HIV Testing Week

David Mundell Excerpts

Thursday 13th February 2025 Westminster Hall

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

I beg to move,

That this House has considered HIV Testing Week.

It is a great pleasure to serve under your chairmanship, Dr Allin-Khan. I am grateful to the Backbench Business Committee for granting this debate during National HIV Testing Week in England. Each year, the campaign funded by the Department of Health and Social Care, and delivered by the Terrence Higgins Trust as part of the national HIV prevention programme in England, brings us together to raise awareness of HIV and to promote regular HIV testing, in particular among the groups most affected by HIV. It is always the way that Parliament works that this debate coincides with a debate on LGBT+ History Month, although the two subjects are so linked.

Over the Christmas recess, I was reading Alan Hollinghurst’s book “The Line of Beauty”, which brings home the fact that, at that time in the 1980s, a test was potentially a death sentence. People dreaded going for one, because of the result it might bring and the impact on their life and the lives of their family and those close to them. We have moved on to be able to say with 100% certainty that, if someone gets a positive result from an HIV test —which people can do in their own home—treatment means they can have a normal life expectancy and cannot pass the virus on. That remarkable fact is what makes this a generation that can end new HIV cases across this country.

I encourage everyone in the Chamber, across Parliament or watching these proceedings to take part in the current campaign and to order a free HIV test. I was particularly pleased to see the Prime Minister take a test and demonstrate how straightforward and lacking in process it is. Many people still think a test might involve needles and health service professionals, but a test can be taken at home with an easy-to-access kit.

[Florence Eshalomi (Vauxhall and Camberwell Green) (Lab/Co-op)]

I thank the right hon. Member for his excellent opening remarks. Does he agree that the Prime Minister taking that test in Downing Street highlights the issues around stigma and the fact that people can test safely within the confines of their own home, without anyone else or the glare of a clinic? It is that person and the test kit, with sample results.

[David Mundell]

I absolutely agree with the hon. Lady, who is one of my co-chairs on the all-party group on HIV, AIDS and sexual health. She has done so much to promote this issue, particularly among difficult-to-reach groups in the black and minority ethnic community and among women, and I commend her for that. I agree absolutely: taking a test, as I have done many times, is a routine matter that, in essence, involves merely pricking a finger and delivering a small amount of blood. That can be returned anonymously, and the result comes back without anyone else being involved. Were any issues to arise from the test, the person would know that proactive and supportive contact would generally be made with them.

Normalising HIV testing is crucial if we are to find the 5,000 people across the UK living with undiagnosed HIV. Central to that is opt-out testing in emergency departments. I am proud that with parliamentary colleagues on the all-party parliamentary group, and with the help of Sir Elton John and the amazing campaigning of HIV charities, we won the case for a £20 million investment in opt-out testing in England in 2021 and for a further £20 million for expansion to 47 more A&Es in 2023.

Since its routine introduction in 2022, opt-out testing has been an incredible success in normalising HIV testing in the health sector. Across 34 emergency departments over just two years, nearly 2 million HIV tests have taken place. In its first 18 months in London, Brighton, Blackpool and Manchester, more than 900 people were newly diagnosed with HIV or were found, where they had been lost to HIV care. A further 3,000 were found to have hepatitis B or hepatitis C.

This approach also relieves pressure on the health service. Data from Croydon university hospital found that when it first started opt-out testing, the average hospital stay for a newly diagnosed HIV patient was almost 35 days. Within two years, the average stay was just 2.4 days.

I am proud that the last Government were the first to fund opt-out testing. I am also pleased that in November the Prime Minister announced further funding to extend the testing intervention period. That will bring to 89 the number of hospitals funded to routinely test for HIV anyone who has their blood taken in the emergency department.

As a Scottish MP, I want to be able to tell hon. Members how we are leading the way in addressing the HIV epidemic in Scotland, but unfortunately that is not quite the case. There are good news stories. Early action to make pre-exposure prophylaxis—PrEP—freely available on the NHS has helped to drive down new transmission of HIV in Scotland. Year round, everyone in Scotland has access to free at-home HIV testing, which is made available through the Terrence Higgins Trust testing service and funded by the Scottish Government. In 2023, a landmark campaign delivered by the Terrence Higgins Trust addressed the stigma that we all know surrounds an HIV diagnosis. It is astonishing that that campaign was the first of its kind since the tombstone adverts four decades ago. I hope that that important work to combat HIV stigma continues in Scotland and across the rest of the UK; it cannot be a one-off.

However, for all this success, the reality is that progress towards achieving the historic feat of ending new HIV cases in Scotland by 2030 is now at risk. I have mentioned the resounding success of emergency department opt-out testing in England, and the role that that will play in helping to get the NHS in England back on track towards reaching zero new HIV cases by 2030. The clear evidence is that opt-out testing works, yet Scotland is still to adopt the same universal approach to HIV testing. As it stands, no area designated as high prevalence, such as Glasgow and Edinburgh, is benefiting from the opt-out testing programme. I have again written to Scotland’s Health Minister, Neil Gray, to ask that that be reconsidered.

An estimated 500 people are living with undiagnosed HIV in Scotland, and a growing population of people are living with diagnosed HIV but are no longer accessing vital treatment and care. If we are to succeed in getting to our 2030 goal across the UK, we must reach each and every one of those people. Every day that emergency department opt-out HIV testing is not on offer, opportunities to find and support people living with HIV are being missed.

Although Scotland is clearly not within the Minister’s remit, I hope that she, the public health Minister and the Health Secretary will use opportunities to raise this issue with the Scottish Government and to highlight their own successes. As she may know, the Scottish Government are keen to highlight what they perceive to be health failures in England. This is a great opportunity to highlight a health success and to call the Scottish Government out on their own approach.

That also applies to HIV testing week. For this week to be most effective, it should apply across the United Kingdom, so that we can benefit from the positive publicity that came from the Prime Minister’s test. That is not available to people in Scotland, because HIV testing week is not happening there this week, despite my calls last year for it to be extended to Scotland. There is a testing week in Wales, but it is not as co-ordinated on a UK basis as we would want to see. Such co-ordination would allow everyone to benefit from promotional campaigns such as the excellent one in Parliament this week, which the Terrence Higgins Trust facilitated for Members of the House.

I very much recognise the work of Terrence Higgins Trust Scotland and Waverley Care, which I had the great pleasure of visiting at its premises in Edinburgh recently. They are doing a great job, but when we have National HIV Testing Week, it needs to be across the whole United Kingdom. Testing is the only way we know to find a person’s HIV status, and that is why the current campaign, testing week and interventions such as opt-out testing are so integral to our HIV response.

We are now five years away from 2030, and in no part of the UK are we on track to achieve our goal of ending new cases of HIV. Getting there will require cross-party working, and we have always worked cross party on the all-party parliamentary group, which has the highest number of members of any APPG in this Parliament and has been around for over 30 years. Many Members across Parliament work tirelessly in that group to ensure that we reach the 2030 goal, and I am sure the Minister will tell us more in her response about what is being done to achieve that.

I know that this is not directly within her remit, but it would be remiss of me not to mention testing in other countries. We have heard about HIV testing week here in the UK, but poorer countries rely on the Global Fund to Fight AIDS, Tuberculosis and Malaria, and particularly the United States President’s Emergency Plan for AIDS Relief, which it funds along with the US to deliver testing and treatments. We know that the future of US funding is, at best, uncertain. This country has always been at the forefront of the Global Fund, and leadership on this year’s replenishment is important. I was pleased to hear what the Prime Minister had to say yesterday about Gavi and vaccinations, and I hope he will be able at some point to give a similar commitment on the Global Fund. I hope all Members would agree that it would be quite wrong if we were to achieve the target in the UK, but just left poorer countries and the rest of the world to get on with it and, in fact, go backwards as a result. I make that call in relation to the wider issue.

I encourage anyone to take a test. It is very straightforward and easy, it will help to identify those we do not know about and it will help us to achieve that 2030 goal.

[Several hon. Members rose—]

--- Later in debate ---

[David Mundell]

I do apologise for the length of my constituency’s name, because otherwise we could have had a longer debate. It has been a good debate with some powerful contributions. I, too, commend the hon. Members for Sittingbourne and Sheppey (Kevin McKenna) and for West Ham and Beckton (James Asser) for reflecting on their personal experiences. It is so important that we do so, and both hon. Gentleman show that it is possible to move on, as someone who is HIV-positive, to play a full part in the world and in Parliament.

I particularly want to refer to a point made by the hon. Members for Clapham and Brixton Hill (Bell Ribeiro-Addy) and for Vauxhall and Camberwell Green (Florence Eshalomi), which was that this is not just about gay men. There is a stereotype that this is all about gay men. It is not. As we have heard, the statistics show that gay men are among the most prolific in having tests. It is about other communities, and it is about women. That is the message that we have to get across, and that is why opt-out testing is so important.

