Hospice Funding
Baroness Laing of Elderslie Excerpts(7 months ago)
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Madam Deputy Speaker (Dame Eleanor Laing)
Order. It is the hon. Gentleman’s ICB, not mine.
Sally-Ann Hart
Yes—my hon. Friend’s ICB is not very good. Obviously, leadership structure and a clear list of priorities is essential to deliver what the public need.
The significant funding challenges are particularly concerning in the context of increasing need. Sue Ryder, a palliative and bereavement support charity, projects that the demand for specialist palliative care services in England may rise by 55% over the current decade. That rise in demand is due to several factors, including increased mortality rates and a growing desire by patients to die at home rather than in hospital. We clearly need a commitment from Government to fund a much higher percentage of total palliative care costs than at present to ensure the sustainability of the hospice sector and the vital services that hospices provide in the medium term. ICBs cannot commission specialist services without the funding to do so.
The APPG’s report made a number of recommendations to Government, the NHS and local authorities. On funding, the APPG recommended that the Government produce a national plan to ensure the right funding flows to hospices, and conduct or commission a piece of work to understand the costs of providing different models of palliative and end of life care. It also called for Government funding to address immediate pressures of paying increased staffing costs for hospices, and said that ICBs must ensure uplifts to hospice contracts that are equitable with uplifts received by NHS-run services.
Tobacco and Vapes Bill
Baroness Laing of Elderslie ExcerptsTuesday 16th April 2024
(7 months, 1 week ago)
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Several hon. Members rose—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. There are more people here than I was expecting, so I hope we can limit our remarks to about five minutes each, please.
Several hon. Members rose—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. I must impose a time limit of five minutes.
Richard Graham (Gloucester) (Con)
What a fascinating afternoon of different speeches. As my right hon. Friend the Member for Chelmsford (Vicky Ford) has just indicated, there are two very different ways of approaching the Bill. It is very much a personal matter: tonight’s vote is not whipped, and therefore all of us will have our different perceptions, but I start by saying that we are not all here—as one Member said—to try to prevent restrictions on human activity. I do not see that as the reason I was sent to this House, but surely we were all sent here to try to achieve a better future for the children and grandchildren of our constituents. Once we have all agreed on that, we can discuss whether a ban on children smoking now that will, in time, mean a ban on everyone smoking is a wonderful way of preventing what is not a liberty but an addiction, or whether taking away that freedom is just a slippery slope towards taking away all other freedoms.
Of course, although we cannot measure precisely the future damage of allowing people to carry on as they have been—being able to do themselves considerable damage—we know that the NHS calculates that the current financial cost of smoking is £17 billion a year. For those of us who are also concerned about the size of the state, the use of resources, the productivity of the NHS, and the ability of our constituents to have elective surgery when they want it and to see doctors when they wish to, this is surely a huge opportunity to make a massive difference—not just to future generations’ potential to avoid addiction to tobacco, but to their ability to get the health services that they want at a cost that this country can afford. That is the crux of what we have been discussing today.
It is very interesting to me that all the doctors in the House and all the health professionals in our constituencies—as my neighbour and hon. Friend, the wonderful Member for Stroud (Siobhan Baillie), has highlighted in Gloucestershire—are absolutely united that this is one of the single most important and useful interventions that this House could make. It is a huge credit to this Prime Minister that he has set out a vision with clarity and pursued it with determination, and is absolutely clear that were this House to vote this Bill through, it would be part of whatever legacy he leaves in the future, as a politician keen to make a difference.
I believe the idea that, on the contrary, encouraging worse health outcomes should continue because it somehow benefits people’s freedoms would be a valid one only if the whole business of smoking was harmless and largely cost-free, and we know that that simply is not the case. We have heard the data and the calls: 75,000 GP appointments a month, 690 premature deaths in the Gloucester Royal Hospital alone, and every minute of every day a new patient somewhere in a hospital in the UK because of smoking. We cannot argue that the freedom to smoke and to be addicted comes cost-free, and I cannot imagine opposing a Bill that supports better health and better life outcomes. For the libertarians, it will in fact help to reduce the size and cost of the state. Therefore all these things are fundamentally Conservative goals. In fact, they are not even just Conservative goals, but surely human goals that all of us in this House can share.
In all this, we do not need to think too much about a nanny state—none of us is keen on the phrase “nanny state” or the concept—but how many people here would stand up and vote to take away safety belts in cars, or suggest that everyone could drive motorbikes without a helmet? I believe that what may seem like a slight increase in bureaucracy will, in a few years’ time, be seen as so obvious that we will all be astonished there was any opposition at all. I believe strongly that protecting children, just as we banned children from being chimney sweeps in generations gone by, by banning them from smoking for future generations is exactly what a progressive Conservative Government should do. This Bill, if passed, will be one of the most far-reaching laws that this Government and this Parliament have made. I am absolutely convinced—
James Grundy (Leigh) (Con)
I rise in an unusual position, because I smoke like a chimney, but I will give the Government the benefit of the doubt tonight, even though I have concerns about the enforceability of some of the Bill’s measures.
Those who are regular readers of the Leigh Journal—I realise that my audience might not include too many of those—will know that I have written repeatedly about the problem of illicit and illegal tobacco and vapes in Leigh. The simple truth is that there is real concern that a lot of these products are a means to money launder for the gangs who cause the heroin problem in Leigh and for the people smugglers. I have spoken in the Leigh Journal about how Leigh was one of the end points of an international smuggling gang based in the Balkans that used illicit tobacco and vapes as part of their criminal enterprise.
Some people have spoken today about how they do not think the Bill is right and will not support the Government. I will support the Government, but I will complain about the Bill too, because the Government must go further. If someone is selling illegal tobacco and vapes, they should be held accountable. If someone was selling beer or spirits made out of turpentine or toilet water, for example, people would be outraged and there would be a demand for action, but that is happening day in, day out and week in, week out with illegal and counterfeit tobacco and vapes. Some products are made illegitimately to copy “legitimate” products in sweatshops in the far east, and some vapes contain up to 10 times the legal limit of nicotine. As some colleagues with medical knowledge have spoken about today, we simply do not know what damage that will do to young people.
