Liver Disease and Liver Cancer

Andrea Leadsom Excerpts

Thursday 25th April 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I have to say that I am a bit disappointed, because the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), in particular, knows very well my personal commitment to the best start to life, so to hear her saying that the Government have done nothing and Labour is going to fix it is a bit rich, but there we are.

I congratulate the hon. Members for Stockport (Navendu Mishra) and for Glasgow Central (Alison Thewliss) on securing this important debate; it is an absolutely vital debate. All hon. Members, including the hon. Members for East Renfrewshire (Kirsten Oswald) and for Washington and Sunderland West (Mrs Hodgson), have raised the importance of prevention, early intervention and, in particular, early diagnosis. I commend them all for doing that. The Government are taking significant steps. The hon. Member for Glasgow Central talks about what the Scottish Government are doing. I can absolutely assure her that the Government of the United Kingdom are totally committed to improving early diagnosis and treatment, and I will go on to explain exactly what we are doing.

First, it is important to set out that we know that there are 6,000 new cases of liver cancer each year, making it the 18th most common cancer, with 5,000 deaths a year; that is 5,000 deaths too many. As my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) said during his tenure as Health Secretary, regional inequalities are “the disease of disparity”. He was absolutely right because—as the hon. Member for Stockport stated in his opening speech—economic and health inequalities go hand in hand.

Blackpool is a perfect example. It is one of the most deprived cities in England and flashes red on every indicator—for life expectancy, alcohol dependence and liver cancer. No fewer than 40% of the people unemployed there are not fit to work due to ill health, and the rate of death from chronic liver disease is almost two and a half times the average for England. That is an area that I have visited a number of times, to visit its family hubs and to look at the excellent work and huge efforts that go on there to level up to improve the disparities. Nevertheless, there is so much more to be done, and our strategy to eliminate disparities in liver disease and liver cancer is based on two key facts.

First, 90% of liver diseases are caused by alcohol dependency, obesity or viral hepatitis. Secondly, the five-year survival rate for liver cancer is only 13% precisely because people do not come forward with their symptoms until it is too late; early detection is vital. We know what causes liver disease, and we know that diagnosing it more quickly will save thousands of lives. That is why prevention and diagnosis are the twin pillars of our strategy to end inequalities in liver disease and liver cancer across our country.

To be clear, this is not about criticising people for drinking alcohol, but stopping the level of drinking that leads to liver disease and liver cancer. We know that rates of alcohol dependency are double in the most deprived local authorities. That is why, in December 2021, we published our drugs strategy, which does three things. First, it has brought the greatest-ever increase in funding —an extra £780 million—for drug and alcohol treatment, over £500 million of which is going straight to local authorities with the highest levels of deprivation and alcohol dependence. Secondly, the strategy is boosting screening capacity for liver disease, and thirdly, it is beefing up referral pathways to build a seamless system from diagnosis to treatment.

Since we published our strategy, we are treating more people than ever before for alcohol use. In February, almost 135,000 people were receiving treatment, compared with just over 117,000 just under two years ago, which is an increase of more than 15%. NHS England is investing almost £30 million to bring specialist alcohol care teams to hospitals in the most deprived parts of England. Those experts in addiction identify people in hospital with alcohol dependence, start their treatment and refer them to local authority community services where they can complete their treatment, overcome their dependence and move forward with their lives. I pay tribute to all those brilliant clinicians who are helping vulnerable people to turn their lives around.

Obesity is another major risk factor for liver disease and is a real scourge on the poorest parts of our country. During last week’s debate on the Tobacco and Vapes Bill, we came under fire from hon. Members on both sides of the House who said, “Well, what about sugar? Are you going to ban that too?” This Government are not in the habit of banning things, but I am proud of our record on sugar reduction, healthy eating and obesity.

We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks industry levy: we almost halved the sugar content in soft drinks between 2015 and 2019. I want to make the point that that is not with people saying, “Oh, this drink I used to like, I don’t like it anymore because it’s not sweet enough,” but was actually the result of reformulation that nobody noticed, which is the great thing about reformulation. If we can reduce the sugar, salt and fat content in foods so that people can carry on as normal without having to undertake some punishment routine, that is a good way to tackle the obesity problem.

[Alison Thewliss]

Having paid close attention to the sugar tax when it was brought in, there was a particular exemption in the products that required reformulation. Milkshakes could contain as much sugar as any of the full-fat fizzy drinks, but were somehow exempted because they had milk in them. Will the Minister perhaps take the opportunity to go away and think about whether they ought to be contained within a future iteration of the scheme?

[Dame Andrea Leadsom]

The hon. Lady will not be surprised, because she knows me well, that I am absolutely determined to tackle childhood obesity in particular, so that we can reverse the problems that we have seen in recent years, especially the spike in unhealthy eating and overeating during the covid pandemic. We know that people—both adults and children—are consuming too many calories. As she would expect, I am all over this and I am happy to debate any point with her. I agree on the sugar content in milkshakes, but there are many other foods that we also need to focus on. I hope I can reassure her on that.

For two years, we have been restricting the placement of less healthy products in shops and online to help consumers to make healthier choices. We are building on that progress. By the end of next year, further restrictions on price promotions on television and three-for-the-price-of-two offers in shops will come into force. I have been encouraging the big takeaway companies, the big supermarkets and so on to try to do it anyway— to get ahead of the regulations and to take action now. A number of them, I am pleased to say, are doing just that.

I am also pleased to update the House on the recent success of the NHS digital weight management programme. This week, the Obesity journal published a study showing that almost 32,000 people achieved sustained weight loss with the programme over a single year, which is really positive news. The programme is helping people from deprived backgrounds: more than a third of those referred were from black, Asian and minority ethnic communities. It is obviously early days, but there are positive signs.

The other major contributor to liver disease is hepatitis. Thanks to increased testing and improved access to treatment, we have reduced the number of people living with chronic hepatitis C virus in England by more than half since 2015. Deaths related to hepatitis C have fallen by just over a third since 2015, well above the World Health Organisation’s 10% target.

Liver disease is known as the silent killer because many people are unaware of their condition until it is too late. That is why, as part of our ambition to detect 75% of cancers at an early stage by 2028, NHS England has launched the early diagnosis programme for liver cancer, which aims to prevent liver cancer by actively checking for liver disease in our most deprived areas.

An important part of the early diagnosis programme includes 19 community liver health check pilot sites that were launched in 2022. The most recent data shows that the CLHC programme reached more than 7,000 people in our most deprived areas using mobile units between June ’22 and January ’23. These units are equipped with fibroscans, which is a fantastic new technology, as many hon. Members have mentioned, for detecting liver damage and identifying liver disease before it becomes life threatening. These non-invasive tests have diagnosed more than 830 patients with cirrhosis or advanced fibrosis. I am pleased to update hon. Members that there are now eight community diagnostic centres providing fibroscans and a further 14 planned.

For my entire career, I have fought for the principles of fairness and equal opportunity—from helping children and babies in deprived areas to get the best start in life to levelling the playing field for small businesses when I was Secretary of State for Business, Energy and Industrial Strategy and encouraging young women in my constituency to get into politics. I have done that throughout my career and I will not stop now. I am passionate about making our health service faster, simpler and fairer for all who use it, and tackling liver disease and liver cancer is at the heart of that mission. We have already delivered significant progress and, through prioritising prevention and driving early diagnosis, we have a plan to go further and faster in the years ahead.

Oral Answers to Questions

Andrea Leadsom Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Vicky Ford (Chelmsford) (Con)]

4. What recent progress she has made on retaining GPs.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

General practitioners are a rock. They are the underpinning force of primary care. I want to take the opportunity to pay tribute to them for all they do for the health of the nation. My right hon. Friend is right to raise the issue of GP retention. During covid and since, GPs have been exhausted and the return to primary care provision has been difficult. The Government are doing a lot, such as improving digital telephony and reducing the administrative workload. I am about to launch a future of general practice taskforce to look at what more we can do to provide more support to this critical part of our primary care.

[Vicky Ford]

Chelmsford is a growing city, and it is very good that, compared with pre-covid times, we have more clinicians in our GP surgeries, but we need more surgeries as well. One new surgery is being built. I have been told that the limits that local district valuers impose on NHS lease costs make it increasingly difficult for developers to deliver new surgery buildings, not only in Chelmsford, but in other parts of the country. Will my right hon. Friend meet me and other affected MPs to see whether we can resolve that issue and help growing areas, where there are more houses, to deliver the new surgeries that we need?