The hon. Member for Cardiff West (Mr Barros-Curtis) raised my pet subject, which is PrEP. It is ridiculous that, during this debate, I could have emailed somebody in India and obtained PrEP, but I could not go up Victoria Street into a pharmacy and do that. As well as making sure that we continue with the testing initiative, let us make PrEP more readily available.

Motion lapsed (Standing Order No. 10(6)).

Cardiovascular Disease: Prevention

David Mundell Excerpts

Thursday 13th February 2025 Westminster Hall

[David Mundell (in the Chair)]

Demonstrating my own multifunctionality, I am now going to chair but not participate in the next debate.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the prevention of cardiovascular disease.

I do not know where my functionality comes into it, Mr Mundell, but we are doing two debates in a row and it is lovely to serve under your chairship. As I explained in the last debate, I am my party’s health spokesperson. I have a lot of interest in this subject; I also declare an interest as chair of the all-party parliamentary group on respiratory health. Cardiovascular disease is one of the things that the group focuses on.

Back in 2019, the NHS long-term plan defined cardiovascular disease as the single biggest area where the NHS can save lives over the next 10 years. Six years on, that statement still rings true, but I am not sure whether we any closer to arriving at a conclusion. Over 7.6 million people are living with heart and circulatory diseases in the United Kingdom, and CVD is responsible for a quarter of all deaths here every year. It is one of the biggest killers.

I am very pleased to see the hon. Members here, and I thank them for coming. The Parliamentary Private Secretary, the hon. Member for Glasgow South West (Dr Ahmed), is here for the Minister, and I look forward to the Minister’s contribution. I am pleased to see the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans); he and I seem to regularly share debates. I am also pleased to see the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett).

According to predictions from the British Heart Foundation, by 2030 the prevalence of heart and circulatory conditions in the United Kingdom will have increased by 1 million. By 2040, it will rise by 2 million, due to a growing elderly population, the high prevalence of CVD risk factors and improved survival from major CVD events. Cardiovascular disease care in the United Kingdom is most certainly at a critical juncture. That was starkly illustrated by Lord Darzi’s recent independent investigation into the state of the NHS; I know that we are all aware of some of the key points of that. The investigation set out how nearly 50 years of progress to improve CVD outcomes has begun to reverse in recent years. That must not happen.

I seek reassurance from the Minister that we are out to stop that reversal. The number of people dying before the age of 75 with CVD has risen to its highest level since 2010, while the association between poor CVD outcomes and health inequalities has also increased, with people living in the most deprived parts of the country being twice as likely to die from CVD as those in the least deprived. Something is seriously wrong when those who just happen to live in a deprived area have a bigger risk of dying than those who do not. The slowing of progress is creating an enormous cost for the NHS and society as a whole, including £12 billion in total healthcare costs and £28 billion across the wider economy due to premature death, long-term care, disability and other informal costs.

A key challenge relates to the high prevalence of CVD risk factors such as high blood pressure, obesity, diabetes, limited physical activity, air pollution and smoking. I declare an interest as I have had type 2 diabetes for almost 20 years. Mine is controlled by medication and I thank God for that, but I understand the impact on others much worse off than I am.

Raised cholesterol is another significant risk factor, associated with one in five deaths from CVD. Just over half of all UK adults are living with raised cholesterol, significantly increasing their risk of heart attack and stroke. However, due to the lack of immediately obvious symptoms, high cholesterol levels often go undetected. There are concerns that without immediate action there could be a further tidal wave of CVD deaths due to the thousands of “missing patients” living with undetected and unmanaged heart and circulatory conditions.

There are similar challenges in Northern Ireland. I always give a Northern Ireland perspective, which I think replicates what happens here on the mainland; that is why I do it. An estimated 225,000 people are living with heart and circulatory diseases in Northern Ireland—remember that we have a population of 1.9 million; that gives you an idea of the proportions. Since the 1960s, significant progress has been made, with CVD death rates falling by three quarters. But that improvement has plateaued in recent years: some 4,227 people died from CVD in Northern Ireland last year, including 1,133 people under age 75. It is not just an elderly person’s disease. That has to be put on the record.

Annual NHS expenditure on CVD in Northern Ireland is some £290 million—a colossal amount—and CVD’s overall cost to the Northern Ireland economy equates to some £740 million each year. Those are massive figures. I know that we should not look at health from a purely financial point of view, but those figures tell us that if we were working better to combat CVD the impact on the economy and health service would be greatly reduced. Northern Ireland faces similar problems when it comes to identification and management of CVD risk factors, with around 400,000 people living with high blood pressure, including 110,000 who are undiagnosed. Some 45% of adults in Northern Ireland are not performing enough daily physical activity.

In my constituency of Strangford, the prevalence of hypertension, coronary heart disease and stroke is significantly higher than in the rest of Northern Ireland. The reason for that could well be that our population is elderly: people tend to retire to my constituency. Despite the dire figures, there are real opportunities, both in Northern Ireland and the United Kingdom as a whole, to reverse the trends and help the UK become a world leader in CVD, as at one stage it was clearly trying to do. To get there, however, we clearly have to start doing things rather differently. Recent years have seen a number of policy commitments from successive Governments, but those have not shifted the needle, focus or direction. Today’s debate is about highlighting that and seeking help to address the situation.

There was the NHS long-term plan of 2019, which set out ambitions to prevent 150,000 heart attacks, strokes and dementia cases over the following 10 years. Unfortunately, in my constituency and elsewhere there are high levels of dementia cases, strokes and heart attacks. In Northern Ireland the figures are unfortunately incredibly high.

Successive versions of the NHS annual planning guidance have encouraged local systems to prioritise CVD and address the significant inequalities associated with it. Although the previous Government’s major conditions strategy was not fully implemented, it set out a series of robust principles to improve CVD care, including personalised prevention, early diagnosis, effective management of multiple conditions, integration of physical and mental health services, and services tailored to individual needs. The previous Government’s strategy was clear. I think this Government’s strategy is equally clear, but we need to address some of the issues that I will come to as I go through my speech.

We are lacking a deeply embedded, system-wide approach to CVD prevention that moves care upstream, is backed by sustainable, long-term funding and deploys the latest technologies and innovations. The National Audit Office’s recent report, “Progress in preventing cardiovascular disease”, provided stark evidence that such an approach has been lacking. It focused on the delivery of the NHS health check, which is one of our main tools for enabling early intervention on heart disease. It concluded:

“there is currently no effective system for commissioning Health Checks, despite it being a statutory responsibility on local authorities. DHSC and local government have weak levers to encourage primary care or other services to deliver Health Checks.”

That will be one of my asks of the Minister, who I am pleased to see in his place. I wish him well, and I know I will not be disappointed by his response to our requests.

In 2023-24, only half of the eligible population attended a health check, and only 3% of local authorities covered their entire eligible populations. We have to change that, so my request is that local authorities, which have statutory responsibility, primary care and other services that deliver health checks increase the number of people who get checked.

We need an action plan. The NAO report said:

“This is not a satisfactory basis for delivering an important and potentially life-saving and money-saving contribution to population health.”

Major improvements are needed, and the Government must embed them in a policy environment that promotes prevention rather than treatment. I have always been a believer in prevention rather than treatment. We must diagnose early and prevent disease at an early stage to stop the whole thing going further.

The current approaches do not sufficiently take account of genetics and the role of inherited familial conditions such as familial hypercholesterolaemia and cardiomyopathy in increasing CVD risk. Children are not routinely screened, GPs often fail to take account of people’s family history, and many patients report difficulties in accessing genetic screening.

Patients and doctors need to be empowered to access genetic testing, secure diagnosis and take preventive measures, which will ensure better health for the future and save money in the NHS. I am pleased that the Government have committed an extra £26 billion to the NHS, because right across this great United Kingdom of Great Britain and Northern Ireland, we will all benefit from that.

Up to 80% of premature deaths from CVD are preventable—we cannot ignore that figure. Preventing those deaths must be our goal, so the importance of this issue cannot be overstated. The evidence shows that CVD prevention pays. Analysis from HEART UK estimates that merely improving the management of cholesterol, triglycerides and other lipids through increased uptake of NHS health checks and, by extension, increasing the number of patients on lipid-lowering therapies, could deliver more than £2 billion in annual savings for the NHS and wider society.

I will focus on lipid-lowering therapies, because that is a solution that I am keen to see the Government take on board. Although prevention spending is often deprioritised in favour of meeting short-term measures, that is the kind of investment that we need if we are to deliver on the Government’s pledge to shift from sickness to prevention. I welcome the Government’s commitment to do that; that is what my party and I want.