The way we should go further is through a mechanism that we already have to license shops, which is the alcohol licensing scheme. We should expand that scheme, which is run by local authorities, to tobacco. It should be an alcohol and tobacco licence, so that someone cannot apply for one or the other, but has to apply for both. If someone is caught selling a dodgy £2 vape to a 14-year-old, they should have their licence taken away so that they can no longer sell alcohol either. I guarantee that that would basically clean up the system, because nobody will take the risk of selling a dodgy £2 vape to a 14-year-old and risk the loss of their ability to sell alcohol to a much wider pool of people. Those who do will, I suspect, be the organisations that are fronts for the drug dealers and people smugglers. We should also trigger an automatic investigation by His Majesty’s Revenue and Customs into those people and follow back the chain of the dodgy vapes and dodgy tobacco to find out who they are. Not only should we take away their licences so that they cannot sell alcohol and tobacco; we should fine them, and not £50 as said earlier, but £10,000. Let us really go for this and teach those people a lesson, because the black market in tobacco and vapes already exists, and it is costing the Treasury millions. It is funding other criminal activity such as heroin dealing and people smuggling, so it must come to an end.
My only criticism of the Government with regard to the Bill is that it does not go far enough. We need more robust regulation, because a giant black market in tobacco and vapes is already there. It needs to be done through the existing licensing system for alcohol, and it needs to have concrete outcomes that will shut down the dodgy shops and cut off a source of funding for the dangerous criminal gangs who also operate in heroin dealing and people smuggling.
The Government have the right intention. I have doubts about some of the detail, but I will give them the benefit of the doubt. However, I urge them to strengthen the legislation; it would be to the benefit of us all if they did so. Let us deal with these criminal gangs while we deal with this public health issue, because I am afraid the two are deeply intertwined.
Cass Review
Baroness Laing of Elderslie Excerpts(7 months, 1 week ago)
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Anna Firth (Southend West) (Con)
I welcome the Secretary of State’s powerful statement and the Cass report. However, we have to acknowledge that the report would not have been commissioned without this Government, with the support of some other parties. So many Opposition Members just stayed silent and thought the report was pretty much a waste of time, and to see the lack of any appreciation of that today is shocking and shameful.
On the timetable to enact the wider findings of the Cass report, I am grateful for what the Secretary of State said about meeting the GMC over the weekend, but there is work to be done. Secondly and really concerningly, what steps are—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. I am sure the hon. Lady does not mean “secondly”, because she is not making a speech. She has one question to ask, and I would be grateful if she could ask it.
Anna Firth
What are we going to do to provide emotional and psychological support for those who have already undergone this treatment with irrevocable consequences?
Victoria Atkins
Not only have I tried to espouse those principles in every ministerial role that I have held, but it is the guiding light of this Government to try to ensure that we get the right healthcare and support to patients as quickly as possible. We also want to ensure that we are treating not just the condition, but the patient as a whole. As some of the complexity of the debates that we had this afternoon shows, young people are at the very heart of this. I think this is the final question, Madam Deputy Speaker, so I will end with the young people that we are concerned about. [Interruption.] I am so sorry; I have one more question from the hon. Member for Strangford (Jim Shannon). The children and young people who are the focus of this report have to be, and will be, the focus of our work going forward. We want to get the right services to the right children at the right time.
Madam Deputy Speaker (Dame Eleanor Laing)
I do not want to say that the Secretary of State could ever be wrong, but on her last judgment I have to say that the show is never over until the hon. Member for Strangford (Jim Shannon) has spoken.
Jim Shannon (Strangford) (DUP)
You are most kind, Madam Deputy Speaker. I know that I have now caught the Secretary of State’s eye.
May I thank the Secretary of State for her fortitude and determination, and Dr Cass for all her endeavours? Both ladies—honourable ladies, I believe—have been incredibly impressive and capable. We should be taking on board Dr Cass’s report in Northern Ireland. Indeed, I will make it my business to ensure that the Minister in Northern Ireland takes this in, so I shall be sending him a copy of the report. What help and support is available for all those patients who have been in the Tavistock since its inception? Importantly, what steps can be taken by the Government to stop this malpractice and to stop the movement of the vulnerable—some have called this tantamount to abuse—into privately funded abuse? How quickly can that protection be put in place?
St Peter’s Hospital, Maldon
Baroness Laing of Elderslie Excerpts(8 months, 1 week ago)
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Madam Deputy Speaker (Dame Eleanor Laing)
The right hon. Lady has not asked me, the Minister or the right hon. Member for Maldon (Sir John Whittingdale) whether she can take part in the debate, but she can ask now.
Heart and Circulatory Diseases: Premature Deaths
Baroness Laing of Elderslie Excerpts(9 months ago)
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Several hon. Members rose—
Madam Deputy Speaker
Order. It will be obvious to the House that we have very little time this afternoon, so I hope that Members will limit their remarks to around five minutes.
Andrew Bridgen (North West Leicestershire) (Ind)
Five minutes?
Madam Deputy Speaker
Would the hon. Gentleman like to find some way to make the House sit longer?
Andrew Bridgen
No, Madam Deputy Speaker. I am just rather surprised. We often have three hours for Backbench Business debates, but we have ended up with an hour.
Madam Deputy Speaker
I appreciate the point that the hon. Gentleman is making, but there is nothing I can do about it now. Don’t we all sometimes wish that we could turn back the clock? I do not have that power.
Andrew Bridgen (North West Leicestershire) (Ind)
I thank the hon. Member for Watford (Dean Russell) for securing this important debate, and for sharing his personal experience of suffering a heart attack. I am delighted to see that he has made such a strong recovery that he can be here in the Chamber today. I am sure that many Members have been affected by cardiac disease, or know people close to them who have been deeply affected by this appalling and shocking killer.
The Library briefing pack for this debate contains a startling statistic. Almost casually, it mentions that cardiovascular deaths per 100,000 population have risen by 10% since 2019, after falling steadily for decades.
Madam Deputy Speaker (Dame Eleanor Laing)
Order. I apologise for interrupting the hon. Gentleman, but I have taken what he has just said to heart. I have done my best to squeeze out more time, and he can have around seven minutes.
