Cass Review

Tonia Antoniazzi Excerpts

Monday 15th April 2024 Commons Chamber

[Tonia Antoniazzi (Gower) (Lab)]

The starting point of all modern medicine must be robust and reliable—in fact, rigorous—evidence. Back in 2017, I tabled a written question at the request of a trans constituent who was concerned that many adults and young people were putting themselves through a process that was not the right one for them. That was in 2017, and we still do not have much better data, but the data is the most important thing; it informs everything.

There has been a chilling effect in this Chamber, and on social media, on people who have spoken out, and who have asked questions like that—questions that we ask for reasons to do with everyday healthcare, which we have denied, and the Government have denied, to the children in our care. My hon. Friend the Member for Ilford North (Wes Streeting) has been fantastic; he has shown great maturity and reflection in his comments in the Chamber and in the media, and so has the Secretary of State, but as someone who has been at the other end of this, I say: please, Secretary of State, let us get the tone of this debate right, and move forward. The Cass report is a great thing, and we have to work with it to deliver the best outcomes for the children in our care.

[Victoria Atkins]

Again, I approach the Dispatch Box with humility because I know about the journey that the hon. Lady has been on, and about the debates and questions that she has brought forward, not just on behalf of the constituent that she mentions, but on the wider issue of the treatment of women in healthcare and in other parts of public life. I very much want us to view the future as a clean sheet, so that we can build services around children, rather than expecting them to slot into services for the convenience of arguments that were put forward in the past.

However, we have to acknowledge that this has been such a long and toxic debate that there will be people who want answers. I appreciate the fact that the hon. Member for Ilford North (Wes Streeting) has walked back some of his comments, but it is important that we acknowledge the toxicity, so that we can move on and achieve exactly what the hon. Lady and I, and others around the Chamber, seek. [Interruption.] Interestingly, Opposition Members are chuntering from sedentary positions. I think that we can make a real change, but a little less sniping from the sidelines and a little more constructive work is needed.

Under-age Vaping

Tonia Antoniazzi Excerpts

Wednesday 12th July 2023 Commons Chamber

[Andrew Gwynne]

I am grateful to my hon. Friend for succinctly stating the reason for this debate. That study is very clear: for adults, the appearance of the packaging makes no difference, but children and young people are attracted to the bright colours and cartoon characters and so on. The same arguments were made about smoking and led to us moving several years ago to standardised cigarette packaging. The evidence on children vaping is now so overwhelming that Parliament must take the lead. Industry will not act without a nudge from us. We must make sure that vapes are not packaged and advertised in a way that attracts children.

In a recent article penned for The Independent, a teacher in Oxfordshire described having been:

“rostered on to control numbers of students in the toilet block in an attempt to prevent the constant vaping that goes on in there.”

She went on to describe discovering

“a stash of over 50 vapes stored above a ceiling panel in the toilets—a tactic learnt and shared on TikTok.”

Worryingly, ASH estimates that most children who vape make the purchases themselves, despite it being illegal to sell vapes to those under the age of 18.

[Tonia Antoniazzi (Gower) (Lab)]

My hon. Friend is making an excellent speech. Only yesterday, I had a call from a head of year in Gowerton School in my constituency who wanted to know why the police and social services were not acting on his reports of sales of vapes in a barber’s shop in Swansea city centre. Does my hon. Friend agree that it is up to the police, social services and trading standards to take a stand and stop the face-to-face sale of vapes to under-age children?

[Andrew Gwynne]

Absolutely. There has to be a strategy that is not just about restricting packaging and advertising. There has to be more enforcement at the local level. I have some sympathy with local government, which has had to endure massive cuts over the past 13 years, so that things such as trading standards have been cut right back to the bone, but there can be no excuse whatsoever for shops selling these products to children. Every action should be taken to prevent that and to enforce the law.

Prescription Charges: People Aged 60 or Over

Tonia Antoniazzi Excerpts

Monday 6th March 2023 Westminster Hall

[Tonia Antoniazzi (Gower) (Lab)]

I beg to move,

That this House has considered e-petition 594390, relating to prescription charges for people aged 60 or over.

It is an honour to serve under your chairship, Sir Edward. The petition I am presenting touches on a number of incredibly important issues in healthcare from access to treatment to public health and preventative care, all within the context of how the NHS adapts to an ageing population. Although the petition focuses on prescription charges, it must be considered in the broader economic context of the cost of living crisis, with months of rising prices and inflation where even the most basic necessities are becoming luxury items for many.

The steady rise of pensioner poverty since 2015 shows no sign of stopping, continuing a trajectory that will see millions of us face a retirement dominated by debt and hardship. That context means we are duty-bound to look beyond figures on spreadsheets and examine what the proposed scrapping of free prescriptions for that age group would mean for those who would be impacted by it. It is those impacts that the petition creator Peter had in mind when he set it up.

When I spoke to Peter about why he started the petition, he shared his concern about the impact these changes would have not on him, but on his local community—the men and women who are already struggling with costs and are making difficult choices about what to prioritise. It is people like him who have spent a lifetime working in industry and those who, because of that work, now suffer from a variety of medical conditions, each needing different medications. It is those women, including his wife, who had their lives upended by the callous way the Government implemented the equalising of the state pension age. WASPI—Women Against State Pension Inequality Campaign—women, who were born in the 1950s and live in England, have further issues to deal with compared with those in devolved countries.

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

Uprating the age when prescriptions become free in England to be in line with the state pension age, as the Government consulted on, would be harmful given the cost of living crisis, as the hon. Lady said, and the growing economic activity in those over 50 for various reasons, including their health. Does she share my concern about what this could mean for ease of access to medical treatment for the older generation?

[Tonia Antoniazzi]

I thank the hon. Lady for her contribution. It is, indeed, a huge concern that people with multiple health problems are facing extra difficulties in accessing prescriptions and are having to make those difficult choices about how they spend their money.

For Peter, it seems that something has gone incredibly wrong to get us to this point—something broader than this planned introduction of charges, but something encapsulated by it. It is the breaking of a promise—the promise between citizen and state and the promise that a lifetime of contribution, whether financial through tax and national insurance or through the unpaid labour of care that enables our economy to function, means support in retirement. Peter kept his part of the bargain. It was great to have a conversation with him. He could not believe that his petition was being debated in this place, and it is so important that his voice and the voices of others are heard in this place. He kept his part of the bargain, first in the shipyards on the Tyne and then working on aircraft. He paid in and did what was expected, as did hundreds of thousands of others, but the Government have not held up their end of the bargain. They have changed the rules, and it looks like they will do so again. That unfairness is the reason why we are discussing the matter today.

The plan to introduce charges seems particularly unfair when Peter does not even have to look that far from home to see a better way. England is the only nation in the United Kingdom without free prescriptions and, as colleagues may have guessed from my accent, I am Welsh. I have the great pleasure of representing Gower, one of the three Swansea constituencies, which is beautiful. If anyone ever wants to visit, please do.

Swansea and Newcastle have a lot in common: both are port cities with a proud industrial heritage; both are famous for an excellent night out. It seems the height of unfairness to many in Newcastle and across England that they alone in the United Kingdom pay for prescriptions. I am sure that the Government will tell us that several conditions are exempt and that pre-payment certificates cut costs, but, as I said earlier, we must look beyond the briefings to the reality of the system actually. The exemptions list is not only woefully out of date but, apart from the addition of cancer in 2009, it has not been reviewed since 1968. It also does not cover several life-changing conditions, such as Parkinson’s, arthritis, asthma, Crohn’s disease, cystic fibrosis, lupus or motor neurone disease.

That is the tip of the iceberg. People with those conditions, and other complex, lifelong conditions, still pay for their prescriptions. For those with multiple, co-existing conditions, the cost is even higher. Evidence from the Prescription Charges Coalition, a group of 50 organisations calling on the Government to scrap prescription charges for people with long-term conditions in England, shows that people with long-term conditions struggle to pay for their medication. A third of respondents in England with long-term conditions reported that they had not collected a prescription item due to the cost. Nearly a third admitted that they are skipping or reducing medication doses, with cost concerns a key factor for more than four out of 10. As a direct result of reducing or skipping medications, nearly three in five—59%—became more ill, and 34% needed to visit their GP or hospital. In fact, the Government’s own impact assessment on the introduction of charges highlighted that issue and noted the potential effect on people’s health.

