Pharmacy First

Andrea Leadsom Excerpts

Wednesday 31st January 2024 Written Statements

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

Following constructive consultation with Community Pharmacy England, I am very pleased to inform the House that on 31 January, the Pharmacy First service will be launched in community pharmacies in England.

Pharmacy First was announced in May 2023 in the delivery plan for recovering access to primary care. This made significant new funding available for community pharmacies to deliver Pharmacy First and to deliver more blood pressure checks and contraception consultations. The new and expanded services will release around 10 million appointments in general practice per year once scaled. We want to do everything we can to support our GPs in supporting patients with higher acuity conditions—a job they do so well. Making use of the clinical skills in community pharmacy does just that.

Four in five people in England can reach a community pharmacy within a 20-minute walk and there are twice as many pharmacies in the most deprived communities. Our vision is to support community pharmacists to evolve further into a more clinically focused role, with members of the public able to take full advantage of their skills and capabilities. Pharmacy’s role has been increasing in recent years. In 2019 we set out how we would work to embed and integrate community pharmacy into the NHS, delivering more clinical services and making them the first port of call for many minor illnesses. We had already made good progress, for example:

General practice, NHS111 and urgent and emergency care (UEC) can now refer patients to community pharmacies for advice and treatment for minor illnesses, and NHS111 and UEC can also refer for urgent medicines supply. Over 3.4 million referrals have been made through these routes to date.

We expanded the new medicine service which supports over 200,000 people a month when they start new medicines and we introduced the discharge medicine service which supports 8,000 patients a month who have had their medicines changed following a visit to hospital, reducing medication errors and readmissions.

Over 9,000 pharmacies have delivered over 2 million blood pressure checks since October 2021, allowing those with high blood pressure to be identified and referred for onward management. The delivery plan has made funding available for 2.5 million additional checks. It is estimated this could prevent over 1,350 cardiovascular events such as heart attacks and strokes in the first full year of service, and could lead to savings of around £13 million across primary, secondary and social care.

We introduced a contraception service in April 2023 to enable community pharmacists to manage oral contraception on the basis of an existing prescription and in December 2023 this service was expanded so that pharmacists can now also initiate oral contraception. The delivery plan has made more funding available for this service so that up to half a million women will be able to access oral contraception through their pharmacy.

Pharmacy First will go further, building on this success and enabling pharmacists to supply prescription-only medicines, including antibiotics and antivirals where clinically appropriate, to treat seven common health conditions without the need to visit a GP. The seven conditions are sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women. Patients will be able to walk into a pharmacy if they have symptoms or may be referred to a community pharmacy by a GP or NHS111. Ninety-four per cent of pharmacies have signed up to deliver Pharmacy First from 31 January 2024.



The investment in Pharmacy First will also deliver significant upgrades in the digital infrastructure in community pharmacy. This will streamline referrals to and from other NHS services, provide additional access to relevant clinical information from the GP record, and share structured updates quickly and efficiently following a pharmacy consultation back into the GP patient record.

Pharmacy First is the next step on the journey to make the best possible use of the knowledge and expertise of community pharmacists and their teams, improving patient access to care.

[HCWS232]

Smoking and Vaping

Andrea Leadsom Excerpts

Monday 29th January 2024 Written Statements

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

Today, the UK Government with the devolved Administrations have published our response to the UK-wide consultation, “Creating a smokefree generation and tackling youth vaping”.



Tobacco is the single most important entirely preventable cause of ill health, disability and death in this country. It is responsible for 80,000 deaths in the UK a year and one in four of all UK cancer deaths. Smoking is one of the biggest drivers of health inequalities across the country. The majority of smokers know about the risks of smoking and want to quit but are unable to due to the addictive nature of tobacco. Four in five smokers start before the age of 20 and are then addicted for life.



Smoking costs the country £17 billion a year, including the £14 billion cost to productivity, which is equivalent to 6.9p in every £1 of income tax received. In comparison, the tax raised in duty revenue is only around £10.2 billion per year. Smoking puts a significant pressure on the NHS and wider health and social care services.



Moreover, while the evidence is clear that vapes can be an effective tool to help smokers to quit, we are incredibly worried about the alarming levels of illicit youth vaping—rates have tripled in the last three years with around one in five 11 to 17-year-olds in Great Britain now having tried vaping. Vaping carries the risk of future harms and nicotine addiction and, therefore, is never recommended for children. Despite this, it is clear that vapes are being deliberately targeted and marketed at them.



It is essential that we take action to protect future generations from the harms of smoking and stop youth vaping. That is why on 12 October, the Department of Health and Social Care published a Command Paper, “Stopping the start: our new plan to create a smokefree generation”. Following this, we published a consultation, together with the devolved Administrations to gather evidence and views to inform future legislative measures and next steps.



The consultation ran for eight weeks from 12 October 2023 to 6 December 2023. We received nearly 28,000 valid responses to the consultation from a wide range of stakeholders across the UK. A clear majority of responders, 63.2%, supported the ambitious proposal to create the first smokefree generation—one of the most significant public health measures in a generation.



The UK Government and devolved Administrations’ response to the consultation therefore sets out our plan to introduce legislation as soon as possible. Legislation will introduce measures to:

Change the age of sale for all tobacco products, cigarette papers and herbal smoking products whereby anyone born on or after 1 January 2009 will never legally be sold tobacco products alongside prohibiting proxy sales and changing warning notices in retail premises.

Stop vapes from being deliberately targeted at children, while continuing to support adult smokers to quit using vapes to help. It will introduce new regulatory-making powers to restrict flavours, point of sale and packaging for vaping products—nicotine and non-nicotine—as well as other consumer nicotine products. Any restrictions will be taken forward in subsequent secondary legislation, which will be subject to further consultation.

Introduce new fixed-penalty notices for England and Wales to the value of £100 for underage sale, proxy sale and free distribution of tobacco and vapes—nicotine and non-nicotine—and regulate to extend these provisions to other consumer nicotine products.

Additionally, the consultation confirms that the UK Government, the Scottish Government and the Welsh Government intend to introduce legislation to implement a ban on the sale and supply of disposable vapes. The UK Government will work with the devolved Administrations to explore an import ban. Northern Ireland officials acknowledge the issues raised during the consultation and will consider potential legislation in future.

These legislative measures sit alongside a package of support to help current smokers quit—including doubling the funding for local authority stop smoking services. They also sit alongside additional enforcement funding. HM Revenue and Customs (HMRC) and Border Force have published a new illicit tobacco strategy, “Stubbing out the problem”, setting out their continued commitment to reduce the trade in, and demand for, illicit tobacco, and to tackle and disrupt the organised crime groups behind the illicit tobacco trade. The strategy sets out the new root and branch approach, which targets the demand for illicit trade—the consumers that criminals seek to exploit—as well as the supply—the criminals themselves. It is supported by new funding over the next five years which will be used to boost HMRC and Border Force enforcement capability. The strategy also establishes a new, cross-Government illicit tobacco taskforce, combining the operational, investigative and intelligence expertise of various agencies, and enhancing HMRC’s ability to disrupt organised crime.

I am grateful to the many people who took time to respond to the consultation which helped us accurately consider this policy. The consultation response has been published on www.gov.uk.

[HCWS219]

Health and Social Care

Andrea Leadsom Excerpts

Thursday 25th January 2024 Ministerial Corrections

The following is an extract from the Westminster Hall debate on a Smokefree Future on 11 January 2024.

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

First, let us be crystal clear: the tobacco and vapes Bill will save many lives. Unlike other consumer products, there is no safe level of nicotine consumption; it is a product that kills up to two thirds of its long-term users and causes 70% of lung cancer deaths.

[Official Report, 11 January 2024, Vol. 743, c. 178WH.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire:

An error has been identified in my response to the Westminster Hall debate on a Smokefree Future. The correct information is as follows:

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

First, let us be crystal clear: the tobacco and vapes Bill will save many lives. Unlike other consumer products, there is no safe level of tobacco consumption; it is a product that kills up to two thirds of its long-term users and causes 70% of lung cancer cases.

Oral Answers to Questions

Andrea Leadsom Excerpts

Tuesday 23rd January 2024 Commons Chamber

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

18. What progress she has made on introducing a dentistry recovery plan.

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

I am determined to ensure that everybody who needs NHS dental care can receive it. We have already implemented a package of reforms to improve access and provide fairer remuneration for dentists. That has had an effect, with 1.7 million more adults being seen, 800,000 more children being seen and a 23% increase in NHS activity in the past year. We know we need to do much more, and our dentistry recovery plan will be published shortly, setting out a big package of change.