Amy Callaghan (East Dunbartonshire) (SNP)
I congratulate the hon. Member for Watford (Dean Russell) on securing this debate on such an important and prevalent issue. He and I have a shared interest in health inequalities, largely due to our personal experiences. He and I joined the House at the same time. I remember sitting in this very Chamber for his maiden speech, in which he quoted Sir Elton John’s song “I’m Still Standing.” I am absolutely delighted that we are both still standing. [Hon. Members: “Hear, hear!”] Just a few short months after my hon. Friend’s maiden speech—I will call him my hon. Friend— I was in rehab recovering from a stroke. “I’m Still Standing” was one of the songs that we ironically listened to while doing physio—a dark sense of humour can be a powerful tool in the face of adversity, but of course we need to equip people with more than just a sense of humour to get through these very difficult conditions.
This issue is one that my party and I are deeply concerned about, with nearly three in 10 Scots dying from heart and circulatory diseases, equating to about 50 people per day or 1,500 people per month. Preventing those deaths, and in particular premature deaths, is something that the Scottish Government are committed to. The hon. Member for Watford outlined the signs and symptoms of many heart and circulatory conditions. I commend him for shining a light on them. We cannot overestimate the impact that a debate like this will have. Support for the mind after a health trauma is necessary, as he also outlined. After my stroke, I did not realise that I needed help for my mental health until I reached a crisis point. Getting help was the best thing that I could have done for myself. That support needs to be there for everyone.
As we have heard, there are clear risk factors for developing cardiovascular diseases centring around people’s lifestyles. We can call them lifestyle choices, but the choices are often heavily influenced by inequality and poverty. We know that people in poverty have poorer health outcomes, and improving people’s ability to make healthier choices on diet, smoking and alcohol consumption are essential to change that. We know that sadly the prevalence rates for circulatory and cardiovascular diseases are significantly higher in the most deprived areas. We also know that poverty rates are higher for some minority ethnic groups, and therefore they are often disproportionally vulnerable to health inequalities.
That is why improving health and reducing health inequalities across Scotland are clear priorities for the Scottish Government, especially in the face of UK Government austerity measures. The British Heart Foundation says that there has been
“a lack of meaningful action”
from the British Government
“over the last 10 years to address many of the causes of heart disease and stroke, such as stubbornly high obesity rates”.
Obesity and unhealthy lifestyle choices are intrinsically linked to poverty. That is why the SNP’s action to mitigate the effects of this Tory Government’s cost of living crisis are so important to today’s debate.
Recent analysis from the British Heart Foundation shows that the number of people dying before the age of 75 in England from heart and circulatory diseases has risen to the highest level in over a decade. We know that 700,000 people in Scotland are living with circulatory diseases. We do not know how much that is affected by covid-19 or other factors, but it is clear that an increasingly unhealthy population plays a key role in these worrying statistics. This is why the SNP’s focus on tackling these inequalities and tackling poverty is such an important and proactive step in reducing these premature deaths.
The Scottish Government’s focus and commitment to tackling poverty and other risk factors relating to cardiovascular disease are despite this Tory Government’s austerity measures. The British Government’s austerity policies are harming the economies across these isles, driving more people into poverty and making our health outcomes worse. Health inequalities are rampant the length and breadth of these isles. I stand here as proof of that. I had cancer as a teenager and had a stroke in my mid-20s—an example of the health inequalities prevalent in the west of Scotland.
Economic austerity is to blame for the slowing progress in health outcomes over the past decade. The British Government would do well to cast their eyes up to Scotland and consider a focus on our wellbeing economy, with people at its heart, as we do. Funding—or, in this case, the lack of it—is a political choice. The UK has considerable wealth, so it is shameful that so many people are in poverty and that their health is suffering as a result. The levels of universal credit have been too low for too long. The SNP and the Scottish Government continue to call on the UK Government to introduce an essentials guarantee to ensure that social security benefits adequately cover the cost of essential goods and properly support our most vulnerable people. The Scottish Government have gone to great lengths to increase income for Scots by promoting fair work and improving the value of social security through bold measures such as the Scottish child payment and the real living wage.
I know that we are short of time, Madam Deputy Speaker, so I will bring my remarks to a conclusion. I urge the Government, and whomever forms the next Government, to consider taking the Scottish Government’s approach to tackling health inequalities by reducing poverty and guaranteeing that people have the resources to make healthy lifestyle choices. It is abundantly clear that while Scotland is tied to this place, Westminster and the British Government hold the purse strings, and any action that the Scottish Government take can be outdone by austerity measures in this place. Only with the full powers of independence will we truly be able to tackle health inequalities in Scotland and reduce the number of premature deaths from cardiovascular disease.
National HIV Testing Week
Baroness Laing of Elderslie Excerpts(9 months, 2 weeks ago)
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Charlotte Nichols (Warrington North) (Lab)
I beg to move,
That this House has considered National HIV testing week.
I am the understudy today for the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), who secured this debate. It has been 42 years since the untimely death of Terrence Higgins, who was not only the first recorded British person to die of HIV/AIDS, but a Commons Hansard reporter. Since then, we have made huge progress in the testing, diagnosis and treatment of HIV. Today, people living with HIV can continue to live very normal lives. It is essential to remember, however, that HIV remains a critical global health issue, with millions of people living with the virus and many more at risk of infection.
Early diagnosis and treatment of HIV is essential in reducing the spread of the virus, improving health outcomes and reducing the stigma associated with the disease. I thank charities such as the Terrence Higgins Trust, the National AIDS Trust, the George House Trust and others that have worked tirelessly to lead the fight against HIV. They have done and continue to do phenomenal work to help those living with HIV and to achieve the goal of no new HIV transmissions by 2030. I take the time on behalf of all the members of the all-party parliamentary group on HIV and AIDS to thank the outgoing chief executive of the National AIDS Trust, Deborah Gold, for her hard work and dedication to the charity for the past 10 years, and for her immense contribution to the fight against HIV. I am sure that everyone will join me in wishing her the best of luck in her new chapter.
As Members will be aware, HIV weakens a person’s immune system and their ability to fight everyday infections and disease. HIV is passed from human to human and, if left untreated, can progress through a series of stages leading to acquired immune deficiency syndrome, or AIDS. Though there is currently no cure for HIV, treatments are available that enable a person to live a long and healthy life. A person living with HIV has a similar life expectancy to a HIV-negative person, provided that they are tested and diagnosed in good time. In 2022, the Government introduced the national HIV action plan. It had the clear aim of reducing new infections by 80% by 2025 and, crucially, ending infections and deaths from HIV by 2030. That goal can be achieved only if the plan is properly financed and implemented.
