Tobacco and Vapes Bill

Alex Cunningham Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Victoria Atkins]

I thank my hon. Friend for bringing the City of Westminster right into the Chamber. There are, in fact, five times more people in England today smoking non-cigarette tobacco, which includes cigars and shisha, than there were a decade ago. Worryingly, the greatest increase is in young adults. That is why we have said that tobacco in all its forms is a harmful product, and that we therefore wish to ensure we are consistent in the policy and the messaging that this is about helping young people to stop the start.

[Alex Cunningham (Stockton North) (Lab)]

rose—

[Rachael Maskell (York Central) (Lab/Co-op)]

rose—

[Victoria Atkins]

I am going to make some progress and then I will give way.

As I have said, the tobacco industry questions the necessity of the Bill on the grounds that smoking rates are already falling. It is absolutely correct that smoking rates are down, but as I said, there is nothing inevitable about that. Smoking remains the largest preventable cause of death, disability and ill health. In England alone, creating a smoke-free generation could prevent almost half a million cases of heart disease, stroke, lung cancer and other deadly diseases by the turn of the century, increasing thousands of people’s quality of life and reducing pressure on our NHS. An independent review has found that if we stand by and do nothing, nearly half a million more people will die from smoking by the end of this decade. We must therefore ask what place this addiction has in our society, and we are not the only ones to ask that question of ourselves. We know that our policy of creating a smoke-free generation is supported by the majority of retailers, and by about 70% of the public.

The economic case for creating a smoke-free generation is also profound. Each year smoking costs our economy a minimum of £17 billion, which is far more than the £10 billion of tax revenue that it attracts. It costs the average smoker £2,500 a year—money that those people could spend on other goods and services or put towards buying a new car or home. It costs our entire economy by stalling productivity and driving economic inactivity, to the extent that the damage caused by smoking accounts for almost 7p in every £1 of income tax we pay. As Conservatives we are committed to reducing the tax burden on hard-working people and improving the productivity of the state, which is why this Government have cut the double taxation on work not once but twice, giving our hard-working constituents a £900 average tax cut. That is a moral and principled approach.

Having celebrated the first 75 years of the NHS last year, I am determined to reform it to make it faster, simpler and fairer for the next 75 years, and part of that productivity work involves recognising that we must reduce the single most preventable cause of ill health, disability and death in the UK. This reform will benefit not just our children but anyone who may be affected by passive smoking, and, indeed, future taxpayers whose hard-earned income helps to fund our health service. Today we are taking a historic step in that direction. Creating a smoke-free generation could deliver productivity gains of £16 billion by 2056. It will prevent illness and promote good health, help people to get into work and drive economic growth, all the while reducing pressure on the NHS.

[Alex Cunningham]

Of course, the tax burden is the highest it has been for some considerable time. I welcome the Bill, but the Khan review estimated that the Government’s smoke-free ambition would not be fulfilled in poorer communities until 2044, and there are many such communities in my constituency, so how will the Bill tackle that issue? Will it really be another 20 years before we see a result in poorer communities?

[Victoria Atkins]

No, because, as I have said, the modelling suggests that among the younger generation smoking levels will be close to zero by 2040. As for the hon. Gentleman’s point about tax, I do not remember him voting against the Government’s furlough scheme and other support during covid; nor do I remember him complaining that we were trying to help people with the cost of living. We as Conservatives understand that this is sound money, rather than the magic money tree that will somehow fund Labour’s £28 billion black hole.

--- Later in debate ---

[Alex Cunningham (Stockton North) (Lab)]

I draw attention to my role as a vice chair of the all-party parliamentary group on smoking and health, an APPG that supports this Bill and in particular the commitment to creating a smoke-free generation by raising the age of sale for tobacco. This will be the most impactful public health intervention since the introduction of smoke-free legislation under the last Labour Government. The Bill is particularly welcome after years of Government inaction on tobacco, which has put us well behind schedule for achieving the Smokefree 2030 ambition. According to Cancer Research UK, we are currently not on track to be smoke free until 2039, which is almost a decade later than planned, and it will be even later for the most deprived.

I welcome the new funding committed to local tobacco control activity and national mass-media campaigns, which will go some way towards fixing the damage done by more than a decade of cuts to public health funding. Those cuts have fallen disproportionately on local stop-smoking services, which are a vital component of our strategy for reducing smoking rates. I am pleased that the Government have now recognised the importance of such services.

Since the legislation to raise the age of sale progressively by one year every year was announced, tobacco manufacturers have argued that it will be burdensome to business. They have also paid for advertising urging retailers to lobby against the legislation. Despite this, a survey by NEMS Market Research for ASH shows that more than half of a representative sample of retailers are supportive of such action, compared with only a quarter who are opposed.

Of course, the tobacco industry has form on trying to use retailers to lobby against tobacco laws. The Tobacco Retailers Alliance, a trade body 100% funded by tobacco manufacturers, funded the “save our shops” campaign against the display ban and the “no to plain packs” campaign against standardised cigarette packaging. Both campaigns used exactly the same argument now being used to campaign against raising the age of sale: that it will put a terrible burden on small businesses, that it will be impractical to implement and that it will increase illicit trade. Both campaigns were exposed as being fronts for the tobacco industry, and the subsequent legislation was successfully implemented by retailers. Indeed, a 2022 survey by NEMS Market Research for ASH found that the vast majority of small retailers report no negative impacts on their business due to the display ban or plain packs.

My region, the north-east, has been hit particularly hard by the tobacco epidemic, with 117,000 deaths from smoking since the turn of the century and thousands more added each year. That is not to mention the thousands more living with tobacco-related illnesses. As in every other region, this suffering is concentrated in the most deprived groups and areas. Although around 13% of adults in the north-east smoke, the figure rises to 21% of adults in routine and manual occupations, 28% of adults in social housing and 41% of adults with serious mental health conditions.

In the north-east, we are fortunate to benefit from the incredible work of our regional tobacco control programme. Fresh was set up in 2005 in response to our region having the country’s highest smoking rates. As a result of dedicated and sustained collaboration and investment from local authorities and the NHS, smoking rates have fallen further and faster in the north-east than anywhere else in the country—13.1% of the adult population now smokes, compared with 29% less than 20 years ago. The north-east is a prime example of what can be achieved with an effective regional tobacco control programme. Fresh is now funded by both the local authorities and the integrated care board, and that regional funding model is repeated in Greater Manchester. I encourage other regions to follow suit.

Children are especially vulnerable to second-hand smoke, which greatly increases their chance of developing a host of illnesses. The Royal College of Physicians has estimated that smoking by parents and carers is responsible for around 5,000 children being admitted to hospital each year, primarily with respiratory conditions. That is why I tabled a private Member’s Bill in 2011, aided by the British Lung Foundation, to ban smoking in cars carrying children. Despite the strong public health case for the measure, it was not initially welcomed by the Government or the Opposition, and it took a long, hard campaign to get it over the line. Four years later, in 2015, legislation banning smoking in cars carrying children was put on the statute book with strong cross-party and public support.

[Gareth Johnson]

How many times has that offence been prosecuted?

[Alex Cunningham]

That is an interesting question. There have been only a handful of prosecutions because the legislation has played an important role in people changing their behaviour. YouGov’s 2008 polling for ASH found that banning smoking in cars was supported by less than half of all smokers. The proportion had risen to 62% by the time of my private Member’s Bill, and to 82% after the ban came into effect. The lesson to be learned is that support has grown significantly over time for the tougher regulation of tobacco. After measures have been put in place, support continues to grow, particularly among smokers. We have come a long way in our attitudes to smoking since I became an MP in 2010. I have enjoyed campaigning on the issue, but I look forward to the Bill becoming law before I step down. Not only will the legislation prevent future generations from acquiring this terrible addiction; it offers the most direct path to making smoking truly obsolete in our society.

North Tees and Hartlepool NHS Foundation Trust

Alex Cunningham Excerpts

Tuesday 27th February 2024 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I beg to move,

That this House has considered the governance of the North Tees and Hartlepool NHS Foundation Trust.

I am pleased to serve under your chairmanship, Sir Charles, for this short debate about the historic governance of the trust, and about how the management of NHS North East and Yorkshire has dealt with the formal inquiry that questioned the integrity and performance of the board over two years ago. The outcome of that inquiry remains a mystery, as NHS North East and Yorkshire has fought for the past two years to keep the report a secret—a fight that continues today, and not just through my speech.

Before I get into detail on the failures of NHS North East and Yorkshire and its leadership, I want the House to know that I was proud to serve as a non-executive director of the trust before I was elected to Parliament nearly 14 years ago. I was proud that the trust was recognised not just for sound finances and delivering for patients, but for innovation and a can-do, will-do attitude that continued long after I found myself in this place.

Much of the credit for performance being maintained goes to the non-executive directors, who gave a large part of their lives to the trust and provided a robust challenge to the executive. That ensured that the trust’s performance, finances and proposals for new projects were examined in detail, not simply signed off; they were forensically examined to ensure that they were all delivering for patients. We owe a tremendous debt of gratitude to those people and to all independent non-executive chairs and directors for the work they do across our country, often in the most difficult circumstances.

Sadly, two years ago, the trust went through a very difficult patch that included the resignation of several non-executive directors, a few of whom I put on the record as my friends. That happened after the NHS regional leadership launched an inquiry that questioned the integrity and performance of the trust’s board, and in particular its non-executives. This was a trust that was rated as good. The contents of the ensuing report remain shrouded in secrecy, sadly, although what can only be described as a well-edited but short summary was published in 2022.

The inquiry was launched after a robust challenge from the non-executive directors to a proposal from the then new joint chair of the North Tees and South Tees NHS foundation trusts, Professor Derek Bell, to have a joint chief executive on an accelerated timescale. I suspect to this day that this was being driven not by the chair of the trusts, but by officials in the regional office, led by the regional director for North East and Yorkshire and North West, Richard Barker. So much for local decision making! I do not name an official on the Floor of the House lightly, but—given his approach to the issues raised by the inquiry—I believe that in the interests of natural justice I have no other option.

It appeared to the non-executive directors that the proposal for the new joint chief executive in November 2021 was being rapidly pushed through without due process, including consultation with the health and wider community, and without proper papers or a business case for the idea. That meant that there were no answers to the robust challenges from the non-executive directors. I can capture their views and concerns in a few bullet points: the joint chair’s proposal was made without consultation or discussion with the NEDs or governors; principles of good governance and due process were ignored or sidelined; the proposed timetable was highly risky and unlikely to lead to a sound appointment of a joint CEO; any proposal to install a joint CEO and some form of amalgamation of management structures would require careful planning, options appraisal and scenario modelling, extensive consultation with the boards and governors, senior trust stuff and other stakeholders, and expert input from human resources and legal teams; and the timeline for a successful appointment of a joint CEO was likely to be 18 months to two years, not a matter of just a few weeks.