[Layla Moran]

I listened carefully to what the Minister said. That change has not come to Oxfordshire, for sure—it is in a dire state. An Oxford resident wrote to me saying that when his NHS practice closed, he rang a dozen others across the county. Each one said they were offering NHS services but, in fact, they were not; they were only offering private care. In this cost of living crisis, people simply cannot afford that. As a result, they are waiting in A&E rather than getting treatment, and that ends up in their having oral surgery. What is the Minister doing now to improve the situation in Oxfordshire and across the country?

[Dame Andrea Leadsom]

I am incredibly sympathetic to what the hon. Lady says. In fact, in Buckinghamshire, Oxfordshire and Berkshire West integrated care board, the number of adults seen by an NHS dentist rose in the 24 months to June 2023 from 448,000 to 485,000, with a similar increase in the percentage of children seen. The situation is improving, but I completely agree with her that we need to do more, and we will be coming forward shortly with a big package of dental recovery plan reforms.

[Giles Watling]

I thank my right hon. Friend for her answer. Following my very productive meeting with her only a few days ago, will she confirm that NHS England locally has finally been unblocked and that my constituents in Clacton will soon benefit from more dentists practising on NHS patients?

[Dame Andrea Leadsom]

As my hon. Friend will know, this is a local matter, and it is for his ICB to determine whether it wishes to support the excellent pilot proposal for overseas dental students in Clacton. At the same time, it needs to ensure that its actions are compliant with current legislation and within the delegation agreement with NHS England. I have just written to my hon. Friend about that, and my letter should address his concerns, but of course I would be happy to see him again if he has any further questions.

[Rachael Maskell]

We were promised “before the summer”, we were promised “after the summer”, we were promised “before Christmas”, we were promised “soon” and now we have been promised “shortly”. The reality is that Labour has a plan and the Government have not. In York, we cannot get an NHS dentist either. Blossom Family Dental Care is just handing back its contract. My constituents have nowhere to go. What is the Minister going to do to ensure that my constituents can access NHS dentistry?

[Dame Andrea Leadsom]

As I said to the hon. Member for Oxford West and Abingdon (Layla Moran), I absolutely understand the challenge for some people. The situation has improved over the last year. Since the covid pandemic, where almost every dentist had to stop working altogether, we have not seen the recovery we want. We are putting in plans—not a paper ambition like the one Labour has put forward, but significant reforms that will enable many more people to be seen by NHS dentists. I say gently to the hon. Member for York Central (Rachael Maskell) that a recent Health Service Journal article states that Humber and North Yorkshire ICB

“have indicated in board papers that dentistry funding will be squeezed to help them balance their books.”

I encourage her to talk to her ICB about that too.

[Paul Bristow (Peterborough) (Con)]

For new patients, accessing an NHS dentist in Peterborough is almost impossible. Should a new medical centre wish to establish a new NHS dental practice, doing so would require flexibility in units of dental activity rates and the ability to recruit dentists from overseas. Would the Minister give that effort her enthusiastic support and encourage NHS bosses to do the same?

[Dame Andrea Leadsom]

My hon. Friend is pushing against an open door. He may be aware that in 2023 we made some legislative changes to give the General Dental Council more flexibility to expand the registration options open to international dentists, tripling the capacity of three sittings of the overseas registration exam from August 2023 and increasing the number of sittings for the part 2 exam in 2024 from three to four. That will create an additional 1,300 places overall for overseas dentists aiming to work in the UK. We will also be bringing forward measures to enable dental therapists to work at the top of their training, which will expand the capacity. He is right that reform of the UDA is also required and we will be bringing forward our plans shortly.

[Mr Speaker]

I call the shadow Minister.

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

I want to share with Ministers the experience of Emma from Grimsby, who said:

“NHS dentistry is a joke in the town at the moment. Thankfully I managed to get an emergency appointment in Scunthorpe (after being offered one in Doncaster originally) and I’ve now been referred to hospital to have 3 wisdom teeth removed. My dentist closed at the onset of the pandemic and I’ve not been able to register with an NHS dentist since.”

What does the Minister have to say to Emma and the millions like her who cannot get an appointment when they need one?

[Dame Andrea Leadsom]

The hon. Lady is absolutely right to point that out. Emma has my absolute sympathy and apology for the fact that since the covid pandemic we have not seen the recovery of dentistry that we would have liked. I can tell her that in July 2022 we brought in significant reforms to encourage dentists to take on more NHS patients, but we recognise the need to do more. The long-term workforce plan will increase training places and the overseas registration will improve capacity, as will the changes to dental therapists’ programmes. All those things will improve the situation, but in the meantime we will be bringing forward our recovery plan very soon, which will immediately expand the incentives to NHS dentists.

[Simon Lightwood (Wakefield) (Lab/Co-op)]

5. What steps her Department is taking to help reduce pressure on NHS services in winter 2023-24.

--- Later in debate ---

[Mrs Sheryll Murray (South East Cornwall) (Con)]

T10. Rural constituencies such as mine are seeing a growing number of dentists withdraw from NHS provision. What steps is the Department taking to ensure that vital dental care is provided for everyone, particularly in rural communities?

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

My hon. Friend is a great advocate for her community, and I pay tribute to her for working with determination to see more access to dentistry in Cornwall. She is right to do so. We have a plan, which is almost ready. I urge her to wait just a little longer. She, like all colleagues across the House, will see significant and real measures to improve access to dentistry.

[Ian Byrne (Liverpool, West Derby) (Lab)]

T2. NHS staff have expressed concerns about the Anaesthesia Associates and Physician Associates Order 2024. Can the Minister tell me if resource will be needed for AAs and PAs to be properly supervised by doctors on a one to one ratio? Will he meet trade unions and professional bodies as a matter of urgency to clarify the Government’s position on this hugely important public health issue?

--- Later in debate ---

[Chris Green (Bolton West) (Con)]

The single biggest concern my constituents raise about healthcare is access to GPs, especially in Blackrod and Westhoughton. What more can my right hon. Friend do to ensure we have better GP access?

[Dame Andrea Leadsom]

I am pleased to tell my hon. Friend that our NHS long-term plan sets out a real-terms increase of at least £4.5 billion a year for primary and community care by 2023-24. We now have over 2,000 more full-time equivalent GPs working in our NHS, and we have had the amazing achievement of more than 50 million more appointments per year, beating our target several months early. Things are improving significantly, and there are many more measures I would be delighted to talk to him privately about.

[Samantha Dixon (City of Chester) (Lab)]

T4. In the NHS in Cheshire and Merseyside between April and June last year, the 62-day cancer waiting time target was not met. If the target had been achieved, around 150 extra patients would have been treated on time. What would the Secretary of State like to say to those 150 patients?

COP10: WHO Framework Convention on Tobacco Control

Andrea Leadsom Excerpts

Thursday 18th January 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 today, Mr Vickers. I thank all colleagues who have taken part in this Backbench debate, especially my hon. Friend the Member for Northampton South (Andrew Lewer) for his leadership in organising it. It has been very interesting, and I can absolutely assure colleagues that I have learned some new things myself today.

To tackle the very first question, I do not intend to go to Panama for COP10. That is because I am preparing flat out for our smoke-free generation Bill, including the response to the consultation and the measures. I just do not think it would be a good use of my time to travel on 5 February. However, the Government will be represented by our excellent colleague from the civil service, Dr Jeanelle de Gruchy, who has done fantastic work representing the UK’s position.

I will give a rough overview of the UK’s position. There will be discussion about global progress on tobacco control. Of course, the UK is an outlier on the topic of vapes, and we will be putting forward our position that vapes are a very important tool for helping adults to quit. There will be some discussion on advertising and sponsorship. The UK has no plans to implement further restrictions on advertising and sponsorship, particularly in the COP’s desire to see further restrictions implemented. On novel and emerging tobacco products, different parties take different approaches. At the moment, the UK is still looking at issues around heated tobacco, so the UK delegation will be in listening mode. In terms of parties going further on tobacco control, certainly the UK Government would welcome other parties going further to protect people, but we will be monitoring the negotiations to ensure that nothing becomes mandatory. Finally, there will be discussions on whether there should be an increase in assessed contributions. The UK intends to press for contributions to stay where they are now. I am very happy to provide a statement to the House after COP10, giving feedback on exactly what happened. I think that covers a lot of the issues raised by colleagues. I hope that was clear, and I would like to again thank everyone for attending.

