is this ever likely to be re-opened, this question of the next round of vaccinations?
Professor Harper: Oh, yes.
Q121 Dr Naysmith: Will these products be re-assessed?
Gillian Merron: And will be assessed, yes.
Professor Harper: We evaluate all of our programmes. We are just introducing a new vaccine in another area which protects against a broader range of viruses that is very important in the pneumococcal area. I think it is incumbent upon us to keep these areas under continual review, but we do work on the basis of the independent expert advice that is provided through the Joint Committee on Vaccination and Immunisation, and so that is absolutely fundamental to the decisions that we take.
Q122 Sandra Gidley: I wanted to ask a question on exactly that point, the JCVI. It has been very, very difficult for those of us trying to track the progress and the decision-making. The JCVI is a very, very opaque organisation compared to NICE, which is very open: everything goes on the website; you get the details of the meetings straightaway. Is there not a case for actually abandoning the JCVI and giving that work to NICE?
Professor Harper: I think we need to keep in mind that internationally the vaccination programme, in particular the childhood vaccination programme in the UK, is one of the most highly regarded in the world in terms of efficacy and cost-effectiveness, and the JCVI do consider cost-effectiveness as part of their consideration.
Q123 Sandra Gidley: But they are very opaque. Why do they not have the same standards of openness as NICE?
Professor Harper: They publish their minutes ---
Q124 Sandra Gidley: Eventually.
Professor Harper: --- usually within a matter of weeks after the meetings.
Gillian Merron: My own view would also be that they do carry out different roles, and if there is an issue, obviously, with transparency, I think that is a separate matter but would not be a reason for me to suggest any merging or change. They both carry out a well-respected, influential and very helpful role for us.
Q125 Sandra Gidley: What do the JCVI do that NICE do not? There is huge amount of expertise within NICE. This Committee has not always been entirely complimentary about everything NICE does, but there is a huge amount of expertise. Surely the same principles apply to vaccines. I have never been able to understand why vaccines are this slightly cosier little club?
Gillian Merron: It is not intended to be a cosy little club. The JCVI are there to do a job of work, and that is to advise and give us their best information that we can make decisions on.
Q126 Sandra Gidley: You do not think that can be done by NICE. NICE covers everything else. What is so different about vaccines?
Professor Harper: All I would say on this is that we have a range of what we describe as independent, non-executive arm's length bodies providing a huge range of scientific advice and risk assessment in all sorts of policy areas within the Department. Historically the Joint Committee on Vaccination and Immunisation has been an essential part of that system of horizon scanning, of policy information and expert advice and it works according to the codes of practice that are set down, for example, by the Government's Chief Scientific Adviser. There are issues around communication, around transparency, around conflicts of interest, around impartiality and objective advice. That is a tried and tested system, and that is the system that at the moment is providing a vaccination programme which is internationally very highly regarded indeed.
Q127 Sandra Gidley: As is NICE.
Professor Harper: Yes. I am certainly not wanting to convey any other impression. I am just talking about the Joint Committee on Vaccination and Immunisation.
Q128 Chairman: David, I received an email on 17 February from Dr O'Mahony, who was the consultant physician in sexual health at the Chester NHS Foundation Trust. Could I send you a copy of that and you could comment on it? He went into some detail about the cost analysis that was done between the different immunisation bodies.
Professor Harper: I would be very grateful for that, thank you.
Chairman: I would appreciate that.
Q129 Dr Taylor: Minister, I am sure you have noticed that we are catching up on a lot of the inquiries that we have done before.
Gillian Merron: As is your right to do.
Q130 Dr Taylor: Smoking, alcohol, safety, sexual health. When we looked through your list of responsibilities we noticed that it was deep vein thrombosis. We did not twig that the Department had got a separate minister for deep vein thrombosis and for venous thromboembolism, because to all sane and sensible people they are the same thing. You cannot get a venous thromboembolism unless you have got a deep vein thrombosis.
Gillian Merron: Doctor, I bow to your ---
Q131 Dr Taylor: Anyway, I am going to put you through some questions on VTE, because you cannot have VTE without a DVT. First of all, how are the Government ensuring that hospitals are prioritising screening for the DVT that leads to the VTE?
Gillian Merron: May I be honest?
Q132 Dr Taylor: Yes?
Gillian Merron: Thank you. You might find it remarkable, but the expert on this is Ann Keen, and I am very happy to take the questions and to get a written answer from the Minister.
Q133 Dr Taylor: There are some quite important things we would like you to pass to her.
Gillian Merron: The other person who might be able to assist on some of them is, of course, Professor David Harper, but we are very happy to get a proper response to you from Ann Keen, if that is acceptable.
Q134 Dr Taylor: Let me go over the specific sort of things we want to know.
Gillian Merron: Yes; of course.
Q135 Dr Taylor: The inquiry we did was way back in 2005, so it is five years ago, and every recommendation, to our amazement, was completely accepted by the Government and yet it has taken all this time for anything to happen. What we would like to know is if the recent Government initiatives have, as yet, achieved any reduction in the number of deaths from VTE. That is the first thing. The second thing: since NICE has just produced its latest guidelines - its updated guideline is number 92 - there is considerable concern from clinicians that the risk assessment tool, which was written before these latest NICE guidelines, does not include all the risk factors that are in box one of the NICE guideline. I have got a letter that puts this, which I will pass to you and ask you to pass on because it is crucial that the National Risk Assessment Tool is updated to take account of the latest NICE guideline. The other one is that VTE is now attached to CQUIN as a target, and the target figure is a 90% assessment and .3% of CQUIN funding is attached to this target. The question is: will this change in 2011-12? Should we not be having a target of 100%, because the risk assessment is incredibly easy? It only needs a few questions when somebody comes into hospital, for whatever reason, medical or surgical. Those are the specific questions and I will pass you this letter.
Q136 Chairman: Okay.
Gillian Merron: We will get back to you, and thank you.
Q137 Chairman: Lastly, Minister, I think something that is in your area of responsibility.
Gillian Merron: A lot is; there is a lot there.
Q138 Chairman: When we were doing our inquiry into patient safety we
visited
Gillian Merron: The first thing is that it
is very good that places like
Professor Harper: I think that actually covers
much of what I was going to say. There
is particular interest in some of the technological advances that we are
looking at with great interest, such as the pilot at
Q139 Chairman: Minister, I think that is it. Thank you very much indeed for coming along. I hope you found it an education.
Gillian Merron: It always is!