In November, at the event to honour Sir Elton John organised by the APPG on HIV and AIDS and hosted by Mr Speaker, the Secretary of State for Health and Social Care outlined that the UK Government would be expanding the hugely successful NHS opt-out virus testing programme for HIV and hepatitis to 46 new emergency departments across England. Expansion of the programme from the current 33 sites to every high-prevalence area could identify a significant proportion of the estimated 4,500 people living with undiagnosed HIV, prevent new transmissions and save more lives.
As hon. Members will know, we have been marking National HIV Testing Week with events across the country, including on the parliamentary estate, to raise awareness of HIV testing. This annual campaign aims to raise awareness of the importance of regular testing to reduce the number of people living with undiagnosed HIV and those diagnosed late, and the campaign’s strapline “I test” is in its second year. I urge everyone to take advantage of the services available during National HIV Testing Week and throughout the year to get tested and know their status.
Recent UK Health Security Agency data highlights that while HIV diagnoses among white gay and bisexual men are falling, inequalities are deepening. HIV transmissions have increased in the last year among heterosexual men and women, as well as gay and bisexual men of other ethnicities. Persistent inequalities must be overcome. At the same time, the experience of people living with HIV is not equal or equitable. Worrying numbers of people living with HIV are afraid to visit healthcare settings, with women and people of black African ethnicity more likely to be afraid than men or people of white ethnicity. Those inequalities are mirrored in the experience of people offered an HIV test: 40% of women eligible for a test were not offered one when attending a sexual health service. I urge the Minister to do everything she can to tackle the inequalities in the HIV response in order to deliver the Government’s action plan and end new transmissions by 2030.
Along with tackling inequalities, we need to tackle the growing number of people previously diagnosed with HIV who are not accessing the care they need. The UKHSA estimates that as many as 14,000 people living with HIV in England have not been seen by their HIV clinic for at least a year, often for complex social and stigma-related reasons. They are essentially lost from the health system. One in three of those testing positive for HIV through opt-out HIV testing in accident and emergency departments knew about their status but were not accessing care. Hospitals in London are now reporting that people lost to care have overtaken undiagnosed HIV as the leading cause of HIV-related hospitalisation and mortality. Those are entirely preventable incidents.
Pilot work in south London funded by the Elton John AIDS Foundation has shown that with case finding, focused follow-up and wraparound support, people can be successfully returned to care at an average cost of £3,000 a person. HIV clinics currently do not have the resources to do that work, but it is significantly cheaper than care costs when people develop serious illness. A national programme must be urgently introduced to find everyone lost to HIV care in England and ensure that they are getting the lifesaving treatment they need. Will the Minister confirm what action the Government are taking to find people living with HIV who have been lost to care?
Finally, we must tackle late diagnosis. Certain groups are more likely to be diagnosed late and therefore experience worse health outcomes. Last year, 44% of people diagnosed with HIV in England were diagnosed at a late stage, and late diagnosis rates are even higher for women, at 51%. The number of people living with HIV who know their status but are not in care could be higher than the number of people with undiagnosed HIV. That is a risk to their health, expensive for the NHS and threatens HIV elimination. People not in HIV care are disproportionately from underserved communities, including black communities, women and people who use drugs.
The impact of late diagnosis can be extremely damaging: as well as meaning that someone might unknowingly pass on the virus, if they receive a late diagnosis, their chance of dying in the first year after diagnosis is 10 times greater than if they had received an early diagnosis. Additionally, late diagnosis can have a detrimental impact on an effective response to treatment, which in turn leads to greater healthcare costs at a time when there are already financial strains on the NHS. Late diagnosis is particularly common among certain groups, with 54% of heterosexual British black Africans and 29% of gay and bisexual men diagnosed late. Opt-out testing has allowed us to identify that those are the groups most likely to be HIV-positive.
Although opt-out testing highlighted that those groups were most likely to have HIV, we need to encourage more people from them to get tested. A simple solution for that could be to use public message campaigns. Targeted messaging across radio, television and social media could be created to encourage people to come forward and get tested. It could also specify the importance of testing and tell people where their nearest local test centre is.
Ultimately, to address late diagnosis in both primary and secondary care services, HIV testing needs to become more prominent across the entire NHS primary and secondary estate. If we want to turn the UK into a science and health superpower, and if we want there to be no new cases of HIV transmission by 2030, it is essential that we address the issues that I am highlighting. In particular, it is vital that we rapidly increase testing levels in high and very high prevalence areas through opt-out testing. That will not only save the NHS money and reduce the backlog but enable patients to know quickly whether they have HIV.
My challenge to the Minister is to fight her corner and fight the inequalities in the HIV response, ensure that access to testing is increased and ensure that once testing has started in hospitals, funding for it will continue until we find the last person living with undiagnosed HIV in England. The opportunity to eliminate new cases of a long-term condition is rare, yet we have the tools to do just that now. We must grasp that opportunity and create a culture where failure to follow guidelines is considered wrong and HIV testing is considered routine.
I end on this note. It is crucial that HIV and AIDS remain firmly on the agenda of our Governments, both domestically and internationally. They must be held to their promise to reach zero new infections by 2030.
Jim Shannon (Strangford) (DUP)
It is a pleasure to follow the hon. Member for Hammersmith (Andy Slaughter). I thank him for his contribution and his knowledge of his constituency. I also thank the hon. Member for Warrington North (Charlotte Nichols). She led a debate yesterday on mindfulness, which I attended, and she led this debate on HIV testing exceptionally well.
I am the Democratic Unionist party’s health spokesperson, so it is a pleasure for me to be here to make a contribution. I always like speak in such debates if possible. Once or twice I have missed them, but I am very pleased to be here today. We celebrate the fact that HIV is now a disease that people can live with, and can enjoy a better life with. That is something to celebrate.