As has been pointed out, the framework convention on tobacco control was the first treaty negotiated through the World Health Organisation. However, as colleagues will appreciate, I am not one to get misty-eyed about international conventions, or indeed international regulatory frameworks. I am not terribly romantically attached to this, and I feel that the UK’s sovereignty is actually the most important aspect. My priority as the Minister will be to help us in the UK protect our citizens from harm. Is there not a song that goes, “I did it my way”? The UK has a world-leading approach to reducing harms from tobacco and nicotine, and we will continue to do that.

The conference of the parties has, however, been a helpful way of keeping strong tobacco controls at the top of the global health agenda. It is also, as I hope I have just illustrated, a very useful forum for sharing best practice. All papers are presented and all decisions made are published online via the dedicated COP10 website. The UK remains committed to the convention, because we are a world leader in tobacco control. Like many friends around the world, we want to see a tobacco- free future. Next month’s conference will be a fantastic opportunity for us to showcase the UK’s strength, being at the cutting edge of a smoke-free generation. As I have said, our deputy chief medical officer, Dr Jeanelle de Gruchy, is the chief delegate. I have every confidence that our team will encourage other countries to follow in our example.

Now, my hon. Friend the Member for Northampton South is a big fan of common sense, and so am I. I want to reassure everybody that our delegation will be bound by common sense, and not by conference decisions that run contrary to common sense, or indeed to decisions that run counter to our national interest. That includes the decisions we take in helping smokers to quit through quit aids such as vapes and nicotine replacement products. We are a sovereign nation, and it is not within the WHO’s remit to intervene in our internal affairs.

Last week, I was given a couple of opportunities to update the House on our progress towards a smoke-free generation. With permission, I would like to reiterate a few of the points I made then. Our new tobacco and vapes Bill will save lives. Unlike other consumer products, there is no safe level of smoking: it is a product that kills up to two thirds of its long-term users, causes 70% of lung cancer cases, and massively increases the risk of stillbirth. It causes asthma in children; dementia, stroke and heart failure in old age; disability and early death. Almost every minute of every day, someone is admitted to hospital because of smoking, and up to 75,000 GP appointments every month can be attributed to smoking. It takes a massive toll on both our health and our NHS.

Smoking also takes its toll on our economy. Detractors will say, “But what about the £10 billion a year the Treasury gets from taxes on tobacco—how will the Chancellor do without that?” But independent analysis shows that the overall cost of tobacco to society totals £17 billion a year, completely offsetting—and then some—whatever we receive in taxes. The cost of smoking is equivalent to the annual salaries of more than half a million nurses, almost 400,000 GPs, 400,000 police officers or 400 million GP appointments. Reducing smoking rates will bring down those costs and help our economy to become more productive. Our modelling suggests that the smoke-free generation policy we are looking to introduce will reduce smoking rates in England among 14 to 30-year-olds to close to zero by as early as 2040, and will provide cumulative productivity benefits of up to a staggering £85 billion over the next 50 years. That is why bold action is necessary. We are making history with this Bill.

I took up smoking at 14 and gave it up as my 21st birthday present to myself. It was not easy. To this day, I hate talking about smoking because I sometimes think, “I’d quite like a cigarette”, but I shall never be tempted. It is so hard to quit. To those hon. Members who mentioned that nicotine is not bad in itself—yes, it is; it is desperately addictive. When people try to give up nicotine, they suffer cravings and get irritable. It is really difficult to give up nicotine, no matter how it is consumed. Combustible tobacco certainly has all sorts of other horrendous health issues, but nicotine itself is not a harmless product by any means. There is no safe level of nicotine consumption.

Like so many smokers, I desperately wanted to give up this lethal addiction. We want to help more smokers than ever to quit through significant new funding and support. All smokers deserve our support to quit and lead a healthier, longer life, which is why we have announced we are doubling the funding to stop smoking services across England to a total of £138 million a year, to help around 360,000 people quit every year. We are also backing these efforts with substantial new money to support marketing campaigns. As my right hon. Friend the Member for Clwyd West (Mr Jones) and my hon. Friend the Member for Northampton South both pointed out, four in 10 smokers think vaping is as bad as, if not worse than, smoking cigarettes. With this substantial marketing support, the stop smoking campaigns will be common sense and easy to use, setting out the facts to help smokers to be able to quit. We will also provide vapes as a quit aid to those who want to stop smoking.

As colleagues will know, I am passionate about helping mums, mums-to-be and new families, which is why I have asked officials to redouble our efforts to tackle smoking in pregnancy. Women who smoke during pregnancy are two and a half times more likely to give birth prematurely. Smoking is also a significant driver of stillbirth. I want to do everything I can to spare parents the heartbreaking tragedy of losing a baby. One in 10 mothers smokes at the time of delivery; this figure rises to one in five in some parts of the country. Pregnant women who receive financial incentives are twice as likely to successfully quit in pregnancy as those who do not. We must also protect pregnant women and their babies from second-hand smoke. We are working to roll out a financial incentive scheme by the end of 2024 to help all pregnant smokers—and, crucially, their partners— to quit.

As I have said, vapes can be an effective tool to help smokers quit. That is why we have committed to providing 1 million vapes to smokers through our “swap to stop” programme. That is a different approach from that taken in the WHO proposals; we are proud to take it, because we know it works.

Along with millions of parents across the country, I am alarmed by the number of children using vapes, a device that should be used only by adult smokers who want to quit smoking. Youth vaping has tripled in the last three years, and one in five children has used a vape. We have a duty to protect children from under-age vaping while their lungs and brains are still developing, so we are taking decisive action to reduce the appeal and availability of vapes.

In our recent public consultation, we sought views on restricting flavours, point-of-sale displays and packaging, and on restrictions on disposable vapes. We will take tough new action to reduce the appeal and availability of vapes to children through the tobacco and vapes Bill.

I totally get the point that my hon. Friend the Member for Northampton South made about flavours. These are all areas that are being carefully looked at, but he will appreciate that Cherryade, Yazoo and bubble-gum flavours are not really designed for him and me. Packages that look like a little Coke bottle, or are brightly coloured, like a bubble-gum package, are marketed not at him, but at children. Of course we see the vape stand right next to the sweets stand, and vapes are sold, conveniently, at pocket-money price, so let us not be naive about this. A lot of the flavours and colours are specifically designed to appeal to children, and that has to stop. A strong approach to enforcement is a crucial part of making sure that it has a real-world effect.

Under-age and illicit sales of tobacco, and more recently vapes, are undermining the Government’s work to regulate the industry and protect public health. We are cracking down on this appalling illicit trade by backing enforcement agencies, including Border Force, His Majesty’s Revenue and Customs and trading standards, with £30 million extra per year. In the tobacco and vapes Bill, we will introduce powers to give on-the-spot fines, to tackle under-age sales.

[Sir Christopher Chope]

Will my right hon. Friend comment on the undue influence of China on the WHO, as exemplified in my remarks? China is trying to ensure that its policies are adopted by the WHO, and it seems to be funding the WHO and controlling it. Should we not be concerned about that?

[Dame Andrea Leadsom]

I will look into my hon. Friend’s concerns and respond to him in writing. That is probably the most helpful I can be, because that is not something that I have been briefed on. I am, as are all hon. colleagues across the House, concerned about the undue influence of China on public policy that finds its way into national policies. I am grateful to him for raising the issue.

[Mr David Jones]

Does my right hon. Friend know why the WHO exhibits such hostility to the harm reduction measures that the United Kingdom Government are putting in place?

--- Later in debate ---

[Dame Andrea Leadsom]

No, to put it simply—and I do not know if that is the case. I am grateful to my right hon. Friend. As he knows, I always listen carefully to his usually very wise words, so I will take that away and get an answer for him.

We should be proud of our record on keeping tobacco control at the top of not just the national agenda, but the global agenda. We are a world-leading trailblazer in tobacco control, and our delegation to COP10 will proudly set out our unique and sovereign approach. My firm belief is that our policy could save countless lives in this country and, through our example, overseas. Crucially, we are using the conference to showcase UK plc to the world.

