World ME Day

Caroline Nokes Excerpts

Wednesday 1st May 2024 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to see you in the Chair, Dame Siobhain. I congratulate my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) on his leadership on this issue. We know that he started the train of getting work done on ME when he was Health Secretary. Too often in this place, we move on from Departments and never speak of them again, but he has not. He has championed the cause of the sufferers of ME, and indeed their families, with real vigour.

It seems bizarre in this place to refer to long covid with a welcome message, but long covid has shone a spotlight back on ME. We know that it is a post-viral condition, but we do not know why. The number of sufferers of long covid has given us an opportunity to look again at ME. Hopefully, in this place some of us will begin to understand more and broaden our knowledge of the condition. My right hon. Friend taken a new approach, and my constituents certainly wish to extend their thanks to him for that.

I always say that I am blessed with constituents in Romsey and Southampton North who are not only articulate and willing to share their views with me, but in many instances are often experts as well. Professor Sir Stephen Holgate contacted me ahead of the debate to make the pertinent point that, for sufferers of ME, many of whom have been bedbound for years, surely I could spend an hour of my time raising their plight in this Chamber. I am certainly very pleased to do so. He highlighted, as did the hon. Member for Putney (Fleur Anderson), the well-established sex bias among sufferers of ME. Of the 17,000 sufferers recently surveyed, women made up 83.5% of the respondents. We know that they are five times more likely to suffer than their male counterparts.

I say to the Minister, very gently—an unusual stance for me—that we have to do more about the bias that exists in medical research and clinical trials. We have to stop the situation, which prevails to this day, where too often conditions suffered by women are portrayed as them being simply hysterical. ME is a serious condition. It is not all in the mind, as my constituents have been told on too many occasions. We need to ensure not only more investment into research to find the causes of ME and hopefully more effective treatments—and of course, the holy grail, a cure—but research focused on the women who need it.

I welcome the cross-Government delivery plan that was set in train by my right hon. Friend the Member for Bromsgrove, but we need to see it. We need to see not just the interim version but the final plan, and we need it to be delivered. We need it to be rolled out into every trust and integrated care board. We need it to be effective for our constituents, which brings me on to my next point: my constituent. I was contacted by a mother, Elaine. The point she made in her email was that she wants her voice and the voice of her daughter to be heard. Her daughter was a high achiever, training to be a dancer. She had already secured 5 A-levels when she was struck down with ME. The words that she used are heartbreaking. She has been stigmatised, gaslighted and ridiculed. As a result, she now avoids doctors. She avoids going to get the very help that she needs because she fears that her condition will lead to ridicule.

That is simply not acceptable in a 21st-century health system. We have to do more to ensure greater awareness not just in the Chamber today, but out in our ICBs and GP surgeries, so that the sufferers who are presenting for the first time do not get ridiculed or labelled as hysterical women, but actually get the help that they need. We cannot have a situation where our constituents are avoiding the people they need to turn to for help.

As I have said, there is bias that we have to overcome. There is a gap in research funding. Only £8 million has been spent on ME research over the last 10 years, which is simply disproportionate to the number of sufferers—it should be several times that figure—and we still know less about every aspect of female biology than we do about male biology. I would like to hear a commitment from the Minister that, while he is in this role, he will do his utmost to eliminate the gender bias that we still see in medical research.

Cass Review

Caroline Nokes Excerpts

Monday 15th April 2024 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Women and Equalities Committee.

[Caroline Nokes (Romsey and Southampton North) (Con)]

Dr Cass’s observations about violent and degrading pornography are chilling, and we know of the impact that is having not just on young girls but on all our young people. Her recommendations also include significant and specific references to expanded services and follow-through services for 17 to 25-year-olds. What concerns has my right hon. Friend about the capacity for that, and about the possible impact on other areas of healthcare?

We know that the transition from children’s services to adult services can be problematic in the case of a wide range of services, not least for those suffering from body dysmorphia or eating disorders. Might there be any crossover, with young people having access to some sort of interim service before the age of 25, and will more funds be committed so that we do not continue to see what all of us will face in our constituencies: the horror of young people being unable to access child and adolescent mental health services before they turn 18 and become reliant on adult mental health care?

[Victoria Atkins]

My right hon. Friend is right to identify the cohort of young people between the ages of 17 and 25 as being of particular concern. Now that we have a clear pathway in relation to the treatment of children and young people under the age of 17, I have asked NHSE to focus primarily on that next cohort. Speaking to parents gives one a very real sense of their concerns about what they describe as the cliff edge between children and young people’s services and adult services for this very vulnerable group of young people. I do not want that to continue, and over the coming months we will see NHSE develop work to help that cohort.

My right hon. Friend has an understanding not just of how transformational the report and its evidence are, but of the challenges that this means for our health service in England and how we choose to respond. As for funding, NHSE has committed more than £17 million to the two new hubs in the current financial year, and I hope and expect that our devolved Administrations will commit similar sums to looking after children and young people in their areas.

Access to Migraine Treatment

Caroline Nokes Excerpts

Wednesday 20th March 2024 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

I congratulate my hon. Friend the Member for Bishop Auckland (Dehenna Davison) on having secured this important debate. I am going to be a little bit cheeky: it is always a privilege and a delight to follow my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson, but I have absolutely no memory of him advocating radical and bold behaviour from the Dispatch Box when he was Chief Whip—in fact, quite the opposite.

Migraine treatment is a serious subject. In November last year, I was privileged to host an event for the Migraine Trust. My hon. Friend the Member for Bishop Auckland did an incredible job of setting out the history of migraine and explaining in detail the challenges that sufferers face. When I agreed to host an event for the Migraine Trust, I thought I understood migraine and recognised the symptoms and impacts and how sufferers endure the most horrible events in their lives. That was right up until I spoke to some of the sufferers who were there that evening.

We have focused on the one in seven people—the 10,000—in each of our constituencies who suffer from migraines, but I was particularly struck by the chronic migraine sufferers who were there that evening. They are triggered endlessly by such a radical thing as light, and they were having to stand in that room with dark glasses on and with ear plugs in to avoid noise. They were telling me about the food and drink they avoided rigorously, because they could identify each individual trigger that would perhaps set off a period when they would have a migraine literally every single day for days on end. It was eye-opening for me, because I thought I understood migraine after the first attack I had when I was about 10 years old.

We should not focus exclusively on our own experiences, but I remember my first attack to this day. I blame my father—I blame him for many things—because he took me to McDonald’s when I was 10 years old. The blue light in those McDonald’s in the early 1980s—I can remember where this McDonald’s was; it was in Southend—triggered a migraine in me that day, and I did not understand what was happening to me. That is the challenge for children: they do not understand and they cannot process that this is something that, if they lie down quietly and take their medications, they may get through. It impacts their education and their entire childhood because they become anxious, as my hon. Friend detailed. They become anxious and worry endlessly about when the next one will come. Of course, as we know, stress can trigger migraines, so the sheer act of worrying about the next migraine can in fact trigger one.

My evening with the Migraine Trust talking to those chronic migraine sufferers was incredibly eye-opening and made me absolutely determined to redouble my efforts to tackle the lack of knowledge and the stigma that surrounds migraine. I was quite surprised to hear from only one constituent ahead of the debate, but I want to focus on her story, because many of the issues have been highlighted today. She has suffered from migraines for 30 years—30 years in which it has impacted every single job she has had. Not a single employer has understood that this is not just a headache, but something utterly debilitating, and that she will not be able to attend work or function normally. As a result, she has had extreme difficulties with her employers. Her ask of me is that I advocate to the Minister—and I do so now—that we should perhaps look at considering migraine as a disability, because, to be frank, it absolutely is.

My constituent also talked at length about exactly the point my hon. Friend highlighted about medications. As we have heard, there is no one silver bullet; some medications will work for some people, and some will work for others. It is almost a process of trial and error, with someone going three months with a medication that they know is not working—going through the different steps and jumping through the hoops—so that they can demonstrate that it has not worked and then move on to the next stage of medication.

I want to talk briefly about the stigma and how some of us are too embarrassed and ashamed to talk about this issue. I remember taking beta blockers for migraines when I was a Minister, so let me talk about the side effects of beta blockers and how impactful they are. When I stood at the Dispatch Box, beta blockers made me feel stupid, slow and dull. The one thing that everyone expects a Minister to do at the Dispatch Box is to answer a question immediately, wittily and with facts tripping off the tongue instantly. When I was taking beta blockers, I found that I simply could not do that. I would stand there and feel dull, detached and as if I was not really in the room.

I stopped taking beta blockers and resorted to a type of medication that is hugely stigmatised. Botox is approved by NICE for migraine and is, for me, incredibly effective, but it is incredibly expensive because I cannot get it on the NHS. I was frantically tapping on my phone—I was not sending messages; I was using the calculator—to work out how much I might have spent on Botox over the past 15 or so years. It appears to add up to a phenomenal £20,000—just to ensure that I can stand in this place, talk relatively coherently and, at times, make sense.

I remember vividly being sat in the Tea Room and not being able to think of the right word. I thought, “Well, that’s fine. We all get a little bit of brain fog when you get to my age,” but it was not that, and it got worse and worse. The longer I sat there, it was not just that I could not think of the right word; I could not think of any word, and then I found that I had been sat in the Tea Room silent for about half an hour because I could not actually speak. As I mentioned, my right hon. Friend the Member for South Staffordshire, who is sitting next to me, is a former Chief Whip, and he would no doubt have been absolutely delighted if I had gone through entire spells of not being able to speak. I am sure the current Chief Whip would also be very happy if I lost the power of speech. But it is absolutely terrifying, and has a profound impact.