The non-executive directors summarised their concerns and objections in a formal document, with an outline of how to organise progress towards a joint CEO and potentially a joint management structure in a way that would minimise risks and maximise benefits. The joint chair’s response was, I am told, obdurate and unyielding. There was no offer to discuss the matter at full board or a meeting of the council of governors, or to consider an alternative to his proposal. Trust between the joint chair and the non-executive directors had been severely damaged by his actions. It was at that stage that the members of the board, concerned that there was no proper process and that they were being steamrollered into a decision, alerted me to what was going on. For me, that was the real reason for the inquiry.

I believe that NHS England’s influence on the joint chair’s proposal was palpable and unhelpful. In late December 2021, the joint chair, CEO, deputy chair and senior independent NED were called to a meeting at short notice with representatives of NHSE, including Richard Barker and national board directors Sir Andrew Morris and Sir David Sloman, as well as the chair of the North East and North Cumbria integrated care board, Sir Liam Donaldson. Although the NHSE representatives recognised that they had no formal powers to oblige the board of a foundation trust to change its organisational form, they were insistent that the joint chair’s original proposal should go ahead as quickly as possible. The trust was informed that it had until the end of January to agree a plan. The meeting ended with the NHSE representatives commenting, “Don’t tell us that it’s going to take two years,” and “Just get on with it.” Some would suggest that this was simply an exercise in bullying.

In January 2022, it became clear to the non-executive directors that they could not approve a proposal that was not supported by a full and proper case, but within a month Mr Barker ordered the investigation into whether the board was acting in a unitary fashion, and into its behaviour and leadership. On 18 February, five of the six NEDs resigned with immediate effect, as they felt that they were being prevented from doing the job they believed they had been appointed to do, and that NHSE and the joint chair would steamroller their way to the desired outcome regardless of any advice to the contrary. I suspect that that is exactly what the powers that be wanted: the removal of people who were not sticking to the line or doing what the officials wanted, but were instead maintaining their independence and putting patients first.

There was an allegation that the non-executive directors were somehow deliberately delaying the proposal for a joint chief executive. Were they supposed to roll over and not do their job of scrutiny properly? I am sure that the Minister will understand that the non-executive directors were insisting on due process and consultation with the trust’s wide range of partners. I believe to this day that they were right to ensure that others were aware of what was going on. They were concerned, as I was, that it was the start of a merger process for the two trusts. One of the trusts, North Tees, was considered high-performing at the time; the other, South Tees, was struggling and under considerable scrutiny from the Care Quality Commission. Happily, there have been improvements since then.

Non-executive directors are required to be independent and put the interests of patients first. Their robust challenge was clearly not appreciated by the chair and regional bosses. Those non-executive directors were local. They knew their community and wanted to do their best for them. I would like to put it on the record that not one of the new non-executive directors lives in the general area served by the trust—a completely opposite picture to the one before. It took me several attempts to find out where the new people hail from. Only when I issued a request under the freedom of information system was I told the answer: the new non-executive team come from Stafford, Hexham, Newcastle, Middlesbrough, which is quite nearby, Crook and Northallerton. I hope that the Minister will acknowledge that the idea of local trusts is just that—local—and that local people best know the needs of their community.

The outcome of the inquiry remains a mystery to all, including those who were investigated. The full report is being kept under wraps by NHS North East and Yorkshire executives, despite Richard Barker sitting in my office in Stockton and assuring me that it would be made public. What on earth have they all got to hide? Perhaps it is the fact that their actions were being questioned or that they had needlessly mounted an inquiry because the non-executive directors wanted to understand why a joint chief executive was being proposed and would not just roll over.

When Mr Barker refused to publish the report in full as he promised, I wrote to him several times, but I had to resort to the FOI request, which was ignored for some considerable time. I did think I had finally persuaded them when I eventually got a copy of the report, but it was so heavily redacted by Mr Barker and his team as to render it useless. The excuse that individuals had to be protected was far from satisfactory.

We still do not know whether the report showed that the non-executive directors were failing in their duty, or whether NHS North East and Yorkshire was even justified in mounting the inquiry. As I say, the fight for the full report continues. Although I contested the decision to make the redactions, I decided, on learning that one of the former non-executive directors was pursuing it through the Information Commissioner, to allow that action to take its course. That is still in play. Today I am asking the Minister to save the Information Commissioner a job and order Mr Barker—who commissioned the report, but then blocked its publication—to publish it now.

The Minister should also find out why this sorry mess was allowed in the first place. The decision to mount the inquiry called into question the integrity of people of long-standing service, yet not even they have been allowed to see it. They remain damaged by what has gone on, and they deserve to know what the report says—a report that cost tens of thousands of pounds. They want to see whether it is critical of them or not.

I suspect that the report remains under wraps because it may be critical of others in this sorry saga; in fact, I know that to be the case. In my Stockton office, when Mr Barker promised me full transparency and publication of the report, he said that it would be critical of the chair’s role in the scandal. That was omitted from the short summary report published by the regional officials and is not obvious from the redacted report. Mr Barker also acknowledged that the region could have handled the matter better, and I suspect that the report does too. He, too, now needs to be held accountable; I have, in the past, called for his resignation. I have no doubt that the regional officials have some questions to answer about the appalling way in which they have handled this matter.

To go back to the central issue, neither the non-executive directors nor I were opposed to the idea of a joint chief executive. In fact, I placed it on record that I was not even opposed to the two trusts one day becoming one, provided that our local hospital services were maintained and even improved. Yes, the regional officials did get their way in the end, but it was a genuine pleasure for me—I mean that honestly—to meet the new joint chief executive recently when the mayor of Stockton-on-Tees, Jim Beall, held his charity ball. Only time will tell whether a joint chief executive is the right decision. I sincerely hope that it is.

I reiterate my request to the Minister to order the publication of what should never have been a secret report. It is in the interests of natural justice, it is the right thing to do and it will give those affected the chance to move on with their lives. I provided the Minister’s office with the gist of the issues that I wanted to raise today, and I can provide him with a much fuller timeline that was too detailed for me to put on the record today. I look forward to a positive response that can help us to draw a line under this whole sorry matter.

--- Later in debate ---

[Andrew Stephenson]

I thank my hon. Friend for making that point. I recognise that they are two trusts with very different characteristics. He is right about the eye-watering legacy in one trust—I think it is £57 million a year of PFI debt—which can make joint working controversial. However, as I will come on to say, I have been assured that the two trusts want to work together with joint arrangements, but not merge. I hope we can set the record clearly: in doing the research behind this speech, I have heard that this is not the prelude to a merger through the back door; rather, it is about trusts wanting to work together to address the healthcare needs in the area.

It is right that any decisions about shared leadership arrangements are made in Stockton, not Westminster. However, where an NHS trust is facing performance challenges, the Government back targeted interventions by NHS England, bringing the trusts together to properly diagnose the problem and develop an improvement plan, which could include shared leadership. Any leadership changes should be kept under constant review to ensure that they are effectively delivering for patients and the local area. The point is to help challenged trusts to improve and take ownership of local issues. External evaluations of NHS England’s leadership interventions have found them to be effective.

I will address the current leadership arrangements of the North and South Tees trusts. Up and down the country, trust governance fits a variety of different frameworks. As the hon. Member for Stockton North knows, putting a round peg in a square hole is pointless. However, although we support a diversity of models, I am crystal clear that every arrangement should be geared towards building a faster, simpler and fairer NHS that works for both patients and staff. I am happy to assure him that, in this instance, I have been assured that the shared leadership and joint working arrangements are not in any way a precursor to trust mergers or acquisitions. In other words, both trusts intend to remain statutory organisations in their own right.

NHS England promotes those models of working to maintain consistency within trusts and to ensure that everyone is on the same page when lessons are being learned. However, for over 10 years now, North and South Tees trusts have been discussing how to work together to provide a better offer for the people of Stockton.

[Alex Cunningham]

The Minister may like to acknowledge that the North Tees and Hartlepool trust and the South Tees trust have worked together for many years. It is not a case of how they can do it in the future; they have been doing it for many years.

[Andrew Stephenson]

They have been doing it for many years. There are shared challenges in the area that they need to work on together, and this model of operation has worked in many parts of the country. I hope that what the hon. Gentleman describes is very much a bump in the road rather than something that characterises the past 10 years of joint work, most of which seems to have been constructive and conducted through local consensus.

In September 2021, the trusts appointed a joint chair. Just over a year later, they announced plans to form a group model to strengthen health services in the local area. That model was intended to improve recruitment and retention of specialist doctors and nurses, ensure join-up with local communities and partners, and secure capital investment to rebuild and upgrade hospital facilities. To deliver that new way of working, I understand that North Tees and South Tees foundation trusts engaged extensively with partners in the local area.

There is now strong collaborative work taking place across the Tees Valley, in the long-term interest of patients. The North Tees foundation trust is one of the best performing providers across the country for urgent and emergency care. The area’s NHS urgent care services will now be run by an alliance of four health organisations, including the North Tees and South Tees foundation trusts. Together, the partnership will oversee minor injuries and illnesses across the Tees Valley, including urgent care centres at the University Hospital of Hartlepool, the University Hospital of North Tees, and Redcar Primary Care Hospital.

I am delighted that the new urgent treatment centre at the James Cook University Hospital opened in March. We are backing the centre with a £9 million investment in urgent care services on Teesside, which will integrate services, provide patients with care close to home, and ease pressures on A&E. We should also celebrate the new Government-funded Tees Valley community diagnostic centre, which will open in Stockton town centre later this year. The centre will offer rapid scans, tests and checks for a number of major conditions. It will help thousands of people to access simpler services, with easily accessible life-saving tests and faster treatment.

I turn now to the investigation that the hon. Member for Stockton North raised. I understand that NHS England looked into the proposed appointment of a joint chief exec, as well as the actions and behaviours of the board. It aimed to find out whether these concerns amounted to breach of the trust licence. The investigation determined that the trust board had not acted consistently in relation to moving to a single chief executive appointment for South Tees. This constituted evidence suggesting a breach of a provider licence by the North Tees and Hartlepool Trust, which would normally lead to formal regulatory action being taken. After careful consideration, however, NHS England decided that the trust should implement the recommendations on a voluntary basis.

[Alex Cunningham]

Does the Minister recognise that the non-executive directors had moved on by then? They had actually resigned from their posts in protest at the lack of due process. Does the Minister, or maybe even the region, accept that this matter could have been handled a lot better?

[Andrew Stephenson]

I hope the hon. Gentleman recognises that there are local government arrangements, and also that these are very much operational matters for NHS England and for the region. Certainly, given the concerns that he has outlined, it is quite clear that things could have been done better to take people with them, rather than alienating people. I also echo the tributes he paid to people who serve as non-exec directors on trust boards across the length and breadth of the country. They play a vital role in local NHS governance, and it is therefore regrettable to see a large number of non-execs resign for any reason.

