Tobacco and Vapes Bill

Luke Evans Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Victoria Atkins)]

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

Before I start, I should declare an interest: before I was elected to Parliament, I used to prosecute serious and organised crime, including organised crime gangs who attempted to import illicit cigarettes.

For a moment, I would like us to imagine that we are not in this historic and magnificent Chamber but instead standing at the entrance of a local hospital. A patient comes through the doors, struggling to breathe; smoking sent their asthma spiralling out of control. A minute later, another patient passes by; smoking caused the heart disease that they are battling. A minute later, another person comes in, and then another. That vicious cycle repeats itself nearly every minute of every day in our national health system, because here in the United Kingdom almost one hospital admission a minute is the human cost of smoking.

Smoking leaves people with premature dementia. It puts them in care, attached to oxygen, for the rest of their life. It increases the risk of stillbirth by almost 50%. It is responsible for 75,000 GP appointments every month, and it takes about 80,000 lives every year.

[Dr Luke Evans (Bosworth) (Con)]

I urge everyone who has come to the debate to go to a respiratory ward—I served on one for a year in my first junior doctor role—to watch people gasp for breath, struggle and fight, with their relatives asking you as a doctor to do something and you simply cannot. If the Bill is a step forward in stopping that situation, I am very much in favour of the Secretary of State taking it forward.

[Victoria Atkins]

I thank my hon. Friend for bringing to the Chamber his professional experience and the real-life consequences for his patients. If I may, I will unpack some of the details behind that invaluable intervention. The premise behind the Bill is exactly as he says—to stop the start—because there is no safe level of smoking and no safe tobacco product. In fact, it is the only product that, if consumed as the manufacturer intends, will kill two thirds of its long-term users.

The Bill is not about demonising people who smoke or stopping them from buying tobacco if they can do so today. It will not affect current smokers’ rights or entitlements in any way. Indeed, we want to help them to quit. We are supporting them by almost doubling funding for local stop-smoking services. Instead, the Bill is looking to the future, to give the next generation the freedom to live longer, healthier and more productive lives.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 5th December 2023 Commons Chamber

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

The shortage of ADHD medication is a global issue; it is not Brexit-related. We are hoping to have some positive news over the coming weeks.

[Dr Luke Evans (Bosworth) (Con)]

T9. My local practice, on Heath Lane in Earl Shilton, released its “did not attend” figures. Between 20 November and 24 November, 69 appointments—including 36 GP appointments and 28 nursing appointments—were missed. That was 12 hours lost in five days. If that is happening up and down Hinckley and Bosworth and across the country, that is thousands of hours being missed. I know that the Government are keen to see more on data, so will they consider statementing patients on how much missed appointments cost, because clinically that would make a big difference to the awareness of what people are cashing out on?

[Victoria Atkins]

May I thank my hon. Friend for bringing his professional expertise to the Chamber? Of course, minimising “did not attends” is a critical part of ensuring that clinical time is optimised, and I will take his suggestion away and mull it over.

Mental Health Treatment and Support

Luke Evans Excerpts

Wednesday 7th June 2023 Commons Chamber

[Neil O’Brien]

I was just coming to that, but on the point about prevention and the social origins of these things, we are in agreement about tackling the origins of these things. In terms of financial security, that is why we are providing financial help worth £3,300 per household, one of the most dramatically generous packages anywhere in Europe. The question of good housing was raised earlier. We have the Social Housing (Regulation) Bill and we are taking action to extend the decent homes standard to the private rented sector.

[Dr Luke Evans (Bosworth) (Con)]

Is it not the case that we have to be really careful about what we are talking about? There is a difference between mental wellbeing and mental health. We all suffer with our mental wellbeing but we do not all suffer with our mental health, and we therefore need to have the support that is appropriate. Social prescribing, for example, has a fundamental ability to help people who suffer with their mental wellbeing. Are the Government doing anything more to drive up social prescribing, so that GPs and allied professions can get the support from the third sector and other voluntary organisations that people so desperately need for their mental wellbeing?

[Neil O’Brien]

My hon. Friend, as an experienced clinician, makes an important and thoughtful point. This is exactly why we have so dramatically increased the number of social prescribers in primary care. An example in Britain is the parkrun practices initiative, which is connecting people to sporting and cultural activities that can improve mental wellbeing as well as mental health. My hon. Friend is completely right, and that is why this is a priority for us.

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[Dr Evans]

My hon. Friend is making a powerful speech about raising awareness. Yesterday, I hosted members from the NFU, who candidly said that, a few years ago, they would never have been speaking about these kinds of issues. We know that rural communities and farmers in particular suffer when it comes to asking for help. Is it not exactly those organisations coming forward and speaking about the problem that allows us to have this debate?