In 2018, thousands of over-the-counter medicines were taken off the list of those that GPs are able to prescribe, leaving those with long-term conditions facing additional costs for their conditions and to stay well. Those worrying health outcomes come with a cost to the NHS. Several member organisations of the PCC conducted research last year. They found that, of those surveyed, one in six of those with asthma and lung disease had cut back on using their potentially life-saving inhalers, as they were worried about the cost; 29% of respondents with cystic fibrosis reported that they had skipped their medication due to prescription charges; and one in five people with multiple sclerosis say that they do not have enough money to pay for the medication or treatment they need.

One lady who lives with kidney disease was hospitalised twice because she had to wait until payday to collect a prescription. In hospital, she had to have a lumbar puncture and an MRI scan, which cost the NHS thousands of pounds more than the prescription would have. As colleagues can see, the impact is vast and, when meeting campaigners prior to this debate, I heard far too many stories like that one. The lived reality of those impacted by this proposed change and the issues caused by the current dysfunctional exemptions system are best understood through that lens.

I work closely with Parkinson’s UK, which is one of the many organisations deeply concerned by this proposal. Medication is the only way to control the symptoms of Parkinson’s disease; most have to take a cocktail of medications to stay well. Research shows that Parkinson’s cost households over £19,000 a year in 2021, due to loss of work; and additional health and social care costs. As Parkinson’s progresses, it becomes more complex. Among people eligible to pay for prescriptions who are aged 60, in any year 5.5% will die within five years and 23.8% will need support to live independently—that is within only five years of being diagnosed. However, they would still have to pay for their essential medications for Parkinson’s.

I want to tell the Chamber a little about Denise. She is 59 and was diagnosed with Parkinson’s in April 2019. She has had to reduce her working hours from 37.5 to only 12 per week, due to her symptoms. She uses a prepayment certificate for her prescriptions, because it is cheaper than purchasing them individually. If the exemption age rises to 66, however, she will have to continue paying for them.

Denise told Parkinson’s UK about the impact that that would have on her:

“I always thought I would work until I was 67, because I would be able to. However, as my Parkinson’s advances I worry about whether I physically will be able to. My employer is really understanding, allowing flexibility to start later in the mornings until my medication has kicked in, but I have already had to reduce my hours by 60% and I’m already noticing the impact of this reduced earning capacity on our household.

I have to pay for my prescriptions, and this is eating into the diminishing amount I can contribute towards the household bills. If they were to increase the age at which I become exempt, it would be really tough because we haven’t allowed for more years of these additional charges.

It feels like the Government is once again penalising those living with a long-term condition like Parkinson’s that anyone could get and for which currently there is no cure.”

Denise’s story is not an isolated one. Parkinson’s is not the only condition whose sufferers will be further disadvantaged by the change, but this is not a problem that will be solved by changing the exemption list. An exemption list has winners and losers baked into its design, and the complexities of managing chronic conditions mean that any approach that is not universal is not fit for purpose.

Furthermore, the Government need to answer why the change is being prioritised now. What evidence is there that it will have any kind of positive impact? We cannot see one. Even if the Government make savings in the short term, the long-term impacts could be catastrophic, leading to greater illness and to more GP and hospital visits.

A poll published in Pulse found that 40% of GPs linked prescription charges to adverse patient outcomes, also indicating that those could lead to far greater costs and more adverse outcomes down the line. Initial results of the 2023 survey by the Prescription Charges Coalition showed that nearly 10% of respondents had not collected medicine due to cost. Of that group—I have more data —30.74% said that they now have other physical health problems, in addition to their original health condition; 30.33% said that they had to go to their GP; 17.32% said that they had to go into hospital for treatment; and 8.32% said that they had to go to A&E.

Research published in 2018 by York Health Economics Consortium highlighted how ending prescription charges for long-term conditions could save money and reduce pressure on the NHS. That comes from preventing avoidable health complications that occur when people do not take their medication. The research identified net savings of more than £20 million per year if the NHS scrapped prescription charges for people with Parkinson’s and inflammatory bowel disease alone. Instead, the Government are discussing introducing additional charges. That flies in the face of common sense.

We know that the NHS is under pressure, but that is the case across the United Kingdom, and the devolved nations are not even discussing removing universal free prescriptions. I urge the Government to follow that lead, to look to the future and not to engage in short-termist, quick fixes that will not be a fix for all, and not for the petition creator.

--- Later in debate ---

[Tonia Antoniazzi]

I thank Members for participating in the debate and the Minister for his response. I am sure that the people I have met will not be reassured by that response, but it is difficult, with no decision having been made about the reduction in prescription charges. That needs to be done, and the Minister needs to confirm it.

I feel for the many unpaid carers—mostly women—who look after children or partners, given of the impact of this situation on them. People see that as unfair, and the system is not perfect, so we hope that change will come.

Question put and agreed to.

Resolved,

That this House has considered e-petition 594390, relating to prescription charges for people aged 60 or over.

Health and Care Bill

Tonia Antoniazzi Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I will not now, but I may during my wind-up speech, if I have time. I want to conclude my remarks so that colleagues can make their contributions on the matters that I have referred to, but if there is time, I commit to taking an intervention from the hon. Lady at the end of our consideration of this set of Lords amendments.

We come, finally, to Lords amendment 92 and the amendment offered in lieu relating to abortion. I am aware of strong and sincerely and genuinely held views from Members on all sides of this debate and this issue, and I respect the integrity of their views. Although I will set out why the Government took the action that they did and the procedure that is in place, I emphasise at the outset that, given that this matter is before the House because of an amendment by their lordships, it is right that this is properly considered and that this will be—in line with how we normally treat these matters—a free vote, in which how individual Members vote will be a matter of conscience.

In response to the covid pandemic, an approval was issued in accordance with the Abortion Act 1967 that allowed women to take both pills for early medical abortion at home. That temporary measure addressed a specific and acute medical need, reducing the risk of covid-19 transmission and ensuring continued access to abortion services. My right hon. Friend the Secretary of State announced last month that the approval will end at midnight on 29 August 2022.

[Tonia Antoniazzi (Gower) (Lab)]

Does the Minister acknowledge that, in Wales—[Interruption.]—and in Scotland, telemedical abortion will continue to be available to all women after the covid-19 pandemic has finished? To be honest with the Minister, that needs to follow suit in England.

[Edward Argar]

I would not suggest for a moment that Wales or Scotland should follow England or that England should follow Scotland and Wales. They are devolved competences. Each devolved Administration will rightly form their own view of the balance of benefits, the pros and cons, and that is right. That is what our devolution settlement is for. This House is considering the amendment that was brought here from the Lords and this is an opportunity for Members to express their view on what should happen in this country.

The Government remain of the view that the provision of early medical abortion should return to pre-covid arrangements, and face-to-face services should resume, given that the temporary change was based on a specific set of emergency circumstances. However, we recognise that their lordships have made an amendment in that respect and it is therefore right that this House considers it.

In normal times, we prefer and believe that decisions about the provision of health services are more appropriately dealt with through the usual processes, rather than through primary legislation. We have a number of concerns about the approach taken in the amendment. Parliament has already given the Secretary of State a power to issue approvals under the Abortion Act. That allows the Secretary of State flexibility to make decisions about how healthcare in this area is provided, which can be adapted quickly and easily to respond to changes in service provision or other external circumstances, as was the case with the temporary approval in response to concern about the risk to services from covid-19.

From a process perspective, it is not appropriate, in our view, to insert into primary legislation the intended detail regarding home use of both pills. That would mean that should any issues arise, there would no longer be scope to react quickly, as the Secretary of State did during the pandemic. However, we recognise that that is now a matter for debate and decision by this House.

In addition, Lords amendment 92, as drafted by my noble Friend Baroness Sugg, would not have the intended effect. If agreed to, it would create legal uncertainty for women and medical professionals by including wording on the statute book that does not, in fact, change the law in the way it appears to. On a procedural point, we therefore urge all right hon. and hon. Members to disagree with the Lords in their amendment.

All Members have the opportunity, however, to vote on our amendment (a) in lieu, which we have drafted to ensure, irrespective of colleagues’ views, that the provision does the job it was intended to do. We all agree that it is crucial that the law is clear in this area and does not create any uncertainty for those who rely on it. That is why we have tabled our legally robust amendment in lieu, which stands in my name and which would achieve the intended purpose of Baroness Sugg’s amendment.

It is for right hon. and hon. Members, in a free vote, to judge how they wish to vote on the amendment in lieu. I encourage them to reflect and make their decision when the amendment is pressed to a Division.

Abortion Services Commissioning: Northern Ireland

Tonia Antoniazzi Excerpts

Tuesday 14th December 2021 Westminster Hall

[Tonia Antoniazzi (Gower) (Lab)]

It is a pleasure to serve under your chairship, Mr Pritchard. I congratulate my hon. Friend the Member for Pontypridd (Alex Davies-Jones) on securing this timely debate on the commissioning of abortion services in Northern Ireland. I am proud of her work, as my predecessor, for women and girls in Northern Ireland. I will endeavour to do all that I can to support them.