I think that looking at the reasons behind this and investigating the best way forward is something best delivered by the NHS, and not dictated centrally by Ministers. The recommendations arising from the report were that a summary of it should be presented at the next board meeting and that an action plan for the next steps should be agreed, which has now been completed. It was also recommended that proper consultation between board members of both organisations should take place in future, so that they can reach the best collective decision for better services for Stockton. I hope that the trusts are now able to move forward with these new arrangements, especially with a new joint partnership board, establishing a clear chain of accountability going forward to address their challenges during this troubled period.

In wrapping up, I would like to thank the hon. Gentleman for bringing this debate forward.

[Alex Cunningham]

The Minister has just indicated that he is wrapping up, but the central question here is whether or not that report will be published. I have a heavily redacted report, which has more black ink than white paper. Does he accept that those people have the right to understand what judgments were made on the accusations against them? They should see the full report, not a version from the person who ordered it and then refused to publish it.

[Andrew Stephenson]

I hope the hon. Gentleman will appreciate that the NHS commissions a large number of reports on a whole range of services. When those reports are published internally, we expect all participants to be frank and open with investigations. They do so on the basis that they are internal reports to improve the governance of the organisation. It is not expected, and it is not the normal course, for such a report to be published. My understanding is that, following the hon. Gentleman’s freedom of information request, the report will be published in a heavily redacted fashion, as he said. The redactions were made by NHS England, in accordance with its policies. It is not a report that I am privy to and, to the best of my knowledge, it has not even been shared with the Department. It is an NHS England report that, as I say, has been published in accordance with its usual practices.

[Alex Cunningham]

Frankly, I find it amazing that a Minister cannot even get access to a report that questioned the integrity of five long-standing non-executive directors, who then resigned because of the lack of due process in the appointment system. I remind the Minister that, as I said in my speech, Mr Barker sat in my office and told me, face to face, that he would publish the report and that I would get to see it. He has reneged on that promise. Does the Minister think he should fulfil that promise?

[Andrew Stephenson]

Unfortunately, I will just reiterate the point that a summary of the recommendations emerging from this investigation were published; they were shared with the board. They are accessible by anyone who wishes to see them. Through his own endeavours, the hon. Gentleman has been able to secure a copy of the redacted full version of the report. As far as I can see from the investigations that I have made, the report has been published fully in accordance with NHS England’s normal practices.

Clearly, this is something that has led to a rocky period for the trust, but I believe that the recommendations that have been shared with the board are now being implemented and that the group model of working, as I have said today, is not a merger by the back door. I know that, in securing this debate, the hon. Gentleman wanted to give greater impetus to the trust to get its act together and resolve these issues. I am absolutely sure that the issues he has mentioned today will have been heard by members of the trust’s board—I am absolutely sure they have been listening. I urge them to work with him and other local MPs to ensure that any other concerns that he has raised, and any other concerns that other hon. Members may have, are addressed in due course.

[Alex Cunningham]

Can I wind up, Sir Charles?

[Sir Charles Walker (in the Chair)]

No, not in a half-hour debate.

Question put and agreed to.

NHS Dentistry

Alex Cunningham Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

It is deeply disappointing. Let me assure the hon. Gentleman that as with the last Labour Government—13 years that created a rising tide that lifted all ships across the country, when we had an NHS with the shortest waiting times and the highest patient satisfaction in history—the next Labour Government will deliver a rising tide to benefit people across the country.

[Alex Cunningham (Stockton North) (Lab)]

The British Dental Association highlights that:

“Hormonal changes during pregnancy can make gums more vulnerable to plaque”,

and:

“Changes to dietary habits, and morning sickness”

can also impact on oral health. After being told of the importance of seeing a dentist after suffering multiple miscarriages, a constituent tells me that she has been struggling for three years to see a dentist within a 50-mile radius of her home. Dentists say that they are going private and are helping only with emergencies. Surely that is evidence of a colossal failure of Tory Government dental policy, and even the most vulnerable are suffering.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. In fact, he has the ability, as the Labour MP for Stockton North, to speak for his residents. If only other people across the country had MPs standing up for them. Chris Webb, Labour’s candidate in Blackpool South, reported to me that pregnant mothers have been telling him they cannot get an NHS dentist, despite being entitled to free NHS check-ups and treatment. Alice Macdonald, Labour’s candidate in Norwich North, reported similar conversations to me. Expectant mothers have told her that they have been travelling hundreds of miles to see a dentist when we know that pregnant women probably need that support more than many others. What an indictment of 14 years of Conservative Government.

Under-age Vaping

Alex Cunningham Excerpts

Wednesday 12th July 2023 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

I draw attention to my role as a vice-chair of the all-party parliamentary group on smoking and health.

Perhaps I could start my speech with a quiz, although I do not really want any answers because that would in effect name killer cigarettes. No. 1: which brand is promoted here?

“Give your throat a vacation…Smoke a fresh cigarette”.

That brand was promoted with a picture of an ear, nose and throat specialist holding what was described as a “germ-proof” pack of cigarettes as he had tested the brand’s ability to filter the

“peppery dust…that makes you cough.”

No. 2: Cigares De Joy makes the claim that these cigarettes benefit those suffering from

“asthma, cough, bronchitis, hay-fever, influenza & shortness of breath”.

No. 3, and I will name this one for context: Eve, the cigarette for the “feminine woman”, packaged in a box with a floral design, with ads claiming:

“Flowers on the outside. Flavor on the inside.”

I remember the former Member for Broxtowe, Anna Soubry, speaking of the sophisticated, long, slimline menthol cigarettes that were a passion in her days.

There are hundreds, if not thousands, of other adverts promoting cigarettes that we can see online today. Yes, there is cigarette advertising selling the health benefits or the glamorous, sophisticated femininity of a killer product that we all know would never be allowed to be manufactured if someone came up with the idea today. The laws, over the years, have put those ads into the past, but the tobacco companies have always been very clever in their marketing. Let us be in no doubt but that, for generations, they have always had their eye on the next generation of smokers, with children very much in their sights. Now we have e-cigarettes, many of them manufactured by the same tobacco companies, which are becoming increasingly popular with children and young people. When I drive past local secondary schools, it is common to see young people—it appears more girls than boys—sucking away on one of these devices. The advertising of them is a real throwback to those days I have described, when cigarettes were sold as healthy, sophisticated products that everybody should use.

Yesterday, at Health and Social Care questions, I asked the Secretary of State why he has not acted to stop the new range of advertisements for e-cigarettes featuring gummy bears and Skittles, with bright colours and cartoon characters on packaging and labelling, by adopting Labour’s amendment—that of my hon. Friend the Member for City of Durham (Mary Kelly Foy)—to the Health and Care Bill to ban such advertising. He answered that

“we have already taken action. We took measures in April, and the Prime Minister announced further measures in May. We are keen to follow the evidence. That is why we have had a call for evidence. The ministerial team are looking extremely closely at this, and we will take further action to clamp down on something that we all recognise is a risk to children, which is why we are acting on it.”—[Official Report, 11 July 2023; Vol. 736, c. 156.]

But he is not acting on advertising. He could put a stop to it now. I take issue with people who say that this is not a political issue, because Ministers have taken what I can only describe as a political choice to do nothing in this space. The Minister asked my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) for specific things that need to be done. Well, an advertising ban is very specific.

[Peter Gibson]

Will the hon. Gentleman give way?

[Alex Cunningham]

No, I will not.

Yes, something may change in the future, but we need action now. I think the Immigration Minister would probably agree with us—he had the cartoon characters in a detention centre painted over because they were too welcoming and attractive. I will not condone that callous approach to children by the Immigration Minister, but I am sure he would agree that such attractive things should be removed from vape advertising and packs.

I well remember my original ten-minute rule Bill and other Back-Bench Bills to outlaw smoking in cars with children present. Ministers refused to back the measure, even though 600,000 children every day had to share their driver’s smoke. Three years later, the Health Minister, the then MP for Battersea, proposed her own amendment. To be fair, she did acknowledge my work and that of organisations such as the British Lung Foundation, Action on Smoking and Health, and Fresh. The Minister said then that the Government were following the evidence, but there had been years of it, and we do not need any more evidence for the Secretary of State to follow in relation to the advertising of e-cigarettes. It is already plain to see.

[Peter Gibson]

The hon. Gentleman is making an impassioned speech, which includes a great deal of discussion about advertising. Would he care to comment on the advertising for vapes on London buses?

[Alex Cunningham]

That is an interesting question. I would not personally want to see the advertising of vapes on London buses, particularly if they appeal to children.

It has been plain that manufacturers are directly targeting young people. I do not know whether gummy bears and Skittles are akin to the claimed glamour and sophistication of cigarettes, but the advertising is promoting a product with the kind of modern images that appeal to youngsters. We must not forget that e-cigarettes have their place, but that is as an adult quitting aid, not a child’s toy or sweet substitute.

In my area, North Tees and Hartlepool NHS Foundation Trust now includes vapes as part of its adult in-patient tobacco dependency treatment service. Vapes are offered as part of a wider toolkit of treatments available to those who smoke on admission to hospital, alongside nicotine replacement therapy and specialist behavioural support. Patients are provided with support to remain smoke-free during their hospital admission, and following discharge home. Reducing exposure to second-hand smoke has been a priority of mine for many years, and led to that ban on smoking in cars with children present in 2015.

We have known for a long time that breathing in tobacco smoke concentrated in enclosed places is harmful, and at its worst deadly, particularly when children are involved. For parents and carers addicted to nicotine, replacing cigarettes with vapes can substantially reduce the risks to their children. However, promoting vapes to adults as a quitting aid should not go hand in hand with the dreadful marketing of vapes to children. Requiring standardised packaging for vapes is essential, and the Government can be reassured that that has strong public and political support. Indeed, it may not be a political issue, because Members across the House support it. The overwhelming majority of the public would like us to go further and ban all advertising and promotion in shops, which is currently unregulated.

When I walk into shops in my local constituency—I am sure I am not alone in this—e-cigarettes are promoted everywhere. As others have said, vapes are thrust in children’s faces in all kinds of shops, at the till or by the sweets, which is totally unacceptable. When the Government respond to the consultation on youth vaping in the autumn, I urge them to commit to bringing forward legislation to ban not just the child-friendly branding of vapes, but their in-store promotion. As my hon. Friend the Member for Denton and Reddish said, we must not forget the issue of smoking itself, which is still the leading cause of premature death and inequalities in healthy life expectancy across society. Smoking does not just damage people’s health; it undermines our nation’s productivity, costing more than £20 billion a year to our public finances for health, social care and social security.

I know that the Minister is committed to achieving the Government’s smoke-free 2030 ambition, and I welcomed the measures announced earlier this year to support smokers to quit with free vapes, and to provide additional support to help pregnant smokers quit. However, those were only a tiny proportion of the measures recommended by the independent review that the Government commissioned from Javed Khan, to provide advice on how to achieve the smoke-free ambition. Indeed, the funding was only a quarter of that called for by Javed Khan, and the commitment was for only two years. Meanwhile, big tobacco continues to make extreme profits by selling highly addictive, lethal products. A levy on the industry is popular, feasible, and supported by voters of all political persuasions, as well as by the majority of tobacco retailers. The manufacturers have the money, and they should be made to pay to end the epidemic.