National HIV Testing Week lasts from 5 to 11 February, and special recognition is deserved for reaching a decade since it started. We should look at what has been done in the last 10 years—how we have progressed and done better, and how people have a better quality of life today. It is important to mark this week in Parliament, as testing is the only way for people to know if they have HIV. The Father of the House said that he would go and get a test, even though he does not need one. He said that people should recognise that testing is important. The latest figures show that rate of HIV diagnosis is falling, but people of a heterosexual orientation are getting more HIV diagnoses, so there is a lot of work still to do. Testing is free, quick and easy, so it is imperative that people of all ages are aware of the services available to them and take advantage of them to prevent passing it on to others.
I would point the Minister, for whom I have great respect—I understand her deep interest in this subject and very much look forward to her response today—to the issue of PrEP, which the hon. Member for Hammersmith referred to. In Northern Ireland, we have had a very successful campaign on that for some time, which seeks to raise awareness, reduce sexual diseases and then, by its very nature, give people longer lives.
Some 69,000 HIV tests were carried out in Northern Ireland in 2020; from those, there were 52 new diagnoses, bringing the total number of people diagnosed with the disease in Northern Ireland to 1,123. With a population the size of ours, we might say that those figures are not bad—I do not think they are. It illustrates that testing and the use of PrEP, among other policies in Northern Ireland, have enabled us to reduce diagnoses and keep them at a manageable figure. That is a decline of 49% from 2015, which is a massive success story. There has been a declining trend in the annual number of diagnoses in people born in the UK. There is no doubt that we are doing our best to encourage people to partake in testing.
It is important to recognise how far we have come since the ’70s and ’80s, when there was a huge stigma around HIV diagnosis, testing and treatment. As I have said, I am my party’s health spokesperson, so I try never to miss these debates. It is amazing to see how far we have advanced since then, both socially and medically, and it is important to say how wonderful our NHS is, being capable of transforming what was once a much-feared virus into something that is now easily treated. That does not mean we become nonchalant in relation to it; it means we have to recognise what we have done, and then recognise what our policy will be for the next period, because people are now able to live long, healthy lives through treatment.
I look to the Minister for a commitment that we will dedicate more resources to educating young people on HIV and other viruses that can be passed on through infected bodily fluids. Many young people will not remember, or even be aware of, the years when HIV was a massive concern to so many. It is crucial that we keep on raising that awareness today, and that young people are encouraged to test, if necessary, and to have those conversations with family and friends, to ensure they do not have the disease and that they are safe, well and healthy.
Where we can do that most effectively is in schools and universities, which have a role to play in ensuring that young people feel comfortable and have a safe place where they can speak to someone privately. The Father of the House was absolutely right: these subjects are sometimes difficult to deal with, and those conversations may need to be private. Many universities already have sexual health clinics, which are fantastic services to offer young people.
So many organisations do incredibly hard work to provide support for other nations with a high prevalence of HIV. In National HIV Testing Week, I want to make a plea to the Minister. Ards Elim church in Newtownards, in my constituency, operates aid and missions out of the church and is incredibly active with missionaries in Africa, especially in Swaziland and Zimbabwe. Every year, a group of young people come to our constituency, every one of whom is HIV-positive—their parents had it, and they have it—but they are living their life today because of the new medications that we have. I feel greatly encouraged when I see them and when I hear them singing in their heavenly voices. It reminds me that we in this great United Kingdom of Great Britain and Northern Ireland have done magnificent work out in Swaziland, Zimbabwe and across Africa. I know it is not the Minister’s responsibility, but could she perhaps give a hint or write a letter to myself and others on what can be done to continue the work on HIV in Swaziland and Zimbabwe? It is of great interest to my constituents who attend that church.
At one stage, 40% of the population of Swaziland were HIV-positive, but today, after receiving medications and doing testing campaigns, the rate there is manageable. If that is not a success story, I would like to know what is. As many will know, there is a high prevalence of HIV in certain parts of Africa, and the ministry is keen to secure help for young children and parents who are suffering. There is so much ambition to help others, as it has been proven that catching cases early through frequent testing hinders the spread and lessens the impact of HIV on an individual. Across the UK, we are successful with our figures. Can the Minister provide some clarity on whether we are able to help other countries in desperate need as well?
This week is another opportunity to encourage people to take advantage of services offered to combat HIV. There is fantastic potential to protect people from HIV and to prevent severe illness and even death. When I think of the royal family, I often think of Princess Diana and the work she did when she was alive. She reached out and was one of those great motivators who tried to make sure that people across the world knew that HIV should not and would not be a death sentence.
To conclude, I thank the local health trusts in Northern Ireland, and indeed across the whole United Kingdom of Great Britain and Northern Ireland, for providing these worthwhile facilities. I call on the Government and the Minister to ensure that we continue to provide sufficient testing services to all across the United Kingdom of Great Britain and Northern Ireland, as testing has proven instrumental in saving lives. Why would we not celebrate an occasion like this, when across this great United Kingdom, many more people are alive today because of what we have done?
NHS Dentistry: Recovery and Reform
Baroness Laing of Elderslie Excerpts(9 months, 2 weeks ago)
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Victoria Atkins
I take that constituency case very seriously. I am really keen to urge the hon. Lady that if a constituent contacts her in future with that level of discomfort and pain, she should advise that constituent to contact 111 and, if necessary, go to accident and emergency—[Interruption.] Labour Members are shaking their heads, but what she has just described is a serious situation. That constituent needs medical attention, and the NHS is there, ready and willing to help. That is the advice that she should be giving her constituents, and I hope that she takes it as seriously as I do. [Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. The Secretary of State was giving an answer to a question. We do not need all this shouting. People might not agree with the answer, but you have to listen to the answer.
Sir John Hayes (South Holland and The Deepings) (Con)
In congratulating my right hon. Friend—my personal friend—on this welcome, excellent statement, may I ask her to forgive the ferocity with which my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) and I made the case for NHS dentistry when we met her recently? In that spirit, will she ensure that some of these new dentists come to rural Lincolnshire, where we desperately need good dental care? She has today irrigated the dental desert.
Victoria Atkins
Very much so. The truth is that teeth appear long before reception class, and this is why we want to focus not just on babies and toddlers in early years settings but, importantly, on pregnant mums because their oral health while pregnant can have ramifications for their baby. The dental recovery plan is seeking to address this through a long-term sweep from the very beginning of life to adulthood, with 2.5 million more appointments and a long-term plan for NHS dentistry in our country.
