Public Health (Control of Disease) Act 1984 (Amendment) Bill

Christopher Chope Excerpts

2nd reading
Friday 26th April 2024 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

I beg to move, That the Bill be now read a Second time.

This is the Bill’s first outing in debate, because although it was presented in the 2022 Session, unfortunately the House was unable to debate it. It relates directly to the beginning of the pandemic and the emergency measures that were taken by the Government and Parliament in implementing the Coronavirus Act 2020. At the time, a lot of concern was expressed about insufficient scope for parliamentary scrutiny under the Public Health (Control of Disease) Act 1984, and how the level of scrutiny available under that Act compared unfavourably to that available under the Civil Contingencies Act 2004. Since that time, a number of academic and other articles have been written, and speeches given, in which the concern has been expressed that the Government used the wrong tool to implement restrictions on individual liberty during that pandemic, resulting in this House having an insufficient role in scrutinising that important legislation.

This issue was raised, very ably, by my hon. Friend the Member for Windsor (Adam Afriyie) during the original debate on the Bill that became the Coronavirus Act 2020. He said:

“the whole purpose of the 30-day provision in the Civil Contingencies Act was for the Executive to be accountable to Parliament.”

The Leader of the House, however, responded to a point that he had made earlier by saying:

“we cannot use the Civil Contingencies Act…If we have time to bring forward legislation, it is proper that we do that, and anything we did under the powers of the 2004 Act would apply for only 30 days.”—[Official Report, 23 March 2023; Vol. 674, c. 132.]

Well, that is exactly what the Civil Contingencies Act 2004 is there to do. It was implemented to deal with emergencies even graver than that caused by the coronavirus pandemic.

The Civil Contingencies Act was the subject of detailed discussion before its enactment. Section 28 is entitled

“ Parliamentary scrutiny: prorogation and adjournment”,

while section 27 provides for “Parliamentary scrutiny” in other circumstances, stating that

“Where emergency regulations are made”

under the Act,

“a senior Minister of the Crown shall as soon as is reasonably practicable lay the regulations before Parliament, and…the regulations shall lapse at the end of the period of seven days beginning with the date of laying unless during that period each House of Parliament passes a resolution approving them… If each House of Parliament passes a resolution that emergency regulations shall cease to have effect, the regulations shall cease to have effect…at such time, after the passing of the resolutions, as may be specified in them, or…no time is specified in the resolutions, at the beginning of the day after that on which the resolutions are passed… If each House of Parliament passes a resolution that emergency regulations shall have effect with a specified amendment, the regulations shall have effect as amended”.

The Civil Contingencies Act therefore enables the regulations introduced under its provisions to be amended, unlike the Public Health (Control of Disease) Act 1984. The Government took advantage of that during the pandemic, and I am trying to put it right by including in my Bill provisions to ensure that there is scrutiny so that there will no longer be a perverse incentive for the Government, when faced with a pandemic or similar emergency, to resort to the use of the 1984 Act rather than the Civil Contingencies Act, on the basis that it would suit them to use the former rather than the latter because it would be subject to less scrutiny.

Clause 1 of my Bill provides that section 45D of the 1984 Act should be amended so that

“the appropriate Minister must lay before Parliament a statement that the restriction or requirement is proportionate under subsection (1)”,

and that

“In the case of English regulations, that proportionality must be demonstrated by a regulatory impact assessment that has been laid before Parliament.”

The importance of such a regulatory impact assessment cannot be overstated. We now look back on that period three years ago, and consider the consequences that flowed from the over-zealous restrictions that were introduced by the Government. Almost every day we hear of the adverse consequences for a whole cohort of young people who were excluded from school for extensive periods. As a result, not only has their education been damaged but their health, welfare and, particularly, their mental health. In my view, that is a direct consequence of this House not having had the opportunity to consider the costs and benefits of introducing such draconian restrictions on people’s ability to participate in their school education.

A similar point can be made about businesses being able to carry on what they were doing normally. I visited a garden centre a few weeks ago. In the height of the pandemic it was verboten that people could visit garden centres. For a time people were not even allowed to go to the refuse disposal points to get rid of their rubbish. They were not allowed to venture out and meet their loved ones, even in open spaces. As a result, a whole mass of people lost their loved ones without really being able to say goodbye to them, because they were incarcerated in care homes. We must never allow such a situation to be repeated in another health or other type of emergency without the proper scrutiny.

When one looks back over the course of this Parliament, it is possible to say that if we had been able to scrutinise the social distancing regulations to a greater extent, the Prime Minister in office at the time of the pandemic would still be in office today. The regulations and restrictions of which he fell foul would not have been in place, because somebody would have asked some sensible questions. The Government would have been persuaded that the workplace regulations should have enabled people working during the emergency to try to deliver benefits for the public to be allowed have a cup of tea or a bun together without falling foul of the law.

The use of the Public Health (Control of Disease) Act 1984 may well have had the direct consequence—unintentionally, obviously—of depriving the former Prime Minister of his post. When the history books come to be written, these restrictions may be seen as a much more significant decision by the Government, though as the head of the Government, the Prime Minister himself at that time decided to use the 1984 Act rather than the 2004 Act regulations.

My Bill would ensure that we not only have proper parliamentary scrutiny of the regulations under section 45D of the 1984 Act, but that under section 45Q we introduce a provision that

“before such regulations may be made, a draft of the statutory instrument containing them shall be laid before each House of Parliament for a period of not less than twenty days on which that House has sat, and, if either House before the expiration of that period presents an address to Her Majesty against the draft or any part thereof, no further proceedings shall be taken thereon (but without prejudice to the making of a new draft statutory instrument) and that part of the draft shall not have effect unless both Houses by resolution approve it, or, if any modifications in that part are agreed to by both Houses, except as so modified.”

The consequence of that would be that there would be no incentive for a Government to introduce restrictions on freedom under the 1984 Act; instead, they would use the Civil Contingencies Act, which was of course set up for that very purpose.

I referred earlier to the public commentary about this issue. Most significantly perhaps, the noble Lord Sumption gave a lecture in which he expressed doubt about the legal basis for the draconian measures and argued strongly that we need proper parliamentary scrutiny. Another commentator, Tom Hickman KC, made the case not for using the 2004 Act but for having bespoke legislation to deal with such situations in the future.

The public health regulations that came into effect on 26 March 2020 set out criminal laws that required each person or household to remain in their homes until further notice. There were very narrow grounds on which people were able to leave their homes. The guidance that the Government issued was, as we eventually discovered through the courts, often over-claimed and overused by the enforcement authorities. We also found that those regulations essentially set up a system of false imprisonment, completely in breach of all principles of English common law. There were tremendous restrictions on people’s ability to go out and earn a living, and the reasonable excuses available to them to avoid the lockdown requirements were strictly limited.

Let us not forget the consequences for individual liberty, and for a whole generation of young and old people, who were particularly affected by these draconian laws, brought in by the Government under the wrong piece of legislation and insufficiently scrutinised by this House. Let that never happen again. Let us hope that Baroness Hallett, when she looks at this issue in the public inquiry, reaches the conclusion that the Government did indeed go too far in locking down, restricting freedom and preventing people from accessing education or seeing their loved ones in care homes. That inquiry will reach a conclusion in perhaps five or 10 years’ time—who knows?—but I hope that, if the Government do not support my Bill today, a future Government will be persuaded by Baroness Hallett’s report to do exactly the same thing and ensure the Public Health (Control of Disease) Act 1984 contains proper scrutiny provisions as safeguards.

[Mr Deputy Speaker (Mr Nigel Evans)]

The shadow Minister has indicated that she would like to make a very short contribution.

Tobacco and Vapes Bill

Christopher Chope Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Elizabeth Truss]

No, I am not giving way to the party that filibustered on my Bill and stopped us taking action to protect children. That was a disgrace.

[Sir Christopher Chope (Christchurch) (Con)]

Did my right hon. Friend hear the comments of Sir Chris Whitty on the radio this morning? He refused to apologise for or explain the failures of the NHS to deal with the issue of puberty blockers while, at the same time, he professed great support for these oppressive measures which are before the House.

[Elizabeth Truss]

My hon. Friend makes absolutely the right point. There are double standards in this debate. My view is that it is absolutely right that we protect the under-18s from these potential dangers before they have full decision-making capability, but we should allow adults to exercise that freedom. It seems to me that the medical establishment, the national health service and others working in the health industry have unfortunately been captured by this gender ideology, which is preventing them from seeing the truth of what is happening. That is why the Cass report is welcome. If only the hon. Member for Ilford North (Wes Streeting) had shown the same level of interest in dealing with the issue of young people and puberty blockers that he has shown in pursuing his crusade against smoking—he was not saying this a few years ago.

Children’s Cancer Care: South-East

Christopher Chope Excerpts

Wednesday 13th March 2024 Westminster Hall

[Munira Wilson]

This is not about political interference; it is about ensuring that there has been a fair, balanced and transparent process. I will talk about the process in a moment, but that is the concern. The hon. Lady talks about clinical input. The consultation, albeit that it was run in a very flawed way, had 2,500 responses—some were from clinical experts, and many were from patients and their parents—and it provides very strong evidence that St George’s is best placed and that the Evelina has been predetermined. I have nothing against the Evelina, and in fact I was just about to sing its praises, because I have had personal experience.

To make myself clear, the Evelina is a brilliant hospital that does incredibly important work in treating children. My own daughter, who is nine, is currently undergoing treatment at the Evelina and has received outstanding care. This is not about pitting hospital against hospital; it is about looking at the process and the evidence before us. As the hon. Member for Vauxhall (Florence Eshalomi) has alluded to, I would like to personally thank the medical director at the Evelina, who showed me around its excellent facilities on Monday. However, as I have mentioned, the evidence overwhelmingly demonstrates that, in this case, St George’s is best placed to deliver for this highly specialist cancer service.

Before I come to that evidence, I want to raise serious questions about the decision-making process to date. [Interruption.]

[Sir Christopher Chope (in the Chair)]

Order. There is a Division in the House. I do not know whether there will be just one Division. If there is only one, we will come back in 15 minutes; if there are two, we will come back in 25 minutes.

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[Munira Wilson]

Absolutely. There is the point about transparency, the fact that it has been predetermined, and the point about outcomes, which I will touch on briefly in my speech.

In a consultation response submitted by Healthwatch Richmond and Healthwatch Merton, the groups concluded that the consultation design was insufficient because it “fails the legal test” for consultation and appears to have no prospect of altering the decision to award the new service to the Evelina. I am therefore keen to hear from the Minister what assessment her Department has made of how NHS England has carried out this process. Further, can she give an absolute assurance to Members that the decision made tomorrow will have been made fairly?

Regardless of the way in which it was carried out, the consultation received over 2,500 responses from affected groups, such as patients, their families, clinicians and professional organisations. Those voices must be heard, and I will seek to ensure that they are. One of the most important themes raised was specialist knowledge and experience of children’s cancer care. It is undeniable that St George’s has invaluable experience to offer: it has already been treating child cancer patients, in partnership with the Royal Marsden, for over a quarter century. Not only is that experience highly valued by patients and their families, but it has resulted in excellent outcomes, as the hon. Member for Wimbledon (Stephen Hammond) said. According to national data collected from intensive care units, St George’s children’s cancer intensive care outcomes are the best for a large unit in the UK. All the institutional knowledge, specialist expertise and professional networks that have been built over decades risk being lost if cancer care were to move away.

Another key theme that was repeatedly mentioned in responses was that the centre should be conveniently located. Travelling via public transport with a vulnerable and immunosuppressed child is both stressful and very risky, so patients and families have repeatedly stressed that a new centre must be easily accessible by car. Anyone who has lived or worked in central London knows how difficult and unpredictable driving in and out of central London can be. However, located in Tooting, St George’s is much easier to access, and has strong road links to parts of the south-east. That is particularly appreciated by those travelling from afar.

Finally, responses highlighted the importance of having most specialisms on a single site. One service that is particularly vital to child cancer patients is neurosurgery, which is required by one in four of them. Currently, out of the two options, only St George’s offers neurosurgery. According to the Children’s Cancer and Leukaemia Group, the fact that the Evelina does not currently provide cancer surgery is not an issue that can be resolved quickly, and relocating surgery services comes with associated risks to both patients and staff. In its consultation response, the British Association of Paediatric Surgeons notes that where that has happened in previous cases, a lack of support and structure has resulted in staff “leaving the relocated unit.”

Further, clinicians have shared concerns that, if children’s cancer care were to move from St George’s, other services could be disrupted, which may create unforeseen consequences for the many areas served by St George’s. By contrast, placing the new centre at St George’s would ensure that NHS services are not overly centralised, but rather evenly distributed across the region. What assessment have the Government made of this crucial clinical evidence and the associated potential risks to the cancer service and other children’s services?

The decision is such an important one because at its heart are children with cancer: a group who have dealt with the most challenging and frightening of circumstances so early on in their lives. In many cases, the children can go on to lead full lives. One such example is Zoe, a teenager who was treated by St George’s when she was just four. She has since recovered and now has dreams of becoming a children’s nurse. She says:

“I’m so grateful to the paediatric staff at St George’s Hospital for looking after me, and for always being there for me throughout my life. Thank you to the nurses who told me to follow my dreams and never give up.”

The experience, expertise and convenience that St George’s offers are extremely valued by patients and those who care for them. That must be reflected in the final decision that is made tomorrow, and that is why it is so crucial that no doubt is cast over whether the decision is being made fairly and transparently. Yet, as I have set out, the way that NHS England has handled the process means that it is very difficult to make that judgment at this point.

