Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Andrew Stephenson]

We are working to improve radiotherapy services across the NHS, and I would be happy to meet my hon. Friend to discuss that in more detail.

[Daisy Cooper (St Albans) (LD)]

West Hertfordshire Hospital Trust is at the front of the queue for the new hospital programme. We have the land, planning permission, building design, political and staff support, and enabling works are under way. But, like many other trusts around the country, the hospital trust is being asked to submit business case after business case. Will the Secretary of State clarify whether those delays are down to bureaucracy and the new hospital programme, or are they deliberate delaying tactics by a Government who do not want to release funds to hospitals before the general election?

[Victoria Atkins]

Normally, a Secretary of State would appear at the Dispatch Box after a question like that and say, “I refer the hon. Member to the answer I gave earlier.” On this occasion I will refer her to the question from my hon. Friend the Member for Watford (Dean Russell). He has just set out the business case for Watford General, which is great news, and I hope she will join him and me in welcoming that new hospital when it is open.

Tobacco and Vapes Bill

Daisy Cooper Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

First, I want to put on record my thanks to the public health Minister the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) and the chief medical officer Sir Chris Whitty, who spent time answering my questions and those of some of my colleagues. It was a very collegiate exercise and I am grateful to the right hon. Lady. It would be good to see more of that.

The Government proposals on vapes are an absolute no-brainer and are consistent with Liberal Democrat party policy that was adopted at our conference last year, including the ban on single-use vapes on environmental grounds. Parents and teachers in St Albans are particularly concerned about the insidious marketing of vapes to young people: the colours, flavours and packaging are designed to appeal to children. Earlier in the debate the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting) talked about children gathering in toilets, desperate to use their vapes. I am aware, unfortunately, of one example in my constituency where children have gathered in toilets not just to use the vapes but to take them apart to use as containers for smuggling in more dangerous substances, thereby using the vapes as a new gateway drug. I therefore entirely support the Government’s proposals on the regulation of vapes.

The question of a so-called smoking ban on those aged 15 and younger, stopping them being sold cigarettes, is not so straightforward, however. For Liberal Democrats there will be a free vote on this Bill; there are some good liberal arguments to be made both for and against it. I will be supporting the measures in the Bill, but some of my colleagues have remaining liberal and practical concerns. For example, in 30 years’ time how does somebody prove they are 46 and not 45 without a driver’s licence or a passport? How can we prevent abuse at retailers, too? I hope the Government will be providing more reassurances to colleagues on these issues.

[Sammy Wilson (East Antrim) (DUP)]

Does the hon. Member accept that that difficulty puts the onus on the retailer, who is meant to distinguish between a 45-year-old and a 46-year-old, and if they do not do that or they do so incorrectly, they could find themselves faced with a fine? Is that fair?

[Daisy Cooper]

Colleagues across the House have genuine concerns about that point. I know from engagements in my constituency that a number of retailers already suffer attacks when challenging people wishing to buy other age-related products, so I hope the Government will offer reassurances about what they intend to do to tackle that.

As I have said, I will be supporting the measures in this Bill, but coming to that decision was a bit of a journey for me. My first reaction on hearing of the Bill before it was published was indignation, because the measures are just a drop in the ocean in terms of what is needed to tackle cancer. One in two of us will get cancer at some point, yet the Government have missed their targets to provide fast cancer treatment every year since 2015 and have dropped their 10-year cancer plan. What we need is research in rare cancers, outdated cancer scanners updated, cancer nurses and efforts to tackle waiting times. It would perhaps have been better if the measures in this Bill had been a single clause in a much broader Bill. To be honest, I am frustrated that so much energy is going into this Bill, which could be described as low-hanging fruit, rather than into producing a much more ambitious plan to tackle cancer more broadly. We need to see more ambition in this area.

My second reaction was the raising of my liberal hackles. Liberals are not libertarians; we do not object to all bans. Liberals support bans as a last resort, but not as a first lever. The situation here is frustrating, however: it is a bit rich that the Government are bringing this Bill forward when they have simultaneously been slashing public health budgets, including for smoking cessation programmes, since 2015. Even with the new money the Government have put into smoking cessation programmes, the funds still fall far short of 2015 levels. We also know that smoking rates among young people have dropped very quickly; they are now down to 1% and continue to drop.