In recent discussions I have had with stakeholders on this area, they have agreed a number of key themes that will be crucial to delivering progress on CVD prevention. Those include securing dedicated and ringfenced funding for CVD prevention, to enable targeted prioritisation of preventive approaches; identifying at-risk patients through early detection and risk assessment strategies, including testing from birth and family cascade testing; developing comprehensive public awareness campaigns that empower patients to self-monitor—if we can have patients’ participation in this as we go forward, that will be much welcomed; increasing access to prevention services by moving them closer to home, including by delivering more community-based diagnostic services; and ensuring timely implementation and consistent application of evidence-based clinical guidelines.

There is growing recognition of the potentially transformative opportunity that can be realised through wider awareness and recognition of another key CVD risk factor: lipoprotein(a), or Lp(a), which is a large lipoprotein made by the liver. Lipoproteins are parcels made of fat and protein. Their job is to carry fats around the body in the blood. Elevated levels of Lp(a) in the blood are an independent, inherited and causal risk factor for CVD, due to its pro-atherogenic, pro-inflammatory and pro-thrombotic effects.

One in five people are estimated to have raised levels of Lp(a) in their blood. That equates to some 13,400,000 people in the United Kingdom—equivalent to filling every seat in Wembley stadium about 150 times. Lp(a) is associated with an increased risk of several life-threatening events and conditions, such as myocardial infarction, heart attack, stroke, coronary artery disease, peripheral arterial disease and heart failure. Sadly, those events are often premature, so we need a way of diagnosing, doing early prevention and doing things better. My ultimate request to the Minister will be that that happens.

In severe cases, which applies to about 12% of the population, raised Lp(a) contributes to a two to four times higher risk of heart attack, stroke and heart disease. The prevalence of raised Lp(a) is typically greater among African and south Asian populations—a trend that is likely exacerbating existing health inequalities even further.

Despite the huge numbers at risk, few people know that they have a raised level of Lp(a). If they did, preventive measures might be taken: they could get a diagnosis, and we could ensure that their lives were better and longer, as well as reducing the cost to the NHS. The awareness of the role of Lp(a) in contributing to CVD risk is low among the general public and healthcare professionals, so there is a need to raise awareness. With that significant burden comes a huge opportunity to improve outcomes for a so far largely untreated and unserved patient population.

I want to mention my constituent, Dr Paul Hamilton, and also Gary Roulston. They are consultant chemical pathologists at Queen’s University Belfast and Belfast health and social care trust. They are leading pioneering work to proactively measure Lp(a) levels in patients who are at risk of CVD. I am always amazed—I always like to say this about Queen’s University, and it is right to do so—that when it comes to research and development, it is at the forefront, including on Lp(a). I encourage the Minister to interact with Queen’s University. The recent audit of its testing programme has revealed that early measuring of Lp(a) levels leads to a change in CVD management for a large number of patients. That demonstrates that Lp(a) testing and management can be implemented to improve population health and reduce the risk of CVD.

When we look at those things, we see something that can be done even better. Although there are currently no specific therapies for lowering Lp(a) levels, the taskforce believes that there is a clear and growing case for taking action now to incorporate Lp(a) testing and management within mainstream CVD prevention strategies. Several new therapies to lower Lp(a) are currently undergoing late-stage clinical trials, and could well be available in the near future, pending the outcome of those trials. That is a really exciting way forward, and an exciting way to save and improve lives. It is therefore vital that steps are taken to enable system readiness for those therapies and to ensure that the NHS is in the best possible position to maximise their anticipated benefits.

In the interim, there is a growing clinical consensus about the value of identifying patients with elevated Lp(a). In particular, knowing an individual’s Lp(a) can inform more intensive management of other cardiovascular risk factors, including blood pressure, lipids and glucose, and empower people to make a lifestyle change to reduce their overall CVD risk. It can also support cascade screening of family and close relatives—again, a positive way forward —given the genetic status of Lp(a). There is clearly a way to use technology and innovation to test more and to do more good for people. Tangible progress in that area could play a key role in supporting many of the key principles that have been identified as crucial to guaranteeing the future sustainability of the NHS, such as reducing pressure in the acute sector, delivering more personalised care and precision medicine, and capitalising on the pioneering innovation led by the UK’s life science sector.

More broadly, Lp(a) testing can support the Government’s ambitions right here in Westminster to get people back into work, by reducing the incidence of major CVD events, which can prevent people from participating in the labour market. Diagnosis and prevention can support people. To be fair, most people want to work; they want to have a normal life. The ones I speak to are not seeking benefits for any reason other than that they are unable to work.

Without formal recognition of Lp(a) in national policy, the only Lp(a) testing that takes place will be reliant on the work of proactive local clinicians. We need to make it the norm; we need to make it acceptable and the way forward. The regional variations are also not acceptable, and local systems need clear direction from the centre to encourage them to start thinking proactively about how Lp(a) testing and management could be incorporated into their local CVD prevention pathways.

What are we seeking? We are looking for a review of current CVD prevention and treatment pathways, for an assessment of where Lp(a) testing could be incorporated to deliver tangible benefits now—not later, but now—and to maximise the benefits of therapies that lower Lp(a), when those become available. We are also looking for engagement with local specialist lipid clinics and clinical laboratories to assess current levels of Lp(a) testing and whether it aligns with agreed best practice and to consider what will be needed to upscale activity in the coming years. We want to encourage local CVD champions to start thinking about the role of Lp(a) in contributing to CVD risk and to disseminate information about Lp(a) within their local networks.

In the taskforce’s call to action, it identified several system barriers that are holding back progress in this area; these are also applicable to the success of other health prevention strategies. They include National Institute for Health and Care Excellence procedures and methodology. NICE’s guideline methodology needs to take account of wider evidence criteria beyond the ones that apply to a specific treatment. In the case of Lp(a), although specific therapies to lower Lp(a) are not currently available, the taskforce believes that there is none the less a strong case for taking action now to proactively incorporate recommendations on Lp(a) testing and management in NICE guidance. If replicated across other disease areas, that more proactive and anticipatory approach from NICE would help to improve NHS system readiness for new innovations and treatments, encourage healthcare professionals to think more proactively about how a specific risk factor may be contributing to overall risk, and embed a more preventive mindset across the health system, reflecting the significant role of NICE in driving clinical behaviour. If it is possible to make those improvements—it is cost-effective, and early diagnosis will make things preventable—we really need to look at that.

Barriers also include the accuracy of health risk assessments. Risk assessment tools, particularly in CVD, play a crucial role in supporting health prevention strategies. An accurate assessment of an individual’s risk of experiencing a major CVD event can inform the most appropriate action to proactively manage and reduce that risk through a combination of treatment interventions and lifestyle changes—each of, us individually, has to play a part.

Going forward, it is vital that existing CVD risk assessment tools are updated to take account of Lp(a) and its known association with a range of life-threatening or life-changing cardiovascular events and conditions. That recognition will be essential to delivering a truly holistic assessment of an individual’s cardiovascular risk profile.

It is important to look at the standardisation of testing and reporting. The success of health prevention strategies also depends on the accuracy and consistency of diagnostic processes. In the case of Lp(a), testing should be conducted according to the best practice principles set out by HEART UK. Has the Minister had a chance to talk to HEART UK, which has some great ideas and positive ways forward? It is important to work in partnership to deliver therapies, diagnoses and prevention.

On emerging therapies, in particular, it is vital that there is a focus on encouraging greater diagnostic standardisation from the outset. Clinicians often get used to the numbers they first use, and it is important that they do not become entrenched in using the wrong, or indeed superseded, units. Without action in these areas, Lp(a) testing and management risks becoming another promising area of health innovation where the UK falls behind comparative systems.

We need to look further afield and to work with other countries; I met the shadow Minister, the hon. Member for Hinckley and Bosworth, this morning and said the same thing to him. Prominent European and American guidelines, such as those from the American Heart Association, the National Lipid Association and the European Atherosclerosis Society, have set out the importance of considering Lp(a) screening as part of CVD prevention approaches. Some countries are even thinking practically about how universal Lp(a) screening could be introduced. The present approach therefore puts us at risk of missing a rare opportunity to save lives that may be cut short by CVD, and will be increasingly out of line with the Government’s focus on transforming prevention across the NHS.

The Lp(a) taskforce is a coalition of experts from across the cardiovascular, lipid and laboratory community, with members from all four nations of the United Kingdom. They have come together to help tackle the lack of awareness and to set out the value of testing for Lp(a) in routine clinical practice to improve CVD management. Chaired by HEART UK, the group published its calls for action in August 2023, and it has since been working with key stakeholders to set out the potentially transformative role that Lp(a) could play in the future and, more broadly, to help renew the UK’s status as a world leader. We can be the world leader in CVD prevention and care.

I have some questions for the Minister. Is there a willingness to meet me and representatives from the Lp(a) taskforce, as well as other Members here with an interest in the subject, to discuss the essential steps that need to be taken to ensure that the UK is in the best possible position to integrate Lp(a) testing and management as a core part of CVD prevention strategies? Further, will he commit to engaging with key system partners such as NICE, NHS England and the devolved Administrations to address policy barriers that could hold back progress? I am ever mindful that the Lp(a) taskforce already comprises the four nations of the United Kingdom.