[Dame Andrea Leadsom]

Of course I would be delighted to meet my right hon. Friend to discuss that issue, which several colleagues across the House have raised with me. She will appreciate that the District Valuer Services is crucial in ensuring value for taxpayer’s money from the rents that are charged for GP practices. Nevertheless, the Department is working hard to support better primary care facilities. I understand the point and would be happy to meet her.

[Sarah Dyke (Somerton and Frome) (LD)]

There are 56 fewer fully qualified GPs in Somerset now than there were in December 2016, so it is no surprise that my constituents in Wincanton feel that they can never access one. How will the Minister support general practice to enable it to continue to provide the vital services that our communities deserve?

[Dame Andrea Leadsom]

It is fantastic that hard-working GPs have delivered 60 million more appointments a year than in 2019. That is a credit to their efforts. The Government have undertaken a wide range of approaches to try to reduce the administrative burden. We are focused on trying to deal with some of the issues that GPs have raised with me about the primary and secondary care interface so that they do not have to write all the fit notes and liaise with consultants. We have also spent more than £200 million on digital telephony. Importantly, the additional roles reimbursement scheme has added more than 36,000 more professional staff, from physios to pharmacists to those in GP practices, to try to support patient access.

[Mr Speaker]

I call the shadow Minister.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

At the last general election, the Government promised to deliver 6,000 more GPs by 2024-25, but there are still 2,000 fewer GPs than in 2015. Part of the problem is that morale has plummeted in the past decade, meaning that experienced family doctors and newly qualified GPs are hanging up their stethoscopes. What does the Minister say after scrapping two GP retention schemes last month? Will she come clean today about another broken manifesto promise?

[Dame Andrea Leadsom]

The hon. Lady is choosing numbers out of the air. She will be aware that there are almost 3,000 more GPs now than in 2019, and very importantly the long-term workforce plan is scheduled to introduce 6,000 new training places by 2031-32. In 2022, we had the greatest number ever of new trainee GPs. That is great news for GP practice, as they are crucial to primary care.

[Anna Firth (Southend West) (Con)]

5. What steps she is taking to ensure adequate funding for hospital repairs.

--- Later in debate ---

[Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)]

7. What steps she is taking to increase levels of nurse recruitment and retention in GP practices.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

We hugely appreciate the work that general practice nurses do. I know that the hon. Lady was a nurse in her previous life, and I absolutely pay tribute to her for her service. She will be aware that last year the Government provided additional funding for the general practice contract to uplift pay by 6%, in line with the pay review body’s recommendations. We are very much aware of the need to try to ensure that general practice nurses feel appreciated and are keen to be retained in GP practices, which is one of the reasons I have launched a taskforce on the future of general practice. As she will know, it is for GP practices themselves to determine the pay uplift for their nurses. I am looking closely at that, because we know that sometimes the pay rise provided by the Government was not passed on.

[Mrs Hamilton]

We have all seen images of people queuing around the block for an appointment at their GP surgery, and in my local integrated care board, there has been a decline in general practice nurses since June 2020. It currently takes 12 months to train nurses wishing to move into general practice. Will the Minister tell me and my constituents in Erdington, Kingstanding and Castle Vale what she is doing to ensure that the retention of experienced nurses and the training of new nurses does not add to the pressure that GPs are already facing?

[Dame Andrea Leadsom]

The hon. Lady raises an important point. The long-term workforce plan commits to increasing the number of general practice nurses by more than 5,000 by 2036-37. In her area, the number of doctors in general practice in the NHS Birmingham and Solihull ICB increased by 134 full-time equivalents between 2019 and 2023, but the number of nurses decreased slightly, by 34 full-time equivalents. However, over the same period, direct patient care staff increased by 1,195 full-time equivalents. I think that demonstrates to the hon. Lady that the actual resources in GP practice are increasing, with specialisms such as physiotherapy and pharmacy, as well as nurse prescribers, to provide patients more access to good healthcare.

[Kenny MacAskill (East Lothian) (Alba)]

8. What steps she is taking to support the recruitment and retention of community and district nurses.

--- Later in debate ---

[Rachel Hopkins (Luton South) (Lab)]

21. What steps she is taking to improve patient access to primary care.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

We are enormously grateful for the work of GPs in delivering 64 million more appointments nationally than in 2019. Our primary care recovery plan enhances GP access by expanding community pharmacy services nationwide. Some 98% of community pharmacies have signed up to the Pharmacy First offer, with over 125,000 consultations claimed in the first month.

[Alistair Strathern]

Across Bedfordshire, we suffer from patient to GP ratios that are well in excess of the national average; high housing growth is simply not matched by GP capacity. At Wixams, we have been able to break through 15 years of deadlock by putting stakeholders together, but issues still remain across the county. From Shefford to Stondon, heartbreaking stories are commonplace. The issue is not ICB-specific; it affects people right across the country. What more can we do to ensure that areas with high housing growth have the GP capacity that residents deserve?

[Dame Andrea Leadsom]

The hon. Gentleman raises a really important point. He may be aware that the Bedfordshire, Luton and Milton Keynes ICB received £36 million for its operational capital budget in 2023-24, with over £118 million for this spending review period. That operational capital is core funding provided to ICBs for delivering primary care, among other things. In addition, he will be aware that ICBs are able to provide input to planning permissions to ensure that primary care is delivered where there are new housing developments. I have worked with other hon. Members across the House to tackle this issue, and I am very happy to meet him to discuss it further.

[Kerry McCarthy]

When I speak to my constituents in Brislington, they tell me they have to wait an inordinate time to get through on the phone to their GPs at the Brooklea health centre, and wait over two weeks for appointments. Constituents in Fishponds have been told that it is over an hour’s wait for prescription medication at the local pharmacy—and we all know the situation with dentists. The other thing my constituents are waiting for is a general election. Does the Minister agree that that is the only way we will sort out these problems in the NHS?

[Dame Andrea Leadsom]

I certainly do not agree. If Labour were in government, we would see significantly worse outcomes. Covid was a once-in-100-years pandemic, and we have pulled out all the stops to recover from that. It is a huge tribute to all those working in primary care that they have done so well. In the hon. Lady’s ICB— Bristol North, North Somerset and South Gloucestershire —38.4% of all appointments were delivered on the same day they were booked in February this year, and 84% were delivered within two weeks of booking, with 66% of them face to face. These are extremely positive numbers for the 482,000 appointments delivered in February 2024. What is really important is that the number of patient care staff has increased by 656 full-time equivalents since 2019.

[Rachel Hopkins]

I have listened to the Minister’s comments, but the number of patients per GP in the Bedfordshire, Luton and Milton Keynes area is nearly 25% higher than the national average. Will the Minister explain why her Government think it is a good idea to cut the proportion of doctors being trained as GPs from around one in three to around one in four?

[Dame Andrea Leadsom]

The hon. Lady is simply wrong. She will be aware that, in fact, our long-term workforce plan is intended to raise the number of training places for GPs to 6,000 by 2031-32. In 2022, we had over 4,000 new GPs apply to take training places—an absolute record. There is much more to do, and I am working with GPs on a future for GP practice taskforce to make sure that we do everything we can, including hiring the 36,000 additional professionals now working in GP practices, in order to relieve the pressure on GPs and deliver much better patient access.

[Dame Andrea Jenkyns (Morley and Outwood) (Con)]

Last week, a constituent contacted me to say that her teeth crumbled during pregnancy and she was unable to get a dentist appointment. Another constituent, who was in agony, desperately pleaded for help to find a dentist. My own son, Clifford, has been waiting two years for a tooth extraction, and I have received hundreds of emails about similar issues. It is simply not good enough. What plans do the Government have to sort this out once and for all, and what advice does the Minister have for my constituents?

[Dame Andrea Leadsom]

My hon. Friend raises an incredibly important point. We know that because all dentists were locked down during covid, the recovery in access to NHS care has not been as fast as we would like. That is why we announced our dentistry recovery plan, including a new patient premium, which, since it was launched on 1 March, has already seen hundreds of thousands of new NHS patients who have not seen a dentist in two years. Some 240 dentists will receive golden hellos to encourage them to work in underserved areas. We also have our new Smile for Life prevention programme, which will ensure that babies receive an early dental check for their milk teeth in family hubs, and that pregnant mums receive better dental care and advice. We are now trying to work with dentists to look at reform of the units of dental activity contract, but following the first meeting of the group yesterday, it seems that dentists feel that all the parameters are in place. What we now need to do is ensure that the incentives are there and that we see things changing rapidly.

[Siobhan Baillie (Stroud) (Con)]

My GPs are working extraordinarily hard to increase access in the face of ever increasing public demand. I am alarmed by the Labour party’s talk about scrapping the GP partnership model, as I find in the Stroud district that GP practices are some of the most efficient parts of our NHS services. They need support, the removal of bureaucracy and the opening up of funding pots, rather than dismantling. Will my right hon. Friend explain how access to primary care would not be helped by removing the partnership model, and what are the Government doing to help ICBs create more flexible partnership funding pots?

