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Prevention of Ill Health: Government Vision

Volume 648: debated on Monday 5 November 2018

Last week, the Chancellor confirmed that the NHS budget would rise by £20.5 billion over the next five years, because we care about the NHS being there for everyone. As well as money, however, reform is crucial. Before Christmas, we will bring forward a long-term plan for the NHS. We know that so much of what contributes to good health comes not just from what happens when someone is in hospital but from what we do to stay out of hospital. Prevention is better than cure. Today I have laid before the House our vision for the prevention of ill health. It covers what the NHS needs to do, including more funding for community and primary care and the better use of technology. The plan also outlines what we need to see more broadly; everyone has a part to play.

As well as the rights we have as citizens to access NHS services free at the point of use, we all have responsibilities, too. Individuals have responsibilities, and we want to empower people to make the right choices. For instance, smoking costs the NHS £2.5 billion each year and contributes to 4% of hospital admissions. That is despite the massive reduction in smoking over the past 30 years. The next step to a smoke-free society is targeted anti-smoking interventions, especially in hospitals.

As well as stopping smoking, we must tackle excess salt. Salt intake has fallen 11% over just under a decade, but if it fell by a third, that would prevent 8,000 premature deaths and save the NHS over £500 million annually. We are working on new solutions to tackle salt, and we will set out more details by Easter and deliver on chapter 2 of our obesity plan, too.

Next, prevention can save money and eliminate waste. At the moment, it takes too long, with too many invasive tests, to diagnose some illnesses. Doctors often have to try several different treatments before they alight on what is right for a patient. However, two new technologies—artificial intelligence and genomics—have the potential to change that. I want predictive prevention to help prevent people from becoming patients and to deliver more targeted interventions, with better results, when people do fall ill. Instead of simply broadcasting messages to the nation, technology allows us to support much more targeted advice, messages and interventions for those most at risk.

Turning to environmental factors, our health is not determined only by what happens in hospitals. In fact, only a minority of the impact on anyone’s healthy lifespan is delivered by what hospitals do. The other factors include the air we breathe, whether someone has a job and the quality of our housing. That means our GP surgeries, our hospitals and our care homes all working more closely with local authorities, schools, businesses, charities and other parts of our communities. Of course, the record number of people in work is good news on that front, and employers have a big role in helping their staff to stay healthy and to return to health after illness. That is where we can learn from the excellent record of our brave armed services, which have an 85% return-to-work rate after serious injury, while the equivalent rate for civilians in only 35%. Building on all that, the Government will next year publish a Green Paper on prevention, which will set out the plans in greater detail. This is all part of our long-term plan for the future of the NHS.

If I may, Mr Speaker, I will now address two separate issues that I know are of interest across the House today: the treatment of those with learning difficulties and autism, and the medical use of cannabis. Since becoming Health and Social Care Secretary, I have been shocked by some of the care received by those with autism and learning difficulties. Where people deserve compassion and dignity, they have been treated like criminals, and that must stop. Like everyone across the House, I have been moved by the cases of Bethany, Stephen and so many others, whose stories have laid bare what is wrong with our system and what needs to change. I have instituted a serious incident review, but this is not just about individual cases; it is about the system.

Three years ago, the Government committed to reducing the number of people with learning disabilities or autism in secure mental health hospitals by at least a third. Currently, it is down by a fifth, but that still leaves 2,315 people with learning disabilities or autism in mental health hospitals. I want to see that number drastically reduce. I have asked the NHS to address that in the long-term plan, and I know that its leadership shares my determination to get this right. I have also instigated a Care Quality Commission review into the inappropriate use of prolonged seclusion and segregation. The long-term use of seclusion is unacceptable both medically and ethically. It must stop. The review will recommend how to protect vulnerable people better and how to ensure that everyone is cared for with the compassion, respect and dignity they deserve.

On the prescription of medicinal cannabis, I pay tribute to my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning), my hon. Friend the Member for Dover (Charlie Elphicke) and the hon. Member for Inverclyde (Ronnie Cowan) for their campaigning on this issue. We have changed the law to make it possible to prescribe medicinal cannabis where clinically appropriate. Urgent cases have been brought to my attention, including concerns that those who have received treatment on an exceptional basis are now being denied that treatment. There is no reason for that to happen. The treatment of each individual patient is and must be down to the decision of the specialist doctor, working with patients and their family to determine the best course of treatment for them.