The Government must take wider action through their forthcoming 10-year health plan to secure renewed focus on CVD prevention, underpinned by ringfenced funding, enhanced early detection, expanding community diagnostic capacity, the timely implementation of evidence-based guidelines, and comprehensive public awareness and patient empowerment programmes. Will the Minister explore the scope to develop a dedicated national strategy for cardiovascular disease? We had that in 2019; I believe we need it in 2025.

Reversing these worrying trends in CVD is one of the great healthcare challenges that we face in this Parliament, and it must be approached with the necessary focus and attention. The UK must be able to capitalise on new and emerging areas such as Lp(a), which will be crucial if it is to renew its status as a world leader in CVD prevention and care. Just as with cancer, one in two people in this Chamber today are likely to develop heart and circulatory conditions in their lifetime. Just like the cancer community, the CVD community would welcome a commitment from the Minister to publish a dedicated national CVD strategy. At the end of the day, that is what I am asking for.

--- Later in debate ---

[Jas Athwal (Ilford South) (Lab)]

May I say what an honour it is to serve under the chairmanship of such a multi-talented, multi-functional Chair?

[David Mundell (in the Chair)]

You can speak for as long as you want. [Laughter.]

[Jas Athwal]

I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate.

Cardiovascular disease changes lives, takes lives and robs families of loved ones. I speak from personal experience: my father has been gone for 29 years and my mother for 28 years because of cardiovascular disease, so I know it absolutely robs families of loved ones. Across the UK, cardiovascular disease alone is responsible for one in four premature deaths. Beyond the personal impact it has on families, cardiovascular disease also places an enormous burden on our NHS, costing more than £7.5 billion per year. Preventive medicine and early detection can save lives, keep families together and reduce the burden on our NHS.

While preventive measures can take many different forms, which my colleagues have addressed today, I will focus on early diagnosis, as I know personally how critical it can be. In 2023, having cycled 85 miles on a Sunday, I felt the healthiest and strongest I had ever felt in my life, but one precautionary test taken purely to reassure myself that I was fit shattered my illusions and changed my life, but ultimately saved it. I was diagnosed with chronic heart disease. Within weeks, I had a triple heart bypass. Had I not taken that test, I believe that I would not be here today. Early detection saved my life, and it can save millions more.

In my constituency of Ilford South, a community-based study was conducted across four GP practices by Dr Laskar and Professor Lloyd from Barts hospital. Non-specialist healthcare workers used handheld echocardiogram devices to screen 518 local people. The study found that 22% of those screened were referred for specialist assessments, potentially saving the lives of one in five of those screened. The study in Ilford South demonstrates how we can detect serious conditions early without requiring expensive hospital visits later.

As my hon. Friend the Member for Dudley (Sonia Kumar) just said, prevention and early intervention save lives. By investing in local healthcare services and using tools such as the handheld echocardiogram device, we can catch problems sooner, treat people faster and relieve pressure on our overstretched hospitals sooner. Early diagnosis is not just a medical advantage, but lifesaving. It delivers more time with loved ones, less strain on our NHS and a future in which fewer lives are cut short. We have a golden opportunity to prolong life and to give the gift of life, and I urge the Minister to grab it with both hands.

--- Later in debate ---

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Before I start my speech, I think it was Gandalf who said:

“A wizard is never late…Nor is he early; he arrives precisely when he means to.”

I think it is correct protocol to be here at the start of a debate, although I for one would certainly like to see the Minister sprinkle his magic on this topic, because I hope that he will provide some enlightening answers in response to such an important debate.

Once again, I thank the hon. Member for Strangford (Jim Shannon) for his industrial strength in always securing these debates. I believe it is said that the man who moves a mountain begins by carrying away small stones; the hon. Member for Strangford is moving the metaphorical health mountains, one Westminster Hall debate at a time. I raise my hat to him, because I have had the chance to respond to a debate of his at least half a dozen times. He always conducts himself in an incredible manner and provides incredible detail, so I thank him for that.

If we can tackle the risk factors behind cardiovascular disease and identify it at an early stage, we can make a significant difference by reducing the number of people lost to premature deaths every year. The hon. Member for Ilford South (Jas Athwal) spoke movingly about his mother and his father. That was followed up by the hon. Member for Mid Sussex (Alison Bennett), who spoke about her father 13 years on; her father will be very proud to see his daughter in this debate. I am sure the parents of the hon. Member for Ilford South would be proud of his achievements as well, and the fact that he is raising such an important topic.

I come to this topic as a GP, and this is pretty much the bread and butter of life for a GP: advising on healthy lifestyles, and managing blood pressure, angina, obesity, smoking, heart failure, strokes and many more conditions. I pay tribute to the hon. Member for Dudley (Sonia Kumar), who pointed out how important that is. It is not just the doctor’s role any more; this is the MDT approach, and actually a quality MDT really helps the GP to understand where they need to look and to manage their workload, which is so important not just for clinicians but, most importantly, for the patients. It is an honour to take part in this debate and to help to shape it.

From a public health perspective, the last Government made significant progress on things such as calorie labelling, salt and sugar reformulation and smoking cessation, which are all contributors to cardiovascular disease. It was just three years ago that the NHS published its CVD prevention recovery plan, which set out four high-impact areas for every part of health services to focus on risk factors, detection and management. Examples include the rolling out of blood pressure checks in high street pharmacies and allowing people to measure blood pressure at home. The NHS long-term plan set out five ambitions to detect and treat people at risk of developing CVD. The plan has been revised twice, in 2022 and 2024.

This work was reinforced by the introduction of the NHS digital health check in spring 2024, which aimed to prevent 400 heart attacks over four years. The National Audit Office report into CVD, which was published in November 2024, said the disruption to the NHS caused by the covid pandemic has had substantial impacts on elective care, and this has undoubtedly had an impact on the prevention and treatment of cardiovascular disease. We do not have to look back too far to think about lockdown and the effect that that had on people’s physical activity, their ability to seek help and some of the preventive and advisory medicine that would have normally taken place. Following the NAO report, the Government committed to reviewing the NHS health check programme. Will the Minister confirm the timescales for the review and when the reports on the outcome will be published?

The hon. Member for Strangford rightly pointed to cholesterol and lipids. Lipids are often not given the attention needed; they are hugely important when addressing cardiovascular disease, so I thank the hon. Gentleman for mentioning them. I have done constituency casework on this topic as a Back-Bench MP. He mentioned lipoprotein(a), and I have been questioning Ministers about the development of genetic testing for familial hypercholesterolaemia and the development of a familial hypercholesterolaemia service in Leicestershire. Although this is a complicated and involving space, given the great advances in the testing and understanding of lipids, it is really important that we get to the bottom of it to understand the environmental impacts that are causing this, as well as the genetic ones at play.

To that end, work has also included looking at how bodies can track patients and the difficulties that familial hypercholesterolaemia services have in cascading to local people’s relatives, which I think is what the hon. Member for Strangford was pointing to. This is probably beyond the scope of this debate, but given the hon. Gentleman’s success with this debate, it would be great if he were to secure a Back-Bench debate on lipids. Will the Minister consider asking the Department to look at improving the clinical pathways for familial hypercholesterolaemia and the possible roll-out of screening for both patients and family members? I appreciate that this has to be done through an evidence-based approach.

More people are living with multiple long-term conditions; that is no different for many people living with CVD, who are also living with other conditions, such as diabetes. That is why the last Government were developing the major conditions strategy to try to improve outcomes across major conditions, including cardiovascular disease, as well as cancer, diabetes, respiratory disease, mental health and musculoskeletal disorders. Since the general election, Ministers have decided to go in a different direction, so will the Minister reassure me that the NHS 10-year plan will address the impact of those long-term conditions? As the hon. Member for Mid Sussex pointed out, inequality plays a role when it comes to cardiovascular disease, so I would be grateful if he would comment on that.

I think the quote goes, “Study the past if you would divine in the future,” and I am always keen to gain insight from across the House of what has previously happened. I note that almost a year ago today, there was a debate held in the main Chamber on the topic of heart and circulatory diseases by the then MP for Watford, the brilliant campaigner Dean Russell, who talked about his experience of having a heart attack. Of course, the debate was just a few months before the general election, but it gives us a good insight into what the then shadow Health team were thinking before they came into government, which they were successful in doing. The then shadow Minister, now the Minister for Secondary Care, was responding. She said:

“Labour has a mission to reduce deaths from heart attacks and strokes by a quarter within 10 years…Under our ‘Fit for the Future’ fund, we would double the number of scanners—speeding up heart and circulatory disease diagnosis”.

