NHS Backlog

Helen Morgan Excerpts

Monday 6th January 2025 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House has considered backlogs in the NHS.

Happy new year to you, Madam Deputy Speaker. I thank the Backbench Business Committee for granting the debate. I applied for it because many Members were interested in having the chance to discuss the problems and consult constructively on the potential solutions for the NHS across the country. It has ended up being a particularly timely debate given the Secretary of State’s statement this afternoon, which we broadly welcomed.

The Conservatives have pushed the NHS to breaking point, leaving a legacy that includes the biggest waiting list in history and a healthcare system on the brink of collapse. We have reached a crisis point of backlogs in the NHS system. They affect not only those who are in dire need of medical care, but the wonderful staff who work tirelessly in hospitals, GP surgeries, dental surgeries, pharmacies, social care providers, hospices and so on. The situation in Shropshire right now demonstrates the scale of the crisis.

The pressure is extreme on every aspect of healthcare and reflects the fact that in many cases rural areas are bearing the brunt of a national problem. Shropshire’s NHS has declared a critical incident—one of many across the country, I know—as staff battle to cope with the huge winter spike of viruses. That means that people cannot visit their loved ones on a regular basis, and are required to wear a mask when they go into the hospital. That is just one example of how the system is failing to cope with the pressure.

Understandably, talk about NHS backlogs centres on the 7.5 million cases waiting for treatment. But backlogs also apply to the overflowing A&E waiting rooms and to the long lines of ambulances queuing outside. They apply to the elderly people who have fallen and waited many hours for an ambulance. They apply to possible heart attack and stroke patients being told to make their own way to hospital by West Midlands ambulance service at certain times this year. Outside Shrewsbury and Telford hospitals last Sunday—the latest day we have data for—ambulances waited an average of three hours and 48 minutes to hand over a patient. Across England on the same day, 2,620 patients had to spend more than an hour stuck in an ambulance waiting for space to become available at A&E.

[Steve Darling (Torbay) (LD)]

In my constituency, our hospital faces almost 700 sewage leaks, which has an impact on its ability to provide services. That is another pressure. Does my hon. Friend agree that the sooner the Government advise on what investment they will make to enhance services for our hospitals across the UK, the better?

[Helen Morgan]

I had not put the crumbling estate into my speech, but my hon. Friend makes a very valid point, because people cannot work efficiently when they are dealing with terrible hygiene and safety issues around them every single day.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on bringing forward this debate, and on being so consistent and assiduous on this issue. I understand that she will come on to the Lib Dem manifesto, which a lot of us in this Chamber, whether Lib Dem or not, can agree with. In Northern Ireland we have the health and social care board, which has been working on various strategies to reduce the backlog, but the scale is truly significant. Does the hon. Lady agree that, collectively, England, Scotland, Wales and Northern Ireland should look at all the recommendations and bring them together so that this great United Kingdom of Great Britain and Northern Ireland can benefit collectively?

[Helen Morgan]

The hon. Gentleman always makes an excellent contribution to our debates. He is right that we should look at best practice in Northern Ireland and the devolved nations, as well as in England, to get the right solutions for the problems that we face. I hope colleagues will forgive me as will not take any more interventions because we are tight on time and a lot of people want to speak.

We have reached a point where patients suffering heart attacks are being advised to find their own way to hospital. How can that be acceptable? Once patients get into A&E, they are confronted with the brutal reality of the backlogs. The reality means that only half of patients arriving at A&E in Shropshire were seen within four hours in November. The statistics are shocking, but individual people with serious problems suffer as a result—people such as my constituent with a pericardial effusion, who was deemed fit to sit and left in a chair for more than 24 hours before finally being taken on blue lights to receive the care she needed.

Staff in this situation are so overworked that the standard of care that they give is below what they would like to provide. The patient’s dignity is compromised, and staff are being driven from the service because they are unable to provide the care that they desperately want to. Until the Government put a plan in place to solve the workforce crisis, there is a risk that these scenes will continue to happen. In my local hospital trust alone, a total of 854,839 hours of nursing shifts went unfilled in the 12 months to October.

Liberal Democrats are calling for a qualified clinician in every A&E waiting room to ensure that anyone whose condition is deteriorating is treated more urgently. We are also calling on the Government to publish accessible localised reports of ambulance response times so that the delays that blight places such as North Shropshire and other rural areas can finally be addressed.

A key reason for the emergency backlog is that every day, around 12,000 hospital beds are filled with patients who could leave if they had a care package in place. That is the equivalent of around 26 hospitals being out of action every day. That is why Liberal Democrats have been banging the drum for social care. Without capacity in the care system, beds will remain blocked, A&Es will stay clogged and ambulances will continue queuing outside hospitals.

I am pleased that the Government have finally listened to our call for cross-party talks to fix a broken care system, and I look forward to constructively engaging with them throughout that process, but we cannot afford to wait three more years for this plan to be enacted. I hope that the Government will reconsider their timescale and get the review done as soon as possible, so that the care sector can see the long-term cross-party commitment to reform that it so drastically needs.

Part of solving this issue is supporting preventive measures, which stop people needing secondary care in the first place. I recently visited the North Shropshire charity Energize and saw the work of its Elevate programme, which works to improve fitness, balance and co-ordination in elderly and frail patients. It has had some amazing achievements: I met a gentleman suffering from Parkinson’s who had been falling five times a week before he started his programme, and who is now falling only once a week. Of course, it would be great if he did not fall at all, but I am sure everybody would agree that that is a huge improvement. It is estimated that for every £1 invested in that programme, £26 is saved, so it is an area where we can really make a difference to the crisis in the NHS.

Few backlogs have as much impact as those in cancer diagnosis and care. Nationally, the target of 85% of patients receiving treatment within 62 days has been missed every month since December 2015. At my local hospital trust, fewer than two thirds of patients began treatment within the 62-day target. Improving this situation is integral to increasing survival rates. It is also key to restoring patient faith in the NHS, stopping cases like that of my constituent, whose family felt completely failed by the NHS after he waited almost a year for treatment after first presenting with bowel cancer symptoms. Could the Minister clarify whether the Government remain committed to meeting the cancer waiting time targets this Parliament, as promised in their manifesto, and whether those targets will be included in their new national cancer strategy?

To achieve that improvement, we need to address key workforce issues, notably in radiology, where there is a 31% shortfall of consultants across the country. Again, in rural places such as Shropshire, it is recruitment and retention issues that have caused the sharpest problems. Throughout 2024, it became normal in Shropshire to wait months for cancer test and scan results, with patients in my constituency only receiving their results after their next scan was due to have happened. I am pleased to report that under new management, this backlog is now in the process of being cleared. However, that is happening due to overseas outsourcing, which is not a sustainable long-term solution for this country. We need to retain, recruit, and retrain more radiologists and ensure that enough modern equipment is in place across the country so that no one has to wait too long or travel too far to get the scans that they need. Will the Minister address whether that will also be part of the national cancer strategy?