Liberals do sometimes back bans when a particular product or practice causes excessive harm, and that is why I have decided to back this ban. Fundamentally, I asked myself a simple question: is this going to help reduce the overwhelming harm caused by the significantly dangerous and addictive practice of smoking? The answer is yes, it is. We know that smoking is dangerous and highly addictive. We know that smoking is the UK’s biggest preventable killer, causing around one in four cancer deaths, including 64,000 in England alone. We know that 75,000 GP appointments each month are taken up by smoking-related illness. We know that smoking costs the economy £17 billion a year through smoking-related lost earnings, unemployment and early death. We know that it comes at enormous cost to our NHS, and we know that smoking rates in pregnancy vary hugely, with as many as 20% of pregnant women smoking in some parts of the country, increasing the chance of stillbirth by almost 50%. That is an incredibly stark health inequality.

Some people have suggested it could be contradictory for a liberal to support a ban on tobacco for 15-year-olds and younger while wanting to legalise cannabis, but let me say to them that they are wrong. It is entirely consistent for a liberal to want to make harmful products illegal—harmful products such as nicotine in cigarettes, skunk and products with high THC levels that can cause psychosis—while simultaneously wanting to have a legal regulated market for less harmful products such as vapes for nicotine and cannabis products with low and regulated THC levels.

In conclusion, do I think this measure is the first or best thing that the Government should be doing to tackle cancer? No. Do I think this measure is particularly ambitious? No. But do I think it is a useful step that will help us to tackle the dangerous health impacts of smoking addiction, to improve population health and to take pressure off the NHS? Personally, I do.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I remind colleagues to stick to the guidance of seven minutes, because otherwise I will have to impose a time limit, and it might not be seven minutes, which would be annoying for everybody.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 5th March 2024 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I have been corresponding with the Primary Care Minister, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), and her predecessors about urgently needing to protect general practice locations in city centres from outdated Treasury rules that potentially force them to move to ring-road locations. The Minister’s latest reply suggested that the ICB could use capital funding to pay for new premises, but my ICB claims that that is against the rules. Would she and her officials please urgently meet me and my local ICB to bottom out what the rules are and urgently protect our city centre GP locations?

[Victoria Atkins]

I will ask the relevant Minister to write to the hon. Lady.

NHS Dentistry: Recovery and Reform

Daisy Cooper Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

Very much so, and that will be primarily through the patient premium, which will mean that from next month dentists will be able to turn their signs from “closed” to “open” for NHS patients. We wanted to use levers that could be deployed immediately in order to help our constituents.

[Daisy Cooper (St Albans) (LD)]

It is estimated that more than 12 million people are waiting for dental treatment, but the Government’s announcement says that it will help just 1 million. The Government’s underspend last year was £400 million, and it is expected to be the same this year, but only £200 million has been announced. This plan is a drop in the ocean. In St Albans, my dentists are desperate to provide NHS care, and my constituents are desperate to see a dentist. At the heart of the problem is the broken contract. Will the Government take up the Liberal Democrats’ plan to reform the contract and provide guaranteed access to an NHS dentist for everybody needing urgent and emergency care?

[Victoria Atkins]

I heartily recommend the recovery plan to the hon. Lady, because it offers 2.5 million more appointments and has a long-term ambition for the prevention of tooth decay in children. In addition, it has that long-turn vision about increasing training places for our dental professionals by 40% by 2031.

Pharmacy First

Daisy Cooper Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

My hon. Friend raises an important point. Pharmacists will keep their community pharmacy open for up to 72 hours a week in most cases, and up to 100 hours in some cases, which means there is weekend accessibility. We keep this under review, but the availability is very good.

[Daisy Cooper (St Albans) (LD)]

The Liberal Democrats have long supported calls for Pharmacy First, and the National Pharmacy Association, based in my St Albans constituency, has been calling for it since at least 2017. This is a welcome move, but it is long overdue. The Minister will be aware that there have been almost 700 permanent pharmacy closures since 2015, and the Company Chemists Association now estimates that eight pharmacies a week are closing, including one in my constituency. What steps is she taking to make sure there are no more closures this week, next week and every other week this year?

[Dame Andrea Leadsom]

The hon. Lady might remember that the Liberal Democrats were in government for a good part of that period. She talks about pharmacy closures, and we see pharmacies opening and closing. There has been a small number of net closures, but we are very well served across England and we keep a close eye on that. Pharmacy First is a new boost to community pharmacies across England.