In a debate in the House on 20 June on the smoke-free 2030 ambition, the hon. Member for Harrow East (Bob Blackman) asked the Minister to explain how, when and where the Government will find the additional funding needed to deliver that ambition without a commitment to a levy on tobacco manufacturers. He received no answer, so I hope the Minister will answer that question today. Finally, I ask again: will the Minister bring forward the necessary legislation to end the child-targeted advertising of e-cigarettes? Ministers know that is the right thing to do.

--- Later in debate ---

[Maria Caulfield]

The evidence is there that vapes are considerably safer than smoking, and that was borne out in the 2022 report. The 95% figure was not used then, but I think there is a general consensus that, as the chief medical officer has said, vaping is a much safer alternative to smoking cigarettes.

It is important to remember that regulations are currently in place; it is about enforcing them, which is why the Government have introduced the illicit vape enforcement squad to tackle under-age vape sales, as well as the illicit products that young people can access. We are funding that with £3 million of Government funding.

[Alex Cunningham]

Will the Minister give a timescale for when the Government will introduce plain packaging for vaping products?

[Maria Caulfield]

As I just said and as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) said earlier in the debate, the consultation closed only recently. Officials are going through the evidence and will come forward with the results in the autumn and take them forward.

Oral Answers to Questions

Alex Cunningham Excerpts

Tuesday 11th July 2023 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

5. What steps he is taking to tackle vaping by young people.

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

The hon. Gentleman raises a point of concern across the House that we recognise. That is why we have already taken action, through £3 million to crack down on those selling vapes illegally to children, closing the loophole that allowed free samples to be offered to children, and our call for evidence, so that we can examine what further measures we can take, particularly on the concerns about disposable vapes, which are prevalent among children.

[Alex Cunningham]

That is helpful, but Labour proposed a new clause to the Health and Care Bill that would have given the Government the primary powers needed to stop the use of sweet names such as gummy bears and Skittles, bright colours and cartoon characters on packaging and labelling of e-cigarettes. The Minister will agree that such promotion aimed directly at young people is highly unacceptable and takes us back to the worst days of cigarette advertising. If the Government are so committed to acting in this space, why did they vote down that new clause?

[Steve Barclay]

As I say, we have already taken action. We took measures in April, and the Prime Minister announced further measures in May. We are keen to follow the evidence. That is why we have had a call for evidence. The ministerial team are looking extremely closely at this, and we will take further action to clamp down on something that we all recognise is a risk to children, which is why we are acting on it.

Oral Answers to Questions

Alex Cunningham Excerpts

Tuesday 6th June 2023 Commons Chamber

[Steve Barclay]

I am very happy to confirm that it is the largest investment in Swindon facilities. My hon. Friend is right to draw the House’s attention to the £26 million investment in A&E and the £23 million investment in radiotherapy. It is a tribute to his championing of the need for those facilities in Swindon that the NHS has responded and this capital funding has been provided.

[Alex Cunningham (Stockton North) (Lab)]

I have seen the wide smiles in the pictures of the Prime Minister, former Health Secretary and other MPs who have been happy to visit North Tees hospital in my constituency, where health inequalities are some of the worst in the country. They know that it is not fit for purpose, so why on earth have the Prime Minister and his Health Secretary turned their backs on the dedicated staff there and rejected their bid to replace our rundown hospital?

[Steve Barclay]

The hon. Gentleman seems to have missed the £12 billion record investment in capital across the NHS, the investment in the NHS app, the investment in tech—

[Alex Cunningham]

That is not North Tees. You cancelled it 13 years ago.

[Steve Barclay]

No, the technology programmes are national programmes that cover everyone, including North Tees. It is slightly odd to suggest that one place alone in the country would be exempt from a national programme; that is simply not the case. We are making record investment, including over £20 billion in the new hospital programme and 160 diagnostic centres and 43 new surgical hubs this year.

Junior Doctors’ Strikes

Alex Cunningham Excerpts

Thursday 30th March 2023 Commons Chamber

[Steve Barclay]

I agree with my hon. Friend that we need to do both: we need to get inflation down, recognising that has an impact across the whole workforce, including for those working within the NHS itself, and we need to recognise the real pressure that junior doctors and others within the NHS have faced. That is why we stand ready to have meaningful and constructive talks with junior doctors, in exactly the same way as we have had with midwives, nurses and others within “Agenda for Change”. We must balance the wider issue of inflation and what is affordable to the economy against recognising the real pressures the NHS has faced and responding to that, including for junior doctors.

[Alex Cunningham (Stockton North) (Lab)]

The Secretary of State cannot blame the Opposition for his mess. Nearly every day I retweet ads from the local NHS trust, which is trying desperately to recruit doctors and other staff. Does he accept that pay is a key factor in the large number of vacancies within the NHS, and will he do something to sort that out?

[Steve Barclay]

I accept that pay is an important factor. It is not the only factor—the estate and technology are also important. There is a range of issues. That is exactly the conversation I had with the trade unions representing “Agenda for Change”. We discussed with them both changes to pay and the non-pay measures. There are a range of factors, and we stand ready to have those discussions with junior doctors. However, they have chosen to take a more political, militant stance, in contrast with the approach that other trade unions have pursued.

Hospital Provision: Tees Valley

Alex Cunningham Excerpts

Tuesday 28th March 2023 Westminster Hall

[Jill Mortimer (Hartlepool) (Con)]

I beg to move,

That this House has considered hospital provision in the Tees Valley.

It is an absolute pleasure to serve under your chairmanship, Sir Christopher. I start by thanking all the hard-working staff of the three main hospitals in the Tees Valley: the University Hospital of North Tees, the University Hospital of Hartlepool and the James Cook University Hospital, south of the Tees. They include my son, who I am proud to say is a student nurse at one of those hospitals.

While we have had some welcome new additions to provision in the Tees Valley, for example the new diagnostic and mental health care hubs in Stockton, in the light of the state of disrepair at the North Tees hospital, we are still in need of improved hospital facilities. The trust and the wider Tees Valley are experiencing severe challenges around current estate capacity, which is not suitable for the needs of the population it will serve over the next 10 to 20 years. For example, a significant volume of elective surgical procedures are performed within the private sector because of a shortage of resources within our NHS trust.

It is my contention that the University Hospital of Hartlepool could fill that provision gap, and that it is underutilised in providing services to the people of the Tees Valley. Not only can it play a greater part in delivering these services, but it can take some of the pressure off the other hospitals, which are undergoing renovations. It can do both those things with a relatively small amount of investment.

It should be pointed out that, in its heyday, Hartlepool hospital served not only the people of Hartlepool, but all the communities north of the Tees. Its position in the north of the trust’s geographical area meant that it also provided vital health services to the mining villages to the north and west, in County Durham, which saw Hartlepool hospital as their local hospital, too. It has provided much-needed healthcare to all those communities since it was founded in the late 19th century. The hospital’s generous 28-acre site has a lot of potential, with a significant amount of cleared land that we should use to build more services for the people of Hartlepool, of the Tees Valley to the south and of the ex-mining communities to the north.

[Alex Cunningham (Stockton North) (Lab)]

I am grateful to my next-door neighbour for giving way. I congratulate her on securing the debate and her son on his role in the NHS. Does she remember that it was her Government who cancelled our new hospital 13 years ago without a plan for future health delivery? Recently, the Health Minister, who is in his place, wrote to the Labour candidate for Hartlepool, Jonathan Brash, turning down the funding for a centre of excellence in the town despite cross-party support, including from the Conservatives in Hartlepool. Does she have any thoughts about how we might change the Minister’s mind and deliver for Hartlepool and wider Teesside?

[Jill Mortimer]

I am delighted that the hon. Gentleman has brought that up, because he has mentioned two things that I want to address. I will talk about the new super-hospital later in my speech. I think we dodged a bullet there, because it would have created another private finance initiative like the unsustainable one at James Cook University Hospital.

[Alex Cunningham]

It was not a PFI.

[Jill Mortimer]

It was. The other thing I want to say is that this is an extremely good example of Labour putting politics above the people of Hartlepool. The Labour candidate in Hartlepool, the councillor Jonathan Brash, has had no interest in the hospital. He has had no interest in anything in Hartlepool for a long time. However, every time it looks like I am going to succeed in bringing something forward for the people of Hartlepool, Jonathan Brash is there, ready to have a photo opportunity or write a magic letter to try and take the credit. I am grateful to hon. Gentleman for raising that so I can clarify the situation.

Some may wonder why there is a need to invest in new services. If the hospital had been properly loved and maintained, there would be no need to do so. Sadly, Hartlepool has not been championed by my predecessors —the Labour MPs who went before me—resulting in a significantly lower amount of investment compared with surrounding regions. The Labour centralisation policy of the mid-2000s meant that it became Labour party policy to close down Hartlepool hospital. Indeed, the candidate who stood against me in the by-election, Dr Paul Williams, co-authored the report that recommended that critical care and other services be taken away from the hospital and moved elsewhere. As I have said, there was Labour talk of a new super-hospital, to be funded by one of Labour’s public-private finance initiatives, and we have seen the issues that have arisen from that at James Cook—a prime example of the huge amount of money that the schemes now leech from our NHS.

[Jill Mortimer]

I totally agree with my hon. Friend. In fact, less than a year’s-worth of the £1 million a week that goes into propping up James Cook’s PFI deal—£40 million—would be enough to upgrade and put in the services that we want Hartlepool.

Sadly, my constituents got caught in the political crossfire and were left with a shell of a hospital at Hartlepool and faced with long journeys to North Tees and James Cook for many hospital services. When the accident and emergency unit was closed down in 2011, local opposition was so strong that roughly a third of the population of Hartlepool signed a petition organised by the “save our hospital” campaign. It was incredible—there were more than 30,000 signatures, and there were marches through the town.

I was elected in 2021 on a promise of bringing positive change. That includes bringing education, skills, jobs and prosperity to the town, but there was also an overriding call on the doorsteps for the return of services to our much-loved Hartlepool hospital. I set about trying to find a solution for this long-standing and ignored issue. I have therefore been working directly alongside North Tees and Hartlepool NHS Foundation Trust and its excellent chief executive, Julie Gillon, for in excess of 18 months. During that time, I have built a strong working relationship with Julie. Sadly, she has recently announced her decision to retire from her role and pursue other things, but she intends to dedicate the next six months to championing our proposals for Hartlepool. She will be a sad loss to health provision in the Tees Valley, and I will be one of many who will miss her. She is a competent leader and a good, strong woman—the sort we excel at in the north-east.

[Alex Cunningham]

Will the hon. Lady give way?

[Jill Mortimer]

I need to make some progress.

The first plan that Julie and I favoured was an upgrade and return of services to Hartlepool, new diagnostic hubs in Hartlepool and Stockton, and a new hospital closer to the A19 in Hartlepool, which would be the major trauma centre. This was a bold new model. It would allow people to access diagnostic and out-patient facilities very locally and to travel to the true central point of all the communities in the Tees Valley for major procedures in a state-of-the-art new facility. Sadly, with the huge pull on public funds created by the pandemic, the war in Ukraine and the rising cost of living, it has become clear that that project will not be possible in the near future.