I met the head of the NHS on that this morning, and I have immediately instigated a system of second opinions. We have put out a call for research to develop the evidence, and we have also commissioned the National Institute for Health and Care Excellence to produce further clinical guidance on this issue. No one who currently gets medicinal cannabis should be denied it, and there is a system in place now for those who need to get it in future.

We want to deliver the best possible care to the most vulnerable, and we want to help build a more sustainable health and care system for all. Today’s announcements will help to do that, and I commend this statement to the House.

I thank the Secretary of State for advance sight of his statement. We welcome his remarks on the use of medicinal cannabis and on the appalling, barbaric abuses of those with learning disabilities and autism, by which we have all been shocked. I understand his point about the review and about asking NHS England to carry out some work, but is it not time that these institutions were closed down and proper support provided in the community instead?

Of course we welcome the emphasis and focus on prevention, but these promises are not worth a candle if they are not backed up with real, substantive action. They come on the back of £700 million-worth of cuts to public health services, with more cuts to public health services pencilled in for next year, including £17 million-worth of cuts to sexual health services, £34 million-worth of cuts to drug and alcohol services, £3 million-worth of cuts to smoking cessation services and £1 million-worth of cuts to obesity services.

The Secretary of State did not mention childhood obesity in his remarks.

I apologise if I missed it. Could the Secretary of State tell us when he plans to outlaw or ban the advertising of junk food on family television and when the consultation will end?

Immunisation rates for children have fallen for the fourth year in a row, so a big part of prevention should surely be a focus on investment in children’s and early years health services, yet Government cuts to those budgets and, indeed, the privatisation of many of those services in our communities have seen health visitor numbers fall by more than 2,000, school nurse numbers go down by 700 and 11% of babies miss out on mandated health checks. What is the Secretary of State’s plan to reverse those cuts to health visitors and school nurses?

All in all, alongside wider Department of Health and Social Care budgets, there will be £1 billion-worth of cuts to health services next year, with public health budgets taking considerable strain. Those £1 billion-worth of cuts should have been abandoned today, and it is a missed opportunity that the Secretary of State has not abandoned them. When he was asked about this in the Budget debate, he said it was a matter for the spending review. Well, today the Association of Directors of Public Health has said that the spending review should allocate an extra £3.2 billion for the public health grant next year. Does he accept that figure?

Of course prevention is about more than just public health; it is also about primary care. But GP numbers are down by 1,000 since 2015, and since 2010 district nurses have been cut by more than 3,000, so can the Secretary of State tell us what his plan is to increase the primary care workforce to support his wider ambitions on prevention? We know he wants a higher proportion of NHS spending to go to general practice, so does he agree with GPs that general practice should again receive around 11% of the overall NHS budget? If not, why not?

Of course, prevention is also about mental health services, but 30% of patients referred to IAPT—improving access to psychological therapies—services never receive treatment. What is his plan to ensure that everyone who needs IAPT services next year gets them?

Finally, on the wider social determinants of ill health, the shameful reality is that people in poorer areas die earlier and get sick quicker. Life expectancy has begun to stall, and has actually gone backwards in some of the poorest parts of the country. Rates of premature mortality are twice as high in the most deprived areas of England compared with the most affluent, and mortality rates for the very sickest of babies are increasing. As laudable as many of the aims that the Secretary of State has announced today are, this document does not even mention poverty or deprivation. It does not even recognise that some of the deepest cuts to public health grants have been in the areas of highest need and highest deprivation.

Yes, we welcome a focus on prevention—we have long called for such a focus—but a genuine commitment to prevention would go hand in hand with a genuine commitment to ending austerity. That must start with reversing the public health cuts and blocking the £1 billion of further cuts to health services to come next year. On that test, the Secretary of State has failed today.

Great, well I take that as a broadly positive response from the hon. Gentleman, and I will address the points he makes. He asked about money, and we are putting £20.5 billion extra into the NHS—this is the largest and longest financial commitment any Government have made to any public service ever. Of course, as well as the NHS budget, local authorities have budgets for public health; as he said, that will be addressed in the spending review. The increase in funding must ensure that we do more on prevention, which means more going into community services and into primary care, as well as making sure we get the appropriate level of spending into public health.