We cannot talk about backlogs without talking about mental health. According to the Darzi review, 1 million people were waiting for mental health services by last April, over 340,000 of whom were children—children whom we as a nation need to protect, because they are our future. Waiting times for child and adolescent mental health services are shocking in every constituency in the country; from ADHD diagnoses to anxiety, depression and eating disorders, far too many people are not getting the urgent support that they need. A headteacher of a school in north Shropshire told me that in recent years, nine students at his school have lost a parent to suicide, yet there are no community mental health services in the town.

Along with the Government, Liberal Democrats would introduce a mental health professional in every school. However, we are also calling on the Government to improve early access to mental health services, and to cut mental health waits by establishing mental health hubs for young people in every community and introducing regular mental health check-ups at key points in people’s lives when they are accessing the NHS, so that we can pick up those problems and intervene early.

Meanwhile, GP surgeries are also struggling to handle the growing pressure being exerted on them. More than a million patients who tried to contact a GP last year could not get through. If patients cannot access primary care, they seek help elsewhere, or they do not seek help at all; in both cases, this creates further problems down the line. In Shropshire, we have lost 14.3% of fully qualified GPs in the past eight years. A young constituent of mine had to wait seven weeks just for a telephone consultation—a wait that would have been even longer if they had wanted an in-person meeting. Liberal Democrats would give everyone the right to see a GP within seven days, or within 24 hours if it was urgent, using 8,000 more GPs. If we can improve primary care, we can reduce backlogs across the health and care system.

Yet the Government have pledged to increase national insurance charges that could cost GP surgeries the equivalent of 2 million appointments a year. This hike will also hammer pharmacies, with more than a third of pharmacy owners now worried that their business may not survive the winter. If pharmacies close, backlogs will simply increase elsewhere. If we can keep them open and improve services such as Pharmacy First, we can reduce pressure across the system. We would like the Government to commit to removing the increase in employer national insurance contributions to support these crucial community services, so that fewer people end up in hospital and more people are treated in the community, where they will get better and quicker treatment.

Meanwhile, in dentistry, where practices will also be hit by the national insurance rise, there is not so much a backlog of care as an absence of care. Some 6 million adults in the UK are not registered with an NHS dentist and, in places like Shropshire, it is becoming almost impossible to find one, with increasing numbers of practices handing back contracts that have become unsustainable. One of my constituents has been trying to register with an NHS dentist for five years, while another pulled out his own tooth with a pair of pliers.

The Labour Government must show that they understand the problem better than the Conservative Government, whose solution was to introduce golden hello payments. They have been in place in Shropshire for years and they have not achieved the desired outcome. With that in mind, will the Minister outline the Government’s plans in relation to the new patient premium and offer assurances to dentists that any changes will be communicated, so that practices can plan and prepare to best serve their patients? NHS contracts need to be reformed so that we can end the use of the term “dental desert”, end DIY dentistry and guarantee access to people who are in pain.

In conclusion, the Liberal Democrats believe that people should be able to take control of their own lives and their own health. That means everyone should be able to access the care they need, where and when they need it. We welcome much of today’s announcement on elective care, and we welcome today’s announcement on social care, but we are concerned that the decision to hike employer NICs could worsen the crisis in the NHS. Hitting GPs, hospices, dentists and social care providers with higher taxes makes no sense. The Treasury is giving to the NHS with one hand, but taking away with the other. We also want much faster action on social care. As I said, I look forward to engaging constructively with the Minister to come up with the consensus we need, but we cannot afford to wait until 2028 for improvements to be made.

The Conservatives’ legacy on the NHS is that it is on its knees. The Liberal Democrats understand that there is no magic quick fix to change that, but to give people the care they need and deserve we must look at the measures needed for the whole service, giving equal priority to both heart attacks and hip replacements.

--- Later in debate ---

[Helen Morgan]

Looking at the time, I shall be extremely brief. I thank all colleagues who have come along today to make such thoughtful and, in some cases, harrowing contributions to the debate. I would like to thank the Minister, the shadow Minister and the hon. Member for Chichester (Jess Brown-Fuller) for their contributions and for so effectively summing up the arguments that have been made today.

Everybody knows that the NHS is in crisis. The Government have acknowledged that, which is welcome. We all want to see things improved for our own constituents, who are suffering the consequences of a system that is on its knees. I welcome the Government’s announcements over the past few weeks. I hope they will listen to the constructive comments made by Liberal Democrats, because they are intended to deliver the NHS that our constituents deserve, and that I know the staff who work in the NHS want to be able to deliver.

Question put and agreed to.

Resolved,

That this House has considered backlogs in the NHS.

Hospice Funding

Helen Morgan Excerpts

Thursday 19th December 2024 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I wish you and the whole team a very merry Christmas, Mr Speaker.

Last week, I visited Hope House in my constituency, where I met beautiful young Esmay, one of hundreds of children cared for by the hospice every single year. She is nearly three and has a life-threatening heart condition. Esmay’s family do not know what the future holds for her, but they know that Hope House will be there to support them, as it has since before she was born.

There are 300,000 people like Esmay treated in hospices every year, and just one third of their funding comes from the NHS. That leaves institutions such as Hope House and nearby Severn hospice reliant on generosity and unable to plan as they wait for confirmation of the funding they will receive from the NHS. That situation has been made more difficult this year because of the increase to national insurance contributions, which Hope House estimates will cost £177,000.

Funding is welcome, and I welcome the Minister’s commitment today. Will she explain whether the increase that she has announced today will cover the NIC hike for hospices and the increase in the living wage that was announced at the Budget? Will she also commit to providing future settlements in a timely manner so that hospice managers can budget effectively for the coming year?

[Karin Smyth]

I thank the hon. Lady for her questions and for welcoming the announcement. She will know that, in the past 14 years, the sector has been neglected, like the rest of the NHS and social care system. As we have repeatedly said, to govern is to choose. We have improved the settlement for the sector this year. Today’s welcome announcement can be used by the sector to manage some of those pressures and deliver the sorts of services it wants for the future.

Winter Preparedness

Helen Morgan Excerpts

Wednesday 18th December 2024 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I express my thanks and those of my Lib Dem colleagues to everyone working over the Christmas period to keep people healthy and safe. Preparedness for winter is absolutely critical for our health and care system, and a quick look at what happened last year shows us why. Ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over, and a quarter of a million people waited more than 12 hours to be seen. Every winter we are warned of a winter crisis. Under the Conservatives, crisis became the norm not just in winter but all year round.

This year is very concerning so far. A&Es have overflowed through spring, summer and autumn. At my local hospital trust, Shrewsbury and Telford, one in three ambulances have had to wait more than an hour to hand over patients, while patients with devastating cancer diagnoses have had to wait months for crucial scan results. Across England, more than 7 million people are on waiting lists. Meanwhile, I am afraid, we have not heard enough from the Government on fixing one of the root causes of this crisis, which is our broken social care system.