[Dame Andrea Leadsom]

My hon. Friend makes a fantastic point, and I say again that GPs absolutely underpin our primary care. We all absolutely rely on them, and our measures to create 36,000 additional roles in GP practices will provide them with the additional capacity they need so that they can serve their patients better. That is good for patients, good for primary care and incredibly good value for the taxpayer. It is ludicrous that Labour is proposing to undermine the GP partnership model; that would be a disaster for primary care.

[Mark Eastwood (Dewsbury) (Con)]

T1. If she will make a statement on her departmental responsibilities.

--- Later in debate ---

[Maggie Throup (Erewash) (Con)]

Just yesterday, the Office for National Statistics released data showing that alcohol-specific deaths in 2022 were 4.2% higher than in 2021 and a massive 32.8% higher than in 2019. Will my right hon. Friend now seriously consider a stand-alone alcohol strategy based on this worrying trend and agree to meet me and other interested parties to discuss a way forward to tackle alcohol-specific deaths?

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

My hon. Friend was an incredibly hard-working health Minister and I pay tribute to her for all she did in this area. She will be aware that our groundbreaking drug and alcohol strategy commits more than half a billion pounds of new funding over the spending review period to rebuild drug and alcohol treatment services, with plans to get an additional 15,000 alcohol-dependent people into substance misuse treatment by 2024-25, which we are currently on track to achieve. I would be delighted to meet her to talk about it further.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

At my last surgery, a young woman told me that, thanks to the delay in her GP diagnosing her ovarian cancer, she is now infertile and receiving aggressive treatment. She had made four GP appointments over several months for her unexplained stomach cramps. Only in an emergency admission in another country was the ovarian cancer diagnosed and the tumour removed. How long will it be before the symptoms of female-specific conditions are taken seriously by our medical establishment, from initial training onwards?

--- Later in debate ---

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

Mandatory fortification of flour with folic acid could save many thousands of children from spina bifida, so why is it happening so slowly, at such a low level and applied to too few products?

[Dame Andrea Leadsom]

I assure the hon. Member that we remain firmly committed to the mandatory fortification of flour with folic acid. That will help to protect around 200 babies each year from being born with neural tube defects. The policy is being delivered across the UK as part of a wider review of bread and flour regulations. In January we published our consultation response, and we will bring forward legislation to implement the policy later this year.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Ten days ago I went to the Whipps Cross A&E department to see for myself the pressures that the brilliant team there are under—pressures that are heavily exacerbated by the failure to redevelop the hospital. Originally, we were promised that the new hospital would be open by 2026, but we have still not agreed with the Department a plan and timetable to submit to the Treasury for that redevelopment. As a result, the hospital is having to spend huge amounts of money trying to stem the damage as well as being able to treat patients. It is costing us all. For the sake of patient care and NHS budgets, will the Minister meet me to work out where the hold-up is in getting Whipps Cross redeveloped?

Dentistry: Access for Cancer Patients

Andrea Leadsom Excerpts

Wednesday 17th April 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Stretford and Urmston (Andrew Western) on securing this really important debate on behalf of Michele and all the other petitioners. I would of course be delighted to meet Michele to hear her views, and I particularly take note of her call for all cancer patients to be advised of the potential impact of cancer treatment on their oral health. That is a really solid and actionable thing that I undertake to take away today. I look forward to meeting Michele and the hon. Gentleman in due course.

I wish to take this chance to pay tribute to the Mouth Cancer Foundation, the Oral Health Foundation and Dentaid, to name just a few of the excellent charities that provide support and advice to so many.

I thank all Members who have spoken in what has been an excellent debate. I say to the hon. Member for Tiverton and Honiton (Richard Foord) that I fully appreciate the challenges in Devon. He will no doubt welcome the fact that a mobile dental van, which will be quite a boost for very underserved and geographically distant areas, will be forthcoming for Devon in the near future. In addition, one of the real problems in Devon—this is not the hon. Gentleman’s fault at all—is that in his area on average only around 57% of commissioned units of dental activity are actually undertaken by dentists. I am sure he might like to talk to his local integrated care board about that, if I can help in any way, I would be delighted to.

As I will come on to talk about, our dental recovery plan attempts to incentivise further NHS dentists to really ramp up delivery. In fact, we have already seen hundreds of thousands of new dental treatments just since 1 March, when the plan went live. Unfortunately, the data is not publishable as yet, but I feel really optimistic. I totally understand what Members say about it being not good enough—I totally get that—but we are seeing rapid improvements and I encourage the hon. Gentleman to talk to his local ICB.

[Richard Foord]

On the Minister’s point about only 57% of the units of dental activity being taken up in Devon, is that not a workforce issue?

[Dame Andrea Leadsom]

No. How it works is that the ICB commissions dentists to provide NHS dentistry, and the NHS contractor undertakes to fulfil a number of units of dental activity. If they do not do that, for whatever reason, at the end of the financial year the ICB claws back the money they gave the NHS dentist to fulfil that contract. I am not judging anything; I am merely giving the hon. Gentleman information that I hope is helpful to him.

[Yasmin Qureshi]

Will the Minister give way?

[Dame Andrea Leadsom]

Yes, but I do not want to run out of time.

[Yasmin Qureshi]

On that point, it is very much an issue of being able to survive: many dentists say they return the units because if they took on all the NHS appointments, they would not be able to survive financially.

[Dame Andrea Leadsom]

I hear what the hon. Lady says. My own assessment is slightly different, but I obviously respect her view.

The hon. Member for Birmingham, Erdington (Mrs Hamilton) and I have worked together for many years on all matters to do with early years intervention. She made a really good point about less survivable cancers, but I would highlight to her the 160 diagnostic centres that are being opened, which will help with early detection. She also made some good points about the importance of good oral health assessments, and she is right to raise that. One thing I would point out to all hon. Members, which was astonishing to me when I came into this role in November, is that since 1948, when the NHS started, only between 40% and 50% of adults in England have ever received NHS dentistry. It is not like Scotland, where the hon. Member for Aberdeen North (Kirsty Blackman) said the number is 90%—is that the right number?

[Kirsty Blackman]

95%.

[Dame Andrea Leadsom]

Yes, 95% of people in Scotland receive NHS dentistry. In England, it is extremely different, and it always has been under Governments of all parties. I would just put that to hon. Members as a piece of information that it is really important to know.

To the hon. Member for Bolton South East (Yasmin Qureshi), I would highlight SMILE4LIFE, which is a big part of the dental recovery plan. The shadow spokesman, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), also raised the SMILE4LIFE. It focuses on the earliest years, including getting pregnant mums to have their teeth checked, and on good oral health in babies and toddlers, so that by the time they go to school they are used to brushing their teeth twice a day. Good oral health is absolutely critical. In answer to the point raised by both the hon. Member for Bolton South East and the shadow spokesperson, I should say that the Secretary of State and I both made very clear and full responses to the Health and Social Care Committee on the issue of where funding for the dental recovery plan has come from.

Moving on to the things that I actually intended to say, I am absolutely aware that almost everyone in our country has been personally affected by cancer, whether themselves or through a friend or relative, and that includes members of my own family, so I really do understand the issue. Last year, just over 340,000 new cancer patients were diagnosed in England—almost 1,000 every single day or one every 90 seconds. We know that receiving a diagnosis can be terrifying, and we should never lose sight of what those patients and their families are going through. I am really glad that the petition has been brought forward to highlight the terrible disease of oral cancer and the impact on the oral health of those with other cancers.

Before I turn to cancer, I want to quickly outline the steps we have taken to improve access to dentistry across the country since publishing our recovery plan on 7 February. As colleagues will know, access has simply not recovered fast enough since the covid lockdowns, and the issue was my top priority on appointment to this role in November. I am really proud that the plan is creating around 2.5 million additional NHS appointments. We are supporting dentists through a new patient premium to take on patients who have not seen a dentist for two years. We are increasing the minimum value of a unit of dental activity to £28. We are helping patients to find a dentist through a new marketing campaign. We are bringing dental care to our more isolated communities through mobile dental plans and by encouraging dentists to work in underserved areas through golden hellos for 240 dentists. As I have mentioned, the SMILE4LIFE initiative is designed to get in early and help families to understand the importance of good oral hygiene.