I resort to expensive treatments that are socially stigmatised. Everybody assumes that it is vanity—I prefer to use the phrase, “Two birds, one stone.” The impact those have means that I can live my life, but it is not a choice available to very many people. That is the stark reality. As Monica would tell us, she wants the new CGRP medications to be more easily available. She wants them to be available in every NHS trust so that there is no postcode lottery. Most of all, she wants the stigma to be beaten down so that she never again has to explain to an employer what a migraine is, and that it is not just a headache.

It was fascinating to hear the tales of the hon. Member for Caerphilly (Wayne David) and my hon. Friend the Member for Banff and Buchan (David Duguid), who cannot be here, about not only their migraine experiences, but watching a child suffer from them. As I said, I blame my father for my migraines, and my daughter blames me for hers. There is clearly quite a significant genetic link to suffering. We need to have much more research and investigation into not only the condition more widely, but some of the specifics we have heard in this debate.

We need to reflect that stress can be a phenomenal trigger of migraine, and we therefore need to be much more holistic in the way we approach it and think about how we manage our lives. If my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) was here, she would undoubtedly be making a pitch for a new Government Department for wellbeing, and that approach could sit very firmly in that. If we address the mental health challenges around stress, we can also address the challenges of migraine. I do not pretend that we can address all of them—there is clearly a crucial and important role for medication, which needs to be much more widely available.

I finish with the thought that this is a complex, difficult subject. There is no silver bullet, but what we require in this place is a real drive from the Department to make sure it is thinking about including migraine in all of its health strategies. I stand here as the Chair of the Women and Equalities Committee, and I was really struck by the fact that women are more than twice as likely as men to suffer from migraine. If we look around this Chamber today, it appears, as ever, that it is a male problem. We cannot allow things like the women’s health strategy, which is crucial, and which I welcome, to be about stereotypical women’s conditions. We also have to have a thread that weaves through the fact that in almost every health condition, women are under-represented in research and in how it is treated. As my hon. Friend the Member for Bishop Auckland mentioned, too often we are deemed hysterical as opposed to actually ill. My final comment to the DHSC is: please, can we make sure that the impetus on the women’s health strategy is maintained and kept up, and that we do not allow it to become about just reproductive health? It has to include the whole of women’s health to make sure that we are being treated fairly.

Sexual Harassment of Surgeons and Other Medical Professionals

Caroline Nokes Excerpts

Wednesday 13th December 2023 Westminster Hall

[Rosie Duffield]

Absolutely, and I thank the hon. Member so much for raising that important point, which is supported by all the work that the BMA has done, including the report that he mentioned.

The rape of a female child under 13 was included in those shocking statistics, alongside the rape of a female over 16 by multiple offenders in west midlands hospitals, three rapes of a female under 16 in Cambridgeshire, and six rapes of girls under 13 in Lancashire. It is important to note that although the FOI responses do not record the sex of the victims, national data shows that less than 5% of rape victims are men, so it is reasonable to assume that most victims are female. The investigation uncovered 13 rapes of males over the age of 16, however, including one incident involving multiple offenders, and the sexual assault of a male child under the age of 13 in a Cambridgeshire hospital.

We know that hospitals are, of course, monitored by many CCTV cameras, and individual wards usually have safe-door entry systems, which prompts the question of why only a tiny percentage of cases—4.1%—resulted in a charge or a summons. Indeed, five police forces did not issue a single summons or charge a single suspect for any of the 334 reported sexual assaults in their areas. Why not? The WRN report says:

“The damning figures are probably ‘the tip of an iceberg of indifference’ around the safety of NHS patients and staff”,

as some forces gave inadequate information. For example, Police Scotland did not provide any figures, citing cost constraints, and of those forces in England and Wales that did respond, seven forces provided incomplete responses, five did not give information on the number of assaults that occurred on hospital wards, and three did not provide information about the number of people charged or summonsed.

As Heather Binning, founder of the Women’s Rights Network, says:

“These statistics are jaw-dropping. We began this investigation because a number of members raised concerns about the safety of women and children on NHS wards, but we are horrified at what we have uncovered.”

I am grateful to the WRN for highlighting this problem and shining a light on something that has gone almost completely unnoticed in this place before.

The BMA represents doctors and medical students across the UK. It also produced a briefing for today’s debate, as we heard earlier from the hon. Member for Strangford (Jim Shannon). It states:

“The BMA is deeply concerned by the overwhelming number of doctors who have experienced sexual harassment at work.”

Its “Sexism in medicine” report of September 2021 found that 91% of women doctors in the UK have experienced sexism at work, with 42% feeling that they could not report it.

[Caroline Nokes (Romsey and Southampton North) (Con)]

The hon. Lady is highlighting a very important issue. She made a point about reporting, which is certainly an enormous challenge. The Women and Equalities Committee heard from Chelcie Jewitt of Surviving in Scrubs, who made the point that when doctors tried to report harassment, they were often told by the General Medical Council that it was a trust issue, yet the trust would say that it was a GMC issue. Does the hon. Lady think that goes some way to explaining why there is a lack of reporting and that, when there is reporting, it seems nothing gets done?

--- Later in debate ---

[Caroline Nokes]

I thank the Minister for giving way, and welcome him to his new role, appreciating that he has only been in it a few weeks. I gently say to him that there is a real challenge in our NHS when 10% of women in one study reported unwanted sexual conduct in return for career opportunities. That is absolutely about power, and it is going to take a step change to break down those structures that enable such harassment to continue, behind a veil of silence, so that women are still afraid to speak out.

[Andrew Stephenson]

I pay tribute to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), who is the Chair of the Women and Equalities Committee, for her work in this area. I completely agree with her point; there needs to be a serious culture change. We would all recognise that over many years the NHS has been fantastic in treating patients. However, quite often the same clinicians, in many regards, have not been as compassionate when looking after each other.

The workplace culture that has developed in parts of the NHS need addressing. Even though I am new to my role, with only three weeks in post, as part of the NHS long-term workforce plan, I am looking at that culture and the staff leaver rates across a whole range of different parts of the profession. That is important because we must ensure that people have a safe and enjoyable working environment. At the moment, reports such as those detailed by the hon. Member for Canterbury show that in far too many trusts, employers are falling well short of providing that supportive environment, which is the least people should expect.

Turning to what has been happening, most NHS organisations now have trained staff to help colleagues raise concerns in this area. That includes a network of more than 1,000 local freedom to speak up guardians across all trusts, supported by an independent national guardian to help drive positive cultural change. We have also established a confidential helpline for staff who want to speak up but need guidance about what to do and where to turn. That, again, goes to the point made earlier by my right hon. Friend the Member for Romsey and Southampton North about the experience of people complaining but being passed from pillar to post between the GMC and trust. I hope that the confidential helpline will help make a difference.

NHS organisations must do everything they can to stamp out the unacceptable behaviours at all levels across the health and care system. In April, the former Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), convened an urgent meeting with NHS England to ensure that NHS organisations are doing more to tackle such behaviours. We have made some progress, although I acknowledge that there is much more to do.

This year, NHS England broadened and strengthened the remit of its domestic abuse and sexual violence programme, which was established in 2022, to address sexual harassment and misconduct on NHS premises. All trusts and integrated care boards were asked by NHS England to appoint an executive and operational lead for domestic abuse and sexual violence. Those leads are reviewing their policies, training and support systems to enhance support for staff and patients.

In September, NHS England launched the first ever NHS sexual safety charter across the healthcare system. There are now 200 signatories, including NHS employers and the Royal College of Surgeons. Signatories commit to taking a zero-tolerance approach to any inappropriate or harmful sexual behaviours in the workplace by implementing all 10 charter commitments by July 2024. The commitments include establishing clear reporting mechanisms, implementing training programmes and providing essential support for those involved in investigations. NHS England will use the new network of domestic abuse and sexual violence leads to share and promote good practice and develop practical solutions in implementing the new charter.

Data capture is also a key commitment in the charter and to gauge the charter’s impact, the NHS staff survey now includes a question related specifically to sexual safety. That systematic approach reflects a commitment to transparency and accountability in creating a safer working environment. The Equality Act 2010 has also been amended this year to include a new duty on employers to take steps to prevent the sexual harassment of their employees. Implementation of the charter will assist NHS employers with meeting the duty when it comes into force next October.

The GMC is unable to consider complaints about registrants that relate to matters more than five years old unless it considers it to be in the public interest to do so, which has been raised during the debate. We are modernising the legislation that governs professional regulators, which includes removing the five-year rule as part of the reforms to regulatory legislation for doctors. It will allow the GMC greater discretion to consider whether a concern should be investigated. Introducing those changes remains a top priority for the Government.

I hope that these measures show that we are committed to addressing the problem with targeted action. However, I acknowledge that there is more to do, and I would be happy to work with the hon. Member for Canterbury and Members across the House to ensure that we get it right. We will not be satisfied until the number of staff facing sexual harassment is down to zero. There must be a collective effort across our health service to enact change. Strong and effective leadership is crucial, and it starts from the top. The Government, with NHS England driving this work, are calling upon all NHS boards to sign the sexual safety charter and ensure that their healthcare settings are safe places for our current and future workforce.

I will close by acknowledging the bravery of all those women and men who have come forward with their experiences of sexual harassment and misconduct in the healthcare workforce. That includes the testimonies in the report from Surviving in Scrubs, some of which the hon. Member for Canterbury read out. It takes incredible bravery and selflessness to come forward. Thanks to those brave women, and some men, we are getting ever closer to ending the scourge of sexual assault in our health service. I thank the hon. Member for putting a spotlight on the issue today. We must not tolerate it.

Question put and agreed to.