NHS Winter Update

Daisy Cooper Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

First, I sincerely thank my hon. Friend. I was in contact with her over the weekend when she had come off a very long shift in emergency care, looking after patients locally. I have nothing but admiration for her and the many, many other people who stepped in at short notice to cover urgent and emergency care in our NHS during the strikes. On minimum service levels, she will know that we have already introduced them for ambulance services—something that was opposed by the Labour party—but we have just closed the consultation on minimum service levels in hospitals and we are, of course, carefully analysing the responses. Again, the point that 40—four zero—patient safety mitigations were made by NHS leaders yet only two were granted by the BMA, is very, very worrying when it comes to how seriously the BMA is taking concerns about patient safety.

[Daisy Cooper (St Albans) (LD)]

A few weeks before Christmas, NHS bosses were here in Parliament briefing MPs that, notwithstanding their preparation for the winter crisis, the one thing that would push them to the brink would be a rise in respiratory illness. Now here we are: cases of flu, covid, RSV—respiratory syncytial virus —and whooping cough are all rising rapidly. A strong public health intervention by the Government could have prevented that from happening. When will the Government get serious about public health interventions such as vaccine uptake, air filtration and protecting the immune compromised to stop people getting so ill so often for so long?

[Victoria Atkins]

I thank the hon. Lady for re-emphasising the critical timing of the strike actions and the impact it has on patients. We know that winter is difficult. It is not just difficult for our healthcare system. Around the world, when cold winter strikes, it has physiological impacts on people with underlying health conditions. We also have a rise in infectious conditions, too. As she will appreciate, that is precisely why, on the advice of clinicians, we brought forward the flu and covid vaccination programme to try to protect the most vulnerable in our society. But again, the timing of the strikes is so very cynical, because their impact and tail will, I am sorry to say, have consequences beyond tomorrow’s stop date.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 17th October 2023 Commons Chamber

[Steve Barclay]

I am happy to join my hon. Friend; indeed, I am sure the whole House is happy to pay tribute to the exemplary public service Mr Warrender has provided, both in the Royal Navy and with the ambulance trust, and to wish him a very happy retirement.

[Daisy Cooper (St Albans) (LD)]

Immunocompromised patients are facing their fourth winter without adequate protection from covid, despite a new study showing that they now comprise approximately 25% of all covid hospitalisations, intensive care unit admissions and deaths. In the last few days, some hospitals have been giving guidance to their staff that they should not even test for covid unless they are working on specific wards. After three and a half years, what are the Government going to do to put an end to this appalling situation, where some of the most clinically vulnerable patients are scared of accessing the healthcare they need for fear it could literally be a death sentence?

[Steve Barclay]

During the pandemic, as the hon. Lady knows, the Government prioritised the clinically extremely vulnerable and significant investment went in there. We follow the guidance from the UK Health Security Agency about the right level of infection control. More widely, we need to look at what medicine is effective. If it relates to immunosuppressants, there was a big debate in summer 2022 about that issue and we keep the science under active review.

Under-age Vaping

Daisy Cooper Excerpts

Wednesday 12th July 2023 Commons Chamber

[Andrew Gwynne]

My hon. Friend is absolutely right. There is a place for banana, custard and even doughnuts, but that is not on a vape package. She is right that we need to close the loophole and protect children’s health. That is why we have tabled this motion.

In a recent evidence session on youth vaping, Laranya Caslin, the headteacher at St George’s Academy in Sleaford, told the Health and Social Care Committee:

“we have a significant proportion of students vaping. They vape regularly”.

The problem is so bad that St George’s has had to change smoke sensors to heat sensors, to clamp down on young people leaving the classroom to vape.

I would love that to be an isolated case, but we all know, across the House, that it is not. In Hartlepool, concerns have been raised about an increase in primary school children using vapes—that is just shocking. In Devon, schools have reported confiscating e-cigarettes from children as young as seven. Those claims seem to be reinforced by the fact that last year 15 children aged nine or under were hospitalised due to vaping, with health experts warning that the excessive use of e-cigarettes in children could be linked to lung collapse, lung bleeding and air leak. In Yorkshire and the Humber, it is estimated that 30% of secondary school students have tried vaping, which equates to around 109,000 children. It is just staggering.

[Daisy Cooper (St Albans) (LD)]

I am grateful to the shadow Minister for giving way. I have heard really shocking reports from parents and teachers in my constituency that children as young as 11 are using vapes and that one young person, at the age of 17, is now addicted. In the worst cases I am hearing, some young children are being targeted and are taking the vape apart to carry much harder drugs on the inside, which is causing an even bigger problem. Does the hon. Gentleman agree with me that we simply cannot wait any longer? We need urgent action from the Government to stop that happening.