[Dean Russell]

I thank my hon. Friend for his important intervention. This morning, I was fortunate to host the Royal College of Psychiatrists. We had a roundtable discussion with different charities, organisations and leaders in this space about what we need to do and what that looks like. It looks like more funding—there is always an argument for that and rightly so; it means ensuring that we support people who have gone through crises, and that we look at that long-term support; but it is also about how we shift the conversation. For me, it must be about parity between physical and mental health. A few years ago, an amendment was tabled that would have introduced more parity of funding. As a Government, we need to look again at that amendment. Other important steps would include a mental health Bill. I appreciate that we need to move forward with that as soon as possible, and I echo the calls for such legislation, but we should not be damning everything that has been done so far, because huge strides have been made, especially in relation to extra funding.

When I was a councillor many years ago, I worked with local schools to look at what support was in place. I wanted to know whether the children as well as the teachers were aware of the support that was available. If we were to do the same survey today, we would find that the situation is far better than it was 10 or 15 years ago, but, as I have said, there is still a way to go.

I want to finish on a few brief points. When we consider the challenges around mental health, we must understand that the problem is not mental health alone. There is always some sort of comorbidity and there is always some impact on physical health. When we talk about parity, we are not just saying, “one person with mental ill health and one person with physical ill health must be seen equally”. That, of course, is important, but we must also be mindful of the fact that if somebody has a mental health condition it may affect their ability to work. On the flipside, a physical health condition may impact a person’s ability to get out of bed in the morning and their ability to do exercise. All those things are essential.

I hope that my words, from the Conservative Back Benches, will echo across the House: we want to get to a position where mental health is a priority across all of society. Both the Government and our communities play a part in that, and how we talk about this matters. I hope that we can talk civilly about the opportunities that are available. I urge colleagues to talk about what support is out there as much as, quite rightly, challenging Government and all of us to do more.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 6th June 2023 Commons Chamber

[Neil O’Brien]

At every stage, we are taking action to get more dentists doing NHS work. There are 6.5% more dentists doing NHS work than in 2010. The hon. Gentleman has an important idea. We are doing other things to retain NHS dentists, such as the important reforms that we made to pensions, which have helped both GPs and NHS dentists.

[Dr Luke Evans (Bosworth) (Con)]

13. What progress he has made on improving hospital facilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

The Government are providing record investment in NHS hospital facilities to improve staff and patient experiences and provide extra capacity to cut waiting lists, including the more than £20 billion that we announced just under two weeks ago.

[Dr Evans]

I thank the Secretary of State for his serious investment in Leicestershire, with £14 million for the diagnostic centre in Hinckley and now part of that £20 billion going to Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital, including for upgrading the car park. But there is one final part. In 2018 we had £7 million allocated to Hinckley for improvements, but due to covid and the community diagnostic centre investment, the business plan has changed to a day case unit. The money is there. Will he remove the red tape and look on this kindly and swiftly?

[Steve Barclay]

My hon. Friend is right to highlight the series of investments that we have made in his local area. On the specific case he raises, he will know that the business case needs regional approval, and that is currently with NHS colleagues, but I am happy to commit to him that once that is received, we will look at it very keenly.

Recovering Access to Primary Care

Luke Evans Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

As I said in my statement, we have 4,000 doctors training in primary care, compared with 2,600 in 2014. We are also looking at how we can better retain the GPs we have. That is why we made the pension changes, which will affect around 9,000 GPs. It is also why we are looking at additional roles to take pressure off GPs, and at how we can reduce some of the burden of bureaucracy, too. We are training more doctors, and we are looking at retention and bureaucracy. No one is suggesting that this is solely an issue of telephony or online booking, as the hon. Lady suggests, but all of this will help to relieve pressure on extremely busy primary care.

[Dr Luke Evans (Bosworth) (Con)]

I am pleased to be talking about primary care, for obvious reasons. It is important that the Government made the pension changes, which will make a difference to retention, but I am also pleased with the next part of the plan. When I was a clinician, 15% of my workload was chasing letters and administration, which is borne out by the evidence we have heard on the Health and Social Care Committee. Will the Secretary of State comment further on the bureaucracy he is cutting? Will he ensure that this is the first step in pushing down on that bureaucracy, as that will improve the welfare of both our workforce and our patients?

[Steve Barclay]

My hon. Friend has a great deal of experience, and he is right to focus on the amount of clinical time often spent on non-clinical issues. Sending reminders through the NHS app will reduce non-attendance. We are also looking at the key interface between secondary care and primary care, as well as considering which appointments can be done elsewhere, such as through pharmacies and the additional roles. The online booking system can better triage people to the right place, and there will be some self-referral in order to take pressure off GPs—not for things that carry a clinical risk, such as internal bleeding, as the Opposition suggest; but for things like hearing aids. If a person has taken a hearing test, they will not need to clear an appointment for a hearing aid through their GP.