At the beginning of my parliamentary career, I worked as Parliamentary Private Secretary to the shadow Northern Ireland team and was a member of the Women and Equalities Committee. This afforded me the opportunities to work with colleagues in Northern Ireland and to have a greater insight into the inequality of women in Northern Ireland compared with the rest of the UK. I had the opportunity to meet the hon. Member for Belfast South (Claire Hanna) before she was in this place. I remember the conversation well. She spoke today about compassion and learning and that this issue is a journey. I think we all understand what a journey it is for women in Northern Ireland.

Being part of the Women and Equalities Committee when it did the report on abortion law in Northern Ireland gave me an in-depth view of the change that was needed to move forward. I pay tribute to all the organisations and politicians who spoke to us. Moreover, I pay tribute to the women who shared their deeply personal experiences with us as well.

The standpoint of the Labour Front Bench is that these women should have the right to make an informed choice. Any woman who suffers a loss or makes a decision to end a pregnancy should have support services available to them. I was very dismayed to hear that there is an 80% increase in need, and limited funding means that women have got up to a six month waiting list for support. How can this be acceptable in 2021?

I have listened to all of the speakers in today’s debate. It is important that we all understand and are respectful of each other’s views. I was brought up a Roman Catholic and my father was the deputy head of a Roman Catholic school. I had that one-sided view of the right to life. However, as a woman and having been in education for 20 years, I have seen at first hand the pain that girls and women have had to go through. That is why those services are so important. As my hon. Friend the Member for Pontypridd outlined at the start, this is not a debate about the mechanics of devolution; it is a debate about the rights and the duty of this Parliament to uphold the rights of citizens across the United Kingdom. The law is clear: we need to get on with delivering those services.

The hon. Member for North Antrim (Ian Paisley) and the hon. Member for Strangford (Jim Shannon) talked about the views of the people in Northern Ireland. I want to draw their attention to an Amnesty International poll, done by an independent research company in 2020, which

“demonstrates an overwhelming demand for change to Northern Ireland’s draconian abortion laws.”

It is important that we are fair, just and transparent about the data that is out there on the views of people in Northern Ireland.

As my hon. Friend the Member for Pontypridd explained in her excellent speech, the changes to abortion laws extended abortion rights to the women of Northern Ireland. They were made in line with the recommendations of the UN Committee on the Elimination of Discrimination against Women and affording women in Northern Ireland those rights was about aligning abortion policy across the United Kingdom. It was a key moment for us, but little has changed since March 2020 for women in Northern Ireland. This is the title of the debate, and the lack of the commissioning of abortion services in Northern Ireland is having a direct impact on women.

The debate is about the rights of women in Northern Ireland and their right to access basic reproductive healthcare without needless barriers. It is about their right to clear, accurate and impartial advice and guidance about their healthcare choices. There is a worrying lack of impartial guidance, if any guidance at all, on a woman’s right to choice when she finds out she is pregnant. The GP should be women’s first port of call and they do not always get the advice they need there. When women turn to the internet and google abortion services in Northern Ireland, they are led to services that put in delaying tactics, making it impossible for them to terminate their pregnancy if they wish to. It also forces more and more women to purchase abortion pills online. We should not be in that situation. Fortunately, those women are not living in fear of prosecution now when they use that service.

[Ian Paisley]

Will the hon. Lady give way?

[Tonia Antoniazzi]

Unfortunately, I need the time.

The lack of commissioning means that Informing Choices NI has had to withdraw its central access point and BPAS has had to come in to support it as well. Women have a right to have high-quality access services as early as possible and as late as necessary and those rights are currently denied to women because of the inaction of the Northern Ireland Executive, the Department of Health in Northern Ireland and the Secretary of State. It has been nearly two years since those essential services should have been made routinely available in Northern Ireland, but as colleagues have said, the reality for many women is that the change in legislation might as well not have happened.

The lack of funding or a commissioning framework has led to piecemeal service provision, with women’s access dictated by their postcode. Women in the Western Health and Social Care Trust area have had not access to services in nine months and they cannot go to another trust to access services, having to pay nearly €500 privately to go to Ireland or to England and access pills online if it is not too late. What should be a service for all becomes a service for a lucky few: those who can take a hit to their income, take a day off work or travel the hours to access healthcare. That is not fair. The impact of covid has also been felt in service provision and in the travel restrictions.

The reality for women in Northern Ireland is that access to basic healthcare rights is in no way guaranteed. Will the Minister and the Secretary of State for Northern Ireland meet me to discuss an immediate way in which the Government can address the current crisis for women in Northern Ireland? What additional measures will the Executive put in place, especially in light of the new covid variant omicron, to ensure that the provision will be extended and maintained into the new year?

I look forward to hearing what the Minister has to say, because this is a very important issue for women and girls in Northern Ireland.

Health and Care Bill

Tonia Antoniazzi Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Caroline Nokes]

I thank the hon. Lady for using exactly that term because she is right: it is about the NHS picking up the pieces and spending taxpayers’ money trying to correct something that should not have been done in the first place. If it is to be done to somebody, it should be done only by the qualified, trained and, as my new clause argues, licensed. I call today for some form of licensing or regulation. I absolutely accept that the Minister may view my new clause as deficient and not doing what he would want it to do. I appreciate the fact that he took the time to meet me and other Members last week to discuss the issue, because there are concerns throughout the House.

I pay particular tribute to my hon. Friend the Member for Sevenoaks (Laura Trott), who has done so much work on injectables in respect of under-18s and deserves absolute credit for getting her private Member’s Bill on to the statute book. That is amazing work and I really appreciate the fact that she has done it. Nevertheless, we need to do more and to go further.

I pay tribute to a number of my constituents who, following the work I did last year on the beauty industry, approached me on this issue. In particular, I pay tribute to Dr Chris Rennie of Romsey Medical Aesthetics, and to Dr Mitra Najafi, who has developed an incredible process by which plasma-rich platelets are extracted from a patient’s blood and injected back into them. It is a highly medicalised procedure and her big worry is that if it falls into the hands of somebody who is unregulated and unlicensed, it could be extremely dangerous indeed. Those with medical qualifications absolutely understand how they have to treat blood products; the stark reality is that those without do not.

I pay tribute to aestheticians—I struggle to say that word—such as Naomi O’Hara who came to me, as someone who practises, to call for regulation and licensing.

I pay tribute to a lady who is not my constituent but travelled to Romsey to see me: Tania Gough, who publishes the Image Directory. Her concern was that it is perfectly possible for someone to set themselves up in practice with next to no training whatsoever. She spoke to me of some of the horror stories that she herself had seen and some of the training courses she had gone on that she said were quite simply not worth the money she paid for them or the waste of her time. She said that certificates were issued at the end of such courses that gave the impression that people were qualified and trained when in fact they had had no more than a couple of hours—in one case it was 90 minutes—of training.

I also pay tribute to the Chartered Institute of Environmental Health and the Joint Council for Cosmetic Practitioners; they have been incredibly supportive and helpful in the drafting of new clause 1. The Joint Council for Cosmetic Practitioners says:

“The creation of a national licensing scheme for practitioners of aesthetic non-surgical cosmetic procedures would ensure that all those who practise are competent and safe for members of the public.”

To my mind, that is the abiding word: safe. We want those who receive these sorts of treatments not to be putting themselves in harm’s way.

I look forward to the Minister’s response; I know he is listening on this issue. He can expect me not to push my new clause to a vote, but I very much hope he can show us a constructive way forward that may take us to the regime that we want to see.

[Tonia Antoniazzi (Gower) (Lab)]

I could speak about so many aspects of the Bill—such as the U-turn on the social care cap, the lack of action to include health inequalities, allowing private healthcare providers to access our NHS and, frankly, whether a reorganisation of the NHS at this time of crisis is what we need to support all our healthcare workers—but I am sure that colleagues will more eloquently cover a lot of those points in their contributions. As the chair of the all-party parliamentary group on cancer, I will restrict my comments to the amendment on the NHS workforce tabled by the right hon. Member for South West Surrey (Jeremy Hunt).

Staffing is the biggest challenge facing the NHS. The Prime Minister claims to be building 40 new hospitals; if that ever happens, they will be of no use to anyone if there are not the doctors, nurses, radiotherapists, pharmacists, porters, cleaners and other staff to look after patients. As we have already heard, the NHS had 100,000 vacancies before the pandemic started. That, coupled with the intense strain and burnout that staff have suffered over the past 18 months, is causing a crisis in staffing that needs bold action now.