What is the amount in that fund? Has it been deployed, and what is the timescale? What scanners were specifically commissioned for cardiovascular disease? The then shadow Minister went on:

“We would also incentivise continuity of care in general practice, which would improve care in our communities for people living with heart and circulatory disease.”—[Official Report, 22 February 2024; Vol. 745, c. 940.]

No one has to tell me, as a GP, about the importance of continuity of care, so will the Minister explain what this would look like in the GP contract? What incentivisation is being considered for GPs?

The then shadow Minister went on:

“That is why Labour will introduce a child health action plan that will put prevention at the top of the agenda”.

Forgive me, but looking on the Government’s website and speaking to the House of Commons Library, I cannot see a report or plan on this topic; if I have missed it, will the Minister provide it? If there is not one, will the Minister set out the goals and timelines for achieving the plan, if the Department will provide them, and place it in the House of Commons Library?

On research, the then shadow Minister went on:

“That is why Labour’s regulatory innovation office would make Britain the best place in the world to innovate by speeding up decisions and providing a clear direction based on our modern industrial strategy, alongside a plan to make it easier for more patients to participate in clinical trials.”—[Official Report, 22 February 2024; Vol. 745, c. 941.]

Eight months into the new Government, I believe a chair has not been found, so will the Minister update me on when the role will be filled? Given that this was the stated aim of the Labour party in the CVD debate, what conversations is he having with the Department for Science, Innovation and Technology about speeding up cardiovascular trials?

I thought it fitting in closing to use the lines of Dean Russell, who used his closing remarks back then to point to the importance of data, education, protection and research in dealing with cardiovascular disease. I think the entire House can get behind that. The story of the hon. Member for Ilford South is a testament to the life advice that Dean gave to us then:

“if anyone at home is worried, they should get checked. If they are concerned that they have symptoms, they should get them looked at. It is better to get rid of fears before the event than to wait for them to become a reality and have to deal with the outcomes of that.”—[Official Report, 22 February 2024; Vol. 745, c. 944.]

I think we can all agree on that, too.

[David Mundell (in the Chair)]

I am sure that the Minister will begin with an apology to me, to Mr Shannon, as the Member in charge, and to all other participants, because it was very clear on the Order Paper that these proceedings would begin at 3 pm.

--- Later in debate ---

[Jim Shannon]

I apologise, but at the end of my speech I asked for three things. I asked whether there would be a willingness to meet me and representatives from the Lp(a) taskforce to discuss the essential steps that are needed, and that—

[David Mundell (in the Chair)]

Mr Shannon, I remind you that these proceedings go on to 4.30 pm, so there is no need for you to try to speak in a very short period of time.

[Jim Shannon]

I will not test your patience by speaking till 4.30 pm, Mr Mundell—I would test everybody’s patience if I were to do that—but could I sum up, if that is okay?

[David Mundell (in the Chair)]

Yes. That is what I was saying, but I felt you were summing in a way that anticipated that we were concluding at 4 pm.

[Jim Shannon]

I would have asked to intervene, but the Minister had sat down.

First, I thank all Members for coming along. The hon. Member for Dudley (Sonia Kumar) set the scene incredibly well with her knowledge and experience through her work—I think the Minister also referred to real-world experience. I thank her for her contribution; she is certainly establishing a name for herself in the Chamber.

There is no better way of illustrating a point than by telling a personal story, as the hon. Member for Ilford South (Jas Athwal) did. It reminds me of one of my constituents who came to see me one day; he is a man I know very well, although he is in a different political party. I asked him how he was and he said, “Jim, I went to see my doctor; I thought I was okay, but before he finished the tests on me, he gave me a bit of paper. I said, ‘What’s that for?’ and he said, ‘You have to go hospital right now.’” He went and had a quadruple bypass—he thought he was perfectly healthy, and did not know that he was not. I thank the hon. Member for Ilford South for sharing his story earlier.

The hon. Member for Mid Sussex (Alison Bennett) very clearly underlined the differential—that someone in Kensington and Chelsea can live for 20 years longer than someone in Blackpool. That has got to be wrong; we have to address those issues. She also mentioned the issue of obesity in children, and said that better food and school meals would improve public health and help to deliver more resilient people.

The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), referred to genetic testing and to the cascading of those tests right down through families, which is one of the things that I asked for. He referred to the 10-year plan, of which the long-term condition of CVD needs to be a part. The aims of the Government seem to indicate that there will be a wish to do those things in relation to CVD, and we very much hope that the Minister can do them.

I thank the Minister for arriving—look, things happen in life. Sometimes I am late as well, which is probably my fault on most occasions and I take the blame. On this occasion, I asked the Minister for three things, and I will repeat them now. Is the Minister willing to meet me and representatives from the Lp(a) taskforce to discuss the essential steps that need to be taken now to ensure that the UK is in the best possible position to integrate Lp(a) testing? Will he commit to engaging with key system partners such as NICE, NHS England and the devolved Administrations to address relevant policy barriers that could hold back progress? I am ever mindful that the Lp(a) taskforce has already integrated the four nations of the United Kingdom in what it is doing. I always try to be positive—you know the person I am, Mr Mundell. My objective is not to catch anybody out; I only want positivity and a solution-based approach to what I am asking for. My last question was: will the Minister explore the scope to develop a dedicated national strategy for cardiovascular disease?

Those are my three requests, which I put forward genuinely, sincerely, honestly and kindly. I ask the Minister to let us all know his response and his policy, because I think that other Members, from all parties, would also like to know.

[David Mundell (in the Chair)]

I am sure the Minister will have heard the three points that Mr Shannon raised. On that basis, I will put the Question.

[Dr Evans]

On a point of order, Mr Mundell. In perfect symmetry, this debate has taken a somewhat different procedural pathway than usual; that is indeed what can happen to patients with cardiovascular disease—things surprise them, although we have systems for dealing with cardiovascular disease. My concern is that some of the questions I raised on behalf of His Majesty’s Opposition have not had the chance to be answered. I would be grateful if the Minister would take them away and write to me—perhaps I could put them in a letter. Would it be within the scope of the Chair’s powers to allow that to be the case, Mr Mundell?

[David Mundell (in the Chair)]

That is not technically a point of order, but I am sure the Minister has heard what you have had to say. I am sure he and, indeed, the hon. Member for Glasgow South West (Dr Ahmed)—who was here from the start—will have noted all the points that Mr Shannon raised. If the points that Mr Shannon raised at the end—and indeed earlier, in his contribution before the Minister spoke—were unaddressed, I am sure that the Minister will write to him.

[Stephen Kinnock]

I absolutely will. I would be happy to complete my remarks, but I do not know that would work, given that Mr Shannon has made his second contribution.

[David Mundell (in the Chair)]

I will make the determination that Mr Shannon’s contribution was an intervention—although an excessively lengthy one, which he will not repeat at the conclusion of the debate.

--- Later in debate ---

[David Mundell (in the Chair)]

Mr Shannon, do you wish to make a final contribution?

[Jim Shannon]

I am not quite sure what happened today, but I thank everyone—the Minister, all the hon. Members who made a contribution and the Backbench Business Committee for making this possible. We look forward to the delivery that the Government have indicated for the years ahead, on which all the nations of this great United Kingdom of Great Britain and Northern Ireland can work together.

[David Mundell (in the Chair)]

It has been a little unconventional, but we got there in the end.

Question put and agreed to.

Resolved,

That this House has considered the prevention of cardiovascular disease.

Women’s Health Strategy

David Mundell Excerpts

Thursday 30th January 2025 Commons Chamber

[Karin Smyth]

The chief executive is right that the previous Government did not have women’s health at the heart of their strategy, and that is why we do.

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

As chair of the all-party parliamentary group on HIV, AIDS and sexual health, may I ask the Minister about the very low take-up of pre-exposure prophylaxis among women in the UK? What steps are being taken to change that? Obviously, there are barriers such as stigma and low levels of information, but does she agree that PrEP should not just be made available in sexual health settings, particularly as we have had the roll-out of opt-out testing?

[Karin Smyth]

I thank the right hon. Gentleman for the work he does in this area. He does an excellent job and makes an excellent point. I do not know the detailed answer to that question—it is not directly my area—but I am very happy to make sure that we write to him.

Medicinal Cannabis

David Mundell Excerpts

Thursday 30th January 2025 Westminster Hall

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

It is a great pleasure to serve under your chairmanship, Ms McVey. I commend the hon. Member for Strangford (Jim Shannon) for bringing forward this debate on an important issue.

On the number of Members present, the Thursday afternoon slot in Westminster Hall is challenging because Members often have to return to their constituencies. For people outside who have an interest in this matter, it is very important to convey that there are a large number of Members on both sides of the House who are focused and interested in this subject. I am a member of the all-party parliamentary group for medical cannabis on or under prescription, which is chaired by the hon. Member for Gower (Tonia Antoniazzi). I contributed—as did the hon. Member for Strangford and the Minister as the then Opposition spokesperson—to the last debate that took place on this in Westminster Hall.