Last week, together with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey) and my hon. Friend the Member for Richmond Park (Sarah Olney) I wrote to the Secretary of State requesting that she uses her formal powers to call in this decision should NHS England press ahead tomorrow with awarding the children’s cancer service to the Evelina; and a group of cross-party council leaders from across south-west London and Surrey have done the same.

I conclude by urging the Minister in the strongest possible terms to join that call and to support us in saying that this decision must be called in tomorrow if the Evelina is chosen, because of the serious process and clinical arguments that I have laid out today.

[Sir Christopher Chope (in the Chair)]

Back Bench speeches in this debate will have to finish by 5.38 pm.

--- Later in debate ---

[Ed Davey (Kingston and Surbiton) (LD)]

I congratulate my hon. Friend the Member for Twickenham (Munira Wilson) on securing the debate. I should declare an interest of sorts, because my disabled son, John, has been treated at both these hospitals. A few years ago, he had a very successful operation at St George’s, and for most of the last two years he has been attending a weekly clinic at the Evelina. My wife and I are grateful to both hospitals; they are both excellent hospitals, and we regard them very highly. So the fact that I strongly believe that NHS England should choose St George’s is no reflection on the Evelina—not in the slightest.

I have approached this issue from the start by looking at the facts, talking to clinical experts and listening to both sides. I have also looked at the risks of each of the options, because that is what we really look at when we take big decisions: which is the least risky option to make sure we have the quality of services? I have looked at the facts and the evidence, and talked to clinical experts, and they suggest to me that St George’s is easily the less risky option for locating these specialist children’s cancer services—for my constituents and for people across south London, Surrey, Sussex and beyond.

I want to take everyone through some individual cancers and how risks lay for those. I will start with neurosurgery. Twenty-five per cent of children with cancer have a brain or spinal tumour, and many of those will need neurosurgery. St George’s currently delivers that; the Evelina does not. The Children’s Cancer and Leukaemia Group, which is the UK’s professional association for those involved in the treatment of children with cancers, said in response to the public consultation that if the Evelina was the option chosen, it

“would be the only Principal Treatment Centre in the UK where neurosurgery is not carried out on site”—

the only one—and that there is

“evidence that suggests that Principal Treatment Centres for childhood cancers should be co-located with neurosurgery.”

In other words, with respect to neurosurgery, the Evelina option is the most risky. The Evelina’s solution to that—to use King’s—defeats the purpose of uniting children’s cancer services.

Let us move to oncology surgery. Another 15% of children with cancer will have a neuroblastoma, renal tumour or germ cell tumour. Those children often require major surgery by a paediatric oncology surgeon to remove or reduce the tumour. That expertise is rare. There are around 20 such surgeons in the country, three of whom are at St George’s. The Evelina does not have that expertise at all and will need either to rely on surgeons from St George’s going to work at the Evelina or to build a new surgical team from scratch.

If St George’s surgeons were to travel to the Evelina to operate on children with cancer, there would remain the question of the wider, non-surgical expertise required to manage those children, including the specific anaesthetic skills. Furthermore, it would be much more challenging to manage post-operative complications. In other words, for oncology surgery, as for neurosurgery, the Evelina option is the most risky.

Let us go on to bone marrow transplants. Another 42% of children with cancer will have leukaemias, other blood cancers or lymphoma. For those children, bone marrow transplants and, increasingly, chimeric antigen receptor T-cell treatment, where a patient’s cells are modified to help fight cancer, are key treatments for any new primary treatment centres to be able to deliver. Those treatments are complex, high risk, heavily regulated and difficult to set up without experience. Indeed, the process to do that probably takes years, not months. St George’s has a bone marrow transplant programme for adults and is accredited to provide CAR-T for adults, so it is well placed to extend that offer to children. The Evelina partnership, including Guy’s and St Thomas’ Hospitals, does not currently have a bone marrow transplant programme and is not accredited to deliver CAR-T. Developing such a programme there and delivering it with the required quality, without the adult service, will cost much, much more and be much, much more challenging.

I could go on with other examples of specific cancer treatments for children, but I will end by focusing on some wider issues where, once again, it is clear that the Evelina option is just more risky. Which of the hospitals has the most experience with paediatric cancer? As my hon. Friend the Member for Twickenham said, St George’s has 25 years’ experience of caring for children with cancer. The Evelina does not have the experience of caring for children with cancer—nothing like the experience of St George’s.

On staff, where are the specialist cancer staff currently working, and what would they do if there was a change? There are 432 staff at St George’s who are involved in caring for children with cancer. They are from a wide range of specialities and professions. The vast majority of those staff and the expertise they have built up in caring for children with cancer over the years will not move to the Evelina if the primary treatment centre is moved there. Why? Because most spend only a proportion of their time caring for children with cancer and the majority of their time caring for children with other conditions. St George’s estimates that only four whole-time equivalents, out of 432 staff, would be likely to transfer under TUPE regulations. Not only would the skills be lost, therefore, but they would need to be redeveloped in another group of staff. At a time when the NHS is facing one of its most substantial staffing and skill shortages ever, is that really a risk that NHS England wants to run? That type of basic medical risk analysis points clearly to St George’s being the solution.

But let us look at the financial risk too. NHS England itself has assessed the St George’s proposal as involving lower capital costs—£13.5 million lower—representing better value for money and having a better revenue impact. By 2030-31, the St George’s option would be breaking even, whereas the Evelina option would be running a £2 million-a-year deficit. Even taking into account the charity funding envisaged for the Evelina option, it would cost the NHS £3.5 million more in capital funding than the St George’s option, and the charity funding could presumably be used elsewhere. If the PTC were moved to the Evelina, St George’s would lose the income but would not be able to lose the associated staff. The trust estimates that that would leave a £2.5 million financial gap to close in the first year. Given that NHS finances are under real strain, why take the capital and revenue risk of opting for the most expensive option?

I have listened to the counter-arguments brought forward by the Evelina, some experts and NHS England. A big focus of those arguments is on research into developing new treatments into the future, so let us look at that. Cellular treatments such as CAR-T are likely to be central to the future treatment of children’s cancer. St George’s is accredited and commissioned to provide CAR-T, whereas the Evelina is not. Research into using vaccines to treat cancer is at an early stage, but St George’s, University of London, co-located with St George’s, is an international leader in research into vaccines, infection studies and clinical trials, with the long-term potential for vaccine technology to be developed to support the treatment of cancer. The hon. Member for Carshalton and Wallington (Elliot Colburn) was right to point to the Institute of Cancer Research and the Royal Marsden being in close proximity to St George’s. Again, they are part of the research offer that only St George’s can provide.

To conclude, I think this is a no-brainer. I am staggered that anyone has any doubt about which is the right option. I listened to the hon. Member for Mole Valley (Sir Paul Beresford), and I take him very seriously. He is a great professional in dentistry—he offered my wife some treatment in a previous debate, and I was grateful for that. He is right that we are all looking in expectation to see what happens with tomorrow’s decision. However, having listened to the experts and spent a lot of time looking at the issue, I just do not think there is any doubt: yes, the Evelina is a fantastic children’s hospital, and my son goes there every week, but it is not an expert in cancer services or in children’s cancer services, which is the point of this decision. St George’s can offer those specialities and the expertise, and it can do it more cheaply and in a more accessible way. It is by far the less risky option. I am grateful to the Prime Minister for saying that I can meet the Health Secretary to discuss this issue, and I look forward to that. I hope that tomorrow, given the arguments set out in this debate and elsewhere, NHS England will decide for St George’s.

[Sir Christopher Chope (in the Chair)]

I let the right hon. Gentleman finish his speech, but I am told that there are now going to be two Divisions, which means the sitting is suspended for 25 minutes.

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On resuming—

[Sir Christopher Chope (in the Chair)]

In the absence of the Minister, but with the consent of the hon. Lady about to speak, I call Sarah Olney.

--- Later in debate ---

[Paul Scully (Sutton and Cheam) (Con)]

rose—

[Sir Christopher Chope (in the Chair)]

Order. We now have another Division in the House. I put on the record the fact that the Minister has profusely apologised for her absence; she was misled on whether there was going to be a gap between the Divisions. There was a gap, and although we have exploited it as much as we could, it is now time to suspend the sitting again. I am told that there will be two more Divisions, so it will be suspended for another 25 minutes. That means we will start again at 6.27 pm.

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On resuming—

[Sir Christopher Chope (in the Chair)]

I call Sarah Olney, a few minutes early.

[Sarah Olney]

Thank you, Sir Christopher. I was on the verge of taking an intervention.

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[Sir Christopher Chope (in the Chair)]

Before I call Karin Smyth, I should say that this debate has to end by 6.54 pm according to our new timetable. That includes a maximum of two minutes for a response to the debate.

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Christopher—it has been severely tested this afternoon, but you have done remarkably well in getting us all to the end of this important debate, particularly for local people, on the issue of children’s cancer. I commend the hon. Member for Twickenham (Munira Wilson) on securing it. The hon. Members for Carshalton and Wallington (Elliot Colburn), for Richmond Park (Sarah Olney) and for Mole Valley (Sir Paul Beresford), my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) and the right hon. Member for Kingston and Surbiton (Ed Davey) all spoke on behalf of their constituents with the diligence that we would expect.

Receiving a cancer diagnosis is always distressing and deeply worrying for anyone; for a child and their family it can be particularly devastating. Watching a child go through that is a difficulty that most parents, fortunately, do not have to face, but my thoughts are with the many who do, who are being talked about today—particularly those who have lost a child to cancer. I pay tribute to the many families campaigning for good cancer care for children and young people.

Every year, 4,000 children and young people are diagnosed with cancer in the UK; sadly, it is still the biggest killer by disease of children and young people in our country. As we have heard this afternoon, the needs of children and young people with cancer are very different from those of adults. They can face real challenges in cancer care. It is crucial that they get the right treatment and family support. Often that treatment takes place in dedicated specialist treatment centres far from home: children can travel on average 350 miles to get their cancer treatment.

According to research by Young Lives vs Cancer, distressed and vulnerable children often travel across the country to receive care. As we have heard, the location of the centres is important for local people seeking the best care for their children. My city, Bristol, is home to the paediatric haematology/oncology programme, which serves the whole south-west region, working with shared care centres from Gloucestershire to Cornwall to ensure that children receive care as close to home as possible.

What should that care look like? We know that children receive the best care with early diagnosis and access to treatment from well-supported and trained staff, based on the latest research. Sadly, under this Conservative Government swathes of targets have not been met, and children are left waiting for a diagnosis when every second is vital. Those missed targets include the faster diagnosis standard, with three in every 10 patients waiting longer than 28 days for a diagnosis or to have cancer ruled out in 2022-23. Waiting lists have risen to a record high, with over 400,000 children awaiting consultant-led treatment. Prolonged waits have a detrimental impact not only on children’s health, but on their education and overall wellbeing. Although I welcome the children and young people cancer taskforce announced last month, without a properly functioning wider health system, children with cancer will continue to be vulnerable to those missed targets and delays in care.

The root of the crisis is the failure to provide the NHS with the staff it needs to treat patients on time. Indeed, the Royal College of Radiologists, which represents specialist paediatric radiologists, has said that after years of underinvestment, the workforce is stretched, causing backlogs and delay. That is why Labour is committed to providing the staff, the modern technology and the reform that are crucially needed to bring down those waits to safe levels. We will provide 2 million more appointments a year for planned surgery, diagnostics and out-patient care, and double the number of CT and MRI scanners, speeding up diagnosis and access to treatment for children.

We know and we have heard in the debate how important it is for people, and particularly for their families, to be confident that they will receive the right care in the right place. The guidelines produced by NHS England are very clear about the processes to be followed and the clinical case to be made for major service change. Indeed, that was much discussed in the Bill Committee for the Health and Care Act 2022, on which I sat. I look forward to hearing from the Minister—I will give her plenty of time—about any assurances that she can give to local people on the decision, and to the Members of Parliament who have spoken today on both the process and the substance of decision making in the NHS.

[Sir Christopher Chope (in the Chair)]

Minister, over to you.

Heart and Circulatory Diseases: Premature Deaths

Christopher Chope Excerpts

Thursday 22nd February 2024 Commons Chamber

[Andrew Bridgen]

Thank you, Madam Deputy Speaker. That is a 40% increase. Ask and ye shall receive.

The previous steady reductions followed major improvements in public health policy, reductions in risk factors such as smoking, and the controlling of blood pressure, as well as improvements in medical care. Although I am grateful to the hon. Member for Watford for securing this debate, and to the other Members who will contribute, there is an elephant in the room—indeed, there are so few speakers that there is probably room for a herd of elephants. Why has there been a significant uptick in cardiac deaths in recent years? What novel intervention in public health has occurred since 2019?

Some might think that covid is the cause. Not so. The same uptick in cardiac deaths was observable in Australia and Singapore before those countries got covid but after they rolled out the experimental messenger ribonucleic acid injection. Ah, the jab! I can see some Members tutting and turning away. Everyone knows that MPs with a science degree are few and far between, and that some Members’ eyes glaze over when science is discussed. Well, I am one of those MPs fortunate enough to have a science degree. Another was Margaret Thatcher, who was rather prouder of being the first Prime Minister with a science degree than of being the first woman Prime Minister, and rightly so.