The Budget was a missed opportunity to invest in the people who make the NHS great, but amendment 10 would go some way to rectifying that. According to research from Macmillan, it is estimated that we need an extra 3,371 cancer nurse specialists by 2030—that is a doubling of the number of cancer nurses in just over eight years if we are to have any chance of providing the care and support that patients deserve. Macmillan has worked out that it would cost £174 million to train and develop specialist cancer nurses to plug the gap. Any increase in funding would be passed on to devolved Governments through Barnett consequentials. In the grand scheme of things, £124 million in England, £31 million in Scotland, £12 million in Wales and £7 million in Northern Ireland is not too much to ask of the Government—it is probably in the region of the amount of money spent on security for the Prime Minister’s trip to Peppa Pig World at the weekend.

World Menopause Month

Tonia Antoniazzi Excerpts

Thursday 21st October 2021 Commons Chamber

[Tonia Antoniazzi (Gower) (Lab)]

I would like to commend the hon. Lady for her speech and to commend my hon. Friend the Member for Swansea East (Carolyn Harris) for the excellent work that she has been doing. I also commend everybody in the Chamber this afternoon. I had a very similar experience to that of the hon. Lady at the age of 48 or 49. On the point about prescriptions, we are fortunate in Wales and I did not have to pay for my HRT prescriptions. I would like to give a shout-out to the Welsh Labour Government for looking after women in that way.

[Nickie Aiken]

I thank the hon. Lady for her intervention.

I had a discussion with the Secretary of State for Health and Social Care this week about the costs of HRT and the stresses and strains on the NHS budget following covid, which I understand. With this in mind, will the Minister reiterate to the House the current NICE guidelines and ask NICE to reach out to GPs and encourage them to tell their patients about all the options available to them, as well as any associated costs? I understand that there is a system in place where women can get an annual prescription for their HRT, but there is a lot of confusion about that, so I would appreciate it if the Minister could address that in her summing up.

As has already been said, and I completely agree, the menopause is not just a women’s issue. This is a people’s issue, and men have to be part of the discussion, too. I thank my hon. Friends the Members for Totnes (Anthony Mangnall), for Eastleigh (Paul Holmes) and for Heywood and Middleton (Chris Clarkson) for sitting down with me last week to ask about the menopause—my hon. Friend the Member for Totnes asked, “Will you please talk me through the menopause?” because he knows how important it is—and I gave them a complete and utter description. They were quite horrified, to be honest.

It goes back to what my hon. Friend the Member for Hazel Grove (Mr Wragg) said: men have to understand what their mothers, sisters, partners and work colleagues are going through if we are ever to break down the barriers and make the menopause less of a taboo. I reiterated that to the Secretary of State for Health and Social Care this week, and he agreed with me that men have a huge part to play in breaking down the barriers.

It is important that we consider the workplace. I take my hat off to the likes of Timpson and PwC for their brilliant work. Women, and particularly menopausal women, make up so much of the workforce. I am a woman in the prime of my life and hopefully just beginning my political career in this place. I believe I have so much to offer, and knowing that I have the HRT and the support will help me. We need to ensure that companies focus on developing strategies to help their women, and to help their colleagues to help women through this.

I am proud to support the Government’s ambitious project to set women’s health as a huge priority. We are making women’s voices heard and putting them at the centre of their own care, to make sure that our national health system truly works for the whole nation. I believe the Minister is listening and I look forward to her response.

Medicinal Cannabis

Tonia Antoniazzi Excerpts

Monday 6th September 2021 Commons Chamber

[Christine Jardine]

The right hon. Gentleman makes an excellent point. We do have that overwhelming body of observed evidence of the efficacy of cannabis oil. I have seen at first hand the difference that medicinal cannabis has made to Murray Gray’s life—it has transformed his life. When his mum, Karen, first came to see me, he was a very unwell wee boy who was, as I mentioned, constantly in and out of hospital with dozens of seizures a day, and his family were worried that they could lose him. Since being prescribed cannabis oil, he is seizure-free and a happy youngster who plays football with his dad. When he came to visit me in my office, he explained everything I have ever need to know about dinosaurs. It was a joy to see him so happy. The medication has given him a life that he may not otherwise have had.

It is time for the Health Secretary—just as he did when he was Home Secretary—and his team to intervene to make the case that the medical profession should put its shoulder to the wheel. It is time to close the huge gulf between what the Government promised—and, I believe, wanted—and what has been delivered.

[Tonia Antoniazzi (Gower) (Lab)]

The Secretary of State for Health and Social Care is the best-placed person to move the debate forward, because he was the one in government in the Home Office who changed the law. Does the hon. Member agree that we need action now?

[Christine Jardine]

I agree 100% with the hon. Lady that we need action now—it is actually overdue—and that the Secretary of State for Health and Social Care is the very person who can give us what we need.

Because this is not a political football kicked between party politicians—it never has been and never should be; we have always resisted that—a little over a year ago, more than 100 MPs across the House from the Liberal Democrats, Conservatives, and Labour and Green parties wrote to the former Health Secretary to demand action.

--- Later in debate ---

[Sir Mike Penning]

I completely agree on the medical profession and know exactly where the Home Office stood when I was at the Department. I would love to say that the whole of the Home Office and my civil servants in the narcotics part of it were thrilled by what I said in Westminster Hall all those years ago, but I can assure colleagues that they certainly were not, to say the least; fortunately, I had covered my back with the Home Secretary.

We need to move on from this, however. This is not about reform of the 1971 Act. It is about whether there is a group of children who we know get benefit from this, and whether, as we all know from our constituency postbags, there are other conditions that could also benefit from this type of oil with a THC product in it. That is where we are struggling.

We need to roll back this debate and talk, as I did at the start of my speech, about children—children who deserve the best possible start in life and just happen to have been born with a medical condition that the medical profession, in its infinite and great wisdom, has not quite got an answer for. This product is part of the answer, although it only alleviates the condition. As parents have said to me on many occasions, it does not take away the condition but it does let the children live a life as close to normality as possible; it is not normal, because it involves dropping oil on a little boy or girl’s tongue on a daily basis, but it is as normal as we can get.

[Tonia Antoniazzi]

It was a pleasure to serve with the right hon. Gentleman as co-chair of the all-party group on medical cannabis under prescription. On the point he makes about children, we have Bailey Williams in Cardiff, a constituent of my hon. Friend the Member for Cardiff West (Kevin Brennan), and that case highlights that these children are no longer classified as children after four years; they become adults. Bailey Williams is now 18, and the question arises of how things will change for him in a different health system with different rights. What would the right hon. Gentleman say on that?

[Sir Mike Penning]

The hon. Lady was a brilliant co-chair with me for all those years; we agreed on most things even though there is a tiny number of things we do not agree on. The hon. Lady is absolutely right. I have a constituent who has now turned 18, although it is not the THC but another medical component that particularly helps her. People come out of the care of one part of the health service and there is a little bit of a transition period but there is very little research on the evidential base going forward, and we need to do that research.

Let me touch for a second on what has been said to me by senior medical people in the Department of Health and Social Care. They said, “We need to do trials, Mike. We need to use placebos. We need to find out whether this actually works or whether it doesn’t work.” What parent on this planet is going to take their child off a medication that actually works, with the risk that they may get a placebo, have a seizure and die? Is that where we are in the 21st century, really and truly?

We had a statement earlier from the Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi). We are a world leader in doing medical things. We have done things in this country around the vaccines that no one dreamed possible, yet we are talking about giving placebos—and those people were serious. I can tell the House that the parents were very serious, too. I cannot repeat some of the comments I got from some of the parents, but they quite rightly said—I will speak politely on their behalf—“Not in a million years.” Let us put it in those terms.

I know that the Minister will do her level best, but this is not about the Government taking over Epidiolex. Yes, they need to pay for research—I absolutely agree with the hon. Member for Inverclyde (Ronnie Cowan) about that—and research in this area could change the whole way that pain is addressed and perhaps get us away from using so many opioids, but this is actually just about having trust in the expert who has written the prescription for a child who may well die if he does not get that oil with the THC component on prescription.

[Tonia Antoniazzi]

I am sorry for intervening on the right hon. Gentleman again. The NHS keeps asking experts, but those experts are not experts in medical cannabis; they are experts in the condition of epilepsy but have no insight into that. Where is the foresight and vision to help these children with intractable epilepsy?

[Sir Mike Penning]

I alluded earlier to the narrow-mindedness of people who have taken an oath to protect people and protect children. No one, I would have thought, goes into the medical profession to hurt people, but at the end of the day, we have a group of children—not thousands, but a small group—whose parents are crying out, “Please listen to my specialist. Please listen to me, as a parent trying to save my child’s life.”