I say to the hon. Member for Linlithgow and East Falkirk (Martyn Day) that I have been delighted with the collaborative, cross-party approach that colleagues in the devolved Administrations have taken to our smoking and vapes Bill. However, importantly, at an official level, there has recently been an agreed approach to the COP10 delegation. I hope that reassures him that all views from all parts of the United Kingdom are carefully being taken into account.

COP10 will be a forum in which we can exchange ideas with countries such as Canada and Australia. We will back other countries in their efforts to kick the habit, but we will also present our case as strongly as we can. We are going beyond the convention in certain areas, and we have a different view in others. All colleagues should be reassured that we alone will decide what those views are, through our sovereign Parliament.

[Martin Vickers (in the Chair)]

Andrew Lewer has two minutes to wind up.

Illegal Vapes

Andrea Leadsom Excerpts

Tuesday 16th January 2024 Westminster Hall

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

It is a pleasure to speak under your chairmanship today, Sir Mark. I thank my hon. Friend the Member for Darlington (Peter Gibson), and all my hon. Friends who are here today. It highlights the importance with which the Government Benches view this issue.

I would just assure the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) that all of the issues that she has mentioned are indeed top priorities for me. I am on the warpath when it comes to children vaping. Whether it is nicotine-free, cherry-cola flavoured, legal or illegal, children should not be vaping. I will bring forward, as soon as possible, the results of the consultation, and then the smoking legislation, and all colleagues will be able to see that. However, I pay tribute to all my hon. Friends, who are here in droves in this Chamber today to make known their very serious concerns about the protection of children. I also pay tribute to the hon. Member for City of Durham (Mary Kelly Foy), who has done so much to try and promote this issue and to ensure that children are kept safe.

I am pleased to have the opportunity to talk about the work that we are doing to tackle the use and sale specifically of illicit vapes, and I am grateful to all colleagues for this being largely a cross-party issue, where we are all on the same side, and I very much hope that we will keep it that way. Like so many parents right across the country, we are all incredibly worried about the damage that is potentially being done to children’s bodies by vapes—particularly illegal vapes.

One of the main health risks posed by vapes is from their highly addictive nicotine content. Young brains are more susceptible to the effects of nicotine, and so the risk of becoming addicted is greater for younger people compared to adults.

[Kirsten Oswald]

Will the Minister give way?

[Dame Andrea Leadsom]

I will not give way, I am sorry; there is no time left and I want to make my points.

It is appalling and unacceptable when businesses knowingly and deliberately encourage children to use a product that was designed for adults to quit smoking. Often sold at pocket-money prices, easy to use and widely available, disposable vapes are the product of choice for children. Over two thirds of current youth vapers use disposable products—all illegally, because they are under age. And, as if we needed another reason to regulate, 5 million disposable vapes are either littered or thrown away in general waste every week. That has quadrupled over the last year.

Our duty is clear: to protect all kids from vaping while their lungs and brains are still developing. Businesses are shamelessly using bright colours, alluring packaging and attractive flavours, as hon. Friends and colleagues have said, like “candy bubblegum” and “blueberry razz”, in Coke-can shaped packaging, right next to the sweet counter, in the full knowledge that our children are going to become addicted to nicotine. This cannot go on.

Businesses should abide by the existing regulations setting product standards, including prohibitions on certain ingredients and restrictions on nicotine strength, bottle size limits and advertising. Products should be registered with the Medicines and Healthcare products Regulatory Agency to be sold legally in the UK. Any product that is not notified and does not meet our high standards should not be sold to anyone, let alone children.

Unregulated vapes pose a massive risk because they circumvent the high standards of regulation, contain unknown ingredients, as colleagues across the Chamber have said, and stronger nicotine, and are often made available to children through black-market channels. Illicit vapes may contain dangerous metals such as lead, nickel and chromium, and contents such as antifreeze and poster varnish—unbelievable, extraordinary contents. We have no idea what frequent inhalation of those does to adult lungs, let alone still-developing lungs.

Independent research suggests that there is a direct link between the rise in children vaping and the flood of illegal, non-compliant vapes coming to our shores. That is why, to keep vapes out of our children’s hands, we must first enforce our regulations to stamp out the sale and supply of illicit and underage vapes, and, secondly, educate our children about how those products will hurt them.

On enforcement, we have learned much from our successful campaign to tackle illicit tobacco. Targeted enforcement saw the overall consumption of illegal tobacco plummet from 17 billion cigarettes 25 years ago to 3 billion cigarettes last year. In April, building on this success, we announced the formation of a new, specialised illicit vaping enforcement team, named Operation Joseph, to identify and seize illicit vapes on entry to England through the seven ports that have seen increased illegal activity. We are giving National Trading Standards £3 million of new funding over two years for the sole purpose of getting illicit products off our shelves. Across the country, it is diligently testing products for dangerous substances, and carrying out test purchases online and in shops. Recently, I had the great pleasure of meeting some of its officers in action—people such as David Hunt, a senior officer and illicit tobacco lead in Hackney, who is doing incredible work to ensure there is a fair and honest market. As a result of National Trading Standards’ work across the country, 2.1 million vapes were seized by trading standards officers in England between 2022 and 2023 alone.

My message to people and businesses that sell illegal vapes is clear: they should stop it right now. If they do not, they may receive an unlimited fine or a custodial sentence of up to two years. However, there is no room for complacency, and I am not naive to the scale of the challenge. That is why in October we announced an additional £30 million per year for our enforcement agencies over the next five years, to support their efforts to extinguish the illicit trade in tobacco and vapes. The additional funding will give agencies the resources they need to catch criminals and rogue traders.

Cracking down on illicit products entering the country is critical, but such efforts must go hand in hand with educating children about the dangers of these products to prevent their use in the first place. Over the past two years, we have taken a number of steps to increase the training resources and support available to teachers in schools, to update the curriculum to include the health risks of vaping, and to publish new online content on the potential risks of vaping for young people. We have also written to police forces right across England to ensure that dedicated school liaison officers are keeping vapes away from the playground as much as possible.

Finally, I want to touch briefly on our wider plans to reduce the overall rates of youth vaping. As I said at the start, I will set out much more detail in the near future. As colleagues know, we recently consulted on a range of measures to reduce the appeal, availability and affordability of vapes to children. Our consultation has also considered what further measures we could take to strengthen enforcement, such as by introducing new fixed penalty notices. We are in the process of finalising our response to the consultation and will update Parliament shortly on the measures we are taking forward.

As I said at the start of my remarks, we all have a duty to protect our children from under-age vaping as their lungs and brains continue to develop. We do not yet know about the long-term damage being caused to their lungs and brains, but I dread to think about it, so we will be ruthless towards those who disregard our safeguards and undermine our work to protect children’s health. I am on the warpath where vaping is concerned, and I urge all children to stop vaping. I look forward to working with colleagues across parties and across Government to make youth vaping a thing of the past.

Smokefree Future

Andrea Leadsom Excerpts

Thursday 11th January 2024 Westminster Hall

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

It is a pleasure to speak under your chairmanship today, Mr Sharma. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing a debate on such an important issue, and pay tribute to his work as chair of the all-party parliamentary group on smoking and health. He really has been tireless in holding not only Health Ministers’ feet, but the Prime Minister’s feet, to the fire and making sure that we keep tobacco control a top priority. I am also grateful to the hon. Members for City of Durham (Mary Kelly Foy), for North Antrim (Ian Paisley), for Strangford (Jim Shannon) and for Blaydon (Liz Twist) for their participation today. I welcome the chance to update the House on our progress towards a smoke-free future. I welcome the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) to her place, and look forward to working constructively with her on the tobacco and vapes Bill and other things. I hope there will be much that we can agree and collaborate on.

I want my legacy as Public Health Minister to be weighed and measured by everything we have done to protect the vulnerable in society. Critical to that, of course, is keeping our children safe. We already know that in the United Kingdom, smoking kills around 80,000 people every year, causing one in four cancer deaths; costing £17 billion a year in ill health, lost productivity and demands on the NHS and social care; and putting a huge burden on our health service. Like many others, I have been appalled in recent years to see the number of children vaping treble. It is estimated that no fewer than one in five children have now used a vape.

That is why, in October, the Prime Minister announced action across four areas: first, creating a smoke-free generation by ensuring that children turning 15 this year, or younger, will never legally be sold tobacco products; secondly, supporting existing smokers to quit through significant new funding and support; thirdly, protecting our children from vaping by reducing the appeal and availability of vapes; and fourthly, introducing new action to enforce these rules.