Undeterred, Julie and I returned to the drawing board with a plan to upgrade Hartlepool further and maximise the return of services to that site. I mentioned that there is not enough capacity for the significant volume of elective surgical procedures in Tees Valley NHS sites. The upgrade at Hartlepool, with a proposed 40% increase in operating theatres, would address that lack of resources and increase capacity to perform those elective procedures in a new centre of excellence. That would be alongside a new, much-needed primary care hub and a community hub, which would enable patients to be fully rehabilitated before being discharged. That would free up hospital beds on wards.

I also point out to the Minister that, like most things that I inherited in my constituency, hospital services had not been championed by predecessor Labour MPs for too long.

--- Later in debate ---

[Will Quince]

I thank my hon. Friend for his question. I know from his persistence in campaigning for the community diagnostic centre that his continued persistence in campaigning for a new hospital and upgrades will not have been missed by the relevant Minister, Lord Markham. I will come on to talk about the new hospital programme and the selection of the next eight hospitals.

As I said, the Government are committed to building 40 hospitals, backed by an initial £3.7 billion. Two schemes are already complete and five are currently under construction. The programme is delivering facilities that are at the very cutting edge of modern technology. Critically, it is engaging with clinical staff to ensure that we provide a better working environment for them. We know that enables increased efficiency; importantly, it also promotes staff wellbeing and improves retention.

[Alex Cunningham]

First, I apologise to the Minister—he was not, in fact, the Minister who turned down the funding for the centre of excellence in Hartlepool. I pay tribute to Julie Gillon, with whom I have worked for 16 years; she is a tremendous officer and I am sorry she is moving on. I very much welcome the diagnostic centre in Stockton, which is the result of many years of work between the local authority and the health trusts. We heard a tale of woe from the hon. Member for Hartlepool (Jill Mortimer), who spoke of a lack of capacity, difficult buildings, buildings falling down—all manner of problems after 13 years of Conservative rule. Does the Minister agree that we should work together to secure what we need: new hospital facilities to serve our communities on Teesside?

[Will Quince]

I agree with the hon. Gentleman that we need to invest in new facilities up and down the country. From spending time in Hartlepool speaking to residents, certainly during the by-election, I know how frustrated they are with public services more generally—or certainly they were, because they did not feel like they had a champion at the heart of Government making their case. However, they now have that champion in my hon. Friend the Member for Hartlepool, whose dogged persistence in campaigning for not just better health infrastructure locally, but broader investment in Hartlepool, is critical. My hon. Friend is making that case today, and I know she will continue to do so. On his point, the hon. Member for Stockton North (Alex Cunningham) is absolutely right that we need to work together to deliver better services for people.

Turning specifically to my hon. Friend’s constituency, I am pleased to say that we have received an expression of interest from the North Tees and Hartlepool NHS Foundation Trust for the University Hospital of North Tees in Stockton to be one of the next eight hospitals to be included in the new hospital programme. I can confirm that we have assessed the expressions of interest we have received, and the Government aim to make an announcement in due course.

I am sure my hon. Friend will understand, because we have had many such conversations in the run-up to the debate, that I cannot comment on individual bids while the selection is ongoing. However, she has made her case very articulately and eloquently, and certainly very strongly, and she has put it firmly on the record. I will ensure that her representations are brought to the attention of both the Secretary of State and Lord Markham, and that she secures the meeting for which she has been waiting too long.

If my hon. Friend will permit me to digress for a moment, I will take a couple of minutes to highlight some of the significant funding that North Tees and Hartlepool NHS Foundation Trust has been allocated recently, largely down to her campaigning efforts. The funding includes £23.9 million for a community diagnostic centre in Stockton-on-Tees—I note the nods from my hon. Friends the Members for Cleethorpes (Martin Vickers) and for Darlington (Peter Gibson); they too have been champions of that centre—£3.9 million as part of the targeted investment fund for elective recovery, which is really important because too many of our constituents are on waiting lists for surgery and out-patient appointments; £8.4 million from our community diagnostic fund; £6.5 million as part of the critical infrastructure risk fund to address some of the backlog maintenance issues in our hospitals; and £3 million from our A&E upgrades fund.

In addition, the Tees, Esk and Wear Valleys NHS Foundation Trust has been allocated £3.4 million from the mental health crisis fund to improve urgent and emergency care facilities for mental health, as mentioned by my hon. Friend the Member for Hartlepool. That is really important for taking the pressure off our accident and emergency departments. I know that my hon. Friend will agree that this investment has been invaluable in updating outdated infrastructure and ensuring that modern and sustainable facilities are available for both staff and patients.

Once again, I want to put on the record my sincere thanks to my hon. Friend for all the work that she is rightly doing to support her hospital and, more broadly, hospital and health provision in Tees Valley. She is absolutely right to champion the needs of her constituents and to hold me, Lord Markham and the Department to account on this important issue. Let me take this opportunity to reassure her that the Government are committed to delivering our improvement programmes and upgrades to hospitals and, importantly, to our NHS estate across the country. We very much look forward to delivering the step change in the quality and efficiency of care that we have promised.

Question put and agreed to.

NHS Workforce Expansion

Alex Cunningham Excerpts

Tuesday 28th February 2023 Commons Chamber

[Aaron Bell (Newcastle-under-Lyme) (Con)]

Thank you, Mr Deputy Speaker. It is a pleasure to catch your eye a little earlier than I did yesterday evening.

I welcome the speech from the SNP Front Bench. It is good to see Scotland is having its say in this debate. I disagree with a lot of what the hon. Member for Central Ayrshire (Dr Whitford) said, but it is good to see that she is standing up for her Government. At the start of this debate, there were no Welsh Labour MPs in here at all. I see that a couple have popped in now. It is interesting, given what Labour claims it is going to do for the NHS in England, that no Welsh Labour MPs have put in to speak in this debate to defend their record in Wales.

I also note that the hon. Lady, in praising how things work in Scotland, did not refer to the recent report by Audit Scotland that said that the plans to hire GPs in Scotland were not on track, the target for more mental health staff was at risk and the number of operations was still 25% below pre-pandemic levels. It was described as an ever-increasing crisis in the Scottish NHS, with the double whammy of nursing vacancies going up at the same time as staff are leaving, yet the man responsible for the NHS in Scotland, Humza Yousaf, is standing to be the next leader of the SNP. Wikipedia does not inform me as to the hon. Lady’s preference in that election—perhaps she has not endorsed anybody yet—but I find it extraordinary that the man responsible for presiding over the state of the NHS in Scotland is putting himself forward to be the next leader of the SNP. It is an astonishing succession failure from Nicola Sturgeon to have such a weak field vying to be First Minister of Scotland, which is a very important job. But as I say, I respect the fact that the hon. Lady is here standing up for what she believes in and standing up for her Government in Holyrood.

Turning to the motion, as I said in my intervention on the Minister—I congratulate her on her speech—I reject some of the premises of the motion and some of the statistics involved. It is pretty rich to be lectured by the Opposition, given the backlogs they left in 2010 when they had no covid to contend with. There is no mention of covid in the motion. They left a 20,000 backlog in elective surgery that successive Governments got down to 1,000—a 95% fall—before the pandemic. [Interruption.] If the hon. Member for Ilford North (Wes Streeting) does not think the pandemic is relevant in the context of backlogs, I don’t know what to tell him. Under the Labour Government there was also a lack of productivity growth in the NHS—it was at less than 1% a year—which we have got back up to 1.7% since 2010. The hon. Gentleman spoke about IT, and I agree with him on that—I used to work in IT—but the Labour Government wasted £12.8 billion on IT for the NHS, which was a complete disaster and exposed as such by the Audit Commission.

[Alex Cunningham (Stockton North) (Lab)]

I do not quite understand this backlog the hon. Gentleman is talking about. I remember when it took three years for somebody to get a knee replacement or a hip replacement. Under the Labour Government it took six to eight weeks. Not 68 weeks; six to eight weeks. Across all elective surgery, we put those lists well and truly through the floor. Surely he can acknowledge that.

[Aaron Bell]

When Labour left office, more than 20,000 people were waiting over a year for elective treatment. Before the pandemic—this was not acknowledged properly—the number of people waiting more than 52 weeks for elective treatment had fallen by 95% in England, to just over 1,000. Those are the statistics. The hon. Gentleman can argue with them if he likes, but they are there in black and white.

As I said, it is interesting to see the lack of contrition about the state of the NHS in Wales, which is a complete mess. I will refer to that in detail later, but only yesterday the NHS Board in North Wales was put into special measures for a second time. I accept that there are challenges everywhere—in Scotland, Wales and England. Indeed, if we look at the comparisons across the continent, we can see that these challenges are international in nature, because everybody is recovering from covid, but I believe that this Government are tackling the challenges, and the workforce challenges, head on.

Future of the NHS

Alex Cunningham Excerpts

Thursday 23rd February 2023 Commons Chamber

[Kate Osborne]

I absolutely agree with my right hon. Friend. The problems for our children further down the line are worrying, but of course, they are preventable if the right action is taken.

The Conservatives blame everything else—the weather, the pandemic and even NHS staff—but their 13 years of failure have left the health service in crisis. At Prime Minister’s questions yesterday, the Prime Minister boasted about

“record sums into the NHS…and…a clear path to getting people the treatment they need in the time they need it.”—[Official Report, 22 February 2023; Vol. 728, c. 222.]

He is not living in the real world. Every briefing and communication that we have received has cited delays in treatment and the devastating impact that they have, as well as the decade of underfunding. It is hard not to agree with the British Medical Association, which called the Prime Minister “delusional”.

The last Labour Governments allocated, on average, a 6% rise in the NHS budget every year. Successive Conservative and coalition Governments have since allocated a rise of only 1% a year. The Prime Minister can talk about “record sums” all he wants, but he is fooling no one. In reality, the settlement is not enough, and it is nowhere near what previous Labour Governments invested. This crisis can be laid firmly at the Government’s door.

There are so many awful headlines and statistics, and I will delve into some of them, but let me say from the outset that we must all remember, when we talk about the 7 million people on waiting lists, or the 500 avoidable deaths every week, that we are talking about people. There are faces behind those statistics: the faces of women who cannot get urgent gynaecological treatment, the faces of children who cannot access mental health support, the faces of families whose loved ones have died—lives that could, should and would have been saved if this Government cared about communities and invested in our NHS.

When we talk about 133,000 NHS vacancies, we are talking about people who have left their work in the NHS because they cannot cope financially or emotionally, we are talking about the rest of the workforce working harder to pick up the slack, we are talking about the NHS being unable to recruit because of poor wages and conditions, and we are talking about the impact that that has on patients.