Oral Answers

Luke Evans Excerpts

Tuesday 25th April 2023 Commons Chamber

[Steve Barclay]

First, I very much welcome the good care that the hon. Gentleman received, and it is great to see him back in the Chamber. On the wider issue, that is why we have an elective recovery plan, in which we have applied a boost in capacity, particularly through the surgical hubs. We are looking at how we build greater resilience, especially in winter, when elective beds are often under pressure. We are also investing in areas such as eye treatment, and we are rolling out through Getting It Right First Time a programme of improvement in a range of areas, including that one.

[Dr Luke Evans (Bosworth) (Con)]

Provision for special educational needs and child and adolescent mental health services is one of the biggest issues in my inbox in Leicestershire, particularly in respect of delays in assessment and diagnosis. One of the Government’s plans was to introduce school mental health support teams. The Health and Social Care Committee heard that the aim was that 35% of pupils should be covered by 2023. May we have an update on progress and on when we are likely to reach 100%?

[Steve Barclay]

My hon. Friend makes an important point, and I am happy to update the House, as we have already achieved 35% coverage. By the end of the month, we expect to have 399 operational mental health support teams, covering 3 million children and young people. We plan to go further, with over 500 such teams by spring 2024.

NHS Workforce Expansion

Luke Evans Excerpts

Tuesday 28th February 2023 Commons Chamber

[Wes Streeting]

I wholeheartedly agree. It is why we are in the worst of all situations: the shortage of staff means not only that patients are receiving poorer care, but that we are paying over the odds as taxpayers for the Conservatives’ failure to recruit and retain the staff we need.

We are not alone in thinking that the biggest expansion of NHS staff in history and doubling the number of medical school places is the right solution. Amanda Pritchard, the chief executive of NHS England, has rightly said that we need greater investment in training to stop excellent British students being turned away. The Royal College of Physicians has called for medical school places to be doubled, and now the NHS is formally asking the Government to fund it. Why are the Government refusing to fund a doubling of medical school places, which the NHS and the Royal College of Physicians say is necessary, and which patients can see through experience is desperately necessary?

[Dr Luke Evans (Bosworth) (Con)]

rose—

[Wes Streeting]

Perhaps the hon. Member can tell us.

[Dr Evans]

I am grateful to the shadow Secretary of State for bringing me in on this point. Training is really important. As someone who has been a medical student, I know that one of the most important things to look at is how many people will be on one’s firms. We do not want 12, 15 or 20 people all coming into a cubicle to see a patient. Although I welcome the idea of expansion, can he talk me through what the ratio will be on ward rounds for medical students being trained?

[Wes Streeting]

I am glad that finally Government Members have noticed that Labour has got a plan and are asking how it will work; I wish that Government Ministers would join in. The proposal we set forward to double the number of medical school places is based on modelling put forward by the Royal College of Physicians, which understands perfectly well the points the hon. Member makes. I have had excellent meetings with university vice-chancellors, who are keen to roll up their sleeves and help. The reason we set out a plan this far from a general election was for two reasons. First, we want to give medical schools and NHS employers time to prepare for the expansion. Secondly, we hope that the Government adopt this plan to give the next Labour Government a head start. I very much hope, as this motion says, that the Chancellor will take our plan and incorporate it into his Budget, and I will cheer him if he does so.

I will tell the House how ludicrous the situation is today. There are medical schools in England today that are exclusively training international students, many of whom will leave upon graduating, while at the same time we are turning away thousands of straight-A students from our own country who want to help the NHS. Brunel University is training 100 new doctors, with not a single UK student. Chester University has deferred the launch of its medical degree by a year because the Treasury will not give it a penny. Local NHS trusts and charities have chipped in to fund 20 UK medical student places at Three Counties Medical School at Worcester University, because the Government are refusing to fund a single domestic student. Despite pleas from the NHS, the Minister for Skills, Apprenticeships and Higher Education, the right hon. Member for Harlow (Robert Halfon), has threatened to fine medical schools if they increase their offers to applicants next term.

--- Later in debate ---

[Wes Streeting]

I wholeheartedly agree with the hon. Member. I will talk about this later in my speech, but it is why the Government have to resolve this pay dispute with existing NHS staff. The danger is not that they walk out for another day of strike action, but that they walk out of the NHS altogether for countries that treat them better. What an absurd position to be in. It is also absurd, by the way, that we still have doctors retiring early for no other reason than that the pensions rules create an active financial disincentive to work up to normal retirement age, as many of them would like to do. It is completely absurd.

[Dr Evans]

Will the shadow Secretary of State give way?

[Wes Streeting]

I am happy to give way to the hon. Member again, but may I gently suggest that he would be better off lobbying current rather than future Ministers?

[Dr Evans]

As the hon. Gentleman sees himself as a future Minister, what is his solution for the pensions position for consultants?

[Wes Streeting]

I am delighted that the hon. Member asks. I had a good meeting with the British Medical Association pensions committee recently. There are a number of ways in which this matter could be resolved, one of which might be a tax-unregistered scheme, which we have seen used successfully in the judiciary. [Interruption.] I am perfectly fine with having a tax-unregistered scheme. I think the difference between the Opposition and the Government is that the Government have an army of civil servants to do the modelling. That is what I would like the Government to do. I say to the hon. Member again that it is no use lobbying the next Government—lobby the current Government.