The hon. Member for Strangford, as is often the case, delivered a tour de force on the issues and concerns, with the appropriate level of compassion and empathy for those who are caught up in this issue and affected by it. I do not want to overly dwell on the issues that he set out, because he did that very well.

Medical cannabis is demonstrably a cost-effective way to treat an array of conditions, including childhood epilepsy, to ease the impact of chemotherapy, or to alleviate the stiffness and spasms of multiple sclerosis. There is a strong body of evidence that it could be used for even more conditions, and the hon. Gentleman highlighted the continuing and ongoing need for trials.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

The right hon. Gentleman touches on something that piqued my interest in this subject 20 years ago, when my constituent the late Biz Ivol, who was a sufferer from multiple sclerosis, told me that the only relief she got from multiple sclerosis was by her own—shall we say—non-prescribed use of cannabis. She described multiple sclerosis to me as being not just stiffness and spasms, but like somebody was pulling barbed wire down inside her spine. When somebody is feeling that sort of pain and discomfort, surely it is incumbent on us all to find a way, through medicine, to give them some relief if we possibly can.

--- Later in debate ---

[David Mundell]

The right hon. Gentleman makes a very good point. Indeed, over time, I think all of us who have taken an interest in this issue have heard from multiple sclerosis sufferers about the pain and difficulties that they have encountered. It is incumbent on us, those in Government and those in the medical world to do what we can to make sure that that is no longer the case.

I want to focus my remarks on the economic case for medical cannabis. I will talk about the contribution that a different and more progressive approach could make to the economies of rural constituencies such as mine—those were some of the points that I touched on in the previous debate—because, at its core, the nascent medical cannabis sector is horticultural in character and is situated in rural and agricultural communities such as the one I represent.

In my constituency, I see Hilltop Leaf develop growing and processing facilities that are pristine and equipped with high-tech quantum sensors, microscopes or leaf barometers. It is a stark contrast to the damp tinfoil-wrapped rooms of illegal production, referred to earlier. It is certainly a marked contrast to the circumstances in which some people feel forced to acquire cannabis and the dangers and difficulties that they place themselves in through doing that. As the hon. Member for Strangford said, they do that because they love the person who is suffering. They do not want to see them suffer, and they are willing to take risks and do things that they would not otherwise consider.

In that context, it is all the more important that we see the industry—a modern, progressive industry—as a step forward. I enormously support the investment in my constituency. I particularly hope that good horticultural, administrative, managerial and logistics jobs, which will anchor the young people in the constituency, will flow from it; young people all too often feel the need to leave such communities for the want of opportunities.

The facilities at Hilltop should also be able to provide some 10% of the UK’s medical cannabis needs. I have hopes that Hilltop can go further still, because the medical cannabis sector could potentially bring more than £1 billion to the UK economy. I do not wish to divert into the Chancellor’s remarks about economic growth, Dame Esther, because we have heard a lot about that in the Chamber. But this industry is there and ready to grow—ready to create wealth and jobs, particularly in some of the most difficult rural environments in the UK. It has been estimated that tens of thousands of good quality jobs could be created if the UK’s regulatory, legal and medical frameworks were in line with norms elsewhere.

Sadly, byzantine rules on prescribing and overlapping and onerous regulations are holding the sector back. Medical cannabis was legalised in 2018 by my former colleague Sajid Javid, then the Home Secretary, but it remains unduly difficult to prescribe on the NHS across every part of the United Kingdom. Those in need—we should be clear that this is a matter of need—turn to private medical services, with the huge costs that they bring; the hon. Member for Strangford also highlighted that. They turn to criminals as well. It is absurd to make something of medicinal benefit legal, but for it to be put out of the reach of so many people who need it.

The situation has a knock-on effect on the sector. In recent years, we exported 213 tonnes of medical and scientific cannabis of the 329 tonnes produced in the UK. The sector could meet domestic patients’ needs and international demands, but incoherence in regulation and approach is hindering that. That also extends to cannabidiol or CBD, which has many benefits too. It is readily available to purchase on the high street, so much so that the CBD market in the UK is the second largest globally. However, hemp licensing laws mean that the flowers and leaves where CBD is found must be destroyed. Overseas imports then fulfil the needs of the domestic CBD market, and British supply chains do not benefit. Because of that approach, growers have to forsake the opportunity of a crop yielding £10,000 per acre, compared to £400 for wheat. At a time when rural Britain is struggling, such yields would be a real boon and bring income into the pockets of farmers.

Patients, producers, taxpayers and even the police, as the hon. Member for Strangford mentioned, could all benefit from unblocking the bottlenecks in prescription and production. As I have said on many occasions, for that to happen the various strands of Government need to be stitched together. Instead of keeping the strange patchwork of overlapping and clashing components, there needs to be a clear policy of supporting the prescription of medical cannabis, and the necessary regulation and official approach that would allow that to happen. The UK Government and, where appropriate, the devolved Administrations should review the prescription process, medical guidelines, acceptable technical levels and the overlapping regulatory and legal regimes.

We have debated and discussed this issue many times. I hope that we will see some progress and that we do not have to repeatedly debate an issue to which we should have a common-sense approach. It benefits patients and our economy. It has an adverse effect on criminals. Why would we not do it?

World AIDS Day

David Mundell Excerpts

Wednesday 27th November 2024 Westminster Hall

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

Thank you, Sir Mark. I will simply agree with what both the previous speakers have said. I commend the hon. Member for Uxbridge and South Ruislip (Danny Beales) for securing this debate and for his work with the National AIDS Trust. I positively support its report, along with the Terrence Higgins Trust and the Elton John AIDS Foundation, “Getting on track”, and I am pleased that the Minister has engaged with that report already. As co-chair of the all-party parliamentary group on HIV, AIDS and sexual health, I will focus on the global issues. We have already heard that there were 1.3 million new transmissions last year, and in sub-Saharan Africa, 62% of those infections were among women and girls.

I have three asks of the UK Government. First, I ask that they continue to be a major contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since 2002, the UK has committed over £5.4 billion, making it one of the largest donors, and it is extremely important that it continues to do so. Secondly, the UK needs to focus on expanding access to antiretroviral therapy—ART—for people living with HIV. ART is a lifesaving treatment that not only improves the health and quality of life of individuals but reduces the risk of HIV transmission.

Thirdly, the UK needs to be a leader in confronting anti-LGBT+ legislation globally. We know that the risk of arrest and criminality leads people to hide their sexuality, avoid testing and eschew treatment, because they are evidence of so-called subversive or criminal behaviours. Such laws are an impediment to progress and undermine the efforts of the UK to assist health systems. We must stand up against them, and I hope the Minister will confirm that.

Oral Answers to Questions

David Mundell Excerpts

Tuesday 19th November 2024 Commons Chamber

[Andrew Gwynne]

As somebody who still suffers from long covid, I know how debilitating and complex it can be, and I am committed to improving support for people affected by it. There are now more than 100 long covid services across England, and £57 million is being invested in long covid research. I recently co-chaired a roundtable on strategies to stimulate further research into treatments. I am more than happy to meet my hon. Friend and Ollie for further discussion.

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

Opt-out testing for HIV at A&E has been a great success since it was announced last year, particularly in identifying those who were not aware they had the disease and among difficult-to-reach communities. Can the Health Secretary confirm whether the programme will continue?

[Wes Streeting]

Opt-out HIV testing has been a great success so far. Of course, we will make further announcements on its future in due course. I would like to say, as a former member of the HIV commission that made the representations to the previous Government, that he has me at a real advantage—or disadvantage, depending on the side of the spending fence. I very much welcomed the approach taken by the previous Government, which this Government plan to continue.

Access to Migraine Treatment

David Mundell Excerpts

Wednesday 20th March 2024 Westminster Hall

[Dehenna Davison]

I agree with the hon. Member. In severe cases, migraine is absolutely a disability. It ruins lives. There is a separate discussion to have with the Department for Work and Pensions—I do not want to put all the pressure on the Department of Health and Social Care—about how it addresses chronic migraine and intractable migraine when making its assessments. I thank the hon. Member for raising that really important point, which came through from a number of our survey respondents as well.

Some workplaces make adjustments, such as allowing flexible working, but there are also reports of workplaces not making suitable adjustments. One respondent said:

“There is a complete lack of understanding that chronic migraine is a disability and employers are not willing to make allowances for this condition in the way they do with other disabilities.”

Shockingly, the Migraine Trust found that 56% of migraine patients said that their workplace had not made reasonable adjustments. That is why the organisation has launched its workplace pledge this week to encourage employers to make small, often low-cost adjustments that can make a huge difference for staff with migraine. We must remember that with one in seven people living with migraine, there is a good chance that even if someone does not, at least one of their colleagues probably does.