[Andrew Gwynne]

The hon. Lady makes a powerful case. Those are precisely the reasons why we have called this debate. It should shock each and every one of us. The ease of access to e-cigarettes for children, many younger than the ages she gave as an example, just cannot be allowed. We must be doing all we can on e-cigarettes, as we did to tackle the packaging and advertising of actual cigarettes, to ensure that children are weaned off their nicotine addiction and that other children do not start vaping in the first place.

--- Later in debate ---

[Daisy Cooper]

The Minister said that this is “literally illegal”. According to the director general of the UK Vaping Industry Association, 40% to 50% of the disposable vapes market is made up of illicit products. So does the Minister agree that as well improving the regulation of vapes within the legal market that we have heard about so far, we must also see improvements to border security, to clamp down on illicit vape sales?

[Neil O’Brien]

I completely agree with the hon. Lady on that point; this is exactly what our enforcement squad is doing, and I completely agree about the importance of doing it.

On the call for evidence, we will be producing our response in early autumn, identifying and outlining areas where the Government will go further. The key point is that we need evidence to take effective action to stop children vaping. While that call for evidence has been running, we have already taken further steps. At the end of May, the Prime Minister announced several new measures to support our efforts to tackle youth and kids’ vaping. That included closing the loophole in our laws that has been allowing companies to give out free samples of vapes to under-18s, which ASH estimates could total as many as 20,000 a year. He also announced that we will overhaul the rules on selling nicotine-free vapes to under-18s and on issuing fines to shops selling vapes to the under-18s.

The Prime Minister also announced that we will update the school curriculum, to emphasise the health risks of vaping within relationships, sex and health education lessons, just as schools currently do for smoking and drinking, so that kids understand the risks of vaping. We will be writing to police forces to ensure dedicated school liaison officers across the country are using the new resources available to keep illegal vapes out of schools.

I want to use this opportunity to outline the work we are doing to successfully reduce smoking, not least because the Opposition Front-Bench spokesperson touched on it. In the 1970s, more than 40% of people smoked, and it was still 21% in 2010. Since then, we have taken a series of steps, including doubling excise duties and introducing a minimum excise tax on the cheapest cigarettes, that have helped to drive down smoking to a record low of just 13% in England.

We have gone from 21% to 13%, but of course we want to go further. In 2019, we announced our ambition for England to go smoke-free by 2030, which is considered to be 5% or less. Over the past decade, we have made significant progress towards making England smoke free. We have continued to invest in local stop-smoking services, to help smokers get the right support for them. We continue to work in support of the NHS. Last year alone, we provided £35 million to the NHS long-term plan commitments on smoking.

Youth smoking rates are now at their lowest rates on record. In 2021, just 3.3% of 15-year-olds were regular smokers, although of course we want to reduce that figure even further. Through the new measures I announced in April, the Government will be supporting many more smokers to quit through the tobacco reduction strategy. Some 1 million smokers will be encouraged to Swap to Stop, swapping cigarettes for vapes under a new national scheme that targets those who are most at risk and gives them free vapes. That is first scheme of its kind in the world. It is based on experience from the successful local pilots, and is an evidence-based initiative.

Likewise, we will offer innovative, but evidence-based, financial incentives for all women to stop smoking in pregnancy. Again, this is based on evidence that has been gathered during local pilot schemes and the strategy will be implemented at a national level. Shortly, we will launch a consultation on cigarette pack inserts to provide further information to support smokers to quit, which is something Canada has done successfully.

Further, those who supply tobacco for sale in the UK must be registered for tobacco track and trace, and obtain an economic operator ID. We brought in that scheme to tackle illegal tobacco, but we now want to use the existing system in a new way, to help strengthen enforcement and to target the illicit market. From now on, when people are found selling illicit tobacco, we will not just seize their products but remove their economic operator ID, so they will no longer be able to buy or sell tobacco. We are exploring how to share information with local partners about who is registered on the track and trace system, so that they know who is and who is not legally entitled to sell tobacco in their areas, helping to drive enforcement.

We are committed to doing all we can to prevent children from starting to vape and we are already taking robust action in a range of areas. We are actively working on ways that we can go further, but it is essential that those methods are evidence based and that we have measures that will be effective.

--- Later in debate ---

[Neil O’Brien]

Act robustly? I think we all want to act robustly. The shadow Minister said in his speech that he did not like banana-flavoured vapes, but would they be banned? I am happy to take an intervention if the shadow team have an answer. I do not think that we have an answer. That, ladies and gentlemen, is why we need to have evidence. We need to have an evidence-based approach, and we need to have not just the evidence about what drives these things, but clear definitions of these things on which we can actually take action. We have to be clear about what we are and are not doing within all these fields.