The scale of the crisis is demonstrated by the challenges facing ambulance services across the country at the moment. October—before the winter—was the third worst month ever for handover delays at West Midlands ambulance service, which covers my constituency. The equivalent of 130 ambulance crews are out of action, waiting every single day. Now these overstretched ambulance services are formally changing their advice to reflect the pressure they are under. At times of peak demand, even category 2 patients—those suffering a heart attack or a stroke—will be asked to make their own way to a hospital. People in North Shropshire have long had to put up with some of the worst ambulance waits in the country, and they have come to harm as a result. It may no longer be the case that they can rely on an ambulance arriving.

Action is urgently needed to prevent more preventable deaths this winter. I am sure the Minister shares my alarm that ambulances may not be reaching people facing life-threatening situations. If she does, will she commit today to the Government tackling the handover delays paralysing the ambulance service by accepting Liberal Democrat proposals to make a £1.5 billion fund to provide more staffed beds, and by agreeing to urgent cross-party talks to fix the crisis in social care?

[Karin Smyth]

I think I have addressed the Government’s plans on social care. The hon. Lady makes an excellent point on ambulance delays, which we know to be a problem, and particularly so in the west midlands. That is one of the things I have asked the system to look at particularly, so that the Government and hon. Members can better understand the particular problems in their particular systems. We know that ambulance and handover delays are a particular problem in some systems. We are making sure that clinical and managerial leads from NHS England are visiting those systems and that they are understanding in depth the process issues in some places, where they may not be adopting the best practice that can be learned from others.

We need to roll out best practice across the country. When the Secretary of State and I visited the operational centre of the London ambulance service, we sat in on some hear-and-treat calls; in dealing with people in mental health crises, in particular, some places are doing that better than others. Those are the sorts of examples we want to learn from. I absolutely hear what the hon. Lady says about the unacceptable delays in particular parts of the country. That is very much on our priority list.

Puberty-suppressing Hormones

Helen Morgan Excerpts

Wednesday 11th December 2024 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I thank the Secretary of State not only for the content of his statement, but for its tone and his recognition of the importance of such a tone in this place. For too long, children and young people who are struggling with their gender identity have been badly let down by low standards of care, exceptionally long waiting lists and an increasingly toxic public debate.

Before GIDS closed, more than 5,000 young people were stuck on the list for an appointment and waited, on average, almost three years for their first appointment. For teenagers going through what is often an incredibly difficult experience, three years must feel like an eternity, so change is desperately needed.

The Liberal Democrats have long pushed to ensure that children and young people can access the high-quality healthcare that they deserve. We welcome the NHS move to create multiple new regional centres, but those centres must get up and running as quickly as possible. Will the Secretary of State outline what steps the Government are taking to ensure that happens in every region, and will he give a timetable for that work? Tackling waiting lists and improving access to care must be priorities.

I understand why today’s news is causing fear and anxiety for some young trans people and their families, who have been badly let down for so many years—not least those I have met in my constituency, who have highlighted the catastrophic mental health impacts of the situation. It is crucial that these sorts of decisions are made by expert clinicians based on the best possible evidence. Will the Secretary of State publish all the evidence behind his decision, including the results of the consultation, to give those families confidence that this is the right move for them?

We welcome the announcement of a clinical trial. We need the NHS to build up the evidence base as quickly as possible, and the Government to provide certainty that they will follow evidence and expert advice on behalf of those children.

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her approach to this matter. I can certainly respond to her questions. We want all those regional centres to be up and running by 2026, and we are working with NHS England to achieve that outcome.

The hon. Lady mentioned the waiting lists. To give people a sense of the challenge, the latest figures show that 6,237 children and young people are on waiting lists for gender services, so we have seen growth in the waiting list in the time that she mentioned. As with all NHS waiting lists, I want to see those numbers fall. It is particularly important to note, in the context of children and young people’s services—be they gender identity or other paediatric services—that a wait of many years can represent a school lifetime. I know that for that group of children and young people, time really does feel of the essence, so we owe it to them to get the waiting lists down faster.

We are also working to implement the recommendation on the follow-through service for 17 to 25-year-olds. I know that there is some anxiety about that issue—some people have interpreted it as an extension of children’s services up to the age of 25, but that is not what we intend. It is about a transitional service from children’s to adult services, which I think will lead to better care.

Finally, in the context of a statement that focuses on puberty-suppressing hormones, it is worth pointing out that they are not the only treatment for children and young people in this area. I think there is a danger that the focus on that treatment—because of an inevitable but necessary political process—means that it is held up as the gold standard, so some children and young people and their families feel that if they miss out on it, they are missing out on all treatment. That is not the case. Indeed, for many trans people of all ages in our country, puberty blockers have never been considered an appropriate intervention. We must see all the treatment options in the round, which is why I support the holistic approach to supporting children and young people with gender incongruence, as Dr Cass outlined in her excellent report.

Lobular Breast Cancer

Helen Morgan Excerpts

Tuesday 10th December 2024 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Ms Vaz. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for bringing this really important debate to the Chamber and for her excellent speech, which told the story of her friend Heather and the stories of Katy, Emma, Kirstin and Cressida, who have suffered a pernicious type of disease that we are currently unable to treat effectively 100% of the time.

I thank my hon. Friend the Member for Wokingham (Clive Jones), the hon. Member for Bexleyheath and Crayford (Daniel Francis), the hon. Member for Strangford (Jim Shannon), and my hon. Friend the Member for Horsham (John Milne) for their speeches, which were all excellent. I also thank the hon. Members for Maidstone and Malling (Helen Grant) and for City of Durham (Mary Kelly Foy) for sharing their own stories, which were very helpful to the discussion. I thank Dr Susan Michaelis for the bare-root rose—when we received it in the MPs’ offices, we were all a bit stumped by what the enormous box might be for—and, more importantly, for her tireless campaigning to secure funding for research into lobular breast cancer.

The speeches today have been excellent and detailed, and I wish to avoid repetition. As we have heard, 22 people a day in the UK—mostly women—and 1,000 women globally are diagnosed with invasive lobular breast cancer. It is the second most common type of breast cancer, so it is really important that we support the Lobular Moon Shot Project. Liberal Democrats will fully support that project, which is run with the Manchester Breast Centre. Some £20 million over five years to better understand the diagnosis and treatment of this disease is not really a significant investment for the Government, but it would have an enormous and meaningful impact for those people—mostly women, but, as I said, there are some men—who are affected by it every single day.

Research funding is such an important part of investment in the early detection and treatment of cancer—particularly for lobular breast cancer—which is better for everyone, including the patients who have been diagnosed. Receiving a diagnosis of any type of cancer is a really difficult moment for any individual and their family, but receiving a diagnosis of a cancer for which there is not a clear treatment pathway is even more concerning. It is really important that we try to address the problem that these women face. It is better for them and for the NHS, because, as we all know, early treatment tends to be more successful and quicker. Because of that, it is also better for the taxpayer. It is entirely consistent with the recently announced Government strategy of rewiring the NHS to focus resources on early prevention, detection and treatment to ensure that people are kept healthy, rather than treated when they are sick.