The only way to solve the NHS staffing crisis is by sorting out pay. The Government agreed yesterday to negotiate with the Royal College of Nursing, and nursing strikes have been paused for those negotiations to happen. The Government could have agreed to negotiations months ago, but they chose not to. Negotiations with the RCN alone will not solve the staffing crisis. Junior doctors have voted by 98% to strike, but the Health Secretary has not even offered a meeting. Negotiations with one section of the NHS workforce are not sufficient; all unions representing NHS staff need to be negotiated with. The Government must make a pay offer that is not linked to efficiency savings and productivity, because NHS staff are already working unacceptably long shifts.

An offer—such as the one we saw on Tuesday—of 3.5%, when inflation is at least triple that and NHS workers’ pay is worth less than it was a decade ago, is, as Sharon Graham of Unite the Union said, a “sick joke”. Christina McAnea of Unison announced further strike days next month. The Government are failing to resolve this dispute; instead, they are attempting to blame workers for putting patients in danger. Patients will never forgive the Conservatives for refusing to negotiate and using patients as bargaining chips.

The staffing crisis must be urgently addressed. The impact of waiting times on individuals can be severe and the consequences irreversible. Two hundred people in my Jarrow constituency have Parkinson’s disease. Parkinson’s UK is concerned about people waiting longer than two years for a diagnosis. Similarly, the MS Society has said that more than 13,000 people have been waiting more than a year for a neurology appointment. Those delayed diagnoses and treatments have a hugely detrimental impact on the individuals concerned.

Delays in cancer diagnosis and treatment are life-threatening. For years, the Government have missed cancer targets because of a lack of concerted action on matched funding. In South Tyneside and Sunderland NHS Foundation Trust, only 73% of people were treated within the target of two months following a cancer referral, and only 61% of people are treated within that target nationally. The UK is being left behind, and people are dying avoidable and preventable deaths. That is why we need a workforce strategy—yes, to pay people properly, but also to enable the NHS to save people’s lives.

Labour has a workforce strategy, while the Government have not even committed to fully funding their promised workforce plan. The Chancellor praised Labour’s plan, so why does he not put his money where his mouth is by implementing it? Labour will deliver a new 10-year plan for the NHS, including one of the biggest ever expansions of its workforce.

[Alex Cunningham (Stockton North) (Lab)]

I congratulate my hon. Friend on securing the debate. This will come as a surprise to her, but I have visited a private health provider in my constituency in the last fortnight. People there told me that they are recruiting staff directly from university, so people are trained at the state’s expense but are then used for private profit. That means that the health service, which cannot afford to pay the same wages, loses out. Does she have any ideas about how that might be sorted out?

[Kate Osborne]

I will address my hon. Friend’s point in my remarks. This Government’s ideological commitment to the free market has led them to force through more and more privatisation of our national health service. Some Government Back Benchers are talking openly about moving to an Americanised healthcare system in which people are priced out of healthcare, and they have even mentioned it in this Chamber. We have seen corrupt contracts for cronies, and friends of the Government making millions while people suffer. The Government have allowed the private sector to run rampant, taking hundreds of billions out of the NHS budget over the last 10 years.

It is as if the Government are on a mission to destroy the NHS as we know it. They have even performed smash-and-grab raids on hospital repair budgets, taking £4.3 billion away and leaving hospitals crumbling, leaking and falling apart at the seams. Fifty per cent. of trusts now have structural issues with leaks, collapsing floors, raw sewage and unsafe wards.

American news agency CNN said last week:

“Britain’s NHS was once idolized. Now its worst-ever crisis is fueling a boom in private health care.”

The number of people paying privately for operations is up 34% in 2022. If that trend continues, it will embed a two-tier service in our NHS and price many people out of healthcare. My constituent Christine was referred to a private health company by her GP, while another constituent, Ray, was told that he could no longer get a service from the NHS and that he would need to pay privately, at a cost of £50. Ray said to me:

“As I am 74 years old and rely on my state pension it makes it very difficult for me in the current economic climate to pay this amount. Having paid national insurance contributions for 50 years, I don’t understand. Why do I have to pay again?”

I look forward to receiving a response for Ray from the Minister.

Ray is correct, of course. As Nye Bevan said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

As with any crisis, companies step in to exploit the situation and make money.

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[Matt Hancock]

Two of my arguments for what the NHS needs to do better in the future are responses to precisely the two points that have just been made. I cannot decide which order to go in, but both are absolutely vital. I agree with my hon. Friend, and disagree with the right hon. Member for Islington North (Jeremy Corbyn).

Given the pressures on the NHS, in order for it to succeed in the future, all of us who care about the NHS must have a hard-headed view of what needs to happen for it to function long into the future. One of those things, which I think is absolutely central, is the use of technology, so I will come to that point first. Today, the NHS has more clinicians in it than ever before. Contrary to what the hon. Member for Jarrow said, it has a higher budget than ever before. It has more nurses and more doctors than ever before, it is delivering more service than ever before, and it takes up a higher proportion of our national income than ever before. That has all happened under a Conservative Government that believes in the NHS. Those are the facts.

[Alex Cunningham]

I am sure the right hon. Member will acknowledge that a lot of the doctors who are now working in the NHS were trained under a Labour Government, with the Conservative Government now getting the credit for them. Since then, we have seen a reduction in the number of doctors trained.

[Matt Hancock]

No, that is not right. There are record numbers in training, and the opening of the new medical schools that were put in place by my right hon. Friend who is now Chancellor of the Exchequer is another Conservative achievement in that space.

However, given the record numbers of nurses and doctors, the record numbers of training places, the record numbers of GPs coming out of training places and the record funds going into the NHS, there is still a record-scale problem. I do not at all deny the scale of the challenge, but that challenge demonstrates to me the vital importance of reform of the NHS—we cannot support its long-term future without supporting reform. My experience of the NHS and of being Health Secretary tells me that the single most important thing that has to happen for the NHS to be as effective as possible in the future is the widespread and effective adoption of the use of technology and data, so that the NHS can be more efficient, giving clinicians back—as Eric Topol put it when he launched his review in 2019—“the gift of time”.

The inefficiency of the NHS because of poor use of data leads to appointment letters being sent out that arrive after the appointment date has passed. Who gets a letter these days for an appointment, anyway? We all use modern technology instead.

[Matt Hancock]

I will in a moment.

That inefficiency means that different parts of the NHS cannot talk to each other, and indeed cannot talk to social care. It means that a person can end up going into hospital for a serious procedure, but their GP will not know that they have had that procedure, because they went in urgently rather than through that GP. It means that there are people right now who go into an NHS hospital and find that their records, which are on paper, cannot be adequately analysed. Service provision is worse as a result, which directly impacts people’s health. The poor use of data is the No. 1 factor holding back the effective use of the resources that we put into the NHS—not only the cash but, crucially, the staff. They find it deeply frustrating that they have to work with these terrible IT systems when every other organisation of any scale in this country, or in any developed part of the world, uses data in a much more efficient, effective and safe way.

[Alex Cunningham]

Will the right hon. Gentleman give way?

[Matt Hancock]

I will make one final point before I give way to the two hon. Members who are seeking to intervene, which is that the inefficiency in the NHS is best exemplified by its ridiculous continued use of fax machines. Those machines are totally inefficient and completely out of date, and are also terrible for privacy and data protection, because one never knows who is going to be walking past the fax machine. When the Minister sums up, I would like him to set out what he is doing to not just get rid of those fax machines—I tried to do it and made some progress, but did not manage to finish the job—but, more importantly, drive the use of high-quality data, data analytics and digital systems throughout the NHS. Investment in that is the single best way to ensure that all patients can get the service that they need.

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[Matt Hancock]

Of course, if somebody cannot use eConsult, they should be able to phone up or turn up in person, but that does not take away from the fact that there will be more resources to help those people if the existing resources are used effectively, because the vast majority of people use modern technology for so much of their lives. The arguments that we have just heard are arguments for ensuring that there is also provision for the small minority who do not use data and technology, as demonstrated by the vaccine programme, where a tiny minority of people did not use technology but the vast majority did.

We require high-quality privacy for data in many different parts of our lives—for example, financial information. Whether in the public or private sector, privacy is vital, and the General Data Protection Regulation is in place to set out the framework around that. That is an argument not against the use of data, but in favour of the high-quality use of data. Health data, financial data and employment data are all sensitive and personal pieces of information. The argument that we should not use data because of privacy concerns is completely out of date and should go the same way as the fax machine.

[Alex Cunningham]

I am grateful to the right hon. Member for giving way for a second time. It seems to be a common theme for former Health and Social Care Secretaries to come and tell us about the litany of failures in the national health service and offer some solutions. I am interested to know which of those failures he takes personal responsibility for.

[Matt Hancock]

I wish that I had been able to drive forward the use of technology even more than I did. I pushed it as hard as I could, but if I could have gone further, I would. It is about not just efficiency for the health service, but a better service for patients and the research agenda. Another advantage of a universal service is that, because almost everybody in the country is within the NHS system, we can do amazing research to find out what treatments work better. If we can get high-quality data into the hands of researchers, they can discover new drugs or new procedures to save lives.

Yesterday, for instance, I signed up and had my bloods taken for Our Future Health, which is a wonderful programme run by Sir John Bell that aims to sign up 5 million people—ill and healthy—to give, with consent, their health data and blood to a large-scale research programme to find out what keeps people healthy. That is for 5 million people, but we can use the NHS effectively —with proper consent and privacy—to save future lives, which is yet another benefit of a universal healthcare system.

My second point—I will make three—on what the NHS needs to do more of in the future is about efficiency. The Prime Minister was right in the summer to float the idea that if someone misses too many appointments without good reason, they should be charged for them. One of the problems for efficiency is that many appointments are missed, which wastes clinicians’ time. It was right to consider that idea, but I would be totally against people having to pay for the first appointment.

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[Alex Cunningham]

My hon. Friend and I were in a meeting earlier this week with the regional care board, and it told us that, in the north-east, we actually perform a little bit better on elective care. However, it also told us that the growth we can expect in the north of England is going to be much smaller than elsewhere in the country. Does that concern my hon. Friend as it does me?

[Liz Twist]

That certainly concerns me and, yes, my hon. Friend is absolutely right to say that. Actually, I would say that in the north-east we have really good and positive acute services, which are the ones he is talking about, thanks to the hard work of so many people, but what we lack is the preventive work and the work to avoid people becoming ill in the first place. We have the lower life expectancy and the health inequalities that my hon. Friend the Member for Jarrow talked about, so it is important to our people that we do that.

I was interested to hear the comments of the right hon. Member for West Suffolk on health inequalities. He is right to identify them, but what the Government have done is reduce the amount available to public health to address those issues before they develop. It is great that we have good hospitals and good-quality services, although they are really under pressure, but unless we address those public health issues and fund public health services, we are not going to tackle some of those issues.

The other aspect of that is social care. Once again, the Government have failed to tackle social care, and we know that one of the key things in tackling social care is getting people discharged from hospital, and getting them and supporting them to be independent at home. However, we really need a plan and to think some more about this. It may be a different Department—[Interruption.] No, it is the same Department now—sorry; my mistake—but we need to tackle that issue if we are going to make real progress.