Not only that, but we are also making progress to increase the workforce and, in fact, there were 1,352 more dentists doing NHS work in 2022-23 than in 2010-11. It is not the case that dentists are disappearing from the NHS; there are 1,350 more. As announced in the long-term workforce plan, we are going to increase dentistry training places by 40%, so that there are over 1,100 places by 2031-32. We are also increasing training places for dental therapists and hygienists to more than 500 a year by 2031-32. Importantly, we are exploring whether the prospects for a tie-in could ensure that dentists spend a greater proportion of their time delivering NHS dental care, rather than receiving that very expensive training and then perhaps going off to do private dentistry, which means fewer people have access to NHS dentists. It is great to see that, since we published the plan on 7 February, and it went live on 1 March, hundreds more dental practices are already opening their doors to new patients. I look forward to giving the House a full update on the recovery plan shortly, when I will be able to talk to colleagues about the significant increase in the number of patients able to access an NHS dentist.

In the hon. Member for Stretford and Urmston’s own integrated care board in Greater Manchester, there is the second highest number of dentists doing NHS work in England. That is almost 71 dentists per 100,000, against a national average of 53.5. I understand that the ICB there is supporting a local initiative called the dental quality access scheme to improve access to NHS dentistry, which requires practices to commit to seeing new NHS patients and, importantly, to providing urgent care access. The practices have been asked to prioritise vulnerable patients and patients with serious conditions, including cancer. That is a fantastic scheme by the ICB, and I encourage other ICBs listening to this debate to follow suit. The scheme brought over 200,000 extra appointments for patients in the last financial year, which I am sure the hon. Member is delighted about.

Turning to the hon. Member’s specific points on charges, the Government responded to a petition on 9 November that requested

“Free Dental Treatment for All Cancer Patients”.

Our reply pointed out that, in 2022-23, 47% of all courses of treatment for NHS dental patients were delivered free of charge, and those who do pay for dentistry are providing an important contribution to NHS budgets. I am sure the hon. Member will know that dentistry charges have been in place almost since the foundation of the NHS 75 years ago. Also, as I have already pointed out, under Governments of every party only about 40% to 50% of adults have ever received NHS dental care.

Despite inflation and other spending pressures, we froze charges between December 2020 and April 2023 to help all our constituents with cost of living pressures, and since then we have raised the charges only proportionately. The hon. Member is right to say that cancer patients face additional financial burdens, and that is why the Government are committed to supporting every patient who faces financial hardship with full or partial exemptions from dental patient charges, which are available through the NHS low income scheme. As the hon. Member for Aberdeen North pointed out in the case of Scotland, those also apply to people being treated in hospitals, and that will not change.

I am sure that the hon. Member for Stretford and Urmston will appreciate that, at a time when NHS budgets are under extreme pressure, it is not feasible to offer free dental care to every patient regardless of their means. We are instead focusing our efforts on continuing to ensure that the most vulnerable are supported to access NHS dentistry, including patients with cancer. In 2021, there were just over 9,100 oral cancers, which was equal to around 3% of all cancers. It is clear that cancer must be caught at the earliest opportunity to give people the best possible chance for recovery. Dentistry plays a crucial role because dentists check for signs of oral cancer in every routine check-up, and it is a contractual requirement for dentists to prioritise patients at a higher risk of oral cancer for more frequent recalls.

Turning to the hon. Gentleman’s specific point about prioritising dental appointments for cancer patients, I am aware of instances where patients have faced unacceptable delays to the start of their treatment because of a lack of dentistry appointments. I agree with all hon. Members that such delays are just unacceptable, and we are committed to making sure that everyone who needs a dentist should get one. That is why, along with the raft of measures we are introducing to improve access to NHS dentistry across the country, we are also publishing new guidance to make it crystal clear to every integrated care board that they have a responsibility to commission additional specific services in their local area when they identify problems such as cancer patients being unable to access timely treatment.

As soon as we published our dentistry recovery plan on 7 February, I turned my attention to seeking out the expertise and knowledge of dentists and their representative bodies to understand their perspectives on the need for dental contract reform. I am specifically looking now at what reforms would improve access to dentistry and encourage greater capacity, as well as how at we can consult the dental profession and prepare for further announcements later this year. I can assure hon. Members that, in every decision, I will keep pushing for every patient in our country to have access to the dental care they need, while protecting our cast-iron guarantee to support those most in need with full or partial exemptions from dental patient charges for those on low incomes.

Tobacco and Vapes Bill

Andrea Leadsom Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

I want to start by thanking the many lung cancer and asthma charities, particularly ASH, for their advice, research and support. I personally pay tribute to the chief medical officer for England for his commitment to making the strongest possible case for this life-changing legislation, and to Health Ministers across the UK for their collaboration in what will be a UK-wide solution for future generations.

I was very disappointed with the hon. Member for Ilford North (Wes Streeting), who opened for the Opposition. I have said it before and I will say it again: I like the hon. Gentleman. He once said on air that that was death to his career! Why would he have said that, Madam Deputy Speaker? But I am really disappointed today, because he was not listening. My hon. Friends had some very sensible questions about consultation, and they raised very serious points about flavours for vapes and how they might help adults to quit. He was not listening; he was making party political points. In fact, he barely said anything sensible about the legislation. All he did was talk politics. I appreciate the fact that Labour Members have been whipped to support the Bill. On my side, colleagues are trusted to make their own decisions on something that has always been a matter for a free vote. [Interruption.] He sits there shouting from a sedentary position, political point-scoring yet again.

The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) raised a very serious question about stop smoking services. I can tell her that the Government have allocated £138 million a year to stop smoking, which is more than doubling. The Government’s commitment to helping adults to stop smoking is absolutely unparalleled.

I thank the hon. Member for East Renfrewshire (Kirsten Oswald) for her support for the Bill, and for the collaborative approach of the Government in Scotland in their work bringing forward this collaboration among all parts of the United Kingdom.

I pay particular tribute to my hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health Committee for his excellent speech and his strong case for long-term policies that will prevent ill health and thereby reduce the pressures on the NHS, which is so important. He asked when we will see the regulations and the consultation on vaping flavours, packaging and location in stores. It is our intention to bring forward that consultation during this Parliament if at all practicable.

I thank my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) for his tribute to Dr Javed Khan for his excellent report into the terrible trap of addiction to nicotine. My right hon. Friend made the point that it is simply not a free choice, but the total opposite.

I thank the Liberal Democrats and their spokesman, the hon. Member for St Albans (Daisy Cooper), for saying that they will support the Bill on Second Reading. I am not quite sure where they are going on the smoking legislation, but I am grateful for their support on vaping. I hope to be able to reassure them during the passage of the Bill.

The case for the Bill is totally clear: cigarettes are the product that, when used as the manufacturer intends, will go on to kill two thirds of its long-term users. That makes it different from eating at McDonald’s or even drinking—what was it?—a pint of wine, which one of my colleagues was suggesting. It is very, very different. Smoking causes 70% of lung cancer cases. It causes asthma in young people. It causes stillbirths, it causes dementia, disability and early death. I will give way on that cheery note.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I thank the Minister for giving way. I draw the attention of the House to my entry in the Register of Members’ Financial Interests as a practising NHS consultant addiction psychiatrist. Does my right hon. Friend share my concern that what we have heard from the libertarian right today is a false equivalence between alcohol and bad dietary choices, and smoking, and that moderate alcohol and moderate bad eating are very different from moderate smoking, because moderate smoking kills. It means that people live on average 10 years less and it means less healthy lives. Does she agree that this is not about libertarianism but about doing the right thing, protecting public health and protecting the next generation, and that is why we should all support the Bill?

[Dame Andrea Leadsom]

I am grateful to my hon. Friend, who makes such a powerful point and speaks with such authority. Similar points were made by my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who as a paediatrician spoke with great expertise on this matter. It is absolutely true: it is a false choice. It is not a freedom of choice; it is a choice to become addicted and that then removes your choice.

Every year, more than 100,000 children aged between 11 and 15 light their first cigarette. What they can look forward to is a life of addiction to nicotine, spending thousands of pounds a year, making perhaps 30 attempts to quit, with all the misery that involves, and then experiencing life-limiting, entirely preventable suffering. Two thirds of them will die before their time. Some 83% of people start smoking before the age of 20, which is why we need to have the guts to create the first smoke-free generation across the United Kingdom, making sure that children turning 15 or younger this year will never be legally sold tobacco. That is the single biggest intervention that we can make to improve our nation’s health. Smoking is responsible for about 80,000 deaths every year, but it would still be worth taking action if the real figure were half that, or even a tenth of it.