As other speakers have pointed out, this disease is the sixth most common cancer in women, and it needs to be treated as a distinct disease. We must ensure that women who face this diagnosis are given the treatment for the disease that they have, not for one that they do not have. It is really important that that is built into the Government’s new cancer strategy, which they have committed to work on. The last Government did not have a 10-year cancer plan, although they did include lobular breast cancer in their women’s health strategy, so I was really pleased to see that in a debate led by my hon. Friend the Member for Wokingham, this Government committed to a national cancer strategy. That is a really important step forward, and we are really pleased that the Government felt able to make that step. I hope that for people who have been diagnosed with lobular breast cancer and, indeed, any other type of cancer that the Government are able to deliver on the strategy as soon as possible.

One of my key concerns is the dreadful waiting times for scans and for results from MRI scans, which are the best way of detecting lobular breast cancer, and other types of CT scan. In my constituency of North Shropshire, which is part of the Shropshire, Telford and Wrekin integrated care board, we have some of the worst records in the country for scan interpretation. As a result, I have been contacted by constituents who have had devastating outcomes, where scan results have been delivered to them, only for them to find out that they have been on the wrong type of treatment in the meantime, sometimes for many months. We need to avoid that happening in the future. The leadership team has shown that it can address the problem, and I am pleased to report that it is beginning to do so in Shropshire.

I hope that the cancer strategy will identify where there are shortages of radiologists and of the machinery needed to carry out those scans and to ensure that we hit the 62-day waiting-time target for people who need to start urgent cancer treatment. Part of the capital expenditure plan announced by the Government is critical to that, and I look forward to hearing the details from the Minister.

The Liberal Democrats also want the Government to pass a cancer survival research Act that requires the Government to co-ordinate and ensure funding for less survivable and less common types of cancer, and for types of cancer that are not currently treated as distinct or treated appropriately. We want the time it takes for new treatments to reach patients to be halved, which would mean expanding the capacity of the Medicines and Healthcare products Regulatory Agency. That would ensure that patients with cancers that do not respond to current standard treatments can access new treatments much more quickly as they come online.

I echo the request of the hon. Member for Dulwich and West Norwood and the other hon. Members who have spoken so powerfully today. The Lobular Moon Shot Project would change the lives of 8,500 women in the UK every year. In developing the national cancer strategy, I hope the Minister will consider some of the proposals that we have put forward collectively today, which are aimed at improving detection, treatment and survival rates for people with invasive lobular cancer and all other types of cancer.

World AIDS Day

Helen Morgan Excerpts

Wednesday 27th November 2024 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to see you in the Chair, Sir Mark, and indeed to represent the Liberal Democrats for World AIDS Day. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for his excellent introduction to this topic and for securing the debate. There have been so many brilliant contributions. I want to leave plenty of time for the other Front Benchers to speak, so I will not go through them all, but I am very impressed that in such a short time we have covered so much ground, and so eloquently. I particularly want to pick up on the speech by the hon. Member for Bournemouth East (Tom Hayes), who powerfully told us the story of John Eaddie, and thank him for that contribution.

AIDS is one of the globe’s biggest killers, as we all know, despite being entirely preventable and treatable. In 2023, nearly 40 million people across the globe were living with HIV, 1.3 million of whom became newly infected within that year. Given that it is entirely preventable and treatable, we can aspire to bring that number right down to zero.

In the United Kingdom the fight has been serious and ongoing since the 1980s, and yet since 2021 the numbers diagnosed have been increasing, while the numbers tested have been decreasing. We absolutely have to ensure that that is turned around rapidly. Testing is still 4% lower than pre-covid levels, and that has been driven by a drop among heterosexual men, where the testing rates are 22% lower than pre-covid. The most recent UK-wide estimates have about 5,000 people as undiagnosed and not aware that they are living with HIV. Again, that shows that the importance of testing—I entirely support the call for opt-out testing—is paramount to bring such people into the healthcare that they need and deserve, and to prevent the disease spreading.

Internationally, good progress has been made, but the picture is still extremely concerning. I want to pick up on the inequality in that picture. Every week, globally, 4,000 adolescent girls—young women aged between 15 and 24 years—become infected with HIV; in 2023, 3,100 of those infections occurred in sub-Saharan Africa. Poverty and displacement drive those higher rates of infection, and there is a worrying link between conflict, sexual violence and HIV. That is something we need to address.

I want to be brief, so to summarise the policy ask, the Liberal Democrats are keen to ensure universal access to HIV prevention, such as PrEP, and treatment. I have mentioned the importance of opt-out testing. We still need to work to eliminate the stigma and the discrimination linked to HIV, especially the racist element highlighted so carefully earlier. We press on the Government the importance of restoring the public health grant, which the Conservatives have cut by a fifth since 2015, to deliver better access to sexual health services. On helping globally, it is important that we restore, or at least set out the path to restoring, the 0.7% of gross domestic product for international aid, to enable issues such as AIDS to be prioritised in accordance with our requirements. With that, I will leave time for the other Front Benchers.

Tobacco and Vapes Bill

Helen Morgan Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I can confirm that it has been a very long time since anyone has asked me for ID to make a purchase—a moment that is even further into the past than the last time I bought a packet of cigarettes. That experience will inform some of my comments today. I support this legislation, but it will be a free vote for my Liberal Democrat colleagues, and I will use my speech to explain why.

First of all, the Bill is split into two sets of measures: one to deal with smoking and one to deal with vaping. We are 100% supportive of the set of measures dealing with vaping, which is in line with our party policy that was passed at our 2023 conference. I think everyone in this House is united in agreeing that the targeting of nicotine products at young people and children through bright colours and attractive flavours is a shameful practice. Measures need to be taken to prevent that.

I am the mum of a teenager—lucky me—and he reports that some of his friends are unable to concentrate through a 40-minute lesson, because they have been exposed to such high levels of nicotine in the vaping products that they use that they are even more addicted to nicotine than someone who might have taken up smoking many years ago when I was young. We welcome the changes to prevent the targeting of vaping at children, and the recent ban on disposable vapes. We also acknowledge that vaping is an important part of smoking cessation, and legal vaping needs to continue into the future.

The introduction of a phased smoking ban is problematic, and not because Liberal Democrats want to see people smoke themselves into an early grave—far from it—but because it raises issues of practicality and civil liberties, which I will run through on behalf of my colleagues. The first question is, practically, how will this work? My son was born in January 2009. He will be one of the first people to benefit from a smokefree generation, and I sincerely hope that he never takes up smoking, but if his friends who are just a few weeks older choose to take up smoking, they will be able to continue to do that for the rest of their lives. Under this Bill, those future adults will be able to buy tobacco products for themselves but it will be illegal for them to pass them on to others a few weeks younger, such as my son. Problematic enforcement causes some concern and leads us to question why there was not an alternative way, perhaps by setting a very high minimum age to buy cigarettes, so that most people get through the flourish of rebellious youth and do not take up smoking in the first place. The concerns about practicality are legitimate.