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[Jim Shannon]

I thank the hon. Lady for her intervention. That is exactly how I feel, and I think it is exactly how we all feel as elected representatives on behalf of our constituents. I can well recall the bad old days of the pressure that was on the family: the pressure on the parents, the pressure on the child and the pressure on their friends, with all the multiple issues they had to address. There is an evidential base. It is as clear as a bell. I can see it in that wee girl Sophia. I can see it in the improvement that she has quite clearly made. That is why I totally support this product. I believe the evidential base is overwhelming. I can vouch for that, as I see that lovely wee girl and the improvements she has had.

My hon. Friend the Member for Belfast East (Gavin Robinson) sent me a letter, which I will record for Hansard if I can, written by his constituent, a fellow called Robin Emerson, whose daughter is a wee girl called Jorja. There is also an evidential base in her improvement. My hon. Friend very kindly gave me a copy of the letter last week, which refers to

“an important intervention to enable a number of children suffering with epilepsy to receive a treatment containing Cannabidiol (CBD) and Tetrahydrocannabinol (THC). This has made a crucial difference to their quality of life over the past two years”.

In some cases, quite honestly Mr Speaker, I believe they save lives. They definitely do. In my heart I believe that, which is why I am here tonight to speak on this matter. I feel it is so important.

[Tonia Antoniazzi]

I thank the hon. Gentleman for giving way on that point. Does he agree that there is no other medical intervention suitable for these children? It is intractable epilepsy. Nothing else has been found to give them that quality of life. Does he agree that we have to move forward in this debate?

[Jim Shannon]

The hon. Lady is absolutely right: we do have to move forward, and that is the message from us all in the Chamber tonight. I know that Robin, on behalf of Jorja, and Darren and Danielle, on behalf of Sophia, tried almost every other thing that they could before they came to medicinal cannabis, and they have seen the difference almost right away.

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[Crispin Blunt]

I was delighted to take that intervention from my hon. Friend. He is absolutely right: this is about science and technology. It is about finding a route to a Government who can deliver policy based on evidence. We have heard very clearly why randomised controlled trials and placebos are not going to work in this case and are a completely inappropriate way of providing proof, and that there is a vast amount of observed evidence out there. What we need to do is understand the context. The case is unanswerable for these epileptic children—of course it is, and of course their treatment should be should be paid for privately if it cannot be provided by the NHS because all these barriers have appeared—but behind them sit a vast number of other people who are not being served by our system of developing drugs that will work for their conditions.

[Tonia Antoniazzi]

The hon. Gentleman has made some very valid points about the wider issue of drug reform, and I agree with much of what he has said. As he well knows, when I first came to the House the late Paul Flynn, then Member of Parliament for Newport West, was a doughty campaigner for medicinal cannabis. I had many conversations with him about it, and much account was taken of what he said. He advanced valid arguments about people with multiple sclerosis, many of whom were our constituents, and I believe that the hon. Gentleman too has a genuine argument in that regard. Tonight, however, we are focusing on the cost of medicinal cannabis to end the pain of epileptic children, and our real ask of the Government is a fund to provide them with money immediately, although we will work together on the wider debate.

[Crispin Blunt]

I wholly agree with the hon. Lady, whose leadership of the all-party parliamentary group on access to medical cannabis under prescription, along with that of my right hon. Friend the Member for Hemel Hempstead, adds to the whole discussion and illuminates the fact that our drugs policy is in a serious state of strife. It is not based on evidence, and we have to drag it in that direction. Behind the hon. Lady sits my friend the hon. Member for Manchester, Withington (Jeff Smith), with whom I have the honour of co-chairing the all-party parliamentary group for drug policy reform. We took over from the hon. Member for Brighton, Pavilion (Caroline Lucas) and from Paul Flynn. My objective, as the first Conservative to take his place, was to drag this conversation into the mainstream, which is where it belongs.

However, we need to remember just what got this over the line in the first place. The Dingley family behaved perfectly within the rules. They made applications and everything else, and indeed we had an urgent question on the subject. I remember my right hon. Friend the Member for Hemel Hempstead interrogating the then Policing Minister, who had taken on the responsibility, about when this was going to happen, particularly for Billy Caldwell.

What got this over the line, however, was the fact that Bill Caldwell’s mum, Charlotte, was brave enough to obtain the medicine in north America, present it to customs and have it confiscated. Her son was then hospitalised and was fitting, and within three days the overseeing consultant was on the steps of the hospital saying, “I do not care about what is going on here; it is unbelievably cruel to take a medicine that works away from a child.” The following day, the then Home Secretary—now, wonderfully, the Health and Social Care Secretary: what a brilliant repositioning that is—authorised the return of Billy’s medicine, or at least some of it, from customs so that he could receive his treatment.

[Crispin Blunt]

This is where we come to the cost, to which the hon. Member for Gower (Tonia Antoniazzi) drew my attention. In order to get Alfie Dingley’s prescription over the line, it would have taken £5,000 for the person who was going to make the application, who happened to be on holiday in the Galapagos Islands and who then had to be interviewed by Home Office officials before he was allowed to make the application; £5,000 for the pharmacy to get a licence to bring it in; £5,000 for the pharmacy then to hand it out to the doctor; and then £5,000 for the licence for the prescribing doctor. I mean, I ask you! It might have been possible to pay in that case, but behind the case of Alfie Dingley, there is not just a score of epileptic children.

[Tonia Antoniazzi]

On that point, I made two journeys to The Hague with families—out of my own pocket, which was absolutely fine; it was not funded by anybody—because they needed the support to go over and get those medicines. They do not have the extra money and they do not have the time, which is why we stand by them and why we have to help them.

[Crispin Blunt]

The hon. Lady has behaved as the best of constituency MPs would. Indeed, I am sure that all of us, faced with the opportunity to help people in that way, would want to do so.

I say to my hon. Friend the Minister that, despite the legalisation in November 2018, the system remains broken. It remains broken in respect not only of cannabis but of the psychedelics. A wave of interest came into medicine as a result of cannabis; it came from North America where a significant amount of investor money was going into the new industry because people could see the opportunities that were available there. However, we could not do the research here because it was a schedule 1 drug, and hardly any universities had a schedule 1 licence to do that research. The level of oversight was far greater than that for heroin, as the hon. Member for South Antrim (Paul Girvan) said, so it is no wonder that there has been almost no research on all this down the decades.

As far as I can see from the 1960s, the psychedelics got shoved into that group as well because pop stars used them. Then, in 2008, we managed to dismiss the chairman of the Advisory Committee on the Misuse of Drugs because he had the presumption to say that riding a horse was a damn sight more dangerous than MDMA. That is what we do to the scientists who produce the evidence: we refuse to listen to the evidence because it will be politically inconvenient and subject to misrepresentation in the media. We owe our constituents way more than that, and it would be remiss of us if we do not examine this whole area on the evidence. I implore my hon. Friend the Minister to listen to it.

I have spoken about MS, and the hon. Member for South Antrim and others have referred to pain relief. As an alternative to opiate-based medicines, given all the difficulties of the opiate crisis in the United States, cannabis-based medicines offer a serious group of advantages if they can be deployed properly. Meanwhile the psychedelics still sit in schedule 1, making research incredibly difficult and expensive.

Let us consider depression, addiction and trauma. Of the veterans who have come back from their service in Afghanistan and Iraq in recent years, 7,500 have post-traumatic stress disorder, about a third of whom are beyond treatment within the current treatments available. However, the evidence is that the prescribed and overseen use of psychedelics can get to the relevant part of the brain and enable the psychotherapy to take hold and teach people to acquire the tools with which to manage and deal with their trauma. That can also work for depression and addiction. We are potentially talking about millions of people, if we enable the research to happen. Are we a country that will be on the frontline of bioscience? Are we serious? There is an opportunity for our pharmaceutical industry to get this to scale, and millions of people can be helped.

A huge cost is currently imposed on our economy by these medical conditions, so surely it makes sense to enable my hon. Friend the Under-Secretary of State for Health and Social Care, as Minister for medicines, to draw on evidence-based advice. Sitting alongside the MHRA ought to be some kind of cannabis authority, as has been done in Denmark, Holland and Germany, for Ministers to get the advice they need to be able to advance policy confidently, and it needs to be within a wider office for drug control that engages all the relevant Departments. A Department of Health and Social Care lead would be good, but a Cabinet Office lead that brings together everyone who has an interest in this area would be a fine thing, too.