Some Members appear to have prejudged the issue. It is often said that it is easier to fool someone than to persuade them that they have been fooled. For posterity, we must remember that it was 11 years after the thalidomide scandal was exposed in 1961 before the word “thalidomide” was mentioned in the Chamber. I refuse to let this new mammoth medical scandal be ignored in the same way.

We are witnesses to the greatest medical scandal in decades—perhaps in living memory, and possibly ever. It is bigger than thalidomide and bigger than the Tuskegee untreated syphilis scandal, in which some black people were deliberately not treated to see what would happen to their bodies over time. It might be bigger than the Vioxx scandal, hitherto the grandaddy of medical scandals.

I can see some Members looking puzzled. Vioxx was a new drug invented by Merck as an alternative to aspirin—a mild painkiller. A researcher first highlighted an issue to Merck’s senior management in 1997, two years before the drug was approved. One in 115 people who took Vioxx suffered a heart attack. Merck’s profits from Vioxx comfortably exceeded the criminal fine, the compensation and the litigation costs after the drug was pulled. It was a good business decision for Merck. Not one pharma executive went to jail for skewing the trial results, for deceiving the regulators or for recklessly causing the deaths of 60,000 ordinary Americans for profit. It is always for profit—lives tragically cut short, families destroyed and children devastated. Imagine the incentive structure in an industry where profits like that can be made, and the corporate greed where there is full immunity from prosecution. In 1986, pharma companies got immunity in the USA for all vaccines. The number of vaccines administered to children in America has exploded since then.

[Sir Christopher Chope (Christchurch) (Con)]

Does the hon. Member share my hope that the Minister, in responding to the debate, will address the article in The Daily Sceptic on 20 February this year by Will Jones, headlined “Covid Vaccines Linked to Large Increase in Heart, Blood and Neurological Disorders, Major Study Finds”?

[Andrew Bridgen]

I hope that the Minister will address that, and of course this will go on. Cardiac deaths were already the biggest killer in our country, but we have a mysterious 10% increase. I am sure that the hon. Gentleman, like others in the Chamber, has witnessed the horrifying sight of super-fit athletes keeling over on pitches around the world. A mountain of peer-reviewed evidence is emerging and hypotheses are being proposed. Numerous cardiologists have concerns, but unfortunately, many experts do not feel able to speak out openly about their concerns because of the climate of fear, and the consequences of whistleblowing or speaking out against big pharma, which has so often been found to be not operating in the public interest, and causing harm. I am afraid that we will see much the same, following the roll-out of the covid-19 vaccines, as we saw with Vioxx and thalidomide, and in so many other cases.

The evidence is mounting up so rapidly, and the only people who cannot appreciate what is going on in this country are those who really do not want to see. The public will be extremely harsh on this Parliament and our response to the covid-19 pandemic, including the roll-out of the vaccines. We were going to stop vaccinating after the over-70s, but we then decided that vaccination would include the over-50s. We then decided it would be for everyone. Then this House took the appalling decision, unsupported by the Joint Committee on Vaccination and Immunisation, in September 2021 to vaccinate children who were at very little risk, if any, of covid, but who have been harmed seriously by the vaccines.

Why ever did we use a systemic vaccine for a mucosal respiratory virus? One expert said last year:

“it is not surprising that none of the predominantly mucosal respiratory viruses have ever been effectively controlled by vaccines. This observation raises a question of fundamental importance: if natural mucosal respiratory virus infections do not elicit complete and long-term protective immunity against reinfection, how can we expect vaccines”

to work, when natural immunity does not give protection? And what is the name of this expert? Mr Anthony Fauci, the former head of the Centres for Disease Control and Prevention in America, who pushed the vaccines.

I wish I had more time, Madam Deputy Speaker; this is a huge issue and we need to debate it again. It is the biggest killer of our constituents, and our fear is that the rate of increase in cardiac deaths will not slow in the UK, or the rest of the world.

[Philip Davies (Shipley) (Con)]

It is a pleasure to follow the hon. Member for North West Leicestershire (Andrew Bridgen), as I often seem to in these debates, which often resemble Madame Tussauds: the same faces appear, time after time. As you will know, Madam Deputy Speaker, I have a reputation for brevity in my speeches, and I intend to support that reputation now.

I congratulate my hon. Friend the Member for Watford (Dean Russell) on securing this important and rather timely debate, and I echo the hon. Member for North West Leicestershire in saying that we enjoy seeing him looking so fit and healthy after the trauma that he had. This is a really important matter, and he is right to raise it today. As I highlighted in last month’s Westminster Hall debate on excess death trends, a recent article in The Lancet found that although the causes of ongoing excess deaths in the UK

“are likely to be multiple”,

Office for National Statistics data showed some clear trends—in particular, the “largest relative excess deaths” since the pandemic occurred in young and middle-aged adults, with the number of cardiac deaths happening outside hospitals being the most elevated. In other words, young and previously healthy people are dying at home from cardiac-related events, and we do not know why.

These are not just numbers and statistics—these are real people, loved ones, often from younger age groups, who are dying before their time. It is urgent and our duty to get to the bottom of the situation sooner rather than later. As I am sure we are all aware, there are many theories circulating about the causes of these excess deaths. One is the possibility of a causal link between the population-wide use of covid-19 vaccines and the marked increase in cardiovascular-related critical events, including heart attacks and strokes, among otherwise apparently healthy people. We do not know if that is the cause or not, because the data is not being released. Until certain data sets are released, it is impossible to rule that theory in or out.

That is why I, along with cross-party colleagues, wrote yesterday to the Secretary of State for Health and Social Care; Professor Steven Riley, the director general for data at the UK Health Security Agency; and Dr Alison Cave, the chief safety officer at the Medicines and Healthcare Products Regulatory Agency. We warn that by withholding official data, the Department, UKHSA and MHRA are helping fuel concerns and hesitancy about public health. We have asked that anonymised record-level official mortality data be released, alongside vaccination dates, doses and co-morbidities, without delay. We understand that the MHRA has collected and already shared this data with pharmaceutical companies to enable those companies to produce post-authorisation safety studies for their products, so I see no reason why it cannot also be shared with parliamentarians and the public right away. Will the Minister say whether that data has been shared with pharmaceutical companies? If so, why is not being shared with the rest of us?

As the Minister surely realises, repetitive generic assurances that the Government and the UKHSA take excess deaths “seriously” and monitor them “constantly”, and that the MHRA have

“systems in place to continually monitor the safety of our medicines”—[Official Report, 16 January 2024; Vol. 743, c. 235WH.]

do not serve to reassure anybody at all. Likewise, the news from the Office for National Statistics this week that it has revised its excess deaths methodology, and that there are suddenly 20,000 fewer excess deaths last year, has done little to quell public concern. If anything, it has done the exact opposite: people cynically see it as a convenient sleight of hand.

As we say in our letter, if the Government and their agencies are not willing to share the data we have requested, will the Minister explain to us why not? We are all on the same side and want to look after people. We are all concerned to do the best we can for everybody, but until we have all the data, we just do not know what we do not know. If there is any potential that public health interventions, such as covid-19 vaccines, are causing harm and premature death to some, we must act on that without delay. If the evidence shows that that there is no issue, then it is in everybody’s interest for that reassurance to be in the public domain as quickly as possible.

[Sir Christopher Chope]

If that information was in the public domain, then the Prime Minister would have been able to answer the question that he was asked in the GB News interview the night before last.

[Philip Davies]

My hon. Friend is right. It is in everybody’s interest that the information be in the public domain, so that we can reassure people, or at least let them know. Frankly, there is never any harm in giving people information and letting them make their own mind up about what has happened.

Opinions need to be put to one side, and the data need to be examined in the cold, hard light of day. Otherwise, we will do harm to people, and we will do even more and irreparable damage to trust in public health policy. I hope that the Minister will provide some reassurance that the data will be forthcoming as soon as possible, and that the Government do not give the impression that there is something to hide.

COP10: WHO Framework Convention on Tobacco Control

Christopher Chope Excerpts

Thursday 18th January 2024 Westminster Hall

[Andrew Lewer (Northampton South) (Con)]

I beg to move,

That this House has considered COP10 to the WHO Framework Convention on Tobacco Control.

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the co-sponsors of today’s debate, the hon. Members for Ealing, Southall (Mr Sharma), and for Linlithgow and East Falkirk (Martyn Day). I also thank all colleagues who have requested to speak, and the Backbench Business Committee for giving this application the urgent consideration that was asked for. The fact that Members wished to contribute to this debate, and to many others on similar topics of late, demonstrates how important this issue is across our United Kingdom.

I am pleased to see my right hon. Friend the Minister in her place, and of course I welcome her back to Government. I say that with no small amount of friendly bias, as she and I are constituency neighbours in Northamptonshire and have known each other for a very long time. We look forward to hearing from her later. I also welcome the shadow Minister, the hon. Member for Bristol South (Karin Smyth); I am keen for her to share her perspective on today’s proceedings. I state for the record that I have served as a vice-chair of the all-party parliamentary group for vaping.

I beg your indulgence, Mr Vickers, as I set the scene for why we are here today and outline the importance of what we are discussing. My co-sponsors and I were clear that this debate is not yet another opportunity to opine generally about smoking and vaping, or to merely rehash some of the well-known talking points that arise when we talk about these issues. Hopefully, it will not be a debate in which each side of the political divide claims to be cloaked in unique righteousness. I was pleased to have tripartite support for the debate application, and even more pleased that colleagues from a wide array of political parties, and from all four parts of the UK, have expressed a desire to speak in this and related debates.

It has been a stressful few days in Parliament. In some senses, the timing of this debate is very important, as it comes ahead of the 10th conference of the parties, but in other senses it is less fortunate, coming as it does straight after what we have been through over the past two or three days. Nevertheless, the debate is an opportunity for this mother of Parliaments to show our democracy at its best. We in the legislature can come together on a non-party basis to question the Executive and hold the Government to account. We should be conscious that many people from around the world will be watching these proceedings, given that the debate relates to international agreements and has a global perspective.

To the best of my knowledge, this debate is one of a kind. It is the only substantive discussion on next month’s meeting of the framework convention on tobacco control, COP10, taking place in any parliamentary democracy. It is my hope that we can shine a light on the World Health Organisation’s sometimes less than ideal proceedings.

I thank my hon. Friend the Member for Harrow East (Bob Blackman) for having secured the debate in this place on the WHO framework convention on tobacco control in March 2020. We all share a dislike, to put it mildly, of smoking. I pay tribute to the work that he and his colleagues do on the all-party parliamentary group on smoking and health to drive smoking cessation. Who in Parliament does not hate smoking? I do, and where we have differences, they are only on how best to drive it out. Since that debate nearly four years ago, we had one subsequent conference of the parties to the WHO: FCTC COP9, which took place in Geneva in November ’21. Today, of course, we are discussing COP10, which will be held in Panama in just over a fortnight.

We all know the term “COP”; it has become something of a household name, thanks to the United Nations climate change conference, which concluded its COP28 meeting in the United Arab Emirates last year, and which is heralded as a beacon of openness, transparency and engagement. The UK hosted COP26 in Glasgow in November 2021, which was expertly presided over by my right hon. Friend the Member for Reading West (Sir Alok Sharma). Ministers from Governments from all over the world attend these meetings. Indeed, our own Minister for Energy Security and Net Zero, my right hon. Friend the Member for Beverley and Holderness (Graham Stuart), was so enthusiastic about COP28 that he went to it twice. The conference sessions are open to the media, to civil society and to other interested stakeholders to participate in.

What a contrast that is with the FCTC and COP10. Despite smoking being one of the leading causes of death in the UK, killing about 80,000 people every year and causing one in four cancer deaths, there is likely to be no ministerial representation from the Government in Panama. It is unfortunate that such an important area of health policy is left to officials. Unlike the climate change COP, the FCTC COP meets and takes decisions behind closed doors, away from the scrutiny of Parliament and the press. The decisions taken in Panama next month will have wide-ranging influence over the UK Government’s approach to smoking cessation and the regulation of tobacco harm reduction products, which many smokers use to quit combustible tobacco.

For nearly a year, I have been asking the Department of Health and Social Care who will be in the UK’s delegation to COP10 in Panama. I have been asking what positions that delegation will take, and whether we will continue to stand up for Britain’s world-leading and evidence-based approach to tobacco control and smoking cessation. I know that a great many Members from across the House have made similar representations to the DHSC. Despite repeated oral and written parliamentary questions on the subject, Ministers have not yet set out the UK Government’s approach to COP10 in any detail. Clearly, none of us wants our Government to be as opaque as the World Health Organisation is on this and many other issues.

My first request of the Minister is that she asks my right hon. Friend the Minister for Energy Security and Net Zero to give serious consideration to attending COP10 in Panama next month. Members may ask why that is so important. The UK is one of the largest financial contributors to the FCTC, with millions of pounds of taxpayers’ money being shipped off to the WHO in recent years to support this agenda. That is whole streets-worth of residents of my constituency’s total contribution to the Exchequer. Every penny of tax that street after street of them pay goes to funding the WHO. We have an obligation to our constituents to ensure that the money is well spent, so we need to know who will be standing up in Panama on their behalf, and what policy positions will be supported or opposed.