The Bill also raises the spectre of an ID card, because those people who choose to start smoking will potentially be forced to carry an ID card or some other form of ID with them for the rest of their lives. That is a concern for the Liberal Democrats, who are strongly opposed to requiring people to carry ID around with them, for various issues of privacy and personal liberty. There is also an ideological point about discriminating between two people because of their age. We are generally opposed to that as a society, but the Bill does that.

The concerns about retailers suffering abuse are also legitimate. They are already suffering from a wave of shoplifting and antisocial behaviour. Some of the abuse directed at them comes from the enforcement of age legislation for things such as alcohol and existing tobacco legislation. We need to be cognisant of the decimation of community policing under the previous Government. We need to be sure that those retailers are fully protected. The Bill creates an extra risk for them.

Finally on the risks, there is a concern for the licensing authorities, which presumably will be local councils, although we do not have the detail on that yet. Lots of local councils are unable to carry out much more than their statutory duties currently, so I would appreciate confirmation that licensing will be fully funded for them, so that they are not put in charge of enforcing something that will be impossible.

I want to touch on what for me is quite an important area: the creation of a black market. Criminal gangs exploit young people in North Shropshire by getting them hooked on cannabis. It is an extremely difficult problem. Young people get into debt to those criminal gangs and are hooked into criminality for life. They see things people should never see and are extremely damaged by that exploitation. I share the concern that progressively banning tobacco products will increase the scope for the black market and the risk to children.

For all those reasons, as some Members may be aware, I abstained on the vote last time the legislation was brought through the House. It would be a legitimate question to ask me why I have changed my mind. I met somebody called Linda Chambers, a Liberal Democrat councillor in Hull, who came along to an event organised by Action on Smoking and Health to encourage Members to support the Bill. Linda was devastated when she lost her husband of 50 years to cardiovascular disease. As with a number of other speakers at the event who also spoke very powerfully about their experiences, her loved one had tried on several occasions to give up smoking but had been unsuccessful. The speakers at the event explained that the nicotine addiction had taken away the personal choice of their loved ones to live the lives they wanted to live. They were not exercising their personal choice any more. For a liberal, that is a very powerful argument. Personal choice is so important, and addiction really does take that away.

As the asthmatic daughter of two smokers who have repeatedly tried and struggled to give up over the years, Members might perhaps have expected me to understand that argument a little bit earlier. Typically, as the daughter of two smokers, I took up smoking myself. I did not smoke very much and did not smoke for very long, but I still occasionally have the odd craving for reasons I cannot explain, especially when I am in a traffic jam. But it is not funny, is it? Tobacco is uniquely harmful and uniquely addictive, and that is why I support the measures we are taking to address that.

Another really important, persuasive and powerful argument I heard in the previous Parliament was when Dame Andrea Leadsom, the responsible Minister at the time, and Chris Whitty took the time to provide a briefing to the Liberal Democrats. One point they highlighted was health inequality. A point that struck me—at the time, I was the co-chair of the all-party parliamentary group on baby loss—was that 21.1% of pregnant women in the most deprived areas of the country are likely to smoke while pregnant, whereas in the least deprived parts of the country only 5.6% are likely to be a smoker. That huge difference correlates to a horrifying differential in the rate of stillbirth. Women who smoke while pregnant are more likely to have a stillbirth, and stillbirth rates in the most deprived areas of the country are 50% higher than in the least deprived areas. If we are serious about tackling health inequality rather than just paying it lip service, we have to take additional measures to tackle those inequalities.

For all the reasons I have outlined, I will support the Bill. However, I retain a few concerns, and I would be grateful if the Minister could address them in his wind up. The powers in the Bill effectively allow the Secretary of State to make any public place or workplace a no-smoking area. That is very far reaching. I would prefer to introduce measures in Committee that would require him to come back to Parliament before extending the areas affected. That would protect the hospitality industry, which, as hon. Members have pointed out, is struggling, particularly in rural areas. I will also point out the obvious, which is that anybody who is currently over 16 could potentially be a smoker for life.

There are many, many people who took up smoking and who want to give up but are unable to. We must reverse the cuts to the public health budget and the smoking cessation budget to enable those people to benefit from stopping smoking. The Conservatives have slashed the public health budget since 2015. We would like the Secretary of State to use the money provided for health in the Budget to address that problem. A quarter of cancer deaths are caused by smoking and 75,000 GP appointments every month are for smoking-related illness. Many women who smoke during pregnancy will continue to smoke for up to another decade.

Despite my concerns, I will support the Bill to ensure that people like Linda do not have to lose their loved ones to an addiction they were unable to end. I urge the Secretary of State to look at measures to deal with the practical considerations we have outlined and to support the current generation of smokers to quit if they want to.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 19th November 2024 Commons Chamber

[Mr Speaker]

We come to the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Hospices provide essential care for people at the most difficult point of their life, and they are usually only partially funded by the NHS. Hospice UK says that real-terms funding has fallen by £47 million since 2022, and hospices are struggling with this hike in national insurance contributions. Hope House children’s hospice in North Shropshire estimates that it will cost £178,000. Will the Secretary of State commit to either exempting hospices from the NICs increase or ensure that they are funded to cover those additional costs?

--- Later in debate ---

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The Conservatives’ disastrous legacy on dentistry means that more than 4.4 million children have not seen a dentist in the past year. In Shropshire, dentists continue to hand back their contracts, including one in Wem in recent weeks. Will the Minister outline his plan to reverse that terrible decline and ensure that the issue is addressed in rural areas where there are dental deserts?

[The Minister for Care (Stephen Kinnock)]

There will be 700,000 extra urgent appointments, golden hellos, and a prevention and supervised toothbrushing scheme for three to five-year-olds.

Income Tax (Charge)

Helen Morgan Excerpts

Tuesday 5th November 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I declare an interest as a vice-president of the Local Government Association. I welcome the shadow Secretary of State to his place. He responded to my first Adjournment debate on a Thursday before Easter, and I was very grateful, but he will be disappointed to hear that we have not seen the improvements in ambulance response times that we would have liked to see in Shropshire.

Last week’s Budget brought £22 billion of investment for the NHS. By anybody’s standards, that is a big number, so the Liberal Democrats welcome the investment. The NHS was left in a dire state by the Conservatives, and it is clear that something radical must be done. What is the Conservatives’ legacy? Well, we all know: crumbling hospitals, 7 million people on NHS waiting lists for secondary operations, our constituents struggling to access a GP when they need one, dental deserts such as the one in North Shropshire, appalling ambulance waiting times with horrifying outcomes, and a tsunami of a mental health crisis waiting to overwhelm us. It is clear that investment is needed, which is why the Liberal Democrats put the NHS at the front of our election manifesto and our campaigning since.

It is very important that the £22 billion is spent wisely to keep people healthy and to save money in the future, so I look forward to hearing how the Budget will affect the public health grant and mental health services in particular. Those are two really important areas where we can invest to save taxpayers’ money, and to get better health outcomes for people and avoid their suffering in the future.