[Crispin Blunt]

I largely agree with my hon. Friend, apart from on the views he imputed to me. He decided what my views are on the legalisation of drugs, but I simply want policy based on evidence.

All I will say is that the current situation is a catastrophe, not just here but around the world. It is the basic reason why we were run out of Helmand province. The farmers around Didcot were growing poppies for the legal medical morphine market, but we did not allow the farmers in Helmand to grow poppies, so they were driven into the heroin market. We then decided to go and burn their crops, reducing them to penury. And we wonder why they changed sides and were against us. We were run out of Helmand, even with 20,000 American troops coming to the aid of our soldiers.

This issue permeates the world. It is a global issue. We simply need to proceed on the basis of the evidence, so we need to create the institutions that can give us that evidence. There should be an office for drug control, promoting all the science and bioscience of which this country should be capable, within which ought to be a cannabis authority of some kind that could give the Minister and her colleagues the advice they need. The opportunity for the Department of Health and Social Care is huge, and the opportunity for the Department for Business, Energy and Industrial Strategy in sponsoring our science is enormous. The opportunity for the Treasury is not exactly minuscule either, and there is an opportunity for the Home Office to have a policy that contributes to the whole of the public interest, not just a very narrow part of it that has done so much damage. The policy of preventing things from happening has been in the lead in the drugs policy area, so this proposal is long overdue.

I beg the Minister to have this discussion with me and the think-tank I have established. I have no financial interest to declare, as I take nothing from the Conservative Drug Policy Reform Group. I set it up to give me research and scientific evidence on which to help advance these arguments. I am passionate about this issue, and it is one of the issues on which I wish to use my remaining time in public life. Having seen what I have seen as Prisons Minister and in my own experience, I know the opportunities are as great as the opportunity to end the terrible mess of our wider drugs policy. If we can grasp the science opportunity, the medical opportunity follows. There would be a huge advantage for patients in the United Kingdom.

[Tonia Antoniazzi]

The work the hon. Gentleman does with his think-tank is brilliant. How much would this cost? How much does he think the Government need to put aside—we are talking about the cost of medicinal cannabis—to reform policy? Are there any figures? Are there any plans to put that in place?

[Crispin Blunt]

The machinery of government changes can be made at very little cost. This is about getting the right advisers and the machinery of government advice. Obviously, we would then have to recruit the people into the cannabis authority who understand the issue, and allow them the authority and space to be able to advise Ministers and the office of drug control. However, the up-front cost would be minimal. The opportunities and the number of people we can really help by having far better drug provision in the UK are huge. All of us have a duty to engage properly with that and to be able to disaggregate all the issues and negative connotations associated with the use of cannabis and heroin. Let us focus on the evidence and get this conversation into the mainstream as a means by which we can make huge advances for our country. I look forward to the ongoing conversations with the Minister, who as the Minister for medicine could make a huge impact if she were able to deliver on this part of her agenda.

[Ronnie Cowan (Inverclyde) (SNP)]

Thank you very much for calling me, Mr Deputy Speaker. I just jumped up quickly before you changed your mind! [Laughter.]

I thank the hon. Member for Edinburgh West (Christine Jardine) for securing this debate, which has been great; we were looking forward to a 30-minute Adjournment debate, a battle through and a quick exchange of views, but because nobody cares that much about national insurance contributions amendments, we have been given this extra time. I will not take too much more, because a lot has been covered by the previous speaker and there is no point going over old ground. I would genuinely like to say that at 9.10 on a Monday evening there is nothing I would rather be doing on my birthday than fighting the cause of something I truly believe in.

On 19 March 2019, the then Secretary of State for Health and Social Care said that medical cannabis “would be made available”. If I had heard those words as the parent of a child who would have benefited, I would have been thinking that it was going to be made available. I would not be expecting to jump through hoops or to have to raise thousands of pounds to pay for it. My hopes would have been raised. A child with such a condition would, typically, have 30 seizures a day and so over 900 days we are talking about 27,000 seizures. If they had had medical cannabis, we could be talking about zero seizures. However, it will be made available some day. After this time, the general frustration in this Chamber is, “Why are we still talking about it?” We have said this a number of times in Westminster Hall, and here and there, and we know everything that has been said today.

I am genuinely glad that the Minister has informed us that we are now manufacturing some of these medicines here in the UK, as that is a big step forward. However, we are still reliant on private prescriptions and, as was pointed out earlier, the main provider of those is about to retire. Yet again, if I was a parent in that situation, would the sword of Damocles not be hanging over me? This is the same idea as what happened when we left the EU—we could not get the medicines in and we had to have an extension to January, to July and now to next year. That is a ticking timebomb hanging over those young lives that we just do not need to have there. The long and short of it is that people who cannot afford it or cannot raise the funds for it—during covid, raising funds for many a charitable cause has been incredibly difficult—simply go without. They go without and so there are 27,000 seizures because they have to go without a medicine that they know is available and know would do the job for their child. It should not be this way. In less time, we have developed, tested and rolled out a covid vaccine throughout the United Kingdom. The vaccine did not exist, it had to be tested, and we have done it. It concerns me that these kids are less of a priority.

What are the UK Government going to do? How will they finally going create a legal framework in which GPs are comfortable writing prescriptions for cannabis-based medical products? If we could do that, it would be a game-changer. I am not playing politics with this issue, but I have contacted the Scottish Government, and in Scotland if people get an NHS prescription, the Government will pay for it. The same thing has to apply down here, so let us facilitate that. Let us go to doctors, explain what it is we are asking them to do and give them the confidence to stand up and do it. If a senior clinician can do it, a GP can do it.

[Tonia Antoniazzi]

The point the hon. Gentleman is making is really interesting. With covid, we have seen so many families really struggle and their children have been hospitalised—we are talking about such vulnerable children—so his point is so valuable. I thank him for all his work on this issue because together, across party lines, we will take this issue forward.

[Ronnie Cowan]

I thank the hon. Lady very much. The point that this is very much a cross-party issue should not be missed. We are not going to split down party lines or fall out over this. We will fall out over other things—I am absolutely sure of that—but this issue has strong cross-party support. I look around the Chamber at the Members present and I know the different politics we have, yet we are united behind this cause. The Government should take real note of that. I know they have a working majority of 80 or so, but people in the Conservative party are rightly backing this issue.

I shall not keep the House any longer. I fully acknowledge that the past 20 months have been incredibly demanding for the Department of Health and Social Care. We all get that—we all appreciate what has been done during that time—but the time for talking is well and truly over and the time for action has well and truly arrived.

--- Later in debate ---

[Jo Churchill]

Not no more, but I understand where his passion comes from.

I can also see in their places the hon. Member for Manchester, Withington (Jeff Smith)—we have spoken about this matter—and my hon. Friend the Member for Reigate (Crispin Blunt).

At the heart of this debate for me are Alfie; Billy; Eddie Braun, who was not mentioned; Murray; Jorja; Maya; Bailey Williams, mentioned by the hon. Member for Gower; Sophia; and others. It is about those children. I have personally met several of the families and heard at first hand how it feels not to be able to have anything more. To be honest, as a mum of four, I can say that sympathy feels a bit useless when it comes to a mother who, in some cases, can watch their child fit 100 times a day. They have explained to me the relief that applying Bedrolite under the tongue brings to their children. They have spoken about the financial challenges, but I would like to use the time available to go over some of the challenges that I am trying to wrestle with to get to a solution.

We have had an accordion debate tonight. Initially, the hon. Member for Edinburgh West said that this debate was about access to NHS prescriptions. However, many others also spoke about how much this might benefit multiple sclerosis sufferers and those with chronic pain. Indeed, Lord Field in the other place has written to me on this subject and spoken about the relief of chronic pain that I think he himself gets from using a cannabis-based product. However, there does have to be an evidence base that is more than observational.

[Tonia Antoniazzi]

There has been a lot of talk about randomised control trials this evening, and I understand the difficulty that the NHS has with this. We have had numerous meetings with NHS England and with pharmacists on this. The issue is that the RCTs are a no-goer. They are just a no-goer. I would never take my child off a drug if I knew that it could possibly kill them in order to enable the NHS to prescribe. We have to overcome that hurdle. I would like to see a push from the Minister to make that change happen. We have seen it with covid and we have seen it with the vaccine. What the NHS has done is incredible. I would really love to have the Minister onside to be able to push the NHS forward to change its mind over the RCTs.

--- Later in debate ---

[Jo Churchill]

I agree that there are other medicines, but one of the challenges is how we treat people with ongoing needs as their conditions vary, if we do not have the ability to understand how the body is responding.