What we do know is that the WHO takes a highly sceptical view of tobacco harm reduction products, including vapes, heated tobacco and oral nicotine pouches, arguing that they pose a risk to health. As I have mentioned, that is in direct contrast to the UK’s world-leading approach to tobacco control. It really is world leading, and we should be proud of what we have accomplished in recent years in driving down smoking rates and saving lives. Public Health England, which is now the Office for Health Improvement and Disparities, has been clear that vaping is at least 95% less harmful than smoking, and that heated tobacco products are considerably less harmful than conventional combusted tobacco cigarettes. That is independent, peer-reviewed evidence from a glittering array of public health experts, clinicians and scientists, not funded by players in the tobacco industry. Not only has it formed the bedrock of the UK Government’s approach to smoking cessation in recent years, but our model has been heralded by public health experts in countries and universities across the world as a beacon to follow. I therefore pay tribute to the Minister’s predecessor, my hon. Friend the Member for Harborough (Neil O'Brien), for the groundbreaking “swap to stop” scheme, which he announced early last year. For many of my constituents, vaping is a vital alternative that helps them to curb their smoking habits and quit, and the “swap to stop” scheme, which offers free vape starter kits to smokers, is a welcome tool in the arsenal.

When the Minister unveils her legislation later this year, we will have the opportunity to debate some of the fundamentals, including ensuring that children do not access nicotine products, and giving trading standards the enforcement powers that they need to tackle rogue traders who sell to minors or sell illegal products. However, we must not throw the baby out with the bathwater by introducing draconian measures that discourage adult smokers, whether deliberately or not, from making the switch to vaping. That is a fundamental point. Over-regulation and blanket bans are not the safe option; they could cost lives.

I agree with the Minister’s remarks in the debate last week that we must clamp down on packaging with cartoon characters, and vapes shaped like toys, but I discourage the misconception that flavoured vapes are not designed for 60-year-old smokers. There is very clear research on this: in a 2003 opinion poll by OnePoll, 83% of smokers stated that flavours helped them to quit smoking, and there is a definitive and widely available study on this matter by the University of Pennsylvania. Constituents tell me that it is precisely the availability of a wide range of non-tobacco flavours that enables them to make the switch away from harmful cigarettes. I oppose the suggestion from the hon. Member for Walthamstow (Stella Creasy) that adults are not interested in fruit-flavoured vapes. Why should adult smokers be discouraged from switching away from smoking, which will cost them their life, by a vaping market that is reduced to tobacco-only flavours that constantly remind them of smoking, and trigger their desire to smoke a cigarette?

There is also a danger that over-regulation will exacerbate the black market. In fact, as colleagues pointed out in the Westminster Hall debate on illegal vapes on Tuesday, the black market has flourished in recent years. Between 2020 and 2023, more than 2.5 million illicit vapes were seized by trading standards across 125 local authorities, and the enforcement agency warns that that is just the tip of the iceberg. Do we want to grow that iceberg, or reduce it as much as possible?

There is a tendency for us politicians to pass legislation or produce guidance from Whitehall so that we can say that we are taking robust action on an issue, without having regard to how it might be implemented. The UK already has stringent restrictions in place via the Tobacco Advertising and Promotion Act 2002, so much of the issue is really about enforcing the many existing laws, rather than a need for new ones. Speaking as a long-standing local government man—and I am still vice president of the Local Government Association—underpinning this issue is the new burdens doctrine, which this Government have signed up to and adhered to for many years. That doctrine states that all new burdens on local authorities must be fully assessed and funded. It is a cornerstone of Whitehall Departments’ preparatory work before they pass responsibilities on to local authorities, and I urge the Minister and her officials to keep that broader point in mind for discussions at the conference.

The real risk is that at COP10, the WHO will, as is expected, call for regulatory equivalence for tobacco harm reduction products, so that they are treated in exactly the same way as combustible tobacco products. That is not only counter to the UK Government’s position; if successful, it will significantly harm public health goals, not just in this country but across the world. Some countries have already banned vapes but not cigarettes, and that will cost huge numbers of their citizens’ lives.

Additionally, why bother to “swap to stop” at all if cigarettes and vapes are taxed in the same way and there is no price differential or flavour incentive to quit? That said, I am conscious that the Minister is still compiling her response to the recent consultation on smoking and vaping ahead of new legislation, which we await with interest.

There is one occasionally repeated fallacy that must be nailed and not repeated, given its harmful potential. It is not nicotine that causes lung cancer, and nor does nicotine itself kill its long-term users; rather, it is the constituent chemicals inherent in the combustion of tobacco within cigarettes that causes harm. Nicotine vapes, oral nicotine pouches, and indeed heated tobacco products—which are sometimes known as “heat not burn”, given that there is no combustion involved—are all essential in giving adult smokers a range of solutions for their smoking cessation journey. For the avoidance of doubt, I quote Cancer Research UK, which says that nicotine

“is not responsible for the harmful effects of smoking, and nicotine does not cause cancer.”

Tackling misinformation is at the heart of this debate, as we consider some of the measures that the WHO is proposing to enact at next month’s COP10 meeting, and the harmful effects they will have on public policy here at home.

As ever, the devil is in the detail, so I ask colleagues to forgive me if I take a few minutes to speak to some of the specific policies under consideration in Panama, and why the UK delegation must stand firm against them. The words of the Chief Medical Officer for England are ringing in my ears:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

We need to consider how our public health bodies can effectively communicate that to adults who currently smoke.

One of the most worrisome proposals being put forward by the WHO is item 6.2 on the agenda, which covers tobacco advertising, promotion and sponsorship. It is widely understood that the WHO will push for an expansion of article 13 of the FCTC to include reduced-risk products—vapes, “heat not burn”, and oral nicotine pouches —within the restrictions on advertising, as if they were the same as combustible tobacco, when, as I hope I have already illustrated, they are not.

Like everyone else in this room—I cannot stress the importance of this enough—we have to ensure that children are not targeted by nicotine products, but successful uptake by adult smokers of these reduced-risk products as part of the UK Government’s strategy of tobacco harm reduction relies on the ability of responsible manufacturers and retailers to provide important and accurate information about the products’ health benefits when set against traditional combustible cigarettes. There are still 6.4 million smokers in the UK, and they are our constituents, our neighbours, our families, and—I am very sorry to say—for many of us, our friends.

Misinformation on this issue is not only dangerous; it is lethal. The best must not be the enemy of the good. The extent of misinformation is such that, according to Action on Smoking and Health, four in 10 smokers believe that vaping is as harmful or more harmful than smoking. That figure increased by a third last year. A recent YouGov poll also found that over 50% of people thought that vaping was more harmful or as harmful as smoking. Whenever there is an online newspaper article about this subject, to which I have obviously been paying particular attention in the last week or so, I am amazed by the extreme, contradictory and occasionally potentially dangerous views expressed.

The proposals under discussion at COP10 would limit the ability to tackle misinformation on relative harms, while simultaneously restricting the promotion of reduced-risk products to adult smokers. As I alluded to earlier, the UK delegation must challenge any attempt to bring about regulatory equivalence between combustible tobacco and reduced-risk products—in particular “heat not burn” products, which the Office for Health Improvement and Disparities has made clear are substantially less harmful than smoking.

There is a risk through item 6.3 on COP10’s agenda that the WHO will seek to do just that: to push Governments around the world to regulate vapes and other reduced-risk products in the same way as combustible cigarettes, leading to the concern that that could extend to proposals on taxation and price points. If the WHO is successful, any financial incentive to switch away from cigarettes will be removed. That point has been made by many colleagues on many occasions, and I know from our work together on the APPG for vaping that the hon. Member for North Tyneside (Mary Glindon)—my colleague and co-author of an article on the issue—has spoken passionately about it and her own personal experiences. Such measures would send the wrong message, and would only perpetuate the dangerous myth, believed by 40% of smokers, that vaping is as harmful as smoking, and would therefore obviously discourage them from switching in the first place.

Will the Minister undertake to confirm that the UK delegation will block any measures to restrict the ability to effectively communicate with adult smokers on the health benefits of switching away from combustible cigarettes? Will the UK delegation oppose any move towards regulatory equivalence, including on taxation and price points?

I am conscious that other colleagues wish to speak. Thank you, Mr Vickers, for indulging me in setting the scene more generally and outlining some of the concerns as the Government head into COP10.

[Sir Christopher Chope (Christchurch) (Con)]

My hon. Friend is making a brilliant speech, and I am grateful to him. Can he explain why we would be required to follow any recommendations that come out of COP10? As a sovereign country, surely we would be able to decide whether we wished to accept the recommendations.

[Andrew Lewer]

I will develop my hon. Friend’s point in my closing remark.

If the UK delegation attends COP10 and goes along with international agreements, even if they are not legally binding, there will be a mood music and atmosphere, as we have heard in recent days, that because we are a signatory and have agreed to go along with them, we therefore need to follow along. My hon. Friend the Member for Christchurch (Sir Christopher Chope), possibly more than anyone else, has been robust about the limitations of international bodies with respect to this Parliament and this country. However, as we discovered this week, their prevailing influence is great, and not standing up to proposals at such events therefore leads inexorably to their proposals being absorbed into British policy and lawmaking.

It would be hugely beneficial if the Minister attended COP10 in Panama and flew the flag for our world-leading public health strategies for smoking cessation. She is someone who passionately championed, when she stood astride that Wembley stage back in 2016, Britain’s great future as an independent, free-trading and outward-looking nation, having taken back control of our laws, borders and money. I do not believe for one moment that she wishes to see responsibility for our public health policy abrogated to another supernatural—sorry, supernational: a Freudian moment there—unelected body of bureaucrats. To assist in setting out the UK position, perhaps my hon. Friend the Member for Winchester (Steve Brine), in his capacity as Chair of the Health and Social Care Committee, might have the UK delegation appear before him and his colleagues to answer questions before COP10 gets away on 5 February, as well as afterwards.

Our constituents, many of whom have written to us about this in recent days, have the right to know what the UK delegation will or will not be doing on their behalf, let alone who is in it. I am sure that I speak for many Members when I say that we would welcome clarity on that point. I am grateful to the Minister for coming to respond to the debate. I am sure that she will use the opportunity to provide us with some of the answers we seek, and will undertake to keep the House and colleagues fully informed. I hope she will make a statement from the Dispatch Box at her earliest convenience after the conclusion of COP10 to update us on the outcomes from Panama.

I look forward to the contributions of colleagues from all parts of the House, and to the response from the shadow Minister, the SNP, and the Minister, who I know shares my passion for ensuring that our Parliament retains its status as the sovereign decision-making body.

--- Later in debate ---

[Mr David Jones (Clwyd West) (Con)]

May I say what a pleasure it is to serve under your chairmanship, Mr Vickers? I congratulate my hon. Friend the Member for Northampton South (Andrew Lewer) and the hon. Members for Ealing, Southall (Mr Sharma) and for Linlithgow and East Falkirk (Martyn Day) for securing the debate, and I thank the Backbench Business Committee for facilitating it. At the outset, I declare an interest as an honorary life governor of Cancer Research UK.

I agree entirely with my hon. Friend the Member for Northampton South that the stance the UK adopts at COP10 next month will be crucial to the future of tobacco harm reduction in this country. To their great credit, the Government have pursued a distinctive and very successful UK-made policy on smoking that has significantly reduced its prevalence in this country. Nevertheless, as we heard from my hon. Friend, 6.4 million people still smoke—around 12.9% of the UK’s adult population.

To help reduce smoking rates, the UK is taking a world-leading approach, supporting the principle of tobacco harm reduction. In particular, the UK takes the view that vapes can have an important role in reducing the prevalence of cigarette smoking. The Government have allowed vaping to develop on a market basis, and that has gradually taken 1.5 million people off smoking altogether.

As we have heard, the smoke produced by combustible tobacco represents the greatest threat to the health of smokers. The UK has therefore been keen to point smokers to alternatives to combustible cigarettes. As we heard from my hon. Friend, in April the Department of Health and Social Care announced that a pioneering “swap to stop” strategy would be rolled out across England, providing a million smokers with a vape starter kit, alongside behavioural support to help them quit. That approach has a history of success. The largest such programme to date was conducted in Salford in 2018, and it resulted in over 60% of participants being smoke-free after just four weeks.

While no one route can be said to be the only one to help smokers to quit, the fact is that, for many, vaping does work. I repeat the quote my hon. Friend mentioned from the chief medical officer for England, who said:

“If you smoke, vaping is much safer”.

However, he went on to say:

“if you don’t smoke, don’t vape.”

The 2022 Khan review made it clear that the Government should

“embrace the promotion of vaping as an effective tool to help people to quit smoking tobacco.”

However, one solution does not suit all smokers. It is important that the Government, and indeed the devolved Administrations, which have responsibility for healthcare in their areas, keep as many options open as possible to have the highest chance of success in reaching smoke-free status by 2030. That is the Government’s highly commendable ambition, and it must not be thwarted by the likely stance of the World Health Organisation in Panama.

The WHO opposes reduced-risk products, including vapes, heated tobacco and oral nicotine pouches, arguing that there is insufficient data to understand their effects. The WHO, to be entirely blunt, is being stubbornly backward. It does not accept any harm-reduction approach to smoking. It does not accept that smokers switching to vapes is a better choice. It does not accept British scientific consensus—for example, the Public Health England report stating:

“While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals that are present pose limited danger”

and that

“best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes”.

The WHO’s stance, therefore, runs counter to the UK Government’s successful, evidence-based approach to tobacco harm reduction through the use of reduced-risk products to help to cut smoking rates. We must remember that the United Kingdom is one of the largest financial contributors to the FCTC, and the Government should not be afraid to remind the WHO of that. British taxpayers have in recent years provided millions of pounds to support WHO policies that are contrary to those operated by the United Kingdom.