HIV Action Plan Annual Update 2022-23

Caroline Nokes Excerpts

Tuesday 18th July 2023 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I, too, would like to congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on securing the debate and on her comments. She has already said much of what I wanted to say, so that will spare us some time.

I apologise if anyone thinks I am about to drift out of order—I am not—but I want to focus on the women’s health strategy. We know that the HIV action plan has been incredibly effective in increasing the number of men diagnosed with HIV. We have seen a fantastic and sustained fall in HIV incidence for gay, bisexual and other men who have sex with men, but not for women. That is because there seems to be a lack of joined-up thinking when it comes to breaking down some of the stigmas and taboos that still exist for women, and we need to do more to ensure that they are tested.

This is where I drift off into the women’s health strategy, which is a comprehensive and excellent document, and I pay tribute to you, Dame Caroline, for ensuring we saw it get over the line. It clearly states:

“independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.”

The document contains some important and crucial points around tackling taboos and stigma and addressing disparities in outcome that might be affected by age, ethnicity or where the woman is from. It says clearly that those factors should not impact a woman’s ability to access services, but they do.

We know that women are less likely to have access to PrEP and that they are the least likely group to have their need for it identified—only 33% in 2021 had had their need identified. They are also the least likely to continue taking PrEP. The HIV action plan told us about making PrEP available from GPs, and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) commented on making medication more readily available from pharmacies. We have already done that for a range of conditions. Some contraception is readily available from pharmacies. For women, some forms of hormone replacement therapy are available from pharmacies. The morning-after pill is available from pharmacies. What we need to do, to break down the stigma and taboo, is to ensure that PrEP is more accessible from pharmacies. It seems to be a complete no-brainer.

[Lloyd Russell-Moyle]

The right hon. Lady makes some very good points about PrEP. But is this not also about a problem with sexual health and reproductive testing in clinics? In Britain, only one in 10 clinics offers online testing. That means that many people who cannot take time off work, or who cannot get away at the right time, are never able to get tested.

[Caroline Nokes]

The hon. Gentleman makes an important point, and one that I had completely forgotten about but that I wanted to highlight. Online testing and receiving test packets through the post is incredibly discreet, quick, easy and efficient. I know that because even I have availed myself of those services—that will send the Twittersphere into an absolute frenzy. It is a really important point: to be in control of their own health, a person needs to know. Annually, I have an HIV test provided to me—I believe it is Terrence Higgins Trust that does that, because it is a brilliant charity that does fantastic work, not least in providing us with up-to-date information. It also promotes relentlessly the need to make sure that testing kits are readily and easily available through the post and online. It is absolutely critical that we have that. We learned during the pandemic, did we not, the importance of test, test, test?

That moves me on to tests, tests, tests of the opt-out variety. My constituency in Southampton does not benefit from opt-out testing at present. It is classified as having a high prevalence of HIV, with 2.4 adults per every 1,000 living with HIV in the area. We know that opt-out testing finds people living with HIV and brings about an earlier diagnosis in many cases. We all know that earlier treatment is the most effective and that once somebody on treatment has got to the point where their viral load is undetectable, it is untransmissible. Of course, we have to do the maths backwards; we know that if people are not diagnosed and not receiving treatment, they are more likely to be transmitting HIV.

We know that opt-out testing works. We know that it works in Blackpool and London, but we know that in Southampton, more than a third of HIV diagnoses are late, which puts people at much greater risk of ill health and death and increases the problem of onward transmission. We also know that women, black Africans and older people are more likely to be diagnosed late. My plea to the Minister is to ensure that we have an expansion of opt-out testing so that we can identify those people from groups who are less likely to be identified. We know that opt-out testing means that a higher proportion of women and older women are also likely to be identified.

That takes me very neatly back to the women’s health strategy, which puts people into three stages of life. There is the early stage, from puberty up to about 24; the mid-stage of life; and older people, such as me, who have passed their 51st birthday. The important thing about the women’s health strategy is that it is absolutely explicit in saying that sexual health and wellbeing is relevant across all three of those age groups. I make a big plea that we do not forget older people; the hon. Member for Vauxhall (Florence Eshalomi) mentioned a woman of 85 going through opt-out testing. It is absolutely, crucially important. Representing Romsey and Southampton North, it would be remiss of me not to make a quick plea for those living in rural areas, who wait an average of 19 days to get an appointment with a sexual health service. That is far too long to wait.

Much of this comes down to education and information. We know from the women’s health strategy that there is a big emphasis on relationships, sex and health education and that the Department for Education is conducting a review into that at the moment. We must teach boys as well as girls about sexual and reproductive health. The best place to do that is via RSHE, yet a written answer from the Department of Health and Social Care tells me that there has not yet been any contribution to the RSHE review from the Department. That is remiss of the DHSC; it should feed into the review in the same way that every other Government Department that has even a passing interest in the wellbeing of our young people and their ability to respect themselves and each other should. Notwithstanding the fact that I had a very negative answer from the Department, dated earlier this week—it might have been the latter end of last week—will the Minister take back to the Department how crucial that is if we are to hit the target of living HIV-free? Government Departments must work together to ensure that that happens.

Under-age Vaping

Caroline Nokes Excerpts

Wednesday 12th July 2023 Commons Chamber

[Andrew Gwynne]

Absolutely. There has to be a strategy that is not just about restricting packaging and advertising. There has to be more enforcement at the local level. I have some sympathy with local government, which has had to endure massive cuts over the past 13 years, so that things such as trading standards have been cut right back to the bone, but there can be no excuse whatsoever for shops selling these products to children. Every action should be taken to prevent that and to enforce the law.

[Caroline Nokes (Romsey and Southampton North) (Con)]

The hon. Gentleman is making an interesting and important speech, but he is focusing on advertising, marketing, the bright colours and the sweet flavours, and he has not mentioned price. Price promotions are banned for tobacco, yet vapes can sometimes be bought for three for £12, which is pocket money territory.

[Andrew Gwynne]

The right hon. Lady is absolutely right. We tabled the motion because we believe that the action it calls for is something we can do quickly, but the price of vapes is also a driver, and she is right that we should look into deals whereby vapes can be bought really cheaply—as she says, with pocket money—because that would be another step to take vaping out of the reach of children and young people.

As I said, ASH estimates that most children who vape make the purchases themselves. Put simply, children are then increasingly being hooked on to addictive substances that are deliberately packaged—and, indeed, sometimes priced—to catch their eye. This affects not only their health but their education.

Who could have seen it coming? Well, not the Government, it turns out. In November 2021, my hon. Friend the Member for City of Durham (Mary Kelly Foy) tabled an amendment to the Health and Care Bill that would have given the Secretary of State the power to prohibit branding that appeals to children on e-cigarette packaging. It received cross-party support but was voted down by the Government. When the Minister stands up in a few minutes and claims that the Government are on top of the epidemic of youth vaping, I hope he will explain to the House—to Members from all parties who supported that measure—why the Government voted down that sensible amendment in 2021, and why they are still failing to do something about this acute problem now.

Sadly, this approach to public health has become all too familiar when it comes to the Conservatives. We were promised a tobacco control plan; that was binned. We were promised a health disparities White Paper; that was binned. We were promised a ban on junk food advertising to children; that was binned. Why? Because the Prime Minister is too weak to take on those on the fringes of his own party who view public health with suspicion. That is why, on the Conservatives’ watch, health inequalities have widened, and why vaping companies have been given free rein to profit off children and young people.

The next Labour Government will not allow the trend to continue, which is why in Labour’s health mission we have been clear that we will ban the packaging and marketing of vapes to children, and we will come down like a ton of bricks on those who sell vapes illegally to children.

--- Later in debate ---

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is an honour to follow the hon. Member for Ealing, Southall (Mr Sharma) and to be able to speak in this debate. May I first pay tribute to my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who has done so much work on this issue? She is a paediatrician and, frankly, we should always turn to her when looking for advice on vaping. I also pay tribute to a previous Member of this House, Jim Fitzpatrick, who was the Member for Poplar and Limehouse. He has now retired to my constituency—a blessing, although perhaps not an additional vote at the next election. His wife is a cardiologist, and she was talking to me about vaping and the fact that we simply do not know what the health implications might be 20 or 30 years hence. However, it would be an act of gross hypocrisy for me not to confess to liking the odd puff on a vape, and I regard it as an important tool for the cessation of smoking.

We need to be careful when we start discussing things such as flavours. The average vape stick has the most horrific, synthetic, disgusting flavour. They do not taste like strawberry ice, blue raspberry or anything else. They taste weird, but they do not taste as weird as the tobacco-flavoured ones. When I first came to this House—a long time ago now—it was when the tobacco companies were first marketing vaping. The products were almost invariably tobacco-flavoured and tasted disgusting, if we are being brutally honest. I do not know how best to describe them, but they were clunky in design. They were big and chunky and did not fit easily in the pocket. That is where the big difference has come—with cheap, slimline vape sticks, which are much more pocketable and much cheaper.

I really think that price is a two-edged sword. For those looking to stop smoking, there is the sheer fact that vaping disposable bars in particular, which are so cheap and easily obtainable, is really cost-effective. We therefore need to be a little careful and nuanced in looking at how we go about pricing them effectively. It is important that they still be a cost-effective route into smoking cessation, but equally—I made this point to the Minister—we must do something about what I referred to as promotional selling. It is simply not allowed to do two-for-one deals on packets of cigarettes or any other tobacco products—I hasten to add that two-for-one deals are not allowed on things such as baby formula, either—but they are allowed on vape sticks. I know from experience that the village shop sells three Elfbars for £12, making them £4 each, so three kids can easily club together and get a product that is incredibly cheap.