The hon. Gentleman asked about the consultation on advertising as part of the obesity plan. As he knows, that will be published before Christmas. He also asked about rates of immunisation. I want to see immunisation used right across the country. There is a campaign all of us can take part in to persuade people and ensure that immunisation takes place. We do not have compulsory immunisation in this country. I believe that is right, on civil liberties grounds, but by goodness it means it is incumbent on all of us to persuade everybody of the health benefits of immunisation.

The hon. Gentleman asked about GP numbers. We want 5,000 more GPs, and I am glad to report that we have got record numbers of GPs in training, thanks to action by this Government. Finally, he asked about the economic causes of ill health. The No. 1 economic cause of ill health is not having a job, and there are record numbers of jobs in this country. If he says that inequality has an impact on ill health, he should probably welcome the fall in inequality that we have seen under this Government.

I am grateful to the Secretary of State for what he has just said. A lot of Members wish to take part in this exchange, but I remind the House that there are two debates to follow. The Government have chosen to put on two ministerial statements, which is entirely their prerogative. Naturally, people do then tend to stand to ask questions, as that is what we do here, but I have also to protect the subsequent business. I therefore politely say to colleagues: if you have a long question in mind, cut it or do not bother. That would be really helpful. Let us start with the Chair of the Select Committee, Dr Sarah Wollaston.

In the Secretary of State’s vision for prevention he rightly points out that £14 of social benefit accrues from every £1 spent in public health. Therefore it is going to be much more challenging for him to deliver on his objectives if there is a further transfer from the public health budgets into NHS England budgets. However, I recognise that this requires action across all Departments, so will he set out what he is going to do to encourage cross-government action on physical activity, because we all know that that is a vital part of public health and prevention?

I agree with my hon. Friend the Chair of the Select Committee on that. Of course, the public health budgets for local authorities and Public Health England will be settled as part of the spending review, and there was no change to them in the Budget last week. There are also much wider responsibilities on activity—on cycling and walking—on which I am working with the Department for Transport. The document is all about the cross-government action, and the NHS will come forward with its long-term plan for the NHS-specific action. If there are aspects of cross-departmental working that she suggests we have not yet taken up, I will be looking forward to listening to her on that.

I thank the Secretary of State for advance sight of his statement and, in particular, I welcome his determination to reduce the inappropriate and sometimes disgraceful treatment of vulnerable people with autism and learning disabilities. He says that prevention is infinitely better than cure—nobody is going to disagree with that—and that the Government are encouraging people to make better choices, which is fine. However, that will ring hollow if the Government themselves duck difficult decisions that could help citizens to make better choices; we have heard about the example of junk food advertising already, but let me touch on the issue of alcohol. If he is serious about supporting healthy choices, surely he must bring to an end the free-for-all that sees supermarkets encouraging alcohol consumption by selling it at ludicrously discounted prices. Some estimate that in the first five years a 50p minimum unit price in England could save more than 1,000 lives, reduce hospital admissions by 75,000 and cut healthcare costs by £326 million. If the Secretary of State is serious about prevention, will he support minimum pricing?

Finally, I welcome the moves in respect of the prescription of medicinal cannabis, but too few are benefiting. My constituent Caroline was given months to live after being diagnosed with a brain tumour. Those treating her link her ongoing good standard of living with her use of cannabis oil from Canada, which comes at an enormous financial cost to her and her family. However, those treating her will not prescribe cannabis oil because there is no suitable medical research on which to base such a prescription. Why not let Caroline become part of that research by prescribing medicinal cannabis to her? We can then all learn from her experience.

On medicinal cannabis, I announced more research today and there is now a route in England. The hon. Gentleman will of course have to talk to the Scottish health service to ensure that a constituent in Scotland gets access, but I am very happy to look into specific English cases.

On the broader point about alcohol, it is important that we tackle alcohol abuse and it is vital that we do it in the right way. I do not want to punish people who drink responsibly at responsible levels, including myself. I occasionally drink at a responsible level, and I am sure that the hon. Gentleman does—certainly his colleagues enjoy a wee dram. Nevertheless, 5% of people in this country drink 30% of the alcohol. It is the small minority who present significant problems for the NHS and we need significant, targeted action.

We have cut salt dramatically and the Secretary of State now wants to cut it further; life will certainly seem longer, will it not?