I will push on a little bit. Let me provide an update on Bedrocan oils from the Netherlands. As stated previously, the commercial agreement between Transvaal Apotheek and the UK special medicines manufacturer, Target Healthcare, is progressing. The Medicines and Healthcare products Regulatory Agency and the Home Office are working with those companies to ensure that all regulatory standards for manufacturing these medicines in this country are met. We continue to work closely with the Dutch Government, Transvaal, the Home Office and the MHRA—which I have met with and which says it will look at the international evidence—to ensure continuity of supply until domestic production has been established. We have had movement; I can sense the frustration in the House tonight, but we are moving forward. I will continue to keep the House informed of progress.

On the main topic of the debate, it is undeniable that it is incredibly hard for many of the patients and their families. As many Members have said, the challenges have done nothing but worsen during the covid-19 pandemic. The Secretary of State for Health and Social Care, my right hon. Friend the Member for Bromsgrove (Sajid Javid), when he was Home Secretary, changed the law to allow unlicensed cannabis-based products for medicinal use to be prescribed by doctors on the General Medical Council’s specialist register. This removed legislative barriers to legitimate use as a medicine. However, there is still caution across specialists in their ability and willingness to prescribe. [Interruption.] Indeed. However, with respect, if the prescribing of these medicines by a clinical specialist was that seamless, we would have more of it, but we do not.

The whole thing comes back to the fact that clinicians want to rely on an evidence base, and that includes clinicians in Scotland. We recently received a letter from the Scottish Government, outlining that Dr Rose Marie Parr, former chief pharmaceutical officer, had chaired a teleconference with key paediatric neurologists from specialist centres. The clinicians had a clear and united view that, following the GMC and British Paediatric Neurology Association guidelines, they would be unwilling to prescribe CBPMs containing THC, including Bedrolite, until there is clearer, published evidence available following a clinical trial.

[Tonia Antoniazzi]

rose—

[Christine Jardine]

rose—

[Jo Churchill]

All three Members rose at the same time. I will make my next point before I take interventions.

While the evidence base remains limited, I am sure that everybody, including clinicians in this place, will agree that decisions on whether to prescribe, as with any other medicine, have to remain clinical decisions. A doctor would not appreciate me in their consulting room telling them that they did not know their job as a doctor.

[Tonia Antoniazzi]

I thank the Minister for giving way again. I would just like to point out to her that that is not the case. There are three NHS prescriptions. If the law was changed, why are there those three NHS prescriptions? Either these medicines are safe or they are not. They must be safe. I understand what she is saying about the clinicians, but let us look at the risk-benefit for the particular group of children we are talking about. We know that “First do no harm” is how our clinicians treat their patients, but they have to move forward. Hannah Deacon is a classic example. She is continuing to campaign because she sees the unfairness and injustice that Alfie has his prescription but other children do not. Please, Minister, help us to move this debate forward.

[Jo Churchill]

Hannah has said those exact words to me. That is why I say that we have to look at this in a selection of doable, achievable pieces, because it is not possible to look at it for every condition. We are talking about those children with refractory epilepsy, and trying to find solutions there is my main focus currently.

--- Later in debate ---

[Sir Mike Penning]

rose—

[Tonia Antoniazzi]

rose—

[Jo Churchill]

I will give way first to my right hon. Friend.

[Jo Churchill]

I thank my right hon. Friend. I have met clinicians, as well as the families. Like just about every other area of medicine, there is divergence in how they approach it. There are those who prescribe and those who do not. I have also spoken to Alfie’s general practitioner, who was very articulate in describing the benefits that Alfie saw from taking medicinal cannabis. However, it is still fundamentally the decision of the clinician who has the child as the patient. One thing that has been said to me is that it is important, as we try to move forward and do better, to ensure that private specialists also have conversations with those who are treating the children for other issues in their NHS care, because of contraindications and so on, as was referred to earlier.

[Tonia Antoniazzi]

I thank the Minister for being so generous with her time. The right hon. Member for Hemel Hempstead (Sir Mike Penning) has made a real point about there being a culture of fear within the NHS and with clinicians, who are too scared to prescribe because they do not know what the consequences are. The Minister has a role to play here in enabling them to have the confidence to prescribe and work with the drug that we refer to as cannabis. In this House, we should not be using the word “cannabis”, because it strikes that fear into the hearts of many, many people across the UK. Most other drugs have a single active ingredient; medical cannabis has many. If the Minister does not accept that randomised control trials are not applicable, we are in a Catch-22 situation and we are forever stuck. This is not acceptable.

[Jo Churchill]

I do not believe we are stuck, but we should proceed with caution. I think that is a totally acceptable way to go on. I think it was the hon. Member for Edinburgh West who asked why it is any different from insulin or the other drugs she listed. It is different, so we must proceed with caution.

--- Later in debate ---

[Jo Churchill]

I am obviously very cognisant of the latter point, and my right hon. Friend the Member for Hemel Hempstead mentioned a court case. This adds to the need to find solutions to the problem. On adult steroids, that is a clinical decision by a doctor, and my hon. Friend would not expect me to comment on that, because we are dealing here with incredibly poorly children, and our heart goes out to them.

[Tonia Antoniazzi]

rose—

[Jo Churchill]

The hon. Lady is looking at her phone intently and jumping up again, so I will give way.

[Tonia Antoniazzi]

I thank the Minister for her generosity in giving way, and she is right that I want to make yet another observation.

One of the reasons why we all came into this House was to make change happen, and I know the Minister feels exactly the same. Maybe her hands are tied, but under the Health and Social Care Act 2012 the Secretary of State has the power to commission an investigation and research into new medicines. End our Pain has shown this to her officials several times; it has even been cited by a Queen’s counsel, whose opinion is that this is possible. This would be a great way to run an observational trial at no cost to parents; why will the Minister not take this option?

[Jo Churchill]

It is not in my gift to take that option, but I will take that comment back to the Health Secretary and have further discussions. As I said, in our very first meeting he highlighted this as an area where he wanted to see movement, and we are determined to get some movement.

We need the evidence base and we need trials to be ongoing to help inform future commissioning decisions. NHS England has also established a patient registry to collect uniform outcome data from licensed and unlicensed products. The refractory epilepsy specialist clinical advisory service has been established to provide expert impartial advice for clinicians treating complex cases while we await the outcome of clinical trials.

I hope I have managed to convey how committed I am, because I do believe that we ought to be able to find the solution for these children, and I was very aware of the hon. Lady’s point about what happens when they reach adulthood. My right hon. Friend the Member for Hemel Hempstead has spoken to me about the fact that as children move through and medicines gets better they thankfully survive longer, but then we have the added complexity of having to look at the system, which is why we want to make sure we find a solution. Finding the right solution is what we are after, because it will take time to generate further evidence and see the results of clinical trials. I do understand, however, that patients and families continue to access these medicines privately, and that the cost of doing so is very high. There are no easy or quick solutions, but I am committed that the Department will reconsider what action the Government may reasonably take with regard to access to unlicensed cannabis-based products for medicinal use where clinically appropriate.

The health of the children and adults dealing so courageously with these difficult-to-treat conditions is of paramount importance. I think it was Hannah who said to me that for every time Alfie does not end up in hospital having fitted repeatedly, there is a saving to the system.

Cervical Screening

Tonia Antoniazzi Excerpts

Monday 19th July 2021 Westminster Hall

[Tonia Antoniazzi (Gower) (Lab) [V]]

I beg to move,

That this House has considered e-petition 317336, relating to cervical screening.

It is a pleasure to serve under your chairship, Mr Pritchard, for this really important debate. I apologise for not being able to be there in person today, but I thank the House for these hybrid proceedings because I was pinged last week.

I will begin by putting on the record my huge thanks to Caitlin, who is Fiona’s sister, for speaking to me last week about Fiona’s case and the way that it has affected her whole family. I also thank Fiona’s friends, Melissa Macdonald and Niamh Foley, who started the petition, and all those who have signed it, which led to this debate being held today.

As a woman, I know that we all sort of dread getting the call-up for our smear test. For most women, it is not painful, but it is uncomfortable and awkward. What can someone even chat about when the nurse is having her little look? But why should it be like that? We have all been there; the nurse has seen it all before. It is just not spoken about, so we feel a sense of shame about it. It is time we stopped being so coy about it, because that may well persuade more women to go for screening and ultimately it may save lives.

Cervical cancer is one of the most common cancers in women under 35, and 99.7% of cervical cancers are caused by human papillomavirus, or HPV. In recent years, testing for HPV has meant that it is easier to identify who is at greater risk from cervical cancer at the earliest stage.