There is also a strong economic case for the Bill. Every year, smoking costs our country at least £17 billion, far more than the £10 billion of tax revenue that it draws in. It costs our NHS and social care system £3 billion every year, with someone admitted to hospital with a smoking-related illness almost every minute of every day, and 75,000 GP appointments every week for smoking-related problems. That is a massive and totally preventable waste of resources. For those of us on this side of the House who are trying hard to increase access to the NHS and enable more patients to see their GPs, this is a really good target on which to focus. On the positive side, creating a smoke-free generation could deliver productivity gains of nearly £2 billion within a decade, potentially reaching £16 billion by 2056, improving work prospects, boosting efficiency and driving the economic growth that we need in order to pay for the first-class public services that we all want.

I know that hon. Members who oppose the Bill are doing so with the best of intentions. They argue that adults should be free to make their own decisions, and I get that. What we are urging them to do is make their own free decision to choose to be addicted to nicotine, but that is not in fact a choice, and I urge them to look at the facts. Children start smoking because of peer pressure, and because of persistent marketing telling them that it is cool. I know from experience how hard it is, once hooked, to kick the habit. I took up smoking at the age of 14. My little sister was 12 at the time, and we used to buy 10 No. 6 and a little book of matches and —yes—smoke behind the bicycle shed, and at the bus stop on the way home from school. [Interruption.] Yes, I know: I am outing myself here.

Having taken up smoking at the age of 14, I was smoking 40 a day by the age of 20, and as a 21st birthday present to myself I gave up. But today, 40 years later—I am now 60, so do the maths—with all this talk of smoking, I still feel like a fag sometimes. That is how addictive smoking is. This is not about freedom to choose; it is about freedom from addiction.

There is another angle. Those in the tobacco industry are, of course, issuing dire warnings of unintended consequences from the raising of the age of sale. They say that it will cause an explosion in the black market. That is exactly what they said when the age of sale rose from 16 to 18, but the opposite happened: the number of illicit cigarettes consumed fell by a quarter, and at the same time smoking rates among 16 and 17-year-olds in England fell by almost a third. Raising the age of sale is a tried and tested policy, and a policy that is supported not only by a majority of retailers—which, understandably, has been mentioned by a number of Members—but by more than 70% of the British public.

[Tim Loughton (East Worthing and Shoreham) (Con)]

If I had known that my right hon. Friend was such a keen smoker, I would not have recruited her to the Conservative party at the tender age of 18 when we were at university.

I have always taken a free-choice approach to health matters, and as shadow Children’s Minister I had to lead on both the tobacco advertising ban and the public smoking ban. We were wrong to oppose them. Who would now think it remotely normal for people to be able to smoke around us in restaurants and other public places? Does my right hon. Friend not agree that in a few years’ time this measure will seem just the same as banning smoking in public places, and people will ask why we did not do it earlier?

[Dame Andrea Leadsom]

As I have said ever since I met my hon. Friend at the age of 18, he is always right. I can never disagree with him.

I want to say a few even more furious words about vaping. It is just appalling to see vapes being deliberately marketed to children at pocket-money prices and in bright colours, with fun packaging and flavours like bubble gum and berry blast, and with the vape counter right next to the sweet counter.

[Sir Jake Berry]

Before my right hon. Friend gets too furious about vaping, may I ask her to clarify two points on smoking? First, she said that because of the addictive nature of nicotine, it is extremely important that we stop people smoking from the age of 15. I do not support that, but if it is so important, why are we not starting at 17? It is already illegal for 17-year-olds to smoke. What is the magic of 15? If we really believe in the policy, why delay? Secondly, she spoke about her own experience, and I am a former smoker myself. She started smoking at 14, and I started smoking at about 14 as well. It was illegal when I started smoking at 14, but it did not stop me. I am a lawbreaker—how shocking. Why does she think that this ban on people starting smoking when under age will be different?

[Dame Andrea Leadsom]

I am grateful to my right hon. Friend for raising those really important points. As I will come on to, we will be putting £30 million of new money each year into trading standards and our enforcement agencies to clamp down on enforcement, and we are making it illegal to sell cigarettes to anybody turning 15 this year. He asks why. It is precisely because we are trying to bring in the Bill with a decent amount of notice so that people can prepare for it, precisely to protect retailers and allow all the sectors that will be impacted to be able to prepare.

I come back to the area where I am seriously on the warpath: targeting kids who might become addicted to nicotine vapes. I went to Hackney to visit some retail shops, where I saw the vape counters right next to the sweet counters. I saw that it is absolutely not about me—it is not about trying to stop me smoking. It is about trying to get children addicted through cynical, despicable methods. Sadly, for too many kids, vapes are already an incredible marketing success. One in five children aged between 11 and 17 have now used a vape, and the number has trebled in the last three years.

[Kirsten Oswald]

I am grateful to the Minister for giving way as she ploughs through all of this. I wonder whether she can share her views on the advertising of vape products on sports kits and via sports facilities.

[Dame Andrea Leadsom]

The hon. Lady is aware that there is already very restrictive advertising for smoking and vaping. We are very concerned that some advertising is breaching advertising standards regulations, and I will write to retailers specifically about that.

Parents and teachers are incredibly worried about the effect that vapes are having on developing lungs and brains. The truth is that we do not yet know what the long-term impact will be on children who vape. Since I was appointed, I have done everything I can to ensure that this Bill will protect our children. The Government’s position is clear: vaping is less harmful than smoking, but if you don’t smoke, don’t vape—and children should never vape.

We will definitely make sure that people who smoke today continue to have access to vapes as a quit aid, which will absolutely not change, but we cannot replace one generation that is hooked on nicotine in cigarettes with another that is hooked on nicotine in vapes. That is why we are using this Bill to take powers to restrict flavours and packaging, and to change how vapes are displayed in shops. To reassure the Chair of the Health and Social Care Committee and my right hon. Friend the Member for Rossendale and Darwen (Sir Jake Berry), we plan to consult on that before the end of the Parliament, if practicable. The disposable vapes ban will likely take effect in April 2025—those regulations have already been published.

These are common-sense proposals that strike the right balance between helping retailers to prepare, giving sufficient notice and protecting children from getting hooked on nicotine, while at the same time supporting current smokers to quit by switching to vapes as a less harmful quit aid, supported by £138 million a year. Our approach is realistic for those who smoke now and resolute in protecting children. I am convinced that, just like banning smoking in indoor public places and raising the age of sale to 18, these measures will seem commonsensical to all of us in 10 years’ time. In decades to come, our great-grandchildren will look back and think: why on earth did they not do it sooner? I urge all right hon. and hon. Members to vote for this Bill as the biggest public intervention in history. I commend the Bill to the House.

Question put, That the Bill be now read a Second time.

NHS Prescriptions, Wigs and Fabric Supports: Charges Uplift

Andrea Leadsom Excerpts

Monday 15th April 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

The National Health Service (Charges for Drugs and Appliances) (Amendment) Regulations 2024 (the Amendment Regulations) have been laid before Parliament to increase certain National Health Service charges in England from 1 May 2024.

We have applied an increase of 2.59%, rounded to the nearest 5p, across the single prescription charge, three-month and 12-month prescription pre-payment certificates (PPCs) and the HRT PPC. This year we have increased the prescription charge by 25p from £9.65 to £9.90 for each medicine or appliance dispensed. The HRT PPC will cost £19.80, an increase of 50p due to its rate being set at twice the single prescription charge; and the three- month PPC and 12-month PPC will cost £32.05 and £114.50 respectively.

Charges for wigs and fabric supports will also be increased by the same rate. Details of the revised charges from 1 May 2024 can be found in the table below:

Healthy Start Uptake Data

Andrea Leadsom Excerpts

Tuesday 26th March 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

I would like to make the following statement on Healthy Start.

Background

Healthy Start is a passported scheme with eligibility being derived from certain qualifying benefits, such as universal credit and child benefit. The uptake percentage for the Healthy Start scheme is calculated by comparing the number of eligible people to the number of beneficiaries (individuals who were eligible and accessing the scheme).

I regret to inform the House that an issue has been identified with the statistics provided that means that the uptake figures used in PQ198857, PQ199201, PQ199480, PQ201335 and PQ9386, and referenced by Viscount Younger in a debate in December 2023, were incorrect.

It is important to state that this issue affected eligibility uptake statistics only; it did not impact any Healthy Start individual applicants, existing beneficiaries, or live claim processes.

Issue

Healthy Start uptake percentage statistics are calculated using information provided by the Department for Work and Pensions (DWP). The DWP generates potential eligibility statistics through matching DWP benefit data with HM Revenue and Customs (HMRC) child benefit data. When a new HMRC child benefit data feed was introduced in June 2023, the DWP omitted to add it to the matching process. This means that the figures provided between July 2023 and February 2024 were inaccurate.