It is astonishing that there was no mention in the statement of poverty as a cause of ill health. Is the Secretary of State really so out of touch with communities in this country that he does not see how austerity is making people ill?

The statement talks all about the wider determinants of health. If the hon. Gentleman wishes to talk about poverty specifically, it is absolute poverty, not relative poverty, that has a link to ill health, and that has fallen.

Is the Secretary of State aware that experts have warned that a million patients are getting useless drugs and injections for back pain, but his Department makes very little use of statutorily regulated osteopaths and chiropractors? Is he also aware that there is a Faculty of Homeopathy here and that the doctors are not employed enough, despite the fact that there are a quarter of a million homeopathic doctors in India?

I respect my hon. Friend’s understanding of these issues, not least because I am married to an osteopath, so my back is feeling okay and I hope that other people can access such services, too.

I very much welcome what the Secretary of State said about people on the autism and special educational needs spectrum. I also welcome his enthusiasm for the use of new technology, big data, data analytics and all that. Across party lines many of us see some real opportunities for delivering real public education in the health sector. When the Secretary of State makes good decisions and puts in the resources, he will have our support.

I am grateful for that. We put significant resources into the NHS last Monday. The hon. Gentleman makes an important point about the use of data. Instead of just targeting the average, it is about making sure that we get the public health messages to the people who really need to hear them. There is an argument that just broadly targeting public health messages actually exacerbates health inequalities, because people who are likely to listen to the messages tend to be people who are more likely to take responsibility for their own health in the first place. We need to be much more targeted and work is under way to make that happen.

I very much welcome the Secretary of State’s statement today. It is not only the right thing to do, but the smart thing to do for the NHS, and also a healthy economy needs healthy people. Communities such as my own have very many young people, who are often renting, do not necessarily stay very long and therefore do not register with a GP. Will he take that into account when he is looking at where investment in primary care flows to in the detailed strategy?

My right hon. Friend makes an incredibly important point. The way that money for primary care is allocated is being looked at right now, taking that and other things into account.

To really make a difference to keep our nation well, prevention has to be the preserve of both local and central Government. I note that the conclusion of the Secretary of State’s report says that he will be considering what a health-in-all-policies approach to policymaking could look like next year. Will he signal his support for the health-in-all-policies principle by supporting the Second Reading of my Health Impacts (Public Sector Duty) Bill on Friday 23 November?

We have a duty of care to support all our citizens to maintain good health by empowering employers in the private and the public sectors to motivate staff to invest time and commitment into their diet, fitness, and long-term health. How will the Secretary of State create that new ethos?

There is such an important role here for employers. It is not part of the culture of the UK, except in some excellent examples, that employers take a proactive view of the health of their employees. Other countries around Europe do that much, much more systematically. I am attracted to the Dutch model, but there are others, too, and I am grateful to my hon. Friend for her support in doing that.

Breastfeeding has a significant preventive effect, and babies who are not breastfed are at greater risk of eczema, asthma, obesity, diabetes and sudden infant death syndrome, among other conditions. Scotland has invested in breastfeeding support and seen rates at six to eight weeks rise, whereas in England the rates have fallen for the second year running. Will the Secretary of State invest to bring all maternity and community services up to UNICEF’s baby-friendly standard, and will he act to make sure that women who wish to breastfeed are not being failed by the cuts in England?

The earlier that we can start with this sort of strategy of preventing ill health the better, and there is a lot of merit in a lot of what the hon. Lady said.

I very much welcome the statement today. I also welcome the Government’s commitment to the daily mile in primary schools—I am a particular fan of it because it was invented by a Scottish headteacher in Stirlingshire. Does the Secretary of State agree that young people being fit and active is good for their mental, social and physical wellbeing?

Absolutely. I strongly support the daily mile and I try to do it myself. The key is that this is about activity. It is not necessarily about competitive sport, but about healthy activity that can help to prevent all manner of ills.

I welcome the Secretary of State’s focus on learning disability and autism. He will have seen the report in The Times today, which highlights the outrageous profiteering of a number of people in providing the wrong model of care—long-term institutional care—which frequently breaches people’s human rights. Will he commit to bringing an end to this profiteering and will he also look at including the endemic use of force—restraint—in these facilities along with seclusion in the Care Quality Commission’s investigation?