I think the hon. Member for East Renfrewshire (Kirsten Oswald) referred to the Elfbar as the most popular and one of the most widely accessible vape sticks. I take real offence to the Elfbar name, because I think it sounds somewhat like “health bar”, if not pronounced in quite the same way that I would.

It strikes me that the motion does not address myriad issues. It does not address the naming or pricing of these products. There needs to be some good and effective research on flavours. I am happy to say that these things should be in plain packaging, and they should not be brightly coloured. I do not see what is wrong with a slimline black vape stick—or olive green, which we know has been so effective in the plain packaging of cigarettes.

Tomorrow, I will meet the two headteachers of Romsey School and Mountbatten School. A problem in my constituency is the ease with which children can obtain vape sticks, including—we have heard reference to this—doctored vape sticks. We do not know what is in them. I think my neighbour, my hon. Friend the Member for Winchester (Steve Brine), commented on the letters home from school. At the start of the Whitsun half-term week, the two headteachers wrote a letter to parents explaining that children from both schools had been hospitalised because of vape sticks and, to be frank, nobody knew what was in them. One child was suffering from seizures, and they were having an impact on heart rates. Those are really serious health implications that are affecting children.

My hon. Friend mentioned toileting, and I will go there, too—nobody will want to listen to this conversation, but it is important. Way back in 1983, the most terrifying place I ever had to go was the girls’ loos in the main block of Romsey School, where the air was thick with cigarette smoke and hairspray—a unique combination that many male Members of the House will have had no experience of. It is disgusting. We now have a situation where Romsey School has had to introduce alarms because—guess what?—through vaping, it is back, but we cannot smell it.

My mother had the nose of a bloodhound, and if I had had a single cigarette some hours previously, she would sniff it the second I was in the house. If my daughter walks in today, having consumed God knows how many vape sticks, I have no idea that she has done so. The same, of course, is true for teachers, who simply will not know from sniffing children—there are probably all sorts of safeguarding rules why they do not go around sniffing children—whether they have been vaping in the girls’ loos. I suspect that the boys’ loos are also a hotbed of it.

This has massive health implications for children. I remember how, at 11 years old, I would not go to the loo all day because the main block loos were so scary. We do not want to go back to that. We need our children to be able to go to the loo safely and with confidence, and part of that is about making sure that the loos are a safe environment and free of vapes. I pay tribute to my constituent Pete Sandhu, who has developed and indeed marketed a vape alarm, but they are still in the region of £300 to £400 per alarm. I gather that they compare well with an American brand, which is about £1,200 per alarm, but our schools simply cannot afford to be installing such equipment to ensure that pupils are safe while going to the loo.

In addition, I want to mention the levels of nicotine in vape sticks and the nicotine hit. I can talk from experience. The stark reality is that someone will get a far more intense nicotine hit from a disposable vape stick than from a cigarette. That is getting children addicted very quickly.

I speak in defence and support of the Minister; he is right to do a great deal more work on this issue, which we need to be evidence-based. As the Chair of the Health and Social Care Committee said, children are very price-sensitive, but I was disappointed to see the issue of price not included in this motion. Clearly, the DHSC needs to have that conversation with the Treasury. We need the pricing to be right so that vaping remains affordable for those of us wanting to quit smoking, but is too expensive for those price-sensitive children to afford.

The places where vapes can be bought, such as hairdressers, beauticians and tanning salons, are inappropriate. We need a robust licensing regime that does not put those products on the ends of supermarket shelves, as I see in my local Morrisons. God bless Waitrose—Leckford, the home of the Waitrose estate, is in my constituency. It is a market leader in taking the right and principled stand. In the nearest Morrisons to my constituency—it is not actually in it—vape sticks are on the promotional end of supermarket shelves. Vape companies will have paid more to be in that prime location.

As Chair of the Women and Equalities Committee, hon. Members will expect me to make some comment at the end of my contribution—I will not drone on for too much longer—about gender. There has long been a real problem with girls still taking up smoking more than their male counterparts. Some of the packaging and design of Elfbars is gendered—there is an awful lot of pink out there. It is important that any sort of consultation bears in mind that there may be a more targeted marketing strategy towards young women than young men. Please could the Minister bear that in mind?

This is such an important debate and I commend the Opposition for having selected it. I am inclined to agree with my hon. Friend the Member for Winchester, but I hope the shadow Minister will take my comments in the spirit in which they are intended. I want the idea to be done better, not just trashed. It is an important step, but there is an awful lot more work to do than just ban advertising. That is too simplistic.

Hospice Services: Support

Caroline Nokes Excerpts

Wednesday 14th June 2023 Westminster Hall

[Several hon. Members rose—]

[Caroline Nokes (in the Chair)]

Order. Members will see that a lot of colleagues want to get in. I will do my best to call as many Members to speak as possible, and that will require a three-minute time limit from the start. I call Kate Hollern.

--- Later in debate ---

[Several hon. Members rose—]

[Caroline Nokes (in the Chair)]

Order. I will reduce the time limit to two minutes after the next speaker.

--- Later in debate ---

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I pay tribute to the hon. Member for Eastleigh (Paul Holmes) for securing this important debate.

St Mary’s Hospice at Ulverston, St John’s Hospice at Lancaster and the Eden Valley Hospice at Carlisle provide tender, professional and specialist care for people with life-limiting conditions and their loved ones—something we are so grateful for. They prove that life has dignity from beginning to end. Hospitals, however marvellous they are, do not have the resources to replicate the care that is provided by hospices.

The costs of running a hospice have gone through the roof in recent times. Val Stangoe, the chief executive of St Mary’s, one of our three local hospices, said to me:

“The recent settlement by the NHS Lancashire South Cumbria ICB of 0.0%”—

as pointed out by the hon. Member for Lancaster and Fleetwood (Cat Smith)—

“has left our hospices in a state of financial deficit, with potential loss of hospice beds and services.”

She went on:

“Your local hospices”—

our hospices—

“are now operating on a deficit budget, have received the lowest settlements in England. The proposed 0.0% uplift equates to almost 10% in cuts, significantly impacting delivery of services. This stands in contrast to other regions, where hospices have received an average uplift of 2.7%”—

which is not enough. She continued:

“The disproportionate treatment faced by hospices in Lancashire South Cumbria is unfair and must be addressed.”

My fundamental ask of the Minister is this: will she directly involve herself in that situation to stop our hospices in Cumbria suffering? I have been asking the Government for months to come up with a scheme to help hospices that are struggling with their energy costs, which have gone up three times in recent months. There are lots of promises and no action.

There is a cost to meeting the NHS pay settlement. There is a cost to ensuring that hospices are paid properly so that they can pay their staff, keep them, and recruit them in the first place, and so that they can pay their energy bills. But the cost of not doing that is far greater, not only in terms of the health damage and people’s pain and suffering, but for the hospitals that have to pick up the pieces when hospices are not able to meet people’s needs.

[Caroline Nokes (in the Chair)]

Because one speaker has dropped out, I am going to increase the time limit back to three minutes.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

This is one of those occasions when being called last means I gain a minute, so I am pleased to have the opportunity to do just that—thank you, Ms Nokes. I thank the hon. Member for Eastleigh (Paul Holmes) for setting the scene so well, and for giving us the chance to participate in a debate that moves us all. Some Members have told very personal stories.

I put on the record my thanks to all the charities, groups and staff who give hospice care, and give families, and us in this House, so much across this great United Kingdom. Our NHS is under immense strain, and we completely understand that there is a finite budget, but questions have to be asked about the use of funds when we look at those at the end of their lives living in conditions that are not acceptable. Rising costs from energy, food prices and staff costs, which are required to meet expected NHS pay rises, mean that hospices across the United Kingdom of Great Britain and Northern Ireland are collectively budgeting for a massive deficit of £186 million this year. Unless we are going to understaff, under-feed, under-medicate or under-heat our dying patients, more money is needed—that is the bottom line.

It is always a pleasure to see the Minister in her place. She grasps the situation very well. She is a lady well known for her compassion and understanding, and I look forward to her response. I agree with Hospice UK, which says that hospices need financial support to continue to offer their essential services. Government funding of £30 million for UK hospices to offset the increased cost of energy bills in the year ahead needs to go beyond the energy bills discount scheme. Additional funding for hospices from the Department of Health in Northern Ireland is also needed; I do not know whether the Minister has had a chance to consider that. The fact is that funding for hospice care is unsustainable. By the end of the year, 86% of hospices will be impacted by increasing energy prices. They need to keep medical machines running and their in-patient units warm for those in their care. Some 71% of hospice expenditure is on staff, which is a massive issue. As I referred to in an intervention, charities and volunteers run 66% of adult hospices and 80% of children’s hospices.

Over the next few years, I and others, as we often do, will help those hospices. Marie Curie, based in Knock Road in Belfast, is a hospice that I have visited to see people who have now passed away. I understand what such hospices do. The facts are clear: savings can always be made with improvements, but on nowhere near the scale that is needed. I therefore believe, with respect, that the Government and the Minister must man the breach. We regularly prioritise human rights in other nations, and the most basic right to a good death must be prioritised in the United Kingdom. That is what we want. It is a very simple request, and I hope the Minister can answer in a positive fashion.

[Caroline Nokes (in the Chair)]

That brings us to our Front Benchers. I call Patrick Grady.

--- Later in debate ---

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

I thank the shadow Minister for giving way. I completely agree with the points she has raised. I thank the hon. Member for Eastleigh (Paul Holmes) for bringing the debate forward and for sharing his personal story, as have others in this room. It is not easy to share those stories, but it is important that we do.

I have seen first hand how hospices play a vital role in communities. They go over and beyond, and are truly heroic. I am patron of Greenwich and Bexley Community Hospice in my constituency; I have seen how they provide compassionate end of life care. Does my hon. Friend agree that it is vital that the Government recognise the issues hospices face, particularly during the pandemic and with the cost of living crisis?