It is also really important that the £22 billion of investment is not undermined by a decision made by the same Government on the very same day. It is hard to believe that the decision to increase employer’s national insurance contributions and to lower the threshold—at a cost of £566 per person—was properly thought through before the Budget was delivered last Wednesday. That decision is going to hit GP practices, hospices, social care providers and the charities that provide so much additional care outside the formal NHS structure. A local GP got in touch with me over the weekend to say that the decision will

“serve to directly undermine access and patient care at a time when practices are already under strain due to years of neglect.”

Another said it will “kill the family doctor”.

Why will it kill the family doctor? Because GP practices are not eligible for employment allowance. They cannot put up their prices, and their only option is to cut staff and services, which would be a disaster. The Conservative Government proved that if we cut the number of GPs, we end up with a really big problem in the NHS—one that we are fighting now. Labour’s plan to increase the number of GPs, which is welcome, is surely in jeopardy because of the increase to employer’s NICs. The Liberal Democrats are calling on the Government to exempt GPs from the NIC hike or ensure that they are funded to cover it. Otherwise, no one is going to see their GP within seven days—a right that the Liberal Democrats think people should have.

I want to touch on social care, which feels a bit like the elephant in the room and is likely to be significantly affected by the change in thresholds and rates of employer’s national insurance contributions. We all know that the sector is in crisis, and the Budget took note of this but did not really go far enough to address it. I think we can all agree that we cannot fix the NHS without fixing social care. We know that there are thousands of patients in hospital who are medically fit to be discharged and who would recover better in their own bed at home, but who are stuck in a hospital because the social care packages are not available to allow them to return home.

That bed blocking, which is a horrible term, causes patients to be unable to flow through a hospital when they are admitted. It causes the queues of 12, 13 or 14 ambulances that we see outside hospitals in Shropshire on a regular basis, and it means that those ambulances do not arrive when somebody is in a life-threatening position in their community. Social care is so important in dealing with this urgent problem.

[Stuart Anderson (South Shropshire) (Con)]

As the MP for South Shropshire, I have been in the same meetings as the hon. Lady, who represents North Shropshire. In Shropshire, about 80% of council funding goes to social care. Does the hon. Member believe that we need a fairer system to support funding for social care in Shropshire?

--- Later in debate ---

[Helen Morgan]

Fair funding for rural authorities, and indeed all local authorities, is something I have talked about many times in this House, and I absolutely agree with the hon. Gentleman on that.

We saw £600 million allocated to social care in the Budget and an increase in the national living wage, both of which are obviously welcome, but the huge pressure on private providers as a result of the national insurance contributions increase will be really problematic, unless councils are funded to pay those additional costs. It is not clear that the funding announced in the Budget will even touch the sides of the crisis in local government funding or in social care. We all know that this is a thorny problem, and that funding social care is extremely expensive and difficult; that is why cross-party talks are so urgent. I urge the Secretary of State to instigate those as soon as possible, so that we can work towards a permanent fix for social care. Liberal Democrats believe that free personal care on the Scotland model would be the best way of achieving that, and the Institute for Public Policy Research says that we could save £3.3 billion by 2031 by implementing that model. That would be a good investment, because it would save taxpayer money and it would keep people in their homes—where they want to be—with dignity.

The debate today covers other public services, and I want to touch on a couple; education is an important one, and we welcome the investment in it, but I want to talk a bit about SEND budgets and local authorities. Schools are under enormous pressure to provide SEND measures for the children they look after, and local authorities are under huge pressure to provide transport and specialist places. The £1 billion for local government will be insufficient to deal with social care, the SEND crisis and SEND transport. As the hon. Member for South Shropshire (Stuart Anderson) mentioned, Shropshire council is spending about 80% of its budget on social care, so without adequate measures for social care, it seems unlikely that this Budget will address all the problems that local authorities need to deal with.

We are therefore concerned about the decision to put VAT on private school fees. Schools such as Oswestry school in my constituency take a relatively large number of pupils who have failed to thrive in a larger setting. They have special educational needs but no education, health and care plan, and they might even have refused school altogether. There is a risk that those children, whose parents are saving hard to put them into that alternative place, will end up back in the state sector, where their needs are not met. They might refuse to go to school, and the school would struggle to cope with those additional children. The capital expenditure is welcome, and I hope that the demountable buildings at the Corbet school in Baschurch will benefit from that announcement, but I urge the Government to reconsider some of those measures.

On transport, it was disappointing to see the bus fare cap increased, although in Shropshire it will not make any difference, because it is almost impossible to catch a bus anywhere. We would really like to see some of the detail behind the public transport plans announced by the Chancellor, particularly the bus service improvement plan that Shropshire council has put forward, and railway schemes such as the Oswestry to Berwyn line.

Finally—it may be stretching it to call this a point about public services—I believe that farmers provide an essential public service in feeding us, looking after the countryside and protecting the rural environment, and it is disappointing to see that there is confusion between the Department for Environment, Food and Rural Affairs and the Treasury about how many farms will be affected. My sense from talking to local farmers in Shropshire is that the DEFRA numbers are more accurate.

[Peter Swallow (Bracknell) (Lab)]

Does the hon. Lady not see that by opposing every measure in the Budget to raise money while supporting every measure to spend more money on our vital public services, she is creating a bigger problem than the one we inherited from the last Government?

[Helen Morgan]

I thank the hon. Gentleman for his intervention. The point that we are trying to make is that some of the Budget measures will cost extra money. If we look at the detail on the national insurance contributions hike, for example, we see that changes in behaviour and exemptions for the NHS will reduce the amount of money raised to about £10 billion. We have absolutely put forward alternative measures to raise £10 billion. Whether by reversing the Tories’ cuts to the banking taxes or by putting taxes on online media giants, we would find alternative ways to raise those funds. The point about private school fees is the same. If we overburden the state sector with children who have special educational needs, difficulties and disabilities, those children will not have their needs met, and that will cost us more in the future. This is all about making sensible choices to save taxpayer money in the future and, most importantly, delivering public services to the people who need them most, whether they are trying to access NHS care or whether they need help to get through their school career in order to thrive and achieve their potential.

[Laurence Turner (Birmingham Northfield) (Lab)]

Will the hon. Lady give way?

[Helen Morgan]

I am just about to conclude, so I will carry on.

I was about to talk about farmers and the concerning differences between DEFRA and the Treasury on the number of farms that will be affected. My sense from talking to farmers locally is that the DEFRA numbers are more likely to be accurate, and I therefore think there may have been a serious misstep in the plan to raise what will be a relatively small amount of money.

Liberal Democrats welcome investment in the NHS. We welcome the ambition to undo the damage wrought on this vital service by the previous Government, but we are concerned that, in social care in particular, we are in danger of kicking a thorny problem down the road. We urge the Government to consider immediate cross-party talks on funding social care and providing a long-term solution. We are also really worried about the impact of increased national insurance contributions on key providers outside hospitals. We cannot have GPS going out of business because of a Government measure that was intended to improve and expand their services.