I will address each priority area in turn. First, let us be crystal clear: the tobacco and vapes Bill will save many lives. Unlike other consumer products, there is no safe level of nicotine consumption; it is a product that kills up to two thirds of its long-term users and causes 70% of lung cancer deaths. We are not doing this blind. We already know that action to increase the age of sale works. When the age of sale was raised from 16 to 18 years old, smoking rates for 16 and 17-year-olds in England fell by almost a third. This is a tried and tested policy, and while we have seen some progress, I know there is a lot more to be done—almost 13% in that age bracket are still smoking.

Our modelling suggests that this measure to increase the age of sale will reduce smoking rates in England among 14 to 30-year-olds to close to zero as early as 2040. I am sure that is not early enough for my hon. Friend the Member for Harrow East, and colleagues across this Chamber, who would like to see that happen sooner—as would I. Nevertheless, that is what the modelling suggests. It is progress in the right direction and will save many lives. I am committed to publishing an impact assessment very soon that will set out for colleagues a more complete picture of the costs and benefits of the Government’s smoke-free generation policy.

No one doubts that smoking massively increases the risk of stillbirth; a number of colleagues have raised that today. Smoking also causes asthma in children, and is strongly linked to dementia, stroke and heart failure in old age, as well as to disability and death throughout the life course. Non-smokers, including children, pregnant mums-to-be and their babies are exposed to second-hand smoke, putting them at serious risk through absolutely no choice of their own. This is not about freedom of choice; it is about protecting the vulnerable. Almost every minute of every day someone is admitted to hospital because of smoking, and up to 75,000 GP appointments can be attributed to smoking each month—that is over 100 GP appointments every hour. Reducing that burden will therefore save the NHS money that we can reinvest into research, frontline care and cutting waiting lists.

This measure is not just the right thing for our children’s health; there is a very strong economic case for it too. Analysis by Action on Smoking and Health has estimated the cost of tobacco to society to be £17 billion a year. That figure is out of date, and I think my hon. Friend the Member for Harrow East has just updated it—the Department is very swiftly trying to verify that—but the last published data showed that the directly attributable cost of smoking to society was around £17 billion a year. That dwarfs the £10 billion a year the Treasury receives from taxes on tobacco products.

That cost of £17 billion includes £14 billion lost to productivity through smoking-related lost earnings, unemployment and early death, as well a direct cost to the NHS and to social care of £1.9 billion and £1.1 billion a year, respectively. The cost of smoking to the economy and wider society is equivalent to the annual salaries of over half a million nurses, almost 400,000 GPs, 400,000 police officers, or 400 million GP appointments.

Reducing smoking rates will bring down those costs and help our economy to become more productive. The smoke-free generation policy could provide cumulative productivity benefits of a staggering £85 billion within the next 50 years. That is why the Government are taking such bold and historic action through the tobacco and vapes Bill.

As well as stopping children starting, our second aim is to do more to help current smokers to quit. Quitting smoking is the best thing a smoker can do for their health: someone who quits before turning 30 could add 10 years to their life. That is very reassuring to me; I started smoking at the age of 14 and gave up as my 21st birthday present to myself, by which time I was smoking 40 a day. I was a student—how did I afford it? I have no idea! I am so glad I stopped. For anyone who doubts how addictive it is, I turned 60 last year and still—

[Bob Blackman]

Surely not!

[Dame Andrea Leadsom]

Yes, I know. You can’t believe that, can you?

Even to this day, talking about smoking all the time, I sometimes think, “Ooh a cigarette.” That is how addictive it is—40 years on and I still think, “Ooh!” It is that addictive, and that is absolutely appalling.

We have announced that we will more than double the funding to local stop smoking services across England to a total of £138 million a year, which will help around 360,000 people to quit every year. We are backing these efforts with substantial new money to support marketing campaigns. These measures are easy, common-sense and cost-effective ways to help people to kick the habit.

As colleagues will know, I am passionate about helping new mums, mums-to-be, new parents, new families and their babies, which is why I have asked officials to redouble our efforts to tackle smoking in pregnancy. Women who smoke during pregnancy are two and a half times more likely to give birth prematurely, and smoking is a significant driver of stillbirth. I want to do everything I can to spare parents the awful and heartbreaking tragedy of losing a baby, which we have heard so much about in this place only recently.

On average, just over one in 10 mums smoke at the time of delivery, but that number is as high as one in five in certain parts of the country, as some colleagues have spoken about already. We know that pregnant women who receive financial incentives are twice as likely to successfully quit throughout pregnancy compared to those who do not, so we are working to roll out a national financial incentive scheme by the end of 2024 to help all pregnant smokers and their partners to quit. This will build on our work over recent years to develop high-quality stop smoking support for pregnant women and their partners, with programmes such as the NHS long-term plan commitments on maternal smoking and the saving babies’ lives care bundle.

Thirdly, as I said at the start of my remarks, youth vaping has tripled in recent years. One in five children have now used a vape. I am especially worried about the damage being done to children’s bodies by illegal vapes, which is a growing concern for mums and dads across the country. The health advice is clear: young people and those who have never smoked should not vape. We have a duty to protect our children from underage vaping while their lungs and brains are still developing. There is not yet enough evidence on the long-term impact of vaping on young brains and lungs. I will not stand by while businesses knowingly and deliberately encourage children to use a product that is designed to help adults quit smoking. Those business do so with full knowledge that our children will become addicted to nicotine—well, not on my watch.

We have announced that we will take tough new action to reduce the appeal and availability of vapes through the tobacco and vapes Bill. In our recent public consultation, we sought views on restricting flavours, point-of-sale displays and packaging. On a visit to retail outlets in Hackney, I saw sweet counters and vape counters side by side, with the vapes in pretty packaging with cartoon characters and in little things that look like Coke cans. These vapes are not designed for 60-year-old smokers; they are designed for children, to get them addicted to nicotine.

The consultation has revealed something we already know: there are serious and justifiable environmental concerns over disposable vapes. It is a simple truth that more than 5 million disposable vapes are either littered or thrown away in general waste every week. That number has quadrupled in just the last year. Being sold at pocket-money prices, easy to use and widely available, disposable vapes are, of course, the product of choice for children. More than two thirds of current youth vapers use disposable products. We must and will take action.

Fourthly, a strong approach to enforcement is vital to ensure that our policy actually takes effect. The underage and illicit sale of tobacco, and more recently vapes, is undermining the work the Government are doing to regulate the industry and protect public health. We are cracking down on this evil and illicit trade by backing enforcement agencies including Border Force, HMRC and trading standards with £30 million extra per year. We will introduce powers in the tobacco and vapes Bill to give on-the-spot fines to tackle underage sales. I am pleased we can count on the strong support of trading standards officers right across the country.

Our public consultation closed on 6 December and we received nearly 28,000 valid responses. I am happy to assure all colleagues that we will publish our response in the coming weeks, ahead of the introduction of the tobacco and vapes Bill. I believe that our actions in this space show that the Government are willing to take tough, long-term decisions to protect our children and safeguard the health of future generations.

I will now answer some of the questions raised by hon. Members today; I thank them again for their contributions. In response to my hon. Friend the Member for Harrow East, our public consultation closed on 6 December and within the next few weeks we will publish the consultation. Of course we will then bring forward the Bill, which is, as everybody knows, a top priority for the Prime Minister.

As for the point about a polluter pays levy, the Treasury has looked at that in detail, but so far it has decided against it. I absolutely assure colleagues that I will take that point away and consider it again.

I thank the hon. Member for City of Durham for her invitation to visit her constituency, which I would be delighted to accept. She highlighted the fact that the discrepancy in life expectancy between different parts of her constituency is 50% attributable to smoking, which is a shocking figure. That is not uncommon around the country, so we need to tackle that issue.

I say gently to the hon. Member for North Antrim that when the legal age for smoking was raised, it reduced illicit tobacco sales by 25%; the evidence suggests that far from increasing criminality, raising the legal age for smoking decreases it.

The hon. Gentleman also asked a question about Northern Ireland specifically. I am pleased to tell him that in the Bill we propose to give Northern Ireland the powers to regulate in the same way as the rest of the United Kingdom. There has been a lot of consultation with the devolved Administrations and once the Stormont Assembly—which I urge him to get back up and running —is back up and running, Northern Ireland will be able to legislate to have exactly the same regime as the rest of the United Kingdom.