Impact

Due to the missing data feed, the Healthy Start statistical data provided has led to an underestimated number of eligible beneficiaries from July 2023 to February 2024; this in turn has led to an overstated estimated uptake percentage for the same period.

It should be noted that while these statistics are a key element for reporting uptake of the Healthy Start scheme, there has been no impact on new claims where volumes have remained stable. The scheme continues to be promoted by NHS Business Services Authority (NHSBSA), which administers the scheme on behalf of the Department of Health and Social Care (DHSC), through a variety of publications, social media, exhibits and other routes.

Corrective Action

The DWP has now added the new data feed to the matching process and has provided the updated statistical data for March 2024. Additional checks have been added to ensure the issue does not occur in the future.

The incorrect statistical data has been removed from the NHS Healthy Start website; the revised March figures will be published shortly by the NHSBSA.

Unfortunately, we are unable to publish corrected historical figures as the two systems involved in the matching process do not have the historical data that could be matched.

This issue did not impact any Healthy Start individual applicants, existing beneficiaries, or live claim processes but did affect eligibility uptake statistics. The DWP will continue to work closer with HMRC and DHSC to ensure the quality of this data going forward.

[HCWS389]

WHO Framework Convention on Tobacco Control

Andrea Leadsom Excerpts

Monday 18th March 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Between 5 and 10 February, the Deputy Chief Medical Officer (DCMO) led the UK delegation at the 10th conference of the parties (COP10) of the World Health Organisation (WHO) framework convention on tobacco control (FCTC) held in Panama City, Panama.

International leadership on tobacco control

This was an opportunity to showcase our international leadership on tobacco control following the Prime Minister’s smoke-free generation announcement, which has the potential to be one of the most significant health policies in a generation. The DCMO made a key intervention to confirm that we will shortly be introducing legislation to:

Create the first smoke-free generation, so that children turning 15 this year or younger can never legally be sold tobacco;

Further crack down on youth vaping by providing powers to restrict flavours, point of sale and packaging for vapes and other consumer nicotine products; and

Ban the sale and supply of disposable vapes.

During the conference, the DCMO also clarified the UK’s position on heated tobacco products. She confirmed that the health advice is clear: we do not recommend their use and the Government encourage users to quit all forms of tobacco. There is no safe level of tobacco consumption, and all tobacco products are harmful. There is also clear evidence of toxicity from heated tobacco in laboratory studies. The aerosol generated by heated tobacco also contains carcinogens, and there will be a risk to the health of anyone using these products. In the UK, heated tobacco products are regulated as a tobacco product and are covered by our strict tobacco advertising and promotions ban—and they will be included in the new smoke-free generation policy.

Outcomes of COP10

COP10 committed to protect the environment from the harms of tobacco and to address cross-border tobacco advertising. COP10 also adopted decisions related to the promotion of human rights through the WHO FCTC.

COP10 also adopted the Panama declaration, which highlights the significant conflict between the tobacco industry’s interests and the interests of public health. The declaration stresses the need for policy coherence within Governments to comply with the requirements of article 5.3 of the WHO FCTC, which aims to protect public health policies from commercial and other vested interests of the tobacco industry. At the conference, the delegation made clear the UK’s commitment to this article.

The COP has been a helpful way of keeping strong tobacco controls at the top of the global health agenda. It is also a very useful forum for sharing best practice. As a world leader in tobacco control, the UK remains committed to seeing the FCTC implemented worldwide. At the same time, we are clear that the UK’s sovereignty is of paramount importance, and we will continue to take policy decisions that serve the UK’s national interests.

[HCWS349]

Children’s Cancer Care: South-East

Andrea Leadsom Excerpts

Wednesday 13th March 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

Thank you, Sir Christopher. It is a pleasure to serve under your chairmanship in what has been quite a drawn-out debate on such an important topic. The hon. Member for Twickenham (Munira Wilson) has raised an incredibly important issue. I hope she and all hon. Members accept that clinical assessment and knowledge are crucial to making vital decisions that affect children’s health at such a difficult time for them and their families.

I am responding to this debate on behalf of my right hon. Friend the Member for Pendle (Andrew Stephenson), but I will endeavour to respond to each colleague and commit to writing where necessary. The debate has understandably stirred some strong emotions, because every colleague has had direct or indirect exposure to some of the questions it has raised. I am therefore grateful to all hon. Members for their contributions, which demonstrate the huge importance to us all of getting the right outcome.

Each of us has helped a parent who has called our constituency offices seeking help at an incredibly difficult time. I want to assure everyone that each person in the Government, from the Prime Minister down, knows the importance of getting this right. That is why cancer services for children are an absolute priority. From my own work in the Start for Life programme, and in the few months I have been in my current role, I have seen a collective determination to ensure that children right across the country receive the highest possible standards of care. Children with cancer are the key priority.

The Royal Marsden Hospital and St George’s Hospital currently care for most of the children with cancer in south London and the south-east. I pay tribute to the work of those dedicated doctors and nurses who do everything they can to look after the children entrusted to their care, and I want to be clear that NHS England’s proposed changes do not reflect on the stellar service that those staff members have given and continue to give. Rather, the proposals follow advice from Professor Sir Mike Richards’ review, which made it a clinical requirement for cancer services to be placed in the same location as an intensive care unit in order to give critical life support to the most unwell children.

Sir Mike’s reasoning was simple. First, we need to end transfers between hospitals for very sick children, which add risks and stress for them, not to mention their families, during what is already an unimaginably difficult time. Secondly, while we will not compromise on safety, we need to ensure quality of care. As every Member will agree, children deserve to benefit from the very latest technology available. Thirdly, we need to ensure a seamless, joined-up approach.

NHS England has listened to patients, parents and clinical experts to hear how we might best improve their care. The NHS England process has been rigorous, and it has been immensely important for all those patients, parents and specialists to put forward their own significant insights. Last year, NHS England carried out a 12-week public consultation on two options for the future location of the principal treatment centre for south London and much of the south-east: Evelina London Children’s Hospital and St George’s Hospital. Under both options, all radiotherapy for children with cancer would be at University College Hospital.

Both Evelina London and St George’s deliver outstanding-rated children’s healthcare. They also provide outstanding-rated education in their hospital schools. Both are capable of delivering a future principal treatment centre that meets our high standards. They are also both adept at listening to children, young people and their families to improve on the care they deliver.

The experience and expertise of specialists working side-by-side with intensive care and surgical teams will make a real difference: enabling children to get care where they need it, when they need it, on a specialist cancer ward; bringing down the number of children admitted to intensive care; making it easier for different specialist teams treating the same child to work closely together; improving care for children; upskilling the workforce and supporting new kinds of research. Importantly, it will also mean that the future cancer centre will be capable of offering the most innovative and cutting-edge treatments, which may bring precious new hope for children and their families.

The centre will build on the strengths of the existing service, including high-quality care by expert staff and access to clinical trials. It will be a family-friendly centre for children and young people, at the forefront of groundbreaking research and continuing the close relationship with the Institute of Cancer Research.

[Munira Wilson]

The Minister said a moment ago that the new centre will build on the service and the experience. The point that I and many Members have made is that St George’s has that experience. While the Evelina is brilliant in many paediatric specialisms, it does not have children’s cancer experience, so what will it build on? On the point about process, it was already predetermined, as I pointed out. It has been made clear in meetings we have had that a lot of the responses will not be taken into account unless there is new evidence. The views of children, their parents and clinicians are not being listened to in the consultation.

[Dame Andrea Leadsom]

I am afraid I fundamentally disagree with the hon. Lady on that point. The consultation has been open, with an open mind and following the best principles of open consultation. I think she is taking quite a liberty to suggest it is a foregone conclusion. I do not think she is correct in her belief. It is essential that clinicians can take all the inputs from those consultations to come to the right decision.

[Several hon. Members rose—]

[Dame Andrea Leadsom]

I will give way first to my hon. Friend the Member for Mole Valley (Sir Paul Beresford).

[Sir Paul Beresford]

Knowing quite a number of consultants at St George’s, if they heard that they were at a standstill position and not building on what they have now, they would be insulted.

[Dame Andrea Leadsom]

I will also take the intervention from my hon. Friend the Member for Woking (Mr Lord).

[Mr Jonathan Lord (Woking) (Con)]

Like several colleagues, I thank the existing hospitals for the amazing care that they have given over the years, but I agree with my hon. Friend the Member for Mole Valley: I do not think this decision is necessarily a no-brainer. We need to look at the final decision and report, and weigh up what is good and what is bad. Who knows what the final decision and its reasoning will be? I agree with the Minister that it has been a proper process. We should allow it to come to its conclusion very shortly, look at the evidence, and look at the decision in that light and with an open mind.