The impact of migraine on the workplace is not just confined to individuals dealing with the stress of potentially losing a job and income; there is a wider impact on the economy too. The Work Foundation has found that migraine causes between 28 million and 43 million lost work days per year in the UK, at a cost of around £4.4 billion. When we add the cost of that absenteeism to the cost of presenteeism—showing up and putting on a brave face but not being able to function normally —the Migraine Trust estimates that the total cost is closer to £9 billion.

We often talk about the need to improve productivity here in the UK, so surely helping those living with migraine access quicker and better treatment so they are able to work and fire on all cylinders would be a great step forward. That is especially so when coupled with the fact that, according to the Journal of Health Economics and Outcomes Research, the excess fiscal costs to the Government of one person living with migraine come to £19,823. That is the cost for one person, when there are 10 million in the UK battling the illness.

Giving up work for health reasons is not a choice that anyone makes lightly. For many, as well as the financial cost, there can be a significant cost to people’s mental health. Research by the Migraine Trust found that 78% of those living with migraine said it had a negative impact on their mental health and 65% reported experiencing anxiety as a result. People are missing work, cancelling arrangements with friends, missing out on social experiences that they have been looking forward to—and paid for—and feeling like they are a burden on their family. Others may not believe them, and they may wait months if not years to see a specialist; or they have the hope of trying another preventive that might work, only to have that shatter when it is another one that does not do so, and all the while they are living with excruciating pain. They are losing friends, losing relationships and feeling like they are losing their mind.

For some people such as Mollie, the darkness takes over entirely. She said that

“deep inside, I still had that same passion for life that all people in their twenties do. I want nothing more than to go outside and live my life, but this condition has me trapped in my own living room. My pain is now so severe, it has impacted on my mental health so intensely I contemplate suicide every single day of my life and have almost succeeded at times simply because I want the physical pain to end”.

We are here today to help people such as Mollie. We have a responsibility to help them and the millions of others suffering through migraine who need a lifeline. By improving access to treatments we can give them that lifeline. I hope the Minister will agree to meet me and the two brilliant charities represented here today to discuss further how we can do just that together.

[David Mundell (in the Chair)]

I ask hon. Members who wish to be called to bob.

Sexual Harassment of Surgeons and Other Medical Professionals

David Mundell Excerpts

Wednesday 13th December 2023 Westminster Hall

[David Mundell (in the Chair)]

I will call Rosie Duffield to move the motion. I will then call the Minister to respond. There will be no opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Rosie Duffield (Canterbury) (Lab)]

I beg to move,

That this House has considered the matter of sexual harassment of surgeons and other medical professionals.

It is a pleasure to serve under your chairship, Mr Mundell. I am grateful for the opportunity to raise the issue of sexual assault against surgeons, nurses, doctors and other healthcare professionals and patients in clinical settings. In April, I used my Prime Minister’s question to mention the report commissioned by the Women’s Rights Network and written by my friend, the sociologist and criminologist Professor Jo Phoenix, entitled “When we are at our most vulnerable”. The report revealed some truly shocking statistics about violent sexual assault, and everyday inappropriate and unwanted acts intruding into the work lives of professionals and disrupting the recovery of the most vulnerable and ill. How dare we call ourselves a civilised society if we turn a blind eye to this and do not do everything possible to support those women, and some men, who are brave enough to come forward, as well as those who do not feel that they can and suffer in silence?

Professor Phoenix found that more than 6,500 rapes and sexual assaults had been committed in hospitals in England and Wales over a period of nearly four years. Some were against children under 13, yet in a mere 265 cases—a minute 4.1%—was anyone known to have been charged. In total, 2,088 rapes and 4,451 sexual assaults—6,539 cases—were recorded by police forces from January 2019, and one in seven of those, or 266 a year, took place on hospital wards. As the researchers at the Women’s Rights Network sent freedom of information requests to 43 police forces across the UK and 35 responded, the figures are, in truth, even higher and even more shocking.

HIV Action Plan Annual Update 2022-23

David Mundell Excerpts

Tuesday 18th July 2023 Westminster Hall

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

It really is a great pleasure to serve under your chairmanship, Dame Caroline. I am grateful to my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing this timely debate and for her thoughtful contribution, which laid out the principal issues. I am also grateful to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for making sure that the full gamut of issues was covered, because sometimes it is possible for the perception to be that this is just an issue about gay men, and it is not. The hon. Member for Vauxhall (Florence Eshalomi), who, along with me and others, is a co-chair of the all-party parliamentary group on HIV and AIDS, made it absolutely clear that this is a wider issue than for just that one group.

As the HIV action plan has put in print, we have already reached the UN’s 95-95-95 target and are hopefully within touching distance of ending new transmissions by 2030. If that can be achieved, we should be clear that it is a milestone, equivalent to the eradication of polio in past years. I believe it is also a tangible example of British leadership in health and a testament to consistent and concerted efforts, which have produced incremental gains, giant leaps and, ultimately, a pathway that others have followed. As we have heard, however, we are not there yet.

The HIV action plan makes it clear that the goal will not be reached without PrEP. We know that PrEP works, with new transmissions of HIV dropping by over a third from 2019, but a recent survey by Prepster, the National AIDS Trust, the Terrence Higgins Trust, Sophia Forum and One Voice Network found that many people end up being diagnosed with HIV while waiting for PrEP. We need to close the gap between awareness of risk, accessing services and receiving PrEP, and I absolutely agree with the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) about the availability of PrEP. I could sit down after this speech, go on my phone and order PrEP to be delivered to me from India in the next few days, but I could not go to a pharmacy in the centre of London or, indeed, in my own constituency to receive that. Not only is that discriminatory, in the sense that people who can afford to buy it or access online services have an advantage; as the hon. Member suggested, it is putting the risk ahead of the reality that people are already accessing it. It is far better to get it from a pharmacy than from an Indian or other overseas supplier.

Our targets on new transmissions will not be reached if we have not identified those who are living with HIV, and we have heard Members speak about that. Many of these issues are devolved in relation to Scotland, but one thing that I would like to see there is a properly funded national testing week. To maximise its impact, it should work in tandem with that which already takes place in England, because having a UK-wide event—with a focus on national television, in the national media and on social media—is a much better way to draw attention to the issue. We have heard from my right hon. Friend the Member for Romsey and Southampton North; like her, I can confirm that even someone like me can use a test kit. I am grateful—this will interest the hon. Member for Vauxhall—that the funding is at least better now in Vauxhall, because people used to have to phone up at 3 am to get the kit. If someone tried to phone at about 9 am, all the kits for that day had been distributed, but now people seem to be able to get them 24 hours a day. Virtually anyone can use such a kit effectively.

As the action plan identifies, reaching those who do not know that they are living with HIV will mean targeting hard-to-reach parts of our society, and those who either do not see themselves at risk or ignore the risk because of stigma. Opt-out testing has proven to be a success in that regard, and it is also cost-effective. When I was in South Africa, I had the opportunity to hear directly from medical professionals that opt-out testing, where it applies, has had a remarkable effect on the identification of cases in women. There are issues with support and treatment, but in terms of identification of cases, South Africa demonstrates that opt-out testing has a proven record. We should not prevaricate before rolling out opt-out testing beyond the areas already identified. Agencies and charities are champing at the bit to partner the Government to do just that.

The position of no new transmissions is almost tangible, but, as with the progress we have already made, it will not come without consistent and concerted action. Like the hon. Member for Vauxhall, I commend the all-party parliamentary group on HIV and AIDS, and the Members across both Houses who are part of it, for the continued commitment to action. As the hon. Lady did, I vouch that the group will continue to work with any charity, trust, health board or Government to get our country to the position of no new transitions and to highlight the issue globally.

Medicinal Cannabis: Economic Contribution

David Mundell Excerpts

Thursday 20th April 2023 Westminster Hall

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

I beg to move,

That this House has considered the economic contribution of medicinal cannabis.

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the Backbench Business Committee for allocating this debate. This slot on a Thursday afternoon is a challenge for many Members to attend because they have constituency commitments on a Thursday afternoon, but I am confident that we will have a good-quality debate and, importantly, that the issues I want to raise will be put on the record.

I am conscious that a number of these issues relate to the Department for Business and Trade and that my hon. Friend the Minister will obviously respond in his capacity as a Minister in the Department of Health and Social Care. I hope that if any issues are not within my hon. Friend’s remit and he does not feel able to respond, he will undertake to take them forward with ministerial colleagues.

Many Members will have been introduced to the issue of medical cannabis by constituents getting in contact to tell them, as their MP, about the real difference that this form of cannabis has made or could make to their own or their families’ lives. Such testimonies, along with scientific study after scientific study, led to my right hon. Friend the Member for Bromsgrove (Sajid Javid), when he was Home Secretary, legalising medical cannabis in 2018, and thereby ending the potential criminalisation of those living with or just trying to manage multiple sclerosis, cancer or epilepsy. That was a significant step forward for patients.