The WHO’s approach is that nicotine products pose a risk to health and that the safest approach is not to use them at all. Well, of course—that is self-evidently the case. Non-smokers should never start using nicotine, but it is counterproductive to prevent adult smokers from accessing reduced-risk products in a world in which 1.1 billion people still smoke. That makes no sense at all.

As my hon. Friend the Member for Northampton South said, some of the proposals in the provisional agenda for COP10, published on its website, are a serious cause for concern. For example, item 6.2 aims to impose the same restrictions on the advertisement, promotion and sponsorship of reduced-risk products as on conventional tobacco products. That would limit the ability of the UK Government, the devolved Administrations and public health bodies to promote to adult smokers less harmful alternatives as part of a smoking cessation strategy. It should be noted that, in contrast, Sweden is set to become the world’s first smoke-free country, after seeing substantial reductions in smoking rates through the use of a wide range of reduced-risk products.

Item 6.3 on the agenda threatens to establish regulatory equivalence between combustible tobacco and reduced-risk products. That sends a dangerous, misinformed message that reduced-risk products are as harmful as, or more harmful than, combustible cigarettes.

[Sir Christopher Chope]

Is that not exactly what has happened in China? China is regulating vapes in the same way as tobacco, and we know that the WHO is controlled by Chinese interests. Should that not make us really alarmed?

[Mr Jones]

Yes, it certainly should, and it is another reason why the United Kingdom, which has significant influence within the WHO, should actually exert that influence, and I propose to discuss that a little later in this speech.

Misinformation about vaping is already an important and worrying issue. According to Action on Smoking and Health, four in 10 smokers in the UK now believe that vaping is as risky as, or riskier than, smoking. That is the consequence of the misinformation, and the WHO’s position simply compounds the misinformation.

In the teeth of this hostility on the part of the WHO, the Government should confirm what policy positions the UK delegation to COP10 will take, especially on the agenda items that I just mentioned. I hope my right hon. Friend the Minister, in her winding-up speech, will be able to assure us that the Government will challenge the WHO on the science head-on. Will she say, as my hon. Friend the Member for Northampton South has asked, whether a Minister will attend COP? I believe that a Minister should be there—I think she should take a slow boat to Panama. We need ministerial involvement at this conference. Will my right hon. Friend also say what policy positions she will be instructing officials to take, and will she undertake to provide a further statement to the House on the key outcomes—particularly where there may be an impact on health policy and smoking cessation strategies—after the closure of the conference? Critically, will she confirm that the UK delegation will oppose, and if necessary veto, any proposals that would impact on the UK’s world-leading and evidence-based approach to tobacco control through the successful use of reduced-risk products?

I repeat that we are a major funder of this organisation. If we are to meet our goal of being smoke-free by 2030, the Government, working with devolved Administrations, must ensure that adult smokers are provided with a wide range of reduced-risk products to help them to quit, such as vapes, including single-use vapes; heat-not-burn and heated tobacco products; and oral nicotine pouches. Different solutions will work better for different people. Japan, with heated tobacco, and Sweden, with snus, the organic form of nicotine pouches, have had even more success in reducing smoking than the UK, so vapes should not be the only solution. Indeed, these products have been even more successful in their home markets than vapes have been here. We should be learning from other countries’ experiences.

At this COP, there will be an attempt on the part of the WHO to create a global norm of treating harm reduction products, including vapes and heated tobacco, exactly like combustible cigarettes, as if they were equally dangerous, including by raising their excise duties to the same level. That would be a colossal disincentive to any smoker who might consider switching to a less dangerous choice. I hope my right hon. Friend the Minister can confirm that the UK will stand against what would be a reactionary and profoundly dangerous error.

The WHO should not be allowed to undermine the UK’s evidence-based and science-led approach to tobacco harm reduction. The UK’s successful use of vapes to reduce smoking rates is rightly seen as a model of success around the world. The UK delegation at COP10 must do all it can to oppose measures that may threaten that.

[Sir Christopher Chope (Christchurch) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I had not expected to speak in this debate, but I think it is worth re-emphasising the point that the WHO is controlled by China in very dubious circumstances. The chairman and director general of the WHO were appointed under Chinese influence. We have debated several times in Westminster Hall the influence of China when it comes to other areas of activity with the World Health Organisation. Here we have a specific example of how Chinese leadership is trying to persuade this WHO body to introduce the same policies and regulations that it has already introduced in China.

We should be the world leaders in this. We should be out there explaining why tobacco harm reduction products are really well suited to the consumer and the battle against the harms caused by smoking, but we do not seem to be in a leadership role. I urge my right hon. Friend the Minister to show that leadership by leading the UK delegation in Panama. Otherwise it will seem as though we are diffident. There is even a danger that what we believe in this country and the pioneering work that has been done, to which reference has already been made, will count for nothing when it comes to the debates in Panama.

We know the extent of Chinese influence across the world. The next stage may well be that what is advisory for this WHO body will become mandatory. That is the Chinese agenda. They are trying to take over the these international bodies and get their way. What should we be doing? We should be fighting back robustly. We should not be naive about this. I fear that we are far too diffident.

I am disappointed that despite the number of constituents who have written to me and on whose behalf I have written to the Government, we have still not had clear answers about exactly what our position will be when the discussion takes place in February. My right hon. Friend the Minister has always been a champion of national sovereignty, but I urge her to demonstrate that by leading the way and telling the Whips that we can manage without her for a few days, while she raises the flag in Panama on behalf of the United Kingdom and all we are doing to improve our public health and reduce the harm that comes from smoking.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a real pleasure to serve under your chairmanship today, Mr Vickers. I thank all colleagues who have taken part in this Backbench debate, especially my hon. Friend the Member for Northampton South (Andrew Lewer) for his leadership in organising it. It has been very interesting, and I can absolutely assure colleagues that I have learned some new things myself today.

To tackle the very first question, I do not intend to go to Panama for COP10. That is because I am preparing flat out for our smoke-free generation Bill, including the response to the consultation and the measures. I just do not think it would be a good use of my time to travel on 5 February. However, the Government will be represented by our excellent colleague from the civil service, Dr Jeanelle de Gruchy, who has done fantastic work representing the UK’s position.

I will give a rough overview of the UK’s position. There will be discussion about global progress on tobacco control. Of course, the UK is an outlier on the topic of vapes, and we will be putting forward our position that vapes are a very important tool for helping adults to quit. There will be some discussion on advertising and sponsorship. The UK has no plans to implement further restrictions on advertising and sponsorship, particularly in the COP’s desire to see further restrictions implemented. On novel and emerging tobacco products, different parties take different approaches. At the moment, the UK is still looking at issues around heated tobacco, so the UK delegation will be in listening mode. In terms of parties going further on tobacco control, certainly the UK Government would welcome other parties going further to protect people, but we will be monitoring the negotiations to ensure that nothing becomes mandatory. Finally, there will be discussions on whether there should be an increase in assessed contributions. The UK intends to press for contributions to stay where they are now. I am very happy to provide a statement to the House after COP10, giving feedback on exactly what happened. I think that covers a lot of the issues raised by colleagues. I hope that was clear, and I would like to again thank everyone for attending.

As has been pointed out, the framework convention on tobacco control was the first treaty negotiated through the World Health Organisation. However, as colleagues will appreciate, I am not one to get misty-eyed about international conventions, or indeed international regulatory frameworks. I am not terribly romantically attached to this, and I feel that the UK’s sovereignty is actually the most important aspect. My priority as the Minister will be to help us in the UK protect our citizens from harm. Is there not a song that goes, “I did it my way”? The UK has a world-leading approach to reducing harms from tobacco and nicotine, and we will continue to do that.

The conference of the parties has, however, been a helpful way of keeping strong tobacco controls at the top of the global health agenda. It is also, as I hope I have just illustrated, a very useful forum for sharing best practice. All papers are presented and all decisions made are published online via the dedicated COP10 website. The UK remains committed to the convention, because we are a world leader in tobacco control. Like many friends around the world, we want to see a tobacco- free future. Next month’s conference will be a fantastic opportunity for us to showcase the UK’s strength, being at the cutting edge of a smoke-free generation. As I have said, our deputy chief medical officer, Dr Jeanelle de Gruchy, is the chief delegate. I have every confidence that our team will encourage other countries to follow in our example.

Now, my hon. Friend the Member for Northampton South is a big fan of common sense, and so am I. I want to reassure everybody that our delegation will be bound by common sense, and not by conference decisions that run contrary to common sense, or indeed to decisions that run counter to our national interest. That includes the decisions we take in helping smokers to quit through quit aids such as vapes and nicotine replacement products. We are a sovereign nation, and it is not within the WHO’s remit to intervene in our internal affairs.

Last week, I was given a couple of opportunities to update the House on our progress towards a smoke-free generation. With permission, I would like to reiterate a few of the points I made then. Our new tobacco and vapes Bill will save lives. Unlike other consumer products, there is no safe level of smoking: it is a product that kills up to two thirds of its long-term users, causes 70% of lung cancer cases, and massively increases the risk of stillbirth. It causes asthma in children; dementia, stroke and heart failure in old age; disability and early death. Almost every minute of every day, someone is admitted to hospital because of smoking, and up to 75,000 GP appointments every month can be attributed to smoking. It takes a massive toll on both our health and our NHS.

Smoking also takes its toll on our economy. Detractors will say, “But what about the £10 billion a year the Treasury gets from taxes on tobacco—how will the Chancellor do without that?” But independent analysis shows that the overall cost of tobacco to society totals £17 billion a year, completely offsetting—and then some—whatever we receive in taxes. The cost of smoking is equivalent to the annual salaries of more than half a million nurses, almost 400,000 GPs, 400,000 police officers or 400 million GP appointments. Reducing smoking rates will bring down those costs and help our economy to become more productive. Our modelling suggests that the smoke-free generation policy we are looking to introduce will reduce smoking rates in England among 14 to 30-year-olds to close to zero by as early as 2040, and will provide cumulative productivity benefits of up to a staggering £85 billion over the next 50 years. That is why bold action is necessary. We are making history with this Bill.

I took up smoking at 14 and gave it up as my 21st birthday present to myself. It was not easy. To this day, I hate talking about smoking because I sometimes think, “I’d quite like a cigarette”, but I shall never be tempted. It is so hard to quit. To those hon. Members who mentioned that nicotine is not bad in itself—yes, it is; it is desperately addictive. When people try to give up nicotine, they suffer cravings and get irritable. It is really difficult to give up nicotine, no matter how it is consumed. Combustible tobacco certainly has all sorts of other horrendous health issues, but nicotine itself is not a harmless product by any means. There is no safe level of nicotine consumption.

Like so many smokers, I desperately wanted to give up this lethal addiction. We want to help more smokers than ever to quit through significant new funding and support. All smokers deserve our support to quit and lead a healthier, longer life, which is why we have announced we are doubling the funding to stop smoking services across England to a total of £138 million a year, to help around 360,000 people quit every year. We are also backing these efforts with substantial new money to support marketing campaigns. As my right hon. Friend the Member for Clwyd West (Mr Jones) and my hon. Friend the Member for Northampton South both pointed out, four in 10 smokers think vaping is as bad as, if not worse than, smoking cigarettes. With this substantial marketing support, the stop smoking campaigns will be common sense and easy to use, setting out the facts to help smokers to be able to quit. We will also provide vapes as a quit aid to those who want to stop smoking.

As colleagues will know, I am passionate about helping mums, mums-to-be and new families, which is why I have asked officials to redouble our efforts to tackle smoking in pregnancy. Women who smoke during pregnancy are two and a half times more likely to give birth prematurely. Smoking is also a significant driver of stillbirth. I want to do everything I can to spare parents the heartbreaking tragedy of losing a baby. One in 10 mothers smokes at the time of delivery; this figure rises to one in five in some parts of the country. Pregnant women who receive financial incentives are twice as likely to successfully quit in pregnancy as those who do not. We must also protect pregnant women and their babies from second-hand smoke. We are working to roll out a financial incentive scheme by the end of 2024 to help all pregnant smokers—and, crucially, their partners— to quit.

As I have said, vapes can be an effective tool to help smokers quit. That is why we have committed to providing 1 million vapes to smokers through our “swap to stop” programme. That is a different approach from that taken in the WHO proposals; we are proud to take it, because we know it works.

Along with millions of parents across the country, I am alarmed by the number of children using vapes, a device that should be used only by adult smokers who want to quit smoking. Youth vaping has tripled in the last three years, and one in five children has used a vape. We have a duty to protect children from under-age vaping while their lungs and brains are still developing, so we are taking decisive action to reduce the appeal and availability of vapes.

In our recent public consultation, we sought views on restricting flavours, point-of-sale displays and packaging, and on restrictions on disposable vapes. We will take tough new action to reduce the appeal and availability of vapes to children through the tobacco and vapes Bill.

I totally get the point that my hon. Friend the Member for Northampton South made about flavours. These are all areas that are being carefully looked at, but he will appreciate that Cherryade, Yazoo and bubble-gum flavours are not really designed for him and me. Packages that look like a little Coke bottle, or are brightly coloured, like a bubble-gum package, are marketed not at him, but at children. Of course we see the vape stand right next to the sweets stand, and vapes are sold, conveniently, at pocket-money price, so let us not be naive about this. A lot of the flavours and colours are specifically designed to appeal to children, and that has to stop. A strong approach to enforcement is a crucial part of making sure that it has a real-world effect.