Turning again to the international picture, the NHS is having to recruit from countries on the World Health Organisation’s red list—countries that desperately need the few doctors and nurses they have—because our Government cannot be bothered to train their own. I think that is unethical, immoral, a disgrace and a kick in the teeth for the UK students who desperately want to be the doctors, nurses, midwives and allied health professionals that our country needs.

The Chancellor is refusing to budge, I believe, on cost grounds, but Labour’s plan before the House today would cost £1.6 billion a year. We have shown how we would pay for it: scrapping non-doms would raise more than £3 billion. If the Chancellor needs any tips about the non-doms system, or if perhaps he is worried that non-doms might flee the country, he need only knock on his next-door neighbour’s door to see a case in point. He will find out how the system works, and that when people are asked politely to pay their taxes here, they do not flee the country.

Inaction also has costs. The NHS spent an eye-watering £3 billion on agency staff last year. One hospital was so desperate that it paid £5,200 for a doctor to work a single shift. Does that not sum up the approach of this Government: penny wise and pound foolish?

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[Wes Streeting]

The hon. Gentleman is absolutely right, and I have been following his work and that of the all-party parliamentary group on radiotherapy in this area, because he raises issues that ought to be taken very seriously. I was very grateful to my hon. Friend the Member for Easington (Grahame Morris) for coming to meet me about these challenges in particular. Of course, this has to be at the heart of a serious plan to improve cancer outcomes.

There is no doubt but that Labour’s workforce plan—supported by the NHS, supported by the professions, supported by so many members of the public—would make a difference. In fact, our inboxes have been filling with people welcoming the plan. It was a particular surprise to me to see one piece of fan mail that said:

“Despite my obvious political allegiances it would be remiss of me not mention the fact that Labour has pledged to double the number of medical school places and recruit additional health visitors and district nurses.”

It goes on to say that it

“is something I very much hope the government also adopts on the basis that smart governments always nick the best ideas of their opponents.”

Well, what luck that this particular fan of Labour’s policy joined the Government just two weeks after he sent the email. It is, of course, the Chancellor of the Exchequer, who I must say I thought was an excellent Chair of the Health Committee. It is almost as if he had learned from all his mistakes when he was the Secretary of State for Health.

This is Lent, a period for atonement and a time for forgiveness, so I make this pledge today: if the Chancellor realises the errors of his ways and comes to this House to double the number of medical school places in the Budget and adopt Labour’s NHS expansion to deliver the biggest expansion of the NHS workforce in history, I will cheer him on from the Opposition Front Bench during the Budget. I will cheer him on—

[Dr Luke Evans]

Come across!

[Wes Streeting]

Well, I need the help of the hon. Gentleman and Conservative Members, because my pleas seem to be falling on deaf ears. That is why I have taken the trouble to circulate this email to every Conservative Member, so that they can collar the Chancellor in the voting Lobby this evening—no doubt when he is voting with us, because he agrees with us—and I look forward to their assistance in helping him to see the error of his ways. In all seriousness, it is time that the Chancellor put his money where his mouth is, abolished non-doms and used the proceeds to train the doctors and nurses that the NHS needs.

We know the consequences of the current NHS crisis. Earlier this month, I met Samina and Minnie Rahman, who lost their loving husband and father on Christmas eve after calling for an ambulance three times. The family were initially told a nurse or paramedic would call them back, as it was deemed Iqbal did not require an ambulance. Forty minutes later, when his condition worsened and his family were unable to lift him into their car to drive him to hospital, they phoned 999 again. This time an ambulance was sent, but was then diverted to a higher-priority call. When Iqbal stopped breathing an hour after the first call, his family called 999 a third time, and an ambulance eventually arrived 24 minutes later. The paramedics spent 90 minutes attempting to revive Iqbal in front of his family, but they were unable to. That story is tragic and awful for the family who lost a husband, a father, and a grandfather. Perhaps most depressing is that this case is no longer surprising. The hour and a half that Iqbal waited for an ambulance was the average amount of time that patients with conditions such as heart attacks and strokes waited in December.

The West Midlands Ambulance Service has apologised to Mr Rahman’s family, but they want the Government to take action. They are calling for change to ensure that no other family must endure what they have been through, and they have three asks. First, they want an independent review to establish the number of deaths and serious harms caused by ambulance delays. The Government have rejected figures from the Royal College of Emergency Medicine that claimed that up to 500 people a week were losing their lives this winter due to long waits for emergency care. They also rejected figures from the Office for National Statistics on the number of excess deaths suffered in the past year. Well, Mr Deputy Speaker, “ignorance is bliss” is not a responsible approach to the crisis in emergency care. Sunlight is the best disinfectant, so I hope the Minister will commit to establishing the true scale of the harm caused by the crisis in the NHS.