Madam Deputy Speaker (Dame Eleanor Laing)
I thank the Secretary of State for answering for more than an hour. We will now proceed, but first I will take points of order.
Pharmacy First
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The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)
With permission, I shall make a statement on the launch of our Pharmacy First service.
Pharmacies are at the centre of our communities. They are an accessible front door to our NHS for millions of people. Alongside general practice, optometry and dentistry, pharmacy is one of the four pillars of primary care in England. Four in five people in England live within a 20-minute walk of a community pharmacy. Pharmacies provide fast, fair and simple access to care and advice for the kinds of illnesses from which people suffer every day. Our constituents can now walk in off the high street whenever it suits them—whether they are at home, at work, or visiting somewhere.
Our pharmacists are not only conveniently located, but highly skilled professionals with years of training under their belts. The number of registered pharmacists in England has grown considerably under this Conservative Government—up 61% compared with 2010. None the less, these skilled healthcare professionals still represent a rather untapped resource in our NHS, so this Government are bringing forward reforms that will make the most of their expertise: giving people up and down the country a variety of quality care and wise advice, quickly and easily, saving them a trip to the GP; freeing up appointments for patients who need GPs the most; and driving our plan to cut waiting lists. The benefits are clear. That is why this Government have consistently taken the decisions that allow community pharmacists to deliver more clinical services and supply more treatments— whether that be other parts of the NHS referring patients suffering from minor illnesses to community pharmacists for advice and the sale of over-the-counter medicines, offering lifesaving blood pressure checks in pharmacies, or making it easier for women to access oral contraception in pharmacies. I am proud of everything that we have accomplished so far.
To unlock the full potential of our pharmacists, we need to go further and faster. That is why I am delighted to inform the House today that we are launching the Pharmacy First service—a personal priority of the Prime Minister, who is himself the son of a pharmacist. This will give pharmacists the power to supply prescription-only medications, including antibiotics and antivirals for seven common conditions: sore throats, ear aches, infected insect bites, impetigo, shingles, and minor urinary tract infections in women. More than 10,000 community pharmacies have signed up—over 95% of pharmacies in England—which is a brilliant sign of their approval.
The next time that anyone is suffering from any of those seven conditions, for most people their first port of call will be a quick trip or a call to their pharmacist. They will not need to see their GP first. They will not need to spend time making an appointment, and they can turn to their pharmacist whenever it suits them. That benefits everyone involved: people get the care they need faster; GPs can focus on more complicated cases; and pharmacists can make better use of their knowledge and skills. This is a common-sense reform. Pharmacists see and advise people with these sorts of conditions every day, but we have now enabled them to provide prescription-only medicines where clinically appropriate, so that they can help people more easily.
All this will deliver results. Pharmacy First will make it easier for millions of people to get the care they need on the high street and, together with the expanded blood pressure and contraception service, it will free up as many as 10 million GP appointments, in turn reducing unnecessary trips to A&E, reducing the pressure on GPs, and driving forward our plan to cut waiting lists for patients.
The investment that we are putting into Pharmacy First will also level up digital infrastructure in community pharmacies up and down the country, streamlining referrals to and from GPs, giving pharmacists better access to relevant information from patients’ GP records, and allowing them to share relevant information quickly in return.
Pharmacy First is not just about delivering care faster, but about making care fairer by driving down health inequalities. That is because there is double the number of pharmacies in the most deprived communities in our country. Getting the right care, the right contraception and the right test will now be faster and simpler for all those people in our more deprived communities than it ever has been before. Thanks to Pharmacy First, they will be able to take full advantage of their pharmacists’ expertise and use them to complement the care they receive from their GPs and throughout the NHS.
Pharmacy First was made possible only through close collaboration with Community Pharmacy England, which I thank for all the work it has done and will continue to do to support community pharmacies to gear up and deliver this new service for our NHS.
We on the Conservative Benches have a clear plan for the NHS: getting patients the care they need faster; making the system simpler for staff; and making it fairer for everyone. That is our plan and I look forward to working with pharmacists up and down the country to deliver today’s announcements as we build a brighter future for families right across the country. I commend this statement to the House.
Several hon. Members rose—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. That was a perfect answer. I have to tell the House that we have a lot of business to get through today, and I will therefore need short questions and admirably short answers, because otherwise not everyone who is standing will have a chance to ask a question.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
I do not agree with most of what the Minister has said today. We are all in favour of pharmacies, but I think this statement is a distraction from the real problems in our health service, our GP service and much else.
Madam Deputy Speaker
Order. Will the hon. Gentleman please ask a question?
Mr Sheerman
Has the Minister looked at the number of pharmacies that have closed in the poorest areas of our country? Lastly, what is she going to do about companies like Boots? It has even closed its local branch in Westminster—
Madam Deputy Speaker
Order. Because of his seniority, I have allowed the hon. Gentleman a little leeway. One question, one answer.
Dame Andrea Leadsom
The more deprived parts of England are much better served by community pharmacies than better-off areas are.
Sarah Jones (Croydon Central) (Lab)
The three pharmacies in Shirley, in my constituency, have been there for decades. They are very well known and very trusted, but they are all on the edge of having to close. To stay open, one pharmacist is using their own savings and not paying themselves a wage. I welcome your announcement, but would you read a letter from them—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. There may have been lax obeying of the rules at other times, but would the hon. Lady please refer to the Minister as “she”, not “you”?
Oral Answers to Questions
Baroness Laing of Elderslie Excerpts(11 months, 3 weeks ago)
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Madam Deputy Speaker (Dame Eleanor Laing)
No, no—you do not get another supplementary question. I was about to call Layla Moran for Question 16, which is grouped with this one, but unfortunately she is not present so I shall go straight to the Chairman of the Health and Social Care Committee.
Steve Brine (Winchester) (Con)
The Government previously committed to publishing a dental recovery plan, which the former dental Minister, my hon. Friend the Member for Harborough (Neil O’Brien), said that the Government would publish shortly. He also told my Committee:
“We do want everyone who needs one to be able to access an NHS dentist”.
We were surprised, but he said it. We were told that the plan would be published during the summer or before the summer recess. When will the plan be published, if that is still the intention? Presumably it will come alongside the response to our “Dental Services” report, which was due on 14 September.