[Dame Andrea Leadsom]

I absolutely agree with my hon. Friends that the consultation is critical, that it has been an open consultation and that all views are being taken into account. I am grateful to them for supporting the process. As Members of Parliament and constituency representatives, we all want the best for our constituents, but in the case of clinical care, it is vital that those with specialist knowledge and understanding should be able to make such important decisions that will affect life and death outcomes for children.

The new centre will be a family-friendly centre forusb children and young people at the forefront of groundbreaking research, continuing a close relationship with the Institute of Cancer Research. The centre will lead joined-up working between different children’s cancer services so that children get proper access to care, wherever they live. Importantly, it will have many more services on site, reducing the need for some families to travel, which will be particularly helpful for children with complex needs and families that struggle to speak English.

I assure colleagues, and anyone who might be watching at home, that once the decision has been taken, there will be no sudden changes to how patients receive care. Of course, some families will naturally be worried about what the change might mean for their children. That is entirely normal, and NHS England will carefully involve every clinical team currently providing care, keeping parents and families closely updated at every stage. NHS England will encourage experienced staff to move to the future centre so that they can continue to provide a friendly and familiar face to the children they serve. No one from among the clinical staff will be made redundant in any future changes resulting directly from this decision. NHS England has met staff to listen to their views, and they assure me that that will continue.

The consultation heard from children, their carers, and families who have received the worst news. They have talked about their own experiences selflessly to try to help others. The consultation closed in December last year, and an independent research organisation published its findings in January. NHS England has taken into account every word of feedback and every inch of evidence to inform the decision-making process. NHS England leaders are meeting tomorrow to decide the future location of the centre. The meeting will be livestreamed so that everyone who is interested can hear the discussion and the decision.

In conclusion, wherever the future centre is placed, I am confident that tomorrow’s decision will offer the right outcome for our children and take all views into account.

[Munira Wilson]

Before the Minister sits down, will she give way?

[Dame Andrea Leadsom]

No, the hon. Lady will have her chance in a moment. Throughout this process, the guiding principle has always been safety, quality of care and the best outcomes for children with cancer, now and for the long term. The children and their families deserve nothing less.

Parents and Carers of Infants: Support

Andrea Leadsom Excerpts

Tuesday 12th March 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a real pleasure to serve under your chairmanship, Mr Henderson. What a lovely debate! I thank all colleagues from across the House for their contributions; it has been genuinely interesting. I would like to begin by thanking my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) for introducing her Bill on such an important topic and for securing time to debate it today. As Members will know, I have been championing the needs of babies for getting on for 27 years—gosh, that makes me very old. Now, having the huge honour of being the Minister with responsibility for Start for Life, I remain as committed and as passionate as ever in my mission to make sure that every baby gets the best start for life.

It began with my mum, a qualified midwife, asking me to help her to write a business plan for the Oxford Parent-Infant Project, a charity that to this day helps families who are struggling emotionally to cope with the journey to parenthood. Having experienced post-natal depression myself with my first son, who is now 28 and very big, I know only too well how crucial the earliest years are.

I have spent much of the last 27 years helping to establish parent-infant partnerships and various different charities providing therapeutic support for families, and then, in Parliament, working on the cross-party manifesto for the 1,001 critical days, and championing babies in Government and in Parliament.

I have worked with many colleagues. I am grateful to the hon. Member for Denton and Reddish (Andrew Gwynne) for noting that this is a cross-party agenda. I totally agree with him. I had so many conversations with Dame Tessa Jowell about the fact that Sure Start went so far, but that family hubs would be the 21st-century version. That is not to denigrate in any way the fantastic work of Sure Start, but family hubs are a one-stop shop, building on that excellent work and using the potential for digital to create a digital red book. The shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), has been sending me parliamentary questions about that. I encourage him to continue doing so, because it might speed things up.

There are many different measures to create the one-stop shop for parents, in a way that did not exist with Sure Start. Crucially, we want to make sure that those services are completely universal. What every parent and carer has said is, “No.1: tell me where I can get services and what they might consist of. No. 2: don’t stigmatise me. Don’t make me feel that if I go to this place, you might start proceedings against me and my children.”

The programme is designed to improve on, build on and grow that crucial support for the early years, and I am delighted to hear that it has the support of the hon. Member for Denton and Reddish.

As well as the support from Dame Tessa Jowell, Lord Field, Lord Blunkett, Lord Cameron, my right hon. Friend the Member for Maidenhead (Mrs May), Boris Johnson and our present Prime Minister, who all support this crucial early days agenda, I pay particular tribute to the support from my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), who has worked with me for so many years. We met when I was 18 and he was 19 at university. Before we were in Parliament together, we had this same interest in early years. As a former Children’s Minister, he has done so much to promote this agenda. I have mostly enjoyed working with him; sometimes I wish he would pipe down, but it is really excellent that he carries on banging the drum for early years. We have worked on it for so long together; he feels like an old pair of boots. Is that parliamentary language, Mr Henderson? I am sure it is.

As my hon. Friend the Member for East Worthing and Shoreham discussed, there is strong evidence that the 1,001 days from conception to the age of two set the foundations for our cognitive, emotional and physical development. Nurtured babies will go on to develop strong relationships and, as they grow up, will be better equipped to tackle the challenges that life throws at them. Investing in that critical period represents a real opportunity to improve outcomes and tackle health disparities by ensuring that millions of babies and their families have access to a one-stop shop style of family hub where all support services can be found in one welcoming universal hub.

Shockingly, up to 40% of babies are not securely attached by the time they reach the age of five to a loving adult carer. Worse still, around 10% have disorganised attachment, which is closely linked with the worst outcomes in our society.

I was delighted, back in July 2020, when the then Prime Minister asked me to chair the early years healthy development review. The goal was to create a vision for brilliance during the 1,001 critical days from conception to a child’s second birthday.

During that review, I met with families, academics, frontline professionals, charities and volunteers to understand what was going well and where change was needed. I saw excellent examples of people helping families when they needed it most, but I also heard how hard it can be for parents and carers to find timely support. I heard about the many services available to families, which are delivered by a workforce of highly skilled professionals, as well as many dedicated volunteers, but I also heard that information on those services is often patchy and difficult to find, with parents finding it almost impossible to navigate the system and understand what support is available to them.

In March 2021, the Government published “The best start for life: a vision for the 1001 critical days”. The vision set out six action areas for improving support for families during those critical days to ensure that every baby in England is given the best possible start in life, regardless of their background. It is the first action area in that vision that describes how every local authority in England, working with the NHS and other partners, will be encouraged to provide a clear and joined-up Start for Life offer to every new family.

Each local authority’s Start for Life offer would describe the essential support that every new family might need, as well as providing information on the additional support that some families require. A clear and accessible Start for Life offer will help to signpost families to the support and services available where they live, and those Start for Life offers should explain clearly to parents and carers what exactly is available and where to find it. The recommendations included in the vision are relevant to every local authority in England.

In my role as the Under-Secretary of State for Public Health, Start for Life and Primary Care, I now have the ongoing pleasure of visiting local authorities up and down the country, and I see directly some great work happening to give every baby the best start in life. Just last week I visited Uxbridge family hub, where I saw some fantastic work by Hillingdon Council and its partners to provide vital services to families with babies. That included providing a welcoming space for parents and carers to make new friends, and offering many different specialist support services, including antenatal, midwifery and health visiting, as well as infant-feeding and parent-infant-relationship support.

To support the implementation of the Best Start for Life vision, the Government are investing around £300 million to improve support for families through the family hubs and Start for Life programme. The programme is implementing many elements of the vision and is delivering a step change in outcomes for babies, children, parents and carers in 75 upper-tier local authorities in England, including most of those with high levels of deprivation.

The programme provides funding for local authorities to publish Start for Life offers and to establish parent and carer panels so that they can receive direct feedback from those using the services. There are many examples of good progress in publishing and publicising Start for Life offers right across the country. For example, Northumberland County Council has equipped every health visitor, midwife and family-hub practitioner with a QR-code keyring that, when scanned, takes users to a bespoke website setting out the local Start for Life offer. That ensures that parents and carers can be encouraged to access the offer at every opportunity.

Many local authorities that have not yet received additional funding through the family hub and Start for Life offer have also chosen to publish their Start for Life offers anyway, and to implement other elements of the vision, because they can see the huge benefits to future outcomes for families and their children. Early prevention is not just kinder but much cheaper than later interventions.