Secondly, Minnie and Samina ask the Government to instigate Cobra-style meetings to deal with the public health emergency of ambulance delays. That is already happening to deal with the fallout from industrial action, but we need the same level of action for non-strike days. Thirdly, Minnie and Samina have asked to meet the Health and Social Care Secretary, so that he can hear at first hand about their experience, and see the trauma it has caused. The Secretary of State is not able to be here this afternoon, but I hope the Minister will convey that request to him. I gently remind her that I passed on Zaheer Ahmed’s request to meet the Secretary of State after his five-year-old nephew passed away following multiple failings by the health service, but that meeting is yet to be arranged. I think the least we can do as public servants is listen to those we serve, especially those who have suffered in the most unimaginable way. I hope the Secretary of State will meet those families, and that they are able to spur the Government into taking the action we need.

One promise of the NHS is that it is there for us when we need it. That has been completely fundamental in this country for as long as many in the Chamber can remember, but that promise is now broken. People are frightened that the NHS will not be there for them in an emergency. It is not hard to understand why. Look at the news today that more than 1.5 million patients waited for more than 12 hours in A&E last year, which is estimated by the Royal College of Emergency Medicine to have seen 23,000 people lose their lives.

This is not just about emergency care. Patients in need of an operation or even a GP appointment do not know whether the NHS will be there for them when they need it. That is why so many people are voting with their feet, and with their wallets, and going private. Of course most people in this country cannot afford to pay, so they have no choice but to wait and worry. Restoring that promise of an NHS that is there for us when we need it should be a basic task for any Government, but this Government do not even have the ambition, let alone a plan to get there. Instead, the Health and Social Care Secretary said last month that a world where patients are seen within four hours at A&E is “too ambitious” and “not achievable”. But it was achieved until 2015. It was certainly achieved under the last Labour Government.

The target for ambulances reaching patients with strokes or heart attacks has almost doubled to half an hour. If someone wants to see a GP, there is an “expectation”, not a guarantee, that they will be able to do that in two weeks. Two weeks! I remember Tony Blair being attacked because people were forced to see a GP within two days—what people wouldn’t give to be in that position now. Millions wait longer than a month. The Government missed the goal so they moved the goalposts. They have accepted that the NHS will not be there for all of us when we need it. That is what managed decline looks like. That is what brings about the end of the NHS. It is not calls for a different model from the right hon. Member for Gainsborough and others; it is this: slow, irreversible decline. That is what the end of the NHS will look like, and that is why we desperately need a change in Government.

Performance-enhancing Drugs and Body Image

Luke Evans Excerpts

Tuesday 21st February 2023 Westminster Hall

[Dr Luke Evans (Bosworth) (Con)]

I beg to move,

That this House has considered the matter of steroid and image and performance enhancing drug use.

It is a pleasure to serve under your chairmanship, Ms Fovargue.

We need to talk about steroids in the UK. I am talking about not just any steroids but anabolic steroids and image and performance-enhancing drugs—or IPEDs. There are an estimated 500,000 to 1 million users in the UK, but no one is talking about it. The closest we get is the “natty or not?” discussions on social media about naturally built men and women versus people who are enhanced. There is particular discussion about Hollywood actors.

[David Mundell in the Chair]

I will not cast any aspersions about who does or does not use steroids and performance-enhancing drugs, but it is fair to say that the debate is becoming bigger and louder, not only in this country but in America and throughout the western world. The Priory Group did some research about 10 years ago and estimated that around 50,000 people were using steroids; its estimate now is that 500,000 people are using them. It says that

“we are sleepwalking into a health crisis”.

I know from my time as a GP that when it comes to—[Interruption.]

[David Mundell (in the Chair)]

Order.

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[David Mundell (in the Chair)]

The debate can continue to 5.38 pm.

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Mundell.

Until we were rudely interrupted by that vote, I was saying that we need to talk about steroids in the UK because, as the Priory Group has said:

“we are sleepwalking into a…crisis.”

As a GP, I know that the obesity epidemic has been a real problem, but part of the nation is actually getting fitter while part of it is getting fatter. I will concentrate on the part that is getting fitter, because of those who go the gym—mainly men—we know that one in 10 suffer from bigorexia. What am I talking about? Bigorexia is body dysmorphia—the idea that someone’s muscles are not big enough, no matter how much they eat or train. It is important to understand that this is a growing epidemic in our country; even more importantly, it is quite prolific in the gay community. I will break the issue down into three sections. I will talk a little bit about how I came to this topic, the drivers behind it, and, most importantly, what needs to be done.

Growing up, I was a fairly normal kid. At the age of 14 or 15, I was playing sport and was reasonably academic, but I was an outlier, because for my 15th birthday I had saved up £500 to buy a multigym. In my head, I wanted to improve my rugby, get girls, fight off bullies and improve my body image. Surprisingly, I was the under-16s first-team captain, but the other three aims fell to one side. Looking back, I think, “How many other young men feel like this?” That was 25 years ago. I think the points I mentioned are the driving forces behind why men want to go to the gym and improve their body image. Society says to them, “We need to be perfect”, but what is that perfect image?