My constituents were fed up with being taken for granted by the Conservatives and they voted emphatically to change that situation, but I am sure that they are very worried that they are about to be ignored by Labour. I urge the Government to rethink their damaging policies on national insurance contributions and the care sector, to have another look at the impact of the Budget on family farms, which I think may have been underestimated, and to back the infrastructure that rural areas need.

[Several hon. Members rose—]

NHS Winter Readiness

Helen Morgan Excerpts

Wednesday 30th October 2024 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House has considered NHS readiness for winter 2024-25.

It is a pleasure to serve with you in the Chair, Sir Roger, and I am grateful to have secured a debate on the crucial topic of preparing the NHS for winter. This is particularly timely on a day when the Government have delivered the Budget and outlined their priorities for the coming year, and indeed, the years after that.

We all know that due to the Conservative failure to protect the NHS, winter is a time when pressure on the NHS peaks. Every year, we suffer what we describe as a winter crisis. But for the millions of people stuck on waiting lists, the thousands of people treated in corridors and the legions of staff battling to keep people safe, it must feel like the winter pressure never ends.

I am sure we would all agree that the health and care crisis requires long-term action—improving public health, focusing on primary care, training and retaining more doctors, dentists and nurses, fixing the crumbling NHS estate, and fundamentally, finally addressing the crisis in social care. But while we wait for that action, winter is now looming. The clocks have gone back and time to prepare for winter has run out. I am here to find out what the Government are doing both to get the NHS through the upcoming winter and, following the Budget statement, to get the NHS ready for the winters to come.

I am aware that the Chancellor has just announced a £22 billion cash injection into the NHS, although further detail on that was scant, so we will put forward our ideas in this debate and hope that they come to fruition over the next few weeks. For the sake of staff and patients, it is crucial that winter crises become a thing of the past. We have reached the point where winter pressure is normal all year around. We should be striving for the reverse, where pressure is relieved and the forecasted crisis does not happen. I am pleased to hear some of the measures that the Government have outlined today, but I remain worried that fundamental issues are still being ignored—most crucially, the crisis in social care. Until that is resolved, we will not be able to fix the NHS.

So what is the state of play? Dr John Dean, the clinical vice-president of the Royal College of Physicians, warned that the latest NHS statistics show the health service

“is in an extremely concerning position as we head into winter.”

He is not alone in holding such concerns, for it has already been a really busy year for the NHS. In fact, it has been the busiest ever summer for A&E departments in England, with NHS staff managing 6.8 million attendances in just the past three months, according to a briefing by NHS England on readiness for winter. Last month, emergency departments had 2.2 million attendances—the highest such number for a September on record—with more than 38,000 people waiting longer than 12 hours after the decision to admit them. Meanwhile, the weekly average of extra bed days for patients remaining in hospital beyond seven days due to delays in discharge was the highest since December 2022.

A look at my local hospital trust in Shropshire illustrates the situation well. In Shropshire, at the Shrewsbury and Telford hospital NHS trust, our bed occupancy rate is constantly around the 95% mark. That is not unusual; it has become the norm at acute hospital trusts up and down the country, and not just in winter, but all year around. Hospital staff constantly have to juggle resources to try to secure people the care they need. As the wards fill up, A&E becomes crowded and care moves on to corridors.

Every month, I am contacted by constituents who are shocked by what they have encountered in the hospital: being forced to wait for hours in pain on plastic chairs, or having their dignity taken away as they occupy a trolley in a corridor, in agony and in full view of the public. Many people remain unaware of how common that is until they find themselves with a loved one in that situation.

The “Dispatches” documentary filmed at Shrewsbury and Telford hospital trust earlier this year brought the reality home to the nation. The issues with hygiene and infection control were startling enough on their own—I am pleased that the trust is addressing those directly—but most stark was the human impact on the patients. Scenes included that of the elderly man who was forced to urinate while on a trolley in a corridor, in full view of staff, or the woman who cried out in agony for hours, with staff being left in despair at the terrible situation they were trying to deal with. That was not in the depths of winter; it was in April and May.

Corridor care takes a toll on patients and a huge toll on the staff who are forced to attempt to cope. However, the full scale and the impact of corridor care are unknown, because there is only patchy reporting on the level of care in temporary environments. As we seek to better understand and prepare for pressure in the winter, and all year round, will the Government consider mandating the recording and publishing of the number of patients receiving care in temporary environments, such as corridors? Honesty and transparency are key if we are to properly prepare for the winters to come.

Every month, more than 2,000 patients spend more than 12 hours in the A&E department at Shrewsbury and Telford, and one in every three of the many ambulances arriving outside have to wait more than an hour to hand over their patient—not in winter, but in every month of the year. Since April, ambulances have lost around 15,000 hours through waiting outside the two hospitals in Shropshire, and one poor patient was stuck in an ambulance in Shrewsbury for 15 and a half hours. As we have discussed many times, that keeps ambulances off the road, and has a knock-on effect on how long people who may be in life-or-death situations have to wait for help. This leads to situations such as the one in my constituency in April this year, where a carer was left alone performing CPR for 23 minutes while being told by the 999 call operator that no ambulance was available. Tragically, the victim died, and the carer who tried so hard to save her has been left traumatised—as, I would imagine, has the 999 call operator.

As I mentioned in the Chamber a couple of weeks ago, an 11-year-old in my constituency, Charlotte, has an adrenal deficiency that leads to her needing an urgent injection of hydrocortisone if she has some kind of trauma. When that happens, she is logged as needing an automatic category 1 ambulance response. Recently, a car crash happened involving Charlotte and her mother, and when an ambulance was called for, they were told that none was available, and the family had to make their own way to hospital. That is not good enough. It is endangering lives.

The target for a category 1 response time is an average of seven minutes. So far this year in Shropshire, the average has been 11 minutes and 57 seconds. For a category 3 response, which still means that the person urgently needs an ambulance, the average wait is more than two hours, which is more than double the target time. That is not new, but it is very wrong, and it demonstrates the pressure already facing the health service as we head into winter.

Perhaps more worryingly, the situation in many areas this summer has been getting worse, rather than better. West Midlands Ambulance Service, which serves my constituency, described a

“significant, rapid deterioration of delays at hospital in September which has continued further in October.”

The service has been operating with the highest level of risk score for the past year. October is forecast to be the second worst month on record for lost handover hours, with the equivalent of 130 out of 600 ambulance crews in the west midlands being lost to delays every single day—and it is only October. That takes a huge toll on the mental health of the hard-working staff involved at every level. It also undermines staff retention, which will be crucial for any NHS plan, such as the 10-year plan or any winter plan to come. We must retain these experienced professionals; we cannot rely on recruitment alone to solve the staffing crisis in our NHS.

These wonderful staff have been stretched to breaking point by years of neglect and mismanagement by the Conservatives. Labour must do better, yet patients and staff are understandably fearful as we approach winter. According to a recent poll commissioned by the Liberal Democrats, one in four people in Britain have avoided calling an ambulance because they were frightened that it would take too long to arrive.