[Ian Paisley]

I do not know whether it is relevant, Mr Sharma, but for the completeness of the record I ought to have referred to my registered interests. I chair a charitable trust on employment and skills development that is named after Tom Gallaher, a leading industrialist of his age who was a tobacconist. I should just declare that on the record.

On the point that the Minister has just raised, may I ask her to go back to the Department and get advice for us? If Northern Ireland is restricted from regulating on this issue, because of our EU connection through the Windsor framework, even the Assembly would not be able to legislate on it, in the same way that the Danes were unable to do it. I really seek advice on that from the Minister.

[Dame Andrea Leadsom]

I am very happy to write to the hon. Gentleman on that point to give him absolute clarity.

I thank the hon. Member for Strangford for his contribution today. I very much enjoyed the visit that I made to his constituency, which was a long time ago—indeed, many years ago. He spoke about the importance of the four nations working together. I completely agree with him; the UK is much stronger together. I hope that in my remarks I have answered his other questions.

I also thank the hon. Member for Blaydon for her support for the Bill and for pointing out that it is vital, particularly in the north-east where smoking prevalence is higher than average in many other parts, that we really take steps to tackle the issue. I echo her expression of gratitude to local councillors, the NHS and to Fresh, the charity in her constituency, for the work that they have done to try to tackle smoking.

As I have said to the hon. Member for Birmingham, Edgbaston, I hope we can work together constructively to ensure that we introduce these changes as soon as we can.

In closing, I will quickly address the New Zealand Government’s announcement that they will no longer introduce the smoking measures that had been planned there. There have been many calls, not least from the tobacco industry—I wonder why!—for us to row back on our plans following that decision. In response to those calls, I stress that the New Zealand plans included a licensing scheme to limit quite significantly the number of retailers able to sell tobacco and plans to limit the amount of nicotine in consumer products. Our Government are introducing a smoke-free generation, by protecting future generations from the harms of smoking while leaving current adult smokers the freedom to continue smoking if they choose to do so.

[Jim Shannon]

I thank the Minister for her response to the debate. In my contribution, I gave a couple of examples from Canada that we had followed here, and I urged the Government here to follow the new ideas in Canada to dissuade people from smoking. Has she had an opportunity to look at some of the Canadian legislation? I am very simple: if I see something good, I think, “Let’s do it”. If it works there, it should work here as well.

[Dame Andrea Leadsom]

I absolutely agree. We should always keep an eye on what other nations are doing.

I reiterate that our position remains unchanged. This will be world-leading, and we want to be a trailblazer in the absolutely crucial area of protecting future generations; protecting the health of our nation; protecting our future children and babies; and, at the same time, protecting our NHS. Let other nations follow our example. I look forward to working with colleagues right across the House as we bring that to fruition, and I thank them for their contributions.

NHS Dentistry

Andrea Leadsom Excerpts

Tuesday 9th January 2024 Commons Chamber

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

I welcome the chance to come to the House to hear from colleagues about the challenges of dentistry and access to dentistry, as well as some of their constructive ideas for our recovery plan, so that all our constituents can get the healthcare they deserve at a time when systems continue to be under huge pressure since the covid pandemic. The Opposition were rather determined to debate dentistry today; I am a bit suspicious that that is because they are trying to pre-guess what the Government’s dentistry recovery plan will contain, but I am as desperate as they are that we get on with it and I can assure all colleagues across the House that I am working flat-out on that.

When the Prime Minister asked me to take on this job in November, I leapt at the chance to improve our whole nation’s health and especially—as colleagues throughout the House will know—to prevent future ill health in babies and children. It is the chance to change the future health of every baby and child that is the big opportunity here, and I am proud of some of the measures we have already introduced to support supervised toothbrushing through the start for life programme and in local authorities.

The Opposition’s motion talks about supervised toothbrushing for three to five-year-olds. I do not know whether they do not know this, but we have teeth from before we are born. If children do not get your supervised toothbrushing until they are three at a minimum, their teeth are about four-and-a-half years old. It is much more important to have that supervised toothbrushing in the family hub, education for parents and supervised toothbrushing in nurseries. Let us say that that is something we can all agree on: children certainly have their teeth long before they are three, so I think our plan will be significantly better.

As my right hon. Friend the Secretary of State said in her opening remarks, recovering and reforming NHS dentistry is a top priority for the Government. That is why one of the first things I did as a new Minister was to host a roundtable with key figures from the dental sector, including the chief dental officer Jason Wong and dentists from right throughout the country, to hear about the challenges they face. I have also met colleagues from throughout the House to hear about the specific challenges in their constituencies. I have heard them loud and clear, and every bit of feedback is informing our dentistry recovery plan.

I want to set out some of the recovery that is already under way—not enough by any means, but good progress, and not the failure that Labour wants to portray it as. It is a good recovery from a disastrous situation during covid. In 2022-23, 6.1 million more courses of treatment have been delivered than in 2021-22, and seven out of 10 patients have had a good overall experience of dental services, according to surveys. More than 18 million adults were seen by an NHS dentist in the 24 months to June 2023, which was an increase of 10% on the previous year. Some 6.4 million children were seen by an NHS dentist in the 12 months up to 30 June, which was an increase of 800,000 compared with the previous year. Nearly 1,400 more NHS dentists were available in 2022-23 than in 2010-11.

Of course, in our long-term workforce plan we announced a 40% increase to dentistry training places—that is incredibly important. I pay tribute to all our NHS staff, who continue to work tirelessly to deliver vital dental care to those who need it the most. Dental staff deserve our support, which is why we are working flat out on both short and long-term solutions for the recovery and reform of NHS dentistry.

Colleagues raised a number of points that I will seek to answer in turn, although I apologise that cannot deal with them all. The hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss) and a number of other Opposition Members raised the issue of tooth decay in children. I totally agree with her that good oral hygiene right from the very beginning, even before milk teeth come through, is absolutely crucial. She also praised community dental services, and I share her gratitude to those who go out into care homes, hospitals and community centres to help people with urgent care needs.

My hon. Friend the Member for Winchester (Steve Brine), who chairs the Health and Social Care Committee, made a number of incredibly helpful points. He asked specifically whether we plan NHS access for all. We certainly intend it for all who need it. He asked how we will realise it. He said that we need to get NHS dentists back on side through our reforms, and asked about the dental workforce. He is absolutely right to raise those issues, all of which will be dealt with in our recovery plan.

My hon. Friend the Member for St Ives (Derek Thomas) is a huge campaigner for his area’s needs. He and I have already met on a number of occasions to talk about dentistry. He is right to highlight that some areas are struggling more than others because of under-delivery on NHS contracts on the one hand and insufficient NHS contracts on the other. I am prioritising measures to tackle both.

The hon. Member for Stockport (Navendu Mishra) talked about the UDA rate, which he said was just too low. I have a lot of sympathy for that argument, but equally, he will appreciate that the ’22 reforms ensured that dentists would be paid more for complex treatments.

My hon. Friend the Member for Totnes (Anthony Mangnall) rightly challenged Labour. This is a Labour Opposition day, but Labour has no real plan. Labour Members talk about lots more appointments but do not say how they will deliver them. They talk about raising the money from non-doms but they have spent that money many times over. They plan to supervise toothbrushing for three-year-olds, but that is too little, too late.

The hon. Member for Weaver Vale (Mike Amesbury) raised the issue of access to dentists. He was right to do so because that is a key challenge for everybody throughout the country. There is no clear pattern of deprivation going hand in hand with poor access to dentistry; if anything, the worst access to dentistry is in coastal areas. We are looking carefully at that to improve access right across the country.

The hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) pointed out that his ICB is supporting and promoting drop-ins where there is availability for patients. That is exactly what ICBs should be doing and is brilliant news. I appreciate his points about the difficulty that dentists find in updating the NHS website. If he wants to take that up with me separately, I will be happy to look into it on his behalf. Likewise, the hon. Member for Lewisham East (Janet Daby) raised an important case about dental insurance. If she writes to me, I will be happy to take it up on her behalf.

My hon. Friend the Member for Congleton (Fiona Bruce) talked in particular about the workforce plan and training, which are so important. We will look at many ways of increasing access, both by enabling dental therapists and hygienists to work to the extent of their licence and by getting far more overseas-registered dentists and improving their throughput so that they can start working, particularly in the least well-served areas.