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Social media and reality TV have played a huge part in promoting unrealistic body ideals, which we often do not think about when it comes to men’s self-esteem. Does the hon. Member agree that there should be some greater controls around edited, unrealistic imagery?

[Dr Evans]

The hon. Member is spot on. The advent of social media over the last 20 years has really brought home that idea of body image. With the likes of Instagram, if a man is interested in using a gym, they are sent hundreds of images in 30, 40 or 50 seconds. Each individual image in itself is not the issue, but the cumulative effect of repeatedly being sent such images is a problem.

I would argue that the way to solve the problem is through the social media companies’ algorithms, to ensure that there is transparency about what people are being sent. Facebook talked about diet pills aimed at young girls being a real problem. If we do not deal with male body image and body dysmorphia, this will be the next iteration of that problem.

As a doctor, over the last 10 to 15 years I have started to see more and more young men coming into my clinics and asking to be prescribed protein powders or creatine, and asking, “How do I bulk up?” I also started to see more and more men in their 20s, 30s and 40s who were using steroids and having side effects, including bad acne, scarring acne, mood problems and depression. I have even seen some men who have had strokes, heart attacks, liver problems, kidney problems and erectile dysfunction, none of which are really talked about when it comes to steroids.

The problem with steroids is that they work, so people use them and see a drastic improvement. People who want to build muscle will see that improvement, take the cycle of whatever substance it happens to be and then plateau, which is very hard for them to deal with because they no longer see the gains they were initially getting under their regime. They say, “Oh, I’ll only use it once”, but once becomes twice, twice becomes thrice, and so on.

[Sir James Duddridge (Rochford and Southend East) (Con)]

My hon. Friend listed symptoms, but I do not think that he mentioned swelling of the brain. Matt Dear, a 17-year-old from Essex, tried to build himself up by taking bodybuilding pills, because he was committed to a career serving in the armed forces. He took pills that he had bought for £30, his brain swelled up and, tragically, he died. The memory of Matt has helped to educate children in the community. Is my hon. Friend concerned that even taking these things once can be terminal?

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[Dr Evans]

My hon. Friend makes an incredibly important point—these are dangerous prescription drugs, if they are not used properly. There is a plethora of side effects that are not talked about, from the short-term acute stuff that could mean someone has swelling of the brain or a clot, or is having a heart attack, or the long-term effects, such as depression, scarring acne or erectile dysfunction, which, particularly for young men, can have a huge psychological effect when they are trying to find partners. My hon. Friend is spot on. My heart goes out to Matt’s family; I am pleased there is a memorial for him.

Our role as responsible elected Members is to think about what we can do. The obvious area I get directed to is sport. It is actually quite hard to dope in sport, especially for an elite athlete. It does happen, but the culture is quite strong not to do so. Many athletes who want to be elite have come to me, as their GP, and have refused to take prescriptions because they are not sure whether it will be an exemption or clean, or whether it might get them in trouble with UK Anti-Doping.

Sport is an interesting area. I have met UN Anti-Doping a couple of times, and it is seeing people using these drugs to improve their image, but then finding out that they are quite good at sport and then getting into trouble with the authorities. The classic example is the young Welsh rugby player, who wants to look big on the streets when he is out and about, and wants to look good in Ibiza—and he finds out that having that size and strength is good on the rugby field. He starts playing semi-professionally and then gets picked up by UK Anti-Doping.

At the other end of the spectrum, we see cyclists, particularly affluent middle-aged men, who have the money and wherewithal to train, dedicate their time, buy the equipment they need, and start to see progression through the ranks of cycling. Then they meet the edge and ask, “What’s next? Let’s lose weight. Let’s have a fat burner. Let’s think about steroids or something else, like EPO.” That sees people caught out.

Those are the people going into elite or semi-elite athlete status; we have not even touched on society and the health aspects. We have heard a lot over the past 10 years about women’s health and body image, but less so about men’s. “Love Island” is back on TV at the moment, and we often hear a debate about how the females look: “Is there diversity? What about their shapes?” Very rarely do we hear that about the men. Nine out of 10 of them will have a six-pack, large shoulders and big biceps, and we seem to think that is okay.

Spencer Matthews from “Made in Chelsea” talked about the pressure and the need to use steroids he felt, because of his concern about what he looked like. We only have to look at what is currently in cinemas—the Marvel comic films—to see the aspiration set for young men.

[Nick Fletcher (Don Valley) (Con)]

I congratulate my hon. Friend on securing this debate. Does he agree that boys and men are in a unique position in the 21st century? There are all kinds of pressures on boys and men that are often not seen, and which they often do not talk about. Does he agree that one way the Government could help is by putting in place a men’s health strategy? We could look at subjects such as this, and other issues that men are facing, as a whole to help men today.