Victoria Atkins
A theme is emerging of underspend in dental work, which is one of the things that the ministerial team and I are looking at. NHS England emphasised in its guidance to ICBs that the funding should be ringfenced. I very much understand the pressures that my hon. Friend and other south-west Members have been raising over many months on the care that their constituents are getting. To ease pressures in the south-west, NHS England has commissioned additional urgent dental care appointments that people can access through NHS 111.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
I begin by welcoming the Secretary of State and her Ministers to their posts.
Last year, the Prime Minister pledged to restore NHS dentistry, including a specific promise to protect its budget, yet last month we learned that he will break that promise and allow ICBs to raid dentistry budgets to fill the gaps. Labour has a plan for 700,000 extra appointments, supervised toothbrushing in schools and a targeted dentistry recruitment scheme in left-behind areas. It is all fully funded by abolishing non-dom tax status. We have a plan, but the Government’s plan is four months overdue. Where is it?
Helen Whately
The hon. Member refers to yesterday’s announcement on migration. First, I am very grateful to all the international workers who come here to help in our health and social care system and to care for our loved ones. Clearly, we must get the balance right between migration and making sure that our health and care system has the workforce that it needs. That is what we are doing, both with the migration changes announced yesterday and with our reforms to the social care workforce to ensure that working in social care is appealing to home-grown talent.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
Thanks to their own internal chaos, the Conservatives have utterly failed in their promise at the last general election to fix the crisis in social care once and for all. We now have over 150,000 care vacancies and 390,000 care staff leaving their jobs each year, meaning that 60% of patients in England who are fit for discharge are being kept in hospital each day. Will the Minister therefore back Labour’s plan to deliver a fair pay agreement, with better terms, conditions, training and pay, to ensure that we have the staff required to care for all those who need it?
Helen Whately
Labour really have not got a leg to stand on when it comes to social care reform. They did not do anything the last time they were in government, and they still do not have a plan for social care. In government, we are reforming social care careers—[Interruption.] If the hon. Lady will take a look at what we are doing, we are introducing a new career structure for people working in social care, introducing new qualifications and investing in training for social care. We are doing what needs to be done to ensure that social care as a career works for UK workers. [Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. You won’t get your turn if you shout from there.
Catherine West (Hornsey and Wood Green) (Lab)
Helen Whately
My hon. Friend makes a very important point about the additional challenges in rural areas. I want to ensure that this winter people get care when they need it and get it faster. We are already seeing progress on that. For instance, we are investing in making sure there are more ambulance hours on the road, and we are seeing ambulances get to people quicker—in fact, this October, they got to people 20 minutes faster than last October. Ambulance handover delays are reducing and we are already seeing progress in A&E, where people are being seen faster, too.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
Under the last Labour Government, there was no winter crisis. Under the Tories, we have gone from no winter crisis, to an annual crisis, to a crisis all year around. Rather than tackling the crisis at source, this Government have only sticking-plaster solutions for a few months at a time. How will patients know that a winter crisis has been avoided if problems persist into the spring?
Maria Caulfield
I pay tribute to my hon. Friend’s work in this place. She will be pleased to know that we are rolling out perinatal pelvic health services in every part of England, which should be in place by the end of March next year. In addition, we are rolling out obstetric anal sphincter injury bundles, which my hon. Friend raised in her debate on birth trauma; those have the potential to reduce the number of tears by 20%. She is absolutely right to be driving this issue forward. It will be covered in the women’s health strategy, but we are not waiting for the second year: we are already making progress in this place.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
The Care Quality Commission now says that almost two thirds of England’s maternity services are rated inadequate or requiring improvement in safety, up from 55% last year. The Government have been told time and time again to recruit more midwives, and to value midwives so that they do not want to leave the profession in the first place. As a result of ministerial failure, mothers—especially those from black and ethnic minority groups—do not get the safe, good-quality maternity care that they deserve. What is the Minister’s plan to properly improve maternity care?
Maria Caulfield
The hon. Lady may not have listened to my first answer. We have increased the number of midwives—it is up 14% since 2010—and increased the number of midwifery training places by 3,650. We have also introduced a maternity support programme that is providing intensive support for the 32 trusts that are going through it. The hon. Lady may want to speak to her ministerial colleagues in Wales, where Labour runs the health service, because Healthcare Inspectorate Wales recently issued an immediate improvement notice to Cardiff and Vale University Health Board for its maternity services.
Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)
Maria Caulfield
I have outlined some of the financial support that the Government have given during covid and the cost of living pressures. I also point to schemes that the Treasury has rolled out, such as the Breathing Space programme, which sees enforcement action from creditors halted, and interest frozen for people with problem debt who are experiencing mental health issues, and covers a 60-day period. That is the sort of practical help that this Government are giving to people.
Madam Deputy Speaker (Dame Eleanor Laing)
We now move to topical questions. We are running late because questions have been too long, as have answers. I often make this plea. In any case, Members should not be reading their questions—questions are not meant to be read; they are meant to be questions. Can everybody please cut out those bits that say their constituency is beautiful, for example, and just ask a question? We all believe that our constituencies are beautiful, and none more so than mine.
Marion Fellows (Motherwell and Wishaw) (SNP)
The Secretary of State for Health and Social Care (Victoria Atkins)
My priority as Secretary of State is to reform our NHS and social care system to make it faster, simpler and fairer. Since my appointment, we are making progress. To make our system faster, we have hit our manifesto target to recruit and retain 50,000 more nurses for our NHS, and to deliver 50 million more GP appointments, achieving both commitments months ahead of time. We have made an offer to health unions that I hope will end the consultants’ strike, which has disrupted care for the public and put a strain on staff. To make our system simpler, we have announced Pharmacy First, which will make it quicker and easier for millions of people to access healthcare on the high street. To make our system fairer, we have agreed a deal with pharmaceutical companies that will save the NHS £14 billion in medicine costs and give patients access to more life-saving treatment. The NHS is one of the reasons I came into politics—[Interruption.] I know Labour Members do not like to hear that, but I look forward to working with patients and staff across the country—[Interruption.]
Madam Deputy Speaker
Order. I do not need any help, thank you. The Secretary of State has answered the first question at length. I am sure that means she will answer the other questions much more briefly.