[Caroline Nokes (in the Chair)]

Order. I remind the Member that interventions should be short.

[Liz Kendall]

I absolutely agree with my hon. Friend and will come on to many of the points she raises.

I want to touch on about five issues, as part of shifting us to a different position on how we ensure people have a good death in the 21st century. The first issue, which I hope the Minister will comment on, and which all right hon. and hon. Members have spoken about, is the real need to review how hospices in England are funded, so that this absolutely critical sector has certainty and security in the months and years ahead. That was a key recommendation of the all-party parliamentary group for hospice and end of life care.

Many Members have spoken about the huge financial pressures on hospices: food prices, energy costs, the costs of NHS pay settlements. As Sue Ryder says, most hospices have seen a 10% increase in their costs, but only a 1% increase and in some cases no increase at all in NHS funding from integrated care boards, creating a perfect storm. ICBs have a statutory requirement to meet palliative care and end of life needs of their populations, but where is the funding? I hope the Minister will say whether the Government will institute the review because, without that, we will not have security for the future.

My second point, which has not been discussed in this debate but which I care passionately about—I would like to hear the Minister say something about this—is inequalities in access to hospice, end of life and palliative care. We know from the Parliamentary Office of Science and Technology that the pandemic exacerbated inequalities in accessing good palliative and end of life care for minority ethnic groups, and there are also socio-economic inequalities in access to hospice care. We know from Sue Ryder that there are also inequalities in access to bereavement support. We want to see everybody have fair access. Will the Minister say something about that?

The third issue relates to help to die at home, something I have campaigned on for many years as a Member of Parliament. There are still at least 10,000 people a year dying in hospital when they want the choice of dying at home. They are not getting the fast track NHS continuing healthcare support that they are supposed to get within 48 hours so that they can die at home. Our brilliant hospices have all sorts of support that they want to give, so I ask the Minister: why is that still a problem and what are we doing about it?

My next issue, which has been raised by many Members, concerns children’s hospices. Rainbows, the sole children’s hospice in the east midlands, wrote to me to express its concern about the children’s hospice grant potentially being wound up. As recently as 22 May, the Government replied to a written question:

“Funding arrangements for children’s hospices beyond 2023/24 have not yet been agreed.”

We cannot have children’s hospices not knowing what is happening to their grants. We have to be able plan ahead better.

Fourthly is something that my hospice, LOROS, has raised with me, but also lots of care homes. Bear with me on this. Many care homes are now essentially providing a lot of end of life care because the level of need that people have when they go into a care home is so great that that is what they need. But the staff might not be properly trained, and LOROS has said that it could work with care homes to make sure the staff are trained. That is one specific ask, so perhaps the Minister could meet me and LOROS to look at what hospices could do to better support our care homes.

Last but by no means least is workforce shortages. Sue Ryder stated:

“The Government must plan for the workforce as a whole system across health and social care”

and charitable providers. That is really important. We have to stop seeing all those different bits of the system as separate. We Labour Members have set out our plans for the biggest expansion in the NHS workforce’s history and for fair pay agreements and for social care staff. We urgently need to see the Government’s workforce plan, and I would like to see that covering all the issues.

In conclusion, we have heard today about the manifold pressures on hospices. I do not think I have ever been in a debate where so many Members have spoken so powerfully and positively about a part of the health and care system and what it does. It shows the strength of feeling and support, but I ask everyone here to think about how we as a Parliament can put achieving a good death as a big thing that we can make progress on and continue this campaign in future. I look forward to hearing the Minister’s comments.

World AIDS Day

Caroline Nokes Excerpts

Thursday 1st December 2022 Commons Chamber

[Lloyd Russell-Moyle]

I agree exactly. I will come on to the Global Fund at the very end of my speech, but let me move on now to the picture globally, which I am afraid is totally different.

Back in 2018, I said that

“one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes.”—[Official Report, 29 November 2018; Vol. 650, c. 496.]

The situation globally has become bleaker. Last year, an adolescent girl or young woman was newly infected with HIV every two minutes. In the past year alone, 650,000 people have died of AIDS-related illnesses and 1.5 million people became infected with HIV. Only half of children living with HIV have access to life-saving medication. Inequality between children and adults in HIV treatment coverage is increasing rather than narrowing.

Why are people still dying unnecessarily of AIDS? Why are there so many new HIV infections year after year, globally? It is too easy to put the blame on current crises such as covid and war; the reality is that we were already off target before many of those crises hit. The lack of a comprehensive healthcare system, a lack of education and the growing influence of evangelical Christian churches in Africa—often American-backed—have led to an environment that is hostile to an effective HIV response.

Uganda was the first country to host the world AIDS summit—it was a revolutionary leader. The same President is in power now, but has completely rolled things back. When Uganda hosted the world AIDS conference almost 30 years ago, condoms were given to every delegate and given out into community settings. When I went to Uganda only a few years ago to visit aid projects that we were paying for, I sat at the back of a classroom with Stephen Twigg, the then Chair of the Select Committee on International Development. We heard a teacher tell children that they could prevent AIDS if they washed the toilet seat and observed “sex only after marriage”. I am afraid that things have gone backwards because of the influence of some malign groups. It is concerning.

One of the inequalities standing in the way of ending AIDS is access to education, particularly for young girls. Six in seven new HIV infections among adolescents in sub-Saharan Africa occur among girls who are outside formal education. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV by more than 50%. All children, including those who have dropped out because of covid and those who were out of school anyway, should get a complete secondary education, including comprehensive sex education.

[Caroline Nokes (Romsey and Southampton North) (Con)]

The hon. Gentleman makes such an important point. Does he agree that we cannot shy away from talking about sexual and reproductive health in the developing world, because that is the single most effective way to ensure that girls stay in school, stay not pregnant and stay free from diseases that will affect them in future? It is crucial that in our role as providers of international aid we do not step back from programmes that talk about contraception.

[Lloyd Russell-Moyle]

I totally agree. As dark forces around the world try, I am afraid, to withdraw money from programmes that talk in a rational and evidence-based way about sex and reproductive rights, we have a greater responsibility. We must step up, because if we do not, others will not. As the right hon. Lady points out, there are two sides to the coin: providing better sexual health education means that girls stay in school, and staying in school allows them to get better education about their health. Those are both positive things. Both issues need to be tackled together.

Another inequality standing in the way of ending AIDS is the inequality in the realisation of human rights. Some 68 countries still criminalise gay men. As well as contravening the human rights of LGBT+ people, laws that punish same-sex relations help to sustain stigma and discrimination. Such laws are barriers preventing people from seeking and receiving healthcare for fear of being punished or detained. Repealing them worldwide is vital to the task of working against AIDS.

Of the 68 countries that outlaw homosexuality, 36 are Commonwealth countries. The majority of Commonwealth countries are still upholding laws that we imposed and that never originated in the countries themselves. In fact, before British colonialism—British imperialism, I should say—many of those countries had better customs and practices around homosexuality than they do now. These customs and practices are not native to people’s home countries; they were imposed. They should be discarded with the shackles of imperialism, which we all now recognise was wrong. One in four men in Caribbean countries where homosexuality is criminalised have HIV. Globally, 60% of people with HIV live in Commonwealth countries. Collectively, we have a responsibility to tackle that in the Commonwealth. Barriers undermine the right to health: a right that all people should enjoy.

Beyond the human rights implications, the laws criminalising homosexuality also have an impact on public health. LGBT+ people end up not seeking health services for fear of being prosecuted. Those who do seek health services often have to lie about how they were infected. Astronomically high numbers of people with HIV in Russia say that they were infected because they were drug-injecting users; that is widely believed to be partly because of the attitude in Russia that it is better to be a drug-injecting user than an LGBTQ person. Without accurately knowing the source of infections, we cannot accurately run public health programmes to save people. Putting people undercover in the dark, hidden in corners, means that the virus lives on. That is a danger for us all.

In some countries, people living with HIV are at risk of being criminalised even when they take precautions with their sexual partners. That opens them up to blackmail and fraudulent claims from former partners. People with HIV in the UK are not immune to that either, as we have seen in some high-profile cases. We have known for at least 20 years that antiretroviral therapy reduces HIV transmission, and for the past few years we have known that it stops it completely, so there should be no doubt that a person with sustained undetectable levels of HIV in their blood cannot transmit HIV to their sexual partner, and laws should not punish them. However, under Canadian criminal law, for example, people living with HIV can be charged and prosecuted if they do not inform their partner about their HIV-positive status before having sex. The law does not follow the science, and it puts people at risk.

Laws requiring disclosure perpetuate the stigma against HIV-positive people. With the advent of PrEP and with “Undetectable = untransmittable”, the law should now reflect the fact that everyone has a role in protecting themselves against HIV and everyone must step up. The criminalisation of drug-injecting users and sex workers has an equally negative effect on HIV prevention and treatment, as I have outlined, in LGBT communities. In all these areas, a health and human rights-based approach must be taken if we truly want to see the end of HIV.

Beating pandemics is a political challenge. We can end HIV and AIDS by 2030 in this country, but only if we are bold in our actions and our investments. We need courageous leadership. We need people worldwide to insist that their leaders be courageous. That is why last month it was so disappointing not to see courageous leadership from this Government. The UK Government were the only donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria to cut their financial settlement—by £400 million. The fund asked donors to raise their pledges by 30% this year, and almost all the G7 nations—which are suffering economic problems that are, in many respects, similar to ours; as the Government often remind us, this is a global crisis, not a crisis of their own making, although in our view it is a bit of both—increased their amounts. For decades the UK was the leader in the global response to these infections and diseases, but that is no longer the case. When our allies met the fund’s request for a 30% increase, the UK went for a 30% cut from their 2019 pledge.