In the Government, and across parties, we all remain committed to ensuring that every baby gets the best start in life. Central to that is ensuring that parents are able to easily find the support that they need, when they need it most. The Support for Infants and Parents etc (Information) Bill, introduced by my hon. Friend the Member for Hastings and Rye, has the potential to help ensure that that is the case, so I want to conclude by reiterating my thanks to my hon. Friend for her introduction of that private Member’s Bill, and for securing today’s debate on such an important issue.

The debate has highlighted just how important the 1,001 critical days are, as well as the huge opportunity that the Bill provides to ensure that families have access to vital information about the support available to them at such a critical stage in both their lives and the life of their baby. I look forward to the Bill’s Second Reading on Friday.

5.20 pm

[Sally-Ann Hart]

I thank everyone who has attended this debate and made a contribution, showing support on this very important issue. I especially thank my right hon. Friend the Minister for her comments and her interest in this private Member’s Bill.

I thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) for his valuable comments as chair of the APPG on conception to age two—first 1001 days. As a former Children’s Minister, his knowledge, passion and focus on children and families is exemplary. He highlighted the long-term aims that were in the “Building Great Britons” report—it was extremely helpful for him to draw attention to them—and how failing to intervene is not just a social and human issue, but an economic one, too, if we are going to put the pound signs in front of our eyes.

My right hon. Friend the Minister and my hon. Friend the Member for East Worthing and Shoreham are the dream team for early years. I have to say that—it is absolutely right. I also thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his kind words and support, for his clear passion for children and families, and for his clear acknowledgment that children and families are not political. They really are not political.

In conclusion, I believe that the support for my private Member’s Bill, the Support for Infants and Parents etc (Information) Bill, will play an important role in helping to achieve the Government’s aim of giving every baby the best start in life. I hope that the Government will support the Bill when it has its Second Reading on Friday.

Question put and agreed to.

Resolved,

That this House has considered information on support available for parents and carers of infants.

5.22 pm

Sitting adjourned.

Prescription Charges: Long-term Health Conditions

Andrea Leadsom Excerpts

Monday 11th March 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Dame Maria. I am grateful to the hon. Member for Neath (Christina Rees) and the many members of the British public for raising the important issues covered in the e-petitions. I pay tribute to all members of the public who have written in with their stories. I shall set out exactly what the Government’s thinking is and what measures are in place to support people with the cost of prescription charges.

Every single one of us has constituents with long-term and chronic conditions who are suffering from financial hardship. I have a number in my own constituency of South Northamptonshire, and I have helped many get the financial support to which they are entitled. The Government are fully aware that the rise in the cost of living has been particularly severe for people who are unable to work or who have had to reduce their hours. Long-term and chronic conditions affect a person’s career opportunities and put them at a higher risk of becoming reliant on benefits to meet their basic needs.

The prescription charge, currently set at £9.65, applies to each item on a prescription form and is reviewed annually. This charge has no link to the cost of a prescribed drug or appliance, or to any of the costs associated with distribution or the dispensing service. Let me set out the extent of the exemption arrangements that are in place to provide people with free prescriptions or to limit their cost.

Eligibility for free prescriptions falls principally into three broad categories: age, income and medical condition. Some of these also provide exemption from other NHS charges, such as for dental treatment. The age-related exemptions cover all children under 16, teenagers between 16 and 18 in full-time education and all those aged 60 and over. The income-based exemptions are for those on a low income. Most are based on receipt of certain benefits, including universal credit. Help is also available through the NHS low income scheme.

With a medical exemption certificate, exemptions apply to people with medical conditions such as epilepsy, certain types of diabetes and cancer. The certificate is valid for a period of five years, exempting patients from paying for any of their prescriptions. In addition, prescriptions are also free for pregnant women and new mums with a maternity exemption certificate. As a result of all the exemptions available, 89% of all prescription items are dispensed free of charge. In addition to exemptions, we also have provisions in place to cap the total cost of prescriptions to any individual.

Our approach to exemptions is that it is not right to look at specific conditions in isolation. Someone might well consider, as has been put forward today, that their condition is particularly deserving of an exemption and that it should be added to the list of exemptions. I do have the utmost sympathy for anyone who needs regular or extensive medication, so while I must advise colleagues that the Government have no plans to extend the list of conditions that confer exemptions at this time, I do want to address some of the concerns raised by colleagues about affordability.

When the medical exemptions list was introduced, it meant that around 42% of all NHS prescription items were dispensed free of charge. Now the figure has risen to around 89% of all prescription items, and around 60% of people in England do not pay any prescription charges at all. Many people with medical conditions who are not on the list may already get free prescriptions on other grounds, because current exemptions already provide help for those on lower incomes and the most vulnerable in society. So while not everyone qualifies for free NHS prescriptions, support is available to ensure their affordability for those with greater need. Those who do pay charges are entitled to a 12-month prescription prepayment certificate, no matter how many prescriptions they need. That fixes prescription costs at £111.60 a year currently, or just over £2 a week. A prescription prepayment certificate can also be purchased to cap the cost of prescriptions for a three-month period at a cost of £31.25.

It is really important that all our constituents understand that. As Minister for Primary Care and Public Health, I get letters from people saying that their prescription costs are high and recurring, and I want people to understand that the prepayment certificate caps that cost at—I will say it again—£111.60 a year, or just over £2 a week. That annual certificate can be purchased by monthly instalments, which means that a person can have all the prescribed items they need for just over £2 a week, providing real help for someone with a long-term or chronic condition.

The NHS low income scheme provides help with prescription charges and full or partial help with other health costs. It is designed to help those on a low income who do not receive benefits that qualify them for exemption from prescription charges. As colleagues would expect, it is means-tested by comparing a person’s income with their requirements.

There is no doubt that long-term conditions place huge stresses and strains on our constituents and their loved ones. People are living longer, which is a wonderful thing, but the truth is that those extra years are not always enjoyed in good health. In England, around 26 million people have a long-term health condition that cannot be cured, but can be controlled with medication or other therapies. Some 10 million have two or more long-term conditions, and their number is expected to increase in the coming years. Caring for people with long-term conditions already accounts for over two thirds of the money we spend on health and social care in England, which was nearly £206 billion in total in 2022-23.

Long-term conditions can also mean reduced mobility, chronic pain, shrinking social networks and worse mental wellbeing. People with multiple conditions in particular are more likely to have poorer health, poorer quality of life and a higher risk of dying early. That is why we are carefully considering how to improve their outcomes in our major conditions strategy. The strategy will focus on tackling the six major conditions groups that account for 60% of ill health and early death in England: cancers, mental ill health, cardiovascular disease including stroke and diabetes, dementia, chronic respiratory diseases, and musculoskeletal disorders. We are determined to ensure that care is better centred around the patient, with more focus on prevention and a holistic approach to support.

Turning to some other ways in which the Government are providing support, we are backing people with health conditions who want to work to do so. We remain committed to bringing down the employment gap for people with long-term conditions, and we continue to support those people to start, stay and succeed in work. That is why we are increasing work coach support in job centres for people with health conditions receiving universal credit or employment support, and boosting the number of specially trained advisors in job centres offering advice and expertise.

Once we have helped people into work, our Disability Confident scheme encourages employers to think differently about health and disability and take action to address issues that employees face. We are also providing access to work grants towards the cost of working beyond standard reasonable adjustments. We do not want anybody with long-term conditions, whether one or several, to feel, “That’s it. I’m in long-term terminal decline.” We want to help people to feel that they have a future and that we can help them to get support back into the workplace to make something more of their life and to start enjoying it again.

To help with energy costs, the energy bills support scheme delivers a £400 Government discount in instalments over six months, helping no fewer than 29 million households with energy bills over winter. The energy price guarantee has been extended to April 2024, reducing typical annual household bills in Great Britain by about £3,000.

Colleagues pointed to the abolition of prescription charges in the devolved Governments. Health is a devolved matter and the devolved Administrations have full discretion in how they spend their budgets, but looking at health in Labour-run Wales or the outcomes for the Scottish National party-run health service in Scotland, I am glad that this Government in England make the right decision to require those who are better off to contribute to vital NHS services in England. In 2022-23, those contributions gave about £670 million in revenue to England’s NHS—a sum equivalent to the cost of employing about 12,500 full-time nurses and health visitors for a year in 2022-23. That income helps our NHS to maintain vital and much needed services for all patients.

Personally, I support continuing to require better-off patients to contribute to their own prescription charges, while recognising that 89% of all prescription charges are no longer payable. Furthermore, we provide support to those with multiple conditions, making that affordable for them.

I thank colleagues for participating in this debate, which touches on so many of our constituents, their families, friends and carers up and down the country. I assure all colleagues and our constituents that every penny we get from prescription charges is reinvested into our NHS. We will always keep support in place for those who need it the most.