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[Dr Evans]

I am grateful to my hon. Friend for his intervention. I commend his work on the men’s health strategy, and on securing the men’s world health debate. He is right that these tend to be pertinent male issues. There is a difference: from my clinical approach, I see men’s health-seeking behaviours. It is apt to say that we should target some of these issues in these ways, particularly steroid abuse and performance-enhancing drugs used for imaging, because men tend to be most affected—not exclusively but mainly. My hon. Friend is absolutely right.

That leads to the fitness industry itself, which purports to put out images of the six-pack and shoulders bigger than a fridge. The problem is that those are stationary images of a point in time. Aspiring to live in that point in time is very difficult. Young people may not understand that many people in bodybuilding go through cycles of bulking up and then dropping weight to fit a certain image for their competitions. That is fine for a bodybuilder, but it is not good for a 19 or 20-year-old university student to aspire to that, because they are at a time of meeting other people and creating relationships.

There is a ratchet effect. We see images of very large, muscular men, which people aspire to, and there is a cheap and effective way to get there; that is a real concern. That leads to a wider issue currently faced by societies across the western world: what is masculinity?

We have heard a lot about toxic masculinity, which allows space for the likes of Andrew Tate to step in. Lots of people listen to what he has to say, in part because he is saying, “Be strong, stand up, look after yourself.” On the other hand, he has been found to be completely wanting and is now under investigation. Is that the kind of role model we want in front of our young men? Young men who do not understand what masculinity is because they are not told within society will look for other options—be they the Marvel comics or the likes of Andrew Tate—to tell them what is acceptable to be masculine. That is a dangerous place to settle in.

But we are waking up to the issue; the online culture is starting to move towards calling it out. The likes of James Smith and Ben Carpenter talk openly about the pros and cons of the fitness industry, and how it has been marketed. The Women and Equalities Committee did a report on body image, as did the Health and Social Care Committee. The Advertising Standards Authority produced an interim report that identified the key issue of depictions of muscularity in advertising, and it hopes to have further information about that in quarter four of 2023. Awareness is there and the culture is starting to think about it, but we are still at least 10 years off in comparison to the female idea of body image.

We are not doing enough, which comes out when we speak to the likes of UKAD. I thank Trevor Pearce and Jane Rumble from UKAD for providing me with information when I met them. In 2019, a UKAD survey found that 34% of gym goers are aware of IPEDs being used in their gym. That is certainly my experience as a gym goer. Wherever I have been in the country, I have been aware of such drugs being taken, because I have found syringes and packets in the changing rooms. That is quite a scary thought, from my own anecdotal experience—yet one in three men who use gyms is finding the same.

The Medichecks survey of people who go to the gym found that 61% of men want to be bigger, and that 80% of men are aware of some of the side effects of steroids, yet three out of four of those men would consider using steroids or IPEDs. As I mentioned, one in 10 gym goers has bigorexia—a number that is thought to be increasing. Thinking back to being that young boy with my multigym at the age of 15, if I had had the online ability to get hold of such substances, and an ever-growing social media pressure to conform and have muscles, maybe I would have been tempted? That is a scary thought for the generations coming through.

In 2020, The Times reported that users could easily buy steroids through Instagram, even though they are class C drugs. The law says that class C drugs are lawful for personal use with a prescription, but it is illegal to distribute or supply them. In 2021, Border Force seized 1.225 million doses of anabolic steroids, which was down on the number seized a few years before—that does not cover other drugs that are available, such as the fat-stripping drug Clenbuterol—yet there were only 37 convictions for possession or supply last year. The trend has been for between 30 and 40 people to be convicted each year, over the last five years.

The Government have produced an updated drug strategy, called “From harm to hope: A 10-year drugs plan to cut crime and save lives”. The House of Commons Library confirmed to me that there is no mention of the words “steroid” or “IPED” in that report. The start of the report says:

“Over 300,000 people are addicted to heroin and crack cocaine in England. This is the biggest section of the illegal drugs market”.

Is it? Given that we expect 500,000 to 1 million people to have taken steroids, we simply do not know. That is the point I am driving at. The report talks about the principle of

“putting evidence at the heart of this approach”.

When it comes to IPEDs and steroids, we need data and evidence.

That leads me to my asks of the Government. Given that a Health Minister is responding, I think it is fair to concentrate on simply the health aspect of the issue. I ask for three things. First, will he commission the research into steroids and IPEDs suggested in the Health and Social Care Committee report on body image? Secondly, will he pull together the different Departments that the issue crosses over? The issue is not a single departmental issue. It is not covered simply by the Department of Health and Social Care, the Department for Digital, Culture, Media and Sport, the Home Office or the Government Equalities Office; it is all of them—there is a crossover. We need to pull together in roundtables and a taskforce to think about how we deal with this.