During covid, England had an attendance rate for smear tests of 72%, which means that more than one in four women are not going for screening when invited to do so. The wonderful charity Jo’s Cervical Cancer Trust has a number of ideas to increase the uptake of smear tests, and I suggest that the Minister meets it to discuss ways of increasing the number of women being tested; I know that she has a keen interest in women’s health.

I was really moved when I spoke to Caitlin, because I got a real sense of how difficult it must be to lose a sister, especially at such a young age. Fiona was only 30 when she died. She was married to Andrew and was the mother of two young children. When Fiona died, Ivy was only four and Harry had just turned two. As Caitlin said, Fiona used all her strength to stick around for Harry’s second birthday.

Fiona was called for her first smear test in 2015, but she was pregnant with Ivy and so was told not to go. When she was called again, she was pregnant with Harry, but there was no follow-up to the first appointment. Fiona never received a reminder to go to her smear test in the interim. This situation is not about someone missing appointments when called to attend them; Fiona went to every appointment that she was meant to go to.

Fiona’s cancer was finally diagnosed after a routine smear test in 2018. She did not have any symptoms, but there seemed to be a lot of hold-ups and delays before her cancer was diagnosed. Caitlin mentioned that it could perhaps have been because of Fiona and Andrew moving from England to Scotland that Fiona received her first invitation. That raises questions about communications between the devolved Administrations and about what procedures are in place to make sure that communication between different trusts and devolved countries is clear.

A hysterectomy was performed and Fiona then went through chemotherapy and radiotherapy as a belt-and-braces approach to dealing with the cancer. After that, Fiona had a number of visits to A&E, including one where the doctor later admitted that she knew the problem was cancer and not a hernia, but did not say anything as Fiona was seeing a specialist soon after.

Most of us are not medical experts. We rely on doctors to tell us the truth because we do not know what is going on, and that vulnerability is really exposed when we hear such stories. I know it is extremely rare to hear stories such as Fiona’s, and the vast majority of our doctors, nurses and other health service staff really care, but it is shocking none the less.

Before covid hit, cancer services were already struggling due to severe staff shortages. Despite the incredible efforts by staff, a backlog has built up. Relying on current staff, who again have not had a pay rise, to clear the backlog on top of delivering regular services will only lead to burnout. It is just not sustainable. Research from Macmillan Cancer Support in 2017 showed that 2,500 specialist cancer nurses were needed to maintain cancer services. By 2030, we will need 3,700 new nurses—an increase of 124% on 2017 levels. Those figures will also have been hugely impacted by the pandemic. The Government have come forward with their own cancer workforce strategy, which is inadequate, and I implore the Minister to reconsider the plans that they have and come up with something that will really help those living with cancer.

Everything that happened to Fiona came before the pandemic hit last year. We have heard countless times about the delays in diagnosis and treatment that the last 16 months has caused. Approximately 1.5 million smear tests take place every year. With the pressure on the NHS since March 2020, that could mean 1.5 million women missing out on a vital tool in diagnosing cervical cancer.

We know that the rates of covid infection are on the up. Hospitalisations for covid are rising, and some NHS trusts across the UK are already cancelling operations as they are at capacity. The recklessness of so-called “freedom day” in England and the removal of all the measures that have been in place to keep us safe is therefore unbelievable. Putting the immunosuppressed at risk, such as those going through cancer treatment, is downright dangerous, and I am glad that the devolved nations have taken a more cautious approach.

What will the extra pressure on the health service mean? Another delay in getting a smear test. And what will that do to the outcomes for so many young women? What will the Government do to make sure that those women who miss out are not left behind, and to stop a knock-on effect on testing? We are looking at new ways forward. Fiona’s case has highlighted some of the gaps that were there before the pandemic started, and things have only deteriorated since covid hit. We must work together to make sure that cancer services are the best that they can possibly be, and that our cancer workforce is protected and given all the tools that it needs to continue to save lives.

When Fiona got really ill, her daughter Ivy used to ask why mummy had to spend so much time in bed. To stop another family having to answer those questions, I want the Minister to answer the questions that Fiona’s family and friends, and all of those who have lost someone to cervical cancer, need answers to. What procedures are in place to make sure that women like Fiona do not fall through the cracks? How does that work across the devolved nations? What is the current screening backlog? What plans to increase the cancer workforce are currently in place?

Caitlin finished our meeting by saying that any change that could come from this debate—if one life is saved, or if one family does not have to go through what her family have been through—would make it worth it.

[Mark Pritchard (in the Chair)]

Before I call John Lamont, I have to say that even though the attendants have been fantastic in helping with the air conditioning, it is still very warm, so if hon. Members want to remove jackets, they should feel free.

--- Later in debate ---

[Tonia Antoniazzi [V]]

I thank the Minister for her response. I also thank the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont) for his contribution. As Andrew Mathewson’s MP, he made a heartfelt contribution on behalf of Fiona’s family and all her friends. In the really powerful and very personal speech of my great friend, my hon. Friend the Member for Pontypridd (Alex Davies-Jones), we heard about the serious risks that missing a screening can cause. Her story is a stark reminder of the importance of keeping appointments and being tested regularly.

The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) touched on many of the groups that are less likely to attend their appointments and the Government’s duty of care to improve messaging to those in harder-to-reach communities. In fact, in her intervention on the Minister, my hon. Friend the Member for Pontypridd highlighted the fact that non-binary and trans men should not miss their cervical screening appointment, and that it is important to record biological sex on medical records to ensure that that does not happen.

The hon. Member for Strangford (Jim Shannon) was very clear in his message that screening is not a test for cancer but a test to prevent cancer. That is a really important message to get across to all women. My hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) highlighted the fact that not one trust in England achieved 80% coverage of the test. He highlighted the work of Hologic, a cutting-edge company in his constituency that specialises in high-volume population screening. We need to take full advantage of that resource when beating cancer.

I echo the call of the hon. Member for Central Ayrshire (Dr Whitford): if you have vaginal discharge or bleeding, go and see your GP—not your MP—and do not wait for an invitation. She also mentioned the 30% to 4.5% reduction as a result of the HPV vaccine. She noted the difficulties that physically disabled people have in attending their cervical smears. The Minister spoke about the self-sampling project that is going to be rolled out nationwide, which is going to be key to getting as many women as possible to attend cervical screening tests. My hon. Friend the Member for Nottingham North (Alex Norris) drew on his vast knowledge of health issues and made a powerful case for building back better our screening capabilities and using all of the available technological advances that have been mentioned today.

In conclusion, I thank the Minister for her comments. I am glad that Members, cross-party and from all of the devolved countries of the UK have been able to discuss this issue sensibly. The bottom line is that we must improve take-up and we must talk about it, because screening saves lives.

Question put and agreed to.

Resolved,

That this House has considered e-petition 317336, relating to cervical screening.

Covid-19 Update

Tonia Antoniazzi Excerpts

Monday 17th May 2021 Commons Chamber

[Matt Hancock]

My hon. Friend makes an incredibly important point that we cannot stress enough. We all, especially developed countries, have a role to play in making sure that we get the vaccines around the world. The UK approach is focused on outcomes and on getting as many people as possible vaccinated globally. The best way to do that is to allow the work that we have done here—the research and the proving of the Oxford-AstraZeneca vaccine—to be replicated and manufactured everywhere at cost. That is a better approach because it protects future intellectual property values and allows for the research money to go into new vaccines and variant vaccines. It does not undermine the system of intellectual property, which is the underpinning concept of all pharmaceutical development, yet at the same time it makes sure that we get people vaccinated around the world. This country should be incredibly proud that we have helped vaccinate over 400 million people, with many hundreds of millions more to come.

[Tonia Antoniazzi (Gower) (Lab)]

On Saturday, my friends and I put on our trainers and walked 26 miles in Gower to raise a bucketload of cash for the fantastic breast cancer charity Walk the Walk. As chair of the all-party parliamentary group on cancer, I know only too well the devastating impact that the pandemic has had on cancer services. One of the key ways in which the Secretary of State can help with the Government’s goals to recover from the pandemic is by ensuring that we have enough well-trained and motivated NHS staff now and into the future. What discussions has he had with the Treasury to ensure a comprehensive, multi-year funding settlement for the NHS in the autumn spending review? Will he meet me and Macmillan Cancer Support to discuss this urgent matter?

[Matt Hancock]

I am always very happy to meet the hon. Lady, who works incredibly hard on this topic. I am delighted to say that the recovery of cancer services is going well and that in many of the centres, the rate of diagnosis, testing and surgery is above 100% of 2019 levels. That is very important. Of course, we are working towards the spending review. The NHS has a long-term baseline settlement, but on top of that we are putting extra money into the recovery that she rightly champions. I would be delighted to talk to her more about it.