Marion Fellows
People with disabilities and serious health conditions already have higher living costs, and the proposals in the work capability assessment activities and descriptors consultation will mean that if they are reassessed they will lose £390 a month. I appreciate that the Secretary of State is new to her role, but will she commit as a priority to taking this up and consulting Cabinet colleagues, to ensure that people who are disabled and have serious health conditions are not pushed even further into dire poverty?
Victoria Atkins
I would be very pleased to meet my right hon. Friend, the families and other Essex MPs to discuss that important inquiry.
Miriam Cates (Penistone and Stocksbridge) (Con)
My constituent Dan Archer runs the highly successful Visiting Angels care agency, which has an annual staff turnover rate of just 13%, compared with an industry average of 60%. The secret to his success is very straightforward: paying decent wages, investing in training, valuing staff and prioritising client satisfaction. As a consequence, an enormous amount of money is saved on recruitment and invested into training and retention instead. Would the Minister meet my constituent to learn more about the success of Visiting Angels and how it can be shared more widely to help solve the shortage of workers in the care sector?
Madam Deputy Speaker (Dame Eleanor Laing)
Order. Can Members please cut their questions in half? Otherwise, I will have to stop this questions session and people will not get a chance at all.
The Minister for Social Care (Helen Whately)
I would be delighted to meet my hon. Friend’s constituent. What the employer does is really important for retention and recruitment of adult social care staff, along with our ambitious workforce reforms for the care workforce.
Mrs Emma Lewell-Buck (South Shields) (Lab)
Cancer remains the leading cause of death by disease in children and young people, with nearly 500 dying every single year, yet the Government continue to reject calls for a dedicated children’s cancer plan. Why is that?
Madam Deputy Speaker
Order. We have gone considerably over time because I have endeavoured to ensure that everyone whose name is on the Order Paper has had a chance either in substantive questions or in topical questions to ask questions on these important subjects on behalf of their constituents. Again, I appeal to Members: they are not meant to read questions, they should just ask them. It is not meant to be a speech, and it is certainly not meant to be drafted for Twitter or Instagram. It should be a question to the Minister. Let us hope for some improvement.
I apologise to the right hon. Member for Wentworth and Dearne (John Healey) for keeping him waiting to ask his urgent question.
Countess of Chester Hospital Inquiry
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Steve Barclay
I thank the hon. Gentleman for the content of his response and the manner in which he delivered it. I think it underscores the unity of this House in our condemnation of these crimes, and our focus on putting the families at the centre of getting answers to the questions that arise from this case. I join him in paying tribute to those consultants who spoke up to trigger the police investigation and to prevent further harm to babies. I note the further work that the police are doing in this case, and also pay tribute to the police team, which I had the privilege of meeting. They have worked incredibly hard in very difficult circumstances in the course of this investigation.
As the hon. Gentleman said, the families are absolutely central to the approach that we are taking. That is why I felt that it was very important to discuss with them the relative merits of different types of inquiry, but their response was very clear in terms of their preference for a statutory inquiry. I have certainly surfaced to Lady Justice Thirlwall some of the comments from the families in terms of the potential to phase it. Of course, those will be issues for the judge to determine.
On the hon. Gentleman’s concerns around the revolving door, clearly a number of measures have already been taken, but I share his desire to ensure that there is accountability for decisions. As Members will know, I have been vocal about that in previous roles, and it is central to many of the families’ questions on wider regulation within the NHS.
The hon. Gentleman mentioned the importance of good management. I am extremely interested in how, through this review and the steps we can take ahead of it, we give further support to managers within the NHS and to non-exec directors. The Government accepted in full the seven recommendations of the Messenger review. The Kark review was largely accepted. There was the issue of recommendation 5, which is why it is right that we look again at that in the light of the further evidence.
It is clear that a significant amount of work has already gone in. A number of figures, including Aidan Fowler and Henrietta Hughes, have focused on safeguarding patient safety, but in the wake of this case we need to look again at where we can go further, which the statutory inquiry will do with the full weight of the law. I am keen, however, that we also consider what further, quicker measures can be taken. Indeed, I have been in regular contact with NHS England to take that work forward.
Madam Deputy Speaker (Dame Eleanor Laing)
I call the Chair of the Health and Social Care Committee.
Steve Brine (Winchester) (Con)
I place on record my sympathy to the families, who have conducted themselves with the utmost dignity throughout this process and who remain in my thoughts and prayers as well. I welcome the judge-led statutory inquiry that my right hon. Friend has announced. It is the right thing to do, as are the phases of the inquiry, which prevent stuff from taking too long to move fast. As that work moves forward, and the debate rightly continues to touch on how we regulate managers working in the NHS, and remove them, I ask that Ministers remain alert to any “us and them” thinking between managers and clinicians. Surely any successful hospital trust is one team working together, so that defensive medicine is all but impossible.
Steve Barclay
Just to reassure the right hon. Gentleman, it is not that we are waiting. Having discussed it with NHS England, not least in last week’s meeting looking at the Kark recommendations that were accepted and why recommendation 5 was not accepted, the view at the time was that the accepted recommendations were sufficient in addressing the concern about the revolving door. It is right that we test that, but it is also right that we get the balance right.
The right hon. Gentleman mentions concerns that certain trusts may be seen as more difficult to manage. We do not want to create an environment where people are unwilling to go to those more difficult trusts because they fear the risk that they carry. It is important that we get the right support for managers, particularly around some of the more difficult trusts to manage, alongside having the accountability. Getting that detail right requires us to work closely with NHS England and the wider NHS family. [Interruption.]
Madam Deputy Speaker (Dame Eleanor Laing)
Order. There is a lot of noise in the Chamber. People who have come in for the next piece of business are forgetting just how very serious and sombre this piece of business is. Have some thought for others.
Shailesh Vara (North West Cambridgeshire) (Con)
The Secretary of State has rightly spoken of the enormous pain and suffering of the parents in this horrific case. He will appreciate, however, that during the course of the Lucy Letby trial, they have had to relive all that pain and suffering. As the statutory inquiry progresses, that pain will be continuing for weeks and months ahead. Will the Secretary of State give an assurance to the House that in the period ahead—during the course of the inquiry and beyond—these parents will receive all the support they need to get through this ordeal?