Yes, I will. I pay tribute to the work that the right hon. Gentleman did in the Department and the fact that he continues to champion this issue.

Order. The Chair will be keen to move on to the main business at 6 o’clock, or very close thereto, so if people have questions in mind, will they think about how they can shave them?

I welcome the Secretary of State’s statement. Will he outline what his views are for community pharmacy as part of the strategy of prevention?

Community pharmacies have a hugely important role to play in keeping people out of hospital and in supporting GP surgeries by doing more. Here, it is the French model that I look to for inspiration, but we should look all across the world to improve our health service.

Tooth decay is entirely preventable, so will the Secretary of State act now to address the concerns of the British Dental Association and others that the new dental contract will not go far enough in prioritising prevention?

We are trialling the new contract to get it right. We want to get it right, and I look forward to listening to the hon. Lady’s concerns in more detail.

As my right hon. Friend is aware, I am a very part-time dentist and I am also a supporter of the British Fluoridation Society. Probably the very biggest reason for children attending hospital for general anaesthetic is to extract decayed, rotten, abscessing teeth caused by dental caries. Fluoridation of the water supplies is a very effective means of prevention. Does he support fluoridation of the water supplies, and what can he do to actively promote it, because, at the moment, it is in only 10% of our supplies?

My hon. Friend is of course a dentist, and I would love to listen to him speak in more detail about what we can do to get this right.

If the Secretary of State does not think that poverty and deprivation are key factors in health inequality, can he explain why life expectancy for women in Sheffield has fallen by four years since 2009?

I said the opposite actually. There are environmental and economic factors, and they are very important. My point was that having a record level of jobs in this country is a benefit.

In my constituency of Mid Derbyshire, there is an amazing group of community pharmacies that are saving people going into hospital and getting them out quicker. I invite my right hon. Friend to come and see them. He does not need to go to France; he can come to Mid Derbyshire instead.

I will actually be in Derbyshire later this month visiting a neighbouring constituency, but it looks like I have just put another stop on the itinerary.

I am quite certain that the Secretary of State will want to visit the hon. Lady’s constituency.

I welcome the focus on prevention. Of course, the next best thing is early diagnosis. Will the Secretary of State look again and remove the arbitrary age limit of 25 for women’s smear tests?

We are reviewing questions around that issue, because we want to ensure the best possible prevention and early diagnosis.

I welcome the focus on physical activity in the new prevention strategy. First, how will the Secretary of State work with the Department for Digital, Culture, Media and Sport on this? Secondly, would not travelling to work provide a great opportunity? Activities such as walking, cycling, tennis before work, Mr Speaker, and my eight minutes of pilates are all cheap or free. What does the Secretary of State have to say about that?

Well, I wish I had time for eight minutes of pilates with my hon. Friend. I cannot think of a better way to start the day. I am delighted that the Secretary of State for Digital, Culture, Media and Sport was here for the statement. We have been working with his Department on the strategy because it is so important to work across Government.

There is lots that we can agree on in this strategy but, as chair of the all-party parliamentary group on HIV and AIDS, I am genuinely disappointed to see that there is no mention of sexual health, HIV or crucial preventive measures such as PrEP. We have made huge progress in reducing new HIV infections in this country. Surely, we cannot risk the reversal of that progress now. Local services have been cut and the Health Foundation estimates that sexual health services in England will have been cut by a quarter by 2020. That means huge consequences for the individual and costs for the NHS. What is the Secretary of State going to do?

Public Health England is trialling PrEP, and I am willing to work with the hon. Gentleman and others to ensure that we do everything we can in this space. The truth is that outcomes are improving in many areas of sexual health, and we have to ensure that we get the right treatment to the right people at the right time.

The Secretary of State’s focus on clean air and reducing childhood obesity is massively welcome. In the Netherlands, half of all children cycle to school. In the UK, it is 3%. What more will he do across Government to up that figure?

I am working with the Department for Transport. Transport Ministers feel very strongly about this question. The document details some of the things that we are going to do, but I am sure that there are a lot more.

May I suggest that the Secretary of State has a look at the report, “Fair Society, Health Lives”, by Professor Sir Michael Marmot, particularly at his recommendation about a minimum income for healthy living? With this in mind, what assessment has the Secretary of State made of the impact of universal credit and cuts to that scheme on poverty and healthy life expectancy?