I want to talk a little about mental health services. Many Members will know that I chair the all-party parliamentary group on suicide and self-harm prevention. We see the impact of a whole range of different policies, and the inability to access services. Too many mental health patients are forced to seek mental health treatment through emergency or crisis services. One in 10 ends up in A&E. We need to ensure adequate access to mental health services for both children and adults facing mental health crises.

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[Rob Roberts (Delyn) (Ind)]

It is a pleasure to follow the hon. Member for Bolton South East (Yasmin Qureshi), and I congratulate the hon. Member for Jarrow (Kate Osborne) on securing a vital debate on a topic on which I believe we could spend hundreds of hours, rather than the few short ones available to us this afternoon. But we take what we’ve got and we make a start.

I had hoped that this would be a serious debate about solutions, but sadly it seems to have descended into the same finger-pointing blame game that we always get. We will come back to that later.

I declare an interest: my fiancé is a research nurse who until recently worked in the NHS but has now gone into private sector research. I told him to watch this afternoon’s debate. He said, as a senior research nurse and someone who worked on the AstraZeneca covid team, “Why? It’ll just be a load of politicians blaming each other and not actually addressing anything.”

[Alex Cunningham]

Thirteen years!

[Yasmin Qureshi]

You have been in power for 13 years!

[Rob Roberts]

How right he turned out to be. However, he is watching it, and my phone has not stopped receiving messages such as, “Don’t agree with that intervention from the Opposition”, and, interestingly, “Hancock is making sense!” in respect of my right hon. Friend the Member for West Suffolk (Matt Hancock). My fiancé is not by any stretch of the imagination a traditional Conservative voter, but he gets it—he understands.

On 5 July 1948, the NHS was founded under Labour Health Minister Aneurin Bevan, who built on the initial idea in the 1944 White Paper, “A National Health Service”, introduced by Conservative Health Secretary Henry Willink, which set out the need for a free and comprehensive healthcare service. Aneurin Bevan is rightly hailed as the father of the NHS, but it is the Conservative Minister years earlier who can arguably be called its grandfather. And as we are all aware, grandparents always treat the grandchildren a lot better than their parents do.

There are 40 MPs in this place from Wales, the home of Bevan, and 26 of them represent various Opposition parties, but there are zero here today to talk about health services and to defend the record not of the UK Government over the past 13 years—right hon. and hon. Members have taken aim at them this afternoon—but of Labour’s control in Wales over the past 25 years.

In 1948, average life expectancy was about 68 years old; today it is almost 85. That is a 25% increase in lifespan. In 1948, hospitals had a couple of X-ray machines. CT scanners did not come into use until the 1970s, while MRI scanners appeared in 1984. Ultrasound, which was previously an instrument used to detect the flaws in the hulls of industrial ships, was first used for clinical purposes in Glasgow in 1956 due to a collaboration between an obstetrician and an engineer.

A new CT scanner sets us back £1 million to £2 million. An MRI takes up to £3 million, and ultrasounds a few hundred thousand each. Each hospital has multiple numbers of those machines. Drugs and treatment developments cost literally hundreds of billions globally every year. We are keeping people alive longer, diagnosing them with ever more expensive machinery and treating them with ever more expensive medication and devices. In 1948, the population of the UK was just under 50 million. Today it is almost 68 million—an increase of 36%.

My right hon. Friend the Member for West Suffolk talked about data earlier. I am no healthcare specialist or expert data scientist, and I do not in any way have all the answers, but I like to think that I have a reasonable amount of common sense, and my common sense tells me that, when 36% more people are living 25% longer and are being diagnosed by expensive machines and treated by a pharmaceutical industry that costs hundreds of billions, we cannot keep running things based on principles devised 75 years ago.

The main point I want to get across in my short contribution is one of openness and debate. I have sat and listened to right hon. and hon. Members in this debate and others over the years talking about various elements of the NHS in England. It is all a Conservative problem, they say. Tories are destroying the NHS, they say.

[Alex Cunningham]

Thirteen years!

[Rob Roberts]

They are saying it now—they cannot help themselves. It is endemic in their thinking, but it does not help. Where is shouting at me getting them? Nowhere at all.

[Alex Cunningham]

Look at the stats!

[Rob Roberts]

I invite them to come to Wales and view the conditions in the north Wales health board, where only 62% of buildings are operationally safe and where the hard-working staff, including friends and family of mine, are working in impossible conditions. In England, one in 20 people—5% of them—have been waiting more than a year on waiting lists. In Wales, the number is one in four—25%. The NHS in Wales performs worse in virtually every measurable area than the English equivalent. Labour Members are not shouting any more—how interesting. Currently, only 51% of red call patients are responded to within the target eight minutes. These are the second longest ambulance wait times ever. Only 23% of amber calls, which include strokes, were reached within 30 minutes.

The hon. Member for York Central (Rachael Maskell) mentioned dentistry in an intervention. Only 7% of dental practices in Wales are accepting new patients. Where is the outrage? Where are the demands for better? For every one pound spent on healthcare in England, there is almost £1.20 available in Wales—it is not a money problem—but for markedly worse outcomes in all areas. Where is the outrage? Instead, the Leader of the Opposition, in a speech last year in Wales, described the Welsh Government as providing

“a blueprint for what Labour can do across the UK”.

Well, good luck to the rest of the UK if it chooses to install the right hon. and learned Gentleman into Downing Street next year on that basis.

I am not helping the discussion with these statistics at all. I am guilty of the very thing I always tell others not to do—to stop blaming people, stop trying to score silly political points, and stop wasting everybody’s time by saying that different Administrations are to blame. There is no prospect of an open debate on the actual issues—the real, fundamental problems—if all we focus on is finding blame. It is easy, it is lazy and it gets us nowhere.

The NHS across the United Kingdom is in difficulty. It is in difficulty in England, Scotland, Wales and Northern Ireland. It is not in difficulty for political reasons; it cannot be, because there are three very different Administrations running health services in all those parts of the UK, and the same problems occur in all of them. We need to ask why there is so much waste in the NHS and why there are nurses graduating from universities with degrees who—as the RCN agreed with me recently—cannot draw blood or insert a cannula into a vein. It is not their fault; as with everything, it is the systems that let them down—systems that mean that health boards across the UK spend hundreds of millions of pounds sending graduates on courses to learn the clinical skills that they were not taught on their degrees.

I commend the shadow Health Secretary for something he said recently. He said that he would be prepared to use private sector resources to bring down waiting lists faster. He asked the question: “How can I look someone in the eye as a prospective Health Secretary and tell them that I have a way to provide them with a better outcome, but my ideology is standing in the way of their recovery?” He was lambasted for that view from his side of the aisle but, while he and I will disagree about almost everything else, I have to say that my respect for him went up significantly with that intervention.

The NHS health boards across Wales are sending people to private facilities, which is costing hundreds of millions of pounds. I commend them, because it is all about outcomes. We get so caught up on process and procedure—on who does what, when—that we lose sight of the outcomes for people. One of my most hated phrases in politics is “political football”. It is used almost exclusively in discussions about the NHS, but the bottom line is that things such as the health service have to be run by political decisions; otherwise, who could be held accountable to the public? If we take decisions out of the hands of politicians, who should make them and how can they be held to account?

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[Sir Christopher Chope]

The hon. Lady makes a very good point, and I am glad that I gave way to her to enable her to make it. We must do everything possible to increase the size and quality of the workforce and enable people who are already in it to improve their qualifications and progress through their chosen profession.

Constituents also tell me that there is a problem with retention. When nurses retire, they are expected to continue with continuous professional development; if they do not do that and fill in a lot of bureaucratic forms, they become ineligible to return to nursing later on. One of my constituents contrasted the situation in our country with that in the United States, where there are not so many bureaucratic barriers to someone’s carrying on nursing after they have retired, perhaps temporarily. I raised that point with the Government, thinking that it was a really good idea and that they should be getting to grips with it, but their answers to my questions suggested that it was not really on their radar and they were not interested in investigating it. Their response was, “We have a graduate-based profession, we have a retention scheme that we are not interested in changing, and the register will stay as it is.” I thought that that was a remarkably complacent response to what I considered to be quite a constructive suggestion from a qualified nurse.

Many people have made the point that we are training nurses and doctors at great public expense, and they then leave the profession and the national health service before they have paid back their dues. Again, there is a big contrast between what happens here and what happens in the United States. I am not saying that help with people’s development as they go through university should be conditional on their being forced to work for a particular employer or for the NHS when they graduate, but I do think there should be a system similar to the one in the United States, whereby those who are not going to work for the NHS are expected to pay back some of the costs of their training. There is a great deal of talk in this country about increasing the number of doctors and nurses, and the newspapers today refer to the need to increase the number of graduates, but that is not much use if so many of those graduates do not provide their services to the NHS.

[Alex Cunningham]

The same problem applies to dentists, who have no responsibility whatsoever to work for the NHS when they finish their training, which, of course, is funded by the state. Perhaps the hon. Gentleman would encourage Ministers to look at some form of requirement for them to work in the NHS at least for some time, which might shorten the waiting list for my constituents.

[Sir Christopher Chope]

That, too, is a good point. I am not saying that the hon. Gentleman has necessarily got the right answer, but the Government should be looking at this. I listened with interest to the earlier references to NHS dentistry. In my constituency, there are a fair number of NHS dentists who would like to take on more patients, but the rules require them not to exceed 110% of their quota. Some of them are saying, “I would love to take on more patients,” but they are being told by the local bureaucrats that if they do so, they will suffer financial penalties.

[Alex Cunningham]

One of the main problems with dentistry when it comes to resources is the difference between the unit prices that dentists receive for their work. One practice in my area has two parts, each of which is paid a different rate per unit from the other, and it is much lower than that paid in some other parts of the country. Does the hon. Gentleman agree that the Government need to look at the fee structure and make sure that dentists are being properly paid to work in the community?

[Sir Christopher Chope]

In fairness to the Government, they say that they are now looking at it—a bit late in the day, I think; a review should have been instituted much earlier—but the hon. Gentleman is right. It is ridiculous to have a structure in NHS dentistry in which the rewards are linked to the number of specific procedures that have been carried out. Each procedure is given a different rating, and then they are all added up to establish whether the total exceeds the permitted 110% capacity. That is another case of there being plenty of scope for reform and fresh thinking, but it seems to be almost a culture in the NHS not to be receptive to such ideas.

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[John McDonnell]

Anyone who has talked with them will have heard local police officers say that they have become social workers, mental health workers and so on. In many instances, they are doing the best job that they can, but they need expert support, including from health workers in the community.

I looked at the figures, and there are now 1.6 million people on the waiting list for specialist mental health services. One of my concerns, which was raised in a debate some months ago, is what is happening with CAMHS —child and adolescent mental health services. Delays in treatment have increased massively since 2019, and waiting lists are getting longer. I have looked at the stats: 77% of CCGs froze or cut their CAMHS budgets between 2013-14 and 2014-15, which was the crunch year; 55% of the local authorities in England that supplied data froze or increased their budgets below inflation; and 60% of local authorities in England have cut or frozen their CAMHS budgets since 2010-11. Again, that is staggering.