All I was trying to do is to demonstrate that, while we are committed to taking action—I feel very strongly about taking action on this—and while we have done a whole range of different things on this point, we need evidence to make good policy, which is why we are having a call for evidence.

[Daisy Cooper]

The Minister will know that the Government commissioned the Khan review, which reported on 9 June 2022—a year ago. The Khan review took the evidence. It had the consultation and it made very firm recommendations about certain things that the Government should do. Why are we here again? Why are we consulting? Why can the Government not just follow the recommendations in the Khan review?

[Neil O’Brien]

On driving up support for people to Swap to Stop, we are following the recommendations. On the things that we have been discussing in this debate, a whole set of other questions have been raised, on which our call for evidence explicitly invited evidence, because we want to have an evidence-based policy.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

Again, I agree that disposable vapes are a particular concern: in our view, the growth in youth vaping is largely due to the growth in the use of disposable vapes. That is why we have particularly focused on that issue in our call for evidence, and that is what we are considering.

[Daisy Cooper (St Albans) (LD)]

6. What assessment he has made of the potential impact of guidance issued by District Valuer Services on the availability of city-centre GP premises.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

While it is a very long-standing system, we keep the approach to funding for GP premises under review. We have taken action in the primary care recovery plan to improve access to section 106 funds, so that new homes always come with the GP infrastructure that is needed.

[Daisy Cooper]

The Secretary of State and his Ministers will know that I first raised this issue in the Chamber on 6 June this year. Integrated care boards, GPs, and now the medical property sector are all telling me that the Treasury rules are out of date and are a massive block to securing much-needed primary care premises in the right places, particularly in city centres such as St Albans. When I have asked the Department via written parliamentary questions for its assessment of how much of a problem this issue is, the Department has told me that it just does not know. Could the Minister please tell us when he will be speaking to colleagues in the Treasury to resolve this issue, so that we can make sure that GP premises are secured where people need them most?

[Neil O'Brien]

We talk all the time. I am conscious that there are 60% more full-time patient-facing staff in the hon. Lady’s constituency than there were in 2019, which of course puts pressure on premises. The capital allocation for her local ICB between 2022-23 and 2024-25 was £200 million, so the money is there, but I am happy to continue the conversation about how we get the premises in the places where we need them.

NHS Long-term Workforce Plan

Daisy Cooper Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

My right hon. Friend makes a valid point about the integration between health and social care, and that was a flagship part of the reforms in 2022, which brought the NHS and social care together through the integrated care system. I join him in welcoming the news about William Harvey Hospital, which is extremely important to the local area. On social care more widely, we must also be cognisant of the differences. The NHS and social care employ roughly similar numbers at around 1.5 million people, but one is one employer and the other is 15,000 employers, so the dynamics between the two are different. The prioritisation of that integration is exactly right. That is why my right hon. Friend the Chancellor announced up to £7.5 billion for social care in the autumn statement, recognising that what happens in social care has a big impact on discharge in hospitals and hospital flow, which in turn impacts on ambulance handovers.

[Daisy Cooper (St Albans) (LD)]

After promises of new hospitals that have not got off the ground and 6,000 more GPs that never came to pass, it is fair to say that the British public will judge the Government on their actions not their words. Let me press the Secretary of State further on social care. He will remember that at the start of this year, people were dying in the back of ambulances and in hospital corridors, in part because people could not be discharged from hospitals into social care. If the Government believe, as I do, that we cannot fix the NHS if we do not fix social care, will he also bring forward a workforce plan for our social care sector?

[Steve Barclay]

That repeats the previous question, so I will not repeat the answer. It is slightly ironic to call for a plan for a new hospital programme and for a long-term workforce plan, and then criticise us when we deliver on both of those, as we have done with more than £20 billion of investment in the new hospitals programme, which we announced last month, £2.4 billion in the first ever long-term workforce plan and the biggest ever expansion of workforce training in the history of the NHS. Of course we need to take action in the short term to deal with the consequences of the pandemic. That is what our recovery plan does. The urgent emergency care plan that I announced in January takes specific action on demand management in the community. There are measures upstream on boosting capacity in emergency departments and downstream on things such as virtual wards. A huge amount of work is going on. We are putting more than £1 billion into 5,000 more permanent beds to get more bed capacity into hospitals. On social care, in the autumn statement the Chancellor committed up to £7.5 billion of further investment over two years, and it was part of our reforms to better integrate health and social care.