I have of course looked at that report. It is important, and it is important that we get the answers to it right.

Will the Secretary of State agree that more education should be spent on understanding the total role of sugars in combating diabetes, to go with the success that he has had with regards to the direct focus on sugars in drinks and food?

My hon. Friend is absolutely right; I strongly agree. Reformulation is critical. However, it is crucial to look not just at sugar, but at calorie count. Replacing sugars with higher calorie products is not necessarily the right way forward.

Current average waiting times for eating disorders are 27 weeks, during which time the condition can become much worse. Will the prevention strategy look into concrete proposals to reduce waiting times, with, specifically, targets for waiting times for adult sufferers from eating disorders?

Yes, we are considering this as part of the long-term plan. We have already announced that more than £2 billion extra will be going into mental health services and services to tackle eating disorders, and there will be more to come on this very shortly.

Will my right hon. Friend join me in congratulating Whitestone surgery and its patient participation group, who have brought forward a social prescribing model that has reduced the prevalence of early-onset dementia and reduced the number of anti-depressant drugs being prescribed at that surgery?

Yes, I absolutely will. I am a huge fan of social prescribing. I essentially think that because drugs companies have a big budget to try to market their drugs—and of course many drugs do wonders—there is not the equivalent level of organisation to drive up the use of social prescribing. Examples like the one that my hon. Friend mentions are incredibly important.

The half-a-million-pound cut in public health in York has had very serious consequences, while nationally, with regard to the Government’s flagship project of health visiting—the crucial profession in improving outcomes—the number of health visitors has plummeted by 23% from the previous figure of 10,309. Why?

We are increasing the budget in future and making sure that we target it more on community services and making sure that we get more prevention rather than cure. I can look at the case of York; I can look right across the country at what we need to do. Making sure that we get better prevention is all part of that.

Children’s dental health is shocking and child obesity levels are too high. Will the two words, “parental responsibility”, appear in the Secretary of State’s forthcoming Green Paper?

They will now. I believe very strongly in parental responsibility as well as personal responsibility and the responsibilities of employers. We all have a part to play. As parents, we have a very big responsibility to bring up our children in a heathy way, too.

As my right hon. Friend may be aware, one of the benefits of turning 40 is that we become entitled to an NHS MOT every five years. Has he, as part of his very welcome shift towards prevention, considered extending both the age range and frequency of these very important tests?

Well, you learn new things every day, Madam Deputy Speaker—as someone who only just turned 40, I had no idea. I think we should send everybody a 40th birthday card from the NHS saying, “You can now have these MOTs every five years.” [Interruption.] The shadow Secretary of State would like one, too. We will make sure that that is arranged right away.

As it is my 40th birthday next month, I will look forward to getting a card. The Croft Hall medical practice in Torquay has taken a bold step to use what was once just a derelict backyard as a community garden as part of its wellbeing hub. What role does my right hon. Friend see that type of work by local GP surgeries playing in this strategy?

That sort of work is absolutely brilliant. At one level, it is common sense, but it also needs to be a bigger part of the system. I congratulate my hon. Friend on bringing this to the House’s attention. Perhaps he should be the first recipient of one of the NHS’s 40th birthday cards.

The Secretary of State is obviously too young for it, but will he endorse the mile walk aimed at the over-50s that leaves the Stan Ball centre in my constituency at half-past 10 every Monday morning?

The daily mile—or, in this case, the mile walk once a week—is not just for children but for all of us who can make it. The example that my hon. Friend mentions is valuable to the community, and I am absolutely delighted that it is happening.

I have a couple of years to go until I am 40, but one in four of my constituents is over 65. Lincolnshire has done great work on frailty and assessing the whole person. Does the Secretary of State agree that actually we need to look at the whole person in the round, and that, for older people, technology can also pay a huge role?

Perhaps by the time my hon. Friend becomes 40 it will be a birthday text rather than a birthday card, thus saving on postage costs within the NHS and moving on from the fax machines of old. In all seriousness, the point that he raises is incredibly important. The role of technology in this whole agenda is transforming what we can achieve for the over-65s and for the whole population, as in every other area of life. I know that he is a huge champion of technology, and I would like to think that I am, too. We have yet more to learn about what more we can do to improve people’s lives through technology within the prevention agenda.