My hon. Friend the Member for Darlington (Peter Gibson) highlighted the problem with NHS dentists returning their contracts in order to work privately, and he is right that we need to work on that. He shared great thoughts about a dental school at Teesside University, about the importance of graduate dentists working in the NHS and, of course, about the importance of mobile dentistry, all of which are crucial ideas.

My hon. Friend the Member for North Devon (Selaine Saxby) talked about long distances and the problem of getting dentists into more rural areas. She also raised the fact that toothbrushing and prevention are crucial. There have been some great contributions from Members right across the House, for which I am very grateful.

Dentistry has been one of the most challenging subjects in my portfolio as a new Minister, and I am determined to address it. As my right hon. Friend the Secretary of State outlined, we are investing £3 billion a year in dentistry, and we need to ensure that every penny is spent properly and delivers the best results. However, the honest truth is that to recover from covid, during which hardly anyone saw a dentist, whether private or NHS, money will not be the silver bullet—a quick funding fix cannot solve all of the backlog and deliver on our ambition that everyone who needs an NHS dentist should be able to access one. As such, we are working on both short-term recovery and long-term system reform, supported by the profession. We will be fixing some of the fundamental flaws in patient access and health inequalities that have been highlighted and exacerbated by the pandemic, many of which have been raised in the Chamber today. We have made good progress on dentistry, particularly through the 2022 reforms, and can be proud of the improvements achieved to date. Again, I sincerely thank all dental staff for their hard work and commitment to recovery.

Finally, having been on the receiving end of “in due course” for many years myself, colleagues will realise that I am chomping at the bit to reveal more about our dentistry recovery plan. I need to ask them all to be patient just a little while longer, but I will change the line about when to expect it from “shortly” to “very shortly”.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

Oral Answers to Questions

Andrea Leadsom Excerpts

Tuesday 5th December 2023 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

5. What steps she is taking to help reduce vaping by young people.

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

The hon. Lady raises such an important question on a subject that is dear to both our hearts. We all know it is an offence to sell vapes to children under 18, yet one in five children tried a vape in 2023 alone and the number trying vapes has tripled in the last three years. We know the industry is targeting children, quite cynically. That is unacceptable. Our tobacco and vapes Bill will restrict the appeal and availability of vapes to children, and we are consulting on that right now.

[Helen Hayes]

As the Minister rightly said, under-age vaping has increased by 50% in just the past three years. Ministers had the chance to stop this trend two years ago, during the passage of the Health and Care Act 2022, when Labour tabled an amendment to prohibit branding that appeals to children, but Ministers would not support it and Conservative Members voted it down. Does the Minister regret the fact that the Government did not act sooner? When will the planned new legislation be brought to the House? The consultation is welcome, but there is consensus on the issue and action is urgently needed.

[Dame Andrea Leadsom]

The hon. Lady knows full well that making decisions that change legislation requires consultation. That is both the convention and the requirement. The Government have brought forward the consultation as soon as possible. It will close tomorrow and we will introduce legislation as soon as possible in the new year. I think the hon. Lady will find that that legislation really will tackle the problem of the cynical targeting of children.

[Mohammad Yasin (Bedford) (Lab)]

6. 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)]

The hon. Gentleman will be pleased to know that, with huge thanks to all the superb GPs and health teams, our manifesto commitment for 50 million more general practice appointments a year compared with 2019 has now been delivered. Our primary care recovery plan is addressing access challenges by tackling the 8 am rush for appointments, cutting bureaucracy for GPs and, of course, expanding community pharmacy services.

[Mohammad Yasin]

I thank the Minister for her answer, but let me correct her. Since 2014, the number of GP practices in Bedford and Kempston has decreased from 18 to 11; there are fewer doctors, while the patient list has increased; and the number of patients per qualified GP now stands at 2,812, which is a rise of 60%. Will the Minister apologise to GPs and to my constituents, who face a daily struggle to access a GP because her Government have decimated NHS primary care services?

[Dame Andrea Leadsom]

The hon. Gentleman will appreciate that 50 million more appointments between 2019 and now is a fantastic increase. There are just under 4,000 new GPs since 2019, and the hon. Gentleman will appreciate that through the post-covid recovery plan to improve access we have said to GP practices that they should provide urgent appointments on the same day and for every patient within two weeks. That has significantly improved access for patients, and GP appointments are now being hugely supported by access to community first, our flagship programme to improve healthcare throughout the country.

[Kelly Tolhurst (Rochester and Strood) (Con)]

I am incredibly grateful for the significant increase in the number of GP appointments offered to residents in my constituency. However, last week Aspire announced that it wishes to close the Lower Stoke surgery on the Hoo peninsula, where the council proposes to build thousands of homes. Will my right hon. Friend meet me to discuss how I can work further with the integrated care board? I have been trying over a number of years now to work with the ICB so that it can come up with a plan for how it will deliver much-needed services, so I would be very grateful for the Minister’s help.

[Dame Andrea Leadsom]

I am of course always delighted to meet my hon. Friend to talk about issues in her constituency. I reiterate that 50 million more GP appointments is brilliant news. Our flagship Pharmacy First programme will mean that more low-level infections and problems—such as sinusitis, oral contraception, impetigo and various other conditions—can be treated by community pharmacists at great convenience to patients, and it will expand GPs’ ability to deal with more complex problems. All these things are alleviating the pressures on primary care and are very good news right across the country.

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

A primary care walk-in facility at Warren Farm in my constituency faces closure due to the presence of reinforced autoclaved aerated concrete. The proposal to close the service will mean that services are relocated away from residents who need them. What is the Minister doing to fund the investigation and removal of RAAC in health facilities while making sure that communities can still access the healthcare that they so desperately need?

[Dame Andrea Leadsom]

I am incredibly sympathetic to the hon. Lady’s constituents. The issue of RAAC is one that the Government are determined to resolve. There has been a £698 million programme of new funding to eradicate RAAC from the healthcare system, and that work is under way. She will appreciate that it is for integrated care boards to ensure that the provision is there for all patients but, if she should need help with contacting or negotiating with her ICB, I will be delighted to help her.

[Steve Double (St Austell and Newquay) (Con)]

A recent report highlighted the fact that in September there were 15,000 missed GP appointments in Cornwall. That is 15,000 appointments that could have gone to people desperately waiting to see their GP. It is happening month after month. Does the Minister agree that that is completely unacceptable, and can she highlight what steps the Government will take to address the issue?

[Dame Andrea Leadsom]

My hon. Friend is right; it is appalling that people book an appointment and then do not show up. In many GP surgeries now they post the numbers of patients who do not turn up for their appointments and urge people to make the effort to cancel. As part of our access to primary care, we are creating digital tools so that GP surgeries can notify patients that they have an upcoming appointment and say, “If you don’t need it, press here and it will cancel the appointment.” Measures such as that make it easier for people to cancel, but he is quite right that it is incumbent on us all, if we book that appointment, to turn up for it.

[Priti Patel (Witham) (Con)]

7. What funding her Department is providing to help tackle health inequalities in Essex.

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[Peter Gibson (Darlington) (Con)]

T6. Some six months ago, the dentist based at Firthmoor community centre, serving 8,000 of my constituents, handed back its contract to the integrated care board. I was shocked last week to learn that the ICB has still not commenced the tender process to replace that provision. What advice can the Minister give me to ensure that our ICB is doing what it needs to do?

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

My hon. Friend has already raised this issue with me several times in the almost two weeks I have been in this post, so he is doing a great job, and he is right to raise it. Tendering exercises for NHS dentistry are bound by current procurement law, but I am happy to meet him to discuss how much faster we can go to get this sorted out.

[Amy Callaghan (East Dunbartonshire) (SNP)]

Brexit broke Britain and it is continuing to wreak havoc on supply chains. The shortage of ADHD medication is now set to drag on into next spring. The shortage has seen 70% of patients forced to ration their supply of ADHD drugs, with 62% reporting an increase in suicidal thoughts. What steps is the Minister taking to ensure that supplies of these vital medications are reaching pharmacies across the UK?

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[Selaine Saxby (North Devon) (Con)]

While I recognise that money does not grow on trees, neither do teeth. Can my right hon. Friend advise me of how quickly my North Devon constituents will be able to see the NHS dentists they so desperately need?