--- Later in debate ---

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to follow the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), who speaks with such passion, knowledge and indeed experience. I vividly remember being in the Chamber four years ago when he spoke of his own diagnosis, and of how he had coped with the emotional stress and trauma and the physical challenges. Of course it is always a privilege to follow any Member who speaks with such a depth of knowledge.

I apologise for the fact that my speech will focus almost exclusively on women. As Chair of the Women and Equalities Committee, I am very conscious that some of the people who are diagnosed at the latest stage, and some of those who are afraid of going for a test, are women. It has always been a humbling experience for me, in my role as Chair of the Committee, to meet those women living with HIV who have spoken of the barriers that they felt prevented them from taking a test. That is why I commend the work done by organisations such as the Terrence Higgins Trust and, indeed, the all-party parliamentary group, which has always led the way in trying to break down the stigma associated with testing.

There should be no such stigma. After all, there has been no stigma attached to covid tests over the past two years; and making oneself aware of one’s own HIV status is actually one of the most empowering actions that an individual can take. That is why, as Chair of the Select Committee and indeed before that—I was about to say, “I have never been afraid”, but that is the wrong term to use. I have always been keen to ensure that I use my role to emphasise to others that it is perfectly okay to go and get a test, and it is also much easier to do so nowadays than it used to be.

I was going to say that I had never been afraid, but I vividly recall that Simon Kirby, the hon. Gentleman’s predecessor as Member of Parliament for Brighton, Kemptown, used to arrange in this place, every year, a testing session for Members. I remember Simon telling me, years ago, “Nokesy, you have to go along and get a test”, and I remember rolling my eyes and saying, “I don’t really fancy that.” I was rather terrified of the prospect of going. However, I also remember coming away after the test and thinking, “That was the right thing to do. I now know that I don’t have HIV, so I can relax about that, but I also know how important it is to talk about it.”

I remember, too, the grief that I was given on social media from the ill-educated, ignorant and—to be frank—bigoted people who used that as a stick with which to beat me: “Ooh—why did she need an HIV test?” Why did I need one? First, to know, and secondly, to be a voice for everyone else who felt anxious about getting an HIV test. I wanted to tell them, “There is nothing wrong with it; there is no stigma attached to it; you are doing it for your own wellbeing.” That is why I now act as a champion for all women, telling them how important it is to go and get a test.

The hon. Member for Brighton, Kemptown made a very important point—I dwelt on it a little when I was thinking about what I wanted to say—about the prevalence of online and postal tests. I think that they are great innovations. Earlier this year, however, I received a little package through the post with the message “Give HIV the finger”—which was a wonderful message, but it was hard to get the required amount of blood out of my finger, and I felt slightly concerned about whether it was enough. I thought, “Will this be effective? Who knows?” For me, much of that process was about being photographed proudly holding up the box, having taken an HIV test. However, another part of it was to do with the fact that we need these testing programmes to be effective, we need people to be confident enough to use them, and we need them to be available in all sorts of locations.

That brings me to my next point. We need people to be culturally competent and aware. We know from statistics that a third of the people living with HIV are women, and we know that 25% of the new diagnoses are in women, but we also know of the prevalence of HIV in black African communities. Covid taught us—and I am an absolute advocate of this—that we must learn the lessons of really difficult experiences. We learnt through covid about the importance of speaking to people in languages that they understand, in a way that they can relate to, on the media channels that they instinctively use. It is no good broadcasting our public health messages exclusively on the BBC; we have to find different channels in order to communicate with the audiences who are most at risk, where the prevalence is highest, and where people might not be engaging with the traditional forms of media that you and I, Madam Deputy Speaker, might use. That is a really important message that I would like to give to NHS England and the Department of Health and Social Care. We must keep up the pressure, and talk to communities in which there is high prevalence and where there might be barriers, cultural or otherwise, to getting a test.

I have an important wider point on research. It was crucial that a great deal of the research on HIV and AIDS be done on those who were most likely to be affected by them, so of course, a massive wealth of research has been done on men. I absolutely acknowledge that that was right, but there are knowledge gaps when it comes to women with HIV and which drugs might be most effective for them. There is certainly still a barrier to women accessing PrEP; that is borne out by the numbers. They are simply not using it. We have to understand why that is, and how effective that drug and indeed other HIV drugs may be on women. We have to make sure that the DHSC and NHS England not only have sufficient data, but disaggregate it, so that it can be broken down by gender and ethnicity. Often when I talk about health, I find myself complaining and browbeating others about the lack of data that is relevant exclusively to women, the lack of women coming forward in drug trials, and the lack of research done on women. Those things are true when it comes to HIV.

I turn to what we have been good at. The action plan for HIV talks about the successes on vertical transmission; a tiny number of children are now born with HIV in this country. A big part of that is down to opt-out testing of pregnant women; the take-up has been absolutely enormous. The figures show the result: of the 60 people diagnosed in 2019 who acquired HIV through vertical transmission, only five were born in the UK. That is a huge step forward, and we have done brilliantly on vertical transmission, but it is crucial that we never let up on that, and that we get the message out that effective drugs taken during pregnancy can prevent HIV transmission to a baby. The mother has to be mindful of risks to do with the method of birth, be that natural delivery or via caesarean, and there is a risk factor involved in breastfeeding. All those pieces of information can effectively and easily be communicated to expectant mothers, and they absolutely should and must be.

I am conscious that my knowledge is not as great as that of other Members in the Chamber, so I have deliberately kept my comments relatively brief. We need to keep up the pressure. The hon. Member for Brighton, Kemptown referred to approaching the finish line. When I do anything that involves running, there is definitely a slowdown, usually due to exhaustion, as I approach the finish line, but we cannot afford a slowdown here. We must accelerate to the finish. We can now see a UK without HIV. He made important points about the developing world and the efforts that still need to be made there, but the end is in sight, and it is absolutely crucial that we reach it and see a world that is free of HIV.

World Menopause Day

Caroline Nokes Excerpts

Thursday 27th October 2022 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to the hon. Member for Swansea East (Carolyn Harris), and to my hon. Friend the Member for Lewes (Maria Caulfield), who did so much to ensure that people can get prescriptions for HRT over the counter. I also pay tribute to my hon. Friend the Member for Mid Sussex (Mims Davies), who is here but cannot speak in the debate. In her role as employment Minister, she recognises that the menopause is not simply a health issue; it also affects the economy, employment and women’s wellbeing in later life. I hesitate to use that phrase; I must declare my interest.

I will give the Minister a hard time. Back in July, the Women and Equalities Committee published our “Menopause and the workplace” report. I recognise that he is a Health Minister, but I hope he understands my disappointment that we are still waiting for a Health response to our report. This afternoon, I was sent an email apologising again for the fact that tomorrow the response to that report will be one month late, and telling me to expect the full response in the coming months. It is a very bad plan to tell a menopausal woman to wait for anything. They should not be waiting for their single prescription over 12 months, and we should not be waiting for months for the Government to come up with a response to a very sensible—I would say that—report.

What do I actually want from that response? I want to see flexible working, so I want an employment Bill. That is not the Minister’s responsibility. I want to see a consultation on whether the menopause should be a protected characteristic. That is not the Minister’s responsibility either. I am disappointed, because we should have a cross-Government response to the report.

We should see mandatory workplace policies, with the Department for Business, Energy and Industrial Strategy leading the way to provide that resource to employers, free of charge on its website, as easy as anything. Great organisations such as Henpicked already do that. I was at the Menopause Friendly employers awards last month, and it was absolutely brilliant. Lots of employers have signed up, but why is BEIS not leading the way on that? We want to see the enactment of section 14 of the Equality Act 2010. That will be lost on the Minister; he will not know what I am talking about. I urge him to talk to the Government Equalities Office and at least consider that.

I want to see menopause ambassadors Government. It was great that Maddy McTernan was appointed HRT tsar, but she has returned to vaccines now. I want confidence from the Health Minister, as I have him here today, that Dame Lesley Regan will stay in place as the women’s health ambassador and that there will be a real commitment to the women’s health strategy. I shuddered when we had an “ABCD” of priorities, because I thought, “How long does it take to get to W for women’s health?” That was from the former Health Secretary; I hope the new Health Secretary will reinvigorate the women’s health agenda, and I urge the Minister to encourage him to do so.

I would like to see the Government working with a large-scale public sector employer to trial menopause workplace leave. I hesitate to point this out to the Minister, but it seems to me that the NHS is a large-scale public sector employer with lots of women working in it, so it might be ideal. I also want to see better training for GPs, and I want to know who is supporting our GPs. It is great that the workforce in general practice have been hugely feminised over the last few decades, but those women working in the health service also need support.

I want to champion the local women doing such fantastic work, whether that is Claire Hattrick and Jo Ibbott in Hampshire, or the brilliant GP I met at the Sutton Women’s Centre, where I went to do a menopause event, who was absolutely taking the message out there: “Your menopause can be celebrated and enjoyed, but it also needs to be managed.” For my final shot to the Minister, let us have a national formulary, let us deal with HRT shortages once and for all, and let us ensure that the info is out there for women.

--- Later in debate ---

[Will Quince]

I certainly agree with that. I also want to say thank you in passing to PHS Group; it is important that employers play their part, and it is good to hear about what that organisation is doing. I did some work with it on the period product scheme in a previous role as Minister for Children and Families. We should celebrate companies that are doing the right thing by their employees.

Somebody said that the hon. Member for Swansea East—I will call her my hon. Friend—has a lot to answer for. There is no more effective campaigner in the House of Commons. I recognise the incredible work that she has done in raising awareness of the menopause, which affects millions of women across our United Kingdom. I also thank her for chairing the all-party parliamentary group, which recently published its first report, on menopause support.