Under-age and illicit sales of tobacco, and more recently vapes, are undermining the Government’s work to regulate the industry and protect public health. We are cracking down on this appalling illicit trade by backing enforcement agencies, including Border Force, His Majesty’s Revenue and Customs and trading standards, with £30 million extra per year. In the tobacco and vapes Bill, we will introduce powers to give on-the-spot fines, to tackle under-age sales.

[Sir Christopher Chope]

Will my right hon. Friend comment on the undue influence of China on the WHO, as exemplified in my remarks? China is trying to ensure that its policies are adopted by the WHO, and it seems to be funding the WHO and controlling it. Should we not be concerned about that?

[Dame Andrea Leadsom]

I will look into my hon. Friend’s concerns and respond to him in writing. That is probably the most helpful I can be, because that is not something that I have been briefed on. I am, as are all hon. colleagues across the House, concerned about the undue influence of China on public policy that finds its way into national policies. I am grateful to him for raising the issue.

International Health Regulations 2005

Christopher Chope Excerpts

Monday 18th December 2023 Westminster Hall

[Sir Christopher Chope (Christchurch) (Con)]

I, too, thank the hon. Member for Lancaster and Fleetwood (Cat Smith) for setting out the issue, quite succinctly. I also thank her in her capacity as Chair of the Petitions Committee for having allowed us a three-hour debate. A consequence is that once all the Back-Bench contributions have been heard, we will be able to hear in extenso how His Majesty’s official Opposition will deal with this issue. Even more importantly, we will be able to hear the Minister, who I am delighted to see in his place, say exactly what the Government are doing in response to each of the issues raised in this debate, which are of crucial importance to so many of our constituents.

One of the reasons why we are where we are today is that the response to the debate we had on a petition on this subject in April was, frankly, totally inadequate. It was full of generalisations, and vague suggestions that somehow it was all going to be all right in a day. It really was, “Why are you bothering the Government with this trivial material?” This issue goes to the heart of what the House is all about. It is about who is in charge. Are we, as a democratic Parliament, in charge of the laws of our country, and any attempt by the Government to give away control over those laws to an unaccountable international organisation? It is because of that concern that so many people have signed this petition and we are having this debate again today.

If my right hon. Friend the Minister does not address these issues today, people will say that the Government are not taking this seriously. That would be a disaster. Once we have given away these powers to the WHO, which is power hungry—what international organisation is not power hungry? The WHO certainly is—it is very difficult to get them back. There are ongoing discussions about where we stand in relation to international treaties and international law. There is the insidious development, following the recent Supreme Court case, of what is called “customary” international law. That development basically means that a group of outsiders can tell us in this country what is good for us and what is not.

[Mr Francois]

For the avoidance of doubt, will my hon. Friend agree that none of us has argued this afternoon for withdrawal from the World Health Organisation—we might call it Wexit, for want of a better phrase—

[Mr Francois]

“Yet,” says another hon. Friend. But we want to be assured that the WHO cannot overrule this sovereign Parliament. That is a fundamental difference, is it not?

[Sir Christopher Chope]

Absolutely; I agree with my right hon. Friend. We do not want to withdraw; there is no need to withdraw from a voluntary organisation that is confined to giving us advice and providing data and information. Who would resent having access to data and information? Indeed, the essence of the relationship between a responsible society and its Government is that the Government should provide information to enable individuals to decide for themselves whether they want to take particular medicines, go on trips to particular countries, be vaccinated in a particular way, or whatever.

I see the proper role of the WHO as providing information to Governments across the globe. Those Governments can then decide for themselves what they like and do not like, having regard to the fact that the WHO’s chairman seems to have been imposed on it by the People’s Republic of China, and was strongly opposed by our Government. It seems very much as though the whole WHO is too beholden to China. The WHO is also beholden to some of its big donors; if one analyses how the WHO is funded, one sees that organisations such as the Bill & Melinda Gates Foundation are significant supporters. He who pays the piper calls the tune. I think that is a good starting point when looking at these things. In the case of the WHO, there is too much evidence that the people paying the piper are calling the tune to too great an extent.

Once bitten, twice shy. Let us remind ourselves what happened during the pandemic. As others have mentioned, the WHO went into the pandemic with a policy of saying that lockdowns were not, and could not be, the right answer to a pandemic for all sorts of reasons. We can now see the adverse consequences that flowed from our country’s decision to have a lockdown, and we can compare that with what happened in Sweden. Then, during the early part of the pandemic discussions, and without any evidence being brought forward, the WHO suddenly changed its advice. Why? There is a suspicion that it was because of undue influence from the pressures that I have been describing. We will never know why it changed its advice. All we know is that somebody who changes their advice like that, without any evidence, should not tell us what to do. We should say, “If you want to change your advice, fine, but why do you change it? We don’t have to follow it.” However, under the proposed treaty amendments, we would have to follow it. That is obviously of great concern, because people can see what happened in the past, and that is potentially a guide to the future.

Even more sinister than the change in advice on lockdowns was the WHO’s approach to finding a treatment for covid-19 patients. There was a lot of evidence to suggest that ivermectin—it was not the only such drug—could be used to really good effect to improve outcomes for patients suffering from covid-19. Strong evidence suggested that treatment with ivermectin might improve someone’s chances of survival by as much as 81%, but the WHO intervened at the behest of certain pharmaceutical companies that were in competition with the producers of ivermectin. It gave very dubious advice, to the effect that ivermectin should be used only in clinical trials.

To those who are not familiar with too much of the detail, I commend a book by Dr Pierre Kory, a distinguished physician and epidemiologist—I think he is an epidemiologist. He certainly deals with pulmonary and critical-care medicine; he is a specialist in that. He was in charge of the Front Line COVID-19 Critical Care Alliance, and produced a book called “The War on Ivermectin”. It was a war, organised by the WHO, against a remedy for covid-19, because, obviously, the whole vaccine development programme was premised on there being no cure for covid-19, and no effective treatment for it. In the absence of such treatment, it was legitimate for experimental vaccines to be brought into play without undergoing the full process set out in the Licensing Act 2003, because there was there was nothing else. We were in the desperate situation of there being no other way out. Actually, however, there was a lot of evidence to suggest that ivermectin—

[Dame Maria Miller (in the Chair)]

Order. I am sure that the hon. Member is not intending to use a prop. Let us leave it to Amazon to sell books.

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[Sir Christopher Chope]

I was holding the book as I was about to quote from it, Dame Maria. I was not trying to advertise it, and I have not contributed to it, although I have to admit that it was given to me; I did not pay for it. However, so that I can put it down, and so that people do not have to look at me waving it around any more, I will get to the quote. On the WHO’s recommendation against ivermectin, Doctor Kory says:

“The corrupt anti-recommendation that followed read like this:

We recommend not to use ivermectin in patients with COVID-19 except in the context of a clinical trial. This recommendation applies to patients with any disease severity and any duration of symptoms. A recommendation to only use a drug in the setting of a clinical trials…is appropriate when there is very low certainty evidence and future research has a large potential for reducing uncertainty about the effects of the intervention and for doing so at reasonable cost.”

That recommendation was given in the knowledge, as a result of work that had been done that, there was an 81% reduced risk of dying. Indeed, the reason that India was very successful in reducing the number of deaths immediately after the pandemic started was that it was using ivermectin in extenso. In the eyes of Dr Kory, the WHO’s refusal to endorse a remedy or treatment contributed to the loss of

“millions of lives across the world.”

Those are quotes from his book, which I will now put down, Dame Maria.

When I first read about that aspect of the work of the WHO, and the way in which it had been corruptly influenced by drug companies that had a direct financial interest in discrediting ivermectin, it raised alarm bells. I thought, “Hang on a minute, why is the WHO engaged in this sort of activity?” I hope that the Government will start looking really seriously, and sceptically, at the work of the WHO, and at the extent to which it is unduly influenced by external factors. A lot of its work is not based on straight science, but is actually political. Reference has already been made to the fact that the WHO does not seem too interested in getting to the bottom of how covid-19 began. Did it begin in a laboratory in China? That narrative would not fit in with the WHO effectively being under the control of the Chinese Government.

[Philip Davies]

This comes back to the point that our hon. Friend the Member for Devizes (Danny Kruger) made so effectively. The WHO said, prematurely, that it was “extremely unlikely” that covid started from a lab leak. Then, over a year later, I think, the director general said there had been a “premature push” to rule out the lab leak theory. Does that not confirm the point made by my hon. Friend the Member for Christchurch (Sir Christopher Chope) that there are clearly external factors at play when the WHO gives its advice, and that it should be treated with caution, not as gospel?

[Sir Christopher Chope]

Absolutely, and I am grateful to my hon. Friend for bringing that to our attention.

Let us reflect for a minute on what other countries are doing. I would have thought that we were one of the proudest sovereign countries, determined to ensure that our Parliament retains control over these sorts of issues; but we seem to have been sidelined by Slovakia, Estonia and New Zealand. If those countries have already come out publicly with their scepticism about the process, why have our Government been sitting on their hands, not saying anything? Instead of being mum about this, I hope that our Government will now say, “By all means, let’s keep the WHO as a body that provides advice, but under no circumstances will we sign up to anything that will give them control over our lives.” It was bad enough that we effectively had a requirement in this country that people should take vaccines—that there was a vaccine mandate.

I spoke the other day to a constituent of mine who worked as an inspector of care homes. He was told that he would lose his job if he refused to be vaccinated; he still refused, and he lost his job. I am pleased to say that he won his case in the tribunal, but that was the sort of consequence for people who fell foul of vaccine mandates. The prospect that it would not be our Government telling people what vaccines they had to take, but rather some unaccountable, foreign international organisation, is even more disturbing.

These are really important issues, and I hope that my friends in Government will take them a lot more seriously than they seem to have done up to now. It is still not clear whether the Department of Health and Social Care or the Foreign Office is in charge of these issues. As has been said, we need to know who among the Ministers will get down to the detail, argue the toss, and ensure that the WHO continues as an organisation but does not take control of our lives.

[Sir George Howarth in the Chair]

I am pleased to see you in the Chair, Sir George. If I sit down now, we will have just shy of two hours in which to hear from the Front Benchers—it is significant that there does not seem to be any SNP spokesman here—on what action they will take to address the concerns of more than 100,000 petitioners on this subject, and a whole lot of other people besides.

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[Andrew Stephenson]

I thank my right hon. Friend for that point. I genuinely believe that a lot here is in all our interests, and I do not want to turn this into a party political ding-dong. I genuinely believe that having us in Government leading the negotiations and getting them settled before any general election is firmly in the UK’s national interest, because I believe that we will deliver a treaty that is in the interests of all our citizens and respects national sovereignty. However, I very much hope that an incoming Labour Government would do the same. That is one of the reasons why I believe that we need to make rapid international progress to agree any revisions to the IHR—because I believe that we are in a good place to do that now and should move swiftly, rather than kicking it into the long grass. The last pandemic taught us that trying to make things up as we go along was not the best course of action. Laying some good foundations and providing some better certainty on how things will be dealt with is the best way forwards.

[Sir Christopher Chope]

Surely the regulations and the changes are not just one block that we either accept or reject. The Government can deal with each proposed amended change seriatim—one by one. That is why I hope that my right hon. Friend will spell out, in response to the points that have been made, exactly which of the amendments he supports and which ones he does not.

[Andrew Stephenson]

My hon. Friend tempts me, but he will remember that we did not provide a running commentary on the Brexit negotiations. We do not provide a running commentary on our trade negotiations. We do not believe that is in the national interest. Indeed, it is very clear that no text in the latest draft of the accord, published in October and available on the WHO website, has been agreed yet. The whole text is still under negotiation. The draft is just a basis for negotiations, and it will evolve. There are areas of the new draft that we clearly reject and there are areas that we would like to make even stronger. This is an active negotiation between 193 member states to come up with revisions to the IHR that we all believe, by mutual consensus, will be in our global interest.

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[Andrew Stephenson]

I hope that no Government would sign up to any treaty that it will not follow. I agree that, in a whole range of areas, countries around the world have sometimes not fulfilled their part of international obligations, but the UK Government will certainly not sign up to something that we do not believe is fair and proportionate, that is not our national interests and that we would not seek to follow ourselves. I share my hon. Friend’s concern that other countries have not followed regulations in the past, and there is no point in our passing strengthened regulations if we do not believe that other countries will follow them. We believe that the regulations are designed to prevent and control the international spread of disease. They are limited to public health risks and designed to avoid unnecessary interference with international traffic and trade. That is why we support the process of agreeing targeted amendments to the IHR as an important way to better prepare for future global health emergencies.

[Sir Christopher Chope]

Can the Minister explain the process in relation to the amendments? He talks about consensus, but what happens if this country does not get its way in relation to some of the amendments that it opposes? Would that mean that, if those amendments are incorporated in the final text, we can and will opt out of them?

[Andrew Stephenson]

Yes, that is exactly what consensus means. To be clear, the WHO secretariat is supporting both processes by hosting the international negotiating body and the working group on amendments to the regulations, and by supporting the chairs to prepare texts and answer questions from member states. Both negotiations, however, are member state-led processes. It is member states that are negotiating; it is not the World Health Organisation. I completely appreciate that some see this as a WHO power grab, but it is important to remember that it is a member state-led process.