Of course, many pensioners are particularly fearful this year. Winter is a perilous time for older people, given the additional diseases that they might catch, and many will be more at risk after being denied the winter fuel payment for the first time. This will be the first winter without the payment being universal, and the annual uprating of the state pension will not make up the shortfall until next spring, which will be too late for people to pay their electricity or gas bill—and if someone in my constituency has to top up their oil tank now, it is too late for that, too. There is a danger, as happened when fuel costs increased two years ago, that people will reduce or turn off their heating entirely, with possible consequences for their health and a knock-on effect on the NHS.

So what are the solutions? First, we need to stop throwing money at the fire and instead prepare properly. As we all know, the most cost-effective cure is prevention in the first place. Over the past seven years, the Conservative Government announced an average of £376 million of emergency funding each year to tackle the winter crisis, much of which arrived too late to make any meaningful difference.

The Liberal Democrats want to create a winter taskforce armed with a ringfenced fund of £1.5 billion for the next four years. That would be used to build resilience in hospitals, A&E departments, ambulance services and the discharge of patients, and allow integrated care boards and NHS trusts that are struggling to balance their books to plan their budget more effectively in advance to cope with the winter crisis. The taskforce would bring together senior leaders from the NHS and the Government, along with staff representatives, to ensure better co-ordination and preparation for winter. It would be empowered to deliver rapid changes in day-to-day operations to ensure a co-ordinated response—for example, by deploying more beds to certain hospitals or boosting social care capacity where it is most needed.

Tackling the issue of patient flow is the most fundamental aspect of steering our health system through this winter and the years ahead. If patients are to be treated on time, they need an ambulance to arrive on time, and that ambulance must be able to hand over its patient to A&E as soon as it gets there. If A&E is to have more capacity, we need to reduce the amount of people there in the first place through prevention and investment in primary care. We must make hospital beds available so that patients can be moved out of the A&E department and into the medical or surgical part of the hospital, as appropriate. If we are to move patients on when they are ready to go home, when they would be better served in their own home with the proper therapy, we must invest in social care and deal with its capacity issue, which is at the heart of so many of these problems.

Half a million people in England are waiting for care, stranded in hospital beds that are so important to free up over winter, and those in power have continually ignored social care for many years. I am extremely worried that the Government have not said an awful lot about social care in the Budget today. The additional money announced for local councils, £600 million of which is for social care, will presumably be gobbled up largely by the increase in national insurance contributions and the minimum wage. It is really concerning that those councils will not be able to meet their social care commitments in the future. We urgently need cross-party talks so that, between us, we can commit to a long-term solution to the crisis in social care.

Liberal Democrats believe that we should introduce free personal care along the lines of the model in Scotland. That would help people to stay in their own homes and out of hospital and ease the pressure on the NHS. We should pay for a fairer deal for unpaid carers and a higher carers’ minimum wage, which of course, we saw some movement towards in today’s Budget. We welcome that and look forward to the review of the cliff edge in the unpaid carers’ allowance. Critically, a higher carers’ minimum wage must be fully funded, because councils will be pushed over the edge if they are not given the money to support that, as will many small care providers, which provide the vast majority of paid social care in this country.

We need to ensure that people can see a GP when they need one, so that they do not end up adding to the overwhelming pressure on A&E departments. I recently spoke to someone in my constituency who waited seven weeks for a telephone consultation. We must ensure that we focus on the outcome for the patient, which is why we would give everyone the right to see a GP within seven days, or within 24 hours if the need was urgent, and we need to increase the GP workforce by at least 8,000 to deliver that. As I said, it is crucial that that is done through retention as well as recruitment and more training.

We also need to reform the NHS dental contract and guarantee access to an NHS dentist for anyone needing urgent or emergency dental care, ending the dental deserts that exist in my North Shropshire constituency and the rest of the country. The biggest reason for a child to go into hospital is to have a tooth extracted, because their teeth are in such a poor state. That is scandalous, and I look forward to hearing what the Government will do to address that issue.

We also need to support community pharmacists, who are critical to the preparedness of the NHS, by making sure that everyone has access to the healthcare advice and medicines that they need. Pharmacy First is an excellent idea and helps to relieve the pressure on the NHS, but community pharmacists are closing at an alarming rate, and we risk that good idea going to waste. Are enough people being vaccinated against the “tripledemic” of flu, covid and respiratory syncytial virus, including staff? Analysis by the Health Service Journal showed that 283,000 fewer staff received a flu jab last winter than at the end of 2019, despite the number of frontline staff growing. If staff are not protected, fewer patients will be protected when they get seriously ill, and staff will not be able to go to work to treat ill people. Increasing the awareness of what is on offer at pharmacies and reversing the cuts to the public health grant to increase the health and fitness of people up and down the country are both integral to relieving pressure on hospitals and preparing the NHS for winters to come.

Stories and statistics from up and down the country show that the NHS was already under extremely severe pressure this summer. That has been the case throughout this year and last year. It is autumn now, so it is critical that the Government outline their plans to deal with the added pressure of the winter to come. More fundamentally, we need bold, long-term action so that winter crises become a thing of the past. We need to train, recruit and retain staff, and make them proud and happy, instead of tired and stressed, with them then leaving the system. We need to fix our crumbling hospitals so that money can be spent on care instead of fighting fires and draining floods. We need to invest in all aspects of primary care, including dentists, doctors, pharmacists and optometrists, as I reminded Members in the Chamber last week. Most crucially, we must confront the crisis in social care.

Earlier this week, the Secretary of State said that the Budget will arrest the decline in the NHS, but I am afraid that that is not good enough. The annual winter crisis costs lives, jobs and patient dignity. It also costs the taxpayer more than we can afford. We must invest now; we cannot afford not to do it. We must invest to save so that we have an NHS fit for the future.

--- Later in debate ---

[Helen Morgan]

I thank you, Sir Roger, the Minister, the shadow Minister, all my Liberal Democrat colleagues and the hon. Member for Strangford (Jim Shannon) for coming to this debate on a very busy day. I am grateful for all their contributions, which were positive and constructive, as always. I thank the Minister in particular for her comprehensive response. It is reassuring to hear that she has considerable expertise in this area.

We welcome the investment that was announced in the Budget, including significant investment in day-to-day NHS spending, capital investment and investment to deal with the repairs backlog, which needs urgent attention. We called for the Government to address the backlog in our general election campaign, because we recognise its importance. However, the very nature of the Budget statement means that we have been a bit light on detail today, and that is why we want to provide constructive opposition and ideas to move this forward.

I reiterate my concerns about social care. Little was said about it today, but many social care providers are small businesses that will be heavily impacted not only by the increase in the minimum wage, which is welcome for carers, but by the increase in employer national insurance contributions. We risk a real crisis in those companies and in local government budgets, which are perilously stretched, if we do not have a plan to fund those carers and their wages. I leave the Minister with that thought, and thank everybody for attending.

Question put and agreed to.

Resolved,

That this House has considered NHS readiness for winter 2024-25.