It will not have escaped your notice, Mr Hollobone, that I am not my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson). I have stepped in at the last minute, and I wish her well.

The hon. Member for Swansea East said that women are more sceptical and less jubilant. Although I am not the Minister responsible for this policy area or brief, the hon. Lady knows me and knows the issues on which we have campaigned together. She knows that, in me, she has an ally at the Department of Health and Social Care. She referred to men at the football coming to get a selfie with her. I think I speak for all men in the Chamber when I say that I would be honoured to have a selfie with her. In seriousness, I was moved by the stories that she and others told of the impact of the menopause on women in the workplace. In bringing about the change that we all want to see, she has an ally in me. That change is an issue not just for the Department of Health and Social Care but for BEIS. I have heard that loud and clear.

I thank my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for all her work as Chair of the Women and Equalities Committee. Its recent report, “Menopause and the workplace”, to which she referred, demonstrates the significance of the topic to the House. I know that my hon. Friend the Member for Sleaford and North Hykeham has written, albeit today, to my right hon. Friend to explain that we are carefully considering the Committee’s recommendations. We will respond in due course, and I will ensure that that happens—I will chase it up today. I will also speak with BEIS and the Government Equalities Office about the issues my right hon. Friend raised.

I thank all Members who have spoken, whether on behalf of themselves or their constituents, to mark World Menopause Day. It is important to say that 51% of our population will experience the menopause. There is no question but that the stigmatisation of this important part of life must end. That begins with us talking more openly about the symptoms and the treatment and support available. Vitally, when women talk, we have to listen.

I would like to update the House on the Government’s important work in this area and to reflect on how far we have come and the distance we still have to go, and I will respond to as many of the points raised by hon. Members as I can. For too long, women’s experiences of menopause support have not been good enough. That was the clear message from our call for evidence on the women’s health strategy last year. The menopause was the third most selected topic for inclusion in the strategy. It was chosen by 48% of nearly 100,000 individual respondents.

During last year’s debate on World Menopause Day, the Government committed to listening and to making menopause a priority for our women’s health strategy. I am delighted that the first ever women’s health strategy for England has been published. It contains our 10-year ambitions and the immediate actions we are taking to improve the health and wellbeing of women and girls across our country, from adolescents through to older age. It details an ambitious programme of work to improve menopause care.

It is important to stress that we are not implementing the strategy alone. As I think was said already, we appointed Professor Dame Lesley Regan as the first women’s health ambassador. The hon. Member for Swansea East and I have worked with her on both baby loss and maternal health. She is an expert, and she will do an amazing job as the first women’s health ambassador for England. She will help us to raise the profile of women’s health and break down harmful taboos. I have no doubt that she will bring a range of voices to help us implement the strategy and deliver on our commitments.

Numerous Members raised healthcare support. I bring to the House’s attention the NHS England national menopause care improvement programme, which is improving clinical menopause care in England and reducing disparities in access to treatment. That important work sits alongside a menopause education and training package that the NHS is developing for healthcare professionals.

I turn to the important point of raising awareness. My right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) said that we know more about Viagra than about the menopause, and she may well be right. Awareness is vital to tackling the stigma around the menopause. We want everyone in this country to be educated about the menopause from an early age. All women going through the menopause and perimenopause should be able to recognise the symptoms and know their options. We are transforming the NHS website into a world-class first port of call for women’s health and have recently updated the menopause page.

As my hon. Friend the Member for North Devon (Selaine Saxby) rightly pointed out, we should educate the next generation of boys and girls to help break taboos and ensure that children growing up today can speak about the menopause openly. Menopause is included—I know this as a former schools Minister—in the statutory relationships, sex and health education curriculum, and we are working across Government to understand women’s health topics that teachers feel less confident about to provide further support.

The hon. Member for Enfield North (Feryal Clark) raised the issue of HRT supply. Although most HRT products remain in good supply, various factors, including increased demand, have led to supply issues with a limited number of products. That has improved significantly recently, and we have been working hard to ensure that women can access the treatment they need. We are implementing the recommendations of the HRT supply taskforce and continuing to use serious shortage protocols where appropriate. We keep that under close review.

The hon. Members for Swansea East and for Enfield North and my right hon. Friend the Member for South Northamptonshire mentioned the cost of HRT—an incredibly important issue. We are committed to reducing the cost of HRT prescriptions through a bespoke prepayment certificate for HRT, which we will introduce from April 2023, subject—here is the caveat—to the necessary consultation with professional bodies. The hon. Member for Swansea East asked me for a cast-iron guarantee, but she knows that I do not make promises that I cannot keep. I am not the Minister responsible, but I do know and firmly believe that politics is the art of the possible, and as long as I am a Minister of State at the Department of Health and Social Care I will ensure that the Department’s feet are held to the fire to deliver on that April 2023 ambition. It is taking longer than any of us would like because we have developed an entirely new system, and we have to create an implementation programme as well.

[Caroline Nokes]

I am not sure that what we have heard is entirely consistent. The Minister, who I know will work hard on this, indicated that there still needed to be a consultation with professional bodies, but he then indicated that the delay was in bringing forward a whole new technical system. Can he clarify that point?

[Will Quince]

My right hon. Friend is right to push me on that point. The reason for any potential delay would only be around the consultation that we would need to have. The delay—as in why we could not have done it before April 2023—is because we needed to design a whole new system. We are confident that that will be okay for April 2023. I am caveating it only because I am not the Minister responsible, and I try wherever possible not to make promises that I definitely cannot deliver on. I will not be the Minister delivering on this, but I have no doubt that the Minister who will be responsible will be able to update my right hon. Friend in due course.

Importantly, numerous Members mentioned menopause in the workplace, and, as I mentioned earlier, there were some very difficult stories. As a former Department for Work and Pensions Minister, I know the impact that that has on individuals who want to go to work and on employers, so we have to tackle that. This summer the Government responded to the independent, Government-commissioned report into menopause in the workplace, and we committed to working with a range of stakeholders to consider what more we can do. That will include an employer-led, Government-backed communications campaign on menopause in the workplace.

My right hon. Friend the Member for Romsey and Southampton North mentioned the civil service and the NHS. They are two of the biggest employers and they have signed Wellbeing of Women’s menopause workplace pledge, which is a public commitment to making our organisations a supportive and understanding place for employees going through the menopause. I encourage all other employers to do the same.

Hon. Members also referenced an employment Bill. Again, that is a promise that I cannot make because it does not fall under the remit of the Department of Health and Social Care. Nevertheless, I will have that conversation with my counterpart at BEIS.

I want to ensure that the hon. Member for Swansea East has plenty of time to sum up, so I will conclude by thanking all right hon. and hon. Members for their contributions to this important debate and for their dedicated work across Parliament to improve the experiences of women in this country going through the menopause. As I said, they have an ally in me at the Department of Health and Social Care. I am glad that we have had the opportunity to discuss this hugely important topic and that I have had the opportunity to update the House on the work under way. It is vital that this conversation continues.

Super Health Hub in Plymouth City Centre

Caroline Nokes Excerpts

Tuesday 25th October 2022 Westminster Hall

[Caroline Nokes (in the Chair)]

I will call Luke Pollard to move the motion and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up; that is the convention for 30-minute debates.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I beg to move,

That this House has considered Government support for a potential super health hub in Plymouth city centre.

It is good to see you in the Chair today, Ms Nokes. Plymouth’s NHS is in crisis. Our brilliant NHS and social care staff are working their socks off. The health crisis is not their fault. Things in Plymouth are getting worse, with severe ambulance waiting times, a critical shortage of hospital beds at Derriford Hospital, a social care system in crisis, a shortage of GPs and gaps across our NHS that we simply cannot fill, and we have dentistry waiting lists that last for years. I am here today to deliver a very simple cross-party appeal from Plymouth for the funding we need to build a super health hub, or Cavell centre, in Plymouth city centre.

I know the Minister is familiar with what a super health hub is, but the genesis of the project is important to understand as it shows Plymouth’s health services and our political parties all working together to deliver something truly transformational for our city. The super health hub project is one that I have been associated with for many years. In October 2018, I proposed that Plymouth should build on the success of the network of health hubs across the city with a super health hub in the city centre, repurposing one part of our city centre and bringing health to the high street. That was in response to GP practices, including the one that I was registered at, handing back their contracts and closing.

The proposal was swiftly adopted and advanced by Plymouth City Council and then ultimately rolled into the nationwide Cavell centre programme. Both Conservative and Labour-run councils in Plymouth recognised the importance of the scheme, which enjoys considerable and locked-in cross-party support. The project goes by many names—the super health hub, the West End health hub, the Cavell centre. They are all different names for the same pioneering development.

The Minister will know that the Cavell centre’s programme, developed by the NHS, has six sites under consideration nationwide, of which Plymouth is by far the furthest advanced. Although it was not funded in the comprehensive spending review, the Plymouth Cavell centre project advanced thanks to financial reassurances from the NHS about using capital underspends elsewhere in the national budget. I am sorry to report that the promised funding is no longer available and the project is now at risk. The Minister confirmed to me about the funding last week. So my job today is simple: to ask the Minister to restore or find from elsewhere the £41 million NHS funding that we need for Plymouth to build the super health hub.

Plymouth’s primary care crisis is acute. In 2019, the BBC’s “Panorama” programme showed the severe problems that staff face at the North Road West medical centre: GP vacancies unable to be filled, severe illness and far too few staff. The practice was due to move into the new super health hub—the West End health hub—into modern facilities, and that is now at risk.