Some 17,000 UK patients are estimated to have been prescribed Sativex, nabilone and Epidyolex in the UK last year. I am sure that many Members of Parliament could tell a story from their constituents about what a difference such prescriptions have made to the quality of users’ lives by easing agonising muscle stiffness, by reducing chemotherapy-induced sickness, or as a therapy for seizures, especially for children.

The 2018 legal changes were also a significant step for the medical cannabis industry in the UK. We should be clear that medical cannabis is just that. This is a legitimate industry, and an industry of the future. Its products do not come from humid, tinfoil-draped sheds or sunlamp-lit lofts; they come from laboratories and facilities that are as controlled an environment as those that synthesise a vaccine, for example. I know that to be the case, having seen at first hand such facilities being developed in my own constituency. The medical cannabis industry is one of legal and professional standards, rigorous regulators, approvals, licensing, inspections and almost endless specialist equipment—be it quantum sensors, microscopes or leaf barometers—not to mention stringent safety and security protocols.

Of note is not just the standards to which the cannabis is produced but the volumes produced. In the UK in 2021, some 59 hectares were harvested, producing 329 tonnes of cannabis for medical and scientific purposes. Of that, 213 tonnes were exported—more than half the reported world total. Beneath those impressive headline figures, though, is the impact that the industry can have on local economies and local communities. That is why I have been and remain very supportive of the development of a facility in my constituency by Hilltop Leaf.

Too often, investment in new industries is funnelled into enormous singular developments captured by large corporate interests, or it goes straight into cities. Rural and agricultural communities such as those I represent often get overlooked, with seemingly only wind farms and tourism receiving investment. The medical cannabis industry is an antidote to that.

In many ways, I feel the growing of medical herbs is a form of farm diversification—an evolution of horticulture that builds on local strengths and skills. I hope that the investment by Hilltop Leaf, with one of the largest greenhouses in the UK, will demonstrate that medical cannabis can have a transformational impact on local communities. It will bring a variety of good horticultural, administrative, managerial and logistical jobs that I hope will anchor young people, who often feel the gravitational pull of large cities for the want of opportunities in a rural area such as the one I represent, which has seen the demise of traditional industries such as textiles. It could also meet nearly 10% of the UK’s 2019 domestic need.

For all the successes of the UK cannabis sector to date, it could be so much more. Bureaucratic, legal, administrative, regulatory, medical, licensing and planning issues all inhibit the industry’s potential and hinder vital investment in rural Britain. Indeed, the over-onerous process for being licensed in the first instance has given me cause to worry about the development in my constituency stalling. I am afraid the UK’s approach to the industry is incoherent and insufficiently consistent.

Yes, medical cannabis can be prescribed, but only by specialists, and that is predominantly being done outside the NHS, particularly in Scotland. Although I said earlier that in 2021 some 17,000 people received legal prescriptions for medical cannabis, it is conservatively estimated that next year there will be approximately 337,000 potential patients. That could be many times larger should new conditions be covered. This state of legality but inaccessibility is grossly unfair, and is contrary to the principles of our health service that those who can pay can get private prescriptions—or source their requirements from drug dealers—while those who cannot pay go without. All the while, there are almost 24 million prescriptions for opioids in the UK. Those figures, in differential terms, are staggering.

The potential savings for the NHS in the prescribing of medical cannabis have been detailed, with one US study showing a potential provider saving of 29% because of reductions in opioid dosage. As I said, by confirming the efficiency of medical cannabis in helping with certain conditions while stopping it being readily available, we are pointing those who are desperate to illegal markets. Do we really think that patient safety is best served by criminal suppliers, who provide a product of poor quality that is likely to contain contaminants because of the fashion in which it was grown? I certainly do not. Do we need to see the benefits for British growers, supply chains, jobs and tax revenues bypassed and go instead to criminals and smugglers, both here and overseas? Clearly not, especially when the medical cannabis sector has a potential value to the UK economy of more than £1 billion.

Our incoherence also extends to cannabidiol, or CBD. We allow its purchase—indeed, the UK’s CBD market is the second largest globally and was worth £300 million in 2019—but our hemp licensing measures mean that the flowers and leaves, where CBD is found, must be destroyed. As such, the CBD market fulfils its needs through overseas imports, and British supply chains do not benefit. Growers are necessarily forsaking the opportunity to yield a crop of £10,000 per acre, compared with £400 for wheat, because of this approach. Such yields would be a real boon for rural Britain.

If the UK’s regulatory, legal and medical frameworks were in line with those elsewhere, it is estimated that up to 100,000 jobs of the future could be created, and they would be good-quality jobs, as I have already set out. It is an opportunity that should be within our grasp, but unfortunately we currently do not seem able to take it forward. On 14 November last year, I was disappointed when a fellow Member asked the Business Department about its willingness to take forward the approach to the medical cannabis industry as part of its medical sciences strategy and commitment for the UK to be a world leader in such fields; unfortunately, the then Minister gave what I regarded as a lukewarm and non-committal answer.

As I am sure the Minister and all present will agree, nascent industries need nurturing, and the medical cannabis sector is no different. Much like the plants that the sector grows, the industry is seeking the conditions to grow. I hope the Government will be minded to support the sector and the economic benefits it could bring, particularly to rural Britain. This should not be considered an ask for wholesale legalisation, which is a completely different debate; it is an ask for consistency and coherence for the industry, and for access to medical cannabis for NHS patients.

We need the various strands in Government to be stitched together to provide support, rather than maintaining a strange patchwork of overlapping and clashing components. The UK Government and, where appropriate, the devolved Administrations should therefore accept the need to review the prescribing process, medical guidelines, acceptable tetrahydrocannabinol levels, and the overlapping legal and regulatory components. My specific ask of the UK Government is that they appoint a senior official to do so holistically, and that individual should be mandated to engage directly with the industry.

With coherent and consistent oversight, and by bringing the UK into line internationally, the medical cannabis sector could help to get rural Britain, and particularly constituencies such as mine, growing economically. In doing so, we could supply our domestic market with homegrown supplies and, even more importantly, relieve the pain and suffering of hundreds of thousands of our constituents, if they could access the prescriptions they need.

--- Later in debate ---

[David Mundell]

I feel that we have had a very useful debate. Like you, Mr Stringer, I chair these sittings and it is extremely good to get half an hour from a Minister rather than five minutes. Although it was not necessarily comfortable for him, we were able to cover a lot of ground. Whether deliberately or otherwise, he came back to one of the issues that I raised, which was the need for co-ordination in Government on this issue. The hon. Member for Inverclyde (Ronnie Cowan) read out the list of Government Departments with an interest in this matter, and I am sure there are others that were missed, such as the Cabinet Office and the former bailiwick of my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright), the Law Officers. There is a need for co-ordination. I do not think the Minister was saying this, but we cannot push back to the industry and say, “Well, actually, it’s your job to co-ordinate all these different bits in Government.” The industry needs to have a clear “in” or conduit to Government to discuss and engage on these issues.

I fully understand, having been a Minister myself, that it is not possible to commit the Home Office—of all Departments, it is certainly not possible to commit the Home Office. We know how government operates, but we need to have a co-ordinated approach with which the industry can engage. Of course the Minister is right that this should not be economically driven in terms of the clinical decisions, but we have already made the decision, as my right hon. and learned Friend said. We are not debating whether this should be done; that decision has been made, and now we want to do it on a basis that benefits not only the patients, but the economy of the United Kingdom.

It is always poignant to hear individual examples. In any debate in which he participates, the hon. Member for Strangford (Jim Shannon) is particularly good at bringing the discussion down to the personal level of individual examples, and I thank him for doing that today, as I do my right hon. and learned Friend the Member for Kenilworth and Southam. I have had the pleasure of meeting Alfie’s mother in my constituency. She is a very powerful advocate, but I do not believe, or think that anybody who has taken part in this debate believes, that the pain and suffering of anybody should be the requirement for us to do the right thing.

I was remiss in my opening remarks in not referencing the APPG, because I have engaged with it and particularly the hon. Members for Gower (Tonia Antoniazzi) and for Edinburgh West (Christine Jardine), who are also strong advocates on these matters.

Although I did not agree with everything that the hon. Member for Inverclyde said, which is often the case, what I did admire particularly was his passion for this subject, which came across clearly. It is shared by many hon. Members across the House.

I welcome the opportunity that we have had to air the issues, and the Minister’s full and well intentioned response, but we need to see action. I reiterate that the principal ask is for co-ordination within Government to take this forward. We are not requiring those in the industry and those lobbying for patient interests to manage the process across a wide range of Departments. That is one doable ask that could flow from today’s debate, and I hope that it will.

Question put and agreed to.

Resolved,

That this House has considered the economic contribution of medicinal cannabis.