[Dame Andrea Leadsom]

My hon. Friend is absolutely right: there is a lot more that we can do. We are working at pace to see what announcements we can make on the dental recovery plan as soon as possible. In the meantime, she will be aware that, in the south-west, NHS England has commissioned additional urgent dental care appointments that people can access via NHS 111.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

T7. Last week, the former Health Secretary admitted at the covid inquiry that sick pay across the UK is “far too low”. It is far lower than the European average and encourages people to go to work when they should be getting better. Does the Secretary of State agree with her predecessor? What discussions will she have with her Cabinet colleagues to improve the inadequate sick pay system?

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[Richard Fuller (North East Bedfordshire) (Con)]

Will the primary care Minister join me in congratulating the Conservative Mayor of Bedford borough for proposing council money to invest in primary care facilities in Great Barford, Wootton, Wixams and Kempston? Will she condemn Labour and Liberal Democrat councils for voting it down?

[Dame Andrea Leadsom]

I am glad that my hon. Friend has raised this issue. He is absolutely right; in local authorities we need mayors and integrated care boards supporting primary care and not listening to the Opposition, who talk it down the whole time. The 50 million more GP appointments is something to celebrate.

[Mr Ben Bradshaw (Exeter) (Lab)]

Given that obesity now costs the NHS and our economy much more than smoking, why does the Secretary of State support a total ban on smoking but think that measures to tackle obesity are nannyish?

[Dame Andrea Leadsom]

The right hon. Gentleman raises a completely artificial barrier. Smoking is totally preventable; it is the cause of one in four cancers and 75,000 deaths. It is unbelievably appalling. Obesity is a complex area and one that the Government are focused on. We need to tackle it, but it is entirely different.

[James Sunderland (Bracknell) (Con)]

Would the Health Secretary please agree to meet me to discuss improved access to GPs and dentists in Bracknell Forest and Wokingham boroughs?

Contact in Care Settings

Andrea Leadsom Excerpts

Thursday 27th October 2022 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

I would say that it is a rare Minister who welcomes a debate on day one following their appointment, but truly I do welcome this particular debate because it is so important. Visiting in care settings is something I have spoken to many people about, and I had hoped that by now it would no longer be a problem now we have put lockdowns behind us, but it is still a problem.

I thank and commend the hon. Members for Liverpool, Walton (Dan Carden) and for St Albans (Daisy Cooper) and my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for leading this debate and for their powerful speeches, and I thank all the other Members who also contributed very powerfully. I would also like to thank those who have been campaigning so hard for visiting rights, such as the Rights for Residents campaign, John’s Campaign and the Relatives & Residents Association. I know that some of them are here with us in Parliament today, and I am sure that many others are watching from home.

I do recognise the efforts that so many care homes have made to get back to normal, or as close to normal as they can, on visiting after the enormous challenges of the pandemic, because visiting matters. Visiting matters for the resident in a care home—we must never forget that it is indeed their home—and for family and friends who want to spend time with their loved ones. It can be the moment a resident looks forward to all week, a time that keeps their connection to life beyond the doors of a care home and—not to be underestimated—the chance to hold the hand of or have a hug with someone who loves them. I say this knowing that, sadly, many residents in care homes are living with dementia and may be confused or unable to remember things for long. Visits matter for them and their families, not least because dementia can progress so cruelly, as was mentioned in particular by the hon. Member for St Albans.

[Dame Andrea Leadsom (South Northamptonshire) (Con)]

My hon. Friend is absolutely right to talk about the impact of dementia in particular. During lockdown, a large number of people wrote to me, including a close family member of mine, whose dementia significantly worsened because they were not able to see family members just to keep those memories going. It was absolutely terrible, and I think we should do everything we can to make sure that cannot happen ever again.

[Helen Whately]

I thank my right hon. Friend for making that point, which we have heard from others in the Chamber.

Visiting is not just a “nice to have”, as we have just heard—all the stories we have heard today can leave us in no doubt about that. The hon. Member for Liverpool, Walton spoke very movingly about the experiences of others, but also about his own personal experience with his father, which he very courageously shared with us. The right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts)—I cannot pronounce her constituency, but Hansard will resolve it—also spoke very powerfully about her mother. I say to both of them that I am sorry for their loss.

Very importantly, my hon. Friend the Member for Chatham and Aylesford reminded us that this is not just about older people. Visiting, both into a residential setting and out of it, is also so important for younger people—for instance, those with learning disabilities. However, I am short of time, so I will press on.

On top of the stories, there are the facts. We know there is a body of evidence that supports the argument that not having visitors can be detrimental to the health of people living in residential care, as my right hon. Friend the Member for Tatton (Esther McVey) mentioned. For instance, there is a connection between social isolation, loneliness and mental health. In fact, back in October 2020, when I was previously the Care Minister, I commissioned research on the benefits of visiting as well as an assessment of the risks at the time and the options for opening up visiting.

I can also say that I do know personally what it feels like not to be allowed to visit a relative. In the summer, my mother was admitted unexpectedly to hospital and I was not allowed to visit her, even though I did not know whether I would ever see her alive again. The same was the case for my father, her husband for 50 years, who was also barred from entry to her ward, and that was even though we were clearly not in the heart of the pandemic by any stretch of the imagination.

I will look at this issue in three parts, at pace: what has happened to get us to this situation; what is really going on; and what can be done.

Sadly, during the pandemic we saw how hugely vulnerable to covid people who lived in care homes were, and the Government priority was to keep people safe, which meant doing everything possible to prevent covid from getting into care homes. It meant reducing the number of people going in and out who might take in covid. It meant requiring the use of personal protective equipment. It meant regular testing for care home residents and staff, and when we got the covid vaccine it meant prioritising vaccinations for care home residents and staff.

However, even back in 2020 we knew that residents in care homes and their families were suffering from the visiting restrictions, although I should mention that not all residents and their families had the same views. While some wanted more visiting, others did not because they were more worried about the risks. Balancing those two things, the Government sought to enable visiting in ways that would be safe, and we also made it clear that end-of-life visiting should always be possible.

In March 2021 we introduced the concept of the essential care visitor who would be able to visit a resident who needed personal care in any circumstances, including during an outbreak, following the same covid testing regime as staff. In June 2021 we expanded that to apply to all residents. At all times we worked with social care providers—with care homes—because they were the ones that had to put the guidance into practice; they were the ones at the frontline, balancing the prevention of covid with the practicalities of supporting visiting. I do not underestimate the demands that put on care homes, which were also carrying out testing, providing PPE and everything else.

Moving on to the situation today, since April 2022 the Government guidance has been that there should not be any restrictions on visiting in residential settings unless there is a covid outbreak, and even if there is an outbreak every resident should be able to have a visitor. Local public health teams may advise other restrictions on visiting if there is a particular local risk, but that should be proportionate and should stop visiting only in extreme circumstances.

Some Members have said today that the guidance is not clear, while others have said that it is not being followed; it has also been said that the problem is that it is guidance. On the content of the guidance, we have heard from many accounts that it is not being followed, and I will do further work on that.

Knowing the concerns during the height of the pandemic about visiting, the Department of Health and Social Care started tracking visiting restrictions; indeed, I started that as Care Minister, to try to get data about what was going on, because one of the challenges is knowing what is going on at the frontline, as the social care system is so diverse and fragmented. Our data told us in September that 98.4% of care homes were allowing visiting, but I recognise that that data is not the whole answer.

The CQC has been referred to in the debate. I spoke with Kate Terroni, chief inspector of adult social care at the CQC, many times during the pandemic about visiting and she, too, saw the importance of it. The CQC looks at visiting when inspecting care homes, and a lack of visiting or access is a red flag for it. Families should be reporting visiting concerns to the CQC, which then investigates them. I heard, however, the points made by the hon. Member for St Albans about some families feeling they got a mixed response or who were fearful of reporting to the CQC because of the possible consequences. Again, I will take that away from today’s debate.

Under the existing regulations, the CQC can take action if it believes that safe and proportionate visiting is not being facilitated, but I also took note of the point made by the hon. Member for Liverpool, Walton about the CQC powers to get live data being limited and its not having powers to require care homes to report changes to visiting restrictions. I will look into that, too.

Although we have the guidance and the CQC is able to take action on care homes, there is clearly still a problem. I have also seen the data from the Rights For Residents survey showing that 45% of responses said that restrictions on visiting had still been in place since April, and in 11% of outbreaks no visitors were allowed at all. Again, I am concerned to see that.