Hiring a GP in Plymouth is almost impossible, especially for the practices in the most deprived areas. We are moving at pace to move to paramedic and senior nurse-led practices, because there are simply no doctors available to provide the healthcare that they might provide elsewhere. As a city, we are innovative and creative because we have to be. One third of Plymouth’s population is currently covered by GP practices with emergency standing contracts, but as more GP surgeries close in our communities and practices hand back their contracts, we need an alternative long-term and large-scale intervention. That is what the super health hub, the Cavell centre project, delivers in buckets.

The new super health hub would provide a number of considerable health benefits. At least three GP surgeries in substandard accommodation, currently with large lists of patients—North Road West medical centre, Adelaide surgery and Armada surgery—would relocate to larger premises where they could see more patients. There would be space for 24/7 out-of-hours GP surgeries and pharmacy and X-ray facilities, enabling earlier diagnosis and better management of conditions, such as weight management, smoking cessation, district and practice nursing facilities, physiotherapy and occupational therapy space, mental health services, drug and alcohol treatment, and nutrition. Importantly, alongside that would be advice and information services, debt assistance and housing support, and access to training and employment, volunteer support, social care and prevention services, all under one roof with a single entrance. People would not have to travel miles and miles and fork out for buses or taxis to see someone who can help. In short, the super health hub in Plymouth is about giving people better chances to live longer, healthier and happier.

The benefit that the super health hub would bring to the area cannot be underestimated. The super health hub is to be built on Colin Campbell Court car park, in Stonehouse. Stonehouse is a community with extreme levels of poverty and deprivation. It is an area full of life and full of good people, but the economic and social picture is challenging and the cost of living crisis is making it worse. Stonehouse is in the bottom 0.2% of communities for super output in the entire country, and in the bottom 1% for nearly every other major economic indicator.

Life expectancy in that community is a full 7.5 years lower than the national average; health outcomes are poorer; cardiovascular and heart disease are found in younger people than elsewhere. A third of our private rented homes are classed as non-decent in that community, school grades are a third lower than the city average, and crime is a considerable scourge. Health problems are exacerbated by poverty. This community is responsible for approximately 20% of Derriford Hospital’s emergency admissions. I say this not to talk Stonehouse down but to make the case that this is a community worthy of investment, priority and attention.

The Cavell centre’s focus on early prevention and good healthcare is key not only to dealing with the health inequalities that we have face as a city but to cutting the ambulance queues at Derriford hospital. At this very moment, nearly 20 ambulances are queuing outside our hospital. Derriford has the fourth worst record in the country for ambulance queues. The pressure on our emergency department is critical. Staff there do an extraordinary job, but we need to find ways of reducing the number of people going to the hospital—not just building better facilities at the hospital but reducing the flow.

As more surgeries and dentists close in our community, the case for a super health hub—a centrally located facility—is more profound and powerful than ever. Bringing health to the high street really helps: it repurposes the city centre with the creation of a new health village, with the super health hub at its heart. Plymouth city centre is a very large, post-war city centre serving a population that has found new ways to shop, so we need to repurpose many of the empty buildings. The Colin Campbell Court part of town is an area that could do with a bit more love. It would not only regenerate a part of our city centre but would create more local jobs and, importantly, healthcare accessible to local people. Every bus in Plymouth goes to the city centre—it is not just about supporting people in Stonehouse; it would support people right across our city to access first-class healthcare services.

We have had some mixed messaging from the NHS about this project. It is well regarded and supported. One part of the national health service believes that the £41 million of capital funding would be available for the project. However, it now seems apparent that the intention to make that funding available is no longer present. I thank the Minister for investigating the funding options and speaking to me and my neighbour, the hon. Member for South West Devon (Sir Gary Streeter), so frequently. This issue matters right across Plymouth. A predecessor of the Minister, the right hon. Member for Charnwood (Edward Argar), has also been very helpful. I encourage the Minister to continue being helpful as we look at the options to ensure that we can build a super health hub in Plymouth.

There is considerable support for this project from our local NHS infrastructure, the NHS system and the city as a whole: from the primary care sector to the acute hospital at Derriford; Livewell, our health social enterprise; NHS England; the University of Plymouth; Nudge Community Builders; our local councillors of every party; and our integrated care commission. The project is well supported. But the Minister knows that the capital funding does not exist in the Devon healthcare system to deliver the project without Government support. Without the spending commitment being honoured, the plans for the super health hub in Plymouth will not be able to proceed. The intention was that spades would be in the ground in the new year, once demolition of the site was complete. At this very moment in Plymouth, JCBs are knocking down buildings surrounding the Colin Campbell Court car park in preparation for construction to begin in the early new year.

The business case for the super health hub has been praised locally and regionally, and is supported nationally, but it cannot proceed unless the funding can be allocated within an NHS budget. Because the hub does not neatly fit into an NHS line item, there was always going to be a challenge of sweeping up underspent capital funding from other projects, but being able to do so was the route whereby we could construct this project, as a trail- blazer for the country.

I would like to propose the three ways to proceed that could rescue this project. First, I ask the Minister to look again at the capital underspends across the NHS to see whether a combined effort with our local NHS groups’ funding could deliver this project as a national pilot for a Cavell centre roll-out in every town and city in the country. I would like a research and evaluation project to be attached to this project, so that when it is rolled out the expected massive benefits can be calculated, valued and understood.

Secondly, the Minister knows that so many of the so-called new hospitals are exceeding the spending envelope that has been allocated for them, so that without huge extra sums being allocated to many of the 40 new hospitals, they simply will not be able to proceed. Extra funding is very unlikely given the state of the national finances, but there is a way through. Will the Minister consider whether as part of the Government’s new hospitals programme, funding could be allocated to the Cavell centre programme, delivering a new fleet of pocket hospitals or health hubs before the next general election? It would use only a fraction of the allocated capital budget for the so-called new hospitals.

Work at Derriford’s new emergency department extension starts in the new year. That is because as a city we were further ahead in wanting to invest in our NHS facilities, before the Cavell centre and new hospital programmes were even invented. I encourage the Government to not punish us for being innovative early. I do not mean to do the Government’s PR for them, but I suggest that the super health hub could be the Tesco Express of new hospitals, with everything people need on a regular basis, while still allowing for a big shop at a larger store on an irregular basis. There would be GPs, nurses, physios, diagnostics, X-rays and prevention services on the high street, with the emergency cases, complex treatment and scans at larger hospitals, thus taking pressure off the acute hospitals and ensuring that healthcare is more accessible.

The super health hub is precisely what Dr Claire Fuller’s stocktake of primary care recommends in many ways. The Minister will know that report’s vision for integrating primary care and improving access, with more personalised care available locally to the individuals. The integrated offer is powerful. More importantly, it is more cost-effective than the distributed model we have today, which is failing. It also gives patients more of what they want—more same-day services, less travelling and greater continuity of care—not to mention the expected boost for recruitment and retention of GPs and medical staff in more integrated and better facilities.

The Cavell centre in Plymouth would deliver these objectives, the Government’s own objectives and so much more. That is why I am here to ask for a rethink on the funding—not just to help Plymouth, but to provide a national pilot that the Government could champion nationwide. The building’s design is already set, and it is common across all six Cavell centres across the country. Why not replicate that model elsewhere as well? These pocket hospitals could revolutionise primary and social care.

To raise an issue that is closer to home, we need to be bolder about reimagining our high streets. I have heard the Minister in a previous role talk about the need to put health on the high street and have more innovative city centre and high street models. That is precisely what the Cavell centre model could deliver. I would like to see the Cavell centre in Plymouth be part of a new Plymouth health village, attaching to Plymouth not just a super health hub, but a dental development centre and community diagnostics hubs. It would be a new destination for healthcare. That would not just be for Plymouth; it would be a model for elsewhere. Importantly, that would take pressure off Derriford Hospital, allowing it to breathe and ensuring a better flow through the hospital, which is what we need. While the super health hub project is on pause until we find the funding, can the Minister give reassurances that the other ambitions for the health village—the dental development centre and the community diagnostics hub—will not be sidelined as part of that integrated plan?

If the Minister is looking for shovel-ready projects that demonstrate the Government’s commitment to addressing ambulance times, backlogs, care, doctors and dentistry, this project would be an excellent way of delivering it and, importantly, delivering it quickly. The Minister needs to know that, although I am making the case for this project as a Labour MP, it enjoys cross-party support. Richard Bingley, the Conservative leader of Plymouth City Council, said:

“The Super Health Hub will critically reduce demand on Derriford Hospital and is a key development in addressing some of the vast health inequalities in the area.”

Labour’s Councillor Mary Aspinall said:

“I am absolutely shocked that the rug is being pulled from under this huge investment in our city which would provide about 3,000 appointments a day and employ 250 staff and we will fight for it tooth and nail. People in Plymouth do not deserve to be treated this way.”

I thank all the NHS staff who have been working so hard on the project, not just in Plymouth but in the regional NHS and the national Cavell centre programme. I know the work that they are doing. I will be grateful if the Minister looks again at where £41 million could be found to support our work. For many people, today is the day they learned that that £41 million has been lost. Work was expected to start in just a few weeks’ time, and the news will be a gut punch for many of our GP services, which were hoping to move out of dilapidated premises and into the super health hub. It will be a real dent to our confidence. We know that the problems in primary care will worsen over the winter, and for many people, this was our hope that better days would be ahead.

Such is the strength of feeling that I alone cannot hope to do justice to the case for the super health hub. Will the Minister therefore commit to visit Plymouth and hold a cross-party multi-stakeholder roundtable, so he can hear about the real benefits that the hub would bring to our community? It would be not only a nation-leading project for Plymouth but a trailblazer for healthcare in the rest of Britain.