We came together with other nations through the World Health Organisation to agree a process to negotiate targeted amendments to the IHR at the 75th World Health Assembly back in May 2022. By consensus, we adopted process-related amendments under article 59 of the regulations. The UK supported those amendments because they increased the timeliness of member states’ compliance with future amendments to the IHR. That will better protect us from future global health emergencies. As part of the agreed process, member states could submit proposed amendments for consideration, and to that end a working group, made up of all WHO member states, through which the amendments would be negotiated and agreed was created.

Oral Answers to Questions

Christopher Chope Excerpts

Tuesday 6th June 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

I want to see the care workforce recognised and rewarded for the work that they do. That is one reason why we gave adult social care a record uplift to its funding of up to £7.5 billion in the autumn statement, for local authorities to fund care providers to pay their workforce in turn. That goes hand in hand with our workforce reforms to develop the skills and career opportunities for the care workforce.

[Sir Christopher Chope (Christchurch) (Con)]

Has my right hon. Friend the Secretary of State read the report “Safe and Effective?” produced in April by a group of senior clinicians, which is very critical of the work of the Medicines and Healthcare products Regulatory Agency? If he has not yet read it, will he do so, please?

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my hon. Friend for his question. I feel that we had a very productive meeting yesterday with the all-party parliamentary group on covid-19 vaccine damage about the vaccines for covid and the issue of the MHRA. He raised a number of important points during that meeting, including that on the MHRA, and I will be responding to him shortly.

mRNA Covid-19 Booster

Christopher Chope Excerpts

Friday 17th March 2023 Commons Chamber

[Andrew Bridgen (North West Leicestershire) (Ind)]

On 13 December last year, I was kindly granted an Adjournment debate on the potential harms that emergency use experimental mRNA covid-19 vaccines cause. It is fair to say that, that night, my life changed. During that speech, in the evidenced data that I presented to the House, which no one has effectively rebutted, I highlighted to the Minister the scale of harms that the experimental vaccines have caused and continue to cause. In giving that speech to an almost empty Chamber, on this most important of issues—quite literally life and death—two things happened to me immediately. First, I was cancelled by the mainstream media. Despite sending a data sheet in the wake of the debate, scientifically evidencing every point that I made, not one media organisation wanted to talk about the issue of serious harms or deaths occurring as a result of the mRNA vaccines.

I fully expect that the media will show the same level of disinterest in today’s debate. It is what we have come to expect from a media more interested in navel gazing at the pontifications of Britain’s foremost football pundit instead of the horror and tragedy of excess deaths taking place before their eyes. Some three months on from that speech, a scattering of reports are now just appearing in the mainstream media. Sadly the number of people affected in the UK and across the world cannot be ignored or hidden indefinitely.

[Sir Christopher Chope (Christchurch) (Con)]

Does my hon. Friend accept that there is a bit of light on the horizon in that, this week alone, the Express has had four full pages on the subject?

[Andrew Bridgen]

My hon. Friend is a stalwart supporter of those who have been vaccine-harmed. I do hope that we can see some light at the end of the tunnel. Hopefully, this speech today will bring more light into the darkness.

In truth, I care little about being cancelled by the media, because, in the wake of that speech, something far more important has happened. I was contacted by thousands of people offering their support, and received many hundreds and hundreds of emails from all around the globe recounting to me their own stories of the harms caused in the wake of their or their loved ones’ covid vaccination.

I have been contacted by parents in my own and surrounding constituencies, thanking me for questioning why we were giving these experimental vaccinations to healthy children and young people who patently do not need them and who gain no protection from them. I was contacted by far too many relatives who had lost loved ones suddenly after having the Moderna, Pfizer or AstraZeneca experimental gene therapy treatments shot into their arms. Many of them asked in their emails why this vital issue was not being taken more seriously by many of my hon. and right hon. Friends and colleagues. That, Mr Deputy Speaker, is a question for my colleagues to answer.

Many more questioned why, as evidence continues to emerge, almost on a daily basis, the fourth estate was so remiss in its coverage. That, Mr Deputy Speaker, is a question for the lobby to answer. But every one of those who contacted me, asked me to keep up the fight and to continue to raise awareness of vaccine harms and vaccine deaths. That is the question that I am here to answer today.

Despite the media silence, there is huge, enormous and growing interest in this topic. Today, I once again ask the Minister why more is not being done, both in the United Kingdom and globally, to investigate and publicise the clear and well-documented adverse effects of covid-19 vaccines—vaccines that have made big pharma billions, and also vaccines that have resulted in completely unprecedented levels of yellow card reports. The Government’s own data in this respect is damning. It is interesting that only this week, the Medicines and Healthcare products Regulatory Agency announced that it will no longer be publicly reporting the yellow card updates on the reported harms of these experimental treatments. Can the Minister explain the reasoning behind that decision, especially given that the number of yellow card reports of adverse events is far higher for the experimental covid-19 vaccine than the total yellow card reports of all conventional vaccines administered for the past 50 years?

If you will grant me a little leeway, Mr Deputy Speaker, I will start by looking at data from the US state of Florida and the reported level of vaccine harms there. Prior to the covid pandemic, there were never more than 2,500 incidents per year of harms reported to the state’s surgeon general as a direct report of vaccination. In 2021, that number shot up to over 41,000 cases—a surge of more than 1,600%. Of course, some will understandably point out that the increase in cases was inevitable, as more vaccines were being administered. The answer to that, Mr Deputy Speaker, is that in the state of Florida, there was a 400% increase in vaccine administration in 2021, not 1,600%. In the state of Florida and in the rest of the world, 1,600 does not go into 400; it never has, and it never will.

The real-world data from Florida shows that the mRNA vaccines are resulting in vaccine harms disproportionate to the number of vaccines being administered when compared with all previous vaccinations. That backs up the clear warning signal from our own yellow card system in the UK. Data held by the US Government’s National Library of Medicine was used for research by Dr Joseph Fraiman that details the frequency of serious adverse events following vaccination with both Pfizer and Moderna mRNA vaccines. For clarity, a serious adverse event is defined as anything that results in death; is life-threatening at the time of the event; or results in in-patient hospitalisation or prolongation of existing hospitalisation, persistent or significant disability or incapacity, a congenital anomaly or birth defect, or something considered to be medically important based on medical judgment.

Using that definition, the study confirms that there are 10.1 serious adverse events for every 10,000 Pfizer vaccinations administered. That means that one in every 990 people vaccinated with the Pfizer booster will have a serious adverse event. The risk with the Moderna vaccine is even greater: there are 15.1 serious adverse events for every 10,000 Moderna jabs. That means that one in 662 people vaccinated with the Moderna booster will have a serious adverse event. Combining the data for the Pfizer and Moderna mRNA vaccines or boosters, we can see that there are an average of 1,250 serious adverse events for every 1 million vaccine boosters administered—in other words, an average one in 800 chance of a serious adverse event every time someone is boosted.

Let us now move on to the UK Government data. On 25 January this year, the Department of Health and Social Care published data from a presentation given by the UK Health Security Agency to the Joint Committee on Vaccination and Immunisation. The data published split the population into groups by age, and further divided those age groups into those considered healthy and those considered at risk. The numbers needed to vaccinate for each of those subgroups were calculated to prevent first, a single hospitalisation, and secondly, a single serious hospitalisation requiring oxygen or intubation—effectively, intensive care.

The figures are stark. To prevent just one healthy adult aged between 50 and 59 from being hospitalised due to covid, the Government’s own published data states that 43,600 people had to be given an autumn booster jab. With a serious adverse event rate of one in 800, that means that in the healthy 50 to 59-year-old group, as a result of using the mRNA boosters, 55 people would die or be put into hospital with side effects to prevent one single covid case presenting in hospital. The same data shows that, for healthy younger people, the number needed to be boosted to prevent a single hospital admission with covid-19 is far higher. Some 92,500 booster jabs were required to be administered to prevent one hospitalisation due to covid in the healthy 40 to 49 age group, which would simultaneously have put 116 people at probability of death or serious adverse reaction into hospital from the jab. The healthy 30 to 39 age group required 210,400 booster jabs to prevent a single covid hospitalisation, so 263 of this group will have been into hospital or, sadly, died as a result of the booster side effects just to keep one covid case out of hospital.

However, the data gets worse because hospitalisation does not necessarily mean a serious medical intervention such as intubation or oxygen. To prevent severe hospitalisation from covid-19, the numbers needed to be boosted become astronomical. I would suggest this is the real benchmark for comparison with the risks of death or serious adverse events from the boosters themselves.

The Government’s own data shows that, in healthy adults aged 50 to 59, it was necessary to give 256,400 booster jabs to prevent just one severe hospitalisation, putting 321 people into hospital with a serious side-effect from the booster, which includes, obviously, risk of death. For healthy 40 to 49-year-olds, that number increases to 932,500 who needed to be boosted to keep one covid patient out of an intensive therapy unit, putting potentially 1,165 people into hospital with serious harms, death or disability. And for healthy 30 to 39-year-olds, no one knows the answer to the number needed to be boosted to prevent a serious hospitalisation because the Government’s own data says that there has never been such a case of this age group being put into intensive care due to the current variant of covid-19. But many, indeed on average one in 800 of this group that has been boosted, will have died, or been disabled or seriously harmed by the booster itself.

Let me focus on the most vulnerable group for which the Government data is available, the over-70s with comorbidities—the most vulnerable group in our society. According to the Government’s own data, it would be necessary to administer 800 vaccine boosters to prevent just one hospitalisation for a patient over the age of 70 in this highest risk group. That means that all the most vulnerable group in our society are doing by being boosted is swapping one risk from covid of hospitalisation for exactly the same risk from the booster itself—but of course in the process big pharma are making huge profits.

We have looked at the health implications of the vaccine programme. Now I want to look at some of the cost implications of the booster programme in the UK. Total funding of the covid-19 vaccination programme in the UK up to the end of March this year is budgeted at £8.3 billion. In February 2022, the GPonline website, championing general practice professionals, published that GPs and community pharmacies were being paid £24 per dose for administering vaccines. That figure increased to £34 per dose at dedicated vaccination centres. These costs of course do not include the cost of the experimental vaccines themselves. For ease of calculation, I will count those at £20 per dose across the board. I will be generous and use the lower of the two figures for administering the vaccine, giving a total cost of £44 per dose, but even when I do, we see, from the Government’s own data on the use of boosters, that it cost over £1.9 million to prevent just one hospitalisation among healthy 50 to 59-year-olds and over £11 million to prevent one serious hospitalisation due to covid-19 in that age group; the cost to the taxpayer of preventing a hospitalisation of one healthy 40 to 49-year-old is over £4 million; and for healthy 30 to 39-year-olds the cost of preventing just one hospitalisation is over £9 million. Of course, to prevent serious hospitalisation in these groups, the cost is far higher.

It is of course worth noting that, in setting up the vaccine programme, the Government indemnified vaccine manufacturers, which gave them total cover against all future claims of the adverse effects of their products. Given what I have already explained about the incidence of serious side effects, that cost may well be extremely significant to the taxpayer, on top of the obvious human tragedy and loss that is self-evidently happening.

The data is clear: for all healthy people and all those considered at risk under 70, the probability of being seriously harmed by covid is seriously outweighed by the risks associated with the experimental vaccines and boosters. Even for the most vulnerable group—the over-70s with health problems—the risks are absolutely identical. The Government data not only comments on the efficacy and effectiveness of the autumn booster campaign, which I have quoted from—we have already had that—but looks forward to this year’s booster campaign. Not unsurprisingly, it predicts the same level of efficacy from the same boosters put into the same arms. Surely, in the light of the data, we will not continue with this absolute madness. If we were to perpetuate it, we would be engaging in expensive state-sponsored self-harm on a national level.

In the winter of 2020, the experimental mRNA vaccines were announced to the British public as “safe and effective”. That narrative was repeated by the vaccines Minister in her response to my speech in the Chamber on 13 December. It is interesting that the NHS website today describes the experimental vaccines as “safe and important”, and describes serious side effects as “very rare”. But the truth, as we know, is somewhat different. One in 800 is not rare, especially when the public are expected to take multiple doses, exposing themselves again and again to the same risk.

The Government need to be honest about this, just as they need to be honest about the fact that the MHRA is 86% funded by big pharma. Based on the manufacturers’ own trial data, the experimental mRNA vaccines are not safe, with an average of one in 800 people taking them facing death or serious injury as a result. Based on the Government’s own data, despite the initial and repeated assurances, the experimental mRNA vaccines are not effective in preventing infection, transmission or hospitalisation from covid-19. The experimental mRNA vaccines are not necessary given the risks and benefits of the treatment, and they are costing the country a fortune and creating huge pressure on the NHS from the side effects.

Given that the data released on 25 January by the UK Health Security Agency was actually presented to the JCVI on 25 October 2022, I ask the Minister: why was the booster roll-out not halted last October in the light of the clear lack of efficacy and the evidence of risks being greater than the benefits for all age groups, except possibly the over-70s with underlying health conditions, for whom the risk was absolutely identical? Was the data presented to the JVCI passed to the MHRA? If so, when? And if not, why not?

Why was the MHRA still asking the Government to authorise the administration of experimental vaccines to children as young as six months of age in December 2022, six weeks after the booster efficacy data was received by the JCVI? If the data was not passed to the MHRA, surely the JCVI should have spoken out against the vaccination of small children last December. Members of the JCVI declared between them interests of more than £1 billion of investments in big pharma, but I am sure that that would never have influenced their judgment. Can the Minister also confirm that two thirds of all NHS staff refused last year’s autumn booster?