My third ask is for education and awareness. We need to think about schools, outside agencies and the NHS—a bit like the Government have done with eating disorders. The number of people suffering eating disorders has skyrocketed, and the Government have responded well by getting the information and support out, and looking at ways to strategise. We are a long way off dealing with eating disorders, but this is the next big, similar crisis. I urge the Government to take that kind of strategy forward.

It would be remiss of me to come to the debate without offering wider solutions and there are some ideas that need to be talked about. They have pros and cons; I raise them because we need to have the conversation. We could look at compulsory mandatory education for personal trainers, who are the most likely people to come into contact with gym goers. We could change the IPED laws, and make sentencing more severe; or do the opposite, and take them out, and say, “No, this is a health issue that we need to deal with.” The debate needs to happen.

We can look at examples from across the world. Norway has licensing of gyms. If new drugs were being found in a nightclub—with new drugs being found and one in three people being aware of the situation—the authorities would be knocking on the door saying, “Should we be licensing? Should we revoke that licence? What should we do about it?” We are a long way off putting such a scheme in place, but it is not beyond our remit to have a discussion about whether that is something we should do to increase the responsibility of the gym owners. There are pros and cons. Fundamentally, we do not have the data and none of the details has been explored enough. That leads us full circle; we really need to start a conversation—we need to talk about steroids in the UK.

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[Dr Evans]

Thank you for your chairmanship, Mr Mundell. Indeed, I thank both the Chairs we have had during this debate, as well as the Clerks for staying late and the officials for being here.

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for talking about algorithms and body image. My hon. Friend the Member for Rochford and Southend East (Sir James Duddridge), who is no longer in his place, raised the sad case of Matt. The constant campaigning of my hon. Friend the Member for Don Valley (Nick Fletcher) for men’s health has been fantastic. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) hit the nail on the head: this issue is about how we record data.

I am grateful to the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) for his point about bold ideas. The whole point of this discussion is that no stone should be left unturned. The bold ideas might not be right, but they need to be explored, because that is the key thing to do when trying to deal with this issue.

I am glad to hear about the twins of the hon. Member for Croydon Central (Sarah Jones). These are exactly the conversations that people should be having up and down the country. Mothers, fathers, grandfathers and grandmothers should be asking questions about what young people are aware of and what they are seeing.

It is lovely to come into a debate after three years and hear that there is unanimous support across the House on this issue and a desire to fill the void, because there is a worry that the likes of Andrew Tate will step into it. I would love to take the Minister up on his “keen pursuit”—to quote him—of this issue. We are at the start of a road, and this is all about having a conversation about steroids in the UK.

Question put and agreed to.

Resolved,

That this House has considered the matter of steroid and image and performance enhancing drug use.

NHS Strikes

Luke Evans Excerpts

Monday 6th February 2023 Commons Chamber

[Will Quince]

Once? The shadow Home Secretary, the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper), has spent it twice over already. And that is if indeed it would raise any money; I know I look very young, Mr Speaker, but I am old enough to remember a former Chancellor, one Ed Balls, say he did not believe taxing non-doms would raise any money whatsoever.

[Dr Luke Evans (Bosworth) (Con)]

I declare my interest, Mr Speaker.

We have spent a lot of time talking about pay, but making working conditions for frontline staff much better is key, so what are the Government doing to focus on improving the simple things in a clinician’s life such as joining up testing, improving prescribing, and making sure that 10% to 15% of a GP’s workload is not spent chasing admin? These are simple things that would make a huge difference and improve outcomes for both patients and staff.

[Will Quince]

I completely agree with my hon. Friend. Ensuring that we support the mental health and wellbeing of NHS staff and that working conditions and working environments are the best they can possibly be is how we can attract and retain the best. Measures such as wellbeing champions, training for line managers, occupational health services and flexible working are very important, but the key to this is having conversations with the unions, because they are the representatives, ambassadors and advocates. That is why I very much hope they will engage in the pay review body process and continue to have those conversations with me, not just about pay, but about how we can improve working conditions and working environments and reduce the bureaucracy that makes the job so difficult.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 24th January 2023 Commons Chamber

[Steve Barclay]

Those discussions are ongoing with my right hon. Friend the Chancellor. The hon. Gentleman will know that we made progress in the summer on a couple of areas in relation to pensions, and my right hon. Friend is having further discussions with us in that context.

[Dr Luke Evans (Bosworth) (Con)]

I declare an interest as a GP and the immediate family of a GP and doctors. GPs are working incredibly hard in tough times. It is true that supply has gone up, but so too has demand. Change needs to happen in primary care, but one of the bedrocks is the GP partnership model. Does this Government agree?

[Neil O’Brien]

Unlike the Opposition, we do not regard GPs’ finances as murky and we do not want to go back to Labour’s policy of 1934 by trying to finish off the business that even Nye Bevan thought was too left-wing. We do not believe in nationalising GPs; we believe in the current model. [Interruption.] We do not believe that people with a problem should immediately go to hospital, driving up costs and undoing the good work of cross-party consensus in the last 30 years. A plan that was supposed to cause a splash has belly-flopped.