To come back to mental health nurses, in 2010, we had 40,297 of them; we are now down to just 38,987. That does not seem a significant drop, but it is still a drop. As a number of Members on both sides of the House have mentioned recently, we are going through a mental health crisis—one that affects young people and young men in particular, as my right hon. Friend the Member for Islington North has pointed out.

Let me come to the stats on social care. Age UK estimates that more than 1.5 million people aged 65 and over have some form of unmet or under-met need—[Interruption.] Excuse me—[Interruption.] Thanks a lot; I could do with something stronger.

[Alex Cunningham]

That can be arranged later.

[John McDonnell]

That’s right.

The social care figures are startling. Some 1.5 million people aged 65 and over have some form of unmet care need. There are 165,000 vacancies in the social care sector across England and Wales—a 52% increase in the last year. The Health Foundation estimates that an extra £6.1 billion to £14.4 billion will be required by 2030-31 to meet the demand. As others have said, that has meant delayed discharges from the NHS, and—as I mentioned on Tuesday—it places a huge burden on unpaid carers, who are living on the pittance of the £70-a-week carer’s allowance.

The Institute for Government published a report today in which it basically argues for social care overhaul. It describes how social care has been overwhelmed in recent years and states that 50,000 fewer posts are filled than a year ago—the highest vacancy rate ever in social care. Then, there are the stats on what has happened as a result of under-funding—and I am afraid that it is because of under-funding; we cannot get away from that fact. I would be saying the same thing on these statistics no matter which party was in power. We need to go further in the coming month’s Budget.

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[Alex Cunningham (Stockton North) (Lab)]

We can all be very proud of our NHS and the people who care for millions of patients every year, whether that be in GP or dental surgeries, in hospitals, or in the community. However, a lack of appropriate funding and workforce planning across the piece has made those people’s challenges greater than they need to be. They are let down almost every day.

Today, I want to address one specific issue affecting the running of services on Teesside, but I would first like to welcome the decision to fund a new diagnostic centre in Stockton town centre, and to comment on some trusts in the north. That new diagnostic centre is a direct result of a great partnership between Stockton-on-Tees Borough Council and the local health trust, and will go some way towards addressing the tremendous health inequalities in my constituency and elsewhere on Teesside. What we really need, though, is to have our ageing North Tees hospital replaced, and I remain hopeful that one day, we will get it. That replacement hospital was planned 13 years ago, but was shelved by the Tory-Lib Dem Government in 2010.

Trusts in our region have faced challenges of late, with inspection outcomes that have been far from great. They go across the piece, from the mental health trust to hospital trusts and the north-east ambulance trust. For me, that illustrates a systematic failure of Government: everywhere is under pressure. As I said earlier, it is always interesting to listen to former Government Health Secretaries and people on the Government Benches—I note that only a Whip and the Minister now remain on those Benches—talking about the problems in the national health service. Sometimes, they even offer a few solutions, but what have they been doing since 2010? I will tell you, Mr Deputy Speaker: they have been growing the waiting lists and alienating the staff.

Despite a couple of ideas for improvements from Conservative Members, it is abundantly clear that the Conservatives are out of ideas when it comes to fixing our broken NHS. That task is too much for this Administration, who have overseen a decline in their 13 years. A Labour Government will undertake the biggest expansion of medical training in the history of the NHS to give it the staff it needs. The last Labour Government delivered the investment needed to bring waiting times down to their lowest ever levels, and also restored staff pay to fair levels. We were able to do that because we grew the economy and created the revenue to fund our public services, something that seems to be beyond the current Government.

I was proud to serve as a non-executive director of the North Tees and Hartlepool Hospitals NHS Foundation Trust before I was elected to Parliament 13 years ago. I was also proud that that trust was recognised, not just for sound finances and delivery for patients, but for innovation and a can-do, will-do attitude. Much of the credit for that performance being maintained goes to the non-executive directors who gave a large part of their lives to the trust and provided a robust challenge to the executive. That ensured that the trust’s performance, finances, and proposals for new projects were examined in detail—not simply signed off, but forensically examined to ensure they were all delivering for patients. We all owe a tremendous debt of gratitude to all independent non-executive chairs and directors for the work they do across our country, often in the most difficult of circumstances.

Sadly, we have recently seen our trust go through a very difficult patch, including the resignation of several non-executive directors, a few of whom I put on record as my friends. That happened after the NHS England regional board launched an investigation that basically questioned the integrity and performance of the trust’s board, and in particular its non-executives—a trust that was rated “good”. The contents of the ensuing report sadly remain shrouded in secrecy, although what can only be described as a well-edited summary was published last year.

In the summary, there appears to be a failure to acknowledge the actions and behaviour of the chair and the regional office in pushing through a proposal for a joint chief executive officer to cover the North and South Tees trusts. Instead, it focuses almost entirely on the former non-executive directors, all of whom served the trust diligently for a number of years and oversaw outcomes that we can all be proud of.

I wish the Minister was listening, because the full report is being kept under wraps by NHS North East and Yorkshire executives, despite the regional director, Richard Barker, sitting in my office and assuring me that it would be made public. Despite a series of emails to NHS England, that is yet to happen. My application under the Freedom of Information Act 2000 on 17 November, although acknowledged, has yet to be responded to. It strikes me that the regional bosses do not want it to be published. Bearing in mind the gravity of what happened, I wonder whether it has even been shared with the NHS England national board, as it ought to have been.

What is going on in the management of the NHS northern board, particularly in relation to the North Tees and Hartlepool Hospitals NHS Foundation Trust? It goes back two years to the appointment of a joint chair with the South Tees Hospitals NHS Foundation Trust—those two trusts have worked together closely for longer than I care to remember. Within weeks of the appointment of Professor Derek Bell, he proposed to appoint one chief executive for both trusts. From the controversy that followed, it appears that it was presented more as a done deal, but I still wonder where it had been determined.

It was not just that, but what was seen as a disproportionate emphasis on structural change across the two trusts with the appointment of that joint chief executive. That approach is contrary to the evidence relating to success in a health and care system, whereby strong system leadership and collaboration are essential to represent local communities, incorporating local stakeholders and populations. Indeed, the benefits realisation to populations and patients of integration and collaboration occurs in trusted relationships and focused system leadership.

The problems started at that point, with the non-executive directors insisting on due process and consultation with the trusts’ wide range of partners. They were also concerned, as was I, that it was the start of a merger process for the two trusts—one high performing, North Tees, and the other struggling and under considerable scrutiny from the Care Quality Commission, South Tees. No one would fail to sympathise with those non-executive directors’ concerns. They, in particular, are required to be independent and to ensure that they put patients’ interests first. That is exactly what the team at North Tees did—they made a robust challenge to the proposed changes, which was clearly not appreciated by the chair and NHS bosses, who mounted an investigation.

I could go on at great length about the to-ing and fro-ing, but suffice it to say that most of the non-executives resigned, which I suspect is just what the powers that be wanted to happen. In other words, they wanted the removal of people who were not sticking to the line or doing what the officials wanted, but were maintaining their independence and putting patients first.

That sorry saga raises issues about the running of foundation trusts, which are supposed to be standalone organisations that make decisions for their local community. They are not supposed to be carrying out the orders of someone in a regional office 40 miles up the road. Let me be clear: no one wants to resist change and no one would stand in the way of an eventual merger, but it has to be at the right time and always in the best interest of patients. People north of the River Tees do not want their hospitals to be mere satellites of their larger neighbour eight miles down the road; they want services in their home towns of Stockton and Hartlepool.

To go back to the mystery report, I appeal to the Minister to encourage the NHS board in the north to carry out its promise and publish the report. It calls into question the integrity of people of long-standing service, yet not even they have been allowed to see it. I suspect that it remains under wraps because it is critical of not just the non-executive directors—in fact, I know that to be the case. Mr Barker told me in my Stockton office that it would also be critical of the chair’s role in the scandal, which, as I said, was omitted from the summary report. That is totally wrong. He, too, needs to be held accountable, and I have in the past called for his resignation. Perhaps the report even features the regional officials, who I certainly believe have some questions to answer about the appalling way they have handled this matter, including in refusing to publish that report, as promised.

As I draw to a conclusion, I would like to share with the House how the board is now made up. Previously, it was of people from the North Tees and Hartlepool trust area, and I always thought that boards were supposed to be representative of and from their communities, yet none of the new non-executive directors is local, and one of them comes from Stockport. I do not know how many miles it is to Stockport, but it is at least 130 miles from where the trust is based, which is not good. When the current vice-chair, Steve Hall, steps down in a few weeks’ time, there will not be a single person on the board who lives in the trust area. In the words of a certain former Prime Minister, “That is a disgrace!”

I would therefore be grateful if the Minister, instead of reading his papers, actually listened to me and got involved. He should find out why this sorry mess was allowed to be created, and ensure that that report is published. To do otherwise would be not only unfair, but a dereliction of duty.

--- Later in debate ---

[Rob Roberts]

If Labour Members have this plan, have they communicated it to the Welsh Health Minister? Why is this not happening in Wales? With the greatest respect, and I really do not want to score these political points—

[Alex Cunningham]

Don’t score them, then.

[Rob Roberts]

It is not a political matter! These issues affect the entire United Kingdom. Does the hon. Lady agree that that is the case? Does she agree that these matters are just the same in Wales as they are here, and that we need much wider reform?

--- Later in debate ---

[Neil O’Brien]

Is that not a revealing comment from the Opposition? The Government do not have any money. All this spending comes from hard-working taxpayers, and the Conservative party wants to keep the burden of tax down. On the hon. Lady’s point about the other pot of spending, we chose to prioritise funding through the frontline. That is our choice and it is one we will defend because we know we urgently need to improve social care—[Interruption.] It is tax, yes. All Government spending comes from tax, that is correct, and the idea that that is in some way a revelation speaks volumes about where the Opposition are.

In December 2021, “People at the Heart of Care: adult social care reform” was published, setting out a 10-year vision for reforming adult social care. We have made good progress over the last year on some of the commitments in that White Paper. We invested £100 million to begin implementing reforms on digitisation and technology, local authority oversight and new data collections and surveys, so that people working in the NHS and adult social care have improved access to the information they need to ensure personalised, high-quality care. The Carer’s Leave Bill, currently going through Parliament, will introduce a new leave entitlement as a day 1 right, available to all employees who are providing care for a dependant with a long-term care need. We will set out our next steps on social care soon.

We are committed to supporting our NHS by putting in place the investment and reform to secure its future and we will bring forward a workforce plan later in the year. We are building back better from the pandemic.

[Alex Cunningham]

I got the impression the Minister was winding up; I just ask him to commit to looking at the issues I raised in my speech about the secret report into the activities of North Tees and Hartlepool NHS foundation trust.

[Neil O’Brien]

I am happy to make that commitment.