The simple facts are that, in the light of the Government’s own data, covid vaccinations and boosters are not effective. From the evidence of the yellow card system, they are not safe, and for the UK taxpayer, they are not value for money. Indeed, given their side effects, if they were free, we could not afford them. The only ones who really benefit from the booster roll-out are big pharma, who have a licence to print money and indemnification against the harms that their products cause. Once again, big pharma have put profits before people and, on this occasion, Governments across the globe have been their willing marketing agents.

The whole covid-19 vaccine narrative is slowly unravelling. As I believe I have demonstrated, no one should have been boosted after the efficacy data was received on 25 October last year, and, based on that data, no one should be boosted in future. Given the evidence of harms caused by the boosters, I now believe that we have the full explanation for both the continuing excess deaths that we have seen since the pandemic— 63,000 in England and Wales in the last 12 months—and the huge and unrelenting pressure of demand on the NHS: the vaccines, the boosters and their side effects.

Sadly, I am confident that I will be proved correct, but I sincerely wish that it was not so. But the longer it takes our Government to accept the truth, the more people will be harmed and die. The first step to putting right the problem is always to admit that there is a problem. The Government narrative of “safe and effective” is in tatters, as evidenced by their own data. Three months on from my original speech in this House, we have surely now sacrificed enough of our citizens on the side of ignorance and unfettered corporate greed to satisfy everyone. I therefore call on the Government to immediately stop the mRNA vaccine booster programme and initiate a full public inquiry into not only the vaccine harms but how every agency and institution set up to protect the public interest has failed so abysmally in its duties.

I look forward to the Minister’s response. I am aware that it is neither his area of responsibility nor his area of expertise. I accept that, if there are any questions that he cannot answer at the Dispatch Box today, he will respond in writing.

Future of the NHS

Christopher Chope Excerpts

Thursday 23rd February 2023 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

It is a great pleasure to follow the hon. Member for Birmingham, Erdington (Mrs Hamilton) and to congratulate the hon. Member for Jarrow (Kate Osborne), who introduced the debate. She is from the north-east and I represent a constituency in the south of England, but many of the issues that have been raised are common right across England.

I will begin by referring to today’s report in The Times of the recent survey by the Health Foundation. The report’s headline is, “Public’s faith in the NHS sinks to lowest level in two decades”. That is obviously a good reason for us to have this debate; we cannot have a situation in which the public’s faith in the national health service is so low and declining.

Only 33% of adult respondents to that survey said that they thought the NHS was providing a good service. That is down from 43% in May last year and 66% in 2012. Only 8% of people believe that Ministers are following the right policies. That view is not confined to people who are not natural Conservatives; only 24% of Conservative voters believe that Ministers are following the right policies. I hope that my hon. Friend the Minister, when he responds to the debate, will give some hope to those disillusioned Conservative voters that the Government will restore confidence in the health service by introducing the right policies.

Similarly, there are concerns about the standard of general practitioner care. Some 47% of people said it was worse than 12 months ago, and only 9% said that it was better. That figure is very low compared with historical records. Then we have the consequences of ill health being borne out by information that, of the 3.5 million people in the 50 to 69 age range who were economically inactive in the last quarter of 2022, 1.6 million reported ill health as the main reason for their inactivity, and another 155,000 reported ill health as an additional factor. We are talking not just about the circumstances of people not being able to get the help that they need from the health service at the time that they need it, but about the consequences for our economy of those people not being able to get to work when they would wish so to do.

The latest figures that I have are that there are still 406,000 patients who have been waiting over a year to start treatment. Many of them will be either unable to work full time or unable to work at all as a result. On the other side of the equation, 53% of people think that the health service often wastes money, only 4% believe that it never wastes any money, and only 33% believe it is generally efficient. We do indeed have a crisis on our hands, and I think it ill behoves the Government not to face up to these realities.

Probably like lots of hon. Members, I have received a mass of suggestions from constituents for how things might be improved. One, which came in a long letter from a leading member of the nursing profession, is that we made a mistake in 2009 when we made the nursing profession a fully graduate profession, with the result that someone cannot become a nurse unless they get a degree. They cannot even get a nursing apprenticeship, because that has to be linked to getting a degree.

I have heard from people who have been in hospital recently that some of the most caring people that they had looking after them were nurses who were not graduates, but people who decided to go into the profession some time ago—obviously they are now in the older age group—to look after their fellow citizens. Why did we have to make nursing a graduate-entry-only profession? Of course, that has enabled the profession to become more of a closed shop and to use some of its increased bargaining power in recent salary and wage negotiations.

[Rachael Maskell]

I am listening carefully to the point that the hon. Gentleman is making. The knowledge and skills framework was introduced in 2004 as part of the “Agenda for Change” package, but the Government have not invested in the opportunity that the framework provides to do the very thing that he suggests—to enable people to climb the skills escalator and move through their profession into higher roles. Does he agree that we need to make that investment so that we are using the skills that are already in the NHS?

[Sir Christopher Chope]

The hon. Lady makes a very good point, and I am glad that I gave way to her to enable her to make it. We must do everything possible to increase the size and quality of the workforce and enable people who are already in it to improve their qualifications and progress through their chosen profession.

Constituents also tell me that there is a problem with retention. When nurses retire, they are expected to continue with continuous professional development; if they do not do that and fill in a lot of bureaucratic forms, they become ineligible to return to nursing later on. One of my constituents contrasted the situation in our country with that in the United States, where there are not so many bureaucratic barriers to someone’s carrying on nursing after they have retired, perhaps temporarily. I raised that point with the Government, thinking that it was a really good idea and that they should be getting to grips with it, but their answers to my questions suggested that it was not really on their radar and they were not interested in investigating it. Their response was, “We have a graduate-based profession, we have a retention scheme that we are not interested in changing, and the register will stay as it is.” I thought that that was a remarkably complacent response to what I considered to be quite a constructive suggestion from a qualified nurse.

Many people have made the point that we are training nurses and doctors at great public expense, and they then leave the profession and the national health service before they have paid back their dues. Again, there is a big contrast between what happens here and what happens in the United States. I am not saying that help with people’s development as they go through university should be conditional on their being forced to work for a particular employer or for the NHS when they graduate, but I do think there should be a system similar to the one in the United States, whereby those who are not going to work for the NHS are expected to pay back some of the costs of their training. There is a great deal of talk in this country about increasing the number of doctors and nurses, and the newspapers today refer to the need to increase the number of graduates, but that is not much use if so many of those graduates do not provide their services to the NHS.

[Alex Cunningham]

The same problem applies to dentists, who have no responsibility whatsoever to work for the NHS when they finish their training, which, of course, is funded by the state. Perhaps the hon. Gentleman would encourage Ministers to look at some form of requirement for them to work in the NHS at least for some time, which might shorten the waiting list for my constituents.

--- Later in debate ---

[Sir Christopher Chope]

That, too, is a good point. I am not saying that the hon. Gentleman has necessarily got the right answer, but the Government should be looking at this. I listened with interest to the earlier references to NHS dentistry. In my constituency, there are a fair number of NHS dentists who would like to take on more patients, but the rules require them not to exceed 110% of their quota. Some of them are saying, “I would love to take on more patients,” but they are being told by the local bureaucrats that if they do so, they will suffer financial penalties.

[Alex Cunningham]

One of the main problems with dentistry when it comes to resources is the difference between the unit prices that dentists receive for their work. One practice in my area has two parts, each of which is paid a different rate per unit from the other, and it is much lower than that paid in some other parts of the country. Does the hon. Gentleman agree that the Government need to look at the fee structure and make sure that dentists are being properly paid to work in the community?

[Sir Christopher Chope]

In fairness to the Government, they say that they are now looking at it—a bit late in the day, I think; a review should have been instituted much earlier—but the hon. Gentleman is right. It is ridiculous to have a structure in NHS dentistry in which the rewards are linked to the number of specific procedures that have been carried out. Each procedure is given a different rating, and then they are all added up to establish whether the total exceeds the permitted 110% capacity. That is another case of there being plenty of scope for reform and fresh thinking, but it seems to be almost a culture in the NHS not to be receptive to such ideas.

[Rob Roberts]

May I take up my hon. Friend’s point about dentists not taking on more work? The same applies to NHS doctors, who are subject to punitive measures involving their pension schemes. If they take on extra work or responsibilities, they receive huge pension bills—tens of thousands of pounds a year. Does my hon. Friend agree that a simple way of fixing a very simple problem would be to get rid of the annual allowance tax charge on the NHS defined-benefit scheme so that doctors could take on more work and reduce the waiting lists?

[Sir Christopher Chope]

I do agree with that. I have raised this subject in parliamentary questions, and what have I had in return? Complacency and inactivity, and generalisations such as, “We realise that there is a problem and we must try to do something about it.” As a matter of fact, I do not think that this problem is confined to doctors; I think there is a much bigger problem relating to pensions, but that is a subject for another day.

Then there is the issue of productivity—or rather the lack of productivity—in the NHS. As we have heard, although the number of staff is increasing, output is not going up; in fact, it is falling. The Government again seem to be refusing to face up to these problems. Last April, NHS England carried out an internal review of productivity issues, which was referred to by the National Audit Office in its report on the subject in November. I submitted a parliamentary question asking for the NHS England report to be published, and I had to wait weeks for an answer. On 22 December, I was informed by the Minister for Health and Secondary Care, the hon. Member for Colchester (Will Quince), that the publication of information about NHS England productivity available to the National Audit Office

“could prejudice the conduct of public affairs.”

I was amazed to receive such an answer, because surely we are the public. We are speaking on behalf of the public. Why and how could withholding from us an internal review carried out by NHS England be prejudicial to the conduct of public affairs, and how could it be prejudicial if it had already been seen by the National Audit Office?

I tabled another parliamentary question on 9 January, asking in what way the publication would prejudice the conduct of public affairs. One might have assumed that there would be a quick answer to that, because the Department must have thought about it when the first answer was approved by a Minister, but I had to wait until 20 February. In other words, I had to wait for about six weeks, until more than a month after the question should have been answered. The Minister replied:

“This report”—

the internal NHS England report—

“is currently being used by National Audit office and NHS England to inform internal policy for public services. To share this information would inhibit the open, free and frank discussions that are being had on these internal policies.”

I think that those “internal policies” should now be discussed openly in this Chamber. My message to the Government is that they need to get their act together in a way that they have not done hitherto, and address these serious issues.

--- Later in debate ---

[Neil O’Brien]

I am happy to make that commitment.

[Sir Christopher Chope]

The Minister has not covered the issue of productivity. He has mentioned, quite rightly, that the Government do not have any money. It is our money, taxpayers’ money, so why are the taxpayers not allowed to have access to these issues in the NHS with lack of productivity?

[Neil O’Brien]

I am as keen as my hon. Friend to explore all those different things and I am happy to take them up with him following this debate. Many things I have been talking about in this speech, the new technology we are putting in for GPs and the new ways of working, are crucial not just to getting taxpayers better value for money, but to protecting the NHS in the long term by enabling people to do more. The NHS is an enormous source of pride in this country. It is free at the point of delivery and it always will be, giving high-quality care for all. That remains our enduring commitment to our national health service.

Covid-19: PPE Procurement

Christopher Chope Excerpts

Thursday 24th November 2022 Commons Chamber

[Neil O’Brien]

The right hon. Lady asks two main questions, the first of which is what we are doing on PPE Medpro. It has been widely reported that it had an underperforming contract. Let me set out what we do in such cases. The first step is to send a letter before action, which outlines a claim for damages. That is followed by litigation in the event that a satisfactory agreement has not been reached. To answer the right hon. Lady’s question directly, we have not got to the point where a satisfactory agreement has been reached at this stage.

On the high-priority group, let us be clear about what it was and what it was not. Approximately 9,000 people came forward. All Ministers will have had the experience of endless people ringing them up directly to try to help with the huge need that there was at the time. Many of us, as Back Benchers, will have been approached by constituents who were keen to help and needed to be referred somewhere. All that the route did was handle the huge number of contacts coming in to Ministers from people offering to help. Let me be clear that it did not give any kind of successful guarantee of a contract; indeed, 90% of the bids that went through it were not successful. Every single bid that went through the route went through exactly the same eight-stage process as all the other contracts—it looked at the quality, the price and the bona fides of the people offering to produce.

On the point about PPE that has not been useful, I set out in my answer the extraordinary context in which we were operating. There was a global scramble for PPE. People were being gazumped: goods would be taken out of the warehouse if people could turn up with the cash quicker than them. It was an extraordinary situation in which we had to act in a different way. Loads of us will remember standing up in this House and saying to Ministers, “What are you doing to get more? More, quickly!” That was the context in which we were operating.

[Sir Christopher Chope (Christchurch) (Con)]

Does my hon. Friend agree that if we had not wasted billions of pounds of taxpayers’ money on PPE, we would not have to increase taxes as much as we are doing? What has happened to the £122 million that was spent on 25 million gowns supplied by the company referred to earlier? Those gowns were not fit for purpose and were never used.

[Neil O'Brien]

That was the underperforming contract that I referred to in my previous answer, and I set out the process that we go through when we take action on underperforming contracts. There is the initial letter before action, and then a process in which we look to see if a satisfactory agreement can be reached. If not, that leads on to litigation. Of course, there was wasted PPE—my hon. Friend is absolutely correct about that—but I have already set out the context of the global scramble and the huge amount of PPE that was successfully delivered, saving lives and protecting workers in our NHS.